Season 2, episode 8: trust the messenger // Thursday, November 12, 2020

This is Shelter in Place, a podcast about coming together in a world that pulls us apart. From Oakland, California to Hamilton, Massachusetts, I’m Laura Joyce Davis.

Céline: I think frankly, our biggest enemy is giving up--is fatalism--of saying, “well, this is just going to happen. There's nothing we can do.” I think that is the biggest threat, because the fact is there remains a lot we can do.

Effective public health does not happen in the lab. It happens in real life.

A lot of it comes down to trust. Do you trust the messenger? Is it somebody from your social group? And unfortunately because we've become so polarized in this country, finding those messengers who can communicate trusted messages is very challenging.

Laura: This past week, while Americans were waiting for votes to be counted, there was another count happening as well. For the first time since the pandemic began, there were more than 100,000 COVID cases in a single day. 

The day before the U.S. presidential election, Joe Biden announced that if he won, he’d create a new coronavirus task force to manage the increase in cases, make sure that vaccines are safe, and give special attention to at-risk populations. This past week, I got to talk with someone on that task force.  

Céline: I'm Dr. Céline Gounder. I'm an internist and infectious disease specialist, an epidemiologist, and a medical journalist. 

Laura: Celine is a practicing physician and professor at NYU’s School of Medicine and Belleveue Hospital in New York City. She’s got the kind of jaw-dropping resume that makes you wonder if she’s secretly immortal. She’s studied and trained at Princeton and Johns Hopkins and Harvard. She’s a medical analyst for CNN, and she’s written stories for The New Yorker, The Atlantic, The Washington Post, and Sports Illustrated, just to name a few. She was named one of People Magazine’s “25 Women Changing the World.” If there’s anyone who is equipped to handle the challenges of this pandemic, it’s Céline.

If you’ve been following Shelter in Place, then you know that the backdrop to season 2, which we’re calling Pandemic Odyssey, is the sudden, unexpected voyage from one coast to another that my family and I made after our lives were upended by the California wildfires and the pandemic.

If you’re just tuning in, you’re welcome to listen to these episodes out of order--the original Odyssey, after all, begins right in the middle of the story. But when you’re done listening, I suggest going back to the beginning, where you can hear about the adventures that found us--often more adventure than we’d gone looking for.

Odysseus’s journey is indirect and meandering--much like ours--but he never would’ve made it home to Ithaca without the guidance of both divine and mortal beings. One of those guides was Hermes, famously known around Greek mythology as the messenger god. Hermes appears to Odysseus three times in the Odyssey--and every time he does, it’s a life or death situation. He’s the messenger who convinces Calypso to release Odysseus from captivity. He warns Odysseus about Circe, an enchantress who transforms some of Odysseus’s men into swine. And finally he escorts to the underworld some dead men who refused to believe they were in danger. 

Maybe it’s a stretch to compare Celine to Hermes, but I don’t think so. What she’s sharing with us today has a lot of power--power to help us avoid danger or even death, power to escape captivity to fear, power to help us make decisions that keep our humanity in view.

When Céline and I spoke, she didn’t mention that she’d been selected for Biden’s task force. I didn’t find that out until later. After talking with her, I’m not surprised. Because even though Céline’s has accomplished a lot, she’s incredibly approachable and gracious. 

The first time Celine and I spoke was back in early September, when my family and I were on the road, making our way through Colorado. It was weeks later when I finally had a chance to revisit the conversation, but when I opened the file, our conversation wasn’t there. I know I saved it, not just in one place, but three. But it was gone. Like the gods had swooped down and snatched it, just to mess with me.

I searched for days, and then finally in desperation reached out to Celine. I wanted to at least apologize. I figured that would be the end of it. Hard lesson learned.

But the next day Celine sent me a message saying that it was no problem. We could talk again. She said that once a long time ago, something similar thing happened to her, and the person she’d interviewed was really nice about it. Celine was just paying it forward. 

Celine: My father immigrated to the U.S. from India in 1968. He was from a rural village in Southern India. All of the family were rice and sugar cane farmers, and most of the family actually still lives in the village. He was the first of his family to go beyond the fifth grade in schooling. 

He grew up without plumbing and electricity. And even now there is not a flush toilet in my uncle's home back in the village. So understanding how lucky I have been to have been born in the U.S., to have grown up here, to have had the education and other advantages I've had, I very much felt that I had a duty to give back. Health equity was really what drove me. So then it was more about, are my skills best suited to within that? 

Laura: Celine has been finding ways to give back for a long time--both here in the U.S., and back in India. She established a foundation in her father’s name to support children’s education in India. Every year she provides scholarships for some of those students to pursue higher education. She’s supported 30 disabled children through the village’s Inclusive Education for Differently-Abled Children center. Even before India was on lockdown, she sent guidelines to help her father’s village prevent the spread of COVID-19. And by the way, she didn’t tell me any of this. I had to find it out for myself. 

Celine’s father got scholarships to go to college and graduate school, first in Toronto and then in Chicago, where he met her mother, who was visiting from Normandy, where Celine’s grandparents had moved after World War 2. 

Celine: And so I was born here in the United States to two immigrant parents. It was definitely a complicated situation with the Indian family. You know, in India the caste system even today is a very strong system. And so my father was marrying somebody who was not only outside of his caste, but outside of his culture, outside of his country--a white woman, and this was not accepted at all by the family.

I think now, seeing how my father turned out, how we--me and my sisters--turned out, the family back in India is very proud of that. But that wasn’t the case in the beginning. 

Laura: This week, the New Indian Express published a story about Céline. Celine’s father’s family is quoted, saying, “Our family is very proud of her. Children and residents fondly remember Celine’s visit to the village.” 

In this moment when our country is so divided, it’s encouraging to hear a story about people overcoming cultural differences, and doing the hard work of relational repair. It’s a reminder that change is possible--even within systems of inequality and injustice. 

Celine says that her father’s upbringing in India had a lot to do with why she went into public health, and why she didn’t stop at becoming a clinical physician.

Celine: My dad was born in India right before partition, and so there was a lot of politics, some of that related to religion, some of that related to language. You could say it was identity politics, really. And that is something that he very much passed on to me, the understanding of those politics and how that affects people's lives in a very real way.

When you think about big issues, public health, health policy issues, it becomes very clear that you can't fix these things just as a clinician. While I do practice medicine, big picture, I do think of myself as a public health-focused person, and think about things more on a macro level. 

In working on some of these issues, both in the U.S. as well as in Sub-Saharan Africa, it was really clear to me that we need to find a better way of translating science into policy and action. 

Laura: Celine has worked all over the world studying Ebola, Zika, HIV, TB, opioid overdose, and gun violence. She also spent a lot of time talking to people out in the community. 

Celine: I think that's when I started to think about journalism as an important piece of this, because it's really about how do you communicate and disseminate information in a way that people connect with and understand, and this is something I had thought about over the course of  six months or so, deciding truly to make that pivot. And I just started submitting pieces, and reached out to some old friends from college who were working for some of the television networks, got my foot in the door. And then it's really a question of, o you impress people and do they invite you back and do you get better with more repetition and practice, and one thing led to another. 

Laura: By 2016, Celine had been doing a lot of TV work in addition to her work as a physician. But she still felt like she wanted to do more to help people to connect the dots when it came to public health.

Celine: Podcasts were really blossoming, and I was myself a big consumer--remain a big consumer of podcasts. And it seemed like such a good medium, because a lot of these public health policy issues are not readily explained in three to five minutes on television. There's something a lot more intimate about a podcast as well, where you can really share the details of someone's story, and give it some context, and still do it pretty efficiently, where somebody can come away really having felt like they connected with the story.

Laura: Celine founded Just Human Productions, a non-profit multimedia organization that brings medicine to the people. Today she has two podcasts, which is how I met her. 

Celine: 2017 is when I launched the first of the two podcasts, called American Diagnosis. And that one's really about the intersection of health and social justice issues. The first season was on youth and mental health, the second season was on the opioid overdose crisis, and the third season was on gun violence. And I have a couple of bonus episodes that will be released in the coming weeks before we launch season four in January, which will focus on Indigenous health, specifically around what's happened with uranium mining and other natural resources on the Navajo Nation, and how that's impacted their health. 

The second one, Epidemic, launched in late February of this year. Season one--not surprisingly--is covering the COVID coronavirus pandemic. And we'll cover other such epidemics, infectious diseases, in future seasons. Unfortunately there is not going to be any shortage of those to cover. The focus is not just the science--it's definitely some science--but also the policy, the public health, the sociology, the cultural aspects of this. Effective public health does not happen in the lab. It happens in real life. And so you really have to tackle all of these different facets of it in order to have an effective public health approach.

Laura: I’m making my way through season 3 of American Diagnosis, which is about gun control, and it’s fascinating. I’ll include links to both of Celine’s podcasts in the show notes for today.

As one of the experts on Biden’s new coronavirus task force, Celine is thinking a lot about how to better educate the public. So I asked her to bring us up to speed on what we know about the virus now that we didn’t know in the beginning. 

Celine: We are learning more about the long-term effects of COVID on somebody's health. So just because you survive, it doesn't mean you've come through unscathed, and unfortunately some people are having long-term consequences of this.

There does seem to be some overlap with auto-immune kinds of disease. In fact, the infection may be kicking off an auto-immune disease not dissimilar to lupus or rheumatoid arthritis. That can mean a lifelong disabling condition. So I think that's an important piece of this: how can we figure out how to care for these people? Are we going to be offering them some sort of disability benefits? I think that's the kind of thing we're going to have to be thinking about long-term. 

I think in terms of the vaccine, it's becoming more clear that the first-generation vaccines, so the ones that come out earliest, are not going to be perfect. It's unclear what level of immunity they will generate, and it's not clear how effective they are going to be in creating herd immunity. 

So herd immunity, first of all, is an expression that should only be used in the context of vaccination, not with natural infection. We have never achieved herd immunity with natural infection. Smallpox is just one example. We eradicated smallpox. 

So smallpox is another respiratory virus. It also spreads through coughing and sneezing and through the air. Human populations were afflicted by smallpox for millennia, and we did not achieve herd immunity. There's actually a graph of this in my Twitter feed and in the Epidemic Podcast feed. If you look at what happened prior to the World Health Organization really undertaking a massive vaccination campaign, which started in the fifties, but really went full force in the sixties, you really start to see the numbers dampen significantly. And you really finally reach herd immunity by the late seventies. And then in 1980, smallpox was declared eradicated. That was a success story with herd immunity. We see that with other vaccine-preventable diseases, like measles or polio. But even measles--you know, we've had some outbreaks in the last few years, because there have been enough people in certain communities who have not wanted to take the vaccine. And so those communities have not been able to maintain herd immunity as a result.

What you end up getting when you have natural infection, is you have these epidemics, these peaks. And then you'll have a short lull in between, where you could maybe call that a natural herd immunity--and it could be months, it could be a couple of years--but it doesn't last that long. And the reason it doesn't last that long is one, you have births, so you have new people entering the population that way. You have people whose immunity is waning. And then you have people migrating into the area. So you are always going to have enough people susceptible--either maybe they never had the infection, or because you have these new people entering the population--where periodically you end up getting spikes and epidemics, and that does not go away.

And so the only way really to sync up, you could say, the entire population to have enough immunity at once. To really get to herd immunity, you need a vaccination. 

That is important to understand. And I think understanding that this first generation of vaccines may not be the vaccines that can get us to herd immunity--they may be vaccines that protect us from severe disease--but this is also why a lot of public health officials are saying some of the things we're having to do now, like wearing masks, may not go away for quite a while if we're trying to prevent transmission. And so it's probably gonna be a combination of things we're going to have to do for a while yet.

Laura: When the pandemic began, it seemed like our country had finally found something to unite us. Covid-19 was our common enemy, and we’d band together to fight it. But of course that didn’t last for long. Wearing a mask or not wearing a mask just became one more political act to divide us. I was surprised by that change, but Celine wasn’t. 

Celine: This pandemic has been political from the very beginning, and I think it was political in China.

It'll be a while before we understand that full story. But certainly there was information withheld from the Chinese people, as well as from the World Health Organization and the broader global community. And that was certainly political because these were decisions that were made because certain political leaders did not want to look bad. They didn't want there to be political and economic fallout. As the disease spread elsewhere, you see the same pattern replicate itself, whether that's here or in the UK or Brazil, or, you know, you name it.

We have to assume an outbreak like this is going to be politicized. We saw that with Ebola, both here as well as in West Africa. You know, why were people really upset about being told how to bury their dead? It's not really that different from people being upset about being told whether they can attend church in person. It's really the same thing. 

And a lot of it comes down to trust. Do you trust the messenger? Is it somebody from your social group? And unfortunately I think because we've become so polarized in this country, finding those right messengers who can communicate trusted messages is very challenging.

I think frankly, our biggest enemy is giving up. It is (the) fatalism of saying, “Well, this is just going to happen. There's nothing we can do.” I think that is the biggest threat, because the fact is there remains a lot we can do. And it's not public health versus the economy. We can still have a functioning economy while pursuing public health interventions. And I think that is the biggest threat, frankly, to people's health right now is do they buy into that or not? 

I think New York is one of the places that has done this best. I think there are other places--San Francisco's done a very good job as well, for example. And I think it's really about how well do you collect data, report data, analyze data. It's very difficult to control something like this when you don't know what's happening, when you're flying blind. That's the most important piece of this, is just having the information and being transparent about it. And testing and contact tracing are very much part of that information-gathering process. Then how do you use that information, which is where New York city and New York state have been setting thresholds based on the data of, you know, if we're in this place, these are the things we need to be doing. If things get better, maybe we can roll back some of these measures. If things get worse, then we have to re-institute them. But I think having a data-driven plan that is not about emotional decisions really helps clarify the decision-making process, helps to depoliticize it--and frankly has just worked much better.

I wish we had done a much better job of messaging about masks in the very beginning.

And I understand why that happened. It's because there was confusion about the science. We were learning. And we were also very worried that there would not be enough masks for healthcare workers, and healthcare workers were very much being exposed in a way that was not optional, whereas other people could at least shelter at home. That had to be the priority. But I think we could have explained that better. 

Since then we should have done a better job scaling up production of personal protective equipment, including masks. And (we) simply have not done that. So I think that was a major gap, because now we find ourselves in a situation where, because the messaging was not great, and then unfortunately it became part of the culture wars, we find ourselves in a position where a very cheap and easy public health intervention that really does not get in the way of economic activity is now being underutilized. And I think that has been truly unfortunate.

We crossed a hundred thousand cases in one day for the first time and things continue to rise and deaths will follow, and they come six to eight weeks later. And so I am very worried about what we're going to see in several weeks. Yeah, we're going to see a lot of deaths. 

I don't think places like New York city are going to see what we experienced back in March and April. I think it's going to hit parts of the country that are frankly far less prepared, that have a lot fewer hospitals, fewer hospital beds, fewer ventilators, fewer doctors, where they're going to have to make some really tough choices. And I worry for those who are going to be the ones sick with this, and for those who are doctors and nurses and other healthcare providers. I think a lot of us still have a form of PTSD from the spring in New York. And to see others having to go through that now--it's this vicarious flashback of sorts--that's very painful when we know that that could have been prevented.

Laura: When my family and I were driving across the country, we saw everything from people wearing masks even when they were nowhere near other people, to a high school cross country race right in the middle of town, with crowds of people cheering as the runners went by. 

And while they tried to be pretty cautious, most of our friends and family weren’t all that concerned about the virus. No one they loved had died from it. Some of them lived in rural areas with low or nonexistent numbers of cases. It hadn’t touched them the way it did places like New York City.

I asked Celine to shed some light on why we’re seeing COVID spikes the way we are, and if it’s directly correlated to whether or not people are wearing masks in those places.

Celine: I do think that the fact that the weather's getting cooler is definitely driving more transmission. People are indoors more. I think there's also a component of people are just sick and tired of having to wear masks and socially distance, and they're letting down their guard.

I am really worried about the next two months. I'm really worried about November, December,   I'm worried about what the public health policies are going to be between now and the end of the calendar year, if there's going to be any significant change at all. I'm worried about how people are going to choose to celebrate Thanksgiving, and can definitely see that fueling the spread. 

Laura: With the holidays coming, our family has been talking a lot about how to celebrate. 

Some of our family members have already announced that they’re not traveling or accepting visitors because they don’t want to risk exposure. My mother-in-law usually has a crowd at Thanksgiving, so she’s been angling for at least including a few folks who are annual attenders, who don’t have family to celebrate with. And I get it. The traditions that involve relationships, that bring us close to people are the saddest ones to let go of. 

Celine: There's no question (that) the safest, most conservative thing would be to say, “I'm going to stay home, celebrate Thanksgiving within my family bubble and I'm not going to travel.” That would be the safest option. 

Can you fly safely? You can. Your biggest risk is going to be actually at the airport, where you're around other people, and on the plane, when you take off your mask to eat or drink.

And so there are things you can do about that, one of which is don't eat or drink on the plane, or if you're around other people at the airport, keep your mask on during those situations. You might consider wearing glasses or goggles or a face shield while you're on the plane. That would further mitigate your risk. But I think most importantly it's the masks and keeping them on.   

Also what is the plan once you get wherever you're traveling to? Are you traveling from a hot spot where you might be bringing virus with you to not just the family, but the community? Or are you traveling from a place where there's not a lot of COVID, but you're going to a place where there's a lot of transmission, and you could be bringing it back home with you on the return trip?

And then finally, in terms of the people that you would be celebrating with, I think it's important to be on the same page with other people, because the last thing you want is to be traveling, sitting down to dinner with family at Thanksgiving, and then to have a big fight over are you wearing masks or not?

Are you all on the same page about how to be safe? And that would again include wearing masks, keeping the density of people low, ideally doing as much celebration outdoors as possible--especially when you're eating and drinking, because you can't wear a mask to do that. This really does seem to be a respiratory virus, so spread through droplets and aerosols much more so than contact.

I think a lot of people behave based on what is pretty much peer pressure. We do what other people do, and that's what gives us a comfort level to behave that way. And I think it's important for people to know that the vast majority of Americans are wearing masks. They may not wear them all the time. They may not wear them perfectly. But as of June, almost 90% of Americans reported wearing masks. The majority of Americans are also doing other things like staying six feet apart. They're avoiding crowded places. They're avoiding restaurants. Over half of Americans are doing those other things as well. They're trying to keep themselves and their families safe. That's really the goal here.

Laura: My family and I are staying put at least through the holidays here in Massachusetts. We still don’t know when we’ll be headed back to Oakland, or if our schools will be opening in the spring. 

Celine: We're still learning. It does seem like younger children are less likely to transmit to adults like teachers and so on, but we do see household transmission from kids to parents. It does seem like schools that have taken precautions like social distancing, improving ventilation in the schools, hybrid models to reduce the number of kids in a classroom--it does seem like those measures are working. And so where schools have put those in place, it seems like it is safe to reopen schools. 

But you know, this is another example of where you really need the data. You need to have a sense of how much transmission there is in the community, where the school is located. Are you testing students and staff, so that you can react very quickly if there is a case to prevent further transmission? To do contact tracing? To assess whether it's safe to keep the school open? This really needs to be a decision that's made based on the local epidemiology.

And unfortunately, what we've really seen is that these decisions by and large have been made on the basis of the balance of power between teachers’ unions versus local government that might want to put pressure on the schools to reopen. And so really what is the balance of power between state and local government versus the teachers’ unions?

Laura: Celine’s work has often focused on the balance of power, and specifically on why our healthcare system fails certain groups of people more than others. It’s one of the things she’ll be working on as part of Biden’s task force. And she says the reasons and solutions for these inequalities are complicated--but it’s not impossible to effectively address them. 

Celine: You have sort of two sides to it. One is pandemic preparedness, which is investing a lot in public health. We have let our public health systems deteriorate over decades now. Since the 2008 recession alone, either through layoffs or retirements, we've lost 50,000 public health workers. And so that leaves us much less prepared for a situation like this. And that's one piece of the puzzle, which benefits everybody. 

It's definitely gonna mean training people, and recruiting them. And that's not a small thing. You know for example in New York City, to scale up their contact tracing was not a small undertaking, because it meant having to recruit and hire and train--and to do all of that in the middle of a pandemic, where it's being done virtually also--is quite challenging. And so to do this at scale for the country, we need something like a GI bill or a massive public works project kind of approach to this, where you're thinking of it as really building up this essential core to respond to these kinds of crises.

But also in terms of addressing the health inequities, we really do need to consider why are people of color at higher risk--not just for COVID, but for any number of health issues? And that is intimately tied with socioeconomic inequity. We have used more recently the term “structural racism,” and it is very real. And this goes back to why do certain jobs come with health insurance and others don't? That is the definition of structural racism. 

I think it's a reflection of what kind of jobs people of color hold, and what their baseline health status is, and what kind of access to healthcare they have. And unfortunately much of this dates back to the Great Depression era laws that were passed around that time. The protections that were passed for white workers were not applied to the industries in which people of color were concentrated at the time. And they were largely concentrated in agriculture and domestic work, so those industries have been left out of certain health and safety protections. Those are jobs that do not by and large come with employer sponsored insurance, and so these are people who are working very hard, and yet don't have those same health and safety protections. So that's one critical piece of this. 

And then how much upward mobility have these populations had to move into jobs that do afford those kinds of health and safety protections? And unfortunately they have not had that kind of mobility, so they do remain concentrated in service industries, front-line essential worker positions. And those are the people who have found themselves more heavily exposed to coronavirus, and because of the result of decades of inequities, whether it's with respect to housing or education or clean air or clean water, all of these things are additive in terms of predicting risk for underlying health conditions that also translate into they're having worse COVID if they get it. So they're being exposed to it more, and then if they get it, they are at higher risk for worse disease.

Until we're honest about those problems, (until) we face them head on, I do think you are going to have certain populations who find themselves especially vulnerable in a crisis like this. 

Laura: As we made our way across the country, we were pretty cautious. We made even the kids wear masks, and did a lot of handwashing and using hand sanitizer. We stayed only in places that were taking extra precautions in cleaning, and spent most of our time outdoors, away from people. 

But there was one moment in Utah when things got tense. We stopped at the only gas station for miles around, and the sign on the door said, “wear a mask if you want to, or don’t.”

I put mine on and went inside to use the bathroom. When I came out, my husband was letting our 3-year-old wash the windows with one of those squeegees that is there next to the pump, the ones that everyone uses and I’m guessing never get cleaned. And I lost it. I furiously wiped her down with disinfectant wipes and even made her change her clothes. And even then, I didn’t want her to touch me. 

It took miles of road behind us to realize that my overreaction was rooted in more than paranoia. I think Celine’s right, that people are tired of wearing masks and social distancing, to let down our guard. 

But I think there’s a darker reality beneath the mask/no mask conversation. If we agree to these precautions, we have to acknowledge that even the people we love most, the people who make us feel safest, are dangerous. If we accept that this virus could kill us, and that the only way to stop it is to put physical distance or a barrier between us and our loved ones, it forces us to view each other through a lens of fear. But Celine says it doesn’t have to be that way. 

Celine: I think the problem with fear is it's very disempowering, right? It makes you feel like you're helpless. And I think by taking action, you conquer that fear and helplessness. I think my personality is I'm a doer, a fixer, and so that's how I cope with stuff. I figure out what I can do, and that's what I pour my stress and anxiety into. And having that sense of purpose, feeling like I am making a difference in my small way, makes me feel empowered.

I am hopeful. I have seen people rise to the occasion in incredible ways, people I work with, to do everything they can to help. That has been amazing. I feel so privileged to work with the people I work with at Bellevue . . . (they are) just so dedicated. The sacrifices that people have made to save patients, to make sure we're staffed and staffed safely, has been remarkable. 

I know that we can control this. I know we can. And so knowing that gives me hope. And I am hopeful that others see that, and put that into action. I think what we're seeing is the loss of hope and action. That's why we're losing. I think we need to have hope in order to win this.  

Laura: I’ve been ending every episode this season with an invitation. And so today I’m extending Celine’s invitation. 

Celine: Have a conversation about how you plan to celebrate. How can we be happy, healthy, and safe with family over the holidays? And that's going to look a little different for everybody. And understand that you're not going to change people's minds, but rather approach it from the perspective of how can we enjoy one another? How can you maximize safety and avoid unnecessary conflict during a time that really should be about celebrating family?

Laura: This will be the first year in a long time we’ve been with family for Thanksgiving. Many years ago, when we were twenty-something who were new to Oakland and couldn’t afford to fly back to the places we were from, we made up our own tradition. We called it Misfit Thanksgiving. We ditched the turkey and other brown Thanksgiving foods, which we’d never really liked, and instead cooked a meal of our favorite foods. We invited anyone we knew who didn’t have local family. Often there were near-strangers at our table. It’s nothing like the Thanksgivings we grew up with, but it’s become one of our favorite family traditions. I’m going to miss Misfit Thanksgiving a lot this year.

But I’m also thinking about Celine’s invitation, to rewrite the rules of Thanksgiving once again, with the singular goal of enjoying each other--but also figuring out how to include a few people who really need to be invited in--and how to do doing that safely, not from a place of fear, but from a place of love, of action. 

And I’m thinking about what this means for our country, to have people like Celine guiding us, helping us rewrite the systems that are meant to protect and care for us, so that they care well for everyone. 

As always, if you listen all the way to the end, you’ll hear Shelter in Place outtakes as well. But first, I want to thank Celine Gounder, who could have been doing so many other things on election night after a long day at the hospital, but instead spent the evening talking with me. Thank you for your kindness, your willingness to share your knowledge freely, and for paying it forward not just to me, but to our country. I’m so glad we’ve got you to guide us for whatever is ahead.

https://www.politico.com/news/2020/11/03/biden-plans-for-covid-transition-task-force-433955

https://www.celinegounder.com/