Mike Pence, Dr. Fauci & Coronavirus Task Force Press Conference June 26

Mike Pence: (01:33) Well, good afternoon and to our fellow Americans out west, good morning, we just completed today's meeting of the White House Coronavirus Task Force, and I'm pleased to be joined by many members of the task force with us for this briefing. I want to thank Secretary Azar, Dr. Birx and Dr. Fauci, Dr. Redfield at the CDC, as well as our attorney general, Dr. Giroir of the U.S. Public Health Service and Dr. Han and Seema Verma. We'll make a series of presentations to update the American people on the status of the coronavirus pandemic in the country, and then be available to take questions, but we very much appreciate the attendance of all who are here and all of you who have made time to tune in. Mike Pence: (02:28) As we reported today, we have now more than 2,500,000 Americans that have contracted the coronavirus. And sadly, we've lost more than 126,000 of our countrymen to this disease. And I know I speak for the president and for every American, when we express our sympathies and our deepest condolences to all the families who have lost loved ones. Despite those losses, since the end of our 45 days to slow the spread and the beginning of efforts to open up America, thanks to the cooperation of the American people, the efforts of governors and state health officials efforts, I want to proudly say of the entire federal team under the leadership of President Trump, we have made truly remarkable progress in moving our nation forward. We've all seen the encouraging news as we open up America again, more than 3 million jobs created in the last job report, retail sales are rolling. And of course the extraordinary progress in New York, New Jersey, Connecticut, and New Orleans areas that just a matter of a month ago were struggling under the weight of this pandemic and now have arrived at a very, very different place. Mike Pence: (03:59) As we stand here today, all 50 states and territories across this country are opening up safely and responsibly. But with cases rising, particularly over the past week throughout the south, President Trump directed our task force to brief the American people on several topics. First, we want to share with you as Dr. Birx will, what we're seeing in the rise of new cases that today surmounted 40,000 new cases in a single day. Mike Pence: (04:35) Secondly, we want to speak about what we've done and what we are doing at the federal level to support the state efforts, particularly in the states where we see rising cases. We'll talk today about how this moment in the coronavirus pandemic is different than what we saw two months ago, to better equip the American people to respond and ultimately we will speak about what every American can do to play their part in reducing the spread and the impacts of the coronavirus pandemic. Mike Pence: (05:12) For our part also, I've spoken to governors into Arizona and Florida and Texas in the last 12 hours. And Dr. Birx and I will be traveling on Sunday to Texas, on Tuesday to Arizona, and I'll be traveling to Florida on Thursday of next week to get a ground report. And of course, on Monday, we will conduct what will be our 26th weekly call with the entire White House Coronavirus Task Force and all of the nations governors as we meet this moment. Mike Pence: (05:50) As I mentioned, it's important gathering today, I think, that we take a step back and think about how far we've come as a country. When the president tapped me to lead the White House Coronavirus Task Force, he said we had one mission and that was to save lives. President Trump's decision to suspend all travel from China in January, to stand up the White House Coronavirus Task Force in February, to declare a national emergency, to halt travel from Europe and amend travel from other places around the country, all contributed to giving our nation time to stand up a broad based response. The whole of government response that we spoke about so many times at the podium throughout this pandemic. Mike Pence: (06:43) We at the state department also coordinated the repatriation of 95,000 Americans. And then came the moment when we brought this chart to the President of the United States on the council of our very best scientists. The president was presented with a decision that if we did nothing, no intervention, the possibility existed at that moment in time that we could lose between 1.5 million and 2.2 million Americans, but with intervention and with mitigation, by calling on the American people to embrace the mitigation efforts, social distancing, that were called upon first in the 15 days to slow the spread that would become 45 days to slow the spread our best scientists believed that we could reduce the number of American fatalities to a number ranging between 100,000 and 240,000. But the president made that decision and we unveiled the 15 days that became the 45 days to slow the spread. And inarguably, as we see where we are today as a nation, because of what the American people have done, because of the incredible work of our healthcare workers, because of a partnership with governors in every state, we did just that. Mike Pence: (08:14) We slowed the spread, we flattened the curve. We saved lives. In the midst of that we exponentially scaled testing capacity partnering with private sector commercial laboratories. We've now reached some 30 million tests across the country, conducting some 500,000 tests a day. In that partnership with governors also, the president directed us to make sure that states had what they needed when they needed it. And at this point, I'm pleased to report that the federal government both delivered and facilitated the delivery of billions of supplies of face shields and gowns and gloves and masks. And we continue to be on track to construct more than 100,000 ventilators in 100 days. And as I spoke to governors last night, they confirmed to me again, what FEMA's reported that we have no outstanding requests from any state at this time for personal protective equipment or medical supplies. Mike Pence: (09:23) Let me say that again, in the effected areas, particularly the states down south that are seeing rising cases, we have no outstanding requests, but as I told the governors, we are ready at a moment's notice to surge personnel, to surge supplies, to expand capacity and to support their healthcare response. In the midst of all of that I think it always bears saying that because of the great work of our healthcare workers and because of American manufacturing, no American who required a ventilator has ever been denied a ventilator in the United States. And I consider that nothing short of a national accomplishment. Mike Pence: (10:03) We also surged hospital capacity in areas of the greatest anticipated need. We send military and national guard personnel and these charts showing the progress that we've made in New York and New Jersey and New Orleans all demonstrate the efforts of the people of those states, in cooperation with federal government and all the great healthcare workers, to show the progress that we made in areas that were once deeply impacted. And we extend our thanks. We extend our thanks to the people of each of those states, for the sacrifices that they made during those great and challenging times. Mike Pence: (10:45) But at the close of that 45 days to slow the spread, we unveiled a plan to safely reopen America again, and now all 50 states and territories are moving forward. And as I said, we're seeing America go back to work and in much of the country where we're seeing jobs expanding and economic activity expanding. But our focus today is very much on the advent of a rising series of new cases across the American south. But where our first mission was to save lives, once we came out of the 45 days to slow the spread, what our task force has been focused on over the course of the past two months is to partner with states to save lives and safely reopen. Mike Pence: (11:40) In fact, we've had some 17 meetings of the White House Coronavirus Task Force in the intervening days, since we began the process of opening up America again, and we've been working very closely with states to move that agenda forward. But as the president's made clear, we want to open our economy up. We want to move America forward even while we take and continue to take the steps necessary to protect lives and the health of the American people. Mike Pence: (12:13) We stand here today because with the rising cases among southern states, President Trump asked us to brief the American people to give details on what we're seeing, what we're doing and how it's different from two months ago. As you may recall, after seeing overall cases dropped from a 30,000 a day average in April to 25,000 a day average in May the first few weeks of June actually saw cases averaging roughly 20,000 new cases a day. We now have seen cases begin to rise precipitously across the south. Mike Pence: (12:54) In fact, 34 states ... let me make sure I've got my numbers exactly right here. As we reported early on 34 states across the country though, are experiencing a measure of stability that is a credit to all of the people of those states. And when we speak about a stability, we are talking about not necessarily states where there are no new cases, but these would be states where they're either no new cases and no rising percentage or no combination of those two things. There may be states across the country that are seeing a modest increase in cases, but their percentage of positive rates is remaining very stable. But nevertheless, there are 16 states with rising cases and rising percentages, and we'll be focusing on those states today. Mike Pence: (13:50) The first thing we'd share with the American people is that while there is a penchant in the national debate to use a broad brush and to paint an entire state one color, if there rising cases in a portion of the state, this is actually a better picture of the data that we literally analyze every single day. Dr. Birx will take a few moments to unpack the specific outbreaks in Texas, Florida, Arizona, and California. But the first thing we would convey to the American people is that from this new positive results in the last three days, you can see the concentration of new cases in specific parts of states and of course, very specifically in parts of countries, parts of the country. Mike Pence: (14:43) Secondly, we want the American people to understand it's almost inarguable that more testing is generating more cases. To one extent or another the volume of new cases coming in is a reflection of a great success in expanding testing across the country. As I said at the top, we're testing more than ever before, some 500,000 people a day. And perhaps we could go to that testing chart if it's there, just to show you the acceleration of testing that's taken place over the course of this pandemic in the United States. It's truly been a remarkable, and it's been a public and private partnership from the very outset. One of the things that we're seeing among the cases, and we hear this in Florida and we hear this in Texas and elsewhere, is that roughly half of the new cases are Americans under the age of 35, which is at a certain level, very encouraging news as the experts tell us, because as we know so far in this pandemic, that younger Americans are less susceptible to serious outcomes of the coronavirus. And the fact that we are finding more younger Americans who've contracted the coronavirus is a good thing. And so we'll speak about the testing and Admiral Brett Giroir is here and can detail any questions that you might have about testing going forward. Mike Pence: (16:16) Thirdly, we'll talk about what these new numbers mean and how we can address them. Dr. Fauci will speak about that in just a moment, particularly in the effected areas. And the other area that we spend a great deal of time thinking about is hospitalization. Not only do we track new cases every day on a county by county basis, but we also track hospitalization. And the map on the left of your screen represents how some healthcare workers have the resources and support they need. Again, as in the matter of new cases ... highly focused, highly detailed and highly specific. Secretary Azar will speak about hospitalization, the work of HHS to make sure that our hospitals around the country have the capacity to meet this moment. But as Dr. Birx may well reflect as well, we are encouraged that where two months ago we were seeing some 15% of new cases being hospitalized now that number is averaging roughly 5% around the country, which is also encouraging news, to say the least. Mike Pence: (17:56) And so while we have 16 states that we're focusing on, again I would just reiterate to the American people the most useful thing to know is where it's happening so that you can take the steps necessary to do your part. But rest assured in our conversations with governors in all of the most impacted the states, we continue to be assured that hospital capacity remains strong and they know the federal government stands ready to provide them with the personal protective equipment or supplies or even expanded capacity and personnel to meet any moment. But at this point in time, we are told that in all of the states most deeply impacted that hospitalization remains very, very broadly available. Mike Pence: (18:46) Finally, I want to speak about the progress that we've made as a country on the most difficult aspect of this. I said at the beginning that our hearts and our prayers go out to the families who've lost loved ones in the course of the coronavirus pandemic. And I know I speak on behalf of everyone in this country when I extend our sympathies to the more than 126,000 families that have lost loved ones. As the president has said many times one life loss is too many, but nevertheless, we, I believe at this point in the course of the pandemic, we can still take some comfort in the fact that fatalities are declining all across the country. There literally was a day two months ago this week where we lost 2,500 Americans in a single day. This week because of the extraordinary work of our healthcare workers, because of the availability of new medicines, like Remdesivir and new treatments like steroids and because of the cooperation of the American people heading the guidance that we gave at the federal. Mike Pence: (20:03) ... American people heading the guidance that we gave at the federal level and state and local officials gave. This week there were two days where we lost less than 300 Americans. You can see from this chart, what has been a precipitous decline from some of the worst moments of this pandemic, as it impacted areas of New York and New Jersey and the Northeast. Again, I have a heavy heart anytime I recite these numbers, but the fact that we are making progress reducing the number of Americans that we have lost and are losing, I hope is an encouragement, because as we see new cases rising and we're tracking them very carefully, there may be a tendency among the American people to think that we are back to that place that we were two months ago, that we're in a time of great losses and great hardship on the American people. Mike Pence: (21:04) The reality is, we're in a much better place with the efforts President Trump mobilized at the federal level, with the efforts of this team, this whole of government approach, the efforts of governors across the country, our incredible healthcare workers and the cooperation of the American people, we're at a much stronger place. The truth is we did slow the spread. We flattened the curve. We were able to stand up the resources and the capacities in our healthcare system to be able to meet this coronavirus in a way that would put the health of all of our country first. Mike Pence: (21:41) We also cared for the most vulnerable and continue to focus resources and testing and supplies on the most vulnerable, seniors with serious underlying conditions. I believe with all my heart that we've continued to save lives. We created a solid foundation for whatever challenges come, either in the days ahead or in the months ahead. That's a credit. That's a credit, I believe to our President, to our federal team, to our state partners, mostly it's a credit to the American people and our healthcare workers. Mike Pence: (22:15) So we stand here today, we believe we've made progress, but as we are reminded, as we see cases rising across the South, that we still have work to do. And so we say to every American, particularly those in counties and in States that are being impacted by rising cases, that now's the time for everybody to continue to do their part. I think you'll hear from this podium today, a particular message to younger Americans, younger Americans across the Sunbelt and the role that you can play in protecting the vulnerable and making sure that while the coronavirus doesn't represent as significant a threat for a serious outcome to a younger American, none of us would want to bring the disease back to our parents or grandparents, moms, and dads, an elderly friend, or a friend who has an immuno deficiency and cause a serious outcome as well. Mike Pence: (23:23) And so we leave you just with the guidelines for all of the phases. When we put out the guidelines to open up America again, we laid out at the outset guidance for responsible reopening. States across the country, as I mentioned are doing just that. 34 States are reopening safely and responsibly and seeing low and steady cases and not seeing a rise in the percentage of positives. In the 16 States that are being impacted, particularly those that we'll focus on here today, we would just encourage every American to follow the guidelines for all the phases, continue to practice good hygiene, wash your hands, avoid touching your face, disinfect frequently. Mike Pence: (24:16) People who feel sick should stay home and when it comes to businesses, social distancing, protective equipment, temperature checks, testing, and isolation. These are the guidelines for all of the phases and they are good practices to implement if you're in a community that's affected or even if you are not, because we're all in this together. The progress that we made that you saw illustrated in those charts in places like New York and New Jersey, Connecticut and New Orleans was a result of the American people stepping forward, heading the guidance of federal state and local authorities. We encourage you to continue to do just that. Mike Pence: (25:13) But for those in the areas most affected, we just want to encourage you to listen, to and respect the guidance of your state and local authorities, but recognize that this is different than two months ago, both in our ability to respond and in the nature of those that are being infected and that younger Americans have a particular responsibility to make sure that they're not carrying the coronavirus into settings where they would expose the most vulnerable. Then lastly, as I prepared to bring Dr. Birx up to the podium, I just encourage every American to continue to pray. Pray for all the families that have lost loved ones, pray for our healthcare workers on the front lines and just to continue to pray, that by God's grace every single day, will each of us do our part to heal our land. With that, I'll introduce the Coordinator of the White House Effort on the Coronavirus, Dr. Deborah Birx. Dr. Deborah Birx: (26:18) Thank you, Mr. Vice President. Thank you for that great introduction. Just to remind everybody where we have come from in the last four months, we have a great deal of understanding now about the differential disease, differential infections, no, we believe everybody is susceptible to infection, but we know infection leads to a spectrum of disease. We have much better details about who is vulnerable and why they are vulnerable. As the vice President said, at one time we were diagnosing people in the ICU after they came into the emergency room. Thanks to the millennials who have been heading our guidance, they have been coming forward and getting testing. And so, whereas before we told them to stay home, now we are telling them to be tested. And this is a great change for us, because it allows us now to find the asymptomatic and the mild diseases that we couldn't find before. Dr. Deborah Birx: (27:17) As Dr. Redfield talked about yesterday from the serology test, we have a great understanding of what was happening in March and the number of asymptomatic and mild conditions that led to individuals to have antibody, but never come forward with significant disease. We now know who's at risk for significant disease. We now know it's particularly the elderly, individuals over 80 and individuals with comorbidities. And remember those comorbidities span the entire age group. Dr. Deborah Birx: (27:49) We do know that we have people in the younger age groups with significant type one diabetes, and may also have individuals with significant obesity. We know that those are risk factors. And so risk factors go with your comorbidity, not necessarily with your age. So as we call on individuals to protect one another, by passing someone on the street, you don't know what comorbidities they have, and this is why we've been focused on trying to protect one another. Dr. Deborah Birx: (28:18) We also know who's at risk for the highest mortality. And because of that, the clinical care has dramatically improved. And I want to thank NIH who has been working constantly to update the clinical guidelines. So physicians around the United States and frankly around the world who are using those have the most updated information about how to actually improve disease courses of those that are in the hospital. We of course, have improved treatment in the hospital that we didn't have in March and April with improved methods of oxygenation, which is really quite important, improved treatment of acute respiratory distress, that's the individuals on the ventilator, we know now will respond quite well to steroids and then research that is ongoing and what we call that acute cytokine storm, that is when often in that later stage, when people are on ventilators, the seriously ill may need steroids and other items, and that's being researched and the work that's being done on clotting research by the NIH. Dr. Deborah Birx: (29:18) We also have new therapeutics that have been used both as compassionate use, like convalescent plasma, and now Remdesivir that we just reallocated and ensured it was available to these States that are facing the increased hospitalization, as well as the monthly allocations that we have been sending out. Dr. Deborah Birx: (29:39) If we can go to the first slide please, and start where the Vice President left off. This disease is tackled community by community, testing at the community level and working with community groups to understand the spread in those communities. So we've spent the time to really map this epidemic in new positives down to the level of communities to understand where spread is occurring, so that we can match our prevention interventions to those areas. Dr. Deborah Birx: (30:06) Next slide, please. As we discussed, and it's difficult for you to see on this graphic because the top line is New York, and we should remember where we were in that slope, that early slope that you can see in the case of the New York cases, that rapid acceleration. On the same slide, you can see California, that is the blue line that is just passing the orange line. Also on the slide it's Texas in green, Florida in orange and Arizona at the bottom. Dr. Deborah Birx: (30:40) As dramatic as the slopes are, they are not equivalent to the original acceleration that we saw in New York. That doesn't mean that we aren't absolutely focused on working with the governors in those communities to stop the spread of the virus in those four States. Dr. Deborah Birx: (30:55) Next slide, please. This shows you through the entire country that we're tracking state by state. Now, obviously this axis is vastly different than the one on the prior slide, because that slide included all of the cases in New York City. But you can see on this slide that we've been tracking very closely, North Carolina, a team's been with North Carolina, working with the state and local public health authorities to really respond to the changes there, as well as the South Carolina at the bottom. Dr. Deborah Birx: (31:26) The next slide, I'll just go quickly through these, so you can see Oklahoma's at the bottom of this slide. Next slide, you can see on this slide, Idaho and Oregon, those are the ones in the light blue and the dark green, where you see an inflection in their slopes. These inflection points and understanding when they occur and why they occur are critical for understanding how to prevent the spread. Dr. Deborah Birx: (31:53) Next slide. Now what the Vice President talked about is we've created an alert system that brings together what we just talked about, rising cases with an understanding of test positivity. And so this chart, which is difficult for you to see, those States on that far side, that have the highest test positive that you can see at the higher level of the graph, those are the States that we have concerns about because the rising number of cases and the rising test positive. This explains the extent of community spread. In States that have increasing cases, but falling test positives, it tells us that they're getting into the communities to find the asymptomatic cases. So these are the things we put together to understand the full picture. Dr. Deborah Birx: (32:44) Next slide please. So this really puts on one slide, the States that we have that we've been talking about across the South, where we have our greatest concerns. The two top States with the largest increase in test positives are Texas and Arizona, followed by Florida, Mississippi, South Carolina, Alabama, Georgia, Louisiana, Nevada, and Utah. Those last few States are under still 10%, but we're tracking them closely as we look at that individually. Dr. Deborah Birx: (33:15) Finally, next slide. You can see on this slide we are tracking and this is when you hear about, we have a certain 2% or 3% of the counties under specific alerts. So it doesn't matter the size of the county. We're tracking the increase and the rate of increase of new cases at the county level, we currently have about 130 counties out of the 3,100 in the United States in that category. Dr. Deborah Birx: (33:43) Next slide. [inaudible 00:33:46] level, this shows you the case positivity by the metros and the number of tests that have been done. Dr. Deborah Birx: (33:51) Next slide. Then this shows you specifically the change over time of test positivity in the largest metros where we have concerns, and this is Austin, Phoenix, Houston, Dallas, San Antonio, Tampa, Orlando, Miami, Riverside, California, and Atlanta, at the bottom. And so this is how we continue to integrate data on cases, data on testing, and data on hospitalizations, so that we can work with the States for a comprehensive, integrated response. Dr. Deborah Birx: (34:22) Next slide. I know many of you would be interested in seeing how high the test positivity rate became in April, well, March and April. So that top line is New York City Metro, and you can see it reached over 50% on a series of days for almost two weeks. 50% of the tests were positive for COVID-19. Underneath that, you see New Jersey and Minnesota and a whole series of individuals. Detroit is the second large mountain. Dr. Deborah Birx: (34:54) Next slide. So quickly to show you how we look at this at the state level and work with the governors and the local health authorities. So this is Florida. We track testing. It's done, the number of test positives that are in the blue line, the total number of cases, seen in the black bar and what we call this syndromic presentations of early respiratory diseases and pneumonias. Dr. Deborah Birx: (35:19) Next slide. Then we look at the county level to look for changes in the slope of the number of new cases. So you can see that top county that has the largest increase in slope in cases is Miami, Miami Dade, followed by Broward and Palm beach. All the other counties are much lower in their daily case increases. This allows us to focus resources and testing along with this state into these specific sites. Dr. Deborah Birx: (35:49) Next slide. That all comes together to create this graphic, so that individuals can understand and we can understand precisely what the rate of growth is and where the rate of growth is occurring, by the shading of the boxes. I'm going to quickly take you through Texas because it's the same story. Dr. Deborah Birx: (36:08) Next slide. So this shows you that exact same graphics, now shown for Texas, showing continue rise in the daily tests performed, but also a rise in the test positivity, the blue line. You can see throughout May, after opening, their test positivity continued to decline as their testing increased. It was in the last two and half weeks that we saw this inflection of rising test positivity, along with rising testing, but it was the increase in test positivity that alerted us, along with the increased cases that this was becoming an alert. You can see in the red boxes, everything is heat mapped, so at a glance, you can tell those two boxes that are in the middle that are red, that's the heat map, showing that this has rising cases and rising test positivity. Dr. Deborah Birx: (37:04) Next slide, but even in Texas... Next slide, please. This gives you a map of Texas, or it shows where the cases are and where they're rising the most rapidly. Finally, I'm just going to go through Arizona very quickly, along with California. Dr. Deborah Birx: (37:22) So next slide, same situation that we're showing here with Arizona rising number of tests being performed, but also rising test positivity, rising cases. Dr. Deborah Birx: (37:34) Next slide. Arizona is unique in they have essentially one county that is primarily represented by the depth of the new cases and this is in the Phoenix area. Dr. Deborah Birx: (37:45) Next slide, then next slide. So this is California. So you can see California over the last week has had that increase in test positivity. You can see that dramatic increase at the end of that bar in the blue line, along with still increasing test positive testing that has been done. We just want to thank all of the governors and all of the work in all the laboratories that has allowed us along with HHS and Brett Gerard, who ensured that the supplies were there to really increase these orange lines. You could see at each of these cases, these orange lines have dramatically gone up over the last four weeks. Dr. Deborah Birx: (38:21) Next slide, and like New Mexico, the primary infections right now in California at the highest level are in the LA area. But because LA is a large metropolitan area... Next slide, you really need this kind of more specific and local graphic to really show that it's also increasing in the Central Valley. This gives us the ability to focus resources among agricultural workers to improve testing and isolation for those who become positive. Dr. Deborah Birx: (38:54) So I just wanted to take you through how we've been looking at data, how we consolidate that data, then Monday report it out to the governors. We hope over the next week to be able to really have this data available in real time on the White House website so that everybody across the country can see where the cases are, because in the end we really want a call to action. Dr. Deborah Birx: (39:18) When we started talking about what can be done, we said the most important thing that would change the spread and I'm going to turn that over, because I know Tony's going to talk about it, is really individual behavior and our respect for one another through social distancing, wearing a mask and ensuring that we're protecting the most vulnerable that may be in multigenerational households. I just want to end by thanking again, the millennials who have come forward. I know during the protest, we asked a lot of them to go forward to get testing and we see those testing rates really improving in the under 40 age group. That is going to be important to continue to accelerate testing among the under 40 age group, because that's the age group most likely to have asymptomatic spread and be- Dr. Deborah Birx: (40:03) ... most likely to have asymptomatic spread and be spreading the virus unbeknownst to them. And I want to really make it clear, no one is intentionally spreading the virus. But they don't know that they're positive. They don't have symptoms and need to be tested in order to have that awareness. And so, we really want to thank them again for coming forward and really enriching the amount of testing that has been done in the under 40 year old age group. And, to our older population, you know if you have comorbidities. You know if you're over 80. We ask you, in any hotspots in these states that are having expansion in cases, to continue to shelter as much as you can and use your grandchildren to go and do your shopping. Dr. Fauci: (40:44) Thank you very much, Dr. Birx. And thank you, Mr. Vice President. So, I want to extend just for a couple of minutes some of the comments that were made, both by the vice president and by Dr. Birx, and it has to do with the situation that we find ourselves facing right now. It's very clear from the maps that you saw, that there are certain areas in the country, states, towns, cities, regions, that are doing very well, that have followed the guidelines and are opening up in a prudent way that's been effective. Dr. Fauci: (41:16) However, as you can see, we are facing a serious problem in certain areas. Now, when you look at the map, it's very interesting because you see some dark parts of the map and some light parts of the map. We have a very heterogeneous country. But heterogeneity does not mean that we are not intimately interconnected with each other. So, what goes on in one area of the country ultimately could have an effect on the other areas of the country. Dr. Fauci: (41:45) So, let's take a look at this problem that we're facing now, this resurgence of cases. I don't think there's time enough now all day to try and analyze and figure out the multifaceted elements that went into that, everything from maybe opening a little bit too early on some, to opening at the right time, but not actually following the steps in an orderly fashion, to actually trying to follow the steps in an orderly fashion but the citizenry did not feel that they wanted to do that for a number of reasons, likely because everyone feels the common feeling of being pent up for such a long period of time. So, we're not going to say blame. We're not going to try and analyze it, but there is something that's very important about it that I would like to get a message to the country in general. Dr. Fauci: (42:31) When you have an outbreak of an infectious disease, it's a dynamic process that is global. So, remember, what happened in China affected us. What happened in Europe effected us. What's happening here is affecting others. We can't get away from that. It's interconnected. So, therefore, if we are an interconnected society, we've got to look at the fact of what our role is in trying to put an end to this. Everybody wants to end it. Everybody wants to get back to normal. And everybody wants the economy to recover. I think we all are pretty common in that. That's a given. Dr. Fauci: (43:10) So, what can we do? What I think upon talking to a lot of people and reflecting on it, we have such an unusual situation because of all of the decades that I've been involved in chasing infectious diseases, I've never seen anything that is so protean in its ability to make people sick or not. There's no other infectious disease that goes from 40% of the people having no symptoms, to some having mild symptoms, to some having severe, some requiring staying at home for weeks, some going to the hospital, some getting intensive care, some getting intubated, some getting ventilated, and some dying. So that, depending on where you are in that spectrum, you have a different attitude to this particular thing. Dr. Fauci: (43:57) But anyone who gets infected or is at risk of getting infected, to a greater or lesser degree, is part of the dynamic process of the outbreak. And I know because I can understand when I was at a stage in my life when I said, well, I'm invulnerable. So, I'm going to take a risk. I think what we're missing in this is something that we've never faced before. It's that a risk for you is not just isolated to you. Because, if you get infected, you are part, innocently or inadvertently, of propagating the dynamic process of a pandemic. Because the chances are that, if you get infected, that you're going to infect someone else. And although you may feel well, and because we know, if you look at the numbers, that you'll probably hear later on, the overwhelming majority now of people getting infected are young people, likely to people that you see in the clips and in the paper who are out in crowds enjoying themselves, understandably. No blame there, understandably. Dr. Fauci: (45:03) But the thing that you really need to realize that, when you do that, you are part of a process. So, if you get infected, you will infect someone else who, clearly, will infect someone else. We know that happens because the reproduction element of the virus is not less than one. So, people are infecting other people. And then, ultimately, you will infect someone who is honorable. Now, that may be somebody's grandmother, grandfather, the uncle who is on chemotherapy, aunt who is on radiation or chemotherapy, or a child who has leukemia. So, there is what I call, and again, I just want to bring this out without making it seem that anybody is at fault, you have an individual responsibility to yourself. But you have a societal responsibility. Dr. Fauci: (45:51) Because, if we want to end this outbreak, really end it, and then hopefully, when a vaccine comes and puts the nail in the coffin, we've got to realize that we are part of the process. So, when the vice president went back, pulling back a couple of months ago, when we showed about the guidelines to safely reopen the country, we've got to make sure we drop back a few yards and think about that. That this is part of a process that we can be either part of the solution or part of the problem. Dr. Fauci: (46:29) So, I just want to make a plea with people when they understand the stress that they're under, as we try to tackle, not only those states, but the light colored part of the country, even though they've done well, they may have gotten hit badly like New York and then came down, or they may not have gotten hit badly at all. They are vulnerable if we don't extinguish the outbreak. Sooner or later, even ones that are doing well are going to be vulnerable to the spread. So, we need to take that into account because we are all in it together. And the only way we're going to end it is by ending it together. Thank you. Alex Azar: (47:12) Well, first, thank you all for joining us here at HHS to update the American people. I want to begin by thanking everyone around the country, working to defeat this virus, all of the healthcare providers on the front lines, those working to reopen our economy safely, the American people who have sacrificed so much in this fight, and the incredible members of our HHS team who have been working tirelessly to protect the health and wellbeing of all Americans. Alex Azar: (47:40) Before covering today's topic, I want to mention a major milestone for global health yesterday. The end of the second largest Ebola outbreak in history, in the Eastern Democratic Republic of the Congo. We congratulate the Congolese government and all of the healthcare workers and community members involved, some of whom I had the chance to meet and thank in the DRC last fall. Under President Trump, the United States was proud to play a bigger role in this major public health victory than any other single nation. Alex Azar: (48:12) And now, thanks to the president and the vice president's leadership and the hard work of our team, America has never been readier to combat COVID-19. We've built up our readiness under the strategy we developed to address surges, save lives, and in time, defeat the virus. We're in a much stronger position to support states, hospitals, and individuals, as they fight back. Alex Azar: (48:33) There are six parts to the strategy, surveillance, testing, containment, healthcare capacity, therapeutics, and vaccines. First we've been strengthening surveillance so that we can be aware of and respond to surges. That means, for instance, being able to track more cases among younger Americans that we never would have caught earlier in the pandemic. Second, we have the world's greatest testing capabilities, enabling us to confirm the presence of the virus when it crops up. And we're confident that capacity will continue to rise in the coming months. Alex Azar: (49:05) Third, states are building the capacity to track and contain outbreaks of the virus. With federal help, many states have substantially expanded their own capabilities. And we're deploying knowledgeable, experienced CDC and HHS public health teams to the areas now seeing increases with a focus on community testing and community based interventions. Alex Azar: (49:27) Fourth, we're helping healthcare system secure sufficient capacity and supplies. We've dramatically expanded American manufacturing of PPE. And the FDA has authorized new technologies to sterilize equipment for reuse. We've spoken with hospitals and states that are building up their own PPE reserves, many of them getting up to 60 or 90 days of supplies. Through the strategic national stockpile, we have far more visibility into the supply needs across the country, including central coordination capabilities that we lacked just a few short months ago. Visiting healthcare providers around the country, I've seen how they're adapting to bring patients back while taking appropriate precautions. America's hospitals are ready to get back to business while maintaining their readiness for COVID-19. Alex Azar: (50:16) The fifth and sixth elements of this strategy are thanks to the president's Operation Warp Speed. We now have promising therapeutics that are benefiting tens of thousands of American patients and, in all likelihood, have already saved thousands of lives. We've identified two very promising pharmaceutical treatments, Remdesivir and Dexamethasone. As of today, we've allocated more than 120,000 courses of Remdesivir to all of the 50 states. We've added Dexamethasone, a very low cost steroid, to our treatment guidelines. And we believe it's reasonable to assume that other corticosteroids, which may be more readily accessible in some places, would have similar immunological effects. Another promising therapeutic, convalescent plasma, has been used treat more than 25,000 Americans in nearly 3000 sites across the country. There are no certainties in science, but with more than 140 clinical trials underway in the U.S. it's a pretty safe bet that more good news on therapeutics is on the way and on the way soon. Alex Azar: (51:18) Finally, we've announced large investments to support three different vaccine candidates all the way through to manufacturing. These candidates are now in human clinical trials, some with the potential to start delivering safe and effective doses before the end of the year. And we'll be adding support for several more candidates. We're expanding manufacturing capacity and already making the vials, needles, and syringes that we may need. Our capabilities have grown exponentially in the time allowed by the patriotic sacrifices of the American people. We have a much better grasp of the virus, as Dr. Burke said, and much more data with which to model it. Alex Azar: (51:55) With that data, as you've heard today, we can focus on local trends. We have some very concerning hotspots. And we can track when other hotspots emerge, as we expect they may. We're focused on the states and the counties within those states, just 3% of counties that represent hotspots. It's important for the American people to be aware of this variability and variation across the country. Americans need to understand their local trends because we want to help people make the right decisions for themselves. Making decisions for yourself has to be based on the three axes of risk, as our surgeon general taught us in March. You want to assess where you are, who you are, and whom you live with, and what activity you're thinking about doing. There are gradations of risk within each of these axes. Going to an outdoor restaurant in Montana is a great deal different from a crowded indoor bar in Houston. When you interact with fewer people in an activity, when you interact with them for a shorter period of time, your risk is reduced. And individuals can balance these kinds of factors. What I've laid out today is remarkable progress by the president's administration and a particular credit to the team here at HHS. We've got a lot of work ahead of us, but Americans can be confident that we have a rock solid foundation to help us get safely back to work, back to school, back to worship, and back to healthcare, while we tackle surges of the virus where they occur. Thanks to President Trump's leadership, we've got the capabilities, the knowledge and the strategy to protect Americans' lives and their livelihoods at the same time. And every American should feel proud of that. Thank you. Mike Pence: (53:33) Great. Great. Dr. Redfield : (53:48) Thank you, Mr. Vice President. I wanted to add some comments. Once again, I want to stress and thank all Americans to embrace the importance of social distancing recommendations to slow the spread of COVID. As I've said before, we're not defenseless. These are, in fact, very powerful weapons. And it's our collective responsibility to recommit ourselves to put them into routine practice. Again, to stay six feet apart from each other, as much as possible, to wear face coverings when we're in public, and to practice vigorous hand hygiene. And to commit to do so, as we've heard today, to do our part to protect the vulnerable. Dr. Redfield : (54:34) I also want to appeal to the millennials and those that are under 40. It's really important that this group really commit themselves to these practices to protect those at risk. And it's not just the elderly that are at risk. Many us may have friends and colleagues that are younger that may not advertise their underlying comorbidities, as the case would be with, say, type one diabetes or an underlying immune deficiency. So, again, asking this team of millennials and younger people in this country to come and commit themselves. I agree with Ambassador Birx. We're very thankful that the group is now coming forward to get tested. But I also want this group to put into vigilant practice the importance of our social distancing. Dr. Redfield : (55:29) The one thing that I wanted to stress though, is that there are differences in what we're experiencing today than what we all experienced in March, and April, and May. And one of the things I want us to focus on is not the cases per se, but the consequences, the impact of those cases. It wasn't long ago, probably within two months ago, it's hard to believe, I don't think many people realized that 27% of all deaths that occurred in the United States actually died of a pneumonia. That was a pneumonia, could have been influenza, could have been COVID. 27%, one in four of all the deaths in the United States just two months ago was caused by pneumonia. I'm happy to say today, the deaths due to pneumonia and this nation is back to baseline. It's about 7%. That's a big difference. A lot of those pneumonias that were dying were actually COVID infected individuals that were the elderly, nursing homes, and individuals with comorbidities. Dr. Redfield : (56:41) We are seeing, despite these increased cases, we have seen a progressive decline in deaths. The last, say, two week average deaths in the United States now is around 650. And, as you heard the vice president, it wasn't long ago that, sadly, we were losing 25,000 individuals a day. So, I think it's critical that we continue to focus on that, the consequences. And it's part of that, why it's important that we continue also to look forward to how we deal with, and contain, and control the COVID infection, but as we also changed the consequences of the impact it's had on education in this country, or as in our economy and business. Dr. Redfield : (57:23) So again, as I close, I want to just re, re, reemphasize how important, for now, for individuals to really think seriously, as Tony said, about the responsibility to others that we have. Because this infection pathogen really does have the capacity to cause quite serious illness in individuals at higher risk, and embrace our nation's recommendations, that the vice president put up again, that we have for all phases of reopening in America. Dr. Redfield : (57:58) Again, I also want to thank the younger groups for stepping forward and getting tested. Clearly, what we're seeing now is this age group is much more likely to be asymptomatic. And again, to make that commitment, to do their part, to protect those of us that, whether we're young or old, have a comorbidity and would be more vulnerable to serious illness from this virus. Thank you very much. Mike Pence: (58:24) Thank you, Dr. Redfield. Questions? Speaker 2: (58:28) Mr. Vice President? Mike Pence: (58:29) Yes, please. Speaker 2: (58:30) All the experts here within the task force are stressing the importance of social distancing and also the threat of crowds. Yet your campaign has held two massive rallies. Mike Pence: (58:41) Right. Speaker 2: (58:43) No social distancing, no masks. Can you tell me... even Dr. Fauci had talked about not gathering in large crowds. Can you tell me why you continue to do this, why the campaign continues to hold these rallies? Mike Pence: (58:55) Well, the freedom of speech, the right to peaceably assemble is enshrined in the Constitution of the United States. And we have an election coming up this fall. And President Trump and I believe that taking proper steps, as we've created screening at recent events, and giving people the very best counsel that we have, we still want to give people the freedom to participate in the political process. And we respect that. Mike Pence: (59:29) I was pleased to see that now the better part of a week since we were in Oklahoma, I think their positivity rate has actually declined as of today. And that's a great testament to the fact that people are using common sense. They're being responsible. They know and understand what's happening in the community in which they live. And our emphasis today is really to say that we think it's most helpful if the American people understand that what we're seeing across the South today is really- Mike Pence: (01:00:03) Understand that what we're seeing across the South today is really outbreaks. They're outbreaks that are in specific counties, in some cases they're outbreaks that are in specific communities and we've surged CDC personnel, HHS personnel. I didn't mention before but three weeks ago when we were seeing similar activity in North Carolina and Alabama, we sent personnel into those states and we've actually seen declining numbers beginning in both of those states. Mike Pence: (01:00:31) So the important thing is is that not size fits all. The overall guidance to every American to practice good hygiene, to practice the measures that we recommended at home and at work stand but our focus today is to make sure that in those areas of the country where we're seeing a significant not only increase in cases but an increase in positivity levels that the American people know just how important it is to listen to what their state and local health officials are directing them to do. Please. Speaker 3: (01:01:05) Mr. Vice President, I was curious. It seems that the wearing of masks has kind of become a political statement or I guess the decision not to wear a mask, are you concerned about that and is there a message that you would like to send to people about the importance of wearing masks? Mike Pence: (01:01:22) We think that where ... The first principle is that people ought to listen to their state and local authorities. I have to tell you, President Trump and I couldn't be more grateful for the partnership we've forged with governors around the country. I spoke to the governor of Florida, of Arizona, of Texas just within the last 12 hours and I told them that from this podium today, we would remind their citizens to heed the guidance and the direction of state and local officials. In some cases there is statewide guidance with regard to facial coverings and with regard to events and gatherings. In other cases there are specific countywide or citywide directives, and we just believe that what's most important here is that people listen to the leadership in their state and the leadership in their local community and adhere to that guidance, whether it have to do with facial coverings, whether it have to do with the size of gatherings and we'll continue to reinforce that message. Please. Speaker 4: (01:02:26) Mr. Vice President, I actually have two questions actually. You just mentioned the importance of listening to state and local authorities. What is the correlation between the spike in cases that we're seeing in states like Texas and Florida and the way those states handled their reopening? Was it too much too soon? Secondly I've wanted to ask Dr. Fauci, you've said in an interview that "Something is not working." What isn't working and did you all in your meeting today come up with a plan to fix whatever isn't working? Mike Pence: (01:02:59) Well let me respond first and then I'll let Dr. Fauci address it as well and Dr. Birx may as well. I think there will be a temptation for people to look at these Sunbelt states that have been reopening and putting people back to work and suggest that the reopening has to do with what we're seeing in the last week or so but frankly in the case of each of these states they reopened in some cases almost two months ago and their test cases, their new cases from testing was low and steady, their positivity rate was low. What we're observing today, and I've heard this from Florida, I've heard this from Texas and some other states along the Sunbelt is that we're seeing more and more young people under the age of 35 who are testing positive. In many cases they have no symptoms but they're coming forward and confirming that they have contracted the coronavirus. We're working with the states, so you speak about our plan. We've got CDC personnel embedded in every state in the Union. We're surging more CDC personnel as requested to each of these states to help them unpack what the data is suggesting. Mike Pence: (01:04:27) I know the governor of Texas announced some new measures this morning which we fully support but what we're going to continue to do is give our state leadership the very best information, the very best counsel that we have and if there's one message that comes through today, I hope it is saying to younger Americans in these states and in these counties in particular that they are a big part of the numbers that we are seeing in new cases and while there may not be a significant threat of a serious health outcome to them, I know of no young person, and I got three twenty somethings in my immediate family, no young person would ever want to inadvertently expose a mom, a dad, a grandmother, a grandfather, or someone who is vulnerable to a serious result. So alerting them that there has been spread among that age group, urging them to take countermeasures, and heed what their governors and local officials are directing will be our continued strategy. Dr. Fauci did you want to respond? Dr. Fauci: (01:05:40) So what I meant by what is not working, and this is not anybody's fault or any institution's fault, is that what we're dealing with right now is community spread in the context of a substantial proportion of the people who are getting infected, do not know they're infected, they're not symptomatic, they're asymptomatic individuals. The classic paradigm of identification, isolation and contact tracing to actually contain that is very difficult to make that work under those circumstances. You superimpose upon that the fact that even with identification, isolation and contact tracing, often the dots are not connected. If you get on the phone and talk to people who are in some of these communities, you find that a lot of it is done by phone and when it's done by phone maybe half of the people don't even want to talk to one who they think is a government representative. If you live in a community that is mostly brown or black, you're in a different situation that maybe 70% of them don't really want to talk to you. You can identify a contact but you don't isolate them because you don't have the facility to isolate them. Dr. Fauci: (01:06:49) That is what's not working, so what we're going to do and we are doing and you're going to be hearing about this, flooding the area of a community to get a feel for what's out there, particularly among the asymptomatics. So in other words, it's a paradigm shift because we're dealing with young people, people who are going to be asymptomatic, and people who are getting infected in a community setting, not an outbreak setting where you know who to identify, isolate and contact trace. That's what I meant. Speaker 3: (01:07:19) So Dr. Fauci and Dr. Birx - Dr. Deborah Birx: (01:07:27) I just want to finish it, expand his thought for just a second. About three months ago we talked about how important it was to have community at the center and I think when you talk about what's going to be different and part of the reason why the president and vice president have asked me to go out to Texas, New Mexico and Arizona is to not only meet with the state and local health officials but to meet with the community groups, so that the community groups can help us support community-specific messaging. Public health messaging, when you just keep saying the same thing over and over again and the people get tone deaf to it, it's because it's not tailored to their specific circumstances and they don't see that message resonating in their lives. We've had to do this across the world. Done this over and over again for HIV, TB and malaria. At the center of this has to be the community, and the community will help us identify who needs to be tested, to help us identify which households have the most vulnerability in them, and how we can really go into those communities and support that response at a very local and ground level. Dr. Deborah Birx: (01:08:35) When we started this we were very much facility-based and we know facilities carry us a long way, but if we want to change the transmission rates in these metros, in specific communities and specific parts of those metros, we've got to walk side by side with our community leaders and our community groups that know how to translate our scientific dogma and information down to a level where people will understand it here and act on it. I know when they hear it and understand it, they will act on it, and so that's how ... When you ask what's going to be different, that has already started and it's already going to be different. Speaker 3: (01:09:13) Dr. Birx, question - Dr. Fauci: (01:09:14) Just let me add to that. That's exactly what we did with HIV 30 years ago. We got the community involved in helping us to outreach and I think that's very important to underscore what Dr. Birx said and that's exactly what's being planned to do, to get people who know the community, who live in the community, who the community trust. Mike Pence: (01:09:33) [inaudible 01:09:33] How about right here. Speaker 5: (01:09:36) Mr. Vice President, do you expect the death rate to go up in the next three or four weeks just like we're seeing the rate of infection go up now? Mike Pence: (01:09:44) Well our hope and our prayers is not the case. We've seen ... As you noted we've seen a precipitous decline in fatalities. Again, one is too many. We grieve the loss of every American life but the fact that two months ago we had lost 2,500 Americans in a single day. In two days this week we lost than 300 Americans is a testament to our healthcare workers, to all of the medicines that Secretary Azar just described being available in all 50 states. It's a testament to the efforts of the American people and we hope as we continue to engage that we'll continue to see those numbers decline. Mike Pence: (01:10:34) The other reason we're encouraged is because at this point, when we look at our losses, roughly 2.5% of all of our losses took place in people under the age of 25. Younger Americans, and in each case, or at least 90% of the cases, they were people with pre-existing conditions, underlying conditions that contributed to the sad outcome. So as we see that in Florida and in Texas, they've reported to us that half or even more than half of the new cases that are showing up every day are people under the age of 35 or younger Americans in most cases asymptomatic, our hope is is that those younger healthy Americans like most have already will continue to go through the coronavirus. We'll recover but our message today as we've spent so much energy in the last four months protecting the most vulnerable and we've deployed testing resources, we've supported states' efforts, states across the country in the last month have answered our call to test all the residents of their nursing homes to set up a plan to test all of the staff on a regular basis. Mike Pence: (01:12:02) We need to protect the most vulnerable and we want to message going out to younger Americans, particularly those along the Sunbelt in these counties where we see new cases on the rise, positivity on the rise, to know that we need them to do their part to make sure and protect the most vulnerable so that we don't see those losses but it's in the hands of the American people, and particularly young people in this country. Right there. Speaker 6: (01:12:35) Mr. Vice President, thank you. A question for you and then a question for the doctors on childcare. On the campaign, it really does sound though like you're saying do as we say not as we do. You're telling people to listen to local officials but in Tulsa you defied local health officials to have an event that even though you say it didn't result in a spike, dozens of Secret Service agents, dozens of campaign staffers are now quarantined after positive tests and then in Arizona, one of the hardest hit states, you packed a church with young people who weren't wearing masks. So how can you say that the campaign is not part of the problem that Dr. Fauci laid out? Mike Pence: (01:13:08) Well I want to remind you again that the freedom of speech and the right to peacefully assemble is enshrined in the Constitution of the United States, and even in a health crisis, the American people don't forfeit our constitutional rights. In working with state officials as we did in Oklahoma and as we did in Arizona, we're creating settings where people can choose to participate in the political process and we'll continue to do that. I think it's really important that we recognize how important freedom and personal responsibility are to this entire equation but allowing younger Americans to understand, particularly in the counties that are most impacted, the unique challenges that we're facing in their age roup, we think it is important. Mike Pence: (01:14:14) Look, it's so important that we recognize that as we issued guidance to reopen America now two months ago and now as all 50 states are opening up our country again, people are going back to work, American everyday life is being restored, kind of one step, one day at a time, I think it's important that we remind ourselves this is not a choice between the health of the American people and a strong economy. There are profound implications to the lockdowns through which we just passed. I heard a statistic not long ago at a task force briefing that in one jurisdiction there had been a 50% increase in the number of people presenting at emergency rooms having attempted suicide. There are profound mental health issues. There are profound economic issues, people needing to be back to work and so our objective here today is just to make sure the American people know in 34 states that the cases are largely stable and there's no combination of rising cases and rising positivity rates. Mike Pence: (01:15:34) That's a tribute to the American people and in the 16 states we're focused on today, we want to equip particularly young people with the knowledge of the part that they can play in stemming the rising tide of new cases. Not because the coronavirus represents a significant threat to them, in most cases it doesn't if you're a younger American, but because no younger American would ever want to spread the coronavirus to someone who would have a serious outcome but I'm grateful for the time today. We hope this has been helpful and [inaudible 01:16:14] back more information as time goes on. Thank you. Speaker 7: (01:16:22) Dr. Fauci, are these rallies okay? Are these massive rallies okay? Your opinion, Dr. Fauci. Speaker 8: (01:16:26) When is our next briefing?