Transcript: Coronavirus Task Force Holds Press Conference on Efforts to Contain Virus

Secretary Azar: (00:00) Task force aims to do two things. We want to provide you with an update on the novel coronavirus, and we want to provide the latest on the extensive aggressive actions that the president has taken to keep Americans safe and respond to the outbreak. Following my remarks, you'll hear from Dr. Robert Redfield, the director of the Centers for Disease Control and Prevention, Dr. Tony Fauci, the director of the National Institute of Allergy and Infectious Diseases, deputy Secretary of State Stephen Biegun, acting Deputy Secretary of Homeland Security Ken Cuccinelli, and Assistant Secretary of Transportation. Joel Szabat. We're also joined by HHS's Assistant Secretary for Preparedness and Response, Dr. Robert Kadlec. First, we want to send our sympathies to everyone in the United States, in China, and elsewhere in the world who have been sickened by the virus or seen loved ones fall ill. I want to emphasize how grateful we are to those responding to the outbreak in China and around the world. Secretary Azar: (01:06) As I said last week, we are working as quickly as possible on the many unanswered questions about this virus. That includes exactly how it spreads, how deadly it is, whether it's commonly transmitted by patients who are not yet displaying symptoms and other issues. There have now been 12 confirmed cases of the novel coronavirus here in the United States, including two cases of transmission to people who had not recently been in China. Right now, our scientists and public health experts are trying to learn more about the virus using the data we have from China and the cases we have. In the very near future, we hope they will be able to work with their Chinese counterparts and other international experts on the ground in China. Even as we endeavor to answer these important questions, our assessment of the immediate risk to the American public from the virus remains the same as last week. Secretary Azar: (02:02) Although the virus represents a potentially very serious public health threat and we expect to continue seeing more cases here, the immediate risk to the American public is low at this time. Now, as we've said, our top priority is keeping the risk to the American public low, and we're working on all fronts to do that. The president takes his responsibility to the health and safety of the American people extremely seriously. The State Department, HHS, and other agencies have been working to help Americans repatriate from Wuhan, if they so desire. Here at home, state and local public health departments are working with the CDC to follow the playbook for an infectious disease response. Identify, diagnose, isolate, treat, contact trace. This week, the FDA issued an emergency use authorization for the CDC's diagnostic test. The CDC's test kits are now available for order from the International Reagent Resource for qualified laboratories, including U.S., state and local public health laboratories, Department of Defense laboratories, and select international laboratories. All told, 191 international laboratories. Secretary Azar: (03:21) Since last week, we've notified healthcare providers that those billing Medicare and Medicaid are expected to follow CDC guidelines for infection control related to the novel coronavirus. Our Biomedical Advanced Research and Development Authority, or BARDA, has expanded its work with a pharmaceutical company around a candidate therapeutic for the coronavirus, while research on such countermeasures continues at NIH and elsewhere in the private sector. Our longstanding offer to send world-class experts to China to assist remains on the table, and this week the State Department helped deliver 17.8 tons of relief supplies to Hubei province, the epicenter of the outbreak. Meanwhile, we are working on the ground in countries around the world as we always do, in Africa, Asia and elsewhere, to assist them with the detection and prevention through CDC offices, State Department personnel and partnerships we've built through years and years of preparedness work. Secretary Azar: (04:27) The FDA is actively working to accelerate the development and availability of countermeasures and to assess the risks that the outbreak could present to the American medical supply chains that involve China. Finally, we've been implementing the prudent policies the president announced last week to reduce the risk of transmission by travelers. We've implemented temporary quarantines of U.S. persons who have recently been to Hubei province, and we've asked for voluntary self-monitoring quarantines for U.S. persons who have recently been elsewhere in mainland China. We've required that all other individuals who have recently been to mainland China wait 14 days, the outer limit of the incubation period of the virus, before coming to the United States. These steps are a targeted approach aimed at slowing the virus's spread to and within the United States, giving our government and the global community more time to take preparedness measures, understand the virus and develop medical countermeasures. Secretary Azar: (05:28) These policies are consistent with those of many other governments. They are based on the current public health situation, and they are in line with the accepted best practices and the international health regulations. The travel measures complement the generous help we're offering at home and around the world and we believe they will help slow the spread of the virus. Every arm of the federal government that can help to protect the American people has been engaged, and we're continuing to take new steps, as Dr. Redfield will explain. We look forward to continuing to coordinate that work through the President's Coronavirus Task Force, and I now want to hand things over to Dr. Redfield, who can provide a more in-depth update on the CDC's work. Thank you. Dr. Redfield? Robert Redfield: (06:14) Thank you, Mr. Secretary. First, I want to emphasize that while this is a serious health situation in China, the immediate risk of this virus to the American public remains low, and our goal is to keep it that way. As of today, there are more than 31,000 cases across mainland China, and the death toll has risen over 600. Outside China, there's now over 300 cases that have been detected in 27 locations, including the United States. Most of these individuals have a connection to Hubei province in China. Additionally, there are 14 locations with 69 cases of person-to-person transmission in individuals that did not travel to China. From the onset, we have a layered response, and our goal is centered around early case recognition, isolation, contact tracing to prevent further spread of this novel coronavirus in our nation using effective and proven public health measures. Our public health and medical community have been instrumental in identifying and characterizing the confirmed cases that we've had in the United States today and are critical to our efforts to contain the spread of this virus. Robert Redfield: (07:35) To date, 12 confirmed cases has been identified in the United States, and we've continued to do persistent contact tracing of those 12 cases and identified two additional cases that did not travel to China but were close spousal contacts of confirmed cases that had returned from Wuhan. We have at CDC now more than 800 responders working with, in support of the U.S. government with our efforts at ports of entry, military installations, and state health departments. Currently, CDC is working in coordination with the State Department, as well as state partners, to support the arrival of the new passengers, American citizens from Wuhan. We are screening, monitoring, isolating and referring these individuals for medical treatment as needed. In addition, we appreciate our partnership with Customs and Border Protection to screen the Americans arriving at other parts of mainland China through the 11 US airports. Since the airport screening began, CDC and our partners now have screened more than 17,000 passengers, and as of today, we're screening roughly 4,000 passengers today. Robert Redfield: (08:48) We are grateful to these travelers for their cooperation and patience as we employ aggressive public health measures to confront this virus, strengthen our nation and protect America and Americans and their families. Today, the Department of Health and Human Services issued an interim final rule to amend foreign quarantine regulations. This will enable CDC to collect certain contact information data regarding airline passengers and crew when they arrive from other countries who may be exposed to communicable disease. This action is part of our [inaudible 00:09:32]. People. CDC will work with the interagency partners and airlines to implement this initiative. Robert Redfield: (09:37) Finally, we expect to see additional cases of this novel coronavirus in the United States from returning passengers, as well as through contract tracing to detect human-to-human transmission within our country of close contacts. I want to emphasize again that this is a serious global public health situation, and it continues to evolve rapidly. It's understandable that Americans are concerned, but again, the immediate risk to the American public is low, and we are vigilant in our efforts to confront the challenges that this new virus presents. Thank you. Dr. Fauci: (10:22) Last time we had a briefing like this, I had mentioned to you that we were in the process of developing and implementing and testing a variety of countermeasures in the form of diagnostics, therapeutics and vaccines, so I'd like to give you a very brief update on where we are. You heard from the CDC that on the basis of an emergency use authorization, that their diagnostic tests, which they developed very rapidly in the beginning, has now been distributed to health clinics, state and other local health clinics, throughout the country so that that diagnostic will be available not only in the CDC. At the same time, simultaneously, we, together with the CDC, are working on point-of-care diagnostics, and in particular one that would be important would be develop antibody tests so that you could do broad serosurveillance screening, which I think would be important to determine the scope of the outbreak. Dr. Fauci: (11:16) Next is therapeutics. I had mentioned last time that at least two known therapeutics were being used in an empiric way. While I'm happy to report now that one of those, Remdesivir, which had showed some activity in vitro in an animal model has now begun in a randomized control trial of two separate trials in China by one of our colleagues, Bing Kao, who we have collaborated with in the past. And what they're looking at in a randomized control trial is the effect of this drug, is either the drug plus standard of care versus standard of care alone. The reason I think this is important, because in order to really understand what works and what does not work, you have to do a kind of trial that would give you a definitive answer, so I think pretty soon we are going to get a definitive answer whether one of these among several drugs works. Dr. Fauci: (12:07) And then finally, I had mentioned to you that a number of organizations, pharmaceutical companies, individual investigators, were involved in developing a vaccine or vaccine...Was a messenger RNA platform that I told this group would hopefully and I think likely be ready within three months. Well, a little time has passed, and I said that would happen, provided there were no glitches. And I'm happy to tell you that there have been no glitches so far. Dr. Fauci: (12:43) So what do we mean by that? There are a number of steps that you have to go through. One of the first steps is to successfully get that gene that has been published by the Chinese in the database and insert it into the messenger RNA platform successfully and allow it to express proteins. We've succeeded in that. The next is to put it in a mouse animal model to induce immunogenicity, and the next, to get the company to start making GMP products. And in fact, all of those have now been successfully implemented. And now there have been no, thus far, glitches. And I think there will likely not be, but you never know. If that occurs, we will be in people in a phase one trial within the next two and a half months. Thank you. Secretary Azar: (13:33) Secretary Biegun. Stephen Biegun: (13:36) Thank you. And good afternoon. Stephen Biegun: (13:39) Since taking office, President Trump has been clear that his top priority is the safety and wellbeing of the American people. And as Secretary Azar has said, it is in that conviction that he took swift and decisive action to minimize...On this task force. While our colleagues from the Department of Health and Human Services and the CDC continue to do a tremendous job leading the overall response to the outbreak, the Department of State has responsibility for ensuring the safety and welfare of U.S. citizens abroad. The Department of State has all hands on deck with bureaus and offices from across the department, such as medical services, consular affairs, East Asian and Pacific affairs, crisis management and strategy and many others covering health, economic and public affairs leading an exceptional effort to evacuate U.S. citizens from Wuhan, China, while continuing our important work to support U.S. citizens elsewhere in China and around the world. Stephen Biegun: (14:58) Thanks to these efforts, we've evacuated more than 800 people from Wuhan. The first charter flight...The State Department, working closely with our partners in China, has loaded the holds of those arriving 747s with 18 tons of privately donated medical supplies and humanitarian assistance for the Chinese people. This includes urgently needed masks, gowns, gauze, respirators, and other vital materials. These donations are a testament of the generosity of the American people. Stephen Biegun: (15:49) The novel coronavirus outbreak that began in China has now spread to 27 other countries. And today, at the direction of the Secretary of State, I am pleased to announce the United States government is prepared to spend up to $100 million in existing funds to assist China and other impacted countries, as well as the World Health Organization, to contain and combat the novel coronavirus. Stephen Biegun: (16:15) This commitment, along with the generous donations from the American private sector and faith-based groups, signal's strong U.S. leadership in response to the outbreak. The United States Agency for International Development has done a tremendous job in this area and continues to assist more than 25 countries to build their health security programs. Since 2009, USAID has invested over $1 billion to strengthen the capacity of these countries to prevent, detect, and respond to existing and emerging infectious disease threats. Since 2015, the U.S. has also invested over $1 billion under our commitment to the Global Health Security Agenda. This support has helped improve surveillance and laboratory. Stephen Biegun: (17:03) ... agenda. This support has helped improve surveillance in laboratory systems, risk communication, outbreak response, and to address the rising threat of [anting 00:17:10] microbial resistance, all in preparation for a day like this. The United States is and will remain the world's most generous donor. We will continue to carry out the important work of strengthening the global health security and combating threats such as the novel coronavirus. Thank you. Secretary Azar: (17:30) Secretary Cuccinelli. Secretary Cuccinelli: (17:33) Good afternoon. I'm acting Deputy Secretary for Department of Homeland Security, and I'm the DHS's representative on the President's Coronavirus task force led by Secretary Azar. We're going to tell you a little bit about what our professionals are doing to implement the layered system that you heard Dr. Redfield reference, and we're doing this first and foremost at our international ports of entry, whether they be air, sea, or land. As of last Sunday, all flights from China and passengers who had been to China in the two preceding weeks are traveling to 11 airports in the United States. These were the airports where all those individuals are being funneled, and the first, the primary layer is the OFO folks you see when you travel internationally. These are customs border protection folks who say, "Can I see your passport?" They are also asking some other questions about recent travel. Secretary Cuccinelli: (18:40) Then you will go to a second [inaudible 00:18:51] that level you'll be asked a series of medical questions by trained medical professionals, and for those who have any of the flags, whether they have been to the Hubei province, whether they are showing symptoms of illness, they will go to the tertiary level of screening which is run by the CDC themselves where they connect up with local and state authorities, health authorities to cooperatively manage those cases. That's what you see coming into those airports. Secretary Cuccinelli: (19:23) At sea, the Coast Guard is in charge of every port of entry for each ship that comes to the United States, whether they be passenger or cargo, and the cargo ships are continuing to process. The economy and the supply chain is trying to be continued in its vitality through the efforts of the Coast Guard and also Customs Border Protection. That continues a pace. Secretary Cuccinelli: (19:48) At our land ports of entry. We are also doing additional screening questions for travelers who come to the United States to determine whether been in China and the previous two weeks, and if that is the case, we use a long standing practice of phone contact between those office of field office representatives and the CDC. That is how we conducted business before this virus ever showed up. We have always been looking for people who show up at our border with signs of illness, and we have always contacted the CDC for consultation in those instances, this virus situation has merely brought it to other people's attention, but this is a long practiced exercise between CDC and CBP, and it is working quite well. Secretary Cuccinelli: (20:42) As you heard earlier, the partnerships are working, whether they be at the federal level with our local partners or whether they be across the entire inner agency of the United States government. We'll continue to do that consistent with President Trump's charge to lean forward, to be on the front edge of keeping the people of this country safe from this threat and any other threats that we work on in the Department of Homeland Security every day. But right now, our focus today at this press conference is on the novel Coronavirus and all the steps that are being taken by CBP, by the Coast Guard, and within the Department of Homeland Security. They're being supported by our CWMD, countering weapons of mass destruction where our Chief Medical Officer resides, and our biological capacity, as well as FEMA as their backup to work with Dr. Kadlec here frequently. Secretary Cuccinelli: (21:40) So there's a deep engagement across the US government to keep the American people safe. We're proud to do that. So far we're happy to see we're keeping that risk low, as the medical professionals attest to, and we're going to keep doing that for you all and for the benefit of the United States. Thank you. Secretary Azar: (21:58) Thank you. Secretary Secretary Joel Szabat: (22:03) I'm Joel Szabat, Assistant Secretary for Aviation International Affairs at the Department of Transportation. I'm Secretary Chao's designated representative to the task force. Since the President's executive order went into effect on Sunday, we've established an international first layer to screen travelers who had recently been in China. This involves over a thousand daily flights inbound to United States being carried on over 400 air carriers from 288 airports worldwide. Over 200,000 Americans are in or have recently left China. Returning American nationals are now coming home from anywhere in the world to any one of 11 designated airports for health screening. As part of the layered approach to health screening, we are working with the aviation community so that our medical professionals will have essential contact information for all arriving passengers. We also now have health protocols in place to protect the crews of passenger and cargo aircraft that are continuing to fly between the United States and China. Mr. Secretary. Secretary Azar: (23:11) Great. Thank you very much. So at this point we'd be happy to turn it over for some questions. I just want to express my appreciation to fellow members of the task force from across the inner agency and the NSC, OMB, and also especially to Secretary Esper at the Department of Defense who's just been providing such incredible help and assistance to us. How about if we go right there to, yup. If you could just wait until the microphone, in the brown blouse. Next row back. Thank you. Brianna Ehley: (23:45) Brianna Ehley from Politico. Thank you for taking my question. Secretary Azar, You notified Congress earlier this week that you may use your authority to transfer funds over to the Coronavirus response efforts. I'm wondering if you do plan to do that in the near future, and if not, do you plan to request new funding from Congress? Secretary Azar: (24:03) So what I did with the transfer request, under the law, I have the ability to make transfers among account within our appropriation, but it requires 15 days advanced notice to Congress, to the appropriators. In the interests of just precautionary principle, I sent a notice up as soon as possible to the appropriators letting them know that we might tap into the $136 million of transfer authority there. No decision has been made to need to tap into that. Secretary Azar: (24:30) At the moment, we're operating on the $105 million on the infectious disease rapid response fund at CDC that we initiated a week ago. Saturday, I believe, on my declaration of a threat to the United States. It's premature to be talking about any additional needs for money at this point. There's still so many unknowns about the situation. We've got 12 cases in the United States, two of them are already out of treatment. Even from the measures that we initiated, we spoke about last week in terms of travel restrictions, we have 12 individuals who were in quarantine as a result of those measures. So at this point it's really very premature to talk about needs for additional money. We won't let resources be any kind of barrier to the response activities here, but let's not put the cart before the horse. Thank you. Back in ... Yes, back there in white blouse. [inaudible 00:25:40] Speaker 1: (25:41) Certain small number in, and what exactly, I mean, interested in elaborating on what you're [crosstalk 00:25:48]- Secretary Azar: (25:48) Sure, sure. So I'm as I think I mentioned to you in a previous conference, I spoke with Minister Ma, who is my counterpart in the Chinese government, the Minister of Health in China, a week ago Monday to reiterate the offer that a Director Redfield had made on January 6th of our willingness to send teams over, expert teams to help the Chinese both with their response as well as to learn more about the nature of this virus. Reiterated that offer, and then the following day, Director General Tedros met with President Xi and secured his agreement that he was open to a World Health Organization team coming over. Secretary Azar: (26:26) Then we provided 13 of the 25 names that the World Health Organization provided to China are actually CDC, NIH, and BARDA individuals, experts who could assist that WHO team. These are virologists, drug development experts, epidemiologists who would be part of that team. We continue to expect fully that a President Xi will accept that team that the WHO has put together as an expert team. We're ready, willing, and able and we'd like to get on with the work as quickly as possible. Thank you. Yes, in the green blouse here. Anne Flaherty: (27:11) Anne Flaherty with ABC News. How confident are you in the information that China is providing you on case numbers, and also what message would you provide to Americans who might be looking to get on a cruise ship or they're wondering if they should send their kids to school with masks? Anything outside of the usual hand-washing recommendation? Secretary Azar: (27:28) Sure. Thank you for that question. Let me ask Dr. Redfield, if he wouldn't mind giving his expert advice there. Robert Redfield: (27:33) Starting with the last part, now we obviously at this stage, we don't recommend masks. Okay. The rest of the American people is low. As I mentioned, unless you recently have been in the Hubei province, and when you do get respiratory symptoms that may be flu like it's much more probable that in fact it's flu. We actually recommend that hand-washing, we recommend when you cough, you cough into your elbow. We recommend that you don't touch your face a lot, and that you wash your hands frequently. That's what we recommend for flu. At this stage, that's what we recommend, because the real threat to the American public right now is flu, and we also recommend if you haven't got the flu vaccine, you get the flu vaccine. Robert Redfield: (28:17) Related to the data, we have both Dr. Fauci and I have regular contacts with our counterpart in China who we have a very good communication sharing information. I think the challenge is understanding more right now the spectrum of this illness. It does appear that you can actually have this infection and not have symptoms. Remember, China's looking at cases that were sick enough to go into a hospital and have to be admitted. There's been very little broader look at the spectrum of this to see how many people are truly infected, and it also is very clear that individuals that don't have symptoms can in fact transmit the virus. So that's where we're at right now. But I think the information we're getting from China's CDC, I think we have a lot of confidence in, it's just that we don't think the full extent of this outbreak has been defined through the spectrum of asymptomatic/symptomatic disease. Speaker 2: (29:17) Do you have any views, or Secretary Cuccinelli perhaps on the cruise ship question that Anne was asking? Robert Redfield: (29:25) It's complicated, because these cruise ships, you're really depended on the place of origin of your crew passengers. As you're going to see, there's three cruise ships now in the press, and we can talk about it more, where there has been individuals from a high risk area to get on that cruise ship. Then obviously there has been significant transmission, particularly in the case in Japan right now, where now there's been significant cases of the individuals that are there. Robert Redfield: (29:57) So I think it's really a time to be prudent. If you're going on a cruise ship in, say the Caribbean, which attracts most of the individuals from South America and the United States, it's really no risk. If you're going on a cruise ship where you may have a number of the passengers, as we saw with the cruise ship in Japan that happened to just come out of China where this virus happens to be transmitted, then there's risks. So again, it's going to be a judgment call as you make that for you and your family. Secretary Azar: (30:35) In the Brown blazer here. Speaker 3: (30:40) [inaudible 00:30:40] from Hong Kong, Phoenix TV. I have a question about there are a lot of Chinese students coming back after winter break before the travel restrictions. So what recommendations did you give to schools who host a lot of Chinese students? Also, there are incidents that in the US in New York city and also abroad about people have very negative views about people who have been to China or Chinese. Can you clarify? Is this virus, Asians more vulnerable to this disease? Are all the cases in the US now Asians? Secretary Azar: (31:20) Thank you very much. I'm going to ask Dr. Redfield and Dr. Fauci if they could address those, as they're very much ... Robert Redfield: (31:25) Thank you. One of the most important things we've tried to do, as I said, this is a layered approach, and actually the most important layer that we found for early identification is the health notices we put out to medical doctors in the medical health community. Of the 12 cases that we confirmed, 11 of them. Whereas, nine of them actually came as a consequence of physicians recognizing it, or educated individual citizens saying, "Listen, I got sick, and by the way I just have come back from the Hubei area." Robert Redfield: (31:55) Two of them were diagnosed because of the aggressive contact tracing that we're doing here in the United States with the state and local territorial groups, along with ourselves. We have reached out then with broader information to the public, and include targeted education to heads of schools to really try to reach out with that same educational message to Asian students that may have recently returned from New Years, for example, from the Hubei area. Again, making them alert of the early symptoms. Don't just shrug your shoulders and say, "I just think I have a cold." If you just came back from Hubei you need to be medically evaluated. Obviously with that medical community, which has been very vigilant. I'm going to let Dr. Fauci answer the second question. Dr. Fauci: (32:41) Well, since most of the cases are in China, obviously no one has done a study, but if you look at the history of these kinds of respiratory viruses, there is really no indication that Chinese are more susceptible or vulnerable than anyone else, so I would think that that's something you shouldn't be concerned about. Secretary Azar: (33:03) Thank you. The gentleman in the blue blazer. Thank you. Dan Vergano: (33:05) Dan Vergano with Buzzfeed news. I'm wondering what the task force outlook is on the trajectory of this outbreak. Is containment still possible at this point, or are we just doing things to buy time for a pandemic? And does that matter? Do your actions change either way you're looking at this thing? Thank you. Secretary Azar: (33:21) Let me ask Bob. If you don't mind. Robert Redfield: (33:22) Yeah, I think that's a really important question. Obviously in China, they're in mitigation stages. Okay? They're really now beyond containment. The virus right now is not under control in China. In the United States I think the multi-layer system that we've put out is still got us in a mode of containment. They're not mutually exclusive, containment and mitigation. I can tell you, we're actively beginning to think about what other steps we would take if there was broader cases occurring in the United States. But I do think right at this stage, we're still in a containment phase, and the ... Robert Redfield: (34:03) We're still in a containment phase and the extraordinary efforts that we put out, I think most people know we haven't instituted federal quarantine and over 50 years. That I think the containment strategy we have with the continued cooperation of the American public that have recently returned to China to get in touch with their health department and the aggressive layered screening that we're currently doing with the funneled airports, I think we're in a still in that place. It doesn't mean that two weeks from now or four weeks from now, we won't need to begin looking at some mitigation strategies. Secretary Azar: (34:34) Thank you. In the red blouse right there. Thank you. Speaker 5: (34:39) Hi, are local and state health departments that are assisting in this response, getting any funding assistance from the CDC or are they relying on their own resources and how might this impact their own public health issues they might be dealing with like the flu or measles in their community? Secretary Azar: (34:57) Well thank you for that. The local and state officials are of course vital partners in this. The federal government works together with our local partners, our state partners. I think approximately 50% of the budget of local and state public health departments is actually funded by the CDC, and in fact we have a fund about $670 million a year goes out to states, particularly for emergency preparedness and emergency response work like this to be ready for that. Secretary Azar: (35:25) So we already have significant funding to the state and local governments to their public health departments to build capacity for this. For the types of activities. There is additional work here, laboratory response work there are for certain jurisdictions, preparedness on potential quarantining, especially with the 11 airport ports of entry as a preparedness. We've, as I said, only had 12 individuals who've been subject to that so far and we'll certainly want to work with state and local governments to find if there is additional money needed from CDC grant funding, we'll certainly work to try to be fair and find available sources for them, but at the moment we certainly have funded tremendous capacity for exactly this type of activity through over a decade of the pandemic flu preparedness activities and emergency preparedness work. I don't know if Dr. Redfield, if there is different you want to add? Robert Redfield: (36:19) No, I think Mr. Secretary, that was right on. Just to emphasize that it's a fluid situation. We're currently evaluating what the resource requirements are and as the Secretary said, we're not going to get resource requirements get in the way of response, but it's really I think, premature for us to say this is exactly what needs to be done now, but we are working in partnership with the state and local health departments to help define that. Secretary Azar: (36:44) Thank you. Bob. Yes, in the blue shirt. Thank you. Speaker 4: (36:48) I'm sorry. Zolan Kanno-Youngs from the New York Times. I just want to follow up on the question regarding American experts going to China. Is it then accurate that China has not extended that invitation yet? And can you elaborate? Do you have any indication on why they haven't extended that invitation? And one final one, just do you think that if American experts had gotten on the ground earlier at this point that this mitigation, that this controlling and containing this virus that it would be more efficient at this point? Secretary Azar: (37:18) I'll discuss the first and then I'll ask Dr. Redfield to discuss the second since it would be largely his people and his interactions with his counterpart at the Chinese CDC. So at this point it's really, it's a decision for the Chinese. We have made the request now for almost a month to say, we are ready, willing and able. We are here to support the Chinese government to help China with their response. But primarily our activities would be to learn more about the nature of this virus with our expertise. You know, we've played a very important role. We have a decade long working collaboration with Chinese public health. It's not an accident, it's called the Chinese CDC. We have really worked productively for decades together. We have CDC staff who are permanently based over in Beijing as part of our health attache mission there. Secretary Azar: (38:13) So these are very deep, longstanding connections. So what we would do is be able to really help add expertise to be able to get to those questions we talked about at our first meeting in this room, some of the uncertainties. Can we do line tracing to get a better handle on what the incubation period is that's being experienced? What the severity index is on these cases? What the real risk of asymptomatic transmission is? Those types of questions we believe we can add significant expertise to help with. Secretary Azar: (38:45) But of course this is a matter for the Chinese leadership to make the final decision, but we feel very optimistic that this will happen. They have their own process as we do to make decisions on accepting that kind of assistance and we have to defer to them in respect to that process. Robert Redfield: (39:01) I would say in your first question, one thing I think we should all be humble about is you can't predict these infectious disease outbreaks. So I can't make a prediction. What I can say in infectious disease outbreaks, time matters. You know a lot of time in humanitarian crisis they grow to a point where then you'd necessitate intervention. In infectious disease, you kind of want to get in there preferably before they start, but at least when they do start, once they get to such a critical mass, then it's very hard for the tried and true approaches of public health to make that impact. Robert Redfield: (39:40) So I can't predict. I can say though, we're on a close watch around the world to see is there another country that starts to get what we call sustained human to human transmission. We're going to see isolated cases all around the world. We've seen over 300 of them now. And maybe occasionally a human to human transmission, but what you're really looking for is when you get a sustained human to human community based transmission and obviously being on the lookout for where that occurs and then trying to get the collective effort of the world's public health community to try to prevent a second China right now as we try to work to help China contain their outbreak that they currently have. Dr. Fauci: (40:24) Just to underscore what Bob said, but I think, and also an answer to the question that the gentleman from Buzzfeed asked about where is this epidemic going to go? The issue is we don't know. And any kind of prediction I think would be ill-advised because we really have so many unknowns. But there are several possible scenarios. I mean, the best scenario would be that the Chinese successfully contain and we see a turnaround of the curve. We see no more seating in the international areas and we don't see the sustained transmission in those parts of China. Excuse me, those parts of the world that have travel related cases, that would really be the best scenario. Dr. Fauci: (41:09) The thing that could happen that we don't know, and that's the reason why we don't predict is that A, they don't control it very well or they do, but it gets seated in a country that doesn't have the resources to be able to do the kind of identification, contact tracing and isolation. And then you have again, a sustaining of the outbreak. All of these are possibilities. So what we're doing is that we are, as we always say, to become somewhat trite, but it's the truth, is that you really prepare for the worst possible scenario. And then hopefully that we'll see the one that does bring an end to this. Secretary Azar: (41:48) In the jacket here. Yes. Speaker 6: (41:53) I'm Eunjung Cho with the Voice of America following up to Dr. Fauci, what he just said, earlier this week, the WHO said that we're not yet in a global pandemic, but this is an epidemic in multiple locations. I want to hear your take on whether we're heading quickly towards a global pandemic, and also WHO is against travel restrictions and many medical health experts say that travel restrictions won't stop virus from coming in. So what were the considerations in coming up with the travel restrictions and do you think those that travel restrictions are effective in stopping virus from coming in? Secretary Azar: (42:28) I'll address your second question then I'll turn it to Dr. Fauci. So the travel restrictions that we put in place in consultation with the President were very measured and incremental. These were the uniform recommendation of the career public health officials here at HHS. These are people who have been like Dr. Fauci, Dr. Redfield, Nancy Messonnier, Marty Cetron, individuals who have been doing this work for decades and decades in their career and this was their considered recommendation, which I and the President adopted. Secretary Azar: (43:02) These are steps really meant to slow down the spread. It's not meant to hermetically seal the United States from the virus, but rather to allow us to focus our resources. It is precisely these measures that have allowed us to provide such support to the state department's efforts on repatriating Americans because of the considerable effort and activity to do 14 day quarantine procedures on those Americans that we're bringing back. So, it's about focusing resources. It's about slowing spread. As we learn more, we develop countermeasures and we also hopefully see a change in the disease. The epi curve profile in China as China takes their very extreme measures to try to contain this within Hubei and within China itself. So then Dr Fauci. Dr. Fauci: (43:53) Just to extend a bit what the Secretary mentioned, it is true, I mean health officials, myself included, have said in the past that travel restrictions are not going to stop completely when you have an outbreak. That is a true pandemic, but I think most health officials agree that at best it delays and as the Secretary says, kind of pauses things and that's really the reason and the underlying rationale why that was done. I mean if there is, and I hope it doesn't happen, a broad pandemic throughout the world, travel restrictions are not going to help. You can't just travel restrict everyone. But I think many public health officials would agree that although it's not perfect that it will stop, it could delay and what we needed was a delay to essentially prepare better, but also to get a better feel of where this is going. Dr. Fauci: (44:45) The negative collateral negative components people say is you incite panic in a country or you have difficulties with resources getting in and out. Thus far, there's been no panic in the country and there has been no inhibition of the kind of resources that we need. So the kinds of collateral damage that you're concerned about have not occurred. This is a temporary thing. We're not talking about something that's permanent, so we recognize the potential negatives of it, but this decision was not made lightly. It was made after much consideration of examining all of the aspects. Secretary Azar: (45:23) Again in the center please. This will be the last question, please. We've got to run. But of course our public affairs office is available for questions for you at all times. Thank you. Brianna Ehley: (45:36) Thanks for taking my question. Brianna Ehley from Politico. The U.S. relies on a lot of medical products from China. Are there any facilities that you know of in the region that have had to stop production because of the outbreak and what is the expected impact on U.S. supply? Secretary Azar: (45:50) Great. Thank you. Good question. In fact, we have our Commissioner of food and drugs here, Dr. Stephen Hahn. Dr. Hahn, you and Dr. Kadlecik have been involved in communicating with American suppliers, drugs, devices, generics. Could you please address that question about the supply chain? Dr. Kadlecik: (46:09) Thank you very much sir. Dr Hahn do you want to come up? Come on up. Well, first of all, we're doing this as a team, not only across HHS but across the inter- agency. Today we basically held two important meetings. The Whole of Government Logistics Council. I know that sounds a little dry, but it's really all the entities across the U.S. government that have equities in terms of supply activities, particularly healthcare supplies as it relates to their respective activities. Veterans Administration, Department of Defense, Indian Health Affairs, the whole bunch. Dr. Kadlecik: (46:39) And the second one is basically looking at the utilization of respiratory protection, protective equipment. So what we're doing is both, not only monitoring the supply and the sourcing of that supply, but also the use. And I'll give you one quick example. We're very sensitive to the supplies of personal protective equipment such as masks. Dr. Kadlecik: (46:58) That was a great question earlier and the thing is if you use them now, you won't have them later if you need them. And so I think it's very important to level set across the government and for the public to understand that. And CDC has been a vital partner in this to basically evaluate not only how do we use these products but how we can potentially reuse and again extend their use. So there's been a lot of activity in this area and I'll defer to Dr. Hahn To explain his agency's activities. Dr. Hahn: (47:25) Thank you. The FDA is closely monitoring the situation. We're working with our government collaborators as well as manufacturers to monitor what's going on in the supply chain. At this moment we have received no reports from manufacturers about disruptions to the medical product supply chain. Obviously the situation is fluid and we'll do everything we can to continue to monitor this and act accordingly. Secretary Azar: (47:50) Thank you Dr. Hahn, and thank you all very much. And again, we're going to periodically want to make sure you have access to the principals on the task force. We've of course, got the daily press briefings that we're doing out of HHS, congressional briefing, state and local public health briefings. We really want to have just radical transparency on these issues. I speak, I think for each of our departments to say, our press shops are available to you as you have questions, and we'll try to convene just as the rhythm and development of this situation progresses. Secretary Azar: (48:18) So you have access to us directly, but also please know you have access to our expert teams so we can get you the answers. We'll get you what we know when we know it, and also tell you the uncertainties that we're facing as we face uncertainties. So thank you very much for being here today and to thanks to my colleagues.