Transcripts For CSPAN Discussion On Coronavirus Outbreak Global Health Threats 20240713

Director kadlec. I am pleased to convene the meeting. Thank you to todays council on Foreign Relations meeting. Regostownsend of legal and business affairs. And i will be presiding over todays discussion. I will have the privilege of leading a conversation for 30 minutes. And then i will open it to questions and answers. We will end promptly at 1 30 as you might imagine. These gentlemen are very busy right now dealing with coronavirus. So lets just start. Looking back over roughly the past decade, emerging Infectious Diseases have played an ominous heme being h1n1, ebola, zika and now the novel coronavirus. The threat is not disapating. The stafford act provides Disaster Relief funds to enable immediate response. O we need a more staffordactlike mechanism to research these new threats . So maybe ill take the first whack at this. Because i think the feeling in congress in discussions with both house and Senate Members is that clearly theres a value for having some kind of Disaster Relief fundlike activity. And the c. D. C. Has an emergency Infectious Disease fund which has been enabled right now. But the question is what is the scale . Because i think that the feeling in congress, at least from discussions with both house and Senate Members, that clearly there is a value for having some kind of Disaster Relief fund like activity that the cdc inflew enzi n an smartic the other side of it is there has to be some mechanism by rapidly access funds. This is a little bit different scenario than the pandemic influenza setting. But i think it highlights the idea for speed, agility and mobilization, as the doctor can maybe elucidate here in a minute, the kinds of things that he has in his box of tricks, if want to call it that, to rapidly accelerate products that could be helpful to manager this kind of event. Fauci. The answer to your question is that we needed some sort of reserve fund and we can actually tap into and also backfill when you tap into it. The two examples, for better and worse i have been through all the outbreaks but when we had the Ebola Outbreak we got immediately the money we put into it, but when the zika virus came out and present obama asked for a supplement, it took many months to get it. That messed everything up. It depleted not only what we were doing but we had to tap out from other activities and finally we never paid it back. Like right now, i am moving resources to respond in a countermeasure way. Fortunately, the things were doing are not that expensive. But they are going to get really expensive really quickly, when you go from a phase one trial, the one million to 2 million, which goes to the phase two 20, 30, 40, 50, 60 million. We absolutely need it. When you have to rely on appropriations to go through the appropriations process, the only takes take and debate and it does not work. Frances lets talk about the coronavirus. Lets set the stage. The outbreak has set a number of historic firsts, the largest quarantine in World History of the china locking down over 60 Million People. Is the first mass epatriation of citizens climbing over 1,000. Can we level set the basics, how contagious is it, what is the morbidity rate, and how does it compare to others, like sars . Give us the basics. Dr. Kadlec you can judge it by two things. One is transmissibility, the other is morbidity and mortality. As far as transmissibility, is highly transmissible. Sars was less, but had a mortality of 9 to 10 . Dr. Fauci mares had a mortality of 36 . The seasonal flu is very transmissible. And has a mortality of. 1 . The pandemics that we in our lifetime have experienced, 1957, 1968 and 2009 have a mortality of 1. 3 to 1. 6 . The catastrophic pandemic of 1918 had a mortality of about just shy of 2 , about 1. 8 . Therefore, where do we stand now . We have a highly transmissible virus that has a calculated c. F. R. ,y, which we call rate of 2 . Ty but there is no doubt it is lower than that. The reason it is lower is because the only things that we are counting with people that come to the attention of health care providers, which means inevitably there will be multifold more people who have no symptoms or minimum symptoms they dont get counted in the do nominator. If it is 2 now with a small denominator, when the dominator increases by threefold or fivefold, you will probably have a mortality of about 1 or less, which means if it continues to evolve into what we hope it does not, a pandemic flu, it will be very much like a really bad flu season or a moderately bad pandemic season. Frances can you be an asymptomatic carrier of the coronavirus . Dr. Fauci without a doubt. The real question we are trying to sort out, because we are getting anecdotal reports, can you transmit it efficiently when you are asymptomatic . We know there are people infected who do not have symptoms, or who have minimal they dont even notice. We have anecdotal stories of people who clearly transmitted it when they were asymptomatic. That has implications for things like tracking or testing or screening. Because if screening is dependent upon symptoms, then the asymptomatic person throws a glitch into the screening. Frances how efficient, how good and reliable is the diagnostic at point testing right now . Dr. Fauci we do not have pointofcare testing right now. The testing going on is in the Public Health laboratories around the country. At the cdc has come up with an effective test, there are issues in terms of some of the agents, but in terms of it spreading it around the country, there are 190 locations in u. S. Labs where testing. Do the there is certainly a lot of development. Thats a significant concern of aking it available to clinicians so they can do the very things that i think everyone would like to know, do it or does someone i love have it and whats the risk of someone else in that family. Frances are we close to or working on that point of examination testing . Dr. Fauci with the cdc did was very soon after the chinese put the sequence on the public we pulled out the gene make a protein to vaccine. The cdc took the whole sequence to develop a pcr, a molecular test. They developed it at rocket speed. It was amazing, like in a couple weeks. They perfected that. And the answer to your question, that is a good test. So if you test me and my test is positive, i am infected. If my test is negative, there are a couple of explanations either i am not infected or the level of virus is still so low in me that you are missing it. It becomes a matter of sensitivity. It is pretty sensitive. The pointofcare test that bob was mentioning is the one you want to get out there that you can actually get an answer, just like that, and it is sensitive and specific. We are not there yet. We have a good test, but it is not pointofcare yet. Dr. Kadlec to your question about timing, we would hope in a few months you could have a test that would have to undergo fda evaluations for the same reasons he talked about, sensitivity and specificity of the test, giving you a true positive or potentially a false positive, or worse, a false negative. Frances i am getting the sense from both the testing point of view and diagnostics, and what you said earlier about the cases we are aware of, that we are at the beginning of the beginning. We do not have a sense of size or scope or scale yet of the magnitude of the worldwide infection. Dr. Fauci right, it is even more disturbing because not only do we not have, uh, an appreciation of the magnitude, even more disturbing is we do not have an appreciation of where the magnitude is going. Static and we do not yet know what it is, you can do out. Ing and figure it the critical issue now is how that have es travelrelated cases are going being ent them from sustained transadmissibility. Once you hit sustained transmissibility, you have a real problem. We have handled travel related cases very well. We have 15 cases, we now have 14 extra people, we flew 14 over from the cruise ship. But we have done identification, isolation. So to our knowledge there arent individuals in society in the United States that are infected. We do not think so, but we do not know 100 because they may have come in under the radar. So what we are doing to mitigate that is that we are taking five cities, representative cities that is los angeles, new york, san francisco, chicago and the le and going into clinics where people present ith flu like symptoms that dont have the flu. Test them for coronavirus. If they do have it, it indicates we are missing some. If not, we are in good shape. But what about the countries at that do not have the capability of doing that identification, isolation and contact tracing. Into sustainedde transmission, the more they do to the more you get closer a classic definition of a pandemic. Frances lets talk for a moment because we are a globally and interdependent world and not all Health Systems are as capable as the u. S. How good a partner have the chinese been . We know they closed the market started on the first. They sequenced the gene virus on the ninth, they did not share it until the 12th. How transparent have they been . How transparent have the chinese been about how they are handling it and what they are doing to cooperate with the United States . You take the first one. Dr. Fauci you could talk about 2003 and i could talk about today. Dr. Kadlec if you compare it to the sars outbreak, they were egregiously nontransparent. They had a new infection, it was in november. They did not say until february hong kong that this was not flu, it was not flu, it was something different. That put us behind a fair amount. Today, at least from the standpoint of publishing the in the database, the sequence, that was good. They did that. But when you talk about transparency, it depends on who you mean by the chinese. We have colleagues that we have dealt with for years, if not decades, some of whom trained in the United States. They are very transparent on the what is h us about going on. The official numbers that come out, it is opaque where that is coming from. I am not saying it is wrong, but i do not know for sure. Dr. Kadlec i was going to say, another way to look at it is if you think our bureaucracy is big, china is bigger and the manner by which these things are basically handed from the local province or city and whatever else, and obviously at least according to the press that there may have been either confusion or deliberate decisions at the local levels, may be not to report it, you can imagine something that is novel, and this is, gets lost in the noise of the regular flu season and it may not become apparent. So i think there are reasonable reasons, but to that point i think that we are getting information, and now that we have a team in beijing with the who and a couple americans on there, that will enhance opportunities to understand better and really work collaboratively to really manage this. Because quite frankly, as he said, we do not know what the magnitude of this could be, but we certainly know it is very disturbing. Frances it makes clear what you are saying, that we are going to depend on information from our foreign partners around the world. Are there obligations in terms of reporting outbreaks around the world, and what are those obligations and what should we expect from our International Partners . Dr. Fauci when you get in outbreak, you have to, that is a responsibility of any nation when you have an outbreak of a new infection, that you obliged to make it public so that you can let people know. Frances presumably not all health not all Health Systems are equal. We know there is a large ex expatriate Chinese Community in africa. Do we have the same level of confidence at that those Health Systems will have the ability or capability to observe those requirements . Dr. Fauci almost certainly they do not. It is not a question of knowing and not telling the rest of the world, it is more a question of not even knowing what is going on in your own country. Dr. Kadlec i do think it is say y a good shoutout to that this Global Health Security Policy that there is a initiative that is an important we build is how do greater capabilities around the world particularly in areas where they know that they are not only vulnerable, but they have less than capable systems. So small investments can mean a lot in those settings. Frances how does the current outbreak affect our domestic medical supply chain . What does it mean in terms of our domestic supply chain . Dr. Fauci ruh roh. [laughter] we are seeing that play out in real time here. Clearly, there is good news, but also more chilling implications. First of all, for the manufacturers and distributors, typically before lunar new year, when it is anticipated that the factories in china will be closed, they order more and ship more in terms of making have an adequate supply. That factors things and like the flu season. I just saw something in the post that said that theyve estimated about 22 Million People with the flu this year, 12,000 deaths. So the distributors and suppliers, right now they are ok, but how this plays out in the longer term is still a matter of concern. Let me give you examples. So this is a joint team effort that we are leading at hhs with our fda colleagues and with dr. Han and others and with our Veterans Affairs colleagues as well as the private sector, sharing information and understanding where we stand. There are things that we could need for this outbreak, things like respirators and 95 masks. We know 90 of the Raw Materials come from china. We know that the supply, a supplier of masks come from china as well, 3m has a factory that has been commandeered by the Chinese Government and they are not exporting those masks their own personal use. That goes with other health care products. So there are significant things. Same thing with antibiotics, there could be a risk with generic products. But a lot of her health care, healthcare our products, the Raw Materials, the ingredients or finished products, they come from india and china. India gets its Raw Materials from china. So there could be significant events, depending on how long this lasts, and how it affects chinese system going forward. Dr. Fauci we cannot see them crash. We will have a real problem. Frances that is a vulnerability whether or not you have coronavirus. That is a vulnerability that we should fix with or without this. What is the fix . What do we need to do . Is that congress, legislation . Dr. Kadlec it is a whole government approach, congress and everybody and quite frankly the private sector. If you have not read the book china rx, it is worth a read, because part of the Strategic Plan of china is to basically become the source of these products. Of issuesre a variety at hand. So if you believe in domestic capacity and domestic jobs and having an uninterrupted supply of things, it is clearly a matter of National Policy and support by congress and involvement by the private sector to figure out a solution set to do this. There is intense interest in congress, particularly in the to see how we can address this. There will be a hearing with energy and commerce. That will be coming up. But the notion that we probably need to kind of change the way do business in these areas because of the significant risks that are abilities being highlighted by this event. Frances over the weekend, we saw another 14 americans repatriated who were infected. If we are at the beginning of the beginning, we will see more. Do we have the medical infrastructure if the quarantine expands, if there are more americans repatriated do you have the infrastructure that will be required and how quickly is it likely to be overwhelmed . Dr. Fauci i think that 14 americans repatriated does not stress our system. You could have. A lot more and it wouldnt but probably buried in the question is if we really get a pandemic, then you will get into mitigation, which is very different in many respects than containment. You will have getting people to stay in their own homes, because he will run out of institutional quarantine capabilities, which i think is the question you are asking. And once you do, then you will require social distancing, keeping people at home. Using teleworking, closing schools and things like that. Frances we looked at that when i was in the government, we looked at the context of pandemic flu. So how are we thinking about that now . And are we working with the private sector . The difficulty is, how do you execute against that and implement that. Dr. Fauci thank goodness for the pandemic flu plan that we put together, really, because we did that in response to prepandemic, if you remember, the h7n9, what happens when you have the emergence of a pandemic. Much of that is easy to apply to what we are doing now. Dr. Kadlec we are doing that now in terms of interagency work and modeling out what it would be for the. 1 mortality rate versus the 1 mortality rate, to see what happens. The one thing that is embedded in that question is the fragility of our health care sector. In terms of the ability of hospitals to manage cases depending on the severity of the situation. In light of what is flu season already, it does not mean if you have the coronavirus on top of the regular flu season, it is additive it does not subtract the flu problem. I think that is one of the issues. Tomorrow, we will be meeting with Senior Health care executives across the country to basically talk about what they need to do in preparing for this. I will highlight one thing. Et sophisticated audiences to share one important message. We talked about the respirators. 55 of them are reduced every year, there are millions of them, and if you go to home depot today you cannot find them. Through off the shelves. 50 are used by the Health Care Industry and 50 by the private sector, people for painting, sanding and everything else. The problem is there is a huge demand and supply will be constrained because of the Raw Materials. And what we need to make people understand is those kinds of masks do not need or are not needed by the general public. For people buying them, you are depriving the healthcare industry, the doctors and nurses and people who will take care of you and your families and we have got to get people to understand that the run on these kinds of products is really going to hamper the ability of the Health Care Industry to protect itself, so they can treat you and everyone else in our society. So there is very simple things and messages we need to get out. I think that is one of them. He can even say a better one about you do not need the mask unless you are sick, right . Dr. Fauci i do not want to denigrate people who walk around wearing masks, but the fact is the mask is probably for somebody who is sick to prevent them from infecting somebody else. The one thing you want to do during an outbreak, when somebody comes in coughing and sneezing, put a mask on them, not on yourself. Frances folks often paint Infectious Disease and bio defense in separate categories. The truth is there is significant crossover in terms of preparedness and research, understanding it is a sensitive topic, talk about how we should approach these risks in a comprehensive manner so that we can achieve Public Health and National Security. Dr. Kadlec they are inseparable, meaning Public Health, security and National Security are inseparable. You look at the events what china will do with its economy and what it will do to our economy, we will see a loss or a decrease of expectations in the First Quarter based on the parts they can get from china, and they are not unique in their dependency. Impacts have enormous on our economy. And if it is unabated and goes on a trajectory it seems to be going on. The thing is, one, i make this an affirmative fact and it goes back to money. The strategy that the president signed in september of 2018, it basically shows we spent about 8 billion a year on the whole kit and caboodle subject to our investments, the institute, the investments in local and state and Public Health. That is half the cost of an aircraft carrier. We have 12 aircraft carriers. We probably could benefit from some kind of thoughtful investment at all levels of government to build capacity, to make sure that we can have a domestic manufacturing capability for vaccines, so that we could rapidly, as identified pandemic dents influenza plan, that we need to manufacturing, not only for vaccines, but for other healthcare components. So there is a real need to take a different approach to this. Because of the global interdependencies, because of the risks to our livelihoods, as well as our social stability, and our National Security. Remember 1918 happened during world war i. More people, more soldiers died flu than combat actions. So they are interconnected. You cannot separate them. I think that some of the issues we have to get our heads around, and it is incremental, is we have to somehow understand that we need to kind of engage, particularly now with this on the table, in the long term fix to this which was started, i would say by fran and her in 2005 and 2006 with dr. Fauci. Frances let me take one minute. We wanted to meet and talk about bio weapons originally, but let me ask before i open it up, you know, bio shield was written in 2003. E had the Strategic National stockpile. One of the things we worried about was bioweapons like smallpox, that sort of thing come and we have a strategic stockpile that protects us or tries to at least begin to protect us against those sorts of threats, but we have seen other emerging threats like north korea, that assassination using a weapon. We see russian assassinations. How do you stay on top of the emerging threats and how do you think about the Strategic National stockpile and emerging threats . Dr. Kadlec emerging threats are the next potential bioweapon. Dr. Fauci you have to think of it as a continuum. Mother nature serves up agents at that we are susceptible to inconceivably could be used by somebody in a way that could be to optimize that natural agent into something that could significant. So number one. Number two, the stockpile, we must think of it not as something that is static, because the worst thing we could have was a medical maginot line, a stockpile that is not agile, anticipatory, and i will use the resistance as an example. Some of the antibiotics we have, 2002 nes we identified in to address the anthrax problem. That there is a microbial problem in the world. Somehow we must use that engine of Public Health to also support the need for National Security. How do we do that . We are thinking through that, but it does make it difficult in saying, i have this box on a shelf and hopefully it will not expire. But the thing is we need to keep rotating the stock and also shelf new items on the that can address these things. Quite frankly, i think that this example of a coronavirus, and he can talk eloquently about it, what happened with his vaccine for sars, that kind of lost steam. Dr. Fauci there is another side to the coin of stockpiling things that you know our for something you are anticipating. That would be to take, which we are doing in addition to the stockpiling. It is not one or the other but to take a more generic approach and develop platforms of diagnostics, therapeutics and vaccines. O what when you get a new microbe, a new pathogen that you havent anticipated, therefore, stockpile anything, you just didnt anticipate, what you need is the ability to move quickly to get a vaccine for that. The way you do that is that you rely on having to identify t, grow it, activate it or attenuate it, but that within a day of sequencing it, you can genes, stick it in whatever vector you want and then go for it. Have an example of that right now with the coronavirus on. Cine that were working were not the only ones working on it. Good candidates. What were doing from the time sequence to the time for the phase one trial is 2 1 2 is overwhelmingly a world indoor record. It would be years before you do that. You get it into a phase one trial and you know that the using, that youre whether its a vector or a partial and you could move much with that than you would if you again went back 20th century, e find the organism, identify it, grow it, et cetera. O two things, you anticipate organism x and you stockpile you develop as or quick moving process to make a countermeasure more quickly. Things both of those together. You cant have one or the other. Question, the f. B. I. Recently arrested a harvard scientist for accepting grant money from china for scientific research. Its been reported there are at a r investigations number of u. S. Universities ncluding yale and m. I. T. To name two, the grant money are in the billions of dollars. What are the foreign governments looking for, why in the u. S. And clearly there is a national is this a sk, concern. Ns why should we be concerned about this . Is the force government interest do we think . It is a stealing technology issue. It is very clear. It is unfortunate, because it has put a taint on all chinese, and that is too bad because it is a small fraction of chinese scientists who have, in this country, taken fellowships, gone to study sections, and taken confidential issues, brought it back, and developed it in china. That was picked up by people at the nih and other places. It is an unfortunate situation. I dont think it has anything to do with bio defense. But it does have to do with economics. Stealing our best ideas and innovations and translating it overseas so they can do it may be better, cheaper, faster. I dont know about better, but certainly cheaper and faster. That is the issue that is where the issue of National Security comes in. An economic thing. At this time, i would like to invite members to join their conversation with her questions. A reminder, this meeting is on the record and wait for the microphone. Speak directly into it, one question, not a speech. Be as concise as possible to allow as many members as possible to speak. We will start here. Thank you for the panel. Diamond princess confirmed about 540 cases of infection. That is out of 2400 tested. The concentration of infection is 15 to 25 rate. Remaining on how many to be tested. What does this floating you about the virus and does that help us to understand sort of the prognosis is going to happen to the rest of the world . Thank you. I think it just confirms the high degree of transmissibility of the virus, and when you create a beautiful setting for the virus, people on a large ship, altogether at the same time, all of the time, you couldnt ask for a better incubator for infection. It confirms what we already know, that this is a highly transmissible virus. Thats one of the things thats of concern. You amplify that when you put it in a closed space. It could also tell us something about maybe some modalities of transmission that we didnt appreciate before. We had an interesting experience with sars in hong kong in 2003, in an apartment complex. We had assumed, correctly, that sars was spread predominantly by respiratory droplets, the respiratory infections are transmitted. There was something going on n the apartment where it was aerosolized. It was likely due to the plumbing, because the virus gets into the stool, and feces, and when people were flushing toilets, they didnt see this nvisible aerosolized so that vertically transmitted it. So people on the second floor people on the to 10th floor. Even a wave that went across to another apartment. That is rare that happens. That is something that could possibly have been going on on the ship. We dont know, but that vessel was an incubator for infection. Doctor, does the virus survive on a surface, and for how long . Do we know . You know, the answer is last week i wouldve given you the history of the influenza with x number of hours, coronavirus with x number of hours. Most of the time it survives for not days or weeks. It depends on the medium its in. If its in the mucous code, it survive longer. What we are doing at my institutes laboratory in amilton, montana, we are doing the experiments. We are taking the virus and putting it on stainless steel, wood, cardboard, trying to find out how long it lasts. We will know soon. Yes, sir . [indiscernible] [laughter] could you Say Something about of those who are what ed, what works, doesnt work. We hear the old succumb more quickly. What you find out and what do we need to know about the treatment . Lets start with the second part of your question first. Like influenza, similar to influenza, influentials individuals who are elderly without other conditions or anybody with an underlying medical condition, and those are chronic pulmonary isease, congestive heart failure, diabetes, obesity, immunosuppressive therapy for underlying diseases like cancer. They overwhelmingly are overrepresented as the individuals who get serious disease and ultimately die. Regard to treatment. There is no proven direct coronavirus. Rug for so treatment is generally sim to matich and if you get into pulmonary with roblems, it is supportive therapy. That could mean oxygen, it could mean intubation, anything that gets somebody through an acute stage of pulmonary decompensation. We are doing, and others are doing, Clinical Trials of repurposed drugs, drugs that were developed for other viruses, to see if they have activity against this virus. At the same time, as we are screening small molecules and doing targeted Drug Development but the bottom line is that there are no antiviral therapy. Yes, sir. [clearing throat] hi, tom, director of the Global Health program here at council. I wanted to ask about the cruise ship. Several hundred passengers disembarked. I gather only 20 on the ship were tested. One passenger has, after the fact, tested positive as being infected. What is the current strategy for the passengers that did disembark, and how far along are we in executing it . You ask the right question, because you are the guy that decision. Simply those individuals on the ship are being tested. There are a couple hundred people in the hotel evaluated, so the thing is that one of the things that is an important issue to figure out is, where does that individual get infected . Phenom penn . The incubation period could be as short as two days or as long as 14 days. There are a lot of unknowns, but i think everyone is going through it in a deliberate fashion to say, what can we do to assure we just dont send the people around the world and say everything is fine . The state department is doing an to work with the government of cambodia to work them to evaluate those folks appropriately before we them on their way. Dr. Fauci it creates a difficult situation when you have an exposure that is low to medium risk, and then you have to ask yourself, do you have the resources to go trace everybody . I dont want to be pejorative against cruise ships. If theres one thing you dont want to do right now is take a cruise in asia. [laughter] yes, back here. Sonja stokes, last week, the who hosted a meeting with multiple Tech Companies including facebook and google to address the issue of medical misinformation, impeding the response. What are some of the strategies being used to combat this isinformation online with respect to Public Health. Specifically whats working, what is not, and what can we be doing to mitigate the impact of infodemics on contemporary and future outbreaks. Dr. Fauci i dont know its being done to counter that, other than what is being done in the normal things you read about how to get disinformation of social media. With all of the problems of reluctance to do that because of freedom of expression and freedom of speech, i think medical information, the only thing we do, as physicians and scientists, the way bob and i are, is to try and get out the facts as often as you possibly can. In other words, to counter misinformation with correct information, as opposed to yanking out misinformation. Dr. Kadlec i will highlight the fact, having trusted spokespeople doing that, like fauci, and i think the key thing here is people will not facebook, they will ollow dr. Fauci because he aint wrong. Tim from the u. N. Foundation. That was a terrific program. Really appreciate your great work. Could you drop away for a minute . I want you to focus on Climate Change. Has Climate Change, and are you rojecting for the institutions for which you are responsible very significant changes as a of Climate Change . Related to that, is the Research Agenda and are we pursuing that Research Agenda as aggressively as we might be . Dr. Kadlec i will defer to you fauci, first. Dr. Fauci Climate Change is always problematic to try and relate Climate Change directly to things we are doing. If you look at my responsibility as the director of a Research Agency that involves Infectious Diseases, some of the things we are really interested in is the expansion of vector range and vector capability, with even slight increases in global temperatures, things like ticks, mosquitoes, overwintering. One of the critical issues, when you have a mosquito Borne Disease in a region in which you get cold enough at one part of the year that the mosquitoes cannot overwinter, they go out of action, and then they come back the next warm season. If there is enough change in temperature to allow them to persist even longer, you could have the extension of a season of a vectorBorne Disease. That is just one example of where Climate Change clearly has a direct impact on the things we do. All the way in the back. Hi. Im with radio free asia. Dr. Kadlec, are the experts among the huawei io team, and according to the Chinese Foreign the expert team beijing, not the epicenter of wuhan. Do you think we are able to get the full picture of the epidemic . And dr. Fauci, yesterday, you said you dont think china is the number, but you are on the force and we sk have seen them commenting on a transparency. Why do you trust the information china is providing . Dr. Fauci today, today i do, for the following reason that what has changed in china is that the chinese officials have been more than adamant about actually punishing people who are holding back information, whereas, early on, there was a reluctance and hesitancy on the part of the scientist to talk about what really is going on there. There was a phase early on where the people that i knew, people i had dealt with for years, who were very concerned about speaking out publicly. They would speak to me over the phone, but they would not speak publicly. Now, they feel the government is rein to be the free completely transparent. There really isnt any discrepancy except what was set at the white house before and now. With regard to the people in china, we are sensitive to the chinese wanting to be the ones that make the statements where these people are and where they are going, because we are guests in their country. Although it is an understandable question, tell me who is there, where they are, where they are going. We would prefer to have you hear that from the chinese, because you do not want to get ahead of the chinese. What we dont want to do is for them to pull back on the offer of having our people there. Yes, sir . Thank you. Im with the Chinese Agency of hong kong. How would you evaluate the efficiency and effectiveness of the chinese approaches to contain the virus . From the standpoint of the expert, not from the politician. If the chinese did not take all of these measures to contain the virus, would you be more concerned that the virus will spread more quickly all around the world, and secondly, now that the new cases are out of , the nationwide cases have stepned, what is your next for the chinese . Thank you. Dr. Fauci what china has done, in response to this outbreak, is unprecedented. One could describe it almost as draconian. To shut down 50 Million People from traveling in and out of an area, essentially shutting down the entire city of wuhan, of 11 Million People, from a pure Public Health standpoint, the conventional wisdom would have been that that is overreacting because there are so many potential downsides to that, but as a matter of fact, even though it was unconventional and is subject to understandable criticism, it very well may have dramatically slowed down the exodus and export of cases out china. So at the same time that we imposed an unprecedented travel ban from china, the chinese were being even more dramatic in what they were doing in their own selfcontainment. Since the evolution of a pandemic, when you have a single region that overwhelmingly china is the epicenter, unlike a pandemic flu where it started off, remember in 2009 in alifornia and texas, within a week it was all over the world. It was confined there. An unusual, unprecedented, dramatic restriction of access in and out, i think at the end of the day, saved us from a lot more travel related cases. And, with more travel related cases, inevitably, you would have had secondary and tertiary transmission. At the end of the day, i think they did something that really helped a lot, even though it was unusual, and quite draconian. Dr. Kadlec i just put it as a strategic context like this. You have an annual flu season like we do, and superimposed on hat is a novel agent that you cannot detect or cant account for what is happening. If it happened in our country, there would be a moment in time where we say why is the spike in incidents . Then, it becomes a race to identify it, the root framework of the epidemiology, to begin what would be the appropriate interventions. That you the fact dont have a therapeutic or a vaccine. Left with really nonpharmaceutical interventions. This idea of quarantine, isolation closing schools, look at japan. They are addressing this in a way that addresses the reality of the virus, right . Try and quarantine it, limit the spread. As we would look at it, in our country today, in lieu of maybe a vaccine, and we are working on therapeutics using the same mechanisms that dr. Fauci dentified, taking the gene sequence and trying to produce with dies like we did ebola in real time, to have a the cocktails that may be [frpn] ib114. This scenario and what china did is extraordinary for sure, but the doctor should not the brakes on this but probably slowed the risk of widespread, rapid spread. Will it continue to spread . We see cases everyday continue. The risk is, it gets embedded in talked about e earlier, africa or other places here Healthcare Infrastructure is not very good, that could be risk, if source of the you will. Even though china has done extraordinary things to clamp down. Again, this we are living in an historic time, if you want to think about it, and terms of the race against the microbe, and again, i think the challenge we have is how do we do i recall of working ece merging about Infectious Disease by dr. Lemler and dr. 1990s that highlighted the risk of this happening. That was kind of like the piece of work of National Academy of sciences that started this intellectual race to say how do we address and we are 20 years into that conversation, and now is a critical time to do what we need to do to limit the spread as well as prepare for the next one. We know in the 20th century, how can how many pandemics where there . Three to four. One of the second 21st century, but it wont be the last one. Bob, something you said triggered a question. Do we know if there are existing therapeutics or drugs that could be repurposed, and might work against the coronavirus . Yes, we are testing two of them. One that we developed for a number of other viruses. We used it against ebola and it was not successful. There is an antihiv drug that has inhibitors that we are using. Both are being tested in randomized controlled trials. Questions . All the way in the back. Do you have the capacity or the scientific capability to not only address the current coronavirus outbreak but also anticipate others that, looking back. Could anything you do now hope with prevention and treatment so you are not just addressing covid19 but also what might emerge in five years or 10 years so you are ahead of the curve. It is very unpredictable because 75 of all the new ,nfections that afflict mankind from an animal to a human. That is what this coronavirus did. If you look at sars, we showed it went from a bat to a cat that is used at ceremonial dinners. That is how it infected the chinese population. This virus, if you look at the evolutionary biology of viruses, the coronavirus likes bats. If you collect a thousand different bats, you will find ses in them. He reaches a point where it will combine to a human receptor. I do not want to get into leads with you, but the human respiratory tract has a receptor called ace two. The protein of the coronavirus binds to that receptor, which allows it to infect a human. The ones that do not do not have the right confirmation or molecular confirmation. When you people, when you evolve, you get the right mutation and then boom. It you infect one or two humans and it will stop stayed sometimes for reasons that are unfortunate for mankind, it adapts itself very quickly to transmitting from human to human. That is exactly what this coronavirus did. That. Know the root to how you can prevent it is to have good surveillance, good diagnostics and good response capabilities. It does relate to the bottom line which is, you need to take tony said, develop these platforms that allow you to rapidly respond. There is another reproach, which is, can you look for broad therapies that will have activity against the coronavirus. Challenge inge terms of, how do you do it . You cannot do one approach or the other. It has got to be fast. Said, we are going to have to beat the record again in terms of, how do we position ourselves for this one and the next one. What can we do and platforms are very different advantages. It allows for the regulatory is familiarhe fda with these things. There is a broad Science Behind it. Complicated, but the answer is, that is what we need to do, and we are doing it. You mentioned one of the keys is surveillance. It is our domestic surveillance capability up to this challenge . Internationally, as the surveillance capability there that we need . Systemcdc has a good that partners with state and local health authorities. Not only is the cdc a great organization, but they are connected to the state and local health authorities. Globally, it is spotty. There are some places that have good surveillance. The Global Health surveillance we have right now i think is much better than it was 15 to 20 years ago. John andrews, George Washington university and the university of colorado. My point is related to what was just mentioned. I chair the Panamerican Health Organization Regional commission for measles and rubella elimination. Presentations from colombia and venezuela. Venezuela has lost its measles free status. Talkwo countries would not to each other. The role of the Panamerican Health organization in tackling the international relatedness of Infectious Disease is crucial. My point is partnerships. Could you comment more on the partnerships required . In our own backyard, there are opportunities to maintain the current level of collaboration. I think you hit the nail on the head. If you do not have partnerships and collaboration, you have destroyed the continuity of the system, which is what happened in south america. It is tragic that happened, but it did. Hi, andy weber. Thanks for a great talk. Conductwe postured to Clinical Trials in china of these antiviral and vaccines you have mentioned . It is happening. The chinese have agreed to do a randomized controlled trial plus standard of care versus standard of care alone. Ethically sound. Scientifically sound. Two separate groups of 500 people a piece. One group of people with advanced disease and another with moderate to light disease. I am pretty sure that we are going to have an answer to whether this particular compound works. Do one withkely is two, with which antiviral drugs. Barb and i were just exchanging emails last night and this thatng with trying to get trial, which is a master protocol for people in the unit states who have been shipped to nebraska. Hopefully we will get that going. That concludes our meeting. Them forike to thank taking time out of their busy days. Thank you very much. Thank you for your service. Cspans washington journal live every day with news and policy issues that impact you. Andng up, former chair president of the u. S. Export import bank on his new book. 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