Coronavirus Report: The Hill’s Steve Clemons interviews Vivek Murthy

Steve Clemons asks former Surgeon General Vivek Murthy about his new book, “Together: The Healing Power of Human Connection in a Sometimes Lonely World,” and about the state of loneliness in America.

Read excerpts from the interview below.

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Murthy: Several years ago, when I was surgeon general, I was finding in the stories I was hearing all across America where there were stories of addiction or loneliness or violence — or whether it was parents concerned about their children — they were often threads of loneliness. People would say, “I feel I have to carry all of these burdens on my own,” or “I feel that if I disappear tomorrow, nobody would even notice,” or “I feel invisible.” And what I started to realize as I delved into the research around loneliness was that it is more than just a bad feeling. Number one, it’s extraordinarily common with more adults in America struggling with loneliness than have diabetes or smoke. But it’s also really consequential for our health. We now know that loneliness is associated with an increased risk of heart disease and depression and dementia and premature death. Loneliness is important. It’s common, and it’s extremely important that we address it, especially at moments like this during COVID-19 when the loneliness that we were experiencing even before has been compounded by the physical distancing that we’re asked being asked to observe.

Clemons: What do we do with that? Because everything you just laid out was a pre-existing condition for the nation. And then COVID-19 has come in as you said, it’s compounded the situation. How should we deal with this?

Murthy: It turns out that during major stressors like hurricanes and tornadoes and other natural disasters that we see a spike in mental health concerns, in depression, anxiety. And it’s important to think of these as trauma-related events. And COVID-19 is an even deeper trauma, in a sense, because it is not only transformed our lives and often in very, very difficult ways. But there’s also no clear end in sight. You don’t have a specific date when the storm is ending, so that makes it even more stressful for us. But I think what we have to remember is that in moments of stress, one of the most powerful tools we have for restoring our sense of wellness and for reducing the adverse impacts of stress are our relationships. This is why we naturally turn to other people during critical moments in our life, when we’ve had a major disappointment or a heartbreak. And in times like this, it could be pretty really difficult to stay in touch with people because we’re being asked to visibly separate from them. And we also may feel that in our moments of stress we don’t have enough emotional energy to give to our interactions with others. But I do think that there are some simple steps we can take to strengthen and to reconnect with others in this moment. So number one, we can spend just 15 minutes a day reaching out to someone we love. That could be video conferencing with them. It could be writing to them to say, I’m thinking of you. We can also focus on the quality of time that we spend with others. We can eliminate distraction, for example, when we’re talking to others, putting away our email and our social media feeds so that we’re just focusing on them. Five minutes of high quality conversation when we’re fully present can often be more powerful than 30 minutes of distracted conversation. Finally, we can focus on service. It turns out that one of the things that I learned during the writing of this book on loneliness and social connection was that one of the most powerful antidotes we have to loneliness is service. When we serve other people, we shift the focus from ourselves to someone else in the context of a positive interaction, and we also reaffirm for ourselves we have value to bring to the world. If we look around us right now, we’ll find that there are many opportunities to serve. Could be our neighbor who might be struggling to get groceries. It could be a friend who’s struggling to telework and actually home school their kids at the same time. We could offer to be virtually baby sitters just for 10 or 15 minutes. There are many ways that we can serve other people, and in doing so, we will strengthen our social connections at a time where we desperately need them.

Clemons: I would love you to share what you did when we were in the pre-coronavirus era and noticed people in your office didn’t know each other. How can carry that to today?

Murthy: I will tell you that as human beings, all of us have a need to be seen as who we are, to know that we matter and to be loved. Those are common human needs across cultures and one of the ways that we can strengthen connection with people, and in groups in particular, is to create opportunities for people to get to know each other beyond their skill set. Opportunities for them to be open and vulnerable with each other. What we did when I was in the Office of the Surgeon General is very, very simple. We took five minutes during our all-hands meetings, and we did something called our “inside scoop” exercise where we gave one person during that meeting the floor to share pictures of anything they wanted to in their life as long as it wasn’t related to their current job. And people brought in pictures of their family, they brought in pictures of hobbies that they had engaged in in the past, all kinds of things. But in those five minutes we got to see a dimension of them that in many cases we hadn’t seen despite having worked with him for a year. And so what I noticed after that exercise was that people felt more comfortable with each other than before, because they weren’t sure if they mattered if anyone cared what they said. They started raising their hands more and participating because they felt more seen. And so these are things we can do online and offline. But what they all involved is creating opportunities and spaces for people to see and understand each other in a human way.

Clemons: You called in early March for national stay-at-home order. Would you issue that again now or do you think we’re getting to where we can mix reopening and staying at home?

Murthy: Well, I think we’ve made uneven progress across the country, and clearly the pandemic is hitting different states at different paces. But what I worry about is that we have still not in the vast majority of the country fulfilled the key steps that we need in order to open up safely. Look, everybody wants to open back up, and I’ll say as somebody who’s struggling also to figure out how to manage a 3-year-old and a 2-year-old and do work and take care of family at the same time. … But you know, as somebody who is also trying to balance things, you know, and I have it probably better off than most people. I know. A lot of us are struggling and a lot of people need to open up. But if we don’t do so safely then we risk another flare of infection, that could be even worse than the first. So what do we need? We need to, number one, make sure that the number of new cases are coming down and are at very low levels. Number two, we’ve gotta have broad based testing, not just a number of tests, but make sure that the distribution of tests is even across the country and that the turnaround time is quick. And finally we have to make sure that we have the ability to trace contacts. So once we find somebody who is ill, we need to know who they were in touch with and be able to, in a sense, put a net over that infection so we can contain it. Right now, we do not have this capacity to do this effectively in most of the country, and what that means is that if we open up without the capacity than we risk further spread and this has been traumatic already to the country, I would hate to see us have to go through multiple spikes because we weren’t prepared.

Clemons: Now you may be famous for many reasons, but one of the reasons you’re famous is your relationship with Elmo. The messaging when you were surgeon general of the United States was around vaccines. I am interested in your advice on creative messaging to reach key communities today.

Murthy: I think when you’re trying to communicate in the modern era, you have to think about different messages, different messengers and different channels to reach the broad population. We can’t just assume because we’re on a major network, that we’re reaching people. And so in this time, I think what’s especially important is to harness the power of trusted voices in communities. It’s often people who we trust that we listen to more and those could be teachers, it could be faith leaders in our community, it could be business leaders, it could be others. And so what we need to do, I think in this moment, is think really creatively. We, for example, should be partnering with YouTube influencers and other social media influencers to bring a message that’s palatable to people about the precautions we have to take. We’ve got to partner with faith leaders as well. We should be forming strong partnerships with teachers and with workplaces to make sure that we’re communicating consistent messages to them about how to be safe. The truth is, this is not like the 1980s where we could have one singular figure who everyone would listen to and trust, and that would get the message out. We need a coordinated strategy to partner with a broad swath of people. For example, when when I issued the e-cigarette report when I was in office in 2016 — instead of going on all of the major network shows, we realized that we needed to do to reach youth was actually to go to YouTube influencers and others who had the reach on social media. And that’s what we did. This is a time where everyone needs to get the core messages about COVID-19 so they know how to protect themselves and their families. You gotta pull out the stops on building those kind of partnerships.

Clemons: Why we were caught so flat-footed with this pandemic?

Murthy: Absolutely, and each time were hit with a major outbreak, whether it’s Ebola or Zika or H1N1, we learns, and then we’ve got to incorporate steps to get better. What’s important to recognize also is that the improvements that we make have to be across the nation, not just in the federal government, but also at the state and at the local level. On a federal level, we did take steps to improve the system after Ebola and Zika, and part of that came in a massive investment in a global health security agenda. Recognizing that we’ve gotta build partnerships across the world, we gotta strengthen health care systems around the world because of a disease, you know breaks out in, you know, part of Africa or Asia or Europe, it can quickly spread to the United States in modern times. The other thing that we did is we began to invest more now on the research side as well, so that we could have the scientific apparatus in place to be better prepared the next time something came around. But what matters here also are two other things. One is local and state funding. Even now, we rely on local health departments and state departments to enforce and to implement contact tracing, just as an example. And so if we’ve got a great federal apparatus but were massively underfunding local and state health departments then the actual on the ground contact tracing we need to contain an infection isn’t happening effectively. And for decades we have been underfunding public health in local and state regions. We cut their budgets massively after the great recession in 2008 and we still have not built those budgets back up and we’re paying the price of that right now. But lastly, I should say the only thing that really matters is however much you invest, in terms of money, you have to have a consistent strategy and consistent leadership that goes across parties and recognizes that we’ve got to keep the ball moving when it comes to pandemic preparedness. I mean, strengthen your institutions, keeping our funding in a good place and also building partnerships with other countries around the world. And I think we have been uneven in that respect. I don’t think we have seen the kind of coordinated leadership that we need to ensure that the pandemic response here is strong and also that we’re set up for the future. I don’t think it’s too late for us to recover. But it is true that we’re behind right now. And if we don’t catch up, we will pay the price in terms of further human suffering and lives lost.