Experts from the department. We have just concluded what are now regular briefings that we are doing that are open to the full senate, open to the full house of representatives, trying to make sure that we are being radically transparent what we know when we know it as well as the uncertainties we face. We acknowledge this is a time of angst and concern by many people and trying to educate people about what we know and dont know in these times. We had a lot of discussions especially about lab testing. We are happy to provide you with more information and answer your questions as we did the house and the senate, because there has been some confusion around those issues and want to make sure everything is being clear. And we want to make sure everything is being clear. A major focus in both the senate and the house discussions today was around the issue of just the Patient Experience and the provider, the doctor experience, and we were able to point them c. D. C. sd out from the website an information sheet that says i am an individual, im concerned i might have covid19, what do i do . We want to ensure senators and members of the house are armed to be able to talk to their constituents to provide that kind of information. Thats available right on c. D. C. s website. We also have fact sheets that we gave out which have that are also available on c. D. C. s website, which have q as. Basic background information. And what we talked about is we want to keep getting these questions from them because its helpful for us to know where the information gaps are, what people might need to understand better, and how we can give best guidance. We also reminded them that the state and local Public Health departments are the leaders in this country on any type of response like this. We get our information from them. Theyre experts. We provide background report. Background support. We surge in to help them. We provide a lot of infrastructure. Of course we provide about 50 of the funding for their work. But they really are a trusted local source of authority in this space. We count on them, members of the house, the senate, and the public should count on our local and state Public Health leaders also. Im going to stop, and then well take your questions. But i want to ask dr. Fauci if he can say a couple of words. Then well open it up for questions. Dr. Fauci thank you very much, mr. Secretary. I want to address one issue we continually get asked about. I would like to clarify it a bit. The question we get asked is, what is the risk to the American Public . You have to divide it into two general areas. When you look at the country as a whole, what is the risk of actually getting infected with the coronavirus . The risk in the United States as a whole is still low. When you look at what were seeing, and were following it literally on a daily basis, this issue of Community Spread, as were seeing right now in the seattle area, which they are addressing by a variety of ways, the risk of getting infected when you have Community Spread in a certain area is a bit higher. Quantitatively, im not sure. But still, when you look at the country as a whole, the risk of getting infected is low. However, if a person is infected, like in seattle where like taking those unfortunate situations like we are seeing in seattle, where several people have gotten infected, the risk of getting into trouble widely varies. If youre a young, otherwise healthy individual, the risk of your requiring any kind of medical intervention is low. And we know that from data from china and from recent data from korea and recent data from italy. And that is about 80 or more of individuals who get infected will do well without needing any medical intervention. However, if you are elderly and have underlying conditions, the common ones that we use with flu, heart disease, chronic lung disease, diabetes, obesity, or being immunosuppressed for reasons like cancer chemotherapy, if you get infected, the risk of those individuals getting into trouble is significantly higher. So it isnt like a uniform risk across the board. Which tells us that the vulnerable among us, those with those conditions, need to be particularly paid attention to protect them, not only from getting infected, but to give them the care they need when they get infected. Ill stop there and we can answer questions. Secretary azar admiral, do you mind talking about the fatality rate data issue . That is something that came up quite often. I think youd all like to know the latest information and assessments weve got. Sure, thank you, mr. Secretary. We are still very early in understanding, all the evidence isnt there, so i want to caveat that. But to set some foundation. The typical mortality rate for seasonal flu is about. 1 or. 15 . The best estimates now of the overall mortality rate for covid19 is somewhere between. 1 and 1 . Ok . Thats lower than you heard probably in many reports. Why is this . Number one, its because many people dont get sick and dont get tested. So probably for this reflects the overseas experience. So probably for every case, there are at least two or three cases that are not in the denominator. So i just want to scale that, that it certainly could be higher than normal flu. It probably is. But its not likely in the range of 2 to 3 . Now, full stop, i want to reemphasize what dr. Fauci said. Is that for young or healthy people, its very unlikely. Still possible, but very unlikely to have severe illness or death. But it is an extremely severe condition in elderly or those with Chronic Health conditions. Ok . So that is a very important population and one reason why administrator verma leaned in very hard yesterday to support all her quality measures and measures in education for all the facilities that she governs that deal with the elderly. Reporter just to clarify on the mortality rate. When youre saying. 1 to 1 , are you talking about within the u. S. Specifically . So, we believe that is the overall rate that we might expect in the United States between. 1 and 1 overall for all groups. But again. Reporter thats lower than the w. H. O. Figure. Why . So, again, were very early here now. Right . Were very early. But the modeling suggests that we have a denominator problem, right . If youre really sick and you have respiratory failure, you go see someone and you get tested. But if youre not very ill, as most people are not, they do not get tested. They do not get counted in the denominator. Especially in a crisis situation like in china. So again, we are very early in this and i hope people dont the main point of this is, number one, this is likely more severe in its mortality rate than the typical flu season, but its certainly within the range. So we dont want peopling to crazy like its 30 mortality like in mers. But main point is, if youre young and healthy, you are likely to have a very mild illness. Theres always a oneoff here or there where a young person could be severely ill or even die. So thats one batch. But we need to make sure that those who are elderly, particularly those in nursing facilities, or those who are chronically ill. If you have chronic obstructive pulmonary disease or severe diabetes and hypertension and heart disease, you are at a very highrisk, and precautions need to be taken. Reporter are you going to meet your timeline of having a million coronavirus tests available by the end of the week . Secretary azar i want to walk you through whats going on in terms of the lab tests. Because i think its really good to have clarity. Ill ask the admiral to make sure and clarify. So there are basically three stages to the availability of lab testing for the novel coronavirus. The first stage is the test that the c. D. C. Developed, that the c. D. C. Is producing, and is sending out to Public Health labs. Thats a little over 70 Public Health labs here in the United States. There currently is the capacity to test, at the beginning of the week, 15,000 people. Each person needs more than one test as part of the testing regiment. By the end of the week, we believe well have shipped enough for 75,000 people to be tested. These tests are sent out free, they go to the 70 or more Public Health labs that are part of our network. What that means for those tests is a doctor or a hospital wishing to test somebody for novel coronavirus, they work with these Public Health labs on testing all the time. They would reach out to their Public Health lab and say, i have a suspect case, i would like to get this person tested. And they would work on how to do that. That might involve the patient going to a lab, it might involve the doctor getting instruction on what type of swab to use, how to swab the sample, what type of medium to use, how to transport it, etc. The second step here is i. D. T. Which is the manufacturer that works with c. D. C. Has worked to get its own authorization to develop and market that same c. D. C. Test. They believe by the end of the week, they will have sent out to their hospitals, other labs, around the country, commercial, Public Health, whatever labs, enough tests to test one million specimens, which would be the equivalent of being able to test about 400,000 people. From that. They also believe they can scale up their production so that by the end of next week, they can be in the range of perhaps four million is that correct . Four million tests. Specimens which would then come down to a million and a half. Very rapidly. Secretary azar people. So for that that means more traditional things like youre in the hospital, that hospital might very well have that test in their lab. Be able to test you right there. If that hospital buys that test and has it. Or other labs. Commercial labs. The third stage, the third stage is the guidance we put out on saturday morning from the f. D. A. That said since the obama administration, if youre developing a Clinical Lab Test like this, as c. D. C. Did, you need to go to f. D. A. And get approval. An emergency use authorization to send this test out. C. D. C. Did that. What we said on saturday is if you are a certified clinical lab able to handle highcomplexity tests, these are labs that are actually regulated by administrator verma and c. M. S. , you may develop your test and you dont have to wait for us to approve it before you can start using it in patients, send us your validation data, and send us your emergency use authorization after the fact within 15 days of beginning use. Thats your lab corpses, your , your large diagnostic companies, and that will also radically expand availability. It will also make for a much easier experience for doctors and clinicians, because theyre very used to working with Lab Companies like this to get tests done. There is a work process flow that is very patientcentric and easier. I was very candid with both the house and the senate that as this expands, that experience will get better. But right now there is it is a challenge if you are a doctor wanting to get somebody tested, you do need to reach out to your Public Health lab, see if they have a test. Were going to be putting up on c. D. C. s website information about which Public Health labs have the tests. Also, by this weekend, that Broad Network of hospitals, other labs, will be receiving from i. D. T. Those million tests that we referred to, and they will then work they have to validate in the facility, and then once theyre validated, theyll be up and running. So that experience will get better over the next week, week and a half, two weeks. But do not be surprised if you hear concerns of doctors saying, i have a patient, i dont know how to get this done, well try to put more guidance out from c. D. C. To help with that experience. Reporter youve been trying to get out Accurate Information to the public on selfquarantine, what the numbers are, the testing. All those things. When the president is countermanding things by saying the numbers of w. H. O. Are wrong, when he says people who might have this can go to work anyway, is it helpful to get your message out when youre being countermanded by the president on tv fairly regularly . I dont think im being countermanded i dont. Reporter the president said last night that people who had the mild disease could essentially go to work. He suggested that. Ive not heard that. I cant comment. Reporter he thinks the number is wrong, the w. H. O. Is wrong. I do think the admiral just walked you through the difference thats based on international data. Reporter the w. H. O. Has been wrong . Its how one describes it. Our best modeling, again, you have a denominator problem and i want you to understand that. That only the people who are really sick or have symptoms come in and get tested. So based on the models we have right now, we estimate the mortality is. 1 to 1 . It is likely not in the range of 2 to 3 . Now, remember, if you have a if you have a cruise ship where people are 70 or 80 years old on the cruise ship, the mortality is going to be higher as it is in a Skilled Nursing facility. And let me make it clear that for the best guidelines of what people should do, go to cdc. Gov. Theres a huge banner across the top. What you need to know if youre a patient. What you need to know if youre a provider or a health care. Thats the current guidance. And remember, the guidance will change over time as we learn more and more about the disease and it will also change over time depending on were in a full containment situation or whether were in a Community Mitigation situation like they really are in seattle. Because the rules do change depending on what phase youre in. Reporter why did the c. D. C. Decide not to use the World Health Organizations test . Thank you. Theres a process of developing tests when theres a new disease. We followed that procedure. There wasnt a need to follow the w. H. O. Test. We developed a test very rapidly after china produced the sequence. We are in the process of validating that, and thats the test that were going to be using. Reporter why is it that once we realized the first c. D. C. Test had several faulty tests, you didnt go to the w. H. O. Test . And we knew how quickly this was spreading . So the process as weve described, the emergency use authorization, really getting the test out and then using that initial experience to make sure that its working the way it is supposed to, when we found that that wasnt the case, we really looked at what was going on and thats where the new test has come from. The one that were talking about today. Reporter shouldnt we have been prepared given that we had weeks ahead of time, that we knew this was coming . We heard from Health Officials literally for months that this was going to spread here, that there was only a matter of time before an outbreak. Yet still the tests werent working. We Began Development of the tests within hours of the posting of the china sequence. So i dont think there was any delay on our side. Reporter so even though in south korea, for example, they are testing 10,000 people a day once they had a diagnosis, and it took us a week, i dont even know if we have tested 10,000. As of sunday it was 3600. I think the steps the secretary outlined will ramp up our capacity to test many, many more people than weve been able to test before. I think thats the right step at this time. And our testing in the United States has been very consistent, if not even more aggressive than similarly impacted countries. So we are not korea. Korea is in a very active hot zone outbreak. As is northern italy. And so, we have been ramping up our testing and actually where we will stand in the next week to week and a half in terms of availability of testing will place us far ahead, far, far ahead of similarly impacted major countries around the world. So weve actually been progressing with this on par with all of our peer countries. In europe, for instance, similarly impacted. Reporter do you think seattle should be shut down . The former f. D. A. Commissioner said that for the good of the country, a city like seattle should basically be shut down. Do you have plans for Something Like that . Let me ask the c. D. C. If you might talk about Community Mitigation steps and what were doing with the state of washington and king county and seattle. Right. So when theres widespread virus transmission or community transmission, theres a different approach to controlling that disease that moves away from identifying cases and tracking contacts to moves that are more communitybased. So weve seen that some schools have been closed, and thats to reduce transmission among children. There are discussions under way within the local government for how to keep people from congregating who might be affected. So these are not measures that are directed at individuals who are known to be affected or their contacts, but more general measures. All of them to reduce the chance that an infectious person will come into contact with a susceptible person. Reporter the Vice President said that coronavirus tests would be designated as an essential Health Benefit but that only applies to private plans. How will you make sure that the vaccine is covered for people on medicare and medicaid . Let me be clear. It is covered in medicaid and medicare, and people in those programs can get tests and the individual exchanges, this is a common type of test, just like you get a swab for strep throat or for the flu test. These are the kind of things that are typically covered. I think private insurance companies, it does depend on coverage, but this is something that is commonly covered service. Reporter you cannot mandate that this be an essential Health Benefit for private insurers . The essential Health Benefits are defined in law. It does not in that particular section of the law, it doesnt identify laboratory tests. That being said, in the individual exchanges, and the products