https:/
Suzanne Clark: (41:20)
You’ve been pretty clear that you think there’s a good chance that we’re back at some kind of new normal by the fall [inaudible 00:41:30] and yet we have some questions from the business community about how they should be planning for earlier in the year. And I think this next question from the audience gets to that. Could we roll that question please?
Chris Clark: (41:45)
Hi, Dr. Redfield. I’m Chris Clark, President CEO of the Georgia Chamber of Commerce, and we are excited and proud to have the CDC headquartered here in the Peach State. A lot of people on the call today are really focused on Q1 and Q2 of next year. A lot of us have programs, events, receptions that we plan throughout the year. And I’m curious, what advice do you have for us as we try to plan those events for Q1 and Q2?
Dr. Robert Redfield: (42:13)
Thank you. Very important question. I think that we’re going to still be heavily in mitigation for limiting crowd size, limiting gatherings during that timeframe. So you’re going to, I think, want to be vigilant and smart about it. Outside is better than inside and smaller is better than bigger. I wouldn’t be surprised if a lot of jurisdictions either at the state level or local level still have very significant guidelines for size of crowds.
(42:56)
You can see when I tell you that if 30% of the people in say the Dakotas that got tested are positive, that if you have a crowd size of a hundred people, there’s probably a lot of positives in that crowd that you don’t know about. And this virus is so, so, so easily transmissible. So really, I think you are going to have to plan virtual is going to dominate the scene for the first quarter of 2021. Small limited crowds are going to limit the seat. I don’t think you’re going to have any significant grace from people being vaccinated or people who have antibody from previous infection. So I do think the first two quarters, particularly the first quarter of 2021, and I think most of the second quarter is still going to be a fairly restrictive environment for us when it comes to crowds, crowd events. I don’t think we’re going to start getting out of that until the fall of 2021.
Suzanne Clark: (44:13)
So let me ask you another question that press is reporting that you may be releasing new guidance on quarantine periods from 14 days to seven days. And one of the things you and I talked about backstage that was [inaudible 00:44:30] was the clear and consistent guidance is so helpful. And as the science evolves and the data evolves, it’s really important that we’re spreading good information so the public is getting a consistent viewpoint. So talk to the audience for the quarantine period, if you would.
Dr. Robert Redfield: (44:36)
Yeah, I think it’s really important, I appreciate Suzanne what you said. Agencies like ours have to have the courage to change when we have data that says we need to change. And I will say not everybody understands that. When we thought this fire was, was largely transmitted symptomatically, we then thought, well, if you’re symptomatic, you wear a mask and that will protect my source control so I won’t infect you. But we didn’t realize back in early March that a lot of the infection was actually asymptomatic. And so therefore I don’t know who’s infected. And so if I really want source control, I want everybody to wear a mask. And again, that got into a lot of controversy, how did we change? We change based on data.
(45:32)
So quarantine is… and isolation is a key tool as I mentioned to try to keep this virus from spreading. And a lot of people never understood when, if I was infected, I was told to isolate for 10 days. But if I was not infected, I was told to isolate for 14 days. And a lot of people suggested that maybe I didn’t make any sense because why do I isolate for only 10 days if I am infected? And I isolate for 14 days if I’m not infected? And the reason for that is if I know I’m infected either I got tested and I was asymptomatic, or if I got symptomatic and got tested, we know that the virus shutting within the body when an individual’s infected really does become negligible at 10 days. And that’s why we were able to have people test out a quarantine when they were infected at 10 days.
(46:28)
But the problem with people who were exposed, we don’t know if you’re exposed when does your body start to replicate the virus. And originally we had studies that said the average was 5.2 days. And then later we had studies that said it was 7., I think somethings. Somewhere in the seven days. And so we only had data to really look at when was the probability that I was not going to somehow start shedding the virus. And it turned out that the greatest probability that we would not miss anybody was 14 days. And that’s why we have it.
(47:04)
Now we’ve since done a number of studies because obviously 14 days quarantine has an impact on productivity. 14 days of quarantine also has an impact of whether people quarantine and we’ve done a lot of studies over the spring and summer that we were able to get enough data then that we could model. And you are right today actually. The new guidance will be coming out from CDC. I think they’re doing a press thing as we speak. And that guidance is, again, based on data that we gathered and modeling of that data, that if you isolate for 10 days, that the probability that you will start replicating the virus after that is about 1%. So it’s a balance. It’s not that 14 days is bad. It’s just that, how does society want to balance it? Do you want to get 99.-
(48:02)
… balance it, do you want to get 99.9%, or if we’re 99%, is that good enough at 10 days? That model also shows that if you test, and we’ve done this with the SEC football leagues and trying to gather all this data in some other college groups, if we tested day five, six, or seven, and you’re negative, the model would predict that we’ll define at least 95%.
(48:32)
CDC now is coming out with guidance today to allow people to make those judgments that they can test out at seven days, and they can get out at 10 days, but at the same time, if they want to be the closest to perfect, they can stay in isolation for 14 day. That will be coming out today. I think that’s going to make a big impact. We found a lot of people really don’t isolate for 14 days, and I think getting people to commit to this getting out of the transmission cycle I think is important. That’s the data that will be coming out two days, seven days with the test between day five and day seven, and 10 days without a test.
Suzanne Clark: (49:20)
It feels really important that we, especially with the community leaders on this call and the business leaders on this call that that we’re really getting out this information and that when information changes, it’s because we’ve learned more, we’ve studied more. That’s a good thing and [inaudible 00:49:39] public health, and they’re very intertwined as we report to here, and keeping people out of work and out of school [inaudible 00:49:47], so-
Dr. Robert Redfield: (49:47)That’s right.
Suzanne Clark: (49:50)
… I think balancing this is so important and so hard. Let me try to end on [inaudible 00:49:55] positive note, which is… Well, I’m hoping it’s a positive note. Maybe I’m leading the witness here, but do you think that our experiences as a country with COVID-19 will help us prepare for the next crisis, which seems sure to come in some ways, and do you feel that we’re learning something as… We just talked about how the scientists and doctors are learning as they go. Do you think public is learning too?
Dr. Robert Redfield: (50:21)
I think there’s a lot of lessons here, Suzanne. The first one that I want to emphasize because my time as CDC director’s coming to an end in January, this nation was severely under-prepared for this pandemic. I think we have to call it the way it is. When I became CDC director, I wasn’t prepared to understand how little investment had been made in the core capabilities of public health at what is the premier public health institution in our nation, the premier public health nation in the country. But we really have not invested where we need to be in data, data analytics, and predictive data analysis.
(51:08)
We really haven’t invested in what I call laboratory resilience to make sure that our public health capacity has multiple platforms. When we rolled out our original test, despite all the news, it was not botched. That test worked the day we [inaudible 00:51:22] and the day we… and to this day, where there was a problem is when we manufactured the test for the public health labs around the country so they didn’t have to send it. One of the reagents had a technical flaw, either contamination or actually a design flaw, which was corrected over the next five weeks, and since then, the public health communities had that.
(51:46)
But we had no resilience. We developed that test on a flu platform, which was a low throughput platform, so none of these public health labs had high throughput capacity. There was no resilience in laboratory technicians if they wanted to do any surge in public health workforce. I had some states that their public health contact tracing workforce was less than 50 people. There’s a huge lack of investment, which I hope this pandemic will change.
(52:13)
On the other hand, I am concerned that as the vaccine comes through and we get this behind us, people may forget. I’ve had lots of congressional testimonies on this issue that this pandemic is going to cost this nation straight out probably about $8 trillion. Then as you all know, the indirect cost, and Larry Kudlow and others would say in terms of the economy, maybe another 15, $20 trillion.
(52:39)
It would seem wise for us to invest $100 billion that we need to invest across the nation. Remember, CDC, most of our funding actually goes to the local, state, territorial, tribal health department, and if you look at in many of the states, we’re the dominant funder of the public health infrastructure of both state or local community. That has to be invested in, so that’s the first lesson, not to let that go by and really realize it’s time for this nation to have the public health system that not only we need, but we deserve. I hope that’s one big lesson.
(53:25)
Second lesson for the public I think, and it’s a painful lesson, is how critical it is, is to have harmony and messaging. When you really want to get everybody on board, you got to have clear unified reinforced messaging. I think the fact that we’re still, we’re arguing in the summer about whether or not mask work or not was a problem. I think the fact that we’re arguing about non-surgical… I mean, the fact that we closed health care. We didn’t need to close health care. We needed to maybe close some elective cosmetic surgery, but we didn’t need to have 85% of the kids not get their vaccination [inaudible 00:54:21]. We didn’t need to see individuals no longer seek emergency care, and we saw many more heart attacks at home than we did in people going to the hospital. We didn’t need to see cancer screening stuff.
(54:37)
It needed to be much more thoughtful, much more surgical, much more data-driven. I would say the same for the economy. We didn’t need to have a broad shutdown of the American economy. We needed to have a surgical, thoughtful, data-driven approach that was able to validate the necessity. We didn’t need to shut down schools. I think hopefully what we’ll be able to learn is that it’s important to be thoughtful, step back, not have a tendency to, as I said, the salami approach is we’re going to do it for everything. I think people that fought to get the schools open, like myself, we never wanted the schools opened unsafely, and we never wanted them open irresponsibly. We wanted to work to figure out how to keep them open safely and responsibly because we believed they were great public health value.
(55:33)
I would say the same thing about business. Our nation runs on business, and probably one of the greatest casualties of the pandemic this year was the impact on the business community and as I mentioned, the impact on just general healthcare, the impact on our children’s education. These to me are extremely significant, so I think that’s the lesson too, consistency and messaging and thoughtful surgical interventions that are clearly designed based on data that they have a critical role in helping us impact the epidemic, but I think you’re going to see a lot of books written on this. I know I’m going to do a lot of reflection when I get out in January. I do think that’s key that we owe the next group is what did we learn, what do we learn that works, what did we learn that didn’t work so that the next time this happens, and there will be a next time, this happens, this nation’s much more prepared.
(56:50)
I will say, the last thing I’ll just say is we should celebrate. We really should celebrate the innovation that was brought to bear on this. When you think about it, we have these vaccines now. I said two will be approved before the end of the year, two more probably very soon after that. We have five vaccines now that are moving through the system. When you look at the new therapeutics, when I was sitting here last, say, March and April, I don’t know how many of you know this, but 27% of all deaths in America in April were caused by COVID. 27%. Now, today, it’s about 11%, which is still huge.
(57:35)
Normally, we would think these pulmonary deaths would count for about 6%, but COVID and pulmonary-like illness now, but it was 27%. The mortality in someone over the age of 70 was over 25%, which is not really good. You had a one in four chance of dying. I think enormous impact with the new therapeutics that have been developed both the monoclonal antibodies, remdesivir, some of the anti-inflammatory strategies, and now in the potential for convalescent plasma, many of these therapies too, and you’re going to hear more about it from us I think this week, many of these therapies where it’s monoclonal antibody or convalescent plasma, they actually, and even remdesivir, these therapies need to be given before you get sick enough to go to the hospital.
(58:21)
As soon as you get diagnosed, you need to be able to get into care and get treated. They work to keep you from having to go into the hospital. There’s two phases of the illness: the virus, and then there’s the inflammation. The time the virus is in charge when you’re still out of the hospital, that’s when we need to hit hard with therapy. When we now have mortality in the 70-year-olds, probably somewhere between 3 and 8%.
(58:45)
Then again, it’s to celebrate the innovation that this nation has brought to bear, but that innovation won’t get us where we need to go if we don’t come back to what I said before. We need a public health system that’s robust and [inaudible 00:59:01], and it needs to be throughout the nation. We need to have consistency of messaging so that the American public will come along with us when we’re trying to articulate what are the critical mitigation steps that we all need to take to beat this pandemic.
Suzanne Clark: (59:23)
Well, thank you so much for all of that. I hope you will come back and help us get out clear and consistent messaging about the efficacy of vaccines when it’s time in Q1 for us all to be thinking about that. In the meantime, I think the country also needs more calm wisdom from people like you. We’re so appreciative of your message today, of your hard work and service to our country and its citizens. Thank you. Dr. Redfield.
Dr. Robert Redfield: (59:49)Thanks a lot, Suzanne. [inaudible 00:59:50]. Thanks for the time.
Suzanne Clark: (59:52)
I just want to say to our audience, thank you so much for tuning in. You can catch past episodes at uschamberfoundation.org or on YouTube. Please, stay safe, wash your hands, wear a mask, get your flu shot, and take really good care of yourselves and each other. We’ll see you again soon.
Suzanne Clark: (41:20)
You’ve been pretty clear that you think there’s a good chance that we’re back at some kind of new normal by the fall [inaudible 00:41:30] and yet we have some questions from the business community about how they should be planning for earlier in the year. And I think this next question from the audience gets to that. Could we roll that question please?
Chris Clark: (41:45)
Hi, Dr. Redfield. I’m Chris Clark, President CEO of the Georgia Chamber of Commerce, and we are excited and proud to have the CDC headquartered here in the Peach State. A lot of people on the call today are really focused on Q1 and Q2 of next year. A lot of us have programs, events, receptions that we plan throughout the year. And I’m curious, what advice do you have for us as we try to plan those events for Q1 and Q2?
Dr. Robert Redfield: (42:13)
Thank you. Very important question. I think that we’re going to still be heavily in mitigation for limiting crowd size, limiting gatherings during that timeframe. So you’re going to, I think, want to be vigilant and smart about it. Outside is better than inside and smaller is better than bigger. I wouldn’t be surprised if a lot of jurisdictions either at the state level or local level still have very significant guidelines for size of crowds.
(42:56)
You can see when I tell you that if 30% of the people in say the Dakotas that got tested are positive, that if you have a crowd size of a hundred people, there’s probably a lot of positives in that crowd that you don’t know about. And this virus is so, so, so easily transmissible. So really, I think you are going to have to plan virtual is going to dominate the scene for the first quarter of 2021. Small limited crowds are going to limit the seat. I don’t think you’re going to have any significant grace from people being vaccinated or people who have antibody from previous infection. So I do think the first two quarters, particularly the first quarter of 2021, and I think most of the second quarter is still going to be a fairly restrictive environment for us when it comes to crowds, crowd events. I don’t think we’re going to start getting out of that until the fall of 2021.
Suzanne Clark: (44:13)
So let me ask you another question that press is reporting that you may be releasing new guidance on quarantine periods from 14 days to seven days. And one of the things you and I talked about backstage that was [inaudible 00:44:30] was the clear and consistent guidance is so helpful. And as the science evolves and the data evolves, it’s really important that we’re spreading good information so the public is getting a consistent viewpoint. So talk to the audience for the quarantine period, if you would.
Dr. Robert Redfield: (44:36)
Yeah, I think it’s really important, I appreciate Suzanne what you said. Agencies like ours have to have the courage to change when we have data that says we need to change. And I will say not everybody understands that. When we thought this fire was, was largely transmitted symptomatically, we then thought, well, if you’re symptomatic, you wear a mask and that will protect my source control so I won’t infect you. But we didn’t realize back in early March that a lot of the infection was actually asymptomatic. And so therefore I don’t know who’s infected. And so if I really want source control, I want everybody to wear a mask. And again, that got into a lot of controversy, how did we change? We change based on data.
(45:32)
So quarantine is… and isolation is a key tool as I mentioned to try to keep this virus from spreading. And a lot of people never understood when, if I was infected, I was told to isolate for 10 days. But if I was not infected, I was told to isolate for 14 days. And a lot of people suggested that maybe I didn’t make any sense because why do I isolate for only 10 days if I am infected? And I isolate for 14 days if I’m not infected? And the reason for that is if I know I’m infected either I got tested and I was asymptomatic, or if I got symptomatic and got tested, we know that the virus shutting within the body when an individual’s infected really does become negligible at 10 days. And that’s why we were able to have people test out a quarantine when they were infected at 10 days.
(46:28)
But the problem with people who were exposed, we don’t know if you’re exposed when does your body start to replicate the virus. And originally we had studies that said the average was 5.2 days. And then later we had studies that said it was 7., I think somethings. Somewhere in the seven days. And so we only had data to really look at when was the probability that I was not going to somehow start shedding the virus. And it turned out that the greatest probability that we would not miss anybody was 14 days. And that’s why we have it.
(47:04)
Now we’ve since done a number of studies because obviously 14 days quarantine has an impact on productivity. 14 days of quarantine also has an impact of whether people quarantine and we’ve done a lot of studies over the spring and summer that we were able to get enough data then that we could model. And you are right today actually. The new guidance will be coming out from CDC. I think they’re doing a press thing as we speak. And that guidance is, again, based on data that we gathered and modeling of that data, that if you isolate for 10 days, that the probability that you will start replicating the virus after that is about 1%. So it’s a balance. It’s not that 14 days is bad. It’s just that, how does society want to balance it? Do you want to get 99.-
(48:02)
… balance it, do you want to get 99.9%, or if we’re 99%, is that good enough at 10 days? That model also shows that if you test, and we’ve done this with the SEC football leagues and trying to gather all this data in some other college groups, if we tested day five, six, or seven, and you’re negative, the model would predict that we’ll define at least 95%.
(48:32)
CDC now is coming out with guidance today to allow people to make those judgments that they can test out at seven days, and they can get out at 10 days, but at the same time, if they want to be the closest to perfect, they can stay in isolation for 14 day. That will be coming out today. I think that’s going to make a big impact. We found a lot of people really don’t isolate for 14 days, and I think getting people to commit to this getting out of the transmission cycle I think is important. That’s the data that will be coming out two days, seven days with the test between day five and day seven, and 10 days without a test.
Suzanne Clark: (49:20)
It feels really important that we, especially with the community leaders on this call and the business leaders on this call that that we’re really getting out this information and that when information changes, it’s because we’ve learned more, we’ve studied more. That’s a good thing and [inaudible 00:49:39] public health, and they’re very intertwined as we report to here, and keeping people out of work and out of school [inaudible 00:49:47], so-
Dr. Robert Redfield: (49:47)That’s right.
Suzanne Clark: (49:50)
… I think balancing this is so important and so hard. Let me try to end on [inaudible 00:49:55] positive note, which is… Well, I’m hoping it’s a positive note. Maybe I’m leading the witness here, but do you think that our experiences as a country with COVID-19 will help us prepare for the next crisis, which seems sure to come in some ways, and do you feel that we’re learning something as… We just talked about how the scientists and doctors are learning as they go. Do you think public is learning too?
Dr. Robert Redfield: (50:21)
I think there’s a lot of lessons here, Suzanne. The first one that I want to emphasize because my time as CDC director’s coming to an end in January, this nation was severely under-prepared for this pandemic. I think we have to call it the way it is. When I became CDC director, I wasn’t prepared to understand how little investment had been made in the core capabilities of public health at what is the premier public health institution in our nation, the premier public health nation in the country. But we really have not invested where we need to be in data, data analytics, and predictive data analysis.
(51:08)
We really haven’t invested in what I call laboratory resilience to make sure that our public health capacity has multiple platforms. When we rolled out our original test, despite all the news, it was not botched. That test worked the day we [inaudible 00:51:22] and the day we… and to this day, where there was a problem is when we manufactured the test for the public health labs around the country so they didn’t have to send it. One of the reagents had a technical flaw, either contamination or actually a design flaw, which was corrected over the next five weeks, and since then, the public health communities had that.
(51:46)
But we had no resilience. We developed that test on a flu platform, which was a low throughput platform, so none of these public health labs had high throughput capacity. There was no resilience in laboratory technicians if they wanted to do any surge in public health workforce. I had some states that their public health contact tracing workforce was less than 50 people. There’s a huge lack of investment, which I hope this pandemic will change.
(52:13)
On the other hand, I am concerned that as the vaccine comes through and we get this behind us, people may forget. I’ve had lots of congressional testimonies on this issue that this pandemic is going to cost this nation straight out probably about $8 trillion. Then as you all know, the indirect cost, and Larry Kudlow and others would say in terms of the economy, maybe another 15, $20 trillion.
(52:39)
It would seem wise for us to invest $100 billion that we need to invest across the nation. Remember, CDC, most of our funding actually goes to the local, state, territorial, tribal health department, and if you look at in many of the states, we’re the dominant funder of the public health infrastructure of both state or local community. That has to be invested in, so that’s the first lesson, not to let that go by and really realize it’s time for this nation to have the public health system that not only we need, but we deserve. I hope that’s one big lesson.
(53:25)
Second lesson for the public I think, and it’s a painful lesson, is how critical it is, is to have harmony and messaging. When you really want to get everybody on board, you got to have clear unified reinforced messaging. I think the fact that we’re still, we’re arguing in the summer about whether or not mask work or not was a problem. I think the fact that we’re arguing about non-surgical… I mean, the fact that we closed health care. We didn’t need to close health care. We needed to maybe close some elective cosmetic surgery, but we didn’t need to have 85% of the kids not get their vaccination [inaudible 00:54:21]. We didn’t need to see individuals no longer seek emergency care, and we saw many more heart attacks at home than we did in people going to the hospital. We didn’t need to see cancer screening stuff.
(54:37)
It needed to be much more thoughtful, much more surgical, much more data-driven. I would say the same for the economy. We didn’t need to have a broad shutdown of the American economy. We needed to have a surgical, thoughtful, data-driven approach that was able to validate the necessity. We didn’t need to shut down schools. I think hopefully what we’ll be able to learn is that it’s important to be thoughtful, step back, not have a tendency to, as I said, the salami approach is we’re going to do it for everything. I think people that fought to get the schools open, like myself, we never wanted the schools opened unsafely, and we never wanted them open irresponsibly. We wanted to work to figure out how to keep them open safely and responsibly because we believed they were great public health value.
(55:33)
I would say the same thing about business. Our nation runs on business, and probably one of the greatest casualties of the pandemic this year was the impact on the business community and as I mentioned, the impact on just general healthcare, the impact on our children’s education. These to me are extremely significant, so I think that’s the lesson too, consistency and messaging and thoughtful surgical interventions that are clearly designed based on data that they have a critical role in helping us impact the epidemic, but I think you’re going to see a lot of books written on this. I know I’m going to do a lot of reflection when I get out in January. I do think that’s key that we owe the next group is what did we learn, what do we learn that works, what did we learn that didn’t work so that the next time this happens, and there will be a next time, this happens, this nation’s much more prepared.
(56:50)
I will say, the last thing I’ll just say is we should celebrate. We really should celebrate the innovation that was brought to bear on this. When you think about it, we have these vaccines now. I said two will be approved before the end of the year, two more probably very soon after that. We have five vaccines now that are moving through the system. When you look at the new therapeutics, when I was sitting here last, say, March and April, I don’t know how many of you know this, but 27% of all deaths in America in April were caused by COVID. 27%. Now, today, it’s about 11%, which is still huge.
(57:35)
Normally, we would think these pulmonary deaths would count for about 6%, but COVID and pulmonary-like illness now, but it was 27%. The mortality in someone over the age of 70 was over 25%, which is not really good. You had a one in four chance of dying. I think enormous impact with the new therapeutics that have been developed both the monoclonal antibodies, remdesivir, some of the anti-inflammatory strategies, and now in the potential for convalescent plasma, many of these therapies too, and you’re going to hear more about it from us I think this week, many of these therapies where it’s monoclonal antibody or convalescent plasma, they actually, and even remdesivir, these therapies need to be given before you get sick enough to go to the hospital.
(58:21)
As soon as you get diagnosed, you need to be able to get into care and get treated. They work to keep you from having to go into the hospital. There’s two phases of the illness: the virus, and then there’s the inflammation. The time the virus is in charge when you’re still out of the hospital, that’s when we need to hit hard with therapy. When we now have mortality in the 70-year-olds, probably somewhere between 3 and 8%.
(58:45)
Then again, it’s to celebrate the innovation that this nation has brought to bear, but that innovation won’t get us where we need to go if we don’t come back to what I said before. We need a public health system that’s robust and [inaudible 00:59:01], and it needs to be throughout the nation. We need to have consistency of messaging so that the American public will come along with us when we’re trying to articulate what are the critical mitigation steps that we all need to take to beat this pandemic.
Suzanne Clark: (59:23)
Well, thank you so much for all of that. I hope you will come back and help us get out clear and consistent messaging about the efficacy of vaccines when it’s time in Q1 for us all to be thinking about that. In the meantime, I think the country also needs more calm wisdom from people like you. We’re so appreciative of your message today, of your hard work and service to our country and its citizens. Thank you. Dr. Redfield.
Dr. Robert Redfield: (59:49)Thanks a lot, Suzanne. [inaudible 00:59:50]. Thanks for the time.
Suzanne Clark: (59:52)
I just want to say to our audience, thank you so much for tuning in. You can catch past episodes at uschamberfoundation.org or on YouTube. Please, stay safe, wash your hands, wear a mask, get your flu shot, and take really good care of yourselves and each other. We’ll see you again soon.
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