'A Fuse Has Been Lit': Dr Jerome Adams on Racism and Civil Unrest

John Whyte, MD, MPH; Vice Admiral Jerome M. Adams, MD, MPH

Disclosures

June 05, 2020

Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

  • SARS-CoV-2 has truly proven itself to be a novel virus and has caused a lot of confusion. We need to approach this pandemic with a degree of humility and the understanding that what we think we know today may not be true a week from now.

  • Know the trusted resources for information, such as coronavirus.gov, which is updated daily, and state and local health department websites.

  • People who experience individual and structural racism can internalize pain and stress for only so long before it's expressed in negative ways. It is incumbent upon the leaders of this country to provide a way for people to feel heard.

  • A potential unintended consequence of the recent civil unrest is spread of COVID-19 in communities that are already more vulnerable to this virus. Protesters should consider getting tested for COVID-19.

This transcript has been edited for clarity.

John Whyte, MD, MPH: You're watching Coronavirus in Context. I'm Dr John Whyte, chief medical officer at WebMD. I've been interviewing people for the past few months, experts to help us put coronavirus in context. My first guest joined me 3 months ago; it was Dr Jerome Adams, the United States Surgeon General. Today is our 100th episode, so I've asked Dr Adams to come back to join us and tell us how we're doing, as well as to answer questions about what the next few months might look like. Dr Adams, thanks for joining me.

Vice Admiral Jerome M. Adams, MD, MPH: Thank you, John. It's amazing how much the world has changed, how much our knowledge has changed, how different of a place we are in now [compared with] just 3 short months ago. I think people often lose sight of the fact that 3 months ago we knew almost nothing about this disease. And it's hard to appreciate—even as we learn more each day—how much further along we are in terms of being able to respond to it.

Whyte: What do you think the biggest learning has been?

Adams: It's hard to put your finger on one thing. I think the biggest thing that I've learned is how much we don't know. We call it a novel coronavirus, and it truly has proven itself to be novel, even among prior coronaviruses. One of the big things that we've learned that has impacted a lot of our policies and caused a lot of confusion in recommendations is the high degree of asymptomatic spread that you have with SARS-CoV-2.

It might have affected everything from our recommendations on face coverings to whom we choose to protect, and decisions about whether people decide to go out and reopen, and contact tracing. I think we really have to continue to approach this with a high degree of humility and understand that what we think we know today may not be [the basis for] what we're recommending a week from now or a month from now.

Whyte: And we have to be flexible. I think sometimes the public sees it as confusion, but it's really a reflection of how most data aren't black and white. It's gray. And often we'll have to make changes based on [new] information, so that might impact the role of facial masks or gloves or other aspects of public health initiatives. Would you agree with that as well?

Adams: I would absolutely agree. And it underscores the importance of knowing the trusted resources that you can go to for information. Coronavirus.gov is a website that's run by the CDC. I would recommend people go there frequently because the information is updated on a daily basis. Your state and local health department websites have up-to-date information about what is going on in your city and what the policies and recommendations are.

I would also beg the public to have patience and understand that we're out there trying to give the best possible advice today based on the information we have today. We are also approaching this with our own humility and recognizing that if the circumstances, the data, or the information changes, we need to change those recommendations. It doesn't mean that someone did something wrong a week ago or a month ago; it means that that was the best advice then and the information has changed, so we're revising our recommendations now.

Whyte: Absolutely. And we've talked about how important it is to go to reputable sites to get information, to check the credibility of the people who are writing it. You've expressed your frustration about seeing elements in social media about this idea early on that people of color could not catch COVID-19. It probably caused some challenges and problems for people.

Adams: Absolutely. With a pandemic of virus, we also have a pandemic of misinformation out there. There is some confusion, which you can understand, based on how tricky this virus has been. But there's also confusion that has intentionally been infused into the discussion. One of the things that we talked to the promotores in the Hispanic community about was how to recognize fraudulent companies and the fact that people are preying on individuals now because of fear of coronavirus.

Again, it's important that people have those trusted sources of information. People are also scared, and they're looking for answers. They're looking for medications. They're looking for treatments. They're looking for things that will ultimately protect them from the disease, in their minds. But it's important that if you listen to advice, that you're listening to trusted advice and that you're not doing something that you haven't discussed with your healthcare provider.

Whyte: Let's talk about what's happening in the world today. COVID-19 has been pushed a little off to the side, based on what's happening in terms of the protests and, at times, riots. Help us understand. What are people protesting about, in terms of social justice, in terms of equity, in terms of health disparity?

Adams: Thank you for that question, John. I really appreciate it. As a black man myself, I know that it's challenging to exist in a world where literally everything you do, from decisions about the clothes you're going to wear—Should I wear a hoodie? Should I wear my uniform? How are people going to view me?—to how fast I drive on the road—If I go a little bit over, am I going to be at risk for being pulled over?—to the type of car I drive—Is this car too flashy?—to how I raise my kids, to where I can go to school—all of that is impacted by the color of my skin, even while being Surgeon General of the United States. I am not allowed to just be the Surgeon General of the United States. I have to be the black Surgeon General of the United States, and so many people see me as a spokesperson for an entire race.

And so there is, from a medical and public health standpoint, a concept of allostasis. Allostasis refers to the idea that stressors that you're facing in your day-to-day life are ultimately manifested in different ways that your body deals with that stress. That can be anything from blood pressure changes to kidney changes to heart attacks, or to higher rates of cancer. And what we've seen medically also plays out, quite frankly, in people from a mental health point of view. We know that people are frustrated. You can internalize pain and stress for only so long.

Whyte: Do you feel more stress and more pressure right now?

Adams: What's interesting is that that's the concept of allostasis and weathering. People tend to internalize it, and they don't even realize that their body is experiencing that stress and that it's building up until it starts to come out in negative ways. Pain that is not allowed to heal often finds ways to come out. And often those ways aren't productive. Some people self-medicate with alcohol, with tobacco. Some people yell and scream. Some people are just angry and they don't understand why they're angry.

Right now, a fuse has been lit with the killing of George Floyd, and it's really brought to the forefront a lot of that frustration that people have kept bottled up for a long time. It's painful. For me, personally, it's painful. For my family and my kids. It's painful to have to talk to my teenage boys about how they are—or may be—at risk, based on their dad's color of skin and based on their color skin.

As Surgeon General and as a physician, what I want people to understand is that it's okay to not be okay. We need to give people ways to express their concern and their emotions and their pain. We need to give them the space to grieve and to vent. And we also have to try to balance that with the need to protect property and to protect lives from violence and from COVID-19. Those are tough trade-offs, but we're working with communities to try to give people that space to be heard and to help them understand that there's a meaningful change occurring, but to give them the knowledge and to support them to be able to protect their health.

Whyte: You've been talking about the importance of First Amendment rights but also, at the same time, what are potential unintended consequences. It's been reported in the news over the past 24-48 hours that many COVID testing sites have closed, particularly in those communities with disproportionate impact, or we see people without wearing masks, without physical distancing. Can you talk a little bit about these unintended consequences where we're trying to balance being able to make statements while at the same time potentially exposing yourself to greater risk, particularly in communities that are disproportionately impacted? In some areas, 60% of the cases are in people of color, 60% of the deaths are in people of color. So how do we balance these, Dr Adams?

Adams: You brought up several key points, and I just want to quickly give it context. We've long known, for well over 100 years, that people of color are at higher risk for an array of medical diseases, whether it's high blood pressure, cancer, or mental health issues. And that is not just a biological predisposition, in many cases—it's a social predisposition. It includes housing. It includes transportation. It includes economic opportunity. And it also includes individual and structural racism.

So it is not a surprise to see disparities in who is susceptible to COVID and who is susceptible to complications from COVID. We've seen that play out. African Americans, American Indians, and Hispanics in particular are more likely to be exposed to COVID and more likely to suffer complications from COVID, up to and including death.

This is now being combined with a civil unrest that is putting people who are already vulnerable—in communities that are already vulnerable—in a situation where they are even more predisposed to COVID for the reasons that you mentioned. The disease spreads person to person. If you are in a crowd of people protesting, you are going to be more likely to be exposed to COVID and spread COVID than if you're not. If you're yelling and screaming, we know that you're going to be more likely to spread COVID asymptomatically than if you weren't in that situation. So the very [act] of protesting puts people at higher risk.

I really worry about the long-term impact, but I don't want people to hear me say that they shouldn't be expressing their First Amendment rights. Really, it's incumbent upon the leaders of this country to provide opportunities for people to feel heard in a way that doesn't cause harm to them or their communities. That's one of the things that I'm focused on.

We talked to governors just recently and said to them, "Please make sure you're handing out face masks at protests. Please make sure people who are protesting know where to get tested in the future. Please make sure people who are protesting understand that if they have a vulnerable person at home, they should be especially attuned to precautions like good hygiene and wearing face coverings and maintaining 6 feet of distance, and should even consider self-quarantining or not going around their vulnerable family member or friend for 14 days after they've been to a protest."

Whyte: Should they consider getting a COVID test, a diagnostic test? You had mentioned that some persons might want to consider that.

Adams: What we want those individuals to do is to understand where they can get tested in their state. And it's also incumbent upon the leaders. I talked to public health and community leaders yesterday and said, "Please make sure everyone in your community knows where they can get a test and the criteria that you have in your communities to get a test." If you have symptoms, certainly you should go in and get a test. Some states and some communities are actually offering tests for people who are asymptomatic who've been at a protest, simply because there is a higher likelihood that they've been around someone who may have been exposed to COVID.

Whyte: Dr Adams, I want to thank you for all that you're doing to help keep our country safe. I know it's a challenging job, so thank you.

Adams: Thank you. And again, what I would tell folks is to be safe and to really try to think about your fellow neighbors. Love each other. Reach out to people who are hurting, and that's whether we're talking about coronavirus or whether we're talking about people who are struggling with a lot of the social inequity and the civil unrest that's going on in our country right now. Sometimes just asking someone how they're doing can really lift them up, can really help them feel heard.

And please know that as Surgeon General, my initiatives, whether it's maternal mortality or hypertension control or promoting the opioid epidemic, are geared toward identifying vulnerable communities, people who've been forgotten about, and trying to decrease the disparities out there. One of the things that keep me up at night about COVID is the worry that disparities could be worsened after we help resolve our acute COVID situation.

We've seen vaccination rates go down. We've seen many women forgo prenatal care. We've seen many people not go in for regular checkups that would pick up cancers or risk factors for diabetes. So please reach out to your healthcare provider. Please understand that there are many disparities that exist, and the way that we address them is by working together. And please know that you've got a Surgeon General of the United States who is passionate about these issues and who wants to make sure that your voice is heard, and wants to make sure that everyone has the opportunity to be able to live a long and healthy life.

Whyte: Dr Adams, you are our first guest and our 100th guest, and hopefully we can check in with you as our 200th guest when we get to that point.

Adams: I'd love that.

Whyte: Thank you for watching Coronavirus in Context.

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