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So, for the next pandemic....


Matt and Dara are joined by Vox's German Lopez to talk through some of the lessons we seem not to have learned from the way the Covid pandemic unfolded — or, is still unfolding. Our hosts discuss the abandonment of the Obama-era pandemic playbook, the politicized messaging and idiosyncratic inattention of former President Trump, and what it would mean to develop a truly harm-reducing strategy for the America we actually have. Plus, some research is discussed that evaluates the relationship between access to treatment facilities and morbidity due to substance abuse.


"America still needs to learn from its biggest pandemic failure" by German Lopez (June 4; Vox)

"The US doesn't just need to flatten the curve. It needs to 'raise the line'" by Eliza Barclay, Dylan Scott, and Christina Animashaun (Apr. 7, 2020; Vox)

"The fundamental question of the pandemic is shifting" by Ed Yong (June 9; The Atlantic)

White paper: "Tackling the Substance Abuse Crisis: The Role of Access to Treatment Facilities" by Adriana Corredor-Waldron and Janet Currie (NBER; May 2021)


Matt Yglesias (@mattyglesias), Slowboring.com

Dara Lind (@DLind), Immigration Reporter, ProPublica

German Lopez (@germanrlopez), Senior Correspondent, Vox


Erikk Geannikis, Producer

Paul Robert Mounsey, Engineer

As the Biden administration gears up, we'll help you understand this unprecedented burst of policymaking. Sign up for The Weeds newsletter each Friday: vox.com/weeds-newsletter.

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This is an unofficial transcript meant for reference. Accuracy is not guaranteed.
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start restaurant to try. First, you know Washington now experienced easy to plan. Your trip today Visit Washington, DOT, Org. Welcome to another set of the weeds on the box media podcast network. I meant we glaziers here with public, has dared Lindh and boxes on her. Mom Lopez wanted to talk today about the covered nineteen pandemic, which is not over. We should I have to say, but I think as a U S domestic issue
policy response to cover this sort of over at this point- and you know- and I think it's an opportunity to look back at sort of what happened over the past twelve to eighteen months and about how we did. It seems to me that most people, whether they are on the right on the left have some kind of varied negative effect toward not just toward the pandemic, which obviously has barely had him. We too should have happened, Words policy response to the pandemic and yet haven't seen something like after nine eleven like there was a big commission, an addition, some recommendations on you know what we should have done better to prevent mass couch deterrence, the tax after the financial crisis. We didn't have that kind of blue Ribbon Commission by Democratic
Congress Road, a bill that became the Dodd Frank ACT and it I was to be- There- was a partisan take, but it was like their take, unlike what we have learned, from their symbol we were going to do in the future its having it, interesting to me about the covered situation is that we have a lot of like negativity, a lot of bad feelings, lot of criticisms and a lotta kind of takes in the media. and in politics- but we don't have either like a bipartisan high minded effort to say like years war wrong- and we also dont, have like a partisan ideological effort to say. Ok, here's how we're gonna fix everything it seems. It seems weird to me because at least I feel like I've been alive at this time- and you know even without pointing fingers- are blaming anyone or being too harsh, like not everything that we did worked out there well and it seems like we could do
I would even go a little further and say that the the extent to which the it is fair to say that the cover nineteen pandemic, is over in the. U S has become a at like that. Whether the truth of that descriptive statement has become a debate. by people who, like really want to be debating the policy response. Re like the Among the kind of I would say, covert response hawks, who have been throughout the pan, Emily urging for more aggressive lockdown measure. And who have been the you know the people who live it been more cautious about what vaccinated people should do. What states and localities should do as vaccination rates increase? You know that's because the the eye that the pandemic is not over, has become the response to decreasing lockdown and instead of actually what would it
what it's really saying is the policy risk. We have not yet hit the point where the policy response should being non crisis policy response and their those, I think, are kind of the two. That's like the the main underlying question the even rests below the. What should the response be right is at what point? Is it fair to step into a crisis footing? How long can you expect people to be in that crisis footing and when your to devising you're like here is the policy mode that we slip into in terms of in times of crisis? What is the goal of that policy mode? I think another thing that's interesting to me too, as one we're talking about hoof, who did poorly, who did badly. I may basically, almost everybody in the: U S dead, poorly, which has like like this has been framed in large part as a partisan issue. But if you look at the numbers from like some of the democratic,
states and not just like New York who, which has hit hard early but like a foreign. It did not do particularly great compared to the rest of the world in terms of handling cove it and the states. It do well like where we're talking about Lake Vermont, which has republican governor, but there must be democratic, otherwise, and then Hawaii, which is democratic lake, is, is just there's really know. There's there, some signs at like states that were a little stricter, probably did a little better and on the average, but when you look at the does the failures here, I think, what's really striking. Is that there's plenty of room for both parties to say, like look, there's plenty, we could have improved here. There's somebody like our policy approaches, warrant working exactly as planned here and, and I mean that, should I think, to match point likely to a bit of reflection as to what can improve
the next pandemic, but were or does not seem much of that yet written. Instead, what we are seeing is a kind of a reflection on human nature rate, where it seems like the lesson that many people have taken away again, like people who are more hot, who were more hawkish on lockdown. Is that human beings cannot be trusted to look out for their fellow men, which is kind of waving the white flag on policy right. It's it's, I implicitly, assuming that no locked down strategy could possibly work origin kind of caving on while we shouldn't even try aggressive locked downs, because there will be people who don't think that's a good idea and actually having conversation about was ill down. You know. To what extent did we pursue a lockdown strategy? Was that the right line where that get undermined in what we're both the lake political and you know policy barriers to what we said where the goals, if it is the conversation that should be pursued,
eating the oh. Well. I can't trust my fellow man to look out for me, so I guess I have just learned that humanity sucks lesson that it seems some people have taken away with this. is where a sort of I would start this waiting for. If I, if I got to chair the commission- and I would say you have to ask questions on to love- fry, one is what play book should we try to run and the other is how good war we at running the play book, and I think that alone you will know- I don't want to see. I dont think that this has been harmful to people in the sense of causing them to get sick or or causing illness, but I think, like psychic harm damage to american societies, ability to reflect and understand, has been done by a goal posts, shifting unsure of communications breakdown.
That happened last April and may we're you know if you go back in red coverage in the New York Times or box. Guenaud establishment, e media outlets in March and April of there was all this stuff about How we half do flattened the Kirk's right and it would have you know it was citing the CDC was citing leading epidemiologists. This was not like people freelancing. It was pro social public health journalists trying to echo their understanding of what the public health communities understanding of what the panel Playbook was right and you can read the stories. They say that we are not going to reduce the aggregate quantity of people who get infected with the disease right. They say that what we are going to do is prevent infection load from becoming so high that it crushes healthcare
system capacity than it was like a follow up. Eliza Barclay in and done. Scott for box did a good one on how we need to raise the lie in as well as flattened the curve. You know what you say: invest in our health care systems, capacity to treat people, and I think that that philosophy carry What did the experts? I will say said in spring: twenty twenty characterizes pretty well what the Red States did right, and so, but it's not what the blue state instead and they wound up being a kind of an odd breakdown. And if you look at something like giving look, it Gregg Abbots executive lifting mask incapacity restrictions in Texas. What he says is that a high percentage of Texas senior citizens have been vaccinated. He says that.
This hospital capacity is very high and he says the county judges, which is what they call account. Commissioner, and access will be able to re, impose these restrictions if possible, utilization hit certain kinds of thresholds. Right. So if you ignored everything that happened between April twenty twenty an April twenty twenty one great abbot was like reading New York Times articles, quoting epidemiological experts and doing exactly what they said. He should do But what happened was that during the hard block down of April twenty twenty, I think boast expert came to decided that we should actually be doing something other than that Instead of running the? U S pandemic playbook. We ought to run the Taiwan Pandemic Playbook, but there was never
and on that right, I mean like you: can you can say which will about Donald Trump, but he was in fact the present to the United States, and he was not persuaded right that we should switch to this other playbook and I it created a situation where we feel a lot of people feel like we failed, but like we didn't fit all in terms of the goals that way set out right, I mean New York City and the greater New York area has just still by far the highest death toll like the reason doing, like red state, blue state map and stop gets messed up. Is that that far and away the highest casualty rates are just that initial pandemic way? If we're hospital capacity was overwhelmed and the case vitality rates, straight. Then. I think it is a case that South Dakota, which was like Chrissy NOME, was being hyper. Irresponsible, like Showily arisen,
sensible and they seem to have gone sort of over the line at points, but others AIDS, including ones that have been very Lucy Goosey. That didn't really happen. Senor said, you know tat. They had time seniors relatively cautious health care institutions did good investment management protocols The problem is that hundreds of thousands of people died, but, like its exact we the strategy. As far as I can tell that the play book called for and the question we. Should be asking is like, should we write a new playbook for next time, but we're not we're not like having that dialogue and accounts I will not actually like I would. I would also I think why Herman's reed on this, as someone who was in also follow the kind of dual evolution of the epidemiology and policy responses like it. Do you think that mats broadly correct about which playbook we
which playbook was getting run and because that that I think is you know as asthma. Sadly, part of the then needed and this is here and especially if the playbook, that was in practice getting run, wasn't what people were who were really following this issue or understanding at the time, it's probably useful, too kind to really slow down and and draw that out, some NASA. Gone on average matters right. In that light, we were doing, I think, as a country were generally aiming for flattened the curve. I think we're back its complex
That is sometimes I mean you listen to what trumpet sang and obviously Trump has not was not the most eloquent person on cove it. So it's like really hard to say if he was following any specific strategy, but if we look at Red States, that's where I mean that the moment that taxes, for example, did actually impose a mask mandate and did impose social distancing requirements last summer was when there were news reports of hospital starting to get over run at the local, level, so that was his that seem to be taxes. This big concern were another area where I think this is more complicated. Those blue states did kind of seem to like take this lake. Almost licks gets a frantic approaches turns out. They would like switch between flattened the curve during better times and then, like truly the pressing cases during worse times and like you would see this switch back and forth, because I think that would freak out that there were seeing a lot of dad stirring, like the worst time, serene some
point in the summer and later in the fall and then they would try to you're like known and unknown over trying to suppress case now. We have to make sure that we do. We drive these cases as close to zero as possible and you can assad between where, where even blue states, our high number of cases for a long time. But yet I think it was what makes this complicated as mad essays. If you go back and read our like pan the pandemic playbook at the that the Obama administration left behind, for example, and has a lot of stuff tat, we we ve. All we all know about now is like social distancing, use, p, b and masks, if applicable, and on and on and on what the playbook is less clear about is what the goal, as all these policies is whether the goal is to flattened the curve or suppress cases and drive them down to zero, and I think that's really the like. The original sin here is like the country never really agreed. To this I mean there were two
eggs by like mad included and others that there were just like planned. The curve isn't good enough and lake. We just as a country that would we just never really move past and I think more people over time realized maybe find the crevice in good enough, as we saw. Hundreds of thousands of deaths tally up, but we just never came to an agreement, any sort of consensus, especially between balloon, read so as to what the goal should, and I think we should search seriously looking at lake for the next pandemic. What is the goal? What is the death toll that were essentially willing to accept here or one of the goals that were trying to reach, and I think this would actually be important, even if there was a consistent trend of lake states that did X, Y and Z did substantially better than states that did avian see right, because one of the big things we ve learned out of this pandemic is that when
You're asking for thing for behaviour. Changes like whether that's states mandating lockdown policies, because your then still relying on a certain amount of individual compliance. You're, you know you're just not going to like. Logistically it's not going, who work to say we're going to put you in congregate housing? I e jail if you disobeyed these social distancing mandates, but but even beyond that, just like the the idea that whether or not there are locked downs in place, you are expected to be responsible for not only your wellbeing but the wellbeing of others like we ve seen the that that the willingness to comply with that seems to be very closely linked to you know psychological expectations about how long this is going to go on and like a point that you know we ve made on this podcast over and over again. Is that like as long
this has dragged on and dismay waves of lake covered as a partisan phenomenon. We ve had the very first wave in spring twenty twenty didn't that kind of partisan polarization and had a great deal of voluntarism by in the then wasn't repaid with the government. Action of lake scaling up p p that we originally promised, and so even if we work is it like, even if you were to look at the covert responses, It actually doesn't matter that the goals were incoherent because the results were fine. You would still have some benefit for the experts dammit of being able to figure out how do we clearly communicate to the public? What they should expect to see, because that's going to give us an even higher sense of voluntary commitment and behavioral change, then what we got regardless of how six, regardless of whether it was more successful than somebody what somebody else
but I mean I think this time in question is intimately linked to what Herman said about the playbook not having a clear sort of Gaul, because I think that it became Clear like pretty soon after the sort of a regional national spring time shut down way was what are we gonna do right? We gonna stay at that level of restriction until it, accede was available. Were we going to stay at that level of restriction until it pushed case, nationally to zero, despite because at that time we had spread what we were successful. I would say in
pulling down the Tri state area outbreak gonNA, which was really really bad right and that came down the restrictions on what people could do were fairly effective at preventing the exodus from New York from turning into a national, huge epidemic right, because we didn't quarantine, Newark City, but we kept having outbreaks at me packing plants and imprisons in jail swayed to places where decision was hard. You know it said our inside our Cosette the illness wasn't like truly truly gone, so there was, I think, clearly, a sentiment from some people that, like that that was unacceptable and that we should maintain April twenty twenty conditions. You know just like until those numbers mechanically were pulled down, but the place I didn't say that exactly, and there was nobody there was no. There was no like mechanism for making some kind of choice
about that and this romance it. It's like even the blue states would ping pong back into curve flattening bode once things got to a certain point, and I think one reason for that is that the duration just would have been really really lawn, especially because states felt apparently that they could impose into. All travel controls right. So I mean, I think, one reason if you look at among the blue states, the states it best, it's like Vermont Mean Washington, Hawaii they're off in the corners of the country, like literally and, while I mean did not like prevent people from entering the state did for a long time in twenty twenty have some serious restrictions on hotel operations, which sort of in effect stop people from coming there and Canada completely locked down its borders. White means surrounded by Canada. Cinema
like fewer people coming in and that's what the asian suppression Success stories all did why they didn't just use like domestic lockdown suppress cases. They you couldn't co to Taiwan, Korea, Australia, New Zealand place like that. They very tough manner worry quarantines, because that's the only son totally girl, like Taiwan, now is having a little bit of an outbreak because they tried to ease up but internally they let themselves relax by closing their borders. Which we didn't want to do for sort of states and want to do it when I think it might be unconstitutional for them, to do so, if you said you know, look realistically like this is the best we can do. That would be one
I've been also. You know if you were to say again. If we had a commission, you would say, look to things. People didn't know about when they were coming up with these strategies was how successful remote work would be for why I workers how successful Ellie some people would clean remote school was like I would, speak that, but yet you know like we had this whole big school reopening debate and, like obviously a premise in that was the idea that remote schooling was ok and then we had a much more rapid vaccine development time than we had ever had so american society would not have collapsed if we had kept everything closed, except for grocery stores all the way. Until January, twenty twenty wine,
the aid might have been too costly. But I think if you were thinking this through, like as recently as twenty thirteen, literally no like that, won't work right, like the the economy, will completely collapse. People will be able to do anything. The ability for, like we ve, been recording, respond cast on Zoom for a long long time and lots of white collar people doing lots of step. This way means that you could consider harder, longer, lock, downs, then I think you would have in the past, but the impact of that I'm people is very disparate, based on their sort of class situation and attitudes toward guenaud various things in life and you so that you don't have to think that through in an explicit way, I think and not just kind of like caught takes like you. You need to like bring the stakeholders together and have a conversation. Why think? One one way we? U? You mentioned one way that I think we did actually fail at even flat named the curve, which was
when we did have lockdown say, had no clear goals as to what was supposed sit there were supposed to accomplish in in the sense that, like if you look at like Australia, for example, some some other provinces were pretty, in that, like look once we get at this level of cases will start eating up restrictions, the? U S didn't really have like a lot of states. Some states follow these tricks here and there, but by and large I was saying we're gonna reopened, it feels right, which is, I think, internal, actually making the lockdown actionable just makes it way harder on people because it makes it feel like this is going to last for an indefinite period of time. When you give people a clear goal as to why this horrible restriction is to be put in place, I think people are gonna, be one amenable to that if, if they know that there is like an end point here, I mean
the other side of this is like during these lockdown? Do we didn't even like we took a very long to like buildup testing, even once we did build up testing. We didn't really use it for surveillance like we didn't have genomics sequencing for like to see what what different variants there aren't like the last few months, which is pretty pretty awful, but but we deftly than use testing for they contact racing. We didn't build out those cops that. So just like say that, like there were alternatives exist locking down blindly and indefinitely and other places like Taiwan, like Australia. Did the those things I just never really follow that there and I think that hurt us even just on the basic premise of flattening the curve like if we had those done those things, and I think we would have been more successful at just, even though the them, I think the more conservative approach to the pandemic. Let's take a break. I really yeah
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ass fan. You can be so I will do we really want to underline what her mind saying about the indefinite sea of this indefinitely indefiniteness indefinite dude, because I think that that lake, if you look at it, I think with hindsight, if you look at the way that the political argument over lockdown developed in the states in spring twenty twenty, you have a couple of things happening that I think are a little clearer retrospect, one of which is that, like it was not at the time, really understood just how much the lockdown served as an inflection point for the spread of Cuban on and like we ve seen and ended and adjacent conspiracy. here, is about met scenes about. You know the real reason that the government wants to assert these kind of powers, etc, etc, and, like we ve seen enough data points, in the months after that, too. I think Heaven
you understanding that what was happening in spring of twenty twenty wasn't just people who were previously politically act, Finding like a new bohemian, but people who were in a state of lake disorientation, trying feel like they understood that something more nefarious was going on because it was so dislocated for them. But the other thing is that the sense of indeterminate see was really the was the ballast for a lot of these arguments, both in terms of lake, the policy of it and in terms of just what people could expect right. You would see a lot of people who work you and honours being in the small business owners and folks being like, we can't live like this forever. We shouldn't have these aggressive lockdown moves, because we can't do this for the years and years and years that the pandemic is going to take and that in
made that that seemed like an overly slippery slope argument at the time. But if you think about where people were saying like it was how long was going to take for vaccines to get developed, you know the the very cautious messages we were getting in twenty twenty, that we should not expect anything to return to normal before you know meet like mid twenty two may twenty twenty two at the very earliest. The argument of I can do this. I can then be in a state of you know like in a crisis state first, an amount of time, but if you're telling me, I need to be in this crisis state forever, I'm going to have some questions about why or doing bass? And if this is really reasonable? And if this is an infringement on my freedoms? Lake is a myth. our common sense argument, and so as long as we're talking about the kind of failure to communicate
Locked down would have you know like lake, when when lockdown was supposed to come into play and come out of play, I think that create a lot of medium and long term political problems in terms of giving a allowing some kind of common sense veneer. You and anti lockdown movement that, among its firmest adherence, was either very, very much a partisan politics. We're going to you know like our state governor is a Democrat and our state, legislatures republican, and so we're gonna like we're. Gonna. Do, though, is constantly booking use. This is as a way to restrict theme It's, U powers or the governor, or with these q and on and Q, and on a J sent conspiracy theories about why they really
to keep you from being able to show your face outside here's. A couple thought said that that I have answered tick take away from this I mean why tears point, but a little on the other side, like I think governors of states would divided political allegiance, is need to take seriously the fact that political consensus is a binding constraint on what you can do and then you know if you're, the governor of Wisconsin and was constant, you know is like a fifty fifty stay in terms of you know people on the ground and has a republican ledge
Fletcher you need to have a meeting with the legislative leaders from both parties and whichever experts they want. A cot like you calling your experts, but they bring their exports to the table to, and you have to work something out that you can agree on where you're not yelling at each other, then it will ultimately, even if it's a lack sir I'll, see link if it's a lax or policy that the five of you can all stand together on a stage and be like this is bad. Your covered, like I think, that's gonna, be a better results than fighting about things, and you know, like that's. Donald Trump
biggest failing personally. Is it he would never in a million years considered like trying to operate by consensus or defer to other people's ideas, but then that, like Champions Spirit, did I think, like trick down to other political leaders who are much point like not crazy by temperament in the same way, but just became taken for granted that we were gonna handle this. You know like attacks or budget issue where to account about votes and get out? You see what your lawyers tell you, you can get away with. Cars- and this is the next thing, is that I think that the blue governors, consistently didn't think about what am I actually prepared to enforce right like like what what do? I
please think about That'S- am I going to send cops to bust up house parties if I suspect that over twelve you know people are gathered secretly and if the answer to that is now, which I think it should be now like. I think there is a reason that nobody, actually implemented that kind of draconian policy why should it be? Did fur like a hot minute in New York against has already Jews and leg? That was a very good, love? Why nobody else tried very obviously became a question of wire you targeting this community. That is, you know it's like I don't know like the house around the corner. For me I want to say we were constantly throwing parties this past winter, like they had more than zero francs merchant, and I didn't call the cops optimum and if I had the Cubs would do shown up, and I think that that's fine, but you have consider what the implications of that reality are for policy
on reinforced guidelines can still be meaningful right because it's a signal to people about what goes on and what does it? I support I mean this is my feeling like I got very invested in indoor dining as a vector of transmission, which think is valid given masks and Bob Bob Bob Bob BAR? But if realistically the alternative to indoor dining is poor, people just have a party at their house, then the public health benefits of white shifting that from the restaurants and the houses seems maybe a little less clear to me and it may be, doesn't maybe that's not worth picking on quite the same level. Maybe that's not right, but those are the kind of questions you need to ask yourselves is like what, but what's the real bottom line here, like one of my actually willing to do, I mean
in what they were like welding, beautiful doors shut at one point it, like literally, you had to stay home and there is a case for that- you know, but, like you said, I have to have yet to get it your men all in terms of what it is you're actually willing to do and make policy that sort it takes into account he'll infamous we we had like you got gotta wear a mask while you're walking out on the street, which is like nobody, I think ever thought that had very large benefits, but it was like some you could. You could do right as like the mayor of DC to like show you are very serious about Ovid and it didn't have any fiscal cost, like involve anyone actually doing anything.
And so you know, maybe that's ok, but every time I am you signal like that. There's also counter signal I can t see doesn't have like Republicans, so it's fine you can govern totally disregarding whether this can be a backlash. But you know another universe in which people can like people. I know look at those outdoor mass quarters in a black eye, edit its solidarity and shows how serious we are about this, but other people and other parts of the country who I know, sought the opposite- that that's like. Ok, these guys are totally off the rails. Paying any attention to the actual epidemiology or medical science here they're. Just toss off orders for no reason
very guenaud discrediting if you dont operate in a way that by tries to get people bought in. If your strategy is gonna rely on voluntary compliance, then, like you need to you need to do things that might secure voluntary compliance. And take some reasonable estimate of how much compliance your likely to Gatt, which is probably why, for like our next playbook, we should put more effort on vaccine manufacturing because, like that doesn't require voluntary comply and see, requires money too, like spend more in advance to build the factory sooner to waste money on factories, fur for doses that don't work. You know, etc, etc. Like those things you can just do, and then you save lives, you know
sort of its a sort of more like american way of war right, then than to think that we're gonna get everybody on board for like a huge collective response, yeah. I, when I do think that late, I do want to underline the lake the voluntary complaints thing as it relates to the politics, because I think that a lot of people affiliated with the Democratic Party over the last half hour, It is really internalized the idea that it is both in fact is politically and morally wrong to think about. How might this message be misinterpreted because you assume that the Republican Party is? in bad faith, and so there's no set of good faith hoops. You can jump through on your side. That's gonna prevent that outcome, when we're talking about a voluntary complains pandemic response. We're not just talking about our Republicans in Michigan.
legislature going to use this against us we're talking about is someone who is nigh into politics and who is now taking their cues on behaviour from elite political leaders, or rather from like, is not ignore human behaviour from like what does my side say that person's compliance with mask mandate, with you know, indoor gathering mandates is just as important as the person who is super politically committed, and so it is worth kind of disconnecting a little bit for The idea of good faith, bad faith in the political context to think about. You know when We require decision, see me by a bunch of individuals. You are not going to who are going to be motivated by things other than does my side say this is good. There really is a certain amount of worthwhile nest.
clearly and accurately and honestly communicating what the goals are and what the science says. Sorry, her on you should talk about like vaccines and such the imo I was to tackle what both of your saying it is. I think one of the reasons is that Rotation about the next playbook assumption is because I think we I need a more radical rewriting of the playbook then like as being let on and in some circles necessarily cause like we talked about like Taiwan's playbook pursues a U s. as I am not sure lake, though the USA's original playbook I well it's not that I am not sure that uses original people clearly did not work very well. I mean we're talking about hundreds of thousands of deaths, so if, if, if the ghost prevent anything like this from happening again, then maybe we should be thinking more through more lake to mass bonnets, Ache lake. In theory, social distancing sounds great. If impact
These people are not actually following those precautions and finding every way to evade them. Then we need something else and, like you say this and other aspects of public, also like whether it's HIV or or drug use, or or whatever, like. Ideally you would you don't want people injecting drugs like it would be great if people don't do that, but the reality is some people do that, no matter how much you tell them to just say no in whatever so in public health, you develop strategies like needle exchange. As you develop strategies, no locks on distribution like things that don't stop people from using drugs, but at least mitigate the harm from it and if you like so much more of our playbook whatever and expand pandemic playbook, as should be focused on essential these guys, the harm reduction measures where it's like look. It would be better if you are not in Jordan
it would be better, be not gathering or home, but if you are open a window if lake, and also, if, if officials, to take this further at psych during the winter, obviously it go outside a tartar opened. The windows maybe install like outdoor heating for people, so they have a place to gather outdoors where their less likely to transmit viruses and, like you, can go down the line with like these kinds of ideas, and really just as essentially just say like. Ideally, yes, peep be social distancing. They would be masking, they would be doing whatever else might be needed for the next pandemic balikh. If people aren't going to do those things and we need to think a little more creatively. I mean I think, of the Comparison South Korea, for example, South Korea, have these apps, where that made. It really is a test like come top contact with people, because they followed your what
Every movement right. There is no way that Americans, even to those acts are required, are actually going to install those on their phones. Americans are found like Facebook, secretly tracking their information, but once its explicit, I think that's just like off the table completely, so the issues like, but Maybe there is some sort of that lake gotta know like just tells people like what the ass things to do, are in certain settings and like a better way to divert dialect? Deliver public gardens alike, helps you, safe. If you'd, you're, no you're gonna do some sort of tricky activity, I don't know, I think one of the few fears. I like this conversation, is important because we need to actually think up of like harm reduction solutions for pandemic and we haven't been really doing- that kind of work, interests like research and just talking this oh and figuring out what would be possible
now taken and more conservative parts of the country that clearly did not want to do some of the bigger restriction. Sat more liberal places were willing to do so, and young at the Atlantic you know has been like one of them. I think good, really by. pandemic writers. This pass here and he recently published a kind of openness that I read men to everybody, but in this case, because think it's like, is really wrong. He basically says like his take away as like, aha, effective public health requires a high degree of collectivism which individual Stick America doesn't have so in the future. We need to like reengineer all american society, and I think that it is more like what her mindset right that it's like if public health professionals
view is that like what they would like is for american society to be more like south korean society, like that's fine but like they need to get over it and come up with a play book that works for the society that we actually have right, and I think that there is a way- your the end, that the harm reduction analogy with drugs acting is incredibly relevant because you can clearly see too wide public health. People feel like emphasising this incredible fear that if you give people individualised advice about steps that they can take to improve better safety that they will use the steps right, and that is what they do not want. Trade losers. Part of the initial mass communication was concern that people would get a false sense of security from the masks. So one thing
Never sought out, like webcams, were totally sold out for a while during this pandemic, because you don't people went to look better on and zoom calls, but high quality happy filters. Ever sold out because nobody ever wanted to say that getting good air filters reduces Covin transmission rest, because nobody wanted to say it would be ok to have people come over to your house, because you you're going these good air filters, which I agree, we need to be clear like I agree that people should not be holding house parties and then relying on blue air filters to to make it safe. That being said, people were holding part Is there any? I got it all our knowledge and it also downstream meant that we had across the country countless district by district, the state by state school reopening debates without any serious discussion of what
investments in ventilation would be needed to make this school safe again, because that wasn't a part of the public health toolbox that it really percolated down to where those too actions were happen well, and I would say worse to the extent that we did have those discussions. They were these very dichotomy s here's what we need in order to make it safe, rather than just like here facts about the safety benefits of different measures. Right because it's like ok, look what is safe and what isn't is like an interesting almost like a metaphysical question where is like this measure reduces transmission risk by five percent if it is layered with this other measure, it is triple the efficacy. Wait like those are facts the problem is when you a quick people with facts, they might reach a judgment. That is not your judgment,
right, they might say, given my personal health status and my value, I conclude holding a Christmas dinner with one window cracked and some air filters and a lot of hand. Sanitizing is safe enough, even though that does impose external costs, civil society and, like that's gangs, point right that, like where two individualistic but like would read it. The other way like we are in fact very individualistic, and if you equipped people with better information, their behaviors would become safer at the market and whereas I don't just don't, I dont think that, like operation schooled was that effective?
not just because of the bad Republicans, but because of the enforcement issues in the blue, stay swayed that if it was flipped, if the right wing Authoritarian Party was also the party that felt strongly about public health restrictions, they might have pulled it off. Fright, like I could imagine, Donald Trump having quarantined greater New York City, having called out the troops to crush the void, protests right did like liberals doing takes about our trump was using this as a pretext to seize power. There, then being like public health people being like not or no he's right like you could imagine that, but the there's no way Democrats would do that like this was happening at the same time that we were like, we need to re. Imagine the concept
drive to like. How are you going to have like a huge crack down on people holding Christmas with the family? So I can see it? Doesn't? It doesn't make sense right, and so, if you're going to be in a society, very individualistic if you're going to live in a society with a more socialist ye collectivist. Steep local movement is also very sceptical of law enforcement. Like you just like you have to learn to live with their right and by give ball information that they can use and traded. Do medical research because, like everybody, likes getting treatment once they are in the husband FIFA
most people are particularly people and more vulnerable. Population groups are in fact getting vaccinate right like that really worked America doing. Vaccine research was very potent tool and if we were able to generate doses, quadrupled speed, we would run out of american to vaccinate, but we could have saved a lot of lives of his past winter and we could be saving lives around the world and like we'd, be saying- and they were saying now, like that's been America's greatest contribution to Covet- has been- Am Rna, vaccines and like we could have done better there, and I don't think there is a like fundamental partisan cultural impediment to spend more money on backs vaccination. I think one thing here is that
talk to a lot of public health people over the years like even before this band I make I was covering a lot of public health issues, and I think one thing they have struggled with here is that there are just in a very different mind, space and much of the country. So I ve, I mean we ve I think we ve all heard people who are like I would rather die than like restrict my life like. I would rather get sick with curve it, and, eventually die. If that's what it means to like continue living. My life is normal and like to a public health person, the political person that sounds like that. That person is an alien from another planet to them. But I think it's it's like to the to the point of like this. If we live in an individual, six sided or people just have completely different values than you do. You have to
also like the ultimate goal of public health is to serve the public and save as many lives as possible. That's it, and if lake like you know, I M, it might be the case that of Amerika was very collectivist like the next pandemic would go like great like much better than this one, but it's not the place place we live in and, if you're serious, about saving lives. You have to like acknowledge that, and I think that's that's a big thing here, even if it means doing things that you are uncomfortable with, then you have to do like things differently have I visited needle exchanges for export, for example, where they gave out sterile syringes to people who use drugs and, like I talk to some of the same name, love if everyone there serving like their clients, stop using drugs and their uncomfortable with two to end. agree they might be enabling their continued drug use, but they acknowledge that like if we didn't do this Similarly, sharing needles, they were getting hepatitis,
HIV and that would be a much worse outcome than what we have now and I think we just really need to start looking at the pandemic and other public health issues more in this way she would take a break and talk about it. I beds yeah. So this week's paper is by Adriana or Waldron aunt JANET Currie, it was published and be are and basically looks outlet the effect of addiction treatment facilities. What what happens when you open them up, close them down and look particularly at New Jersey, and it found that, where you have more addiction, treatment, You essentially have fewer your related visits, particularly overdoses, so specifically in place in they looked at zip and indecent zip codes worth a facility closed drug related. He our visits increase by sixteen percent, where they opened their decrease
I almost ten percent, so just based on that it that the conclusion is pretty obvious years like if you, if you have an addiction treatment facility in your area, you have fewer, doses another your visits related to drugs. If you don't have dream of studying our era. We are more likely to have problems with drugs, and I think it particularly relevant? Now, because I think one thing that has escapism in the past years, a lot of things seem to have gone horribly is the opiate epidemics, another area that has gone even much worse, gave a numbers this morning and like every time I look, these numbers are like shocking to me were now at almost through November. In the year proceeding November, we had more than ninety thousand drug overdose debts? That is up twenty five percent from the previous year and that is like on a record for drug overdose. Does ever in the? U S like, we would never had more than ninety thousand drug overdose. S
span of one year, and there are many reasons for that which you can talk about. I think its arms are related to people being isolated and different treatment services shutting down, but at least this paper suggested as like, we move back to normal. We have a solution for this, and this is something that public health officials have. An experts have been saying for a long time like, unlike Theo, along like a lot lot of these other problems with the opiate epidemic. We actually do have some good policy solutions, just a matter of investing in them, taking this issue seriously and so forth, and yet newspapers suggested the right like opening more treatment, does, does help out in a lot in this in this area. So when, as we hear, this dispute areas situating itself in a lot of research about like a lot of kind of discussion about what-
sort of facilities are most effective in reducing enow in in successfully treating opium detection, and there is a lot of lake in other. Third, there is a strong preference in the letter is terrific, medically assisted medication, assisted treatment, and you know that requires a certain kind of facility that is more medical, Ized right, where you have like an actual like a doctor overseeing things rather than have been largely counselling south but the while this paper lake is clear that they couldn't for one thing, this rivers there they couldn't do, have really rigorous. Compare some of those, because in New Jersey, where their data set is there aren't enough medical uses. Medication is did treatment centres in there aren't even a time of residential centres as opposed to outpatient, which is another kind of place where the literatures suggests that you know.
that impatient residential centres are more effectively which itself is suggestive, because it indicates that what is you know the kind of best practices industry? ideal is an actually out there, and you know it like it. Is there aren't enough of those beds out there to really make a too to really make the quest and is it better to have residential outpatient? The question is: is an outpatient facility ineffective enough that its Kay not to have one at all, and there. This paper strongly suggest that no, it's much better to have even even on medication, assisted, even outpatient, the things that are generally considered to be like less ideal still, a very strong impact in terms of whether people who are you know, though the kind of marginal overjoyed user who, if this facility clothes,
we'll be able to get a button another one, because there is a bed shortage regardless enow is going to be able to get help end the reason find this interesting. Her mine is that I know you ve done some leg, real, some some great investigative work on the rehab, industry and v in the pieces like the ones you ve done, often end up kind of suggesting that this is that the variants in treatment is so wide that a lot of people are being harmed by an industry that purports to help them, and I'm wondering how you square that with findings like this one, which pretty strongly suggest that the benefit of just having a like having a treatment facility, even in a zip code, that already has a bunch, is pretty high,
is when you know, because the places where treatment centres were closing still had other treatment centres available in Europe is still went up. A bunch and the opening up centres in places where they aren't decreases It's a centrally like I'm wondering how you square the idea that you know, oh, that there is a wide degree of variance and a lot of very Ino, a certain amount of under regulation and exploitation going on in this industry with the kind of bottom line. Finding that is presented here, which is a pretty stark. No really any treatment facility is better than none. While I think one thing I would say, is that this in that regard, as a study was on a new jersey which does, I do want to say they do a great job regulating addition treatment, because, basically no state really does, but they do a generally better job. In terms of that, I wouldn't curious. Have you looked at a place like
order, which has seen some like really fraudulent awful practices. In the past few years, like the notoriously it's called like the Florida shuffle, where have you got a south Florida use, got thrown from my treatment facility to treatment of sodium? Your experiences is, I mean I've talked to people who country send exist. I would not even called US treatment facilities such as I'm sure, there's like the based basically just say that there is a floor here, probably like your your treatment facilities. Protest meet some level of quality that this study I mean, maybe because it was New Jersey, maybe because it wasn't just looking closer like individual facilities. Maybe just wasn't strong enough to to capture that, but besides I mean Like you, I think even like what warmer target, for example, about outpatient versus residential treatment want. Do you find in the research? Is that, like everybody, when they say rehab, they think residential? But if you actually look at the research outpatient facilities do just as well as residential facilities and which ones
and you know that might surprise at first, but when you think about just about any other medical problem, where do you get most your medical care? It's an outpatient facility is lake. That's that's! You only end up at the hospital when things are really really bad and it's the same thing with these other with with crux lake. Outpatient is good. It serves most people's needs. In fact, you would prefer to treat people in our patient, but at a certain point, people might get bad enough where they need residential, and that I think is where, where this study ceases. Like look you, you should just put his many treatment facilities in Europe because, as long as this treatment is accessible than people can get caught early in the process before they get to the point where they need help. The delegation equivalent like residential treatment, then they can like. Then you can catch him, one, drug addiction may not be us as us as a dancer or like as bad as it could be, and lake. What, if you can't you
in those early stages. You might do a lot of work to reduce the harm speakers. It is probably people more advanced ages were more like good overdose. More likely to do other things. I commit crimes to to get money to get Rosen and so on, and that's when you start seem like really the social them, that's what they saw me the anything about outpatient I mean I don't know, I'm I'm I'm matter researcher when I when I see we searched, a patient treatment. I will I will speculate. I mean my experience of quitting smoking, which is not as short term deadly, but I think it is very directive is, it is relatively easy to stop the addictive behaviour under some highly control circumcision. Ants and what's harder is life way and so things where you can get treatment that is less different from living. German law
I could have more even more a sort of extra validity. You know in terms of like actually giving you the help that you me id as opposed to giving you help that only works in the sort of on its own terms straight you not because that's that's like that. The challenge of addiction right is is getting a treatment getting something that will really take and help you do serve over that over a longer haul. It is. It is too bad that this is only a look at New Jersey which has a service stronger reputation, the question with lots of things, you know is about scaling, like I know funny said other schools to show that the states that have the fewest charter schools have really good turn schools and are very highly effective, and it would be very beneficial for them to open more, but that the places that have created lots and lots of charter schools
marginal charter school is actually really bad. You know, and so there's always there's always like that kind of dilemma around trying to scale up efficacious public institutions like the Florida drug rehab is terrible but there's a lot of it in this case is actually not beneficial like giving people ample access to treatments that are ineffective is not helpful. but you want to try to investigate like, whereas that but where's that margin which interesting about a patient facilities being effective in New Jersey at least, is that it's easier to create the right. So you can, you can get more bang for you but there, but you wanna, try to investigate like weird you cross that How old were you dont want to just say more more much more more but like until you they're, like our New Jersey, should open up we're outpatient treatment facilities,
but we still need to know what's up with far there I mean I think this Somerset obtained, well, Sir, said like Vermont as basically take like it's done generally in terms of dealing with the operator epidemic. Then it's like New England peers, and I think one reason for that. Is it really took this challenge. Here's a very early on in just open up like a state wide system of of addiction, treatment facilities there, like really focus towards medications, for addiction, which are proven to be the most effective and like it date they have facilities, are Furthermore, I think one of the saddest lines in this study that, like most people, might not even pick up on his just that it excludes places Don't have any treatment facilities at all, because, obviously you can't study how the facility opening or closing their eyes. In effect, I mean they're like that's bad, like it is If, if you didn't have lake any access to me, care in your account aid, just four for any other kind of health issue. That would you
I would be concerned about, obviously not not a route places like the best hospitals in the country, but it is just to say that, like there should be a push to like make this as accessible as possible everywhere, and that like Vermont, which is really very rural, has taken steps to do that. I don't think other states have done taken steps to do that. We say I'm done at the national level and that's why this kind of study as possible, to begin with, which I think, speaks to just how much how bad access to treatment can be in India. It was with that. Thank you, her mind. Ethics, as always to our sponsors. Thanks to our producer, ouch innocuous we'll be back on track.
Transcript generated on 2021-08-08.