S1E7 / The Destiny of Nations Depends on How They Feed Themselves / José Andres

I'm Dr. Celine Gounder.

And I'm Ron Klain.

And this is Epidemic. Today is Tuesday, March 31st.

In this episode, we're going to speak with Chef José Andrés, who's on the COVID of this week's issue of Time magazine for his heroic efforts to feed those who've been impacted by the coronavirus pandemic and as an outspoken voice of one of the largest group of workers who've been hit hard by this crisis, the many restaurant workers who've lost their jobs.

You'll also hear from a frontline health provider.

And we'll wrap up today with some listener questions. And consistent with our topic on food and coronavirus, we'll answer a question about how you can safely bring groceries and delivery food into your home. But before we get started, Celine, on Sunday, March 29th, President Trump asserted that the supply shortages we're seeing of masks, gloves, protective gear in our hospitals is not a real problem. He essentially accused doctors and nurses of stealing or wasting masks. Here's what he said in the Rose Garden, courtesy of The Washington Post.

How do you go from 10,000 to 20,000 to 300,000?

10,000 to 20,000 masks to 300,000, even though this is different. Something's going on, and you ought to look into it as reporters. Where are the masks going? Are they going out the back door? So, Celine, you've been on the front lines, you've been in a major hospital in New York. What did you see there?

So, Ron, let's, let's just do some basic math. You know, he asked, how do you get from 10,000 to 20,000 to 300,000 masks? So The usual team for people who don't work in the hospital is 1 attending physician, so that's sort of the head physician, to about 20 patients. And between 0 and 1 of those patients under normal circumstances have a medical condition that requires us to wear an N95 respirator mask. Today with the COVID-19 pandemic, we now have 19 or 20 out of 20 patients, so just about everyone, now has suspected coronavirus infection. So in other words, they all have a condition requiring us to wear an N95 mask. So that's a 20-fold increase in the need for masks. So you go from 10,000 to 20,000, multiply that by 20, that gets you to 200,000 to 400,000 masks. The math works perfectly. That's exactly what you would expect. But to your bigger point, Ron, what is it really like to be on the front lines caring for patients right now? Well, in this and future episodes, we'll share short messages from healthcare providers to help everyone understand what these providers are thinking and feeling as they bear witness to all of this. If you're a healthcare worker and have a story you'd like to share, please record an audio file on your phone, keeping it to under 2 minutes, and email that to hello@justhumanproductions.org. This one is from a doctor in New York City. She received an email from the hospital where she works. They were asking for more doctors to step up to be part of a pool of folks willing to put in more time on the wards in the hospital.

In order to get control of this escalating COVID-19 pandemic in the city, we're going to need all hands on deck. Now, I am a hospitalist, but I'm pregnant. I'm actually in my first trimester, and I feel deeply, deeply conflicted about this call of duty, carrying a fetus that hasn't even fully developed. And yes, there are some reassuring observational studies out there, and all of which are just a few women from China, all of which were in their third trimester. You know, I don't think there are any policies right now because there's no data from first or second trimester when the fetus isn't developed. So I just kind of sit here waiting with my anxiety. Will I get called in? How will I protect myself?

You know, Celine, listening to what you said a few minutes ago, listening to the story from this doctor, it's just another reminder that our doctors, our nurses, our healthcare workers, the technicians working in hospitals, they are our heroes right now. And to hear the president accuse them essentially of theft in the Rose Garden, to hear people put pressure on these healthcare workers to do things they feel uncomfortable with. That's just wrong. And everyone like me who is not a healthcare worker needs to use our voices to stand up for these people who are literally putting their lives on the line to take care of the rest of us. You are our heroes at this moment, and we want to go now from the heroes who are in the hospitals to the heroes who are doing something else that is also quite important right now: feeding all of us. And there's no one who knows more about feeding people in a time of crisis than our guest today. He is the internationally acclaimed chef José Andrés, who has fed people all around the world in all sorts of grave circumstances, including during this current coronavirus crisis. So José, thank you for your leadership, thank you for your friendship, and most of all, thank you for being on the podcast today.

Yeah, thank you for having me.

So José, we wanna talk about two things: how we feed people in the middle of a pandemic, and also, how this is affecting all your friends and colleagues in the restaurant industry. But let's start with how you feed people in the pandemic. You were one of the first to this. You helped feed patients who are being isolated in Japan. You set up a tent in Oakland to feed the people where the Grand Princess was eventually docked. How did you get involved in feeding these people who had fallen sick from this disease?

Through the years, World Central Kitchen, probably from the early days in Haiti, when in Port-au-Prince we had cases of cholera that was putting at risk the work that many NGOs were doing in Port-au-Prince and beyond. When I began feeding there in some camps, I began understanding the necessity of protecting the cooks, but also protecting the people we were feeding and making sure that nobody in our system would be part of spreading cholera. So I guess I'm not going to say we're experts because at the end of the day we're cooks. But we took all the right measures to do this. When we saw the cruise ship in quarantine in the coast of Japan, we were thinking about, man, should we do that? And happens that at the same time we were kind of Thinking how we will do that, we got the phone call from the cruise ship line, from Princess. We went there, then we partnered with the Japanese government, and we went to do what we do best. We found a way to do it, keeping everybody again safe, everybody healthy, protected from the virus. So this is how it began. Then Oakland, we worked with the governor of California. And the city of Oakland with the mayor. We did, I think, a very good work. And in that moment, we realized that this was just gonna be crazy if we had cruise ships spreading the virus like in a bad movie. And this is when very early we began saying, man, if this comes to America, many things are gonna go wrong before they go right. Let's prepare for the worst and let's hope for the best.

How were you inspired to do this kind of work? Was there something specific that happened or a certain tipping point for you?

Well, I think my friend and mentor in these humanitarian things, Robert Egger, the founder of D.C. Central Kitchen, a charity in Washington. He told me 27 years ago that charity seems it's always about the redemption of the giver, when charity should be about the liberation of the receiver. With that in mind, I began like, okay, can a plate of food liberate? The receiver, give them an opportunity for a better tomorrow. So when the earthquake hit Haiti, Port-au-Prince, I was in the Cayman Islands and I was on vacation. I had the sense of, I was powerless, I was like, it was happening so close to us and I wish I was there. And then when I came back to Washington, D.C., a few weeks later, I got with a few friends, I landed in Dominican Republic. I drove all the way to Port-au-Prince and I found a local NGO and I began cooking. And I realized then that cooking seems— is always an afterthought, that we don't take food seriously enough to be part of the solution and not part of the problem. And is when the idea of just creating World Central Kitchen made a lot of sense to me.

What are you seeing out there right now in the United States about places where people are having problems being fed because of either they're shutting their homes or because they're sick or because it's just harder to get food when everything's all locked down? Where are the real urgent needs in our country right now that you and your team are focused on?

Yeah, I remember a few weeks ago that on a CNN interview, I said I am listening that the school systems are going to shut down. Schools are very important to provide meals for children, especially children of low-income families. We need to make sure that the school lunch program stays alive because it is the only food that some of the children, sometimes many millions of children, are receiving every day. Two days later, I guess, directly or indirectly, California governor announced that they will— they were going to keep those school lunches, and so this is a great thing to see. We began watching what the food banks were doing, Feeding America. I think the food banks are doing an amazing work. They're gonna be vital to keep feeding America, but we need so much more. Right now, it's a lot of Americans that they are still in the comfort of their homes and their daily lives, like, this is not gonna happen to us. And even people that they think they are safe from getting food, they're going to be in trouble. Supermarkets, we need to make sure they are kept open. Our farmers, who is going to buy the bounty of vegetables from them now that the restaurants are closing? Is the USDA going to be putting money to buy food from those farmers so we can give it to the food banks and to the school districts and make sure that we use that amazing network that is already in place in every corner of America to make sure that every person in need need has food. And I need to make sure that if we go through crazy times where this is going to last no weeks but months, that food is going to be part of the solution and will not be another problem that our mayors and governors and the White House will have to solve. We're here to try to think what may come and trying to be there like if we were firefighters going to stop the fire before the house burns down.

Jose, I think it was in the Time magazine piece that you say coronavirus is a wake-up call and you see that as a call to leadership. What kind of leadership were you referring to here?

I see too many meetings. I see too many speeches. I see too many saying things about what's happening, who is responsible. But I need to see more boots on the ground. We all need to see in this crisis boots on the ground, people on the front lines. If you have a big thing happening in Seattle, and it's one of the bad ones because we got an elderly home badly attacked, leadership to me is having the biggest experts right there on that elderly home and make sure that we learn from what happened, and so we are able to establish a protocol to protect every single other elderly homes across America. We didn't learn the lesson from Seattle, and we didn't put the protocol to make sure that this was not going to be a problem. Leadership should be happening with boots on the ground, never ever again from sitting down in the comfort of an office. Leadership has to happen on the front lines, and it's the only way to be changing the world and make sure that we respond to events like this one.

Well, and speaking of leadership, José, once again, your leadership here has been incredible and it includes you turning your restaurants into community kitchens. How's that going?

I think today we are going to be doing roughly 125,000 meals across America in very strategic places. Community kitchens was a plan to, to say restaurants transforming to community kitchens are going to be playing a vital role in every neighborhood of America to provide basic food relief for people in need. And obviously, if you can, you pay, but if you cannot pay, that's fine, no questions asked. But we went beyond that. We are trying to open, obviously, some convention centers ahead of whatever may happen because I think we have to. Here in D.C., we are trying to open the convention center kitchen where everybody we will put in I want them to be tested. I want them to stay inside, and their service to the country will be that those young cooks and distribution teams will stay for 21, 28 days inside a safe, a safe haven kitchen where they will be all clean, all perfect, in perfect health, but they will never get in contact with anybody with the outside world. This way I can provide to a mayor, to a governor, a place that can produce 50, 100, 200,000 meals a day and deliver to hospitals that may be in trouble because maybe the kitchens stop working because nobody shows up to work. The first responders, firefighters, police doing work, etc., etc. So this is the kind of thinking that we do.

José, could you just describe for us what these community kitchens look like for people who've never been to one?

Number one, we reduce the density of the people in the restaurant enormously. What you're gonna find is that kitchens, restaurants that will have 50 or 60 people working on them, all of a sudden you only have 3, 4 people in the kitchen having protective gear. We're gonna have a very specific way for you to wait in line, keeping everybody 6 feet away with holes we paint on the floor. We're gonna have information on the walls telling you what you should be doing. Stay home, keep away, wash your hands, etc. We're going to create a system that you don't have to be touching credit card or money and that you can use in your phone to see the menu and doing payment and everything.

Jose, one of the worst affected hospitals in New York City right now is Elmhurst Hospital in Queens. And it actually did not surprise me because if you look at where people who are still having to go to work to support their families, to put food on the table, to pay their rent, They tend to live in places like Queens and some of the other outer boroughs, not in Manhattan. Restaurants are closed to the public in New York City right now, but many are still providing takeout and delivery service. So how is COVID-19 affecting restaurant workers right now?

Well, listen, number one, I don't know how this will shape my business, but the day I decide close, I offer all my direct TFD employees at the headquarters cooks, waiters, managers, everybody, we offer 4 weeks full salary and full benefits. This was a way to say we are all in this together, but I'm supporting you to stay home. So for me, this was very important. I'm taking very seriously that my teams, my family at work, my employees will go through this pandemic healthy. I believe that if every single person that is in charge of managing one person or thousand should have this responsibility. And not just be at the government level down. It should be every one of us. So what is gonna happen? What is gonna happen in the restaurant industry? We are 10-12% of the GDP. More than 90% of the money that comes into a restaurant goes into the local economy because we pay the farmers. And the truck drivers, and waiters, and cooks, and bartenders, and managers, and the designers, and the architects, and the guys that do the cleaning. My God, the restaurant community touches every single corner of our economy. I'm realizing that now, this woman that is in the supermarket, cashing you out, all of a sudden she's a hero, because she's feeding one family at a time, by taking, taking the payment, and she's putting herself at risk. All of a sudden, everyday people that sometimes our system seems not to care for them, sometimes undocumented, more than 11 million, that they're going to be right now feeding America and providing aid and relief to America. All those unsung heroes, they are going to be the ones through these hard times in the weeks ahead that are going to be making sure that America is fed and that America keeps moving forward. I hope everybody's gonna be realizing that right now the war is happening, that the virus is shooting at all of us, and that we have people in the front lines fighting this war for us.

Well, Jose, we're gonna let you get back to your important work, but it's the greatest indication of a hero that he talks about other people as heroes. And I think everyone listening to this knows what heroic work you and your team are doing. I want to close just by asking everyone who's listening to go to wck.org/chefsforamerica. That's WCK for World Central Kitchen,.org/chefsforamerica. There's an easy button to click to donate to support this important work. I'm a big supporter of it. I hope everyone listening is a big supporter of it. And most of all, José, I join everyone in this country in thanking you for your incredible leadership, generosity, and hard work to get us through this. Thank you, José. Thanks very much.

Thank you. Thank you to you for being such a light in this moment. Thank you.

Every week we answer a couple of listener questions. You can get your questions answered by recording an audio file on your phone with your question, keeping it under a minute long, and email it to us at hello@justhumanproductions.org. That's hello@justhumanproductions.org. Our first question is an emailed question from Marlo Katz in Carmel, Indiana. If I'm getting groceries and meals delivered to my home, What should I do to these items before I bring them into the house to keep my family safe?

So Marlo, that's a great question. And there was recently a paper published in the New England Journal of Medicine looking at how long the SARS-CoV-2 virus persists on various different kinds of surfaces. Looking at plastic and stainless steel, the virus does seem to persist out to 72 hours, which means that when you're bringing stuff home from the grocery store, you may well want to wipe down plastic and metal items with, you know, just your regular household cleaner, and then wipe down the counter and wash your hands once you're done with all of that.

Next, we have a question from Bobby Strother.

Hello, my name is Bobby Strother in Lewisville, Texas. I understand how social distancing, staying at home, self-quarantine would at least slow down, if not stop, the spread of the COVID-19 virus. But once we return to normal social interactions, won't the virus just start to spread exponentially again?

That's a great point, and that's why we can't lift social distancing measures without a plan for what to do next. So first of all, we do need to see the cases on the decline, so infections on the decline, deaths on the decline, and we need to be at a point where we can do things like contact tracing and testing. So that requires a couple things. One, We need to get to the point where there's not community transmission, where it's much clearer what the chains of transmission are, where you could say person A gave it to person B and C, and we're nowhere near that right now. And then secondly, you need to be able to do the testing so that you can confirm who indeed has it. We simply don't have the capacity yet to do the kind of testing we need to do. So those are the things we need to be putting into place now while we're doing the social distancing measures so that in late April, early May, hopefully at least in some parts of the country, will be in a position to do those things.

You know, Celine, I think that's a great point. I mean, I'm asked this question when I'm on TV all the time. What's the date? What's the date? And this discussion about the date is the wrong discussion. The question is, what are the preconditions that we need to have in place before we can reopen large swaths of economic activity? And I think you hit on the right ones. We have to know that the healthcare system in a place is robust enough that if there is a flare-up, that we're able to treat the people who get sick, that we have enough healthy doctors and nurses, that we have hospital beds, that we have ventilators, that we have the protective gear for those things. So I think we need to get away from this debate about a date and focus more on discussion about conditions. And so now our last question comes from Ryan Loconte in Los Angeles.

A few of my friends and coworkers have mentioned to me that they were sick in early January. I also, for about a week, was sick in early January, and I'm wondering, they're wondering, we're all wondering, is it possible that we could have had COVID-19 before there were documented cases in the news here in Los Angeles in the United States?

Thank you for all of the work that you do.

It's certainly possible that what you and your coworkers in Los Angeles were sick with back in early January could have been COVID-19. It's quite plausible that we did start seeing cases here in the United States in early January given the tempo of transmission back in China and that you have a lot of people who are traveling between various countries around that time of year around Christmas and the New Year. So It's certainly possible. Eventually, when we have what are called serology tests, which is where we can check antibody levels, we may be able to confirm that for you, but right now I can't tell you for sure.

And Celine, don't you think this is very important that we develop these antibody tests because we're going to want to know who had the virus and who therefore is likely, though not yet proven, but likely to be immune to further outbreaks of the virus as it kind of comes back at various iterations over the course of the next year, year and a half.

Well, Ron, I think that's a great point. I think this is precisely the kind of testing we really do want available when we lift social distancing measures because that would be able to tell us much more accurately who is still susceptible, who's already had it, who's presumably immune, because those are the people you could put back to work safely. I think the problem with saying, well, we're just going to have it be young people, people without chronic medical conditions, that's a bit too crude of a way of saying these people are safe to go back to work, and plus, if they're not immune, they can continue to contribute to spread of the disease. So I think having those antibody tests is really going to be crucial in the next phase of our controlling all of this. Epidemic is brought to you by Just Human Productions. Today's episode This episode was produced by Zack Dyer and me. Our music is by The Blue Dot Sessions. If you enjoy the show, please tell a friend about it today. And if you haven't already done so, leave us a review on Apple Podcasts. It helps more people find out about the show. You can learn more about this podcast, how to engage with us on social media, and how to support the podcast at epidemic.fm. That's epidemic.fm. Epidemic Productions is a 501(c)(3) nonprofit organization, so your donations to support our podcasts are tax deductible. Go to epidemic.fm to make a donation. We release Epidemic twice a week on Tuesdays and Fridays, but producing a podcast costs money. We've got to pay Zack. So please make a donation to help us keep this going. We also want to give a shout out to our very first intern. Sonia Baradwa. She's a second-year medical student at Harvard in Boston, but she's currently studying virtually from home in Calgary, Canada. She's one of many medical students who's been asked to stay home in order to conserve personal protective equipment for healthcare workers and to limit her own exposure to COVID-19. In her free time, Sonia is going to be helping us out behind the scenes with the show. Also, check out our sister podcast American Diagnosis. You can find it wherever you listen to podcasts or at americandiagnosis.fm. On American Diagnosis, we cover some of the biggest public health challenges affecting the nation today. In Season 1, we covered youth and mental health. In Season 2, the opioid overdose crisis. And in Season 3, gun violence in America. I'm Dr. Celine Gounder.

And I'm Ron Klain.

Thanks for listening to Epidemic.