Capital Region CATALYZE

Fresh Take ft. Dr. Kavita Patel

June 09, 2021 Greater Washington Partnership Season 1 Episode 9
Capital Region CATALYZE
Fresh Take ft. Dr. Kavita Patel
Show Notes Transcript

This interview features Dr. Kavita Patel, Nonresident Fellow at the Brookings Institution. JB and Dr. Patel discuss the federal government’s COVID-19 response, vaccine rollout, and ensuring our health systems are equitable and accessible to all.

Hosted by JB Holston. Produced by Jenna Klym, Justin Matheson-Turner, and Colie Touzel.

Learn from leaders doing the work across the Capital Region and beyond. These conversations will showcase innovation, as well as history and culture across our region, to bridge the gap between how we got here and where we are going.

About our guest:

Kavita Patel is a Nonresident Fellow at the Brookings Institution. Previously, she was the managing director of clinical transformation at the Center for Health Policy at Brookings. Dr. Patel is an advisor to the Bipartisan Policy Center and a member of Health and Human Services Physician Focused Payment Model Technical Advisory Committee.

Dr. Patel is a primary care physician in Washington, D.C. She also served in the Obama administration as director of policy for the Office of Intergovernmental Affairs and Public Engagement in the White House. As a senior aide to Valerie Jarrett, President Obama’s senior adviser, Dr. Patel played a critical role in policy development and evaluation of policy initiatives connected to health reform, financial regulatory reform, and economic recovery issues.

She also has an extensive research and clinical background, having worked as a researcher at the RAND Corporation and as a practicing physician in both California and Oregon. She currently advises healthcare technology and services organizations through New Enterprise Associates.

Dr. Patel is a previous Robert Wood Johnson Clinical Scholar, and while at Brookings returned to providing clinical care as an internal medicine practitioner. She earned her medical degree from the University of Texas Health Science Center and her masters in public health from the University of California Los Angeles.

Dr. Kavita Patel  0:00  
I think employees have still been left businesses have still been left without structure to give like the advice they're going to need to bring people both in person but also to bring back a sense of confidence.

Nina Sharma  0:16  
Welcome to fresh take a candid interview series featuring thought leaders and innovators from across the capital region. These one on one conversations, highlight the incredible work happening in our communities, and showcase both where we are and where we are going as a region.

JB Holston  0:36  
Welcome, everyone, to this week's fresh take. I am the CEO of the Greater Washington partnership. And this is our regular interview series where we focused on learning from leaders across the capital region and beyond. My guest today is Dr. Kavita Patel. Thank you very much for for joining us. I'm gonna give a short biography of you to everyone and, but thank you again for joining us lead as a non resident Fellow at the Brookings Institute. She was the managing director of clinical transformation at the Center for Health Policy at Brookings. She's a primary care physician in Washington who served in the Obama administration as Director of Policy for the Office of Intergovernmental Affairs and Public engagement in the White House where she played a critical role in policy development and evaluation of initiatives connected to health reform, financial regulatory reform and economic recovery issues. Dr. Patel currently advises healthcare technology and services organizations through an association with new enterprise associates. She's a previous Robert Wood Johnson Clinical Scholars and while at Brookings returned to providing clinical care as an internal medical practitioner, Kavita, it's great to have you on. Thanks very much for joining us.

Dr. Kavita Patel  1:44  
Thanks so much for the partnership. And JP I'm looking forward to hopefully lively conversation about our topic today.

JB Holston  1:51  
Yeah, it will be I'm sure. I want to just do a quick run through of some some items to just hit because I know you talk about these all the time, but not everyone necessarily has heard kind of the latest and greatest in the news oftentimes changes really quickly. So I'll just run through some cricketing things. But before we do that, I just want to talk a little bit about how this last year has been for you. Personally, if you could do to share a little bit with the audience would how's your life? Have you been managing your life through that time?

Dr. Kavita Patel  2:18  
Yeah, thanks for asking. I'll give I hate talking about myself. So I'll just tell you that I don't think I'm out of turn in how my colleagues who are also I've been in a clinical setting about three days a week and ending in a clinic and in the beginning of the pandemic got shut down completely, but actually migrated because they needed us to help with makeshift hospitals, you know, kind of things like that I didn't think I would see in the United States like field, Army hospitals, that kind of thing. More trucks backing up to hospitals, our our mid Atlantic area got hit hard, but nowhere near as hard as some parts of the country which was good. But at the same time, as months went on, and I saw colleagues die, friends die, it just kind of reinforced like how scary all this was. So I essentially retreated into a bubble like many Americans did outside of work. And I think that's had its effects on all of us. So I for one, when some of the when I've been able to get vaccinated, I've been able to feel that sense of security that happens when you do get vaccinated and very confident we will have that sense of security as a country sooner rather than later, I had originally worried that it would be summer fall, when we would start to see some of the things we're actually seeing today where we can actually get together with others. You can travel with some degree of safety, if you take precautions, schools are opening, I thought that would take several months. So I'm very pleased. And I would just say like, it's also been sad to see a lot of the small and medium sized businesses that I had come to frequent. So often being shuttered and thinking about what is not being dealt with by a vaccine, right. A vaccine can save lives, but it can't save an economy. And so it's it's going to be very, I think it's going to take a lot of us I think the partnership, I'm very excited about hopefully working with partnerships like yours in to revitalize kind of how we talk about bringing businesses back bringing employees back safely. I think employees have still been left businesses have still been left without structure to give like the advice they're going to need to bring people both in person but also to bring back a sense of confidence. And and what we're seeing now is that that productivity game I saw a year ago, when people were like, Oh, I can be productive on zoom at home. We're seeing that now wane to some degree. And we're gonna have to learn how to adapt to this kind of weird new normal for at least a year, but my colleagues in healthcare, I don't call them heroes, because I think it's like what we were trained to do. But I hope that we also see some improvements out of the healthcare system as a result of it because the people who have to really been heroes, to me have been some of the home care aides, people who are not physicians or nurses have gotten have done a lot to help people throughout the pandemic. But I would say home care aides some of the unsung heroes and the exposure, we've seen people of color bull who have worked for minimum wage or less, but are the people that help elderly parents and disabled people. I always I have one, I'll stop with this JB, my experience before the pandemic was that if you haven't understood what it's like to help kind of change the diaper of like an 86 year old, you don't understand what our country is doing to people who age. And the pandemic has, like many things revealed the tragedy and a lot of that. So I'm very optimistic, but also help we don't just ignore the lessons from the past.

JB Holston  5:45  
Yeah, those are those are great observations and things that we can follow up. I think women, of course, as a category. Also, we've had dinner 2 million dropped out of the workforce already. We talk a lot here about the path to inclusive growth, which is really our mission is inclusive recovery. And if we can't get to the former without without a real focus on the ladder, right. Thank you for that. Let me because you're such an expert. Let me address some specific questions for you. We could just rip through these fairly quickly, but love to get your take. Let me start with vaccines. And I have a very this is something that's been on my mind for a long time. But we've got new prospective vaccines that don't yet have FDA approval, but you know, are in use elsewhere. Right. AstraZeneca Novavax, looks like it's progressing pretty quickly as well. Why can't the FDA just say, hey, you know, if this is good enough for the UK, then it's it's good enough. You're in an emergency. Like, why doesn't that just happen?

Dr. Kavita Patel  6:45  
Yeah, it's a great question. And I just, you know, part of my bio that's kind of varied is that I worked for years for Senator Kennedy. And we worked on FDA reauthorizations, we actually worked on the pandemic, all hazardous prepared Act, which gave us the ability to have actually have the emergency use authorization that didn't exist before. So I'm very, very great history lesson. It is a great history lesson done by parties. You know, Ted Kennedy would tell us that if we weren't working for the people, and we weren't working with Republicans, we weren't doing our job. So we did that with Richard Bern, who's obviously still in the Senate. So I think that there's an incredible one, you know, I do think that the commitment to safety and the obligation of the Food and Drug Administration really is to United States. And so you see, because of statute and authority in that emergency use authorization is the requirement that we can't really kind of farm out safety to other countries. Now, that's not to say that our standards are that much higher. I will say they are different, though. And we we have been cautiously traditionally follow the EMA the European Medicines Agency. So you know, the word around the world is that if you have a drug or a therapeutic, the EMA is more likely to approve it first. And the FDA is a little more conservative. And I would say that, especially given the conversation about the Russians vaccines, it is okay in my mind to see the US trials being read out and data being done. And it's not because the United States COVID Is that much different from Francis COVID. But actually, it kind of is. And so our wild type strains, the genetic mutations, all these conversations are now becoming much more relevant. So I agree with you. What I will say JB is that I think we fast forward four to six weeks, we will have emergency use applications from Nova Vax and AstraZeneca. And I think that those will be number four and five in our farm event. I do think however, we have enough, apparently, if everything goes as planned, we'll have enough vaccine from the current three manufacturers. So then if we have multiple choices, which I think if businesses are listening will will we will have multiple choices, I think the struggle will be how do we make recommendations for employees? And how do we give some of those excess vaccines to other countries? who absolutely need it? Because they're behind on what they have?

JB Holston  9:03  
Right? Yeah, that's great. Um, second question, Do vaccines prevent asymptomatic transmission?

Dr. Kavita Patel  9:09  
Yeah, we think they do the preliminary studies. There's a growing evidence that are and I'll say briefly why it's taken so long to get this. Yes, I do believe that we will see it's nothing is zero. But it is incredibly low, that we will have any sort of fully vaccinated person like me have a chance of me having a colonized in my nose and giving it to an unvaccinated or even another vaccinated person. But those trials that have all been set up around the world were trials set up for the primary endpoint of preventing death and severe hospitalization. Everything else was considered a not essential primary goal of the trial. So the data and all of that was powered, designed and studied for those primary endpoints, which means that asymptomatic transmission was like a nice to have, but that's what they have to study now. And what we're Seeing from other countries is incredible. And we're going to have some more of that data from the US. But I would say the CDC making the recommendation that vaccinated people can get together in a small gathering with unvaccinated people at low risk is basically their way of saying, Yeah, we believe that asymptomatic transmission is rare.

JB Holston  10:15  
That's helpful translation. That's right. That's great, because it is sometimes hard to interpret those messages. Yeah. But that's, that's helpful. Vaccine passports, good, bad necessary. What's your thing,

Dr. Kavita Patel  10:26  
I think that some form of proof of immunity is going to be necessary. I actually think my friend Andy Slavitt, who works on like all the White House COVID stuff, who's brilliant, set it the right way, anything that's going to be done in the United States needs to be free interoperable from a technology perspective, and kind of multi literate language, health literacy, etc. And I think those are the right three criteria. So I'm not a kind of fan of like, no offense to anybody out there in this company clear or something that causes something where someone would really have to pay into the program, we already are seeing New York state with the Excelsior pass. I mean, I think airlines, I think all industries are thinking about this. So I do think that having something that's kind of a free government good, so to speak, that's accessible to all is the right way to do it. However, having since I take care of patients who are primarily uninsured, probably the majority of them undocumented, and speak, you know, are in Latin X communities. In my practice, I will just be honest, I don't want there to be a perception that this is going to become some big government database, which could come back in some way to haunt them. And so I think that has to be clear also, but I think some proof of immunity is going to likely be the way forward for the entire world.

JB Holston  11:41  
Yeah, makes sense. Let's talk a little bit about the CDC recommendations, but particularly in the context of school, you're opening your book a little bit about that before, obviously, the school questions fraught. I've been engaged with it. I know you have as well. It does seem that there's a lot more alignment around that as a question now than was the case six months ago. It also seems like it also seems, though, that we're not necessarily on that sort of glide path toward all schools reopening in the autumn completely. Right, no matter how that interacts with CDC guidance.

Dr. Kavita Patel  12:12  
Yeah, I mean, short of like some crazy curveball, which certainly a virus that's novel could do to us. It is all there, there should be no resistance to the notion that children are full time in school in person. And that includes, by the way, the possibility that all children who are not vaccinated have to wear masks. I mean, there's certainly some safeguards around that. I think what's very frustrating to all of us, the CDC, putting out the guidance that came out about a month ago, technically, was the first guidance we ever saw that was very detailed on schools. So I personally, again, knowing how agencies operating the government operates, I was actually pleased to see it, even though I realized was a slightly confusing, and sometimes sent mixed messages that you could have a high school because the case rates on one block that actually was you know, all virtual with an elementary school on that same block that was in a hybrid, and it just didn't exist, you can have families with a household that had completely disparate learning examples, despite the household actually being the same risk potentially. So I think that what we need to do, as I've always said, we're not going to show that society is normal until we hear kids laugh at schools are open. And I don't mean open one day a week, I mean, open. So I do think that it would be wonderful places like the partnership have a huge voice in this because I think you do have to show how they're related. And I think we have to support teachers being an educators, staff and others being prioritized, which they are. And I do think that there's going to be no question that anybody who wants to vaccine will get it well before the fall. And I also by the way, will just mention 12 to 16 year olds will likely also have access to a several authorized vaccines by the fall as well. And then maybe even younger than that, depending on the strength of the data. So we could be talking really JB about a fall that's kind of, you know, somewhat mixed, but again, without some boomerang or a wildcard coming from the virus, you know, the spring of 2022, potentially masks in schools and kind of, but I do believe they should be fully open and have opportunities to have society feel a little bit more normal again.

JB Holston  14:21  
Yeah, well, as you put it out, it's for the companies that are involved in the partnership companies generally, that's been critical path. You know, we looked at ways the companies could stand up more testing thing and sort of fill, some of the other gaps are being left, etc. But the feeling was leaving if we did all that if folks are pinned down at home with their kids, it doesn't matter. We're we're still stuck. 

Dr. Kavita Patel  14:39  
Yeah. And that by the way, the digital divide. I'll just say that something that should not again, with that spirit of how you asked me about my personal experience, we should not be coming out of this not recognizing that that digital divide broad broadband access internet that actually shouldn't just go away as a topic once kids go back in school because I think that has also been the prevention. I think that has been one of the big huge gaps we've seen now is actually preventive care of mobility economically. So yeah, so that's just a comment.

JB Holston  15:11  
Yeah, no, I agree with that. My, my sister's a fifth grade teacher and mostly undocumented immigrant kids and public schools out in California. And you know, you would go March they disappeared. Yeah. Right. There's just virtually essentially no way. Let's, let's talk a little bit about my zoom out and then zoom back in. We're gonna have a fourth surge. Are we having a fourth surge?

Dr. Kavita Patel  15:36  
Yeah, we so we're already seeing cases in New York, for example, I've been following a couple of the metropolitan areas very carefully. So cases are coming down about 50,000 and a 24 hour period or less, but we are still dealing with in certain certain parts of the country, New York, for example, for cases are plateauing. And then in some zip codes, neighborhoods cases increasing some clear, we know that variants are driving that. Not the UK, not the b 117, B 1351, or P one UK, South Africa or Brazil, but actually our own homegrown kind of New York variants, California variants in California. And so those are things that we're all keeping an eye on. So instead of a fourth surge, surge implies that the health systems also be completely stretched. I don't think we'll see that I think we'll see an increase in cases. And that means more hospitalizations and deaths, unfortunately. So I That's partly why I think that businesses, humans, individuals, households are just going to have to navigate through some mixed risk. And that means that testing, which is still, in my opinion, a little bit unaffordable, and unaccessible to the broad public testing, quarantine, even if the states have lifted some of those regulations, there's gonna be some hard decisions that we're gonna need to probably work on public health and education and business kind of communities together to sort through until we get more clarity passed these increasing cases, and then hopefully, the kind of herd immunity or majority of people being immunized.

JB Holston  17:11  
Great. You've been in the federal administration. Before, I think we've seen a lot more alignment up and down the country around response since this administration came in then we'd had but they're always things that they could do better. What are we not doing well, yet, in your view?

Dr. Kavita Patel  17:27  
Yeah, I think that, yeah, you're absolutely right, JB I've never based on my background, you can tell I'm a Democrat, but I never think that means you just go into something blind. So I'll give you two concrete examples. Number one, I do think that there still being a little, the Biden ministration has been a little sheepish about just going in to locales and places that are just not meeting vaccination requirements. Now, we know every state is trying to get to some degree of that all eligibility soon. But we have some states that are just woefully behind. And they really do sending female has been the solution. We probably just need to like laser just target and say, Okay, now we're coming in, and I think they're trying to do that. Second is testing I maybe I should move that up to one. It is unacceptable to me that if I want to get a PCR it's still about 100 and $120. There is no cost to it, no costs, everything costs them. There's no such thing as a free lunch as my mentor used to say. So I do think that the inability to get too incredibly cheap testing for a broad scale of people is also a flaw. And then the third thing that I will by no means absolutely sure I will not sugarcoat at all we have to acknowledge that like Mexico, Mexico having no Coronavirus approach whatsoever, Canada not having domestic manufacturing capacity. We're like completely threatened by the Americas not having a strategy. And I know the last thing we want to do is say we're turning over, you know, 10 million doses to Mexico, we probably need to do that. And and I don't have to tell you anything other than point to what's happening in my old state of Texas on the border, then to show you that like between dealing with surges of unaccompanied minors and families, we're setting up our own little public health crisis of its own on the border. And I would say that that deserves health attention. And that's the reason to ship as much vaccine as possible where we can without compromising our supply to like, you know, our neighbors, both here and abroad if we need to. So that's those are three areas testing. I'll move that one to number one, and then to targeting parts of our country that have just been behind for different reasons. And then third is really acknowledging the threat from around us.

JB Holston  19:43  
Yeah, it was good to see the FDA announced yesterday there some moves around approving surveillance testing at home based on but it is it is tough to watch from outside because it does seem like the pace at which we could have been moving on You know, I mean...

Dr. Kavita Patel  20:02  
What are we now? I mean, that 15 months? I mean, that was, you know, no, unacceptable to me unacceptable, just unacceptable. Yeah.

JB Holston  20:11  
It does seem that, you know, learning where the line has to move as to process with respect to things like FDA and CDC, when there is an emergency is something we've got to learn, you know, for the the next time, let me zoom way out, you know, think about apart from changes in administration, and the contributions that the last administration made to the magnitude of this problem. What are we missing in terms of public health infrastructure, generally? And it's really a question, what do we have to make sure is in place the next time and how much of that can be regional versus national? Because one of the things we found that the partnership is, you know, we look at doing things regionally. And it's always easy to kind of say, well, we could but the end of the day, shouldn't the federal in there just be a federal response instead? And let's wait until until that happens?

Dr. Kavita Patel  20:56  
Yeah, no, I. So there's nothing closer to my heart and thinking about public health infrastructure. We got it wrong in the Obama administration by not actually identifying kind of proactively what that is, because we were so worried about not putting this superimposed federal, to your point, federal structure on top of local and regional and I actually think that's the right thing to do. You should not micromanage the way counties and cities or states approach this because it is all local. But then in the absence of that guidance, there was really nothing in most of the country. And over the last four decades, public health budgets have been constantly consistently cannibalized regardless of Governor party, etc. So because it looks until you have a pandemic, you don't really think about what public health does, but it does so much. So here's what I would say. I would say that it's, it's time for the kind of function of public health, there's always going to be the need to have kind of the traditional public health infrastructure that does the testing and tracing, we do that with infectious diseases. We do that with water quality, things like that. I would say it's now high time to have especially for larger sized corporations or coalition's like the partnership to have kind of a point of view on what like public health responsibility, private sector parties need to take, let me give you a concrete example. I think it's incredibly relevant to have conversations with local leaders, that public businesses will be willing to kind of play, whether it's through finances or personnel at the table, that are going to need to be a meaningful part of kind of surveillance as well as a meaningful part of preparedness after 911. Every major every business of any size, including small ones, have kind of a back of the envelope, you know, terrorism plan, so to speak. We see schools now that have gun policies. I think it's high time with everything that's happened that we have some sort of kind of public health infrastructure inculcated not necessarily, you know, this is not yet one more job, like the chief of HR, the person who helps with personnel and recruitment has to deal with, it's probably something that every leader CEO down has some sense of, what's my kind of responsibility to the health of my population, I eat my employees, that's two employees, or that's 2000 or 2 million. So I think that's the way I think about public health. Public health is this is C. Everett Koop taught me this when I was a lowly little medical student. Health care is vital to all people some of the time, public health is vital to all people all of the time. And that's the part we kind of need to get on board with.

JB Holston  23:31  
Yeah. How do you think about it in the context of climate change and sustainability?

Dr. Kavita Patel  23:35  
Yeah, so part of every corporate kind of strategic set of goals has something to do with kind of environmental and response. Almost everybody has something around environmental responsibility or kind of pledges to green or GM moving, you know, any of these auto manufacturers moving to all electric fleets, etc. So, to me, I think it's, I feel like the real kind of victim, not victim casualty, and all of this has been science. So the science of climate change has been demonized well before the pandemic and continues to kind of be politicized and demonized. I think this is a great example of where the the science of this needs to be lifted forward in a way that's accessible for everyone, including businesses, including employees. I mean, it broke my heart coming from Texas where I could still see parts. My sister was in Houston, my family's in San Antonio, I could stay still send me these kind of candid shots of like office parks, it still had electricity going at night. And I'm like, have we done away with that, like, who's still running Office electricity at 10 o'clock at night when there's no inhabitants? And yet, that's what we're doing in society because we're just not reflecting on that inner kind of that in a relationship. I am not a climate change science expert. I have read the literature and feel incredibly motivated to figure out how we can introduce that into like health care a little bit more, but I think It is going to take that kind of all kind of this more inclusive approach. But it's going to be intentional and it should not be it should I hate the notion that we just kind of have more things for people to do, rather than thinking about how it integrates into daily functions in a way that makes sense building owners, people who are hiring that type of thing. Yeah.

JB Holston  25:20  
Well, to your point, I think the CEOs have understood now that health is a primary concern for them as their employees, I think they're thinking about sustainability as a primary strategic issue as well. And you know, you can't not have plants and be active eyes. Yeah, let's talk a little bit about the region and want to talk specifically about inclusion near the partnership has decided that its work is going to focus on what we're calling inclusive growth, the belief is that this region, is in many ways, it is one of the most diverse regions in the in the country, if it also becomes the most inclusive and equitable economy, the view of the partners is that that will mean it's going to be the fastest growing region as well. Inclusion is kind of a new innovation for the next generation. So it's going to become the most attractive place to be as well as the most attractive place to stay and grow. So but there's, there's, you know, decades centuries of history to address or to consider in the process of trying to make sure that we've got an inclusive and equitable economic approach, as you think about the region. And either in the public health context or more broadly, yeah. How do you think about, you know, inclusion, equity, diversity? How are those things going here as a region, not just within some particular jurisdiction? And where's the opportunity to improve from from where, from your vantage point? 

Dr. Kavita Patel  26:40  
Yeah, I think the MidAtlantic because of both kind of a traditionalist, some HBCUs in the area, as well as this incredible, I love that area, because it is kind of a melting pot, it's my husband, who's in New Yorker kind of things with New York is the ultimate melting pot, and I lived in Southern California. But I think the Mid Atlantic is an incredibly rich place from all aspects, including kind of the inclusive diversity. I mean, the dialects to the cultures to like this, I think respect because we do tend to be an international stock, for most people, is an incredible opportunity. Having said that, I would say that there's also a need to be attractive. What I've seen at places like Brookings and other places is what kind of the higher you go on SES and accomplishment, the less inclusive it is. And somebody asked me like, what, why is that? And I said, let's see, it's very obvious. Like, you know, if you look at social networks, and you look at people at incredible high, we look at outliers in society, we like to talk about the person that kind of bucked all the odds and became the CEO, but 99.9% of people, because it's a social network. And if you're not accepted, if you don't have access to that at an earlier point in your career, then you just don't have any hope. And for women, for example, so inclusivity on multiple levels, gender, kind of bipoc, LGBTQ, all of it. It's all about points of accessibility. So I think that, to me, I think we're doing well, but I like this, you know, I like to give us grades like I cuz I think I was a teacher and a former life and future life. And I think that in the middle Atlantic, like I would give us like a sea, and I give a lot of the country a D or F. And I'd say we're a sea with a rising kind of goal, because I do think the intentionality is there and the pieces are there. But I think we have to be very honest, i The hardest thing to do is to do what I had to do after the spate of violence against women in Atlanta. And I had to accept that like, I play a role in that even though I look the way I do I play a role in that. And I, I think very carefully about the environments in which I'm in and come to the rooms I sit in, and it's I struggle. So I think that in order to continue to do what you're talking about, JB, how can we create a better place for us to struggle in a way that doesn't somehow also alienate people who kind of feel like, well, I don't get it? I'm inclusive, you know, and that's the part that's hard. And I do feel, I don't think it comes. I know, there's been a rash of kind of, you know, equity officers or appointments. And I think that's unnecessary to show in organizations that are usually large, that there's money, people time and resources, but this goes back to better public health and everything. How is it that I'm thinking, you know, what's the one thing I'm doing to kind of not face not to not to look at myself honestly, and create change in my organization. And so for most of us in the mid Atlantic, we're doing I think we're doing a lot can always do better, too. I give us a C and we're rising. But I would, I would highlight for me. It's been meaningful to think about the earlier points of access. So some people think that's a mentorship program. I think it's actually fostering I'm a big believer in like the strength of weak ties. And JB, you're a good example you and I kind of met very casually, informally, I have such deep respect for what you do. If you were to tell me, you're thinking about recruiting someone, and how can we find someone in this environment, that's going to be the kind of ties that create those networks that then help people kind of, of all ages, sizes, shapes and colors rise? And I just don't think we know how to do that. Well, because even I fall into patterns where I'm very comfortable with the people I know. And I'm very uncomfortable with things I don't understand. And that definitely where I think our region can do better. And so as a takeaway is that, you know, how are we promoting, like informal networks? Or strange bedfellows? Are people like the two of us kind of talking and working? Yeah, that would be great.

JB Holston  30:50  
Yeah, no, I think that's right. And I do worry about how much we fall we fall back, you know, you talk about points of accessibility, you just awareness of implicit bias, just lots of things where there was a lot of progress being made. And now suddenly, you know, 2 million women are out of the workforce. And, you know, I've had, we've had CEOs of some of our big firms, the consulting firms, in particular, have said, Look, you know, we've got folks who are in their early mid 20s, for whom 18 months of their professional career will have been remote. And during that those 18 months that, you know, that would have been the jungle gym of opportunity normally, and instead, it's, you know, they've got to try to figure out how to navigate that network in some remote fashion. So you can feel okay to work remotely. But in fact, a lot of those points of accessibility have been broken by how we've had to operate.

Unknown Speaker  31:37  
Especially if you're new to and yeah, I mean, I just think you're absolutely, I personally think that this is a greatest opportunity for our region, though, because we are, let's be honest, whatever business we are in this area, we take incredible pride at that kind of melting pot diversity we do. I mean, it is so amazing to be able to travel 10 miles and have an incredibly heterogeneous experience. And so that is both an attractor and a detractor. You have to fight hard to kind of change, like, you have to fight hard to change and also accept kind of with I mean, I fight every day, and I say very publicly, kind of my you know, I am racist, and some of and some of the things I've said or done, and I'm going to be okay with trying to learn how to not do that. And by gender bias about certain, you know, I've seen sometimes environments where women, I have actually seen women not really help other women for fear of being seen as, oh, you're the one woman who kind of helps all the other women. And so you want to play with like an environment that can be largely male, and not be seen as the token female kind of mentee mentor. And that's something we all have to fight. And I have to do it all the time. So I say as a standard rule, any woman, especially anybody who's young, who wants to, like connect or network, I never I usually I can miss an email or two, but I never say no. And, and I think that's not possible for everyone. But some version of people have to have their scale or something like that.

JB Holston  33:13  
That's my mantra. And you know, I regret saying this publicly again, but you know, I always respond. And, you know, I've actually got like a little curated thing that I send to, depending on what the nature of the query is, but it's like, here are five links that matter to you. And, you know.

Dr. Kavita Patel  33:26  
Oh, that's smart. Yeah, no, that's great. And that's, that's something you learn with time. And so, you know, how do we impart that on people who are maybe at lower level mid level, kind of having that be part of like, what they just do? And then those social networks opened up a little bit?

JB Holston  33:41  
Yeah, agree with that. Um, let me share a little bit. I know, You've been consulting a lot of businesses over the last while, what have you learned in that process?

Dr. Kavita Patel  33:49  
I have learned that there is no such thing as like a funny question about COVID. Like, the questions that come up, they're incredibly important. You know, there's, there's just, there's no, like, you know, there's no such thing as a stupid question. It's true. I mean, there's just so much misinformation out there. But I've learned is that it's very hard to find clear. And what people want is kind of clear, concise guidance, like they're being they're willing to even be told you can't have your workers in person, but they need to be told that. And so I would say again, what I've learned, and I hope that people aren't spending, you know, I know people are spending a lot of money to get this advice. I would, what I what I've observed is that a lot of what we give to mostly large corporations that are global, his advice that really should be liberated and democratized in some way. So I've tried to do that by kind of working with people like you are trying to kind of liberate that, whether it's, you know, media or my little world, but that's what I learned. And then the second thing is that I've also learned that all again, in that spirit of CDC guidance, businesses are still left without much to operate with in terms of how do I keep people safe? How do I bring them back safe? What do I do somebody get sick. And so another another thing that kind of I've tried to encourage the C suite to do is to do what we do in public health, which are tabletop exercises, think through your worst scenarios, and how people will respond. And a lot of it is the emotional response. Because if you have a plant with remote workers, sorry, call center with, with workers who are spaced apart, etc. But you have a hotspot developed with 10 people who get sick or one person whose family person member dies, that becomes psychological, but you can plan for it. So that's been also an observation is that we just don't do enough what I would call tabletop exercises, or what if scenarios, and then the third is kind of this meaningful, like commitment around going forward? You know, one day this will be in our rear view. What responsibility now do we have as employers everybody's scrambling to provide vaccines for their employees? Well, what can we take away from that? So that two years from now, three years from now, we're still screening? Can we do mammogram? You know, we bring mammogram trailers so that every woman over the age of 45 gets screened easily in the convenience of the parking lot of their employer. Could we do colonoscopy screenings, you know, not the full on, but like, we can do faecal, we have technology that can allow for so much that prevents so much disease to be done. It's just convenience. So I think that's the third thing, like where are we looking forward? And a friend of mine just became like, I forget his title. It's like chief Delta Airlines hired like forever first, ever the first chief, I want to say health officer, something like that. I don't think you have to do that businesses don't have the budget or EBIT da or whatever to do that. But I think having that notion going beyond I offer health as a benefit is very well. It would be good advice to heed.

JB Holston  36:48  
Yeah, yeah. No, that's great. I think there was a lot that they can learn. I do think you and I spoke a little bit about this. I do think a number of the CEOs still feel like they're kind of in the caboose, you know, that

Dr. Kavita Patel  36:57  
are in the caboose JB are and so I'm offering I think there's some real practical things that businesses in the next six months are going to need. Should I be testing? If someone's sick, do they need to be quarantined? You know, if someone's family member is sick, what should what allowances should I make? How can I encourage people who don't want to get vaccinated to get vaccinated? They're all left without none of these specifics, not one. So yeah.

JB Holston  37:21  
It's been tough to I think a lot of them have tried to learn how to talk to public health authorities.

Dr. Kavita Patel  37:25  
Oh, they're, they're not the right people.

JB Holston  37:28  
Yeah, right. It's tough. 

Dr. Kavita Patel  37:30  
They're understaffed, undervalued, overworked. They're kind of like, Wait, you don't have they're like, look, I don't care. You know, I mean, I'm friends with some of them. And I've had like, interactions where I've said, No, you need to take this seriously. And it's been really hard. So yeah, it's been.

JB Holston  37:48  
Yeah, it's, it has been interesting trying to broker some of those conversations, because you know, the, for the poor public health folks. I just give you one example, you know, every company will say something like, look, we've got sites where we can do massive vaccinations really saying, No, yeah, well, it's even tougher, because they'll say things like, as long as our employees are first in line. Like, if you're the public health person, on the other end, you're like, I can't respond to either part of that query, right? Because, you know, I'm not ready to think about mass vaccinations is because I don't have any vaccines. And I cannot possibly say yes to the second thing.

Dr. Kavita Patel  38:19  
Right. Right. Which is, that was a you asked about where Biden could step in more. Yeah, having the ability to allow for those types of relationships to happen through some form, it won't be through county, state public health agencies, but having some ability to do that, I think would have been, again, I'd like to say like, you know, hindsight, 2020, these things are nice to have. But these are the kinds of things that I hope do get baked into at least a federal pandemic preparedness kind of response and in about other things, because this isn't going to go away.

JB Holston  38:50  
Yeah, no, I agree with that next six months, we're gonna, we've talked a lot about the path to inclusive growth is to inclusive recovery, that there's just been such damage done that even with things like the the rescue plan, et cetera, the reality is that six months from now, the proportion of small businesses that are going to be able to look like they did pre pandemic is is small, you know, particularly in urban core urban areas, if you got the, you know, the DC government or you forget which entity but where should we be focused on trying to help those entities beyond what's already happening so that they're there in in six months, and so that they're also ready for the new world, the new world of work, etc. What comes to mind is, we talk a lot about it. But small businesses in particular, they're largely owned by a to a much greater degree by underrepresented people, women, as well. And they've just been decimated.

Dr. Kavita Patel  39:46  
Yeah. So I having sat on like the side of the recovery in 2009. What we really needed was, I know that sounds trite. We needed actionable kind of data. We needed to understand what were the three key drivers hers for downturn. So we're about to talk about a very large federal infrastructure package. Much of that will flow to these entities we're talking about Jamie, it's not like a federal government is going to manage all of it. But this was like the eternal struggle I had, I actually had to work on this, like what a small businesses need short of just checks and cash, what would be helpful, and we when we turn to some of the small business, we turn to the usual customer councils and organizations and partnerships, etc. But you were not equipped to speak kind of government DS and say, We need direct checks. We also need, you know, X percentage to be forgiven off of energy costs, because those are killing us are. So it would be nice to highlight what are three priorities, probably aside from direct cash? Because I think that's an assumption. What are three high priorities? Is it just zero interest loans, like is the PPP was that the Savior of all saviors so that you could actually do whatever you needed to do? Was it some sort of other tax credit? I'm not a big tax, I find that tax credits are problematic as a Democrat, because they often help those who have the capital to kind of from that, not necessarily the review, but it might be I might be wrong. And so I would say, Could you identify three things aside from direct stimulus checks, that would be high priority actions. And you'd be shocked at how hard it is to get those things together. And so in the absence of that kind of concrete feedback, what we end up having are the conversations I'm listening to now where they're like, well, let's just put out like, let's put out a jobs package, and let's just pour money into certain sectors. And so and I'm like, Is that is that the right thing to do? You know, but nobody knows. Nobody? Nobody knows. And so, yeah, that'd be great. And any data to support it? You talked about 2 million women? What's it going to take to get those women back into the workplace? Right. And so, yeah, and so those are the things that could be really helpful. Yeah. And keep in mind, Congress, as much as I love them, you know, senators and Congress, people aren't trained to do this. So you feed it and they can take it and put it into what they need to do that create the channels for entities that we're talking about to be able to deploy it, including the partnership. 

JB Holston  42:15  
Yeah, that's great. Well, we've reached the end of our time, and I was gonna go really quickly. Just last question I had heard on a podcast you did recently, not hours that you're gonna go out to a restaurant, did you have a chance to do that? 

Dr. Kavita Patel  42:31  
I did! My husband and I just two of us, we went to a restaurant, we felt really weird, because we just felt really weird and it was great just to promote, you know, Fabio trek. Del Mar in like the Navy or the harbor area, and waterfront area. It was wonderful. We wanted to spend as much money as we could like, the restaurant, like, I went to like the guy selling s'mores, like it was just such a it was it was such a they're gonna be those moments JV I hope my closing thought is like, the little things are just gonna feel so great. And you should relish that like there's there's this a horribleness that's happened, but it was so fun. I didn't think of being at a restaurant would be so enjoyed. like talking to the waitstaff who I couldn't have had more people come up and thank us for like coming and literally they were like, Thank you for coming in spending your money. And that's how this is the America that when you ask like what are we doing about diverse you know, diversity and inclusion? That's that's the kind of thing that I will love your children laughing going to restaurants we are we will meet at a restaurant. Yeah, that's gonna happen soon. And I was very happy. So hopefully you're doing something like that for yourself.

JB Holston  43:46  
Soon soon for sure. But to look Thank you. My guest has been Dr. Kavita Patel, who's a non resident Fellow at the Brookings Institute institution a great conversation much appreciated and I look forward to multiplying points of accessibility for for many people with you and in the in the years to come. So thank you for your time today.

Dr. Kavita Patel  44:04  
Thank you JB thanks to the partnership

Nina Sharma  44:09  
thanks for tuning in to fresh take. This episode was produced by Jenna climb Justin Matheson Turner and Colie Touzel. If you liked what you heard, share it with your network. For more information and to access all of our podcasts, events and publications, visit Greater Washington

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