In 2005, then-Sen. Bill Frist had a message for Americans: a pandemic was coming, likely out of Asia, and due to increasing global travel, it would likely affect the United States. Now Frist, a doctor himself, is looking at how and when America can safely reopen. One example of a locale doing it right, in his view? Nashville, Tennessee. Frist, a member of the National Coronavirus Recovery Commission, joins the podcast to talk about his 2005 prediction, what Nashville is doing, and more. Read the lightly edited transcript, posted below, or listen on the podcast:
We also cover these stories:
- President Trump tweets “why should the people and taxpayers of America be bailing out poorly run states … ?”
- House Speaker Nancy Pelosi says that the next coronavirus relief bill will include a provision for vote by mail.
- Attorney General William Barr announces a new effort to ensure Americans’ “civil liberties” aren’t attacked during the pandemic.
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Rachel del Guidice: I’m joined today on The Daily Signal Podcast by former Sen. Bill Frist of Tennessee, who sits on The Heritage Foundation’s National Coronavirus Recovery Commission. Sen. Frist, it’s great to have you on The Daily Signal Podcast.
Sen. Bill Frist: It’s great to be with you today. Thank you.
Del Guidice: Well, thank you so much for making the time and for being with us. We do appreciate it. To start off, senator, can you tell us about the National Coronavirus Recovery Commission and your work on it?
Frist: The commission is a fascinating group of people, first, that represent a great deal of diversity. We have breadth from the consumer side, from the government side, from the nonprofit side, from the academic side, from the foundational side.
We come together and over a period of four or five weeks studying, participating, engaging on how we open the economy, following and during this ongoing pandemic.
The ideas are rich. The ideas are bold. They are very practical. They’re aimed at mayors, at local communities, at states, and the federal government as well.
Del Guidice: Something that the commission has recommended is a five-phase plan, that you all have talked about and agreed on. Can you tell us about the recommendations in this five-phase plan?
Frist: Yes. We’ve come up with really about 40 different recommendations and the recommendations will be changing in time. We’re meeting on a regular basis. We are engaging each other. We have outside experts coming in.
Just like this virus is constantly changing in our own communities and the repercussions that it is having, devastating in so many ways to the economies and to individuals in public health, our recommendations will be changing as well.
It is a phased plan because we take certain dimensions. The first we take, and it’s not in chronological order, is to start this concept of opening. It starts as a concept and then goes to execution and implementation.
We do that, and then the following recommendations come back and face the reality of where we are with the pandemic, that first we have to keep this cagey virus, which is intercepting in all aspects of our life, … under some element of control.
In our phases, we recognize that it’s going to be a long time and coming before we have total control, but we have to move right now from what we call population mitigation.
That is where everything is shut down on order of our governors, on the order of our executive branch and our federal government, and on the order of our mayors. That’s population mitigation.
It’s a blunt instrument. It brings everything to a stop. It creates a psychology and a psyche of anxiousness, of uncertainty.
We’ve moved it through that, with now about a week and a half ago, of a peaking of the new cases of the virus. We’re about a week and a half to where the new cases are beginning to become less and less each day.
As that has occurred, because we can’t reopen the economy until we get the virus under control, we do move from population mitigation to individual containment, instead of all 350 million people hunkering down.
We’ll be able focus much more on individuals and we call it individual containment.
A lot of people set up this false choice of it’s either public health, save lives, fight the virus versus re-economy of opening up our states and opening up our small businesses and getting back to a normal life. That’s a false choice.
We talk about that in the committee and the real choice we have today is looking at the unaffordable containment, individual containment, containment of the population versus affordable containment.
Meaning yes, it’s going to be tough. … We still have to have containment that may be of more specific populations, of specific individuals, and that’s where the testing comes in and the tracing of individuals comes in.
But a type of affordable containment to allow our economy to open back up, to where unemployment—which is as high as 15% today, it may go higher—can get back down to much more normal levels, over time.
Lastly, as we move through these phases, we understand that this is not a week, five-week process. This is a multiple months and probably a year and probably a year and a half process until we get back to a normal, new normal.
Del Guidice: Something that the commission is recommending to President [Donald] Trump is that they direct agencies not to enforce a lot of regulations against small businesses. What do you think this looks like moving forward?
Frist: One thing that we do realize—and I think the virus is devastating and cruel as it is, especially to vulnerable populations, where we do need to focus attention—is the fact that this country has been over-regulated, that these regulations, top-down regulations … have stifled small business, make it next to impossible.
That’s an exaggeration, but next to impossible of even starting a small business today, compared to what other tempers allow, what we’ve been able to do in the past.
These regulations, piled upon the regulations in the COVID emergency, have been pushed aside with the expediency of being able to address the virus and with the pressures it has. That stripping away of regulations, I believe, is going to have to continue.
We realize these regulations have become a burden even pre-COVID and that now we’re going to strip away some of those regulations.
That process, even pre-COVID, had the gun by the current administration. I think we’ll accelerate that going forward, in order to stimulate the economy.
[We] still need regulations around safety and protection of individuals and protection of individual rights, but the excessive regulations on access to capital, of the paperwork that is required and numerous documents that are filled out, we’re really looking at those.
The countries will be looking at those and some of those will have to be reinstated over time, but they certainly won’t be reinstated to their point they were in the past.
So, I think what the COVID climate has done [is it] has accelerated a deregulatory process that was already underway, pre-COVID, by the current administration.
It has accelerated that with a focus and understanding that appropriate regulation by our government is appropriate and is important, but not when it becomes a burden to stifle innovation and creativity and the greatness of America, which emerges with imagination and the flow of capital.
Del Guidice: You’ve tweeted about Nashville Mayor John Cooper’s four-phase approach to begin preparing for and systematically reopening. You’ve talked about how it’s scientifically-based and data-driven. Can you talk a little bit more about his approach and if you would recommend it for other areas?
Frist: You specifically mentioned Mayor John Cooper in Nashville, a metropolitan area of about 750,000 people, so a typical mid-size town. Not on the East Coast and not on the West Coast, where so much of policy and the news is driven, but really mid-America.
A functioning, active, vibrant community that, like so many others, has been devastated in many ways in the short term by the virus.
What I have done, in advising Mayor Cooper and working with his really excellent staff of epidemiologists and physicians and members of the chamber and the business community, is taking what we generated at that level of The Heritage Foundation and our task force, our commission, and accelerated that and applied it to a city.
As you people will see, as they look at the recommendations from Heritage, we basically say that federal has a role, but probably a more important role is the states and that ultimately, in terms of execution and implementation, it’s at the local level, the level of a community, of a ZIP code, of a city.
I took those principles, and those principles really are as follows: As we move a population mitigation to individual containment, we need to be able to identify the enemy. The enemy is a virus.
The virus affects vulnerable populations disproportionately to others. It knows no color. It does disproportionately affect Latinos and African Americans and people low on the social economic ladder. Therefore, we need to do special things for those populations to protect and to promote to their overall well-being.
So, the concept of getting it down to the local level is one that we applied in the city.
No. 2 is testing. You’ve got to know the enemy, and the only way to know that the enemy is to be able to test for it. And our country has failed miserably in the testing of identifying the virus, both the test to identify the current virus, the PCR, the polymerase chain reaction tests, as well as the antibody test.
We have failed, and we continue to fail, and we need to capture private enterprise and work in public-private partnerships to improve that so we’ll know who has been infected.
So, at the local level, we have promoted testing in contact tracing, that’s where you identify somebody who is positive [and] you find the 10 contacts they’ve had with more than 10 to 15 minutes of contact. You call them, you tell them to self-quarantine.
And if they can’t self-quarantine because they’re in a home with 20 or 30 other people who come in the home or they are homeless, … step up and provide them a place to quarantine, and that takes a public investment at that local level.
So, the testing is a big issue. Identify the enemy, but once you do that, you can flatten the curve, it will not spread throughout the community itself.
You can allow the restaurants to re-open and you tell those restaurants you still need to do the social distancing, the physical distancing. You need to not let people sit at bars that are crowded. You need to have disposable menus. You set those guidelines in place.
And then phase down. We have four phases in Nashville, we phase them in over time so that at the end of about two months you can be back to a near normal, at least near normal in terms of the structure itself. The Heritage recommendations have been very important to shaping what we do locally in Nashville.
Then the last thing, and maybe the most important, is that it goes in phases. Every phase is two weeks long. If you don’t meet certain criteria that are based on efforts and analytics and measurement, you fall back to the previous phase and do not advance. …
It takes testing, it takes results. But then based on that testing and those results, you measure, measure, measure, and demonstrate that that virus is being contained.
Remember, it’s individual containment, and if you can individually contain it, you continue to open the economy and bring back the vibrancy and the dynamism of what we know about what the capitalistic system can bring.
Del Guidice: Sen. Frist, actually, one of my next questions was about that contact tracing situation that we’re talking about now as a potential option.
How does that work when it comes to oversight? Do public health officials review those different stipulations or practically in a community? Can you talk us through how it would work?
Frist: Yes, and it’s a great question. It’s one that a lot of people don’t fully think through because it’s easy for people like me and others to say, “That is the answer.”
And indeed it is the answer, and it does not necessarily involve a lot of technology, although, hopefully, technology can be applied to see who you’ve actually been in contact with for how long. Of course, that brings up privacy issues.
But the contact tracing is a concept that goes back literally hundreds and hundreds of years, and it’s no different. When you have a pathogen, a virus, typically one person will get to three people or four people, and that’s what this virus does.
If you have a certain amount of containment and isolation, that person either will give it to nobody or give it to one person. And if you just give it to one person, the virus will eventually die out.
So, what do you do with containment? Right now, Massachusetts has led the way, and they are using untrained, initially volunteers, but now paid, that are actually making phone calls to these 10 associated contacts and telling them what to do. You can use technology to do that, but that takes the hiring of a lot of people.
Remember, probably 5% of the overall population have had the virus today, and it may go up there, 10%, 20%, or 30%, so we’re talking about a lot of people.
Is it a government function? Is it a private-sector function? I’ve written a lot about this, and believe strongly it’s got to be a joint public-private partnership.
Our public health system has been underfunded in the past. It doesn’t have the experience at this point with the human capital on hiring or running such a complicated program, thus we need to have the public health, the leadership, that infrastructure that we need to partner with the private sector, with businesses, with companies, with private companies who actually do this, with the employers themselves.
That partnership will allow this tracing to go forward in a way that will be a successful population mitigation to individual containment.
The public-private partnership is critical. I think, if there isn’t another fund coming out of Washington, D.C., we have to be very careful because we’re [increasing] our deficit, [increasing] our debt, so you have to be very careful. I would argue, instead of these blunt instruments of just cash being sent out, which does have a role.
But I think we’ve done so much of that, that our next round should be targeted with maybe $5, maybe $10 billion, we’re working on the figures themselves, to hire 180,000—yes, that’s 180,000—new people who will be doing this contact tracing over the next year.
It’s very targeted, it would actually help put a lot of people back to work in the short term. And we know, based on all the data, all the science, everything we know about these viruses, that that is the surest way to successfully, individually contain this virus and allow our economy to grow as quickly as possible.
That is what I feel, and our Heritage recommendations have not proposed to that yet, but I do feel, as someone who’s studied it and has been involved in SARS back in 2003 and anthrax and heavily involved with HIV/AIDS, based on my experience, I think this targeted approach of hiring 180,000 more people today to do the contact tracing is the quickest way to beat down this enemy, the virus, and allow our economy to resume.
Del Guidice: Well, some states like Colorado and Georgia are taking initial steps to reopen. I’m curious, what are your thoughts on what they’re doing?
Frist: I have talked to other states, and I’ve talked to our governor in Tennessee. And what I stressed to them is what I stressed to the mayor and what the mayor in Nashville is doing, and that is extensive testing, both the PCR to identify who is sick and who is not.
I’d start with everybody in the hospital should be tested … all the people who are pushing the carts around and the doctors and the nurses because they’re on the front line. … All of the people running nursing homes and delivering the food should be tested, and they’re not today.
It’s obvious that those sort of places should … begin testing, that they need to test extensively, the PCR test as well as the antibody test.
They ought to immediately set up the metrics about when they would open and expand the economy and when they would close the economy.
If a second wave comes in, as it does, in the fall—as it does for most of these pandemics. If you look over the last 10 pandemics in this country, you need to be able to tighten up.
So, it’ll be like an accordion. Opening, and then if the metrics and the measurements based on the testing show no, the virus is getting out of control and it’s beginning that growth and then that goes to that exponential growth, we have to close that accordion down based on those metrics and that data.
If that’s built in at the state level, and if that’s built in at the local level of a city or a county, we can successfully get this economy back.
So to answer your question, I’ve not talked to those two governors, but I would encourage them strongly to use metrics, say they’re going to use metrics, say they’re going to use the analytics and use that data.
Del Guidice: What is your perspective on some situations we’ve seen that happened recently over Easter?
I know one situation that happened was in Mississippi, where some churchgoers were ticketed $500 after they attended a drive-in outdoor church service in their cars. Would you say some cities are abusing their power in these times?
Frist: I’m just not familiar enough with it and what they’re doing. I think, overall, the churches, the mosques have responded well as individuals.
The individual sort of engagement and how people have used it, in terms of compensation, of either participating or not participating, I haven’t really studied enough to know or to comment on that intelligently.
Del Guidice: You mentioned earlier your experience in medicine and as a surgeon as well. How has that impacted your perspective on the coronavirus pandemic?
Frist: Well, it’s really interesting. I did 20 years of medicine. In my 10 years of heart and lung transplant, I did hundreds of heart transplants and lung transplants. And that’s what I did before getting into the policy world and in the business world.
And the No. 1 enemy that I had, my sort of antagonist, the thing that would beat me down or I would beat it down, is the virus.
That’s because I gave my heart transplant recipients, after I transplanted the heart, I gave them drugs to push their immune system down. And when the immune system gets pushed down, these viruses take advantage of that and invade the body, they invade the heart. And my patients would have to fight infections.
So the virus has been an enemy of mine for a long time.
When I went to the United States Senate, I became very involved with President Bush and we were fighting another virus at that time, it was called HIV, and we know it well.
But remember, at the time that we passed a large presidential emergency plan, President Bush, and I was running in the Senate at that time, there were 3 million people a year dying every year of that virus. …
It was bipartisan all the way, both sides working together. But under President Bush’s leadership and me as majority leader at the time—and at that time, the House was Republican, but, again, it was bipartisan— … we reached out around the world, as well as here at home, and we established PEPFAR [the President’s Emergency Plan For AIDS Relief], we invested $15 billion.
That particular legislation has left 20 million people alive, 20 million people alive today who would definitely have died if the United States and the American people and the American taxpayer had not acted. So I think of that a lot.
Then in 2005 I wrote a paper, … I ended up giving 20 different speeches around the country. And the paper you can find in The American Mind today at the Claremont Institute … because they republished it about a month ago.
It argued for a Manhattan Project, it actually said a greater than a Manhattan Project to fight the inevitable pandemic that will come sometime in the next 15 to 20 years, likely out of Asia because of the congestion there and the markets there, made possible because you have airplanes and you have such a small, interconnected world.
But I predicted accurately that this would come out of Asia and that was in 2005. I gave that speech and even though I was majority leader and was on the Finance Committee and the public and the health committee, I was unsuccessful at the time in passing that project.
But there we looked at vaccines, to speed up vaccines. I wish we’d done that today. Instead of waiting a year and a half, we could probably do it in six months.
We said, “Invest in the R&D, research and development, around viruses and the modeling.” And again, if we’d only done that, then we’d have been prepared today. I said we need to heavily invest in our stockpiles to fight these viruses in the future.
And as we all know, whether it’s protective equipment or whether it is the antiviral agents or whether it is the ventilators, we under-invested grossly in what our stockpiles would require.
So my past has been heavily involved in fighting viruses as a doctor. As a policy leader, I did my best, although I failed in the Manhattan Project to fight pandemics in 2005. And this time around, I am very hopeful and I’m just a private citizen now.
I’m a private citizen now and I’m not in government and I’m not doing heart transplants. But I do want to be a loud voice to articulate that pandemic will come back even after we get through this.
These viruses are for their own survival, they can move faster than we can and our immune systems are not immune. They’re not active against all viruses. And we will have another pandemic for sure … unless we can … get better prepared.
This time we were flat-footed. We were not prepared, even though all the warning signs were there.
Del Guidice: Something else that comes along with this pandemic is the economic toll that we’ve seen. What is your perspective on that piece and how do you think we should respond as a country to help people get back to work?
Frist: … At the Heritage committee, in this great resource of diverse people in our community, we talk a lot about the economic cost.
The great lockdown has caused the worst recession since the Great Depression, I believe. I believe we’re going to see that, … we’re going to feel that. And I think it’s going to be far worse than the global financial crisis.
I’m thinking globally now, overall. Our global economy is going to shrink by 3% if the pandemic fails to recede in the second half of this year. We just don’t know.
A lot of people are modeling that it won’t, but these viruses are just so unpredictable. If it fails to recede, the global economy’s going to shrink by another 3%.
Unemployment in America, 24 million people in the last four weeks had filed for unemployment. Right now unemployment is 15%. It’s probably true unemployment’s higher than that.
Yes, in the Great Depression it was up at 25%, but the difference is that the pandemic we’re seeing today, … it hit quickly and the economy was buzzing and doing well, then all of a sudden [people are] unemployed. Hotels in Nashville, Tennessee, have gone from 87% occupancy to today it’s around 7% to 8%, all of those people that are out at work.
And we may see unemployment above 30% in the second quarter. At least some predictions, I know the Federal Reserve Bank of St. Louis has predicted that.
The responses by government have been there, all in all I I would give a B+ to A. If you look at finance ministries and central banks all over the world, they have done sort of their utmost to help people for this economic shock. …
Most people in the U.S. have used these tools from the financial crisis of 2009 with the quantitative easing, which is purchases of all kinds of assets by central banks has occurred in huge, huge quantities.
And to be honest with you, just as an aside, it’s almost too big. It’s sort of threatening with the Fed Reserve balance sheet—I think it went from $4 trillion to about $6 trillion. But the quantitative easing is working and I believe it is a positive thing.
Secondly, the deficit financing, the CARES Act, which is sort of a general purpose bailout of checks to everyone—not a stimulus bail, there’s nothing to stimulate—is $2 trillion and then another half a trillion last week. But we have this federal deficit.
It was expected to be 5% of GDP for 2020 three months ago, four months ago, and it looks like it’s going to be up to 15%, not just in the United States. The U.K.’s public sector has net borrowing as well, large with public data above 100% of GDP. But the world, the public debt is soaring.
Again, the stimulus, it’s a little bit like when I’m a heart surgeon and somebody comes in in shock. … The first thing we give them is just sugar water and the sugar water, yes, it keeps our heart going, but it doesn’t have any of the nutrients that oxidized blood would have to sort of get them back to life.
So we’re kind of pumping money to keep things going, but we’re really not stimulating the economy itself.
I can’t look into the crystal ball with predictions, [but], not a lot of people, but a lot of economists, if you listen to them, think that we’ll turn the corner in the second half of this year.
And I’m not quite that optimistic. But so far I would give our government a strong B+ or A in the response today. Again, I’m worried about the deficit and debt.
Del Guidice: Lastly, Sen. Frist, we’ve seen people in some states like Michigan have protested the lockdown. I want to know what your thoughts on the protest have been and also, if there’s anything you would like to tell those protesters, what would that be?
Frist: Oh, protesting is a part of America and it’s a great part of America and I have a little bit different perspective because of having been in Washington for 12 years and I have been majority leader.
I look at protest through the lens of its freedom of speech. It gives people pause. It sometimes focuses you in the right direction. And so I tend to say protests are OK.
What’s different about today and what I don’t have a full understanding of is how much of these protests are being investigated by certain nefarious originating entities, whether it’s people overseas, Russia, splinter groups here in the country.
So what I do is say back, “OK, there are two sides that are oversimplified here.” Rush ahead and open the economy is one side versus the public health, keep everything locked down.
Somewhere in there the balancing act has to be done because keeping the economy closed kills people. It takes away their livelihood, their spirit, their hope, their imagination, food on the table, unable to buy prescription drugs. So there’s a cost to that.
But to balance that with the cost of opening up then becoming less restrictive on the public health, the physical distancing, the keeping people separated in the lockdown down there.
Because we know, as we lift those restrictions, people are going to die. Just, they’re going to die. The virus kills. We’ve seen that as a fatality rate of 5%, probably a lot less than that. But if you today say confirmed cases versus the people who’ve actually died, it’s 5.4% and, therefore, it’s a balancing act. And that’s the way I viewed the protest.
For the protesters themselves, I said, “This is your right as an American to protest. But do recognize that on the public health, all of the data shows that when we loosen restrictions, you are killing people. People will die.”
What we need to do is open up at a pace where we minimize those fatalities. We maximize well-being and, therefore, we do it at a pace.
Nobody knows exactly what that pace is, but we will know as we get the data, which comes back to why I think the metrics are important, which requires the testing.
And we can’t have people in Washington, D.C., going on every night and saying, “We have adequate test.” Because I can tell you, as a doctor, as a former policymaker, as somebody who’s on the ground, we do not have the test.
Let me just mention, because I know you want to wrap things up here, there are unknowns as we speak. As people come back and listen to our discussion two weeks from now or a month from now, hopefully we won’t call them this, but I call them the known unknowns.
That’s what makes this tension there and the protest there and the challenge that governors and policymakers have, is what we talk about in our Heritage Foundation task force meetings, commission meetings.
No. 1, how many infected people do we have today without symptoms? Because this virus—like almost all others causing pandemics—is unusual in that it causes infections even when you feel healthy and you have no symptoms. That’s why we need the testing.
No. 2, what is the true infection fatality rate? I said there’s a mortality rate of 5.4%—I don’t believe it’s that high, really, but if you look at the numbers so far, because of inadequate testing, it is.
But we don’t know, if you have that virus, what the likelihood of you dying actually is today. It’s a known unknown. We will know it with more testing.
No. 3 the immunity. How long does the immunity last post-infection? We don’t know that. We don’t know.
There’s a report out of China last week that basically says, it came through the World Health Organization, … that this virus may not cause very much immunity and it may not give you much more than a few days of immunity, but I’m not sure.
I don’t know if you agree or disagree with that, but we just don’t know. Is it weeks, is it months, is it years?
[No. 4,] how seasonal is it? Does it have a seasonality to it? Will the virus recede as spring turns to summer? We don’t know.
And No. 5, what are the impacts on the heart and the lung long term and the neurological damage?
The report last week [says] that young people are having strokes after having had the virus when they’re 20 and 30 and 40 years of age and it has a direct impact on the heart long term. We don’t know.
And lastly, which does have a huge economic impact in everything we’ve talked about in terms of opening and closing like an accordion, will there be a second wave as there are with most pandemics? That is in the fall, will there be another surgence in the virus itself?
I mentioned those known unknowns because every day that goes by, we come closer to making those known knowns. We don’t have it yet and that’s why we need to be flexible. We need to be flexible in our recommendations.
If a recommendation doesn’t seem to be working out, we need to be humble enough to back it up and put new recommendations out there if that’s what the data and that’s what the science shows.
The long term, we’re going to be OK with all this. It’s going to be a huge insult to families and too much death, too much destruction, the economy badly damaged, but with the American spirit, ingenuity, and creativity, we’re going to get through this and we’re going to win this battle.
Del Guidice: Sen. Frist, thank you so much for joining The Daily Signal Podcast and for unpacking all of this with us today. We really do appreciate it.
Frist: Thank you very much. It’s great to be with you.