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Story Publication logo November 16, 2020

‘It’s Like Politicizing Toilet Paper.’ A Member of Biden’s COVID-19 Panel Surveys the Task Ahead

Volunteers from Indonesia's Red Cross prepare to spray disinfectant at a school closed amid the spread of coronavirus (COVID-19) in Jakarta. Image by REUTERS/Willy Kurniawan. Indonesia, 2020.

Veteran public health journalists from Science magazine explore what science knows—and is learning...

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New York University physician and epidemiologist Céline Gounder serves on President-elect Joe Biden’s new coronavirus task force. Image by Céline Gounder. United States, undated.
New York University physician and epidemiologist Céline Gounder serves on President-elect Joe Biden’s new coronavirus task force. Image by Céline Gounder. United States, undated.

Science's COVID-19 reporting is supported by the Pulitzer Center and the Heising-Simons Foundation.

Céline Gounder has straddled the worlds of medicine, government, and the media: Now, the New York University epidemiologist and infectious disease expert is one of 13 people President-elect Joe Biden has named to a high-profile task force to help steer his response to the coronavirus pandemic. In addition to her medical work, Gounder co-hosts a podcast about the pandemic with Ron Klain, Biden's newly named chief of staff. Until recently she was also a CNN medical analyst.

Gounder spoke with ScienceInsider 4 days after her appointment to the task force.

The interview has been edited for clarity and brevity.

Q: Do you have particular skills that made you a candidate for the task force?

A: I have a lot of experience in terms of public health and clinical medicine when it comes to epidemics.  

I led the Bureau of Tuberculosis (TB) Control in New York City, another respiratory infection. Contact tracing historically has been based out of TB. I worked in sub-Saharan Africa from the late '90s, up until 2012, on tuberculosis and HIV, public health programs, and research. Then I was also an Ebola aid worker in Guinea.

Q: You also have quite a presence in the communication world. You have a podcast. You're working on a movie. You've written articles for a variety of publications. Do you think that plays a part in it?

A: I'm sure. A big part of public health is communication. How do you convince people to wear a mask? How do you message around social distancing? When we don't yet have a vaccine scaled up, when we don't have things like monoclonal antibodies scaled up—but even after—it's these very basic public health measures that we need to be encouraging and explaining, and that's very much the job of science communicators.

Q: So how do you get people to wear masks?

A: It's a challenging one, because the issue has been so politicized. But in my mind, it's like politicizing toilet paper. It's a basic hygienic measure. It's not about your political party. And we need to somehow break through that.

I will say people are doing better. If you look at the surveys, people are not perfect about wearing masks, but they are wearing them more. Part of this is also just letting people know that this is becoming the social norm. People are more likely to do something if they feel like everybody else is doing it.

Q: President-elect Biden has talked about mask mandates. How much carrot and how much stick do you think play a role in getting masks adopted?

A: Well, I think a mask mandate is almost entirely a carrot. Because how are you going to enforce that? So I think part of the power of a mandate is to really communicate the seriousness of this, and to create a situation where it becomes a social norm.

Q: Has the Trump administration's unwillingness to acknowledge that Biden is the president-elect affected the task force's ability to get its work done?

A: It's certainly not an ideal situation. But you have many people, including Biden himself, who have very long careers working in government. So while you may not have cooperation occurring in any official transition capacity, it's not like they're in the cold.

There's also nothing to prevent the transition team from interfacing with governors and state and local health officials. Finally, much of health care is delivered in this country by the private sector. In particular with respect to tests and vaccines, and monoclonal antibodies, that's really about collaborating with the private sector to figure out how to scale up and distribute.

Q: So is there anything that you as a task force have wanted to do, but haven't been able to do yet because of the standoff?

A: I'm not going to answer that specifically.

Q: How do you recommend the Biden administration address the poor communication and rampant misinformation about the pandemic?

A: Scientists and doctors and public health experts need to be front and center at press conferences, at daily briefings. Not political officials. Because by definition, once you have a political official communicating this it becomes politicized. It really doesn't matter whether it's a Republican or a Democrat, it is politicized.

Q: President Donald Trump has put himself at the center when they held press briefings. But New York Governor Andrew Cuomo has done that at the New York state level. So it seems like you have the risk of politicization on both sides.

A: I 100% agree.

Q: The toll from the virus has fallen disproportionately on communities of color, particularly Black, Latino, and Indigenous communities in the United States. Are there immediate steps that the incoming administration could take to address this?

A: You can't react to a problem if you don't know the problem is there. So I think we need to be collecting data. Part of that is really scaling up testing. But then, as part of testing, making sure we're collecting data on demographics to understand what the problem is, and what transmission patterns are.

Secondly, is making sure there's equitable distribution of vaccines and therapeutics. That's also going to really require addressing issues of trust … some really careful messaging and the involvement of those communities in making those plans.

Q: The Biden team talked about ramping up testing in a big way. What kinds of testing do you think are critical?

A: We need to ramp up testing on asymptomatic persons, because the vast majority of infections are among asymptomatic people. They are very much contributing to transmission in the community.

Q: How do you do that?

A: You need to make [testing] as easy and accessible as possible, which means offering it where people are, where they're working … going to school, in their neighborhood. It means really decentralizing it and if possible some of that may be in the home.

Q: Is there a particular kind of test? Michael Mina at Harvard University is talking about widespread use of antigen tests, which are not as accurate or sensitive as polymerase chain reaction tests, as a way to reduce infection spread.

A: I have spoken to Michael about this. Even if you have low sensitivity, you want to make sure that the specificity is high enough. [Specificity is how well the test avoids false positives.] So that's one piece of it. The other piece of it is, because we're talking about asymptomatic screening, the studies on these antigen tests have been, to my knowledge, all amongst symptomatic. So you need to appropriately study it. Once you do that … then I think you can talk about scaling them up.

Q: Contact tracing is part of the Biden plan. With infections as widespread as they are now, one person likened contact tracing to trying to clean up an oil spill with a paper towel. Is there a place for contact tracing right now?

A: It depends on how widespread the community transmission is. New York, for example, is still not so high that it's a fruitless exercise. And there are different ways to think about contact tracing. Are you using it to identify those contacts as individuals? Or are you also trying to characterize what are the places of spread? For example, our understanding is that indoor dining is very important, in terms of spread. The way in which the contact tracing helped illuminate that was really useful.

But I think it works best where you have relatively suppressed transmission rates, not when things are on fire the way they are in the upper Midwest, for example.

Q: Do the preliminary results on the Pfizer vaccine change how you think about the next steps in tackling the pandemic?

A: We've had this timeline in our minds for a while. We would probably have a vaccine that we could start distributing to the highest priority individuals towards the end of this calendar year. The general public, we could start looking at vaccinating probably around April, May. That timeline has not really changed at all.

Q: How does the Centers for Disease Control and Prevention (CDC) regain its authority and its status as an independent, science-driven organization?

A: I really hope that we'll be hearing from Anne Schuchat [CDC principal deputy director], from Nancy Messonnier [director of the CDC National Center for Immunization and Respiratory Diseases], from people like that, starting in January [2021]. I think that would really change the quality of information, the tenor of the communication. CDC remains the premier public health institution in the world. People are feeling incredibly demoralized, undervalued, and I think they just need a big shot in the arm. And I think an important place to start is really by having them lead the communication.

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