CDC Director Robert Redfield Addresses COVID-19 Spike, Vaccine Expectations Transcript December 2

Dr. Robert Redfield: (00:00) Also now moving back up into the Northeast, as well as, unfortunately, California, Oregon, and Washington. So, we really have a very extensive pandemic now throughout the nation. I think many of you probably saw that in the month of November, unfortunately, we had over a million cases reported each week. Four million cases were reported in November. Unfortunately, our hospitalization rates are going up and maybe we'll talk more about that because that's one of our great concerns. Whereas in the spring we were talking about 20,000-30,000 people in the hospital. Now, we're over 90,000 people in our hospital. I think one of the most concerning things about understanding the impact of the pandemic right now, and there may be questions on it, is to recognize it as we sit here today, 90% of our hospitals in this nation are actually in what we call one of the hot zones, in the red zone therefore at risk for increased hospitalization and potential to negatively impact hospital capacity. 90% of all of our long-term care facilities now are in what we call high transmission zones. Dr. Robert Redfield: (01:19) So, we are at a very critical time right now about being able to maintain the resilience of our healthcare system. In the spring, we were dealing with New York, Detroit, New Orleans, Los Angeles. We could shift healthcare capacity from one part of the country to another. We saw a similar when we had the Southern wave. We could shift healthcare capacity from the heartlands and from the Northern Plains. Right now, we unfortunately have a pandemic that's really throughout the nation. And there really isn't that resilience of healthcare capacity to be able to be shifted. This is why it's so important at this time, and I know we'll talk more about it, is to really embrace the mitigation steps that we've tried to stress. And the time for debating whether or not mass work or not is over. We clearly have scientific evidence. Dr. Robert Redfield: (02:15) We just recently published an MMWR in Kansas when they came out with their mass mandates and certain counties opted out and certain counties opted in. And when you compare those that opted in, they had about a 6% decrease in the observation period of new cases per 100,000. And other counties that decided that they didn't think this was a way to go and opted out of the mass mandate, we found out that they had over 100% increase in the cases. You couple that with social distancing and hand washing and being smart about crowds, doing things more outside than inside. These are critical mitigation steps which to many people seem simple, and they don't really think it could have much of an impact. But the reality is they're very, very powerful tools. They have an enormous impact. Dr. Robert Redfield: (03:07) And right now, it is so important that we recommit ourselves to this mitigation as we now begin to turn the corner with the vaccine. But the reality is December and January and February are going to be rough times. I actually believe they're going to be the most difficult time in the public health history of this nation, largely because of the stress that it's going to put on our healthcare system. Suzanne Clark: (03:38) It's a sobering and important thought there. And there are a couple of directions I want to go. Let's start with some of the public health models. Looking at mortality rates have been really shocking. And so my question for you is, what can we do to change that trajectory? And is it as simple as mask, social distancing, isolating, et cetera? But what do we do to change what looks like a really terrifying trajectory? Dr. Robert Redfield: (04:08) Well, I think you're right when you look at the different models. We looked at the original spring, we lost about 100,000 people. The summer, 100,000 people. The fall, 100,000 people. These are sacred lives that were lost as a consequence of this pandemic. We're potentially looking at another 150,000 to 200,000 people before we get into February. So, this is really a significant time. And you asked the right question, because we're not defenseless. The truth is mitigation works. And if we embrace it, and the challenge with this virus is it's not going to work if half of us do what we need to do. It's not even going to work probably if three quarters of us do what we need to do. This virus really is going to require all of us to really be vigilant about wearing a mask. And unfortunately, not just when we're in the public square. Dr. Robert Redfield: (05:08) I mean, we're finding now that much of the transmission that's driving ... I mean, who would have believed that rural North Dakota, South Dakota, Wyoming, Idaho, Montana, these areas in North Dakota recently over 30%, 40% of the people that got tested were actually positive. And the reason this is happening, because now one of the major drivers of transmission is not the public square. It's actually the home gatherings, where people let down their guard. You bring in family members and they don't realize that the major presentation of this virus for individuals, say under the age of 40, is it's totally asymptomatic. You don't know you're infected. And really being able to get a handle on asymptomatic transmission, in the family setting, which is now driving. And frequently, we don't necessarily ... Communities don't recognize it until, unfortunately, that virus then gets transmitted in somebody that's vulnerable, older, and then they end up developing symptomatic illness and they end up in the hospital. Dr. Robert Redfield: (06:18) So, the reality is, as you saw it just the other day, I think in our reports, we were back up to almost 2,400 deaths that were reported yesterday. So, we're in that range, potentially now starting to see 1,500 to 2,000 to 2,500 deaths a day from this virus. So yeah, the mortality concerns are real. And I do think, unfortunately, before we see February, we could be close to 450,000 Americans have died from this virus. But that's not a [inaudible 00:07:03] complete. If the American public really embraces social distancing, wearing masks, not letting your guard down in family gatherings, limiting crowds, maintaining ventilation, doing in events outdoors rather than indoors, making sure you're vigilant in hand hygiene. And that coupled with some strategies that we're pushing states to do to begin to diagnose through surveillance the asymptomatic infections will begin to help us. Dr. Robert Redfield: (07:39) I give one example of hope, because I used to think that the most difficult group that we were going to have to help contain this pandemic was basically college students. That I felt it was going to be very hard for us to be effective in getting them to fully embrace the messages that I just said. And in the spring, we had significant outbreaks on different college campuses. But what happened over the summer and the fall is many of the colleges and universities really stepped up to developing comprehensive mitigation steps that they really engage the student body to actually buy into. And then they coupled that with screening the student body every week, so they could identify the asymptomatic, silent epidemic that was in the population and then pull them out for isolation and prevent them from further transmitting. Dr. Robert Redfield: (08:45) You look at it today, say Wisconsin, Governor Thompson, who's now the acting president at University of Wisconsin. They have a prevalence rate in there 27 campuses, all through Wisconsin of students in the highest risk group, 18 to 25 year olds. Their prevalence rate is less than 3%. But when you look in the communities where they live, because most of these kids don't live on campus, their prevalence rate is between 10% and 20%. It reaffirms to me that mitigation can work. And even some of the ... What your biases may be the more difficult group to participate. I can show you the same is true in the Northeastern schools, the same is true in the South Carolina schools. The idea that coupling mitigation with routine screening surveillance to be able to identify the asymptomatic carriers, these techniques do work, and they're powerful. The truth is it's our defense against this. When you asked me the big question, how many people are going to die between now and say, February 1st? I'm going to really come back and say, it's really up to us, how vigilant people are going to be about really taking to heart these mitigations. Dr. Robert Redfield: (10:04) I think I'm disappointed at one thing during my time as CDC director during this pandemic was that there was an inconsistency of the American public embracing the message. Mask wearing, this mask wearing, it's not a political decision. This is a public health tool, a very powerful public health tool. Very simple, but very powerful. And yet we really had taken a long time and to this date, there are still jurisdictions probably on this call that really don't embrace the importance of these mitigation steps. And I encourage people to look at the MMWR we put out in Kansas. I mean, it really showed the difference between a 6% decline or 100% increase by one simple thing, whether the county decided to embrace a mass mandate. Suzanne Clark: (10:54) That's really remarkable. And I think we can help you ... We should help you get that message out. I'm going to turn to the first audience question in a minute, but let me first follow up on something you said about the importance or the efficacy really of surveillance. By that, do you mean kind of the random testing or do you mean some of the sewage testing that we've seen on other college campuses? How do you define surveillance? Dr. Robert Redfield: (11:20) Well, I think it's really important, if you want to take sort of a hindsight, the real question that is out there is, how much testing capacity do we really need as a nation to optimize our public health response? I would say that that's more tests than we currently have. There's been a lot of focus on how many tests we have. Second thing I will say is how testing is used. Is it random, or is it strategic? And we would argue right now, one of the big challenges that hit us with this COVID pandemic was we had modeled it in our heads like SARS or like influenza. And SARS and influenza, the way they work is they make you sick. So it's not that complicated for you to have a case identification program that says, “Let's look at people who are sick and find out, do they have COVID-19 and then isolate, contact, trace, and then control the pandemic.” The problem with COVID too, it's not like flu, it's not like SARS. It's major transmission, particularly in those of us say, under the age of 45, is it's asymptomatic. So, you don't know who's infected and who isn't. And so all of a sudden that strategy of looking for symptomatic people like we originally did in January and February and telling symptomatic people to stay home and wear masks, that works for the symptomatic people. But the problem is you just miss 50% or more in certain age groups of the people that are carrying this virus. And so therefore you've got to say, “Okay, well, wait a minute, how do we then define the silent epidemic? How do we define asymptomatic transmission?” And we would argue going back to the college campuses, they figured out by doing regular weekly screening of students. Every week, they're able down to identify the asymptomatic carriers, they're not carriers, asymptomatic infections, pull them out of the transmission cycle, isolate them, contact trace around them, and isolate those individuals. And they've been able to control the outbreak. Dr. Robert Redfield: (13:45) So there has to be a strategic use of testing. We're right now, Liverpool recently in England decided what they were going to do to get a handle on this silent epidemic. They just tested everybody in Liverpool. And they figured out who was infected and been able to isolate. So, we have areas now that we're trying to do what we call community wide strategic testing, where there are hotspots to try to understand. Dr. Robert Redfield: (14:15) There'll be a CDC guidance coming out this week on trying to help institutions, public health groups, companies look at how they may be able to use routine screening. For example, we think it might be useful to offer routine weekly screening for teachers in K through 12. Others feel it might be useful to look at other people that have a lot of contact in the community with people and set them up for routine screening, so that you can start to identify the silent epidemic. You'll see in this MMWR, we list a number of different strategies. None of them have been really proven in the sense that we know that this is the tool that's going to now contain the epidemic. But we do know it's proven that they do help us identify the silent transmitters. And as I mentioned, I think the schools of higher learning are teaching us something. I think they've been able to use testing strategically. Dr. Robert Redfield: (15:16) It's actually very interesting. If you look at the colleges, universities that tested everybody routinely every week, or you compare that to people that tested everybody and contact traced around symptomatic cases and did that constantly, you'll see that the colleges that did the routine screening once a week had a far greater less occurrence of COVID within their population. So, I just want people to know, we do have tools. Testing, I do think needs to be more strategic. One of the challenges is a lot of people that choose to get tested are what we call the “worried well.” I do think it's important for us to be more strategic in our testing in terms of whether you set up a routine surveillance system once a week or- Dr. Robert Redfield: (16:03) Whether you set up a routine surveillance system once a week for employees or some portion of employees so you get a sense of trying to understand is the silent epidemic now working. Dr. Robert Redfield: (16:11) You've mentioned other techniques like wastewater, these are important things we've done in the college campuses, but I do think the biggest challenge right now is to identify the silent epidemic and to try to get that silent epidemic out of the transition cycle. Suzanne Clark: (16:25) Oh, I have so many questions. Okay, so first let me bring in our first audience question. This is Derrick Watchman from Arizona. Derrick Watchman: (16:36) Hi, this is Derrick Watchman. I am here from Arizona. I represent and chairman of the board for the national center for American Indian enterprise development. We represent the Native American businesses around Indian country here in the United States. My question is, Native American communities have been hit hard extremely by COVID-19. With increase in numbers nationwide, is there any evidence that if someone has recovered from COVID that they could be reinfected? Dr. Robert Redfield: (17:11) So it's a very good question. And really so far, we've seen very limited evidence of reinfection. There's been several case reports. We've had other examples that I think really drive the message home. We had, say, a camp that was very careful about trying to control infection and what they had is all the campers were self quarantined before they came to the camp for 14 days, they were all tested and they were all negative, and then they were able to go to the camp. Same with the counselors, they were all tested and they were negative. The camp decided they wanted to have a great camp experience, so they didn't want to have that modulated by something like wearing a mask or not crowding because they felt they quarantined everybody for two weeks and they tested everybody. And what happened in that camp is there was a huge outbreak. I think close to 90% of the campers and the counselors all got infected. So just to show you that, all that precaution. Dr. Robert Redfield: (18:27) But what was interesting, to get at your question, there was a group of individuals who actually had antibody when they went to that camp and none of those individuals got infected. So right now we have pretty good evidence that antibody that is, is really protective against re-infection, we just don't know for how long. We don't know if that's going to be for six months, we don't know if it's going to be a year, we don't know if we're going to be for two years, we're going to learn all those questions right now. Dr. Robert Redfield: (18:57) But it's one of the things that gives us, of course, great hope before we knew this, that the vaccines were likely to work. I think it really is a gift that these vaccines many of us had thought if they worked for 70% efficacy, we would be excited, but to see 95% efficacy for the first two vaccines, roughly, and all the other vaccines are based on the same what we will call immunological target. I think we have a lot of optimism that antibody directed against those vaccines will be protective for some period of time, which we are going to learn in the future and infection, natural infection, is protective for some period of time. Suzanne Clark: (19:39) We have another audience question that's kind of a follow-up to that, which is, given the efficacy of these vaccines, do you imagine there's a world where airlines or schools or employers might require proof of vaccination in order to participate [inaudible 00:19:56]? Dr. Robert Redfield: (19:58) I think each jurisdiction, I talked to the business round table recently, and that question came up directly, and I think each institutions are going to make those decisions. It's clear, I'm a physician and I'm required to take a number of vaccines in order for me to be able to practice in the hospital that I used to work in. I anticipate that being vaccinated against COVID is going to be another requirement for healthcare professionals. It's potential that I could see that long-term care facilities might require some evidence of immunity and for admission to certain long-term care facilities. I think the airline industry, and you've mentioned that, I can see them trying to determine whether they want to make this a requirement for employment within them. Since unfortunately, even though we get control of COVID, which I think we will, by the third quarter of this year, the pandemic in the world's not going to be controlled for multiple years. And so we'll always have a global risk of reintroduction through susceptibles if they haven't been vaccinated. Dr. Robert Redfield: (21:10) So, it will be a decision I think each industry will make, but I do think there are certain industries where I think it would be important to protect their workforce and some other industries where it may be important to make sure that they protect their customers and consumers. So I think as these vaccines get deployed, groups will wrestle with that. But I won't be surprised if a number of occupations or situations make vaccination against COVID a requirement. 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. Dr. Robert Redfield: (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. Dr. Robert Redfield: (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. Dr. Robert Redfield: (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. Dr. Robert Redfield: (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. Dr. Robert Redfield: (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... Dr. Robert Redfield: (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. Dr. Robert Redfield: (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. Dr. Robert Redfield: (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. Dr. Robert Redfield: (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. Dr. Robert Redfield: (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. Dr. Robert Redfield: (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. 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. Dr. Robert Redfield: (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. Dr. Robert Redfield: (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. Dr. Robert Redfield: (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. Dr. Robert Redfield: (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.- Dr. Robert Redfield: (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%. Dr. Robert Redfield: (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. Dr. Robert Redfield: (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. Dr. Robert Redfield: (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. Dr. Robert Redfield: (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. Dr. Robert Redfield: (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. Dr. Robert Redfield: (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. Dr. Robert Redfield: (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. Dr. Robert Redfield: (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. Dr. Robert Redfield: (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. Dr. Robert Redfield: (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. Dr. Robert Redfield: (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%. Dr. Robert Redfield: (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.