Dr. Fauci was unable to join us in person but wanted to share a message with us. Dr. Fauci i am pleased to address this committee from the conference of mayors on this extremely important topic, covid19. I am going to give you a brief overview on talk about the research response. You all know the history. Ago, but ite years was just a few months ago that we had thrust upon us this new virus that came out of china, after, almost certainly, jumping species from an animal, likely a bat, to humans, leading to end up raked that was first recognized leading to an outbreak that was first recognized that they market in wuhan, china. Januaryese reported on 9, when the information went up on a database for us to look at. I will get back to that. The disease is referred to covid19, for coronavirus disease 19. The virus causes sars coronavirus 2, because of its relationship to the 2002 sars coronavirus. These things happened because of the identification of what was going on in china and elsewhere, and travel to the United States from china and points elsewhere were screened. Later, thele of days first travelrelated case of this occurred in the united and then those became very difficult. On january 29, because of theemergency situation, White House Coronavirus task force started off with less people and was supplemented with additional names, and now it is a task force of modest size. Veryis a picture of a typical meeting of the Coronavirus Task force, in this case and the situation room in the west wing. And there i am, explaining to President Trump in detail things we are doing. He does not attend all the task force meetings. The task force is run by Vice President pence. The cdc confirmed first possible incidents of Community Spread of covid19 in the United States. The big difference between the initial case was, that was a travelrelated case, someone who came in from the outside, and one of those got infected to close partner. For reasons you cant figure out, cases pop up in the community and you dont readily identify them. And that is when we have to start doing Contact Tracing. Fast forward a few months. Where are we today . Half aave been almost Million Deaths worldwide, almost 10 million cases reported. The United States has been hard has been hit harder than any other country with close to 2. 5 million cases and as of a couple of days ago, more than 120,000 reported deaths. Started tosee, they come down, but as i will show in the moment, they plateaued at a disturbingly high level, 20,000 to 30,000 cases a day. Deaths continue to come down because deaths lag after cases. So when we starteds seeing started seeing decreasing cases in new york city, very soon you starting decreasing deaths. But if you look at the timeframe comparing the european union, which got hit before us, but look where they are now after getting there up rick under control after getting there outbreak under control after getting their outbreak under control, compared to the United States. So hopefully we will be able to correct that. Again, more about the disease. About 40 of cases are people without symptoms. That is extremely important, because it becomes very difficult to identify cases. When there are symptoms, there 83 to 90 entation, have a fever. The more welearn, see that it was probably a little less of a percent that had fever. Shortness of, 50, breath, weakness, muscle aches, and interestingly a loss of occurs withste that respiratory symptoms. The wide spectrum of the disease, that actually 40 of people have no symptoms, the reason this is perplexing is that this is the only disease that i know, and i have been studying viral diseases for 40 years, in which the range is among people who get no ,ymptoms, some are mild, aching or they may feel poor enough to stay home for a couple of days ago, or may be in bed for a couple of weeks and feel bad for a few weeks after that, or they hospitalization, oxygen, some may require intensive care and some may die. A communitytion in were some people say, why should i worry, i wont have any symptoms if i get infected, there is a small chance i will they need to be of the realization that they are part of a dynamic process in which they have a societal responsibility, not only to take care of themselves, but not be part of the spread of the virus. What are the complications associated with the disease . Fromrange widely, neurological to cardiac, clotting, Kidney Injury and an children,ndrome in multiinflammatory syndrome that can cause serious disease. And then the risk of severe disease. Butody can get infected, the most likely to get severe disease of the elderly and people with underlying conditions. But you dont have to be in a nursing home to be someone who has a comorbidity that would give you a higher incidence of complication. At that is usually high blood pressure, chronic kidney or lung disease, heart disease, obesity, others. If you look at this chart, cumulative rates of hospitalization clearly goes way up the older you get. Fewou look at relatively hospitalizations in children compared to people who are older. There is also significant racial and ethnic disparities. Minorityls in communities, particularly africanamerican, latinx and hispanic americans, have a much higher rate of hospitalizations. As shown here, when you look at the top three bars, compared to whites and hispanics on the lower bar. There are a number of drugs, some shown here, i will get to remdesivir in a moment. There are antivirals, plasma, immunebased therapies dampening the immune response, i dont want to call them antibodies, Natural Products they are, directed against the virus themselves. There was a groundbreaking study a month or so ago that showed a single drug, remdesivir, and antiviral, in a trial showed significant improvement over faster time of recovery for those who were infected and in the hospital with lung disease. , a steroid, was shown in the u. K. To reduce mortality on people with ventilators and others with serious lung disease. Guideline panel that is producing a document online. At nih. Gov. Ss that at the most recent recommendations for treatment of diseases. What about prevention . What other Public Health measures to protect you and protect society . It is based on social and physical distancing. We shut down the country with stayathome orders. We are now trying to reopen different regions of the country, that have different paces. It also takes a look at schools, them, gatherings to ban make sure everybodys wearing a mask, aggressive case identification, Contact Tracing. The recent study that came out showed that largescale, anticontagion policies, particularly wearing a mask, keeping a distance, helps dramatically to the tunes of hundreds of millions of cases avoided and needless deaths averted by doing that. We have been talking about contagion prevention measures, diligent handwashing, avoiding close contact, namely crowds and when you are with people at under six feet distance. Importantly, wearing a facial covering or mask. This is critical. Covering sneezes and coughing, avoiding face touching, regular cleaning and disinfecting of objects. The study showed physical face masks and high protection had a major, major effect on decreasing the risk of infection. It is pretty simple. Someone a mask, if breeds or coughs or sneezes if someone coughs or sneezes or even breeds, you are protecting someone. And finally, vaccines. We are taking a strategic approach, getting multiple candidates that i am sure you have been reading and hearing about. Trying to hold Clinical Trials so that there is a consistency even though there are Different Companies in different products, consistently consistency on the Laboratory Data and use the same endpoints to drive the efficacy of a particular vaccine. So the same board of impartial judges is working at the efficacy. These are the different types of various that are in stages of clinical trial. As i mentioned, there are many. Various literally july, so aw , and also in late summer and early fall. And finally, one of the vaccines, over the next few through initial trials, and a very promise response very promising thatnse that would predict the vaccine might be effective. There is no guarantee that that is the case. I want to leave you with, i am cautiously optimistic of the vaccine that will be protective. It is no guarantee, but we feel that this will be the case sometime by the end of this calendar year and the beginning of 2021. But again, this remains to be as we gethopefully, further into testing, we will get a better idea of where we stand with that. I will close there. Thank you for your attention. Thank you, dr. Fauci. To i am very pleased introduce our next speaker, dr. Schuchat. She has an extensive career at a diseaseined cdc as expert in the Epidemic Intelligence Service in 1998 and became Deputy Director and served as acting cdc director twice prior to this. She served as director of the fornational Center Infectious diseases and chief of the respiratory disease branch. Shuchat served as the Incident Manager for the onavirus disease 20 tiny and also the h1n1 pandemic response, the 2003 sars 2001eak in beijing in the bio attack anthrax attacks. Welcoming dr. In Anne Schuchat . Thank you, mayor stony. I will begin with regrets from dr. Redfield. He was looking forward to participating live, and unfortunately was pulled into something at the white house at the last minute. You, am pleased to talk to and especially to go after dr. Fauci, who has done a nice overview of what we know about the virus, and what we are learning. This is a virus that is part of a very challenging pandemic, and something we are trying to have a rapid learning cycle around. Local, and iis want to say all pandemics are local. What each of you is experiencing at any one time is different than your peers. And you need the very best information, best guidance you can get, but you need that ability to understand your communities, stakeholders, hospital capacity, publichealth capacity, to make the best decisions for your communities. Cdc has been on the pandemic since the beginning, but we want to be a resource to you, your publichealth staffing the city, and to the state Public Health and governmental leadership. But you, as mayors and does the and as themayors council of mayors, plan Important Role in amplifying the voices of the nations mayors on Health Issues at the local and national levels. Your realities have really changed for many of you since january, and for more of you since march, when the pandemic became really clearcut in the u. S. We know you are on the front lines implementing the careful, phase process of reopening our nation. We know youre taking priorities to do things in a manner that is not true to your tradition. What heard from dr. Fauci he is kind of where we are, and i have to say unfortunately, we are not in a good place right now as a nation. Unfortunately, the National Tally of cases is trending upward, but we have some very different patterns, and i think you are probably aware of them. Northeastern states and cities were very hard hit in march and april, but they are trending downward. The southern cities and states and the western cities and states have been trending upwards. It is not a simple situation. Its not the same thing going on in every community, but here are a couple of the factors that have contributed to the increases that we are seeing. In some cases, its local outbreaks. A meet packing plant, a correctional facility, a workplace even a Birthday Party in some places has led to a new ember that becomes a fire that needs to be put out. In other places, there has been great expansion of testing, and that can explain some increased numbers, but unfortunately, in a lot of places, we are seeing an increase percent positive among the cases, so that means these increases are real, not just a function of getting out there and checking more people and finding more people. We seer places, workplaces associated. Nursing places, it is homes. Many of the places we are seeing increases, they are in young people. Not the Elderly Population that dominated the infected populations early on. We are seeing increases in people in their 20s, 30s, 40s. We are seeing increases in certain racial and ethnic groups. In hispanicsases and a number of other communities. We think these may be individuals who cannot stayathome, who are out and about, maybe doing work for others. To some extent, they may be people who have gotten relaxed about the seriousness of the virus. While most younger people have mild or a symptomatically infections with the virus, young people can be severely affected, and im sure each of you is aware of some of the deaths and very difficult hospitalizations we have seen in otherwise healthy young people. Cdc has been responding to the needs of states and cities over andpast several months in over 20as people states assisting in these hotspots where theres increase cases occurring. We are trying to take these increased cases seriously and learn as much as we can about the best ways to control them and support local and state officials in the areas like epidemiology, surveillance, and laboratory activities, and the efforts. Mitigation we have deployed Rapid Response teams to arizona, arkansas, california, north carolina, texas, and utah, areas where cases have been increasing, and we want to help local officials get to the bottom of what is going on and try to turn the tide as quickly as possible. Beyond providing boots on the ground, cdc is also working on guidance and taking the best available information to put putr an update together and update a get and keep america together website to distribute information. I think we have about 1900 guidances. We are working hard to translate that into simpler checklists and flowcharts that can be adapted by organizations and workplaces that need help in understanding how to safely reopen and how to care for their neighbors as well as some of their workers, but we recognize that each community is different and that you, as mayors, are in charge and need the best resources so you can adapt them to your circumstance. One of the things weve done over the last few weeks is pulled together the evidencebased update information about who is at risk and expanded the list of underlying diseases that we think increase the chances that a person will have a severe outcome. Hospitalization, intensive care, or fatality from the virus. One of the updates includes pregnancy. We did not really have data about that before, but now we do think that pregnant women are at of intensive care unit hospitalization, for sure. Not seem to be at higher risk for death. Theres probably a mckenna mole mechanical thing about latent pregnancy and having pneumonia on top of it. We have also updated the information about age. People think that if they are under 65, they are ok. Turns out for every decade, the risk goes up, and the double whinny of underlying diseases plus increase in age can increase the chances of a more severe outcome. Much of the strategy is about reducing the spread between one ,erson and another person preventing Mass Gatherings and ensuring physical distancing, and really trying to protect the Health Care System so we can handle and in so it can handle an increase in cases and is not overwhelmed, and it can protect the vulnerable. More communities may have a lot of high risk people in them, and the demand on the Health Care System may be difficult. This is where understanding of the guidance and getting the best advice locally can be very important. I think most of us dont feel that we are out of the woods at all. The increases we see in the south and the west may be a first wave in those areas while the northeast is in recovery mode. We need to be resilient and resolute and stick with this. Cdc facilitated funding of about to states,billion tribes, and territorial entities and some cities. For most cities, your resources would come through your state. Dollars were to help expand testing, to increase Contact Tracing, to help with slowing the spread, help with the mitigation and the work that when a case is identified so they can be isolated and their contacts can be traced, and they can stayathome. That is a lot of work to do between now and the months ahead. We heard just now about the in vaccine andss therapeutic work. We do not have vaccines yet and we will not in many months at the scale we need. Isolation,cing, quarantine, physical distancing, including wearing face coverings when we cannot have a physical distance, are the tools we have that will keep communities safe and keep businesses open, we hope. Right now, we think we are at about 30,000 or so contact tracers around the u. S. You may know what the numbers are for your jurisdiction, but we may need about 100,000 of these contact tracers. The funds provided were meant to help them staff up on that. Cdc is also supplying additional staff who have developed a variety of training materials to help new hires be able to do that important Contact Tracing. One thing i want to say is Contact Tracing is a local issue. It requires trust. People who can be the most someone, talk to really need to develop a relationship of trust in order to get that information and follow up with other contacts, haveu jurisdictions may fantastic people, possibly people who have lost their jobs recently, who might be able to sign on as contact tracers or other support staff to help them sustain the kind of control measures that we need. It is really critical that we find people who have the virus and that we take care of their health if they need care, provide them with the support so they do not spread further, and we find whoever else they may have s