N.H. Seeks Balance Between Shelter-In-Place And Social Distancing | New Hampshire Public Radio

N.H. Seeks Balance Between Shelter-In-Place And Social Distancing

Mar 24, 2020

New Hampshire Governor Chris Sununu contends that a policy of social distancing is sufficient to "flatten the curve" of coronavirus in the state. A recent executive order prohibited gatherings of more than 50 people; that number was later reduced to 10 people. Some state and city leaders, including the mayors of Nashua and Manchester, are advocating for more stringent measures. We discuss what “shelter in place” means, where the state currently stands with official closures, and the impacts on the state economy.

 

Air Date: Wednesday, March 25, 2020

GUESTS:

  • Dr. Lisa V. Adams - practicing physician and Associate Professor in the Infectious Disease and International Health Section of the Dept of Medicine at the Geisel School of Medicine at Dartmouth. Also the Director of Global Initiatives at Dartmouth and Co-Chair of Dartmouth’s COVID-19 Task Force.
  • Joyce Craig - Mayor of Manchester
  • Juliette Kayyem - homeland security expert.
  • Josh Rogers - NHPR Senior Political Reporter.

Transcript

  This is a machine generated transcript and may contain errors.

Laura Knoy:
From New Hampshire Public Radio, I'm Laura Knoy. and this is The Exchange.

Laura Knoy:
About a dozen states have placed restrictions on what residents can do while the country watches COVID-19 cases rise. Some governors have issued so-called stay at home orders. This includes Vermont, where Gov. Phil Scott yesterday issued what he called a stay home, stay safe order that Vermonters can go out only for essential purposes, such as grocery shopping, caring for others, getting exercise or going to work if their employer remains open. The order also called for the closing of, quote, in-person operations for all non-essential businesses. Here in New Hampshire. Governor Sununu hasn't gone that far, but he has taken steps to reduce social interactions, such as closing all schools and telling restaurants to offer takeout only. And the governor stresses he's constantly re-evaluating recommendations as conditions change. Today, on The Exchange, what these orders mean and how well they work. Let's hear from you. What types of restrictions would you like to see? Do you think those in place now are effective? Should they be looser or tighter?

Laura Knoy:
And we'll talk with several guests this hour. We begin with Juliette Kayyem. She's a homeland security expert and a Boston resident. Juliette, welcome. Thank you very much for your time.

Juliette Kayyem:
Well, thank you for having me this morning.

Laura Knoy:
So, Juliette, lots of semantics out there these days.

Juliette Kayyem:
Yes.

Laura Knoy:
Advisories, orders, shelter in place. How much does language matter with these orders that governors are now putting out?

Juliette Kayyem:
I think language cuts both ways. So there's. Everyone has the same goal, or at least the states that are issuing these orders, which is essentially just limit people's interaction with each other. And if, you know, if we could keep honestly if we could keep everyone inside for two weeks, we would be in so much better shape than this sort of hodgepodge of orders that we're seeing. And so the differences in languages, in language really is significant only I think in terms of the tone that different governors are trying to make, that that social distancing is different and just sort of means maybe don't don't go to concerts as compared to shelter in place, which has sort of a meaning that those of us from New England think about in terms of blizzards, that you want to stay put. And and you're seeing variances ideally from a homeland security perspective, where you have 50 states all encountering the same threat. You would want unity. And that's some that's some of the criticism that the White House is certainly facing right now is each state. You know, each state is doing this differently for a threat that is borderless. Right. That is just going to, you know, go from Massachusetts to New Hampshire and could care less what the what the what the orders are.

Laura Knoy:
It's really interesting. So, again, given your background in homeland and Homeland Security, Juliette, how do you view the fact that this is varying widely state by state?

Juliette Kayyem:
It's not good. I mean, I'm being honest. And so because we don't know now where when the clock starts. So I've been you know, I think there has not been very good communication about what, in fact, we should expect by what we're doing, which is essentially, as everyone now knows, we're trying to flatten the curve, slow the spread. All these terms that we know now, but we're simply trying to limit the number of people who are going to put stresses on the health care, on our health care and our health facilities until we can surge both tests so that we know who's sick. And then, of course, resources to help those hospitals and health facilities. So if you look at New York, which is clearly on the spike. Right. So they're clearly, if you just think of, you know, the the curve they're clearly on their way up. You know, they've now I mean, they've now reached up to, you know, get our head around this. They have now emptied out the convention center and are now using it as a, you know, multi-hundred hospital bed hospital unit. I mean, this is what we anticipate from a planning perspective. So ideally, you would want a uniform effort across the nation led by led by communications by the White House, but enforced by the governors, because they tend to have the authority in their state to have a much more uniform effort, which would be essentially a shelter in place.

Juliette Kayyem:
That is the strongest language, you know, short of a quarantine, which we don't want to get to. But that's the strongest language you want, which is there is something bad outside. Right now, it's a virus. Sometimes it's a hurricane. You must stay inside. And we're going to make it really difficult for you to be outside. In other words, as a state or mayor, we're going to close everything. We're going to, you know, not allow stores to be open. We're going to make it difficult. I would prefer that that's not happening. And the bad part of it, from a planning and response perspective, which is the world I'm in, is that the countries that have done this successfully, fought the virus successfully, have always had a very strong national effort. You know, Italy was a bit late, but it looks like Italy is now over the curve. It looks like Italy has had the worst. The only way they did that was a nationwide shelter in place order. You saw Prime Minister Boris Johnson moved to that yesterday. This president is is not doing that. He's leaving it to the states. And that's that means that we don't even know when the clock starts for us. So when people ask me when it ends, I kind of say, you know, the problem is, is that it hasn't really begun for a lot of us.

Laura Knoy:
Well, definitely going to ask you about that, because that question is definitely coming up more and more. But to this idea that this is being done differently state by state. Juliette, obviously New York seems to be the epicenter of this. But why should a sparsely populated state where everybody is kind of spread out like Wyoming or North Dakota? Why should they have a shelter in place? A very strict measure like New York?

Juliette Kayyem:
Because because all it takes all it takes is one to infect two, then infect six to then infect twelve. Because the the period of which you might have exposure. So let's say even if you live in a rural area, someone who you went to church with was just in Boston where we have you know, we clearly have here in Boston, significant community spread. They're sick. So in other words, that the density, not density, doesn't matter at this stage. We have to assume and I think the assumption is correct that there is vast community spread across the United States. And I think you know, I think your question, you know, that's in the south, you're seeing a lot of southern states kind of ignore this. And the numbers coming out of the south now are horrifying because, you know, a state like Georgia says, you know, well, what? You know, we you know, we don't live like New Yorkers. Atlanta is like without most people knowing it. Atlanta is almost at Max with its hospital capacity right now. So these things are not.

Laura Knoy:
Oh my goodness, I had not heard that.

Juliette Kayyem:
Yeah. Yeah. So, I mean, so red states, blue states, rural states, urban states, you know it. Urban areas it this is not this is not indiscriminate. The virus is indiscriminate.

Juliette Kayyem:
That's why every country has done this successfully, has said, we don't care where you are, you're either a carrier or you're a barrier. Those are the only two options.

Juliette Kayyem:
You either are going to give it to someone or you could get it from someone. So let's keep you inside to be to be protected. And. And we're all living by it. I mean, it's shocking. I sound. I don't mean to sound matter of fact about it, I mean, I was pushing for this well before it happened because I you know, I knew the pandemic planning. I still found last week, really shocking. And I sort of lost, you know, even as an expert, I lost sort of all my sense of, you know, normalcy. I feel a little bit better this week, but, you know, it is hard.

Laura Knoy:
Got an email from Susan in Brentwood, Juliette, who says, I am strongly in favor of Governor Sununu issuing a stay at home order for New Hampshire residents, and as I said earlier, Vermont just did this yesterday, not issuing stronger measures, Susan says is leading many in our community to believe that this is not serious and quote, staying at home is only if they are currently sick, she says. Additionally, we should look to the child care measures our neighbors in Massachusetts have implemented, making availability for required workers only. Susan, thank you for the e-mail. And I want to remind listeners that you can e-mail us. E-mail us as well. For the whole hour. We are talking about these different orders that governors have been putting into place, advisories, orders, shelter in place and so forth. We talked about the different language and what these really mean on the ground. Juliette, Your response to Susan's e-mail?

Juliette Kayyem:
I know. I think that's really true.

Juliette Kayyem:
I mean, Susan's clearly hearing a stay at home order as different than a shelter in place just for, you know, whatever. I think that's right. I think sort of, you know, to the extent our planning is really a communication strategy to the public. And I love the stay at home borders. I mean, they're they're functionally not different. Right. I mean, in other words, you're you're basically we're, you know, as a governor or our mayor is making it hard to go outside. And but I think I think people here, a stay at home will do differently. And I think that's important that they do that. That just seems really serious, like something really bad is happening where shelter in place is kind of like, oh, there's a blizzard and social distancing just seems like, okay, I'm not going to go to a party. Right. See you. The language has to be strong. We're not getting it from the top. So that's falling to governors and mayors.

Laura Knoy:
Well, let's hear a little bit from Governor Sununu at his press conference yesterday about why so far he has not issued a shelter in place and his thoughts around just the linguistics, the semantics around this, let's hear.

Audio Clip:
I understand a lot of folks are asking about a shelter in place initiative. It's one of the hot button terms as being used out there right now and comparing New Hampshire with Massachusetts and New York to states with high density areas and large numbers of confirmed cases. But please keep in mind, even in these states, there is not shelter in place orders. They're asking folks who stay at home just like we are here in New Hampshire.

Laura Knoy:
And again, that's Governor Sununu at a press conference yesterday, want to let listeners know that we have been talking with the governor's office. They've responded to our requests. We're both trying to get the governor back on our air to discuss this crisis. So I do want to let folks know about that. Juliette, what is going on in Massachusetts? What's the situation there?

Juliette Kayyem:
So it's you know, it's just like a moment in time.

Juliette Kayyem:
But basically, Governor Baker with the mayor, I think were reluctant or were not. We're not we were not first out. I mean, I think that's safe to say. And I'm disinclined to sort of criticize it because I don't know all the details. But certainly I thought it was odd that that it took until. No one knows their days anymore. Today's Wednesday. So it took until Monday for Governor Baker to announce a state wide. Essentially, you know, shelter in place, a mandate which which then impacts state services. And and that's where we are right now. So essential services are open markets and things like that. But I went for a run this morning. And I mean, I could have had the street to myself, you know. I mean, it was. People are abiding by it. And I think we all our numbers are. I think we're fourth or fifth state nationwide in terms of the number of patients. We are not seeing we're not I don't think we're seeing I think we're low on the curve. And the anticipation is, is that maybe in a couple days we'll begin to see some of the stuff that New York saw or at least we're in anticipation of it. We are lucky because of our very strong, you know, public sector to health community nexus here. I mean, Charlie Baker, you know, he was a health care executive. And we just have a really strong foundation with the colleges and universities and all of them are leaning in. So I am hopeful that whatever we see the combination of now strong orders for Boston, the Massachusetts, with I think a strong sort of response apparatus that we won't see the worst of what New York and and presumably New Jersey right behind it are about to see.

Laura Knoy:
Well, absolutely, Massachusetts, and especially Boston, known for its robust and preeminent health care sectors. You've got that going for you. Juliette, a listener in Vermont, sent us an email. I'd love to get your thoughts on this. This listener says, My husband works for an aftermarket auto parts factory in Vermont. They insist they are essential and are telling all employees they must come in. This listener says for some, this is a blessing. And for some, a curse. From my point of view, this is not an essential business. I am worried for my husband and our family. How are they defining essential and non-essential in Massachusetts?

Juliette Kayyem:
So it's it's pretty tight. I'm surprised by that definition in Vermont. And I wonder, there's this there's this really not to get too legalistic about it. I mean, I don't know that the company.

Juliette Kayyem:
But if the because the federal government has been so far behind in terms of setting the standard, if any company has a nexus to the federal government. So, you know, think of the military supply company, even a small one or submarine unit or naval base or wherever up in New England, they are deemed as essential so that the worker there is then deemed as essential. So you're seeing the sort of like hodgepodge of who's essential, who's nonessential in Massachusetts. The governor has been very strict. I mean, it is it is essential delivery services, essential sort of functioning of life. Services companies are being, you know, strongly urged that they that the pool of nonessential be larger than the than the smaller essential. And whatever they whatever they're doing that they that they have what's called, you know, continuity of operations that day, that you're able to do everything remotely. And, you know, we've had time and we've tested, you know, hopefully these or these companies have tested the systems. I'm a professor at at Harvard's Kennedy School. I you know, I've. I didn't you know, everything now moved to Zoom. Right. So. So we've had time. So that's sort of. So if people are looking for like clarity, that's the problem here, is that we have 50 states all figuring out what the what they should do with no federal guidance or mandate. And it's like sort of the worst way that one could address, you know, stay at home or sheltering in place orders.

Laura Knoy:
Well, and to that point, your desire for a national order, Michelle in Lee emailed. She says, I live in New Hampshire and my ex-husband lives in Maine. I have my son during the week. My ex has him on the weekends. We have pretty much been sheltering in place, Michelle said. But my ex and people in the household where he lives are going out to work and to relatives houses and not taking this too seriously, Michelle says. I'm very concerned about sending my son to his house, she says. I wish there was a shelter in place order across the board for the country so we can get through this as fast as possible. So that's Michelle in Lee and Juliette. I'd like to take a call. This is Randy in Keene joining us. Hi, Randy. Thanks for calling in.

Caller:
Thanks for it. Thanks for having me. Hope you have the best way they possibly can. Considering the circumstances,.

Juliette Kayyem:
You have different standards. You say, B, people ask me how I am and I go, I'm pandemic good. Like I don't know what else. Yeah. There you go. Good, isn't it?

Laura Knoy:
That's a good way to put it, Julia. Thank you for that.

Juliette Kayyem:
I'm pandemic OK I'm pandemic great. I'm pandemic good. They're all relative.

Laura Knoy:
Yeah. What's your question.

Caller:
Well no, it's more of a comment. I'm a taxi a city councilor down here in Keene. And I've been urging all of the residents of Keene and while throughout New Hampshire, actually, that I can get hold ups through social media, you know, to call the governor's office and just demand that, you know, governor commuted to a shelter in place. Obviously, this should be national. I don't think we're ever going to see that with a lack of leadership in Washington. But at least I'm hoping we get a little bit better leadership up in Concord. Vermont, Maine and Massachusetts have already shown that they have governors that can make the tough calls. And I'm just hoping that we can put enough pressure on this governor to do the right thing, because this makes no sense having all of our bordering states with shelter in place. And there we are in the middle of all of that and we don't have a shelter in place. So I'm hoping he'll call the governor's office today and add a little bit added pressure to Governor Sununu and hopefully he'll do the right thing.

Laura Knoy:
Well, and Randy, thank you very much for the call on the governor again, and I've been watching news briefings every day. He has said I'm looking at the situation and it could change, but there are others who feel the way you do, Randy. And coming up, we're going to talk with the mayor of Manchester, who has strongly come out in favor of also a shelter in place. She says that would help her out a lot. Juliette, a couple last questions for you.

Laura Knoy:
This question of how long be coming becoming more and more as Americans look at weeks and weeks of these orders, whether it's social distancing, stay at home and so forth. It all kind of feels pretty dreary. What's the best way for any responsible public official to answer this question of how long?

Juliette Kayyem:
So I think here's how I would answer it.

Juliette Kayyem:
Not tomorrow and not a date certain that as a leader, you're looking for metrics at this stage and that and those include how many people are getting sick, how many beds are available at the area hospitals, how many ventilators, respirators and testing kits. And that the goal is that we get into a steady state isolation effort. In other words, this is the tidal wave. There's a surge conceptually for people to think about it. So this is the tidal wave and it felt like an on off switch last week. Like it's like what what just happened you know what? I get it right. This is the tidal wave. The recovery will be more like a light dimmer. It's going to it's going to go up and down and maybe there's a pocket here and we we do it. But the ultimate goal is to be able to manage the risk. And we're and and and the only way that happens soon is if everyone stays at home, that the longer people don't stay at home, the longer it will take to manage the virus until We have ultimately a vaccine, so we're not on the inside 18 months. I mean, people see this 18 month number for the vaccine. We're not going to be inside for 18 months, but we're going to get to a better place where we can manage the risk and people can can begin to live their lives again. That begins with you. That begins with all your listeners. The clock does not start effectively, so everyone stays at home and we begin to limit the number of people exposed.

Juliette Kayyem:
So I in my I'm a mother of three. I'm I'm I'm. I am writing off March and April. And then I mean, there's no better way to say it. And I think anyone being honest would at this stage. Bill Gates just just gave a speech about it. We can worry about the economy. You know, the president wants to open up. I will tell you this. Our economy will be worse off by an unregulated unmanaged virus than it will be by this brief but essential hit with the stimulus package, which we're going to get. Those are your only two options now. Right. So so they're both bad, but one is much worse than the other. So let's manage this virus and get back outside.

Laura Knoy:
Oh, Juliette, it's really been good to talk to you. I hope you can join us again. But for now, we'll let you go. Thank you so much.

Juliette Kayyem:
Thank you. Have a great day.

Laura Knoy:
That's Juliette Kayyem, homeland security expert, professor and Boston resident.

Laura Knoy:
Coming up, why the mayor of Manchester wants tighter restrictions. Also, any fears, Josh Rogers, on what the state's political leadership is saying? Stay with us. This is the exchange on New Hampshire Public Radio.

Laura Knoy:
This is the exchange, I'm Laura Knoy. This hour, public health directives from shelter-in-place to closing nonessential businesses to social distancing. How these decisions are made and how effective they are. Let's hear from you. What kind of restrictions would you like to see in New Hampshire? Should they be tighter? Should they be looser or do they feel about right to you? Let us know. With us now in the line is Joyce Craig, mayor of Manchester Mayor Craig, thank you for being with us.

Joyce Craig:
Thanks, Laura.

Laura Knoy:
And also with us, Josh Rogers, NHPR's senior political reporter. And Josh, thank you also very much for your time.

Josh Rogers:
Good morning, Laura.

Laura Knoy:
Well, Mayor Craig, you've called on the governor to impose tougher restrictions on public activity than he has thus far. What what more do you want to see, Mayor Craig?

Joyce Craig:
Well, you know, first, I commend the governor on the steps that he's taken to address this pandemic from closing schools to restaurants and bars and eliminating red tape associated with unemployment. But really, the one thing that's proven based on science and data is to combat the spread of COVID-19 is for residents to stay home. And I think until we hear that as an order coming from the governor, it won't happen.

Laura Knoy:
What kind of behavior are you seeing in Manchester, Mayor Craig? That makes you think this would be helpful?

Joyce Craig:
Sure. So we are seeing individuals obviously make changes in what they're doing, but at the same time, we are seeing people still gathering in larger groups than they should. I read on social media this morning someone who had been at Market Basket for the senior hours and they made note that there were five people deep in a line. So, you know, as much as we encourage and every opportunity I get, whether it's social media or on the radio or on TV, I strongly suggest that families and people, anybody in our communities to stay home whenever possible until there's an order in place. It's just not going to happen.

Laura Knoy:
What else are you seeing besides that grocery store behavior, which I don't know if shelter-in-place would change that because people still to go the grocery store. But what else are you're seeing on the streets of Manchester that make you think, you know, I could use some help here?

Joyce Craig:
So, you know, we are delivering lunches to families and students. And when people are waiting for those lunches, they're closer than they should be. So we're educating people as we go. But, you know, it's getting that word out. We're seeing people walking along the street. And closer than six feet apart. So, again, it's making sure that people understand the best way to fight this virus is for individuals to stay at home. Every day that the governor does not issue a stay at home order means there are going to be more infections, more stress on our health care and eventually more fatalities. And I understand that this is not an easy decision. And really, nobody wants it, but it's absolutely necessary right now.

Laura Knoy:
Josh, remind us, please, what restrictions the governor has put in place.

Josh Rogers:
Well, I mean, there's been a rolling list of restrictions, the most recent one was an order limiting gatherings to 10. You know, that came 10 days after the governor declared a state of emergency. And, you know, eight days after he closed schools. And so, you know, he's saying that he's reacting to conditions on the ground.

Josh Rogers:
And, you know, over the past 10 days, he has been consistently saying that, you know, this could change, restrictions could come. You know, he's been stressing that voluntary compliance is the language he uses is, in his estimation, getting the job done right now.

Josh Rogers:
And, you know, he hasn't he hasn't ruled out taking further action, but he has you know, he has to dwell on the fact that, you know, he knows states do we have, you know, essentially martial law enforcing these with tremendous rigor. I mean, some states and municipalities are more aggressive than others about sanctions for violating, you know, stay at home or shelter in place order, depending on the terminology. But he's suggesting right now he believes we're where we need to be.

Laura Knoy:
Well, the governor has said at these briefings. Yeah, go ahead, Mayor Craig.

Joyce Craig:
Well, we have medical professionals. In fact, you had two on, I think, yesterday or the day before. Kris McCracken and Joe Pepe, president and CEO of Amoskeag Health and of Granite 1 Health and CMC respectively, both saying that we need to support a stay in place. And we also have workers who are forced to go into work for non-essential jobs right now because there is no order. In fact, self-employed or independent contractors are not able to file or are not covered by unemployment benefits unless there's a stay at home order. So, you know, it's a situation where we really need we need the governor to step forward now and provide this order in order to keep our community safe and to curb the spread of this virus.

Josh Rogers:
Mayor,have you talked to the governor?

Laura Knoy:
Yes. Go ahead, Josh.

Josh Rogers:
Have you have you had the chance to talk to the governor about this directly?

Joyce Craig:
I have. It was last week.

Josh Rogers:
What what did he say? Basically what he's been telling the public.

Joyce Craig:
Yes, he wasn't. He's not ready for it yet.

Joyce Craig:
He at the time and he he used the governor of New York having not issued anything yet. But now that's changed.

Josh Rogers:
Well, that is one thing that has been interesting having at his briefings, you know, typically, you know, the gov. There's lots of you know, every governor embraces some form of kind of New Hampshire exceptionalism and, you know, preparing a pandemic that makes less sense. But, you know, the one thing that has been interesting is to track the governors language about, you know, kind of keeping his eyes on what other states are doing.

Josh Rogers:
He's taken to referring them as partner states, which is language you don't typically hear from him. When you spoke with the mayor, did he say, you know, I'm keeping my eyes on what's going on elsewhere? And that will tip my hand?

Joyce Craig:
It wasn't that specific and it was a brief conversation. You know, he said he's not close to it like he continues to say, but he's not there yet. And again, that was last week.

Laura Knoy:
Mayor Craig and Josh, this has come up a lot at these news briefings that the governor and top state officials have been holding week by week, and to that point that you've been raising, Josh, about how, you know, the governor has said he is looking at this day by day. OK, so it's not a I will never do this, ever. I want to play a clip from the news conference just yesterday where the governor said, look, the situation, the rules, the restrictions could change depending on how this virus evolves nationally and regionally.

Audio Clip:
We very well may have to take steps in the future to escalate things as we go. We're not there today. We're going to again look at the variables, the interaction with our citizens, how businesses are doing, how citizens and communities are handling these these very different circumstances of isolation. We're gonna look at our surrounding partners with Massachusetts and Vermont and Maine and Connecticut. These are all variables that have to come into the mix because we are part of a bigger region here, to be sure. And there is so much cross-border contacts that we can potentially have. We cannot just shut down the borders. We can't limit transportation from one state to another, nor would we necessarily want to. But that is isn't in our our our opportunity. So we have to be part of that bigger picture, to be sure. So things could escalate. They could ramp up. But we want folks to take the social distancing very seriously. We want to take the ability to work at home, tell her, tell her teleworking essentially what whenever possible. You know, forcing restaurants to go to take out all of these steps, cutting down social gatherings to 10 people. All of these are really critical steps that other states have taken. We're right there with them in a lot of that. And again, as different states and different regions look at their variables and they escalate things. We have to be cognizant that, again, the surge is still possibly a few weeks off here. This is we're going to get more and more cases identified throughout New Hampshire and we'll take appropriate steps as we go forward.

Laura Knoy:
Again, that's Governor Sununu speaking at a news briefing yesterday, today on The Exchange we're looking at all these public health directives that different states have been coming out with differently from shelter in place to stay at home. Orders to social distancing. We're looking at what these directives mean, how well they work. And we'd love to hear from you. What kinds of restrictions do you think New Hampshire should put in place? Do you think the ones in place now are effective? Should they be tighter? Should they be looser? Let us know. And Mayor Craig Josh Rogers. I want to take a call from Nashua and I believe Mayor Donchess has called in from Nashua. Mayor Donchess thank you for being with us today. Oh, OK. I guess we're having a hard time with Mayor Donchess you know, for the foreseeable future. I am remote. And all our guests are remote. And sometimes these technical things happen and that is OK. Mayor Donchess or anyone else can give us a call at 1 800 8 9 2 6 4 7 7. Josh, you have been at these briefings. We just played that clip from the governor saying repeatedly, look, this could change. Did he give you a sense, Josh, of what factors he's going to examine when he does make that decision, if he makes that decision to put a tougher order in place?

Josh Rogers:
Not with any specificity. I asked him if there were. I think he used the term benchmarks that he was looking at. And and he said no and kind of indicated that, you know what, we'll know it when we see it. You know, there's obviously a question about waiting. You know, he he implied in that in the in the in the tape you played that, you know, the surge is coming.

Josh Rogers:
And perhaps when the surge comes, we'll take more serious action than you know. Obviously, that raises the question of whether the surge is going to be worse because less serious action isn't being taken yet.

Josh Rogers:
But I mean, the bottom line for the governor at this point does seem to be that he sees, you know, this voluntary compliance with advice is essentially achieving the same result that, you know, Mayor Craig and others are finding wanting.

Joyce Craig:
And I think Josh...

Laura Knoy:
What are you doing on your own? Yeah, go ahead, Mayor Craig. Sorry.

Joyce Craig:
Preparing for the surge. You know, we have 250 beds now set up at Southern New Hampshire University in preparing for the surge. And I view an order coming from the governor of a stay at home in the same light as that. It is preparing for the surge as best we can. We need to make sure today that people understand the critical mass of staying at home so we're not spreading the virus. The scary thing about this is that people are carriers and they don't even know it. And so the more we can stay put and that doesn't mean you're locked in your house. Obviously, you can go out for essential things such as groceries or medication. But generally speaking, to work and live and stay at home is critical at this point.

Laura Knoy:
Mayor Craig, you're an avid runner. What about exercise? This is coming up more and more. New Hampshire's an outdoorsy state. We would like to get out. I myself have been out walking every day just to, you know, refresh and recharge. So what about you?

Joyce Craig:
Yeah, absolutely. Yeah, I've been taking more walks now than I have been running at just because of the schedule that I'm keeping. But that's absolutely critical right now. A walk, ride your bike. Once the snow is gone, you know, starting your garden, maybe. But the fresh air is critical.

Laura Knoy:
Let's take another call. This is Roger in Manchester. Hi, Roger, you're on the air with Mayor Craig and Josh Rogers.

Caller:
Hi Mayor Craig and Josh Rogers. I just want to say yesterday I was shoveling in a neighborhood and an elderly lady was talking me that she didn't believe that that this thing was really happening. She's heard that this is a hoax and exaggerated and all that kind of stuff. And I just wanted to say that I think we need people to tell people the truth. And that's not the fault of these conspiracy theories.

Laura Knoy:
Wow. Roger, thanks a lot for calling in. And Mayor Craig, have you heard this, that, you know, some residents are saying it's all a hoax and I don't believe a word of it.

Joyce Craig:
I think that's part of it. Until there's a seriousness in terms of, you know, we've got to stay home in New Hampshire, then it is hard to believe.

Laura Knoy:
Josh, I want to ask you again about the news briefings that you've been covering every day. How much social distancing is going on at these briefings, Josh? I was watching one the other day with a couple of my teenagers and one of them said, gosh, they don't look like they're six feet apart up on that stage. So what's going on in terms of these rules and restrictions that those news briefings?

Josh Rogers:
Well, the briefings have not been daily. I mean, they've been mostly every other day, but they have the social distancing has certainly been more rigorously observed. On the reporters side of the podium, though, the chairs are set up six feet apart. Sometimes I think that. And, you know, certainly the governor and top officials are endeavoring to stay farther apart that they might and there's obviously no handshaking going on. But, you know, I think the observation by the teenager in your midst that, you know, perhaps they were standing closer than six feet is accurate. They are trying to fit within a camera frame. But one thing that has been interesting about these briefings is in the last couple days, they've set up a checkpoint. These briefings are now taking place up on the campus of the fire academy. And the emergency operations center is away. And when you drive in the driveway, there's a quaffing sign that says checkpoint. For the last two days, I and their state troopers there who come to the car requesting I.D., ask what you're doing. Ask if you traveled internationally, asking if you had any contact with anyone who you believe could have been exposed to COVID-19. Ask how you're feeling and then pull out a thermometer that they, you know, take a reading based on your forehand. And if you have a temperature, presumably you're not let in.

Josh Rogers:
And so that that's been in effect the last two days.

Laura Knoy:
Yeah, well, we got an email from Otto who says my employer has been deemed essential by the D.O.D. Department of Defense. So our work will be going on uninterrupted. Otto says, I believe everyone on the manufacturing floor was excited to hear we will not be closing. My question is, if people are now going to work in places where they don't interact with customers or outside people and are doing only essential activities outside of work. Otto says, how is this any more risky than fully sheltering in place? Our highest risk actions are the necessary ones. Otto. Thank you for the email. And Mayor Craig, how do you respond to that?

Joyce Craig:
Yeah. When I think about their first responders and health officials who are working from the city's perspective front line, we are preparing them and making sure that they have everything that they need to keep them safe from materials to, you know, wipes and everything like that. So we are making sure they've got everything that they need. They've also changed the way that they're doing work. So they're really limiting their exposure to the public as much as possible. So we've we've looked at our processes within the city and made changes. We are continuing to provide the services that the community needs and requires, but we're doing it differently to ensure the safety of our employees as well as the safety of our community.

Laura Knoy:
Well, and we got an e-mail from someone who says our veterinary services, essential doctors and staff can not really work from home and can't even do their work at a six foot distance. And I appreciate that point. You know, if you and the veterinarian are dealing with a large dog, you know, sometimes it takes both of you. Sometimes even the cats get pretty upset. What do you think, Mayor Craig? Would you consider if you were in charge, veterinary services essential?

Joyce Craig:
I think that I think they could do the same thing that our physicians have done. So maybe push off sort of the annual exams or things like that, but be available for emergencies only. So they don't have to keep their full staff in as essential employees, but can come in if necessary.

Josh Rogers:
Well, I want to ask both of you about the politics of this moment and then we will let you go. At the news conference yesterday, the governor was asked about President Trump's recent statements that the cure can't be worse than the disease. He's quoting the president there and that it'll soon be time to, quote, re open the U.S. economy. Governor Sununu was asked about this yesterday. He had a very different message. Let's hear.

Audio Clip:
Look, I can appreciate. I think I speak for every governor and across the country. When you say, of course, we want the economy to come back as fast as possible to allow as much of the economy to stay healthy and reactive to the COVID crisis so we can get our groceries and our gas and all of these sorts of things. What we're not going to do is overly accelerate or loosen regulations just for the sake of the economy. At the risk of public health that we are not going to do that in New Hampshire, public health has to be preeminent and come first. There's a lot of anxiety over the unknown. We're going to make sure that we keep taking steps forward to not just allay that anxiety, but to make sure that we're creating a system that can deal with the surge capacity needs or whatever needs you might find in your community, whether it's in education or or even in your business. But we're going to do it in a way that public health is preeminent. So whatever message is coming out of Washington. We're going to take care New Hampshire first.

Laura Knoy:
So, Josh, as a political reporter, how do you view the politics of this moment, of that statement, especially since we've got a Republican governor, a Republican president and a Democratic congressional delegation?

Josh Rogers:
Well, I mean, the first off the governor, has you know, the interests of all of the citizens of the state, you know, obviously it's always a balancing act.

Josh Rogers:
You know, shot through, you know, a lot of the governor's comments on this. I mean, obviously, everyone brings their own ideological perspective and you can see that in his talk of voluntary compliance in some ways. Listening to him talk about shelter-in-place orders, it's sort of like, you know, the argument over mandatory seatbelt.

Josh Rogers:
So if we're getting the proper if a lot of people are using seatbelts and we don't have we don't have to force them, then then that works just as well. And so, you know, there's certainly an ideological overlay, but, you know, it varies from state to state.

Josh Rogers:
You look at Governor Mike DeWine in Ohio, a lot of people are crediting him for being he's a Republican, for being, you know, an early person who was willing to take serious steps to protect citizens in his state.

Josh Rogers:
And, you know, he's interesting to hear the governor speak positively, effusively about the congressional delegation. He's often been at odds with them and they seem to be working together. Well, at this moment, which is certainly something that the public would want. And, you know, President Trump is a different sort of animal in terms of his relationship to, you know, kind of partisan Republican Party politics. Than we've typically seen. And you know, the governor is obviously trying to strike a balance.

Laura Knoy:
Well, and Mayor Craig, last thoughts from you as you worked to at least do the best you can in Manchester.

Joyce Craig:
Yeah. Again, I consistently go back to our community. They're a giving community. They've been very patient and I appreciate all they're doing. And want to just stress again how important it is for all of us to stay home, to remember that this is not going to last forever, that folks are making difficult decisions. But again, it's all based on making sure that our community is healthy and thriving and and again, if at all possible. Please stay home.

Laura Knoy:
Do you have the authority, Mayor Craig, to take further measures than other cities? Could Manchester take different measures than Concord or Nashua or, you know, Claremont?

Joyce Craig:
I do not. Which is why we've had the conversation with the governor and working with Mayor Donchess and just trying to stress again the importance of it from our community's perspective.

Laura Knoy:
All right. Well, again, I want to let listeners know that we have been talking with the governor's office and we are both trying to get the governor back on the air to discuss this crisis. So that is being worked on. For now, though, I will say goodbye to both of you. Mayor Craig, thank you very much for being with us. We appreciate it.

Joyce Craig:
Thank you.

Laura Knoy:
That's Joyce Craig, mayor of Manchester. Josh Rogers, thanks for helping us out. I'm sure we'll talk again soon. Thanks.

Josh Rogers:
We will, Laura.

Laura Knoy:
That's NHPR senior political reporter. Josh Rogers.

Laura Knoy:
Coming up, a leading infectious disease doctor from Dartmouth College's Geisel School of Medicine will give us the medical professionals, take on all these restrictions that we've been talking about that have been burying governors around the country. And we'll keep taking your questions and comments. Lots of e-mails coming up. So I will share those.

Laura Knoy:
This is The Exchange, I'm Laura Knoy. this hour emerging public health directives from social distancing to shelter in place. We're asking how the nation's governors have been making these decisions, what they mean and which ones are more effective. Let's hear from you. With us now is Dr. Lisa Adams, practicing physician and associate professor in the Infectious Disease and International Health Section, Geisel School of Medicine at Dartmouth. She's also director of global initiatives there and co-chair of Dartmouth's COVID-19 Task Force. And Dr. Adams, busy times for you, I'm sure. Thank you very much for being with us. We appreciate it. It's a pleasure to be with you. Well, we've been talking about different types of orders that different states have put in place. Again, stay at home orders like the governor of Vermont just issued shelter in place. Social distancing and so forth. From your perspective, given that this is what you do, infectious disease, what's most effective?

Dr. Lisa Adams:
We certainly know that in in dealing with the COVID-19 pandemic, what we really need to do, we don't have a vaccine that's a long ways off, don't have a medical cure. We need to be implementing public health measures. And those include some things that we've already done, the school closures, the banning of public gatherings. But it's really in the social distancing that has been encouraged. But it's really time now to make that a mandate. We don't have any time to lose. I'm a physician, so I'm concerned about about treating disease and saving lives. And I'm a scientist. So I look at the data. And the data are really clear right now in terms of where we are in the epidemic growth of curve of what we're seeing in New Hampshire. And more broadly in the U.S. And we know from both the global experience. Right, the countries that have been weeks and months ahead of us. And we know from historical data what we need to do to now curtail this epidemic. And I'm happy to talk about the data. I think it's really clear looking at the again, the the global experience, but also historical data.

Dr. Lisa Adams:
So we have studies of what we call non-pharmacological interventions. Right. These include the standard public health measures that we've talked about and that these are what need. These are what we need to do. We don't have the vaccine or medicines to induce a cure. And these measures were studied in a well-done paper by some CDC colleagues. And what they did is they looked at death rates over a 24 week period in 43 U.S. cities during the 1918 influenza pandemic. And what they found was that the use of these non-pharmaceutical interventions, the so the school closures, the bans on public gatherings. Isolating and quarantining of contact.

Laura Knoy:
All the stuff we're seeing now. Yeah.

Dr. Lisa Adams:
Exactly. When these measures were were launched early and were layered as a multi-pronged approach and were sustained over periods of weeks. That's what had the most impact in reducing the overall mortality and really flattening that epidemic curve that we've been talking about and preserving our health care workforce, which is another priority.

Laura Knoy:
Oh, my gosh. We did a whole program on that a couple days ago, really dedicated health care workers here in the state and needing more help in terms of protective gear. So we definitely have talked about that. I want to bring our listeners in, Dr. Adams, if we could. And Andrew is calling in from Concord. Hi, Andrew. Thanks for being with us. Go ahead.

Caller:
Thank you very. Thank you very much for your input on the data. Again, I'm calling in support of the governor. I think that Governor Sununu, again, this is unprecedented time. We haven't seen something like this since the bird flu in 1918. So, again, what data we have at that time is at all rough. But what we're seeing across the world right now is not good. The implementation that Governor Sununu has done, I think, is in a timely and orchestrated manner in coordination with the White House. And he's doing a really good job, because if you do too much, too fast, people panic. We saw this with toilet paper. People thought, I still don't understand the premise of it, but again, informed they were shut down in a calm manner, starting with school, starting with takeout restaurants only starting with tattoo parlors, barbers.

Caller:
Again, it does hurt the workforce. But again, that curve that we're talking about, it can be altered in the steps that Governor Sununu has taken is the right step in the right order.

Caller:
And I think anything more aggressive would be would. Again, people in New Hampshire would not take to that very well.

Laura Knoy:
Andrew, I want to let our guests jump in, and I'm so glad that you called because this is the more moderate approach of the governor has taken. As Andrew says, you don't want people to panic. I also wonder, Dr. Adams, if people do start to feel restrictions are too tight, you know, especially as spring comes to northern New England, will people just say, oh, forget it? You know, so would they be more likely to obey more moderate restrictions? Andrew, good to hear from you. Thanks for calling in, go ahead Dr. Adams, I'd love your thoughts.

Dr. Lisa Adams:
But I think we've got a number of measures in place right now, but let me just make it very clear that time is of the essence here. We are seeing exponential growth of this of COVID-19 in our own state and in the U.S. I mean, I've watched the numbers go from 7 to 13, 26 over a matter of days. We're now at 108 cases. The time to act is now. We know that if we start putting in these measures sooner rather than later, that's what we're going to have the the impact that we need to have to reduce the caseload. And. And as I've said, sort of flatten out that curve, even delaying of cases. So I will. I would also say I know that people are being encouraged to stay at home. And I really like this analogy that someone said we don't encourage people to stop at red lights or to drive on the right side of the road. We mandate that. And I think that's where we are now, because if we start encouraging, I feel like that people, as we've heard from your previous guest talk about that they may not take it seriously enough. And that's really what we need to be doing now. And I think it needs to be delivered in a very careful way so that we don't induce panic, because I do appreciate the risk of that. But I think it's just making getting everyone on the same page so that we understand what we need to do in this unprecedented public health emergency.

Laura Knoy:
Well, lots of e-mails from listeners that I probably not get to all of them today, but we will be covering this definitely in the days and weeks ahead. And we've got Congresswoman Ann McLane Kuster coming up next. So I can also address some of your emails with her, but Elaine sent us an e-mail that I would like to throw to you, Dr. Adams, Elaine says. Why are New Hampshire liquor stores still open? Schools, most businesses, colleges and much more all closed during this medical emergency. If we are called upon to enforce social distancing and remain at home as much as possible, why encourage people to gather in a closed space? Now this is clearly a political and economic question, but I do wonder about that. It's this I'm not gonna ask you to address liquor stores specifically Dr Adams. But just the idea that there are places that are still open. We all kind of still have to go to the grocery store, although I guess it's time for me to maybe sign up for one of those, you know, to go delivery services. But what about that? How do you see people sort of navigating that?

Dr. Lisa Adams:
Yeah, well, again, I think the policymakers are the ones that need to decide what is considered essential businesses in this time. And I will leave that that work to them. But we do know that as much as possible. If we can limit our contact, our physical contact with others outside of our home, do more curbside, you know, really, really limit, allow us to interact and get our, you know, daily functions necessary daily functions done with by practicing social distancing that that's going to be the most effective measures that we can implement at this time. Right. That's that's how we're gonna be able to to mitigate the impact here. And that's what we're talking about. Anything we can do to decrease contact with others is going to have a positive benefit. So that's how I would encourage policymakers to think about it as well.

Laura Knoy:
Well, and toward that end, you know, again, policymakers are the ones who are making these decisions, and we've talked all hour about how different governors have gone about this differently. How much influence do you think doctors like you have? Dr. Adams, you're a leader in this field at a leading medical institution. How much influence do you think people like you have in these decisions, which are, as you noted, partly political?

Dr. Lisa Adams:
Right. Well, I again, I think our role is to as physicians and scientists is to bring the data to play in the decision making so that evidence based policymaking can't can be done. And that's what I think our role is to share what my colleagues are seeing from the frontlines of this epidemic to provide the data of hospital beds, ventilators, epidemiologic projections that we have and to really encourage the urgency to for us to be able to act together. This is an incredible opportunity for us to act collectively. This is a chance for us to all step up and do the right thing. And I think our role can be also to encourage the the population to do that. And I would say particularly young people. Right. The ones who are not likely to get to suffer the worst consequences of this illness. But ah, and with their mild diseases are the ones who may unknowingly contribute to community transmission. So I feel like our role is to say to the public and to others, this is the time to stay home. This is if you won't do it for yourself because you're not worried about getting the disease yourself, do it for your roommate who has asthma. Do it for your 60 year old neighbor who has to go into work because they are working in an essential business. Do it for her doctor so that they can stay healthy and take care of you when you get sick or do it for your grandparents and their elderly community. Again, this is a chance for us to also rise to this challenge, step up together and do the right thing. And I think that's something that we as health care providers and public health practitioners can can. That's a message we can convey.

Laura Knoy:
Well, Dr. Adams, thank you very much. And I hope you can join us again. We really appreciate it.

Dr. Lisa Adams:
Thank you.

Laura Knoy:
That's Dr. Lisa Adams, practicing physician and associate professor in the Infectious Disease and International Health Section at the Geisel School of Medicine at Dartmouth College.

The views expressed in this program are those of the individuals and not those of NHPR its board of trustees or its underwriters. If you liked what you heard, spread the word. Give us a review on Apple podcasts to help other listeners find us. Thanks.