Anesthesiologist Dr. Jerome Adams served as the 20th surgeon general of the United States from 2017 until 2021. His new book “Crisis and Chaos: Lessons from the Front Lines of the War Against COVID-19” offers an insider’s analysis of the successes and failures of the government’s response to the pandemic. In it, Adams offers a vision of public health policy predicated on equity, community, and proven practices to stemming the spread of infectious disease. Ahead of the holiday season, Adams says the dismal numbers of those receiving updated vaccines this fall means the country is poised to once again stoke a spike in COVID cases. Speaking with WAMC, the former surgeon general also compared the effectiveness of the Trump and Biden administrations in managing the pandemic and underscored the ongoing importance of masking.
ADAMS: Well, as much of everyone wants to forget about COVID-19 and pretend it's gone, it remains a significant public health threat. But I want people to think about it the way we think about flu- We have bad flu seasons, every year around this time we remind people to get your flu vaccine, if you're older to get your Pneumovax vaccine, and this year is no exception. We know that hospitalizations are increasing – CDC said 16,000 last week – and in most places across the country, we're seeing those start to tick up. And we know that they're going to continue to go up as people travel, as people gather, as people come inside for the cold weather, and we want people to be able to protect themselves. A shocking stat where I'm from, New York- Only about 8% of people in the state have gotten their updated vaccine despite the fact that we know three quarters of adults have at least one risk factor for a negative outcome.
WAMC: I wanted to ask you about government messaging about the pandemic. Just this week, the White House put out an advisory to folks about getting vaccinated, tested, and treated for various ailments, including COVID-19- But there was no mention of masking, and it seems like the conversation around masking has really swung aggressively into almost nonexistent at this point in the American experience with COVID. Can you speak to that? What role does masking still play in this ongoing situation?
Well, I really, really appreciate that question. I have a new book out called “Crisis and Chaos: Lessons from the Front Lines of the War Against COVID-19,” and it's available on Amazon, Barnes and Noble. I talk about how we continue to make the same mistakes over and over again, no matter which administration is in charge. And one of those mistakes of not leveraging all the tools we have available or helping people understand their risks. We know that masking remains an important tool for people to utilize, particularly if you're at higher risk or in high-risk situations. So, when I travel, I still mask. I was in an airport yesterday, and I masked while I was in the airport traveling, when you're in crowded situations around people you don't know. But we also know that vaccines are a tool that allow you to be able to have a little bit more safety and security, particularly as you're gathering around loved ones. Testing and treatment, incredibly important. We want to make sure we're informing people about the tools and leveraging those tools so that they can stay as safe as possible this holiday season. One of the most important things folks can do is talk to their doctor, make sure they're up to date on flu, COVID, but also if you're older, Pneumovax and RSV vaccines.
Now, in your book “Crisis and Chaos,” you talk about the disparities between different communities and how they've experienced COVID-19. I want to know, from your perspective, what the COVID-19 pandemic has taught us about broadly held standards of health equity in America. What have we learned from this about how we treat different groups?
Well, health equity means making sure everyone has the opportunity to make healthy choices. That's all health equity means. If you're in a rural community, you don't have the same opportunities as someone perhaps in an urban community. You may not have Wi-Fi access, so you can't use telehealth, for instance. If you're someone who's African American, you may have distrust of the medical system based on well-founded experiences: Tuskegee, Henrietta Lacks, the continued issues that people face. If you're someone who's uninsured, you're going to have difficulty being healthy. And so, one of the lessons in my book “Crisis and Chaos” is that we can't have a healthy nation without health equity, and we need to make sure we're giving people the opportunity to make healthy choices. You can honor that individual choice while still making sure everyone has the opportunity to make healthy choices, including making sure we're fighting misinformation and disinformation so that people understand the benefits of vaccination, including making sure people have access to vaccines. And so that's why we now have them available at pharmacies in addition to doctors’ offices- We want to make it as easy as possible for people to make the right choice, because we far too often accuse people of being antivax when the truth is they may just simply have a question they can't get answered, because they don't have a doctor, or they may not have access to a place to get vaccinated.
Given your experience in the Trump administration, how would you compare and contrast how the Biden administration has comparatively handled COVID-19?
Well, that's a great question that I go over extensively in the book. And I try to be as objective as possible. I tell folks, I'm not a Republican or a Democrat, I'm a doctor, I'm an independent. And when you look at the numbers, we had about 250,000, 300,000 people who died in 2021 under the Trump administration from COVID-19. And that was a tragedy by any measure. You go to the next year under the Biden administration, you had 360,000. You had more people die despite vaccines, despite masks, despite testing, and even in 2022, you had 240,000 people die from COVID-19. So, what that tells you is that changing who's at the White House, changing who's at the CDC, changing who's the surgeon general is not changing our trajectory, and we need to make sure people are leveraging all the tools that they have available, that they're not being taken in by politics or by misinformation or disinformation. And I worry with increasing vaccine hesitancy that we're going to lose progress, even more so, on our population’s health. And that's why I'm here today- I really want people to understand one of the most important things they can do to protect their holiday, to protect their loved ones, to protect themselves, to protect their plans, is to get an updated COVID or flu vaccine this holiday season, and then pick up my book “Crisis and Chaos.” Great tips on how you can stay safe, it really helps people understand all the mistakes we made during the pandemic, myself included. I'm very raw in there about the things that I wish I had done a better job of, and the things that we need to do better in the future.
When you look ahead to the next chapter of American public health, what do you think the major takeaways have been from this COVID-19 pandemic experience? And how can we leverage that into an equitable response to the next public health crisis?
Well, one of the big lessons is that we aren't going to be able to move forward if we don't pay attention to baseline health. So, I highlight this in the book- The idea that we did terribly under the Trump administration with COVID transmission is a myth. It is. When you look at the numbers, the transmission rates were about the same as most of Europe in 2020. Actually, transmission rates went through the roof in 2021 when we reopened under the new administration. But, what you did see a difference in in 2020 was hospitalization and death rates. And why is that? Well, it wasn't because of COVID policies, necessarily. So much of it was because of our poor baseline health. People with diabetes, people with obesity, people with high blood pressure are more prevalent in the United States, and they're much more likely to have negative outcomes. And interestingly enough, those are the people who I want to highlight should be particularly cognizant of getting a vaccination this season. If even if you're over 65, 90% of the deaths are occurring in that age group. But if you're taking an inhaler for lung disease, if you're taking insulin or diabetes medication, if you're someone who is taking medication for a heart problem, you need to especially make sure you're talking to your health provider and that you're getting up to date on your vaccinations. We need to pay attention to those higher-risk folks. That is a big lesson from the book. But again, as you've heard me say, we also need to understand that changing the captain of the Titanic but not changing the course isn't going to prevent us from hitting that iceberg. And so, we need to make sure we are trying to approach this in a nonpartisan way, and in a way that looks just at the facts. And the facts tell us we've got to do better. And one of the ways we do better is by increasing our vaccination rates, particularly during cold and flu season.
