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Brian Lehrer: Brian Lehrer on WNYC. With us now is the United States Surgeon General, Dr. Vivek Murthy. He has an op-ed in USA Today, published this morning called Our kids' mental health is as critical as their grades. Here's how to prioritize both. Dr. Murthy has been prioritizing mental health since his first stint as attorney general, under President Obama. President Biden appointed him to a second term. We'll spend most of our time with the Surgeon General talking about that topic but a few minutes first asking him to interpret what President Biden said about COVID on 60 minutes on Sunday, the president said this.

President Biden: The pandemic is over. We still have a problem with COVID. We're still doing a lot of work on it but the pandemic is over. If you notice no one's wearing a mask, everybody seems to be in pretty good shape. I think it's changing.

Brian Lehrer: There's actually a lot to unpack in those 14 seconds, isn't there? The pandemic is over. We still have a problem with COVID. How do those fit together? The pandemic is changing, yet another thought, everybody seems to be in good shape. Those are all lines from that little sound bite, and those are all pretty different concepts. The US has been in a kind of Omicron steady state since the spring, with an average of 400 plus deaths per day, week after week, month after month, according to the New York Times COVID tracker with most experts predicting it'll get worse, not better as the colder weather sets in.

With all of that as a prelude, we welcome US Surgeon General, Vivek Murthy, back to the show. Dr. Murthy, we always appreciate you sharing your time with us. Welcome back to WNYC.

Dr. Murthy: Thank you so much, Brian. I always enjoy being on with you.

Brian Lehrer: I realize you're in an awkward position because you're appointed by the president. I would guess you wouldn't describe the state of COVID exactly the way he did there but do you agree with the president, what he said on 60 minutes, and can all those different statements about COVID fit together in any way, or did he give us a confusing, mixed message?

Dr. Murthy: Brian, here's how to think about where we are. We have made tremendous progress since this pandemic started. The number of people who are dying each day from COVID is dramatically lower than the peak. We have far fewer people in hospitals, and we've got people getting back to normal in many ways. All of our kids, including my kids are back in school in person, people are getting back to work. They're seeing family members and friends, but it is also true that we have more work to do.

Two things can be true at the same time that we've made progress, and that we have more work to do. That work ahead of us involves making sure that we protect as many people possible going forward from COVID. That means making sure people are up to date with their vaccines. We have a new updated vaccine that's in fact just come out. We're encouraging people to get it. If you're 12 years of age and up and you're more than 2 months out from your last shot, you're eligible to get this vaccine.

That along with making sure people know about treatments that are available, if they do get sick, like Paxlovid. This is part of how we're going to make sure we keep doing the work that's ahead. That's how I would think about where we are now. Brian, we've made tremendous progress. I'm optimistic about the future, but we've got to keep our foot on the accelerator because we want to remain vigilant. We want to keep doing the things that we need to do to make sure everyone has protection.

Brian Lehrer: One consequence of the president's remark on 60 minutes on Sunday is that investors started ditching vaccine stocks on Monday, according to the Financial Times, it says they wiped out $10 billion of value from those companies just as the president and you are continuing to emphasize the importance of vaccines, including the new vaccine. Should Pfizer and Moderna be cutting back on vaccine production?

Dr. Murthy: We continue to believe that vaccines are going to be an important part of the backbone of this response. We know that vaccines historically in public health have been one of our greatest gifts. It's helped us provide, prevent so many illnesses, and save millions of lives over the course of history. We're seeing this true with COVID as well that we've been able across the world to save millions of lives because of COVID vaccines in the last year and year and a half alone.

The bottom line is we're going to continue to need vaccines, but the response that we have, that we've built for COVID-19 is a multifaceted response. Yes, vaccines are a key part of it, but they also involves treatments. We want people to know that there are treatments available like Paxlovid includes testing. We've been able to ship millions of free tests to people in their homes so they can see whether or not they actually have this illness and then take steps accordingly but Brian, one important thing to underscore here is that that sustained response requires sustained investment and sustained attention.

One of my worries, going back to when I was Surgeon General in the Obama administration and dealing with Zika and with Ebola is sometimes when things start to get better I worry that we turn away as government, as society and we stop putting the money toward making sure people stay safe. We still need that ongoing investment to make sure we have vaccines for people in the future, make sure that tests are available, that folks can get the treatments that they need. That's how we're going to continue to keep the country safe.

Brian Lehrer: One more COVID thing, should policy do more to protect people who are statistically so much more susceptible to serious disease and death by immune status, which means people with immunocompromising conditions and also by age, because seniors have less of an immune system for the most part. For example, in conjunction with a call-in we did yesterday, someone told me about their mother who was in her 60s and has diabetes and has been working remotely.

She says she would retire out of COVID concerns rather than go back to the office because of her vulnerability if her employer would've forced her into that stark choice. I'm curious if you think there should be some kind of senior citizens and people with underlying conditions, bill of rights, for the endemic era, that we're entering including accommodations for work wherever possible.

Dr. Murthy: First of all, I certainly can appreciate the concern your caller is raising. For all of us who have parents, grandparents who are 65 and above, we ourselves are 65 and above, we know that this has been a tough time for people who are older because they've been at higher risk of bad outcomes with COVID. One hallmark of our response effort and really this has been a guiding principle for many of us who have worked on the COVID response is that equity needs to be at the center of that response.

That means making sure that we are looking to every population and making sure that they have the protection they need. Now with high-risk populations, those who are elderly, who are immunocompromised, who have multiple medical conditions like heart disease and diabetes that may put them at higher risk, it's been especially important to make sure that they have access to treatment.

We have actually focused a lot of our efforts at both getting vaccines and treatments on higher-risk populations, including, for example, going to nursing homes and facilities where people are at higher risk and making sure we supply vaccines directly to them, that we set up services to bring pharmacies directly there to administer vaccines. Yes, we have to continue prioritizing those at higher risk. I think outside of government, I think workplaces and schools, and other institutions should be sensitive to this too.

Should recognize that as we move into this next phase with our COVID response, we've all got to be sensitive to the fact that they're going to be people around us who are at higher risk. That might mean that we need to make special accommodations for them. It might mean that we choose to wear masks in settings where we may choose not to. We've got to recognize that those choices are appropriate for people to make based on their risk and we should be supporting them in that regard.

Brian Lehrer: My guest is US Surgeon General, Dr. Vivek Murthy. Return the page now to talk about mental health and youth mental health, especially in your USA Today, op-ed released this morning you cite statistics that are alarmingly high regarding high school age students, 45% persistently sad or hopeless, 20% saying they've seriously considered suicide over the past year, 10% have tried it. Are those the stats you think represent American teenagers today?

Dr. Murthy: Sadly I do worry that this is where we are right now but it's not where we have to be. One of the reasons I have focused so much on mental health is not only because I care about this deeply as Surgeon General and I see the challenges young people are facing and all people across our country, but also as a doctor I've seen the struggles that people have had with mental health up close for years. As a father, I look at my own two children who are four and six. I look at the world they're growing up and I look at the impact of the pandemic on them and I worry about them, about their friends, about other kids around the country.

If you think about the state of mental health right now, imagine a school that has 1,000 children, 1,000 high school students, about 450 of those students right now are feeling persistently sad or hopeless. About 200 of those students have considered suicide. About 100 of those students have attempted suicide. That is a state of mental health among youth in America today and that's not acceptable. We have to do better.

One of the reasons I issued a Sergeant General's advisory on this topic in December of 2021 was to call the nation's attention to the urgency of this crisis but also to lay out the actions that we have to take to do really three things. One, expand access to treatment. It takes on average 11 years from when a child has mental health symptoms to when they actually get care, that's an extraordinarily long period of time.

The second though is we have got to also invest in prevention programs. We actually know Brian about programs that when instituted in schools and in communities can actually help reduce the likelihood that our kids struggle with mental health issues down the line and turns out have other benefits too like reducing the likelihood they will have to endure substance use disorders, but we are just not implementing these programs. Third, we've got to address the stigma around mental health even though younger generations are much better at talking about mental health than having open conversations.

There is still a sense of shame that many people carry with them when they struggle with their mental health and a sense of shame that prevents them from asking for help. The good news is there is more help available today than perhaps at any time. In recent history, we have 988 set up the hotline that people can call directly if they're in crisis to get access to counselors. We have now more and more counselors in schools for young kids who are struggling. We have more help available through Telemedicine, through remote access. We just wanted to make sure that people feel that it's okay to ask for help.

Brian Lehrer: Listeners, we have about 10 more minutes with Dr. Murthy. We can take some questions for the US Surgeon General especially on teenagers mental health at 212-433-WNYC, 212-433-9692 or you can tweet @BrianLehrer. Since you've framed a lot of that in post-pandemic terms or post worst of the pandemic terms, why wouldn't things be getting much better now from a mental health standpoint with school and all activities back after the worst of the pandemic and social contact back for just about all young people? It could be a time of relief and the joy of reemerging into fully lived lives but that's not the picture you're painting.

Dr. Murthy: I'm so glad you asked this question, Brian, because this isn't always entirely intuitive. Let me frame two reasons why kids may still be struggling. Number one, many kids were struggling before the pandemic and we know that like there was a 57% increase in the suicide rate for example among young people in the decade preceding COVID-19 and many of those things have not changed. The factors that we're driving concerns among youth mental health pre-pandemic included for some kids technology.

For many children, their use of technology including social media has led them to feel more isolated, more anxious, has also led them to feel worse about themselves and about their friendships. For others, they've struggled with bullying both online and offline bullying. Many young people struggle with difficulties and stressors at home, economic stressors and others. Certainly, that was accelerated during the pandemic but it predated the pandemic as well.

A lot of those concerns are still there for young people who are also by the way dealing with trauma, with violence in their communities each and every day. The other thing to look at, the other reason why kids are still struggling today, Brian, even though we are at a better place with the pandemic is because if you look at hurricanes and tornadoes and other natural disasters, what you see is that mental health concerns actually sometimes they stay even or even dip in the midst of the crisis but as the crisis starts to get better, those mental health concerns surface and in fact, they can look like they're getting worse.

It's almost like when you're in an acute stress day, when you're in a crisis, sometimes you manage to pull things together but when the crisis starts to be then everything surfaces, the feelings wash over you, and sometimes you can feel even more fatigued. For many people, not just kids, but frankly their parents also, this is their experience they're having too. Lastly I'll just say, Brian, let me just mention parents for a moment because I know we're talking about kids here but the mental health of children is deeply impacted by their parents.

The truth is parenting was not easy pre-pandemic, but it's become really tough during the pandemic as parents have had to juggle managing their children in homeschooling in the early days to thinking and worrying about their own health. The health of loved ones and to do all the usual things that you have to do with parenting including for many parents working from home and managing telework. This has been a tough time for parents and I say that as a parent who myself has felt overwhelmed at times during this pandemic.

That's one of the reasons I wrote the piece that I wrote, in USA Today was to lay out for parents both signs they can look forward to know if the kids are struggling, but also steps that they can take to help their children. One of those most important steps is to open up a conversation with your children about mental health. It's not always easy to do but simply ask your kids how they're doing, listening without judgment, sharing some of your own experiences, and reminding them that it's okay to ask for help. These can go a long way to reminding kids that they're not alone and that it's okay to talk about mental health.

Brian Lehrer: I love that you put the two simple words unconditional love in your USA Today article. Let's get in a couple of phone calls here for you. Alexis in Red Bank, you're on WNYC with the US Surgeon General, Dr. Vivek Murthy. Hi, Alexis.

Alexis: Hi, good morning, Dr. Murthy. You're hitting all the important points as far as I see them. Unfortunately, our community had a 14-year-old beautiful little girl take her own life last week and last year we had a young 15-year-old boy take his life, both involved in sports, et cetera. It did involve with one child cyberbullying. I agree it's a lot to do with parenting and so many parents are under so much pressure.

They don't necessarily have the time or the tools to support the way they want to and I'm wondering with all of this COVID money, why hasn't some of it been put towards support for parents, educating them on how to block certain websites from their children's phone? Appropriate use of the phone, how to take a phone from a teenager? Unfortunately, until we get all of this under control, this is going to continue. I think it's great that we have individual--

Brian Lehrer: Alexis, I'm going to cut in here. I apologize, but because our time with the Surgeon General is limited, talk to Alexis and everybody about phones and cyberbullying in this context.

Dr. Murthy: Alexis, thank you so much, first of all, for calling in and I'm so heartbroken to hear about the 14 and 15-year-old children in your community who were lost to suicide. I regret that this is unfortunately a too common story that we are hearing young people whose lives are cut short and often related to bullying. Look, I think that this is to me a disturbing and profound issue which is that when it comes to social media, in particular, we are allowing a grand national experiment to take place in our children without fully understanding what the impact is of these platforms.

What kids tell me, high school students, middle school students who are using social media early, and college students is that social media makes them feel worse about themselves and about their friendships. It often subjects them to abuse. We clearly need to do more here. One of the things that's important that you mentioned is the pandemic resources, the funding that was passed by Congress and pushed by the president. A lot of this has actually gone toward helping kids with their mental health in schools, hiring counselors, building and supporting mental health programs in schools but you're also right that we have to do more when it comes to technology.

I think we need safety standards when it comes to this technology, we need to ensure that there's data transparency because we don't have enough data from the companies to tell us which kids are most impacted, how they're impacted by social media, but we know many kids are hurt by it. Finally, to your point about parents, we need to provide parents with more support when it comes to understanding how to manage social media and phones, what are best practices, what are warning signs they should be looking out for.

All of the burden of managing this cannot fall solely on parents. Parents have already taken on too much. We need to have their backs, that means policymakers, friends, and neighbors, community leaders we all need to step up and provide parents with the resources they need. That's why I'm so focused on this issue and we're going to keep working on this until every parent and child has the help that they need.

Brian Lehrer: Arthur in Crown Heights. You are on WNYC with Dr. Murthy. Hi, Arthur.

Arthur: Hi, good morning. Thank you for taking my call. I'm really enjoying this conversation and I think this is just such a core issue for young people today and our entire community. I'm wondering here if we aren't ignoring the elephant in the room which is that a lot of young people today in my experience talking to them and just paying attention to the culture, seems to feel that their life prospects are fairly dismal if they aren't attached to generational wealth.

In other words, it seems like we're at a phase in the development of society where extractive capitalism is fairly hyperactive and it doesn't really open up a lot of prospects for young people to be themselves in creative ways or to imagine a working life for themselves or a family in the future. I just wonder if we aren't putting a bandaid over a gaping wound here until we start talking about what the market economy is doing to human souls, we may continue to struggle in more of a crisis mode in the future.

Brian Lehrer: Arthur, thank you very much for raising it that way and I will throw in the fact that child poverty went down during the pandemic, another may be counterintuitive thing because of all the pandemic relief. As that's going away, child poverty is starting to go up again. That's got to have an impact on their mental health. Dr. Murthy, where would you enter that conversation?

Dr. Murthy: Well, Arthur is raising a really important point, which is that we hope that our kids, when they look at the future, that they feel good, optimistic, positive about the life that they're going to be leading as adults, but too many kids that I talk to these days say that they're not sure the future's necessarily brighter. They look at the violence that threatens and impacts their communities, they look at the threat of racism, they look at the ongoing and growing threat of climate change and they ask me, "Is the future really better than the past?"

Many young people are also struggling with loneliness and disconnection from one another. We often think about young people as being so connected because they're on social media a lot, but when you look at recent studies that have been done of the population more broadly, some show alarming rates of loneliness and isolation. The recent 2020 Cigna study, for example, showed that more than 60% of people are struggling with loneliness.

The group that's struggling the most among those are actually young people of rates that can approach 75% when it comes to loneliness. Why is that consequential? Because when you struggle with loneliness, it increases your risk for anxiety, for depression, for physical health problems like cardiovascular disease. The bottom line is yes, there are deeper issues that play here. We have to build a better, more secure future for our children, and we also have to invest in social connection and stitching together the social fabric of our communities.

Brian Lehrer: Well, I know you got to go here in less than a minute. You've been talking about a lot of personal advice for parents, but you are a government official. What would you say are the biggest policy steps that you would like to see the government take? I realize US Surgeon General can't snap your fingers and make them happen. There's so much partisan politics in Congress and everything, but what would you like to see regarding children's mental health from a policy level?

Dr. Murthy: Yes, well, I think there is so much we have to do in all levels, policies, programs, and communities and personal actions that we can take in our life but on a policy level, if we really want to address youth mental health, we have to one, make treatment more accessible. This is about increasing our investment in the mental health workforce. It's about using telemedicine in more and more sustained way to bring care to people who have a hard time accessing care in rural areas, in urban areas.

We've also got to make sure that we reimburse appropriately for mental health care, so the people can actually get the care they need. A lot of insurance companies, for example, either don't reimburse properly or they have networks that just don't have mental health providers. Number one, we have to use the policy levers we have to increase access to care. Some of that is happening already.

There've been billions of dollars put forward by President Biden and the rest of the team to ensure that there is increased access to counselors in schools and support for mental health integration programs, but there's more to do. The second area though, I would mention, Brian, has to do with investing in prevention programs. This has been an area that I just find deeply painful.

Something I wrote about in 2016 when I published the Surgeon General's report on alcohol, drugs, and health, I laid out a number of programs that help prevent this kind of suffering, not just substance use disorders, but mental health challenges among our kids, but we are just not implementing them. That is a place where policy is in critical to make the investments, provide the technical support that communities need.

Finally, let me just say this, Brian, we've been talking a lot about policies. We've been talking a lot about individual actions, but this has to be more for all of us than a list of steps to take. It has to be a calling that we hold ourselves accountable to because our kids are suffering. As a child who struggled with my own mental health issues, growing up as an adult who's also struggled at times with my mental health, I know what that stigma feels like.

I know what it feels like to feel ashamed of your own struggles. We've just got to make sure that our kids don't feel like that. We've got to make sure when they actually seek out help that it's available and we've got to do everything we can to prevent them from struggling in the first place. The good news is we know how to do this, but we've got to mobilize every element of our apparatus.

If you're out there listening, thinking, "Gosh, I'm not a policy maker. What do I do? I don't run a major organization. What can I really do?" Well, it turns out that simply reaching out to others in your life, to the kids in particular, in your life, whether they're the kids of your family members or your friends, but reaching out to check on them, to ask people how they're doing, letting them know that they're not alone, they have somebody who's in their corner, that can go a long way toward helping kids because you can't always tell from the outset how people are doing it. A lot of people are struggling in silence.

Brian Lehrer: With that, we end with Dr. Vivek Murthy, the United States Surgeon General. Let us not be silent about this. Dr. Murthy, we appreciate it so much. Thank you.

Dr. Murthy: Thank you so much.

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