Mcclellan. A physician and economist. He works on strategies and policy reforms to improve health care. As previously [lost audio] commissioner of the u. S. Fda. Good morning. In some sense, that is the wrong time. We are not opening back up to the way things were before. 2a, b, ceing a phase with some steps forward and some steps back along the way. Enable some businesses to reopen under modified conditions. That includes several key dimensions including a Health Care System that is not under duress. For potentiality further surges in the virus and also adequate capacity to provide cradle critical services. Isond key dimension responses by businesses. We are all in this together with the virus still around us. , it willsses reopen not be under the same circumstances as before. You will hopefully see a lot of steps like we have seen in Grocery Stores and other essential businesses. Distancing, additional cleaning and disinfection, practices among employees to make sure but are potentially sick not coming into work and practicing the same kinds of isolation that we have had universally so people that do have symptoms or are at risk of transmission. And new steps by customers as well. Facemasks will be common. Respecting space. Following the longstanding advice about frequent handwashing and not touching your face. Not to go outful if you have any type of symptoms. Follow the cdc guidance and get into testing. And especially we need to Pay Attention to protecting those who are at elevated risk of serious complications from covid19. Older americans. Those with comorbidities. Reopening this needs to be especially careful on your part in terms of practicing distancing and taking steps to minimize your risk. If you are living with people and going out more, you may need to take extra precautions when you come back. Theso want to emphasize testing and containment part of this phase. Our tests capacity is ramping up. It is getting better. We can talk more about initiatives underway to improve that. Trace contact. To contain outbreaks. Dimensionsultiple that should happen gradually with an expectation that we may need to take a positive in some areas and maybe even go back if there are signs of the epidemic picking back up again. The virus will still be with us. That leads us nicely into one of the questions we got from a reporter. Sean hamill from the pittsburgh postgazette who asked how important Contact Tracing is . Do we have the capacity to do enough Contact Tracing to make a difference . Dr. Mcclellan it is scaling up in different areas around the country and the need for the volume of Contact Tracing will vary a bit. In areas facing increases in cases, that is more contacts to trace so those areas will need a more aggressive attention to testing and tracing as they start to reopen. In areas where there is more lowerl, whether it is a level of case activity, it is easier to get to a stage of test and trace every case which should be the goal. States you will see in that are reopening, some close attention to increasing the tracing capacity. If you look around the country, new york and the new jersey region, the northeast region is expanding hundreds of contact tracers as part of their efforts to expand testing as well is in california where there are some jitter lit digitally innovative efforts. And dell medical in austin, texas is helping. You are going to see around the country in the coming days and weeks hundreds and thousands of new jobs as part of these efforts for containment. There is one followup up there. Have we ever done Contact Tracing successfully in this country during a prior pandemic . Havecclellan we do significant Contact Tracing in this country on an ongoing basis. For example in the case of sars where we had very effective identification of cases and Contact Tracing and isolation and quarantine around them. Those were different. Goes is also tracing that on for conditions like transmitted diseases in this country. Those are different though in the sense that they have not been as widespread and there is not as many asymptomatic transmissions. Here, we have to be particularly vigilant when we see asymptomatic case to make sure were getting that case surrounded by rapid Contact Tracing. An efforty, this is that will be at an unprecedented level in the u. S. As testing is already at an unprecedented level. I think you will see a different scale. That also means some new steps. Digital technologies are helping asking the oldfashioned people about who they have been in close contact with. Digital support can help people with that. And what privacy protections can be used to augment Contact Tracing. This will also be an effort that other groupsoss besides just Public Health authorities. They need help. Health care providers will be an important part of doing the testing and potentially helping to identify contacts and helping people get the care they need in isolation. At home or somewhere out of the Community Like a dedicated hotel. We want to keep those people as close to the community as possible that isolated and out of our Health Care System to minimize transmission and the burden on the Health Care System. I will also mention how going to need to participate in these efforts also. Having programs in place to remind their employees about getting tested if they have symptoms in helping support these Community Efforts around containing further outbreaks. Moderator i will remind everyone that if you would like to ask questions, you can pop can the q a window or you raise your hand. I will move on to some other questions. At cbsme from michael saying we are expecting an announcement today on schools in north carolina. Are there some unique considerations about opening up schools as opposed to businesses . Dr. Mcclellan on the one hand, schools are places where inherently there is close contact between children. That is impossible to avoid especially at younger ages. That means there is some potential risk of spread. While the good news about the pandemic is that it does not seem to affect otherwise healthy all very seriously at compared to older people or those with chronic conditions, the risk to the kids is substantially lower compared to someone who is 60 plus that kids can still be potential forces of transmission. Special considerations around care, prek as well as schools involved trying to minimize that kind of transmission partly for the safety of the kids but also for preventing spread back to family members or others in the community. Some of theneed same steps, attention to frequent handwashing, ininfection, not as much use prek of toys that can not be cleaned cannot be cleaned easily. I dont think we will see a with a mask. D that is one key but there will be more close contact in the settings. The other distinctive feature is we need to get our schools and Early Childhood programs reopened. This is so important for the development of children and for their wellbeing and for helping their parents and the rest of the people in the u. S. To get back to work and be able to do more of their lives as well. Very high priority area. We have put in a lot of effort to try to get this right. Attention to extra these unique features. We have a question from sara krueger. You have already mentioned the role of businesses. She asked what do you want to see before all businesses can reopen like normal . Dr. Mcclellan i want to emphasize that reopening businesses is not going to be the old normal but a new normal. I would like to see progress in the other areas that i mentioned in leading Health Care Systems. These systems are saying they can handle the capacity of patients with covid19 but also the other Critical Care they need to provide on a routine for those that have complications with Heart Disease or other issues that need to be addressed in a timely way. That is one area to try to check the box. We need to support increased testing and capacity for Contact Tracing so if there are outbreaks in communities, we are containing them. For the businesses themselves, it will be a gradual process. Seen whate already this can look like based on their experience with essential businesses like Grocery Stores. Going back in and being in a crowded shop. The amount of capacity will be limited way below the occupancy limits under normal circumstances. There will be more protective barriers between customers and staff. There will be more distancing steps in place like markers and other limits on where people can go. There will be extra handwashing or hand sanitizing capabilities especially to help with minimizing contact with transactions until people remember and carry out their frequent handwashing or hand sanitizing that is needed to support reducing the risk of transmission and facial covering. Cloth face masks and things like that as well. No people sitting around and waiting rooms. Seen in businesses like pharmacies are waiting for a doctors appointment, that will with a phone car notification or a text message when it is about to be your turn. Not back to business as usual at all. But some significantly bigger getrtunities so people can the Retail Products and services that they need. And in other areas also like going to the movies, watching a show probably more distance and a different version of normal than what we had before. I would expect it will unfold gradually. If Testing Capacity keeps getting stronger and tracing capacity gets stronger, maybe we can do more. People should not be surprised if there is a need for pauses along the way and even some steps back in certain areas. Moderator ok, thank you for that. One quick followup will we ever go back to the old normal or is the new normal when to be the normal from here on out . Dr. Mcclellan the old normal window was not a worry about easy transmission of a virus that can cause a Significant Health problem and death that is probably a ways off. It will also not be the way it is now with this limited opening forever either. Know, there is a tremendous, unprecedented amount of work happening at unprecedented speed for developing vaccines that can help with immunity from covid19. Once we have widespread immunity again and we need a lot of immunity for containing a very contagious viruslike this one but we will get there and i think we can Pay Attention to the steps along the way that will let us know how the vaccine is developing. Up the capacity for manufacturing the vaccines even as a clinical testing is going on to minimize the delay. Go from a vaccine that seems to work in animal in humanhat does work testing to widespread distribution of the vaccine. I think there will also be some tests. Round in improving there are a lot of tests underway for drugs that can reduce the severity from intensive cases that require may be an overly strong immuno response contributing to the complications. Antiviral treatment that can also reduce progression of the virus and the intensity of the cases. Those kinds of things will make it easier to move back in the direction of the old normal even before we get vaccines. Moderator we have one other question we got in advance. Question from washington, d. C. What would you identify as the weak spots in the u. S. . In the context of gradual reopening, a lot of whatht has gone into places to reopen firstperiod in the initial round, probably not big sporting events or bars where a lot of people are congregating together. Modified versions of going to a restaurant or a movie. Maybe modified versions of even playing golf. It is not so much that there are specific areas that are completely offlimits as it is paying close attention to these basic principles of distancing even as we reopen. And press not hygiene steps. And the cleaning and disinfection steps that will all be important. With that, we also need to be monitoring closely for whether businesses and people are following these guidelines. Dont, that will create a higher risk of transmitting the virus and that will in turn lead to a higher risk of outbreaks. We need to monitor how well the implementation of the steps are proving ouren ability to safely reopen as we go along. I come back to the importance of people staying home if they do have symptoms that could be covid19. Getting tested and acting on the tests and Contact Tracing as well to keep the pandemic under control as we go through the reopening. Moderator im going to move into the questions we have in the q a. We have a question regarding increasing Testing Capacity. Can you discuss the Capital Investment labs will have to make into additional diagnostic platforms . How quickly can we expect manufacturers to deliver . Dr. Mcclellan the diagnostic test capacity is going up. If you look at testing in the , we are probably doing well over a million test a week which is way beyond where it was before but not where we would like it to be given there are still significant outbreaks we donte country and have containment or the ability to test and trace every case. I do expect more capacity to come online. That will include more point of care tests like the abbott lab tests. Fema has acquired a lot of those and will be giving those to help augment Community Capacity where there are gaps. There are other point of care test manufacturers bringing their test programs to market as well. The point of card point of care tests will augment the other tests which are a critical part of the Testing Capacity. I would emphasize that besides increasing the number of tests and test platforms available, we also have important for their to do in the logistics of matching the test capacity we have to the people that need testing in each Community Around the u. S. And close contactsf if there has been exposure and it consists of important testing of people who dont have in high riskcially environments like Nursing Homes and other areas where people are close together, especially high risk individuals and there could be transmission. We want to tampa down on those outbreaks quickly and we are not there yet around the country. Supply increases as well as just take support in every state and region. They need to undertake that to make sure they have local capacity by health care providers, people that need to get the test in every region. We have a lot of tests. We are not using them optimally yet. Optimally we need Logistics Support including the Rockefeller Foundation which announced this week a Major Initiative along with other private organizations to help states and local governments with the logistics and they are working them out right now. Moderator we have a hand raised. Steve, you should be an muted now if you have a question for dr. Mcclellan. He is having trouble hearing you. Steve you mentioned vaccine, as a former fda commissioner, what do you think about these calls to inject disinfectant into the body or using ultraviolet light . Dr. Mcclellan that is not a good idea. People really need to understand that disinfection is very important for surfaces. There are very affective disinfectants for killing the virus and that is a critical part of reopening. We need to keep our businesses clean, our Common Services clean. You will see deep cleaning and disinfection as part of this effort. That is completely different from the treatments for people who have covid19. Interesting disinfectant or anything like that is not it is still poisonous and it is not a good idea for the treatment. It is important for people to listen to the Public Health authorities, the people like dr. Fauci supporting these innovative programs and trying to accelerate them to make effective treatments available. Disinfection is important but not for ingestion and not for improving your outcome. Thank you very much for that. Trying to get through another quick couple of questions if we can. There are studies suggesting that large proportion of cases are asymptomatic which would been that the disease is more what is more widespread but less lethal than we thought. How does that affect our strategies . Dr. Mcclellan there are a lot of asymptomatic case transmissions. It is a fundamental feature that we need to address in doing containment from here on out. That is why all of these distancing steps are so important. I was fda commissioner during the sars outbreak and tested and testing and tracing were easier. People were very symptomatic. That made identification of cases much easier and containment much easier. Here, that is not at all necessarily the case. Very important for people, even fever, soremptoms, throat, dry cough, to stay home. Workers stay home and to get tested to see if this is covid19 and be able to initiate Contact Tracing. That is also why testing of people that dont have symptoms in high risk settings is also important. There withwill death the Testing Capacity that will be available in the next few weeks. Still some hard work to do on the logistics of connecting the test to the people that need them. In the meantime, very important to take the steps around distancing, cleaning and the businesses that are open and those at 60, 65risk, those over and those with Underlying Health problems to keep in place some of the extra steps they are taking to avoid the risk of transmission. Moderator thank you so much for that, dr. Mcclellan. Those are great points to end on. Thank you so much for your time. We appreciate it. And thank you so much ever so much everyone. Our next briefing will take place on wednesday, april 20 ninth when we will discuss the impact of the pandemic on all businesses. If you would like to participate, please send an female. And stay well and thank you for joining us. Dr. Mcclellan thank you come all. 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