Want to prevent the next pandemic? Fight climate change

Want to prevent the next pandemic? Fight climate change


Below is a written transcript of Episode 4 of the HEATED podcast, out today on all your podcast apps, or at the audio file at the top. My guest is pediatrician and Harvard C-CHANGE interim director Dr. Aaron Bernstein. In it, he makes the case that fighting climate change is essential preventative care for the next pandemic.

My favorite quote from Dr. Bernstein comes at the very end:

“The healthcare community doesn't wait weeks to tell you that, if you don't want to have a heart attack again, you need to stop smoking, change your diet, and the other factors that contribute to heart disease. We're in that moment now.”

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Photo credit: Dr. Bernstein’s twitter, @DrAriBernstein

Emily Atkin: Dr. Bernstein, thank you so much for taking some time to come on to the HEATED podcast.

Aaron Bernstein: Thanks for having me.

EA: A few months ago, the Nieman Foundation for Journalism at Harvard hosted this training workshop for journalists on covering climate change, to help us help each other tell the story of climate change better. You were there, and you made this really compelling case for why we as journalists should be focused on the health impacts of climate change over everything. Could you make that case for our listeners?

AB: Sure. It's an easy one to make. We know that climate is a politicized issue in this country, which is a problem because it has nothing to do with politics. It has to do with reality. And so our charge is to figure out how to make it non-political.

So how do you do that? The evidence I've seen is by talking about climate change as a health problem. And not just as a health problem, but also as a health solution.

Even more so, the message is best communicated through healthcare providers, and that's based on research that has been done across the country looking at a whole suite of folks who could be the messenger on climate and health. The evidence is clear that primary care providers, doctors, and nurses are the most effective communicators.

So I think that's a key part of moving forward on climate. Bringing it down to size, making it personal, making it about health, and making it clear that when we do things, they benefit our health right now. Burning less fossil fuels means less air pollution. It that people are going to lead healthier lives, we're going to have less children showing up in emergency rooms with asthma attacks, we're going to have less adults going to emergency rooms and getting hospitalized with heart and lung problems and a whole suite of other outcomes.

EA: Is there a similar case to be made right now in the middle of the coronavirus pandemic?

AB: I've been working in the hospital off and on in the middle of this, and I'll be going back a week or so now. And one of the first children I cared for, we had to dress ourselves as if we were martians to go see. And you can rest assured that children are generally apprehensive of physicians, and dressing like a martian doesn't help.

As I was with that family and child, trying to form a bond through a layer of yellow gown, green mask and face shield, I realized pretty quickly that if we really want to talk about preventing this—because every time I'm with the family, the parents always want to know, “what could I have done to prevent this”—we have to talk about climate change. Of course hand washing is important. Social distancing is important. But that's actually not going to prevent this from happening again. What's going to prevent this from happening again is tackling climate change, is addressing the causes of biodiversity loss.

Many of us have a hard time grappling with the reality that we're losing life on Earth at a pace that hasn't happened since an asteroid struck 65 million years ago and wiped out half of life on earth. But that loss of life is really a major problem when it comes to these diseases. So if you really care about not having this happen again, we've got to come to grips with the changing climate, and with the loss of life on Earth—of which climate change, by the way, is a major factor.

EA: It reminds me of the testimony that you gave to Congress last year on the health impacts of climate change to children. I'll read very briefly from your testimony.

You said: “I've cared for children with asthma whose lungs have been so damaged by contaminated air they were scarcely able to breathe. I've sat with parents whose children had Lyme disease as they worried about whether their child's half paralyzed face would ever get better. I've cared for children who no longer had a will to live, having survived floods that once washed away their homes and their peace of mind. And I've held in my own arms, infants whose brains were deformed by Zika virus whose prospects of living a healthy life vanished before they were even born. What ties all these experiences together is our reliance on fossil fuels, which when extracted from the earth and burned damage our children's health, through climate change, and through the air and water pollution that they produce.”

How does the COVID-19 crisis compare with those personal experiences?

AB: Well, I think the difference is that we see COVID as a virus, and we put it in a group of experiences that we're all familiar with. People get the flu every year; they get stomach bugs; we get infections. It fits within a framework that people have already in their mind.

The challenge we face with climate is we don't have in our minds a direct connection with all those diseases you talked about. And so that's my job. I need to talk about how burning fossil fuels is, in fact, causing these problems. I need to make clear that, if you want to address these problems, we've got to do something about that. That's an uphill lift. And it’s an uphill lift because it's not within the day to day experience of anybody.

The other reality which we have to confront is that there are very powerful, wealthy individuals and corporations in this country around the world that extract and process fossil fuels, who would rather not change what they do—or more frankly, to accelerate the change we need. And so I think there are real differences. And that really, in my mind, makes it even more important for those who are in medicine and in public health, to talk about climate change despite the obstacles that may be in the way.

EA: How would you as a pediatrician, as an educator, talk to an average person about the link between climate change and coronavirus?

AB: As a pediatrician, one of the first things you learn is that you have to meet people where they're at. If somebody's been smoking a pack of cigarettes every day for years, and you start off by telling them smoking is really going to be bad for your health, you're not going to get very far if their mind is not in a place to recognize the reality that smoking is going to kill them.

And so I have seen huge amounts of blowback from making assertions about climate change, and why dealing with climate change is important for preventing the next pandemic and potentially making less pandemic more severe.

So if I were talking to one of them, I would start by saying, “What do you think caused this virus to emerge?”—trying to get at where their understanding is.

I think one of the challenges we face in this era is that science and scientific understanding is increasingly seen as another belief system. And I don't know that frankly, that's so different than any other point in human history. One might reasonably argue that more people in the world today understand that science is a method of discovering truth than perhaps at any point in human history. I think the difference is that for those who don't want to see science in any sort of fair way, there are any number of places they can go on social media or the internet to validate their worldview. And that's a huge challenge for those of us in public health. It's a huge challenge for those of us in medicine, when we're dealing with Dr. Google, or dealing with somebody who's being funded by a vested interest to confuse the public about an issue. So I think it's really important to get at where people are starting from in their position and understanding on climate change, and or where this pandemic came from.

EA: Speaking of bad actors, I wanted to ask you about this talking point I saw spreading yesterday on conservative Twitter. There's this idea that warm weather kills off viruses, that if we just had a little more global warming right now, we’d be fine.

Is that even true? It's my understanding that scientists are still trying to figure out whether this particular coronavirus would behave like that when it comes to warmer weather.

AB: You know, we don't know whether warmer weather is going to matter or not. There's certainly evidence from other viruses, like influenza. And there's reason to believe that that may be true with COVID. But the truth is, we don't know.

You wouldn't go to see a dermatologist if you had a heart problem. And you wouldn't talk to a politician if you needed to figure out how to wire your house or internet. We, as human beings, are enormously vulnerable to people in prominent positions making pronouncements regardless of their actual understanding of what they're talking about. And so it's challenging in the realm of climate change.

You know, it turns out that there are precious few folks in the public health or the medical world who have spent much time really studying climate change and health. And I think those folks are sitting within a cultural world that is really antagonizing and threatening to other parts of the country. And we're the elitist snobs who are in our ivory towers, and just don't share the values that other people have, people who are just as smart as we are. So we have the ability now, if for any number of reasons, if you don't see climate change the problem, you can find folks or very prominent places to endorse that worldview. Regardless of how well-qualified they may be.

A BRIEF INTERRUPTION: I want to tell you about a podcast called Living on Earth, which features interviews with experts on the most important climate and environment stories.

This week, Terry Tempest Williams on finding courage in the face of ecological grief:

We're going to be facing some very hard things in the future and I, I hope that we have a consciousness that can rise to this moment. That's the question I have. How do we find the strength to not look away?

That's Living on Earth. Listen on your local public radio station or wherever you get your podcasts.

EA: I want to go back to the idea that climate change is linked to coronavirus. Talk a little bit about the degree that climate change is connected to infectious diseases.

AB: Probably the clearest examples now are not the ones that many people think about. People tend to think about mosquito-borne diseases things like malaria or Zika. And there's certainly evidence that climate change and may already and certainly going forward will change where these diseases can be

But the evidence is actually clearest on diseases that come into people through water, so-called waterborne diseases. And a good example of that is bacteria that live in the oceans called embryos. People usually hear about embryos as cholera. But there are others, one of which some years ago showed up in Alaska and oysters and got a bunch of people on a cruise ship sick. And those bacteria should be surviving in Mexican waters.

So research has shown that as the oceans have warmed, these bacteria are able to thrive in further northern latitudes, in the vector-borne disease realm, the clearest signal among the clear signals is Lyme disease. We see the ticks the transmit Lyme disease, able to live further north, including in Canada where they've never been. And we have reason to expect that their ranges may continue to shift.

In the case of vector-borne diseases—where the vector is a a mosquito or a tick—it's important to realize that it may get too warm for these vectors. So evidence suggests that malaria, which historically has been very problematic in western Equatorial Africa, may not do as well as climate change because it's going to be too hot. At the same time in East Africa, where there's mountains, evidence suggests that Malaria is moving up mountainsides already and that that may continue.

Cities are at the cusp of these emerging infections. And so that's a real risk with infections and climate change.

If I can make one more point, and perhaps the most important with climate change and infectious disease, is that we really are staring into a crystal ball when it comes to climate and infectious diseases. As I alluded to with things like malaria, it is possible that the amount of disease that we could see might go down, even overall, even if it spreads into new areas. The same could be true for Lyme disease. It's possible we could engineer our way out of the water-borne disease problems.

But the reality is that, given the uncertainty around the future of climate and infectious diseases, and what we see already, it's probably not going to be good. We can't really afford to wait until it becomes absolutely clear that climate change is a disaster to act.

The virus that we're experiencing right now also has connections to climate change, just in basically the idea that it's a respiratory infection. It's something that gives you problems breathing. And air pollution, which comes largely from fossil-fuel emitting sources that also drive climate change—that's a key factor that worsens any viruses impact on human health.

EA: I imagine you have to be seeing some parallels between air pollution and COVID-19 now, right?

AB: No one has done a study looking at air pollution and its effects on COVID incidence or its spread. [NOTE: They hadn’t when we conducted this interview. A study is out now, though, showing air pollution worsens the virus.] However, we have research done on SARS, which is is also a coronavirus. And that suggests that people who were breathing the most polluted air versus those who are breathing, the less polluted air might be twice as likely to die from disease incidences in China.

More broadly, we have much more research showing that air pollution is a major risk for getting pneumonia, which can be caused by bacteria and viruses and causing deaths from that. So if that same air pollution is fueling the spread of COVID, that research would suggest that it is.

But one among many reasons that air pollution is a major public health problem that frankly, should be addressed. And the evidence from United States couldn’t be clearer. The Clean Air Act resulted in dramatic improvements in air quality.Hundreds of thousands of lives were saved, and millions of hospital admissions and all kinds of health problems were averted. And the economy grew probably faster than it would have otherwise. In fact, GDP grew 260 plus percent in the past several decades, while the cleaner act cleaned up all these pollutants.

There's also research that's been done showing that air pollution makes people dumb. In the moment, we don't think as well and can slow productivity can make people miss work. It's a huge drag on economic activity. The reality is that air pollution has been a drag on economic growth, and the solutions to address it are enormously cost effective in fact, The US case was about a 30 to one return on investment.

EA: Something I want to just get back to briefly is what you mentioned at the beginning of our conversation, which was that you were recently in the hospital in a space martian suit, treating children. Are you actively seeing COVID-19 patients? What does your job look like right now?

AB: So I can't talk about my clinical work directly. I'm enormously protective of families I treat. But I can tell you that our healthcare system—and this includes in pediatrics—is being stressed in ways that amplify its pre-existing conditions.

We have a healthcare system that is essentially now designed to harvest what it can out of elective, high-margin conditions. They pay for all the other care that people need on a regular basis. So one might take pause at the reality that in medicine, pediatrics is generally viewed as a money-loser, that it's hard to make ends meet working in pediatrics and hospitals in the United States, because reimbursements are relatively poor compared to adults.

Why is that? Why do we value our children less? And so what we're seeing with COVID is we're making decisions to shift hospital care to adults, which is absolutely what we need to do based on what we know. But then we have we've already seen stories in the Boston Globe and elsewhere about how people are being laid off in healthcare, how salaries are being cut, particularly how pediatric institutions are being harvested because children are being told don't go to the hospital because we don't want you to get sick. And of course, childrens’ beds are being taken. You know, hospitals often have pediatric floors and adult floors.

My hope is in the process of recovering from this we may find ways to address that, that results in greater resiliency and healthcare to when there are circumstances like this. And that also frankly does more to keep people healthy. You know, the people coming to the hospital with COVID, the people getting sickest, are people who have existing medical problems, obesity, diabetes, heart disease, and a large share of those are preventable.

EA: Do you think that anyone with any power to make these changes is listening to you on the connection between climate change and public health and infectious diseases and coronavirus?

AB: The concern I have is not as much whether I'm being listened to or not. I'm a pediatrician, I'm well used to people not listening to me.

The question is, what's the right thing to do? And I think it's very clear for me that the right thing to do is to be clear that we have a crisis in front of us. There are lots of things we do in this moment to deal with the crisis, which is exactly what the public health science community is telling us about social distancing, and washing your hands and all the things that we're being asked to do. And that's what people really are looking for in a crisis. They're looking for concrete actions that can be done to protect ourselves.

And so I have really no expectation that any human being I run into who's facing the prospect of someone they know getting very sick with COVID to be focused on anything other than these immediate solutions to the challenges we face. But that does not mean we shouldn't or can't talk about reality, which is that no one wants to go through this again. That’s a point on which I think everyone would agree. And if you don't want to go through this again—handwashing, social distancing is not going to do that.

The healthcare community doesn't wait weeks to tell you that, if you don't want to have a heart attack again, you need to stop smoking, change your diet, and the other factors that contribute to heart disease. We're in that moment now.

I'm not expecting that everyone in the country is going to get on board with the notion that climate action is just critical. I think what we need to do is take the vast majority of people in the country who are worried about this, and give them reason to find hope. What can we do to get people from sitting around worrying about it and giving them things to do that are helpful? That's exactly the same issue we have with climate. The good news is that a lot of stuff we can do on climate is also good stuff to do to prevent the spread of diseases like COVID and prevent future emergence of diseases.

EA: I think we can leave it at that. That's a good note to end on. Thanks, Dr. Bernstein for taking some time out of your very busy schedule.

AB: Thanks for having me. Take care.

OK, that’s all for today—thanks for reading (and/or listening) to HEATED!

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