Dr. Mcclellan, good morning. Clubs thank you for setting this up and all the reporters who are joining us today. Thank you for being with us. We will get started. You coauthored a Coronavirus Response plan. Right now were in phase one, the containment phase and reopening states is based 2. What elements of state got to have in place to begin that safely . We are moving from phase 1 to face 2 and i think now people are saying that phase two bank is not just one big step toward reopening. In some sense that is probably the long time. Youre not back opening for the way things were before. Instead, we are saying maybe a c, d, and e as we gradually turn on the faucet. Enable some additional businesses to reopen under modified conditions, get in place some of the additional steps that are needed for successfully. Ork that includes several key dimensions. One is a Health Care System that is not under duress. So adequate capacity for potential further resurgence in the virus and also adequate capacity the same time to provide Critical Services that americans need and many have been putting off, unfortunately, during this period of staying in place. A second key dimension is responses by businesses. We are all in this together with the virus still around us. As businesses reopen, it is not one to be under the same circumstances as before. You will see, hopefully, 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 if they are potentially sick that they are not coming into work that they are practicing the same kinds of isolation that we have had universally for people who do have symptoms or are at risk of transmission. And new steps by customers as well. Face masks are going to be common, continuing to follow the longstanding advice about frequent handwashing or sanitizing and not touching her face and being careful not to go out if you have any kind of covid19 symptoms and instead follow the cdc guidance and get into testing. Especially we need to Pay Attention to protecting those who are at elevated risk of serious complications from covid 19. Comorbidities,th this reopening needs to be especially careful on your part in terms of impugning the practice distancing and continuing to take steps to minimize your risk. That means if youre living with people were going out more, taking some they need to take some extra precautions when they come back with you. I also want to emphasize the testing and containment part of this phase. Our test capacity is ramping up. It is not where we ideally want to be, but it is getting better. I could talk more about initiatives underway to improve that in our ability to trace contact and could take any outbreaks that occur. Dimensionsltiple that should happen gradually with an expectation that we may need to take a pause in seminaries and maybe go back if there are signs of the epidemic kicking back up again. The virus is still going to be with us. Close thank you for that. That leads us nicely into one of the questions we got from a reporter in advance from the pittsburgh postgazette who asked how important Contact Tracing is. Do it the capacity to do another to make a difference . If not, how soon can we have that . Dr. Mcclellan i think it is scaling up in different areas around the country and the need for the volume of Contact Tracing that is needed will vary a bit. In areas that are facing continued increases in cases, a heavy burden of cases, even if they are on the way down, 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 control, whether it is a lower level of case activity, it is easier to get to the stage of being able to test and trace every case, which should be the goal. I think you will see in states that are reopening, some close attention to increasing the tracing capacity. If you look around the country, new york and the new jersey region, that northeast region is expanding hundreds of contact tracers as part of their efforts to expand testing as well. In california where there are some innovative digital efforts. Dell medical in austin is helping. In many of these areas, people who have medical backgrounds, medical students, who have other backgrounds, repurposed Public Health employees, as well as people going through Training Programs to support the tracing capabilities. And 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. Mr. Phillips and there is one followup there. Have we ever done Contact Tracing successfully in this country with a prior outbreak or pandemic . Dr. Mcclellan we do have significant Contact Tracing in this country on an ongoing basis. So it is not just for when there is a new pandemic flu, like the h1n1 flu years ago, or in the case of sars where we had very effective identification of cases and then Contact Tracing and isolation and quarantine around them. Those were different. There also is tracing that goes on an ongoing basis 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 much a symptomatic as much asymptomatic transmissions. Here, we have to be particularly vigilant when we see a symptomatic case to make sure were getting that case surrounded by rapid Contact Tracing. In that way, this is an effort that is going to be at an unprecedented level in the u. S. Just like testing is already at an unprecedented level. So i think you will see a different scale. That also means probably some new steps. I talked about how Digital Technologies are helping augment the oldfashioned asking people about who they have been in close contact with. So, digital support can help people identify that. And what privacy protections can be used to augment Contact Tracing. I have also talked about how this is going to be an effort that will span across other groups besides just Public Health authorities. They need help. So, Health Care Providers will be an important part of doing the testing and on potentially helping to identify contacts and helping people get the care they need in isolation. At home, or somewhere out of the community, someplace locally like a dedicated hotel or Something Like that. We want to keep those people as close to the community as possible, but isolated and out of our Health Care System to minimize transmission and the burden on the Health Care System. I also mentioned at the top of my comments how businesses are going to need to participate in these efforts, too. Having programs in place to remind their employees about getting tested if they have symptoms and helping support these Community Efforts around containing further outbreaks. Mr. Phillips thank you very much for that. I will remind everybody that if you would like to ask questions, you can pop into the q a window or you can raise your hand. I am going to move on to some other questions. This time from michael at cbs 17, who said we are expecting an announcement today on schools in north carolina. Are there some unique considerations about opening up schools as opposed to businesses and other aspects of society . Dr. Mcclellan there are two features unique to schools. On the one hand, they are places where inherently there is close contact between children. That is impossible to avoid, especially at younger ages. So, that means there is some potential risk of spread. And while the good news about the pandemic is that it does not seem to affect otherwise healthy kids very seriously at all compared to people who are older and those with chronic conditions, the risk to the kids of contact and transmission individually is substantially lower compared to someone who is 60 plus, but kids can still be potential forces of transmission. So, special considerations around reopening day care, prek, as well as schools are going to involve 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. And so i think you need some of the same steps, attention to frequent handwashing, disinfection, maybe not as much use in prek of toys that can forbe cleaned very easily, a bit more social distancing. I dont think we will see a threeyearold with a mask. But maybe more games where kids are clapping along or other things that are not so close contact. So one key feature is there will manage that. The other distinctive feature is we really need to get our schools and our 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. So, very high priority area. You see a lot of effort to try to get this right. It does not mean schools are all going to be reopening right away, but i do think it means some extra attention because of these unique features. Mr. Phillips thank you very much for that. Moving swiftly on, we have a question from sara krueger. You have already mentioned the role of businesses. She asks, what do you want to see before all businesses can reopen like normal . Is it more testing, random testing, a vaccine, or Something Else . Dr. Mcclellan i just want to reemphasize that reopening businesses is not going to be the old normal, but a new normal. I would like to see progress in those other areas that i mentioned. Healthcare systems are saying they are good. They can handle not only capacity for covid19, but also the other Critical Care they need to provide on a more routine basis for those patients who have complications with Heart Disease or other issues that need to be addressed in a timely way. We need to support the Health Care Systems. That is one area to try to check the boxes. We need to support increased testing and capacity for Contact Tracing so if there are outbreaks in communities because he virus is still present out there, that we are containing them. But for the businesses themselves, it will be a gradual process. And people have already seen what this can look like based on their experience with essential businesses like Grocery Stores. So, this is not going back in and being in a crowded shop. It is going to be businesses where the amount of capacity is probably going to be limited way below the occupancy limits under normal circumstances would be. Having more protective barriers between customers and staff. Where there will be more distancing steps in place like markers and other limits on where people can go. Where there will be extra handwashing or hand sanitizing capabilities, especially to help with minimizing contact with transactions or things like that, until people remember and carry out the 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. Probably no people sitting around in waiting rooms. We have seen in businesses like pharmacies and waiting for a doctors appointment, that will probably happen in the car with a phone notification or a text message when it is about to be your turn. So, not back to business as usual at all. But some significantly bigger opportunities so people can get the Retail Services and products that they need. And i think in other areas too, like going to the movies, watching a show, again, probably more distance and a different version of normal than what we had before. And i would expect this will unfold gradually. Limited tests firss is probably the best way to go. If Testing Capacity keeps getting stronger and tracing capacity gets stronger, and we get more experience with this, 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 along the way in certain areas as well. Mr. Phillips ok, thank you for that. One quick followup do you think will we ever go back to the old normal or is the new normal just going to be the normal from here on out . Dr. Mcclellan i think the old normal, when there really was not a worry about easy transmission of a virus that can cause a Significant Health problems and death, that is probably a ways off. But it will also probably not be the way it is now with this very limited opening forever, either. As you know, there is a tremendous, unprecedented amount of work happening at unprecedented speed for developing vaccines that can help with immunity from covid19. And once we have widespread immunity again, and we need a lot of immunity for containing a very contagious virus like 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. Some are in critical testing already. And youre ramping up the capacity for manufacturing the vaccines even as the clinical studies are going on to minimize the delay in going from a vaccine that seems to work in animal testing, that actually does work in human testing, to widespread distribution of the vaccine. Mr. Phillips gotcha. Dr. Mcclellan between that i think there will also be some steps around in improving tests. There are a lot of tests underway for drugs that can potentially reduce the severity of intensive cases that require ventilation now, or things like overly strong immune response may be country reading to the complications, that we can wean down the severity of those applications and make this virus less like the real threat that it is and more like a bad flu, that would help. 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. Mr. Phillips gotcha. We have got one other question we had in advance, and i am going to try to get to as many of these as we can before we have to go. A question here from washington, d. C. As we know, avoidance measures like social distancing are only as strong as their weak spots. What would you identify as the weak spots in the u. S. That Health Officials should be cognizant of . Dr. Mcclellan i think in the context of gradual reopening, there has been a lot of thought to address what places and spaces to reopen first. So in the initial round, probably not big sporting events , probably not bars, where a lot of people are congregating together. I talked about modified versions of going to a restaurant or a movie. Maybe modified versions of even playing golf. So, 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 personal hygiene steps. Cleaning andess disinfection steps that will all be important. So with that, we also need to be monitoring closely for whether businesses and people are following these guidelines. If they dont, that will create a higher risk of transmitting the virus, and that will in turn lead to a higher risk of outbreaks. So, we need to monitor how well the implementation of the steps are going and keep improving our ability to safely reopen as we go along. And i come back to the importance of people staying home if they do have symptoms that could be covid19. Getting tested, and acting on those tests and Contact Tracing as well to keep the pandemic under control as we go through these reopening steps. Mr. Phillips thank you very much for that. Im going to move into the questions we have in the q a. We have a question here regarding increasing Testing Capacity. Can you discuss the Capital Investments that lance will have to make into additional diagnostic platforms to enable testing numbers we need . How quickly can we expect manufacturers be able to make and deliver higher throughput machines . Dr. Mcclellan the diagnostic test capacity is going up. If you look at testing in the country today, 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 around the country and we dont yet have containment or the ability to test and trace every case, like i was talking about before. So, i do expect more capacity to come online. That is going to include more of these socalled point of care tests, like the abbott lab tests. Fema has acquired a lot of those and will be using those to help augment Community Capacity where there are gaps. There are other point of care test manufacturers that are bringing their test programs to market, too. Pcrl ab tests,e which are also a critical part of the Testing Capacity. I would emphasize that besides just increasing the number of tests and test platforms available, we also have important further work to do in the logistics of matching the test capacity we have so the people that need testing in each Community Around the united states. And that consists of symptoms that could be covid19, it also consists of close contacts if there has been exposure, and it consists of important testing of people who dont have symptoms , especially in high risk environments like Nursing Homes and other areas where people are close together, especially high risk individuals, and there could be transmission. We really want to tamp down on those outbreaks quickly. And we are not there yet around the country. But the supply increases as well as new Logistic Support that every state and every region needs to undertake to make sure that they have got local access to capacity by Health Care Providers, by people who need to get the test in every region. So we have a lot of tests. We are not using them optimally yet. And i think youre going to see some progress in that area too, Logistic Support, over the next couple weeks. For example, the Rockefeller Foundation this week announced 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. Mr. Phillips gotcha. Thank you. We have a hand raised. Steve, you should be unmuted now if you have a question for dr. Mcclellan. [inaudible] dr. Mcclellan he is having trouble hearing you. Can you hear me now . Sorry about that. You mentioned vaccines. As a former fda commissioner, what do you think about these calls about injecting disinfectants into the body, or even using ultraviolet light to be this disease . To beat this disease . Dr. Mcclellan that is not a good idea. People really need to understand that disinfection is very important for surfaces. For things that they may come into contact with. They are very effective, disinfectants, for killing the virus, and that is a critical part of reopening. We need to keep our businesses clean, our common surfaces clean. You will see deep cleaning and disinfection as part of this reopening effort. That is completely different from the treatments for people who have covid19. And ingesting 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. Who arer. Birx supporting these innovative programs and try to accelerate them to make effective treatments available. Disinfection is important, but not for ingestion or for improving your outcome if you have symptoms for covid19. Thank you very much for that. We are going to try to get through another quick couple of questions if we can. We have a question here, there are studies suggesting that large proportion of cases are asymptomatic, which would mean the disease is more widespread but less lethal than we thought. How does that affect our strategies . Dr. Mcclellan we have talked about it. There are a lot of asymptomatic case transmissions. We do not know if it is 20 , 30 , 40 , but it is a lot, and 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 testing and tracing contacts was much easier than because when people were symptomatic, people were able to spread the virus, they were very symptomatic, they were very sick. So that made identification of cases much easier and made containment much easier. Here, that is not at all necessarily the case. So its very important for people, even with mild symptoms, sore throat, dry cough, to stay home, workers to stay home, and get tested to see whether this is covid19 or not, and to be able to initiate Contact Tracing. That is also why testing of people who dont have symptoms in high risk settings is also important. I think we can get there with the Testing Capacity that will be available in the next few weeks. And we can get a long way there with the Testing Available now. But there is still some hard work to do on the logistics of connecting the tests to the people that need them. In the meantime, very important to take these steps around distancing, cleaning and disinfection by the businesses that are open, and very important for people at higher risk, those over 60, 65, and those with Underlying Health problems, to keep in place some of these extra steps they are taking to avoid the risk of transmission. Mr. Phillips thank you so much for that, dr. Mcclellan. We have hit 11 30. I think those are great points to end on. Thank you so much for your time. We do appreciate it. And thank you so much ever so much every buddy for joining us. Our next briefing will take place on wednesday, april 29 when we will discuss the impact of the pandemic on all businesses. If you would like to participate, please send us an email. In the meantime stay well, and thank you for joining us. Dr. Mcclellan thank you, all. Announcer President Trump will talk about the Paycheck Protection Program today. Several billion dollars for small businesses. That is set for 3 00 p. M. Eastern. We will take you there live when his remarks begin. Announcer washington journal primetime, a special evening addition of washington journal on the federal response to the coronavirus pandemic. Our guests are dr. Richard besser, president and ceo of the Robert Wood Johnson foundation, and former acting director of the centers for disease control. He joins us to talk about the federal response to the covid19 pandemic. Then michael straight, director of i can out director discusses how the virus has affected the american workforce. An Illinois Republican congressman Darren Lahood on the covid19 response in his state, and the next steps lawmakers are likely to take in response to the pandemic. Join the conversation tonight at 8 00 p. M. Eastern on cspan. On the other site. Guest is the Johns Hopkins University Bloomberg school of Public Health Senior Research associate post up he also served as a former director general of the national Public Health institute of liberia from 20172019. We thank you for joining us today. Guest thank you, good morning
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