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Brian Lehrer: It's the Brian Lehrer show on WNYC. Good morning again everyone. Melania Trump is human and that's okay. Last night, the first lady was supposed to make her first campaign appearance since the speech from the White House at the Republican Convention, but she canceled at the last minute because she's still too sick from COVID-19 specifically coughing too much. She's allowed. She's a person, not superwoman. Unlike her husband, apparently, at an Arizona campaign rally on Monday, the president said this about being hospitalized with COVID.

Trump: I woke up and I felt good I said, "Get me out of here," boom, Superman. Through Operation Warp Speed, we will have 100 million vaccine doses before the end of the year and our military is going to distribute them. There's nobody like our military.

[chanting]

Brian Lehrer: They were chanting Superman after he called himself Superman. President Superman made no reference to his human wife's condition. Why not? Would the chanting crowd consider her weak? Would it blow his premise that COVID is no big thing? Would it make the in-person close together, largely unmasked crowd at his daily rally start to question whether it was safe to be there like that? Is he purposely using people's trust to put them at risk for a big crowd photo op? While cases are surging again, and scientists are warning people against big family gatherings for Thanksgiving and Christmas, Trump is telling his crowd this week, things like this.

Trump: People are tired of COVID. I have the biggest rallies I have ever had and we have COVID. People are saying whatever, just leave us alone. They're tired of it. People are tired of hearing Fauci and all these idiots.

Brian Lehrer: Fauci and all these idiots, he said to a group of supporters and reporters on a conference call, and about Joe Biden, he mockingly said this.

Trump: If you vote for Biden, he will surrender your jobs to China, he will surrender your future to the virus. He's going to lockdown, this guy wants to lockdown. He'll listen to the scientists.

Brian Lehrer: He'll listen to the scientists, with a mocking tone. On that note, we welcome Dr. Eric Rubin, Editor-in-Chief of the New England Journal of Medicine. He is also chair of the immunology and infectious disease department at the Harvard T.H. Chan School of Public Health. For the first time in its 208 year history, the New England Journal of Medicine is urging Americans to vote against a specific presidential candidate. Dr. Rubin, thanks very much for giving us some time today. Welcome to WNYC.

Dr. Rubin: Thanks for having me, Brian.

Brian Lehrer: The Journal has never endorsed a political candidate before. What started you discussing the possibility? Was there an event or a moment?

Dr. Rubin: First I want to be careful, we didn't endorse anyone. We just suggested that our readers vote against people. There wasn't really a moment which precipitated all of this. It was really an accumulation of lots of things. We see our job as communicators. We're trying to get the information out there that decision-makers can use. We try to support those decision-makers in making those very tough choices as it has to be done now.

We felt like we weren't being heard. We as a community of scientists and researchers weren't being heard on this and since there was an election upcoming, we thought that the only solution for that was to replace our leadership.

Brian Lehrer: As you say, The Journal did not explicitly endorse Joe Biden, you only urge people to vote against Trump. You said of the Trump administration, we should not abet them and enable the deaths of thousands more Americans by allowing them to keep their jobs. Why did you stop there?

Dr. Rubin: We're not arguing that someone else would [inaudible 00:04:45], we just wanted to call out the incredible and reckless incompetence of our leaders right now. I think we were a little broader in our criticism. We weren't just criticizing the federal administration. I think the criticism that we have could be leveled against the legislators and governors, some of them, and that we wanted to point out that this has been a disaster and our leaders aren't working for us and we really need to think about what kind of leadership we need in a crisis like this one.

Brian Lehrer: The Trump campaign says for all Biden's language about a national response, the actual pandemic policies he's running on are pretty much the same as Trump's. Have you looked closely enough to have an opinion on whether that's true?

Dr. Rubin: All I can say is what [inaudible 00:05:40]. I haven't looked at policy positions, but clearly what we're doing now is a disorganized and inconsistent response. It's not what we need.

Brian Lehrer: Well, you criticized the federal government in the editorial for largely abandoning disease control to the states. Taking that idea forward, what kind of national response would you like to see now to respond to the increases that we're seeing in most places at this time?

Dr. Rubin: I think we know what works and it's not a new message. What works are simple, straightforward, public health measures, masking and social distancing, quarantine, isolation, testing, and contact tracing. I don't think we're doing well in any of those categories. Now remember, any one of those by itself isn't enough. There's a package of responses at work, but they really work. If you look at countries that have done a very good job of implementing them, they're doing far better than we are. By not doing these things-- these things aren't that hard, by not doing them, that's already led to a large number of excess deaths and people are continuing to die in many of them unnecessarily.

Brian Lehrer: Why is the virus also surging again now in Europe, which does not have a denying Donald among the prime ministers that I know of?

Dr. Rubin: I think that if you look at Europe, there are a couple of issues there. One is that it is also inconsistent leadership there. Part of that comes from individuals and part of that comes from inability to really set policies that are strong. The other problem is the same one that we have in the US, each country sets its own public health agenda for the most part. You can't do that much better than your neighbor and when there's free travel across Europe, as it is right now.

Brian Lehrer: You write an interesting thing about testing. We have very large numbers of tests per day at this point, but a useful metric is number of tests per infected person, which puts us way down below such places as Zimbabwe and Kazakhstan or the two examples you said. Why is that number important? Number of tests per infected person.

Dr. Rubin: I think giving an absolute number of tests is meaningless. We're a big country, and we have the largest burden of disease. To figure out how to prevent disease, we have to identify people who are infected, and our numbers of infected are much more than most countries. We just need a lot more testing. Again, I really emphasize, testing is not complicated. It's something that we should have invested in early, we continue to underinvest in. Right now, there are many parts of the country where it's still difficult to get a test and the results come back very late. If you get your test back five days after you had it, it's pretty worthless. It's not very helpful for you and it doesn't help disease control in any way.

Brian Lehrer: Now, your editorial says, instead of relying on expertise the administration has turned to charlatans who promulgate outright lies. In that context, if there is a Trump policy advisor on coronavirus right now, and we heard the reports that he doesn't meet with Dr. Fauci anymore, he doesn't meet with Dr. Birx anymore. It appears that it's this Dr. Scott Atlas, who's not a virus or infectious disease expert, he's a neuroradiologist.

Twitter this week took down a post of his for being COVID disinformation. The tweet said, "Masks work? NO." Twitter took that down. When he was appointed by the president recently, 78 of his former colleagues at the Stanford University Medical School wrote an open letter in which they asserted that many of Atlas's opinions, "run counter to establish science." Besides claiming mask don't work, he appears to endorse a herd immunity approach that keeps society open and lets the virus spread in the community, except for trying to protect groups of people deemed vulnerable to severe cases.

My question for you is, where's the line between charlatanism, which of course we don't want, and a dissenting scientific interpretation, which is something you would want?

Dr. Rubin: I think, you bring up Dr. Fauci's name, and I think that's really important. Becaue the federal government has a very large repository of great science, of excellent scientists. In the institution, some of which have been heavily criticized, including the NIH, which hasn't been so much criticized, but the FDA, the CDC, the staff there are still outstanding. They are producing useful information, the highest quality information.

Now, ultimately, policy makers have to make policy decisions. That's not really the purview of experts. Any president would have to process that information and make decisions based on it. To ignore that advice, to call the infectious-- I'm an infectious disease physician, and I will tell you, Anthony Fauci is the [inaudible 00:11:21]. We who don't really have anyone comparable to him in this country in my area, to call him an idiot, to ignore advice like that and turn to someone whose advice you just-- whose opinion you like more, even if it's not informed.

Really, again, it goes back to the basic premise. There's a leadership vacuum here. We're in the middle of a crisis that's comparable to a war, and our leadership is making decisions based on what they like to hear, rather than what's true. It's an extremely dangerous situation, and it's already costing us tremendously.

Brian Lehrer: Dr. Eric Rubin, Editor-in-Chief of the New England Journal of Medicine. Thank you for joining us. We appreciate it.

Dr. Rubin: Thanks, Brian.

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