Dr. Leana Wen: Physician, Author, and CNN Medical Expert

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I'm Guy Kawasaki and this is Remarkable People. This episode's remarkable guest is Dr. Lena Wen. We recorded this conversation on September 1, 2021. We released the episode on September 8, 2021. I first learned about Dr. Wen because she is the go to medical expert on segments about the pandemic on cnn. She is an emergency physician, Visiting professor of Health Policy and Management at George Washington University and a non resident Senior Fellow at the Brookings Institution. In addition to cnn, her journalistic endeavors include being a contributing columnist for the Washington Post. She writes a newsletter for the Post about public health. It's called checkup with Dr. Wen. I think the Post should rename it Wen in Doubt, but I digress. Dr. Wen is the author of two books, When Doctors Don't Listen, how to Avoid Misdiagnoses and Unnecessary Tests, and her brand new memoir, A Doctor's Journey in the Fight for Public Health. Dr. Wen served as Baltimore's health commissioner from 2014 to 2018. She obtained her medical degree from Washington University School of Medicine, and she was a Rhodes Scholar at the University of Oxford. She completed her residency at Brigham and Women's Hospital and Massachusetts General Hospital. She was a Clinical fellow at Harvard Medical School. She is a member of the Council on Foreign Relations. Her recognitions include being named as one of Governing's Public Officials of the Year, Modern Healthcare's Top 50 Physician Executives, World Economic Forum's Young Global Leaders, and Time magazine's 100 Most Influential People. In other words, she knows what she's talking about. If she ever started a pillow company, I would buy one immediately for every bed in my house. This podcast begins with me asking her about the death of a kid in her apartment building. His name was Tony. He was in the third grade. She was in the fifth grade. She watched him die because of the lack of emergency medical care. This episode of Remarkable People is brought to you by Remarkable, the paper tablet company. Yes, you got that right. Remarkable is sponsored by Remarkable. I have version two in my hot little hands. And it's so good. A very impressive upgrade. Here's how I use it. 1. Taking notes while I'm interviewing a podcast guest. 2. Taking notes while being brief about speaking gigs. 3. Drafting the structure of keynote speeches. 4. Storing manuals for the gizmos that I buy. 5. Roughing out drawings for things like surfboards and surfboard sheds and office layouts. 6. Wrapping my head around complex ideas with diagrams and flowcharts. This is a remarkably well thought out product. It doesn't try to be all things to all people, but it takes notes better than anything I've used. Check out the recent reviews of the latest version. I'm Guy Kawasaki. This is remarkable people. Here's the truly remarkable Dr. Lino Wen what would the arc of your life be were it not for the death of Tony and your own family's experience with poverty and public health?

It's a great question. I don't think any of us know our own counterfactual and actually in writing Lifelines, I came to see so many things that had it not been for something, whether it was some something good, as in, for example, my family, at the last minute we were granted political asylum and we were able to stay in the US but also something bad too. I mean, one of my mentors is the late Congressman Elijah Cummings, who used to talk about how one's pain is what fuels your passion, that becomes your purpose. This idea of pain, passion and purpose. And I guess I don't know what would have happened if I didn't have the painful experiences in my life. Including the experience you referenced watching a young child die in front of me. When I was a child myself, I don't know where I would be if I didn't have those searing experiences early on that very much informed who I am.

So as one parent to another, and I came from a lower middle class family, I didn't have the difficulties you did, don't get me wrong. But it wasn't like I was born with a silver spoon in my mouth. Do you ever worry that your kids will not have this pain, passion, purpose? The. Is it pronounced Chiku?

Yes, exactly. The eating bitter experience.

Like my kids might not eat bitterness. Your kids might not eat bitterness. What do you think the effect of that is?

Yeah, it's a really interesting question and one that I think about a lot now that I'm a parent of. Well, to be fair, I've got two little kids and so right now my bigger concern is my, my son just turned 4 and he recently has gotten into throwing everything down the toilet and he recently flushed our car keys down the toilet. So I think we're a bit of a ways off from. I don't think I'm ready to have the conversation with him about his privilege.

Yeah.

And the sacrifices that his family members have made just yet. I don't think that would quite land. But yeah, I mean it's. I, my husband and I talk about this a lot. That we don't want our children to be ashamed of where they're coming from and to feel guilty. Ashamed is the wrong word, but feel guilty of the privilege that they have. But I want them to recognize their privilege and I also want them to understand the lives that we had and the suffering that so many people across the world and around the country are going through. So I'm not sure I don't know the answer to that. I actually would love to hear from other parents about, about how, how they navigate this too.

I thought I was going to get the answer from you because I don't have the answer.

Yeah, I know. I was going to ask how do you think about it?

I struggle with that question a lot. But I've not come to the point where I said, well, I'm going to make my kids suffer purposely just so that they understand what it's like.

Let's say I also don't want my kids to feel guilty. I mean that's something that for a lot of children, a lot of Asian kids, but also a lot of kids whose parents may have really gone through some difficult circumstances, there is maybe the sense of, well, we sacrificed so much for you and I definitely grew up with that. And I don't know that that's a very healthy attitude either. Yes, of course. In a sense all of us are the products of our parents aspirations and we, we all want to be living our parents wildest dreams for us, but we also should be empowered to live our own dreams too. And I want my children to have opportunities so that they can have more freedoms and more ability to choose what, what they would want to do. And I don't know the answer to this, but I suspect it's something that many parents and children come to terms with over the course of their lives too.

So let's say there's a. I gotta make sure I got the name. It's Lena, right?

Lena. That's right. Thank you for, for asking. It's the, the courtesy of US Immigration is how my name was spelled.

Let's say there's a Lena Nguyen and she and her family were just airlifted out of Afghanistan and they land in the United States. What advice would you give them based on your family's experience?

You know, that's so interesting. And I have been thinking a lot about this, of course, watching the news and thinking about all those families that made it and all those that didn't and how not that very much separates any of us that so many of us could have well been in that circumstance ourselves. In terms of my advice for people coming here now, I would say so much of it is finding community. And community doesn't have to be 100 people, but even two or three other families who you get to know and who can help you in this time, I think is so critical. We were really fortunate when we first came to the US that we settled in a little town in the mountains of Utah, in Logan, Utah, and we had a lot of community. It was a small town, really, no other immigrants or very few other immigrants at that time. The local church really took us in. My mother was a student there and she had professors who invited us over for every holiday meal. People didn't make fun of the fact that I didn't know English helped to teach me English. That was the small town experience that we were very fortunate to have. Then we moved to Los Angeles. I had a very, very, very different experience. Was a much harder, crueler world with a lot less support for us. And we really struggled in la. And so I guess my advice for the family that's coming over now is it really depends on where they go. But I hope that they'll be able to find a community of individuals, even if it's one or two or three other people who can help them during this really challeng challenging initial period.

Don't you think that most people would be a little surprised by that story? In that the stereotype is you go to a large metropolitan city like Los Angeles, in blue California, it's full of liberals accepting people, helping people, all that instead of going to a little town in Utah where you had the good experience.

Yeah, and that's part of the reason I wanted to tell this story because it's. There are a lot of stereotypes that people may have about red versus blue or they think, well, this type of person or this type of community would accept immigrants and that type of community would not. That was really not my experience at all, to be fair, in LA also we encountered a lot of great people. So it's not to say that it was just this brutal world, but rather, I think There are a lot of communities, including the one that we were very lucky to settle in in Utah, that are really accepting too. When we first came to. To the U.S. one of the stories that I wrote about on Lifelines is how it was really cold. We came from Shanghai, which did not get that cold in the winter. I didn't have a winter coat. And we came to Utah in December, and it. There was. And I had never seen snow before. The only way that I could keep warm. We could keep warm was I was wearing five pairs of pants and six sweaters and. And I didn't have boots or even knew that there was such a thing. As I remember, it was so cold. We did our laundry by hand and I went to take down the laundry and it was so cold, and there were icicles on everything that our clothes broke as I took them in. That's the. That's how unprepared we were for that environment. But here's what happened. Our neighbors must have seen us really struggle. And also at that time, we were kind of just scared of everything. You know, we didn't know. I didn't know English. My father didn't know English. My mother was studying and working. I'm sure that our neighbors tried to talk, but we didn't even know how to say anything back. And so pretty soon after we arrived, we found a whole bag of clothes outside our door and blankets and boots. And it was anonymous. It came from various neighbors. I think the church may have held a clothing dry for us. That's just something that happened. It was one of the many, many acts of kindness that we experienced.

Do you think that America still exists?

I do. I think that it does exist. I think that it exists in communities. And so this is part of the reason why I wrote Lifelines is I wanted to talk about how much things happen on the ground. That's very local. That's not about politics, that's not about ideology. That's not involved in culture wars and all of this stuff that we hear on the national level. But I think on the local level, people are just people and they are helping one another, trying to get through. I am not trying to sugarcoat things. I am quite sure that there are many acts of racism and intolerance and misogyny and hatred that are happening all across the country in communities as well. But I also think that at the end of the day, I really think that people want the same thing. We want some level of safety and stability for our families. We want our children to have more opportunities than we did. We want for trash to get picked up, we want to have clean drinking water. We have pretty basic needs. And, and what ends up happening, I think sometimes is that the national discourse and the politics gets in the way of people actually working together. And my initial impetus for writing Lifelines was in fact talking about my experience here in Baltimore, which was not partisan or ideological. It was very much about getting things done. And I think that that's a lot of what actually occurs in local communities all across the country now.

So Eli is in school now. Can you describe how it works there?

Sure. Although as of the time that we're speaking, we have a N equals one day experience. As Eli just started preschool. His orientation was yesterday and his first day of school was today. And so I can't tell you that I have a wealth of experience here. But no, we're, we have a, we're in a community here in Baltimore that is very accepting, I would say of scientific guidelines. The school that, that we enrolled Eli in follows the CDC guidelines and in fact goes even further and it's even stricter in some cases than the cdc. And so yes, I feel a little bit nervous about sending him back to school. Of course I also have a one year old daughter who my own pandemic baby who is not yet in school. But and I worry about, of course, I worry about just how much is around us. We are now approaching Labor Day and we have twice the level of COVID infection that we did last year at this time. I mean it certainly is a concerning time, but at the same time we also have to recognize how much our children suffered by not being in school. And I felt very strongly about getting Eli back to school for his development as well. It's time for us, I think, to reframe far top from talking about is something safe to is something essential. I think schooling is essential work. For many people in person, work is essential. And if that's the case, we have to make those things safer while reducing the risk as much as possible.

And what is essential for school to reopen or continue to be open?

Yeah, I mean, I think right now we have to recognize that two things are true at once. One is that schooling is essential. That our children have really suffered internally, terms of their mental health, in terms of their educational deficits especially the disparities have worsened for children who have, who live in underserved areas and children with, with, with special needs. So they need to be in school. At the same time, we recognize that schools can also be super spreader. Places that, I mean, we would not think about having 20 to 30 unvaccinated, unmasked adults in a room with one another for six hours a day, day after day, in often cramped settings. We would not do that, but we would do that for our children. And so if we do that for our children, of course we're going to have major outbreaks as a result. However, we do know that schools can be made safe. And in fact, there have been a number of studies now that show that the transmission rates in schools, if done correctly, can actually be substantially lower than the community transmission rates of the community. Meaning that the schools can actually be some of the safest place for children. From a Covid standpoint. One way to think about this is think about layers in the winter. We were just talking about when it gets cold in the winter, wearing multiple sweaters. Well, we can think about the same concept here, that you need multiple layers in order to protect against Covid. And the colder it gets, or in this case, the more virus there is, the more layers you need and the better layers you'll need. And so vaccination of staff and eligible students, that's an important layer. Another important layer is testing indoor masking. Another important layer if for many students, in order for them to get back to school. We know that distancing is not possible anymore because you can't have all that many students in class and still keep 6ft distancing. If you are removing one layer, you have to replace it with others. And so I think that concept is important for us to think about that. It's a layered approach that works. The colder it is, the more virus in this case that there is, the more layers it's going to take.

What would you do if you are in a state where the governor is trying to prevent mass and vaccination requirements?

I think it's really challenging. But I also don't think that people and parents are helpless in this situation. I actually recently started a newsletter with the Washington Post called the Checkup. It's something that you can sign up for. It's Wappo St Checkup. Last week I wrote the entire newsletter on what it is that parents can do if they are in the circumstance where their school may not be requiring masks as an example. And you don't know the vaccination status of the teachers and people and the staff in schools. Well, I think there are very tangible steps that parents could be taking. For starters, I would recommend talking to other parents in your child's class because there is strength in Numbers and very likely there are other parents who feel the same way as you. Perhaps you could approach the teacher together even if you don't want to approach the administration together and ask for things like testing, which would be a very reasonable thing to do. You as the parents can form a pact that you will have your children mask and then you can ask the teacher if your kids who are all masked can sit together with one another in class. Also, quality of mask really matters. And so you could choose to have your child be wearing a KN95 if they can tolerate it, or at least a 3 ply or 5 ply surgical mask. That's something that better protects your child as well. One other very important concept is that of cumulative risk. Sometimes we fall into this logical fallacy of thinking, well, if my child is going to, is going to school and other people are not wearing masks or if I'm going to work, then to hell with it. You know, let's just. There's just so much risk that we might as well also go to indoor dinner parties and birthday parties and other things. That's really the wrong way of thinking about it. The right way is to say let's talk about the things that have to be done. Schooling is essential. There is going to be risk, but we have to do that. You have to go into work. There is going to be risk, but you have to do that. But then if that's the case, how can you reduce risk in other ways? So can you make sure that the only extracurricular sports that your child is involved in are only outdoors? Can you make sure that if they're going to sports outdoors that they're not also hanging out in locker rooms or going to carpools or indoor pizza parties together? Can you limit the sleepovers and movie nights? Because those are things that actually have a lot of risk associated. And so think about the idea of cumulative risk. Again, I wish that we were not in this situation. I think it's awful that the same governors and legislators that are normally all for local control and for business innovation and empowering people on the ground, they're now preventing people on the ground from actually doing the right thing. I think that's really hypocritical. It obviously is terrible. But at the same time, parents and individuals are not helpless here.

Let me tell you a story. So on Monday night I went to a restaurant. We sat outside by the way, and there's a horseshoe shaped bar and people are sitting there elbow to elbow, no mass, probably 50% vaccinated, aren't they basically breathing into each other's lungs, just sitting there at the bar for two or three hours?

Yes. I mean, that is one of the highest risk settings that you're describing of people who are indoors, probably in a cramped setting, no physical distancing, probably poor ventilation, unmasked because they are eating and drinking. It's probably loud and so they're talking loudly to one another as well. The other another thing to consider is many of the people who are not taking precautions and are willing to go into these settings are probably also not vaccinated. It tends to be that the people who are vaccinated are actually the ones wearing masks and taking additional precautions, like dining outdoors. We know that bars have been super spreader events, and of course I very much worry about what that means. And I also think that at some point we have to stop using this rhetoric of individual choice, because these are individuals who are not only making the choice for themselves, they're also committing others to infection from them too.

I believe you use the phrase that the US Utterly failed to effectively deal with the pandemic. Can you tell us the ways that we utterly failed?

There are so many, and I think there is going to be time right for us to do a full postmortem of what happened. I would say that in the very beginning, while we did fail in the initial containment, we didn't have testing, for example, we didn't take Covid seriously. I actually think that in a way those were excusable, as in, there is the fog of war, there's the fog of the pandemic. You just initially, you're not trying to make a mistake, you just made the wrong choice. And some things didn't fall into place and we weren't adequately prepared. I mean, I think that could happen. And in a way it's understandable if that's all that happened and then subsequently we did the right thing. It would be tragic that there were infectious and deaths initially, but I think it would be excusable. What is not excusable is what happened basically from April 2020 onward, that at that point we actually knew what it took in order to keep people safe. There was the White House even had a reopening plan that was not followed. There were politicians who were actively at that point going against public health guidance for their own political gain. And then scientists were muzzled and not allowed to speak to the American people to give accurate information on how everyday individuals can keep themselves and their families safe. I mean, all of that is inexcusable. And I think moving forward now, the fact that there are still, of course, so many individuals who are actively going against public health guidance and actively spreading misinformation, disinformation, at the end of the day, that's the part that's really inexcusable.

Do you think we're in a golden age of stupidity? I just, I can't wrap my mind around some of the decisions that we're making.

That's an interesting way of putting it. No, I. I don't know. Right is. And let me think about that. I mean, I think it's very frustrating to a lot of us who know the right thing and then are seeing people actively fight against it. And the consequence is on a whole lot of people who are actually not poorly intentioned. I mean, there are, for example, take the anti vaccine individuals. There are actually people who are spreading disinformation for their own gain. That's horrific. And those are the people to be blamed. Then there are a lot of people who are not spreading disinformation knowingly perhaps, but who are listening to these voices and are not getting the vaccine and therefore infecting their family members and themselves potentially dying as a result. It's hard to know what to make of this group because it's not monolithic. Some of these individuals distrust institutions and the government and health care for understandable reasons. Other people live in communities where everybody around them is unvaccinated and they're listening to their friends and family members. A lot of these people are also scared and they are not sure what to believe. And so they're listening to the voices that they find to be the most trusted for some reason, but actually are not credible, but they don't know that. And so it's hard to know how to make sense of the times that we're in. I'm not sure that I would call the golden age of stupidity. I think it's much more the golden age of polarization. And that polarization has led to so much that is actively against people's health.

Do you see a way to reduce or end the polarization?

I think that there are a lot of efforts that can help, including enlisting local trusted messengers. In public health, we say that the messenger is often more important than the message. And I think that's very true in this case, that the more people you have on the local level who are, who are providing accurate information, the better. Somebody may not be trusting what Dr. Fauci says or what I say. And people you see on TV say when it comes to Covid. But they might trust their own doctor or they might trust their neighbor who's a nurse or their local pastor. Those are the individuals who I do believe their voices really matter in this case and we have to rely on them a lot more. But I also think a lot of the polarization has to do with our media environment. At the end of the day, I think the more that we can focus on what's done on the community level, where as we were talking about earlier, I do think that people want the same thing. If we can focus on what matters, which is getting people healthcare, picking up your trash, getting your kids a good education, making sure that the roads are paved. The more we focus on those local connections that people have, the more we can overcome the national polarization that frankly doesn't really impact a lot of people's lives.

Wearing the hat of a reasonably intelligent person who watches the news, I am confused, and I think many people are confused. To cut to the chase, what's with the CDC and the fda? CDC probably made a decision to unmask too early. Maybe they're calling for boosters too early. I could see this under Trump or it was political, but this is still happening. Fda, the Alzheimer's drug. Two staffers resign about the booster decision making process. So what is the person supposed to believe coming out of the FDA and CDC today?

I think then there are a couple of ways that, that I would want to answer this. One is that right now we are seeing science play out in real time in a way that we normally do not. I bet that prior to the pandemic, most people never really thought about the CDC or the fda. It definitely wasn't part of household conversation. Part of it also is that during a pandemic, decisions have to be made with imperfect information. And not making a decision quickly is a decision too. And so we are going to see a lot of decisions, a lot of guidance being provided that then needs to be changed. And I think that that's okay. I just don't think that we have done a very good job of explaining when these decisions need to be changed and what that means. And it's not just explaining the what, but the why. And I think that's something that certainly was not done during the Trump administration, although I think the Biden administration, one could argue there have been instances where things could be done better as well. But I also think there's a larger point here, which is that we are entering a point in the pandemic where there isn't a clear cut Answer. Sometimes we use this mantra of follow the science with the understanding that science is supposed to have one result. And that's just not the way that this works. I certainly believe in following the science, don't get me wrong. But you could have the same set of data, but two people, smart, well intentioned people, could interpret those data in different ways. And that doesn't mean that they're not following the science. It doesn't mean that somebody is trying to do harm. It just means that people have different values. So, for example, you were talking about boosters. Let's take that same set of data, which is that we believe, based on the information that we have, that the vaccines work very well to protect against severe illness. It keeps you out of the hospital, keeps you out of the morgue. It does very well in doing that. However, we're also getting data that over time the vaccines wane in effectiveness, especially against the delta variant in preventing symptomatic illness, mild illness. Let's say somebody could look at those data and say we don't need boosters because the key point of having vaccines is to prevent from getting severely ill. Somebody else could look at those same data and say we don't want to get ill at all. And so we should have boosters. Now, I think that is actually what we're seeing play out. It's not that we're arguing over the data, but the interpretation of the data as it applies to policy. And part of the reason it's so confusing is there's no agreement for us as a whole, as a country as to what our goal in vaccination is, or even writ large, what our goal in Covid is. And so we're seeing scientists argue with one another, not actually when it comes to the science, but when it comes to the values. And so here I'm going to make a really controversial statement, which is that I don't think that it should actually be up to the CDC or FDA to even be making these judgment calls. I think at the end of the day, it should be up to the White House, because ultimately this is a policy decision based on the values of the American people. The science is the science. Different people are going to interpret the science differently. And when it comes to policy, that policy should be made by our elected leaders, not by scientists.

Wow, my head is exploding.

So.

Okay, I can kind of understand that with the Biden administration, but you're saying that should even have been true from 2016 to 2020. Let the white House make the policy decision. They did that In a sense, didn't they?

They did. And I actually don't think that that was wrong. I think what was wrong was when the Trump White House manipulated the CDC data, didn't allow for certain scientific results to come out, cherry picked their data to make a certain point. I mean, you shouldn't hide the data. But the decision about what the policy should be cannot just be made by scientific institutions. So let me give you an, an example here. Let's say that there is a new disease on the horizon. There is not. And so just to assure your audience there is not. But I want to give a thought experiment based on something that hasn't yet happened. Let's. Because with COVID it gets a little bit too complicated to give the hypotheticals in this case. Let's give a real hypothetical. Let's say that there is a new disease on the horizon and we are able to predict that if we locked down everything for six months, that we could avoid almost entirely any deaths at all. But if we did not lock down, if we did a partial lockdown, we might have a hundred thousand deaths, but we would only have a loss to our economy of 50% versus if we did the total lockdown, we might have a 90% harm to our economy. And then if we did no lockdown at all, maybe 500,000 people die, but there would be no economic impact. Let's just say that those are the numbers based on models of a new illness. The role of a scientific institution should be the same, should be to lay out all these options and to make those models and predictions and then to also help advise people on how they can keep safe in the event of this illness. But the decision is much more complex than just a scientific one. If the only goal in our society is to save lives, then the decision would be clear. But there are so many other elements that we have to weigh too, including the economic impact. What are the geopolitical consequences of closing our borders if that is one? What's the consequence of our children not going to school? What about people who lose their jobs and then experience homelessness? Is that going to cause a knock on effect for generations to come when it comes to poverty too? I mean, that's something that should not just be left to a CDC or FDA to be making that kind of call. That is a political call that is based on values of a society. And we elect our leaders to make that kind of decision.

What is or should be the goal or end game of vaccination?

I think that is exactly another thing that should not be the call only of scientists. I think this is another great example example of this. Let's talk about where Covid could end up. Okay, so there are a number of different things that could happen on the trajectory. And let's just say that it's on the trajectory that we're on now, that it's not like some crazy new mutant comes up in the next month or so that it's. That could also happen. But let's say on the trajectory that we're on now, you have countries like New Zealand that have taken a zero Covid strategy that's actually not working out that well. They're having a lot of cases despite lockdowns. A number of Asian countries have tried the strategy and are finding that this same thing. Then you have the opposite. You've got the UK that vaccinated a lot of people, but but has now opened up everything basically with a live and let live attitude of they're not even requiring masks on on the tube anymore there. The decision about what to do is not just based on the science. It's not like the UK science scientists have uncovered something that the New Zealand scientists have not. And by or vice versa. What's happened is that there is a decision by society, by the leaders who hopefully reflect the views of the of their people to say we will accept the consequence of infection. As in the case of the uk People who want to get vaccinated are vaccinated. We want to protect people as much as possible, but at some point we have to go on versus in New Zealand they're saying we're still aiming for zero Covid. Our goal is to ideally have no one die, but we're willing to have the consequences, the economic consequences, the geopolitical consequences as a result. I think that factors into your question here guy, which is about what about here in the US what is the end goal of vaccination? Some people would argue that the end goal of vaccination is to have as many people vaccinated as possible. Ideally, we are able to reduce the level of infection. But even if we don't, if for most people what ends up happening is that they get a cold or they get mild flu like symptoms, that would be okay and we should be able to go back to normal life at that point. Of course that would also hinge on our children getting vaccinated, which is obviously not something that's occurred just yet. So we're not at that point. But one could say once children are able to be vaccinated too, that is the end game that maybe we stop mitigation measures after that because we think that the consequence of distancing, masking, et cetera, is too great for this country to be able to tolerate. I think there's going to be another group of people who strongly disagree with that and say we should continue with masking, distancing and other measures because we still want to reduce the consequence of severe illness. We as a society have not agreed on this. And that's another one where I think it's not just up to our scientists to make that decision. It's up to the American people as reflected in our elected leaders.

And let's say that we go with that theory and a country, via its elected leaders has made a decision. But what if a neighboring country has made a different decision? There's such interconnection. How does that play out where another country's decision affects your country?

Yeah, I think we're seeing this play out right now within the US with different states that you could have states that have really restrictive guidelines and others that really. And we know that this virus crosses borders. And so I think this. We're going to see the same thing around the world as well. Which is another reason why I'm not really convinced that the New Zealand strategy is really going to work. They are able to do this much better than other places. Or Taiwan is able to do it much better than other places because they're an island, literally an island. But I think a lot of places are not going to be able to do that. And so I think at this point, my sense is that that vaccines are going to be our only way out of this pandemic unless something unforeseen and very good happens. One thing that could happen is, again, I don't think we should bank on this. But one thing that in theory could happen is that we get a new mutation that arises that's more contagious but much less deadly. That would be ideal. Then we can turn SARS CoV2 into the same kind of coronavirus that causes our common cold. That could happen. But the opposite, of course, could just as well happen as well. And I don't think that we can really bank on that. We cannot have hope be our strategy here.

We can't just fire up CRISPR and purposely do this.

Interesting. You mean designing a new mutation of some kind? Yes, that's interesting. I don't know if we are able to do that. I think that there would be a lot of ethical issues involved. We've heard about the supposed Lab leak theory and the gain of function research that was being supposedly done in this lab in Wuhan, China. Making something more contagious would be technically a gain of function research too. And I'm not sure that ethically, it's something that we would consent to as a society.

In a sense, this question may be unanswerable, but there's some things I just can't wrap my head around. And maybe you can just shed some light on this. And I'll tell you all four of them at once, because you may have the same explanation for all four at once. So I know many nurses who aren't vaccinated. I know people who are afraid to get vaccinated because they think that they're gonna be injected with a chip. Of course, they own iPhones that Tim Cook is looking for porn on their phones. I know people who. Well, I don't know people who do this, but there are people who afraid to be vaccinated but will take a deworming medicine. So how does that happen? How do people make this kind of decision or come to these kinds of conclusions?

Yeah, it's really interesting. I do agree with you that I think this is part and parcel of the same thing, that the same individuals who are not getting vaccinated, who are believing conspiracy theories about the vaccine, are also the ones that are believing conspiracy theories about potential treatments that aren't actually treatments. I think that what's happened is that there is a lot of fear. I mean, with the pandemic, of course, understandably, there's a lot of fear. Some people have turned to trusted scientific resources to counter that fear. Others have found other ways to alleviate that fear. When you look at the main reason why people are not getting vaccinated now, it's one thing which is that they are more afraid of the vaccine than they are of the virus, which, of course, is totally backwards. But when you look at all the things that actually go into this, it feeds into the same thing. If they're afraid of a microchip, they're afraid of the vaccine. They think that the government is hiding side effects. They're afraid of the vaccine. They think that if you get infected, there is a deworming medication that will somehow save your life. And they also don't think that Delta is that serious. It's kind of the same mentality of the people, of them thinking that there's less to fear from the virus than somehow there is of the vaccine. And obviously, it's totally backwards. But I think that mentality is quite is quite pervasive.

How can someone think 650,000 people died from COVID and not that I know of, but no one has died from the vaccine. How can they think that the. The vaccine is not safe compared to Covid? How do you put those two facts together?

I think that there is a way to cherry pick data to fit whatever your conclusion is. As in there are people who have died because of extremely rare side effects from the vaccine. It is true. It is also true that there are people who have been vaccinated who have died from COVID There are people who have died from other things that are unrelated. I mean, you could have gotten vaccinated and they had a car accident. That also could happen there. There have been individuals who have played up those incidents and then made it sound like it's some kind of conspiracy, that it is the government not wanting to tell you about more such incidents. And if already you had fear about the vaccine and all your friends are also unvaccinated and your Internet and your social media is full of people who have those similar concerns, I think that's all part and parcel of the same thing. And that then builds one on top of another into this really dangerous picture that we're seeing of massive disinformation.

I would like to hear your perfect world, but still, perhaps pragmatic vision for public health. What should public health be?

I love that question because I think during COVID we have really equated public health to infection control. And infection control is an important part of that and certainly top of mind right now, but it's not all of it. And I do think it's important for us to move to something else. And, and I also think it's important to talk about what. What it is versus what public health is and what it's not. Public health is not just the opposite of private health. It's not just people who cannot afford private health care somehow getting public health. It's public health is much more. It's about the air that we breathe, the housing that we have access to, the food that we're eating. It's about all the conditions in our lives, the social determinants of health that impact us. Us. And it's also about basic social safety net services, which is what I talked about in Lifelines, about these services that my family was fortunate to have access to. So coming back to polarization for a moment, I think that for better or for worse, Covid actually really for worse, Covid has become so polarized in our country. Yes, there are Some people who lionize Dr. Fauci, but there are just as many people who think that he's awful for no reason except that he has been the face of the COVID response in many ways. There are many people who, if you start talking about vaccines or masking, they will not hear anything else you say or trust anything else you say because those have become so polarized in their world. And so I think for us to move to a place where we can talk about public health positively again, we have to actually stop talking about COVID in some quarters of the country. Again, I wish this were not the case. I wish that Covid were not so polarized. But given the that we recognize that it is, we should not talk about it in some places and instead talk about the work that public health is doing to, for example, provide food access for people who live in food deserts or contact tracers when they're contacting individuals and they're finding that there are women in domestic violence situations, are helping them to find shelter or treating the opioid epidemic and mental health issues that, yes, are stigmatized, but are generally seen as bipartisan or not nonpartisan issues. I hope that in time we'll come to embrace the whole of public health. But in the meantime, we really need to look for areas of agreement which I think there actually is a lot of in public health.

As a public health administrator with such great experience, I posed to a moral question. So let's suppose that you are in charge of a government agency and your president or your governor is recommending a policy that is contrary to science, contrary to what you believe. You have two choices. One is you say, I'm going to suck it up. I'm going to do the best job I can and try to minimize his or her impact. Another is I am going to make a statement and resign. What do you think is the right thing to do?

I don't think that there is a clear cut answer in this case. And I actually really take issue with people who think that there is an easy answer. Maybe there's an easy answer for you, the individual, that's okay. Everybody draws their line somewhere about what you are comfortable doing and what you're not. And I think that's okay. If you say, hey, of course you're going to resign, fine. If you're in that situation, you can do that. But I think that a lot of people enter government service in particular, recognizing that we're not going to agree with everything that the administration is saying, but that we will do our best as Public servants to be able to serve people. When you look at the Trump administration, for example, and the many scientists who served in that administration, some of them did quit. Sure. And again, everybody has their own line. But I think a number of other people probably thought, if they quit, who is Trump going to replace them with? Is he going to replace them with their equivalent? But that person will have more influence. I doubt it. They'll probably be replaced by, Remember Dr. Scott Atlas? They'll be replaced by people like that, that who will not follow public health guidance. And so I think people need to follow their own conscience. They also have to think about, for the scenario that they're in, are they actually able to make a difference from the inside? If they are still able to push in their own way from the inside, I think it's a very reasonable decision to be taking. That said, I also recognize that I am a public health pragmatist. My personal philosophy is that you get done what you can do, understanding the position that you're in. Other people may draw their line in a very different place. I draw my line as I won't do anything unethical, I won't do anything illegal. I'm not going to say something that's untrue, that goes against science. But otherwise, I think if I'm appointed to a government agency, as I have in the past when I was the health commissioner of Baltimore, I believe that my job is to serve the city and to serve the person that. That appointed me.

Let's say Joe Biden calls you up and says, lena, I've given you a magic wand. What should I do? And he'll do it. What do you tell him?

I'm not sure that Joe Biden has the ability to. To make a magic wand come true.

Okay, but what would you do if you were in charge?

From a Covid standpoint?

Anything. Covid? Yeah.

I would de. Emphasize Covid. I would really fund public health infrastructure all around the country and stop talking about COVID and instead bolster all the other aspects of public health. In doing so, you strengthen public health. You strengthen the connections on the local level. You increase the ability of local public health officials to have people in the community trust them on other aspects, and therefore builds trust for future pandemics as well. I would fund all aspects of public health and specifically not focus on Covid.

Wow. Totally unexpected answers from you. So what a great interview. How do you do your best and deepest thinking?

I write in order to think. I love writing. It's cathartic to me. But it's also how I think I get words down on paper. Even when I am eventually going to be doing a radio interview or TV interview, I first get down my thoughts on paper. And so I'd say that that's one of the things that helps me really think is writing it out, also talking it out when I have difficult decisions that I'm facing or situations that I'm processing. I have very good friends, including my husband too, who I talk to and in talking to and processing with other people is how I'm able to think through difficulties, whether they're in policies or in my own life.

I'm going to send you a gift from Remarkable People podcast. It's a remarkable writing tablet and it may help you write and be focused and think even better. So I will ask for your address, or maybe I already asked for your address and I'll send you that. And I have five minutes, so I will even let you go early. You provided insights that some of them knock me over with a feather, particularly the stuff about not mentioning Covid and focusing on generally public health and how that some of these decisions are political, not science. Thank you so much for expanding my mind there.

I hope that it was okay that I gave you my honest, whatever, unfiltered opinion. But I think that part of what I have seen, my role during the pandemic is to provide people with accurate guidance to help them to navigate their lives when it comes to Covid risk. But the other part is independent thinking and analysis and I hope that I was able to provide that for you today too.

I've interviewed over 100 people for this podcast and no one has given me answers that came out of left field like Dr. Nguyen. I hope you gained some great insights into the pandemic and public health. Thank you, Dr. Nguyen. My thanks to Jeff C. And Peg Fitzpatrick for turning around this episode in a very short time. My thanks to Rev and Alexis Nishimura who turned the transcript around in a very short time. And finally, my thanks to Madison Nismer who provided background research and draft questions. I'm Guy Kawasaki. This is remarkable, people. Please get vaccinated, please wear a mask and please social distance. Until next time, mahalo and aloha. This is remarkable, people.