The CNN medical analyst and author of the new book Lifelines spoke with AARP about the flaws the pandemic exposed in our health care system and how to focus on what matters most.
Q: What inspired you to become a medical doctor?
A: I had asthma as a child and went to the doctor a lot. I understood the feeling of being frightened when you can't breathe and how much doctors and nurses provided relief. When I was about 10 years old, a boy who lived next to us died in front of me from an asthma attack. The boy's grandmother was too afraid to call for help because she was an undocumented immigrant. I knew from an early age that I wanted to be a doctor in the ER [and never] have to turn someone away because of their inability to pay or their immigration status or anything else.
Q: You became your mother's medical advocate while in medical school. What did that teach you?
My mother was told by her doctor that her symptoms were attributed to depression. She knew that didn't make sense because she was so short of breath that she couldn't walk up the stairs. But she didn't want to speak up. Eventually, she sought a second opinion and was diagnosed with metastatic breast cancer. I spent a lot of time after that trying to understand that disconnect and how to improve hospitals and make patients better advocates for themselves.
Q: You became Baltimore's health commissioner. What got you interested in public health?
My experiences in the ER. I saw so many patients there that I knew I couldn't help because of underlying problems. I remember one woman coming in over and over again, requesting treatment for drug addiction. Everybody knew that the best we could do was find a treatment program for her in a few weeks. We found her a program that started a few weeks later. But later that day she overdosed, and we were unable to resuscitate her. I had so many experiences like that in the ER. We were doing our best to provide treatment. But, ultimately, what was going to save our patients’ lives was not medical tools, but social supports that weren't there.
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Q: Why do you think public health is so undervalued in this country?
A: Public health works because it's invisible. It's very hard to explain the value of something that you can't see. If you prevent children from getting lead poisoning, there's no face of someone with lead poisoning because you've prevented it from happening. As a result, public health becomes the first item on the chopping block. COVID-19 is a stark example of what happens when there's chronic neglect of — and underinvestment in — public health.
Q: What do you consider the big lessons we've learned from COVID?
A: One is the importance of a national plan. When you don't have a coherent plan, you end up with a lot of piecemeal approaches that just don't work. The second lesson is how much public health depends on public trust. When you have scientists and medical officials being actively undermined by politicians, you end up having something as basic as masks or vaccinations being politicized instead of being understood as public health imperatives. And the third thing is the underlying disparities in our health care system that COVID unveiled. The virus didn't create those disparities. They were always there, but the pandemic exposed them.
Q: What kind of disparities are you talking about?
A: We've seen that people who are disproportionately affected by COVID are African Americans, Latino Americans, Native Americans and people of low income. Why? Look at Baltimore, for example. One in 3 African American residents there live in a food desert, compared with only 1 in every 12 white residents. Is it any surprise that African Americans have higher rates of diabetes, high blood pressure and heart disease — conditions that make them more susceptible to COVID?
Q: What advice do you have for people 50 and older regarding the pandemic?
A: We need to stop focusing on one question: “Is x activity safe?” I think people should ask themselves another question: “What is the most important thing to me?” That's dependent on the risk of the individual activity but also — very importantly — on your own values.
Q: What is your biggest concern about COVID?
A: That we're not going to get enough people vaccinated to reach herd immunity. We were waiting for science to rescue us and we weren't willing to do the hard things like masking and avoiding indoor gatherings. Now people are getting in their own way again by not getting the vaccine. I'm very concerned that we'll have the opportunity to end the pandemic, but we don't do it.
Q: What gives you hope?
A: Seeing the many millions of people who have made profound sacrifices for others. That gives me a lot of hope. There has been the sense over this last year that we are all in this together. I think we should take a lot of comfort in that.