Coronavirus Report: The Hill's Steve Clemons interviews Gary Slutkin

Steve Clemons: Gary, thanks so much for joining us. I’d love for you to share in your own words how you saw this link between the diseases and epidemics that we have attacking us, on one side public health, and violence on the other.

Gary SlutkinWell, it was essentially intuitively obvious to an epidemiologist because the graphs and curves and charts, they looked exactly like any other epidemic. So, what we did was, we just tried out basic health epidemic control for violence, meaning we use health workers, the community themselves. And in fact we got 40 percent to 70 percent drops in shootings and killings, treating violence just like any other community-based epidemic. 

Clemons: Well, one of things I have the privilege of doing is meeting some of those that you called “interrupters in the communities” here, right, in the greater Washington, D.C., area and was very, very impressed with them. But tell us a little bit about how the model works on the violence side of that. And also, I'd love to get into what your teams are now doing on the COVID front, because these maps lay over each other in terms of the problems that these communities are struggling with.

Slutkin: Well, it's the same population that's involved because they need to be reached by health workers. The spread is similar, except one is respiratory, the other isn't. But they're both behavioral and in need of behavioral change. And the way that it works is that community individuals themselves have been recruited and hired to become the workers who can, in the sense of violence, cool people down, buy some time and change their minds and persuade them not to do violence, which, of course, is a new behavior. And then the workers keep working with people to change the trajectory of their life as well as, of course, their future, thinking about what they would do if they were challenged in a situation of violence. 

Clemons: Can you share with us some of the results you've had on the violence side? 

Slutkin: Right, so Cure Violence has been reducing violence through community-level work for about 20 years, so there have been about eight or ten evaluations and usually 40 percent to 70 percent drops in shootings and killings are shown. Usually, results are fairly fast, and there's 13 communities now that have gone a year to three years without any shootings or killings. And that's what you aim for. When you're trying to reduce an epidemic, you don't aim for partially getting rid of it. You aim to really reduce it to where it's rarely a problem at all.

Clemons: So, let's be unfair to you for a minute. Let's give you the task, hypothetically, of rolling back COVID. So, given what your experience has been in rolling back tuberculosis and cholera and AIDS, what would you do, Dr. Slutkin, if you were made the COVID Czar today to help achieve a rollback that we're not seeing in the United States, today?

Slutkin: Well, we're doing some of this. Cure Violence retooled all of its programs in 20 cities as well some other countries, in particular in Latin America, to begin to work on COVID as well as reducing violence because we're working in the same neighborhoods. And it's these same neighborhoods that really need the outreach and the trust and credibility and the help with changes in behaviors. So, I mean, the two main things that have gone wrong in the United States are these: One is that the goal has been wrong, the goal of bending the curve. Even epidemiologists are to blame for this, in part. We never state bending a curve as a goal in an epidemic. We aim to get rid of it. We aim to stop its transmission, stop its spread so that goal, bending the curve, is halftime, and the goal of opening up is never actually the goal either. So, the goal has to be changed, too: stopping this epidemic, which about 30 or 40 countries have successfully done. Now the other main thing is that we have to do behavior change because it's all we have. That's all we had for AIDS for 15 years. It's all we have for Ebola, no drugs, no vaccines. And it's all that we have for violence. And it's working. And it's all that we have for COVID. Of course, the behaviors are different. In this case, it's mask-wearing, it’s social distancing and not hanging out, and these are very hard things. Always the behaviors of an epidemic cause you to need to do new things. And so, our workers, the violence interrupters, the outreach workers, the whole teams that we have in multiple cities now in the country are helping these communities understand these new behaviors. You know, and just add this: People need to understand transmission. It isn't just about wearing a mask. People have to understand that this virus can be in somebody's mouth and nose and can transmit it to you even if they're not sick. And they look fine and you know them. Therefore, you need to not take any chances in how close you are to people, even if they look well. You get the same thing we have to do for AIDS. You didn't know who was infected, who wasn't. The same thing that we do for violence, you don't know exactly what's gonna happen next. You need to be reaching out to the people who are at risk. So, this is it. It's about behavior change. It's about shifting the norms to new norms. And then you get very strong changes in the epidemic itself because it’s no longer being transmitted. 

Clemons: One of the things I was so impressed with about your organization when we first met some time ago was that you've been in some of the communities with the greatest incidents of violence in the country. I mean, they’re almost like war zones, and you've achieved enormous results. And on the COVID side, we see Sunbelt states, we see Florida and others with just real surging rates, almost to the point where some observers have said we're getting to a point of no return. You worked in places that were point of no return in my view — you may not frame it the same way — but what would you advise those public health commentators and those people trying to be responsible in these high-density zones that have such a surging infection rate right now?

Slutkin: They've let up way too early. In fact, everybody has let up too early because as soon as you let up or open up, the virus then has its opening. So, we have to have real goals of stopping the spread. And we need to reach the people who don't understand this by explaining how it's transmitted and what they need to do differently. We have to all be all in. Therefore, you know, the basics of wearing masks. We really need to get to 80 or 90 percent universal mask-wearing, wherever there is a problem. We need to do the social distancing at least six feet, if not more. We have to keep people away from indoor public places. I mean, bars, there's no reason for them to be open during a respiratory pandemic, the worst in 100 years. But essentially what we're doing at the level, and I'm talking with mayors and governors and also with the communities, is getting this behavior change in and this understanding of transmission in. This is how you manage. There's an epidemic playbook that we use, those who have managed epidemics, and it needs to go into play to scale now.

Clemons: One of the things that you did with CVG, Cure Violence Global, is you brought on, as you were sharing, people from the community to play a key role. They became stakeholders, if you will, in disrupting. I met some of these folks a while back, very impressive, and many of them come from impacted families. Do you think we need to do something similar? We've got front-line responders, but do we have to have a different kind of stakeholding in our communities to kind of get the behavioral shift going?

Slutkin: Yeah, that's exactly it. That's exactly it for violence, that's exactly it for COVID. And that's exactly it for every epidemic I've ever worked on, tuberculosis or AIDS or anything in there. And there's a method to doing this. It's about recruiting, selecting, training, guiding, supervising, supporting community people themselves. All epidemics are managed from the inside out. They're not managed by police, they’re managed by the community themselves, people who are trusted, who can translate what needs to be done to the people who need to understand it in order to be able to shift what they're doing, for it to make sense to them. So, the workers at Cure Violence use a COVID task force as well as violence interruption work, which, of course, is an alternative to policing. It’s having the community itself do it in a partnership with a well-guided public health epidemiology. That’s the partnership, public health, epidemic control and the community themselves. Community doing the work, being paid to do the work, being supported, supervised, and together we ensure that they get the results. And then you get communities going down towards zero with respect to violence, also for COVID and so on.

Clemons: One of the other sets of factors, and I've discussed this with a lot of the people I've had the privilege to interview here, is that you've got a lot of tidal waves hitting at the same time. So, you've had COVID that has created economic shocks, and we've now got upwards of 44 million, maybe more, officially unemployed, and then of course, you have the George Floyd murder and the protests over police brutality, and essentially these questions about racial identity and inclusion in America coming all at the same time. All of them have a massive overlap among many communities of color that you've been dealing with. And I just want you to help take us down into that for a minute to understand what we should — what viewers watching should understand about this community and what they need today.

Gary Slutkin: Well, I mean, just take the George Floyd situation for an example. Situations like this come to the attention of Cure Violence, community organizations and workers all the time. And they don't escalate. They de-escalate. So, because we're dealing with a problem before it becomes a problem and it's not about threat or force, but about talking people into a cooler situation. So, if the community workers, the Cure Violence workers were around, you know, it would have been ‘well, was this really a bad bill?’ Or did you know? Or someone has to get paid $20 or whatever in apology, so that there is an entirely different way of dealing with a problem like this. Now, to the other part of your question, yes, we have a lot of overlapping epidemics right now, and that's usual in epidemics. It’s usual to have many epidemics falling on top of each other. I've seen this in so many places, but what I'm seeing now is yes, the COVID, the protests, the police violence, the ordinary violence with more violence going on in homes and child abuse now, because of people staying home and of course, the economic stress and add in an election coming up. We've got to have the community itself — and this is what we guide, the community itself performing the acts of changing their situations with our health, including the local structural situations. For example, in a grocery store, it isn't doing helping enough with its workers or with protection and things like this. So, all of these things can be managed together. But you need to have this network of outreach workers who can help with the behavior change and help with the support. And we're doing this in 20 cities, but not only in New York really to a sufficient scale. 

Clemons: One of the things I want to convey to the audience is that I've checked out Cure Violence, CVG online. It's peer reviewed. It's got all sorts of incredible commentary about the results you've achieved. So, I encourage people to go look at that. But in our last minute, Dr. Slutkin, I'm a block from the White House right now, where the coronavirus task force meets. So much of what you have done hasn't depended on those folks. You found ways that have not really depended on the federal government. But I'd like to hear what you think members of the coronavirus task force, people at this large national level, ought to be thinking about and doing most as they approach this kind of epidemic. 

Slutkin: Well, I mean, the first thing is to realize that the economy will follow our success on the virus. The economy will follow our getting the virus under control; it doesn't go the other way around. But I don't know if this is realistic to expect that this will occur federally. But in any case, we need to focus on getting the virus down. They ought to be talking about masks more and closing bars. But their local leadership and state leadership can drive this, but we have to have this local level well done. And I learned this at World Health Organization, well-done behavior change. We’re arguing now about behaviors as if they were political and they’re not. So, this needs to be done with all populations, not just the populations we ordinarily reach, but the ones we may not ordinarily reach too which we want to and need to in these southern, and Western cities as well, to do this on-the-ground behavior-change work. And if the federal government can fund this, it is an alternative to or an addition to the usual police reform, which has not been so successful yet. In other words, a community doing more of the violence reduction work and the other community work as well as the COVID. So, this community-level work Cure Violence Global has been doing for 20 years. We’re retrofitting to COVID as well as finding its right place for the benefit of the communities and COVID as well.