may 16, 2020
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the island of nantucket, massachusetts has reduced its covid-19 infections to zero. not only is this an extraordinary feat, it poses an extraordinary problem: with the island’s three-month summer season approaching on memorial day, how will the island keep that infection rate low while keeping their economy at a high? as people arrive on nantucket, they will inevitably carry disease, and with only one hospital on the island, there’s the chance of a spike in infection and death. tom and rp are joined by matt fee, owner of Something Natural, and dawn holdgate, a real estate agent. both matt and dawn are local to nantucket, and are on the island’s governing select board. nantucket is posed with an incredibly unique situation as the population increases by 500 percent during the summer months: how will cases of covid-19 be prevented, screened, and traced? rp notes that the possibilities to create a successful model for reopening on the island could be impactful to similar environments; however, the island also houses a divided population on the subject of reopening.
tom scott is chairman & co-founder of the nantucket project. rp eddy was the architect of the Clinton administration’s pandemic response framework and the United Nations response to the global AIDS epidemic & is CEO of global intelligence firm Ergo.
rp is co-author of the best-selling award-winning book Warnings: Finding Cassandras to Stop Catastrophes with Richard A. Clarke, Former National Security Council counterterrorism adviser.
Tom Scott [00:00:22] My name is Tom Scott, chairman of the Nantucket Project with his usual R.P. Eddy with us today, or Dawn Holdgate and Matt Fee from Nantucket and introduce those guys in a moment, I’m sitting up on a ridge over the Mississippi River. I’m in Vicksburg, Mississippi. Big battle here, some say, including and perhaps as significant battle in the Civil War as Gettysburg. Yesterday, you may recall, I was in Memphis, RP I had a conversation with Tom Shadyac. We spent a fair amount of time there. He has a what is effectively a community center in downtown Memphis. And like others that we’ve come across on this trip, these are organizations that were doing one thing. Two months ago and something totally different now feeding people. Providing equipment, cleaning supplies, other things for the community, and they’re sort of these heroic things happening. I think the other headline from it, from my point of view is, you know, these towns that we go through, they span the spectrum politically. I mean, we absolutely see both sides of the argument from a political perspective. And yet there is a common level of frustration and fear. I’m worried, you know, because we’re closing in on Louisiana. In fact, that is Louisiana across the river over there. There’s more intensity towards the disease, you see a lot of face masks in this neck of the woods, you see. You saw very few up north and you know, the frustration in Minnesota. We characterize as, you know, where our businesses are essentially destroyed and there really are no cases around here. And then when you get down here, we’re afraid of the disease in a big way. Our businesses are destroyed, too. And they they want answers and they’re trying to sort of navigate their way through. It’s a little sad, I have to tell you. It’s a little bit sad to sort of go through all this and hear these thoughts. However, you know, some of the people who we met yesterday and a lot of the people I’m meeting on this trip. There’s so many heroes here. You know, there’s so many interesting, powerful people doing amazing work in their community. There was a guy Chris we had a photo of him yesterday who’s one of the guys who runs this community center in Memphis. And he’s just out every day literally combing his neighborhood, looking for people to help. So those kinds of things are happening. And that helps me feel good. We’re on our way to New Orleans. We’re gonna visit other states in the south on the way back. And we’ll keep you up to date as we keep going. So that’s that’s sort of the update. I got a call from Matt Fee over the last few days. He’s been sort of watching this. And he talked about could we could we get a conversation with RP about some of the challenges that we face in Nantucket? Some of the decisions we need to make locally. To be clear, neither R.P. or I know these issues intimately. So we’re coming at it a little bit blind. But I know to the extent that RP and this dialog with you guys could be helpful. That’s what we’re here for. You know, one of the things I would just add and I’m sure there are others. The one thing I do know is that Nantucket has a particular challenge as it relates to timing, which is from an economic standpoint. Your your your 2020 is upon you. And it’s because it starts around, let’s say, mid-May now and it ends towards the end of the summer. And if and if that window is missed and a big economic opportunity is missed. So that’s like, you know, this is sort of the definition of a dilemma and important decisions need to be made. And that would be just the way I would set it up, amongst many other things. You know, there’s a whole spectrum of issues that sort of actually are relatively common as you go from place to place. But Matt and Don, it would be nice why don’t we start with you, Matt, if you could just introduce yourself and just talk about, you know, how long you been on the island, what you do on the island and what you bring to this conversation.
Matt Fee [00:04:17] Thanks Tom. I’m 60 years old. I was born on the island, went away for school and traveled a little bit, but most of the time I’ve been here. I run Something Natural, which is a bakery in a sandwich shop. I’ve been doing that for almost 40 years now and I’ve been on the Board of Selectmen. Now, this is my fourth term, I believe, with about 12 years in between. So I’ve been involved on the island’s sort of politics and that type of thing. Never seen, never lived through or seen anything like this. Not even close.
Tom Scott [00:04:54] Thanks Matt. Dawn, you want to do the same?
Dawn Holdgate [00:04:58] I’m sure I. My family moved to Nantucket in 1978. I was three years old and I was born in Massachusetts. We moved out first to build my grandparents first summer house. We camped out in Cisco when there were hardly any houses there and and spent the summer building it and then moved permanently. And I moved back to the island full time after school in 2000. My husband is a fifth generation native and owns Holdgate’s Island laundry and runs and manages that himself. And I’ve been working in the real estate business for probably for pretty much full time since 2004. In my second term on the select board, which has actually become more of my full time job lately. And I’ve never seen anything like this either. And it’s been really interesting between the business owner, select board member, a mother of two who are with kids homeschooling now. So it’s very interesting times.
Tom Scott [00:06:09] And and so RP, I think you may know this, but Nantucket is a it’s run by a select board of five members. And that’s sort of this superstructure of the government of Nantucket. And as chair is that is the role more organizational? Is there is there authority that comes with being the chair?
Dawn Holdgate [00:06:31] The chair works a little bit closer with the town manager in terms of setting the agendas and so forth. The vice chair plays a pretty significant role there as well.
Tom Scott [00:06:42] And then RP, so just the you know, the added layer of complication and Nantucket is Dawn referenced it, you know, it’s one small one small hospital. They’ve done a great job so far. You know, like any one of these situations, opening the economy means opening the risk. It also means potentially a lot of people coming in and the hospital remaining as the hospital is. I would imagine it’s approved a variety ways. I could never quote that, but. But those you know, that’s the other factor that comes into play and you know, it’s a two hour boat ride or one hour boat ride or a 15 minute plane ride. But the bottom line, because it’s an island, you can’t just get in the car and drive to the hospital the next county. There’s other issues that come into play that make this particularly challenging. So RP I’m just curious do you. You know, I think we did a decent job. I think you guys did a decent job of sort of setting up how this comes in, and I’m just curious if you just have a, you know, opening thoughts or opening questions that might lead us in here.
R.P. Eddy [00:07:47] There I have… first of all, it’s nice to meet you. Thanks for taking the time to sit with us. And it’s nice to see the Mississippi behind you, Tom. Your trip is very real and it matters for a lot of us are sitting at home. So this is our little our little vacation. I think it’s a pretty cool laboratory, if nothing else. Right. And it’s a lot more than that. So it’s a laboratory for leadership. Sounds like the selection process is very transparent. You published your notes last night. I think about how your meeting went. I understand the town’s very, very engaged, very aware of what’s going on. And like a lot of other places. People have really very real equities have become extremely pointed during this three month season on all sides of the equation. You know, you’re Dawn, you’re in real estate. And Matthew, you’re in retail. Right. So you guys are right at the pointy edge of of of what those three months looks like and what the economy looks like. You’re seeing it. You’re you’re you’re living and you’re seeing it. And I am partly I’m interested in what the management with the leadership challenge is like for you right now. Right. I mean, I think you can in a lot of places in the country. There’s obviously a huge amount of venom and toxicity and a lot of division. But there’s maybe less of a sense of we’re in this together, we’re on this island together. In Nantucket, you probably still have those divisions, but you guys are on an island together. So you at least historically have tried to figure out how to work through those divisions. It must be a fascinating leadership challenge. And I’d love to talk a little bit about how that is, you know, how how transparency and other centeredness and competences coming into play for your leadership. What if it’s working if you feel like you guys are able to be good leaders? Are they good followers? How’s that dynamic working out?
Matt Fee [00:09:35] Well… it’s it’s. We’re fortunate, as you said, because we’re on an island. And I think people have we people have pretty much followed the, you know, the orders at the beginning. I think it’s gotten tougher. The longer we’ve gone, the more difficult it has become. I think in a way we were really fortunate that we were. So I took it as seriously did we followed the hospital and, you know, and we sort of limited travel to the island. And we really you know, there were few cases early on and we kind of they disappeared more or less. It was still their problem. But it wasn’t, you know, as so the worry that we have and the split that’s happening now is people who are concerned that it’s going to reappear and that it’s going to reappear strongly because we really probably, you know, no one’s tested. So we don’t know how much immunity there is and what will that impact be. You know, most of our discussions have been political and have sent that around, you know, sort of opening. And we haven’t had a lot of discussions about public health or, you know, in that type of information to make our decisions. So as leaders, that’s been for me, obviously, personally, that’s been difficult. You know, I feel like we’re you know, we’re trying to do the right thing. But how do you know what the right thing is? How do you get sort of agreement and get everyone on the same page? And how do you assess the risk? Nantucket has you know, we have some advantages because we’re, we’re this one island and one hospital and it was sort of one government. And we could test and trace and do a lot of things really well if we wanted to. But we also have some challenges. And I think that’s you know, we’ve got some advantages and some challenges that we’re still sorting through.
R.P. Eddy [00:11:23] I should have probably mentioned right at the beginning, like. Though Nantucket is relatively small compared to some of the countries I’m going to mention, you did a uniquely extraordinary job in reducing you didn’t flatten the curve. You ended the disease on your island. And that’s that’s a big deal, right? So Singapore, which I often think of as perhaps the highest form of organized science based government in the world. An extraordinary example of efficient government. Now, there’s all sorts of challenges about freedom and democracy. But you want really extraordinary bureaucrats in the best sense of the word that run a place like Swiss watches, you know that. And they did a pretty good job dealing with the virus in the beginning. But then it came back and the fact that you are able to get rid of the virus and keep it gone. That might be unique. You know, it’s you beat you beat the BVIs. You beat Barbados. You. The UAE is sort of similar. They’re surrounded by a desert. It’s not water, but they’re pretty much air bridge. And only they they’ve done well, but not as well as you. So you should take some solace in whatever you did before worked. And then you have this question of, look, we’re trying to beat it. It sounds to me like we have a highly transparent process. We have highly competent people that are highly passionate and care. We probably have a lot more that brings us together than separates us. But we’re having some divisions now and a lot of it seems to be, at least from what you were just saying, Matt, around answerable questions and some unanswerable questions. Right, so with known unknowns, right, like. How do we assess the risk? You said. How will the virus reemerge? Because it will. It’s going to everywhere. And I think we’ve accepted as a nation, as a world, that we have to accept a certain amount of risk for reopening. And how much immunity is conferred to the populace already? There’s a couple of questions you mentioned. There’s answers to all those things that you know. So a lot of the fog and uncertainty that surrounds this can be answered, at least some of those questions you can have answers to, and that might make your decision making process easier.
Dawn Holdgate [00:13:37] A lot of the challenge that we have been having is. Is one meeting like this not being able to get in the same room together and having information sort of fast enough to make make decisions as well and set a significant amount of guessing on what could happen, what’s going to happen. And I mean, I think that we get for all of the businesses on the island, they’re just really waiting with bated breath to see what Governor Baker is going to do. And that’s a bit of what we have been the boat we’ve been in as well, waiting for this May 18th date, which is literally right before Memorial Day weekend, which is that even beyond the wine festival that would have and this weekend is usually a huge, huge kickoff for the Nantucket season. And, you know, if we have any additional things that we’ll need to do locally, they’re really not necessarily eliminate the illness, but to keep significant illness at bay.
R.P. Eddy [00:14:50] My strong belief is Massachusetts will be open for business to some extent and they’ll give you the chance to be open. And then we’ll be up to you to how to refine that so, you know, to put contours on that, to make it fit Nantucket and again, you have a unique situation by virtue of the really good work you’ve done already. And you might be able to not only make it work in Nantucket, but using it could create, you know, that Nantucket model that a bunch of other jurisdictions think about. I’m talking to some resort towns in the Rockies that are not dissimilar to you, except they’re not islands. Right. So they’ve been able to get the numbers down. They’re looking forward to a bunch of tourists coming and they don’t know what to do. They’re taking a high, high degree of kind of town autonomy, versus versus what the state says and considering putting in all sorts of rules. But there’s a lot of lessons for all of you to think about together.
Dawn Holdgate [00:15:43] I think we have a really good opportunity to get create sorry to get creative here. You know, we have to talk if restaurants are allowed to reopen in some form this summer, closing down streets. Something we’ve never done before. I mean, there there could be some really interesting practices that we could try out this summer where we will probably, no matter what, see a drastic decrease in what our normal occupancy levels are on the island. And maybe some of these things can last into the future.
Matt Fee [00:16:19] And I think that’s that’s the kind of creative thinking that I think we need to do. I know we’re not prepared. I I believed even consider that, because I think we feel like we’ve licked it. I think we feel like, you know, this thing, you know, we’ve licked it and, you know, and travel will not be an issue and we’re ready to go for the summer. I mean, I think that’s kind of I would say three quarters of the island’s mindset right now. So some of that would have to shift to be able to do the planning you’re discussing.
R.P. Eddy [00:16:49] I think it’s I think what’s important and part of what’s missing in the national debate. Is framing those two points of view as much closer than people you know, inherently think they are like those that we can use. Those are not far apart. Right. Like you did lick it. You did a kind of internationally extraordinary job of getting down to zero cases. You’re going to bring people on the island. It’s a fact. You’re not going to shut the island down. I don’t. I don’t know. That’s not going to happen. You got to bring people on the island. Some of them are going to be carriers of the disease. These are facts. You’re not going to have unfortunately, the magical testing capacity is not going to be available at the ferry or at the airplane terminal. It’s not there yet. It’s certainly not going to be there in the next month or two where you can in 30 seconds, test somebody and say, oh, sorry, you can’t come on board. You have active, active disease right now happen. So you’re gonna have people with the disease enter the island just like everywhere else in the world. People are moving around. And then the question is, how do you make sure that doesn’t lead to to ICU admissions, major hospital missions or death? And the answer gets down to a lot of the things you already mentioned. Right. So like, what are the social engineering things, the creative solutions you can build about not using a restaurant, but using outdoor space, keeping people six feet away from each other? It’s a lot, you know. How do you do tracing you’re a small island tracing should be faster and easier. And I would really think a lot about and there’s look, there’s lots of creative solutions and you could learn from all the other nations and all their experiments they’ve gone through. And how do you protect the vulnerable population? You only have one hospital on the island. Is that right?
Dawn Holdgate [00:18:31] That’s correct. But what we normally do here, and that was part of the concern was when people are significantly ill, they get a helicopter ride to Boston. So some of the best hospitals in the world. And there was concern that if Boston was overrun like New York City was, that they wouldn’t have capacity to accept anyone from here. And that’s now not a concern. Right. I do not… want anyone to be that sick that they would have to get med flighted, but. But that the option is there now.
R.P. Eddy [00:19:09] Yeah. Matt, you mentioned earlier about what percentage of your population has immunity. You can do these serological tests to find out if the tests are accurate. Some are and some aren’t, although they’re getting much more accurate very fast, the ones that are available. But don’t. I wouldn’t anticipate that a large number of your population, large as your population has conferred immunity. But that doesn’t mean. You still can’t do things safely, right? So. Czech Republic flattened the curve without a tremendous number of movement restrictions, they had they had good smart ones, but by really highly enforced mask wearing. So two people wear competent masks, you reduce the likelihood of transmission by 500 percent like humungously. There’s a number of things that are proven across other countries that really work, but it all gets down to compliance. And one thing when I think of Nantucket. I mean, it’s it’s not a big spot, you know, and you’ve got 30 tracers already. Perhaps you can recruit other people that are, you know, New York City. Obviously, the NYPD enforcing behaviors initially that turned out to be a problem. Now they’re moving to ambassadors, you know, so like social distancing ambassadors. But there’s a whole litany of creative ideas that if you wanted to spend some more time thinking about it, I’d be happy to talk to a bunch of experts and look across different nations as the things you might want to learn from. Things to do, things not to do. But testing? I don’t know. That’s where the conversation began on. I don’t. I don’t. You you absolutely should not. You’re not going to have a capacity to test people before they get on the island. If that’s going to give you any confidence during this season. I don’t think… tracing, supercritical. I wonder if you could mandate the use of different tracing apps like if you want to come on our island. Here’s the Apple Google app, which is done with extraordinary civil liberty protections built into it, which is probably why it’s not going to be that effective in the US writ large, because people just aren’t going to you know, people are going to opt into it and thereby it’s not going to be that useful. But if you were to mandate this as this is just an example, I haven’t really thought it through. But if you were to mandate, if you want to come onto our island, fill out this survey. Here’s a series of questions that you do online. One thing that we’re gonna mandate is you use this app in the Google. The Google Apple app might be as good as any. There is lots of documentation that’s well done by Google and Apple about why it’s not an invasion of your privacy to use this app, it’s completely anonymized data. It’s only pushed out. It’s not cold out about who you are. Then your contact tracing would be wildly enhanced. Right. So if all of a sudden you had a problem, you’d know precisely where else you could potentially have those problems, etc.. So we’ve talked about a few things. There’s also protecting your vulnerable populations and then looking in the sewage we’ll give you. If you were to do it now, it would give you some insight perhaps on your zero positivity or conferred immunity. It wouldn’t be useful later for. It wouldn’t be as useful later for understanding the viral load on the island. Perhaps because you’d probably end up baseline over over the year before you weren’t testing your servers. But you know, it’s another. There’s lots of opportunities available to you to make this work well, but it’s going to come down to, as I said before, your leadership being trusted in the island, being transparent, being competent, and then having people comply with whatever rules you come up with. And compliance is going to be a humongous issue that makes all the difference. And so if, for example, we look at cell phone tracking data across different states, down to the county, in the zip code level, you can sort of you can not just sort of you can track people’s movement on a year over year basis. And we then build our epidemiologic curves projecting where the disease will go. And it’s kind of bad news, but our curves have been extraordinarily accurate and they’ve been relatively pessimistic. We do a lot of our curve conjuring based on that cell phone movement data. And the point I’m making is when people move around more than they ought to be. The disease spreads. But if you layer in masks and you layer in the protection of vulnerable populations, other things, the disease will spread less. The vulnerable populations are protected. And if you add in good tracing, you can protect it. You can have going on and on with the same ideas. There’s a lot you can do.
Matt Fee [00:23:35] I think we are. There’s a summer resident whose son is doing some sort of app. I can’t remember the name of the app right now, but describes exactly what you’re talking about, which would be great. I mean, that would make it possible for people, you know, for us to trace quickly and easily, you know, if we if need be.
Tom Scott [00:23:55] What what’s your best judgment of the overall sort of tenor of the island in terms of like if there’s a spectrum of like, let’s get out and get back to work, to let’s stay inside and stay safe? Like, how do you see the island generally on that spectrum? I know that’s an inexact science, but I’m just curious what you’re feeling.
Matt Fee [00:24:13] Now, I’ll take I can take a guess at it. But it’s an inexact for sure. I would say there’s sort of a third of the population feels that we should be very careful that we, you know, we still face a risk. I would say maybe as many as half. You know, at this current time, I think as many as half of the population wants to get back to work and believes that they’re safe. And then the rest are kind of in between and it sort of runs the gamut. It’s out here. It’s not so much political on sort of Democrat or Republican as it might be in the rest of it. It’s more based on what industry you’re in and you know, how important different aspects of it are. You know, if you’re retired or, you know, you’re an employee with a pension and you’re home. Those people are sort of pressuring on us more to stay, you know, stay tight. Whereas the other people, you know, other people who don’t who are in need and really need to work. So we’re you know, that’s the that’s the tough part is that we’re in the board of health and the select board board of Health really holds the power if we were to do anything slightly different in the state. And we kind of are we’re not letting we’re not letting people inside take out businesses even though the state does. So there’s certain things that we’re getting closer to the state on some aspects. And, you know, in other aspects we’re going to we seem to want to stay apart from the state. So it’s difficult.
R.P. Eddy [00:25:44] Obviously, it’s a moment of high anxiety. Are these three months going to work or not? How hard will they hit beyond the businesses and the renters? Because it’s gonna be hard for everybody. How hard will it be? How? How sick will vulnerable populations get? There’s lots of anxiety ridden questions. But, you know, you guys are unbelievably lucky. The position you’re in: zero disease in the island. You’re well-led. You’re well-resourced. You have three months kind of to solve for economically. And you’re really curious and you get the benefit of looking at what the rest of world went through for three months, like you had the chance to do a pretty extraordinarily extraordinary job here. It would be very different if you were fighting your own if your curve was peaking on the island right now. Oh my God, you know. But because of the work you’ve done already, you’ve got some you’ve got an amazing opportunity to make it work as well as a pen inside a, you know, a lose-lose environment like. To be fair, Tom makes his point. Well, this is a lose-lose environment. Right. So given that we’re in a pandemic, we’re gonna all have a cost to pay. You have the opportunity to probably come out of this better than anyone else, any anyplace else by virtue of the dynamics that you’ve discussed and that we’ve gone over. And I think there’s some really creative opportunities available to you and to a thing we talked about earlier, Matt. I think, you know. Your ability to lead requires your ability to be transparent and to convey competence to your constituents, modeling different opportunities, different outcomes based on different behaviors could be a tool to do that, right. So if you said here’s a model for the island. If we enforce masks, if we don’t. Here’s a model for the island. If we strongly encourage everyone to use a voluntary tracing app. If we don’t, here’s a model for the island. If we take these 100 multigenerational households and figure out how to protect the older people in those households or not. Here’s a model for the island. If we make these elder care facilities safer by the following steps or not and those tools are available to go through that, then you can have a very informed discussion. The footnote on that, as you know, there is, of course, still tons of informational passe. There is no Paladin, no match. No, no Palantier, no magic ball to look into to get all the right answers. But, you know, we can get directionally accurate. And then you can make really informed and transparent policy decisions based on that.
Matt Fee [00:28:09] That to me would be amazing because right now at times I and I think it’s up to Dawn and I it’s up to our leadership to to do some of those things. I think sometimes I think we present this as a false dilemma. It’s either we open, you know, we sort of look at it, a lot of us on the aisle look at it as we either open or, you know, we’re in blind containment. We’re not open at all. You know, and so I think there’s somewhere in between. And I’ve seen you guys talk about it being nuanced. I think we need to get to that level. And, you know, this conversation has been really helpful for me to sort of see that we need to still get there.
R.P. Eddy [00:28:50] I think, Matt, you make I think false dilemmas is a great phrase, and I think the other thing is there’s always people on either end of the argument. So there’s folks around that are going to say, I can’t believe you let anyone on this island. I’m a pensioner. You know, there’s a dead receiver sensitivity triangle. Right. So if you’re more of a debtor, they’ll be debt desensitise faster. If you’re more of a saver, if you have more savings, if you’re retired, you’re desensitisation level will be higher. Right. And this will see this across sectors, across the country, across nations. There’s someone either end of the spectrum who’s going to have a very powerful point of view. You know that you’re politicians. Right. For everyone else, the differences are probably not as stark as they feel, and they’re certainly not as different as they feel when you look at MSNBC and FOX or whatever, your equivalent is on the island. Right. So I think false dilemmas, the right phrase is I think there’s a lot of opportunity to come up with something. You know, the different points of view are probably much closer than you think.
Tom Scott [00:29:50] So just before we go. Thank you all for taking the time and very respectful fact that you guys have a real challenge in front of you.