“I have to say it’s really weird to be at Bellevue right now. On the one hand, it feels like a ghost town. Basically, the hospital has cleared out, largely devoting itself to coronavirus patients. It’s eerily quiet except for pages overheard every hour or so for patients who are getting worse and need to be transferred to the ICU and put on a ventilator.” -Co-host, Dr. Celine Gounder
In this episode, Dr Celine Gounder opens by sharing observations from her day in service at Bellevue Hospital in New York City on Sunday, March 22, 2020.
Co-hosts Dr Gounder and Ron Klain also talk with Adam Grant, one of the world’s leading experts on how to motivate people.They discuss how we inspire people to do the right thing, and how we keep them from doing the wrong ones.
Celine Gounder: I’m Dr. Celine Gounder, and this is “Epidemic.”
Today is Tuesday, March 24th we’ve got a special episode for you today. Later you’re going to hear from Adam. Grant. One of the world’s leading experts on how to motivate people, discussing how we get people to do the right thing and how we keep them from doing the wrong ones.
Ron Klain: We normally take your questions and we’ll be back with that feature on Friday.
But today we have a very special episode of the podcast with a unique insight on what’s happening right now with the coronavirus pandemic in our hospitals. My cohost, dr Celine Gander, spent a day in a major hospital in New York city on Sunday, March 22nd treating critically ill patients with the covert 19 disease.
Are cases of coven really dominating, taking over the hospital setting.
Celine Gounder: I have to say it’s really weird to be at Bellevue right now. On the one hand, it feels like a ghost town. Basically, the hospital has cleared out, largely devoting itself to coronavirus patients. It’s really eerily quiet except for overhead pages every hour or so for patients who are getting worse and need to be transferred to the ICU and put on a ventilator.
On the one hand, yes, we’re dealing with this huge influx of patients, but the normal sort of activity of the hospital where we’re all sort of working together and and around each other is not the case right now.
Ron Klain: Celine, you talk about the pages that you’re hearing in the hospital about patients going into the ICU.
So let’s talk about the course of disease. People come into the hospital, obviously they’re sick, but once they get there, what’s happening? What’s the kind of course of disease for the patients in the hospital?
Celine Gounder: I think one thing that’s been really striking is how quickly patients de compensate with this disease.
They can really turn on a dime so they can go from needing just a tiny bit of oxygen to needing to be in the ICU just in the course of a couple of hours just in the course of a morning. The other thing that seems to be the case is it’s the prior reports in the literature from China have been that around day seven or eight into diseases when people really crash, and we’re seeing it even earlier a day, five or six of symptoms that they’re emergently needing to be on a ventilator.
So it can be pretty scary because you see somebody in the morning and you think, Oh, they’re doing okay, they’re stable, and then in a couple hours they’re not so stable. They’re critically ill.
Ron Klain: Early on in the coverage of the disease, there was a focus that only people who had special vulnerabilities, serious preexisting conditions, or the very elderly could be at risk of serious illness.
It sounds like you saw something very different than that in the hospital. What did you learn firsthand.
Celine Gounder: Yeah, it’s been interesting. Um, a lot of these patients have never had medical problems in the past. They’ve never seen a healthcare provider, which is its own issue that they don’t have a primary care provider, but many of them have had next to no contact with the healthcare system before this.
And so, you know, it’s been really striking that people who are pretty healthy are getting gravely ill.
Ron Klain: Let’s talk about the patients that you saw. What were their ages or their backgrounds? What was the profile of these patients? Well,
Celine Gounder: They were younger than you might expect. They range from 20 late twenties to late seventies but the median age was late forties so, you know, basically my age, about two thirds of them were men.
And many of them were obese, which has me especially concerned for the U S because about a third of Americans are obese and another third are overweight. The reason that matters is, um, when you are carrying that extra weight, you’re able to expand your lungs less well than if you’re a thinner person.
And so if you’re affected by something like coronavirus, you know you’re going to have a harder time coping with it.
Ron Klain: So saline, the main part of this is treating the patients, of course, but part of this is also dealing with the families of the patients. What did you see in that regard?
Celine Gounder: Well, this is actually one of the reasons the hospital feels so empty right now in some ways, is that patients are not allowed visitors for infection control reasons, and so it’s really patients by themselves, which is incredibly isolating.
Obviously. I had a patient yesterday who I had talked down from a having a panic attack because he. Was really feeling very isolated in his room by himself without anybody else there, you know? And then we have patients, families who are terrified by the idea of their loved one being discharged home.
They are worry that that person may get sicker again, which is not completely unfounded, but we are really trying to. Make a pretty good assessment as to who’s out of the woods and who’s not. But at the same time, if somebody does look like they’re out of the woods, we do need to free up those hospital beds.
You know, you have to kind of weigh that. So those can be some really challenging conversations. And then families are also worried. Well, okay. So my mom, my dad, my brother. Uh, it’s coming home, but what does that mean for me and the rest of my family? Are we at risk for infection? You know, what is this going to mean for the rest of us?
And you know, there’s a lot of nervousness about how to handle that in the home.
Ron Klain: So, saline, take a step back here. What was the morale in the hospital? What was the mindset of you and your colleagues when you were confronted with this disease? Uh, up close face to face.
Celine Gounder: Yeah. I think there’s definitely. Fear, but there’s, there’s this sort of scarcity mindset, um, because there is scarcity in terms of gowns and masks and, and other protective equipment.
Ron Klain: So silly, let me interrupt you there for a second. And we’ve talked about this a couple times, but for our lay listeners, why don’t you walk us through head to toe? What does protective gear looks like? What should they be wearing to keep themselves safe? What are they actually wearing instead?
Celine Gounder: Just straight up surgical mass are really not adequate if you’re going to be working in a hospital and exposed to this degree, to patients, infectious bodily fluids.
And so with that you really should be wearing, um, would include a 95 respirator mask or something equivalent to that. Uh, you should be wearing something covering your face so that if you get sprayed with these aerosols, you’re, you’re shielded from that. So that’s. Plastic face shield or maybe goggles. Uh, you should be wearing something over your hair like a hairnet or Bon.
It should be wearing a gown again to cover your clothing and your skin, and you should be wearing gloves. So that’s sort of the, the outfit. It’s not quite as, it’s not quite the hazmat suit we wore for Ebola, but you know, it’s not so far away from that.
Ron Klain: No dominating the news is the fact that doctors like you, nurses, other healthcare workers are facing a shortage of masks, protective gears, gowns, gloves, all the things they need to keep them safe.
So what were the circumstances, the conditions you had to work under in the hospital on Sunday.
Celine Gounder: Well, we’ve run out of those and 95 respirator masks, which really is what the standard should be. Um, for caring for these kinds of patients. We are now running out of these surgical masks with face shields.
That are probably, you know, as good as we have right now, but we’re running out of those as well. Uh, and we’re also running out of gowns. So, you know, I, I have colleagues who, because they don’t want to create this mentality of shortage, um, are actually under protecting themselves because they don’t want to see a run on what few supplies we have left.
So what does it
Ron Klain: feel like to have to go in and treat patients with a deadly disease without the gear you need to keep you and your colleagues safe?
Celine Gounder: Well, it has me really worried. If we get sick, then it means we’re going to be even more short staffed, which means that the risk. Continues to compound for all of us, whether it’s for us as providers being that much more overloaded, whether it’s for patients, having fewer of us per patient to help them, and it honestly doesn’t feel fair.
It feels like we’re really doing what we can, but that others who should be protecting us and arming us with what we need aren’t doing their jobs for us.
Ron Klain: So, you know, Celine, it’s a really important point. You know, the only time we had someone contract a bowler in the U S we treated many people here who we brought back from Africa with the disease.
But the only people who actually caught the disease in the U S or two nurses in Dallas who are treating an Ebola patient wearing protective gear but not the right. Protective gear, merely having some gear, some kinds of gear. It’s not going to cut it. That has to be the right kind of protection for the threat that our doctors, nurses, and medical workers are facing.
Celine Gounder: Well, and I think that’s a great point. So the CDC recently came out and said, well, if you’re out of personal protective equipment, you can wear a bandana or a scarf. And given the level of exposure we have in the hospital, that is entirely inadequate. So I really appreciate people who are trying to sew cloth masks for us, but I think that their energies might be better spent elsewhere.
Whether it’s raise money to help us get the personal protective equipment we need, whether it’s, um, just delivering food to staff, working in the hospital. Those kinds of things probably will have more of an impact. You know, that there’s really no replacement for the correct personal protective equipment.
Ron Klain: Celine, you’ve obviously been in some very difficult circumstances before you traded patients with Ebola in West Africa, but what about dealing with Kovac patients in New York in the hospital might have surprised you.
Celine Gounder: Yeah. Honestly, Ron, it had less to do with, um, the patients themselves and more to do with how the doctors were having to make decisions.
You know, in terms of where I have worked in the past, I never felt like I did not have what I needed to protect myself and to be sure that other healthcare providers were protected. And I feel like here doctors are having to make very difficult decisions about with what personal protective equipment we have on hand.
How do we prioritize the use of that? How do we ration the use of that. So it’s a, it’s a really strange psychology of, on the one hand, well, I need to protect myself. I can’t be getting sick because then I might transmit to other people and then I can’t work. But on the other hand, you don’t want to create fear.
And so that juggling act I’ve never had to do before.
Ron Klain: It’s a great point. I mean, if you think about it, you were in a developing country, relatively poor country, Guinea in West Africa, and you had the gear you needed. There to treat patients with a deadly disease. And now here we are in the richest country in the world, in the nation’s largest city, and you lack the equipment you need to safely treat patients.
That’s. Condemning failure of our system of Washington to fill, to solve the supply chain issues. To get you and your colleagues the kind of gear you need to keep yourself safe, to keep people in the hospital safe is, there’s no excuses anymore. The president needs to invoke the defense production act. He needs to take the steps.
He needs to get this solved tomorrow. No more delays. And so Selena, again, thank you very much for your candid observations about your experience at the hospital, but most of all, thank you and all the other health care workers out there right now today who are taking on this difficult and dangerous work, trying to save lives and keep all the rest of us safe.
Joining us today on the podcast is a very special guest. One of my favorite authors . Bankers. Adam Grant, he’s a professor at Wharton who teaches in organizational psychology. He’s the author of four New York times bestselling books, including give and take. You recently wrote an article in the Atlantic called a trick to stop touching your face.
And so he asked Adam about how we can motivate people to gage in social distancing to stay away from work and activities on the one hand, and how we can keep them from doing the things we don’t want them to do. On the other hand, like hoarding toilet paper. So here’s our conversation with Adam.
Celine Gounder: I’m going to start with, um, sort of the stuff that you talked about in your recent piece for the Atlantic. This idea of how do you leverage moral responsibility as a motivator and how do you encourage them to be givers and not takers in a crisis like this.
Adam Grant: Yeah. So one of the things we’ve, we’ve known in psychology for decades is people generally don’t believe that they’re at risk when it comes to illness or disease.
And this will not surprise either of you given your professional experience, but there’s, there’s a lot of evidence for the illusion of invulnerability where, you know, people kind of wander around saying, well, you know, germs third, they’re no match for me. And so, you know, one of my big questions for a long time has been how do you overcome that illusion?
And it turns out that when it comes to estimating the risk to others, we’re much more realistic. And you know, we think we might be invulnerable and invincible, but we know that other people are susceptible. I’ve done some experiments with colleagues where we’ve shown that people are more likely to wash their hands if you remind them that it could make others sick if they don’t, as opposed to trying to convince them it can make them sick.
I think, uh, that’s, that’s one of the ways to get people to take some of the social distance and hand hygiene policies more seriously. So Adam,
Ron Klain: we always think of crises as hopefully bringing out the best in people, but also kind of brings out the worst in people too. So talk to me a little bit about your thoughts about how pandemic, like this brings out things like xenophobia and racism.
We’re seeing Chinese Americans being targeted, our country for bullying and discrimination. What’s the, what’s the psychology of all that?
Adam Grant: Oh, interesting question, Ron. So I’ve been thinking about this a lot and it’s, it’s been really obviously disappointing to see in, in many ways. Gosh. There’s a whole literature on mortality salience in psychology that says, you know, being aware that we’re at risk, or, you know, our lives are in danger, can lead to one of two responses.
And one is exactly the one you’re describing, which is people experience anxiety and one of the ways they buffer against anxiety is they double down on their core worldviews. And so they become much more oriented toward defending their in-group, trying to bolster their self esteem. And sometimes they do that by, by attacking the other, so to speak.
I think that’s the bad news. The good news is like you point out. There’s also the possibility that if we’re reacting less from anxiety and more a standpoint of reflection, these kinds of reminders of mortality make us a little bit more generous. They encourage us to expand our moral circle and include, you know, out-groups even, you know, animals.
Um, the environment in our, our conception of, you know, who we’re responsible for. And so I guess one of the, one of the thoughts here very simply is to say, look, if we want to get people to be less Zenith, phobic, less racist. One of the things we could do is we could try to shift people out of anxiety and toward reflection and ask them, okay, you know, not just today, but in the next three to five years.
What would you like to do about, you know, about the problems that we’re facing right now? What kind of pandemic response would you like to see available? How can we better prepare for the long run? And it seems like when people shift their time horizon a little bit, they feel a little bit less personally threatened.
Ron Klain: Interesting. Well, let me ask you about another set of behaviors we’re seeing, which is kind of hoarding and buying things up. Anyone who’s been to a grocery store in the past week knows that you cannot find toilet paper. We saw a story in the Washington post about a guys who drove around and bought every bottle of hand sanitizer in a 20 mile radius are sitting on seventeen thousand
Adam Grant: Seventeen thousand
Ron Klain: Yeah.
70,000 bottles of hand hand sanitizer. So what advice would you give on how to discourage this kind of a bad behavior?
Adam Grant: The place I would start is to say, too often we focus on, on behavior change, when we really need to get people to think about identity change. So the, the research I’m thinking here of here as Chris Brian would he studies is, uh, how nouns are often more powerful than verbs.
This is why, you know, with, with drunk driving, for example, instead of saying, you know, don’t drive drunk, it’s often more effective to say, don’t be a drunk driver. Because, you know, people will say, look, I can, I can drive drunk and I’m still a good person. But if I think about being a drunk driver, well now that that actually cast a shadow on the kind of person I am, so I think, don’t be a hoarder.
Don’t be a taker. Uh, that kind of message could be pretty powerful. I’m curious though, you all have lived in the world of people hoarding supplies and kind of responding to crises a lot longer than I have. What do you think about all this?
Celine Gounder: Yeah, I am really having a really hard time with the hoarding thing myself right now in terms of people around me fessing up to, I know I’m not supposed to do this, but I did and I guess what I am saying to people right now when I hear that is, okay, I understand why you did this.
But here’s the situation now in the hospitals, and you know, if there’s any way to get those supplies back to the hospitals where they’re really needed and, you know, reward them for that. Like, look, I, I forgive you. I understand. You know, that this was your instinct, but, but now we really do need you to help us out.
Um, so I guess that’s where I’m at with it.
Ron Klain: Yeah. One more question was Adam, there’s an interesting piece out recently that um, maybe bad public health communications contributed to this. The more the public health authorities were kind of telling people they were stupid and didn’t know what they were doing, might have provoked him into doing more of it.
Adam Grant: Well, I, I think you both hit on, on themes that, that are, are very salient for us in psychology. So Ron, I’ll start with yours and then, Selena, I want to come back to your point too. Mmm. I think these public health communications might’ve had that effect. What, what’s critical here is actually to highlight that the base rate of of hoarding is really low.
And to say, look, most people recognize that, you know, that it’s critical to get the supplies and resources to, you know, the, the health and safety professionals who need them most. And you actually want to highlight how this behavior is rare rather than common. And then when you do call out the behavior, you want to, you want to express a very clear disapproval of it, right.
And say, look, this is, this is not okay. Uh, and that’s where, you know, people, people seem to recover the better angels of their nature. Selena, and you’re on your point. What I’m thinking of here is a Gary Latham study of, uh, of people actually stealing from, from their employers. Uh, so this is in Canada to a forklift, um, and forest service kind of place where people would actually steal heavy.
Machinery and the company is trying to reduce the employee theft raid. And Gary goes in to find out why they’re stealing. It turns out they’re really bored in their jobs, and so the solution is to kill the thrill. Uh, they announced a policy saying, you know what? Anybody can just borrow equipment anytime they want.
And the theft rate pretty much drops to zero overnight because it’s no longer a game. They’re not competing anymore to see who can steal the biggest, heaviest piece of equipment. But they still have a problem that a lot of the equipment is, uh, has already been stolen. And so what they end up doing is they introduce an amnesty policy and say, look, you know what?
We know that, you know, you might come across some previously borrowed equipment and on the following day you can bring it in and you know, nothing will happen. And, uh, you know, a lot of, a lot of people brought equipment in saying, you know, I’m tired of, of, you know, my spouse wasting space in our garage with this forklift.
I’m going to bring it back. And so that, that makes me think the amnesty day might, might have some potential.
Ron Klain: Adam, as different organizations are coping with this, it’s so many different ways. Should I close down where I’m not required to close down? If I close down, should I pay my workers? What are the hard questions that are coming your way right now?
Adam Grant: You know, honestly, most of the questions I’ve been getting are, are less dire. Uh, from an organizational perspective. They’ve been around how do I, you know, how do I manage remote work? How do I keep my team engaged? And, you know, make sure that, that people don’t start to feel isolated and lonely. I think where, where I probably have gotten, um, maybe, maybe where I’ve been less unhelpful.
It’s just been around basic questions of, you know, how do I help people manage the panic and fear. We know that you can basically either reframe or refocus, and both of those two things help. So, you know, you, you could reframe, for example, your, uh, you know, your time away from the office as, as giving you extra family time or flex time.
Uh, you can, you know, try to refocus on other priorities that you have. Like, you know, getting, getting in shape or, uh, learning a new skill that you might have extra time for. It’s helpful to take a step back from your emotions and say, okay, I’m feeling anxiety. What am I actually feeling anxiety about? Am I worried that we’re not going to have enough food?
Am I worried that I’m, you know, I might be exposed? Am I concerned that you know, I’m gonna end up really isolated? And as you start to name what you’re feeling, you can begin to pinpoint the causes and actually do something about it as opposed to just kind of wallowing in the, in the uncertainty.
Celine Gounder: So, last question for you, Adam.
Um, you know, I think one thing that is especially challenging is where you have political polarization, where you have, um, mistrust in government that really makes controlling an epidemic, or in this case, a pandemic that much more challenging. And I think one of the problems is people believe on the basis of their.
Political identity and whether they think the messenger shares the same political identity. So, I mean, I don’t know if you agree with that, but if you do, you know, how should that reframe how we approach this?
Adam Grant: Yeah, Selena, I think it’s hard not to agree with that, sadly. I think, you know, so much of of communication is filtered through the lens of, well, what’s this person’s agenda.
I think the, you know, the, the good news on that is there are some cross cutting values. So, you know, we know, we know, for example, from work on, um, trying to communicate about climate change across the aisle, uh, that one value that’s shared by conservatives and liberals is freedom. You know what, wherever you stand politically, one of the reasons that we all need to make sure that, you know, we, we stay out of social contact as much as possible.
That, you know, we, we go out of our way to, you know, to wash it very carefully is, you know, we want to maintain freedom. We want to, we want to stay a free community, a free country, and we can’t do that if, you know, if half of our community or half of our country gets sick. So I, I just, I’d probably say there, there are some fundamental values that, uh, they can reach people regardless of their political ideology.
And I think, I think freedom is the most compelling one. Uh, there may be others, uh, any, any others that either of you have, have noticed?
Ron Klain: Well, I mean, you know, one that I’ll talk about a little bit is faith. During the Ebola outbreak, what are the most controversial decisions I made was a decision to authorize the use of us military equipment to fly radically anti-American III moms around different parts of the three countries of West Africa to allow them to tell their followers to engage in safer burial practices.
Adam Grant: Wow.
Ron Klain: And no matter how much we tried to message this safer burial practice message through public health communications. Grew kind of traditional mainstream communications. People were doing it, but these IE moms could reach their faith communities and we made a decision, even though these moms, we’re not friends in the United States, or the best way to save lives was to deploy these people throughout these countries.
And it made a real difference on changing people’s burial practices. Questions of faith and other kinds of belief systems are important here. And a political elite is just one step away from that in many cases. And we have to kind of get to people where they are.
Celine Gounder: Wow. Yeah, I would agree with that. I actually met two of those, the moms and in Guinea and spent some time talking to them about this.
There’s a lot in religion that actually relates to infectious diseases. Um, and so they’re able to draw on those religious texts and reframe these issues in a way that sort of transcends politics. And so I thought that was really powerful.
Adam Grant: I love that. Yeah. I mean, I think it’s, it speaks to the fact that it’s so hard to convince people to change their values.
It’s much easier to appeal to values they already hold, and it’s probably easiest to do that if the message is coming from someone who they believe already shares their values.
Ron Klain: Well, Adam, thank you very, very much for doing this. We appreciate having you on the podcast. We’re very grateful for your incredible insights.
Adam Grant: I just want to say I really appreciate the work that both of you do and, uh, glad to be here.
Ron Klain: Thanks, Adam.
Celine Gounder: Thanks Adam.
Ron Klain: So at the start of the program, you heard from Celine describing the harrowing experience of being on the front lines right now. And if you’re like me, you’re a lay person. You hear these stories of heroism, hard work. You wonder, what can we be doing to help those people to support those people? So Celine, what are your thoughts on that?
Celine Gounder: When I came home from Bellevue last night, my husband told me that some of our neighbors had donated a couple packs of 95 respirator masks. I also got an email from Alan gold who had seen me on CNN talking about the shortage of in 95 masks. He FedEx me a box of 20 and then he and his daughter Danielle, decided they should do more.
After watching governor Cuomo and dr Gander on CNN this past week, my dad has staff and I have taken up the cause to help locate personal protective equipment in the United States. There’s so many industries that use these masks and other equipment. They just need to be notified of the urgent need. We are in the process of calling, emailing, and posting on social media in the oil, gas, mining, chemical and automotive industries.
If you would like to help, it’s as simple as calling your local car dealership or local auto repair center and asking them for any extra masks and sending them as fast as possible to your nearest hospital. Given the number of medical staff that have already died in Italy. This is truly a race for time to help our own doctors, nurses, and first responders.
This is one way we can all contribute to the health and safety of our medical heroes from our own homes. Thank you.
Ron Klain: So Selena, we want to be clear. We’re not urging people certainly to go out and buy these masks. We should let the supply chain do its work. We’re not asking people to privately procure them, and we’re also saying, if you have the supplies, don’t just show up at the front door of the hospital with boxes of them.
That’s only going to add to confusion and distraction. If you have supplies that you think can be helpful, you should go online and figure out where the donation facility is in your community, so please do that the right way. Please do that in an orderly way.
Celine Gounder: You know, and Ron, it’s not just about masks.
David Pizarro, who’s the chef at Porsenna, a restaurant here in the East village in New York city, deliver dinner to all of us working on the medicine service at Bellevue, and at the end of a 13 hour shift, I can tell you that really meant a lot to us. I can’t tell you how much these shows of support, whether they’re.
Big or small have meant so much to me and my colleagues. You know, seeing people come out in solidarity and doing what they can to help. It really does have an impact.
Ron Klain: You know, Selena, those are great suggestions and I’ll say one last thing, even if you can’t do any of the things we’ve talked about, there’s something all of us can do.
People online have suggested that every day at 8:00 PM local time, we go to our front doors, we open them up, we give a round of applause for the healthcare workers who are going off to help save lives and putting themselves at risk. Often. Doing so. So if you can’t, I don’t have supplies to donate. You can’t donate meals to thing.
All of us can do is take a moment each day to recognize and thank the people who are at the front lines doing this work. We can all do. That
Celine Gounder: “Epidemic” is brought to you by just human productions. Today’s episode was produced by Zach Dyer and me. Our music is by the blue dot sessions. If you enjoy the show, please tell a friend about it today, and if you haven’t already done so, leave us a review on Apple podcasts. It helps more people find out about the show.
You can learn more about this podcast, how to engage with us on social media, and how to support the podcast at epidemic. Dot. F M that’s epidemic dot F M just human productions is a five Oh one C three nonprofit organization. So your donations to support our podcasts are tax deductible. Go to epidemic.fm to make a donation.
Starting today, we’ll be releasing “Epidemic” twice a week on Tuesdays and Fridays. But producing a podcast costs money. We’ve got to pay Zach, so please make a donation to help us keep this going. Also, check out our sister podcast, “American Diagnosis.” You can find it wherever you listen to podcasts or at American Diagnosis.fm. On American diagnosis, we cover some of the biggest public health challenges affecting the nation today and season one we covered youth and mental health in season two. The opioid overdose crisis and in season three, gun violence in America. I’m Dr. Celine Gounder and I’m Ron Klain. Thanks for listening to “Epidemic.”