Dr. Richard Besser Story Archives - West Virginia Public Broadcasting

Masking Questions: How Pandemic Health Measures Became Politicized

Health officials and researchers say the science is clear: face maskscan help reduce the spread of the coronavirus. Yet in the Ohio Valley, not all elected officials are in agreement on whether to mandate measures such as the use of face masks in public places.

In April, Republican Ohio Gov. Mike DeWine initially announced the mandatory use of face masks in retail settings, only towalk back the mandate during the next day’s press conference to say it was only a recommendation. West Virginia Republican Gov. Jim Justice recently said that mandatory use of face masks would be impossible to enforce and would “divide us.” Kentucky Gov. Andy Beshear, a Democrat,ordered face mask use in public, but people who don’t wear one won’t be fined, though businesses that require masks can turn away customers who aren’t wearing one.

As of July 1 daily coronavirus case numbers were approaching a high point in KY.

Officials in Shepherdstown, West Virginia, arecalling on Justice to require face mask use in the state, and other Ohio cities arepassing resolutions and ordinances to require face mask use, implementing local enforcement while state authority has dithered. On Thursday, Justicewarned he may mandate mask use while inside public buildings.

The renewed discussion about masks comes as the nation hit a new high for daily COVID-19 cases, driven by rapidly increasing infection rates in parts of the South and West, especially Florida, Arizona, and Texas forcingnew shutdown orders.

In the Ohio Valley, average cases per day have slowly risen over the last weeks of June, with daily totals now approaching levels last seen during the region’s earlier peak of the pandemic. Many rural outbreaks in the region have beenlinked to meatpacking plants, prisons, and nursing homes.

Ohio’s daily cases are approaching levels last seen in April.

The Ohio Valley ReSource spoke with Dr.Richard Besser, the current President and CEO of the Robert Wood Johnson Foundation, a philanthropy that provides hundreds of millions of dollars in grants advancing public health initiatives. Besser also served as acting director of the Centers for Disease Control and Prevention in 2009,overseeing press conferences during an outbreak of swine flu in North America.

Besser addressed the politicization of public health measures, the high vulnerability to COVID-19 in the Ohio Valley, and what these factors mean for the future amid record high numbers of daily coronavirus cases in the country. This interview has been edited for brevity and clarity.

Liam Niemeyer: Should states mandate face mask use?

Richard Besser: This is a really challenging issue. I’m very concerned about mixed messaging. Every public health leader in America is out there saying it’s so critically important that we take all the steps we can to protect our health and the health of those around us. These are the early days in the pandemic, and what we do truly matters. So, that means wearing face masks when you’re outside and you’re going to be within six feet of other people. It means washing your hands frequently, staying home if you’re sick. But we are hearing mixed messages. I am hearing some Republican governors saying this as well. The Ohio Governor [Mike DeWine] was one of theearly governors to shut things down in the state. I haven’t heard his messages about masks. But it’s very confusing to the public, and it’s very damaging to the nation when you see divisions along political lines around public health measures. When I ranEmergency Preparedness Response at the CDC, we did everything we could to try and not create a partisan divide around what we were recommending. And early on, you saw that here at the federal level with theC.A.R.E.S. Act, which was passed with almost unanimous support from both parties, providing supplemental unemployment insurance and eviction protection, and payment to small businesses, to keep them afloat.

And since then, we’ve seen incredible partisanship, and it’s really damaging, especially as we’re starting to try and reopen the economy, get people back to work. Because if people aren’t taking these measures to protect their health and the health of those around them, we’re going to see healthcare systems overwhelmed. Again, we’re going to see states having toslide back and reimpose stricter measures. And no one wants to see that. I’m trying as hard as I can to understand why some people don’t want to wear masks, and what that means to them when they’re wearing a mask. And I want to have those conversations. I understand that because I think that it’s a really important thing to do to protect the health of people around you. And when it becomes a political symbol, then I think we’re in a really difficult position.

Niemeyer: You mentioned the messaging regarding the Ohio governor. In April, Mike DeWine originally announced a face mask mandate for retail settings. But the next day during his press conference, he went back to say it would only be a recommendation. And West Virginia Governor Jim Justice has said recently he thinks face mask use will divide people.

Besser: Yeah, from my perspective, there are real equity issues here. When you look at the impact of the pandemic so far, every community’s been hit, but some groups have been hit hardest: Black Americans, Latino Americans, Native Americans, lower income Americans, people in general who don’t have the choice about whether they’re going to work or not. And I think it’s our responsibility to do everything we can to protect people who must be in the workplace. So for me, if I’m going to the grocery store to get some groceries, I just think it’s a respectful thing to be wearing a mask so that the person who’s in that grocery store stocking the shelves next to me, who’s being exposed to hundreds of people every day, that I’m doing everything possible to protect that person’s health. If we can unify around that and say it’s the ‘American way’ to be, this idea of looking out for each other, it strikes me that there’s a core value there that spans across humanity.

Richard Besser, MD, is president and CEO of the Robert Wood Johnson Foundation and the former acting director for the CDC.

Niemeyer: Moving to a related topic, a Kaiser Family Foundation study from April estimated how vulnerable populations in each state were to severe illness from COVID-19 due to pre-existing health conditions. The Ohio Valley had the highest rates of vulnerability in the country, with abouthalf of all West Virginians at risk for severe illness. How does that vulnerability relate to still rising case numbers right now in rural America?

Besser: It’s hard to paint rural America with broad brushstrokes because of the incredible diversity and richness of cultures, but there’s some things that you can say: there are higher rates of people who live in multi generational households. So, if one person is out working as an essential worker, and gets the illness and they’re young and they’re healthy, they’re going to be fine. But they may bring it home to somebody else who is elderly, or or somebody who has heart disease, lung disease or diabetes. There are very high rates of diabetes in Appalachia. So, from a medical side, there’s high risk. There are real challenges in terms of access to health care, as we’ve seen a lot ofrural health facilities closing around the country. You see a high proportion of low income workers who don’t have the opportunity to work remotely from home…so these factors all combine to increase the risks in many parts of rural America, and the solutions for those problems may be different. We put togetherfive principles for equitable restart of the economy for state, local officials. One of those is the importance of working with communities and understanding communities and what the needs are.

Niemeyer: There was anotherrecent report by NPR that showed Kentucky and Ohio didn’t have enoughcontact tracers needed for their populations. What are the implications of this?

Besser: Contact tracing is a critical piece as we move from lock down to opening up because when you switch and say ‘okay, we’re no longer gonna be operating on this idea that everyone stays home except essential workers.’ What you have to have happen is what’s happened, you know, the approach that’s used in many other countries where you identify cases quickly. So, testing available in every community and you’re doing, you’re looking at the numbers to make sure no communities are being left out on that testing. And then once you find someone who’s infected, you can very quickly identify who all the people they’ve had contact with close contact with. So those people can be aware and they can be provided with services. So they can be under quarantine, in case they get sick. You know, it’s a simple model, but each one of those pieces requires resources. And, you know, we’ve yet to see any of the states that have really seen their numbers come all the way down, make the transition over to this yet…and it’s not just having the number of contact tracers. That’s really important. But you want those contact tracersto be from the communities in which they’re operating, so there’s a level of trust. What we’re seeing in some places is that people don’t want to tell the contact tracers who their contacts were.

Click here to explore our Local COVID-19 Tracker.

Niemeyer: What general advantages do regions like the Ohio Valley and Appalachia have in regards to this pandemic — isolation and sparse populations — and is that necessarily enough to dissuade more outbreaks in this region going forward?

Besser: There’s a real benefit from being in a rural setting where we’re learning more and more about this virus — and outdoor activities are relatively safe. So, being able to go outdoors is great for physical health, it’s great for emotional health. it’s an activity you can do with your family. And when you’re outdoors and you’re more than six feet away from people, you don’t have to have a mask on. There’s nothing that’s going to be happening out there that you need to have that mask on. And it feels good. I think the strength of community, the value of looking out for each other — again, you can’t paint every community with broad brushstrokes — but it’s something that you tend to see in rural America. And there’s real value in that, because this is when you look at unemployment rates and areas being hit hard. A lot of rural America has been under-invested in chronically and is getting hit hard during this pandemic. And so you want to see that as there’s directed efforts to rebuild the economy that rural America is part of that conversation. I see a way forward where we have a stronger social contract. So, imagine what this would look like if you’re at the start of this pandemic, everyone in America had health insurance instead of 28 million people without it. What would that look like? What would it look like if everyone in America had unemployment insurance, and everyone in America had sick leave, family leave so we could take care of our relatives? What would it look like if the poorest people in America weren’t at the greatest risk of eviction, weren’t being forced to pay over half of their income on rent, if we truly cared about essential workers, and we’re paying everybody a living wage so that people could take care of the basic needs and save something so that they have a cushion when there’s a crisis. So, I think that shining a light on these things through the lens of a pandemic could lead us down the road towards a much stronger society, one that truly provides opportunity for everyone to have health and well being.

Niemeyer: We have a couple of questions submitted by listeners to the Ohio Valley Resource through its member stations. This one was submitted by Paula Gill to West Virginia Public Broadcasting: how often do you need to change a mask if it’s only worn once every two weeks for an hour? So, how often do you need to sanitize a mask?

Besser: When I looked at the recommendations on that from CDC and others, their recommendation is if it’s a cloth mask, It’s a good idea to have more than one and to throw it in the laundry and and wash it after each time of use. And you’ll be able to see online recommended ways of taking off and putting on a mask so you’re taking off a mask and you if you throw it in the laundry with your wash. That’s a good time to wash your hands because you’ve touched this mask that may now be contaminated.

Niemeyer: Another question from a listener in west Kentucky, submitted to WKMS Public Radio. This listener says they’re practicing social distancing, out less than two hours a week. How likely is this listener to get this virus?

Besser: Not very. Those activities that you’re doing are very safe. You know, the nice thing about being outdoors, you know, if you’re outdoors and six feet away from people, it’s a really safe way to be, and it feels good. So I think your risk is very low.

Besser said individual decisions like wearing a mask can dramatically impact how many people will become sick or how many vulnerable people could die. He said wearing a face mask is ultimately about protecting one another, a small step that can make a big difference.

Have a question regarding COVID-19 in the Ohio Valley? VisitYourCovidResource.org to submit a question, and our team will look into it for you.

As Economies Reopen, Former CDC Director Says Rural Americans At Higher Risk

As businesses in communities across Appalachia – and across the country – begin to reopen, Richard Besser has been vocal about the measures he feels should be met to counter the spread of COVID-19, most particularly, the disproportionate effect reopening too soon will have on underserved and marginalized communities.

Besser served as acting director of the Centers for Disease Control and Prevention under Pres. Barack Obama and is now president and CEO of the Robert Wood Johnson Foundation. RWJF is the largest private institution in the country devoted solely to improving the nation’s health.

Besser is concerned about the challenges rural communities faced before and that are now more critical in the midst of the pandemic. He also worries that the pandemic is being “hyper-politicized.”

“We can’t see science, and public-health science, as the enemy of economic recovery,” Besser said. “We can’t see the interests of rural states and the interests of more urban states as being in opposition. We need to see the solutions to this as fundamental societal issues that we all have to tackle and find a way to come together around these issues.”

What’s given him cause for hope, Besser said, is that “there’s been a lot of legislation that’s been passed in Washington with near unanimous support. And that’s a good thing. I hope we can get back towards that.”

He spoke with 100 Days in Appalachia’s Taylor Sisk about his concerns for rural communities.

***Editor’s Note: The following has been edited for clarity and length.

Taylor Sisk: We’ve been reading for a while about the potential risk of COVID-19 to rural communities. I’d like to talk about how that’s now manifesting. Do you anticipate the rural infection rate rising to the level of urban areas? And what are you now seeing that alarms you or that maybe gives you reason for hope?

Dr. Richard Besser: What we’re seeing now across the nation, as there’s more and more data available and as the virus spreads, is that rural communities are seeing some of the biggest growth in cases. There’s data showing that in rural middle-American states, the rate of increase is about twice that of the national average. That is concerning. It’s concerning because I worry that the call to reopen the economy, people’s fatigue with staying home and people’s need to earn an income is potentially out of sync with the risk that is still there in so many places.

Sisk: Statistically speaking, rural communities are older. They have lower incomes. They have poor access to health care. In the context of COVID-19, demographically, what concerns you the most about the health of rural communities?

Besser: All of those factors put people in Appalachia at an increased risk. The good news about COVID is that the vast majority of people who get this infection will do well. But older people or people with underlying medical conditions are at increased risk of dying from this. In communities where the population is older, that’s a problem. In communities that, economically, are on the edge, It’s a problem.

People are being forced to make really hard decisions about going to work and having money to put food on the table and pay rent, or staying home and away from others so they can help protect themselves and their families and communities. And if it’s a community where incomes are lower, and there’s less savings, there’s not much of a choice there. People are going to be out and about more, and that increases their risk.

In so many parts of rural America, we’re seeing hospitals and other health-care facilities close. And that’s a challenge, because what you want is that if someone is developing symptoms they have the opportunity to be tested, to know if they have COVID, that they’re provided with support so that they can isolate away from family members and others. And we know that in rural America very many people live in households with multi-generations. So while someone who is sick may not be in a high-risk group, there could be several people at home who are and there may not be the space to be able to isolate away from other people.

These things all put people at increased risk of not just having COVID infection but of having more severe infection and spreading it to others.

Sisk: Even in communities with low infection, there’s a lot of stress over the threat of catching a virus, over finances, over the unknown. Can you talk about the repercussions of that stress on both behavioral and physical health?

Besser: We know that in the short term we deal with stress well, physically. The feeling of stress gets us to change our behavior; that fight-or-flight feeling of stress helps you run from danger.

But when that stress occurs over time, day in, day out, over extended periods, it’s not good for our bodies; those stress hormones become very dangerous. And for people who are exposed to chronic stress, it sets them up for other health issues, inflammatory issues, whether it’s heart disease or lung disease or increases in the risk of infectious diseases.

So chronic stress is not a good thing – the stress of worrying about where finances are coming from, from losing jobs, of all of a sudden having your kids at home and not only having to be a mom and a breadwinner but also a teacher and a principal. There’s a lot of stress on everybody. Thinking about how to use public-health science to get people back to work in as safe a way as possible is critically important.

Sisk: In an op-ed piece for USA Today, you wrote, “Those who have been historically marginalized in our country must not be marginalized again in a rush to reopen.”

A large percentage of rural residents are blue collar workers. A large percentage work in the service industry. As we reopen our communities, these people are being told to go back to work, and I’ve heard some among those workers say that while they’re being referred to as essential, they feel that they’re being considered expendable. What are your thoughts on how much risk is acceptable as we reopen?

Besser: The second part of that is: Who has to accept that risk? That idea of who’s essential and who’s expendable is so important to talk about. We know that people of color and lower-income people have been more likely to be in the category of essential worker, have been more likely to get COVID, have been more likely to be hospitalized and more likely to die.

As the economy opens up and people are being told to go back to work, we can’t continue down this path of saying that lower-income workers, essential workers, are also expendable workers. We need to make sure that everyone who’s going back to work is doing so based on the best principles: So, cases have to be going down. There has to be room in hospitals and health-care facilities not just for people with COVID but for people to be seen for all of their medical issues. We need to make sure that for every industry that’s coming back online, there are agreed-upon standards for how to protect workers and that they’re enforceable.

There’s such a power differential when someone in the service economy is told to come back to work. They get there and they’re told, “Well, it doesn’t look good for you to wear a mask.” What can they do? The option is not go to work and not get paid or not wear a mask and increase your risk. So we want to make sure that workers are protected as they’re coming back online, and that they’re not coming back to jobs until the conditions in their particular communities are such that it’s safe to do so.

Sisk: I know you said that as we reopen, we must “embrace the fight.” And I think that’s what you’re describing there. What all does embracing that fight entail?

Besser: Well, from a public-health standpoint, it means demanding that there’s data so that you can see problems as they arise, making sure that you’re able to see who’s getting infected and who’s getting hospitalized, who’s dying based on race and ethnicity, geography and income level, so you can see if particular communities are getting hit hard and look to address that.

You want to make sure that testing is available widely, and that you’re looking at the testing rates broken down in the same way so that you can identify particular areas where there isn’t enough testing or where the testing is showing that there’s ongoing transmission.

And I think one of the hardest things, and most important things, is that when someone is infected, or they’ve been exposed, you need to work with people in communities to identify safe places for them to spend that 14-day period when they could be spreading this to somebody else or they could be brewing infection. If you’re not doing that – if you’re just telling someone you’re infected and go home and isolate – you’re not recognizing that for so many people across this country that’s not possible to do without exposing other people. You’re just identifying where those little clusters and outbreaks are going to be happening; you’re not really preventing them. These are some of the short-term things.

Long term, there’s a lot we have to do to change the safety net in America. We’re the wealthiest nation in the world and we don’t guarantee paid sick leave and family leave for everybody. Less than half of the lowest-wage earners have sick leave or family leave. We don’t ensure that everyone has unemployment insurance. We have more than 28 million people who don’t have health insurance – and now so many people are losing their jobs, that number is gonna be skyrocketing. There’s so much that we need to do as a nation to show that we value each and every person and that we truly believe that, in America, everyone should have a fair and just opportunity for health.

Sisk: Should there be one standardized set of metrics that every community adheres to as it reopens? Or should those metrics be flexible based on demographic factors?

Besser: I think that there should be a core set that everyone is using, and then areas can do more. What are the metrics that should be collected? Clearly breaking down data by location – not just state and county, but down to the zip code. Breaking down data by income, by race, by gender. If you’re doing that, you’re going to be able to see things that you otherwise wouldn’t. And right now those data aren’t available to even be able to say specifically how different communities are doing.

Sisk: You appeared last week on CNN COVID-19 Townhall and the hosts played a clip of President Trump in which he said of health-care workers: “They’re running into death, just like soldiers run into bullets. I see that with the doctors and the nurses and so many of the people that go into these hospitals. It’s incredible to see. It’s a beautiful thing to see.” What’s your reaction to that analogy?

Besser: When I heard that, it didn’t strike me as a beautiful thing. What would be a beautiful thing would be to ensure that every worker in America has what they need to be protected – whether you’re a health-care worker or someone providing the care that’s so needed in health-care facilities, or you’re a poultry worker or meat processor or someone putting food on shelves so that people can go to the store, or you’re driving a bus – whatever it is you’re doing. It would be a beautiful thing if every single person had the protective gear that they needed so that their risk wasn’t any higher than it had to be. And what I said was, what those workers are doing is heroic. They are heroes, just as all the other essential workers are heroes. But it’s not beautiful that in America we’re letting people put themselves in a risky situation where they shouldn’t have to have the level of risk that they currently do.

Sisk: I’d like to pull another quote from your op-ed. This is something that really stuck with me:

“Whether because of lack of access to health care, low household income, immigration status, racial discrimination, disability, lack of safe or affordable housing or myriad other factors, millions of people are going to pay for our nation’s interest in equities that have existed for generations. They’ve become even more apparent and appalling, during this pandemic.”

What do we need to do as a nation to bridge these disparities in vulnerability that are based on where you live, how much money you make, the color of your skin?

Besser: These are profound societal questions. As we look across rural America, and we look at areas where there’s been major disinvestment, what can we do to spur investment in communities so that we’re supporting people in rural America, hard-working people, people who want a good-paying job that will allow them to take care of their family and save some money for the future? How do we spur that investment? There’s a lot of money that’s going to be coming forward to try and spur our economy during recovery. We need to apply that kind of equity lens and ensure that those dollars are going to some of the hardest-hit communities, communities that were in danger before this pandemic. You have communities that are truly at risk of going away because of this pandemic.

Sisk: Is it a different set of issues if we’re talking about bridging disparities in health care between rural and urban communities, as opposed to bridging those disparities among races and ethnicities? Or are these fundamentally the same issues?

Besser: There are different drivers for different issues. Rural America is extremely diverse. There’s a ton of data that shows that when you add issues of racial disparity, income disparity, geographic disparities together, it’s more than additive. So, if you’re looking at the prospects for Black Americans, Latino Americans, indigenous people, they’re worse at every income level. There are, fundamentally, things that have to be addressed from the perspective of structural racism that’s entrenched in our society, in our history. Beyond that, though, there are issues that are affecting people of every race in every community in rural America and the needs of rural America are critically important, regardless of race.