Coronavirus and economy require balancing act, says ex-CDC chief Frieden
Adhering to science and reopening the economy is not mutually exclusive, the former director of the Centers for Disease Control and Prevention told a New York City watchdog group.
“We can reopen but we must be cognizant of the challenges of COVID-19,” Tom Frieden said on a Citizens Budget Commission webcast Thursday.
Frieden, now president and chief executive of Resolve to Save Lives, an initiative of the global public health organization Vital Strategies, was CDC director from 2009 to 2017 under President Obama. As New York City health commissioner from 2002 to 2009, he ran point on Mayor Michael Bloomberg’s initiative to stop smoking in restaurants and bars.
“There’s no magic ending to this pandemic, no fairy-tale ending, not even with a vaccine,” Frieden said. “It's going to be here for a long time and a lot if it is unpredictable."
The global pandemic, which has claimed nearly two million lives worldwide and roughly 228,000 in the U.S., is resurging nationally with about 75,000 cases per day. Virus effects have battered New York City’s economy and by extension, the city’s budget and credit standing. The city was the first epicenter of the virus, in March and April.
Vaccine availability and effects remain open questions, with a rollout of several expected for 2021. An effective vaccine, Friedman, could presage a steady economic recovery.
"I think we’re getting ahead of ourselves with vaccine wishes and behind where we should be with vaccine planning," Frieden said. "A vaccine doesn’t do any good. A vaccination program does.
"Just simple math. Optimistically, a vaccine might be 70% effective and 70% of people might take it. That's a 49% protection rate societally. And there will always be pockets with the potential for large, explosive outbreaks."
He also warned that six-foot distancing is not a hard line of demarcation, especially in group settings such as dance studios, choirs and bars. “Six feet is not a magical distance where the virus suddenly says 'oh, a border, I can’t go beyond that,'” he said.
According to a study by nonprofit CBC, recently released sales tax data illustrate New York's struggles. In contrast to the rest of the state, where aggregate taxable sales have rebounded to 2019 levels, city taxable sales declined 23% to $34.2 billion in June to August 2020 compared with the same quarter in 2019.
“New York City right now is set up for an economy to really be harmed and challenged during this period," CBC president Andrew Rein said. “Tourism, entertainment, face-to-face interaction, it's is what makes New York City great and it's what is most challenging right now.
"Right now we focus on things we can't do. On the other side, could we flip the lens and [figure out] things we should be doing to open up more effectively?"
Eating establishments, Frieden said, are evolving with bars nationwide looking to recraft themselves as restaurants. Measures could include plexiglass and noise reduction to minimize shouting. "I worry about our restaurants. There are 25,000 restaurants in New York City. How many are going to survive this?"
Bars, he said, are a problem because "people talk louder, linger longer, come from all places and don’t wear masks.”
Subway systems, he said, provide better ventilation systems than many people realize, while commuters bunching while they await trains and buses pose risks.
Asked when people can return to public places such as Carnegie Hall and the Blue Note Jazz Club, Frieden said “I don’t know. Distanced with masks and no drinking or eating, maybe not so far away. But as it was before, no time soon, I'm afraid."
The federal government, he said, has failed to provide states and cities with enough funding for preparedness. "At the state and local level it's challenging to do this because of how difficult budgets will be."
Healthcare systems overemphasize hospital care at the expense of primary care, he added.
“Globally, nationally, statewide and in New York City, we have failed to create good primary-care systems. If you look around the U.S. you've got places like Kaiser and Geisinger, Mayo Clinic, a couple of places that actually do primary care well, but they're oases in a desert of a healthcare system that's misshapen. And that's a problem."
HIP Investor, an organization that compiles environmental, social and governance rankings for municipal bonds and issuers, ranked 29 hospitals in the city on performance and preparedness during the pandemic. In particular, it compared New York University’s Langone Medical Center and Harlem Hospital Center, six miles apart in Manhattan.
Langone Medical, according to HIP Investor, achieved better outcomes on almost every general performance metric, with a lower mortality and readmission rate, and a better rating for care effectiveness.
Its patients experienced fewer complications, including lower death rates for heart failure, pneumonia, and stroke patients, HIP Investor said. Langone also has higher overall patient satisfaction, specifically outperforming in doctor and nurse communication, clear communication about medicine and potential side effects, and whether patients would recommend the hospital.
In addition, said the report, Langone also has lower Medicare spending per beneficiary, a hospital affordability metric.
"Hospitals that have strong patient outcomes, high patient satisfaction and less complications are less likely to have violations and lawsuits," the report said. "Debt issued by high-performing hospitals could be considered more secure, with a lower chance of default."