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- No doubt much has been made about healthcare heroes over the past year or so during this public health crisis.

And Dr. Mandy Cohen is at the top of the list.

Not because she is of the most important, but she has certainly been the face at least in North Carolina for this COVID crisis.

I'm Chris William.

And welcome to an executive profile with Dr. Mandy Cohen, North Carolina's Department of Health and Human Services Secretary.

She joins us again, during this crisis.

And we'll start, right now.

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(dramatic music) On this edition of Carolina Business Review, an executive profile.

Featuring, Dr. Mandy Cohen.

Secretary, of the North Carolina Department of Health and Human Services.

- She has been called off the record, sturdy, scientific, consistent, reliable.

I am talking about, North Carolina's Health and Human Services Secretary, Dr. Mandy Cohen.

And she has certainly been, and I mean this with all the best intent, Dr. Cohen, she has certainly been, the poster girl, for public health, at least in North Carolina.

We welcome her back to the program.

And welcome Dr. Cohen.

And also, you look very healthy by the way.

(Dr. Cohen laughs softly) - Well, Chris, great to be back.

And you know, with each passing day and week, we're seeing more of this pandemic into our rear view mirror.

We're not done yet, but I'm excited, about the progress we've made.

And I'm really proud of North Carolina and what we've been able to accomplish.

- Governor Cooper almost seemed, well no, Governor Cooper seemed giddy when he made the announcement about the dramatic dropping of the mask mandates.

At least in North Carolina in public spaces, was expected.

Was that, try to describe that moment in time when you all came to the conclusion that it was time to take that tact?

- Well, it's been a such a hard year.

And at every turn, these are really hard decisions.

That we try to really hear from so many folks.

Obviously, take in the science and the data.

But also, hear from business.

And understand where our state is.

And I'm really proud of what we've been able to do.

And we had to make some hard decisions at times.

I know that, we're really hard on folks at different moments in time.

But, what we've seen over the last number of months, is that more than 4 million North Carolinians have gotten vaccinated.

More than 50% of adults have gotten vaccinated.

And what we heard from the CDC last week, was even better news than we had heard before, right?

We had heard that vaccines protect you from getting COVID.

I think the new piece of information for us was now we really have more definitive data to show that you, it also prevents you from giving COVID to others.

And that's really when the masks come in, right?

Is a mask were about, protecting you from giving COVID to others even if you don't know you have it.

And the fact that the CDC was so confident to say, now we know that these vaccines not only protect you as an individual, it protects you from giving it to others.

I think that's why we were able to move forward more quickly.

I think, we've done a fantastic job.

And our vaccine providers have been amazing.

Just getting vaccine out to everyone quickly.

Doing it equitably.

I am, we are at a place sooner than I thought, right?

I was talking back January, February, March.

It's gonna be the summer.

I was saying July 4th and beyond before we're going to get to this point.

But, you know, I think the vaccines have really accelerated our progress here.

Now, and like I said, not done, but I feel really good about where we are.

- You know, so let's talk about the vaccines for a second.

'Cause no doubt, vaccines were a lightning rod to the oppositional, folks who were there in a camp to say, there's no way I'm gonna take it.

I don't know how it was developed, blah, blah, blah.

I get that.

And other folks were, absolutely take it.

Is, has there been a shift in the public perception, in the public adoption of taking the vaccines?

Are more people willing to do that now?

- We've definitely seen a shift in public acceptance of vaccines from the very first few weeks that we were asking folks about it until now.

And that's just a mob practice of time.

When you see 4 million, North Carolinians, alone take this vaccine.

And do well and be protected and continue to see data that it's safe and effective.

It's preventing people from getting real sick.

You can talk to not just, hear from people like myself, but you can talk to your own doctor about it.

Frankly, you can talk to your neighbor about it who might've gotten vaccinated.

It does change the conversation.

And I think now we're in a place where, I think there are still folks who definitely wanna get vaccinated.

We just have to make it a little bit more convenient for them to do so.

Maybe it's nights and weekend hours.

Make it real easy, convenient to their work or in their schedule.

So I think we still have more work to do on the convenience side and making it easy.

But, I also think there are legitimate questions that we wanna that we make sure people feel like they get answered about this vaccine if they have it.

Because, you know, it is something new this year.

We want folks to feel comfortable with it.

I got the Johnson and Johnson Vaccine, for example.

And I want folks to hear from others about their own vaccine experiences.

The fact that, again, safe and really, really effective.

- Was it a luck of the draw for the J and J Vaccine?

Or was that an intentional decision by you to go that way?

- So I happened to, it was sort of a timing issue of when state employees and public health officials became eligible for the vaccine.

It was the same week, that Johnson and Johnson became available.

And I, again, as a public health official, I wanted folks to know that I felt all of these vaccines were safe and effective.

And that there were benefits to the Johnson and Johnson have a one and done.

So I got my one shot and I was done.

And so it was intentional.

I chose it specifically to show folks my confidence in it.

And that all three vaccines were safe and effective.

- So does the vaccine, does the efficacy of vaccines, does the deployment now of all three vaccine makers, does the availability of it, et cetera, does that all change the importance of herd immunity?

Have you changed your opinion about herd immunity?

When it's gonna happen?

Is it critical for it to happen?

- You know, so herd immunity is something we don't know exactly what that is.

Because, of a couple of things.

One, this virus is changing even as we speak.

And that's what viruses do.

It's not, anything that anyone's messed up.

Viruses change, the flu changes every year.

And we need to get boosters to the flu each and every year, different flu vaccines.

So I think, herd immunity can be elusive.

And it is often for a respiratory virus like this.

Because it changes so quickly.

And so for us, we always just been focused on getting as much protection out as quickly as possible.

Because what happens if you get as many people vaccinated, the virus doesn't have as much room to spread.

And if it doesn't have much room to spread, it doesn't have as much room to change.

Right?

So we actually are protecting ourselves from that virus changing.

If we can get more and more people vaccinated.

That's why, I'm not so focused on herd, I'm focused, herd immunity, I'm focused on getting as many people vaccinated again, to cut down that likelihood that the virus can change in our, you know, and evade our vaccine.

I think that is really what I'm focused on.

- Early on you said, not surprisingly, but you said that, we got to this point more quickly than you thought we would.

You know, when you look at the science of it all what, in the early days and when we were trying to predict and trying to model, and there was so much, I mean, withering, withering attention on how it was going to unfold and how it was gonna unravel.

When you look back now on the science and how we applied it, was, were there, was it surprising?

Was the science right?

What did you learn about science and modeling and predictive natures?

- Yeah.

Well, it's interesting.

We learned a lot as we went.

So early models, you know, either predicted, what would happen to the trajectory of the virus if we basically did nothing.

But none of us were doing nothing, right?

We were making major changes, decisions to shut down, big swaths of our economy to protect people.

So it was a bit hard to model because we had models that say, well, if you do nothing, this is what's gonna happen.

If you do everything, this is what's gonna happen.

But we were always, somewhere in between, right?

We were, we closed some things down, but it's not, we didn't do the kinds of tight, tight lock downs, like Wuhan, China did.

And so, we were somewhere in the middle.

So it was really hard to actually, figure out exactly where were, we weren't all the, we weren't doing nothing.

We weren't doing everything but we were somewhere in that middle.

And that's what made it so hard to predict.

What I would say ultimately, if you look at the totality of like these 15, 16 months, I think it played out largely like the models said.

Meaning that we have about a million cases of COVID in North Carolina, just by tests alone.

When you look at other factors, when we look to see who has antibodies, we think it's about two, two and a half million people have had COVID in North Carolina.

And if you look back at the early modeling predictions, that's what the modelers told us.

We think over the course of the next year, about two, two and a half million people are gonna get COVID and now, they were pretty right.

And we also saw impacts on our healthcare system.

But, what happened, is that we got, had medicines along the way, right?

We had improvements in how we could treat this as well.

So certainly, we saw more deaths and hospitalizations early on because we didn't know how to treat this.

We got better at protocols, right?

Even knowing to put someone on their belly, for example, was in and of itself really helpful.

And we knew actually to keep people off ventilators as we went into this.

And to keep people off ventilators actually seem to help them more.

And then we just learn more.

Then we got into monoclonal antibodies and things like that.

And now we have treatments.

Now we have vaccines.

So, you know, the modeling, couldn't anticipate all of those things.

So it's never gonna be perfect.

It's not a crystal ball.

But, I actually think they did a pretty good job of pegging the two, two and a half million cases here in North Carolina.

- You know, the subjective nature of this is that we overreact, either bad or good.

We always overreact to something.

And this was no different.

Obviously, the range of emotions for people, for families for organizations were, pretty wide as I know, you know, Dr. Cohen.

Do you feel like, by and large we overreacted?

In other words, the sole focus at the beginning, was the amount of deaths.

Was that, you know, what percentage of a hundred of people, how many of those were gonna die?

How did the subjective nature in the beginning and the emotional reaction compared to where we are now?

- Yeah.

Well, when I think back, you know, you have to remember in March of last year we didn't really know how infectious this was, how it was being transmitted.

And remember, I was so focused on getting PPE or protective equipment and masks for our health care workers.

We didn't even have that.

I didn't have testing, I didn't have PPE.

So we didn't really know what this virus, how it was getting transmitted.

We didn't know the best practices for prevention in terms of masks.

And what did this mean, you know, could the mask even help in this situation?

There's so much we didn't know.

So in a setting where there's so much we don't know, with so much uncertainty about how deadly it could be, I think we made all the right decisions to buy us the time.

To get the protective equipment, to learn about this.

And then, I think we use the right balanced approach.

To say, we're gonna open slowly, look at our trends.

Open more, look at our trends.

And I think that's why North Carolinas avoided, some of the big surges, frankly, that the Southeast saw over the course of the year.

We never overwhelmed our health hospital systems ever, in this whole year.

And I'm really proud of that.

Now, did we get really tight?

Yes, we did.

January, was really, was really tight.

We were not doing elective procedures.

We were moving patients around.

So we were bust, we were close to bursting at the seams but we never overwhelmed our healthcare system.

And I'm grateful for that.

- Well, so, and it's easy to look back on stuff and say what it could or should.

And I think you'd get high marks in the agency and the Governor and many in charge get high marks, emergency management, of course.

But, when you think about the early days, when it really started the weight of it all, and I don't mean the public weight and the attention.

But when you, at the point of the spear for public health in North Carolina, began to personally realize, of what this could be or what it might be.

And now here you are safely on land, instead of being in that boat in the middle of that storm.

When you look back on that, was there any, was there ever a moment in time when you thought that this thing could get away from us?

- So, well, first I should say, it's so much nicer to be on the land.

On the side of things.

So, man.

- It's fair.

- [Dr. Cohen] Yeah, I mean, I did.

I had a lot of sleepless nights, that this could get away from us.

Only because I was watching what happened, in other parts of our own country and other parts of the world.

I mean, look, even right at this moment in India, their healthcare system has collapsed in parts of their country.

And if we didn't have vaccines in the moment we did, I would worry, that we would have, it would have gotten away from us.

Like I said, January, was very tenuous for us.

But we started vaccinating.

We really were very focused on the most vulnerable.

We had the best vaccination rate in our 65 plus population early on.

It was very intentional.

Because, we were bursting at the seams, you know, from a hospital perspective.

So we really needed to protect the most vulnerable, very, very quickly.

So I think, we made those right calls in the moment, to prevent us from getting to that bad place but it could have gotten away from us.

I do believe that.

If we hadn't done the methodical work, followed the science, look at our trends and adjust as we went.

And so, you know, it was hard work.

And I know it was hard on every family, every business, here in North Carolina.

But, I'm grateful that we all pulled together as a state and are coming out the other side of this.

- I know the public job and the Commission of Health and Human Services is much more than emergency response and public health emergency response, no doubt about that.

When you now look and get a chance to really sit and think and go through it with your team and several layers down, how does now, how do the processes, how do the way that you strategically approach, what you do for the public and what your team does for the public?

How has that changed indelibly now?

- Yeah.

I think we always knew we were in a highly matrix world, before.

But this, really shone a light on how we need to pull multiple sectors together.

If we're gonna respond to something like this.

And I hope that the partnerships that we have made throughout this year will stick.

And we will be able to use them as a foundation to solve other hard, hard problems going to the future.

So, but I do think that we need to build for, I call it systemness, I don't have a better word yet.

To actually, where we talk about a healthcare system.

But in reality, we have hospitals who sit over here and public health who sat over there.

Mental health, our social services.

And now, I think we did a great job of pulling that all together to do this response.

But there was a lot of duct tape involved, Chris, this year.

That I'm hoping we can make more permanent.

Because we need to be one system.

It's the same communities, the same person, the same family that we're all trying to help.

And so, you know, some of that for me starts with like actually sitting down at the table, having relationships and talking to each other.

But it's also about sharing data and like practical ways of actually working together.

So I'm hopeful that we can definitely solidify that as we go forward.

- How has it changed the way you approach now child vaccinations?

Obviously, they're next up.

And that's the next goal here is to, get the kids vaccinated that wanna be vaccinated.

But, how has what you learned so far with the adult population?

What the public is willing to embrace?

How does that get deployed now among the kids of minor age?

- Yeah, it's a great, great question.

And I think some of it always for me, throughout this goes back to trust.

And I really think that people, either have a trusting relationship with their pediatrician, right?

For their kid's pediatrician.

In those circumstances or your own personal doctor.

Or maybe, that that trust is about a location, right?

So maybe you don't actually feel a lot of trust at your local hospital.

But maybe, a vaccine event at your local church, makes you feel more comfortable.

And that trust is built there.

So I think, one of the things I take away from the COVID experience is thinking about, trust, as we move into other vaccination efforts.

Or even, addressing other hard problems.

Whether, it's mental health, the opioid crisis, maternal health, infant mortality, anything.

I think I take away from the COVID crisis, a lot about trust.

And in order to build trust, you have to communicate, you gotta be transparent.

You gotta be showing folks that you're looking at the science and the data.

And you have to be building partnerships.

So those are the all of the things I think I take away from COVID that we need to deploy as we try to solve other hard problems.

And there are, we didn't, there were a lot of other problems that we had to put to the side.

But they are still there that we need need to solve.

- Yes.

So, Dr. Cohen, that's a good point.

As the immediacy of COVID demands an action here and now and you can offload that and maybe, move others to the top.

So what is public health, public enemy number one now?

Is it mental health?

Is it what you, originally came here to do around Medicaid?

Is it opioids?

What starts to move now to the top and gets the attention needed?

- Yeah.

Well, I wish it was one thing.

But, it's a complex world, so there's lots of issues to address.

We do have a big change in our Medicaid system coming on July 1st.

We are moving to a managed care system.

And so, that just takes up time to get that transition right.

But, it is really about, for me, thinking about holistically, about health.

And I think this pandemic really had, has us thinking differently about health.

Not just about healthcare, right?

So healthcare might be your access to the vaccine.

But we recognize that your health, is about your mental, your economic health, your educational attainment, right?

All of those things matter, to add up to your health.

And so, we are really thinking broadly about how, we fit into that in Health and Human Services.

In terms of economic mobility, educational attainment.

And those issues to build overall health for folks as well.

- You know, I can't, I don't know that I can remember when a Health and Human Services professionals ever talked about educational attainment so much.

And you've mentioned it at least twice.

And in fact, conversations we've had on this program with leadership, public leadership, around education have talked about you, and North Carolina's DHHS at least, as partners, as partners going forward.

So what does a partnership, much more closer forged in fire, what does that look like now?

- Yes.

Well, I think health and education are so linked.

And you know, we focus a lot on early childhood, health and education that is more in the purview of DHHS, but just by the nature of the programs we run.

But that is, so much of the foundation that happens from birth to age five before kids enter kindergarten.

That foundation helps them be successful, kindergarten, first grade, second grade, right?

That fundamental early learning time.

So we are definitely seeing a lot of opportunities to invest there.

We had an early childhood action plan before COVID.

It's even more important now, to really think about early childhood.

I was just at one of our NC Pre-K sites just this morning doing a site visit.

So that's gonna be really important.

And that's where I think this partnership between education and Health and Human Services is so critical.

'Cause it's, again, it's the same families we wanna make sure are supported, right from birth, as they move through our educational system.

We can put the best teacher in a classroom, but if a kid comes hungry, kid is seeing violence at home, you know, they're not gonna learn even with the best teacher in the classroom, right?

So that's where I think we can offer those wrap around supports, to help students be successful.

- Is there something you feel compelled to build, or work toward, with for-profit companies, for corporate Carolina?

How do you, you know, no doubt and Dr. Cohen, I'm preaching to the choir here, for sure.

But, no doubt the biggest casualty of COVID has been business and industry.

And that trickles down to families.

But, what kind of, well not responsibility, but what kind of interaction do you feel like you would like to have, with business and industry following COVID, that could be something to build on?

- Well, I mean, I think business has always had such an important role in health.

I mean, most people still get their health insurance from their jobs, right?

So I think businesses have such an important role to play to articulate to the healthcare system, what do you wanna buy?

Right?

'Cause you are the, you business leaders are the ones that are paying for what we get out of the system.

And if you don't like what we're getting out of the system we need to ask it, to do something else for us, right?

And I actually see as, the business community, and the state being very aligned.

And saying, you know what?

I want our system to really be thinking about health broadly, for our workers, for my workforce and for us.

So I think there's a lot that the business community really can engage in around health.

Now, there's some like really tactical things right now around vaccines and making sure their employees get vaccinated, right?

If their employees are vaccinated, right, that means less time that they're gonna lose, with those employees being out of work and sick and family members being sick.

So, clearly businesses have an incentive to get people vaccinated.

That's very aligned with us.

We're doing a lot of partnership with businesses right now on that.

That's like one tactical thing.

But I think there's a bigger piece here for businesses, to really engage.

I know, healthcare is complicated and expensive.

And you know, and often is, often, benefits manager, HR realm.

But I really think business can take it's, get in the driver's seat of this to say, this is what I want from the healthcare system and I don't see it.

And I want it delivered.

And I think there's a lot more they can be doing here.

- Do you feel, forgive me.

Do you feel that business will wait into, and have some effect on whatever that July 1st start date looks like when we start delivering a new public health product?

- I don't know what you mean by, oh, you mean in managed care?

Yes and no.

- Yeah, managed care.

Absolutely.

- I mean, I'm more thinking about, here's an important issue in North Carolina.

We have not expanded Medicaid, here.

And I think it's a huge economic issue for businesses.

I think our businesses, in North Carolina and I know South Carolina is not expanded either.

I think, the Carolinas, are at an economic disadvantage.

Because, we aren't providing health insurance to people who are working at many of our businesses.

Yeah, they're working part time and such.

But, think about the restaurant industry, right?

They're challenge right now for workers.

Those are the exact workers who could get healthcare coverage, through Medicaid expansion.

Wouldn't that be so helpful for these businesses from a recruitment, retention place, if those workers knew, that they could come back to work and have health insurance?

Right?

As opposed to, you know, going to another industry that offers them, insurance through their job.

I just think it puts, industry more on level playing field here, with the other states that have expanded.

So, Medicaid expansion for me is obviously, about getting people coverage.

But it's a business issue.

- Yeah.

- It's an economic issue.

- Yeah.

We're out of time which means you don't get the question about if you're gonna run for US Senate North Carolina?

(Dr. Cohen laughs softly) - No, the answer is no.

- Okay, all right.

Thank you for throwing that out.

Dr. Cohen, I think, you're a lot of people's favorite right now.

Thank you for the job you've done and being committed so much.

And we thank your family for that as well.

You do look healthy and you look well.

- Thanks.

- And thanks for being one of the prime leaders in North Carolina.

Best of luck.

- Thanks, Chris.

Great to be back.

Stay well, everyone.

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