With each other what we have to do it really carefully and with a planned strategy or were going to end up in a situation where its going to snap back on all of us and were going to be right back where we are now. Socially distancing from one another in a more extreme way so i think what really needs to happen over the next several weeks and months is that states really should be opening up slowly and considerably with very consistent metrics. I think that we have to have kind of testing everyones been speaking about and the ability to trace and isolate those that are positive in all states. Before we begin opening up and certainly before we begin having any very large crowd events. So the thing thats keeping me up at night right now is sort of the lack of a unified strategy. The way that that happening in a emslightly more piecemeal way across the country so first is that we need to have a unified plan for reopening with a little bit more specificity than what weve seen coming out of the white house and there are many states are starting to put pen to paper on this and in really positive ways lyim sitting on an Advisory Task force in seattle for example so i got some insight into what the government, Governors Office in Washington State has been doing there they been looking at very specific metrics or what kinds of testing to be in place, what kind of Contact Tracing the inplace for ldputting more people in with one another. But i do think that its important to tell americans be really clear about it that the summer isgoing to be very different than other summers. If we want to avoid a site for a set way of this virus and if we want to avoid ending up where we are now i think that means really being honest with people. That crowding at beaches, some of the larger eventsthat we all like to be doing this summer on the concert ,going to games. Those things are going to the very different and may not be able to have at all in order for us to come to to this year and get into a position where we have a space safe and effective vaccine next year and can start restart those activities so i guess i say thats the short term. Over the longterm its clear that we need to treat pandemic preparedness eathe way that we treat our National Defense that means a much more significant investment h. I heard bill gates on Anderson Cooper think that just five percent of the departments Defense Budget , we could be in the 40 billion range i think by my last calculation we would be in a much more significantly impaired position in the United States and by the way, its not just that, we need to invest in working with partners around the world to get prepared. We know there are preparedness gaps everywhere so i do think that we need to put a issue of pandemic preparedness much more at the top of the leaders agenda. Im sure youve seen the demonstrations in state capitals around the country really just some of the photographs courtesy of the detroit news as the demonstrations took place in lansing michigan read and i mention this because people do have the frustration and anger yithing that i want to get back to work, they want to get back to their lives. Weve heard this from the ministration, how do you make certain that docure is not worse than the disease . Its an excellent question read first and foremost this is where all feeling frustrated. Its normal to feel frustrated. Some of the demonstrations a show that frustration, some of the demonstrations have been a little bit more than and have really used some hateful speech and have been an opportunity again to uncover hesome of the divides in our country and some of the challenges that people have when they are feeling frustrated and looking at today that frustration out on segments of our society and unveil prejudices that exist so we do need to address those underlying racial and political social economic tensions in our country but i do think for all americans that are feeling frustrated, the vast majority of which are absolutely paying attention to and adhering to social distancing. The fear should not be worse than the disease and instead what should we we should be doing is recognizing Public Health and our economy are inextricably linked so everything that we do for our Public Health ultimately is better for the economy area i think whats missing is how make that real for individual people and individual families i think some Interesting Research that i have the opportunity to look at last week added some european scientists, their starting from different types of jobs and Industry Sectors and think about whats the longterm plan or subsidies, or making sure that this business unit, function without putting people back out into positions where they would be contacting a lot of people. Those are really the segments of society that are targeted with longterm financial subsidies and more funding. Whereas others i think should really besubsidizing people to stay home. Theres a lot in our country in terms of our social safety net that is really being uncovered here and i know thats not a perfect answer but right now i guess what i say is my number one answer to your question is that if we all go back into society the way that we were in march and february and interact in the same way that we were then we know from looking at the case counts that we will see a spike in the disease and without the ability to test and isolate people were going to be right back where we are now and i think it was melissa slatkin who said this in an interview the other day. The only thing worse than the first wave is the second wave so we really need to get ahead of this and we just need to hold on for a little gbit longer to get those tests and contacts traces out there. You literally wrote the playbook on the pandemic in e 2016. What did you write three or four years ago and how has that played outtoday . The pandemic playbook at first was a huge team effort althat was at the request of the national and Homeland Security advisors and i had the honor of overseeing the upper but it was a huge Us Government effort and the reason i mention that is because the importance is for people to know that playbook was in no way a political piece of paper. It was the sum total of the Us Government expert knowledge read the vast majority of which the people that put input into that playbook were Civil Servants like myself who were trying to pack pack on the best information they had about how to deal with the pandemic so what the playbook actually is is an informational decisionmaking rubric and what i mean by that, thats wonky. What i mean by that is that we were, we wanted to leave behind for the white house a decisionmaking tool thats sort of said look, if the situation looks like this, its green and if it looks like this, its yellow and it looks like this, its red. You really need to be thinking about putting additional measures in place and so the playbook walks through many different scenarios area in the anlifespan of the disease. For example looking at the coronavirus, the outbreak, what its done as it would have identified human clusters of a disease that had the potential to be a pandemic. And then it would have started d flashing maybe yellow. And have been when there were large clusters in china with the potential to be sustainably transmitted between people. And so on and then it asks pacific questions that the white house is supposed to be asking of its Government Experts across all departments and agencies for example, what is the availability ofdiagnostic testing for this disease. Our when should we be thinking about the deployment if it was the disease that had a large dozens in a politically unstable place or a disaster area. When did we deployed Disaster AssistanceResponse Teams id like we did during evil academic when should we start looking at our Strategic National stockpile area so we spent a lot of time looking at the playbook and its questions over the last several weeks. I think it really does hold up its important i think to know that it was supposed to be used to guide the questions that would be asked. The answers still have to come the experts in the context of the Disease Threat that they are currently facing and it was meant to make sure that the white house was asking hard questions as early as possible because we learned in evil law that you need to anticipate and think about the things that will become your points of failure and i think in this outbreak obviously lack of our ability to deal quickly a diagnostic test did become a single point of failure we had a ilbackup plan, we might have been in better shape. That cameron who is a graduate of uva earning her doctorate for Johns Hopkins u university. How is all of this change our nation. I think our nation really is going to be ever change. In many ways and i hope that where change in how we prioritize this particular set of rats. Call flat epidemics and pandemics read but if you think the social fabric of our country will also change. Tony county has been quoted as saying the handshake might be a thing of the past and we are using the less intrusive mama say that using india for example. I think those are small ways that our Society Might change that might have some good knock on benefits for influenza. When we all dont like to get the flu and what still cost thousands of lives around the world every year. But i also think itmay have some significant changes in how we View International travel. Ill we look at the Mass Gatherings and also i hope how we treat one another because one of the only Silver Lining in this parable terrible pandemic we are undergoing is these solidarity that we had amongst people and communities read i hope that translates to solidarity in how we work with our partners around the world because this disease is going to be here for a long period of time even after we havethe vaccine. It has to be equitably distributed and people have to be vaccinated all over the planet and i think thats going to be thing that we need to spend a lot of time preparing for and really working with our partners in africa and asia and europe and african africa and all over the world. A look at the numbers courtesy of Johns Hopkins university. 3. 4 million confirmed cases, 3. 2 million around the world have recovered. A decile in 187 countries is over 244,000 with the us leading the list of cases and the death toll. Thomas is joining us, houston texas. Caller hey beth, hows it going . Its amazing, these guys in there with guns and all this stuff. You cant shoot a virus. One firecracker would have went off and probably everybody would have gotten shot. The reason theyre out there is because of economics. You got 360 Million People 1 million and you would save 1 trillion and they could stay at home. And please, every time you hear this information like a virus cameout of here or there or wherever , youre going to have chineserunning from these other guys trying to blame them for this. It came to europe, somebody flew out of europe and landed at kennedy and here we go. Those scientists, please stand up. When you hear stuff like well, chinese gives us this or that, say something. Host thank you and beth cameron, do you want to respond . Guest i think one of the great things you highlighted ec is how interconnected our world is and youre right. We do know that the cases in the east coast and new york city came from europe and the cases on the west coast by and large came from china and i think what that shows us is that when you have a disease like this one that breaks out and becomes capable of infecting people in sustainably transmitting between them, you dont have a lot of time to respond and you do need to share information extremely quickly. And you do need to anticipate that our interconnected flights are going to be moving everywhere so the second you learn about it a threat like this one you need to assume that its going to be in your country and that youre going to have cases so a lesson finitely that many of us have been thinking about for a while but certainly its been demonstrated here. I think youre alsogetting the question of blame. Whether or not its right or appropriate lato place blame on particular countries and what i would say to that is that we all need to learn some lessons from this including the United States and i think one eeof the lessons thats been arlevied at china is the need to share information as quickly as possible about hathe disease and certainly there have been reports that that wasnt done in that case but Disease Threats start anywhere and we know for example that the 1918 influenza, were not exactly sure where it started. We know it likely was not spain even though its been called the spanish influenza but the first case identified there was here in the United States read obviously 81 and one influenza pandemic started in mexico so we need to be prepared that every country could be, that the virus is going to pop out anywhere. And it doesnt respectborders. It doesnt carry a passport so that means we need to come together with our partners including china and the who and all of our partners to find better ways to prevent the detect and respond to these threats as early as possible thanks for your question. During the transition between the obama and Trump White House were you part of any tabletop discussions or wargames, i say wargames , different scenarios in which this was discussed . I was part of the transition exercise took place at the end of the Obama Administration and i was one of the people who worked with our Homeland Security advisors lisa monico who headed up that effort and International Security ef advisor susan wright read that exercise is actually mandated by legislation and so the Bush Administration did this between bush and obama. The obama tadministration did this between obama and trump. And what this is is an opportunity for the white house and for the cabinet officials from the administration thats leaving to pass on their concern about some of the top threats interface to the homeland of the United States for top threats that theyre worried that the next T Administration towill certainly face and when they thinkthere needs to be a lot of emphasis. So within that exercise that happens brought together the cabinet, from the Obama Administration and then the presumptive nominees from the trump administration, there were several that actually a relatively small number, i shouldnt say several there were three specific c areas that were emphasized and one of them was pandemic. In that scenario we look at a pandemic influenza and had our experts who we brief that group including the outgoing cdc director tom friedman, including the outgoing assistant secretary for preparedness and Response Team lori and i talk about areas where they really felt that we needed to be prepared for a coming pandemic. One of the things that made that point at that moment in time is that age 7 and nine influenza virus which occurred first in humans in 2015, there was a large number of cases in humans that year in 2017 as the administrations were transitioning. So there was a concern, a reallife virus that people were tracking and had a high degree of mortality had not yet still have not yet gained the ability to transmit efficiently between people. So there was a concern there and we wanted to pass that on the newadministration. I then stayed into the new administration and work for the Homeland Security advisor over the home from lisa. I was calm. Cameron is next and in san diego california, goodmorning. Could you question and comment. Question, first question would be could you please ask her to explain to the audience who are listening the difference between mortality and the morbidity rate which i think the general public does not understand and second of all, im actually an independent. Im not arepublican or a democrat. However its very unfortunate that the protesters that are showing up that are being displayed in the cnn msnbc that are showing up to these rallies with weapons, totally, totally disgustedat. Whether youre a phone supporter or not. That really sends out a message of a violence instead of having to figure this thing out of really the virulence of this pandemic. Thats going on n. What ive been hearing a lot from the bureaucrats is that we are looking into this and looking into that. The what im afraid of and what ive been tracking is that the country itself is being taken over by the technocracy anymore. Its no longer a democracy and as far as ms. Cameron, that just explained that we will no longer be shaking hands and were going to be going by the way ofindia. In other countries, i think its absolutely appalling that someone should suggest that. Coming up on 60 years old and ive fought into wars. And ill be damned if i will be changing my life of a virus thats going to have to be changing gpeople live and people die and thats just a fact of life. And people will have to learn to accept that. Unfortunately america itself, the country that ive fought for grew up in was asleep. We believe that there cameron and get a response from beth cameron. Cameron, thank you. First and foremost thanks for your service. I appreciate what youve done for our country and i think youre certainly expressing frustration with this Public Healthemergency that many people have. First i want to say to your question about morbidity and mortality, your first question that yes, mortality is the number of people or the case of people die from the disease relative to those who are infected. And the infections rates is not the case fatality rate so there are many more people who are infected with this disease and who will die and i think when you say morbidity, what morbidity is the people who are affected by the disease, not necessarily the number including the people who died also including the people recover. So there are going to be way more people as steve mentioned with this statistic earlier about the number of cases versus thenumber of deaths. I do think that the number of deaths from this disease is quite high. It would have been much much fight higher in this country if we had not instituted the social distancing measures thats one of the big challenges in Public Health is that you have to really react and overreact really in order to be able to prevent the worstcase scenario from and then whenit doesnt , it looks like you did too much and i think thats what we just have to be prepared for. With Public Health. I do think we need to be Public Health and interconnected way working with partners around the world including india, including china. And including europe and. All partners, these effects are not political and they dont respect our socioeconomic and geopolitical boundaries and we know that a Disease Threat anywhere in the world is a threat here. So i do think that we need to be working closely together with those partners. The last thing i would say is that i think youre right. That it is a it is important, certainly have a right to protest in this country thats one of the things that makes this country great identically and very concerned about the Public Health threats for the people who have to actually make sure that those protests are safe. And making sure that they, Police Officials and First Responders who have to be there are well protected. From potential transmission of this virus. And i really want to see people take more care to not bring weapons and turn these types of protests into political rallies where statements that could turn into violence. Im quite worried about that that really underscores the need for a unified federal response explains clearly and crisply to everyone in america what they are for reopening thenumbers. The tests that we need to be able to get back more people in contact with each other finally just really Clear Communications that we are the essential services are already reopening. People are going to be teleworking, they need to continue to telework and Mass Gatherings really are going to be happening shouldnt be happening safely for a long train of time. Potentially through the summer. I think if we were more clear about that and explainwhat people will and wont be able to do it might be helpful with some of that frustration. Covid19, number from the Labor Department and cdc, the number one killer in april with just over 58,000 three and followed by Heart Disease , cancer, respiratory disease, accidents, strokes and aneurysms and alzheimers. The numbers from the cdc. Official count published this morning in thewashington post. Allie is joining us from bristol virginia. Morning. I hope you have an answer to my dilemma. The amount of infections and that in africa with the exception of africa is very low compared to the rest of the world. The other day a ceasefire gets stated that the reason behind that is because of the lack of tests. However, the death rates are very low. In africa. So my question is, what exactly is going on . Thank you sir. That is an excellent question. I wish i had a perfect answer for you. I dont read and actually speaking next week with the head of africas cdc, an excellent colleague is working on fighting covid19 across all countries and with the African Union is located in addis ababa to answer these questions myself. What ivelearned so far is very similar to what youd said which is theres a couple of problems that are occurring. One endodontist wrote a piece that i commend to you. I think it was in naturebut i can double check. Look at the access of the african continent to test and its really a huge challenge that they are not able right now to access diagnostic test kits in a way consistent with being able to test enough people so there is definitely underreporting of covid19 so thats first. Second, it is possible that some of the underreporting for death rates is simply a function of lack of reporting capability in general and just not being able to know what people are dying of there being so many confounding other factors and Disease Threats in many countries on the continent. So the answer is it is one of the big conundrums that the Global Health and Global Development community are facing and i think the most important thing from a Global Health security professional perspective is that we get ahead of this as much as we can and in africa, that we shouldnt count on their not being as many cases in the future. On the continent. And that we shouldnt count on the fact that there are already a large number of undiagnosed cases now. So i really like to see the United States partnering closely with our partners in africa and the African Union to get more diagnostic test kits not only here but there. So that we have a better sense of whats going on and then of course in order to save lives, all around the world. So very important question, one that i wish there was more clear answer to that one that i believe should be a huge focus for our own government to solve. Polling in buffalo new york,thank you for waiting area. Good morning doctor. I have a question about the malaria drug donald trump pushed quite heavily to you. It was he having any success with that at all . I didnt hear any and that made by a French Company and if so, i also heard that donald trump had a financial in that company. Thanks for the question. That cameron, are you aware of any of these points. The one thing i would say is there have been studies of hydroxychloroquine. But understanding and please take this what its worth, i have not heavily researched the Clinical Trials that have been ongoing with hydroxychloroquine. The military drug that she speaking about is that it has not shown spent substantial benefit read im not aware of the Different Companies that produce it or of any interest financially that thepresident might have in those companies. I would just say that its important to look at the science and also to understand that medication is used for a wide variety of other things. Including malaria and including lupus. So there were a lot of concerns about the run on that drug. But i am not aware of a financial interest in the company. About rem disappear and what you know about it, how significant is that development as a treatment for covid19 . Renders your study to look promising and you seem probably the news on the many callers have seen the news that it was effective enough that they have now given it to the people who are otherwise on the placebo in those Clinical Trials so does look promising theres still work to do