ウィスパリング同時通訳研究会コミュのPart 2 CDC Director Dec 2

Suzanne Clark: (21:51)
So one of the examples I used in the question was schools. And of course we have another audience question here that says, “The CDC, the pediatrics association, WHO, want to keep schools open yet we have districts in the US that won’t open.” It does seem that the school transmission has been lower than we were afraid of when we were first opening schools. What do you think it’s going to take to get schools open and remain open?

Dr. Robert Redfield: (22:17)
Yeah, I think it’s important. I’ve tried to say this every chance I get, so I’m going to say it again. I think it’s important to use data to make those decisions. I was very disappointed in New York when they closed schools, when they hit their 3% point, because as you pointed out, we now have substantial data that shows that schools face-to-face learning can be conducted in K through 12, and particularly in the elementary and the middle schools, in a safe and responsible way. We’ve evaluated a number of schools and we’re not seeing, as you pointed out, cluster infections within schools in any significant way. When we see teachers infected, we’re finding that the teachers are infected from their spouses or their community. When we see students in the school infected, we find out that that was an infection that occurred in the community. We’re not seeing intra school transmission.
(23:25)
So, again, I’ve been a big advocate, and I believe this in my heart, that the public health interests to kids in K through 12 is to have them in face-to-face learning, for all the reasons we talked to them about. Whether that’s where they get their mental health services, where they get food substance programs, where that’s where they get, sadly, that’s where we do get reporting from child abuse, this is where they get significant socialization, obviously we’ve had issues with substance abuse and suicide, as you know. I just think it’s healthy for these kids to be in school. That said, they got to do it safely and they got to do it responsibly, and when this was started over the summer, no one really knew for certain, they thought that these public health measures would work. But now the data clearly shows us that you can operate these schools in face-to-face learning in a safe and responsible way.
(24:21)
So what I’ve asked, and I say to your chambers, is don’t make the decision based on what I say, look at your schools that have been opened and evaluate and see if they’ve been a source for major transmission. And so far when we’ve looked at this, we’ve not found schools to be a major source of transmission. We’ve seen other sources of transmission. Like I mentioned, surprisingly, just family gatherings. So I do think we should use that data and make decisions based on data.
(24:55)
And I do think it’s important that the answer to controlling the COVID pandemic is the answer is not necessarily closure, whether it’s schools or business, et cetera, there may be some strategic closures that makes sense. I’ve been a strong advocate that I don’t think it’s in the best interest of COVID control to have bars open until two o’clock in the morning where people are without their mask drinking in crowded bars, that maybe you should maybe have a hundred people that have 200 people in it. So I do think looking strategically where there could be, but I don’t think we benefit at all in our nation in controlling COVID by broadly shutting down businesses. Clearly, if schools can learn how to do this safely and responsibly, airlines can learn how to do this safely and responsibly, businesses can learn how to do this safely and responsibly. And again, we should use data to define when we’ve defined an industry that poses a unique risk that may require some type of restrictions, rather than these broad restrictions, unfortunately, that happened in the spring and summer.
Suzanne Clark: (26:13)
A couple of interesting things you said there, one was not a physician and not a public health expert but as a mom, the other thing I see is that when schools are closed the kids try to find other outlets for their social entertainment, which is not as controlled a setting as things go to school where there are adults making them wear masks, making them socially distance, et cetera [crosstalk 00:26:36].

Dr. Robert Redfield: (26:38)
I totally agree with you, Suzanne. And I think one of the greatest tragedies early on when schools closed, was the social disadvantaged individuals or the individuals that were in workforces that didn’t have the luxury to telework because they were in some service industry. These mothers, single mothers, how they had to deal with it was they had their kids then go stay with their mother, which is exactly the opposite of what I want to do in protecting the vulnerable. I don’t want to see silent asymptomatic infected children to go stay with grandma who might have diabetes.
(27:24)
So I think really the point is that at least we have the data now, and I really want to applaud the teachers that had the courage to take a chance on the public health advice that was being given, knowing that we were going to be monitoring this very carefully. Also, the parents that had the courage to take the risk. Because in the absence of data, it was all opinion. But that’s what I’m saying now, that’s what I obviously said in the New York situation, that don’t do this [inaudible 00:12:04], look at your data. And I’m glad to see that they’re reconsidering opening at least the schools for the elementary schools, because the truth is we have enough data now, when I say we, each of these jurisdictions, to show that elementary schools are not a source of transmission. And I think when the careful studies are done, you’re going to see kids who are in virtual learning probably have a higher infection rate than the kids that do face-to-face learning.

Suzanne Clark: (28:30)
So the other thread from that last answer had to do with employers. You said if universities have learned how to do it in airlines have learned how to do it, and we certainly know a lot of businesses that have learned how to do it because there are businesses that have never closed. I think this next audience question gets to that. Can we roll that that question please?

Doug Loon: (28:49)
Hi. Good afternoon, Dr. Redfield. I’m Doug Loon and the president of the Minnesota chamber of commerce. Here in Minnesota we have seen growth in community spread that has actually shown up in the workplace and this has caused concerns with availability of workers and threatened certainty among consumers as well. What can you offer as for advice to employers who want to work with their employees to limit community spread through their business?

Dr. Robert Redfield: (29:18)
Yeah. I think you raise a really, really important question that goes over all of this, whether it’s schools, whether it’s businesses, that the key to controlling infection in schools or businesses is just what you said, it’s controlling community spread and how do we control community spread. And I do think it’s just going to come back to… And I don’t know whether a mandate versus non mandate, but I know leadership matters in terms of messaging and that everyone comes to recognize that this is a serious situation. I know that if I hadn’t to walk outside of my car, on the way to the airport from the parking lot in a nanosecond now, I feel like I didn’t put my pants on if I don’t have this mask on. And I can tell you when it started, sometimes I got halfway to the gate before I remembered, people were looking at me and then I realized I didn’t have my mask on. I think making that as such a social norm. And I’m remarkable, I have 11 grandkids now, the youngest one is two. The truth is, all of the ones that are over two, I have I think three, four, five, they’re all wearing their masks when they go do their thing, they’re very conscious of it.
(30:50)
So the more that the community can embrace these mitigation steps, I think is the more that these businesses can start impacting community spread, because that’s really where it’s coming. And if they decide to do the strategic testing that I’ve suggested in some businesses, it also helps them begin to identify in their own workforce where the silent spread is coming into their workforce. And that becomes a very important, I think, tool of identifying the asymptomatic infected individuals, so they don’t become an amplifier within the workforce. Which we know this virus, unfortunately, this virus is really infectious. I think it’s probably the closest thing, and I’m a virologist by training, I think this virus is the closest thing we have the measles we’ve ever seen. It’s interesting that the mitigation we’re doing in this country right now, our influenza rates are at historical lows. We’re still just about to get into influenza season, so I do really encourage everyone to get influenza vaccine, but the reality is our…
(32:03)
And they get Influenza vaccine, but the reality is our spring season of flu, our summer season of flu, and even our early fall season are historical low. So these mitigation steps are really helping, even with the fact that we’re probably only doing them 50, 60, 70% of the American public for flu. But it’s not enough to contain COVID. COVID is really, really, really, really infectious. And unfortunately the reason it’s so infectious as opposed to flu is the instrument of transmission is not a sick person with a cough. The instrument of transmission is an asymptomatic 23-year old that feels great.

Suzanne Clark: (32:46)
So let me turn for a minute, Dr. Redfield, and talk about the vaccine for a minute. Another thing we get a lot from employers and Chambers of Commerce across the country, [inaudible 00:32:55] associations is okay, if early vaccine distribution will go as it should to health care workers, to the most vulnerable populations and then turn to essential workers, how should we be thinking about defining essential worker in that context?

Dr. Robert Redfield: (33:13)
Well, that’s a very good question. As you know, technically the Department of Homeland Security kind of makes those classifications as you know, but obviously each community and I can tell you that someone that supports one of my sons, who’s in recovery, I try to help one of my daughters at starting a family, obviously my own family. If there’s no income coming into the household, there’s a problem. So I mean, everyone I think can re-look at what’s really essential to them to be able to maintain their livelihood. This is one of the reasons I really feel strongly that the knee-jerk response that the control of COVID somehow we have to close things or limit the economy or limit business. I think no, the answer is figure out how to operationalize that business in a safe and responsible way.
(34:19)
And I do think, for me, I actually think teachers are really essential. So I think each community is going to define that there is a technical definition of it by Homeland Security, where they’ve listed and they now do include teachers. So I don’t know, Suzanne, if I really answered your question, if you want to angle it. I mean, I think when I see a single mother raising four kids and she may be doing some type working in a grocery store, or she may be helping provide custodial services, I mean, for her, she’s essential for her and her family.
(35:03)
I do think there is the other aspects of what we need. When we first got into this essential worker issue, where CDC came out with guidance that suggested if you were an essential worker and you were exposed and you were asymptomatic that you could return to that essential job as long as you were asymptomatic and you monitored your symptoms, your employer monitored your symptoms, and you wore a mask. Part of that really came out of when we were in the State of Washington on a visit there where they had a significant number of policemen and firefighters and rescue squad workers were all being isolated, and they didn’t have a fire department. And so this was part of trying to give balance that if there is essential services that are critical to the function, whether it was first responders or whether it’s hospital workers. We had one hospital system in Washington had over 600 healthcare workers out in quarantine, or as in some of our industrial work meat packing plants, et cetera.
(36:12)
So just what we needed. I don’t think this country knows how close we came to having a protein shortage because of the outbreaks that we were having in meat packing plants. I think it’s important for each family to understand that, each group, but I think I’ve become astutely aware that there are a number of people who work that don’t have the luxury that some of us have to be able to continue our work as long as we get on Zoom or we get on a webcast. A lot of these people have to actually go in and work in the environment. Then we need to work hard to figure out how to make that safe and responsible. And we need to honor those people. I mean, you can imagine if all the grocery store workers decided that it was too risky to go to work?

Suzanne Clark: (37:01)
So I guess I’m a little bit confused. I’m a lot confused, but in this topic I’m a little confused, which is if DHS has the role of co-supplying essential workers that you seem to refer to some of these decisions being made at the local level, who is in charge of prioritizing vaccine distribution?

Dr. Robert Redfield: (37:25)
For vaccine distribution, we can come back to that, but for essential workers, it’s DHS. I was just trying to make you at least aware that I’m aware that for individual families, there’s also an arbitrator who they believe is essential. I mean, DHS clearly has essential ones. Okay?
Suzanne Clark: (37:44)Got it.

Dr. Robert Redfield: (37:45)
And so I was just trying to show that I’ve come to understand that the DHS list doesn’t necessarily… I remember a jewelry worker that was supporting his family. He felt keeping his jewelry store was an essential work because without it, he couldn’t support his family. And I’m sure many of you people in commerce understand that a lot of the people that have suffered by having businesses closed. And I would argue that probably didn’t need to be, we didn’t do a strategic decision. It was a salami decision. Well, everybody will do this rather than stepping back. I think now we’re much more smart. We have data behind this, these decisions need to be made.

Dr. Robert Redfield: (38:26)
Now when it comes to vaccines, clearly the issue first it’s exciting that we do have a vaccine. I do think we should give credit where credit’s due when this was first suggested that we’d have a vaccine before the end of the year. I don’t think people saw that as something that was feasible. The reality was the mission was assigned to get a vaccine before January 2021. And as you know, we have two vaccines now with [inaudible 00:38:53] submissions, we have two more vaccines. So we have four vaccines now that are really deep into phase three trials. It’s very probable before February we’ll have, I think probably three to four vaccines approved in the United States, which is really remarkable. And I think we’ll have two have them approved before the first of the year.
(39:17)
The challenge will be that it’s going to be constrained and supply. Ultimately there will be enough vaccine for everybody in the United States that wants to get a vaccine to get a vaccine. I’ve said publicly that I believe that will be somewhere in the second quarter, third quarter of 2021. It’s been criticized by others. But I think those estimates are probably going to be right on target. I do anticipate the vaccine will be starting to be delivered to the American public this month. Currently, the way this will work is we have our advisory committee on immunization practices and have made some preliminary recommendations. And they’ll be modifying those after the UAs are improved in December. But more importantly, we’ve worked since the summer with each of the 64 jurisdictions of this nation, for them to develop what I call the micro distribution plan.
(40:13)
They’re going to get allotment of vaccine based on a macro distribution plan from the federal government. And those allotments have been assigned at least for the first wave of a vaccine that will be distributed this month. And ultimately the individual governors and jurisdiction leaders are going to decide what I call the micro distribution. Okay, fine. The ACIP makes recommendations. CDC makes recommendations through the ACIP, but ultimately it’s the local government that are going to make the decision how that vaccines going to be distributed in their community. And those vaccine plans have all been developed and worked through over the last three months. And I anticipate that will be an evolving situation as more and more vaccine becomes available. And I don’t think it will be unified that every jurisdiction is going to do exactly the same thing.