America's top doctor is warning the U.S. faces an epidemic of loneliness.

U.S.

Surgeon General Vivek Murthy says even though the COVID global health emergency is officially over, the virus and the lonely world it cultivated are far from gone.

Hari Sreenivasan speaks with him about his mission to foster a culture of human connection.

Hari: Thank you so much for joining us.

First off, this week marks the official end of some of the pandemic era benefits that citizens have been enjoying.

Even down to snap benefits.

I'm wondering if you are worried that there might be any negative byproducts of ending this nationally?

Dr. Murthy: I'm glad you asked.

We have come a long way in the last three years in our fight against COVID-19.

At the end of the emergency declaration, it is evidenced and a marker of the progress we have made.

It does not mean that COVID is gone.

It does not do that we don't need to think about it anymore.

It means we have to use many of the tools we have built over the last three years, like vaccines and treatments and tests, and ensure we are utilizing these tools.

With vaccines, we want people to stay vaccinated, stay up-to-date with their vaccines.

We want them to reach for treatments if they are in a high-risk group.

If we do these things, my hope is we can manage COVID the way we manage other respiratory illnesses.

Hari: I was looking back at the stats and I want to say somewhere around 1000 people died a week ago from COVID-19 infections.

4500 were hospitalized.

Is this going to be something that we accept as the new normal?

See any forecast that these numbers could trend downward, for similar to the flu, it is kind of what we will have every year?

Dr. Murthy: That is a good question.

That story remains to be written.

It depends on what we all do collectively.

We have these lifesaving tools available like vaccines and treatment we need to make sure that everyone avails themselves of these tools.

Over the last three years, we have had over 700 million doses of vaccine administered in this country, and we have saved hundreds of thousands of lives.

What we are seeing is many of the people who are losing their lives to COVID today are people who are under vaccinated or who are at high risk groups and not getting treatments.

We will continue our work to make sure people know about these tools.

We are certainly continuing work to make sure that they are covered by insurance, and those who are uninsured, that there are provisions for them to get access to vaccines and treatments.

That program was announced a few weeks ago.

We are going to continue to work on COVID, and we want people to know that even though we are at a better place now, it is important for all of us to know these tools are out there and to use them.

It can make the difference between getting something that feels like it is a mild illness, versus ending up in the hospital or losing your life.

Hari: Do you see or hear from either the pharmaceutical industry the CDC, others that you speak with, that there will be more vaccines or booster shots that senior citizens or people with compromised immune systems will want to keep getting?

Dr. Murthy: This EDC FDA will work together to make sure that when there are recommendations for one people should get additional doses of the vaccine, that they will know that.

Right now, we anticipate that for most people, they may need an annual shot similar to what you get with your flu shot.

They have announced that for people in higher risk categories, six months or so out from their last shot, that they can get an initial -- additional shot of the vaccine.

As new recommendations come out come of the CDC and FDA will make those known to the public.

Hari: Speaking of one of those impacts, you have been writing for some time now and you recently have made statements in an op-ed about loneliness.

But is interesting to me is in your essay you had in the New York Times, you talked about loneliness in a way that I don't think most people would get.

Say, he is a public figure, he is surrounded by family and friends and has a high-profile job where he is constantly meeting people.

Yet you say after your first time as Surgeon General when you finished, you experienced something you did not expect.

Tell is a little bit about that.

Dr. Murthy: I wrote this story about my personal experiences because I realize so many of us feel a sense of shame when we talk about loneliness.

In our extroverted society to say you are lonely is almost saying you are not likable or lovable, or something is wrong with you.

What we now understand is one in two adults are struggling with loneliness at some level.

And kids, young people, are experiencing the highest levels of loneliness in the population.

I am no stranger to this.

As a child I struggled a lot with loneliness.

And then various points as an adult.

During my first tenure ended, I wen through this deep periods of loneliness and -- I went through this deep period of loneliness.

I wasn't doing the work that I found to be meaningful to me.

I also made at this critical mistake that I write about, which is during my job when I was Surgeon General, I had largely neglected my family and friends.

Sure, I was spending time with them at dinner or around the table, but I was always distracted my my phone.

I lost touch with friends who supported me over the years.

And I felt their absence so deeply during that lonely period.

I had to rethink of my life in many ways and with the help of my wife and parents and a few good friends, I have really tried hard over the last few years to build a life that is centered around people and around my relationship.

In focusing on that has made my second tenure as Surgeon General not only more enjoyable and sustainable for me, but ultimately has made me more effective in my work.

Hari: Is there a distinction between how you are describing loneliness and how people might hear those symptoms and say, sounds like he was depressed and how do you measure when you say almost one in two people are feeling this?

This is through surveys?

Dr. Murthy: It starts with how we define loneliness.

Loneliness is a subjective dealing.

It is the feeling that what I need in my life is greater than what I actually have.

You can experience loneliness if you have a lot of people around you.

.

It is about the quality of your connections.

When I talk to college students on campuses who are surrounded by hundreds, thousands of other students, tell -- and they tell me they are feeling lonely, it's because they don't feel they have people that they can be open with and vulnerable with.

That is important for us to have in our lives.

In terms of the relationship with depression and anxiety, we know people when they struggle with loneliness, that increases their risk of depression and anxiety and suicide.

Interestingly, and this may surprise some people, it also increases their risk of physical illness as well.

Of heart disease, stroke, premature death.

As well as dementia.

The powerful effects of loneliness and isolation on our health are really not well understood by the broader public.

That was one of the reasons why I issued the Surgeon General's advisory.

I wanted to people know -- people to know how common this was, how consequential it is for our health, and I want to come to know this is a problem we can address.

That is why we lay out a framework for a national strategy to address loneliness and rebuild social connection.

Hari: One of the pillars you have laid out in this advisory is about reforming digital environments,.

Tell us about that.

We have heard.

in different dribs and drabs about the impacts of screen time, social media on young people.

Is this also the same for adults?

How do we reform those environments?

Dr. Murthy: What we have seen is an introduction of not just digital environments more broadly, but social media in particular has impacted how we communicate with one another, and our relationships.

Too often is people substituted what used to be in person face-to-face relationships for online connections.

We have come to value quantity of connections over quality of connections.

Too many people, especially young people, have been subject to bullying and other exposure to harmful content as well through their experience on social media.

All of this together has had an impact on how people feel about themselves.

When you are scrolling through your feet and constantly comparing yourself to other people, especially young people whose brains are in a sensitive period of development, that can negatively impact your self-esteem, which can make it harder to go out and build friendships with others.

Young people also commonly tell me that in addition to feeling worse about themselves when they use social media, they also feel worse about their friendships.

They feel -- they see the activities people are doing without them and feel left out.

On a policy perspective, we need to establish the safety standards that we have from any other tools and products and platforms that kids use.

We also have to make changes in our personal life and try to draw down Drew's in our -- draw boundaries in our lives.

Think about time at the dinner table, being able to focus on them without the distraction of technology is important.

Bedtime also is essential.

We have so many people, young people and older people, who lose hours of sleep as they are on their phones.

They go to bed at 11:00, come 1:00, they are still on their phones.

We have to carve out time in space in our days that are tech free so that we can enjoy each other's company, have deeper, higher quality interactions with one another, and protect activities that support our health and well-being like sleep and exercise.

Hari: Several of the other pillars you are looking for to is to build a culture of connection, rebuilding social infrastructure and communities.

Such of that seems like OK, these are abstract ideas.

How what I put that into practice if I was small town Council or city that has the ability to create policies in a region?

Dr. Murthy: Let's take social infrastructure.

This is a place where community leaders and policymakers have a role to play.

We are used to thinking about infrastructure meaning roads and bridges and highways.

There is also social infrastructure.

These are the policies of structures in the programs that support the building of healthy relationships.

Think about those spaces and programs that bring people together to learn about one another, and build relationships.

Think about the built environment in cities that can facilitate people seeing and interacting with one another, versus certain environments can cut up cities.

Think also about what we do workplaces and schools.

School-based programs that teach children about emotions and healthy relationships.

The workplaces which help build a culture of connection and support.

People coming together to learn about one another.

These are all elements of the social infrastructure that as school or workplace leaders, as community leaders, we can invest in.

In the last half-century or so, we have seen a decline in participation, in recreational leagues, and faith organizations, and other community and service organizations that used to bring us together and helped us build relationships.

That is why we have to proactively rebuild that social infrastructure.

Hari: It is interesting, I have heard in the context of the pandemic that a lot of people lost that third place, especially people lost that second-place if they were not going into the office and connecting with human beings.

Whether it is the security guard you say hi to on the way in, one of your coworkers.

I wonder, when you're talking about rec leagues and church groups, those are spaces that are not either work or home, but where you can form deep connections with people.

Dr. Murthy: Absolutely right.

And a lot of people did lose those spaces during the pandemic.

In addition to losing the opportunity to see colleagues at work.

The truth is, we have been losing those third spaces, where you can meet people and build relationships, we have been losing those for years now.

It has been the consequence of declining participation.

We also have so much convenience that technology has afforded us.

I don't need to go to the grocery store anymore, I don't need to go to the mall or the store anymore, I can have packages and groceries delivered to me.

This candy really convenient.

But we have to understand there are consequences that come with that.

Have fewer and fewer unplanned interactions with people.

We are not bumping into one another, we are not having the short but pleasant conversation that can give us a boost in our day.

We have to intentionally and proactively build the infrastructure for connection in our communities in our day-to-day lives.

That is why I issued this advisory, because it is time to take that proactive approach.

Otherwise, I worry we will move deeper and deeper into what I think of as a social recession, where we experience fewer and fewer connections with one another, and that has impacts on our health.

Hari: You have already written a book called "together: The healing power of human connection in a sometimes lonely world."

When you were out there researching the book, what did you find that surprised you?

Dr. Murthy: What was so interesting to me in doing the research on the subject is one, understanding how many people were actually affected by this.

But did not feel comfortable talking about it.

Loneliness exists behind the current -- the curtain.

We have to draw it out of the shadows and help people talk about it.

What I also saw that was hopeful for me is I saw examples in communities across our country of people who recognize that loneliness was a problem and we are trying to build programs to address it.

I met a mom and dad who lost their daughter years ago to an illness.

The day after the death, they realize that she had been struggling with loneliness in school.

They decided to create a school -- a program in middle schools and high schools where students would help each other to address loneliness, where they would find people who may have been struggling, and create a place where they could come and feel accepted, where they could build friendships.

I encountered individuals who were making changes in their own lives.

I remember a woman in Texas who I encountered who had just moved to Dallas and she felt really alone, she did not know anyone.

She was not in a relationship, didn't have friends, but she made this bold and courageous decision that she was going to invite her neighbors over for a meal.

She was really nervous, didn't know if anyone would come.

Her father helped her build a wooden table, because her place was really small.

And the big wooden table they placed outside and had an outdoor potluck, and so many people came.

Even though some of her neighbors had been there for years, they also felt isolated.

And her neighbors table, as it came to be called, became a gathering point for people around her community.

Really a place where many beautiful friendships were built.

This is at a time when a lot of people were struggling with loneliness but we can't tell from the outside.

Choosing to check on one another to reach out to a friend and say hey, I'm thinking of you, just want to see how you are doing, stop by a coworker's desk to say hey, how are you doing, I just want to know what's going on in your life.

These are small, small moments, which can make a world of difference to somebody who may be struggling with loneliness.

That is the power we have now to be healers and help each other address our loneliness.

Hari: Surgeon General Vivek Murthy, thank you for joining us.

Dr. Murthy: To be with you.