“It’s not so much a question of if this will happen anymore but rather more a question of exactly when…”
EDITOR’S NOTE: At a minimum, everybody should understand what is presented below in bold. If you are not a reader, then just read what’s bolded.
from CDC.gov (excerpt of transcript of telebriefing on February 26th, 2020, bold and bold added for emphasis):
The global novel coronavirus situation is rapidly evolving and expanding. There are still a lot of news coverage about community spread in a few countries since the last time we talked. This means that cases of COVID-19 are appearing without a known source of exposure. Communities include Hong Kong, Italy, Iran, Singapore, South Korea, Taiwan, and Thailand. Community spread is often a trigger to begin implementing new strategies tailored to local circumstances that blunt the impact of disease and can slow the spread of virus. The fact this virus has caused illness – including illness resulting in death, and sustained person-to-person spread is concerning. These factors meet two of the criteria of the pandemic. The world moves closer towards meeting the third criteria. Worldwide spread of the new virus. 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 introduction of disease notably at points of entry. We’ve restricted travel into the United States while also issuing extensive travel advisories for countries currently experiencing community spread. Our travel notices are changing almost daily. We’ve also enacted the first quarantine of this scale in the U.S. And are supporting the state department and HHS in repatriating citizens from high-risk areas. We are doing this with the goal of slowing the introduction of this new virus into the U.S. And buying us more time to prepare. To date, our containment strategies have been largely successful. As a result, we have very few cases in the United States and no spread in the community. But as more and more countries experience community spread, successful containment at our borders becomes harder and harder. Ultimately, we expect we will see community spread in this country. 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 have severe illness. We will maintain for as long as practical a dual approach where we continue measures to contain this disease but also employ strategies to minimize the impact on our communities. At this time, there’s no vaccine to protect against this new virus and no medications approved to treat it. Non-pharmaceutical interventions or NPIs will be the most important tools in our response to this virus. What these interventions look like at the community level will vary depending on local conditions. What is appropriate for one community seeing local transmission won’t necessarily be appropriate for a community where no local transmission has occurred. This parallel, proactive approach of containment and mitigation will delay the emergence of community spread in the United States while simultaneously reducing its ultimate impact. To illustrate how this works, I’d like to share with you some of the specific recommendations made in the document I mentioned last Friday including some of the steps we would take here if needed. This document is called Community Mitigation Guidelines to Prevent Pandemic Influenza United States 2017. It draws from the findings of nearly 200 journal articles written between 1990 and 2016. This document looked at what can be done at the individual and community level during a pandemic when we don’t have a vaccine or proven medical treatment for the disease. We’re looking at data since 2016 and adjusting our recommendations to the specific circumstances of COVID-19. But this posted document provides a frame work for our response strategy. Based on what is known now, we would implement these NPI measures in a very aggressive, proactive way as he have been doing with our containment efforts. There are three categories of NPIs. Personal NPIs which include personal protective measures you can take every day and personal protective measures reserved for pandemics. Community NPIs which include social distancing measures designed to keep people who are sick away from others. And school closures and dismissals. And environmental NPIs which includes surface cleaning measures. NPIs routinely recommended for prevention of respiratory virus transmission include everyday personal protective measures. These are preventive measures we recommend during influenza season. These NPIs are recommended during a pandemic regardless of the severity level of the respiratory illness. Personal protective measures reserved for pandemics include voluntary home quarantine of household members who have been exposed to someone they live with who is sick. Now I’d like to talk through some examples of what community NPIs look like. These are practical measures that can help limit exposure by reducing exposure in community settings. Students in smaller groups or in a severe pandemic, closing schools and using internet-based teleschooling to continue education. For adults, businesses can replace in-person meetings with video or telephone conferences and increase teleworking options. On a larger scale, communities may need to modify, postpone, or cancel mass gatherings. Looking at how to increase telehealth services and delaying elective surgery. The implementation of environmental NPIs would require everyone to consistently clean frequently touched surfaces and objects at home, at school, at work, and at large gatherings. Local communities will need to look at which NPIs to implement and when based on how transmission and disease is and what can be done locally. This will require flexibility and adaptations as disease progresses and new information becomes available. Some of these measures are better than none. But the maximum benefit occurs when the elements are layered upon each other. Some community level interventions that may be most effective in reducing the spread of a new virus like school closures are also the most likely to be associated with unwanted consequences and further disruptions. Secondary consequences of some of these measures might include missed work and loss of income. I understand this whole situation may seem overwhelming and that disruption to everyday life may be severe. But these are things that people need to start thinking about now. I had a conversation with my family over breakfast this morning and I told my children that while I didn’t think that they were at risk right now, we as a family need to be preparing for significant disruption of our lives. You should ask your children’s school about their plans for school dismissals or school closures. If ask if there are plans for teleschool. I contacted my local school superintendent this morning with exactly those questions. You should think about what you would do for childcare if schools or day cares close. If teleworking is an option for you. All of these questions can help you be better prepared for what might happen. CDC and other federal agencies have been practicing for this since the 2019 influenza pandemic. In the last two years, CDC has engaged in two pandemic influenza exercises that have required us to prepare for a severe pandemic and just this past year we had a whole of government exercise practicing similarly around a pandemic of influenza. Right now CDC is operationalizing all of its pandemic response plans working on multiple fronts including specific measures to prepare communities to respond to local transmission of the virus that causes COVID-19. Before I take questions, I want to address the issue of the test kits CDC is developing. I am frustrated like I know many of you are that we have had issues with our test. I want to assure you that we are working to modify the kit and hope to send out a new version to state and local jurisdictions soon. There are currently 12 states or localities around the U.S. That can test samples as well as we are testing at CDC 400 samples were tested overnight. There is no current backlog or delay for testing at CDC. Commercial labs will also be coming online soon with their own tests. This will allow the greatest number of tests to happen closer to where potential cases are. Last, I want to recognize that people are concerned about this situation. I would say rightfully so. I’m concerned about the situation. CDC is concerned about the situation. But we are putting our concerns to work preparing. And now is the time for businesses, hospitals, community schools, and everyday people to begin preparing as well. Over the last few weeks, CDC has been on dozens of calls with different partners in the health, retail, education, and business sectors. In the hopes that employers begin to respond in a flexible way to differing levels of severity, to refine their business response plans as needed. I also want to acknowledge the importance of uncertainty. During an outbreak with a new virus, there is a lot of uncertainty. Our guidance and advice are likely to be fluid subject to change as we learn more. We will continue to keep you updated.