Learning Curve

Michael Caputo: Hello, and welcome to Learning Curve. I'm Michael Caputo, the Assistant Secretary for Public Affairs of the United States Department of Health and Human Services. Learning Curve is a podcast that I try to do every week. I'm bringing the American people along on my learning curve as I learn from the smartest people in the world about United States healthcare in the time of a pandemic. I came along here now three months ago, I'm not so new anymore but I -- everything I had learned, everything I know about public health I learned from the media, and unfortunately, it's not a very good source. But nowadays, now that I'm in the employ of the United States government, I'm learning from the smartest people in public health. I've had guests on here from across our department, all people that you've seen on television that I actually get to talk to and learn things from, important things, every single day. It's such an advantage. It's such a blessing to me, to be able to understand not just our public health system and healthcare from the smartest people in America on the topic, but now in the middle of a pandemic, in the middle of the coronavirus, you know, my responsibility is to put the experts out there. And one of the ways I wanted to do it was on a podcast. Here on Learning Curve, one by one I'm bringing America's public health system experts for you to learn from.

Today I have Dr. Jerome Adams who is the Surgeon General of the United States -- the 20th surgeon general of the United States. Dr. Adams, thanks a lot for coming on.

Jerome Adams: Well, it's really great to be here with you Michael and I appreciate the opportunity to have a conversation in this format. You know, usually we're only allowed to speak in tweets and in sound bites, so it's good to have a little bit of a longer format to be able to talk about some of these complicated issues.

MC: And you know, it's complex because you're out there -- you're America's doctor, and we don't say that tongue-in-cheek. It's true. Your job is to be the doctor to the United States of America.

JA: Yes.

MC: That's your job. But you know, we've seen -- I'm old enough to remember C. Everett Koop as the Surgeon General. There've been several since then, multiple -- I think I'm really old. But when I saw C. Everett Koop as a young man, I didn't know what the Surgeon General was. And in fact, you're a vice admiral, aren't you?

JA: Exactly. I tell folks there are two main jobs that I have. One that everyone knows about is being the nation's doctor, the guy who's on the side of the cigarette boxes; the guy who's out there -- or female -- who's out there telling you what you need to do to live your longest and healthiest life. But the other role, the one that people don’t know about that actually predates the nation's doctor role, is as the head of the United States Public Health Service Commissioned Corps. So there's eight uniform services now that you have Space Force.

MC: Right.

JA: Army, Navy, Air Force, Marines, And Coast Guard are the ones most people would get on Jeopardy. The other ones are the National Oceanic and Atmospheric Administration, or NOAA, the newly formed Space Force, and the United States Public Health Service. And our service is the one -- the only one that's dedicated to protecting and promoting America's health. We deploy during natural disasters. We helped respond to 9/11, to the shootings in Las Vegas, to the hurricane that hit our country a few years ago. We had people at Katrina and on the ground in Ebola. And I couldn't be more proud than to serve as the head of this uniformed service, particularly at a time when public health really is in the spotlight, albeit for tragic and unfortunate reasons.

MC: You know, the United States Public Health Service Commissioned Corps, it's been around for a while. I had no idea. When I came here -- actually, you won't remember this, but my first day, my first moment in the building here in Washington, D.C. I got on an elevator and you got on with me. You probably don’t remember that at all, but I recognized you from the coronavirus task force press conferences and you welcomed me like I was, you know, just another member of the Commissioned Corps. You guys have been around for a while, haven't you?

JA: We absolutely have. We got started way back with the second president of the United States, John Adams. You mentioned I'm the 20th Surgeon General. It really is something people don't understand when you tell them that, hey, in that time there have been twice as many presidents of the United States as there have been confirmed United States Surgeons General. So the mission goes back a long ways. I never thought that I'd be dealing with some of the same issues that my predecessors over a hundred years ago were dealing with, when you talk about measles, when you talk about some of these infectious diseases. But I think it's important to use this opportunity, this unique opportunity that we have to impress upon people the importance and the relevance of tried and true public health practices like washing your hands, like getting vaccinated, like staying home if you're sick. These are things that would protect you 100, 150 years ago, and they're things that will protect you today.

MC: It's interesting. So what is the Surgeon General's job? I'm not asking what you do every day because I think we all see what you do every day. What is the actual job of the Surgeon General, besides being the commander of the Commissioned Corps?

JA: Well you said "besides --"

MC: I know, it's a lot. [laughs]

JA: It's still pretty cool to be a vice admiral, but it's also a pretty intense job in and of itself. I'm the head of a 6,000-person uniformed service. I'm essentially the chief operating officer of a 6,000-person company and we've got people all over the world, literally all over the world. Most of our folks really help serve the underserved. They work in Indian health services facilities, in the Bureau of Prisons; they work in places where a lot of other folks won't go to. So it's why I'm really proud that that is a big part of what I do.

In the midst of the COVID epidemic, we help stand up testing sites in communities that were particularly hard-hit -- communities that had a high CDC social vulnerability index, meaning that they had high degrees of people who were living in poverty, people who had racial and economic risk factors, and so that is an important part of it. But again, to the nation's doctor role, it really is my job to try to help cut through the noise out there; to help people understand, look, cigarette smoking is bad for you because once upon a time, we didn't know cigarette smoking was bad for you and we actually gave people cigarettes as medical treatments. It's to help people understand that look --

MC: When I went in the army, they gave us little packs of cigarettes in our meals.

JA: Exactly. And you know, that's an important anecdote in the midst of COVID also, because one of the things we talk a lot about in the midst of COVID is confusing or changing recommendations.

MC: Right.

JA: As an example, originally we thought based on everything we knew about coronaviruses, that COVID-19 would have very little asymptomatic spread and so we recommended against people wearing face coverings if you were part of the general public and you weren't sick. We have then learned that 40 to 50 percent of spread can be asymptomatic, and so we changed our recommendations. Again, looking at cigarettes, once upon a time we thought they were a medication for certain diseases. We learned more, and so we changed our recommendations.

And it's important for people to know that's how science works and you want your health professionals to give you the best advice they can at the time, but you also want them to keep digging, keep doing the research, keep collecting the data, and then to have the humility, the courage to be able to say, "Okay, what we knew a few years ago or a few months ago or a few weeks ago has changed. Here are our best recommendations now." And so that's what I do as Surgeon General, is give people the best recommendations from the data that we have to help them understand how to live a long and healthy life. Distill down a lot of that noise out there about what's good for you to eat, how much you should be exercising, what things you should avoid like cigarettes, what things that you should try to take in more of like leafy green vegetables.

MC: So I remember, because I was sitting on the edge of my couch in a little village outside of Buffalo, New York watching you and your colleagues at the task force press conference afterward wondering how to keep my family safe. You know, I have been, well, overseas through a viral outbreak and it was frightening to me to see what's going on. And so I locked my family down right away, and even before anybody else was, you know, giving the order. And being in New York we were watching Governor Cuomo as well as watching you. We were watching our county executive as well. They were really sifting through a lot of information. So at the time it was -- you know, this is not the kind of situation where a mask can be helpful. But now we know that they can. So, it's because of the asymptomatic spread? Is that what it is? You want to wear a mask because even people that don't look sick, don't feel sick, can spread the virus -- is that it?

JA: That is exactly it. We've always said from a medical point of view that if you were sick and you know you were sick, you should stay home. But if you have to go out around other people and you know you're sick, that you should wear a mask to prevent yourself from spreading or minimize the chance you'll spread disease. We've always said that. We've looked at other coronaviruses like MERS, like SARS, like the common cold, and very few people spread those if they don’t have symptoms, so they know that they're sick. And we thought that COVID was going to behave the same. What we've found out is that a high degree of COVID is spread by people who don't know they have it. They can't even acknowledge themselves that, "Hey, I'm sick so I should stay home, or I should wear a face covering." And so now, the safest thing for everyone to do is to wear a face covering and we've seen in studies that if everyone wears a face covering, you can significantly lower the spread of this disease. I know it's an inconvenience, but one of the things I've consistently said to people is it's a small inconvenience that can provide many larger conveniences for you. If we lower the spread of disease, our schools will be open, our churches will be open, our jobs will be open. We'll actually have more freedom because we are willing to take on this small inconvenience.

MC: And it's really and individual responsibility, isn't it? You know, I went back to Buffalo this weekend for the Independence Day weekend, and you know, people who are friends of mine, they're like, "I'm not wearing a mask. I don't care what you do." And I said back to them, "Look, I love you. You're my old friend. But if you're not wearing a mask, you're not coming around my family." And you know, because my family, we stick together, we're you know, but -- you know, when your family is a unit, is together in the house, you don't need to wear a mask around your family.

JA: No, no.

MC: But when you go out among other people, that's when it's your individual responsibility because in fact, the responsibility to stop COVID is an individual responsibility.

JA: Oh, it absolutely is. We can have all the guidelines, we can have all the mandates in the world, quite frankly, but it still comes down to individuals making the decision to do the right thing. And so, it's interesting because that brings us back full circle to your conversation about what the Surgeon General's job is.

MC: Right.

JA: It's really about health communication. Health communication can be quite complex at times, especially when you're in the midst of a new and novel disease like the coronavirus that's embedded in an incredibly political situation. I mean, folks forget that -- and it's amazing to say folks forget this, but as coronavirus was starting to appear on the scene, we were in the midst of an impeachment trial.

MC: Yes, right.

JA: And we are now in full swing in terms of an election year. And so you have all these complicated elements and you're trying to give people a very clear and succinct information, but at the end of the day, when it comes to wearing a face covering, I feel like we -- and I say "we" thinking very much about myself -- need to continue to improve our messaging to help people understand why they should wear a face covering, why they should practice social distancing, because I feel like even beyond a mandate, because if you do a mandate people will only participate when someone's watching.

MC: Right, right.

JA: If you want people to do the right thing all the time, you've got to help them understand why they're doing it. You've got to help them understand how they will benefit. And one of the things I've said to folks is if you want college football in the fall, wear a face covering. If you want to have prom next year, wear a face covering. These are the benefits --

MC: Wear a face covering now.

JA: Now, exactly. Wear it now so we can slow down disease spread. These are the benefits that will accrue to us if we all do the right thing. So when a person says, "I'm not going to wear a face covering," you know, my question is, "Well, why not?" And for some people, they've heard misinformation out there about face coverings making it difficult for them to breathe or hurting their oxygenation. I'm an anesthesiologist. I wear a face mask all day long -- 12, 14 hours a day, and I'm just fine. And so do all of my colleagues out there, tens of thousands of doctors and nurses all across the country.

So I want America to know wearing a face covering is safe. Some people won't wear it because again, as you say, they've got a strong libertarian streak and say, "I get to choose what I want." And I say, "Okay, you do. That's fine." But I want you to understand that if you don't choose to do this small thing, you're going to lose many greater liberties in the long run. And so, trying to reach people where they are is one of my tenets, and I've found that when you do that -- when you approach people with some degree of empathy and you ask them what they want to get out of a situation, and you try to help them reach their goals instead of just browbeating them, that you usually have more success.

MC: That's true. You know, I tell my kids -- we live across the street from the little Catholic school that they go to. And when we got locked down, they closed down the school. They would look -- we would sit on the front porch and they would look across the street to their school and not understand. They did not understand. My girls are five -- well now six, seven, and 18. My 18-year-old, she understood. But my six- and seven-year-old didn't understand, and I told them that, you know, tried to explain to them what was going on with the virus. And then of course, the president called me, and I got pulled to Washington, and I'm here and I didn't get it. I didn't understand that in the end, if you don't wear a mask, that's school's not going to open back up again.

JA: Exactly.

MC: And if you don't wear a mask, you're not going to be able to go to a music festival in the future. Not if you don't wear a mask, you're not going to a music festival now. If you don't wear a mask now, you're not going to a music festival in October. You're not going to an NFL game in November if you don't wear a mask right now.

JA: Exactly. Public health, you know, is simple, tried-and-true. At the same time it's also incredibly complex.

MC: It is.

JA: It's incredibly complex because human nature is to be reactive and not proactive. You wait until the car tire's flat before you acknowledge it needed some air. You wait until you're on the side of the road and the engine's overheated before you decide to put some water in the radiator or to check the oil. And so we've always had a hard time getting people to take the time and the energy and utilize the resources to prevent something bad from happening, and then we always overspend on the back-end to respond to something bad that's happening. And so it's important that we take a step back and we realize that about folks, but then we also again, speak to them in a way that helps them understand here's the immediate, the short-term, and the long-term benefits I will get. And there are immediate, short-term, and long-term benefits people will get from wearing a face covering and from listening to their public health officials.

MC: And when we look at how COVID has hit America, every city's different. We see some cities now where the cases are going up; other cases where it's leveling off. We see a lot of damage to the people who live in the inner city too. What about the disparities of COVID, how it treats individual human beings differently?

JA: Well, it is again one of the places where COVID has been incredibly tricky. We see the flu hit young people particularly hard. COVID hits older people much harder than it hits younger people. We've seen that COVID particularly preys on people who have chronic medical conditions like heart disease, like diabetes, like obesity, and so we've particularly warned those folks. But one of the things that's most shocking and troubling to me is how hard COVID has hit communities of color.

MC: Right.

JA: Native American and Alaskan natives and our Black and African American folks out there have hospitalization rates that are five times Whites.

MC: Five times?

JA: Five times. Five times. Hispanic Americans about four times Whites. And there're many reasons for this. Number one: we know that those groups tend to have more of the chronic and underlying medical conditions that exist in our communities, but number two: we know that many times, people of color are not in the same positions to act on health information as other folks are.

MC: It's an income disparity?

JA: It's income disparity, there's opportunity disparities. I'll give you a concrete example. One of the things we tell people to do to protect themselves from COVID is to try to telework if you can. Well only one in five African Americans and one in six Hispanics has a job that allows them to telework. And we know that people of color particularly in the inner city setting tend to take public transportation more often, and that puts you at higher risk. These are what we call the social determinates of health; the things that give you opportunities to live a long and healthy life. I'm a big believer in personal responsibility Michael, but I also believe the choices you make are 100 percent dependent on the choices you have in front of you.

And the fact is, a lot of people out there for an array of reasons don't have equitable choices in front of them and equitable opportunities to make a healthy decision. We see that play out in COVID just as we've seen it play out in cancer rates, in diabetes rates, and other diseases for years to come. And what I hope is that this recognition in the midst of COVID of the disparate impact that it's having on communities of color will really cause us as a society to take action and to deal with some of these deep, systemic, long-term issues that exist in our society that put people at risk.

And my true hope -- and sometimes people tell me that I am fatally optimistic [laughs] in terms of, you know, people attack me for being too optimistic -- but I really hope that in the long run, 20 years down the road, 10 years down the road, we'll look back and say hey, it was a terrible and tragic time, but it was also a time when we finally decided to tackle some of these tough issues and that in the long run, that hopefully we've been able to change things for the better.

MC: I'm talking to Dr. Jerome Adams, who's the Surgeon General of the United States; a vice admiral in the U.S. Public Health Service Commissioned Corps. I got to tell you doc, I'm -- myself? I didn't really understand healthcare disparities. I didn't know. When I came here I didn't understand that people who couldn't afford healthy organic food were eating more food -- eating the kind of food that made them fat, and I guess I probably understood it but I didn't really know that these people would be then much more susceptible to something as dangerous as the coronavirus.

JA: Oh, absolutely. And one of the things that I'm working on as Surgeon General is a Community Health and Economic Prosperity Report. A Surgeon General's report on the very topic of the intersection between health and our economy because we know that if we don't pay attention to the folks in our communities who don't have opportunities for health, it doesn't just affect them or their families, you actually see factories unable to open because they don't have healthy workers, or they're less productive, or they have higher workers' compensation payouts because they have more workplace accidents. The number two expense for most fortune 500 companies is healthcare.

MC: Right.

JA: And we aren't going to be able to bend those curves unless we look at things like providing green spaces for people to exercise; ways to provide fresh fruits and vegetables at an affordable cost in communities.

MC: In the inner city where they're getting a lot of their food from small markets --

JA: Exactly.

MC: -- that don't even have a supply of fresh vegetables.

JA: Exactly. And the good news is that there are many different organizations and groups and programs such as Blue Zones and Purpose Built Communities. These examples and more will be detailed in my report so I tell folks to stay tuned; it should be coming out later this summer. But, really important for people to understand that there are improvement interventions out there to lift up the community's health and therefore lift up individuals' health, particularly those who are hit by disparities, and that that will not just help their health but it will help them and their economies become more economically profitable. We've seen this in COVID. When you have a health problem that impacts the entire community, it can shut down the entire community.

MC: That's no doubt. But the one thing that we've know, and this has been going on now for several months, and it's really changed a lot. We actually know more about the virus and now we have more therapies, more if you would, treatments for COVID. We started out with, you know, a lot of talk about hydroxychloroquine, we moved on to Remdesivir, we now know that there are some pretty common steroids that help people recover. And we have this plasma solution, convalescent plasma, and others. These are unfolding as we come along. We are now several months into COVID, and there's actually hope.

JA: Well -- and I'm so glad that you went there Michael, because it is easy to get caught up in the doom and the gloom --

MC: Negativity.

JA: -- and the hopelessness and the negativity. No it doesn't mean that we are poo-pooing or downplaying the severity of the disease. We can both acknowledge that this is a severe and deadly disease and a once-in-a-century pandemic, and also acknowledge that there is hope and that we have made progress. And to your point, we have better knowledge than what we had a few months ago about who the disease is impacting and about how to treat people when they're in the hospital. We have more resources available. We know that we significantly increased the supply of personal protective equipment that's available. We're closer than ever to a vaccine that's being developed at a record pace. We have therapies and all this has resulted in the fact that while we're seeing cases increase -- and that is tragic; I am not diminishing that -- that the number of people dying is not nearly what it was for the same number of cases four months ago and that's because we are in a better place to respond. So, we need to acknowledge that and continue to figure out how we better treat the disease, but we also need to focus on again, upstream prevention of disease with those tried-and-true public health measures that will slow the spread.

MC: And one of the therapies is hope.

JA: Exactly.

MC: I mean, it is! The fact of the matter is the vast majority of the people that get this virus don't have -- they're not going to die. Many of them won't even go to the hospital. And we saw, I guess, the president this weekend in a speech at Mount Rushmore -- no, no, in his July 4th speech, he said, "99 percent of the people who get this virus are going to be just fine." And the media went nuts. They went nuts. And the fact of the matter is, if you look at the way that the numbers are moving, in the end, the vast majority of the American people, the vast majority of the sufferers of COVID, are going to be just fine. And the -- I watched as, you know, you got hammered over the weekend by the media. Dr. Stephen Hahn of the FDA got hammered over the weekend by the media. You know, the president isn't a scientist, but he's not all that wrong, is he?

JA: Well, when I go to give someone advice in the hospital on which medication they should take or which cancer treatment I advise, I don't frame it through the context of, "Well, the president said."

MC: Right.

JA: I say, "Here's what I think as a physician." And so, you know, to answer your question, I would say here's what I think as a physician. I think it's important that people know that the death rate from COVID globally now is less than one percent, which means that 99 percent of people who get it actually do not die from it, they live. That is important for people to know. It's also important for people to know that if you get it, that doesn't mean that you're out of the woods if you're not in one of those at-risk categories. You can still go on to spread the disease. Five to 10 percent of the people who get it do become hospitalized. Some have to go on a ventilator, and there can be long-term consequences from getting the disease. We don't want people to think that just because you're not going to die from it that you should go out and go to the bar and have a COVID party like some of these folks are doing. And so, both of those two statistics are true statistics. 99 percent of people who get it live, but a significant number of people who get it go on to have complications from it. And so, we need to help people understand the nuance that exists there, and resist the temptation in the media to try to make something all or none, and to try to make it into a tweet or a sound bite, because that's not doing a service to the American people.

MC: It isn't, and you know, I saw on television this weekend, I was helping you get into the TV this weekend because the messages you were delivering this weekend were vital -- I mean, lifesaving in many ways -- that you know, socially distance. If you can't socially distance, wear a mask. And you know, keep your hands clean. Pretty simple stuff. But you were out there traveling the country. I mean, you were all over Georgia telling people. You were in some hotspots telling folks this is how you avoid it -- pretty simple.

JA: Well, we were in Philadelphia, we were in Georgia, and as you mention, we were in hotspots putting my own personal health at risk by traveling but doing it because my job is an essential job. It's essential to help people understand. If we can help one person do the right thing, that's one less person who's going to spread the disease and one less person who may end up having complications or dying. My advice is really simple; my Surgeon General's prescription is number one, know your risk. Know if you're in a higher risk category due to chronic medical conditions like diabetes, obesity, high blood pressure. Number two, know your circumstances. Am I in a community where spread is going up or down? Am I going to a place where I can be outside which is lower risk than inside? Am I going to a place where I can social distance or where social distancing is going to be difficult? And then number three, know how to stay safe. If you are in a high-risk circumstance or you are high-risk, then the thing to do to stay safe is to stay at home.

MC: Right.

JA: If you aren't in one of those high-risk groups or for some other reason you decide to go out because we know that some people again, frontline workers, don't have that option, still have to go out -- then it's important that you take the measures that we've been recommending: social distance, stay at least six feet apart when you can, wear a face covering, practice good hand hygiene. If we think through these three steps -- know your risk, know your circumstances, know how to stay safe -- that will help us all make intelligent and informed decisions about when to go out, when to stay home, and how to slow the spread when we do go out.

MC: It's interesting, you know, I think your job -- you didn't know what you were in for when you took this. You were head of the State Health Organization in Indiana, you came along to be Surgeon General, and you just got hit. I mean, your job is much more difficult than you would ever have expected, isn't it?

JA: Well, it's been incredibly difficult unfortunately. Throughout my career infectious diseases have followed me and plagued me. My second day on the job as the State Health Commissioner of Indiana I had to stand next to the governor and explain to them what this Ebola thing was and how we were going to keep them safe. And then we had Zika occur; we also had an HIV outbreak that occurred. And so while I certainly didn't expect a once-in-a-century pandemic, I'd kind of been groomed for the fact that you can't run away from infectious diseases.

So all you kids out there, pay attention in your biology class because there's some valuable information in there for all of us, and no matter how much you want to close your eyes and your ears to it, it's going to come back for you at some point one way or the other. And really that's what this is all about. All of us having a basic level of understanding about the spread of infectious disease; all of us taking basic precautions and public health measures -- we have the power to stop COVID. COVID stops with me.

MC: Hashtag.

JA: Hashtag. COVID stops with you. You know, and we want people to understand that. Again, we talked about optimism and we talked about pessimism. Things can get bad really quickly, and the media loves to talk about how quickly things can get bad, but it's important for people to know that things can improve really quickly too.

MC: They can.

JA: They can improve in a matter of weeks if we all take the measures that we know are effective. We can see a turnaround in just two to three weeks. Things can be drastically different in August, in September, if we all do our part.

MC: That's true, and you know, we're looking at the NFL. I mean sure, the players want to play, the owners want to make their money; but the concessionaires want to work. The people who keep the stadium, they want to work. The people who work in the basketball arenas, they want to work. That's how they support their family. The people who work in the major league baseball parks, they want to work. And if we don't wear masks, keep our hands clean, stay socially distanced, not only are we not going to be able to attend these things that we really like -- I mean, as the American society, we deserve these things. We deserve to be able to enjoy our sports and our dance clubs and things like that. We live free lives as free Americans.

JA: And we'll suffer --

MC: But if we don't follow these simple guidelines, we're not going to be able to do any of those things.

JA: Well, and we'll suffer in an array of ways. There was an article that just came out recently talking about from HIV and malaria and tuberculosis, you're going to see over a million people die because of the COVID shutdown. We know that elective surgeries had been pulled down for a while and they're being pulled down in many cases. My wife finished cancer treatment and she's doing well, knock on wood, after her cancer treatment. But if her diagnosis had been delayed by six months, I might be telling you a very different story right now. We have 4.2 million children in this country who have missed their vaccinations because of COVID-19, so I say that again because I want people to know that it's about getting back to football, it's about you know, going back to restaurants and bars, it's also about making sure more people don't die from the fact that we have to shut down and that they're not going in and getting prenatal care as die from the disease. We need to understand that there will be larger term negative impacts if we don't control the spread of this disease. But if we do control the spread of this disease, then we can really help out in more ways than just the direct impacts of preventing the spread of COVID.

MC: It's tough being the Surgeon General of the United States during a pandemic, isn't it?

JA: Well, it's tough too -- you mentioned your kids -- a lot of people don't know that I am the first Surgeon General in anyone's recent memory to actually have school-aged kids.

MC: [affirmative] You're a lot younger than me.

JA: So, I have a 16-, a 14-, and a 10-year-old and you know, they keep me honest. When we're out there talking about things like vaping, when we're out there talking about vaccinations, when we're looking at the impact of the shutdown due to COVID on schools. You talk about the summer slide, you've got the COVID slide superimposed on top of it, and I really worry about the long-term impact on our youth from being shut down. All these things that are things that I'm thinking about not just as a health professional but as a dad whose kids are at home having to deal with this on a very personal level.

MC: It's something. I was at home this weekend in a little village outside of Buffalo, and I went to my barber to get a haircut. I said I'm not going to get my haircut by anybody I don't know. I go in there, he's all got the drapes hanging, they're all masked up, they all have their gloves, they're following the guidelines to a T. I sat there, I took off my mask because everybody else in the place is masked, right? So you're safe. I took off my mask for my haircut, I don't have much hair anyway, so it was quick. I jumped up, put on my mask, and my barber said to a little boy sitting in the chair, "All right son, come on over." And I watched as the young boy and his mother walked over to the chair, and he was really upset. He sat down and I was talking to the barber's wife who runs the shop, and she said, "He's not afraid of getting a haircut. Watch." And he said, "Okay son, take off your mask. I'll be happy to cut your hair." The boy had this superhero mask on, but it was you know, two ties in the back, couldn't cut his hair that way. Really good-looking mask. And he sat there, he shook his head no. Perfectly happy to go sit in that chair and get the scissors running around his ears, right? Didn't want to take off his mask.

JA: Wow.

MC: And his mom said, "Honey, you can take it off if you want. I have this little mask here you can put on, and you can still get your hair cut." And he shook his head no, and his eyes started welling up. I just started getting upset, and I looked at the boy and I said, "Young man, I am the Assistant Secretary of the United States Department of Health and Human Services, and I am here to tell you two things: number one, you can take off your mask, you're perfectly safe; number two, I want to look at that mask, that's pretty cool." So he looks at me, and his mom looked at me, she recognized me from the village we live in and she said, "He is. He's the Assistant Secretary of Health." I didn't tell her I was a PR guy, right? But he took off his mask and he handed it to me, and he got his hair cut.

Dr. Adams, these kids are scared. And how is he going to grow up? I got to tell you, there's a lot more to this tail wagging behind the dog. We know that the people are -- 90 percent of the cancer screenings dropped, you know? People out there, probably a half a million people have cancer we don't even know it. We were talking a moment ago, a million people could die because of healthcare issues that have nothing to do with COVID because they didn't go get checked. But that little boy is scared out of his wits. It's an awful situation, isn't it?

JA: It really is. We worry about the mental health impacts of the shutdown and of the pandemic, and just really quickly I would tell folks if you need help or you need someone to talk to, call 1-800-662-HELP. That's SAMHSA's distress line; and they can direct you to resources or folks to talk to. But what's interesting is you've got the fear of the pandemic and you also have the reality that everything that we tell people to do from a mental health standpoint to promote your mental health is everything we tell them not to do because of COVID-19.

MC: You're right, you're right. Going to meetings if you're a substance abuser -- they can't do it. I mean now they're going back a bit and they're socially distanced. It's a terrible situation.

JA: Well, and I think about my own brother who has substance use disorder, and I've talked about his situation very publicly. There's so many folks out there who are struggling, they're trying. From an HHS perspective, the epidemic we were dealing with prior to COVID was the opioid epidemic. And we were making success; we saw overdose rates level off and start to go down for the first time in quite a while. We had over a million people who were getting medication-assisted treatment. We were making progress, and a lot of that progress has been stalled or is going backwards because of COVID, and so if you're someone out there with substance use disorder, I would say please go to SAMHSA's website, S-A-M-H-S-A, or to the HHS website, or go to the Surgeon General's website surgeongeneral.gov. We have connections to resources out there. There are many different opportunities. One of the nice things that's come out of this is the increase of telehealth availability.

MC: Right.

JA: And the lowering of regulations that make it easier for people to be able to access services and medications that they need to get through this difficult time. So again, it's making sure we understand the unique difficulties that this situation presents to certain groups and meet those needs, but it also increases the imperative for us to take preventive actions and slow the spread so that we can get back to normal, because at some point again, you can't put enough air into a flat tire.

MC: You're right. You're right.

JA: And so, we've got to do both, and I'm convinced that we can do both. Again, I'm really going to continue to focus on our COVID stops with me campaign. We're glad to see the NBA has tweeted it out. There've been several NFL groups that have tweeted it out, other people -- I think it resonates with them because people at a time like this really do want to know from a control point of view, "What can I do?" There are things that you can do to slow the spread and if you do it, and I do it, and our neighbors do it, then that effect adds up. And again, we can turn things around very quickly.

MC: Really, we all look for leadership during a crisis like this. The Surgeon General is an important leader. Every single one of our public health officials are important leaders. But the real leader who's going to get us out of this mess is the person, the individual. In fact, COVID does stop with me. It does. And there's a lot of hope we have: therapies that are going to get people well, we are identifying the virus in people and catching it in time, we know how to get through all of this, but we can't without the individual understanding that they have responsibilities.

JA: Well, and one of those responsibilities is to go to coronavirus.gov and I say to go there because again, personal responsibility also depends on having options available to you. Just as we've had a pandemic of virus, we have a pandemic of misinformation out there. But, if you go to coronavirus.gov, you'll find out all the resources, all the advice, all the guidance we've made available, so that you can make better choices, healthier choices. COVID does stop with you, but I want people to know that we are making sure we're providing the knowledge, the resources to help you make a better decision, to help you make a healthier decision, so that you can stop COVID in your communities.

MC: Ladies and gentlemen, that is our Surgeon General, the Surgeon General of the United States. Dr. Jerome Adams, originally from Maryland comes to us by way of Indiana, helping us lead the way out of the woods we call the coronavirus. Thanks a lot, Dr. Adams, for joining us here on Learning Curve.

JA: Michael, thank you for having me. It has been a true pleasure, and I hope we can have a conversation again in the future, after COVID, about what comes next, because that's the question that's still out there is, "What are we going to do to recover?" But again, you have the power. You have the power, each and every one of you, to stop COVID. Please work with us; do your part. I am optimistic. I am optimistic because I know that when you look back at history, Americans have done the right thing. They have come together in times of crisis, and I'm going to keep working as your Surgeon General to make sure you have the knowledge and the tools to do the right things. If you come along beside me, we can lower spread, we can lower lives lost, we can get back to some sense of normalcy sooner. And again, looking back 10, 20 years from now, I hope we'll be able to say this was a turning point for us and we actually changed the trajectory in a number of different areas to make our country safer and healthier in the long run.

MC: Thanks a lot for listening to Learning Curve today, ladies and gentlemen. I'm Michael Caputo, Assistant Secretary for Public Affairs of the United States Department of Health and Human Services. You've been listening to Dr. Jerome Adams, the Surgeon General of the United States, and we'll catch you next week. Stay well.

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