We've been speaking with top experts to help us think about
how we get through this pandemic and how we get back to work.
Today we're joined by Dr. Scott Gottlieb. He's a CNBC
contributor, a senior fellow at the American Enterprise
Institute. He's on the boards of Pfizer and Illumina. Thinking
about getting back to work and getting back to business. What
do you think that path actually looks like over the coming
winter months getting into next year? When and how do we
actually get back into work, so I'm not interviewing you from my
attic TV studio, that CNBC set up for me.
Well look, I think we're transitioning from the pandemic
phase of this virus to a more endemic phase, meaning that this
is going to become a persistent risk of persistent virus that
circulates every year, much like influenza, and there's not a
clean line to marketing those two sort of states of fitness,
it's going to be messy. And it's going to be unclear when we're
kind of out of the pandemic. And this is more of an endemic
virus, it's something we're going to know when we look back
a couple of years from now. But on the back end of this, we are
going to be entering a more endemic phase of this virus, I
do believe this is the last major surge of infection, even
if you see new variants, they're likely to emerge within the
Delta lineage. And hopefully, we'll be able to vaccinate
against them in the future. And so that question becomes how do
businesses deal with the fact that Covid is going to circulate
like the flow, I think it's going to be a risk, at least on
par with the flu. And we already have a flu season. And so if you
sort of layer on top of our ordinary flu season now Covid
season, and it causes similar amount of death and disease, I
think the total hit on public health and also productivity is
going to be too great for us to sustain and just be business as
usual. I mean, the productivity impact of the flu season every
year is in the 10s of billions of dollars, both direct and
indirect costs, and this on top of it is just going to be too
much to bear in my view.
And we really didn't see any flu in the last year. A lot of
people attribute that to the masking the social distancing,
and the hygiene that we practice through Covid, which didn't work
for Covid. But it apparently worked for flu. what are you
expecting this upcoming winter flu season, when we're perhaps
not doing those things quite as much?
You're right, we haven't seen a flu season last year, we're in
for a whopper because we haven't put immunity into the population
in at least one, and maybe now two years. When the flu does
come back and it will come back, it's going to come back very
aggressively, because you're just going to have a population
that hasn't had much flu, immunity in a number of years.
And so we need to be mindful of that, we could see a situation
either this year or next year where you have a really bad flu
season. And if there's a mismatch between the flu vaccine
and the circling strain, it could be very bad, and then
you're gonna have Covid on top of that. So businesses are going
to have to do things differently. And I think they
ought to start thinking about that now, how they create a work
environment that's safer for people to work in with respect
to respiratory pathogen. So it's things like trying to de-densify
offices, especially in the peak sort of Covid flu seasons. Maybe
allowing people a more flexible schedule, and telework, allowing
people to, you know, zoom into meetings, even within the
office, you're not crowding people into conference rooms.
Putting in place better air filtration and handling so that
the air quality is better in offices, you know, you have
hospital grade air filtration. Trying to find alternative
transportation, so everyone is in crowding on public
transportation, you may be coming to work on off hours, so
you're not going on public transportation during peak
hours. There's things that businesses can do, at least over
the period of time when this virus is going to be circling
and sort of peak Covid season to try to reduce risk and try to
improve respiratory health. And I think we need to think about
what that construct looks like.
Has industry adapted to the extent that it needs to, or is
there more work to be done?
I don't think that businesses really have undergone a very
comprehensive approach to how they improve the work
environment workflow, because people aren't back in the office
yet. And most businesses aren't contemplating bringing everyone
back into the office. And so they haven't had to contemplate
what happens when we go back to work inside an office building
full time, how do we improve the flow of people so that we reduce
the risk that you're going to have the kind of crowding that
creates these sort of, you know, conditions for Super spreading,
if you will. That's going to probably be more likely a 2022
event, my guess is that, you know, business isn't gonna bring
people back in full this year, most businesses have put off
their restart dates. And then once we get into the sort of
density of the winter, I think there's going to be enough
persistent risk and Covid and influenza for that matter, that
they're probably going to take a cautious approach. But we need
to, we need to start thinking about this. Because it's not
just improving the air handling system, that's a key part of it.
But it's changing the workday the idea that you're going to
have meetings in the office, people are going to be
physically in their office, but they're going to be taking the
meetings from their desk. So you're actually using technology
to facilitate interactions within the office. Those are the
kinds of things we need to think about doing if we want, if we're
serious about trying to avoid unnecessary interactions that
could be conducive to spread.
What about keeping the people who are essential workers safe
coming out of the pandemic? What kinds of systems do you see
perhaps being proposed or even being put in place to improve
safety for folks working in grocery stores or restaurant
workers, there's you know other other folks who are essential
workers who don't have the ability to work from their
attics.
You're seeing a lot of the vaccine mandates and businesses
be applied to work circumstances where it's harder to social
distance and harder to change how people flow in a work
environment in order to reduce risk. So you know, the most
obvious was the meatpacking plants, they ended up being very
conducive to spread, you had people working very closely
together in a cold environment that was probably more conducive
to the spread of aerosols. And we saw some pretty significant
outbreaks and, you know, unfortunate outcomes among
people who worked in that industry. And so now you're
seeing vaccine mandates be put in place in those places of
employment, you're seeing masks being used aggressively on the
job, high quality masks. And I think that's really going to be
how we approach this, you're going to see more mask use in
some of these occupations, particularly people who are in
contact with a lot of people over the course of the day, like
a grocery store worker who works on a checkout line is in contact
with a lot of people. And I think you're going to see more
of an imperative to make sure people are mandate, vaccinated
in those environments.
How important is it for kids to get vaccinated for us to feel
like we can get back to normal and get back into the work
environment?
Well, from a clinical standpoint, I think it's
important for kids to get vaccinated even though the
outcomes aren't nearly as severe in kids as they are in older
individuals. This isn't the benign illness in children,
you're still seeing bad outcomes in kids. And we don't understand
the long term sequelae of this infection, there's going to be
some long term consequences of mass infecting a significant
portion of the population with Covid. This is a virus that does
seem to have some lingering effects in a portion of the
population. The UK had a study showing 1.8% of kids had
persistent symptoms, neurological symptoms, at two
months out from their infection, it doesn't sound like a lot. But
if you're infecting 10s of millions of children, that's a
lot of kids on an absolute basis that are going to have some
lingering effects of a virus that was otherwise, probably
avoidable. So I think it's important that we vaccinate the
children from just a purely public health position. I think
it's also important because parents still feel apprehensive
about going into a work environment, because they're
worried about bringing the infection back into the homes. I
know a lot of people, I think it's more than anecdotal, who
feel reasonably confident that they're not going to suffer a
bad Covid outcome because they're vaccinated, they're
otherwise healthy, they might be younger. But their concern is
that they'll go into an office environment, get an asymptomatic
infection or mild infection, not recognize it, and then bring the
infection back into the home where they have unvaccinated
kids. So I think if we want to really instill confidence in
people to go back to work in a more robust fashion, we have to
find a way to allow adults to be able to protect their children
if they want to. And that's going to be through vaccination.
You have not thought that the way the Biden administration has
rolled out its plans for workers to have to be vaccinated has
necessarily been the way to to succeed in getting those people
vaccinated. What do you think is the best way to increase
vaccinations? And what will be the impact of this new rule?
The bigger debate is, is your decision to get vaccinated an
individual choice? Or is it collective choice? Is it, does
it impact the community? I think very clearly, it impacts the
community. These aren't just decisions that people are making
individually, everything's an individual choice, but it's also
a collective choice. And I think that that's a hard concept,
because most people think of healthcare decisions, as you
know, my body my decision. But there is an issues beyond that,
when you're, you know, risking bringing in an infectious
disease into an environment where other people are
vulnerable. But I think the extent that it is a collective
choice, and it does impact the community if there are going to
be requirements imposed on individuals about vaccinations
should be done at the level of the community, the environment
that that's being impacted. So a school board voting to mandate
vaccines for a school district or business deciding to
implement a mandate on its own. I think the extent that we pull
these decisions away from local decision making, it starts to
have a political veneer and people start to harden their
positions. And so I don't think governors should be telling
businesses they can't mandate vaccination, quite certainly.
And I don't think the federal government should be telling
them they have to, because I think when you do that, you take
something that sort of furtively political, and make it
objectively political, and you're just going to harden the
positions. The way to accomplish a high rate of vaccination was I
think, continuing the course that we were on. I think the
administration was doing a good job rolling out the vaccine, the
mandates on the federal workforce certainly is within
the federal government's purview to do and I think that provides
a lot of cover to private businesses who want to impose
their own mandates. And so it's just a question of is the game
that you've achieved worth what you've done from the standpoint
of creating a more greater political debate around
vaccination? And I don't know that the answer is yes, I don't
know that the benefit in terms of pickup of additional
additional couple percentage points of people vaccinated is
worth the impact that we're going to have right now with
this is going to now become a political issue. It's going to
be a legal issue that gets litigated. A lot of businesses
that might have moved forward with mandates on their own and
now going to wait and see what happens. They're going to wait
for the federal government to tell them to do it, because they
know that that may be coming. It's going to take the federal
government months to implement this even if they're not
challenged in court, OSHA, the component of labor department
needs to issue regulations then they need to issue guidance to
businesses on how to implement those regulations, then they
need to give a grace period to businesses to actually implement
the mandate, then they need to figure out how they're going to
ensure compliance. And so this isn't going to be something that
happens quickly. I think it may freeze the marketplace and have
the unintended consequences of actually for stalling mandates
that businesses otherwise would have imposed on their own.
So in your book, which is coming out September 21, Uncontrolled
Spread: Why COVID-19 Crushed Us and How We Can Defeat the Next
Pandemic, you really lay out what went wrong in this
pandemic. That we essentially prepared for the wrong pathogen
we were expecting if we had a pandemic, it would be flu and
all kinds of systemic failures up and down the government and
you really take aim at the CDC. You point out that the
intelligence community can play a much bigger role in preventing
future pandemics. What do you want the audience to know about
what we can be doing better to avoid this happening again, in
the future.
We need to build better capacities for actually being
able to scale up response, develop the antibody drugs and
be able to scale their mass production, be able to quickly
develop a diagnostic test and deploy it very widely. We need
better systems for gathering information and doing analysis
that can inform real time decision making. This is what
CDC was supposed to do. But there, they were late, they
didn't gather good information they put didn't put out good
guidance, it wasn't put out in a way that was interpretable to
people, it seemed confusing, it seemed conflicting. And then we
need to be able to spot these outbreaks when they emerge in
foreign countries. And that's where the foreign intelligence
services come in. We can't rely on the good graces of foreign
countries to just inform us when they have an outbreak of a
dangerous pathogen. We know countries haven't been
forthcoming, even friendly countries haven't been
forthcoming with this information in the past, and
certainly China wasn't forthcoming. In this instance,
they had information that was available much earlier that
wasn't shared with the public, including they never shared the
source strains, which would have helped us develop diagnostics
and vaccines much earlier. So we need to have the capacity
overseas to actually gather this information that's going to mean
a much greater role for our intelligence agencies in the
public, in the global public health mission, where
historically they haven't really had a role.