President's Podcast: Communicating with the public during a pandemic with CNN Chief Medical Correspondent Sanjay Gupta, MD

Carlos del Rio: [00:00:06] Welcome to Let's Talk ID podcast. I'm Carlos del Rio, president of IDSA. Joining me today is my friend and colleague, Dr. Sanjay Gupta, chief medical correspondent for CNN and associate chief of neurosurgery at Grady Memorial Hospital here in Atlanta. Welcome, Sanjay.

Sanjay Gupta: [00:00:21] Thank you for having me. What a pleasure.

Carlos del Rio: [00:00:23] It's great to have you with us. You know, you have been a household name for many years, thanks to your reporting on CNN. But many probably don't know that you are trained as a neurosurgeon and that you still practice as of today. I mean, I see you at Grady on Mondays is your typical surgery day. How did you become involved in journalism and in health communication

Sanjay Gupta: [00:00:41] I always enjoy running into you in the parking lot, Carlos. Especially during the pandemic, we could actually see each other in person sometimes it's really nice. You know, my path to journalism was a bit circuitous. When I was in medical school, I got very interested in writing about health care issues. It was at the suggestion of a professor of mine. I started doing more and more writing, looking at specific issues within health care policy. And as I think you may know, I worked in the White House for the Clinton administration for some time as a White House fellow, focused on these issues of health care policy and doing a lot of writing, domestic policy guidance, speech writing, things like that. Fast forward years later. I was moving to Atlanta to take a job at Emory, and some of the folks I had met when I worked at the White House, I ran into in the airport some of the people who were involved at CNN and they said, hey, let's let's talk about whether or not you can do some commenting on health care policy for television. Keep in mind, this is around the year 2001. I thought that was that was interesting, you know, that it was going to be more like Sunday morning talk shows. Talking about what was happening, state of affairs.

Sanjay Gupta: [00:01:51] And three and a half weeks after I started, Carlos, 9/11 happened. They right away said, look, you know, the reality is we're probably not going to be doing health care policy for some time. But now you're a doctor working at an international news network in the middle of all that is unfolding in the country and in the world. Does that interest you? And it did. You know, I had always been interested in how many of these messages got to the public. But also when you have situations of conflict like what was unfolding in Afghanistan and and Iraq at that time. So many of the biggest lessons in surgery come from the battlefield. That's something that my professors had really instilled in me. So the idea of saying, hey, I'll do other things beyond health care policy, I might even understand how doctors and nurses and corpsman operate in a war zone. That was all sort of my very, very fast introduction to the world of journalism. So it wasn't the plan when I started, but given what was happening in the world, that became something that I sort of gravitated toward. And now over 21 years, I've covered just about every conflict, every natural disaster, including pandemics that have happened anywhere in the world. It's just sort of unfolded that way.

Carlos del Rio: [00:03:06] I still remember the first time we actually got to work together. 2009 pandemic influenza in Mexico. We were both in Mexico and I flew commercial. But you took the CNN jet and then when you came back, they put you in isolation, I remember.

Sanjay Gupta: [00:03:19] Yeah, I remember that very well. And it's a very interesting story. And just to be clear, the reason we flew back on the CNN jet, because that's not typically how we travel, was because and this this speaks to some of the information that was coming out at that time. They made the decision because I had been all over these places in Mexico where clearly the virus had been spreading as a point of precaution. They said, hey, let's not put you on a commercial flight. Now, unlike COVID, which I know we're going to talk about quite a bit, but it was pretty clear that people spread H1N1 if they were symptomatic. I never got sick. But as a point of precaution, they said, we're going to fly you back private and put you in isolation for, I think it was ten days after I got back. And that was based on some of the guidance. And it was very funny, Carlos, because I remember sitting in isolation somewhere, which was a dorm room on the campus of Emory, turning on my TV and seeing you on TV at the CNN Center, even though we had just been in Mexico together. But again, it just speaks to how people slowly gather information, disseminate it and make decisions based on it. Even back in 2009.

Carlos del Rio: [00:04:30] Even back then, I was impressed about your knowledge of infectious disease. And clearly, you know, that pandemic and now this pandemic, you've in a way have become an infectious disease expert. So what resources do you find valuable? How do you get your information that makes you really sound like, you know, the information as well as any of us does?

Sanjay Gupta: [00:04:51] Well, you know, I mean, I'm not saying this just because I'm talking to you, but certainly you're somebody that we call upon often and we see you on TV and we hear your voice in podcasts. But I think what a lot of people don't realize is that someone like you, you're constantly giving us a lot of guidance behind the scenes, if you will. So I approach this as somebody who is a doctor and went through medical training. I think many ways I approached these types of situations the same way that I thought about my education. I started to become a deep study during the pandemic. I was waking up at 430 in the morning every day, just about even on the weekends. And a lot of that was because I was talking to sources all over the world, hearing from different people, understanding how they were framing things. Sometimes people would frame things in a different part of the world than they would here in the United States. Why is that? The basic biology of the virus, and these are all things that we had learned at one point, not this virus. This was a novel virus, but learned about coronaviruses and flu viruses. I mean, I was dusting off textbooks and reading a lot. I was reading not only the journals, but the preprints and everything. So you really immerse yourself in something. I tell my producers that many times. It's kind of like getting a mini master's degree. 90% of what we are taking in and absorbing and learning will probably never make it on television. You know, television is a pretty quick medium, but to have all that background and then to be able to to contextualize things quickly based on that background was our goal.

Sanjay Gupta: [00:06:23] So it's a lot of studying. It's kind of like going back to school. I joke around, I say, in some ways I feel like as a reporter, I have more homework nowadays than I even did when I was back in medical school because we're assigning each other. We have our own journal clubs, we have meetings with graphic designers so that we can really say, Hey, you're not getting the image quite right here. It's when we say there's a crown on this virus, here's what that means. Here's what the spiky points means, here's what the receptor binding domain should look like on a virus. I also have three teenagers at home, and I bring that up only to say that, for example, during the pandemic, a lot of times I would try and explain things to them first. If they understood it and even asked a follow up question, then I had a pretty good idea that I was getting across. They're smart, you know, they're engaged. They were thinking a lot about this issue. So I have my own little trial balloons, if you will, that I have with with people in my life. And you were always one of them. Like I said, I'm not just saying it because you're here, but you had such a good way of not only giving us the information, but hey, let me give you the context of what this means as well. It's one thing to say it. It's another thing to really explain what it means. I think you're a good doctor. You do that for your patients all the time. I try and do that for my patients. It's kind of the same thing here.

Carlos del Rio: [00:07:43] I tell people that frequently. I remind myself of the movie Philadelphia, where Tom Hanks is talking about HIV encapses, and Denzel Washington says, explaining to me as if I was a five year old. And frequently that's what you need. You need a very simple explanation of a very complex issue, right

Sanjay Gupta: [00:07:57] Absolutely. And, you know, when people are going through it, when they're living it, they want that explanation. They want that background. And and I know this is something we're going to get to in terms of how to deliver these messages. But there were times when what we were saying on television, the people who were watching and listening, it was the most important thing in their lives. I say this, leaving aside COVID, I say, you know, we'll do an Alzheimer's story one day. For 90% of the audience, they don't really probably care that much, because they don't have any personal connection to it. But for 10% of the audience, it may be the most important story they hear all week. Sometimes it's tough to know who is who in that equation. But with COVID, I think because it was affecting so many people, it was just such an important story. So we had to make sure we could explain it well.

Carlos del Rio: [00:08:49] And I would just remind people also that besides television that you call a very quick media, you and your team do a lot of writing in CNN, and I enjoy reading the pieces that you write. I particularly just remember right now, you know, when you discharge your patient, your patient, COVID. You discharge him home, you know.

Sanjay Gupta: [00:09:05] Yeah. You know, once you're, you know, doctor, being a doctor is my my first and truest love. So I frame a lot of things in that regard. I wrote a series of nine very long form articles, you know, several thousand word articles during the pandemic. And at times the patient, which was the country, my estimation, was in the ICU with unstable, vital signs. And there were times when the patient would go to the floor out of the ICU, but then have to be readmitted to the ICU, and then the public health emergency being over, when that was declared, I said, well, that's in some ways like discharging the patient, but it doesn't mean that the patient is no longer under our care. It just means they may not need the day-to-day care of a hospital anymore. So you know, just how to frame those things I think becomes really important. Frame it in a way that people understand that's relevant to their lives in some way.

Carlos del Rio: [00:09:54] Yeah, I know. I really love how you do that.

Sanjay Gupta: [00:09:56] Thank you.

Carlos del Rio: [00:09:57] The pandemic really led to a better understanding, I think, of what infectious disease specialists and what infectious disease is. But I still think there's a gap. You know, many people still confuse us with epidemiologists. Other think that I work at the CDC... what suggestions do you have for us? Infectious disease physicians and for those of us in IDSA about how to increase our visibility and letting the public know what really infectious disease is.

Sanjay Gupta: [00:10:20] Well, there's a couple things that that come to mind. First of all, I think that there is a gap, but I think that probably more than ever as a result of the last few years, there is a greater understanding of what infectious disease doctors, who they are and what they do and how important that is. Obviously, so many of these issues become politicized, So that's a separate sort of topic. But I think there's obviously been a huge amount of interest in this work. I think that that's no surprise. We've seen that after big motion pictures or great books like Hot Zone and things like that, you'll see this surge in interest in infectious diseases. But going back to the patient physician model, the bottom line that you will give a patient when you meet with them is obviously really important. But how you arrived at that bottom line, the process, and if you want to just extend that metaphor, the scientific process of things is really a fascinating story. A lot of times I think we cut to the chase, if you will. But for me or you to say, hey, look, so the original, I don't have the exact numbers in front of me, but say the original paper from Wuhan said there were 27 patients that tested positive for this virus. But that came from nine households. So what does that mean? Nine households, 27 patients.

Sanjay Gupta: [00:11:40] Oh, and not everybody was sick. So now there's evidence of human-to-human spread from asymptomatic people. So I didn't just say, hey, so this seems to be spreading asymptomatically, you know, blah, blah, blah. I kind of explained to the audience, how do we derive this conclusion? That's an example of trying to dissect a specific paper. But as much as we can, I think in infectious disease world, really, frankly, any kind of world like that, to be able to explain the thinking behind something versus just always cutting to the chase and getting to the bottom line. And the second part of that is, you know, like you said, sometimes there's a confusion between what is an infectious disease specialist versus an epidemiologist. If you were to explain to a teenager what are the real differences here and make sure that they understand it, and then as part of the television appearances, you do the articles, you write the podcasts like this, to be able to work that in there pretty regularly, then I think that that helps, helps a lot. I think sometimes we assume people understand the process. I think we sometimes assume that people understand the differences between these various medical specialties. They don't I mean, people don't know sometimes the difference between a neurosurgeon and a neurologist. I get that all the time. So I'll have to explain to them what that difference is.

Sanjay Gupta: [00:13:01] And I think the same thing here as well. What has surprised me a bit is that increasingly and sadly, I will add, the medical community has been perceived as arrogant. Scientists are increasingly perceived as arrogant. That breaks my heart, frankly. I mean, you're not an arrogant person. I'm not an arrogant person, but that is the perception. But what that manifests as is people may be more reluctant to ask questions, legitimate questions. What is the difference between epidemiologists and infectious disease specialists? Or how did you understand that this was actually spreading asymptomatically? How did you know that? Like those are good questions, but a lot of times they're not asked because I think there's this perception that it's too didactic, it's too hierarchical. I'm going to sound dumb if I ask a question like that. They're going to make fun of me. You know, they're too there's too much arrogance. And I think that's part of it as well. So telling the story of the process, making sure to constantly reinforce these differences between specialties and being super accessible. You're a very accessible guy, and part of it is because no matter what, you always have a demeanor. I know this is a subjective thing, but you have a demeanor that's very approachable, that allows people, gives them permission to ask these questions. And I try and do the same thing and it does make a huge difference.

Carlos del Rio: [00:14:15] Yeah, I think we have to remind people, number one, there's never there's no such thing as a dumb question,

Sanjay Gupta: [00:14:20] Right.

Carlos del Rio: [00:14:21] And number two, the dumb person is the one that doesn't ask the questions.

Sanjay Gupta: [00:14:24] Exactly.

Carlos del Rio: [00:14:24] Because at the end of the day, we all have to ask questions all the time and we all have to be questioning the different things that they as they happen. And I think COVID was a great example of that. I tell people that the most important lessons, the most important three words I learned in COVID is to say, I don't know.

Sanjay Gupta: [00:14:39] Absolutely, which it can be humbling to say that, especially if people are expecting you to know, but it makes a world of difference.

Carlos del Rio: [00:14:45] Solet's move over to COVID. You know, you were incredible throughout the pandemic. You covered it, you reported it. You did a lot of things. But at the end of the day, you also had time to write this book that you wrote about World War Z, which I frankly enjoyed, and I recommend people to read. But let's talk a little bit about what lessons do you get and what you think as medical professionals, you know, as we are emerging from COVID. I mean, I don't think we need to go back to where we were. Where should we go from here? What are the lessons that we need to apply coming out of COVID that you see that we should really work on?

Sanjay Gupta: [00:15:17] There was a lot of remarkable things that happened, obviously over the last three years scientifically with regard to, for example, the vaccines and things like that. But I think, unfortunately, what a lot of people reflect on is the huge divisions that were created around this pandemic as well, politically and otherwise. Part of this does get back to being completely transparent about what we know and what we don't know at any given time. I think there is a tendency sometimes and I get it, this isn't a criticism as much as an observation, but there is a tendency for sometimes for people to make more definitive statements than are warranted at any given time. "This is what's going to happen. The virus will completely go away or it will do something the opposite." The fact that this was a novel virus, people focused on the fact that it was a virus and a coronavirus. But I think the idea that it was novel sometimes got a little bit of short shrift. Human beings, especially adults, we don't experience novelty very often. Kids experience novelty, but adults not so much. When is the last time you experience something for the first time as an adult? It doesn't happen very much. So the idea that we could say, Hey, look, we don't know this. Here's what we do know. Here's what we're willing to say at this point was really important. That was part of that trust. That is really important, I think, in a situation like this and will be important in the future if there's other pandemics. And from everything I hear, and I'm sure you hear that that's that's a high likelihood.

Sanjay Gupta: [00:16:51] The ability for medical professionals to be able to speak that way, I thought was really important. There were some things that were more specific. You know, I was surprised, frankly, both administrations would regularly have COVID briefings coming out of the White House. I think if you're trying to disentangle science and politics, which I think is important, you can't completely disentangle it. I'm not naive to that. But the idea that you would do briefings regularly at the White House, I thought right away made it sort of a political issue. You remember when Tom Frieden was CDC director during Ebola, he would come out in front of the CDC. Richard Besser during swine flu, during H1N1, he would come out in front of the CDC and basically the message was this: Thousands of the smartest and hardest working scientists in the world are in this building behind me. They're working diligently on figuring some of these things out. Here is what we know at this point, and here is what we don't know. That makes a huge difference. The optics of giving the medical and scientific messages from a medical and scientific building, I don't think you can overstate that. I think it's really important to do that. And also, as much as there's pressure from people to be very definitive, this is going to go away or, you know, by March or, you know, July 4th will be back to normal this year, whatever it might be.

Sanjay Gupta: [00:18:12] We said July 4th would be back to normal in 2021. And then Delta. We thought the holidays would be back to normal. And then Omicron. We kept getting surprised over and over again, which should have probably taught an important lesson for those in the medical profession to be very careful when we're dealing with this novel virus, to just say, here's what we can say at this point in time. The other thing, just more broadly, right now, the United States has dozen, maybe, you know, 15 or 16 aircraft carriers that are circumnavigating the globe. They are doing that to keep us safe because there's always these national security threats. We don't hear about most of them because all of this is sort of taking place in the background, you know, trying to keep us safe, gathering intelligence, keeping an eye on things, making sure that we can address problems before they become bigger problems. A virus is a national security threat. I think that it's a different framing of things. But we saw what this tiny little microscopic piece of RNA did to the world. How do we treat that as a national security issue from a policy standpoint? When I really dug into this with people like Robert Kadlec, who was the assistant secretary for preparedness and response, he basically said, look for basically the price of one half of one of those aircraft carriers, we could become essentially more pandemic proof.

Sanjay Gupta: [00:19:37] We could have investigators in the field who are finding viruses of concern. We could right away mechanisms would go into action if there was concerns within particular municipalities or the country, as opposed to having to litigate everything on the fly. If certain things just went into place in the face of a national security threat, people would understand that setting some of those things up. And we had a pandemic response playbook. It came about during the G.W. Bush administration. Getting back to that level of preparation would be really important. We knew we could do it at that point. And I do give President Bush a lot of credit because he read Barry's book, The Great Influenza, and it scared him out of his mind. He talks about this and he said in 2003 or 4 timeframe, he says, we need a pandemic preparedness plan. And his homeland security advisor, Fran Townsend, at the time said, uh Mr. President, we kind of got more important things going on here, like the war on terror. And he said, Yeah, but this is also very important. So how do we get back to that point where we have a true pandemic preparedness plan that allows all these things to just go into effect if we are confronted with a virus like this again

Carlos del Rio: [00:20:49] Yeah and you know, there's clearly this viruses, there's influenza, there's Ebola, there's probably other coronaviruses out there, but there's also other enormous infectious disease or related threats such as antimicrobial resistance and climate change and many things that we need to we need to be talking about. And I think we need to do a better job communicating on these issues to the general public. So how do we do that in an effective way?

Sanjay Gupta: [00:21:11] First of all, there's a lot of interest in those topics. No question. We get good data just working for a large media company in terms of audience's interest and things, and they are interested in climate change. They are interested in the idea that what we're typically thought of as tropical diseases are now finding their way further and further north into, you know, places like New York, places where you wouldn't think about tropical diseases. It's not that there's not a significant amount of interest in that. I want to give the audience a benefit there, but I do think it does somewhat get back to this issue of trust. If the messengers that are talking about, hey, look, we need to be more serious about infringing on animal habitat and here's why we need to be more serious about climate change and here's why. Because we're seeing these warming climates have a real effect on pathogens in areas of the world that we never saw those pathogens before. And explaining it is important. So the interest is there, but the trust has to lead the way when that is established and it has taken a hit. I think there's no question trust in the scientific community overall over these past few years. But when that trust is there, I think people are willing to listen. So there's lots of lessons about storytelling and really making sure people know how to tell these really important stories of the people, but also the process, the scientific process. But trust is the critical tip of the spear when it comes to something like this.

Sanjay Gupta: [00:22:39] I'll give you an example. Like one of the things that came up a lot was why did the United States get hit so hard by this pandemic? There were a lot of reasons, as we say in medicine, that was multifactorial. But one of the things I think that did not get enough attention was that we weren't very healthy to begin with. Wealth does not buy health. And we know this. We've talked about this over and over again, but in real time, we saw the manifestation of that. You were four times as likely to get very sick if you were overweight or obese, whatever it might be. And yet we probably didn't talk about those kinds of things enough. Why not? I mean, we talked about it. I mean, that was a big part of my book, but it wasn't talked about enough because I think issues like that were politicized. You're blaming unhealthy people for getting sick? No, but this is an issue that as medical professionals, we absolutely have to talk about. You know, just like I would with my patient. You can do that if your patient trusts you, if they believe you have their best interests in mind. We will be continuing to talk about these topics that you're raising quite a bit. I mean, there's no question. But making sure that people understand that ultimately their best interests are what we have in mind and that they can trust us, I think is the most important.

Carlos del Rio: [00:23:59] Trust is humility. And it's also compassion. Right? We need to learn, as you say, to be a lot more compassionate in our communication. COVID, as you said, it was people that were sicker. We were sicker as a nation. But also we have increasingly disparities right as a nation. So we have enormous problems with socioeconomic disparities. We call them social determinants of health. But, you know, poverty, lack of housing, transportation, I mean, clearly COVID hit people very differently. If you were, you know, a meatpacking worker than if you were a physician or a lawyer working in a law firm. You know, it was just very different disease.

Sanjay Gupta: [00:24:34] Yeah. And look, I was always struck by the fact that there was a period of time when we could mostly be in our homes doing a lot of our work via Zoom. And there would be someone at my door delivering DoorDash or Uber Eats or an Amazon delivery. I mean, there was this cognitive dissonance going on. I understand it, but the idea that there were people risking their lives in order for others to be able to stay at home and do their Zoom calls, I think was something that was understandably very frustrating. There was a reason that certain populations were hit a lot harder. And you're right, I think most people did not think about the real social determinants of health when it came to COVID. They weren't even collecting data on this for the first several months, trying to understand who was really most vulnerable. I remember there was a few news stories looking at Chicago, looking at Tennessee and saying, Wait a second, why are certain demographics 4 to 5 times more likely to get sick and die of this disease? My question at that point was, why is it nearly a year into the pandemic when we're asking the question for the first time, why haven't we already been collecting some of that data? And now we do. Now I think it's much better. But there was a lot of I guess a lot of information coming very quickly. People felt like they were drinking out of a fire hose. But now that we have had the chance to sort of reflect on some of that, we know that there were certain demographics that were more at risk. That will likely be the case in the future again, and we have to do something about it. A lesson doesn't mean anything unless you act on it, learn from it, and and do something about it.

Carlos del Rio: [00:26:03] Yeah, absolutely. And again, you know, those of us in infectious disease wasn't it wasn't totally surprising, right? I mean, we know HIV. We know a variety of diseases that that disproportionately impact the poor and the and the vulnerable populations. And we have seen this. This wasn't something that should have been totally surprising to any of us. This is what was going to happen with an infectious disease. And and again, it goes back to really trying to improve the health of the nation overall. It's really improving, you know, addressing a lot of those social disparities.

Sanjay Gupta: [00:26:32] Yep and maybe this will be a very important wake up call from that because, as you say, it wasn't shocking news by any means. There's been these social determinants of health. They've played a role in other diseases and infectious but also chronic diseases. But the time frame of what COVID did. If cardiac disease or diabetes or something, you think, okay, over the next 30 years of my life, I'm going to be dealing with this and trying to improve my health? Well, COVID compressed that time frame from decades into months, and that was a bit of a wake up call for people. We saw the manifestation of the impact of those social determinants of health really, really compressed in a short amount of time. It was very illuminating. And frankly, for people not in the medical world, quite shocking to witness.

Carlos del Rio: [00:27:19] Well, listen. I want to thank you for for your time. And I also want to, on behalf of IDSA and all of us, thank you for your work. You represent us as physicians when you're in the news, it's good to have a trusted source and somebody like you who again, studies the subject and really gets into the bottom line and really tries to understand and ask the questions and phones, the right people. I've seen Fauci and other people calling you. We were at Washington one time when you had to run away because Tony was calling you, but you asked the right questions. But also, people in the right places want to communicate with you and trust you. So you have established a great dialogue. And those of us in the Infectious Diseases Society of America are always willing to take your call and always willing to to help in any way we can, because at the end of the day, having a communicator like you really helps us amplify the message we want to give.

Sanjay Gupta: [00:28:06] Well, look, that means so much coming from you of all people. So I really appreciate that. And we're going to keep reporting on these issues. Dr. Del Rio. So if there's things that, you know, antimicrobial resistance, new pathogens, whatever they might be, please know that you can trust us to be very diligent about reporting these stories, very factual. And, you know, keep us in mind. Keep us in your speed dial.

Carlos del Rio: [00:28:30] Absolutely. Well, thank you very much. And looking forward to speaking to you with you again.

Sanjay Gupta: [00:28:35] Okay, I'll see you in the parking lot sometime. [laughs]