 Welcome, Dr. Mark Levine, commissioner of health in the state of Vermont. We wanted at CCTV, which is a community media center based in Burlington. We wanted to do some opening of our facility and in the process of deciding how much to make our facility available to community members to produce video, we thought we better ask Dr. Levine really what, how to turn the spigot. So I wondered if you could start with where we are today on September 17th in terms of the well-being of Vermonters in relation to COVID-19. Does that all? Sure. So you want a big picture assessment? Yep. So you know, I will piggyback onto the esteemed Dr. Anthony Fauci who of course was here on Tuesday and basically said he would like to bottle up whatever we're doing right and take it with him to other states and that we are a model for the country. So that's his language, not mine, but to support what he said, the fact of the matter is, we have succeeded in achieving a level of virus suppression that would allow us to turn the spigot in the ways that the governor and our whole leadership team have chosen to turn it. So opening up aspects of the economy, increasing the size of groups of people who can gather together, opening up colleges, opening up schools now, all of these are being done very deliberately and very cautiously, but I shudder to think how we would do them in a state that had a much higher level of virus prevalent in the population. So when we are touting ourselves as the case, the state with the lowest new cases per day and the lowest percent positivity level of our tests being well below one percent with abundant testing occurring, we can feel pretty confident in making some of the moves that we're making, but I will again reiterate Dr. Fauci's counsel, which is, Vermonters, don't let up, don't let your guard down, continue to do all the right things and we can continue to enjoy the benefits, if you will. That must have been so encouraging for you to have Dr. Fauci give us this vote of confidence. You've worked so hard, you and the governor in the state, so it must have been kind of thrilling to hear from him. It was actually, yeah, we didn't like put the words in his mouth that he said what he wanted to say, but the bottom line is again, it is hard work to get to where we've gotten to and it's not my hard work alone, it's the work of Vermonters and we really need to emphasize that. If people did not adhere to all of the guidance that we've been providing as a team, I don't think we'd be in the place we're at. So I think it's hard psychologically for people to keep vigilant when they see that the numbers are low. What do you think about the fall and winter, the prognosis for the surge? What's Vermont, how are you seeing that, what kind of impact do you think it will have in our state? Yeah, you know, you've nicely sized up the double-edged sword. On the one hand, you want to be the best and be able to say look what we've done and on the other hand, when you're the best, people are prone to say, why aren't you allowing us to do more because look how low our numbers are and you run into a little bit of a circular line of reasoning because the reality is if you do let up on your guard too much, you'll be back in the place you were at. One thing Dr. Fauci was very strong about saying was the virus does win and if you do let it enter into the picture again, it will do what it normally does. So again, we have to be as vigilant as we can. We know that one aspect of summer ending fall beginning is people will congregate more indoors than they were outdoors. So already that increases the chance of more cases occurring. Today though, there's still occurring in a low prevalent state where very few of the people who are congregating indoors will have the virus. But of course, we're a tourism state. We will have lots of people coming in to do leaf peeping and eventually skiing and we want those activities to continue. So again, when we do have people congregating indoors, we need to be very vigilant still because it's not just remoders who'll be doing that. It'll be people from all around who aren't necessarily ill-willed and have poor intentions, but this is how things happen. So, you know, opening something as big as college or all of our K-12 schools, all of a sudden takes populations of younger adults as well as those who are in their supervisory and teaching positions from being in a stay-home setting or a stay-pretty isolated setting to all of a sudden every day being in a more congregate setting. So we've always forecast the fact that we do think numbers may go up slightly when we do this, but slightly is different than we'll have a real problem on our hands. And I think, you know, we've already seen the number of college students that tested positive was very low. You know, we're talking less than 40 students in the arrival testing out of literally 40,000 tests. And in our K-12, you know, we've gone through a period of time now and we've had only two schools that had very small numbers of cases. And frankly, those cases were students who were just coming off their summer break. So it's not like we put them all into a school and we had a whole bunch of people contract the virus. These were really people just who were ill as they were coming out of the summer and had a day in school when they were feeling fine and then that night they weren't. So we need to watch closely on the schools, but so far so good. Everyone's really upbeat about the way the reopening of schools has occurred. You mentioned the rapid testing or the dissemination of testing. Do you foresee when quick, you know, almost immediate testing could take place with regular people so they know whether they can get together for Christmas? Do you see that coming to Vermont? I do because the federal government is going to be providing a fair amount of rapid testing, access to rapid testing. They're targeting places like long-term care facilities right now. They envision, I think, them going to schools and other settings. So it won't be like every person has their own set of test materials and can just at will do a test before they go out and do something. But the reality is we need to learn a little bit more about the performance characteristics of these tests and we want to make sure that people aren't falsely reassured by doing a test that might miss 10 to 15 percent of the positives. So we have to be very careful as we walk this new into this new territory. And indeed, we're learning more about this all the time, but most of these new tests are so new they don't have a huge track record and a lot of experience. So we'll have to be very careful, but I do see them entering use in Vermont for sure. So I think it's starting to dawn on all of us that this will be in this. I'm not sure what the word is, but this period of time, probably through 2021 or maybe a year from now that we really have to keep up this vigilance for another year. Do you think that's a correct assessment and can you talk about the impact the vaccines might have on our way of life right now? Yeah, so you're referring to what many of us term the new normal. For me, the new normal is we will identify cases throughout the state, but not hopefully large numbers of cases. For you, the new normal is this life that I've had to adapt this lifestyle isn't over yet and I can't act like I used to act before the pandemic. So though the most optimistic of political figures will talk about, you know, November and December, the more reasoned and cautious ones will talk about the fact that even if we have a couple of great vaccines that are ready to go, they're not really ready to go. In November, December, they're just going to be available to maybe 10% of the population. And it's going to take a while to rev up manufacturing of those to get that to the point where everyone who wants one will be able to have one. And that's where you're talking maybe a year from now. I would like to be more optimistic than a year from now, but probably not just a few months from now either. So somewhere in between. And so it's really challenging because we want to have the population be optimistic and see the light at the end of the tunnel while at the same time not letting their guard up and not assuming that the quick fix is here and it's just a little more time and I'll be fine. So I think this change in lifestyle is going to last well into 2021, probably towards the second half of it. And can you just say a little bit more about rolling out vaccinations and sort of how that works? Because again, as you said, it's not as if a vaccination comes out and all of a sudden everyone is vaccinated. What do you see as a rollout in the adoption of the vaccines? Yeah, so, you know, there's several issues. First of all, the trials have to come to a conclusion and the trials have to conclude in some in such a way that the public will have confidence in the scientific integrity of the trials. The effectiveness of the vaccine will be visible to everyone in terms of how effective it really is. And if there's any safety issues, they will have come to light. Knowing that unfortunately some safety issues only come to light when you start disseminating it to large numbers of people because none of the trials can be so large that they might pick up a very rare side effect. But the confidence level of the public has to be high. We also know that people are cautious in their own lifestyles and many want to really wait on something. They don't want it right away even if it means they have to prolong this period of change in lifestyle. So we have to respect that. And we have to understand that while a lot of money is being sunk into these vaccine candidates and some of them, even before the trials are over, are having a lot of manufacturing going on in the hopes that this will be the one and they'll have some ready to go, the reality is think about the number of people in the United States. You know, it's in the 300 plus millions of people. And that's one country in the world. And then you think of all the developed nations, European Union, Canada, etc., some of the Asian countries and millions and millions and millions more people added to that, all of them wanting the same vaccine. And how much can you produce in a period of time and do it safely, of course? And then even if we had 300 million doses available tomorrow, how would we actually do the logistics? Logistics meaning have all the right materials to inject with and store with and any temperature considerations. Have a communications program so that people understand the vaccine better and know it inside out as to what it can and can't do. And if there are any potential adverse effects, how often do they occur? How serious are they or how mild are they? And then have an entire information technology infrastructure because especially if the vaccine is a two dose vaccine, which most of them are going to be, you need to actually be able to track the right dose for the right person, the right vaccine for the right person and not make mistakes about that because you want them to get the maximal benefit. So you have to really have that technology down. That's only the scratch on the surface perhaps of the complexity of this because nowhere on the planet have we done something to this degree before. Doing the annual flu shot is a piece of cake compared to this. Though the reality is we're learning a lot this year as we prepare to be more aggressive with the flu shot and try to make it more accessible to a larger portion of our population. And we're thinking and implementing lots of innovative ways to deliver that vaccine to Vermonters, whether it be traditional like in a pharmacy or a doctor's office, whether it be in a clinic that's set up outside of school, whether it be through a drive-through like some of the testing protocols are done, whether it be through some other innovative partnership where the vaccine can come to the person, meeting them where they are as opposed to some complicated structure that makes people show up somewhere that they normally would never go. So we're going to learn a lot just in the next month and a half about how to deliver a lot of vaccine innovatively and creatively to a lot of people. And why is it important to get a flu shot this year? We think it's really important because we know that the way these viruses behave and especially because they prey on this indoor assembly of people that they will exist at the same time in our cycle, whether it be the fall or the winter or both. And it would be much nicer to have only one of them active and the one we can do something about today is the flu. And if there is a 50 to 60% efficacy rate of this vaccine, which we'll find out but we would hope for at least, that would mean we'd have a lot of people who, if they presented with respiratory symptoms, probably don't have the flu. And we don't have to worry so much about that. And we can then not overwhelm the healthcare system with lots of people sick with both COVID-19 and or the flu at the same time. Plus all the other usual respiratory viruses we see in the wintertime. So it'd be very nice to have done as much as we can to prevent what we can prevent. So I just have a couple more questions. The nuance and complications of public health. I mean, you've just gone through just describing the vaccines. There's so much to think about. Yet, when you're the governor, you need to boil it down and make it as simple as possible. How has your relationship with Governor Scott, you know, bringing the detail that needs to be understood with the political need to communicate? How has that worked for the two of you? Oh, marvelously. I learned a lot from him. So that's an important take-home message. Not just in how to communicate, but really, he's very thoughtful about all the issues. And it's very good to get his point of view on things because it's so often reality-based and almost to the level of a vermonter, and we need to hear that all the time. But Governor Scott has done an incredible job of educating himself in science, in data, in COVID. Admittedly, we play a role in that, but the fact of the matter is he's taken this as job one. So he's become quite educated. We have a great working relationship. He's assigned a whole team to this opening of the spigot process, and we always have the public health input to that process, but not at the same time without the input of all the other sectors of state government. And people in Vermont need to know that their governor really puts health and safety as job one. And that makes it so easy for me and my entire team at the health department because that's what our job is. The mission of the health department is to protect and promote the health of all vermonters. Well, a governor that makes that their job makes my job so much easier, and vermonters should find a tremendous amount of comfort in that. Because just looking around the country, that's not always as obvious as one might like it to be from state to state. So I think in that sense, things have worked very, very well. And I think the communication in terms of communicating our messages out, we get a chance to do that twice a week. We used to do it three times a week. It's been somewhere between 60 and 70 times already this year. And if we don't make the message as clear as we can, we get asked a question that allows us to clarify even further. So our vermoners really get a chance to understand things. Plus, they get to understand things happening on the national front through the eyes of us in Vermont and how we interpret it and try to bring it home to them so that not only is it understandable, but it's applicable to experience here in Vermont. What's the benchmark that you're using to turn the spigot off? What danger signs are you looking for? So every Friday, we do a modeling presentation. And the modeling presentation that Commissioner Pichek does from finance and regulation covers numbers of new cases, the rate of new cases developing, the percent positivity rate, the what we call syndromic surveillance, which means how many people are presenting to ERs or to urgent care centers with COVID symptoms. We look at hospital capacity and how our health care system is doing in terms of numbers of beds available, ventilators available. ICU rooms, et cetera. A whole host of factors like that. And we look to see not only are they stable or are they changing, but did something we did with a turn of the spigot have any impact on them? And so when people say, oh, why can't you move a little faster with opening the spigot? It's because we really do need to respect the virus. And if we do something that creates more opportunity for more people to be together, we need to give it at least that two-week period of virus incubation to make sure that we haven't changed anything in a dramatic fashion before we move on to the next turn of the spigot. And that's really been our philosophy all along and taken us really far along this continuum. So in closing, I would just thank you so very deeply for your work. I know that you have been working on this morning, noon, and even in your sleep, I imagine. But what makes you hopeful in this period of time? The thing that makes me the most hopeful is the performance of our state. If there weren't even a vaccine available, the state has done so well. And though people may not regard their life as back to normal, whatever normal was, who remembers anymore, they at least understand that there's more that they can do than they could do originally. And we've worked with the virus in the background to try to get them back to some things that they enjoy doing, whether it be doing recreational things in the summertime, whether it be sitting out on Church Street in Burlington at an outdoor restaurant, whether it be sending their kids back to school, et cetera. We've been able to do a lot in that context. And I feel pretty confident from the scientific point of view that a vaccine is on the way. And though we will all be very impatient and want things to move faster, the reality that they will at least get us to a point in time that we haven't been to yet and there may be even more of a bright rainbow on the horizon, I think is really, really important for everybody to take into consideration. Well, Dr. Mark Levine, Commissioner of Health in the state of Vermont, we really thank you for your time today and for all that you've been doing for our state. Thanks for having me.