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Speaker 1: I am officially declaring a national emergency in furtherance of

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Speaker 1: the order emerging every state to set up emergency operations centers,

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Speaker 1: effective immediately. We want this thing to end. We don't

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Speaker 1: want a lot of people getting infected. We want it

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Speaker 1: to end and end as quickly as possible. If you

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Speaker 1: are sick, you're not going to miss a paycheck. Your employer,

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Speaker 1: including small businesses, have the ability to provide paid leave

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Speaker 1: to you. On this episode of News World, the coronavirus

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Speaker 1: or COVID nineteen is now in the United States. This week,

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Speaker 1: the lives of all Americans changed at the urging of

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Speaker 1: President Trump, Vice President Pence, the National Institutes of Health,

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Speaker 1: and the Centers for Disease Control and Prevention. Americans were

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Speaker 1: told to begin social distancing and if you show any

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Speaker 1: signs of symptoms of COVID nineteen, you should self isolate

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Speaker 1: or self quarantine for fourteen days. This is the first

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Speaker 1: time many of us have faced a global pandemic in

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Speaker 1: our lifetime, and we have many questions about how to

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Speaker 1: face this new challenge. I'm pleased to welcome my guest,

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Speaker 1: doctor j Butler, Deputy Director for Infectious Diseases at the

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Speaker 1: Centers for disease control and prevention. You've seen a number

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Speaker 1: of various epidemics come up and new strains come out

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Speaker 1: over the years. This one seems to have aroused a

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Speaker 1: great deal more anxiety and a great deal more intense response.

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Speaker 1: What do you attribute that to? Well, I think as

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Speaker 1: we compare it to other epidemics, there's a number of differences.

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Speaker 1: Comparing this to the last public health event of similar magnitude,

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Speaker 1: which would be the H one in one influenza pandemic.

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Speaker 1: We are dealing with something that we've watched from a

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Speaker 1: fall where we focused on containment measures for a couple

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Speaker 1: of months, and in some ways, I think there may

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Speaker 1: actually be a little bit of coronavirus fatigue in the public.

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Speaker 1: But now that it's here and everyone realizes that this

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Speaker 1: is real, there's been kind of an awakening and some

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Speaker 1: of the response right now may not be as timed

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Speaker 1: as well as it should be, because we do think

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Speaker 1: that this is going to get worse before it gets better.

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Speaker 1: The H one in one pandemic, of course, emerged right

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Speaker 1: here in North America, so we started right out with

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Speaker 1: it in our back yard. We've had more lead in

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Speaker 1: to this particular virus The other thing that's different is

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Speaker 1: we're accustomed to influenza. In fact, I would say the

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Speaker 1: greatest misnomer in all of healthcare is it's just the flu,

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Speaker 1: because influenza is actually a terrifying infection. Coronavirus is something

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Speaker 1: that has not been in the public discussion very often,

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Speaker 1: and while public health officials and infectious disease clinicians are

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Speaker 1: familiar with coronaviruses, it sounds very new and very different,

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Speaker 1: and when things are new and different, they can sound

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Speaker 1: very scary. The impact of any kind of major health

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Speaker 1: event goes beyond just the number of people who get

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Speaker 1: sick or the number of people who may die, but

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Speaker 1: there's also a societal impact that translates into an economic impact.

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Speaker 1: An economic impact can then have secondary effects on health outcomes.

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Speaker 1: So there's a big picture of the interactions of how

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Speaker 1: these emerging infectious diseases can really change life for a

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Speaker 1: period of time. In comparing what the response has been

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Speaker 1: in Italy to the response in parts of Asia, it's

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Speaker 1: a bit like comparing oranges and elephants. The epidemic emerged

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Speaker 1: in very different ways, and of course society is very

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Speaker 1: different in Italy as opposed to China, the governmental structure

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Speaker 1: is very different, and of course as we look at

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Speaker 1: the response, then in the United States, we have yet

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Speaker 1: another type of society altogether, where we highly value our

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Speaker 1: freedom and our mobility, and the customary approaches have been

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Speaker 1: to use least restrictive means to control infectious diseases. So

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Speaker 1: the response now in the United States is in many

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Speaker 1: ways unprecedented in response to an unprecedented situation, which also

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Speaker 1: requires a partnership among agencies and the non government sector,

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Speaker 1: as well as flexibility on the part of the public.

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Speaker 1: I know everyone becomes frustrated when it's not easy to

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Speaker 1: just contain the spread of the virus. So our goal

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Speaker 1: is really to look at how we slow the spread.

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Speaker 1: And the initial response was how do we slow the

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Speaker 1: global spread? But now that it is in the United States,

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Speaker 1: how do we sload the spread within our community so

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Speaker 1: that the healthcare system doesn't become overwhelmed. And I think

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Speaker 1: what we're hearing from Italy is that the healthcare system

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Speaker 1: has become overwhelmed in many ways. One of the questions

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Speaker 1: I've been asked I don't have a good answer for

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Speaker 1: is if you look at South Korea, where they apparently

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Speaker 1: developed a drive through model. They have massive testing. Then

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Speaker 1: they've seemed to have had a model of maximizing tests

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Speaker 1: without regard to whether you had any indications because they

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Speaker 1: want to detract people at the earliest possible date. I

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Speaker 1: get the sense that we had a very different model

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Speaker 1: of testing. Could you explain what the American model of

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Speaker 1: testing has been and why it's operated the way it has. Yeah,

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Speaker 1: I think the biggest difference in the approach to testing,

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Speaker 1: particularly now that the availability of tests is more widespread

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Speaker 1: in the United States, has been based on clinical indication.

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Speaker 1: The Korean approach has been more oriented towards, if you will,

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Speaker 1: any nose that walks in off the street can get

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Speaker 1: a swab, and whether or not that's really of benefit

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Speaker 1: or not, I think is a challenge. It also's created,

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Speaker 1: i think concern in the United States because we've initially

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Speaker 1: had challenges with the test reagents, with a problem with

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Speaker 1: one of the controls that are involved in assuring that

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Speaker 1: it's a quality test. That was addressed, and then the

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Speaker 1: very next week we started running into problems with some

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Speaker 1: of the equipment and the reagents that are used to

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Speaker 1: extract the RNA from the clinical specimen, which is actually

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Speaker 1: not an issue of newly developed reagents, but rather a

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Speaker 1: global supply chain issue. And I think when anything appears

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Speaker 1: to be in short supply, that makes it more attractive.

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Speaker 1: And I'll use the example of toilet paper. Suddenly toilet

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Speaker 1: paper is sold off the shelves. The concern is out

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Speaker 1: there that it's in short supply, so everyone wants it.

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Speaker 1: Is not the solution, but testing is an important part

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Speaker 1: of being able to monitor the progression of the epidemic,

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Speaker 1: and with the visibility on where infection is occurring, that

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Speaker 1: allows the opportunity to implement appropriate prevention measures at the

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Speaker 1: right time. And since we don't have a vaccine at

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Speaker 1: this time, we don't have FDA approved drugs for treatment.

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Speaker 1: Some of our best measures are some of the old

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Speaker 1: fashioned public health tools, such as hand hygiene we've talked about.

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Speaker 1: Social distancing can include things like reducing or canceling mass

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Speaker 1: gatherings and in some instances, considering school closures. The important

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Speaker 1: thing to remember, though, is to do these things at

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Speaker 1: the right time and other ways. We want to do

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Speaker 1: the right intervention at the right time based on the

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Speaker 1: right evidence. We go back to test rec What is

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Speaker 1: the test. It is a swab into the nose is

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Speaker 1: Based on the data that CDC is collected, have now

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Speaker 1: made the determination that swab both of the nose and

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Speaker 1: the throat is not necessary, that the swab into the

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Speaker 1: nose alone is sufficient, and that actually will help maintain

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Speaker 1: the supply of reagents as well as equipment to be

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Speaker 1: able to collect the specimens. Again, it's important to recognize

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Speaker 1: that this testing has been going on globally and as

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Speaker 1: we progress into the pandemic that is beginning to strain

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Speaker 1: the global supply of many of these supplies that are

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Speaker 1: required for the testing. Because we live in a day

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Speaker 1: of just in time inventory and the ability to ramp

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Speaker 1: up and suddenly produce ten to one hundredfold times what

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Speaker 1: the baseline product was can be a challenge. Even though

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Speaker 1: we're calling it a nose swab, really it's a NASA

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Speaker 1: fare and jail swab. And the swab is passed into

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Speaker 1: the opening of the nose and then passed as far

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Speaker 1: back as possible, and then it's withdrawn and the specimen

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Speaker 1: is submitted to the lab where the viral RNA is

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Speaker 1: extracted during the first step of the processing, and then

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Speaker 1: that extracted material it goes into a plimerase chain reaction assay,

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Speaker 1: and this is a process using a variety of enzymes

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Speaker 1: where there's multiple cycles that try to amplify that genetic

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Speaker 1: material to determine whether or not it's present or not.

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Speaker 1: And a positive reaction suggests that indeed, that viral RNA

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Speaker 1: is present. It doesn't prove that someone is infectious, but

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Speaker 1: it is evidence that they are infected and if they

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Speaker 1: have symptoms, that's important to know that test is positive

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Speaker 1: and is the most likely cause of the illness that

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Speaker 1: the provider is seeing and that the patient is experiencing.

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Speaker 1: Should we be doing something to ramp up the supply

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Speaker 1: or is it take too long. There's been a number

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Speaker 1: of steps taken to increase the availability of testing Here

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Speaker 1: at CDC. There is a very intense of effort to

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Speaker 1: identify what were the quality control issues that were slowing

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Speaker 1: the availability of the reagents. We are now working with

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Speaker 1: FDA as well as private sector partners to look at

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Speaker 1: ways to be able to use other platforms to perform

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Speaker 1: the PCR assay. There's also work going on in the

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Speaker 1: government and private sector to identify alternative ways to make

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Speaker 1: the diagnosis. It would be wonderful to have a point

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Speaker 1: of use essay where it could be like influenza, where

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Speaker 1: there would be basically a test kit that would be

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Speaker 1: in your provider's office, a swap could be done and

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Speaker 1: we would have a result within a few minutes. We

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Speaker 1: don't currently have that, so one of the challenges is

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Speaker 1: using the PCR technology. The number of laboratories that can

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Speaker 1: run the assay has been relatively limited, but as we've

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Speaker 1: been able to identify and approve alternative platforms for running

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Speaker 1: this particular PCR, the availability has increased, but it's important

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Speaker 1: to recognize that still it's not a limitless supply, so

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Speaker 1: the approach in the US has been more clinically based

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Speaker 1: and also risk based. We know that older individuals are

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Speaker 1: at higher risk of serious infection, so we are working

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Speaker 1: on some guidelines for clinicians to be able to identify

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Speaker 1: who is most important to test, and also it's important

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Speaker 1: to be able to use these tests in situations where

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Speaker 1: there's a high risk of transmission, particularly in long term

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Speaker 1: care facilities. I mentioned mass gatherings earlier. Anywhere where we

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Speaker 1: have people living in close proximity to one another, there's

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Speaker 1: a risk of transmission, and long term care facilities are

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Speaker 1: of particular concern. Given that they are situations where people

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Speaker 1: who are advanced in age oftentimes live in close contact

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Speaker 1: with one another. So are there specific additional things we

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Speaker 1: should be doing in nursing home settings. Basically, don't go

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Speaker 1: visit unless there's some overwhelming reason, because you don't want

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Speaker 1: to come in and affect everybody who's in the nursing home,

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Speaker 1: which apparently happened in Washington State. Yeah, that's absolutely right.

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Speaker 1: We know that the vast majority of people who become

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Speaker 1: infected with this coronavirus have very mild symptoms. There is

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Speaker 1: some evidence that people can be infectious or at least

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Speaker 1: have the virus detectable in their nose and throat before

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Speaker 1: the onset of symptoms. So even though you may be

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Speaker 1: at low risk yourself of severe illness, we want to

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Speaker 1: be able to limit the amount of exposure to people

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Speaker 1: who are at higher risk. I was actually in South

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Speaker 1: Korea at the very beginning of the virus becoming an

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Speaker 1: international problem. And if you walk into a building, they

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Speaker 1: check your temperature. We walked into hotels and they would

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Speaker 1: check our temperature, And apparently in Singapore you get a

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Speaker 1: strip every time your temperature is checked, and at the

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Speaker 1: end of a day. You can have three or four

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Speaker 1: or five strips that you're kind of wearing something that

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Speaker 1: proves that your temperature was all right. Should we be

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Speaker 1: doing something like that level of intense measurement. It's one

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Speaker 1: of the options to be able to screen for early

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Speaker 1: symptoms of the illness and be able to separate people

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Speaker 1: who are potentially infected from others. One of the challenges though,

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Speaker 1: is we've learned more about this COVID nineteen coronavirus, is

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Speaker 1: that not everyone has fever early in the course of

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Speaker 1: the illness. Most people do develop a fever at some

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Speaker 1: point in the course of the illness, but it's not

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Speaker 1: universally present. So temperature screening can be part of the

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Speaker 1: overall response, but it's important to recognize that there are

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Speaker 1: other prevention measures, such as being able to have hand

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Speaker 1: hygiene products available or making sure that soap and water

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Speaker 1: is available as well as towels to dry hands, and

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Speaker 1: then frequently touch surfaces may play a role in transmission.

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Speaker 1: For instance, if I sneeze into my hands and I'm infected,

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Speaker 1: I could put my hand then on the counter, and

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Speaker 1: then thirty seconds later someone else comes along touches the counter,

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Speaker 1: the virus is capable of surviving on surfaces at least

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Speaker 1: for a period of minutes to even a few hours

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Speaker 1: under the right conditions. In fact, in laboratory we can

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Speaker 1: create conditions where it might survive for days, but we

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Speaker 1: don't know that that happens in real life. To focus

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Speaker 1: on hand hygiene is important, and then cleaning those frequently

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Speaker 1: touched surfaces. Thinking about ways that we can minimize our

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Speaker 1: exposure to one another and to frequently touch surfaces is

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Speaker 1: something that we can all do to help reduce spread

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Speaker 1: of the coronavirus. If you start to have symptoms, is

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Speaker 1: there a way for you to distinguish without a test,

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Speaker 1: between the flu or having a common cold, or this

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Speaker 1: is actually coronavirus? What's the difference. Unfortunately, there's no way

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Speaker 1: to distinguish this coronavirus infection from some of the other

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Speaker 1: common coronavirus infections, or for influenza, or from rhinovirus, or

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Speaker 1: from respiratory since issue virus, the whole slew of respiratory

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Speaker 1: viruses out there that can cause respiratory symptoms as well

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Speaker 1: as fever and muscle ake. So it really does require

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Speaker 1: that when you develop symptoms that you self isolate and

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Speaker 1: it's more important than ever that we don't try to

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Speaker 1: tough it out and just go into work when we

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Speaker 1: have a respiratory illness, because it's just putting other people

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Speaker 1: at risk. Next, what Americans can do to protect themselves

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Speaker 1: from the spread of COVID nineteen. Even if you're healthy,

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Speaker 1: Is there a virtue to maximizing the number of people

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Speaker 1: in your shop who work from home or who telecommute

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Speaker 1: rather than coming in. Yeah, that's an important part of

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Speaker 1: social distancing, particularly at this point in the epidemic, so

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Speaker 1: that we can reduce the rapid spread of the infection

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Speaker 1: and distribute the impact of the epidemic over as long

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Speaker 1: a period as possible. So, even though you may be

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Speaker 1: at low risk of severe infection yourself, keep in mind

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Speaker 1: that people you work with, particularly those who are older,

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Speaker 1: those with chronic heart, lung, kidney disease or diabetes, or

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Speaker 1: who are on immuno suppressive medications, may be at higher risk.

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Speaker 1: If I wash my hands regularly and I try to

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Speaker 1: avoid large groups. Are there other specific things the average

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Speaker 1: Americans should be doing. I think the final thing that's

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Speaker 1: important for everybody to do is to monitor the situation closely.

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Speaker 1: Some of the best Sources of information include the website

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Speaker 1: at the CDC, CDC dot gov slash COVID nineteen, as

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Speaker 1: well as information through your local or state health department.

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Speaker 1: I know Johns Hopkins University also has a very well

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Speaker 1: monitored and edited website, The who has daily updates on

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Speaker 1: the global situation as well. And the final thing that's

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Speaker 1: important is while everybody's concerned anytime we have a new

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Speaker 1: pandemic of an infectious disease, it's important to be prepared

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Speaker 1: rather than scared. That we're ready to be flexible when

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Speaker 1: our plans may be frustrated by cancelations or we may

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Speaker 1: be tied up forced to stay at home because of

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Speaker 1: quarantine or isolation recommendations. But the more that we can do,

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Speaker 1: the things that have been recommended all along, such as

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Speaker 1: being prepared for hurricane, earthquake, or other natural disasters apply

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Speaker 1: in an infectious disease outbreak as well. So having some

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Speaker 1: of those non perishable foods on hand is an important

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Speaker 1: part of being able to stay home as much as

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Speaker 1: possible if that becomes need it next how soon will

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Speaker 1: the United States have a coronavirus vaccine? What does your

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Speaker 1: gut tell you as the earliest we're likely to have

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Speaker 1: a vaccine, So a vaccine that's ready to enter into

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Speaker 1: trials and humans maybe a few months away. But there's

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Speaker 1: still a number of steps that have to be taken

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Speaker 1: before we have a vaccine that's available to the general public.

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Speaker 1: So that's at least a year to a year and

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Speaker 1: a half away. And it's important to recognize this is

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Speaker 1: not bureaucratic steps and checkboxes that have to be ticked off.

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Speaker 1: It's critically important that we know a vaccine is safe

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Speaker 1: and that it's effective before we recommend it to the

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Speaker 1: general public. What's your sense of somebody who studied his

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Speaker 1: HU area, is in fact this routine pattern of flu

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Speaker 1: sort of diminishing in the spring and summer and then

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Speaker 1: tending to come back in the fall and winter. Is

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Speaker 1: that in fact a pattern, and if so, is it

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Speaker 1: also likely to apply to the coronavirus. It's certainly true

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Speaker 1: as a pattern for the influenza virus that we have

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Speaker 1: a flu season in the northern hemisphere that aligns with

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Speaker 1: cold weather months and we see a big decline in

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Speaker 1: respiratory illnesses during the summer months. The reverse is true

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Speaker 1: in the southern hemisphere. For this coronavirus. Of course, the

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Speaker 1: evidence is that it only first affected humans about three

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Speaker 1: to four months ago, early in the winter of late

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Speaker 1: November early December of twenty nineteen, so we don't yet

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Speaker 1: know what it's going to do in the summertime. So

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Speaker 1: at this point I would not want to take comfort

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Speaker 1: that it's just going to go away in the summer.

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Speaker 1: I think it's going to be better that while we

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Speaker 1: might hope for the best, we also prepare for the

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Speaker 1: worst and recognize that epidemic may very well continue into

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Speaker 1: the warmer weather months. Is it also true even if

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Speaker 1: it did diminish dramatically the summer that, given the pattern

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Speaker 1: that we've now seen for I think the first recorded

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Speaker 1: epidemic was like eighteen ninety, that we just better spend

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Speaker 1: the summer and fall really working to be ready because

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Speaker 1: it probably will come back. Because these things now, once

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Speaker 1: they cross over from animals to people, they seem to

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Speaker 1: like staying with people. Yeah, that's a great question and

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Speaker 1: a really good point as well. It gets back to

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Speaker 1: what I was saying, we want to hope for the best,

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Speaker 1: but prepare for the worst. So it would be very

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Speaker 1: favorable if we got to break through the summer months

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Speaker 1: with less transmission, we would still not have a vaccine

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Speaker 1: available by the fall, so we'd still have a large

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Speaker 1: proportion of the population that may be susceptible. So we

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Speaker 1: would want to use that time wisely to be prepared

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Speaker 1: aired for the potential for a second wave of an

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Speaker 1: increased number of cases as the cold weather months return. Listen,

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Speaker 1: I really appreciate this, and I wish you well. I

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Speaker 1: know how hard you're working and how much of responsibility

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Speaker 1: you feel for helping the country and for that matter,

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Speaker 1: of the world get through this, and I just want

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Speaker 1: to tell you we're very grateful to have a chance

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Speaker 1: to share these ideas well. I really appreciate the opportunity

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Speaker 1: to speak with you and really have a longer conversation

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Speaker 1: about what's going on. And unfortunately it's hard to put

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Speaker 1: it all into a sound bite, so I love the

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Speaker 1: opportunity to sort of dig into some of the details.

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Speaker 1: I'm currently living in Italy, where the coronavirus has spread

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Speaker 1: from two hundred people to twelve thousand people in the

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Speaker 1: span of just two weeks. I discussed the situation in

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Speaker 1: Italy at newts Inner Circle dot com. It's a subscription

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Speaker 1: service where I offer insights and commentary on the issues

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Speaker 1: that matter to me. Most joined today at newts Inner

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Speaker 1: Circle dot com. You can read more about COVID nineteen

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Speaker 1: on our show page at newtsworld dot com. Newtsworld is

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Speaker 1: produced by Gingwist three sixty and iHeartMedia. Our executive producer

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Speaker 1: is Debbie Myers and our producer is Garnsey Slump. The

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Speaker 1: artwork for the show was created by Steve Penley. Thank

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Speaker 1: you to the team at Gingwrist three sixty. Please email

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Speaker 1: me with your comments at newt at newtsworld dot com.

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Speaker 1: If you've been enjoying Newtsworld, I hope you'll go to

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Speaker 1: Apple Podcast and both rate us with five stars and

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Speaker 1: give us a review so others can learn what it's

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Speaker 1: all about. On the next episode of Newtsworld, coronavirus panic

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Speaker 1: sent world stock markets crashing last week, with an index

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Speaker 1: of global stocks setting its largest weekly fall since the

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Speaker 1: nineteen eighty seven global financial crisis and over five trillion

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Speaker 1: dollars wiped from the global market value last week. We'll

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Speaker 1: discuss the coronavirus and its impact on the star market

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Speaker 1: and the global economy on the next episode. I'm newt

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Speaker 1: gangwish this is news world,