Transcript: U.S - transcription powered by Happy Scribe

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This is a the HHS briefing on the China girl China Corona virus, 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 action administration is taking to respond to the outbreak and keep Americans safe. I'm going today by dr. And shook it. The principal deputy director of the Centers for Disease Control and Prevention in Atlanta, Dr. Tony Foushee of the National Institute of Allergy and Infectious Disease.

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Dr. Robert Catholic HHS, Jessi's Assistant Secretary for Preparedness and Response. And Dr. Steven Hahn, the commissioner of Food and Drugs.

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As of this morning, we still have only 14 cases of the China Corona virus detected here in the United States involving travel to China or close contacts with those travelers. We have three cases among Americans repatriated from Suhan, 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.

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So far, the immediate risk to the general American public remains low. But as we have warmed, that has the potential to change quickly. There is now community transmission in a number of countries, including outside of Asia. That's deeply concerning. And communities spread and 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 viruses potential spread in the United States because we will likely see more cases here, as we have said throughout this episode.

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Dr. Shooken 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. 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, public health leaders were monitoring it and beginning to prepare to travel. Restrictions that the president put in place at the beginning of this month have given our country valuable time to continue to prepare.

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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 dollars in funding available for preparedness and response to five major priorities within the supplemental request, which I underscored this morning before the Senate Appropriations Committee. First, we need to expand our surveillance work building on an existing system we have within CDC 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.

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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 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.

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Dr. Fowlkes, you 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 these strategic national stockpile. The topic that Dr. Catholic can address, I'll conclude by noting that those scheduling conflicts prevented this briefing from including other members of the president's Corona Virus 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.

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This morning, Dr. Messineo from CDC provided the usual telling briefing. That's Dr. Shrinking Wallets. We'll 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 on the president's task force on our preparations to keep Americans safe.

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With that, I'll hand things over to Dr. Shook it for an update from the CDC.

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Well, 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 U.S. government's response to the spread of a novel corona virus into our country began as soon as reports of an unidentified flu like illness emerged from Wuhan, China.

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The U.S. 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 communities spread. Our travel notices are changing almost daily as we get new information and we believe those precautions are working. So far, as Secretary Azar described, the public health system has detected 14 cases in travelers or very close contacts of travelers here in the United States.

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Among passengers repatriated from by the State Department, from Walheim, China, and from the Diamond Princess, there are an additional three 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 communities 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.

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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 and 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 under our current aggressive containment posture? Patients infected with the Corona virus who have mild or no symptoms are being placed in health care facilities for very close observation and isolation.

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That intensive level of medical care is not typically needed as we've watched these cases and learned over the past several weeks. We realize 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 Corona Virus or Kogut, 19, would be management at home through home isolation with use of health care facilities only as needed for those who have severe presentations. But the elderly, those with medical conditions require a closer observation.

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We will maintain for as long as practicable 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.

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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 of a 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. Mazzoni of the CDC today. We've begun laying out for the public what it will look like to mitigate the spread of the virus.

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There are obvious common sense to. Good hygiene. Social distancing. Things like staying home when you're sick. Things we talk about during a difficult flu season or things that we talked about during the 2009 H1N1 pandemic. 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.

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We are committed at the CDC and across HHS and the U.S. 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. Faraji for his update.

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Thank you very much. And I'm going to have 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, he 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 border from Asper and even independent individuals that we have been involved in collaborating with for a period of time.

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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 phase one trial. Well, I'm happy to report to you this afternoon that we are on time, at least that maybe even a little better.

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The 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 an energetic and it's now getting ready to go through the regulatory issues of getting it to go. So I would project that we would be at a human trial. I would say within a month and a half. And I had thought maybe I should cut a week or so off again. Hopefully no further glitches.

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Another thing we need to understand, because we want to make sure people don't get confused that getting a vaccine into a Phase 1 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 protective. Once you do that, you graduate to a much larger trial. The end of the number of people in the phase one trial is forty five.

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When you go to a Phase 2 trial, you're talking about hundreds, if not thousands of individuals to determine efficacy. There's a trial they would have to conduct in those countries, in those areas where there's active transmission. 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.

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Now, you shouldn't be discouraged by that because it is certainly conceivable that this issue with this corona virus will go well beyond this 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 in peer trials that were done during the Maris outbreak.

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One of these and there are several that we're considering. It's called ROOM Dissappear, which is a nucleotide analog that is produced by Gilli at 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.

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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 are sick. So hopefully I'll get the opportunity in the future to continue to update on these interventions. Thank you. I'd love to introduce Dr. Dr. Felcher. Thank you very much. And good afternoon, everyone. Is providing unprecedented operational and logistical support to the State Department to repatriate approximately eleven hundred Americans from China and from the Diamond Princess cruise ship in Japan.

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We are pleased that the passengers evacuated from China have completed their 14 day Cordie quarantine and return to their homes and families. Saiful. Passengers evacuated from the done. princess from the process of completing their 14 day quarantine at two D.O.D installations, one in California and one in Texas. Medical professionals from our National Disaster Medical System and CDC are continually monitoring. These passengers carry passengers and show signs of any illness and not the D.O.D. facility had tested for this virus. Passengers who tested positive for this flu virus cannot stay on the military installations.

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And these patients are being transported safely toward network, a special pathogen treatment centers such as the University of Nebraska Medical Center as part of our aggressive containment posture. These individuals are being placed in these facilities for quarantine and isolation purposes. Wholly and 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. Dr. Phil, to describe with him this. We are honored to have helped the NIH to arrange a clinical trial within the special network of treatment centers.

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In addition, our Biomedical Advanced Research Development Authority BARDA is working with Regeneron to develop two possible treatments and with Janssen and Johnson and Johnson to screen existing and investigational treatments and compounds to identify any that have potential use in treating Corona virus. And with Janssen and Sanofi to develop vaccines using vaccine technology that the United HHS supported for pandemic influenza vaccines. We're reviewing hundreds of proposals for additional therapeutics and vaccines and in particular, diagnostics that can be used in hospital and clinical labs or doctors' offices.

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We're also prepared to support CDC and department, Homeland Security and designated military installations where Americans returning to the U.S. on commercial flights can be parenting based on their travel history. The most recent location to receive such a traveler is a naval base of Inter-County Port Point Mugu, where one American is currently completing quarantine. In quarantine in any of these military installations would not have any symptoms or positive test result. Quarantines based solely on their travel history that places them at high risk for possible exposure.

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Their health is continually monitored and they're transferred safely to medical facilities for testing and treatment. If any symptoms develop, it is not my pleasure to introduce Dr. Steven Hahm from the FDA. Thank you, George Carlin. And thank you for the opportunity to update you today on f.d.r.'s coronavirus activities. The FDA plays a central 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 Kronen Virus Response.

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Working closely with our government and public health partners across the US 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.

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I'm happy to answer questions about FDA use activities, but I'll provide a few updates. First of all, the supply chain is keenly aware that the outbreak will likely affect the medical products supply chain, including potential disruptions to supplier shortages of critical medical products in the US. 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.

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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 health care professionals. And we will take steps to quickly share that information with the public. With respect to inspections for February and March, FDA has identified approximately 100 scheduled inspections in China.

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The vast majority of which are of 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 delay of 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 plant inspections for the year. I 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 US marketplace.

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This process. Has number of layers in place and is not solely reliant on boots on the ground inspections. Overall, this remains an evolving and very dynamic issue that we will deal vigilantly monitor. We are committed to continuing to communicate with the public as we have further updates. Thank you. Thank you, Doctor. At this point, one of the other out for questions. Yes. You just wait for the microphone. So the TV cameras can hear your question.

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Thank you. Secondly, I am all your job with China's state media and the first questions as China's Colonel al-Marri's case seems to be contained. Well, there are other countries like Italy, Japan or South Korea seems expanding. And why are you considering loosen the risk travel restrictions regarding fires? Was travel history from China? Well, considering imposing travel restrictions with no travel histories regarding about sweet countries. And also, I noticed that you were still with farming the Cobia 90 as China coronavirus.

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Well, I think people think that. But to change this, I took over at 19 because they think that China may lead to like then a phobia where misses them. Do you think it's proper to do like refer it to China? I think so.

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We intend to keep our travel restrictions with regard to China and place at the moment. The the fact 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.

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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.

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That is not a ban. That is a temporary restriction and in line with the public health measures that we're taking. So we've tried to be very respectful towards and towards travel. And of course, those restrictions are not based on other than American and permanent resident vs. non Americans. Really, as 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 we not engage in any to the people, not believe that because of somebodies ethnicity, they are more likely to have this disease or not.

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Our criteria are all based on travel in affected areas and warning people about travel in infected areas based on based on the epidemiology and the evidence that you have.

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Yes, sir. Thank you for three days, I said. The CDC said this morning that Americans should prepare for their everyday lives to potentially be disrupted, distracted by the inevitable spread of the virus in the US. 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? And then secondly, given what you know now, are you expecting community spread in the US in the near future?

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And how confident are you that the U.S. is prepared to respond?

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Let me ask Dr. Sugar if she could speak to the CDC discussion this morning. Thank you. Thank you. I think, Dr. Hassan, you 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.

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And of course, the images we've been seeing from from China, from Hubei Province, are are quite different from what we would expect in the U.S. context. So I think what's really important for people is to be stay informed, stay aware and to learn about the circumstances. We really think ever everyday measures like covering your cough or sneeze, staying home when you're sick are very important. And, of course, the evergreen. Wash your hands. We do know that at the beginning of the H1N1 pandemic, schools were closed.

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That's one of those social distancing community mitigation tools. Well, schools were closed briefly until we learned more about the virus and what to expect, and we realized that the tradeoff 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 stay at home when they were sick. So I think, Dr. masumi, his comments were really to frame what might happen in the future.

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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 that she talked about. Yes. Hi, this is Sarma with a P just on the transmission and status movement, primarily respiratory, but is there any more confirmed information about the possibility there've been a few isolated papers on asymptomatic and the fecal oral route and for for the FDA.

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The question was, a, what sort of personal protective equipment are we talking about? Face masks and that sort of thing? Great. Let me talk about you perhaps, and then Dr. Hunt.

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So anecdotally, it's clear that there are people who were judged to be asymptomatic when question who very likely transmitted infection during the period of time that they were the asymptomatic state. The question is, is that a predominant modality of transmission? What we call a driver of an out break? 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, does occur, but B, it is not something that is the predominant way that it's transmitted.

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Now, obviously, you need to be aware that in issues of testing and things like that.

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But I think we're getting closer to a better understanding of that in terms of PDA 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 affect on the supply chain. Yes. Sophie thator ABC News earlier today, members of Congress had a lot of questions about whether or not the emergency supplemental requests would be enough.

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And I guess, can you kind of offer some insight on how do you guys came to that number and why you feel like that will suffice?

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Sure. So so the supplemental request would offer us $2.4 billion in spending. First, it's important. No, 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 carry over overspend into twenty twenty one fiscal year if needed. But really is this year's spending and we told the appropriators is we're in the middle of looking at the next year's appropriation. So let them work together on that.

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On top of in addition to any additional needs and 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 twenty twenty one thousand, 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 need to get. We want to test people with flu like symptoms or any potential symptoms that would resonate with the corona virus so that we can ensure that we have rapid detection if anybody's getting this.

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So that's part of the scale there. The second is our state and local partners on the front lines of any kind of public health response. We fund about half of state and local public health already and six hundred and seventy five million a year of emergency response. But we know there will be additional needs with lab testing, contact tracing, et cetera. Third vaccine developed R&D. Dr. Fouche, you talked to about that. We want to put multiple bets on the table.

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We have a billion dollars in there for vaccine development. We have multiple bets on the table. 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 a unique purchaser, say, of smallpox therapy.

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The market here, we believe, will actually sort that out in terms of demand, purchasing, stocking, etc. 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 Phelps you referred to. And then Dr. Canada will lead our efforts. In addition, on personal protective equipment procurement, for instance, scaling up acquisition of and ninety five facemasks, which would be primarily used for health care providers to protect them and multiple interactions in the community.

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Our advice remains, as it has been, that the average American does not need to need a ninety five mask. These are really more for health care providers and also gowns for use in hospital settings, gloves, et cetera. For that, it's that type of equipment that we would add to our existing stockpiles there. Thank you. Yes. And we'll go you. But as you know, when you guys are saying, well, it's easier saying it's a little different.

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Well, on one hand, you have the president saying, I think he's going to be under control. Mr. Kudlow's say it's time to contain Senator Graham and seems to be getting worse, not better. And the CDC saying that Americans need more air because this might get back. Which is it? And what exactly do they need to do to prepare?

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And so I would ask Dr. Sugar 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 as we go through this.

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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. Shooken said, is contained. We are now two weeks with no additional U.S. based cases, 14 cases on February 11th, 14 cases to day. That is remarkable level of containment here in the United States.

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The only additional cases we have, the ones we imported, that's part of our humanitarian repatriation efforts. Then we tried to be very transparent with the American public. We have 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 room. We announced our initial initial travel restrictions. And we've always said we expect to see more cases. We should. We don't want people surprised if they see more cases here in the United States.

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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. That gets to what Dr. Messineo is taught. 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.

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And it's important for people to know we aren't helpless. We have tools. We have, as Dr. Shooken said, we have actually defined 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 either with the economy or individuals lives necessarily.

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So all of this is it's part of the same message, which is this is a very serious public health condition worldwide. We are 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.

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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 jury 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.

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Dr. Phil, if you'd like to follow what you said there, you understand why things like prepare to have your schools closed and have plans for your kids for daycare. Be prepared for how lower you have members on the Hill asking or telling you they don't think the U.S. is ready. You understand what is so awesome. I can't account for people on the Hill and what they say we are. Yeah, but oh, but we're all here tonight. You know, it s more about for folks like Dr.

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Sugar to discuss what Dr. Messineo 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 are necessary. We hope that we don't face those kind of eventualities. But transparency is being candid with people about what the continual look 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.

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We cannot make predictions with any degree of certainty about how a virus will spread, 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. Phil, good shape.

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Yeah. And just to kind of elaborate on the steps, when we think about communities measures, not just the aggressive containment around each individual case, what we do in our in all their contexts, 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. You know, perhaps if you're elderly with underlying conditions, you might not go to that big concert.

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And others could also think about environmental measures, things like cleaning up, commonly touch 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 under using it and helping people having the health care system be prepared, but also helping consumers. Patients know what to expect when they want to seek care. Went to call a nurse line instead of going to the doctor's herself. So I think these this playbook that Dr.

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Masini 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 in 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 communities spread, what would that mean to you? Maybe something different in your community than another community depends on local circumstances.

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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.

[00:38:09.02]
So people have loved that's when she said get prepared. What that means if your. You're a parent first. Your or my my parents and they're 74 year old or me. What I would say is CDC dot 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 are some places to watch. There's an outbreak, but it's contained. Here, some places where we suggest no travel.

[00:38:40.07]
You know, 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 that's really what I would advise. General, would you need to talk about it in the spotlight of the world? I see what you're getting about when you ask the question, what you should do with doctor, miss. And Jay 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.

[00:39:13.09]
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 already doing. But she wanted it 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.

[00:39:39.07]
But Chris. Yes. Hi, I'm Jeanie down 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 pneumonia, symptoms that end up testing negative, that could potentially indicate that the credit virus might be circulating. And then separately, when do you think the sentinel system for the current virus might be up and running? Yeah. Thank you for those questions.

[00:40:06.00]
Our influenza surveillance uses a number of different approaches and every week we update that data at CDC that got bird flu. What we're doing is adding a test for coronavirus to 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 the coronavirus, we hope to detect before it gets widespread the occurrence of this if it is out there in the community.

[00:40:37.02]
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 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.

[00:41:01.00]
Thank you. One last in the better. I'm Carol Pearson, I'm with The Voice of America just for a reality check. I would like to see the comparison between the lethality and transmissibility of this novel coronavirus with influenza. The current strain that's going around.

[00:41:27.04]
And I would like to also find out if the Ebola outbreak in West Africa between 2014 and 2016.

[00:41:37.00]
The CDC helped the Liberian government run. PSA is about how to protect yourself from getting this.

[00:41:45.08]
Given the fact that an M.I.T. study just showed that only 6 to 7 percent of people wash their hands properly. Meaning? Fifteen seconds with soap and water. Are there any plans for that?

[00:42:02.00]
Thank you, Dr. Patrick, perhaps. Can you talk about culpability or the focus and other of it into the hands? I'll do so, Carol. The standard flu season. Seasonal flu. The lethality is zero point one percent right now, depending upon what the denominator is. The lethality for the current coronavirus infection is somewhere around 2 percent. You know, if you do different studies that are coming out 2.5, 2.6, 1.9. But 2 percent, if you compare it to the SARS outbreak, it was 9 to 10 percent.

[00:42:40.07]
Nair's was 36 percent. And then if you go through the history of pandemic influenza is depending upon the year anywhere from point five point six percent when you get to the 1918 is 1.5 to 2 percent. Yeah. In terms of the consumer education and hand-washing, we are always trying to promote hand-washing. And, you know, that's the core message for child care's 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.

[00:43:23.02]
Great. Thank 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 the media access to us to get the 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 almost, I think every single day senior leaders out in the media. But we're gonna keep doing that to make sure we're very available and giving you information and assessments as we have them.

[00:43:50.08]
So thank you very much.