COVID-19: A Former City Health Commissioner’s Perspective

The social, economic, and public health repercussions of COVID-19 continue to transform our lives in dramatic ways. On March 18, 2020, GLG spoke with Dr. Leana Wen, an emergency medicine physician and former Commissioner of Health for Baltimore City. Her comments on the impact of COVID-19, edited for clarity and space, appear below.

Can you give us a brief overview of COVID-19 response measures we’ve been seeing implemented across the U.S., such as curfews, banning of gatherings of more than 10 people, and closing non-essential businesses?

In the last two weeks, there has been an extraordinary shift in how we in the U.S. are responding to COVID-19. This shift is in response to the escalation in the number of reported new cases; in fact, these numbers are likely vastly underestimated because of our lack of capacity for testing.

These measures – school closures, closures of restaurants and bars – are led by state and local governments. We have a very small window of time to prevent overwhelming our healthcare system. Even a moderate outbreak of COVID-19 could cause many critically ill patients to go without healthcare. People need to comply with measures and practice social distancing. If they don’t, we’ll see these measures grow increasingly more restrictive.

Given that children are typically asymptomatic or only have mild symptoms, do you think that canceling all schools across the country is necessary, and is it realistic as a response measure?

Yes to both questions. It’s true that those who have the most severe symptoms are the elderly and those with chronic medical conditions. Unlike the flu, this does not appear to hit children particularly hard. That said, children are still getting coronavirus; it’s equal opportunity. Children may have mild symptoms or no symptoms at all, but they can transmit it to others.

Children are vectors for disease transmission. I have a two-and-a-half-year-old, and as hard as I try, I can’t convince my son to not put things in his mouth and not cough on other people. Children aren’t great about hygiene. We know that schools are a place where people congregate and germs are spread. A child may come home and bring the disease to parents or elderly grandparents who are living with them, so it’s a necessary measure.

Every restriction put in place comes with substantial trade-offs. Many kids, especially low-income children, depend on their schools as their only source of food. This is a substantial sacrifice that we’re asking people to make. If we cancel schools, that means everybody has a responsibility to also stop playdates. Do not go over to your neighbor’s house. Do not have parties. The least we could do is honor people’s sacrifices and not go out ourselves and do the responsible thing for our communities.

 If you were back in your previous role as a public official in Baltimore, do you think you would err on the side of having extremely restrictive measures?

Dr. Anthony Fauci, who’s been a leading voice in all this for the federal government, said, “We will always be behind where we think we should be.” The best thing that can happen right now is that we overreact, and then we save lives. Unfortunately, I don’t think this is going to happen. I think people are going to look at our actions in time to come and say, “I wish the restrictions came earlier.”

Here’s an example of this from history: In the 1918-1919 influenza pandemic, there were two cities, Philadelphia and St. Louis, that took very different approaches just a few weeks apart. Philadelphia decided to go ahead with a large festival and parade that drew tens of thousands of people. St. Louis, at the same time, began closing bars, restaurants, schools, etc., and banning mass gathering. Philadelphia followed suit after a few weeks, but the total death toll in Philadelphia was twice that of St. Louis.

That’s what is at stake here. It’s literally about the number of people in our cities who are going to die. Knowing that, if I were still a public official, there is no question that I would err on the side of saving lives.

 What types of changes to mitigation measures can be made with more testing and more data on the spread of COVID-19, and how fast do you think public health authorities can change and modify decisions based on new data?

Public health officials are used to making decisions with very limited information. I’m an emergency physician by training, and it’s like working in the ER. You must adjust, constantly reevaluate, and constantly adapt to the new data. But the problem is we simply don’t have the data.

If you’re in a community with only one case, how you react versus if you have 100 cases is totally different. If you have one case, you can trace where it came from, how it came into the community, and who encountered this person. Public health authorities can trace every contact and ideally prevent further spread. If there are 100 cases, it’s impossible to investigate every detail – you don’t have the capacity.

Also, if there are 100 identified cases, then there are probably even more unidentified cases. You need to shift from what’s called a containment strategy – where you’re containing individual cases – to a mitigation strategy, where you’re mitigating the impact on the community. The problem right now is that we don’t know if we’re in the containment or mitigation phase in a lot of our communities, principally because of a lack of testing. I think that’s why testing and information are so critical.

About Dr. Leana Wen

Dr. Leana Wen is an emergency physician and Visiting Professor of Health Policy and Management at the George Washington University’s School of Public Health. Previously, Dr. Wen served as the Commissioner of Health for Baltimore City. She is the author of the book When Doctors Don’t Listen. In 2019, she was named one of TIME magazine’s 100 most influential people.

This article is adapted from the GLG teleconference “Preparing for COVID-19 – Former City Health Commissioner Perspective.” If you would like access to this teleconference or would like to speak with Dr. Wen or any of our more than 700,000 experts, contact us.