Good afternoon, everyone. Welcome the Health Protection agency with Accurate Information when those threats arrive. As the head of the agency, doctor redfield has been one of the leading voices in this pandemic sharing and issuing publichealth guidance and about how to safely return to work, school and daily life. Cases are spiking across the country and as a result we are seeing some states resort to different types of lockdowns like we saw in the initial and americans everywhere are hungry forer information and guidance about how to navigate the Holiday Season and an uncertain winter. We will address all of these issues and more and take questions from the audience as well. Without further ado, doctor redfield, welcome. What can we tell the audience about the state . G thank you for having me. We are at a very pivotal time in this pandemic. We have a significant number of jurisdictions in the stas that are in what we call the red zone and lasted a lot longer than say the spring and summer. The other thing it had a much more steep trajectory so when we look at the surge, this was sort of the rate of increase in the summer. And when we looked at this, this is more with the rate of increase is. Also it is lasting a lot longer. Usually it is between four to five weeks before we get a peek and this time it is closer to eight to ten and in many areas we havent peaked yet so we are in a very serious time and i guess the gooder news is the heartland and the Northern Plains have started to decline and hit their peak. But at the same time thats happening pandemic isth having a resurgence in vienna, ohio, pennsylvania, the midatlantic states, the southern sun belt also now moving back up to the northeast as well as california, oregon, washington. So, we have a very expensive pandemic now throughout the nation. Many of you probably saw that in the month of november we had over a million cases reported each week, 4 million cases were reported in november. The hospitalization rates are going up and maybe we will talk more about that. That is one of our great concerns whereasis in the spring we were talking about 20 or 30,000 people in the hospital and now we are over 90,000 people inn our hospitals. I think 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 sit here today, 90 of the hospitals are in [inaudible] risk for hospitalization and potential to negatively impact the Hospital Capacity and high transmission zones. So we are in a very critical time right now about being able to maintain the resilience of our Healthcare System in the spring we were dealing with new york, detroit, new orleans, los angeles. A we could shift healthcare capacity from one part to another. We saw similarly the southern wave we could shift healthcare capacity from the heartlands and the Northern Plains. Right now unfortunately, we have a pandemic throughout the nation and there isnt that resiliency to be able to be shifted. This is why it is so important at this time and we will talk moremo about it. Its to embrace the mitigation steps that weve tried to stress. The time for debating whether they work or not is over. We have Scientific Evidence we just recently published when they came out with their mask mandate and other counties opted in and when you compare those they had about a 6 decrease in the observation period of new cases per hundred thousand. And other counties that decided that they didnt think this was the way to go and opted out of the mandate we found out that they had over 100 increase in the case. Coupled with social distancing, being smart about crowds and doing things outside more than inside, these are critical mitigation steps many people 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 important that we commit ourselves to this as we turn the corner with the vaccine but the reality is december and january and february are going to be rough times. I actually believe that they will be the most difficult in the publichealth history of the nation largely because of the stress that its going to put on the Healthcare System. My question for you is what can we do to change that trajectory and is it as simple as masks, social distancing, isolating, et cetera. What do we do to change what looks like a terrifying trajectory . I think that you are right when you look at the difference of the models. We look at the original spring we lost about 100,000 people, some of these were lives that were lost at th the consequencef this pandemic. We were potentiallyre looking at another 150 to 200,000 people so this is a significant time and you asked the right question because we are not defenseless. The truthis is mitigation works and if we embrace it, and the alchallenge is its not going to work if half of us do what we need to do. Its not even going to work probably three quarters its going to require all of us to 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, who wouldou have believed north dakota, south dakota, wyoming, these areas in north dakota recently the reason that this is happening is because now one of the drivers of transmission is not theic public square. Its actually the home gatherings where people let down their guard. They dont understand that under the age of 40 its totally asymptomatic and really being able to get a handle on asymptomatic transition in the family setting which is now driving. Then they end up developing symptomatic illness. We are in that range potentially now starting to see 1500 to 2,000 to 2500, and that is per day. So yeah the mortalities are real and i do think that unfortunately before we see february, we could be close to 450,000 die from this virus but that isnt a fait accompli. The American Public really embraces social distancing, wearing masks, not letting your guard down, limiting crowds, maintaining ventilation, events outdoors rather than indoors, making sure you are vigilant with your hygiene. That is coupled with some strategies we are pushing states to begin the diagnose through surveillance the asymptomatic infections will begin to help. Theres one example of hope because i used to think the most difficult group that we were going to have to help contain this pandemic was basically college students. I thought it was going to be very hard to get them to fully embrace the messages that i just said. And in the spring we had significant outbreaks on the collegee campuses. But what happened over the summer and fall is many of the colleges and universities stepped up to develop a comprehensive mitigation step that they engaged the student body to actually buy into and they coupled it with screening the student body every week so they could identify the asymptomatic silent epidemic that was in the population and pulled them out to prevent them from the further transmitting. They had all through wisconsin students in the highest risk group 18 to 25yearolds but most of these kids dont live on campus and their prevalence rate is between ten to 20 . It reaffirms to me that it can work and even some of the biases the difficult groups that participate i can show you the same is true in the South Carolina schools. The idea that the coupled mitigation was routine screening surveillance able to identify the carriers, they are powerful and the truth is it is ourom defense against. Im going to come back and say that its really up to us and how vigilant people are going to be about taking to heart this is a publichealth tool, very simple there are still jurisdictions probably on this call the difference between a 6 decline or 100 increase whether the county decided to embrace. That is remarkable and we should help you to get that message out. That do you mean the random testing how do you define surveillance . I tnk its important if you wanto take a sort of hindsight, the question out the is how many, how much Testing Capacity did we need as a nation to optimize our Public Health response and i would say that is more than w currently ve. The second is how it is used. Is it random or strategic. We could argue right now one of the big challenge that hit us with this pandemic was we had modeled it in our heads so it isnt that complicated to have a aogram that says lets look at people that were sick and then isolate, Contact Trace and control e pandemic. The problem ishat it isnt like sars. Its major transmission rticularly those of us under the age of 45 is that it is asymptomatic. So you dont know who is infected and who isnt. So all of a sudden, that strategy ofde looking for people like we originally did in januy and february and telling people to stay home and wear a mask that works for the symptomatic people, but the problem is you just missed 50 or more in certain age groups of the people that are carrying this virus and so therefore, youve got to say okay wait a minute. How do wee then define the silence and asymptomatic transmission. And we would argue going back to the College Campuses they figured out they are able now to identify the carriers, pull them out in the transmission cycle and theyve been able to control the outbreak. So there has to be a sategic use of testing. Right now liverpool recently decided what they were going to do to get a handle on the silent epidemic. They tested everybody in, wh liverpool and figured out who was infected and theyve been able to isolate. We have areas now we are doing Community Watch stratic testing where theres hotspots to try to understand. We are lookinge at the guidance coming up this wk trying to help institutions and publichealth groups, Companies Look at how they might be able to use routine screening samples to offer routine screenings for teachersy in k12. Others feel it might be eful to look at otherrs people that ha a lot of contact and set them u for routine screening so you can start to identify. You will see that we list a number of different straties. None of them have been really proven in the sense that we know thathis is the tool that is going to now contain the epidemic. But we do know that itwe is pron to help identify the silent transmitters and as i mentioned i think the schools of Higher Learning are teaching us something. G. I think that they have been able to use testing strategically. Its actually very interesting if you look at theolleges and universities that tested everybody or you compare the two people that tested everybody in Contact Tracing around symptomatic cases you will see the colleges that did the routine screening once a week had a far greater or less occurrence of covidnd the popution. I want people to know that we do have tools and it need it needse strategic. One of the challenges is that people that choose to get tested are thet worried well and its more important to be strategic in the testing in terms of when you set ua routine sueillance system once a week or employees or some portion of employees so youor get the sense of trying understand is it now working. Youve mentionedther techniques like wastewater but i do think that the biggest chlenge right now is to identify the silent epidemic and to try to get that out of the transmission cycle. I am chairman of the board with the center for american india enterprise development. We represent the native american businesses around Union Country here in the united states. My question is theyve been hit hard by covid19 if someone has recovered but they could be reinfected. This is a good question. And so far we have seen very limited evidence of reinfection. Thereve been several case reports. Weve had other examples that i think drive the message home. We have had a camp that was careful about trying to control infection and what they had were they results 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 and they were all tested and they were negative. The camp decided they wanted a great experience so they didnt want to have that modulated by Something Like wearing a mask because they felt they quarantined everybody for two weeks and they tested everybody. What happens is a huge outbreak. I think close to 90 all called infected so there was a group of individuals that had an antibody when they went to that camp and none of those individuals got infected so right now we have pretty good evidence that it is protective against the reinfection we just dont know for how long. We dont know if there will be osix months, a year or two yea. We are going to learn all of those questions right now. But its one of the things that gives uss great hope before we o this g. 70 be efficacy we would be excid but to see 95 efficacy for the first two vaccines and all of the others are based on the same target i think we have a lot of optimismsm that is when infectin is protective for some period. A kind of followup to that. Do you imagine that there is a rule where airlines might inquire a proof of a ccination. That question came up directly and i tnk institutions are going to make those decisions. Im required to take a number of vaccines in order to practice in the hospital i used to work in. I anticipate being vaccinated is going to be another requirement forga healthcare. It is a potential for the longterm Healthcare Facilities i think the airline industry, and you mentioned that for employment especially even though we get control which i think we will by the Third Quarter of this year the pandemic isnt going to be controlled for multiple years so lets always have a global risk of reintroduction for the susceptibles that they have. It will be a decision i think each industry will make but there are Certain Industries where i think that it would be important to protect their workforce and some other industries where it may be that theyto make sure protect their customers and consumers and groups will wrestle with that but i will not be surprised if a number of occupations or situations make a vaccination against the requirement. We have districts in the u. S. That wont open. It seems like the transition has been lower than we were afraid of. What do you think that its going to take to open and remain open . I try to say this every chance i get so im going to say it again. I think its important to use data to make those decisions when they hit their 3 point we have substantial data that shows schools, facetoface learning can be conducted particularly in the elementary and middle schools in a safe and responsible way. We are not seeing as you pointed out these infections within schools in any significant way. When we see teachers infected, we are finding that they are infected from their spouses or community. When weth see students we find t that i was an infection that occurred in the community. We are not seeing the school transmission. On so ive been a big advocate of that and i believe in my heart the Public Health interest is to have them in the facetoface learning for all the reasons we talked about. We have had suicide as we know and i think its healthy for these kids to be in school. When thiss started over the summer, no one really knew for certain. They thought that these measures would work. We can operate these in a facetoface learning and in a safe andd responsible way. They have been a source for the major transition and so far when we haveen looked at this, we havent found schools to be a major source of transmission. We have seen other sources like i mentioned family gatherings. So i do think that we should use that data and make decisions based on this anda. Right now te answer to controlling the pandemic isnt necessarily closure. There may be some that make sense to have bars open until 2 00 in the morning where people are without their masks drinking and clouded bars that maybe shouldnt, maybe instead ofha 10 people they have 200 people and looking strategically broadly shutting down businesses. If the schools can learn how to do this safely and responsible, airlines can learn how to do this safely and responsibly. Businesses can learn l how to do this safely and responsibly. And again, we should use the data to define when we find an industry that poses a unique risk that may require some type of restrictions rather than these broad restrictions unfortunately. A couple of interesting things that you said there. [inaudible] one of the greatest tragedies early on is when schools close was the social disadvantaged individuals that really didnt have or the individuals that were in the workforces that didnt have the luxury these single mothers how they had to deal with it is they had their kids then go stay with their mother which is exactly the opposite of what i want to do in protecting the vulnerable. I dont want to see silent asymptomatic infected children stayta with grandma who might he diabetes. So i think really the point is i really want to applaud the teachers that had the courage to take a chance on the Public Health advice that was being given knowing we were going to be monitoring this very carefully. I also, the parents that had the courage to take the risk because in the absence it was all opinion but thats what im saying now and obviously what i said in the new york situation that will get your data and im glad to see the truth is they show they are not a source of transmission and i think that when careful studies are done they willo see Virtual Learning and have a higher infection rate and thefe kids that do facetoface. It has to do with ployers and i know that you said universities learn how to do i and airlines. We certainly know a lot of businesses have learned how to because there are businesses that have been disclosed. Closed. This next audience question gets to that. Good afternoon, doctor redfield. I am the president of the Minnesota Chamber of commerce. Here in minnesota we have seen growth s in Community Spread thats actually shown up in the workplace and this has caused concerned with availability of workers and threatened the cert