Drowning to Swim with Mara Gay

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A new Covid variant B.a.

2.

86, with several new mutations, has scientists on edge heading into the fall, according to a new study. Faulty oxygen monitors delayed care to Black patients with COVID-19. Republican candidates raced to the most extreme positions on abortion and the climate crisis in the first primary debate of the 2024 election. This is America dissected. I'm your host, Dr.

Abdul El-Sayed.

As you probably know by now, I'm from Michigan. What you may not know, unless, of course, you've been blessed to be from this great state, is that we are the Great Lakes State. We're surrounded by 21 of the world's fresh surface water, for as much water as we have, water should basically be up Earth right here, except it's not.

Remember this?

Flint's tap water was laced with dangerous levels of lead. The state knew about it and did nothing.

Aside from the sun, it's one of few resources on which literally all other resources in this world rely. But lack of access to that basic modicum of water we all need isn't the only way that water can be used to kill. The other is drowning, and drowning is an American epidemic, an epidemic that snuffs out the youngest lives. It's the leading cause of death for children 1 to 4 years old and among the leading cause of death for everyone under 24..

See, what makes drowning so peculiarly evil is that it's usually associated with something that should be joyful and carefree. In fact, I'm literally taping this right before I head out to enjoy one last summer weekend on a lake. And as I say that, I can't help but think about the fact that. I have two kids, 5 and 7 months, who are poised to have an absolute blast on the water this weekend. And I have to immediately balance that with the thought that the split screen of those moments of carefree joy splashing in the water could be tragedy. And that, in the back of Sarah and my mind, the entire time, we'll be making sure that it doesn't.

Who's watching the kids? where are they? are they wearing life jackets? And at the same time, I can't help but recognize that when it comes to water safety, my kids are the lucky ones. My 5-year-old has been taking weekly swimming lessons for years, just like I did.

Both of us were privileged enough to grow up with access to quality public pools, with subsidized swimming lessons, and swimming even outside, those lessons was accessible enough to allow us to feel comfortable and confident in the water. But just like the water people need to drink or clean isn't available to everyone, neither is the water. People need to swim. And that's not just some luxury. It's a matter of basic public health, because the best predictor of not drowning is knowing how to swim.

And the best predictor of knowing how to swim is having water to swim in. But just like so many other aspects of American life, what was once understood to be a basic public good, the public pool, has been privatized. A function of some combination, as we've covered on the show before, between racism and a pullback on basic public goods. See, we have nearly 2 million private swimming pools in America, but only a sixth as many public ones. Which means that those without the means or the networks to get into one of the private pools often don't get access at all.

And those folks are more likely to be black and brown, which helps explain why Native Americans are twice as likely to die by drowning, and Black Americans three times as likely. While I've been an advocate for water rights for a long time, I have to admit that while I thought a lot about the water people needed to drink or clean, I'd utterly missed the need for water to swim. That's until I came upon a series of articles in the New York Times on the American epidemic of drowning. Arguing that access to public pools is a public health issue, a human right even.

It hit particularly hard given that the author and our guest today used to sit in front of me at our political science classes at the University of Michigan. Mara Gay is a journalist and member of the New York Times editorial board. She loves to swim, but more importantly, she hates that too few people get to and that that too often costs them their lives. She joined me to talk about that.

Here's my conversation with Mara Gay Okay, can you introduce yourself with the tape?

I want to ask you, what motivated you to write about drowning as both something that happens way too often in our country? But then also as a look into the nexus of a series of policy failures. Around how we value bodies, particularly black and brown people's bodies, about how we value public space, about the way that we tend to atomize or individualize risk in this country. What motivated the piece?

And so once that came into focus, I realized that this is a much bigger, but also simpler problem. In a way with a very elegant, very achievable solution. Which made it even more exciting to me as a journalist and someone who essentially is in politics in this way. Which is, hey, we can build more public swimming pools and we can solve a lot of problems with one solution.

And of course, personally, I love to swim any day in the summer when I'm not working, I'm swimming usually at a beach, a pool, anywhere I can, a river, a lake. Obviously, you and I spent time in Michigan, so I love to swim in a lake too. And so I just want to share that joy, or at least the chance for that joy, with others. And I've come to see both in my life as a New Yorker for many years, but also beyond New York, that so many Americans can't swim.

They don't know how, they're afraid of the water. Many people have family histories, generations of people, especially Black American families, who never learned how to swim. And now, looking at the research, it's clear that drowning itself is a public health crisis. We're losing 4,000 Americans to drowning every year in the United States.

S versus elsewhere. But first, there's something tragic about this, which is swimming, for the most part, in most circumstances, is an elective activity. You can choose to do it, and it's usually as you shared something that's really, really fun to do, and people do it because it's so fun.

But drowning is this moment when something that is so joyful turns so tragic, because every drowning death is avoidable. Every single one. And we don't treat it like that. And it's always an individual who drowned, and there's always a story around the individuals. But it's helpful to step back and ask, why do so many individuals drown? And I want to talk more about public pools. But can you give us a sense of how much worse is drowning in the U.S?

Compared to other high-income countries.

We need to standardize data collection, we need to create a public surveillance system. Around drowning, the same way that we have around smoking or teen pregnancy, or diabetes or asthma. And of course, we have so much work to do on those issues as well. But my argument is really that both as a public health issue, this is essential, not optional, but also as a human rights issue. I believe that swimming is a human right, and so I think we should create a culture of swimming in the United States, rather than one of drowning.

And if you do that, if you think about it in that way, you can not only address the the bad outcomes that we don't want. But you can give Americans an opportunity to swim as well, which is a joyful, healthy and very human experience.

Black children, Native American children are at risk as well, and there are some other groups, but those are the highest risk groups. And I think it's really important that there are some things that we do know about drowning. So even though we don't necessarily have the data that we need to create the perfect public policy around this, we do know certain things. For example, it's much safer to wear a life jacket if you're boating in open water or swimming in open water.

That means a river, a lake, an ocean, something with a current. That's a really important and simple thing that can save lives. We also know that not allowing children or minors to swim unsupervised or to swim at night can save lives. So those are just some of the things that can mitigate the danger of drowning right away, and these are not expensive things.

These are things that can be accomplished by public safety campaigns, I believe so that's another opportunity. There's something that every community, county, state government can do in America.

You think, Oh, geez, it's cold, right? But it has a very strong fishing culture, has a strong culture of having a building relationship with its citizens and the water. It has done. It's made enormous strides to reduce drowning rates. So, you know, there are areas where this is happening well.

There are also areas in the United States, though, where drowning rates are lower. We need to understand more about why, but from my reporting and from the data we do have. What's clear is that Americans who do have the opportunity to build a relationship with the water and know how to swim safely. Or, in some cases, for example, where not to right part of swimming knowledge. Is the current's too strong today?

I'm not going to get in or that's the dangerous part of the lake and so I'm not going to enter it there. I'm not going to swim unsupervised. For those communities, drowning rates are lower, we believe, and again, we don't have national public surveillance data.

So this is imperfect. It's preliminary. But what we know is that wealthy communities across the United States, though, they still see drownings because of lack of public awareness around some of these basic safety precautions. They have invested heavily in public pools and that those are much safer places than private pools. There are 10.4 million private pools in the United States and fewer than 300,000 public pools. That's a figure that includes, it's a stunning figure. It includes hotel pools and condo association pools.

So that's not even really open to the public, so the number of municipal pools is even lower. And so that really gives you a sense of what the problem is. How could you possibly learn how to swim and swim safely if you don't have anywhere to swim at all?

Can you tread water for three minutes? Turns out that their skills aren't as strong as they think, so that's also a danger. There's a false confidence about that. Taking a few swim lessons is great if you can.

Those are hard to come by in the United States. But it's really also just about understanding and respecting the water, not fearing it or avoiding it, but building a healthy and safe relationship with it. Much more data collection is needed. I mean, I think just the fact that 4,000 Americans are drowning every year, that this is a leading cause of death. And yet we have. I can't answer these questions because we don't have the data around it. And if you think about what it would be like to put your child, your infant, in a car seat every time you do that, you know that's something you do automatically.

Well, many years ago, that's not something that parents did now, because of the data we know. You wouldn't put an infant in a car without a car seat. You wouldn't spend hours in a restaurant unless you're a smoker yourself, where there was cigarette smoke around. And yet these things used to be commonplace. Not wearing seatbelts in cars. This is the kind of relationship that America has right now with the water.

It's one that is one of danger, where it should be one of health, joy and safety.

They were fun, they were beautiful. The Astoria pool in New York is a good example of that. A little bit earlier, the Notorium, the Audubon Notorium, the largest swimming pool in the south, which was in New Orleans, these were made to awe.

And then, after World War II, when suburbanization took hold, there was a move away from public spaces and toward the suburbs. You saw white flight and divestment from cities. And as Americans kind of had more private space, their backyards, their picket fences, of course, these were white Americans. Largely. What ended up happening is people were building their own segregated communities that came with their own swimming associations, clubs, country clubs, the rise of country clubs.

All of this privatization started very early on, and then across the south, not only the South, but in particular the South. The next decade. In the 60s and the early 70s, as public pools throughout the South were ordered to desegregate many towns, many communities, sadly, tragically, horrifically, chose to close their public pools, destroy them or fill them in, rather than allow Black Americans to swim in them. And so what that did, was it forced? Black and poor white swimmers, or would-be swimmers locked them out of that opportunity? Where wealthier white communities built their own private pools, either in their backyards or in their country club associations. And that really set off the generational issue that we have and the disparity across the racial lines that we have here in the United States.

It only was worsened during the Reagan era, when privatization was fetishized, and really when investment in social infrastructure like parks but also swimming pools was reduced. So I think, now, to your original question, here we're in this bizarro world of late-stage capitalism. Democracy is under threat, and faith in public institutions and government is really at a low in some ways. And so you have this perfect storm, in my opinion. Where Americans and others outside the United States are saying, well, it's one climate change disaster after another pandemic war. We're all on our own, so I'm going to get mine. And that kind of attitude is really a sad and disturbing, I believe, fruit of this late-stage capitalism obsession about privatization.

And it's because of that that we're really not investing the way we should, in my opinion, in critical social infrastructure schools, playgrounds, healthcare. And what do you know, swimming pools, which are considered a luxury when really they are an essential piece of social infrastructure? We should think of it like a library or a school.

Global health policy before and during COVID-19. To identify why the United States failed to protect vital national interests, develop public and global health capacities, and maintain domestic and global solidarity against health threats. Authored by CFR senior fellow David Fidler, the report notes that since the early 2000s, the United States exhibited leadership in global health. However, Covid-19 exposed that the United States was not prepared for a pandemic. And it has become clear that the U.S is also quite unprepared for climate change. The most serious chronic health danger it confronts. Protecting vital interests from global health threats requires building public health capabilities that COVID-19 and climate change have revealed as inadequate at the local, state, national and multinational levels.

A new strategy for U?

S. Foreign Policy on Global Health should realign global health policy to serve the full range of national interests and make protecting vital interests in security and economic power the top priority. The new strategy for U.S global health policy should also work to reconstruct the solidarity that public health actions at home and abroad require. You can read CFR's 95th Council special report for yourself.

Download it today by visiting CFR.

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Walk me through the mechanism here. My understanding is, if you have public pools, you also have highly subsidized swimming lessons.

And observed swimming opportunities, which allow people to both formally and informally learn water, water safety. And, you know, I'll tell you, I learned to swim, ironically, when I was a kid. We lived part of my childhood in Missouri, part of my childhood in Florida. But we'd come every summer to Michigan. And there was a public pool in my grandparents neighborhood where you had to be certified to be able to swim by yourself. And you got this little card, this red cross card.

And then I remember the summer that I got my red Dot, and my red Dot meant that I could go to the pool by myself because I was a strong enough swimmer. But it was always packed and there were always kids there, and it was just a lovely place. Where I got to meet all these people, these kids that I'd hang out with later on, you know, we'd ride bikes together, et cetera. But we met at the pool because that was like the place to go in a hot summer. And I know for me, it was both the swimming lessons and it was the it was the access to that public pool.

I could just take my towel and go hang out by the pool unsupervised. At that point, I was, you know, like, 10, 11 years old. How would? How does this mechanism work? Does it, you know? Is that the like the picture of it, or would it work in a bit of a different way?

That's one of the reasons that I am so convinced that they work, because wealthier communities have never stopped investing in them. So, you know, for example, I grew up in. I spent my high school years in White Plains, New York, which is an economically and racially diverse place. It's not particularly wealthy, but it does have some money. And so we had a large public pool, it wasn't the fanciest pool in Westchester.

It wasn't like the pool next door in Scarsdale that looked like a country club. It wasn't the pool in Westport, which was at one time a country club. Part of a part of a country club. But it was fun, it was big enough, it was open all hours so that everybody could enjoy it.

It was fully staffed by lifeguards and it was a really safe place to practice swimming and to learn how to swim. It was a fun place to go with your friends, to take your kids there. And so that's really what we want, that's the model. This is not a utilitarian thing.

This is not something where we're saying poor people are dirty and they should bathe like Robert Moses did. That's not what the attitude is here, the attitude is every American, every human, deserves a fun place to cool off. Summers are getting warmer. So this is not something where we need to reinvent the wheel, but it is something where you need to invest a little bit.

You know, it's really, a really good investment, it's a good bang for your buck if you're the federal or state government. Because it costs very little, proportionately to many of the programs that we spend money on. But if you're an individual, there's no way, even if you have a backyard, that most Americans could afford to put a pool in their backyard. And even if they were able to do so, that pool would be less safe, statistically, than the town pool. So this is a no-brainer, I believe.

And there are examples across America of things that communities have done to make these fun places to learn how to swim. So Ann Arbor, Michigan, where we went to school. I've discovered I have a goddaughter that lives there and she's obsessed with all the slides. There's giant water slides throughout all the town pools, and it's not that this is a luxury item. This is a city that has decided this is a priority.

It's essential, and if you build it, people will use it. If you build people, things that are nice to enjoy, it will pay dividends. It says a lot, too, I believe, about what government can be for. I mean, in this era in which you think the polarization, faith in politicians and government is at this all-time low in some ways. Well, the government doesn't just have to be there to arrest you, to make it hard to vote, to collect taxes.

Government can actually do something good, it can bring people together. It can give you a place to cool off, to learn how to swim, give you a life skill. And somewhere for kids to go. Especially in rural areas and in inner cities, where there may not be a lot of opportunities for play. And I think when you think about the teen mental health crisis in America, especially in the years after Covid, I mean, what an incredible opportunity to get Americans, and in particular young people, off of their smartphones and their social media. And interacting with one another, learning about the environment around them, nature, children, what have you interacting with people from different backgrounds? And I just think that the possibilities here are enormous, and it's such a simple, simple thing.

And it's interesting because my daughter always prefers the public pool because there are going to be kids there and kids that she can hang out with. And we don't have a pool, but in the times when she gets to use them, there's one or two kids and at some point they get exhausted. But every time we've ever been to a public pool, if it's just the family, we go and inevitably she'll make two or three friends. And there's a little crew of five-year-old girls running around the pool, not running, walking near the pool, but enjoying their time together and making new friendships, which is half the fun.

The other part of this, though, is you talk about a pool-wide short-staffing. When it comes to lifeguards, can you talk through that?

You need to make that job more attractive. But part of the problem, too, is that so few Americans know how to swim well that the pool, the pipeline of lifeguards, is also lacking. And so there's another example of how my reporting brought me back to. We need to build more public pools because you can't train lifeguards without a public pool. Other people wrote in after I wrote my piece calling for more swimming pools in America, and they said, Well, in my day, we were required to learn how to swim in school. That's nice.

You have to have a pool for that, that's a great idea. Sure, I'm all for it. Do you know how many empty pools are sitting in New York City right now? At my last count, 37 of our pools were non-functional, sitting there empty.

So, to your point, Abdul?

Public spaces can be beautiful spaces if you invest in them. I mean, if you look at Grand Central Terminal in New York City, another great example of a beautiful public works project versus Penn Station. Anybody who's visited New York, you know the difference. You walk into Grand Central Terminal, you feel like, Hey, I'm going somewhere, I'm somebody important. Marble, high ceilings everywhere.

All kinds of different people from around the world gathering. There's kind of an excitement in the air. You go to Penn Station, the ceilings are low.

Part of the reason is because companies make more money. When you convince Americans that buying something private that nobody else can have, to your point, or that's a luxury item is superior. And so whether that's a school or whether that is a country club, I'm not saying that we should ban country clubs, but I am saying we should invest in our public pools.

It is a norm that you expect that any of these public spaces are going to be substandard, not inspiring. And that's why, I think, to your point, Grand Central is so awe-inspiring because it's such an example of a public space. That care was taken to invest in. I happened to go to a high school where we had a pool and they required us to learn basic water safety skills. And in order to be able to graduate and finish your gym class and get your gym credit, you had to be able to swim. I think it was like 100 yards nonstop, something like that.

And I hear your point about needing public pools to be able to do that right, and a high school pool is nothing but a public pool.

I'm wondering if there may be a space to sort of build some of this into curricula and into schools as we think about a place to get started. I'd love to hear your sense of where do we go from here? What is the first step to being able to invest in that water infrastructure? It seems to me that filling those 37 pools in New York would probably be a great place to start.

But how should we think about operationalizing this to maximal efficiency?

And when you do that, you get a sense not only of how important the issue is, but how you know. Their stories are very commonplace. And I don't think that really many Americans understand the basic facts of water safety, and really, anybody can drown, just like anybody can swim. And so I think that's part of the answer. The other part of the answer is the federal government, Congress and the White House can show some leadership. This is a rare opportunity, I believe, a very rare opportunity for some bipartisan collaboration.

This really does affect every single American community. Make some funds available to communities to build swimming pools. It is a very affordable. I don't have a cost estimate on hand, but I promise you, it costs a lot less than many of the things that we spend money on. And so it's a worthy investment. And I think some incentives would go a long way.

I think that's a good place to start, you know? Since writing this piece, I've also heard from just council members across the country who said that it started conversations, that these are things that they've been thinking about. As the country has been suffering from one of the hottest summers, or I think the hottest summer on record, parts of the country. So this is an issue that I think even just because of global warming, because of climate change, has been gaining some salience. I also just I hope it's an opportunity, not just for pools. I mean, not everybody is going to be as obsessed with swimming as I am, and that's perfectly fine.

But just to reinvest in public infrastructure in general and to say, hey, you know, we want as citizens, we want our government to provide services that actually improve our lives, that can build stronger communities. And you know, it doesn't just have to be government telling us what we can and can't do. I mean, what better way to start building some faith in government than by providing a service that can build a stronger country? And just, you know, healthier Americans, too?

My grandmother remained afraid of the water for, I mean, I guess, until her death, even though she technically knew how to swim.

And when I was a child, though, my parents really, they loved the water, so we spent a lot of time around beaches and pools when I was young. But they also went out of their way to make sure that I learned how to swim. I think there's pictures of me floating around in a like, one of those floaties that you put a child in and kind of send them off supervised into the pool with a little palm tree. So I was in that from the time I was like nine months old, and then I remember my father. I must have been four or five when he took me to the ocean and he said, You don't need to fear the ocean, you just need to respect it.

And that's the kind of love of the water that they instilled in me, I think as I got older, and I just have a personal love for water. But I realized that my father's family, as Black Americans, I think that for my dad and his five siblings. Learning how to swim, which they did actually at historically Black college, where their father was the dean of the law school. South Carolina State. That was, in some ways, a form of resistance, of resilience, of joy. It was a way to say this isn't just something for white Americans, this is something for all of us. It was a way to reclaim a human experience, and it was a way to be in nature and just to be equal and to feel free.

And that's how I feel, just on my own, personally. Let alone. I can only imagine my dad, who grew up in the Jim Crow South and partially in Detroit, also Jim Crow, Detroit. So I'm very passionate, I think, in part because of that, about making sure that this experience is one that's available to all people. And, of course, as a Black American, it is especially devastating that this is seen as something that is for white people or for wealthy people. To me, that is heartbreaking because I can't think of any experience that is more needed than something like swimming. For Black children and children who are living in poverty, children from marginalized communities.

I mean, what a great opportunity for them to build a relationship with nature, with their own bodies, and just to know that they deserve every human experience on the planet. And also that there's nowhere that should be off grounds for them. So the idea that the ocean isn't a place where Black kids, for example, belong like that just makes me very angry. But the reality is, so many Americans of color can't swim.

And so I think it's an equity issue, it's a justice issue. There's history there, and it's really quite simple. Not everybody has to be obsessed with the water, but everybody deserves the chance to try to swim.

Mara, thank you so much for taking the time and go blue.

In today's version, it's Ba.

2.

H.6.

While the Omicron subvariant, EG.5, which we talked about a few weeks back, is currently top of the heap, what's got scientists a bit perturbed about this variant is that, well, it's a wide leap from the usual Omicron cousins. Since 2021, it's been one omicron subvariant after another, each building incrementally on the past. This one appears to be something different, almost entirely. And that means that all this immunity we've built up over the waves of Omicron, well, it just might not be as protective.

To start with, B.a.

2.

H6 has 35 new mutations on its spike protein, and if you'll remember, that's the piece of the virus that helps it stick to our cells. Put in perspective, the jump between Omicron and BA.2.H6 is as big as the jump between original SARS-CoV-2 and Omicron. As of last week, there's only been seven confirmed cases in four countries. But we're detecting it in wastewater, which means it's spreading, even if asymptomatically. Remember the three questions we always ask about new variants.

Is it more transmissible, more immune, evasive, and more virulent? And the answer right now is, well, we just can't know. But given the evolutionary leap it's taken to get here, there is concern. We'll watch, wait and let you know. A new study published in JAMA, the Journal of the American Medical Association, with data from over 25,000 patients, found that. Pulse oximeters, which use light to measure blood oxygen, systematically overestimated the blood oxygen levels of Black patients with COVID-19, leading clinicians to miss, worsening respiratory systems, delaying care and increasing the probability of readmissions.

It's a stark reminder that while technology itself may not actively pursue discrimination, the ways we design technology often frame shifts pre-existing bias into that tech, rendering its outcomes racist. A.F. And the challenge is that for too long, the assumptions about who a quote normal patient is have shaped the way we design around them. And guess what? Normal doesn't usually include people of color, women and so many other marginalized folk. Pulse oximeters could easily be tuned to better accommodate different skin colors.

In fact, some of the earliest versions used eight wavelengths of light, rather than just two. But the industry settled on these for the sake of expediency. And we've known that they systematically overestimate blood oxygen in Black people since at least 2005. But the industry argued that the consequences were quote minuscule, but minuscule for whom?

It's simply a matter of who we choose to pay attention to and whom we choose to ignore. Not that you should have watched it, but this happened last week.

I'm the only person on the stage who isn't bought and paid for, so I can say this.

That, and the fact that a hurricane hit the wrong coast and temperatures hit 110 in Phoenix for a month straight last month. Imagine signing an abortion ban in your state that denies basic bodily autonomy to folks before they even know they're pregnant. And then trying to do the same damn thing nationwide. While I doubt anyone on that stage will be president in 2024, it's a major indictment on our country's future. That one of two major political parties in our country is openly adopting such anti-science, anti-health positions and winning support from some corners of the electorate for it. It's easy to watch something like that and throw in the towel. But remember, the only antidote to bad ideas spread hatefully is good ideas spread lovingly.

And that's what we're going to continue to do, not just us here at America Dissected. But all of you in the conversations you have with your friends and family members, co-workers and neighbors, have the courage to have these discussions and the courage to sit with the discomfort of disagreement. Remember, minds don't usually change in the moment, it's only usually long after those conversations have been had.

So keep stepping up and stepping in. We'll be right here with you. That's it for today. On your way out, don't forget to rate and review the show. It really does go a long way.

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America dissected is a product of crooked media. Our producer is Austin Fisher. our associate producers are Tara Terpstra and Emma Ellick-Frank. Vasilis Fotopoulos mixes and masters the show. Production support from Ari Schwartz.

The theme song is by Takao Sazawa and Alex Uguiera. Our executive producers are Leo Duran, Sarah Geismar, Michael Martinez and me. Dr. Abdul El-Sayed, your host. thanks for listening.

This show is for general information and entertainment purposes only. It's not intended to provide specific health care or medical advice and should not be construed as providing health care or medical advice. Please consult your physician with any questions related to your own health. The views expressed in this podcast reflect those of the host and his guests, and do not necessarily represent the view and opinion of Wayne County, Michigan, or its Department of Health, Human and Veteran Services.