Allison Arwady and Isaac Ghinai

Recorded July 19, 2021 Archived July 14, 2021 43:24 minutes
0:00 / 0:00
Id: atl004476

Description

Allison Arwady (44) tells her friend and colleague Isaac Ghinai (32) about her career with the CDC and her current role as the Public Health Commissioner for the City of Chicago.

Subject Log / Time Code

AA talks about starting her new job days before the COVID-19 shutdown.
AA talks about the early experiences that brought her into the public health field.
They talk about AA’s hobbies and balancing personal wellbeing.
IG talks about the differences in the United States and the United Kingdom’s response to COVID-19.
AA talks about working for EIS on the MERS outbreak in Saudi Arabia.
AA talks about the politicization of COVID-19 and her relationship with Chicago Mayor Lori E. Lightfoot.
AA talks about the early days of the COVID-19 pandemic and the role of trust in public health.
AA talks about the work she did in preparing for an Ebola outbreak better prepared her and her team to handle Covid-19.
AA talks about ventilator shortages in Chicago and how her time in Liberia emphasized the importance of adequately protecting healthcare providers during an outbreak.

Participants

  • Allison Arwady
  • Isaac Ghinai

Recording Locations

Virtual Recording

Venue / Recording Kit

Partnership

Partnership Type

Fee for Service

Transcript

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00:02 My name is Isaac and I, I'm 32 years old. It's the 19th of July 2021. And I'm recording this from Birmingham, England, and I'm here. Interviewing. Allison arwady about the epidemic intelligence service.

00:19 Pick up my phone, ready.

00:22 MI.

00:28 Allison already. I am 44 years. Old today is July. 19th, 2021. I am in Chicago, Illinois and I am interviewing. Dr. Isaac. And I who the two of us either are currently or were previously in the epidemic intelligence service with the Centers for Disease Control and prevention.

00:55 Allison. Let's start that you have had more time between your time. And would you like to kind of just briefly go over and play with yourself? Nowadays are. So, I'm a doctor for internal medicine, and Pediatrics. And even before I'd gone to medical school. I actually got really interested in public health and I took an epidemiology class and then I took us history of public health law and tuberculosis vs. HIV. And I was really sold. Even though I had made the decision to go to medical school and I love taking care of patients. I just really, really liked the the large picture thinking and public health, and the ability to pull in my interest in history, in my interest, in ethics and my interests in systems. And so, when I finished my medical training, I did my school and residency.

01:55 Lucy presidency year, you know that was a very clinically focused on my den and the decision applied for and was accepted to CBC zi. Oscar epidemic intelligence service program. It's a two-year postdoctoral program. So the folks who are in the program are Physicians who are fully trained at that point, or their epidemiologist to our phds, veterinarians on other sort of postdoctoral any idea, which really appeal to me, and why I decided to do this, was that I knew I liked Public Health in the academic sense. I really wanted to work on the ground in a public health department. I wanted to take the medical training that I had and really see what it look like to apply it in a prevention lands and apply it. You don't even communal and I also had a big interest which I know you share Isaac and international health and was very interesting to help race. If I hadn't done my ass, I would have done infectious diseases in terms of my specialty and I really, you know, decided to sign on and do this. So the two-year program and I

02:55 Chose to be a CBC employee but assigned to the Illinois Department of Public Health in Chicago. And so I spent really those two years working primarily on outbreaks in learning how to be a Public Health Physician in L. So, I worked across Illinois. I worked in schools prisons hospitals Community settings on a whole range of diseases. Really learned a lot about how to actually do Public Health. An outbreak response. And then because I was part of the IRS had the opportunity to be in Saudi Arabia as part of the MERS Middle East Respiratory Syndrome outbreak with the team from CDC. And then, in particular, two different appointments, with CDC, to Liberia during the Ebola outbreak in 2014, 15, both the very beginning before they're a lot of resources and later. So, you know, he is for me was just my favorite thing ever, in terms of, really fine.

03:55 My people finding the thing that I wanted to do for the rest of my life like meeting this Cadre of the folks who were interested in exactly the same things. I was interested and really wanted to you don't make like make Public Health here in the US and around the world. Like all it could be in more. So it's it's been a really important. A person that works for me, as well as very clearly. What launched my personal? Professional career in the non-clinical sent.

04:29 And so since then, that was 2014 that you finished, it would have been. Is that, right? So since then just kind of quickly talk is 3 what you've been doing in Chicago Bulls as part of the outbreak. There was just this sort of by chance. I kind of knew more about ebola than a lot of people who were working in Illinois. And so had gotten to know in between my two, International deployments for a bowl. I spent all of my time working in Illinois, on Ebola, preparedness and response and had gotten to know a lot of the other people in the hospital setting in the public house wedding. And so, specifically, the Chicago Department of Public Health, which is a City Department of Public Health as opposed to the state, which is where I have been assigned with the CDC.

05:29 They were looking for a chief medical officer. And that is a role. That was a very big role to move into after he is in. That it was taking my medical knowledge, but it was all. So I had been very focused on outbreak response when I was when I was at the state with CDC in, this was moving much more into some of the structures of Public Health thinking about emergency preparedness thinking about Behavioral Health thinking about you know, how you actually operationalize work in a health department. And I had the role of being really the primary medical adviser and decision maker with obviously a huge team. And so moved into that chief medical officer role at the Chicago Department of Public Health. Just learned a ton in that setting was in that role for about five years. And then in the summer of 2019, I moved into the acting commissioner role. So that's when really I oversee the Department District.

06:29 Department of Public Health. And then in, I was actually, finally confirmed as the commissioner of four days before we activated for covid, in January of 2019 to 2020. And so my entire experience really in the leadership role at the Chicago Department of Public, Health has been extremely influenced by Bike by by covid, but it also in terms of sort of timing and right place, it was. If there was going to be a challenge that big that was going to, as I moved into this in a really pretty significant leadership role. It was a space that largely because of the ice and everything, they'd come over. I felt very comfortable in my expertise and I felt like I had a good colleague of networks across the country to turn to. And you know, it's certainly been a journey. It's been a learning experience, but it's it's been really good in the end mean it's been hard hard hard as you know, there's nothing in our team here has just been working like a

07:29 Round the clock for 16 months and more but there's absolutely nothing. I would rather be doing. And its, you know, I really feel grateful to CDC and then Yes program for kind of setting me on the pathway. That was the perfect match for, you know, me and my personality and what I'm interested in.

07:49 Yeah, I think that's a lot of people within the Public Health Community Service and later the people outside the Public Health Community in Chicago, who said that we couldn't go lucky to have you at the helm. At this time in particular, and I was like, all of your experience is today really did, say, he was up for it to be the right. Commissioner at the right time to sort of, I mean things, you never know what you're going to get and I think, you know, in some ways. I, I know what I know and I know what, I don't know. And I know how to find out what I don't know. And I'm, and I'm confident in this space like nobody ever knows. The answer. All the time, right? It's specially with covid in the new pandemic and what is it, but I do think I have a lot to sort of look back on and take from and as, you know, approaching a very tiny, foodborne outbreak is essentially the same as approaching a pandemic like in terms of the steps and what you need to think about. And so,

08:49 You know, it was right about the person. I don't know. But I was the person who is here and I had a team that I knew well and trusted and I do think we have come through this much better than we'd certainly might have. So, I've been thankful for all the preparation I had for it.

09:06 Yeah, I definitely want to talk much more about the last two years and the covid response in particular but also, you know, some of the other fascinating outbreaks that you bought something. But anyway, I asked and subsequent to that but I was thinking it's kind of good right back to the store and see if there were things that you told her. I think kind of your pre-med school, study song to study public health and and and history of medicine. But was there a sign of early in childhood? What was the schooling years? Why you starting to lean towards maybe help with something you thought was important or maybe you know, you have the skills to respond to think too stressful situations, very well. Can you think of any? I'd like to think about big-picture questions and I think when I was in high school, I would I was lucky enough to attend a Math and Science. High School for half of the day and had really good early.

10:06 Exposure and really challenges in in the science Arena. I knew that I liked that knew that I was good at it. And then, when I was in college, I actually felt very secure in my science and math and science background. And I actually my major, my concentration was in history and literature because I wanted to let you know kind of grow my ability to write and communicate and I've always been interested in history and how we sort of learn from what has come before and think about how we talk about whatever is now is very influenced by the moment. We are in not just, you know, not just left before. And so when I was coming out of college, I thought I may be wanted to be more like a science writer. I had done a lot of travel guide writing and updating and I didn't really know about public health like as a feel until after I was already out of cardboard really. Once I kind of once I found it. I was really hooked and knew that I wanted wanted to come by. And so I think you know, I've not had them.

11:06 Direct path and I think that has a funeral in some way. I mean, I would have done it any differently but in some ways it's it's having the chance to kind of try a few different things and take pieces from that. I think it's

11:20 And before we kind of doubt too deeply into the last 18 months or so. Sammy related. Like I know you mentioned Yosemite with nights are best interests. Like you're a history tour, guide in Chicago and I've seen The Incredibles glass sculptures, he made and heard you singing choirs. How have you balance? Not just, you know, if I see a story of a particular like, in a pandemic way, you are the person in the news every day. Have you been assigned responsibility and not visibility with managing to do all the things that you enjoy and, and, and stay sane? And how do I have your personal life outside of your career? During a lot of most of the rest of my life went on hold. And I know that that is true for sort of, you know, the World At Large, but I think in, in my case it was not only the

12:19 Fact that so many things that I normally love. Right? Leading the architectural boat. Tours, or what, you know, seeing patients in clinic, whatever it is. All of that was on hold. But also there was such a need to be just so focused on like what needed to happen next. And so I really tried and end with our staff to trying to like create at least a little bit of space, right? Like recognizing this was going to be and still is a marathon and you know, we were doing stuff 7 days a week for sure at the beginning sign of four months and then really saying, okay, Sundays, at least we're going to try to kind of hold and and making sure that I was reaching out to people for, you know, support. And then when things were a little bit calmer also trying to take that moment to recapture some of that soap, for example, where in reasonably good control right now, we're not done with covid-19, take the pottery class back off. Right? And I've liked, you know, that started going hiking and let you know some of these things that I feel like there's a little more space to do but I do

13:19 I think in the funeral with all of the staff trying to be quite specific about, you must take time off, right? Even if it's a little bit in a little bit in a little bit and recognizing that you know, I need to have that model to so still working on it. But the good thing is that luckily like I still love this stuff, right? Like is in some ways. I absolutely, you know, there's nothing I like doing that when I take the Alva Subway, if you know down in the morning to work, like my favorite thing is to like read the CDC little literature. What's the latest on covid. And look up the article and I still find it like in a three really interesting and thinking about how to take the science and then my job is awesome to translate that like to the community is something I just enjoy thinking about like it's fun for me. And so in that went looking for, we're not fun. I probably would not like to have lasted right in this in this position on both interesting and important but also for me just it is something I love.

14:21 And I think he is does in some ways. Prepare you to tell pretty deep into things and and, and commit yourself to it for a. Of time. And, you know, one of the good things I think about public health in general, but let me about. Yeah, she said, sometimes it can be quite episode. If you have a project, you have an outbreak, you welcome that you try and see it through to, some form of completion. And then you can maybe there's a gap between the next one. Maybe you're lucky enough that takes bands, that sound like that and say it's encouraging to hear that you're picking some of these things back up and get him how much we have more about Simon to come and get it is so, you know your your talk to do outbreak response at least in the most traditional, just the kind of role that I had and I was working on such a variety about race and each one is going to have sort of its own challenges and you know to sort of coming to the space and need to be at at some level the voice of some expertise. Like even as you yourself are learning is an interest.

15:21 Sing challenge and ends of the very clear need like you learn really early on that, unless you've done true engagement work with, you know, stakeholder, that's the term. But like, whoever is being impacted and whatever sudden you're in. Really like, stepping back and saying, let me hear first. Let me understand this problem first and then bringing whatever expertise you have into that. Like, if you don't do that, well, you're not going to get anything, right? And, you know, when I'm thinking about outbreaks, sure. I think about the cases, I would think, but these four seas the cases, which is largely the Healthcare System. What's happening with people who are sick, do we have a safe place for them? You know, S, I think about containment broadly enough to see you for the public health, our worker stopping disease from spreading and preventing it. But then the two places it fails are not on. What is the healthiest enjoying. What is the public health system? If sales on coordination and it fails on communication? And so I'm always trying to think back on like the coordination so I can gauge mint and the communication.

16:20 Internal and external. And those are always the doesn't matter decides the outbreak where things are going to go wrong. And so trying to keep that like in my mind, as where are we having trouble? Where do we need to put more resources, people take for, granted that those are the parts. They think we spend a lot of time trying to figure out how to do contact raising, and we do a little bit of that, but it's those, it's that structural work. That is actually, I think, for long-term success of it. It's really trying to think long-term. And and structure all, if you're going to be successful, not just for like this month, but for like the year in the next 5 years,

16:59 Yeah, and I'm struck that may be the first to it but whose cases and and Containment all relatively similar across across cultures and across diseases, right? Absolute scientific a pretty miserable that pretty, I'll check them in some ways that communication seems to be very good at typing and it sounded very different. Epidemics, the epidemic in the US and, you know, I came to the US with a UK experience and I need some International experience as well. But it's pretty fascinating to see how the communication in the the coronation of different across cultures tonight. I wondered how you felt found that note just in case and before and after that. Yeah, and I think one of the most, you know, when I was in the, I asked you have this opportunity to come into spaces that are very clearly, not your spaces, right? So weather,

17:59 You know, when I was working in operates across Illinois and you're moving into an outbreak in a prison setting that is very much, not your settings. But when you do that internationally, it's like even more magnified because you don't even the CDC if they're there. As part of a response, are there at the invitation of the country in the Ministry of Health and those are the ultimate decision makers and again, it is not your job to make the decisions. It is your job to lend support and kind of land expertise and depending I mean the different like how it is. It's been really interesting to see these these outbreaks, you know, play out and such I think, back to Saudi Arabia, right? We're like 423 is a woman coming in with CDC and then even moving out of the city, used to some settings that were not used to women being having a particularly strong voices, and decision-making. And culturally. It is quite helpful to get dropped in two different.

18:59 I need to think about how to make sure you're you're coming at the situation. First of all, with humility and and and and part of a learning attitude. And then as you sort of learned about that saying, where can I help fill gas? How can I make people feel like I'm on that team and so, you know, an end and there's all kinds of all of these issues. I just think doing work outside your regular setting bills builds those skills in really in really tangible ways. And so it was different with covid-19 cargo. You don't have to come as early as you guys are part of my back out that is very much my job, right. And so as opposed to like being in this like, oh I can advise that somebody's going to make the decision. At the end of the day. It was this major decision making that in some ways was very welcome because I could have like, I didn't feel like I was stuffing on somebody else's turf or meeting.

19:59 Be really cautious but on the other hand like the buck stops with you write like and and feeling a lot of responsibility to make sure that you are still engaging all of those other groups and learning from them. I mean that's been a huge part of our covid response here saying we're not going to get everything, right. A lot of very authentic Pino Community engagement around. What do we need to do differently? Trying to be greedy to drive in? What is the end of the day? One of the reasons I love working particularly at the local level as an American, is that I can make those decisions in a way. That doesn't feel. I don't have to worry as much about whether I am appropriately voice as well as inform, but it's it, it is a different level of a responsibility, but one that I think having a lot of opportunity to be in a very different role has been helpful.

20:59 As we've you know, as I've had to make by far the biggest decisions, you know that I've ever had to make.

21:05 And I know, of course you are the commissioner of the Chicago to Malta Public Health. In the top Public Health decision-maker in a city of three million people. But also I think of it as a tax extension maker that, I think it's really hard to be effective in public health. You have to influence others to make Public Health decisions, right? You'll know in control of all of the schools. You'll know in control of how everybody behaves. This way to Publix to do that. I had to do things in the schools Department in the, in the prison department and how do you cut navigate to that space? Now straddling both the absolute decision maker, I'm the I'm still a technical advisor and you have to listen to me. This is important to take the national version of this is sort of how politicize this has been in a lot of ways. I do not take it all for granted the fact that here in Chicago, you know.

22:05 The mayor really came. I think the trust me and the department, early and consistently. We saw a lot of political leaders across the country. Wanting the public health department to own the difficult decision to write the shutdown's the, you know, requirements that etcetera and they would distance themselves, right answer to say that's Public Health over there and then want to own for the reopening etcetera. And and we really from early on, you know, mayor Lightfoot here in Chicago was very clear that, of course, there's going to be a lot of competing forces and we're going to talk about light at the end of the day. First and foremost, we are going to do what is most needed by public for five helicopters. That is what's going to save lives. And yes, we're going to think about these economics, he says, but I think the fact that she and I have been out together as like taking the hits together have celebrated together and that we've got you a very concretely ice.

23:05 That is a goal that I did not want where there were differences between the city and the county, or the city and the state, or there's always going to be differences. I didn't want that to be the story because I think that brings the politics and, you know, sort of the distrust and that, you know, can we, you know, should I believe what the public health department says that. This one says one thing and this one says the other and so even where we were having, you know, of course. And I need those big decisions. There's going to be conflict. I think the ability at, you know, between the city and the state, for example, to present a largely unified front and not let the behind-the-scenes part of it is, is critical. And so, how do you build that? I mean, I think you come in from a point again of reasonable confidence, like I felt like nobody knew exactly what was going to happen with covid-19 your confident in.

23:57 My training, but also like that. I had a team of people who spend their entire life thinking about this and I was very connected through CDC and others to people who had wait like decades more experience than I did. And we weren't going to necessarily always get it right, but I, I spelled it, I certainly, and we certainly had a better chance than the random person in terms of making decisions and suggestions about covid. And so, I think, having some confidence and just like you, no point, like when Italy right was, was really blowing up very early on. I mean, I remember I didn't know the mayor while before that's like, you know, we didn't meet regularly and having a meeting with her and basically, being like, this is something we have to dress like now, like today, you know what? I know, you don't know me, but here's what this looks like in her sort of quickly, recognizing this pulling, you know, the cabinet together. And like really saying we're going to go for this, especially at the beginning, when

24:57 You know, the fact is Chicago in Illinois. Thank goodness. Work earlier than we might have been to make some of those really that you would have been even worse. So I think it's it's it's about just having some confidence and being really honest about what you know, and what you don't because it will come back and haunt you. If you try to say, you know things that you're still learning but where you do know, things are where you can predict things. You want to be clear about that so that people have some confidence in your expertise and it is expertise in terms of you know, how to best handle. That's even while we're all still learning.

25:35 Yeah, they got kind of critical importance of trust. I think it's been highlighted throughout this week. But I think there's been a few moments for me and response, when

25:52 Particularly actually recently around vaccinations, you know, there's a lot of misinformation around in a lot of my work cuz you know, he's been in. People experiencing homelessness in people living in correctional facilities and people who might rightly have reasons to distrust a lot of systems, but I actually have been willing to take what is a new a very safe and very expressive and drunk. But a new drug laws, Leon the word of people who they want with it. It's about up to trusting relationship with him and that's kind of been a really powerful realization for me just house. Without that. We have nothing. We really have nothing is public health profession. I wondered if you'd had kind of experiences from before I would wear that have gone. Well or that I have not gone well and and how just illustrating how important Rust-eze in everything that we do. If you don't first have good communication and ideally communication before,

26:52 Before the age where I think about, you know, an example is we had really in our, in our emergency preparedness in Chicago. Had quite a lot of work into trying to have our Hospital, be reasonably connected sort of around Public Health preparedness and bringing folks together routinely and, you know, doing exercises, and it wasn't so much content. Although, that was somewhat important than the exercises, as the fact that those relationships, and there was sort of an understanding that in a major Outbreak, The Health Systems would sort of look to the health department and and want to think about how to collaborate and some of that had come out of the woodwork frankly, right? Where during Ebola in Chicago there and I wasn't even in a business. This is when I was at the state, so I wasn't at the Chicago Department of Public Health. What does it? But the cdph, the Chicago Department of Public Health leadership, you don't had really worked with some of our Academic Center.

27:52 Really nervous about raising her hand and saying, I'm going to be a hospital that's willing to take you both patients. Right? This was a major. People saw it as a risk to the reputation of the hospital. People are worried about their stay and sort of. You know, a group of hospitals together to say, we're going to be the Chicago Ebola Resource Network and together, whatever comes when there are patients, were going to trade that risk and that responsibility. And I think having some structure for that wheel. When covid was surging, you don't very quickly being able to pull together data from every single hospital, about how many patients do you have, how much better bail, ability? What are your ventilators? Right? Like, and we had systems in place for that. They gave us more of a Citywide view clearly than many other places had. And so I think, you know, it comes from a place of having communication and Trust in sort of having built that before an emergency. But then also even in an emergency trying to sort of say, okay, we're meeting. I'm sorry.

28:52 And this would be outside the hospital but with community-based organizations, for example, maybe we haven't worked together now, but I think we're in agreement that something needs to be done here and we want to hear from you. What do you need? And here's what the data shows. Here's where were you know trying to get back soon or here's where we're having a hot spot of covid right now and we are going to put testing resources in your community. You tell us where you tell us when you tell us what that look like, right? And really trying to be really thoughtful about building some of that trust wear. If they say, we need this particular thing, done. You then do it, right? And so then the next time, there's the ability to grow this. And you know, what, we, we don't have time probably to talk about sort of all the pieces of how we tried to pull this together, particularly with a, with a raise Equity lens, but I think that there has been a very different way of approaching the many, many, many partners here. And I'm really conscious of the fact that I'm often not the best spokesperson right on particularly.

29:52 Where there are, you know, where there are very good historic reasons for lack of trust in government, lack of trust in health. I have to press and public health. And so, the work of thinking about, who are your proxies, who can you work with, who, you know, understand public health and want to, you know, share the information about vaccinations, for example, you really want to make sure you have Bill and then that just sort of ask people to help, but but funded them and created structures that allow them, you know, in a very neighborhood-based setting where there tends to be more Trust on build that up. Until as we think about preparing. This moving forward is not just, do we have mass on the Shelf, which Chicago actually was quite well prepared compared to a lot of places in terms of having stuff. But but having the Investments to create some of those networks that, that you will then depend on, you know, you can work on. Chronic disease, stop in the interim, but if you've got another outbreak or another pandemic,

30:52 You need a structure that is built on communication and coordination, and that public health infrastructure should exist prior to, you know, prior to really meet again, in an urgent situation.

31:08 How about time is wintrust? Communication and coordination has not gone super? Well, whether that's here or whether that's internationally match in the very early. If I want a response in 2014 would have been relatively chaos that can, how does that manifest? It's actually getting public health. So, I mean that first Ebola deployment, which would have been in the summer of 2014, you know, I was lucky enough to be on the CBC with on the CDC team that was on the ground, really, as the outbreak was showing how big it was going to be and they are well, health systems were shutting down and just seeing how can I quickly overwhelmed?

32:01 Any capacity sort of could be and then.

32:06 Recognizing that.

32:09 Even though there were a lot of people who knew what needed to be done there, just were not the resources and you can, you know, and and is someone, you know, I was going into hospitals that had you known, oppe, no personal protective equipment or like a pair of gloves that they were, like leaving on the table next to the potential Ebola patient. In the healthcare workers are trying to do and then Ebola transmitted by touch like you really, really dangerous. And then seeing these Hospital Workers, Health Care workers, getting infected and then they're not being the PPE to take care of the health care workers and just like you communication, like in the absence of the resources to take care of the cases. And, and do that. You don't do that. Do that work of Public. Health is all about. You know, how are you prioritizing this? Right. And I felt like my job in a lot of ways was to sound the alarm. This was before.

33:09 Public Health, Emergency of international concern had been announced. And we were a small team with a lot of other folks on the ground. And it wasn't. What do we need to do? It was, this is so much worse than anybody's realized and getting that message out. You know what I mean, which is different. The sort of CDC message sort of to the International Community about get the resources in here. Right? Like this is so bad already and it's going to get worse. And then on the ground having these conversations where you just, you couldn't do the most basic things that needed to be done and you can't over promised something but you're also trying to solve those problems, but you do see, I mean like, you know, you saw these communities even in Liberia stepping up and you know, bringing toilet paper to the hospital, right? And bringing like,

34:02 You know drinks in me trying to do what they could in the absence of like these. Most basic things and I do think communities they either they both fall apart and come together, right like in any major stressful situation in a in an outbreak or a big pandemic is going to be one of those most stressful situation going to see all the cracks. You're going to see all the ways in which we made decisions as a society that have molasses vulnerable and you are going to see people at every level sort of rising to that occasion. And if you can coordinate that ride, right? The first time I was there like burned in my brain is some of these doctors, you know, trying to build Ebola isolation Wards out of like tarps in the back. Right? And then six months later being there.

34:51 At a time where it was a much more normal response because they were resources, there were enormous Ebola and isolation units and there was testing and there were hundreds of, you know, paid workers that that could sort of do the work. I really, you know, I I think it's it it is it's communication, but also you just got to have the resources and so just the kind of tie it to Chicago early on here.

35:16 Was so crazy to me to be sitting in Chicago one of the best resource like healthcare settings in the entire world in the richest country in the world and literally feel like panic because we were maybe going to run out of ventilators and it was that same panicky feeling that I had felt most acutely during the situation and in any Bowl, I would in Liberia that we knew what was needed and we just couldn't get it. And to have that happen here. I think was the other part that really just on a personal level made me like that was the most worried. It was the most worried. I was, was it even if we know what to do. We just can't get some stuff. And I had never anticipated that feeling. So Central to our response. I would work on in Chicago.

36:09 But again, some of the same things that you learned in West Africa, Stephen Berry witness to the to the difficulty building trust in those communities. So when they did come look at the people with people because Hospital people, we get vaccinated win, the boxing game. So few doctors and so few healthcare workers to start with and you were literally like wiping out the entire Healthcare System from a Personnel, but also the ability to find more people ended up dying cuz I couldn't get taken care of after an accident or child. I have after that, like, never taken, like at all. For granted, you know, that this sort of how strong a healthcare system can be in. When you think about the indirect effects of if that shuts down, I think that's where, you know, those decisions that if you are threatening Your Health Care system, not in the theoretical way, but in a way that it could actually

37:09 Like we saw happen in settings that were historically really well resource that became you know, the top thing that we do above all things, like whatever we do to protect that Healthcare System. I'll make every hard decision. I need to to make that happen because if you lose that the indirect effects are just so big. And so right there are these things that even if you're seeing it in the small space, I think they burn in your brain as something that is just got to be Central to any, you know, any big response after Lonnie's hot license. I think we just have a few minutes left and I think I kind of just have one of the relatively big question that I wanted to cover. So I know you're very interested in history and

38:01 But it's kind of in the in the in the grand span of human history. But also you have learning from your past experiences in the past experiences of the people. You work with an organization to work for. I was reading something about the the 1918 flu pandemic and how it affected Chicago. And unfortunately some of the same divisions that we seen, you know, Citywide Statewide, Countrywide and worldwide really would come into the communities for the hottest hit all those communities. That it most disenfranchised baselines are those communities and living in close quarters, and now very much communities of color.

38:43 I was struck by something. You said in your last response as well about how moments like Lodge epidemics can really break our society down and really bring a society together. And I think you know some of the racial Justice riots in the last year-and-a-half as a result of the motor Joyce Lloyd I think was an example of that and how kind of Public Health intersect with this wider societal unite the floors, an existing Society at Baseline.

39:12 But I want it kind of Broly. How much have we learned in the last hundred years, and what's going to be different? When inevitably, the next part of it comes, hopefully not for a hundred years, but quite possibly see what? What's going to be the same, what's going to be different and what should everybody listening be doing to try? And make sure that it's not the same old story.

39:33 Yeah, so I'll tell you, I mean, you know, I, I love history and I have regularly look back at what Chicago did during you. Do the 19 1819, flu pandemic, as I'm thinking about decisions and it is in some ways comforting, to sort of say. Oh, they were thinking about what to do with Halloween to what is also somewhat, you know, these patterns of a power, right? Like in Chicago across the u.s. Who is protected from disease and what those beliefs are about, why these lands in a particular community, that why piece actually does change over time, and yet the outcome is the same. And so, right now, I think you a saint in Chicago, you know, there's such a lens appropriately around around structural racism, right? And that like, four years and years and years and years and years where people live in Chicago, the opportunities that they've had.

40:33 Which things are in neighborhoods, where Healthcare is, but not just Healthcare, the education, and economic safety opportunities have built up over decades. And this isn't new with covid. Comes, if you see the disproportionate. That has always been their highlighted to an extent that you can't ignore. And so the thing I take sort of us has helped a little bit is that we have seen prior pandemic also be the source of major changes in terms of who gets to do, what rule, who gets to work, who you know, and if you look sort of over all of human history like need your major changes, and I'm really hopeful hear that. First of all, we will think that it makes sense. Where were thinking about our Healthcare send not just to spend one or two cents of every dollar on public health and the rest on sort of the health-care, the after somebody get stuck, which is important and amazing, but the work of prevention and the work of the real

41:33 Working on these structural inequities being really honest about them, calling them out and thinking about what can we do, for my policy level, from a systems-level to really improve the environment that people are in. That's not just about opening a clinic in an underserved neighborhood. That's these longer-term decisions that don't go on the same timeline, as you know, Florida collections do. But that I hope that people who really care about their communities about this country. About the city are willing to say, what have we learned about the ways we can work. What have we learned about the barriers? What have we learned about? You know, the term essential worker are things that we will make different decisions about as a society. Cuz this shows are cracks as any outbreak does, but it also gives us the opportunity to fill in those cracks. If you will with, approaches at all levels, and I'm hopeful we're going to do that at least here in Chicago and hopefully it'll happen, you know, around the world as well.

42:34 Thanks, and thank you so much for your kind of sharing you at. I'm in it and expertise and experience. Is it in stories with us today? I would just, I think if people are listening to this already, be able to see us through this conversation. So just because of that Halloween coming, I think if people are interested to see what I talked to Allison arwady, commissioner of the Chicago Department of Public Health. Looks like there's a great video with the address to Verona destroyer in a cape and leggings on YouTube, or whatever version of YouTube. There is in the future. That that's where I left want, chicken broth, Joanna. Top time too many in Chicago.