US Surgeon General Jerome Adams Press Briefing Transcript August 7

Dr. Letitia Dzirasa: (00:00) ... that now is not the time to let your guard down. We're in a pandemic. I will say it again, we're in a pandemic, the likes of which none of us have ever experienced. And it may be a little while before we're able to regain a true sense of normalcy. And I understand the desire to get back to normal, but right now, it's best to accept that face masks and social distancing is going to be part of our normal routine. And the sooner we accept that, the safer I think we'll all be. In recent weeks, Baltimore City has been identified by the White House's Coronavirus Taskforce as an emerging hotspot. Community transmission here is widespread and too many of our young people are not heeding the advice of public health professionals. So I ask everyone again, please consider others during your daily activities, continue to avoid large crowds or gatherings, maintain six feet of distance between you and others that aren't in your household when you're out, stay home or seeking medical care, if you're feeling ill, and please wear your face mask over your nose and your mouth anytime you're out in public. We all have a role to play in protecting the health of our community. Thank you. Dr. Jerome Adams: (01:08) And before we take questions, I just want to reiterate something that Dr. Dzirasa mentioned. To the young people out there, I know that this is a challenging time, I know you want to get back to some sense of normal. Here's what I would say to you, I talked to Tony Fauci every day, he believes that we still will have a vaccine by the end of this year or the beginning of next year, but we don't have to wait to get a vaccine before we can start to reopen and get to some sense of normal. Wearing a face mask and maintaining six feet of social distance may seem like an inconvenience, but it is a small inconvenience compared to having to shut things down. Dr. Jerome Adams: (01:52) So we have a choice, we can choose to heed basic public health measures like washing your hands, wearing a mask, and watching your distance. And if we do that, we know we can decrease spread and we know that the mayor and the health department can open more things up. Or we can choose not to heed these public health precautions and we will continue to stay in a restricted state and potentially see more things closed down. The power is in your hands people of Baltimore, people of Maryland, we can get back to normal. Italy, Spain among the hardest hit in the world, now are open for tourism again. They are they're opening schools again, they're playing sports again. So we can do this and we can do it just in a matter of weeks. Dr. Jerome Adams: (02:36) And speaking of a matter of weeks, I want people to understand that when you take these public health precautions, it usually takes two to three weeks after you start doing the right thing before you see cases come down. And across the nation right now, we're actually seeing case numbers start to come down, but it's another two to three weeks after that, before you see hospitalizations go down and another two to three weeks after that, before you start to see deaths level off and come back down. I want everyone to understand that, deaths follow hospitalizations, which followed cases, which followed public health measures, so that you understand that you are, in many cases, doing the right thing. As I look around the city, the majority of people are doing the right thing, we just need to stay the course and continue to normalize that positive behavior. And if we do that, we'll see spread go down, hospitalizations go down, deaths go down, and we'll be able to open more places again. Dr. Jerome Adams: (03:27) And before I turn it over for questions, I'd love to get one of the two doctors up here to just very quickly tell people about the Baltimore Convention Center Field Hospital, and to let them know what people should be thinking about if this is offered as an option to them. Dr. Chuck Callahan: (03:45) So, you get both of them. My name is Dr. Chuck Callahan from the University of Maryland Medical System. Dr. James Ficke: (03:50) And I'm Jim Ficke from Johns Hopkins Health System. Dr. Chuck Callahan: (03:54) And we've been running the Baltimore Convention Center Field Hospital together as a team. Since we joined forces here at the end of March, we've had the privilege of caring for more than 200 of the members of our city and our state and pulling together with a team that really was brought together for the first time in March. And it's just been a privilege to work together, both in the hospital and now as a group of individuals to be able to test across the city. Dr. James Ficke: (04:21) So we want to just make a comment to the citizens of Baltimore and the citizens of the State of Maryland, that it's been a privilege to take care of and we will continue to take care of individuals here at the field hospital. As the surgeon general commented, we wear masks, we watch our distance, and we wash our hands. Thank you. Dr. Chuck Callahan: (04:40) So, Johns Hopkins University of Maryland Medical System and the Baltimore Convention Center Field Hospital, we are here for you, Baltimore City. Dr. Jerome Adams: (04:48) Thank you. Happy to take questions for any of us. Yes, sir? Reporter 1: (04:52) You said looking around Baltimore you've regarded people following the rules, have you specifically see Pennsylvania Avenue, North Avenue where there's a large community who do not wear face masks? How would you address that? Dr. Jerome Adams: (05:09) Well, Baltimore is home to me. I went to University of Maryland Baltimore County, go retrievers. Reporter 1: (05:14) Have you seen the specific area? Dr. Jerome Adams: (05:15) Yeah. I traveled around the city and I've seen specific areas and mask wearing is better in some places and worse than other places. Here's what I think we need to do, I think we need to a) educate people as to why they should be wearing a face covering because people will be more likely to comply with public health measures if they understand why they're doing it and how they benefit. Here's how you benefit, again, young people, if you want prom next spring, if you want sports in the fall, if you want in-person school again, the quickest way to get there is by following basic public health measures. Dr. Jerome Adams: (05:51) And the other thing that I think we need to do for some of these areas where you're not seeing high uptake is to really get some of our local influencers involved. The Ravens, the Orioles, we need them out there wearing a face mask. I tweeted out a picture last night of LeBron James wearing his face mask on the sidelines because as a father of a 16 or 14 and a 10 year old, I know my kids are going to be more likely to do something if LeBron James, or if one of the Ravens says to do it, then if their dad, the Surgeon General says to do it. So, it is a problem, I think we can overcome it, I think we need to recognize the good behaviors, and I think we need to normalize those good behaviors and more people will do the right thing. Reporter 2: (06:27) Last week, the White House Taskforce did identify, like Dr. Dzirasa said, Baltimore City as a hotspot for COVID-19 cases. Still we're seeing the mayor loosening restrictions. Is that really the right thing? I know it's only 25%, but if we are an emerging area for hotspots, is that really necessary? Dr. Letitia Dzirasa: (06:46) Sure. Now I can't necessarily speak on behalf of the mayor, but what I will say is that he's in a tough position, as are many local leaders, where you had to think about certainly the health impacts, but the economic implications of long closures. So, I think that the mayor, again I won't speak for him, but he has to weigh many factors as he develops the executive order. Reporter 3: (07:07) From a public health perspective, sir, can you please weigh in if you could advise an emerging hotspot for restaurants reopening? Dr. Jerome Adams: (07:14) Well, as Dr. Dzirasa mentioned, we know that there are people who are dying from COVID, we also know that there are people who are getting sick and dying from the shutdown, from the economic impacts of the shutdown. We know that for every 1% increase in unemployment, you see a 1.3% increase in suicides. We know that people are not getting elective surgeries, that people are getting behind on their vaccinations, 4.2 million children behind on their vaccination. So, what I would say to the people of Baltimore is these things aren't disconnected, it's not either reopened or you care about health. It's that, if the mayor is choosing to reopen somethings that means that it's incumbent upon us as citizens, and again, I am a citizen too of the local area to do the right things so that we decrease the spread, decrease background community transmission, and the reopening can be successful. If you want places to continue to open and to stay open, then it is incumbent upon each and every one of you to do the three Ws: wash your hands, wear a mask, watch your distance, meaning stay six feet from others and avoid crowded spaces. If we do that, we can reopen and we can reopen in short order. Reporter 4: (08:25) I have a question for Dr. Dzirasa. There's a little bit of confusion surrounding what I'm about to ask you, did the city lift the 25% capacity on religious [inaudible 00:08:35]? Dr. Letitia Dzirasa: (08:36) It did. So, we recognize and had a lot of conversation yesterday around the initial confusion with the order. And so there should be an updated one that's been released as well as interpretive guidance or frequently asked questions that we received. And we have amended it to reflect that religious facilities can have 25% capacity. Reporter 4: (08:54) It sounds like it wasn't an order, [inaudible 00:08:57]? Dr. Letitia Dzirasa: (08:57) So, before it read that they were capped at 25 people, that's how it was... Reporter 4: (09:02) And while you're there, look around, this place is packed [inaudible 00:09:07], people that we know are having a difficult time getting a test quickly and some cases the results are coming back, it takes a very long time. Is there anything that you or the feds can do to speed things up? Dr. Letitia Dzirasa: (09:22) So, we've had a lot of conversations with our state partners as well, who helps support with testing. And right now the averages, certainly at the field hospital, I heard are about two to five days. So, we have seen the average turnaround time come down, but certainly we we've shared the concern that it's taking longer than it should for us to get test results. But again, this is a problem that's been seen nationally with the increase in cases in other parts of the country. Reporter 4: (09:45) But getting [inaudible 00:09:48] test is also usually taking a long time, there's a waiting list. Dr. Letitia Dzirasa: (09:53) So, we actually have listed on our website multiple locations where individuals can go get a test. We have the field hospital here, we also support mobile testing in multiple zip codes throughout the city. Our partners Hopkins, many federally qualified health centers, as well as University of Maryland, also provide mobile testing that's walk up and doesn't require an appointment. So, that information, again, is available on our website, coronavirus.baltimorecity.gov. Reporter 5: (10:18) Is there a threshold, either on these cases, deaths, hospitalizations, where you will recommend for the mayor to go back to shutting down [inaudible 00:10:26] entirely? Is there a specific metric we should be looking for? Dr. Letitia Dzirasa: (10:30) So again, we're looking at all of the metrics that are listed on our website as our reopening indicators and it certainly includes a decrease overall in new cases. Additionally, internally, we're looking at incidence rate and we recognize that positivity, though right now sitting at about 5.8% for Baltimore city, there are some zip codes where it's much higher. So, all of those things factor into how we inform the mayor on how to make decisions about closures in addition to the information we gather from contact tracing and we're individuals may have been when they contracted with it. Reporter 5: (11:01) Is there a trigger point where we will go back to tightening restrictions? Dr. Letitia Dzirasa: (11:07) So I make recommendations, again, based on all the information that I just mentioned, and again, work with the mayor's office to, to get to as close to some of the restrictions as possible. Reporter 5: (11:21) It seems on the indicators' website, there's three indicators now that are in the red. How do you interpret that if we're continuing forward with reopening restaurants? Dr. Letitia Dzirasa: (11:27) Sure, sure. So again, I think that the mayor is forced to make challenging decisions, as are many local leaders, where you may end up reopening things, as you think about the economic impacts of things being closed for a long period of time. Dr. Jerome Adams: (11:41) And you said the website is Baltimore... Coronavirus... Dr. Letitia Dzirasa: (11:44) coronavirsus.baltimorecity.gov. Dr. Jerome Adams: (11:44) coronavirsus.baltimorecity.gov. And I would encourage people to check out that website regularly, follow the metrics. It's a great website, I checked it out this morning. And when you say, how would you interpret three reds? I would interpret that as we need to do a much better job watching our distance and in particularly wearing face masks because that's an indicator that you've got increased spread. And at some point, everything is contingent on background community transmission, whether or not you can open school, to the amount of testing you need and testing turnaround times. Whether or not you can open up places of worship to even more people and I just had a meeting with faith leaders last week, where we talked about the importance of giving people that social connectivity that they get through places of worship. These are all tough trade-offs, but they're made a whole lot easier when people do the right thing, the three Ws, and lower that background community transmission. Dr. Jerome Adams: (12:40) So, that's what I want people to take from me being here today. Baltimore is not quite in the red, there are metrics that are in the red, Maryland is not in the red, but there are metrics that are concerning. And we have an opportunity now to either turn things back in a positive direction, or to see things continue to go in a negative direction. The power to reopen really lies in each of our hands and that is why I'm here today, that's what I want people to understand. The metrics are starting to trend in a bad direction, but we still have time to turn it around. We don't have to close down yet, but we want to avoid having to close more things down. And that's why following the three Ws. Reporter 6: (13:24) There seems to be a lot of discussion over schools, to reopen? Not to reopen? In-person or virtual learning? Based on the numbers you're seeing, New York announced today that the Governor there is going to allow in-person learning because their metrics are so low. What's your advice to school systems who are wrestling with that decision and for parents who might take their kids out of a public school and put them in a [inaudible 00:13:42] where they can do in-person learning? Dr. Jerome Adams: (13:44) Great question about schools. I'm a father of a 16, 14 and a 10 year old, I'm literally having this discussion nightly with my wife and my kids. Here is how I think through it, it's important for everyone to know that the risk to people who are younger, particularly people under 10, is much lower than in adults. Low risk does not mean no risk. So as a parent, I would encourage you to go to coronavirus.baltimorecity.gov or coronavirus.gov, and find out about the risk factors for complications from COVID, so you can make a decision about your child. Dr. Jerome Adams: (14:18) You also have to understand that schools can't open with just children, there's also teachers, there's cafeteria workers, there's bus drivers, there's people who those children live with at home that they could take the disease back to. And we need to have plans in place to be able to protect those teachers and to protect those individuals who were back at home if we decide to go with in-person school. The final thing that I want to reiterate, and I know I sound like a broken record here, is the best school opening plan in the world is likely to fail if you have runaway community transmission. And a mediocre to poor reopening plan will be successful if you have very low community transmission. So, the number one determinant of whether or not you can safely in schools for students, for parents, for teachers and for everyone else is your background community transmission rate, which is dependent on the three Ws: wash your hands, wear a mask, and watch your distance. Speaker 11: (15:11) I think we've got time for two more questions. Reporter 7: (15:13) Any regret about sending the message out back in March, "Don't wear a mask," if we could have gotten ahead of this? Dr. Jerome Adams: (15:20) The question is about face masks and the changing recommendations that we've had. It's important for people to understand how science works. We look at the data, we make the best recommendations that we can at the time based on the data. But then science is about continuing to collect new data and continuing to refine your recommendations when you get new data. You have to have the vigilance and the humility to continue to collect that data. The novel Coronavirus, SARS-CoV-2, that we are dealing with right now is part of a family of viruses, including MERS, including SARS, including the common cold, and based on everything scientists knew about those viruses, we expected that this new virus would have a low degree of what we call asymptomatic spread. Dr. Jerome Adams: (16:03) Asymptomatic spread means that you don't have a cough, you don't have a fever, you don't have a runny nose. If you and I were in a room together right now, and you saw me with watery eyes, runny nose, coughing, you would know to stay away from me. Unfortunately, in up to 50% of cases, and sometimes even more in younger people, I could be spreading the disease and look just fine. That is why we changed our recommendations for people to wear a face covering or a mask. So, I want people to know that we made the best recommendations we could back in February and in March, based on what we knew about the virus and how every other virus like that had acted up until that point. When we found out this virus was different, we changed our recommendations. That's how science works. Dr. Jerome Adams: (16:47) The most important message for people right now to understand is that you can get back to normal, you can get less than a 1% positivity rate like New York has if you do the three Ws: wash your hands, watch your distance, and please wear a face mask when you're out in public. And again, it can be a fashion statement, Dr. Dzirasa, I told her earlier, I love her face mask. We need to make this part of our culture, we need people to understand that these are health promoting tools, they're freedom promoting tools because we will have more choices and more places open if we lower community transmission, but they can also be fashionable tools. And the more we accept that's a small inconvenience we're going to have to live with for the foreseeable future, the more we'll be able to keep places open and have those bigger inconveniences of restaurants, schools, places of worship open. Reporter 7: (17:34) In addition, for people following the three Ws, I'd like somebody or both of you to address, why the uptick in Baltimore City? What does contact tracing reveal? Dr. Jerome Adams: (17:45) I'll let Dr. Dzirasa talk about what contact tracing is revealed in the area. Summer is a hard time, my kids wanted to come with me today to go down to the Inner Harbor and to the science museum. Baltimore is a city that really is based on people coming together, being close at the inner Harbor, in Fells point. And I get it, I get it more than anyone as someone who's spent a lot of my youth right down in the Inner Harbor and right at Fells Point. What we need people to understand though, is it that's going to be taken away from us if we don't take basic public health measures. So, staying six feet from one another, wearing a mask, they are small inconveniences compared to the large inconvenience of missing your homecoming, missing your prom, missing the Ravens play in the fall, but we can get there in short order if everyone does their part. That's what I want people to understand. I completely understand people's desire to get together and be outside, but we need to follow these basic tools that we can get through this virus. Dr. Dzirasa? Dr. Letitia Dzirasa: (18:47) Yeah, I think Dr. Adams touched on a lot of it. What we understand is that individuals, once restrictions were lifted, did want to get, back to some sense of normalcy. So that includes going out to eat or going out to a restaurant, that includes going to family gatherings, or hosting the graduation cookout. It's in those environments, those closed indoor spaces where you may not be socially distancing, you may be eating with individuals outside of your household with your mask off, that transmission is much more likely to occur. Additionally, at a large gathering, we know that those things are more likely to occur. Dr. Letitia Dzirasa: (19:18) I think another challenge that faces many residents in our city is that they support work within critical infrastructure. And so when they're feeling ill, they don't have the option to telework, they still need to go to work. Maybe they serve as the primary breadwinner for their family. And again, they can't stay home and safely isolate. So that they're going to work and they're ill, perhaps they're coming home and also potentially infecting others in their home. So, we know that unfortunately is a challenge facing many of the residents here in our city, which is one of the reasons why we set up the Triage, Respite and Isolation Center to help support individuals who can't safely isolate. This is a location not far from here at the Lord Baltimore Hotel, where people can receive medical care and support. It's a partnership with the University of Maryland Medical System to also provide care coordination efforts. So again, those are some of the main things that we're seeing with individuals in Baltimore City. Dr. Jerome Adams: (20:13) One of the things that add is I have family in the area. Summertime is the time when we come together for barbecues, cookouts, we go down on the water and eat crabs. A lot of the spread that we're seeing is occurring in these large family gatherings and get togethers. And so what I would say to the people of Baltimore and the people of Maryland is please understand that just because you're around people you're related to doesn't mean that you're immune from the virus at that point, or that someone around you may not have the virus. Again, up to 50% of people can spread this disease without ever even knowing that they were sick. So, now is the time to hold off on these large gatherings. If we do the right things now, we can get back to some sense of normal by Thanksgiving, by Christmas, we can have these family gatherings again. But the last thing we want to do is to be at Thanksgiving, at Christmas, talking about a loved one who passed away because they came to a summer cookout, a summer picnic at our house. That is the last thing that we want. Dr. Jerome Adams: (21:22) And additionally, we don't want more places in the city to have to shut down because of runaway community spread. I just want to finish and close by saying thank you so much to the State of Maryland and Governor Hogan for his leadership. Thank you to the Mayor of Baltimore and to the City of Baltimore. And thank you to everyone who's made this field hospital possible. University of Maryland, Johns Hopkins, so many public private partnerships, working with FEMA on a federal level to make beds available for people who need them, to make testing available for people who need them. Dr. Jerome Adams: (22:00) Please remember 410-649- 6200 is the number to call if you want more information on testing. Testing is available, but if you get tested, you need to isolate. And again, we'd rather you not get exposed to the virus in the first place by following the three Ws, wash your hands, wear a mask, and watch your distance, than to have to get tested and tough positive later on down the road. We're here for you if you need testing and treatment, but we'd rather you not get exposed to coronavirus in the first place. So do the right thing, we can open up, again, in short order and we can get back to some sense of normal really quickly if everyone does their part. Reporter 8: (22:35) You said you talk to Dr. Fauci on a daily basis, do you talk to the President every day? Dr. Jerome Adams: (22:39) We have taskforce convenings every day, some days we talked to the President and two days ago we actually had a briefing in the oval office. We brief the Vice President at every meeting and the information gets passed along to the President every day. One thing I want people to know is Dr. Fauci, Dr. Redfield, Dr. Hahn, Dr. [inaudible 00:22:58], Dr. Birx, We are all in every task force meeting giving our medical input and it's being taken into account and, again, weighed against some of these complex variables that we have, including rising unemployment rates that, again, put people at risk for real health harms. And so I want people to know that the doctor's voices are at the table, they are being heard. And right now the nation's doctor is telling you we have the power to get the virus under control very quickly. Arizona, four weeks ago was skyrocketing in cases, they did the three Ws, wash your hands wear a mask, and watch your distance, and their rates are coming back down, their cases are trending back down. We can turn this around Baltimore in just a few weeks and we can get back even more places being opened if you do the right thing. If you don't, you're going to force the mayor's hand and, again, places will potentially be closed. Dr. Jerome Adams: (23:53) So thank you all for coming out today. Encourage people to get tested. Please promote the three Ws. Speaker 14: (23:59) Thank you, sir.