Private Sector Call Update on Coronavirus Disease COVID19 Response

hello and welcome my name is Janelle Gunn and I would like to welcome you to the CDC partner and private sector call and update on the kovat 19 response we would like to thank you for doing all that you are to help protect your employees and communities during this unprecedented time this call will be recorded and later posted on the CDC Ovid website and this call is not intended for media media can direct their questions to media at cdc.

gov before we begin I would like to remind all participants that the CDC coded web site has the latest information guidance and communication resources just since this call last week new documents include child care that remains open resources for Parks and Recreation and critical infrastructure workers who may have been exposed today's call is part of a series of calls to help keep you informed about the Cova 19 response and to hear and respond to your questions thank you to those who sent questions in advance we bet we batch these questions and look for themes and common questions our plan today is to hear a situational update from a leader in our response dr.

Jay Butler then he will do some Q&A based on the questions we received I'm so pleased to be joined today by dr.

Jay Butler he is the deputy director for infectious diseases in this capacity he provides leadership to the efforts of CDC's three infectious disease national centers and helps to advance the agency's cross-cutting infectious disease priorities dr.

Butler has 30 years of experience in increasingly complex public health leadership and management positions he's a board sort of he is board-certified in medicine pediatrics and infectious diseases and has served in public health physicians at the federal state and tribal government I now turn it over to dr.

Butler for situation all right well thank you you now and good afternoon everyone if anybody's out in Hawaii or further refers to their East than that good morning to you so as of today there been over five hundred and fifty five thousand cases of koban 19 in the United States unfortunately there have now been over 26, 000 deaths and I just want to start by extending Nolan says to those of us who have been directly touched by that through loss of family or loved other loved ones as we look at these numbers it's amazing to think we're talking about a disease and a virus that we didn't even know existed only four months ago and the world has been changed in ways that it'll never be the same again so it's humbling as we continue to learn but as we learn we learn new ways to be able to address this virus and to improve the health of everyone so what are we learning a couple of things that I wanted to start by highlighting and then I look forward to taking your questions first of all it's becoming more and more clear that not everyone is impacted by the virus in the same way while everyone is susceptible at least here in the United States we find that African American people are over-represented among those who are hospitalized last Wednesday we were able to get some data out in an mm W our there's also ongoing work and a number of locales that are repeatedly confirming this this finding we don't have a full explanation for that at this time although some early analysis suggests that it may be related to the long-standing health inequities that people of color the burden that people color have to bear particularly related to chronic diseases such as diabetes mellitus which we know is associated with higher risk of severe outcomes with kovat 19:00 there is some data out of New York for instance that shows that hospitalization rates among African Americans about twice what they are among white Americans in New York State we also are learning more about how the epidemic is spreading across the United States this past Friday we were able to get some fairly detailed analyses on the geographic variability of kovat 19 across the United States so far nationally the rates of infection have been 124 100, 000 persons but there's a number of places where the cumulative incidence is much higher than that national average particularly in New York City where the cumulative incidence is 915 per hundred thousand or to put that another way nearly 1% of the population have been confirmed with kovat 19 other jurisdictions with rates above that national average are New York State New Jersey California Massachusetts rather not California Louisiana sorry about that Massachusetts Connecticut Michigan District of Columbia and Rhode Island it also shows some of the temporal trends in in the rates of kovat 19 and we actually see a little bit of reason to be encouraged in that the doubling time that is the amount of time it is required for the number of cases to go up to fold is actually becoming longer and the rate of increase day to day is also falling which suggests that the community mitigation measures that have been instituted pretty much across the the country are having an impact on the rates of new infection I think if you called into this call before you've heard us talk about flattening the curve in fact unless you've been living under a rock you've heard everyone talk about flattening the curve that's terminology that is very familiar to those of you who've been involved in pandemic planning for any number of years but now it's become a household term that when we take these steps to be able to slow transmission we're distributing the impact of the pandemic over a longer period of time so the pandemic does not crush healthcare the healthcare system or the critical infrastructure that keeps the water flowing and the lights on the third area of learning is deeper dig and community mitigation and just today we're able to get some of that information out and the MMWR and all of the MMWR s are available online if you go to CDC gov slash MMWR or if you go to cdc.

gov slash go vat19 you'll also find links to the recent publications in the MMWR the one that came out today looked at community mitigation and the rates of disease in four locations that were hit pretty early in the pandemic Seattle San Francisco New Orleans and New York City one of the things that I think is most interesting about this report is how we can take a fairly traditional public health data and overlay it with other types of data in this case data from safe graphs as a home measure this is data that comes from the GPS on cell phones that indicates how often people go beyond about a hundred and fifty meters of where the phone has spent the night before as a measure of movement throughout the day and it shows that the community mitigation efforts have reduced the amount of leaving the home significantly in all of these locations in New York it was nearly a two-fold decrease in the amount of time spent away from home this is really important as we look at how do we begin to peel back some of the community mitigation efforts we know that it's always a fine line to walk between keeping people from becoming sick but also getting the economy going again recognizing that the longer that the economy continues to decline that too will have a negative impact on people's health we also recognize that there are a lot of things that are being delayed right now particularly as it relates to chronic disease management when primary care in the healthcare sector and that will eventually be causing health impacts that will be negative as well so the overall goal is to be able to begin to lighten up some of the mitigation efforts in the some time in the coming weeks and months but doing it in a way that hits the right balance to be able to support getting life as much as possible back to normal but without causing large second waves of kovat 19:00 we do have concerns as we've watched the experience in other countries that were ahead of the United States particularly in Hong Kong and South Korea where there have been some reports of resurgence –is as community mitigation was backed off also in Singapore in Japan where there's been increases recently in the number of cases related to more open travel finally I wanted to highlight something that if you're if you follow influenza statistics and are familiar with CDC's flu view you may find cope with view sort of a familiar environment this is available on the CDC website and it's weekly updates in the amount of kovat disease that is occurring around the country and it includes kovat like illness if you're familiar with influenza like illness it's a measure similar to that and it's one of the ways you can see that there actually has been some decline at least in terms of health care seeking related to kovat like illness over the past week it also shows mortality figures in just as an example over the of the week ending April fourth seven percent of all deaths in the United States were caused by pneumonia excluding in in kovat 19 but there was another 7% of all deaths that were related to Kovac 19 the influenza number of deaths is actually declined over the past several weeks as an N is now less than 1% so overall we're seeing a combined pneumonia and influenza death rate including those caused by kovat that are approaching the the levels that we saw about two or three years ago when we had a particularly severe influenza season however this is all being compacted into a period of just a few weeks so a very serious situation and finally I want to talk a little bit about prevention and some of the challenges in knowing that we're doing the right thing and how do we measure the impact of prevention torie McGowan is a emergency medicine physician in Oregon recently wrote an editorial on this concept and she writes when it's all over the marker of our triumphs will be an absence it'll be the unused cemeteries delayed funerals unmourned loss it will be hard to measure the spoils because we'll only be able to count them in the ghosts of our fears not realized so with that I'm going to pause and I'll be happy to take your questions okay great thank you um painful questions about the interim guidance or critical infrastructure could you say a little bit about critical infrastructure and then about the guidance yes so you know getting data out and sharing what we learn we're learning is always important but it's not just an academic exercise this being a new disease and the new virus what we learn also then translates into what we do differently it's one of the reasons why you'll see recommendations that are updated and may change last week we spent some time talking about the expansion of the use of mass for source control to more general use in the community using cloth face coverings in the instance of critical infrastructure those guidelines were updated on April 9th and you can find those on the CDC website critical infrastructures include law enforcement 911 ploy ease fusion center employees hazardous material responders from both government and the private sector janitorial staff and other custodial staff workers in food and agriculture and particularly in when we talk about food we're talking about grocery stores or takeout services critical manufacturing in information technology transportation energy and also government facilities in other words the things that keep us fed watered and keep the lights on so the the additional guidelines focus on a number of activities that include being able to identify people who may be potentially infectious and trying to exclude them from the work site and much of this is driven like the recommendation for cloth based coverings in when in public areas in the community on the fact that it's now recognized that the period of infectiousness can begin as much as 48 hours before the onset of symptoms and some proportion of people who who become infected will never develop symptoms it's not clear exactly what role that they may play in the transmission of Tobit 19 but it's very doubtful that it's zero so some of the recommendations include the employer should measure employees temperatures and assess symptoms prior to starting work and ideally these temperature checks should happen as the individual enters facility as we've discussed in previous calls a temperature check doesn't absolutely exclude someone who has Co vid 19 but it is a way to identify people who correct definitely should not be at work that day example we do this now at the CDC when I came into the facility today my temperature was taken with a non touch temperature gun by a friendly person wearing a face mask as and well as a face shield and then I was read a number of questions about any recent symptoms as well as exposure to people with documented Kovach 19 after clearing that I was able to then get a sticker that I have affixed to myself now showing that I've been cleared to enter the facility experience something very similar at a Federal Building in Washington DC about a week ago they went with a with risk wristband approach so that everyone could spot who had been appropriately screened the still this does not replace some of the basics such as employees should be separated by at least six feet and practice social distancing during work duties and ideally a face mask should be worn at all times and particularly in public work areas and that areas such as offices bathrooms common areas shared electronic equipment those high touch surfaces should be routinely cleaned and disinfected and there may be additional detailed questions but I'll pause after that summary there is some questions about temperature so should you take all employees temperatures or just those you believe are potentially accept yes we would recommend that everyone have their temperature taken each day just a few little tips on that if it's chilly outside it may be hard to get a good – reading with an on touch surface so if you can ask the employee may be to pull the shirt collar back just a little bit to be able to get some skin that was not exposed to the ambient temperature outside if it was a chilly day you can get a more accurate reading I think I scared people when I walked in with a temperature of 94 on a cool and breezy day a week ago but by just showing a little my collarbone we got a temperature of 98 point two which I'm sure was much more accurate and so there's questions about picking the temperature with the new attention thermometer but insurance social distancing I think you talked a little bit about that by the healthcare worker wearing a face shield but yeah more about that yes so people who are doing the the no touch temperature screening ideally should be wearing a mask as well as a face shield a gown and gloves to be able to protect themselves they do not have to change these between each employee the other thing that I'll mention that can be handy is to be able to put some sort of marker to be able to remind everybody to remain six feet apart if they stand in line or have somebody who can remind people which I confess I had to be reminded this morning I stood a little too close to the person in front of me and my great eagerness to get to work and then another question on this so if you have confirmed Kovac 19 employees in your facility should you shut down yeah so ideally the facility should be cleaned and disinfected so you want to close off the areas where they were used by the person who is sick ideally you want to be able to air out the area and wait 24 hours before cleaning and disinfecting if 24 hours is not feasible again wait as long as possible and you want to clean and disinfect all the areas used by the person who is sick such as offices bathrooms common areas shared electronic equipment like tablets touchscreen keyboards and remote controls we experienced this in the Emergency Operations Center at CDC just a couple of weeks ago after one of our people here was confirmed with Kovac 19 if it's been more than seven days since the person who is now confirmed with kovat 19 visited or used the facility additional cleaning and disinfection is not necessary but I want to stress that all of us in all work settings need to continue cleaning and disinfection with particular attention to those high touch surfaces and so customer questions about survivability and can the virus survive on clothes and shoes and for how long yes the death on survival of the virus on particularly clothing suggested only for a very short amount of time and that virus on even if it is on present on clothing it's ultimately killed with routine laundry the bigger concern with contamination of environmental surfaces relate to hard surface particularly stainless steel and certain type of plastics the contamination will generally occur through respiratory droplets from someone who is infected as I sit here talking my mask should be catching any respiratory droplets but to make sure you understand me I actually have my mask lowered so if I'm infected I may be contaminating the surface in front of me so I will wipe that down with a disinfectant wipe after we're finished survival on those kind of surfaces can be longer potentially on the order of hours you know how does it then get from high touch surfaces or from horizontal surfaces into the respiratory tract the vector is the hands so hence the concentration on hand hygiene the importance of washing hands with soap and water for at least 20 seconds about as long as it takes to sing happy birthday twice or go through the alphabet I'm wide open to other songs because I'm sick of both of those by now or use an alcohol-based hand cleaner with at least 60% alcohol those high touch surfaces you know I frequently the question is how often to wipe them down and it really is going to depend on how heavily they're they're used but ideally as often as as is feasible there still seems to be some confusion between phosphates covering face mask and who needs to wear what covers employees yeah so let's sort of take it from the top in terms of the the differences between respirators masks and cloth based coverings in the purposes of each are related is it to protect the person wearing it or is it to basically be what we call source control that is to limit spread from someone who is potentially infectious in the case of respirators and these are things like in 95 respirators the purpose is really to filter the air that's inhaled and to protect the wearer these are supplies that have been very precious in recent weeks and really prioritized for healthcare workers that are at highest risk of being exposed to aerosols from people who are infectious a number of steps have been taken to be able to preserve the n95 respirators including recent purchase of units that allow decontamination and sterilization of the mask using vaporized hydrogen peroxide and those are to find out if those are available in your area you can contact your local emergency response coordinator and specifically the regional emergency coordinator with FEMA can provide more information on if and when those type of units are available in your area when we talk about masks we're more often talking about just a simple face coverings such as a surgical mask so the design of some of the cloth face coverings are like surgical masks back in the day actually all surgical masks were cloth face covering and they're designed primarily to keep the the surgeon from potentially contaminating the surgical field while talking and to keep any droplets that come out of the mouths of the nose from falling into the the patient on the operating table we also use those as a way to reduce the spread of respiratory droplets from people with with any kind of respiratory infection so it's not a foreign concept in fact it's really from day one of the response the recommendations for people who are suspected to have kovat 19 who required evaluation in the healthcare environment that they wear some type of mask to be able to prevent spread of respiratory droplets whenever they're in a public area on their way to get healthcare what has changed more recently is the finding that not just people who are symptomatic with Kovan 19 may be able to spread the virus and so the cloth base coverings is a way to do the same thing but without potentially burdening the supply chain for surgical masks if you have surgical masks available it's fine to use them but we can help preserve those by using cloth face coverings and there's a lot of varieties just looking around the room here I see one has ear loops on it also one that I think is purchased a nice black one that has very long ear loops I go with more the classic tie behind the head like what you see on mash and it's basically like an old-fashioned surgical mask although i express myself a bit by having a fabric that has images of bears and salmon on it so the goal there is to be able to protect others and so for instance I think specifically when you go into indoor public venues such as stores it's important that we all be masked and I've noticed that more and more employees are masked and I've also had a number of employees thank me for wearing a mask because they do understand that while I may not be protecting myself I'm doing it to protect other customers in the store as well as the employees in other types of work sites such as the one I'm in right now I'm not interacting with the public but out of respect and care for my fellow employees I'm mostly wearing a mask to be able to reduce the chance of transmission if by any chance I may symptomatically infected or not yet have not yet developed symptoms of a recently acquired infection so I'd like some questions about the virus so you had mentioned some of the factors of why it may be higher for african-americans do you feel like that those are some of the same social terms of Health that might impact Latinos or other racial ethnic groups yeah in your races also a question totally a part but related to race and ethnicity and its socioeconomic conditions we know that respiratory viruses can be spread more readily in crowded situations and in housing where the number of people per square foot is such that there's more people in contact with others also it can be harder to telework oftentimes if you're in the service industry so there may be more exposure for people who are in some of the lower income occupations and again that's why it's important to wear a mask not only if you work in those kind of settings but also if you're a customer it's a way to protect your fellow human being and you know also critical infrastructure we don't often talk about the people that work on the produce aisle at the grocery store as being critical infrastructure but they are important people to keep us fed through this time where many of us are quarantined that at home in either out of work or or working remotely and then questions about this spread so you notice the recommendation from CDC the question is sort of the w-h-o has one meter and then also do it respiratory droplets actually go further than six right yeah so there's nothing magic about six feet in fact I've always thought it was a little funny six feet is Americanized of another recommendation that two meters doubling of the whu-oh recommendation in general the closer you are the higher the risk and it's important to recognize also that six feet is kind of an average when you think about the respiratory droplets that are produced during talking or singing coughing or sneezing but certainly a sneeze is able to project droplets for a further distance a champion water melon seeds spitter may be able to go eight meters or more so it's not an all-or-none phenomenon but six feet is a good rule some to be able to limit the amount of exposure to respiratory droplets from someone who is potentially infectious that alone though I think is not enough so that's why the cloth base coverings are important that's why staying home if you're sick is critically important and also practicing a good hand hygiene is important we receive some questions I can usually do about what we know now about immunity and when this might be over ah so hot topic for the week and something we'll be learning more about very soon some of the work CDC has been involved in has been setting up systems to be able to monitor the prevalence of antibody in the population and locations around the country particularly now that we recognize that some people are infected without symptoms it's important to know what proportion of the population has already been exposed a second part of that question is whether or not the antibodies that are detected through the commercial tests that are becoming available as well as the enzyme-linked immunosorbent assay test that we have here at CDC is a reflection of actual protection so that if that's something that I hope maybe by if not next week two weeks from now we can start talking about some more definite findings the hope is that we would be able to determine who has been exposed and potentially protected and that may open up opportunities for who can return to work particularly in the types of work that are shut down right now and to be able to provide proof of immunity not unlike what's done for kids being able to go to school when they have proof of immunity through vaccination but that's an area that's evolving very very quickly so we'll know more about that very soon the one thing that I'll say that's important to know about antibody testing is that antibodies it appears do not develop until into the second week of illness for people who become symptomatic so it's not going to be useful as a way to diagnose acute infections for instance if you develop sore throat fever and cough today you most likely have no detectable antibodies so still a swab for PCR is the optimal way to be able to make the diagnosis question so I suppose we've received before but about sort of the trifecta of coded the flu and allergies and wondering if you're going to screen out employees who have allergy yes that's a great question because we know that it is allergy season in an increasing portion of the country right now I'm just actually we're by a window and I can see some of the yellow clouds stirred up by the wind of the pollen here in Atlanta allergies will not cause fever so you know the value of fever screening may actually be greater as we get into this time of year and of course symptoms such as runny nose a scratchy throat a rough voice can certainly be caused by the post nasal drip of allergies as well so it if you've never had allergies before and you have those symptoms I think that would be a reason to be concerned for people who have allergies generally if you know what your allergies have been like in the past you can use that as a rule of thumb but I think it's very important to recognize that things like fever headache muscle ache particularly shortness of breath are signs of something much more serious I do recognize that allergy sometimes can precipitate asthma attacks so a cough and shortness of breath may be present with that as well but those may be the kind of things that really reflect that you should stay at home and be able to manage the illness if it's allergy or asthma or if it's Kovach to be able to reduce the risk of transmitting to others and of course the state the obvious if you're short of breath or experiencing chest pain those are the kind of things that really do require urgent medical evaluation so calling 911 approach unless you're able to get yourself to emergency care under your own power I have a question here that CDC uses two terms cleaning and disinfecting what's the difference between these two yeah so when we talk about cleaning we're talking about removing dirt and grime oftentimes we're talking about the things that are more visible whereas disinfecting is using the types of chemicals that are approved by the EPA for killing various types of viruses and bacteria so examples of disinfectants include bleach they include hydrogen peroxide they include alcohol soap and water are necessarily always thought of as disinfectants but for enveloped viruses they're generally killed by the action of soap and water but that's basically you can clean and disinfect it the same time if you're using a a material or a product that contains the chemicals that are marked to be able to tell viruses a number of products actually show an indication for coronavirus based on experience with other coronaviruses but all evidence is that the new corona virus that causes kovat 19 that is still known as SARS Kobe 2 is inactivated and just as the other coronaviruses our question here about we have an estimate of either those who are low symptomatic or asymptomatic and how that might impact screening yes this gets back to the question of why it's so important to be able to take steps to prevent transmission from people who are not yet symptomatic the cloth based covering is an important way to limit the spread of respiratory droplet being able to support hand hygiene and encouraging hand hygiene is important and also cleaning and disinfecting of those high touch surfaces is important as well a question that we're still getting our hands around is what proportion of all infections are asymptomatic there's some data from Iceland that suggested it was 50% there's been other data that suggests it's much lower so at this point in time I think all bets are off there is some proportion of people who are asymptomatic when they become infected as we get more of the data from serological surveys I think we'll have a much better handle on that and then can you say a little bit more about the broader opening up again or returning to work and I think maybe analogy of like it's a bit like pitch or never roll backwards like a dinner yeah maybe maybe it's more like opening the shades where you turn it very slowly and let in just the right amount of the line it's definitely not a light switch because the the scale back could if it's too sudden we'll see a resurgence in cases and second ways that could be even worse than the first one so it's something that will need to be done very carefully what we want to make sure is in place is that we have a healthcare system that is not totally stressed out but able to handle any increase in the number of cases we want to continue to build the capacity to make the laboratory diagnosis so that we can determine who has Co vid 19 and also be able to do the investigations around cases to be able to ensure that people who have been exposed are aware of their exposure status and can take appropriate steps that would limit spread to others and of course the state the obvious we would want to see that we're on the downward trend while some of the recent data nationally and the data from some of the areas that have been heavily impacted early on particularly in New York City and in New Orleans we're seeing some decline in the rate of increase but the the number of cases still isn't cumulatively or going down again we haven't seen a day where we saw a significant reduction in the number of cases when we see begins seeing that happening that's when I think we can start talking about in locales how we might loosen up and I want to stress that while everybody wants national guidelines on that I think national guidelines is the the best we can do because there are areas of the country that have been less impacted than others and we want to make sure that we don't see situations that approach a crisis point such as in New York City where there was such a rapid increase in the number of cases over such a short period of time and I just really want to salute healthcare providers all across the country but particularly in New York City as well as the public health officials just really rapidly ramping up to be able to deal with the influx of the patient's coming into the healthcare system as well as the rapid increase in the number of cases and it's encouraging to see that the number of cases is not increasing as rapidly and there's even some evidence that the number of persons who are hospitalized with kovat 19 have become begun to decline we would want to see that over a period of more than just a couple of days but those are encouraging signs that what we're going is working but we've got to be very careful about not stopping doing not changing a winning game plan too early couple of questions that have come up before about when exterior clinks doesn't know well for six weeks to keep tickets be a separation between employees maybe they're on a manufacturing line or somewhere that doesn't allow that yeah what's really important for employees to take every step that's possible to be able to allow that and it's you know the the recommendations have to be adopted to the individual work environment an example that I know of where that was simply not possible was in air traffic control may have mentioned this last week air traffic control towers can be fairly crowded environments it's also an area where being able to speak clearly is critically important and so those are situations where being able to monitor for temperature and symptoms as well as ideally being able to exclude people with known exposures is important and then let's workplace-related but the last week you talked about a tiger do you know any more about kovat and animals yes so last week we learned about Nadia who was a tiger in the Bronx Zoo who was diagnosed with kovat 19 and I last count I saw there are four Tigers and three lions in the Bronx Zoo that had been diagnosed with Kovan 19 and speaking of occupational hazard I am told that the veterinarians that collected those specimens did sedate the animals before collecting and in peace wall there was a zoo employee that was involved in care of these animals who had koban 19 and was had mild symptoms so the evidence is actually that it's very possible that the virus had passed from this human to these feline species there have been studies in China inoculating a variety of animal species and they did have some success in inoculating cats no success in inoculating dogs chickens pigs or ducks so at this point in time we have no evidence of ongoing or common transmission from animals to humans but the CDC guidelines do recommend if you're symptomatic with kovat 19 I D Lee having somebody else take care of pets to be able to reduce the risk of that transmission and that may be particularly important if we're talking about cats since at least in the laboratory and in one real-world instance it appears to have been feasible to transmit the virus to the animal but I'll stress again in conclusion that while the initial spread of the mutated virus most likely was from an animal to humans this virus is well adapted to be transmitted person-to-person and we're not seeing a lot of evidence at this time of transmission from other animals to humans that said of course I'll say again we're talking about a virus and the disease that we didn't even know existed only four months ago so it's humbling to learn more as we go forward but those are the guidelines based on the science that we have right now thank you so that brings us to the end of our time today do you have any closing comments I just want to thank you for your your interest and thank you for being here this is just a remarkable time and it takes all of us working together to get through this but it's important to recognize that we will get through this there will be too many losses there'll be too many funerals and so I do want to recognize that that but the fact is our America will we'll get through this as will the rest of the world but we still have a long way to go in this pandemic so I appreciate the chance to talk with you today and I hope that I'll have the opportunity to share what more we're we're learning about how to control kovat 19 and prevent infection and death in the near future thank you all for joining us this afternoon this concludes our session thank you everyone.