And ceo of resolve to save lives. I want to begin with the debate now going on in states around the country. What is your advice as they look to reopen their economies, many doing it on a casebycase, gradual basis . Dr. Frieden were all eager to get out as soon as possible. The risk is if we go out too soon, we could have a resurgence of cases, an explosion of cases, which could overwhelm our Healthcare Facilities with the lives of Healthcare Workers and result to having to go back in for a longer period of time so the challenge here really is to look at six different factors. First is, is the virus coming down . Are we seeing fewer cases and fewer deaths for at least two weeks . Second, is our Healthcare System robust so that if there is another surge in cases, we can manage those cases, helping patients to survive and preventing Healthcare Workers from becoming infected. Third, is there a Public Health system ready to box in the virus. We call it the boxitin approach with testing, isolation, Contact Tracing and quarantine. The four corners of the box, if theyre right, you can control cases and clusters so they dont explode. Those are the three characteristics of the virus and our response to it but there are another three in society. First is we have to be ready to shelter those who are medically vulnerable for longer. Older people, people with diabetes or serious lung disease or Heart Disease are going to have to stay in for longer because theyre very vulnerable to this. This component is a safer society. Its not going to be normal when we go back. Its going to be a new normal that may include, for example, no more handshakes indefinitely. Hand sanitizer at the entrance of every building before you go in. Figuring out ways to open doors and push Elevator Buttons without touching. Not going out if youre the least bit ill and if coronavirus is spreading in your community, wearing a mask to protect others and yourself. And six, recognizing we may have to go back to physical distancing, we may have to tighten the response again if cases begin to rise. Thats what we want to avoid and why its so important to have that box of testing, isolation, Contact Tracing and quarantine. If we do those things, well be able to come out as soon and as safely as possible. Steve when you see plans in georgia and tennessee with plans to reopen the economy as early as this friday, whats your reaction . Dr. Frieden it depends on the details. You have to look at whats happening with the virus in the community. If youre not seeing consistent decreases, its very risky. Its a risky experiment, its trialanderror and thats the kind of error that could result in loss of life. But there are nuances. Some communities have very few cases. There are some approaches to opening safely that make a lot of sense. Package pickups at the doorsteps of stores rather than people going into a store where they might congregate. Outdoor spaces which will be much safer than indoor spaces as long as you prevent crowding. But there are tough issues here. How do you get buses and subways going again, what do you do about Nursing Homes . As i said in early march, ground zero for coronavirus in this country are Nursing Homes. There are 1. 5 Million People who live in Nursing Homes in the u. S. And you could see 100,000 or more of those individuals die in the coming months or year from Coronavirus Infection if we dont get better at detecting. Steve and the c. D. C. Is based in atlanta. I mention that because your successor, dr. Robert redfield, today, in a story this morning in the washington post, that there is a possibility that the assault of the virus on our nation, his words, next winter, will be more difficult than what were going through right now. Dr. Frieden what we know is, that in most of the United States, its really been a small fraction of the public who have been infected and we dont have any Natural Immunity to this virus so if the virus doesnt mutate for the better and not harm us as much and if we dont develop a vaccine which is unlikely in the next year, then were going to have to live with this virus and figure out how to control it as well as we can. We dont know what the future will hold. We learn more about this virus all the time but i want to the i want to give you a sense of just how bad things are here in new york city. I was born in this city. I did my medical training here at the height of the aids epidemic. I did my Public Health degree here, my medical residency here. I was at the Health Department as an Epidemic Intelligence Service officer for the c. D. C. And ran the Tuberculosis Program here and was Health Minister here for 18 years. 8 years. I spent a lot of time in this city and ive never seen anything like this. No one alive has seen anything like this. The last disaster this big was the 19181919 flu pandemic. In that pandemic, 6. 7 million new yorkers, there were a reported 30,000 deaths over two flu seasons and in less than two months there have been more than 15,000 deaths from covid19. All day and all night we hear sirens going, ambulance sirens. Thats how were all going to remember this. Across the u. S. , the c. D. C. Identified more than 10,000 infected Healthcare Workers in the first two months and many others who were probably infected and not diagnosed so this is a really, really serious pandemic and anyone who underestimates it runs the risk of making a fatal error. Steve your website, resolve to save lives, you mentioned this but i want to ask you about the practicality of the four steps to box it in. As you say on the website that you want to first make sure youre able to test who has the virus and then you want to isolate those individuals. How do you isolate them and how do you quarantine them . Dr. Frieden isolation means either in the home or in a hospital or if someone cant be safely cared for in their home, many places around the u. S. Are Getting Hotels or other facilities where people who are ill that dont need hospitalization can be cared for. In other countries theyve used some mass forms of care. It has to be appealing. I think it absolutely has to be voluntary. But if youre living with your 92yearold mother in a small apartment, theres a very high risk that she could get the infection and die from it, so you want to be offered the opportunity to relocate until youre no longer infectious. You also need to go through the process of Contact Tracing. This is a tried and true Public Health process. It happens every day all year long, all around the country. But its going to have to happen at much higher rates now to control or help control covid19. Its a process from getting to know a patient, talking with them and walking them through hour by hour what happened, where they were and who they went, had exposed, so those individuals can be warned they may be getting the infection and they need to quarantine themselves to stay separate from others so that if they do become infected, they dont spread it to others. Thats how you stop the chain of transmission. I make an analogy to a hurricane warning. You expect the government and society to warn you if a hurricane is coming so you can protect yourself and your family. In the same way, if youve been exposed to covid19 and you might develop the infection yourself and spread it, you need to be warned so that you can take steps to protect yourself and your family. Steve the website is resolve to save lives. The president and c. E. O. Of that organization is dr. Tom frieden joining us from brooklyn, new york. Lets get to your phone calls. Steve in anaheim, california. Good evening. Caller dr. Frieden, we have a shortage of test kits in this country and the problem i see is that basically the world has already had a test kit out there thats available. If were going to reopen up the government, why cant we get some of these test kits to some of these governors and mayors in their state and use those instead of relying on the test kits still under development . Thank you very much for your time. Steve thank you for the question. Dr. Frieden thats a great question. All the focus of attention is on testing. Just to be clear, theres testing for the virus and theres testing for antibodies to the virus and its important to take those separately. The Antibody Testing is still under development. There are a lot of test kits on the market. Some dont work well. We still dont know what it means to have antibodies, whether that will give you immunity or not and if so, for how long. So focus on the testing for the virus, whats called p. C. R. , preliminary chain reaction, tiny fragments of the virus that are present and that test production is very problematic. It takes a long time and its not just a kit. Its the swabs to collect the test and the liquid to transport the test in and chemical reagent that you run the test with as well as the test kits themselves and the equipment to run it with. Weve seen an increase in test kit availability around the u. S. Over the past few weeks but its still very far from where it needs to be and let me make one thing clear. The c. D. C. Stumbled early on. There was a problem with their test kit and a problem with them addressing that problem and letting it be used when it was much needed in february. But the c. D. C. Test kit has been working fine for a couple of months now. The challenge is that hospital laboratories and commercial laboratories need to ramp up the production of tests and the federal government must coordinate that. If you just take a bigpicture look, a 30,000feet look, were doing between 120,000 and 150,000 tests a day in the u. S. Sounds like a lot but if you work out the highest priority groups, anyone hospitalized, any Healthcare Worker symptoms, anyone in a nursing home or other congregate facility such as a jail or homeless shelter or Housing Project who has symptoms, and anyone in a cluster of disease that might be covid, youre talking about three times more than what we have. Three times more. So until we get to four or 500,000 a day, were going to have a shortage and if were using tests on people who arent in those priority groups, well have an even larger shortage so we have to get past the debate and say we dont have enough tests. Its going to be a while before we get them. Lets do everything we can to get as many tests as rapidly as possible. On the other hand, lets make the best use of the tests that we have today and make sure that were testing the highest priority people, were isolating people effectively in their homes, if theyre not ill and can be safely in their home. Outside of their home, if communities can come up with the resources to support patients to do that. In hospitals, with good Infection Control so they dont spread it there, in Nursing Homes if theyre there. Contract trace to find out who has symptoms and quarantine the contacts. Steve the harvard study said we may need between five and 20 million tests a day. Do you concur with that conclusion . Dr. Frieden weve looked at our estimates. It depends on the traces you make. Are you going to test people who work at Nursing Homes at all, once a week, twice a week . Our own calculations indicated that if you tested everyone you want to test, it could be as many as 20 million tests a day. So yes, weve made that same calculation, but the more relevant one is the bare minimum, to test the highest priority people, will be on the order of 400,000, 500,000 tests a day in the u. S. And were only doing a third of that now. That doesnt mean that its hopeless. Theres a lot we can do even though we dont have enough tests. We can make sure we apply those tests to the highest priority patients who will benefit the most from it and to the situations that will reduce the spread the most. We can make sure were isolating people effectively. We can make sure were finding contacts and warning them so they can isolate and quarantine themselves. In new york city, as an example, there arent nearly enough tests and for weeks we have been telling people, if youve got symptoms, cough and fever, dont come in for a test, stay home. If youre having trouble breathing, medical complications, call your provider and see about coming in but for most people with a cough and fever, well assume you have covid and if you went in a few things would happen. You might infect others on the way. In you might infect others getting care. You will use scarce resources, test kits, the doctors and nurses time, swabs, personal Protection Equipment and if youre positive, youll be told what you would have been told otherwise, stay home. If youre negative, going through that process might get you infected so the situation is different in different parts of the country, even in different states. But you need to look at what the local situation is and how to maximize the resources you have to do the three things that must be our goals in this response reduce the number of people who get infected, reduce the number of people who die and reduce the impact on our society and the economy. Steve dr. Tom frieden is joining us from new york, a graduate of overland college. Earned his medical degree from columbia university. His expertise includes internal medicine, Infectious Diseases and Public Health. Mary is joining us from selma, virginia. Good evening. Caller good evening. I have just a short question. If a person passes away with the virus, does the virus still live on that body . Steve thank you, mary. Dr. Tom frieden thank you, mary. The virus does live but not for very long but you do want to be careful because it can spread from one person to another so you have to be careful and certainly the undertaker profession knows how to do that safely. Sadly, far too Many Americans are dying from this and sadly, many more will die in the coming months but we need to keep that number to the absolute minimum. Steve we were talking about the harvard study and testing between five to 20 million per day. One of the authors of that study will join us this friday on cspans primetime edition of the washington journal. Michael is next in hopewell junction, new york. You are on the air with dr. Frieden. Caller my question is, through all the businesses being shut down, essential businesses that are deemed essential, which would be fast food and uber grub hub, doordash delivering, theres no one tracking any of the people delivering this food and contacting the food. The amount of crosscontamination brought to peoples homes from that is my first question. The second one is why is m. P. A. And the subway system still open in new york . Steve thank you, michael. Dr. Frieden two great questions. First off, for delivery, you really want to encourage everyone to wear a mask. It protects the people around you and if you take in food, you want to wash your hands after you take in anything from the outside. Thats a Good Practice generally. In terms of the food itself, it is possible that things like silverware and plates can be contaminated, so use silverware thats washed. We havent seen foodborne delivery of this virus but you can always heat something. That will rapidly inactivate a virus. In terms of the subway in new york city, its for essential workers. Subway ridership is down 90 to 95 in new york. A colleague of mine takes the subway to work. She works at the Health Department. She described being the only person in the subway car each day. But there was a nice sign the m. P. A. Put up, it has an algorithm, essential worker, get on board. Nonessential worker, why are you even reading this sign . Go home. So its there for the essential workers. Steve robin is joining us from gastonia, north carolina. Good evening. Caller hi. My question is about vaccine. I know its a ways away. But when should they start planning how to distribute the vaccine once its available . And we were so far behind the curve on the virus, and the protection and stayathome, i want to make sure they plan enough ahead that when its available, i mean, for instance, im 70, but im in perfect health. My husbands 65 and he has a lot of health issues. So i think he should get it before me but i think i should get it before like a 45yearold whos in good health. So, i mean, when and how are they going to start planning for the vaccine . Steve thank you, robin. Dr. Frieden . Dr. Frieden what a great question, robin. This is really important. It may be a year, two years, maybe more, before we have a vaccine. One of the things thats so important is to be transparent about the decisions being made. All likelihood, there wont be enough for everyone and it will be a question about who goes first. People will go first who are most likely to benefit. Die or people who are caring for others. Healthcare workers are on the front line and its essential they get vaccinated. So they can protect themselves and work safely and so they dont spread it to other patients and other Healthcare Workers. Thats the kind of discussion well need to have over the coming months. When the h1n1 vaccine came, we were able to get that out rapidly once it was available due to the vaccine for Children Program for all americans. Not just children. You need to get it through the system quickly. There are public systems like vaccines for children that work with the private sector and there are the usual patterns. What you dont want to have happen is that somebody gets it because their insurer or their doctor or their state has more pull with the manufacturer. I think we can all understand waiting, theres a fair way to decide who gets it first and thats an Important National discussion. We dont have to have that discussion yet but its a great time to think about that. Thank you for that. Steve let me follow up marys question and ask you about the different strains of the flu. Every year there is a different strain and vaccine to try to combat that. Would this vaccine combat covid19 and whatever strain of flu we might get in 2020, 2021 . Dr. Frieden no, in all likelihood there would be different vaccines so this would be a vaccine, if it comes, for covid and well also have a flu vaccine because there will also be a flu year. Interestingly, the physical distancing were doing and hand washing were doing to control covid is probably reducing the impact of influenza, as well. Steve diana is next in san antonio, texas. Caller good evening. I just wanted to make a comment that i think that everyone should be going back to work and should be mandatory to wear a mask no matter if you work at an office or restaurant for the remainder of the year at least. And, yeah, and i dont really believe theres going to be a second wave of this covid19. Dr. Frieden for the masks, its a really good idea. What weve learned about covid and were learning more every day, is that people who dont have symptoms can spread it to others. One group that are going to have symptoms in a couple of days are called presymptomatic people and people who are completely asymptomatic and theyre shedding the virus. For those individuals, if theyre wearing the mask, theyre less likely to spread it to others so its socially responsible to wear a mask. In terms of what covid does in the future, no one can predict with certainty. What we can predict, is if it spreads the way it has spread so far, you can get explosive outbreaks which kill a lot of people, endanger Healthcare Workers and can overwhelm our Healthcare System so its crucially important to have tracking systems to see where its spreading, to see where there are increases in people with coughs and fever, going to Emergency Departments or responding to surveys like the one facebook does tracking people with cough and fever in communities. Thats the intelligence we need to get ahead of the virus because if it gets ahead of us, its very hard to stop. Once it spreads widely, it takes weeks or a month or two to calm down. What you want to do is make sure it doesnt get out of hand. But if its starting, be able to quickly physically distance so you dont overwhelm the health and Public Health system. Steve what is resolve to save lives . Dr. Frieden an initiative with two goals; we launched 2 1 2 years ago with support from the zuckerberg initiative, Michael Bloomberg and the bill and Melinda Gates foundation with two goals, one to partner with countries around the world to prevent 100 Million Deaths from heart attack and stroke and the other is to drive down the risk of epidemic and pandemic. Now with covid19, weve scaled up our operations in africa and. We have been working in this space for a few years. With covid19, we have scaled up our operations in africa, and we are beginning to work in the United States. This is the moment to realize we are all connected. What happens to anyone can happen to anyone else, and it is in our selfinterest to make sure we have the systems in place to implement prevention programs wherever that may work. By doing that, we can make ourselves safe and the world safer as well. Host this is the john hopkins map of coronavirus around the world. Carol from st. Louis, missouri, good evening. Myler thank you for taking call. I work in a dental office, and i am wondering what kind of ppe we should be using, and what we should do with the daily hazardous materials. Guest thank you. The best place to go for advice is cdc. Gov, the centers for Disease Control website. They have well over a billion hits on their website. In all health care facilities, essentially, everyone should be wearing a mask, because they could be without symptoms and spreading it. A few things need to be done to ensure safety. Are procedures being done that may aerosolized the virus to help it spread, and 95 n95greater should be you or greater should be used. It is very important to clean. This is a virus that spreads, just as sars did, through contaminated services surfaces. Armrest, veryair, important, because it can spread from one person to another. Make sure you wash your hands you disposed that of things safely. Coronavirus. Gov. Jack from new york, good evening. Caller i was wondering if this could be considered a level for situation that is not contained in a lab, and when we open the country up and businesses, how are we going to retrain businesses to handle this. Guest Laboratory Work is not a level for requirement. This is a virus that is distributed throughout the world. We are not going to be able to contain it in a few laboratories, but Laboratory Work needs to be done very carefully. Contagious. Ly it contaminates things. It is sticky, if you will. It can spread during procedures being done on patients. In terms of businesses reopening, its going to be a new normal. Its going to be using Hand Sanitizer regularly, teleworking more, wearing masks. Be less going to travel, more quarantine. We have seen that all around the world. If you look at canada and australia, there are travel bands between states provinces, where they are not letting people go from one area to another. Controlled ite and other parts havent. People in places that are safer are not going to want other people to come in without being quarantined for 14 days. Its inconceivable that would happen in the United States, but its also inconceivable that it wouldnt unless it is controlled at a high level. Host anthony, you are next. Caller dr. Friedman, i would like to ask you a question. What is the difference if this virus was made in a lab as compared to if it was just picked up in a wet bar in china . Between ifdifference scientists were, playing games, i guess, with this virus could they have done something to make it more serious and harder for other people . We deal with war and this and that. If they were just by accident doing something and unfortunately this disease was not contained and came out, how much harder does that make it on the United States and these countries without china letting us in to investigate what happened, and how hard is that going to be if we find out this animal andt from an people consuming it, and it did actually come from a mistake in the lab . Will it be harder if we dont have the actual knowledge to find out what exactly they were doing in the lab to change the virus . Guest there are two questions there. One is where does it come from. Two, if it was a manmade virus, would that make it harder to control . First, where it comes from, thats there is a combination of things that can be done. Laboratory and genetic epidemiology. Analyzing this virus and finding what is called the intermediate host, it likely came from a central host through another animal. If you can find the smoking gun of the intermediate host, it was where exoticet animals were sold. Thats what happened with sars. The bigger question is why our exotic animals still being sold in markets anywhere in the world . We know it is an enormous risk. Markets can bery a major risk for influenza, bird flu, so, we need to look at risk. G down the the second part of the question, to control. Rd virus we need to see how it changes whether it is more or less spreadable or deadly. We will find that out in the weeks and months to come. We have a sequence and unlimited samples from different parts of the world, so its important to develop models in the laboratory for how to control it. Host maria, go ahead. Caller i am scheduled to have a blood test. Not answerould whether the person drawing the blood had had the test. How do i know if the people drawing the blood are free of the virus . I have been quarantined since the end of march. I dont see my children or my grandchildren. My concern is my exposure. You. Thank i sympathize. It is a difficult situation to be in. My mother has been alone for months. She usually goes to acquire twice a week, book, movies, shows, and they have this restriction of her social connections. It is really hard. In terms of getting blood drawn, you are safer having someone come to your home and do it rather than you going to a Health Center that may have the virus circulating or where you may be exposed to more people. We do not currently have the availability to test and rule out the virus in someone. If they were previously ill, there are antibody tests, but they are not reliable yet. There are a lot of them on the market, but they are not very accurate. Universal precautions. When that person comes to see you, they should wear a mask. They should wear gloves. They should practice sterile techniques. If you want to have them draw then youd outside, will not have to worry about contamination within your home. That, the risk should be minimal to zero. If they practice safe, sterile techniques, wear a mask, use loves, use alcohol, do not touch you with their hands and you wash afterward, the risk should be close to zero. But you are right to be concerned. Our guest is dr. Tom friedman, former director of the cdc based in atlanta. Patricia is next up in massachusetts. Hello. A simple question that has been frustrating me for a while. Since so much of the testing has been politicized. Around the world and particularly, i believe, in the United States, i dont understand why we dont have statistics on testing per capita. There are, from what i inerstand, governors democratic states in this country that have been under attack for not opening up more quickly. There are questions about why there is a low death rate in germany. Understand why we dont statistics. Simple i think we can all do the math on testing per capita so we better understand whats going stop the can politicization of this whole issue. Its a great question, and we do need transparent data. Senator moynahan used to say you are entitled to your own opinion but not your own facts. Themore we are looking at same facts together, the better we can understand this. People are working hard to make more tests, and we hope in the next few weeks, we will see an increase in the number of test available. To prioritize the groups at highest risk and understand that testing is just one part of the challenge. Contact tracing, quarantine, hand washing, all of those things are really important, but yes, we should be looking at tests tests, per state, tests per capita. Some information coming from the news media. We need one