Today, we are delighted to welcome the cdc director, dr. Robert redfield. The cdc as you know is the Nations Health protection agency, looking to save lives and defend americans against dangerous threats and respond with Critical Science and active information when those arrive. Dr. Redfield has been one of the nationss leading voices during this pandemic, sharing new information, issuing Public Health guidance, and advising americans about how to safely return to work, school, and daily life. Him at whatto have is sadly a Pivotal Moment in this crisis. Right now, as you know, cases are spiking across the country. As a result, we are seeing some states resorting to different types of lockdowns like we saw initially with the virus. Americans everywhere are hungry for information and guidance about how to navigate the Holiday Season in an uncertain winter. Dr. Redfield will address all of these issues and more and we will take questions from our audience as well. Without further ado, dr. Redfield, welcome. What can you tell our audience about the current state . Dr. Redfield thank you very much for having me. We are at a very pivotal time in this pandemic. Unfortunately, we are experiencing a substantial surge across the nation, where we now have really a significant number of our jurisdictions and states that are really and what we call the red zone. A wide surge that happened in the heartland and Northern Plains, which really lasted a lot longer than say what we had with the spring and summer surge. The other thing, it had a much more steep trajectory. When you look at the spring surge, this is the rate of increase, and the summer surge. When we look at this more recent surge, this is really more what the rate of increase is. It is also lasting a lot longer. Usually between four to five weeks before we get a peek. Now, this time, it is closer to eight to 10 weeks. In many areas, we have not peaked yet. We are at a very serious time. I guess the good news is the heartland and Northern Plains have started to decline and hit their peak. Unfortunately, at the same time that has happened, the pandemic has had a resurgence in indiana, ohio, pennsylvania, the midatlantic states, the southern sun belt, also moving back up into the northeast as well as unfortunately, california, oregon, washington. We really have a very extensive pandemic now throughout the nation. I think many of you probably saw that in the month of november, unfortunately we had over one million cases reported each week , 4 million cases were reported in november. Our hospitalization rates are going up. Maybe we will talk more about that because that is one of our great concerns, whereas in the spring we were talking about 20,000, 30,000 people in the hospital, now we are over 90,000 people in the hospital. One of the most concerning things about understanding the impact of the pandemic right now, and there may be questions on it, is to recognize that as we stood here today, 90 of our hospitals in this nation are actually in what we call one of the hot zones, in the red zones. Therefore, at risk for increased hospitalization and potential to negatively impact hospital capacity. 90 of all of our longterm care facilities are in what we call high transmission zones, so we are at a very critical time toht now about being able maintain the resilience of our health care system. In the spring, we were dealing with new york, detroit, new orleans, los angeles. We could shift Health Care Capacity from one part of the country to another. Theaw similar when we had southern wave, we could shift Health Care Capacity from the heartland and the Northern Plains. Right now unfortunately we have a pandemic that is really throughout the nation, and there really isnt that resilience of Health Care Capacity to be able to be shifted. This is why it is so important at this time, and we will talk more about that, to embrace the mitigation steps we have tried to stress. The time to debating whether masks work or not is over. We have scientific evidence. We published a paper in kansas when they came out with their mask mandate and certain counties opted out and certain counties opted in and when you compare those who opted in, they had about a 6 decrease in new cases per 100,000. Other counties that decided they didnt think this was the way to go and opted out of the mandate, they had over 100 increase in cases. Couple that with social distancing, handwashing, being smart about crowds, doing things more outside than inside, these are critical mitigation steps, which many seem which may seem simple and people dont think they could have much of an impact, but the reality is, they are very powerful tools. They have an enormous impact. Right now, it is so important that we recommit ourselves to this mitigation as we now begin to turn the corner with the vaccine. The reality is, december and january and february are going to be rough times. I actually believe they are going to be the most difficult time in the Public Health history of this nation, largely isause of the stress it going to put on our health care system. It is a sobering and important thought, and there are a couple directions i want to go. Lets start with some of the Public Health models, looking at mortality rates. They are shocking. My question for you is, what can we do to change that trajectory . As simple as masks, social distancing, isolating, etc. . What do we do to change what looks like a terrifying stretch . Dr. Redfield i think you are right when you look at the different models. We looked at the original spring, we lost about 100,000 people. Summer, 100 thousand people. Fall, 100 thousand people. These are lives that were lost as a consequence of this pandemic. We are potentially looking at another 100 50,000200 thousand people before we get to february. This is a significant time. You asked the right question because we are not offense list. Mitigation works. We are not defenseless. Mitigation works. If we embrace it, and the challenge with the virus is, it is not going to work if half of us do what we need to do. It is not even going to work probably if three quarters of us do what we need to do. This virus really is going to require all of us to be vigilant , and wearing a mask unfortunately, not just when we are in the public square. We are finding now that much of the transmission that is driving, who would have believed that rural north dakota, south dakota, wyoming, idaho, montana, these areas in north dakota 40 of thever 30 , people who were tested were actually positive . The reason this is happening is because now, one of the major drivers of transmission is not the public square. It is the home gatherings, where people let down their guard. You bring in family members and they dont realize that the major presentation of this virus for individuals under 40, it is asymptomatic. You dont know you are infected. Being able to get up a handle on asymptomatic transmission and the family setting, which is now driving that communities dont recognize it until unfortunately, the virus gets transmitted and somebody that is vulnerable, older, they end up developing symptomatic illness and they end up in the hospital. The reality is, as you saw the other day, i think in our reports, we were backup to deaths that were recorded yesterday. So we are in that range potentially now of starting to see 150020002500 deaths per day from this virus. So yes, the mortality concerns are real. And i do think unfortunately, before we see february, we could be close to 450,000 americans dying from the virus, but if the American Public really embraces social distancing, wearing masks, not letting your guard down at family gatherings, limiting crowds, maintaining ventilation, doing events outdoors rather than indoors, make sure you are vigilant in hand hygiene, that coupled with some strategies that we are pushing states to do to begin to diagnose through surveillance the asymptomatic infections, that will begin to help us. I give one example of hope, because i used to think that the most difficult group that we were going to have to contain this pandemic was basically college students. I felt it was going to be very hard for us to be effective in getting them to fully embrace the messages that i just said. And in the spring, we had significant outbreaks on Different College campuses. What happened over the summer of the fall is, many colleges and universities really stepped up to developing stepshensive mitigation that they really engaged the student body to actually buy into. And they coupled that with screening the student body every week so they could identify the asymptomatic silent epidemic that was in the population, and then pulled them out for isolation and prevent them from further transmitting. You look at it today, say, wisconsin, governor thompson, now the acting president of the university of wisconsin, they have a prevalence rate in their 27 campuses all through wisconsin of students in the highest risk group, 1825yearolds, the prevalence rate is less than 3 . When you look at the communities where they live, because most of these kids dont live on campus, but prevalence rate is between 10 20 . This reaffirms to me that mitigation can work, and even what your biases may be, the more difficult group to participate, i can show you the same is true in the northeastern schools, the same is true in the South Carolina schools, the idea that coupling mitigation with routine screening, surveillance, to be able to identify a some dramatic carriers, these techniques do work asymptomatic carriers, these techniques do work. When you ask me how many people will die between now and february 1, i will come back to say it is really up to us. However the how vigilant people are going to be about really taking to heart these efforts. Thingisappointed in one as cdc director and that was that there was an inconsistency of the American Public embracing the message. Mask wearing, it is not a political discussion. This is a Public Health tool, a powerful Public Health tool. Very simple but very powerful, taken aave really had long time, and there are still jurisdictions probably on this call that really dont embrace the importance of these mitigation steps. I encourage people to look at the mmwr we put out in kansas. It shows difference between a 6 decline or 100 percent increase by one simple thing, whether the county embraced a mask mandate. That is remarkable. I think we should help you get that message out. I will turn to the first already athens question it audrey audience question in a minute. Lets talk about the efficacy of surveillance. By that, do you mean the ramp up ontesting, or the testing other College Campuses . How do you define surveillance . It isdfield i think really important, if you want to think in hindsight, the real question is out there is, how much Testing Capacity do we really need is a nation to optimize our Public Health response . That that is more tests than we currently have. There has been a lot of focus on how many tests we have. Second thing i will say is, how testing is used. Is it random . Or is it strategic . We would argue right now, one of the big challenges that hit us with this covid pandemic was, we had modeled it in our heads like. Ars or influenza sars and influenza, the way they work is, they make you sick. So it is not that complicated a case to have Identification Program that says, lets look at people who are sick and find out, do they have covid19 and isolate, Contact Trace, and control the pandemic. The problem with covid, it is not like the flu or sars. It is major transmission, particularly in those of us under the age of 45. It is a symptom medic. So you dont know who is infected and who isnt. All of a sudden, that strategy of looking for symptomatic people like we originally did in january and february and telling symptomatic people to stay home and wear a mask, that works for the symptomatic people but the problem is, you missed 50 or more in certain age groups of the people that are carrying this virus. Therefore, you have to say, wait a minute. How do we then define the silent epidemic . How do we define asymptomatic transmission . We would argue going back to the College Campuses, they figured out by doing regular weekly screenings of students, every week, they are able to identify the a symptom medic carriers pulltomatic infections and them out of the transmission cycle, isolate them, Contact Trace around them, and isolate those individuals, and they have been able to control the output. A strategic use of testing. Right now, liverpool recently in , what they would do to get a handle on the silent epidemic, they tested everybody in liverpool. They figured out who was infected and were able to isolate. So we have areas now that we are trying to do what we Call Community strategic testing where there are hotspots to try to understand. The cdc guidance is coming out this week on trying to help institutions and Public Health groups, companies, look at how they may be able to use routine screenings. For example we think it might be useful to offer routine weekly screening for teachers in k12s. Others feel it might be useful to look at other people who have a lot of contact in the community with people and set them up for routine screenings thee can start to identify silent epidemic. You will see in the mmwr, we list a number of different strategies. None of them have been really proven in the sense that we know that this is the tool that is going to now contain the epidemic, but we do know it is proven that they do help us identify the silent transmitters. As i mentioned, i think the schools of Higher Learning are teaching us something. I think they have been able to use testing strategically. It is actually interesting, if you look at the colleges, universities that tested week,ody routinely every and compare that to people who tested everybody and Contact Traced around symptomatic cases and did that, you will see the colleges that did the routine screenings once a week had a far greater less occurrence of covid within the populations. I want people to know we do have tools. Testing i think needs to be more strategic. One of the challenges he is, a lot of people that choose to get tested are what we call the worried well. I think it is important for us to be more strategic in our testing in terms of whether you set up a routine surveillance employeese a week or or some portion of employees so you get a sense of trying to understand, is the silent epidemic working . You mentioned wastewater. This is something we have done on College Campuses. I think the biggest challenge now is to identify the silent epidemic and to try to get the silent epidemic out of the transmission cycle. Ms. Clark so many questions. Let me bring in our first audience question. This viewer is from arizona. This is derek. Im from arizona. I represent and am chairman of the board for the National Center of American Indian enterprise development. We represent the native american businesses around Indian Country in the United States. Americanon is, native communities have been hit hard by covid. With the increasing in numbers, is there any evidence that if someone has recovered from covid, that they could be reinfected . Dr. Redfield that is a very good question. Seeny, so far, we have very limited evidence of reinfection. There have been several case reports. We have other examples that drive the message home. That was very careful about trying to control infection. What they had is, all the campers were selfquarantined before they came to the camp for 14 days. They were all tested. They were all negative. They were able to go to the camp. Same with the counselors, they were all tested and they were negative. The camp decided they wanted to have a great camp experience, so they didnt want to have that modulated by Something Like wearing a mask or not crowding, because they felt they quarantined everybody for two weeks and they tested everybody. What happened in the camp is, there was a huge outbreak. I think posted 90 of the counselors all got infected. So just to show you all that precaution. But what was interesting, to get to your question, there was a group of individuals who actually had antibodies when they went to that camp. None of those individuals got sick. Right now, we have pretty good evidence that antibodies are really protective against reinfection, we just dont know for how long. We dont know if that will be for six months, we dont know if it will be one year, two years. We will learn all those questions right now. But it is one of the things that gives us great hope before we knew this, that the vaccines were likely to work, and i think it is a gift that these vaccines, many of us thought if they work for 70 efficacy we would be decided we would be excited but to see 95 efficacy for the first two vaccines roughly, and all the other vaccines are based on the same what we call immunological targets, i think we have a lot of optimism that antibodies directed against the vaccines will be protective for some time, which we will learn in the future. And infection, natural infection is protected for some time. Ms. Clark another audience question that is a followup, given the efficacy of the vaccines, do you imagine there is a world where airlines, require employers might proof of vaccination in order to participate in something . Dr. Redfield i think each jurisdiction, i talked to the Business Roundtable and that question came up directly. Institution is going to make those decisions. It is clear, i am a physician and i am required to take a number of vaccines in order for me to be able to practice in the hospital i used to work in