Transcript: Charity Dean



The transcript from this week’s, MiB: Charity Dean on Pandemic and Delta Variant, is below.

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RITHOLTZ: This week on the podcast, I have an extra special guest, and strap yourself in because this is going to be fascinating. Charity Dean is the protagonist of Michael Lewis’ new book, “The Premonition.” She’s also — I’m going to give her a promotion — the Head of Public Health of the California Public Health Department, as well as the co-founder of The Public Health Company. And if you are at all interested in how infectious disease spreads, what we’re doing right and wrong with vaccinations, and containing COVID, and what the risks are that we’re looking at from our current circumstances, including the very dangerous Delta variant, you’re going to find this to be an absolutely fascinating conversation.

So, with no further ado, my conversation with Charity Dean.

VOICE-OVER: This is Masters in Business with Barry Ritholtz on Bloomberg Radio.

RITHOLTZ: My special guest this week is Dr. Charity Dean. She was Deputy Public Health Officer for the Santa Barbara County Public Health Department before becoming Assistant Director at the California Department of Public Health in 2020.

Michael Lewis called her one of the few people who saw the real danger of the COVID virus before the rest of the country did, and she was featured as one of the main characters in his book, “The Premonition: A Pandemic Story.” She is co-founder of The Public Health Company.

Charity Dean, welcome to Bloomberg.

DEAN: It’s a pleasure to be with you. I’m really looking forward to this conversation. I loved the book, I mean, I love everything Michael Lewis writes, but the book was especially interesting, but I want to roll back and start with your background. Tell us what a public health officer is and how did you become one.

DEAN: Well, a public health officer is the local official for a county or a local jurisdiction who is responsible for ensuring that the public is safe against a host of different types of threats. My favorite threat, of course, is communicable disease control, but there’s a number of things they do. They oversee restaurant inspections or water safety.

I think the thing they are best known for though really is disease threats because, in the U.S., public health officers sprang up across the U.S. in response to local needs. You know, if we rewind 100 years, that might have been tuberculosis or smallpox or cholera, polio, et cetera. So today, the local public health officers are largely unknown to the general public, but their role is really important.

RITHOLTZ: And in the book, “The Premonition,” we learned that the local public health officers have a lot of authority. They can shut down doctors if they’re a source of malpractice or a source of infection or, in fact, there’s some really fascinating stories. People kind of push back and say, “You can’t do that,” and the answer seems to be, “watch me.”

DEAN: Well, I learned that on the fly. When I became the health officer for Santa Barbara County, the thing that intrigued me the most is called “layered jurisdictional authority.” And what that means is the police powers to enforce communicable disease control in California sit with the local health officer. In some states, they sit with the state health officer. But in California, it’s with the local county public health officer. And the law actually says that they can take whatever measures are necessary to control the spread of disease.

And that’s an incredible amount of police power authority and it’s a huge responsibility, so really, it’s the job of the local public health officer across the United States to protect national security, health security. And now after COVID, we know even the outcome of the local economy is impacted by the decisions they make.

RITHOLTZ: Quite interesting. What was your early experiences with infectious diseases? How did you gravitate in that direction?

DEAN: You know, I was always interested in outbreaks even as a child. I was interested in pandemics.

RITHOLTZ: As a child?

DEAN: As a child. I was interested in the really awful, gnarly hemorrhagic viruses that we see in — in Africa and interested in how they spread silently. And I love bubonic plague, and I read about the Spanish flu of 1918, and cholera outbreaks, and just a host of different diseases that have swept through societies. So, when I went to college at age 17, I was pre-med, and I majored in microbiology because that’s where you learn about all those horrific diseases.

RITHOLTZ: I don’t think I’ve ever heard the sentence, quote, “I love bubonic plague,” unquote ever — ever stated before on — at least not on this radio station.

DEAN: Well, it’s fascinating, right? I mean, public health disease control has shaped societies. It shapes the world. And if you look out, you know, what’s impacted societies and economies, it’s — it’s been disease. And what’s — what’s the biggest intervention public health has had has been vaccines. And today, people tend to think it’s something that is the underbelly of society that they don’t have to worry about governments got that. If that risk ever arises, government will come and save us.

But as local health officer, they get out really quickly, no one is coming to save you, and yet you have this enormous responsibility. And if you’re really good at your job, nobody knows because that means …


DEAN: … you’ve prevented it. You’ve stopped the outbreak.

RITHOLTZ: Right. They find out when you mess up and — and …

DEAN: That’s right.

RITHOLTZ: … a giant thing of MRSA spreads all over …

DEAN: That’s right.

RITHOLTZ: … all over the county. So how did you work your way from Santa Barbara to state of California?

DEAN: Well, I was the local health officer in Santa Barbara over a number of different outbreaks, disasters. I was the health officer there during the Thomas Fire which, at the time, was the largest fire in the history of California. It was a strange time of year; it was in December. And it was followed by a really powerful rainstorm that led to the Montecito mudslides.

And as I was managing a number of different health risks around the mudslides, not just communicable disease, but a host of other things, I was in close — close communication with the state health officer, Karen Smith, who was my person to call. You know, when you’re a local health officer and you need backup, you need a thought partner, you call the state.

So, Karen and I spent a lot of time on the phone. And shortly after that, she called me one day and said, “What would you think about moving up to Sacramento to be my number two?” And I said yes, and that’s how the adventure started.

And I had always thought that that’s where I want to end up, was being state health officer because I thought I could have, you know, incredible amount of impact there at that level. But California has 40 million people, and California is really like its own nation.


DEAN: It’s so diverse. So, it — it made me nervous moving from making risk-based differential diagnoses on behalf of 450,000 people at the county to doing that at the state on behalf of 40 million people, so it’s a different comfort level.

RITHOLTZ: Right. Stakes are higher.

DEAN: Stakes are higher.

RITHOLTZ: And — and mistakes are — are more costly and — but the same problem if you succeed, nobody knows.

DEAN: It’s always the challenge of public health because we succeed and then it’s silence, and you can’t see that succeed in the data and statistics if you’re not tracking outcomes. And traditionally, public health disease control does not have a good way to show return on investment.

RITHOLTZ: Other than nothing bad has happened and money must be well spent, but that’s — it’s hard to prove a negative, isn’t — isn’t it?

DEAN: It is hard. We can get to that later because I’ll tell you why I’m so passionate about the private sector need for this and the mandate to show return on investment.

RITHOLTZ: So, before we get to the private sector and I have lots of questions for you about that, you were also the co-chair of the California Testing Task Force for COVID-19 and you ramped up to over 100,000 tests a day in a very short period of time. Tell us about that. That sounds like a giant …

DEAN: Yeah.

RITHOLTZ: … logistical undertaking.

DEAN: It was. It was the greatest experience in rapid project management I’ve ever had. And I would be remiss if I didn’t mention my amazing co-lead, which is Paul Markovich. He is the CEO and President of Blue Shield California.

And what happened is there was no testing in California or anywhere else. The state was only able to do about 2,000 PCR tests a day. And the backstory, as you know, is the CDC and FDA had said, “Nobody could test. Wait for the CDC’s test.” So, we waited, they rolled it out, it didn’t work. They said, “Wait, we’ll fix it,” so we waited. They rolled it out again, it didn’t work.

And so, the United States missed that critical two-month window of containment. Without testing, there’s no way you can contain a threat because you can’t find it.

So, by the time they open the floodgates that any microbiology lab could test, the problem was that the labs weren’t doing it, and we had supply chain issues where everyone needed the same testing supplies. And so, we were asked — Paul and I were asked to found and stand-up the Testing Task Force to fix testing for California.

RITHOLTZ: And tell us what you did because California, at least in the beginning of the crisis, seemed to have done a much better job than a lot of other states, especially when you consider the outbreak was in Washington, not that far away from California — from Seattle, Washington.

DEAN: Yeah. Well, I would say the outbreaks were invisible. Communities in California were burning up with COVID. It’s just math and microbiology. I was white boarding it out, you know, at home on my white board. I knew exactly how many cases I thought there were. The problem is we couldn’t detect community spread without testing.

And so, Paul and I have put together a plan. Essentially, I’d break it down in terms of supply and demand. We are doing 2,000 tests a day. Our objective was to get to 100,000 tests a day. We ended up blowing through that. We got to about 140,000 tests a day, much sooner than we thought we would.

And so, the supply part is you need to actually have the testing, you need to have testing locations throughout the state. And the demand part is you need people to show up and get tested. And so, we broke it down into project management. We had task forces and work streams, and we had daily stand-up meetings twice a day. It was 18 hours a day sprint, you know, for about 12 weeks. And the way that we managed it was just getting really tactical and operational.

At one point, I rewrote California’s guidance for who could be tested on a Friday night. And we published it on the website on a Sunday night, and it was far more aggressive than the CDC’s guidance, but we needed people to show up to get tested, and the CDC’s guidance was so restrictive, nobody could get tested.

RITHOLTZ: What was the CDC guidance? Because you would think if you’re trying to stop an epidemic that could spread to anybody with the respiratory system, you would want to say that’s our — our guideline. If you breathe air, you’re eligible for testing.


DEAN: That’s — that’s right, that’s what it should have been. The CDC’s guidance was very restrictive at that time. You had to have symptoms. You had to be in certain risk categories.

RITHOLTZ: Too late …

DEAN: Exactly.

RITHOLTZ: … that’s too late.

DEAN: And so, — so, you know, from a practical public health standpoint, the CDC’s guidance was literally counterproductive to public health. And so, looking out what we need to do, we have to test essential workers. Obviously, they’re on the frontlines. And so, putting it in buckets that made more practical sense …

RITHOLTZ: Prioritize them.

DEAN: Yeah, prioritizing them is really what drove people into the testing centers. And so, in — in parallel to that, we set-up. Over the course of two weeks, we stood at 80 testing centers across the state of California …


DEAN: … which is a big state. And then, of course, revise the guidance for folks to get tested, you know, started driving in people to those locations. And so, that’s how we scaled it up quickly.

RITHOLTZ: Yeah, I was kind of shocked in the early days of testing that if you are an NBA player you can get tested, but if you were a — a grocery worker making …

DEAN: That’s right.

RITHOLTZ: … deliveries into people’s houses …

DEAN: That’s right.

RITHOLTZ: … and if you were literally going from place to place as a super carrier, you couldn’t get tested. It made no sense early days.

DEAN: That’s right, it was bonkers. And that’s why the United States failed at containment. You know, once you — once you lose your chance to contain the threat, then you get to choose between something horrible and something even more horrible.


DEAN: And that choice of, you know, massive outbreaks everywhere and bad health outcomes and the economy, I — I believe it’s a false choice if you put all your energy at containing the threat in the beginning.

RITHOLTZ: And without testing and without an operational infrastructure to contain COVID, the U.S. had no shot. There was no effort to contain the pathogen in the beginning, which is why we’re in the circumstance we are now.

DEAN: Let’s talk a little bit about where we are today. You’ve seen the best and worst parts of the nation’s medical system. What’s your takeaway about how well we did, how well should we have done, and — and — and where did we go wrong?

DEAN: Sure. I would start off by saying the COVID-19 containment effort did not happen, so that was a massive failure …


DEAN: … but it didn’t happen because the United States of America does not have a systems capability to contain a fast-moving novel pathogen that emerges simultaneously at multiple locations in the U.S.

RITHOLTZ: Isn’t that in the modern world how — I mean, we’ve seen Ebola in Africa where it’s restricted, but there’s no mass transit, aircraft, people hopping on a plane in one continent and eighth hours later on a different continent. That’s a very different world and economy. But in a modern interconnected economy, isn’t that how things are going to pop up? There’s going to be the first super spreader …

DEAN: Yeah.

RITHOLTZ: … can seed a million people pretty quickly.

DEAN: Yeah, you’re exactly right. You know, my master’s degree is in tropical medicine, which really is an antiquated term. The diseases that we formally thought were tropical now, thanks to globalization and — and to some degree global warming, can move much faster. And so, what we’re seeing is that the pandemic pathogen spread has sped up. The — the risk is higher and those events are happening more and more frequently.

RITHOLTZ: All right. So now we know we didn’t do a great job with containment. We did no job of containment. What about creating the vaccines? We seemed to have done a pretty good job with that.

DEAN: We did, the vaccines were a shining success. You know, I think what Operation Warp Speed accomplished — in full disclosure, those guys are my friends. They’re wolverines.


DEAN: And so, you know …

RITHOLTZ: From the book — from the Bush administration, the group …

DEAN: Yeah, (inaudible) …

RITHOLTZ: … who essentially created the pandemic response, someone else in the White House named them the Wolverines.

DEAN: Yeah.

RITHOLTZ: I don’t remember why. I think there’s some …

DEAN: It was after a silly 1980’s movie with Patrick Swayze …


DEAN: … called “Red Dawn”.

RITHOLTZ: Right. That’s …

DEAN: Yeah, yeah. So, I think it was Richard Hatchett that nicknamed them the “wolverines” after this Red Dawn movie, and that was the name of our email chain.

RITHOLTZ: But listen, even if they’re not your friends, even the most anti-Trump hater in the world has to admit that was the most successful thing of the entire administration. A vaccine was — not only was it created, it was safe, it was effective, and they made sure that there would be sufficient doses at least three-quarters of the way.

DEAN: Yeah.

RITHOLTZ: Make sure there were a ton of doses in the, you know, early days of the vaccination process.

DEAN: That’s right. Operation Warp Speed to develop a vaccine as fast as they did is a shining success, and there are many lessons learned from that where we can get even better and faster. I think the other success is the private sector.

What we saw during COVID — and what I certainly saw leading California and the Testing Task Force is that private sector ran to the fight.


DEAN: They said our resources are at your fingertips. How can we help you? You know, you look at different companies whether it’s, you know, the pharmaceutical companies that developed the vaccine or the testing companies that quickly developed rapid tests, the private sector played an incredible role.

I think what’s frustrating to me, you know, when I was in government was that there was really a struggle to leverage the private sector in the response, meaning up to this point the response for public health was seen as government’s role alone. That didn’t work. It has to be a whole-of-society response. We have to have a place for individual citizen volunteers, for the private sector so the whole society responds together instead of government trying to piecemeal it on their own.

RITHOLTZ: So, let’s stick with the vaccinations. The numbers were going up enormously in different parts of the country, and then everything seems to have plateaued. We — we were going three million a day, two million a day. We seem to be getting close to national herd immunity, but when you break it down on a state and county basis, there are that whole supercluster between Georgia and Texas is, you know, 30 percent, 40 percent vaccination rates.

You look at the northeast, you look at parts of the west, and — and the industrial Midwest are running well over 50 percent, someplace at 60 and 70 percent. How do you evaluate the state of our — our vaccinated nation or not?

DEAN: You know, it’s a shame that vaccinations have become so politicized because it’s really just science. It’s microbiology and math. The equation for herd immunity is one minus one over R naught.


DEAN: And the R naught is how many people will one contagious person infect. So, the R naught of the original COVID virus was somewhere between 2.5 and three. The R naught of the Delta variant is somewhere between five and eight. That means one contagious person infects five or eight other people.

So, if the equation for herd immunity is one minus one over R naught, what that means …

RITHOLTZ: It’s exponential, it’s much, much higher.

DEAN: It’s exponential. That’s right. It means we actually now need a higher percentage of people who are immune in order to stop the spread of the Delta variant.

RITHOLTZ: So how big a threat are these reluctant vaxxers or anti-vaxxers in that, you know, Texas to Georgia? It’s about eighths — the parts of eight states that really seemed to be. When you look in a map of the country, that’s the reddish, both politically and in terms of the lowest vaccination rate, not a coincidence, but we’ll hold that argument aside to later. How dangerous are these groups of unvaccinated people to themselves, to their friends and family, and to the rest of the country?

DEAN: Well, I think, you know, and I get asked this question a lot around vaccine hesitancy. And it’s one of the oldest issues in public health. It actually …


DEAN: … goes back to Jacobson v. Massachusetts in 1905, the right of the individual to decline vaccination versus the protection of the herd, the good of the whole. And we’ve dealt with this a lot in California. And I really understand vaccine hesitancy. And what I’ve told my friends and family who are hesitant to get the vaccine is …

RITHOLTZ: Stay out of my house.

DEAN: … you don’t — no, you don’t just get vaccinated to protect yourself, you get vaccinated for the people that you love and the people that they love and the people that they love because the situation of the reality is this, people have two choices — they can get vaccinated or they can get COVID.

With the Delta variant, it has an R naught of five to eight, those are their two choices.


DEAN: You get vaccinated and protected or you’re going to get COVID because this is spreading so rapidly.

RITHOLTZ: That’s quite horrifying. So what do you do with the person who basically says this whole thing is a hoax, 600,000 Americans didn’t die, it’s just like the flu? The President said that. It’ll be gone like that. How do you respond to somebody who’s been propagandized to that level?

DEAN: Yeah, I think it’s a real challenge where politics and misinformation has, unfortunately, found its way into science messaging. The way — you know, I struggle with it when I have those conversations with people. What we know from public health vaccine efforts in the past is that coming down with a hammer doesn’t work. It tends to …

RITHOLTZ: Unless you’re more literal than …

DEAN: With an actual hammer?

RITHOLTZ: Right. I think that might be effective.

DEAN: Coming down with a metaphorical — you know, yeah, (inaudible).

RITHOLTZ: (Inaudible).

DEAN: I think the carrot works better, which is explaining to people that …

RITHOLTZ: Protect grandma.

DEAN: That’s right, protect grandma. That’s worked incredibly well in Mexico, which is a different set of cultural values than we have, where the message of protect grandma really, really works.

In the United States, what we know works more is protect the vulnerable children around you, protect the vulnerable people around you. So, I — I don’t know …

RITHOLTZ: Interesting.

DEAN: … I mean, it’s a hard conversation with people that are vaccine-hesitant today, but they need to understand that Delta variant is spreading so quickly. And it’s just the variant of the day. There will be additional variants …


DEAN: … that emerge.

RITHOLTZ: That’s only the fourth letter, there’s more coming.

DEAN: Exactly. You know, this — I trust the behavior of this virus far more than I trust the predictive behavior of people. Why? Pathogens do exactly what we know they’ll do. I love setting pathogens, I love outbreaks, I love front lines.

RITHOLTZ: You start winning competition and they’re going to get …

DEAN: That’s right.

RITHOLTZ: … better and better at infecting their host because if they don’t do that, there’s a reason that Delta variant is dominant. It’s pushed aside the previous variants.

DEAN: That’s right. The — the virus is going to mutate and it’s going to spread, and it’s going to mutate to spread. So, of course, we see a strain of the virus that spreads easier, it won’t be the last strain, there will — there will be more. It will continue to mutate.

RITHOLTZ: That’s quite amazing. And what about the chip that Bill Gates is putting in the vaccine to track me and my iPhone, which I always find hilarious. They’re concerned about being tracked, but this literally tracks everywhere you’ve been. How do you respond to that sort of stuff?

DEAN: You know, my — my 14-year-old and 12-year-old every now and then will — will send me some videos that they see circulating online that have conspiracy theories. And I watch them because I want to understand why people are scared and hesitant. And I think it’s important not to discount their fears.

At this point in the pandemic, people don’t know who to trust. And instead of discounting them, the more interesting conversation to me is how might we, as one united country, build the kind of system, solution, and leadership that a whole-of-society would trust even if they have different political beliefs, you know, red and blue, extreme sides of the aisle. So, I think it’s really a — a systems failure of government institutions in this pandemic response that we’re at the point where people are so politicized that getting a vaccine or not, which is just pure science is now made out to be full of conspiracy theories.

RITHOLTZ: Right. I — I saw a hilarious cartoon this weekend. If we would’ve had Fox News in the 50’s, we’d still be fighting polio, which is kind of — kind of amusing. Let’s move past vaccine hesitancy and talk a little bit about where we are today about whatever the next pandemic is going to be. Are we better equipped now than we were in 2019 to fight an upcoming pandemic or do we still have the same systemic problems that were revealed last year?

DEAN: We still have the same systemic problems. Look, the United States, and companies, and government have essentially duct-taped together a response to COVID with individual vigilance and individual heroic efforts wrote afterwards, but neither of those are an effective strategy in the long-term for managing what we now know as an existential risk to the U.S. economy. And so, if — if a different pathogen threat were to occur today, we are no better prepared. And that’s what I’m really focused on, again not just for private sector for government, but as a whole-of-society response what are the system solutions for the country to contain a fast-moving novel pathogen that occurs simultaneously across the U.S.

RITHOLTZ: And — and so what can we do? What should we be doing?

DEAN: Well, there’s a number of approaches. They certainly include intelligence, leveraging everything all the technology that we have in Silicon Valley has not hit the public health system. And in disease control, largely the decisions and the operations are done manually or by individuals. I was the individual doing that. And so, there’s an incredible opportunity with Silicon Valley innovative technology to apply it to disease control.

There’s also the operational aspect of it, meaning looking at local public health — health departments. They are the frontline generals. They’re on the ground. You know, my job, as Michael describes in the book, was to control disease by all means necessary. So operationally as a country, I really think it’s important that we rethink who’s doing the frontline operations, do they have enough resources, and do we have a way to quickly get centralized intelligence out to all those people.

Right now, the way they share information is fax machines, and emails, and phone calls. And that cannot move as fast as the pathogen.

RITHOLTZ: Well, I guess you can fight pandemics in the 21st century with late 20th century technology.

DEAN: That’s right. The pathogens are moving faster, and so we have to develop systems that can move even faster than the pathogens. You know, what I was inspired by was watching Twitter and how fast rumors can spread on Twitter. In January 2020, that’s where I was going to look for intelligence from Wuhan.


DEAN: Yeah, I was watching, you know, video feeds and information on social media, and I realized Twitter moves faster than the actual virus moves. Things go viral on Twitter faster than the virus goes viral.

RITHOLTZ: I’m going to confirm what you said because I have a vivid recollection of when Osama bin laden was killed by the U.S. special forces. That first was revealed to the public by some local who was describing what was happening on Twitter.

DEAN: Wow, wow.

RITHOLTZ: If we go back and — and recall, that was the first confirmation about helicopters, about an assault going on. And then subsequently, we — we — you know, everybody else put the pieces together. But yeah, the speed of Twitter — Twitter is the new …

DEAN: Yeah.

RITHOLTZ: … when they — when they used to talk about in the stock market the tape, Twitter is the new tape across this Twitter before across as anything else.

DEAN: Yeah. You know, and even though it’s oftentimes spreading misinformation especially around things like vaccinations and — and that’s, you know, something that we really need to address, the truth is the speed at which information goes viral on Twitter is what gave me hope that Silicon Valley technology can revolutionize disease control to move faster than the pathogen because that kind of technology exist.

RITHOLTZ: So, let’s talk a little bit about your new venture, The Public Health Company. The mission is to protect business and communities from infectious disease. That’s quite — that’s quite an aggressive mission, isn’t it?

DEAN: Absolutely. And what inspired me leading the COVID response with amazing humans in California was that the private sector was experiencing what I had experienced as local health officer and a state health officer, and that is no one’s coming to save you. When there is a disease outbreak, you have limited intelligence, sketchy information from scattered sources, but you have to make an operational plan, and not making a decision is a decision. In other words, you’re damned if you do and damned if you don’t, and you’ve got to pick.

And I was amazed how the private sector businesses ran to the fight. They wanted to do everything they could to help, but they did not have the tools. They didn’t have a public health department inside of them. Some of them had duct-taped one together and were really last having transferred the risk management of infectious disease to local and state government who were overwhelmed by the pandemic.

And so, by May or June of 2020, I couldn’t stand it anymore. I knew what needed to happen. I knew that Silicon Valley technology could revolutionize infectious disease risk management and that the tools — the way that I thought about risk and the differential diagnosis and operational — all of that could be revolutionized by tech, and why weren’t we putting that into scalable software.

And honestly, there was nothing else I could do with my life, you know, by — by July/August than to launch that effort. And so, really our mission at The Public Health Company is we are building those solutions and technology to democratize access to risk management of infectious disease so that private sector businesses, globally distributed enterprises that deal with infectious disease all the time,that they have that kind of expertise at their fingertips.

RITHOLTZ: So how was this set-up? Is this going to be like a dot org or — and a philanthropic organization? Are you setting it up like a consulting firm or do you want this to become a scalable technology, an app that people can buy and used to manage their own prevention of infectious diseases?

DEAN: We are developing software. And as I looked at the very early applications we had developed, I got really excited because it had to do with genomic variants and how the virus mutates, and it’s a concept called genomic epidemiology or I affectionately also call it “genomic weather mapping.” You know, how you can look at a weather map and you can see the weather forecast and what’s coming by region.

So we can actually do that for variants of the virus and say, “How is the Delta variant different from the Alpha variant? And what does that mean for the state of Georgia or for a specific county?” We can predict, you know, in a timestamped way the likelihood the cases are going to go up or down. And not just for COVID, but these are the kinds of models that every local disease controller has to do in their head figuring out what’s the direction of the meningococcal outbreak, for example. Michael Lewis tells that story in the book.

So, math and microbiology really is, you know, very simple data science modeling …


DEAN: … codifying not into software and giving disease forecasting. And then the answer to the question, what do I do now based on it? Handing that to someone in a way that is simple, accessible at their fingertips is an incredible need, and it doesn’t exist. And it’s for the private sector, it’s for the public sector, it’s for health care systems. We are creating something new not just with the technology platform, but a new sector of someone that you can pick up the phone and call when — when there’s an infectious disease threat.

RITHOLTZ: So what’s the company going to look like in terms of a product? Will I be able to get an app on my phone and get alerts that, hey, the region where you are is now showing an uptick of infections and take steps to protect yourself or is it going to be more for the private — corporate sector. Tell us what the product is going to look like.

DEAN: Sure. Well, I think the best way to explain it would be the analogy of cybersecurity. You know, there were some really high-profile cyberattacks in 2010-2011. And after that, private enterprise realized, oh, this is a risk that we own. We own this potentially catastrophic risk to our enterprise, and so we have to have that capability running in the background, monitoring the risk that can ramp-up or ramp-down. And so, the quietly humming machine in the background of cybersecurity is a perfect analogy to what we’re creating because really as a — as a technology-enabled service, we are a scalable software, but we are humans behind it.

I would argue the best humans in the world, you know, Carter Mecher and Joe DeRisi from the book are advisors to the company. I talk to those guys every day. We’re codifying that thinking in those tools into scalable software in a way that we can help a business in an ongoing way, manage the risk, the potential threats in all geographic regions, but then help them know how do — what do we do practically, tactically, operationally for our business.

RITHOLTZ: Quite intriguing. So, your — for lack of a better word, your logo is prevent, detect, contain. Explain what those three words mean in terms of providing a shield for the private sector or the public sector against an infectious outbreak.

DEAN: Sure. So, I would start with explaining it by the most important skill is index of suspicion. So, for any doctor or for any frontline public health officer, having an index of suspicion means you’ve gathered data from all the sketchy sources maybe which are somewhat unreliable, but taken together, it gives you a sense of the direction things are headed. So that’s infectious disease modeling and certainly can be codified into software.

So being able to look at disease forecasting and predict what the potential threats are, having a plan of action of how you’re going to prevent that from happening, and then being able to detect it, you know, testing, looking at the different capabilities we have from what we’ve seen in COVID is fast development of rapid tests. The rapid tests that have been developed by the private sector are incredible and are very, very good.

And then containment, you know, I mentioned before containment is where all the effort has to be for the government because the risk of failing at containment as the United States did in 2020 means that then we have to make these awful choices, you know, that it impacts the economy and impact health. And so, for our clients, both government and private businesses, really the — the value proposition is the — the ability to have disease forecasting, take action based on it, decrease your risk, and find that balance between continuity of operation and the health of your employees, the health of the community and knowing that that brand has a safe environment.

RITHOLTZ: And from what I’ve read, this is more than just the germ of a start-up idea. This is a real company that’s funded, that has clients. Tell us a little bit about where you are in the growth curve of The Public Health Company.

DEAN: Sure. Well, my archetype is a public health official, right? That’s what I had been my whole career. And I jumped from being a health official of a state — the largest state to learning Silicon Valley and business, and understanding the pain points of the private sector and of governments, and of health care systems and architecting a technology-based solution. It has been an adventure.

And what has happened is our partners in Silicon Valley have rallied behind The Public Health Company. And our seed funding was in the spring. I’m thrilled to have partnered with Venrock. I was introduced to them by Todd Park who’s on our Board of Directors and was really a thought partner to me in — as I founded this company.

And he introduced me to Venrock because they are very thoughtful at the kind of partnerships that they have around tech-enabled services and healthcare I.T. companies. And so, it’s been an incredible growth curve for me and learning curve.

And we have about 20 employees right now, at this point. Actually, as of recently, I believe the number is about up to 25. We are growing and scaling fast to build out these capabilities and software.

RITHOLTZ: And if memory serves, Venrock has been around for quite a while, haven’t they?

DEAN: I believe since the 1960’s. I believe …

RITHOLTZ: Right, one of the older Silicon Valley companies, yeah.

DEAN: Yeah, yeah. They — they were one of the first. And, you know, partnering with them has been incredible. For me as a first-time founder and first time CEO, I have a ton to learn. And doing that in partnership with someone who is so well-versed in this and has a lot of experience has been incredible.

RITHOLTZ: And tell us a little bit, what is an index of suspicion? It — it sounds so — so clandestine. What is an index of suspicion?

DEAN: An index of suspicion is if you told me I have a 19-year-old college kid that has meningococcal disease and lives in a fraternity, my next thought is, well, I generally know how fraternity social behavior goes …


DEAN: … and I know there’s probably a lot of cross-pollination, so I suspect there are — grab a white board and a pen — 12 other cases currently that are undetected, and that immediately informs the action that I take. So, an index of suspicion is having a strong situational awareness of the environment, knowing the pathogen and how it behaves, and then doing the math and microbiology to figure out very quickly what is the risk. This is about to get really big.

RITHOLTZ: How contagious is this and how bad is the outcome for that disease.

DEAN: That’s right.

RITHOLTZ: Quite, quite interesting. There’s a quote from the book that I grabbed that I really liked, which was, quote, “What scares me the most is our ability to respond to a new pathogen, maybe one we’ve never seen before or an old pathogen like influenza that’s mutated. We know we have to be prepared for that.” Are we prepared for that?

DEAN: I do not believe that we are, and that’s what motivated me to launch The Public Health Company because unless we have a technology platform that can move faster than the pathogen, we will never be prepared.

RITHOLTZ: Quite interesting and — and frightening. So when you got the finished book, and then I want to circle back to how you met Michael, but when you’ve got the finished book, what was it like reading about yourself? How surreal was that experience?

DEAN: You know, it was really painful because I’m a fairly private person, I’ve been a government official my whole career. And to see my life story in print in a book was shocking, and it’s also really hard to read about yourself in print.

RITHOLTZ: That’s kind of interesting, so let’s circle back to the beginning, how did Michael Lewis find you?

DEAN: You know, he texted me randomly out of the blue, and I had never read a Michael Lewis book. I recognized his name.

RITHOLTZ: I was going to say I assume you kind of know who he is.

DEAN: Kind of. I recognized his name. I mainly knew who he was because my friend DJ Patil had told me about the Fifth Risk and that process of being in the Fifth Risk. And so, …

RITHOLTZ: Wait, wait, let me just stop you here. Moneyball, the movies, Moneyball, the Blind Side, the Big Short, these were all pretty big movies. Certainly, the Big Short was a giant movie when it came out. No, not your cup of – didn’t — didn’t catch your attention.

DEAN: Well, the Big Short was not a giant movie for internal medicine and microbiology docs.

RITHOLTZ: Okay, that’s fair enough.

DEAN: So, you know, let’s just say I — I had seen the Blind Side and I love that movie, but I …

RITHOLTZ: Charming.

DEAN: … certainly didn’t remember who wrote the book. Should I be saying this publicly?

RITHOLTZ: You could say that.

DEAN: I didn’t — I — I had never read a Michael Lewis book. I recognized his name mainly because DJ Patil had told me about his experience being in the Fifth Risk. But, you know, Michael texted me in — on that first phone call. I said, “I’m happy to speak with you.” I — I Googled him.

On that first phone call he said who are you, and I said, “What do you — what do you mean?” And he said, “Well, you know, the — the Wolverines and Red Dawns had to speak to Charity Dean.” And he’d contacted DJ and Todd Park, and they said talk to Charity Dean. And then Joe DeRisi at Biohub had said — he said, “I’ve never heard of you.” And I — I thought, well, okay …

RITHOLTZ: I’ve never heard of you.

DEAN: Yeah, okay, that’s fine, but it was a funny first conversation. In fact, it started off. The first two minutes I said, “Michael, I know I don’t know you, but I’ve got to make a 51-49 decision. Have you ever had to make one of those?” And he said, “Well, I’m making one right now. I’m deciding whether or not I’m going to write a book.”

And so, we talked through the 51-49, meaning you have a 51 percent certainty, and how brave are you going to be? Are you going to pull the trigger?

RITHOLTZ: The coinflip essentially.

DEAN: Yeah, so we talked through the decision I was making and the decision he was making. And, of course, what I didn’t know at the time is I think by the end of the conversation he had decided to write a book.


DEAN: And I was going to be in it. And I — I had no clue — no clue about that.

RITHOLTZ: So what was the next step? So, you — you finished the conversation, you leave thinking, oh, so that seemed like an interesting guy. He leaves saying, oh, I’m writing this book now. Meanwhile, the way he operates, he’s already been assembling. He’s been collecting characters, he’s been lighting writing vignettes all year.

DEAN: Right.

RITHOLTZ: He sees a thread that connects all of these together and suddenly there’s a full narrative. What was the next step with him? How did he — how did he proceed from there with you and — and the rest of the characters in the book?

DEAN: Well, what I didn’t know at that time — and he told me later — is before he even called me, he had an entire file with my name on it. Everything I’ve ever done, anything that was out there publicly about me. And it — it makes a ton of sense because as he asked me questions and, you know, would — would come interview me and talk through how the public health system works for microbiology or my own story, he already knew the answer to some of that about me. And so, I think — I think he was getting to know a potential character.

I was clueless when he asked if I would be willing to be a character in the book. I thought I was one of 20, maybe there’d be one or two lines …


DEAN: … from me. I never imagined I would be the protagonist.

RITHOLTZ: Not only are you the — one of the key protagonists in the book, but the book begins with your story. That — that was the surprise that you’re the — the opening scene.

DEAN: It was a total surprise. I had no idea until I read the book, which was the day before I sat down with 60 Minutes. So, I — I had no clue and — and yet, I had made a decision in July of 2020 when he asked me to be a character in the book. I was either going to let him into my life or not.

And I had been such a private person up to that point, but I don’t have any secrets. It’s a fairly vanilla life of a mom and a public servant.

RITHOLTZ: I’m — I’m going to throw a yellow card on that one, but we’ll circle back to it …


RITHOLTZ: … because it clearly is not a — on your life. You’re basically calling governors and saying, “Hey, idiot, if you don’t do this, you’re going to kill a lot of people. You need to — you need to step up your game.” That’s not exactly dropping the kids off at soccer.

DEAN: Yeah. Well, to me, you know, I took my oath of office very seriously to protect and defend the United States against all threats, foreign and domestic, and that includes pathogens. And so, for me, it was always just fulfilling the oath that I took to protect communities by all means necessary.

RITHOLTZ: Well, it’s good to see that some people still honor their oath of office, but we won’t digress into that direction. Let’s stick with the book which, by the way, is sitting on the credenza of my house where — by the front door where I was going to bring it with me to have you signed.


RITHOLTZ: And I completely spaced.

DEAN: Well, that means that we have to see each other again. I’ll come back and sign it.

RITHOLTZ: OK, done, solved. I was going to say after we open up again, but we’re kind of open up again. This — just to digress a little bit — not only is this the first time I’m in the Bloomberg building in a year and — almost year and a half, today was my first COVID test, right …


RITHOLTZ: … (inaudible) test so …

DEAN: And how was it?

RITHOLTZ: I know up here talking, so I assume they won’t let me in the building without it. So, you’re having this conversation back and forth with him, not only are — are you on aware of the fact that you’re becoming the lead character in the book, but you’re educating him on infectious disease. I know he’s a quick learner and an in-depth learner …

DEAN: Yes.

RITHOLTZ: … but tell us a little bit about what that back and forth was like.

DEAN: You know, it was — it was really painful at times. I basically spent a year teaching Michael Lewis microbiology and public health disease control. And I took him on a tour of the places where some of those stories took place in Santa Barbara, so I took him to the homeless shelter, the coroner’s office where the autopsy was done.

RITHOLTZ: Which by the way, again that’s an insane — I hope that makes it into the movie if they make a movie — that’s an insane scene in the book about you like, all right, you two idiots, stop fooling around, and out comes the knife and you crack open the sternum and start pulling out internal organs. And the coroner and his assistant stood there horrified in the book. Was that an accurate depiction of what was going on?

DEAN: The way that Michael wrote it in the book was accurate. And what was funny about that scenario is I knew how risk averse and hesitant the pathologist was to cut open her chest because of the fear that using a bone saw could theoretically — there was one report in the literature …


DEAN: … aerosolize …


DEAN: … the tuberculosis bacteria.


DEAN: And so, I understood the fear, but …

RITHOLTZ: But, by the way, she’s masked and has a — a full-face shield, right?

DEAN: When I showed up everyone was wearing full PPE, but I was the tuberculosis controller, I was — I had literally just been elected president of the California Tuberculosis Controllers Association. You never know it existed.

RITHOLTZ: I was going to say who even such a thing …

DEAN: But I was the president.

RITHOLTZ: That must be — those must be wild parties.

DEAN: They are super fun because we talk about things like drug-resistant tuberculosis treatment.

RITHOLTZ: Sounds like fun. It does sound like a blast.

DEAN: So, TV doesn’t scare me. You know, it’s — it’s all …

RITHOLTZ: So — so you show up and you’re like I’ll crack her up and I don’t care, like they thought they were intimidating you by saying you want those organs, you break her open.

DEAN: I think that they thought — and I should be careful here projecting what I think they thought — but I think my impression was if it was — if they — if I was going to issue a health officer order, which I had, then it would have to be done under their terms, which was outside, and that I couldn’t be absent and not only had to be present, but had to be a very active participant.

And what they didn’t know is I had started out as a surgeon. I’ve done surgery …


DEAN: … for, you know, quite some time in Africa, and I have been a general surgery resident at Cottage. I was super comfortable in the trauma bay, cracking a chest open or, you know, making fast decisions. And so, what might have scared another doctor, to me, was just, OKAY, so this is what we’re doing today? All right, here we go.

RITHOLTZ: (Inaudible), let’s go.

DEAN: Yeah.

RITHOLTZ: It’s really an amazing part of the book, and it sets the tone for who you are. It’s like you’re not going to — you boys are not going to look down at me and intimidate me because I know you show up your five-foot nothing blonde, and these guys think they’re going to run roughshod over you. Is that — is that your life experience?

DEAN: I should be careful what I say here. The truth is …

RITHOLTZ: No, you could say whatever you want. Tell — you — listen, your life is already spread out in Michael Lewis’s book.

DEAN: That’s true, that’s true.

RITHOLTZ: And he implied, you know, I’m following his lead. He implied as much …

DEAN: Yeah.

RITHOLTZ: … that historically you were very much underestimated by the boys club, and this was the perfect manifestation of that and the opportunity to say, “Hold my beer. Watch this.”

DEAN: You know, it’s funny. So, for those of us not here in the studio, I’m five foot four. I’m a solid 115 pounds solid …

RITHOLTZ: Right, solid, solid.

DEAN: … long blonde hair. I always wear a suit and heels, and so I get that the way that I look projects a certain impression. And all my life, all my career I’ve been in the House of Medicine. The House of Medicine feels like a fraternity at times.

RITHOLTZ: It’s a boys’ club.

DEAN: Even in medical school …

RITHOLTZ: Unlike finance which, you know, so — so diverse.

DEAN: … even in medical school, you know, I went to med school at Tulane in New Orleans.


DEAN: And, you know, the halls are lined with — with photos and portraits of — of men. And so, as a woman, it feels like a very different game. And I figured out early on that, in general, I was going to be assumed to be one type of person. And that’s why I love trauma surgery, it’s fast decisions, it’s …


DEAN: … blood and guts, it’s taking action. You’re judged on what you actually do, and so I love that.

So, yeah, Michael definitely locked onto that story as kind of an example, an archetypal example of what I had experience throughout my career. And he wasn’t wrong.

RITHOLTZ: To say the very least. So — so let’s talk about a couple of things from the book that I like that I thought was really interesting and — and see if we can extrapolate forward to today. So, I — I like the concept that measuring hospitalizations and deaths are a bit like starlight. You’re dealing with a phenomena that has taken place long before. Everything that you’re seeing in terms of data is ancient because if someone’s in the hospital today, it means they were infected 10, 14, 21 days ago …

DEAN: That’s right.

RITHOLTZ: … or longer. What does this mean for detecting and containing infectious outbreaks? And — and secondly, what does it mean when you have an entity like the CDC that all they want is more data, and the more data you get, the later you are in that containment curve?

DEAN: That’s right. It’s such a good point, which is basically by design a system or a thinker, a human that can contain a fast-moving novel pathogen. By design it has to operate in the setting of uncertainty.

RITHOLTZ: And the challenge with the CDC, and I could myself in this, local and state public health departments is that they’ve been — or they — they were created under an architecture to reward being risk-averse to only act under certainty, to have a lot of data.

The problem is in an under certain circumstance …


DEAN: … not taking action is action. It means you lose your chance that contain them.

RITHOLTZ: And — and a worse outcome if — if the numbers shake out that way.

DEAN: That’s right. And so, if you wait until you’re certain, you’ve waited too long, you’ve lost your chance. And that’s what we saw happen with COVID.

There was no effort by CDC, states, I would say locals, but there really was an effort by some locals to contain this when — when we had the chance. And the reason is that an institution that needs 99.9 percent certainty, by definition, it will be too late …


DEAN: … too late to act.

RITHOLTZ: So — so let’s talk about states. What states got it right, what states got it wrong or if you want to be a little more circumspect, what were the actions taken that you thought were right, and what were some of the actions taken that had adverse outcomes?

DEAN: I don’t even know how to answer that because we all got it wrong.

RITHOLTZ: Who got it less wrong? Who got it more wrong?

DEAN: I have tremendous respect for Governor Newsom in California. Every decision I saw him make was right. He wanted to understand the science. He wanted to understand the modeling. And he was brave and bold and lean forward, and lead the country when he issued the stay-at-home order.

What was hard about that is governors had a horrible choice where suddenly they were not being led at the federal level.


DEAN: They were not given any tools to test. They were basically told, “You’re on your own. No one is coming to save you.” Does that sound familiar?


DEAN: And so, you know, the way that California led the country, I absolutely believe, was right, but I don’t want to give anyone any more than a D minus in this response.

RITHOLTZ: All right.

DEAN: And that is a systems failure. In other words, like the humans got it right, the humans did exactly what they should have done with heroic efforts, but the system failed, the whole system failed. And so, no matter how good a governor’s leadership was or individual vigilance it was, it was going to be no match for this pathogen.

RITHOLTZ: What are your thoughts on school closing lockdowns because we — from what we’ve learned about the 1918 pandemic, that was very effective when you look at Pennsylvania and Philadelphia versus — was it Cincinnati was the comparable state where city …

DEAN: St. Louis.

RITHOLTZ: … St. Louis where …

DEAN: St. Louis versus Philadelphia.


DEAN: Yeah, (inaudible).

RITHOLTZ: That — that was really an interesting comparison. And when you actually run the numbers, the faster lockdown was much more effective that containment.

DEAN: That’s right. And the reason why it was more effective is what you had pointed out earlier that if you wait until you have deaths and hospitalizations, then you’re too far behind. You haven’t acted …


DEAN: … fast enough. So, with the very first death, with the very first case you have to act quickly.

So, you ask what I think about schools. Well, what I love about having met Carter Mecher and Richard Hatchett is they did not tell me, through the whole time we were on phone calls as — as Wolverines on the Red Dawn calls, they did not tell me that they had written the pandemic plan for the CDC under the Bush administration. They are so humble.

But the premise of that is they have gone back and reexamined 1918 and discovered that the difference between St. Louis and Philadelphia was St. locked down sooner and prevented a number of deaths and — and bad outcomes. And so, schools play a huge role. You know, with COVID, children are less likely to show symptoms.

RITHOLTZ: This is opposite then a century ago, right? That was a …

DEAN: Well, the — so the pathogen is different and that the Spanish flu of 1918 — not to get too wonky here — but the death curve looked like a W.

RITHOLTZ: Right, so very young — were very (inaudible), very old.

DEAN: Very young, very — but also 20 to 40-year-old, so high spike in the children, high spike in 20 to 40-year-olds, and then high spike in the elderly. The difference with COVID is children are largely asymptomatic, but they absolutely still spread it. And so, that was the logic behind closing down schools is children can spread it to each other. We did not have ample testing to detect that, and children can’t be vaccinated right now.

I think it’s really important. You know, I have three kids and I home school them for a year during COVID while running the COVID response. It was hard. I think getting kids back to school is critical. Kids need to be back to school. What does that mean? All of us adults need to be vaccinated.


DEAN: And tools like rapid tests, and masking, and decreasing the risk where we can, we need to implement that to make sure our kiddos can get back to school in the fall.

RITHOLTZ: Makes a lot of sense. What happened in cities where they caved to pressure from either business interest or political interest about reopening more quickly? What were the results of that?

DEAN: You mean now or in 1918?


DEAN: Well, that’s the great St. Louis versus Philadelphia comparison from 1918. In Philadelphia, they moved forward and had their parade as planned with thousands and thousands of people breathing and coughing on each other. And, you know, a few weeks later, it was a massacre of deaths in Philadelphia.


DEAN: And what we’re about to see in the United States is what Carter Mecher calls a tale of two Americas, and I agree, meaning in communities that are under-vaccinated the Delta variant is going to move very fast. Remember, restrictions have been lifted.


DEAN: A lot of people are not masking. Congregate gatherings are taking place. And so, we’re about to see two Americas: vaccinated America versus unvaccinated America. And I’m very, very concerned about the Delta variant causing — wreaking havoc in unvaccinated regions.

RITHOLTZ: Quite, quite shocking. So — so like so many other of Michael Lewis’ book, this book like — looks like it’s heading to be made as a major motion picture. If you could pick somebody to play you in the film — assuming they make a film — who would you pick because I have a couple actresses I would — I would think about, like Natalie Portman or Claire Danes or — there’s a handful of people, I think, could take your role.

Julia Roberts already did Erin Brockovich, so she’s off the table. Who would you pick to play yourself?

DEAN: I am neutral. I don’t have an opinion.

RITHOLTZ: Reese Witherspoon, that could be a good actress for you.

DEAN: What I told Universal Studios is I offer my support and help if I can be helpful to you anyway, and I — I want to just be supportive. They are the artist. This is what they do. They’re really …


DEAN: … good at it. I am a nerdy public health doctor, so I think I’ll let Hollywood do what it does best.

RITHOLTZ: Come on, you know — there has to be someone you think would do a good job playing you.

DEAN: I am neutral.

RITHOLTZ: All right. So, let me …

DEAN: I’ll be supportive.

RITHOLTZ: … so I’m going to throw a different curve ball at you that’s movie-related. Let’s talk a little bit about Star Wars.

DEAN: Oh, let’s talk about Star Wars.

RITHOLTZ: I knew …

DEAN: That’s my favorite topic, yeah.

RITHOLTZ: … see, that’s the reaction I was looking for. So, I have to assume you’ve been watching the Mandalorian, right?

DEAN: I did.

RITHOLTZ: Have you watched any of the other animated features on Disney like Rebels or …

DEAN: No, I can’t bring myself to do it because I’m …

RITHOLTZ: Some of them are really good.

DEAN: … I’m a Star Wars purist. So, I watched the Mandalorian because my — my — I have three boys.


DEAN: They’re 10, 12 and 14, and they begged me and convinced me to watch the Mandalorian.

RITHOLTZ: It was great.

DEAN: It was good, but it’s not a Star Wars — so the reason I love Star Wars is I first got interested in the Hero’s Journey by Joseph Campbell.

RITHOLTZ: Man of a thousand faces and blah blah blah.

DEAN: That’s right. And when I discovered that Joseph Campbell had been a thought partner in designing Star Wars to be the classic Hero’s Journey …


DEAN: … that’s why I fell in love with Star Wars. So, I haven’t been able to watch any of the spin-offs.

RITHOLTZ: Yeah, but you watched — all right, so if you watched — obviously, we all started with Star Wars and then Empire and then Jedi. But then, you know, the — the — the first couple sort of went off the rails after that. And it was only …

DEAN: What?

RITHOLTZ: … the most recent — you want to talk about Jar Jar Binks?

DEAN: That’s scandalous. I — so I love to padre scene in Episode 1 with Anakin as a little kiddo.


DEAN: That is one of my all-time favorite Star Wars scene.

RITHOLTZ: That’s a good scene in a not great particular episode in a series.

DEAN: I love that movie, so I’ll tell you …

RITHOLTZ: The most recent few have been a huge improvement …

DEAN: Oh, they’re fantastic.

RITHOLTZ: … over the previous few.

DEAN: Yeah, they’re fantastic. And what I love about, you know, the first three, so if you look at Anakin Skywalker, Luke Skywalker and certainly, Rey, all of them are orphans in the desert …


DEAN: … who don’t know who their family of origin is, and they don’t know what they’re calling is. And I think that resonates with every human, you know, groping our way in the darkness to figure out who am I and what am I supposed to do on earth.

RITHOLTZ: I love how animated this — this makes you. I can’t get you off the fence on who should play you. Reese Witherspoon, give me a call. But Star Wars and you just suddenly …

DEAN: Yeah.

RITHOLTZ: … so — so I only have you for a few more minutes. Let me jump to my favorite questions that we ask all of our guests. And speaking of — of Star Wars, tell us what you’re streaming. What do you — what do you and the boys watching during lockdown on Netflix or Amazon Prime besides the Mandalorian?

DEAN: Oh, I — I — nothing.

RITHOLTZ: Nothing.

DEAN: That’s not the answer you want.

RITHOLTZ: No, I don’t — I’m just curious. It’s always a …

DEAN: OK, so — so …

RITHOLTZ: (Inaudible).

DEAN: … you want the real answer?

RITHOLTZ: Yeah, listen, it’s always a …


RITHOLTZ: … curiosity when you find out that someone …

DEAN: Yeah.

RITHOLTZ: … who studies infectious disease love Star Wars. That sort of stuff is …

DEAN: So honestly during lockdown …

RITHOLTZ: Like your boys are not watching the Crown.

DEAN: No, they’re not watching the Crown. The question over dinner is which Star Wars episode are we going to watch.

RITHOLTZ: But you don’t watch — it’s been a year, you’re not watching a different Star Wars every night.

DEAN: We watched Episode 7 about 56 times, to the point that my kids say over dinner, “Mom, it’s not Episode 7, we’re not watching that again.” And so, we — we do watch Star Wars a lot.

RITHOLTZ: A lot. That’s frightening.

DEAN: Yeah.

RITHOLTZ: All right. So, let me — let me go on to the next …

DEAN: Sorry, that was — sorry, it wasn’t what you wanted.

RITHOLTZ: It’s got to be — but it’s Star Wars or — well, no, it’s …

DEAN: We watched the Mandalorian.


DEAN: Oh, we watched Stranger Things. We repeated …


DEAN: … Season 1 of Stranger Things …


DEAN: … because it’s so good. We love Stranger Things. I think that’s it that we pretty much — we’re pretty — we stick to the same stuff. Yeah.

RITHOLTZ: This — I’m going to make a recommendation for you, but I’m drawing a blank on the name now, which is pretty awful. And I’ll — I’ll circle back to that.

DEAN: I also make them watch any movies about …

RITHOLTZ: Altered Carbon, did you see Altered Carbon?

DEAN: Altered Carbon, no.

RITHOLTZ: It could be the best sci-fi series I have seen this year.


RITHOLTZ: And that includes — well, the boys, it might be a little too gross and violent for you. I don’t know if that …

DEAN: Oh, we don’t mind gross and violent.

RITHOLTZ: Oh, really?

DEAN: I generally — I generally avoid, you know, certain other categories, but gross and violent is fine.

RITHOLTZ: Well, there’s some sexual stuff in it, but it’s mostly just — what happens if superheroes are corrupt corporate players …


RITHOLTZ: … is the theme on that. It’s from the graphic novel. And if — if — if the boys is a little too grisly for you, Umbrella Academy was really interesting and the same orphaned theme runs through that as — as Star Wars, which is kind of interesting. There’s a ton of really interesting sci-fi that have come out.

But Altered Carbon, it’s two seasons and it’s just …


RITHOLTZ: … everybody I’ve recommended that too has come back and said five stars. It’s just so good.

DEAN: OK, I’ll put it on the list.

RITHOLTZ: So — and I’m a Star Wards fan, so I — I’m going to tell you if I’m going to make one rack, that’s the one.

Let’s talk about your career a little bit. Who were some of your mentors that helped shape and guide your career?

DEAN: When I was at Tulane, I decided I wanted to do trauma surgery because I was working with Norm McSwain. And Dr. Norm McSwain was a famous trauma surgeon at Tulane, and I absolutely adored him. And even though my path ended up twisting and turning into public health disease control, the way that I think about taking fast action, you know, cut the patient open, a lot of it goes back to Norm McSwain.

The other mentor was Dr. Steve Jose who is an infectious disease doctor that Michael Lewis talked about in the book, and he trained me how to think about infectious disease. And so, it was really the combination of, you know, the fast scalpel of a trauma surgeon with the critical risk management of an infectious disease doctor that shaped how I manage outbreaks.

RITHOLTZ: Very interesting. Let’s talk about books. What are some of your favorite books and what are you reading right now?

DEAN: Sure. Well, I’m reading a book by Ben Horowitz called “The Hard Thing About Hard Things,” and I absolutely love it. You know, I’m a new CEO and I’m learning, and I’m learning fast. And so, that book has really influenced my thinking around making hard decisions and doing them sooner.

And I — let’s see, what podcast am I listening? Oh, the podcast I’m listening to is by Reid Hoffman, Masters of Scale.


DEAN: He interviews really interesting business leaders. I actually met him last week for the first time. And so, the Reid Hoffman podcast is really helpful to me to hear from other startup CEOs who ended up being very successful. What were their challenges and strategies in the very beginning?

RITHOLTZ: I’m trying to remember the name of Ben Horowitz’ colleague Scott Kupor, who’s general counsel at Andreessen Horowitz, wrote a book on the secret to Silicon Valley or the secret of venture capital. And it’s really just a very smart basic how to, here’s what you should know if you’re setting up a company, if you’re taking outside financing, and it’s just written from someone from the inside.

So, if you like Ben’s book …

DEAN: Yeah.

RITHOLTZ: … his colleague Scott’s book is really worth …

DEAN: Oh, that’s good to know, OK.

RITHOLTZ: … worth interesting. I’ve — I’ve kind of worked my way through half the A16Z crew. They’re — they’re really interesting guys.

Next question, what sort of advice would you give to a recent college grad who is interested in a career in either public health or infectious disease?

DEAN: I would ask them what they really want to do because if what they really want to do is change the world or protect communities, then they need to think hard about what their career path is because becoming a medical doctor, you know, my path was I went to medical school at the same time in parallel doing a master’s in public health and tropical medicine, then did general surgery, then did internal medicine. It is many, many years. And …


DEAN: … I would tell them to think long and hard about what’s the end game, what are they hoping to do because public health and medicine is not the only path to accomplishing what — what they want to. I think people tend to think, oh, I need to become a doctor and –or get a Ph.D. in public health to make a difference, but there’s lots of ways to make a difference that are not as long of a path.

RITHOLTZ: Interesting. And our final question, what do you know about the world of public health today that you wish you knew 25 or so years ago when you were first getting started?

DEAN: Sure. Well, I’m 43 years old, so 25 or so years ago would put me at what 18 …

RITHOLTZ: Twenty — let’s call it 23 years ago though …


RITHOLTZ: … so when you were first thinking about public health and — and what — what insight you have today might have helped you when you were just getting out of medical school?

DEAN: I wish I had known that I was just a smart — that a poor kid from rural — or I’m sorry, a poor kid from rural Oregon that grew up on government assistance with parents who didn’t have college degrees could not only be just as successful, but could absolutely lead a public health department early in the entire state. I didn’t know that then. I was very intimidated by my classmates who came from wealthy families and Ivy League colleges, and I didn’t.

And that imposter syndrome has plagued me in my whole career, and I still struggle with it. And today, you know, COVID response is such a great example where what really matters is how brave someone is, and how committed they are, and how much they persevere not necessarily the privilege or their family of origin. But when you’re 23 years old, you don’t know that yet.

RITHOLTZ: That’s quite interesting. Thank you, Charity, for being so generous with your time.

We have been speaking with Charity Dean. She is the co-founder of The Public Health Company, as well as the protagonist of Michael Lewis’s new book, “The Premonition.”

If you enjoy this conversation, well, be sure and check at any of our previous 350 or so such podcasts that we’ve done over the past seven years. You can find those at iTunes, Spotify, wherever finer podcasts are found.

We love your comments, feedback and suggestions. Write to us at You can sign up for my daily reads at Check out my weekly column on Follow me on Twitter @ritholtz.

I would be remiss if I did not thank the crack staff that helps push this conversation together each week. Paris Wald is my Producer. Charlie Voldner (ph) is my Audio Engineer. Atika Valbrun is our Project Manager. Michael Batnick is my Researcher.

I’m Barry Ritholtz. You’ve been listening to Masters in Business on Bloomberg Radio.




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