With Margaret Hoover is made possib by. Di additional f is provided by. Corporate funding is provided by. Dr. Tom frieden, glad to join you. Ine. You were the former director of the United States center r Disease Control and prevention. You are currently the president and the c. E. O. Of resolve to save lives, a Global Health initiative which works to prevent epidemics. Andou are joining us in american history. D moment so thank you for being he on Video Conference as we practice social distancing. I look forward to speaking with you. Dr. Frieden, i am two hours outside of new york city, and you are joining us from in your apartmentci in new yor, which was just this week declared the epicenter of the pandemic in the United States. The white house has saidhat anyone who leaves new york city should selfquantine for 14 days. Do you agree with that directive . New york city, unfortunately, is in what we know the acceleration phase of the pandemic. That means that cases are doubling very quickly every couple of days. Unfortunately, the coming week or two are likely to be very difficult for our city. Were likely to see a huge stress on the Healthcare System with the possibility that there will be too many patients who need intensive care. Theres also the reality that many healthcare workers are becoming infected. So right now, unfortunately, new rk city is the epicenter in the United States. This is a warnin for the rest of the country and the rest of the world. This could be you y dont act now. So lets step back. It has been roughly four months since the first known coronavirus case peared in wuhan, china, 7,500 miles away. You wrote actually an opinion editorial on january 22nd and you said, well learn more in the coming daysnd weeks. As i once heard the legendary Nobel LaureateJoshua Lederberg say were outnumbered by microbes by billions to one. Its their numbers against our smarts. so right now, who is winning, the microbes or us . Well, this is world war c world war coronavirus. This is the biggest global stress since world war ii. And it is just the beginning of a long war. And to win that war, we need good strategy and good execution of that strategy. And we have a growing sense of what it takes to do that. Thats crucially int is information, intelligence, so we can understand if you will, how iads, how it doesnt spread, how we can target our efforts most effectively. Help us understand. The covid19 is a coronavirus, which is a large family ofiruses that are common in both people and animals. Can you explain exactly what a coronavirus is . A coronavirus, as you say, there are many, many species that affect animals. But this is the seventh thatop affects that we know of. There are four what we call commoncold viruses. They account for a third or a quarter of all common colds. An interestingly, as we all went back and looked a little more carefully, thcommon cold can also be deadly for people or people who are y. Systems so it doesnt perhaps get the respect it deserves. Then there are mers and sars, two very deadly coronavirusesre thateadlier than covid19, but that dont spread as readily as this coronavirus. What were finding with covid1t is it spreads readily around 1 percent somewhere of the people that it infects. Alright, id like y to take a look at something that former Homeland Security adviser tom bossert said at the beginning of is week. And ill get your reaction after it. What im trying c municate to people in this country, though, is that while new york is very bad, the rest of the country cant take a deep breathr and think thout of it. So i think i guess what everybodys asking is for a prediction ill give one today, george. I think weve got a sixweek growth curve ahead of us inrk new ity. Six weeks . The next two weeks will be the most aggressive,ip mus of 10 potentially. Dr. Frieden, do you agreeha that w at least another five to six weeks to go of things getting worse i fore they get better . One thing thaink we can say with sadly confidence is tt the next one or two weeks at least are going to get worse in new york city. It going to get worse here before it gets better. Past that, its very difficult toredict. Officials have said this week that the spread ofin the coronaviruach region of the United States will have its own curve. So then what is the right way to create a federal response . Its crucially important that theres a federal framerk and guidelines, on the best available scienceed informed by our Nations HealthProtection Agency the centers for Disease Control and prevention, which has been virtually absent in the response so far. That guideline then rolls down to the sta, city, community level. And thats where the rubber hits the road. If and it will berent in different places at different times. In new york city today, the Health Department appropriately is strongly discouraging peopleil withillness from getting a test. Other parts of the country, appropriately, Health Departments are urgingld anyone with llness to get a test. It really depends on where you are and when in this pandemic the action is occurring. Y just said, dr. Frieden, that the center for Disease Control has been effectively absent. Why do you say that . We havent seen t cdc or cdc reasoning going into the decisionsth are being made. ve seen the white house reverse some cdc decisions shortly after with no justification or ale for why theyve done so. Unless c is at the decision table and at the podium, i feel lessafe. Is it fair to say that cdc is not at the table when they aree a member of sk force . The White House Coronavirus task force . I find the organiza of this response very confusing. The Vice President is inharge. There is a white house coordinator. There is a chair of the task force. There is a fema acting director who is running an incident command system. All of those systems could work. But its very unclear whos on first here. But the cdcis n the task force. So its not as though their advice and guidance being explicitly cut out. Is that fair . What we saw on a weekend is at the end of the weekbe re, cdc issued very thoughtful guidance on when schools should close, how that should be done. And then on the monday that followed, the white houseer led that guidance in a footnote to a onepe document with no rationale, no justification. And i think because of that, there are schools in this country that are closed today that maybe didnt have to closes and thery disruptive. In less than a week, on march 30th, the administrations 15 days to stopl the spread w over. And President Trump has indicated what will happen next. Id like you e take a look at this. d love to h open by easter, okay . I would love to have it open by easter. I will tell you that right now. I would love to have that. Its such an important day for other reasons. But ill make it an importa day for this, too. I would love to have the country opened up and just raring to go by easter. Dr. Frieden, what is your response to the idea that we would be open for business again by easter . All of us would like to get bacto business, ck to normal life as rapidly as possible. The decision on when to stop this social distancing, to go back outpeople really is a decision of en, how and what. G and thatng to have to depend on theonditions locally. One ing thats crucial to understand is this is not just about staying home. Th is about staying home while the Healthcare System to geting ready for a possible surge in patients needing ive care, to intensely surge our Public Health system to be able to test, contact trace, isolate and quarantine people who need to be effeively managed. China has done Contact Tracing and 14day followup of that is a mindboggling effort. And thats the kind of effort were going to need here if were going to limit the social and economic dages. We all want to get back to business as rapidly as possible. The economic dislocationst doesnt urt the economy. It hurts health also. But weve got to do that without endangering our heal workers and patients. So then, is it your view that because Public Transportation remed this week within the city of wuhan, china, that that was a welladvised policy because the chinese have caught up with t pandemic . Theres a lot to learn from china now, and they continue to struggle with a large number of imported or reimported cases of coronavirus, and theyre worried,ar i on a call this morning, about the possible second wave of cases there. Bad as it was, in wuhan, it was stillll just a sroportion of the population that got infected. So it could be much worse. But do you think its too early for the Public Transportation to be resuming in wuhan right now . In china, theyre being extraordinarily careful. They sent 42,0 healthcare workers into wuhan to help with the response. And according to their reports, not a single one of them got infected. A so beie to surge effectively and restarting society is something that needs to be done carefully. When you resume, its bestur tothe faucet gradually, not open the floodgates. It may mean that you open certain businesses first, perhaps daycares so parents can work, perhaps Infrastructure Projects or businesses that can make sure that they check everyone comg in for a temperature and have their hands sanitized with alcoholbased sanitizer theres lots of things that can be done to gradually reopen. And whats crucially important is that we will learn. The quicker we learn,e tter we can act. So id like you to listen to governor andrew cuomo, who just hoursefore trump announced his easter goal, said this. My mother is not expendable and your mother is not expendable. And our brothers and sisrs are not expendable. And were not going to accept a premise that human life is disposable and re not going to put a dollar figure on human life. The first order of business is save lives, period, whatever it costs. Dr. Frieden, what is the cost of the public hearing two dramatically different messages from their countrys leaders . I think its understandable that theres some difference of opion here. On the one hand, you see a terrible pandemic that could sll over a million americ and over 10 Million People around the world. D, on the other h if you look at the numbers, you say even in the worst hit citie 96 percent of people dont get the infection and 99 perce of the people who get it will survive. We have to put it to perspective. This is a terrible pandemic, but its something that we can manage. But when you hear two differenssages, one from the president of the United States that says were heading back to work and the other from the governor of new york, the epicenter of the pandemic, sayi will do anything it takes to ensureat eoples lives e saved, how important is messaging being aligned for the public safet and security . Getting communication right crucially important. What were seeing around dont understandt if communities why theyre being asked to do certain things like not go to religious ceremonies or not go to work or not ride d on buses, tht do them. So communication needs to be first, right, d credible. And it needs to provide the basis for the decisions that are being made, both the ethic basis and the scientific basis. L me ask you about south korea, cause the very first confirmed covid19 case in United States was on the same day as korea, january 21st. And throughout february and march, the cases in south korea exoded, rehing a peak of 909 cases inay a single and then less than a week after that, the new number of ily cases declined by 50 percent. And from there in south korea, the numbers have continued decreasi. In other words, south korea successfully actually, what south korea did is exactly what were trying to do here. South korea saw a large peak. They then went into mitigation mode. They were able to mitigate it and mop it up and reduce that transmission. They had some advantages. R thread was very focal, associated with one religious group. S so that sier to contain in one area. They also did massive testing. They also had the advantage of a Healthcare Systemth was aligned and private Laboratory Test producers that hadd develoem well in advance to do them in high volume. And its, in fact, exactly the south korea experience that makes us think that we can move from mitigation mode, which new york city isw, to suppression mode. Thats our current strategy for the war against coronavirus. Okay, but that success that you j is going to take tests. And i want to ask you about an early and major flaw in the american response to coronavirus, which appears to be directly related to the limited testing capability. Id like to break down the issues one at a time. First, it seems that the cdc dose not to use publicly availaba from other countries and instead make our own tests here in the United States. In your view, was th a mistake . I dont know the details of how the cdc test was developed. What i do know is that the problem they had with this one thve never had before. During h1n1, the pandemic of influenza 2009, they developed a test, validated it, got it approved by the fdath in les two weeks. And three days later, they began sending out a million tests to every state in the u. S. And more than 140 untries around the world. So this system has worked well multiple timesnd it goes back to administrations. It was created under george w. Bush. It wastrengthened under president obama. Something went wrong with the cdc tests and also probably with the response oe they realized that it wasnt working well to rapidly adjust and maketi that t capacity available. At the same time, the fda should much sooner have allowed hospital laboratories and the department of health and Human Services should have gotten the private pviders, the private Test Developers in to begin work that only began many weeks later. How many weeks do you believe that it has cost us . The lack of test ailability definitely put the u. S. Behind. If seattle and new yorcity had had more test capacity earlier, theres a possibility they would have been able to identify the infections earlier and prevent the kind of wispread transmission that youre seeing now. Do you think its fair to say that that lost time has cost us lives . I think theres no doubt that many lives not just in the u. S. Is pandemic, but around the world because weve failed to invest in Public Health for m many years. I do really want to ask you about this series of mistakes, though. Wh is the mechanismty foaccountabi i think that really should be an independent evaluation. The cdc itself has a separate laboratory group. They may have, i dont know, done an evaluation of this. There should be an internal evaluation and there should be an external evalon by a group such as the National Academy of sciences, because we need otr things. We need a rapid point of care test. We dont have that yet. We need a blood test, a serology tests. We dont have that yet. These need to be developed because eyre important tools in the fight against this virus. A vaccine is another tool to fight the virus, and its being tested. One being tested in Washington State as you know. Do you believe that until that vaccine is availablet we will ue living the way we do now . I hope that with better understanding of the virus and better understanding of how to limit the spread, we can gradually loosen the faucet and resume much of our everyy activities. A vaccine is uncertain. We hope one will be safe and effectiv if it is, it could take a year, year and a half to become available. But there are lots of Infectious Diseases for which were not able to vaccinate effectively. Think ofuberculosis, malaria or hiv. Weve been trying to develop vaccine for decades. I hope well have more success against the coronavirus thats causing covid19, but only time will tell. O howu assesshe prospects of treating the virus with existing medications . We really need to understand what works to reduce the risk that someone will get severely ill or die from this virus. There are close to 70 different medicines that are being studied the first really rigorous study was of two of the most promising ugs that together kill viruses. And it didnt work. So its one thing to have a promising substance or anecdotal evidence, and its quite another to show that it works. We all hope therell be that may come much sooner than a vaccine that would make a big difference. Dr. Frieden, would you be willing to set the r straight on the president s pharmaceutical recommendations . President trump tweeted, and azithromycin,ne taken together, have a real chance to be one of the biggest Game Changers in the history of medicine. The fda has moved mountains. U. Thank he also after that suggested that this combination of medicines actually saved the life of a man. What is your response . I hink really the president is trying to find things to hope for and is expressing the hope that these medicines will work. I also hope theyll work. But as a physician, as a scientist, i want to know whether ey work. Its one thing to have anecdotal or even promising evidence. A itther to have proof. And all too often in healthcare, we have a treatment that is touted as a miraclcure. And then wheits really looked now, chloroquine ml work,work. But we don know. I it wora test tube, but lots of things kill viruses in a test tube. It boggles the mind anat just a few months ago, the word corona something very different to most people. And now as we lookr, around the cor are there other microbial threats that are lurking around the corner that we should think about carefully before they become a g