good afternoon and welcome to a special presentation about coronavirus disease 2019 our kovat 19 today we're going to answer some common questions about the outbreak I'm Loretta Lepore and today I'm representing CDC's emergency partners information connection the epic team we have dr.
Jay Butler with us today dr.
Butler is CDC's deputy director for infectious diseases in this capacity he provides leadership to the efforts of CDC's three infectious disease national centers and helps advance the agency's cross-cutting infectious disease priorities welcome dr.
Butler it's a pleasure to be here Loretta before we begin I wanted to point out that dr.
Butler and I are sitting 6 feet apart we're doing this because we're comporting with CDC's guidance on social distancing and we would ask all of you out there watching to embrace the same guidance we've got a lot of questions to get down to today so let's get started with today's questions are you ready dr.
Butler I'm ready okay I thought it might be helpful to begin by providing an overview to our viewers of the current outbreak both domestically and internationally well the outbreak is something that started only three months ago and it's an important part of the discussion to recognize that we are talking about a virus and a disease that we didn't even know existed only three months ago so it's really remarkable how much has advanced and how much has changed over that brief period of time the emergence of this new corona virus occurred in central China and for the first few weeks it spread within China but more recently it has really spread globally about three weeks ago we began seeing a significant number of cases occurring outside of China that were reflecting local transmission and at that point we began to see each day more cases outside of China than in China during the past few days we've actually exceeded now the total number of cases occurring globally less than half have occurred in China so we're seeing significant transmission really all around the world some of the hottest spots right now are South Korea all so the eastern Mediterranean area Europe including the United Kingdom and Ireland and also now in the United States and Canada so there was one quite one phrase in there that you used you use local transmission could you could you explain that to our viewers sure so when the epidemic first started a lot of the approach to slow the spread and even prevent the entry into the United States for as long as possible focused on containment measures and that focused primarily on travelers early on the cases that occurred outside of China occurred either in people who were exposed in China traveled out became ill after they returned home or in their household contacts in some situations there's been further spread within communities and this is not unexpected this is what we would expect to see say in an influenza pandemic where there's a new virus to which the community and indeed the human population around the world has little or no immunity as we've progressed we've seen now over a hundred and eighty thousand cases worldwide here in the United States we've seen over six thousand cases so far unfortunately about a hundred people have lost their lives to this infection the people who are most at risk for these severe infections are people who are older and people who have chronic underlying heart lung or kidney disease and those with diabetes so there are two things I want to follow up on as of today how widespread is the outbreak in the United States we've now had cases reported from all 50 states also from Puerto Rico the US Virgin Islands and Guam so as we talk about where we are in the pandemic it's important to recognize it is a global pandemic now so well we'll talk more about travel I'm sure it's important to think about what's happening in our own communities one of the questions I wanted to get back to was about you mentioned the elderly and this is a population that is at risk and is vulnerable to this disease can you explain a little bit more about that and how families should be interacting with with their elderly relatives at this point in time yes and this really was is something that's been observed since the beginning of the epidemic in China and we're now seeing it in the United States as well the people at highest risk of severe infection are those who are older particularly those who are over age 80 meant more than half of the deaths that we've seen in the United States have been among people who live in long-term care facilities but then also people who have chronic heart conditions lung disease kidney failure or diabetes for families what that means is that it's important that we practice social distancing particularly with our elders but also with people who have those underlying conditions I mean just as we're sitting 6 feet apart with a virus between us it's important to do as much communication as possible virtually such as what we're doing with our audience now for families interacting with elderly relatives grandparents this is probably not a good time for the grandkids to run and give Grandma and Grandpa a big hug and a kiss this may be a better time for a phone call for a video chat if those type of technologies are not available even coming by if possible and waving through the window just to be able to maintain that social contact is important one of the challenges when we talk about social distancing is we don't want social isolation and it's it can be very challenging because we know particularly for our elders having that connectivity with family is very important to mental health as well but at least for a period of time it's important that we do things a little differently and make sure that we keep our elders safe it also is probably a good time to reconsider visiting elderly people who live in long-term care facilities because those seem to be situations that are at particular risk and most important is if you have any symptoms of a respiratory illness please do not be in contact with people who are elderly or have underlying heart lung kidney disease or diabetes and it's probably a good time for us to point out that's DC has guidance for nursing homes on our website and folks can reference that for further information yes there's quite a bit of information on the CDC website I think we have now over 450 different guidance documents out there and so it's arranged in a tabular form also Google can be useful for finding those documents but this can be accessed at CDC gov go bid 19 great we talked a little bit about the elderly and their risk to Cove at 19 how severe is covered 19 for the general population for most people we're talking about a mild illness the vast majority of people will not require an interaction with the healthcare provider or certainly not an admission to the the hospital in particularly for younger people and especially children the illness may be very mild so it's one of the challenges in controlling it is that the spread may occur from people have really minimal symptoms there's even some evidence that it may spread from people who have no symptoms at all or who have not yet developed the symptoms so that can be a major challenge and one of the reasons why social distancing may be the right thing to do right now because it's easy to say if you're sick stay home but it is possible that people who are not yet sick may be able to transmit the virus as well I think it's safe to assume that if you're sick you are in the have kovat 19 that is the the person who is most infectious but there there may be more to it than that and there's just so much we still don't know I mean as you said this has only been this outbreak has only been you know three months in and scientists our scientists are still learning so much more about this on a daily basis yes and this is a new corona virus I frequently hear people say well corona virus is not new and the family of corona viruses is not new so oftentimes household disinfectants will say it that it deactivates corona virus that's correct but there's several corona viruses that have been known for years they cause relatively mild symptoms the other end of the spectrum there's also the corona of heiresses that cause SARS and one that causes Middle East respiratory syndrome something called MERS those are more severe illnesses so there's a lot that we know about coronaviruses from those diseases but we're learning a lot because this is a unique corona virus that we've never seen before it's also important to recognize there's a whole world of corona viruses out there that infect other animals and for instance if you've ever looked closely your veterinary bill you may have seen a charge for corona virus vaccine that's actually a vaccine that is for a different type of corona virus so there's no evidence that those type of vaccines would provide protection against the kovat 19 virus so specifically speaking of Cova 19 how how does this disease spread how does this particular virus spread well it appears that the vast majority of infections are transmitted by respiratory droplet and what I mean by that is that the virus infects the respiratory tract including the upper respiratory tract so if I cough or sneeze the spray that's produced will contain the viruses and they will fall as they travel away from me that's why we're six feet apart maybe this is a good time when the virus between us should drop to the floor because that's what would happen in real life but it's also possible that it can survive on surfaces and there's there's some laboratory evidence that it's survival in the environment is not unlike the SARS virus so it's also important to be able to clean surfaces with standard household disinfectants particularly frequently touch surfaces so that's things like doorknobs and phones and even tabletops because the virus may be able to survive for a period of minutes even hours and that provides opportunity for the hands to become contaminated and there's where we get to some of the basic recommendations it's important to wash your hands for at least 20 seconds with soap and water or use that alcohol-based hand cleaner that contains at least 60% alcohol it's also important to break the habit of putting your hands your face because that is one of the ways if your hands are contaminated you can then inoculate yourself with not just covet 19 but any number of respiratory viruses I think we don't think on a daily basis how often we touch our faces and with this outbreak you become much more cognizant of that and have to be more cognizant of that one of the things that I've heard just you know anecdotally the way that people are determining how long to wash their hands as they sing happy birthday twice yes and that that's a sufficient and that's a great way to teach children how long they should be washing their hands with soap and water under warm water so just a little trick for our viewers out there or the alphabet a colleague in Louisiana said wash your hands like you're at a crawfish boil and you need to take your contacts out okay love that one that's regional so one of the big questions that we get often and is probably one of the most difficult questions for our subject matter experts to answer is about when the outbreak will end can you help inform that discussion a little bit well there's a lot of variables that will drive when this epidemic or pandemic will end and in many ways I think we would like it to end as soon as possible particularly those of us who've been involved in it for several months now it could the end couldn't come soon enough but there's actually I'm gonna say something maybe surprising to many people is that in many ways we want the pandemic to spread out over as long a period as possible and I think many people have heard discussions about flattening the curve and this means that we want the pandemic to effect as fewer people as possible it in the any given period of time in other words if the we had say 10, 000 people in a community who became sick if they all get sick over a two-week period that could overwhelm the health care system and really shut everything down for a period a period of time and put lives at risk if it's 10, 000 cases over a period of three to four months that may be something that you can manage society can continue and also the health care system could be robust to be able to take care of people who might have more severe symptoms so when will it run its full course we don't know for sure as we look at influenza pandemics oftentimes they begin to abate after 12 to 18 months you also raise a question that you haven't asked but I bet many of our viewers are wondering because they've heard about it is is this say an infection that will go away in the summertime we know that influenza generally does go away we know from the pandemic of 2009 although the virus first emerged and there were many infections late in the springtime there was then a law through the summer months we don't know about this corona virus yet so while it would be optimistic to think we're going to get a break in the summer time we'll have more time to prepare for what may come in the fall it's important to recognize as we've said earlier this is a virus that we didn't know existed three months ago and we really don't know yet how it'll be influenced by the warmer months in the northern hemisphere one of the points you raised was about the stress on the healthcare infrastructure of our nation and while we do have one of the best systems in the world heavy a heavy burden on that infrastructure could present some problems and so I I wonder if you might address when people should visit an ER when people should visit a doctor's office and should they call ahead to their doctor before going into the office I think that would be helpful for folks at home but also be helpful to the health care providers that are triaging these cases yeah well first of all I think it's important to acknowledge just the heroic job being done by healthcare providers all over the country right now particularly in those communities that have been most heavily impacted in parts of the country the health care system is already stressed to the breaking point and people are working long hours under very difficult conditions in terms of the healthcare system and how we can best keep it resilient it's important that plans are put in place which are generally there in each Hospital I mean many hospitals have done tabletop exercises of what to do in a flu pandemic those plans are still very useful in this situation even though this is a virus that's very different from influenza so things like elective procedures or office visits that might be able to be deferred until particularly several weeks or months down the road this is the right time to do that so for the general public that involves some patience and flexibility to understand if an elective surgery is being rescheduled or a visit your provider is being bumped further down the the schedule understand that this is part of how we keep the health care system robust to be able to take care of those people who do get very sick with kovat 19 in terms of people who become ill with respiratory illnesses two thoughts on that first of all we are still in the the flu season so most likely it'll be something other than Cove at 19 if it is Cove in 19 the vast majority of people will have relatively mild illness so it's important that just everybody with runny nose doesn't come running into the emergency department it's wise though to be on alert for the more severe symptoms so a very high fever shortness of breath tightness or fullness in the chest those are the kind of things that may reflect that there's a more serious manifestation and if those develop pick up the phone call either your provider or the emergency department in advance so you can get instructions on how to come into the healthcare system in a way that'll minimize the risk of exposure to others who may not have Cove in 19 of course if there are symptoms of a life-threatening problem whether it be Cove in 19 or the tightness in the chest as a heart attack call 911 to happen and that's an important component of why maintaining the robust responsiveness of the healthcare system is important because kovat 19 will not prevent people from falling down the stairs and breaking bones it will not prevent automobile accidents there are going to continue to be traumatic events that occur and acute illnesses that occur that have nothing to do with the pandemic that will require care in the healthcare system so a good reminder that our health care professionals and ers across the country are also triaging a host of other medical conditions in addition to kovat 19 absolutely I'm going to shift gears just a little bit here because we've got a lot of questions the next question we have is should Americans be concerned about traveling to other countries or about travelers from other countries coming to the United States well I think in general let me just start by saying this is not the best time to travel and at the CDC website CDC gov slash Kovan 19 you can find links then to advice to travelers there are a number of countries where we recommend that anyone who is considering travel seriously considered delay in it unless it's somehow essential travel China has been in that category for a couple of months now but that's expanded now to include South Korea Iran really all 26 nations of the European Union the United Kingdom and also Ireland also people who travel anywhere in the world we recommend if you were at risk of more severe kovat 19l 'no sand that would be people who are older people with underlying heart lung kidney disease or diabetes it's going to be best to defer that travel we also recommend that no one should be traveling on cruise liners right now our experience to date has been that once Kovan 19 is on board a cruise liner it can spread very rapidly and attack rates can be much higher than we're seeing in communities so for individuals coming back into the country we've seen some new advisories go up recently we've heard a lot about transmission in the European Union and those flights coming back into the United States could you could you for a moment just address for those folks Americans and legal residents that are coming back into the United States how that process is working and what role CDC is playing with that right so if you're traveling back from one of these areas where the travel advisories are in place we recommend first of all that you not travel if you're sick when you re-enter the United States there'll be a process of a brief assessment of your health there's you'll be directed through one of 13 airports in the United States if you're traveling from one of the Asian countries involved or from from Europe and you may be directed to talk to one of the CDC quarantine doctors who are there well they'll be an interview and assessment and if you've developed symptoms during the flight you'll be advised and directed to where to get medical care if you're well you'll be allowed to continue on with your domestic itinerary and it's important for people to realize this is different than what was done initially for travels coming out of whom a province in central China where there was quarantine facility set up in different parts of the country our emphasis now because of the continued spread of the virus and the breadth of the pandemic is that you quarantine at home for a period of 14 days and this is to reduce the risk of spread from these other countries into new communities in the United States this is part of that overall process of how we spread the curve out even as we see some transmission in the United States some communities seeing quite a bit this is a way to prevent additional transmission in the United States and to slow the progress of the pandemic should we be concerned about travel within the US we've seen some high-profile leaders like doctor foul Chi for example from NIH indicate that at his age and his preference would be not to travel at this point in time what is the CDC recommendation on travel within the United States doctor foul Qi is in line with the CDC recommendations and well doctor foul Qi is is quite robust in incredibly intelligence he has also been around a long time so we do recommend the people who are older not travel right now if there's any way to avoid that and also the people who have chronic heart lung or kidney diseases the next question that we have is what should people consider to avoid how should people consider of waiting stigmatizing particular groups or products yeah so let's address the two questions there separately first of all it's throughout history there's been blame placed on different groups of people for different types of diseases and it's important to recognize that this Cove in nineteen is now a global disease it affects everyone so there really is no justification to stigmatize anyone or particularly any racial or ethnic group related to kovat 19 for people who have traveled while social distancing may be important it's also important to not be socially isolated and certainly not to shun people and certainly not to shame people either there's very little evidence that that's going to lead to additional healthy behaviors now the question about products relates back to our earlier discussion about transmission there were a lot of questions early on about products that were made in central China of course supply China is plays a very important role in the global supply chain as does the European Union and the United States and there was concern well is the virus being transmitted via these products or by mail even and while in under laboratory conditions the the virus can survive on paper or cardboard products for a period of time the epidemiology does not indicate that that is what has spread the virus if this were a virus that were transmitted through the mail we would have seen more hot spots popping up all around the world very early on what we saw instead as cases occurred outside of China they were occurring initially in travelers who came out of China and were well during their time of travel during the incubation period before illness onset and then became ill after arrival if there was subsequent transmission it was most often to their household contacts the people they were most closely associated with so we really don't think that mail or products that have come out of any part of the world have paid played a significant role in spread of this infection since this outbreak began there have been a number of new words terminology introduced into America's lexicon some of the most common are the words quarantine isolation and social distancing I think sometimes people get confused between what quarantine means versus what isolation means so could we start with that we've addressed a little bit about social distancing and I'll ask you to go into more detail on that in a minute but I think the differentiation between what it means to be quarantined versus being in isolation there's a difference there and let's clarify that for our future there certainly is and while these base sound like technical terms they may even seem like they could be used interchangeably and unfortunately oftentimes are they mean very different things so quarantine means separating someone who has been exposed to an infectious agent from people who are unexposed it's not a tool that's been used very often recently in Public Health and it's oftentimes more challenging to do because you're basically taking people who are healthy and feel good separating them from their loved ones sometimes and that can be be a challenge but it's a tool that has been used really for centuries with varying degrees of success isolation is much more commonly used and it's used everyday in hospitals all around the country isolation means taking someone who is sick and infected with a specific organism and separating them from people who are well so you're trying to prevent transmission of the infection to the people who are well and there's various types of isolation there are specific guidelines for respiratory droplets such as what we are talking about earlier there's also specific guidelines for airborne pathogens which we we don't see a lot of evidence that this virus is commonly transmitted by the airborne route even though under laboratory conditions we can get it into the air and show that it can be there for a while this is not like tuberculosis or measles where we think it's common that the transmission is is through the air quarantine achieves the goal of being able to prevent transmission that may occur early in the course of the illness isolation achieves the goal of preventing transmission throughout the course of illness and we should mention that you had spoken about the early flights for example of free Patriot Americans from Hebei province some of the passengers aboard the diamond princess that cruise ship they were in quarantine many of them and and the resilience of the American people was demonstrated in those situations because by and large everybody was very grateful to have we've received notices for many of them they were compliant they were they understood the complexity of the outbreak and we're very willing to respond to recommendations and so I think it's just as a point of reference just to acknowledge that when Americans know what's happening and they're asked to rise to the occasion they are doing so and that we're all in this together we wanted to put an emphasis on that I'd be happy to well first of all we recognize that none of us wants to have our freedom of movement restricted so it's always a challenge to strike that balance between our individual freedoms and liberties and what's good for the the larger community I my heart particularly goes out to people on the Diamond Princess many of whom or quarantined on boarded the ship for a period of time and then because there was evidence of ongoing exposure had to again be quarantined upon return to the United States that was a long period of time biess oftentimes separated from family and other other loved ones so that's that's not a tool quarantine is not a tool that we take lightly by by any stretch I will add though in terms of the resilience of the American people I had some reports of the first group of repatriated American citizens coming out of Wuhan in China they landed for refueling in Anchorage Alaska and when the CDC official from the quarantine station went on board it was really unsure what the reaction would be but I'm told that when he said welcome to the United States there was laughter and a round of applause people were very glad to be home and I think that's important for us to remember that our fellow citizens were very glad to be home again that's right and that's a nice segue for us because you were the former public health leader in Alaska at one time and our next question has to do with what can state and local health departments do to prepare for those that perhaps haven't yet had a big outbreak within their jurisdiction what can they prepare for and how can they respond to this outbreak well I think it also ties into another question that we're frequently asked is are we prepared and preparedness is not an all-or-none phenomenon I think we are more prepared now than we were 20 years ago so it's a progress and it's an ongoing process that is a progression for instance every state has gone through some type of pandemic exercise planning how do we work together and you know who are the people that need to be in touch there's an old saying that an emergency is a terrible time to start exchanging business cards but of course there's also the the old expression that no battle plan withstands the stress of combat so these these exercises help us to prepare but they don't answer all the questions so in terms of the ongoing response and preparedness for what's next we tried to stay in close touch with our state local and tribal public health leaders and provide technical advice and fortunately thanks to some appropriation from Congress we've been able to provide some funding locally as well the local jurisdictions have been pulling together I think practically every state has activated an emergency operation center which provides a center of operations because this is while it is at its foundation a health issue the impact is much broader than just health it impacts education it impacts Commerce it you know really transportation is heavily impacted so it really requires everybody working together to be able to respond and be prepared for what's next in terms of knowing what's next that's where the national data that's aggregated by CDC can be very useful to look at where are the hot spots what are some of the travel connections that might help you anticipate when the the virus is coming in the WHI website is also very good to get some visibility on what's going on all around the world so you mentioned some funding that's been approved by Congress to help local and state governments build their capacity could you speak a little bit about that so that folks watching understand what locals are actually doing what the states and the local health department's will be doing with that funding to build capacity what does that mean to build capacity where's that what what does that mean well it's really intended to be flexible for the state or local agency involved because we recognize that the needs may be different in different parts of the country some of the state public health labs are fairly robust in terms of being able to scale up and process a fairly large number of specimens others have more challenges and to be honest some state public health departments have had to struggle with declining funding in recent years so it's Manan challenge for preparedness there's an old saying that at the airport you don't wait till there's a plane crash to buy fire truck unfortunately we do have some of our partners who are really struggling with the response and that's where funding can be very helpful to gear up however it's needed whether it's public health nurses to be able to be out and do case investigations health educators to help get good messages that are appropriate for the community epidemiologists to be able to study the data that's being collected locally it's really intended to be flexible the public health funding though is specifically not designated for treatment centers and there are other streams of funding that will help support those aspects of the response there's also now funds that are available more broadly as part of a disaster response which will assist locally in terms of being able to provide emergency care facilities as needed you mentioned just a moment ago some of the community ripple effects of an outbreak and an emergency response whether it was transportation or other things business commerce specifically there are a lot of businesses that interface with customers have contact close contact with customers on a daily basis what is CDC's guidance for those businesses well for details I don't know if I've mentioned CDC gov slash ghovat 19 yet but I will mention for that yeah there but there are specific guidelines for businesses briefly that involves some of the basic concepts around social distancing as much as possible but also hand hygiene and for management of employees making sure that you have policies in place so that people who are sick can not come into work so looking at sick leave policies and making sure that people are able to take time off if they're sick so that they don't potentially expose your customers are important in terms of hand hygiene not everybody can install a sink in the lobby say if you're a bank but you can make hand gel available you can also make sure that your employee that say the teller window have the ability to be able to sanitize their hands as often as possible so there's there's a number of steps there in terms of how to keep not only your employees safe but also your your customers and finally there's alternative ways to do business which are being implemented in very many parts of the country right now for instance restaurants are being encouraged in some areas required to provide only takeout services to be able to minimize that person-to-person contact and the social distancing to keep exactly in proximity the proper level of practice right so so drive-by services actually are probably more important now than ever services that can be delivered remotely or virtually you know even in healthcare there's a role for telemedicine that's very important for people who don't require hands-on medical care one of the other big areas of discussion obviously is guidance for k-12 school systems where are we with that guidance today well last week CDC posted some guidelines for school closures and the decision to close schools is a very complex one so it's important that health as well as education most importantly the school administrators or the school district superintendents are involved in that discussion and while it's not unlike what decisions that have to be made when there's adverse weather conditions whether it's black ice or after a big windstorm or an earthquake this is different because the perception may be different there's more fear around the ongoing aspects of the pandemic but also school closure may be for a longer period of time so when we talk about some of the the pros we're looking at social distancing again how do we separate kids from one another of course schools can be congregate settings mass gatherings of a small scale and we want to be able to minimize that contact but there's also a numb of downsides there's a large proportion of children who receive one even two meals a day at school and how do we make sure that they're continuing to get nutritious food we also know that when schools are suddenly closed that can stressed the health care system because doctors nurses particularly if there's two parents working somebody has to stay home to take care of the kids and it may not be easy to immediately set up that type of that type of care another consideration is who is going to take care of the kids if the if grandma's 85 years old and the kids also have a respiratory illness that actually could be a problem so school closure is very complex that guideline is available at the CDC website because nationally there are school closures in at least 37 states right now there are literally millions of kids who are home homeschooling has never been more popular than it is right now we are working hard to develop some additional guidelines that people consider can review and consider as they look at the possibility of reopening down the road the last thing about school closures I think it's important for everyone to understand is right now we're in a time in some ways a national timeout almost in terms of seeing what the impact of this pandemic over the next one two to three weeks is going to be it may be that schools will reopen fairly soon but as we progress it's possible they will need to close again so I think it is we we go forward we continue to learn about how this virus behaves the recommendations may may shift because getting back to our opening comments this is something that not only is it unique but we didn't even know it existed three months ago and I think it's important to point out with all of these recommendations CDC is making that there is not a one-size-fits-all approach for all jurisdictions across the country that really local authorities have to make decisions predicated on their Galatians on the considerations leveled outbreak etc within within their communities right and the possibility of doing any type of virtual distance delivered education is quite variable also I think all of us will be learning a lot more about distance delivered education over the next few months right and I'm gonna get to that at the higher ed level as well but but one of the things I did want to go back track on very quickly is you had mentioned that there's a level of fear and I've heard you address this in the past about there's a difference between preparation and and being scared and so if you could address that briefly because I think it's important since that's come up in our discussion that folks understand and we we provide some level of calm and comfort to our viewers to understand again some of the topics you've talked about that most of us it will be a mild outbreak but if you could address that specific issue sure let me start at the risk of sounding like a bumper sticker the advice is be prepared don't be scared because we know that people who are motivated primarily by fear may do irrational things if you live in an area where that's prone to tornadoes if there's a tornado warning you don't go running down the street you seek shelter and you take cover if there's an earthquake you don't you try to avoid things that may fall on you you try to duck in cover and similarly in a pandemic it's important that we understand as much as we can about the disease and the steps that can help protect us and that's where we start the conversation with this particular virus and at this point in the pandemic about social distancing protecting others by staying home if you're sick trying to avoid other people who may be sick as well and looking out for the interests of those who may be at higher risk of a more severe illness and I wanted to backtrack to the higher education piece just if you wanted to add something on to that is there different guidance for higher education university systems etc versus the K through 12 guidance yeah there are different guidelines they're not so much different guidelines as there's a different focus because obviously a kindergarten is very different from a graduate class in in any discipline universities are probably in general more well set up to be able to do distance delivered education so a number of universities universities have already made the decision for the remainder of this semester to not have in-person classes and this will also help with reducing the amount of travel universities are also fairly unique in terms of the number of international students as well as the amount of international travel as students make want to go overseas or do a semester outside of the United States the function a bit differently than primary schools so there's both assets that are available at the university level but also some unique risks primarily because we there's so much more travel associated with attendance at university if ever there was a time to be kind to your neighbor now we're probably it the it are there recommendations for how individual neighborhoods community groups civic groups can be mindful at this particular point in time and helping one another through this period of transition yeah it's important to know more than ever who your neighbors are and if you can find out if there are people who need help do that and that can be done virtually there there really are advantages of some of the online neighborhood groups I saw one recently where someone offered if someone needs groceries let me know I'm retiree but I'm health I'm a young retiree I'm healthy I'll be glad to make that run all I'm asking is reimbursement for the amount on the receipt and you know look at we do need to look out for one another so it's not as time to stand hand in hand but it is a time to stand together all those six feet apart right we all have role to play in this you mentioned early on the issue of transportation and there have been a lot of questions about public transportation and should individuals who have commute regular commutes on public transportation or children that are commute to school on public transportation should they be doing this at this time or are is there a recommendation that maybe they opted for a different mode of travel public transportation really is a major challenge because oftentimes these conveniences can be quite crowded there's a lot of high touch surfaces such as the bars we hang on to and the subway starts or stops so we certainly are concerned about the risk of transmission in those settings the the most important thing is again if you are sick stay home because you don't want to be going on to a bus or a subway with a cough and potentially infecting other people it's also highlighting the important role of business in encouraging teleworking to be able to lighten the load on the public transit system and then if the load can be lightened enough that might provide an opportunity for more social distancing aboard the public transportation routes as well it's important is probably good if you can get some of the small pocket-sized hand gel containers I understand in many parts of the country they're hard to get but that's a great thing to be able to have to do hand hygiene if you've been onboard a subway for instance and holding on to the bar think about that touch surface and for sure and practice hand hygiene as much as possible keep your hand away from your face so we've had some guidance this week about mass gatherings as well and we talked about mass gatherings we're referring to things like public events whether they're sporting events whether their conferences business conferences all types of events of that nature there's been new guidance can you speak to the new guidance that's come out this week with respect to massive events and also to social gatherings yeah in the the newer guidance is based on some of the observations of how the virus has been transmitted excuse me to a relatively large number of people in some settings where people are gathered together so it may be time that we abandoned the term mass gathering excuse me and focused instead on gatherings in general a question that's come up often is well how many people should that be and as you can imagine that might be really variable depending on the type of event you're in this room with there's five of us we're the closest of the five people who are here so this is probably a low-risk gathering on the other hand if we were sitting next to one another across the frontier that might be a higher risk gathering so at this point in time the recommendation is to minimize those gatherings altogether gatherings of more than ten people I think have been particularly called out as of concern and we realized that that's very disruptive because now we've gone beyond just large faith-based gatherings or business conferences but really we're talking about things like weddings and family gatherings so it's it's not easy and of course sporting events have been canceled live audience TV shows have either gone without audiences or have been cancelled altogether so we do recognize that it's disruptive but this is an important part of how we at least start social distancing until we know more about how this pandemic is going to progress and what we can do to slow it so the outset of our conversation we talked quite a bit about the health care setting and some of the challenges presented to them today and potentially in the future one of the questions that's come to us is about is it safe to go to a hospital and I think it might be important to share where CDC provides technical advice in this respect both to you mentioned how you enter a a room a visitation room and how to not disturb and infect others in the room but also about infection control in general in healthcare settings could you speak to both of those issues well first of all if you have a life-threatening condition or have been in an accident it's it is important to seek care still so we're not telling people don't go to the hospital but we are encouraging people to delay unnecessary visits and also to limit visitation to individuals who are in the hospital again this is part of social distancing CDC has some very specific guidelines for healthcare providers to protect themselves as well as to protect the people that they're caring for one of the challenges though that we we have to acknowledge is that the global supply chain for personal protective equipment is quite strained right now and so in some parts of the country the protective equipment is running thin so CDC is also looking at ways to be able to work with the materials that we have available so that the healthcare system can be flexible during this very challenging time so when we talk about protective equipment to kind of break that down for our viewers we oftentimes use shorthand we talked about PPE or protective gear and what does protective gear encompass and and what are the most significant parts of protective gear for the healthcare community right so we're talking about things like masks goggles to protect the eyes gloves you know very broadly in terms of the kovat 19 one of the particular issues have as surrounded masks mm-hmm and there's two types of masks and of course there's there's more than just two because we see them increasingly in the community as well but from a healthcare standpoint they're the types of masks that actually filter the air in 95 is a term people have heard quite a bit lately and that's to prevent inhalation of of the viruses particularly airborne viruses and it is possible that we believe that this virus could become airborne in certain hospital situations where aerosols are generated by medical procedures on the other hand surgical masks provide more broadly some protection against respiratory droplet type infections and also sometimes we'll put a respiratory we'll put a surgical mask on someone who is ill with the respiratory illness if you will as a splatter shield so that if they coughed or sneeze those droplets are contained within the mask so surgical masks have both a protective role for people who are not sick and for people who are sick to prevent spread in individuals you know we saw a rush at the outset of the outbreak for individuals to buy masks and so forth it's important to know that we need to preserve those for our health care workers that are treating those who may come down with co v 19 that's right and CDC does not recommend use of masks in the general community and that's not a new recommendation that's been a standing recommendation for some time primarily because there's not a lot of evidence that there's benefit we also are concerned about the exposure of hands to the face as we mentioned earlier I've just anecdotal observation not true scientific data I've watched people in public who are wearing a mask and how often they put their hand to their face to adjust the mask or to push it away from their eyes it really makes me wonder if it actually may have a negative benefit on the risk of infection as well how can people in their community stay plugged in and be continued to be informed about Co vat19 obviously we've talked about the CDC resources quite a bit but in their local area how can they best get connected right to what's happening there in addition to the whu-oh and the CDC websites each state has a kovat 19 website in many cities and counties do as well so that's probably your best choice to be able to find out what's going on in your area as well as what some of the specific recommendations are because while every state has been involved the intensity of involvement is quite variable around the country some country some cities are seeing quite a bit of activity right now other areas it's it's more like spots where the disease pops up and there does not seem to be as much community transmission yet so I know that your grandfather I'm a mother my children asked me questions on a daily basis about this outbreak and what they should be doing what their friends should be doing their school life has been turned over what should we be telling our children about this outbreak at this time I think it's important to be honest with children we shouldn't say things that are untrue or overly reassuring but at the same time there's no reason to to scare kids and a lot of the things that we can all do are things that we already tell our kids in terms of washing your hands covering your cough it's more important now than ever and explaining things about why schools have closed that maybe a little tougher but I think it's it's okay to frame it in terms of well school sometimes closed as if there's snow or if there's a storm or if there's earthquake damage I mean these are all things that can be scary but there are things that we've experienced in the past so being able to relate to experiences that a child has already had so they can be more confident that this is something that will get through as well I think can be very helpful and of course it's going to be different from for every kid just like adults right so age group I'm sure the message needs to be massaged a little differently right and in every family each kid may be different so that does highlight the important role that parents and grand parents play in being able to live deliver those messages in a way that's the right message for each kid right and a lot of grandparents have lived through outbreaks right so they were in their youth perhaps exposed to measles and other disease outbreaks and they can share what that time was like they can speak from first-hand experience which is quite different I wanted to thank you for all of your time so far we have a few more minutes I'd like to take a couple questions if we have time in this last remaining minutes that we've received from the public great one of the questions the first questions I'm going to pose to you is about vaccine development and therapeutics how quickly could a vaccine be available to Americans well first of all thank you for that very broadly for that question because we've talked a lot about hand hygiene and social distancing quarantine isolation these are some of the important tools in our toolbox but some of our tools that were most accustomed to using such as in influenza it's just antiviral drugs or vaccines are not there yet so there's ongoing work to develop antiviral drugs or to look at different types of antibodies that can be used in treatment of the infection at this point in time treatment is really symptomatic so it's important to recognize that this isn't like in influenza where there's availability of Tamiflu we have no tools like that right now a vaccine will ultimately be the best way to protect the entire population against this corona virus unfortunately it will probably be at least a year to a year and a half out we are at the point where there is a candidate vaccine that's entering into some human trials and these are very early on and this includes assessment of what's the best dose of the vaccine how safe is it and then it needs to move through the next phase so that it can be evaluated in terms of how effective it is and how often are there any rare side effects that we need to consider the overall goal is we want to make sure that any vaccine that's recommended for the general public that we can be confident that it's safe and that it is going to be protective as much as possible dr.
Butler thank you so much for your time today you have been very gracious with your expertise and and the commitment of time that you've given in to us this afternoon we are taking the we are going to be approaching the top of the hour and so we're going to close out today's discussion with a couple of reminders some things that we've pointed out earlier in our discussion if we did not address your questions today please visit cdc.
gov you to visit the website for your state and local health department's so that you can learn the latest information about kovat 19 in your area and if you're looking for global information please visit the World Health Organization's website in whu-oh dot int thank you for joining us today and have a great day.