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A technician works in the lab at Visby Medical, makers of a new COVID-19 test kit, in San Jose, Calif., Aug. 28, 2020. 

Health

Atul Gawande: With right 'political environment,' US can control the coronavirus

While some advanced economies in Europe and the Americas are struggling mightily with COVID-19, a few notable industrialized societies that could provide a roadmap for the US to improve its capacity to manage the pandemic, says Dr. Atul Gawande.

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In this file photo, a technician works in the lab at Visby Medical, makers of a new COVID-19 test kit, in San Jose, Calif., Aug. 28, 2020. 

Credit:

Nathan Frandino/Reuters

The United States' death toll from the coronavirus has nearly reached 200,000. And as colder weather drives more people indoors, the Northern Hemisphere is also bracing for things to get worse.

In Europe, the United Kingdom's chief scientific adviser, Sir Patrick Vallance, offered a stark warning Monday, saying that his country could see a tenfold increase in cases within a month. He stressed though, that anything is possible with the rapidly spreading coronavirus.

But Dr. Atul Gawande, an author and surgeon at Brigham and Women's Hospital in Boston, says nations such as South Korea have implemented COVID-19 testing and safety procedures that the US could easily emulate.

The World's host Marco Werman spoke with Gawande, who is also a staff writer for The New Yorker, about how the US might get through the pandemic this winter. 

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Marco Werman: Could you explain why South Korea has been so proficient at handling COVID-19?

Atul Gawande: What South Korea did was not just work on approving tests. They also worked on making it easy to stand up testing collection sites and connect them to the labs that had capacity. In Korea, they have 600 free testing sites for a population size of Florida and Texas. And then they connect them to laboratories. They have 118 laboratories, and they will shift that laboratory supply, test kit distribution, and everything else to the laboratories that have the biggest capacity so that you're matching that with that. So it's like the electricity system we have. The national grid is such that with electricity, we don't have blackouts in one city while other cities have excess electricity. We have connections that allow it to be distributed.

There were some innovative tools that South Korea used to achieve that success, right?

The week that they had their first three cases of COVID-19, they had samples from those three patients isolated. They put them into diluted samples that were handed out as plates to laboratories as a kind of blinded test. And in that very first week, labs that could pass the test were approved. They approved 47 labs in that first week. We didn't approve three for almost a month and a half. They made one national number, 1339, and you could be connected and scheduled in a testing center that day. And then you would know that that testing center was being supplied by a lab that had turnaround time that would be within a day or two. We never built that. We have our crazy health care system, which makes it incredibly more complicated. And then we did not have a federal commitment to standing up testing sites in large enough scale that you could assure that testing capacity was there and connected to the labs in an efficient way.

RelatedTo quell COVID-19 outbreak, South Korea bans seating at big cafés

So point to a few specific countries that you think are doing well right now and are in a good position to face the winter.

We've had New Zealand, South Korea, England. All of them are facing some degree of surge, however. And what makes them successful is that they have the political environment that they can respond to those surges. So New Zealand had a recent surge and they were able to ramp up the testing, get people wearing masks, pulled back on opening indoor spaces and get it under control. The patterns of the places are not just that they're staying low and remaining low, it's that they're able to respond when you have outbreaks come.

Dr. Gawande, I'd like to just pull back for kind of a big picture. The ultimate goal of medical care, as you described so eloquently in your book, Being Mortal, is not a good death, but a good life — all the way to the end. How does a pandemic reorient our thinking around that, when we're limited as to how to act on that?

The brightest and most sobering example that we've seen of this — and the most upsetting — has been the ways in which we've taken people who are at our highest risk, the disabled and the elderly, and put them into essentially solitary confinement because of inability early on to keep them safe. My own mother is in a senior living community, where the virus began to spread widely, and you had very high death rates among people that she and I know living in or around her. And it terrified me. The idea that she, at 83, with her share of comorbid conditions, could die from this. Now we know that, seeing people outdoors at a distance, we can get together and make it safe to be together. Second of all, by now, we should have the PPE — the masks, the gowns, the gloves — to make it so people can get together and be with one another.

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How is your mother's health, doctor? And are you planning family gatherings?

Yes, we do it very carefully. And she's not someone who would do well if infected by the coronavirus. And I would fear for that, except for the fact that I feel we are in control because she knows how to wear a mask. We wash hands carefully. I know how to do it. The people around her do. And she's now formed a pod with her group of friends where they together are able to be social, enjoy life, and be together while living through this extraordinary time.

So holiday gathering outside — only, with the firepit?

Oh, yes. Looking ahead to Thanksgiving or Christmas, I don't think they will be like any other. And yet I do believe we can figure out how to make it so we will see one another. We will be able to be [together], between masks and testing. And I'm a believer that we can also get tests for one another before we get together for the holidays, and we should have the capacity to make that possible.

This interview has been lightly edited and condensed for clarity. 

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