The COVID-19 pandemic was uniquely colored by the Trump administration, to put it lightly. Almost five years ago, Donald Trump downplayed the public health emergency, spread misinformation and failed to mount a coherent response to the crisis that ultimately killed an estimated 400,000 Americans by the time he left office. COVID is still with us, though it is far less deadly thanks to vaccines, advanced treatments and acquired immunity. But it could surge yet again, as it just did at the tail end of summer. Meanwhile, the bird flu crisis continues to worsen, escalating fears of another pandemic.
All of this and more is weighing heavily on the minds of public health officials as they prepare for another Trump administration. The incoming surgeon general — 48-year-old Janette Nesheiwat, a Fox News contributor, vitamin supplement seller, and medical director of the CityMed network of urgent care clinics — will be tasked with the near impossible: protecting the health of Americans against the odds, which unfortunately includes the administration itself.
That was the situation — though he may not have realized it — that Dr. Jerome Adams faced back in 2016. As another doctor accepts the double-edged honor of the surgeon general appointment, Salon decided to check in with Adams.
Adams, who is currently distinguished professor and director of Health Equity Initiatives at Purdue University, helped lead Americans through the ravages of the initial years of the COVID-19 pandemic. He recently published “Crisis and Chaos: Lessons from the Front Lines of the War Against Covid-19,” an engaging account of those challenging years, the Indiana University-trained anesthesiologist has a lot to say. Despite devoting a significant part of his book to dissecting communications challenges and mistakes he feels he made, his way of communicating is equal parts folksy and conceptually sophisticated. He works scientifically accurate concepts so smoothly into ordinary language that you barely notice it. Adams also seems untroubled discussing the ideological differences that are tearing the country apart, calmly addressing fraught concepts like poor health outcomes among people of color, the drug overdose crisis, or the racism he has experienced throughout an illustrious career.
"I’ve seen these extremes, I’ve spent time with people, and I’ve realized that in most cases, we share the same goals."
He’s had to bridge those differences wherever he goes, not just in Donald Trump’s White House. He told Salon, for example, that publishers, when he started shopping around the idea for his book, tended to exhibit the polarization that increasingly characterizes politics, including the politics of health care, in the United States. In his words, they were either left-leaning people, who wanted “a hostage book: ‘Oh my gosh, it was terrible, It was miserable, here’s all the reasons why’” — or what he calls the other extreme: “a lot of the folks in the administration [are] now being picked this way, of everyone was wrong and Trump was right, and here’s all the reasons why.”
It seemed highly characteristic of Adams’ very genuine attraction to moderation and balance that, in the second of two video interviews, he told Salon, “As usual, the truth lies somewhere in between.” Adams explained that a life spent in very different parts of the country — he was raised in the rural community of Mechanicsville, Maryland — taught him that in reality, most people share similar values. Even in Berkeley, California, where, he said, “I literally had neighbors who proudly call themselves socialists.” He earned a masters in public health with a focus on chronic disease prevention from the University of California at Berkeley. Or now, living in Hamilton County, Indiana, “the most Republican county in the state of Indiana, where people proudly call themselves MAGAs … and proudly were part of the Tea Party.”
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Even across such huge ideological caps, Adams maintains, we actually share common goals — though we may differ in how we think we should meet them.
“I’ve seen these extremes, I’ve spent time with people, and I’ve realized that in most cases, we share the same goals. We want our kids to be healthy. We want to be able to support ourselves. We want to be able to get health care when we need it,” he said.
Even though he ran the Indiana State Department of Health, only the second African American or person of color to do so, and had a warm relationship with new vice president, Mike Pence, the former governor of Indiana, the offer to join the Trump administration as Surgeon General came as a surprise to Adams. His mother, a lifelong Democrat “as most African Americans are,” refused to speak to President Trump or even smile as the family posed for a photo with her son’s new boss. Close friends and family, including his wife, Lacey, were proud but deeply conflicted about his decision to take the position, and worried about how he would be treated as a Black man in the administration of a president who’d said there were “very fine people on both sides” in reference to the tiki-torch wielding white supremacists who terrorized Charlottesville.
“I must admit I am still processing it all to this day,” he writes in the book. The experience was, he stressed, not as glamorous as people might imagine. Adams writes of the first four months of his tenure as surgeon general, when he commuted between Washington, D.C. during the week and his family home in Indiana on the weekends, losing ten pounds in the process.
“The reality of my public service was that, despite being a three-star admiral, I was living out of a suitcase, separated from my family, and surviving off of apples, bananas and microwaved ramen noodles while often using Uber to get from place to place," he recalled.
"I am worried about some of the rhetoric from some of the nominated Trump officials."
Jerome Adams’ term as surgeon general ended in 2021, but he took his time getting to his memoir, which is also a reflection on public health, a blow-by-blow account of steering the Good Ship America through a pandemic, and a practical guide to reducing risk of poor outcomes from COVID-19. He told Salon that he studied the post-Trump book output of his peers — Deborah Birx, the White House Coronavirus Response Coordinator under Trump (“Dishing dirt from behind the scenes … somewhat defensive”)), and Scott Gottlieb, advisor to the former and future president’s 2016 campaign and a member of his transition team in 2016 before being appointed commissioner of the Food and Drug Administration a few months later (“I didn’t think it was very approachable for the average person to pick up and read”). Also, Adams says, he wanted to gain some perspective on the COVID-19 pandemic. So he waited.
“And what’s interesting,” Adams told Salon, “is that the pandemic just wouldn’t go away. We kept having surge after surge after surge. And so we kept going through these ebbs and flows where I’m writing the book from a reflective standpoint.”
He notes — with maybe a touch of defensiveness — that the change in administration represented a natural experiment of sorts.
“We got to change everyone in charge and what’s interesting is in 2020 — with no vaccine, with no treatment, with very little testing and no home testing, with lack of PPE — throughout most of the year, we had about 300,000 people die of COVID. [Under Biden the following year] they had three vaccines, they had Paxlovid, they had ample PPE, they had testing. And twice as many people died under a whole new administration. So regardless of how you feel about Trump or Biden, we actually conducted the experiment, we changed everyone out, and we didn’t get better. We got worse, far worse, and there you can’t argue that.”
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The “variant soup” spawned in the wake of the Omicron surge continues to evolve new strains of the SARS-CoV-2 virus, which is a natural process pathogens undergo to evade our immunity. It has resulted in variants such as XEC, which makes up an estimated 45% of current infections, but something else will inevitably replace it as COVID is now an endemic disease, like seasonal flu or HIV.
“I came to the realization that COVID is not going away, and we can’t just say here’s what we should have done,” Adams explained. “We have to say, here’s what we need to do right now.”
His book conveys both candor and a rigorous attempt to not only scrupulously point out mistakes Adams feels he made, but to “help people understand why you made the mistake.”
Adams feels that while there simply wasn’t adequate or good data to guide many decisions that needed to be made early in 2020 (for example, we simply didn’t know that SARS-CoV-2 was airborne), he and other public health voices failed to make this clear to the public. “We lost a lot of public trust because of some of the flip-flopping advice. But we also need to understand that part of the reason we made those mistakes was because we didn’t have good testing, we didn’t have good flow of data, and we were forced into a situation where we were making policy recommendations without the data to back it up. Not because we were nefarious or because we were idiots, but because we needed to tell the public, we needed to give them the best advice we could — but we were doing it with limited information.”
The environment in which Adams was forced into this delicate balancing act was, he stressed, quite different from that which confronted public health officials in other countries. For one thing, Americans’ baseline health is simply not as good as in many countries, specifically mentioning those in the European Union. Americans also have more obesity and chronic health conditions, drastic differences in health outcomes according to race and socioeconomic level and less preventative health care. For another, Americans also possess less scientific literacy and are less confident in our leaders compared to Europeans. This creates significant challenges.
"We lost a lot of public trust because of some of the flip-flopping advice."
“It creates a challenge because you’re trying to have very nuanced conversations in a rapidly evolving environment with people who don't understand the scientific method, don’t understand basic statistics,” Adams said. “And so it makes it easier for those individuals to be taken in by misinformation when they hear a statistic out of context and they don’t understand, or [when] they don't understand the difference between correlation and causation. And so that basic science and math and reading literacy that we’re failing in in the United States makes it difficult for us to have broader discussions.”
The need to speak in 30 second sound bites designed for Tiktok — and at a fourth grade or even second grade level, at that — was challenging to public health officials trained to communicate via peer-reviewed journals. All of this poses significant risks as the bird flu crisis, caused by the virus H5N1, continues to escalate. Adams says he is “incredibly worried” about H5N1.
“I am worried about some of the rhetoric from some of the nominated Trump officials, particularly if we get to a place where we rely on vaccines to deal with the pandemic, and you have flagging vaccine confidence,” Adams said. “I’m also very worried about some of the rhetoric around tearing down the CDC at a time when you may need all hands on deck to deal with the pandemic. But that said [...] if you don’t understand the root issues that cause you to go towards that iceberg.”
Adams warns that if we don’t address the root causes of these issues, we're going to continue to make the same mistakes over and over again.
“We saw that with mpox, we saw that with multiple COVID outbreaks, we’re seeing that with H5N1,” he said. “The exact same issues: lack of data, a lack of testing, poor communication with the public about who’s at risk and how to protect themselves, [the] same mistakes over and over and over again.”
On the surface, the incoming Trump administration is setting its sights on improving public health with the “Make America Healthy Again” movement. The figurehead for this return to focus on baseline health is Robert F. Kennedy Jr., President-Elect Trump’s presumptive nominee for United States secretary of health and human services. But as Salon has previously reported, public health experts are extremely skeptical of Kennedy’s overall ideology and strategy, given his attacks on vaccines and promises to deregulate agencies like the Food and Drug Administration.
“I think that’s something that I’ve been fighting for my entire career is for us to focus more on nutrition, on exercise, on baseline health. And that’s one of the main points from the book,” Adams said, emphasizing “that our lack of health resilience and the inequities that exist in our society are going to continue to put us at risk whether it’s H5N1 or impacts of COVID or flu, and so I think there’s opportunity.”
“And I remain hopeful, and will work with folks in the new administration to try to help them address nutrition and exercise and overall wellness,” Adams added.
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