Hi good afternoon everyone and thanks for joining us.
My name is Rebecca gold
and I'm working at CDC on the COVID-19 response.
I'd like to introduce you to doctor jay butler, CDCs
department director for infectious diseases.
He'll be giving you an up date about what's happening
currently and also be available to answer some
questions.
Doctor butler.
SPEAKER: All right thank you Rebecca.
Good afternoon or good morning everyone depending on
where you are.
So let's start with a situation up date.
I think everybody's become aware of the spread of the
COVID-19 virus since it's original
emergence in Wuhan China in December of this year.
Over the past two and a half months the epidemic has
progressed.
The first two months really China was the center of the
outbreak and Wuhan province in central China in
particular was impacted.
As of now there have been over 80 confirmed cases in
China and over 3,000 deaths.
However as of about a week ago the number of cases
occurring outside of China began to exceed the number
of cases occurring within China.
Both the cause of
spread of the virus around the world and also because
the number of new cases in China has gun to decline.
Outside of China there's been cases reported now from
some 85 nations.
Of course including the United States.
Overall over 10,000 cases have
been reported from outside of China.
The hot spots currently are in the republic of south
Korea, also a number of cases have been reported with
community transmission in
Japan and then the two other regional hot spots are
Europe, particularly with cases I
aminating out of outbreaks that were occurring in
communities in northern Italy and also the eastern
Mediterranean region with cases I aminating from I ran
particularly the talon of cove.
Here in the United States the number of cases has
increased over the past several days.
With reports of cases from 13 different states.
The cases where there's been community transmission
have primarily been on the west coast but not solely on
the west coastthism is a very fluid situation and as
testing becomes available through an increasing number
of state labs as well as in the near future commercial
laboratories we anticipate that the epidemic will
continue to be
recognized and spread will be better defined.
The issues that I think are of greatest concern to us
right now are spread to people who are more vulnerable
for severe illness.
There has been cases in a long term care facility in
the Seattle area where there have been eight deaths
associated with infection.
The illness
itself is one that's primarily a respiratory illness.
As we know more about the manifestations.
We also know that most people about 80 percent have
relatively mild illness although it may involve
pneumonia.
The majority of people actually do recover but there's
still 20 percent that have more severe illness that may
require medical care or hospitalization.
Mortality is an area of great interest to us because as
we assess the impact of the epidemic and what are the
appropriate interventions and considering both the
risks and benefits we want to know how transmissible it
is and how surear is the illnessment you've probably
heard reports in the illness saying it's 200 times more
fatal than influenza.
I think that's probably a biased statement because we
have less visibility on the milder cases.
Our estimates suggest that it's probably less than one
percent but keep in mind if this is a virus that is
capable of infecting the vast majority of people that's
still a very very significant number.
The people at highest risk are those who are elderly
and also those with underlying illnesses particularly
chronic heart and lung disease as well as diabetes.
The interventions to date have focused on how we could
delay the virus in the country
and limit it's spread.
Those are interventions designed to buy us more time to
be able to be prepared for the entry of the virus and
as we move into a time of progresses of mitigation,
recognizing that community spread is occurring in some
locations again the focus is on how do we spread the
impact of the epidemic over as long a period as
possible so that businesses can remain open as much as
possible and so that the impact on health care is not
going to be overwhelming if it can be at all avoided.
This would also give us more time to develop effective
antiviral
medications and ultimately to have a protected and
preventive vaccine.
Even though it may be possible to have a vaccine that's
ready to enter human trials over the next two to three
months because of what's required to show that's
vaccine would be safe as well as effective I think it's
unlikely that we'll have a vaccine for the general
population in less than 18 months.
There is also a wealth of information that's
available on the CDC website that I wanted to call
attention to.
There are guidelines specifically focused on businesses
how to be prepared.
I think the important take homes from that are issues
related to HR and making sure that em plies
are able to stay home if they are sick.
That will be to your benefit as well as your work
forces benefit as well as your customers.
And then also particularly if you're in the public
service sector being able to provide hand hygiene
products whether that be reminding people to wash their
hands or providing jells to san ties hands as much as
possible those would be things that we would recommend.
Guidelines on large events.
Also recommended precautions
preventing the spread in election polling locations.
Prevention of spread in
communities, interim guidance on public health
communications for communities.
Additional resources for health care facilities.
Strategies for optimizing the
supply of N95 respirators which I think is of
particular interest to health care providers in the
health care industry.
Strategy taz prevent spread in long term care
facilities which I think is an area of keen interest
given the concentration of high risk individuals in
these facilities.
General guidance for health care facilities.
Also guidance for institutes of higher education
including specific guidelines for
students wanting to study abroad.
There's also some household readiness guidance and
some documents on combating sigma and also frequently
asked questions for children.
I think I will stop at that point and I understand
there is a cue of questions
already so I will turn it back over to Rebecca.
SPEAKER: I am here.
First question we got in advance was we heard there's
on going research on the life span of the virus.
Could that change the cleaning requirements because
right now the website says there there's no need for
deep cleaning or extra cleaning measures.
Is that going to change?
SPEAKER: This is a broad answer to many questions.
We're still learning this virus.
What we know about it so far which suggests that the
routinely touched surfaces can be cleaned with cleaners
that are typically used.
These would be using products according to the
directions on the label.
We do not have recommendations for specific PPE for
prevention of infection of people who are doing the
cleaning but of course the PPE whether that be gloves
or eye protection that are appropriate for the cleaning
solution itself is important to continue.
The survival of the virus on surfaces is one of great
interest to us right now the epidemiology as well as
what we know about other corona virus's suggest that
it's probably spread through respiratory droplets
meaning droplets that are not air born but may be
projected during coughing or sneezing.
But there is some experience particularly with the sars
virus that suggests that surfaces can become
contaminated and that the survival of the virus could
be for a period of minutes or hours and that it could
be potentially
transferred usually through hand contact.
That's one of the reasons why we have such a
concentration on hand hygiene as well as break the very
difficult habit of putting your hands to your face.
There have been a number of projects assessing the
viability of the virus on surfaces and I think that
backs the current recommendation.
However it's important to recognize that some of this
research has really focused on what are the outer
limits under absolutely ideal conditions which may be
unlikely to achieve in real life.
So if you hear of contaminated surface and virus being
recovered for days that may indeed be possible.
What we don't really have evidence for is that that's a
significant mode of transmission.
Questions have been raised about whether or not mail
and packages could become contaminated.
Also question
business money.
You know right now the epidemiology does not point
toward that particularly as we talk about the mail.
We would've seen more I think met static
infections very early in the epidemic given that China
is very interconnected with the rest of the world and
is a major exporter of products in a number of
different goods.
The epidemiology of the spread out from China has also
been exclusively, travel to China, exposure to someone
who issismmatic and then exposing other people after
return.
In terms of specific products it's kind of the routine
things in terms of sodium hypo chloride meaning bleach
type products or alcohol wipes.
SPEAKER: Great thank you.
Do we know if recovered patients are still capable of
spreading the disease?
SPEAKER: It appears the people who are most infectious
are people who are actively ill.
Persons who are coughing and sneezing of course are
having a harder time controlling their secretions and
more likely to transmit it to people around them.
There is some evidence that people are shedding the
virus shortly before the on set of symptoms and there
is also evidence of asymptomatic infection.
At this point in time we have very limited evidence
that those asymptomatically infected people are playing
a significant role in transmission.
But we are very concerned about that possibility and we
continue to monitor it very closely and continue to
collect data.
For people who have had documented COVID-19 infection
our current strategy is to have those people isolate
whether it's in a health care facility or self
isolation at home until there has been two negative
tests consecutive respiratory specimens and this is
usually a swab up the nose and also in the throat
through the mouth and that both of
those tests would be negative on two different
occasions at least 24 hours apart.
There have been some isolated incidences of tests
collected later that were positive showing a very low
viral load and at this point in time we are still
determining what
the significance of those tests are.
The PCR is a very sensitive assay.
Particularly at lower viral loads.
Detecting not so much a proven viable virus as
certain pieces of the genetic material of the virus in
that genetic material certainly could still be present
even after the active infection is cleared.
SPEAKER: What are the other things we should be doing
to prevent the spread of COVID-19 that are different
from what we're already doing to limit the spread of
flu.
For example we know to wash our hands, general
sanitation.
What additionally should
we be thinking about doing to prevents COVID-19 spread.
SPEAKER: Rebecca thanks for bringing up flu because
first of all although this may seem a little counter
intuitive it's important to get a flu vaccine.
The on going assessment of the flu vaccine effect
ofness this year is about 50 percent.
That is a significant 50 percent so if you can reduce
your risk of flu by half that's a good
intervention.
It also then provides less protection against flu not
only can protect your health but can make the health
care system more robust by avoiding a big in flux of
people with influenza.
The influenza activity right now is at a peek.
Even
though a lot of the focus has been object COVID this
has been a bad flu year.
We started out with influenza B.
As that was declining influenza AHb one N one, the
descendants of the 2009 pan tellic strain has had a
come back.
This second peak is actually much worse than the first.
There have been tens of thousands of people who
have died of influenza this year.
Those are in many ways those are preventable deaths
through vaccination.
Other things that can be done.
You've already mentioned
hand hygiene.
It also comes down to issues like avoiding people who
are sick.
We more and more are doing what we call the pandemic
handshake around here which is bumping of elbows.
People may have also seen some of the news in France
the
government has suggested that people sus spend the
practice of the kisses on the cheeks to be able to
limit that amount of contact.
Lastly for people who are at highest risk of disease
they may want to consider whether or not they're
attending mass gatherings.
There are in the works some other guidelines from the
CDC including -- and a number of those organizations
have already taken steps to minimize the amount of face
to face contact as well as public contact during
services and other religious
activities.
SPEAKER: Thanks doctor butler.
Can you please clarify whether the CDC is
recommending self isolation after returning from any
country with a level three
travel advisory or just China.
SPEAKER: This is a good question because it delays the
fluidity of this situation in how the recommendations
are transitioning to the global aspects of the
outbreak.
I think the short answer is keep an eye on the
cross-examination DC website.
Currently
the recommendations for what we call level three
countries meaning we would recommend for health reasons
to delay all nonessential travel are continue for China
but in the past week have now also included south Korea
Italy and I are an.
There is a level two recommendation for Japan where we
recommend for people who are at highest risk or most
vulnerable also recur travel.
SPEAKER: Are peal still being screened at the
airports?
Are they screening for flights that are returning from
south Korea or Italy and are those people being told
to self monitor and/or self isolate?
SPEAKER: National level the screening is still for the
flights arriving from China.
The steps being taken to address limiting importation
from other countries are
evolving fairly quickly.
We recognize that's whole process of traveler
restrictions is a cost benefit process.
We want to minimize impact on travel and personal
freedoms as much as possible.
Also recognizing that there is a significant economic
impact as well as personal impact on limitations of
travel.
The caveat in that is that some of the states have that
have not yet had any community transmission have
encouraged self isolation or self quarantine actually
for people who are returning
from these high risk countries.
It's important to recognize how the public health in
the country works.
Often times the implementation of public health is at
the state of local level.
SPEAKER: What does CDC recommend as a good source of
information to help companies and businesses decide
whether they should isolate or quarantine individual
who's have traveled or possibly been exposed to either
flu or COVID-19?
SPEAKER: I certainly use that as a chance to plug the
CDC website.
CDC dot gov'
back slash corona virus should take you there.
There's a whole wealth of
information.
And I think I mentioned earlier some of the guidance
for businesses.
If you have comments on that we would actually welcome
that.
I wanted to make sure people were aware that we want to
make sure we're providing guidance that is practicable
and as helpful as possible.
Our goal is to have science and evidence based
guidelines and the science is quickly evolving and may
be subject to change.
Keep that site book marked.
Keep an eye on what some of the newer publications that
show up on that website are.
SPEAKER: What's the best practice for a company should
an employee report flu like
symptoms after travel.
Should they close the office and have the staff work
from home until lab results come back.
If a family member reports symptoms what's a
companies recommended course of action.
SPEAKER: That's a really good question.
The first and most important step is to make sure that
anybody who is sick goes home.
Or if they're seriously I tell contact their health
care provider.
You want to be able to separate those who are sick from
those who are not to minimize transmission.
The words I used were contact a health care provider.
We don't want people to just show up in the clinic and
potentially
sit there for a couple of hours coughing.
We want them to be able to have an interaction with a
health care provider so they can be advised of the best
way to come see a health care provider if that's
necessary and so appropriate infection control measures
can be in place.
If you have an employee who's confirmed to have
COVID-19 I want to just remind everybody that there are
issues related to personal health care information and
so be sensitive to that.
Your HR offices may be able to provide you some
guidance on that.
And in terms of whether or not that means
businesses should curtail activities or potentially
close those are really critical
questions that have to be made on a case by case basis.
So that's where it's very important to contact your
state or local health department for on going advice
and also you can contact CDC as well.
But do keep in mind that you have those local resources
as well.
SPEAKER: Okay.
Is there an infection matrix or any sort of guiding
numbers of
infected people in the population that would indicate a
recommendation to maybe close
scullers cancel public events?
SPEAKER: Yeah another really good question.
Ultimately whether an event is canceled or not depends
on the situation and ultimately will be determined by
the state or local health authorities.
That's where the legal jurisdiction to be able to do
that sort of thing lies.
The role of CDC in that is to be able to provide
guidance to the state and local authorities and to help
them with some of the preparedness activities to help
them be able to do that.
It really comes down to the specifics yesterday CDC
posted mass gathering guidance on our website.
CDC does not have legal authority to cancel local
events or to close schools and that would not be
appropriate anyway because these are decisions that
really need to be made locally.
Ultimately we may see that this epidemic impacts all
parts of the country but right now it is not all parts
of the country and it will be not all over the country
all at once most likely.
In some ways it's kind of like the flu.
Continues to wane as it continues to
increase in other areas.
SPEAKER: Thank you if we're travsee someone with
symptoms who should we report that to?
SPEAKER: It really depends on the situation that
you're in but traveling is a very broad point whether
we're talking about airports or on board a ship or on
an air plane.
Probably the easiest one if you're on a cruise ship
would be to alert the medical staff on board the ships.
I'm sure if anyones traveled recently you've seen a lot
of people wearing masks.
Anticipate that's something that people may be
wondering about because that's a question we get a lot.
The CDC currently does not recommend use of masks in
community settings.
Because of really limited data that suggests there's
any benefit of that.
If someone wants to wear a mask you know I think the
biggest concern right side two fold.
One is just the limited supply of masks that are
available but second of all just anecdotal observation
by one jay butler is I just noticed how many people are
wearing masks keep reaching up to their face to adjust
it.
Just two days ago in an airport I watched someone on
the escalator who continually took their hand from the
hand rail and took it to their
face to adjust their mask.
It's conceivable that they actually could increase your
risk of the in exposed to respiratory virus possibly
including the COVID-19 virus.
SPEAKER: Thanks.
I got the question that originally we were advised to
screen for travel for the past 14 days and we're now
seeing for up to 27 days.
Which is
correct?
SPEAKER: The vast majority of cases where there is a
discreet exposure fall in the range of about four to
seven days.
The outer limits are mostly in the range of two to 14
days.
Just the observation of the various reports and
interpretation of what's
being published in the scientific literature is those
instances of the outliers that are much larger than 14
days are mostly in settings where one there's a lot of
community transmission and it may be very difficult to
isolate just where exposure occurred and two is in
situations where the information for the possible
exposure is being obtained through things like medical
records review which I can say as a physician we don't
document in the medical record everywhere someone has
been and every sick person they've been around in the
last month.
I think that's a very undependable source of
information.
So at this point in time I feel like the two to 14 days
is going to cover the vast majority of cases when we're
looking at what is the most likely incubation period.
SPEAKER: Okay and I know that your schedule is
requiring us to actually wrap this up early but for the
last question I just wanted to ask what's CDCs guidance
on banning travel to specific countries.
SPEAKER: Again the approach to this is to avoid
limiting movement as much as possible.
But striking that balance between what are the risks
and benefits of
limiting travel.
This is an area where we continue to evolve very
quickly and again the level three guidelines which
really do recommend delaying all nonessential travel
focus on China, south Korea, Iran and Italy.
MALE SPEAKER: Thank you so much and thank you
everybody for joining our call.
If we
didn't get to your question please check our website.
We have a feeling the answer will be there and keep
your questions coming and we will try to answer them
and thank
you for your patience and for your attendance today.