Full interview: Cohen discusses NC's battle with coronavirus
Dr. Mandy Cohen, outgoing secretary of the state Department of Health and Human Services, discusses the highs and lows of her final two years on the job, during which she became the public face of North Carolina's pandemic response.
Hi dr Cohen. Uh It's so wonderful to see you in person be able to interview and you in person um After you just announce you're stepping down from this job that you have had for several years in North Carolina, but certainly the last two are the most consequential. You know, you've been described as the face of North Carolina's pandemic response. How do you carry that responsibility for more than 600 days? Well, it's been I've been able to serve in this role as Secretary of Health and Human Services for more than five years or just about five years. Um and it's been incredible honor. Um I never expected a global pandemic to be on my watch, but it has been a privileged to step into this role. I have certainly learned so much about um leading during crisis. Um and I will certainly take that as I move into the next phase of my um my professional career, but what an honor of a lifetime. And I felt that even in the hard moments um that it was an honor and a privilege to be in that role. Um and I thought every day about how I could build trust with the people of north Carolina to help lead through this really uncertain time. Um and I'm really proud of what we've been able to accomplish. You talked about building trust. I actually saw reaction from people when you said that you were planning to step down that they felt like you became like a family member to them. I mean how do you react to people feeling very close to you because you are guiding them through such a difficult time. Well, it's very kind to hear that and I know I was in a lot of people's living rooms which what a special um, um, opportunity and honor. Um, and I'm grateful that I was able to provide some comfort to folks. Um when things were really uncertain and scary. Um, I was going through that as a mom and a wife, a daughter as well, being scared and so you know, I just want, I I was thinking about that when I was trying to do my job and uh just share what I knew about what we were doing. Um, trying to lead, making sure that we were executing on, on the response effort, but also explaining the science and the data and what we knew and what we didn't. Was there a single moment or event that led you to think, okay, now it's time for me to pass the baton. There's no one single moment. Um, I certainly knew after five years that it's been an amazing run. Um, and it's often great to be able to step back and see the impact you've made on the whole department and my team. I am so proud of them and I watched them leading the last few months through the delta surge. Um, and they were really on top of it. We, we were really firing on all cylinders um, using the tools that we had on vaccines and testing. Um, tpe wasn't even a concern but making sure we had treatment in lots of places. So folks are really doing such a wonderful job and it made me realize that it is possible now for me to think about taking a step back, passing that baton. But there is so much more work to do. And I'm so grateful that it's really been my right hand, my deputy through all of Covid who has led Covid operations, who's going to be taking the baton for the next leg of the race. Has anyone said to you that they feel like you're leaving them and the pandemic is not over yet? Well, the pandemic is not over yet. I recognize that. Um, but that's why they should be very comforted by the great team that has been behind me the whole time and will still be there. So I'm really pleased. As I said, my deputy Cody Kinsley, who's been by my side and his lead and most of the operational work for Covid is now going to be stepping into that role. So he is, it's a big job but he is definitely up for that challenge. So of course it all hasn't been positive. Right? You had to make incredibly impactful decisions that affect people's livelihoods, how kids learn how people gather socially and a lot of people disagreed with some of the decisions that you and the state's coronavirus task force were making? Did you feel the weight of how some of those decisions could negatively affect people's lives? Absolutely. These were some of the most difficult decisions that were in front of us and there were no easy decisions. Um, we knew that there was going to be consequences to any of those decisions, but we tried to stay focused on the science and what we knew about keeping people safe and healthy. But you know, the governor was very much aware of trying to balance all of these different competing factors because we definitely were thinking about people's livelihoods. Absolutely. We were definitely thinking about Children and their their ability to learn. Um, as we made these really, really hard decisions. So they were gut wrenching and there were many, many hours of lost sleep. I will tell you. Um, but I feel really looking back. Um, I feel really proud about the decisions that we made. They were hard, doesn't mean that they're this virus didn't turn our lives upside down. It did. Um, but I think we made the right decisions at the right time balancing the need for safety um, and health, um, with all of those other competing priorities, do you regret any one decision? You have said no essentially in previous interviews, but I wanted to give you another chance to answer that because any leader, especially when you don't have all of the facts, all of the science in your case a lot of times can reflect and say, yeah, now that just doesn't seem like it was the right move. Was there one decision? So what I would say is is that, you know, it's really hard to monday morning quarterback a crisis. Um, and in a crisis, things are not going perfectly right. So, so I don't regret things because things were moving fast. We were learning as we went and we were getting, you know, we committed to, to learn and integrate that learning into future decisions. So I feel good that we're making the right decisions at the time with the information that we had. Um, would, I wish we would have done more in preparation for something like this. Absolutely. We did not have, clearly, we did not have the, the supply chain that we needed in terms of protective equipment and ventilators. We did not have people who were cross trained to be able to move to doing the kind of response work we needed. We didn't have the data systems. So there's certainly a lot of learnings of, gosh, it couldn't have been more prepared. Yes. Um, but given where we were, when we went into this crisis, I feel really good about what we were able, um, what we were able to do. So I don't regret anything. I think I have learned from things. Um, but I, I feel really good about our, our ability to and how we responded to this pandemic? You know, at times. The criticism against your decisions was intense. Personal, even bigoted at times. Did you ever feel fearful? Um I didn't I didn't feel fearful. I understood that people, this was a very emotionally charged time and again, we were asking folks to change the way they move through the world um change the way their kids were learning, changed the way they did their jobs. Um So I recognized what we were asking of folks and so it's not surprising that this was very challenging across the board. Um So I understood it. I think that folks sharing their um frustration at the virus and directing it at me. It wasn't me that was doing it. It really was the virus. But I recognize that some, you know, as the face of of some of that that's going to come back towards me and I just tried to stay focused and try to stay focused on the job um and make the best decisions I just possibly could, but I I never felt unsafe. Um uh and that is because there was a team of people around me um to make sure that I was was safe. Um and um and able to do my job, you had all of that directed at you, you said I'm not the virus but you were the one implementing the response to this virus. Who were you going to lean on for help for comfort, especially when the criticism was really targeted and difficult. Well, I need to thank first and foremost my husband, my life partner, my best friend who was amazing through all of of Covid and I couldn't have gotten through this without him. Um He not only took care of everything at home so I could do my job, but took care of me as well. So I'm very grateful for that. And you know, when you have kids and my kids are now seven and 9, um you know, they don't care that you're on tv or you're doing your job. You know, they when you come home, it is about how can I spend some quality time with them and connect with them. Uh and they sort of bring you back to reality. So those, those are the things that allowed me to get through is like look at them um and watch them. Um you know, actually be incredibly resilient through all of Covid my kids and I was like, okay, they're doing all right. Um My husband's amazing. I could do this. Um and so look and I also had a huge team around me um throughout this that were just amazing and I leaned on a button. I also had colleagues in other states, um that, you know, we would try to be learning from each other other scientists and and and such that, you know, my weekends were filled with calling to others and other experts to learn and get different voices and hear what they were seeing and what should we anticipate for even the week ahead. Um, so there was a lot of collaboration across the country. Um, but certainly it started with support at home. Is your husband glad you're stepping down. Um, he gosh, he is so supportive. So he's like, if it's time it's I'm there for you, so whatever, whatever you need, and I'm so grateful for that. So I want to talk now about the state of coronavirus in north Carolina because um, you know, it's interesting the last time, the first time that I met you in person was that President biden's event in in Raleigh and there was so much optimism in the room because cases were going down, more people were being vaccinated. Um, you had all these grassroots organizers that felt like they were really making a difference in going into underserved communities. And then Delta happened and it felt like that momentum went away. What was that like for you all in having to shift? Yeah, we were, we we were vaccine, we were vaccinating and we had this energy and momentum forward. Um, but it just shows that this virus um, is not done with us yet. Um, what I'm grateful for is that my team had the infrastructure set up to be ready for, um, for a new challenge. Um, but we had to dig deep, right? We were already tired. We were kind of coming out of things. We were thinking that we started planning for the future and recovery. Um and folks were tired but then you know when delta got thrown at us, our team like dug deep to that next level of resilience that we have built up through this um and we're able to lean on each other um and say look we have tools now. We have relationships in ways that we didn't, we're connected to communities and I think all of that helped us through um the delta surge and now a lot of folks got sick and I wish that we had had more vaccines and arms before that came. But given everything where we were, I felt like we were ready as a state to respond and we did. So where are we? Right now? We're at 3000 cases a day. Um you know tragically deaths still dozens of people dying from this virus. And we were told that once we reach herd immunity there would be some normalcy. Have we reached herd immunity? Yeah, well you'll notice I talked very little about that because it's an elusive thing. Um and it's because herd immunity is elusive meaning that this virus is changing. So even as we do work and more to combat this virus, the virus can change. We saw it with Delta getting more contagious. We want to understand what does it mean with this new variant omicron um now I think all of the work we have done vaccinating tests, treatment, those are all foundational. They will continue to help us, but we also just have to continue to evolve our response as the virus changes itself. Um, so it's a really hard to answer that question um about about that and we'll just have to keep learning as we go. So um I want to get to omicron in a bit. But first you've got a lot of hard questions yesterday from state lawmakers who were essentially asking about this concept of an off ramp. When will the state of emergency be over? What does that look like? I've heard immunity is elusive. Well, I do think we are moving in the right direction in terms of the fact we've built the infrastructure to respond to this pandemic. We have the tools we need to use them. And that was my big point to the legislature, but we're not out of the woods yet. And that's the reality. Now, I don't think we're going back to stay at home, but in order to keep making progress, we still need some of that flexibility to in order to respond. Um And so while we're still in a state of emergency, it does just give us flexibility um to allow us to to respond. But you can see we're not using all of the tools, right? We're not ordering Restaurants to be closed to 50% or we're not closing X, Y or Z. Um we're trying to be very judicious with the flexibilities that we use and match them to the moment as we have more tools to fight this virus, the tools that work, vaccines, treatments, test masks, we need to use them so we don't have to use all of the other kinds of things we use back early on in the pandemic. What about breakthrough cases though? Are people, is it still believed that if you have been vaccinated, you should be fine or with more variants. Could that still be unknown? So what we're seeing is that everyone should get their booster to extend the efficacy of the vaccines. And once you get your booster right now, the preliminary data shows that it is actually very protective even against these new variants that are coming out. So that's great. But I would say caveat, we're still learning right? But do what we know works right now. We don't have a micron here right now in north Carolina. We have Delta. We know the vaccines and the boosters work against Delta. So let's protect ourselves right now, particularly as we're looking forward to um, you know, christmas, family gatherings, we know it's going to be more risk exposure for people to get vaccinated right now. It protects you as you go both into the winter and into the holidays. So let's talk about, oh, Macron because that is a concern that it could be more contagious and could impact people who are vaccinated as well. Tell us about this early data. What do we know at this point? And also the breaking news today from Fighter. So what I would say is we are still learning. But what we see in some very early data is that this new variant, A macron could be more contagious than even the delta variant. But again, still learning. We are seeing though that potentially it's less severe than other kinds of covid meaning that it's driving less people to the hospital, less people will die. Um again, I don't know that that's worn out fully in the data yet. And I think we need more data to understand how are vaccines work against this variant. Early data. Again, Fighter released some today to say if you're fully vaccinated and you've gotten your booster good protection. So that's good early news. I think we need to make sure we're continuing um to listen to the scientists um and watch the data um and respond accordingly. Is it concerning that it appears according to early data that it affects Children uh, in a greater way than previous variants. And and with where we are with Children vaccinations in north Carolina. Could that be problematic? Well the good news is is now are 5-11 year olds can get vaccinated. Um as you know I have two daughters who are seven and nine, I got them vaccinated already. They are now. They got their second dose over the over the weekend. And so they're fully vaccinated. So the good news is we have tools and we need to use them. If anything, we know that Children had been a population that is less vaccinated and this virus wants to go to places and people that are unvaccinated. Um, and so the more we can get folks vaccinated, they are going to be protected from covid overall. I want to talk about your efforts in equity. Um, You know, it's interesting because my very first interview with you was um after uh an African American man died from COVID, 19 1 of the first two tragically died from this virus in our state. And he was also what was once referred to as an essential worker. I still think they're essential workers. Initially that early data was showing that black people were dying from covid disproportionately uh in this state and in the country. What did that early data tell you that you needed to immediately start doing well. We saw that unfortunately are historically marginalized communities are african american black communities are hispanic latino communities um were hardest hit at first by the covid covid pandemic. And it's not surprising because you said it's essential workers. These are the folks who were going to work every day, had a lot of exposure to others. Um and, and and got covid. So they had higher rates of getting the virus to begin with. And so it's not surprising that means more hospitalizations and more deaths in those communities? We saw that data early on and said we have to put equity at the center of how we respond to this pandemic. It's work we had been doing before. Um, and I think that is what has really allowed north Carolina to be successful is that we have been building um, components of how we build equity into our work and thinking about whole person health before we went into the pandemic. So when that happened, we saw that data, I think we were able to leap into action a lot more quickly. But I will say the thing that I think separates north Carolina from a lot of other states is that we were able to build trusting relationships with communities, um using community organizations, whether it was the faith community or others, um to say how do we pull together. Um, and we use a lot of community health workers, for example, from from those communities to reach those communities. Um, and I'm really proud of that and we resource them to do really important work to reach out to their communities. And it shows in the data, if you look at our data now, not only are our cases lower in our black communities and our latino communities, they're also vaccinated at higher rates, um, which is um, you know, we still more work to do. Um, but I'm really pleased at the way we've been able to um embed equity in the work and it show in results. Has there been a specific proven way, I mean, you talked about these relationships with these various groups because there are so many complex reasons for distrust. So it was their proven effective way at getting the right messaging to these communities that you think you need now to continue with whoever now takes over. He's a really good question. I don't think there's any one way for everyone, because there are different ways in which folks build trust and communicate. Some folks really want to, you know, feel very connected to their church and that is a way to build trust with communities, others um that, you know, it's social media, um, and actually being a little more fun and engaging. Um, and so it's really doing all of the things. Um, but I think it starts with listening. Um we talk a lot about communication, but we sort of forget the listening part and I spent a lot of time making sure that I was listening, two African American leaders um, to our hispanic leaders across north Carolina to say, what do you need, how can we respond and work together? And really our our response evolved as they gave us feedback. We're missing a gap here or there. Um whether it was testing or this, these partnerships weren't really playing out right on the ground and we have to adapt and change. So I think it starts with listening, um and then showing up and just delivering and what you say you're gonna do. So it's not just saying the right things, but actually making those happen in reality and you all have this new social vulnerability kind of index in terms of how you're able to track data within some of these communities. And you know, what I find interesting about it, is is this a situation where you're trying to track this data within these certain areas, certain communities so that you can have a temporary solution to addressing whatever the gaps are Or have you all now started to think we need some permanent solutions to inequity issues of access those types of issues. So it's not just you while trying to handle the pandemic, but other issues moving forward. And this is where I think the work we have done in the health equity space before the pandemic has really helped us and it will continue. It absolutely has to continue. Um I think Covid has been a focusing event that allowed us to get smarter and build deeper partnerships and relationships, but they absolutely have to be things that carry on into the future. It's why I'm grateful that we brought on our first ever Chief Health Equity Officer here in the department under my tenure. Um and so having victor, armstrong here as the Chief Health Equity Officer is to really think deeply about that work, he is a member of our senior leadership team and to continue that work. Um, so you know, and we need to orient ourselves so that we always are collecting data to allow us to identify problems so we can solve them, you can't solve a problem, you can't see and measure. Um, and then you hold yourselves accountable for making sure that you see the progress in those numbers. Um, so it starts for me with data and relationships and I think we've made a lot of progress on that now. It's going to continue into the future as I passed the baton to Kody kinsley. Um, and the, the wonderful members of my team who have done so much work, Do you anticipate more investment in those efforts? I think about a whole county with incredibly low vaccination numbers with high black and brown populations and they have not seen a lot of progress. What's the plan in communities like that? Well, I think we've already made a lot of investment, but yes, I mean this is, this is a long, long ball game. Um, and you can't build trust overnight. Um, but you can commit resources, which is what we've tried to do and build those relationships and I think it's a sustained effort over time. Um, and so that that's why I know there's so much more work to do that our team is really geared up to do and I think Covid gives us that platform with which to go forward. One thing you were very passionate about that you brought up in many briefings was Medicaid expansion. The state budget has been passed, it was not included. Was that disappointing for you? Incredibly disappointing? Um I I think it's something that hinder north Carolina as we went into this pandemic was the fact we had a higher rate of uninsured, which means that folks chronic illnesses were not taken care of, which means if they got Covid they're gonna get more sick. Right? So we were a sicker state then I think we should have been more uninsured. Um and you know, frankly from an economic perspective and access to care in rural areas, it put us behind. So I think it set us back. Um and that is why as they continue to debate this, it is absolutely critical that we expand Medicaid um particularly as our state has so many rural areas like this is where we need to absolutely invest and make sure we're taking advantage of every opportunity to keep open rural health care access points, not just for the people who are going to get Medicaid because they're working um and do it, but for the folks who are in rural areas and have different kinds of insurance, we need those access points to be open. Um so it's absolutely critical for us to keep keep fighting to get Medicaid expansion. I'm grateful that the legislature at least acknowledge that they got to come back and next year in the short, short, short session, um, and address this again. Are you now going to see the three Ws two people in the grocery store? So, um, you know, so it's been amusing when, when I go to Costco or target, like are you the three Ws lady? And I absolutely like I own, I love that because, look, it means we were repetitive in our message and people hurt us. Right. That's what, um, I was glad we, we cut through. Um, and those messages are still going to be important as, particularly as we go into the winter, um, to make sure that we're, we are wearing a mask when you're indoors around folks who you don't live with, um, that you're keeping your distance when you can and you're washing your hands. Of course. Like I'm a, I'm a hand sanitizer queen. So you gotta gotta have that in your bag all the time. Yeah. Will you stay in north Carolina? I hope so. My family and I love it here. Um, and whatever challenge is gonna be next so far, all the opportunities I'm looking at, keep me here in north Carolina, which is wonderful. Um, so I hope, I hope so. All right. Thank you so much for your time. I appreciate it. And best of luck to you. Thank you. Thank you so much. Stay well