Transcript: U.S. Health Officials on Response to Coronavirus February 25, 2020

Alex Azar: (00:00) This is the HHS briefing on the China coronavirus, and we aim to do two things today. Provide the American public with an update on the risk presented by the virus, and provide the latest update on the actions that President Trump's administration is taking to respond to the outbreak and keep Americans safe. I'm joined today by Dr. Anne Schuchat, the Principal Deputy Director of the Centers for Disease Control and Prevention in Atlanta, Dr. Tony Fauci of the National Institute of Allergy and Infectious Disease. Dr. Robert Kadlec, HHS's Assistant Secretary for Preparedness and Response, and Dr. Steven Hahn, the Commissioner of food and drugs. Alex Azar: (00:44) As of this morning, we still have only 14 cases of the China coronavirus detected here in the United States, involving travel to China or close contacts with those travelers. We have three cases among Americans repatriated from Wuhan and we have 40 cases among American passengers repatriated from the Diamond Princess in Japan. I want to thank the responders and communities that have worked with HHS and the administration to provide these Americans with the treatment they need. I'm also grateful to the governors and other state and local leaders who have worked with us in close partnership so far. The immediate risk to the general American public remains low. But as we have warned, that has the potential to change quickly. Alex Azar: (01:39) There is now community transmission in a number of countries including outside of Asia. That's deeply concerning that community spread in other countries will make successful containment at our borders harder and harder. That's why we've already been working closely with state, local and private sector partners to prepare for mitigating the virus's potential spread in the United States, because we will likely see more cases here as we have said throughout this episode. Dr. Schuchat will provide some more details on what that will look like including how we would treat potential cases that arise from community transmission here in the United States. Alex Azar: (02:20) This preparation has been possible in part because of how aggressively President Trump has responded to this outbreak. As soon as we knew of the threat presented by this novel virus, the public health leaders were monitoring it and beginning to prepare. The travel restrictions that the President put in place at the beginning of this month have given our country valuable time to continue to prepare, and that is precisely what those measures were designed to do. That includes working with Congress. Yesterday, the White House sent a request to Congress to make at least $2.5 billion in funding available for preparedness and response. There are five major priorities within the supplemental request, which I underscore this morning before the Senate Appropriations Committee. First, we need to expand our surveillance work, building on existing system we have within CDC's influenza surveillance network. Second, we will need funds to support public health preparedness and response for state and local governments for what could be a very large scale response. We don't know, but we must prepare for that just in case. This support complements the significant funds that these partners have received from CDC for preparedness, about two-thirds of a billion dollars a year in recent years. Third and fourth, we need to support the development of therapeutics and the development of vaccines. Alex Azar: (03:49) Given the scale of this outbreak, the private sector sees a real market for both kinds of countermeasures as well as for diagnostics. But federal funding and guidance can accelerate this work. Dr. Fauci will address the current status of that work in more depth. Fifth and finally, we need funds for the purchase of personal protective equipment for the Strategic National Stockpile, the topic that Dr. Kadlec can address. I'll conclude by noting that those scheduling conflicts prevented this briefing from including other members of the President's coronavirus task force. We'll be providing a new update from interagency leaders soon and we expect to continue doing so regularly. Earlier this afternoon on CNBC, the National Economic Council, Director Larry Kudlow offered an update on how we see this outbreak affecting the economy. This morning, Dr. Messonnier from CDC provided the usual telebriefing. As Dr. Schuchat will emphasize in just a moment, the Trump administration will continue to be aggressively transparent as the outbreak and our response evolve. We'll continue keeping the American people and the media apprised of the situation as well as what everyone can do to prepare. In the meantime, I'll continue to work closely with President Trump and the President's task force on our preparations to keep Americans safe. With that, I'll hand things over to Dr. Schuchat for an update from the CDC. Dr. Schuchat. Dr. Anne Schuchat: (05:14) Thank you. Thanks so much. I'd like to start out by saying it's a difficult and uncertain time. We along with our partners around the country and around the world, have been confronting a dynamic, rapidly evolving situation. I'd like to let Americans know that CDC and our nation's public health agencies are preparing every day for this type of situation. Preparedness started long before this outbreak. The US government's response to the spread of the novel coronavirus, entire country began as soon as reports of an unidentified flu-like illness emerged from Wuhan, China. Dr. Anne Schuchat: (05:54) The US has been implementing an aggressive containment strategy that requires detecting, tracking and isolating all cases as much as possible, and preventing more introductions of disease, notably at ports of entry. We've restricted travel into the US and have issued multiple travel advisories for countries currently experiencing community spread. Our travel notices are changing almost daily as we get new information. And we believe those precautions are working. So far, as Secretary a czar described, our public health system has detected 14 cases in travelers or very close contacts of travelers here in the United States. Dr. Anne Schuchat: (06:42) Among passengers repatriated by the State Department from Wuhan, China and from the Diamond Princess, there are an additional 3 and 40 cases. The fact that we have been able to keep cases to this low level is an accomplishment, especially given that we are unfortunately beginning to see community spread in a growing number of other countries. Based on what we know right now, we believe the immediate risk here in the United States remains low. And we're working hard to keep that risk low. But we must use this time to continue to prepare for the event of community transmission in the United States. Part of that preparation is educating the public in our state, local and private sector partners about what transition from aggressive containment measures to community measures or community mitigation would look like should we end up there. Dr. Anne Schuchat: (07:44) Under our current aggressive containment posture, patients infected with the coronavirus who have mild or no symptoms are being placed in health care facilities for very close observation and isolation. That intensive level of medical care is not typically needed. As we've watched these cases and learned over the past several weeks, we realized that other approaches to management are likely fine. Outside this period of aggressive containment, the usual and appropriate care for most patients who develop the novel coronavirus or COVID-19 would be management at home through home isolation, with use of health care facilities only as needed. For those who have severe presentations, the elderly, those with medical conditions, require a closer observation. Dr. Anne Schuchat: (08:39) We will maintain for as long as practical a dual approach where we continue these measures of aggressive containment to this disease, but also employ strategies to minimize the impact on our communities. However, current global circumstances suggest it's likely that this virus will cause a pandemic. In that case, risk assessment would be different and new strategies tailored to local circumstances would need to be implemented to blunt the impact of the disease and further slow the spread of the virus. What these interventions would look like at the community level will vary depending on local conditions and on the emerging information about how severe the virus may be. Dr. Anne Schuchat: (09:24) Now, it's not so much a question of if this will happen anymore, but rather more a question of exactly when this will happen, and how many people in this country will become infected and how many of those will develop severe or more complicated disease? We have been preparing to address this type of threat and limit the impact on our communities for many years. As some of you heard from Dr. Messonnier of the CDC today, we began laying out for the public what it will look like to mitigate the spread of the virus. There are obvious common sense tools like good hygiene, social distancing, things like staying home when you're sick, things we talked about during a difficult flu season are things that we talked about during the 2009 H1N1 pandemic. Dr. Anne Schuchat: (10:12) We will be transparent with the public about these measures and the potential that these tools will be necessary. There is literally a playbook for the use of these tools, and one that the states and local public health have exercised. We are committed at the CDC and across HHS and the US government to radical transparency, to making sure we're sharing what we know when we know it, and we're giving you a sense of what the future may hold. I'd like to now turn things over to Dr. Fauci for his update. Dr. Tony Fauci: (10:54) Thank you very much, Anne. I'm going to give a very brief update on the countermeasure development that I introduced to this audience on a number of occasions over the past couple of weeks, and the first regarding the issue of vaccine. You might recall that I had mentioned when we first introduced the topic of vaccine, that very shortly after the sequence was put on a public database, we began a vaccine development program, which was one of several supported both by the NIH as well as [Bauter 00:11:27] from [Asper 00:11:28], and even independent individuals that we have been involved in collaborating with for a period of time. Dr. Tony Fauci: (11:34) One of these vaccines, I think, serves as the prototype of the timing of what we were talking about. You might recall, I had mentioned that from the time we had available sequence, we would hope to be in clinical trials within two to three months. And I said barring any glitches, that would be the fastest ever in any vaccine that we've gone from the identification of a pathogen, to putting it into a human in a phase one trial. Well, I'm happy to report to you this afternoon, that we are on time, at least, and maybe even a little better. The gene has been expressed in the platform, in this case, a messenger RNA, the material has been produced, it's been put into mice, it's immunogenic, and it's now getting ready to go through the regulatory issues of getting it to go. Dr. Tony Fauci: (12:24) So I would project that we would be in a human trial, I would say within a month and a half, and I had thought that maybe cut a week or so off. Again, hopefully, no further glitches. Now, the thing we need to understand, because we want to make sure people don't get confused, that getting a vaccine into a phase one trial within a three-month period, you need at least three to four months to determine if it's safe, and whether it induces the kind of response that you would predict would be predictive. Once you do that, you graduate to a much larger trial. The end of the number of people at phase one trial is 45. When you go through a phase two trial, you're talking about hundreds, if not thousands of individuals to determine ethicacy. That is a trial that we would have to conduct in those countries in those areas where there's active transmission. Dr. Tony Fauci: (13:17) That itself, even at rocket speed would take at least an additional six to eight months. So when you're talking about the availability of a vaccine, even to scale it up, you're talking about a year to a year and a half. Now, you shouldn't be discouraged by that, because it is certainly conceivable, that this issue with this coronavirus, will go well beyond the season into next season. So a vaccine may not solve the problems of the next couple of months. But it certainly would be an important tool that we would have and we'll keep you posted on that. Secondly, and finally the issue of therapeutic interventions. There are a number of candidates that we are now looking at that have shown some suggestion, either in vitro, in an animal model, or some empiric trials that were done during the MERS outbreak. Dr. Tony Fauci: (14:10) One of these, and there are several that we're considering, is called [Remdesivir 00:14:14], which is a nucleoside analog that is produced by Gilead. Today as I speak, there are two major clinical trials going on in China, which are randomized, controlled trials, which means that we will get an answer whether or not it works or doesn't work, I think within a reasonable period of time. An identical copy of that trial is now being implemented in Nebraska with our colleagues who are taking care of the individuals who were taken from the Diamond Princess and brought back here, in addition to our colleagues in Japan. So I'm optimistic that we will at least get an answer. If we do have a therapy, that really is a game changer, because then we could do something from the standpoint of intervention for those who ... Dr. Tony Fauci: (15:03) Because then could do something from the standpoint of intervention for those who are sick. So, hopefully I'll get the opportunity in the future to continue to update on these interventions. Thank you. I'd like to introduce Dr. Kadlec. Dr. Robert Kadlec: (15:13) Dr. Falchi, thank you very much and good afternoon everyone. [inaudible 00:15:16] is providing unprecedented operational and logistical support to the State Department to repatriate approximately 1100 Americans from China and from the Diamond Princess Cruise ship in Japan. We are pleased that the passengers evacuated from China have completed their 14 day quarantine, and have returned to their homes and families safely. Passengers evacuated from the Diamond Princess are in the process of completing their 14 day quarantine, had two DOD installations, one in California and one in Texas. Medical professionals from our National Disaster Medical System and CDC are continually monitoring the health of these passengers. Any passengers that show signs of any illness are moved off the DOD facility and tested for this virus. Passengers who are tested positive for this coronavirus cannot stay on the military installations, and these patients are being transported safely to a network of special pathogen treatment centers such as the University of Nebraska Medical Center, as part of our aggressive containment posture. Dr. Robert Kadlec: (16:17) These individuals are being placed in these facilities for quarantine and isolation purposes only, An intensive level of medical care is not typically needed by most of these individuals. At these centers, the patients who develop this infection can participate in the clinical trial that Dr. Falchi described with Regeneron. We are honored to have helped NIH to arrange that clinical trial within this special network of treatment centers. Dr. Robert Kadlec: (16:41) In addition, our Biomedical Advanced Research Development Authority, BARDA, is working with Regeneron to develop two possible treatments and Janssen Johnson and Johnson to screen existing and investigational treatments in compounds to identify any that have potential use in treating coronavirus, and with Janssen and Santa Fe to develop vaccines using vaccine technology that the HHS supported for pandemic influenza vaccines. We're reviewing hundreds of proposals for additional therapeutics and vaccines, and in particular diagnostics they can be used in hospital and clinical labs or doctor's offices. Dr. Robert Kadlec: (17:18) We're also prepared to support CDC and Department of Homeland Security at designated military installations where Americans returning to the U.S. on commercial flights can be quarantined based on their travel history. The most recent location to receive such a traveler is a Naval base in Ventura County, Point Mugu, where one American is currently completing quarantine. Any quarantine in any of these military installations would not have any symptoms or positive test result. Quarantine is based solely on their travel history that places them at high risk for possible exposure. Their health is continually monitored and they're transferred safely to medical facilities for testing and treatment if any symptoms develop. It is now my pleasure to introduce Dr. Steven Hahn from the FDA. Dr. Stephen Hahn: (18:05) Thank you, Dr. Kadlec, and thank you for the opportunity to update you today on FDA's coronavirus activities. The FDA plays an essential role in overseeing our nation's medical products as part of our vital mission to protect and promote public health including during public health emergencies. The FDA is an active partner in the novel coronavirus response, working closely with our government and public health partners across the U.S. Department of Health and Human Services, as well as our international counterparts. Our work is multifaceted, focusing on actively facilitating efforts to diagnose, treat, and prevent the disease, surveilling the medical products supply chain for potential shortages or disruptions, and helping to mitigate such impacts as necessary, and leveraging the full breadth of our public health tools as we oversee the safety and quality of FDA regulated products for American patients and consumers. I'm happy to answer questions about FDA's activities, but I'll provide a few updates. Dr. Stephen Hahn: (19:06) First of all, the supply chain. FDA is keenly aware that the outbreak will likely affect the medical products supply chain, including potential disruptions to supply or shortages of critical medical products in the U.S. We are proactively reaching out to hundreds of medical product manufacturers to gather information about the supply chain. First, it's important to note that FDA is not aware, not aware, of any medical product shortages at this time. We are, however, monitoring several products that might be at risk, particularly personal protective equipment, but we do not have any manufacturer shortages to report. Please be assured if a potential shortage or disruption of medical products is identified by the FDA, we will use all of our available tools to react swiftly, and mitigate the impact to us patients and healthcare professionals, and we will take steps to quickly share that information with the public. Dr. Stephen Hahn: (20:04) With respect to inspections. For February and March, FDA's identified approximately 100 scheduled inspections in China, the vast majority of which are routine surveillance inspections. Those inspections are just postponed at this time and will be conducted at a later date. It's important to remember that these delayed routine surveillance inspections can happen at any time during the year, and while inspections in China are delayed secondary to the State Department travel advisory, we will send investigators to other parts of the world to ensure we are on schedule for our planned inspections for the year. Dr. Stephen Hahn: (20:41) Also would like to remind everyone that the inspections are just one tool that FDA can use to monitor compliance, and to help prevent products that do not meet FDA standards for entering the U.S. marketplace. This process has a number of layers in place and is not solely reliant on boots on the ground inspections. Dr. Stephen Hahn: (20:59) Overall, this remains an evolving and very dynamic issue that we will vigilantly monitor. We are committed to continuing to communicate with the public as we have further updates. Thank you. Alex Azar: (21:10) Great. Thank you, Hahn. At this point, why don't we open up for questions? Yes. If you could just wait for the microphone so the TV cameras can hear your question. Speaker 1: (21:22) Thank you, Secretary Azar, I'm [inaudible 00:21:25] China's [inaudible 00:21:26] media. My first question is, as China's coronavirus cases seems to be contained, while there is other countries like Italy, Japan or South Korea seems expanding, I wonder are you considering loosen the risk travel restrictions regarding foreigners with travel history from China while considering imposing travel restrictions with travel histories regarding the above three countries, and also I noticed that you were still referring the COVID-19 as China coronavirus. Well, I think that were to change this to COVID-19 because they think that China coronavirus might lead to xenophobia or racism. Do you think it's proper to still refer it to China coronavirus? Thanks. Alex Azar: (22:17) So, we intend to keep our travel restrictions with regard to China in place at the moment. The virus is still spreading in China. We're still having hundreds of case reports per day, if that's capturing all of the information. We're still seeing dozens or more fatalities reported per day. We certainly hope that China is able to engage in effective containment measures to slow the spread of this virus down, but there's nothing at this point that would indicate a change in our posture towards our aggressive containment measures with regard to travel in China. It's important though to remember we've been very moderated and titrated in those travel measures. They simply are based on 14 days, which is the maximum predicted incubation period, and so an individual who has been in China for the previous 14 days who is a foreign national, would not be permitted to enter the United States, and an American or permanent resident would be permitted to return to the United States of course, but asked to home isolate during the completion of a 14 day period outside of China. Alex Azar: (23:24) That is not a ban. That is a temporary restriction in line with the public health measures that we're taking. So, we've tried to be very respectful towards travel, and of course those restrictions are not based on other than American and permanent resident versus non Americans, really is a matter of focusing our resources. They're not based on the ethnicity of an individual or anything else, because as you mentioned, it is important that people not believe that because somebody's ethnicity, they are more likely to have this disease or not. Our criteria are all based on travel and effected areas and warning people about travel and infected areas based on the epidemiology on the evidence. So, Brianna, did you have? Yes. Brianna: (24:13) So, thank you, Secretary Azar. So, the CDC said this morning that Americans should prepare for their every day lives to potentially be disrupted by the inevitable spread of the current virus in the U.S. Your comments haven't gone quite as far, and the President also tweeted that everything is under control. Can you address the difference in messaging? Then secondly, given what you know now, are you expecting community spread in the U.S. in the near future, and how confident are you that the U.S. is prepared to respond? Alex Azar: (24:43) Okay. Let me ask Dr. Schuchat if she could speak to the CDC's discussion this morning. Thank you. Dr. Anne Schuchat: (24:48) Thank you. I think Dr. Messonnier talked about the potential for community transmission and helping Americans think about what that would mean. I think to help Americans frame what to expect, it's helpful to think about a bad flu year, or even the 2009 pandemic where in different locations at different times, the circumstances required different measures. The idea of exactly what that will look like in the United States is hard to say, and of course the images we've been seeing from China, from Hubei province, are quite different from what we would expect in the U.S. context. So, I think what's really important for people is to stay informed, stay aware, and to learn about the circumstances. We really think every every day measures like covering your cough or sneeze, staying home when you're sick, are very important, and of course the evergreen wash your hands. Dr. Anne Schuchat: (25:44) We do know that at the beginning of the H1N1 pandemic, schools were closed. That's one of those social distancing community mitigation tools. While schools were closed briefly until we learned more about the virus and what to expect, and we realized that the trade off between the disruption of school closures and the benefit of school closures for that particular virus, the equation suggested we didn't need to do that, and instead we moved to a message of children staying home when they were sick. So, I think Dr. Messonnier's comments were really to frame what might happen in the future. It's very important to say that our efforts at containment so far have worked, and the virus is actually contained here in the United States. We don't want to delay thinking about other possibilities and it was really an educational moment that she talked about. Alex Azar: (26:38) Yes. Speaker 2: (26:42) Hi, this is [inaudible 00:26:43] with AFP. Just on the transmission, I understand it's primarily respiratory, but is any more confirmed information about the possibility there had been a few isolated papers on asymptomatic and the fecal oral route, and for the FDA, the question was what sort of personal protective equipment are we talking about, face masks and that sort of thing? Alex Azar: (27:07) Okay, great. Let me ask Dr. Falchi perhaps, and then Dr. Hahn. Dr. Tony Fauci: (27:11) So, anecdotally, it's clear that there are people who would judge to be asymptomatic when questioned, who very likely transmitted infection during the period of time that they were in the asymptomatic state. The question is, is that a predominant modality of transmission, what we call a driver of an outbreak, or is it one that's minor? From talking to people who are over there now, and we're getting more and more information as papers come in to look at to review, it looks like A, it does occur, but B, it is not something that is the predominant way that it's transmitted. Now obviously you need to be aware of that, and issues of testing and things like that, but I think we're getting closer to a better understanding of that. Alex Azar: (27:56) Dr. Hahn. Dr. Stephen Hahn: (27:58) In terms of PPE or personal protective equipment, we're talking masks, respirators, gowns, and there's no question that there's pressure on the demand side here. So, we're keeping a very close eye on this and a forward leaning approach, because we may in fact see some effect on the supply chain there. Alex Azar: (28:18) Yes. Sophie Tatum: (28:18) Sophie Tatum with ABC News. Earlier today, members of Congress had a lot of questions about whether or not the emergency supplemental requests would be enough, and I guess, can you kind of offer some insight on how you guys came to that number, and why you feel that will suffice? Alex Azar: (28:34) Sure. So, the supplemental request would offer us $2.5 Billion of spending. First, it's important to know, that's money to be spent in 2020, so that's between now and September 30th of this year. We would have a provision authorizing carryover spent into 2021 fiscal year if needed, but really is this year spending, and we told the appropriators is we're in the middle of looking at the next year's appropriation, so, let's work together on that on top of, in addition to, any additional needs. We'll have a lot more learning. We're learning every day and every week more about this virus and the disease progression, and that will help inform those longer term discussions about 2021. Alex Azar: (29:16) Now, as the $2.5 billion, they said five key areas. First, we've got to expand our surveillance system to be more comparable to what our flu surveillance system is like. We want to test people with flu like symptoms or any potential symptoms that would resonate with the coronavirus so that we can ensure that we have rapid detection, if anybody's getting this. So, that's part on the scale up there. The second is our state and local partners are the front lines of any kind of public health response. We fund about half of state and local public health already, and $675 million a year of emergency response, but we know there will be additional needs with lab testing, contact tracing, etc. Third, vaccine devout R&D. Dr. Falchi talked to you about that. We want to put multiple bets on the table. We have $1 billion in there for vaccine development. We want to have multiple bets on the table and we want to speed- Alex Azar: (30:03) Vaccine development, we want to have multiple bets on the table and we want to speed that along as quickly as possible. Now, we can assess whether there's a need for us to make the market in terms of purchasing. Frankly, this has such global attention right now and the private market players, major pharmaceutical players as you've heard, are engaged in this, that we think that this is not like our normal kind of bioterrorism procurement processes where the government might be the unique purchaser, say, of a smallpox therapy. The market here we believe will actually sort that out in terms of demand, purchasing, stocking, et cetera. But we'll work on that to make sure that we're able to accelerate vaccine as well as therapeutic research and development. Multiple bets on therapeutics also, as Dr. Fauci referred to. And then Dr. Kadlec will lead our efforts, in addition, on personal protective equipment procurement. For instance, scaling up acquisition of N95 face masks, which would be primarily used for healthcare providers to protect them in multiple interactions in the community. Alex Azar: (31:02) Our advice remains as it has been that the average American does not need a N95 masks. These are really more for health care providers. And also gowns for use in hospital settings, gloves, et cetera. It's that type of equipment that we would add to our existing stockpiles there. Thank you. Yes, back there? Speaker 3: (31:22) Inspector, [inaudible 00:01:26]. Alex Azar: (31:22) And then we'll go to you, thank you. Please, sorry. Speaker 3: (31:27) What you guys are saying and what the CDC are saying, it's a little different. And I think people are a little confused. On one hand you have the president saying, "I think it's going to be under control." Mr. Kudlow saying, "It's tightly contained." You have Senator Graham saying it seems to be getting worse, not better. And the CDC saying that Americans need to prepare because this might get back. Which is it? And what exactly do they need to do to prepare? Alex Azar: (31:57) So, I'm going to ask Dr. Schuchat to talk about some of the advice. But let me start by saying, we're trying to engage in radical transparency with the American public as we go through this. Each of those messages is accurate but addresses a particular aspect of what we're talking about. So for instance, abroad, this is spreading quite rapidly. In the United States, thanks to the president and this team's aggressive containment efforts. This disease, as Dr. Schuchat said, is contained. We are now two weeks with no additional US-based cases. 14 cases on February 11th, 14 cases today. That is a remarkable level of containment here in the United States. The only additional cases we have are ones we imported as part of our humanitarian repatriation efforts. Alex Azar: (32:43) Then we tried to be very transparent with the American public. We hit from day one, said, "We can't hermetically seal off the United States." I stood here at this podium, I stood at the White House press briefing when we announced our initial travel restrictions. And we've always said, "We expect to see more cases." We don't want people surprised if they see more cases here in the United States. That's an important part of transparency. People shouldn't panic when they see new cases. They should know their government predicted we would have them and we have plans in place. Alex Azar: (33:15) And then that gets to what Dr. Messonnier was talking about this morning, which was just previewing for the American people that, as we see additional cases, we actually have tools. We may not yet have a vaccine or a therapeutic. We have public health tools of mitigation that we can and will use. And it's important for people to know we aren't helpless, we have tools. We have, as Dr. Schuchat said, we have actually defined a playbook for taking steps to help if we do see community spread. How broad any type of community spread, we do not know. It is very dangerous to make predictions with a virus, especially a novel virus. But we have tools to deal with it that are reasonable, titrated, and don't excessively interfere of with the economy or individual's lives, necessarily. Alex Azar: (34:02) So all of this is, it's part of the same message, which is, this is a very serious public health condition worldwide. We're taking this incredibly serious here in the United States. We are doing the most aggressive containment efforts in modern history to prevent further spread in the United States. We're going to continue taking those measures. But we are realistic that we will see more cases. And as we see more cases, we might have to take community mitigation efforts. What will those look like? We're being transparent about those also. So it's all to make sure that the American public go on this journey, educating with us. We're keeping people fully informed of what will happen almost so that people could predict what we would do and what we would say in advance because we had been so transparent about what our playbook is and how we think about these issues. Alex Azar: (34:55) Dr. Schuchat, if you'd like. Speaker 3: (34:57) Inspector, can I ask a quick follow up to what you just said there. Do you understand why saying things like, "Prepare to have your schools closed and have plans for your kids for daycare. Be prepared for telework." You have members on on the Hill asking or telling you they don't think the US is ready. Do you understand why that set off some alarm bells? Alex Azar: (35:15) I can't account for people on the Hill and what they say. Speaker 3: (35:19) But what I'm talking about is when people hear all of this on the news tonight, it set off some alarm bells for folks today. Alex Azar: (35:25) And I would like Dr. Schuchat to discuss what Dr. Messonnier was speaking about. Which again is about transparency about potential actions or measures in the future. Part of preparedness is an educated population thinking about the future. We hope those steps aren't necessary. We hope that we don't face those kinds of eventualities. But transparency is being candid with people about what the continuum of potential steps are so that they can start processing in their own heads, thinking about in their own lives what that might involve. Might! Might involve, not will. We cannot make predictions with any degree of certainty about how a virus will spread or what will happen. What we can say now is that thanks to our aggressive containment efforts, we have contained the spread of this into the United States. 14 cases now for two weeks solid. And we're going to keep working to contain the spread of this. But if we need to, we'll take appropriate public health measures to help mitigate that. Dr. Schuchat? Dr. Anne Schuchat: (36:23) Sure. Yeah, and just to elaborate on the steps. When we think about community measures, not just the aggressive containment around each individual case, what we do in around all their context. We think about the individual or personal steps at mitigating spread. Things like staying home when you're sick. We think about the community steps. Things like a different approach to gatherings. Perhaps if you're elderly with underlying conditions you might not go to that big concert and others could. We also think about environmental measures. Things like cleaning commonly touched surfaces a little bit more than you might otherwise. A big focus is the health care system and really using it appropriately and not overusing it or underusing it. And helping people, helping the healthcare system be prepared. But also helping consumers, patients know what to expect. When they want to seek care. When to call a nurse line instead of going to the doctor's yourself. Dr. Anne Schuchat: (37:21) So I think this playbook that Dr. Messonnier laid out was really foreshadowing the kinds of things that we may need to do. Of course, we've been watching the situation in China closely. And then of course the recent emergence of community spread in Italy and Iran and South Korea have raised questions with people of what might happen here. We want people to be ready in terms of if we do see community spread, what would that mean to you? Maybe something different in your community than another community, depends on local circumstances. But we wanted people to look at what that road map might be. We do think that we've done mitigation before. We've learned from the past in terms of what was appropriate, what perhaps was overkill. And we want to educate folks about what we've learned and what they can expect. Speaker 3: (38:09) So could you put into like one sentence, when he said get prepared, what that means if you're a parent, versus if you're my parents in their seventies, versus parents of a young child, versus me. Dr. Anne Schuchat: (38:21) Yeah. What I would say is cdc.gov. There are checklists there for businesses, for employers, for schools, for consumers, for travelers. We've already been educating the public about travel. Here's some places to watch. There's an outbreak, but it's contained. Here's some places where we suggest no travel, do not travel unless it's absolutely essential. So I think that the circumstances are changing. And staying informed is the best thing that people can do. That's really what I would advise. Speaker 3: (38:51) But are you trying- Alex Azar: (38:52) Dr. Fauci. Well, would you ... Dr. Fauci, you have the spotlight. Dr. Fauci, answer the question. Dr. Tony Fauci: (38:57) I see what you're getting about when you ask the question, what you should do. What Dr. Messonnier was saying, nothing that you should do right now. But if it comes to the point where we're going to have to respond with mitigation, these are the kinds of things you might be thinking about, you might have to do. She wasn't telling you anything that you needed to do now. So you need to do nothing different than you're already doing. But she wanted, in the realm of transparency, to let the American public know, "If we need to mitigate, these are the kinds of things you might want to think of." And that's why I think, there's no incompatibility with what we're saying here and what she said. Speaker 3: (39:37) Thank you, sir. Alex Azar: (39:38) Thanks. And behind Chris here, Yes, thank you. Jeannie Baton: (39:42) Hi. [Jeannie Baton 00:09:43] with Bloomberg Law. Thank you. I wanted to ask about the Influenza Surveillance System and the use of it. And if you're seeing an increase in flu-like or pneumonia symptoms that end up testing negative, that could potentially indicate that the current evaluators might be circulating. And then separately, when do you think the Sentinel System for the coronavirus might be up and running? Dr. Anne Schuchat: (40:04) Yeah, thank you for those questions. Our influenza surveillance uses a number of different approaches and every week we update that data at cdc.gov and FluView. What we're doing is adding a test for coronavirus to the individuals who are presenting with influenza-like illness. We're still in the midst of influenza season and a very high proportion of those specimens are showing influenza of one type or another. But as we add the coronavirus we hope to detect, before it gets widespread, the occurrence of this if it is out there in the community. We're already beginning this effort in five sites. And that'll be kind of rolling out over the next couple of weeks. And learning from that, how to expand it throughout the nation. So essentially it's adding the PCR, or polymerase chain reaction, test for coronavirus to the other testing for influenza that the public health labs are already doing in this Influenza Surveillance System. Alex Azar: (41:06) Thank you. One last, how about in the back there? Carol Pearson: (41:07) Thank you. I'm Carol [Pearson 00:11:09], I'm with The Voice of America. Just for a reality check, I would like to see a comparison between the lethality and transmissibility of this novel coronavirus with influenza, the current strain that's going around. And I would like to also find out if, during the Ebola outbreak in West Africa between 2014 and 2016, the CDC helped the Liberian government run PSAs about how to protect yourself from getting this. Given the fact that an MIT study just showed that only six to 7% of people wash their hands properly, meaning 15 seconds with soap and water, are there any plans for that? Alex Azar: (42:02) Thank you. Dr. Fauci perhaps, could you talk about the comparability? Or Dr. Schuchat? Either of you? Dr. Tony Fauci: (42:05) Will you do the hands, I'll do the ... So Carol, a standard flu season, seasonal flu, the lethality is 0.1%. Right now, depending upon what the denominator is, the lethality for the current coronavirus infection is somewhere around 2%. If you do different studies that are coming out, 2.5, 2.6, 1.9, about 2%. if you compare it to the SARS outbreak, it was nine to 10%. MERS was 36%. And then if you go through the history of pandemic influenzas, depending upon the year, anywhere from 0.5, 0.6%. When you get to the 1918, it's 1.5 to 2%. Dr. Anne Schuchat: (42:57) Yeah. And in terms of the consumer education and hand washing, we are always trying to promote hand washing. And that's a core message for childcare, kids, and for the American public during influenza season. And I would expect to see more of the types of approaches to promoting hand-washing. Perhaps trying to integrate a little bit more of the innovative approaches and not the old sort of PSA approach. Alex Azar: (43:23) Great. Thank you. Thank you all very much. And we're going to keep trying to do these briefings. I want to make sure they're as regular as possible so that you and the media have access to us to get your questions answered. Of course, we have our regular CDC morning briefings approximately two to three times per week. As well as other events where we've got, I think every single day, senior leaders out in the media. But we're going to keep doing that to make sure we're very available and giving you information and assessments as we have them. So thank you very much.