Eyes on the Virus: The View from the CDC

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Is working around the clock to produce and stand out more test. That's what the CDC has recommended you know how many CDC is administered these days the Centers for Disease Control and prevention also known as the CDC is probably the most recognized institution managing the Corona Virus Pandemic. They're the ones offering guidelines on symptoms travel and prevention. He might have already been to their website. Given the level of fear and confusion surrounding this pandemic I wanted to talk to one of the. Cdc's top leaders and get answers to some of your biggest questions. I'm Dr Sanjay Gupta. Cnn's chief medical correspondent and this is corona virus fact versus fiction. The American public really needs to steady ourselves for a long haul here. This may be more disruptive than other outbreaks. We've been through. Dr Ranch shook. It is the principal. Deputy Director of the. Cdc This is not her first Rodeo. She's been with the CDC FOR OVER THIRTY YEARS MANAGING RESPONSES TO H One n one SARS and Ebola. I've spent a lot of time with her out in the field. I know we've already talked about the movie contagion but remember Kate. Winslet's character the virus hunter. She was modeled after. Dr Shook it. I asked her if she knows anyone. Personally who has contracted the corona virus? No not yet. But you know the epidemiology that we're seeing suggests that all of us are GonNa know someone you are the principal deputy director of the CDC talk us through a typical day for you now. Typical Day doesn't exist to every day is a new adventure But you know we're taking this really seriously for the past several months and so my days start early and they go late and they involve many calls. After I do get home we have over fifteen hundred. Cdc staff involved in the response so my day is always interesting and always challenging and involves connecting with people around the country the states and local public health. Who are on the frontline. You have worked on lots of pandemics and outbreaks in the past. Have you ever seen a response of this magnitude? The National Guard now just deployed to new. Rochelle all that. We're seeing around the country. The extent of this outbreak in the United States and around the world is is serious I was in in Beijing in two thousand three during the SARS outbreak and I saw firsthand Society really stopped I think we all saw that on. Tv when we saw Wuhan China and then who bay province literally shut down. I think each community will be making some decisions about what's the best strategy for their environment. Cdc's working closely with the state and local public health authorities to provide guidance and advice. I have seen some pretty dramatic interventions in my experience I actually was also in West Africa during Bola but I think for Americans. This is quite surprising and stunning in some of the communities. There's been a lot of news about testing and I WANNA ask you some specific questions about that but I just give me your your taken. Hell has the United States done with regard to testing compared to other countries in the world. The rollout of the laboratory testing to the public health system didn't go as quickly and smoothly as we usually see. We had hoped to be able to skill up the testing at the public health. Labs states and cities earlier than we were able to so that was a bit delayed in most of the country the commercial sector really was slow to take this on and scale up and what we saw in a couple of other countries was rapid. Scale UP OF TESTING. I would say that the jury's out about exactly what's the best way to roll out testing? I've heard from colleagues and other countries about concern that there was so much testing going on of people with no symptoms and people who really were not at risk that it clogged up the healthcare system. So I think right now. We're seeing you know we've done more than eleven thousand tests. I believe between CDC in the state and local public health labs now and the commercial labs are just coming online right now. So I think it's going to be important to use them but I know what the American public to get the impression that the right thing is for every single person who wants a test to get tested that could have negative consequences both for the healthcare system in the testing ability for everyone who really needs it right now if somebody is concerned because they have symptoms. They don't seem to have the flu. Maybe they came in contact with somebody with the corona virus as things stand now dr shook. At how easy would it be for that person to get tested? Well I think an important thing is to be connected with the healthcare system to figure out if you need testing you know. It may not be the best thing to go into a clinic and ask about that. It may be better to call. I would say that based on what I've seen so far and learned about this virus. The average person who's young and healthy without underlying conditions like heart disease lung disease kidney disease diabetes who develops cough and fever can probably stay home and Essentially self isolate until they feel better and Doesn't really need a test. Over the course of the weeks or months ahead there may be so many people with these symptoms that testing individual ones may not be as efficient and we really need to shift into the community interventions. And not the one on one or the the man to man you know. We need to move to the zone approach. It sounds like what you're saying. At some point there is going to be this acknowledgement that the virus is spreading in the community and testing every individual given that. You're not gonNA do anything different. Based on the result that testing may not make much sense. But we're not there yet right. I mean we. We still need to get an of how widespread this is in the United States. And it seems like we don't really know the answer to that question right There are a couple approaches to get an understanding of how widespread this is. So you know. We have a number of systems that we use to track a seasonal influenza and those systems are being adapted to also track cove nineteen but another of the systems that we're using as our hospital surveillance that looks at Individuals who are hospitalized for infectious respiratory disease who get influenza testing or adding the coveted nineteen testing for those individuals. So I think we're GONNA have the broad perspective of where things are going and how bad this is with some of these systems so essentially outpatients in patients critical care and also fatalities will all be tracked the way that we track for flu. But we'll be adding in the Cova testing and we're just beginning to get. Those systems rolled out in different areas. One of the questions. I get a lot Dr shook it. I'm sure you do as well has to do with schools We do see that. There are school closings and the United States. And I wonder if you think that's warranted. If that's really going to be of benefit we know that children are very important in the transmission or spread of many respiratory viruses but for the covert nineteen disease. We don't know that children are an important part of the transmission dynamics. We haven't seen that yet. That said school dismissals or school. Closures may be warranted for certain situations for instance a case in a school may appropriately prompt dismissals for cleaning. That's you know dismissals. For just a day or two so sufficient cleaning of the environment can happen. There may be schools that serve a high risk population special needs kids who have many medical problems or have staff or faculty where there's a high percentage of people who are at risk for severe complications. Those types of facilities may need to want to alter their their procedures to be able to protect the vulnerable Schools May in the weeks or months ahead experienced high absentee rates where it's really not feasible to keep the school open but we know that closing a school has a lot of unintended consequences Many times it means parents have to stay home Because their kids are home and those workplaces the parents go to. We'll have unexpected high absenteeism. We know also that A high percentage of American children depend on schools for lunch and for meals. And so What we really want schools to be doing now and communities to be doing is to think through if we do end up needing to close a school for a shorter learn longtime or needing to dismiss students for shorter longtime. What can we get ready to go? That will help. Kids be able to learn while they're home. People who need to be fed be be able to be fed while the school was closed and You know making sure. There's good communication systems so that the community knows what to do when the school will reopen and so forth with Spring break next week. This is another question I get a lot. What is the guidance the? Cdc is giving on travel leaving aside international countries for. Why would you recommend people not travel this next week during spring break? We'll we think that People who are vulnerable those who are elderly with underlying conditions or those with series underlying conditions. Who aren't that elderly Should think twice about about travel. One of the issues is the uncertainty of where you're going and You know what the circumstances will be where you're going We also think that large gatherings you know these. These conferences that bring people together from all across the country. It's not necessarily that being at a conference itself is that Dangerous or being at a large event like in a one of the festival's but I think what we're concerned about. Is that individuals who come from across the country to a large event in then returned to you know fifty or a hundred different cities could bring that virus back into many communities and really speed up how this virus spreads across the country and a mass gathering is. How many people would you say you know? This is going to be variable. We've posted some recommendations on our website. They're called community mitigation strategies. Really what we call social distancing so there's not an absolute number for mass gathering you kind of know it when you see it. But if it's filled with high risk people or people like on a cruise ship where there's lots of high risk people and they're going to be going back to a million places and the shared environment is difficult to keep clean. Those are the kinds of settings that were concerned about. You know I've really been struck by the fact that most of the headlines make the point I think correctly that eighty percent or so of the people who are infected by this virus will recover and be okay but we have defined the vulnerable population as you've mentioned and I wonder for you know people who are in their seventies or eighties. Who are listening right now. People who may have an underlying condition the here this Dr shook it and for many of them. It feels like a death sentence. Just waiting to happen. How do you? How do you respond to them? Yeah every individual's different and there's not a a certain age cutoff or a certain disease that puts you at astronomically higher risk than someone else But there's things that everyone can do Higher Risk and lower risk certainly reducing the context that you have if you are in one of these high risk groups reducing the social exposures finding alternative ways to socialize whether it's by phone or online or video chats with loved ones making sure that you have you know supplies at home medicines at home So the most important things are to reduce those exposures and limit the chances that Joel contract the virus. Now if you do get the virus Most people Will Not have the severe outcomes is just the the risk for the elderly and those with underlying conditions is higher that you'll have those more complicated courses One of the reasons we're trying to slow the spread and really strengthen the healthcare system is so that if you do get infected and you do have a difficult pneumonia or a complicated course of the illness. We WanNa make sure that the healthcare system conserve you. Well one thing that people should know is that their clinical trials going on right now of new drugs that may be promising to reduce the seriousness of the infection. And I I hope that we'll have results of those in the next few months. We've all heard about vaccine studies. Those are going to take much longer but the therapy trials should have some results in the next few months. And that's the kind of thing that would be very helpful to know in the future and just finally stare into your crystal ball for a second. It's early March. How long do you think we're GONNA be talking about this? Well I think we need to be ready for this to be a problem for some time. Many respiratory viruses have a season -ality more disease in the winter and spring less in the summer But YOU. You will recall that with influenza in two thousand nine. When in very new influenza pandemic strain emerged we had disease during the summer to. It didn't go away completely. We had large outbreaks in summer camps and so forth. That was a virus where schoolchildren were really important and it may have been that the summer break from school reduced the circulation and then soon as kids went back to school. We saw a big increase again in the fall. I have to say. We're preparing for a response that lasts months and I think if this virus turns out to be one that sticks with us as a I in terms of humans until we have high levels of immunity either because so many people had mild infection and got protected or because we have a vaccine. We may need to be ready to deal with this virus for years and I think the systems that have led us down or been less robust than we had wanted are going to be critical for us to invest in and to make sure that we do better during this response and that we do even better for the next

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