Cdc director dr. Robert redfield. He is the Nations HealthProtection Agency and defense americans against dangerous threats and the response to inaccurate information on those threats or record of the head of agency data redfield has been one of the nations 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. We are glad to have him with us and what has sadly happened as and a sadly Pivotal Moment in this crisis right now as you all know cases are spiking across the country and as a result we are seeing different types of lockdowns like we saw in the initial wave of thekd virus and americans everywhere are hungry for information and guidance about how to navigate the Holiday Season this winter but back to redfield will address thall of these issues and more d well take questions from our audience as well. Without further ado dr. Redfield welcome. What can you tell the audience about the current state of our country . Thank you very much for having me and we are at a very pivotal time in this pandemic. Unfortunately we are experiencing a substantial surge across the nationhere we n have really a significant numbe of our jurisdictio and states that are what we call the red zone and a wide surge that happened in the heartland and the Northern Plains which really lasted a lot longer than say what we had with the spring and summer surge. The other thing that it had a much more steep trajectory so when you look at the spring surge, this was the rate of increase in the summer surge. When we looked at this more recent surge this is really what it was. Its also lasting a lot longer. Usually it took between four or five weeks before we get it to peak and at this time its closer to eight to 10 weeks and in many areas we have notto pead yet. We are at a very serious time and i guess the good news is the heartland of the Northern Plains have started to decline and hit their peak but unfortunately at the same time that is happening the pandemic is having a resurgence in indiana, ohio, pennsylvania, the midatlantiche states, southern sunbelt also now moving back up into the northeast as well as unfortunately california oregon and washington so 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 1 million cases reported each week. 4 million cases were reported in november. Unfortunately our hospitalization rates are going up andtete maybe well talk more about that. That is one of our great concerns. In the spring were talking about 20 to 30,000 people in the hospital and now we are over 90,000 people in our hospitals. One of the mostsp concerning things about understanding the impact of the pandemic right now and the question about it is to recognize as we sitt, here today 90 of our hospitals in this nation are actually in what we call one of the hot zones and the red zone. Therefore the risk for increased hospitalization and the potential to negatively impact hospitalca capacity. 90 of all of our longterm care facilities are in what we call high transmission zones. We are at a very critical time right now about being able to maintain the resilience of our health care system. In the spring we were dealing with new york, detroit and new orleans, los angeles. We could shift Health Care Capacity from one part of the country to another. We saw it similar when we have the southern wave. We could shift Health Care Capacity to the heartland and from the Northern Plains. Right now we unfortunately have a pandemic that is really throughout the nation and their scent that resilience of Health Care Capacity to deal with the shifts. This is why its so important as time and i know we will talk more about it, is to increase the mitigation steps we have tried to stress. Its time to debate whether or not mask work. We clearly have scientific evidence. We recently published in mmwr mask mandate and certain counties opted out and certain counties opted in. When you compared those that opted in to have a 6 decrease in the observation period of new cases. 100,000 of the counties that decided that they didnt think this was the way to go on opted out of the mask mandate we found out that they had over 100 increase in cases. You couple that with social distancing,co handwashing stayig out of crowds and doing things more outside than inside, these are critical mitigation steps which many people seem simple and they dont think it could have much of an impact but the reality is they are very powerful tools. They have an enormous impact and right now its so important that we recommit ourselves to this mitigation as we now begin to turn the corner with a vaccine. The reality is december, january and february are going to bee rock time. I believe they will be the most difficult time in the history of this nation n largely because of the stress that its going to put on our health care system. Its a sobering and important thought there and a couple of directions i want to go but lets start with the Public Health model for mortality rates. My question for you is what can we do to change that trajectory and is it as simple as masks social distancing isolating etc. . Will i think you are right when you look at the different models. We looked out the original spring. We lost 100,000 people and in the fall 100,000 people. This signifies the loss of this pandemic. Or potentially looking at a number another 100 to 200,000 people so this is a significant time. You asked the right question. The truth is mitigation works. If we embrace it and the challenge with this virus is its not going to work at half off us do we need to do. Not even going to work if threequarters of this do what we need to do. This virus really is going to require allo of us to really be vigilant about wearing a mask and unfortunately not just in the public square. We are finding now much of the transmission that is driving, i mean who would have a leaked that rural north dakota and south dakota, wyoming, idaho montana these areas of north dakota recently 30 to 40 of people that got tested were actually positive. The reason this is happening is because now one of the major drivers of transmission is not the public square. Its actually 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 the age of 40 is totally asymptomatic. Really beingt able to get a handle on asymptomatic transmission in the family setting which is drivingsi it didnt many dont recognize it so unfortunately the virus can get transmitted into someone who is older and amanda developing a symptomatic illness and they ubed up in the hospital. The reality is as you saw just the other day i think in our toorts we were back up almost 2400 deaths that were reported yesterday. We are in that range potentially now, starting to see 1500 to 2000, to 2500. The mortality concerns are real and i do think unfortunately before we see february the could be close to four to 50,000 who die from this virus. That is not a fatal complaint that American Public embraces social distancing, wearing masks, not letting your guard down at Family Gatherings, limiting crowds, maintaining ventilation doing events outdoors rather than endorse making sure you have vigilant hand hygiene and that coupled with some strategies that we are pushing states to do to begin to diagnose surveillance the asymptomatic infections will begin to help. Ill give you one example of hope to coast i used to think that the most difficult group that we were going to have do help contain this pandemic was basically College Students that i thought was going to be hard for us to be effective in getting them to fully embrace the messages that i just said. In the spring we had significant outbreaks on Different College campuses. What happened over the summer and the fall is many of the colleges and universities really stepped up to developing comprehensive mitigation steps that they really engage the student body to actually buy into. And then they coupled that with screening the student body every week so they could identify they asymptomatic silent epidemic that wasnt in the population and pull them out from isolation and prevent them from transmitting. If you look at them today wisconsin governor thompson who is now the acting president of the university of wisconsin they have a prevalence rate in their 27 campuses offer wisconsin of students and the highest risk group 18 to 25yearolds that demonstrate less than 3 . When you look in the communities enwhere they live that most of these kids dont liveus on camps there rate is between 10 and 20. It reaffirms to me that mitigation can work and even some of what your biases may be the more difficult to participate i can show you the same is true in the northeastern schools and here in the South Carolina schools. The idea that mitigation with routine screening surveillance and to be able to identify the asymptomatic carriers, these techniques to work and they are powerful. The truth is its hard to defd against this when he us with a question how many people are going to die between now and therefore he first . Im going to come back and say its really up too us. Vigilant people are going to see about taking to heart mitigation there is an inconsistency of the American Public embracing the message. Mask wearing, this mask wearing is not a political tool, its a Public Health to amend. Powerful health tool. Very simple but very powerful Public Health tool. We have taken a long time and their jurisdictions probably on this call that really dont embrace the importance of these mitigation steps threading courage people to look at the mmwr we put out in kansas. Shows the difference between a 6 decline are 100 in crease by one simple weather the county decided to embrace the mask mandate. It thats really remarkable. We should help you get that message out. Im going to turn t audience questions and folwup on something you saidhere the efficacy of surveillanc. I bet the main ranm testing tesn other colle campuses . The bee defined survelance . Well i think its really portant if you want to have a hindsight the real questn that isl out there is how much testig capacity do weeed as a nation in our Public Health response . I would say thats more test than we currently have. Vanilla oak is on how many tests we have. The second thing i will say is how testing is used. Is it random recent strategic . We would argue right now, one of the big challenges that hit us with this pandemic was we have modeled it, we have modeled it in our heads like a song or like influenza and sars and influenza and the way they work is they make you sick. Its not that complicated for you to have a case Identification Program that says lets look at people who are sick and find out did they have covid19 and isolate contact strays and control the pandemic are the problem with covid is its not like the flu. Its major transmission particularly in those of us under the age of 45 is its asymptomatic. You dont know who is infected and who isnt so all of a sudden that strategy of looking for symptomatic people like we did in january and february and telling symptomatic people to stay home and wear a mask, that works for symptomatic people but the problem is 50 or more in certain age groups of the people that are carrying this virus so therefore we have got to say wait a minute how do we then define asymptomatic transmission and we would argue on the College Campuses they figured out by doing regular weekly screenings every week variable now to identify the asymptomatic carriers of the asymptomatic infections, pull them out at the transition cycle, i salute them, contact trees around them and isolate those individuals and then youll be able to control layout break. Theretr has to be a strategic ue of test. We were recently in liverpool and angling englands. They just tested everybody in liverpool they figured out who was infected and they were able to isolate. We have areas now that we are trying to do the community watch, strategic testing in hotspots to try to understand. The cdc guidance is coming up this weekend trying to help institutions and Public Health groups and Companies Look at how they may be able to use routine screening. We think it might be useful to offer routine weekly screenings for teachers and others feel it might be useful to look at other people who have a lot of contacts in the community with people and set them up for routine screening so you can identify the silent epidemic. Youll see on the mmwr we list a number of different strategies. None of them have been really proven in the sense that this is the tool thats going to now contain the epidemic that we do know it is proven that they the help of the doubt by the side of the transmitters and mentioned i think the schools of Higher Learning are teaching us something. I think theyve been able to us. Its actually interesting if you look at the colleges andac universities that test everybody routinely every week the more you compare that to people who tested everyone in contact trees surround symptomatic cases constantly youllyo see this colleges that did the routine screenings once a week had a far greater less occurrence of covid. I just want peopleof to know weo have tools. Testing i think needs to be more strategic. One of the challenges is a lot of people that choose to get tested or what we call the worried well. I do think its important for us to be more strategic in our tesu set up a routine Surveillance System once a week or some portion of employees they get a sense of trying e to understands the silent epidemic there . You mentioned techniques like wastewater but i do think the biggest challenge right now is to identify thee silent epidemic and to try to get that silent epidemic out of the transmission cycle. Let me bring in ource audiene questions. This is derek lawson from arizona to represent the chairman of the board for the National Centers for American Enterprise that represents the native american businesses in the United States. My question is our committees have been hit hard by covid19 but there increasing numbers nationwide. Is there an incident if someone has recovered from covid that they could beld reinfected . Is a very good question and so far we have seen very limited evidence of reinfection. There have been several case reports. We have had other examples that i think really drive the messagt home. We had a camp thats was very careful about trying to control infection and what they had to solve the campers were so quarantined before they came to the camp for 14 days. They were all tested and they were all negative and then they were able to go to the camp. They were all tested and they werese 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 happens to that camp that there is a huge outbreaks . Close to 90 of the campers and counselors all gotten fed it. Just to show you all that precaution but woe was interesting to give it your question there was a group of individuals who actually have antibodies when they went to that camp and none of those individuals got it. Right now we have pretty good evidence thatpr antibodies that are protected against reinfection. We just dont know for how long. We dont know if thats going to bewe for six months. We dont know if its going to be a year. We dont know if its going to be for two years. We will learn all those questions right now but its one of the things that gives us great hope that before we knew the vaccines were likely to work it really is a gift that these vaccines many of us thought they worked with 70 efficacy they would we would be excited but to see 95 efficacy for the first two vaccines now the other vaccines are based on the same what we would call immunological pardon. I think we have a lot of optimism that antibodies directed against those vaccines will be protective for some period of time which we are going to learn in the future and infection when infection is protected for some period of time. Another obvious question which the followup to that is given the efcacy of these vaccines do you imagine airlines or schools or employers might require vaccinations in order to participate . I think each jurisdiction and i talk t the Business Roundtable recently and that question came up and i think each institution are going to make those decisions. Its clear, i am a physician and im required to take a number of vaccines in order for me to be ablele to does in the hospitals that i used to work in. I anticipate being vaccinated against covid is going to be another requirement for health care. Its potential that i could see longterm care facilities might require evidence of immunity or certain longterm care facilities. Re i think the Airline Industry and you mentioned tt, i can see them trying to determine whether they want to make this a requirement for employment. Unfortunately even thoughe get control of covid which i think we will buy the Third Quarter of this year the pandemic and the world is not going to be corolled for multiple years. We will y always have the global risk. It will be a decision each industry will make but i do think there are Certain Industries where i think it would be important to protect their workforce and some other induries where it may be important to make sure that the protect their customers and consumers. E as theses vaccines get deployed groups will wrestle with that but i wont be surprised at