How tech companies can help combat the pandemic and reshape public health | Karen DeSalvo

Whitney Pennington Rodgers: Before we really dive in to talking specifically about Google's work in the contact tracing space, let's first set up the relationship between public health and tech. You know, I think a lot of people, they hear "Google," and they think of this big tech company. They think of a search engine. And there may be questions about why does Google have a chief health officer? So could you talk a little bit about your work and the work your team does? Karen DeSalvo: Yeah. Well, maybe I'm the embodiment of public health and tech coming together. My background is, I practiced medicine for 20 years, though a part of my work has always been in public health. In fact, my first job, putting myself through college, was working at the state laboratory in Massachusetts. As the story will go with Joia [Mukherjee] we're reconnected again, a Massachusetts theme. And I, across the journey of the work that I was doing for my patients to provide them information and the right care and meet them where they were medically, translated into the work that I did when I was the Health Commissioner in New Orleans and later when I had other roles in public health practice, that really is about thinking of people and community in the context in which they live and how we provide the best information, the best resources, the best services that are culturally and linguistically appropriate, meet them where they are. And when the opportunity arose to join the team at Google, I was really thrilled, because one of the things that I have learned across my journey is that having the right information at the right time can make all the difference in the world. It can literally save lives. And billions of people come to Google every day asking for information, and so it is a tremendous opportunity to have that right information and those resources to people so that they can make good choices, so that they can have the right information, so that they can participate in their own health, but also, in the context of this historic pandemic, be a part of the broader health of the community, whether it's to flatten the curve or keep the curve flat as we go forward.

WPR: And so it sounds like that there is this connection, then, between public health and what Google's work is in thinking about public education and providing information. And so could you talk a little bit about that link between public health and public education and Google? KD: Definitely. You know, the essential public health services include communication and data, and these are two areas where tech in general, but certainly Google, has an opportunity to partner with the public health system and with the public for their health more broadly. You know, going back to the earlier days of this pandemic, towards the end of January, Google first leaned in to start to put information out to the public about how to find resources in their local community, from the CDC or from other authoritative resources. So on the search page, we put up "knowledge panels," is the way that we describe it, and we did develop an SOS alert, which is something we've done for other crises, and in this particular historic crisis, we wanted to be certain that when people went on to search, that there was authoritative information, which is always there but certainly very prominently displayed, and do that in partnership with public health authorities. So we began our journey really very much in an information way of making certain that people knew how to get the right information at the right time to save lives. I think the journey for us over the course of the last few months has been to continue to lean in on how we provide information in partnership with public health authorities in local areas, directing people in a certain state to their state's health department, helping people get information about testing. There's also been, though, a suite of resources that we wanted to provide to the health care community, whether that was for health care providers that may not have access to PPE, for example, we did a partnership with the CDC Foundation. Though the scale of the company and the opportunity for us to partner with public health around things like helping public health understand if their blunt policies around social distancing to flatten the curve were actually having an impact on behavior in the community. That's our community mobility reports. We were asked by public health agencies all across the world, including some of my colleagues here in the US, could we help them have a better evidence-based way to understand the policies around social distancing or shelter in place? Which I think we'll talk about more later. In addition to that sort of work, also been working to support public health in this really essential work they're doing for contact tracing, which is very human-resource intensive, very complex, incredibly important to keep the curve flat and prevent future outbreaks, and give time and space for health care and, importantly, science to do the work they need to do to create treatments and, very importantly, a vaccine. So that work around providing an additional set of digital tools, exposure notification for the contact tracing community, is one of the other areas where we've been supporting the public health. So we think, as we've thought about this pandemic, it's support the users, which is the consumer. There's also a health care system and a scientific community where we've been partnering. And then, of course, public health. And for me, I mean, Whitney, this is just a wonderful opportunity for Big Tech to come together with the public health infrastructure. Public health, as Joia was sort of articulating before, is often an unsung hero. It saves your life every day, but you didn't know it. And it is also a pretty under-resourced part of our health infrastructure, globally, but especially in the US. It's something I worked on a lot before I came to Google. And so the opportunity to partner and do everything that we can as a company and, in this case, with contact tracing in partnership with Apple to create a very privacy-promoting, useful, helpful product that is going to be a part of the bigger contact tracing is something that we feel really proud of and look forward to continuing to work with public health. In fact, we were on the phone this morning with a suite of public health groups from across the country, listening again to what would be helpful questions that they have. And as we think about rolling out the system, this is the way that we've been for the last many months at Google, and I'm just really... I landed at a place just a few months ago -- I just started at Google -- where we can have an impact on what people know all across the world. And I'll tell you, as a public health professional and as a doc, that is one of the most critical things. People need to have the right information so they can help navigate their health journey, but also especially in this pandemic because it's going to save lives.

WPR: That's great. Thank you. So, to talk more about this contact tracing system and the exposure notification app, we've read so much about this. Could you describe this, a little bit about how the app works, what exactly are users seeing, what information is being collected? Just give us sort of a broad sense of what this app does. KD: Yeah. Let me just start by explaining what it is, and it's actually not even an app, it's just an API. It's a system that allows a public health agency to create an app, and only the API, this doorway to the phone system, is available to public health. So it's not designed for any other purpose than to support public health and the work that they're doing in COVID-19 in contact tracing. The second piece of this is that we wanted to build a system that was privacy-promoting, that really put the user first, gave them the opportunity to opt into the system and opt out whenever they wanted to do that, so they also have some control over how they're engaging and using their phone, basically, as a part of keeping the curve flat around the world. The system was developed in response to requests that we were getting about how could technology, particularly smartphones, be useful in contact tracing? And as we thought this through and talked with public health experts and academics and privacy experts, it was pretty clear that obviously contract tracing is a complex endeavor that does require human resources, because there's a lot of very particular things that you need to do in having conversations with people as part of contact tracing. On the other hand, there's some opportunity to better inform the contact investigators with things like, particularly, an exposure log. So one of the things that happens when the contact tracer calls you or visits you is they ask, "Hey, in the last certain number of days," and in the case of COVID, it would be a couple days before symptoms developed, "Hey, tell us the story of what you've been involved in doing so that we can begin to think through where you might have been, to the grocery or to church or what other activities and with whom you might have been into contact." There's some amount of recall bias in that for all us, like we forget where we might have been, and there's also an amount of anonymous contact. So there are times when we're out in the world, on a bus or in a store, and we may have come into prolonged and close contact with someone and wouldn't know who they were. And so the augmentation that the exposure notification system provides is designed to fill in those gaps and to expedite the notification to public health of who has a positive test, because the person would have notified, they trigger something that notifies public health, and then to fill in some of those gaps in the prior exposure. What it does not do is it does not use GPS or location to track people. So the system actually uses something different called Bluetooth Low Energy, which is privacy-preserving, it doesn't drain the battery and it makes it more also interoperable between both Apple and the Android system so it's more useful, not only in the US context, but globally. So we built this system in response to some requests to help augment the contact-tracing systems. We wanted to do it in a way that was user-controlled and privacy-preserving and had technological features that would allow public health to augment the exposure log in a way that would accelerate the work that they needed to get done to interrupt transmission -- keep the R naught less than one -- and do that in a way that we would also be able to partner with public health to think about risk scoring. We could talk more about any of these areas that you want, but I think maybe one of the most important things that I want to say, Whitney, is how grateful Apple and Google are -- I'll take a moment to speak for my colleagues at Apple -- to the great partnership from public health across the world and to academics and to others who have helped us think through how this can be, how the exposure notification system fits into the broader contact tracing portfolio, and how it does it in a way that really respects and protects privacy and also is useful to public health. We're still on this journey with them, and I really believe that we're going to be able to help, and I'm looking forward to being a part of the great work that public health's got to do on the front lines every day, been doing, frankly, but needs to be able to step up.

WPR: That's great, and thank you for that really detailed explanation. And you know, we actually have Chris here with some questions from our community, so why don't we turn there really quickly. Chris Anderson: Yep. Questions pouring in, Karen. Here's one from Vishal Gurbuxani. Uh... Gurbu -- I've pronounced that horribly wrong, but make up your own mind. Vishal, we'll connect later and you can tell me how to say that. KD: Fabulous last name. I love that. That's a Scrabble word. CA: "Given where we are today, how should employees think about returning to work, with so many conflicting messages?"

KD: This has been an important part of my work for the last few months. I joined Google in December, and all this started happening. The pandemic in the world first began in November but it got very hot in many parts of the world in the last few months, and we've been thinking a lot about how to protect Googlers but also protect the community. I've been talking a lot about what we've done externally. You know, internally, Google made a decision to go to work-from-home pretty early. We believed that we could. We believed that in all the places across the world where we have offices, that the more we could not only model but frankly just be a part of flattening the curve, that we would be good citizens. So we have been fairly... I don't know if the right word is conservative or assertive, about it, because we really wanted to make sure that we were doing everything we could just to get people to shelter in place and socially distance. A lot of other companies have been doing the same, and I think the choices that people are making are going to be predicated on a whole array of factors: the rates of local transmission; governmental expectations; the ability to work from home; the individual characteristics of the workers themselves, how much risk they might have or how much risk it would be for them to bring that back into their household if they have people living in their household who would be at increased risk from morbidity, mortality, from suffering and death, from COVID. So these are individual and local considerations. I think for us as a company, we want to, as we've talked about publicly, we want to continue to be a part of the public health solution around social distancing, and so that for us means continuing to encourage work-from-home for our employees and really only be in if it's essential that people are in the workplace. And we've said publicly that we're going to be doing that for many months to come. Now, here's one thing I do want to say, which is, working from home has definite benefits, not only for the pandemic, but for some people, time for commute, etc. I think we're already learning there are some downsides, and there are generic downsides, even just not from work-from-home but school-from-home and just being at home, which is: social isolation is real. It causes depression. It has physical impacts on people's bodies; there's science around this. So as the world is weighing, even beyond the pandemic, when we've achieved herd immunity because we've been able to vaccinate the world with a functioning vaccine that creates immunity, I think probably a lot of workplaces are going to want to encourage work-from-home. But I just want us also to remember that part of humanity is community, and so we'll have to be thinking through how we balance those activities. CA: And, of course, there are huge swathes of the economy that can't work from home. We're a lucky few who can. And speaking of which, here's a question from Otho Kerr. "Vulnerable communities seem to be receiving a disproportionate amount of misinformation. What is Google doing to help make sure these communities are receiving accurate news rather than fake news?" KD: You know, vulnerable communities is where I have spent

most of my career focused. I think with many things that we've learned as a society in this pandemic were things that we, frankly, should have known. And before I get to the information, I'll just talk about access to services, which is to say, and to brag, I guess, on my hometown of New Orleans. One of the early things that New Orleans learned, or remembered or whatever, was that drive-through testing only works if you have a car. So you need walk-up testing, and it needs to be in the neighborhood. We need to meet people where they are, and it's thematic of all the work that we did after Hurricane Katrina in New Orleans was to build back a health care and public health infrastructure that was community-oriented, built with community not for community. Of all the many things that I really do hope last from this pandemic, one of them, though, is that we're being much more conscious of building with especially vulnerable communities and building out policies and processes that are as inclusive as possible. For Google information, we start with, on the search platform, for example, adding up knowledge panels, that we spend time making sure are linguistically and culturally appropriate. We tend to start globally, with global authoritative groups like the World Health Organization or the National Health Service or CDC, and then we begin to build down to more focused jurisdictions. On other platforms that we have like YouTube, we've built out special channels where we do, because it's a platform and we can host content, we've partnered with creatives -- we call them, I don't know, that's a new thing for me because I'm a doctor -- but we've partnered with creatives and influencers whose reach resonates with communities. We have had particular programming, for example, for seniors, African-Americans, so "vulnerable" takes on a lot of meaning for us globally and in the US context. Our work is not done, and we certainly every day are thinking about how we can do more to see that the information is accessible, accurate and also, frankly, interesting so that people want to engage. CA: Yeah. Alright, thank you Karen. I'll be back in a bit with some other questions. WPR: Thank you, Chris. And you know, and this is really wonderful talking about more broadly, where you see tech and public health going, and specifically, talking about these vulnerable communities. And I think one thing, even just beyond Google, it would be interesting to sort of hear your thoughts on where you see tech in general better serving public health, if there are spaces that you think, no matter which tech company we're talking about, we could all sort of come together to better serve the community. Do you have any thoughts on that? KD: I could spend several hours talking to you about that, but maybe I'll just start by saying that I came to tech through the pathway of direct patient care and public health service in local community, and I ended up in a role in the federal government as the National Coordinator for Health IT, which, for my background, felt unusual to me, I'm just being honest. And I thought, well, I'm not really a tech person, but the secretary at the time said, "That's exactly why we need you, because we need to apply tech." And she had the unfortunate experience of hearing me chirp about how public health needed more timely data to make better evidence-based policy on behalf of community and with community. This was a source of frustration for me as a local public health officer, that sometimes the data I was working on, though great, was stale by the time I needed to make decisions about chronic disease interventions, or mental health or even violence or intimate partner violence issues in my community. And so the desire to make data useful and accessible to support people in communities is something that's been burning in me for a long time, and what I have learned since I have been out in Silicon Valley is that desire burns in the bellies of many people who work at Google and Apple and other companies, and it's been really wonderful to see, during this horrible time of the pandemic, the incredibly brilliant engineering and programming and other minds at a company like Google turn their attention on how can we partner with consumers and with public health to do the right thing, to bring the resources that we have to bear. And I said I could talk all day about it because I have many examples from the work that we have done at Google. Maybe I'll just point out a couple. One is to say that we very early on wanted to find a crisp way to help people understand what they could do to protect themselves and their community, to flatten the curve, get the R naught less than one, and this "Do the Five" work that our teams, largely in marketing but then a lot of other people weighed in. It required massive amounts of talent to make that available on our landing page, on search, and then fold it out more broadly. We did that in partnership with the World Health Organization, then the CDC, then with countries all across the world to get simple messaging about staying home if you can and coughing into your elbow, washing your hands. These are basic public health messages that public health has been, frankly, even in flu season trying to get the word out, but it became, the resources at a company like a Google, and the reach to billions, it's a platform and a set of talents that aren't even the technical, computer vision kind of stuff that you would typically think about. Many other companies in Silicon Valley have weighed in the same way. I think similarly, we've been thinking through how we can use tools like the community mobility reports. This is something, a business backer like we have for restaurants. The engineers and scientists said, what if we applied that to retail and grocery stores and transportation to get a snapshot in a community of whether people were using those areas less, whether people were adhering to local public health expectations and sheltering in place, and give that information not only to public health but to the public to help inspire them to do more for their community as well as for themselves. So there has been, I think what I'm trying to say, Whitney, is I think there's a natural marriage, and COVID has been an accelerant use case to demonstrate how that can work, and it is my expectation that companies like Google who, certainly for us it's in our DNA to be involved in health, will want to continue working on this going forward, because it's really not just good for what we need to get done in this pandemic, but public health and prevention are part and parcel of how we create opportunity and equity in all communities across the world. So I'm passionate about the work of public health and very passionate about partnership. Can I just say one more thing? WPR: Absolutely. KD: Which is to say that one of the first things that I did before the pandemic started, I had just started in December, and then in January, I did a listening session with consumers about what they wanted, and they said something kind of similar to what you said, which I just want to call out, and that is, they wanted partnership, they wanted transparency and they really felt like there was quite a lot that tech in general could do to help them on their health journey. But their ask was that we did it in a transparent way and we did it in a partnered way with them. And so as we move out of the pandemic, and we're thinking more about consumers, I want to carry some of this spirit also of prevention and helpfulness and transparency into the work that we're going to continue to do for people every day.