With Critical Science and active information when those arrive. Dr. Redfield has been one of the nationss leading voices during this pandemic, sharing new information, issuing Public Health guidance, and advising americans about how to safely return to work, school, and daily life. Him at whatto have is sadly a Pivotal Moment in this crisis. Right now, as you know, cases are spiking across the country. As a result, we are seeing some states resorting to different types of lockdowns like we saw initially with the virus. Americans everywhere are hungry for information and guidance about how to navigate the Holiday Season in an uncertain winter. Dr. Redfield will address all of these issues and more and we will take questions from our audience as well. Without further ado, dr. Redfield, welcome. What can you tell our audience about the current state . Dr. Redfield thank you very much for having me. We are at a very pivotal time in this pandemic. Unfortunately, we are experiencing a substantial surge across the nation, where we now have really a significant number of our jurisdictions and states that are really and what we call the red zone. A wide surge that happened in the heartland and Northern Plains, which really lasted a lot longer than say what we had with the spring and summer surge. The other thing, it had a much more steep trajectory. When you look at the spring surge, this is the rate of increase, and the summer surge. When we look at this more recent surge, this is really more what the rate of increase is. It is also lasting a lot longer. Usually between four to five weeks before we get a peek. Now, this time, it is closer to eight to 10 weeks. In many areas, we have not peaked yet. We are at a very serious time. I guess the good news is the heartland and Northern Plains have started to decline and hit their peak. Unfortunately, at the same time that has happened, the pandemic has had a resurgence in indiana, ohio, pennsylvania, the midatlantic states, the southern sun belt, also moving back up into the northeast as well as unfortunately, california, oregon, washington. We really have a very extensive pandemic now throughout the nation. I think many of you probably saw that in the month of november, unfortunately we had over one million cases reported each week , 4 million cases were reported in november. Our hospitalization rates are going up. Maybe we will talk more about that because that is one of our great concerns, whereas in the spring we were talking about 20,000, 30,000 people in the hospital, now we are over 90,000 people in the hospital. One of the most concerning things about understanding the impact of the pandemic right now, and there may be questions on it, is to recognize that as we stood here today, 90 of our hospitals in this nation are actually in what we call one of the hot zones, in the red zones. Therefore, at risk for increased hospitalization and potential to negatively impact hospital capacity. 90 of all of our longterm care facilities are in what we call high transmission zones, so we are at a very critical time toht now about being able maintain the resilience of our health care system. In the spring, we were dealing with new york, detroit, new orleans, los angeles. We could shift Health Care Capacity from one part of the country to another. Theaw similar when we had southern wave, we could shift Health Care Capacity from the heartland and the Northern Plains. Right now unfortunately we have a pandemic that is really throughout the nation, and there really isnt that resilience of Health Care Capacity to be able to be shifted. This is why it is so important at this time, and we will talk more about that, to embrace the mitigation steps we have tried to stress. The time to debating whether masks work or not is over. We have scientific evidence. We published a paper in kansas when they came out with their mask mandate and certain counties opted out and certain counties opted in and when you compare those who opted in, they had about a 6 decrease in new cases per 100,000. Other counties that decided they didnt think this was the way to go and opted out of the mandate, they had over 100 increase in cases. Couple that with social distancing, handwashing, being smart about crowds, doing things more outside than inside, these are critical mitigation steps, which many seem which may seem simple and people dont think they could have much of an impact, but the reality is, they are very powerful tools. They have an enormous impact. Right now, it is so important that we recommit ourselves to this mitigation as we now begin to turn the corner with the vaccine. The reality is, december and january and february are going to be rough times. I actually believe they are going to be the most difficult time in the Public Health history of this nation, largely isause of the stress it going to put on our health care system. It is a sobering and important thought, and there are a couple directions i want to go. Lets start with some of the Public Health models, looking at mortality rates. They are shocking. My question for you is, what can we do to change that trajectory . As simple as masks, social distancing, isolating, etc. . What do we do to change what looks like a terrifying stretch . Dr. Redfield i think you are right when you look at the different models. We looked at the original spring, we lost about 100,000 people. Summer, 100 thousand people. Fall, 100 thousand people. These are lives that were lost as a consequence of this pandemic. We are potentially looking at another 100 50,000200 thousand people before we get to february. This is a significant time. You asked the right question because we are not offense list. Mitigation works. We are not defenseless. Mitigation works. If we embrace it, and the challenge with the virus is, it is not going to work if half of us do what we need to do. It is not even going to work probably if three quarters of us do what we need to do. This virus really is going to require all of us to be vigilant , and wearing a mask unfortunately, not just when we are in the public square. We are finding now that much of the transmission that is driving, who would have believed that rural north dakota, south dakota, wyoming, idaho, montana, these areas in north dakota 40 of thever 30 , people who were tested were actually positive . The reason this is happening is because now, one of the major drivers of transmission is not the public square. It is the home gatherings, where people let down their guard. You bring in family members and they dont realize that the major presentation of this virus for individuals under 40, it is asymptomatic. You dont know you are infected. Being able to get up a handle on asymptomatic transmission and the family setting, which is now driving that communities dont recognize it until unfortunately, the virus gets transmitted and somebody that is vulnerable, older, they end up developing symptomatic illness and they end up in the hospital. The reality is, as you saw the other day, i think in our reports, we were backup to deaths that were recorded yesterday. So we are in that range potentially now of starting to see 150020002500 deaths per day from this virus. So yes, the mortality concerns are real. And i do think unfortunately, before we see february, we could be close to 450,000 americans dying from the virus, but if the American Public really embraces social distancing, wearing masks, not letting your guard down at family gatherings, limiting crowds, maintaining ventilation, doing events outdoors rather than indoors, make sure you are vigilant in hand hygiene, that coupled with some strategies that we are pushing states to do to begin to diagnose through surveillance the asymptomatic infections, that will begin to help us. I give one example of hope, because i used to think that the most difficult group that we were going to have to contain this pandemic was basically college students. I felt it was going to be very hard for us to be effective in getting them to fully embrace the messages that i just said. And in the spring, we had significant outbreaks on Different College campuses. What happened over the summer of the fall is, many colleges and universities really stepped up to developing stepshensive mitigation that they really engaged the student body to actually buy into. And they coupled that with screening the student body every week so they could identify the asymptomatic silent epidemic that was in the population, and then pulled them out for isolation and prevent them from further transmitting. You look at it today, say, wisconsin, governor thompson, now the acting president of the university of wisconsin, they have a prevalence rate in their 27 campuses all through wisconsin of students in the highest risk group, 1825yearolds, the prevalence rate is less than 3 . When you look at the communities where they live, because most of these kids dont live on campus, but prevalence rate is between 10 20 . This reaffirms to me that mitigation can work, and even what your biases may be, the more difficult group to participate, i can show you the same is true in the northeastern schools, the same is true in the South Carolina schools, the idea that coupling mitigation with routine screening, surveillance, to be able to identify a some dramatic carriers, these techniques do work asymptomatic carriers, these techniques do work. When you ask me how many people will die between now and february 1, i will come back to say it is really up to us. However the how vigilant people are going to be about really taking to heart these efforts. Thingisappointed in one as cdc director and that was that there was an inconsistency of the American Public embracing the message. Mask wearing, it is not a political discussion. This is a Public Health tool, a powerful Public Health tool. Very simple but very powerful, taken aave really had long time, and there are still jurisdictions probably on this call that really dont embrace the importance of these mitigation steps. I encourage people to look at the mmwr we put out in kansas. It shows difference between a 6 decline or 100 percent increase by one simple thing, whether the county embraced a mask mandate. That is remarkable. I think we should help you get that message out. I will turn to the first already athens question it audrey audience question in a minute. Lets talk about the efficacy of surveillance. By that, do you mean the ramp up ontesting, or the testing other College Campuses . How do you define surveillance . It isdfield i think really important, if you want to think in hindsight, the real question is out there is, how much Testing Capacity do we really need is a nation to optimize our Public Health response . That that is more tests than we currently have. There has been a lot of focus on how many tests we have. Second thing i will say is, how testing is used. Is it random . Or is it strategic . We would argue right now, one of the big challenges that hit us with this covid pandemic was, we had modeled it in our heads like. Ars or influenza sars and influenza, the way they work is, they make you sick. So it is not that complicated a case to have Identification Program that says, lets look at people who are sick and find out, do they have covid19 and isolate, Contact Trace, and control the pandemic. The problem with covid, it is not like the flu or sars. It is major transmission, particularly in those of us under the age of 45. It is a symptom medic. So you dont know who is infected and who isnt. All of a sudden, that strategy of looking for symptomatic people like we originally did in january and february and telling symptomatic people to stay home and wear a mask, that works for the symptomatic people but the problem is, you missed 50 or more in certain age groups of the people that are carrying this virus. Therefore, you have to say, wait a minute. How do we then define the silent epidemic . How do we define asymptomatic transmission . We would argue going back to the College Campuses, they figured out by doing regular weekly screenings of students, every week, they are able to identify the a symptom medic carriers pulltomatic infections and them out of the transmission cycle, isolate them, Contact Trace around them, and isolate those individuals, and they have been able to control the output. A strategic use of testing. Right now, liverpool recently in , what they would do to get a handle on the silent epidemic, they tested everybody in liverpool. They figured out who was infected and were able to isolate. So we have areas now that we are trying to do what we Call Community strategic testing where there are hotspots to try to understand. The cdc guidance is coming out this week on trying to help institutions and Public Health groups, companies, look at how they may be able to use routine screenings. For example we think it might be useful to offer routine weekly screening for teachers in k12s. Others feel it might be useful to look at other people who have a lot of contact in the community with people and set them up for routine screenings thee can start to identify silent epidemic. You will see in the mmwr, we list a number of different strategies. None of them have been really proven in the sense that we know that this is the tool that is going to now contain the epidemic, but we do know it is proven that they do help us identify the silent transmitters. As i mentioned, i think the schools of Higher Learning are teaching us something. I think they have been able to use testing strategically. It is actually interesting, if you look at the colleges, universities that tested week,ody routinely every and compare that to people who tested everybody and Contact Traced around symptomatic cases and did that, you will see the colleges that did the routine screenings once a week had a far greater less occurrence of covid within the populations. I want people to know we do have tools. Testing i think needs to be more strategic. One of the challenges he is, a lot of people that choose to get tested are what we call the worried well. I think it is important for us to be more strategic in our testing in terms of whether you set up a routine surveillance employeese a week or or some portion of employees so you get a sense of trying to understand, is the silent epidemic working . You mentioned wastewater. This is something we have done on College Campuses. I think the biggest challenge now is to identify the silent epidemic and to try to get the silent epidemic out of the transmission cycle. Ms. Clark so many questions. Let me bring in our first audience question. This viewer is from arizona. This is derek. Im from arizona. I represent and am chairman of the board for the National Center of American Indian enterprise development. We represent the native american businesses around Indian Country in the United States. Americanon is, native communities have been hit hard by covid. With the increasing in numbers, is there any evidence that if someone has recovered from covid, that they could be reinfected . Dr. Redfield that is a very good question. Seeny, so far, we have very limited evidence of reinfection. There have been several case reports. We have other examples that drive the message home. That was very careful about trying to control infection. What they had is, all the campers were selfquarantined before they came to the camp for 14 days. They were all tested. They were all negative. They were able to go to the camp. Same with the counselors, they were all tested and they were negative. The camp decided they wanted to have a great camp experience, so they didnt want to have that modulated by Something Like wearing a mask or not crowding, because they felt they quarantined everybody for two weeks and they tested everybody. What happened in the camp is, there was a huge outbreak. I think posted 90 of the counselors all got infected. So just to show you all that precaution. But what was interesting, to get to your question, there was a group of individuals who actually had antibodies when they went to that camp. None of those individuals got sick. Right now, we have pretty good evidence that antibodies are really protective against reinfection, we just dont know for how long. We dont know if that will be for six months, we dont know if it will be one year, two years. We will learn all those questions right now. But it is one of the things that gives us great hope before we knew this, that the vaccines were likely to work, and i think it is a gift that these vaccines, many of us thought if they work for 70 efficacy we would be decided we would be excited but to see 95 efficacy for the first two vaccines roughly, and all the other vaccines are based on the same what we call immunological targets, i think we have a lot of optimism that antibodies directed against the vaccines will be protective for some time, which we will learn in the future. And infection, natural infection is protected for some time. Ms. Clark another audience question that is a followup, given the efficacy of the vaccines, do you imagine there is a world where airlines, require employers might proof of vaccination in order to participate in something . Dr. Redfield i think each jurisdiction, i talked to the Business Roundtable and that question came up directly. Institution is going to make those decisions. It is clear, i am a physician and i am required to take a number of vaccines in order for me to be able to practice in the hospital i used to work in. Beingcipate that vaccinated against covid will be another requirement for health care workers. It is potential but i could see longterm care facilities might require some evidence of for admission to certain longterm care facilities. I think the airline industry, you mentioned that, i could see them trying to determine where, whether they want to make this a requirement for employment with them. Unfortunately, although i think we will get control of covid, by the Third Quarter of this year the pandemic in the world is not going to be controlled for multiple years. We will always have a global risk of reintroduction. It will be a decision i think each industry will make, but i do think there are Certain Industries where i think it would be important to protect their workforce, and some other industries where it may be important to make sure that they protect their customers, the consumers. So i think as these vaccines get deployed, groups will wrestle with that but i wouldnt be surprised if a number of occupations or situations make vaccination against covid a requirement. Ms. Clark one example i used in the question was schools. Theres a question here that says can you see the pediatrics association, the who, some district in the u. S. Wont open. School transmission has been lower than we were afraid of. What do you think it is going to take to get schools to open and remain open . Dr. Redfield i think it is important. I have tried to say this every chance i get, so i will say it again. I think it is important to use data to make those decisions. I was very disappointed in new closed schools when they hit their 3 point. As you pointed out, we have substantial data that shows that schools, facetoface learning can be conducted in k12 particularly in the elementary and middle schools, in a safe and responsible way. We have evaluated a number of schools. We are not seeing, as you pointed out, cluster infections within schools in any significant way. When we see teachers infected we are finding the teachers are infected from their spouses or the community. When we see students in the schools infected, we find out that was an infection that occurred in the community. We are not seeing interschool transmission. So again, i have been a big advocate, and i believe this in my heart, that the Public Health interest to kids in k12 is to have them in facetoface learning for all the reasons we talked about. Whether that is where they get their Mental Health services, food sustenance programs, whether that is where they get, sadly, that is where we do get reporting from child abuse. This is where they get significant socialization. We have had issues with sums Substance Abuse and suicide. I think it is healthy for these kids to be in school. That said, they have to do it safely and responsibly and when this was started over the summer, no one really knew for certain. They thought these Public Health measures would work but the data clearly shows us that you can operate these schools in facetoface learning in a safe and responsible way. , dontto your chambers make the decision based on what i say. Look at your schools that have been open and evaluate and see if they have been a source for major transmission. So far, when we have looked at this we have not found schools to be a major source of transmission. We have seen other sources of transmission. Like i mentioned, surprisingly just family gatherings. I do think we should use that decisions based on data. Right now, and i do think it is important that the answer to ,ontrolling the covid pandemic the answer is not necessarily closure. Whether it is schools or businesses, etc. There may be some strategic closures that make sense. I have been a strong advocate that i dont think it is in the best interest of Covid Control to have bars open until 2 00 a. M. Where people are without their masks, drinking in crowded bars that maybe should have 100 people that have 200 people. I think looking strategically, where there could be, but i dont think we benefit at all in our nation in controlling covid by broadly shutting down businesses. Clearly, if schools can learn how to do this safely and responsibly, airlines can do this safely and responsibly, businesses can learn how to do this safely and responsibly, and again, we should use data to define when we halved have defined an industry that poses a unique risk that may require restrictions rather than broad restrictions unfortunately that happened in the spring and summer. Ms. Clark a couple interesting things you said, one was not a physician or Public Health expert as a mom, the kids try to find other outlets socializing, which is not a controlled setting as a school. Agree. Field i totally i think one of the greatest tragedies early on was when , was the social disadvantaged individuals that really didnt have, or the individuals that were in workforces that didnt have the luxury to telework because they were in some service industry. These mothers, single mothers, how they had to deal with it was, they had their kids go stay , which is mother exactly the opposite of what i want to do in protecting the vulnerable. I dont want to see silent a center magic infected children going stay going to stay silent asymptomatic infected children going to stay with grandma who may have diabetes. At least we have the data now and i want to applaud the teachers that have the courage to take a chance on the Public Health advice that was being given, knowing that we were going to monitoring this carefully. I also, the parents that had the courage to take the risk, because in the absence of data it was all opinion. That is what i am saying now, that is what i have obviously said in the new york situation, a priori. T do this look at your data. Im glad they are considering opening schools for Elementary Schools because we have enough data to show Elementary Schools are not a source of transmission, and i think when careful studies are done, you will see kids who are in Virtual Learning probably have a higher infection rate than kids that do facetoface learning. Ms. Clark the other thread from the last answer has to do with employers. You sent universities and airlines learned how to do it. A lot of businesses learn how to do it because there are businesses that never closed. The next audience question gets to that. Can we roll that question . Good afternoon. My name is doug and i am the president of the Minnesota Chamber of commerce. In minnesota we have seen growth and Community Spread that has shown up in the workplace. This has caused concerns with availability of workers and threatened certainty among consumers, as well. What you offer us for advice to employers who want to work with their employees to limit Community Spread through their business . Dr. Redfield i think you raise a really, really important question that goes all over all of this. Whether it is schools, whether it is businesses, that the key to controlling infection in schools or businesses is just what you said. It is controlling Community Spread. And how do we control Community Spread . I do think it is going to come know, i dont know whether a mandate versus nonmandate, but i know Leadership Matters in terms of messaging, and everyone comes to recognize that this is a serious situation. I know that if i have to walk outside of my car on the way to the airport from the parking lot, in a nano second now i feel i didnt put my pants on if i dont have this mask on. I can tell you one it started, sometimes i got halfway to the gate before i remembered, and people were looking at me and i realized i didnt have my mask on. I think making that a social norm, and i am remarkable. I have 11 grandkids now. The youngest one is two. The truth is, all of the ones that are over two, i have 3, 4, 5, they are all wearing their masks when they go do their thing. They are very conscious of it. More that the community can embrace these mitigation steps, i think is the more that these businesses can start impacting Community Spread. Because that is really where it is coming. If they decide to do the strategic testing that i have suggested in small businesses, it also helps them begin to identify in their own workforce where the silent spread is coming into their workforce. That becomes a very important i think to live identifying the asymptomatic individuals so they dont become an amplifier within the workforce. Which we know this virus unfortunately, this virus is really infectious. I think it is probably the closest thing, and i am a virologist i training, i think this virus is the closest and have to measles we have ever seen. It is interesting to mitigation we are doing in this country right now, influential influenza rates are at historic lows. We are about to get into flu season so i do encourage everybody to get an influenza vaccine. The realities are, spring season, some summer season, early fall season, flu is at historical lows. These mitigations are helping , 50 ,f we are doing them 60 for the flu. It is not enough to contain covid. Covid is really, really, really, really infectious. Unfortunately the reason it is so infectious as opposed to the flu is the instrument of transmission is not a sick person with a cough. The instrument of transmission is in a asymptomatic 23yearold that feels great. Ms. Clark lets turn for a minute and talk about the vaccine. Another thing we get a lot from is,oyers across the country if Early Vaccine distribution goes as it should to help their workers and vulnerable populations, then given to essential workers, how should we be thinking about defining essential worker in that context . Dr. Redfield that is a very good question. Technically, the department of Homeland Security kind of makes those classifications, as you know. But obviously, each community, someonen tell you that that supports one of my sons who is in recovery, i try to help one of my daughters who is helping a family, obviously my own family, if there is no income coming into the household, there is a problem. Think can really look at what is essential to them to be able to maintain their livelihood. This is one of the reasons i really feel strongly that the kneejerk response to control covid, somehow we have to close things or limit the economy or limit business, i think the answer is figure out how to operationalize the business in a safe and responsible way. I do think for me, i think teachers are really essential. Isi think each Community Going to define that. There is a technical definition of it by Homeland Security they have listed, and they now include teachers, and i dont know if i really answered your question. It, when i to angle see a single mother raising four kids and she may be doing some type of work in a Grocery Store, helping provide custodial services, i mean, for her, she is essential for her and her family. I do think there is the other aspects of what we need. When we first got into this essential worker issue where cdc came out with guidance that suggested if you are an essential worker and you were exposed and you were asymptomatic, that you could return to that essential job as long as you work asymptomatic and you monitored your symptoms, and you wore a mask, part of that really came out of when we were in the state of washington on a visit there, where they had a significant number of policemen and firefighters and rescue squad workers were all being isolated and they didnt have a fire department. This was part of trying to give isance, that if there essential services that are critical to the function, whether it is First Responders or whether it is hospital workers, we had one Hospital System in washington that had over 600 healthcare workers quarantined. As you know, in some of our industrial work, meatpacking plants, etc. So what we needed, i dont think this country knows how close we came to having a protein shortage because of the outbreaks in meatpacking plants. I think it is important for each family to understand that, each group, but i think i have become acutely aware that there are a number of people that work that dont have the luxury that some of us have to be able to continue our work as long as we get on zoom or we get on a webcast. A lot of these people have to actually go and work in the environment. We need to work hard to make that safe and responsible. We need to honor those people. You can imagine if all the Grocery Store workers decided it was too risky to go to work. Ms. Clark i guess i am a little confused, a lot confused. Dhs has the role of classifying essential workers, but you refer to these decisions being met at the local level, who is in charge of prioritizing vaccines . Dr. Redfield for vaccine distribution, we can come back to that but for essential work as it is dhs. I was trying to make you aware that i am aware that for individual families, there is also an arbitrator who they believe is essential. Dhs clearly has the essential ones. Ms. Clark got it. Dr. Redfield im trying to show that i have come to understand that the dhs list doesnt necessarily, i remember a worker that was supporting his family, keeping his Jewelry Store was essential work because without it, he shouldnt support his family. I sure many of you in commerce understand that people suffer by having businesses closed. I would argue they probably didnt need to be. It wasnt a strategic decision, it was a salami decision. Everybody will do this, rather than stepping back. I think now we are smarter, we have data behind us, these decisions need to be made. When it comes to vaccines, clearly, the issue, first its exciting that we have a vaccine and we should give credit where credit is due. When this was first suggested we would have a vaccine before the end of the year, i dont think people saw that as something that was feasible. The reality is, the mission was assigned to get a vaccine before january 2021 and we have two with euanow submissions. Areave four vaccines that deep into phase three trials. It is very probable before february, we will have i think probably threefour vaccines approved in the United States, which is really remarkable. I think we will have two approved before the first of the year. The challenge will be, it will be constrained in supply. There wont be enough vaccine for everybody in the United States who wants a vaccine. I have said publicly that i believe we will be somewhere in the second or Third Quarter 2021. That has been criticized by others but i think those estimates are probably going to be right on target. I do anticipate vaccine will start to be delivered to the American Public this month. Willntly, the way this work is, we have our Advisory Committee of immunization practices that makes preliminary recommendations and they will be modifying those after the ewaste are approved in december. We have worked since the summer with each of the 64 jurisdictions of this nation for them to develop what i call the micro Distribution Plan. They are going to get vaccines based on a macro Distribution Plan from the federal government and those allotments have been assigned for the first wave of vaccines. They will be distributed this month. Ultimately, the individual governors and jurisdiction leaders are going to decide what i call the micro distribution. Makesthe aci pa recommendations, but ultimately it is the local governors that are going to make the decision of how the vaccine is going to be distributed in their communities. Those vaccines have been throughd and worked over the last three months, and annticipate that will be evolving situation as more and more vaccines become available. I dont think it will be unified , that every jurisdiction is going to do exactly the same thing. You have been clear that you think there is a good chance we are back at some new normal by the fall. Questions about how communities should be plenty for earlier in the year. This next question gets to that. Can we roll that question . Ceo am chris, president and of the Georgia Chamber of commerce and we are excited and proud to have the cdc headquarters here in the peach state. Lots of people on the call are focused on q1 and q2 of next year. Programs,s have events, receptions that we planned throughout the year. I am curious what advice do you have for us as we try to plan those events for q1 and q2 . Ms. Clark dr. Redfield thank you. Important question. I think we are going to still be heavily in mitigation for limiting crowd size, limiting gatherings during that timeframe. Wantu are going to i think to be vigilant and smart about it. Outside is better than inside, and smaller is better than bigger. I wouldnt be surprised if a lot of jurisdictions, either at the state or local level, still have very significant guidelines for size of crowds. You thatee when i tell if 30 of the people in the dakotas that got tested are positive, if you have a crowd , there is0 people probably a lot of positives in that crowd that you dont know about. So, so, sorus is easily transmissible. So really, i think you are going to have to plan, virtual is going to dominate the scene in the First Quarter of 2021. Small, limited crowds are going to happen. I dont think you are going to grace fromgnificant people being vaccinated or people having antibodies from previous infections. I think the first two quarters, particularly the First Quarter of 2021 and i think most of the Second Quarter is still going to be a fairly restrictive environment for us when it comes to crowds, crowded events. I dont think we are going to start getting out of that until the fall of 2021. Ms. Clark let me ask you another question. Maypress is reporting you be releasing new guidance on quarantine periods from 14 days to seven days. Thealked about backstage, clear and consistent guidance is helpful and as the data and science evolves it is important we explain the information to the public so they get a consistent viewpoint. Talk about the quarantine period if you would. Dr. Redfield agencies like ours have to have the courage to change when we have data that says when we can change. I will say, not everybody understands that. When we thought this virus was largely transmitted symptomatically, we then thought if you are symptomatic, you wear a mask and that will protect you. Realize back in early march that a lot of the infection was actually asymptomatic so i dont know who is infected. If i really want source control i want everybody to wear a mask. That got into a lot of controversy, how do we change . We change based on data. Quarantine and isolation is a key tool to try to keep this virus from spreading. A lot of people never understood, if i was infected, i was told to isolate for 10 days. But if i was not infected, i was told to isolated to isolate for 14 days. A lot of people suggested i didnt make any sense because wide why isolate for only 10 days if i am infected and i isolate for 14 if i am not . The reason for that is, if i know why am infected either i got tested and was asymptomatic or i was symptomatic and got tested. We know the virus shedding within the body when an individual is infected really does become negligible at 10 days. That is why we were able to have people test out of quarantine at 10 days. The problem with people who were exposed, we dont know if you are exposed, when does your body start to replicate the virus . Originally, we had studies that said the average was 5. 2 days, then later we had studies that said it was somewhere around seven days. So we only had data to really look at, when was the probability that i was not going to somehow start shedding the virus . It turned out that the greatest probability that we would not miss anybody was 14 days. That is why we had it. Now, we have since done a number of studies, because obviously 14 days quarantine has an impact on productivity. 14 days quarantine has an impact on whether people quarantine. We have done a lot of studies over the spring and summer that we were able to get it updated and we can model, and you are right, today, actually, the new guidance is coming out from cdc, i think they are doing a press thing as we speak, and that guidance is again, based on data that we gathered and modeling of the data that if you isolate for 10 days, that the probability that you will start replicating virus after that is about 1 . So it is a balance. It is not the 14 days is bad, it is just, how does society want to balance it . Do you want to get 99. 9 or if we are 99 , is that good enough at 10 days . The model also shows that if you test, and we have done this with sec football leagues in trying to gather all this data and other college groups, if we have tested at day 5, 6, 7 and you are negative, it is about the model. We will define at least 95 . The cdc now is coming up with guidance today to allow people to make those judgments that they can test out at seven days ,nd they can get out at 10 days but at the same time if they want to be perfect, as close to perfect, they can stay in isolation for 14 days. That will be coming out today. I think that is going to make a big impact. We found a lot of people really dont isolate for 14 days. And i think adding people to commit getting people to commit to getting out of the transmission cycle is important. That is the data that will be coming out today. Seven days to test, and 10 days without a test. Ms. Clark it feels really important that especially with Community Leaders on the call, Business Leaders on the call, that we are getting this up in the nation when information changes, it is because we learned more, we studied more and that is a good thing. [indiscernible] keeping people out of work and out of school [indiscernible] to end on a positive note. Maybe i am leading the witness, but do you think our experiences as a country with covid19 will help us prepare for the next crisis . Which seems sure to come in some ways. Do you feel we are learning something . We talked about how scientists and doctors are learning as they go. Do you think the public is learning . Dr. Redfield i think there is a lot of lessons here, suzanne. The first one i want to emphasize, because my time as cdc director is coming to an end in january, this nation was thisely underprepared for pandemic. And i think we have to call it like it is. When i became cdc director, i prepared tot understand how little investment had been made in the capabilities of Public Health. At what is the premier Public Health institution in our nation, the premier public country, wen in the really have not invested where we need to be in daytoday in Data Analytics and data analysis. We havent invested in what i call laboratory resilience, to make sure our Public Health capacity has multiple platforms. When we rolled out the original tests, despite the news it was not botched. The test worked the day we did ,t and the day, and to this day where there was a problem is when we manufactured the test to Public Health labs around the country so we didnt have to send it. One of the reagents had a technical flaw, either contamination or a design flaw which was corrected over the next five weeks and since then, the Public Health community has had that. But we had no resilience. We developed the test on a flu platform. None of these Public Health labs had that capacity. There was no resilience in laboratory technicians. Public health workforce, i had some states, there Public Health Contact Tracing workforce was less than 50 people. There is a huge lack of investment, which i hope this pandemic will change. On the other hand, i am concerned that as the vaccine comes through and we get this behind us, people may forget. The blast congressional testimony the last congressional testimony on this issue, this pandemic will cost the nation about a trillion dollars 8 trillion. The indirect costs in terms of the economy may be another 20 trillion. It would seem wise for us to 100 billion across the nation. Remember, the cdc, most of our funding actually goes to the local, state, territorial, Tribal Health apartments. In most of the states, we are the dominant funder of the Public Health infrastructure of those state or local communities. That has to be investigated. That is the first lesson. Not to let that go by. Is timely realize, it for this nation to have the Public Health system that not only we need, but we deserve. And i hope that is one big lesson. Second lesson for the public, i think, and it is a painful lesson, is how critical it is to have harmony in messaging. When you really want to get everybody on board, you have to reinforced unified, messaging. And i think the fact that we are still arguing in the summer about whether or not masks work or not was a problem. I think the fact that we are arguing about nonsurgical, the fact that we closed health care, we didnt need to close health care. We needed to maybe close some elective cosmetic surgery, but we didnt need to have 85 of the kids not getting their vaccinations. We didnt need to see individuals no longer seek emergency care. We saw many more heart attacks at home than we did in people going to the hospital. We didnt need to see cancer screenings stop. It needed to be much more thoughtful, much more surgical, much more data driven, and i would say the same for the economy. We didnt need to have a broad shutdown of the country. We needed to have a surgical, approachl, data driven that would be able to validate the necessity. We didnt need to shut down schools. Hopefully, what we will be able to learn is that it is important to be thoughtful and step back, not have a tendency to, as i said, the salami approach, we will do it for everything. The people like myself, we never wanted the schools to not open safely and we never wanted them opal open irresponsibly. We wanted to work how to figure out how to open them safely and responsibly. I would say the same thing about business. Business. Runs on probably one of the greatest casualties of the pandemic this year was the impact on the business community. As i mentioned, the impact on just General Health care, the impact on our childrens areation, these to me extremely significant. So i think that is a lesson. Consensus see consistency in surgical d offal, thoughtful, surgical interventions that are clearly that theyased on data have a Critical Role in helping us impact the upper to make. I think you are going to see a lot of folks writing on this. I know i am going to do a lot of reflection when i get out in january because that is the key that we owe the next group, is, what did we learn . What did we learn that works . What did we learn that didnt work . So the next time this happens, and there will be a next time, this happens, this nation will be much more prepared. I will say, the last thing i will say is, we should celebrate , we really should celebrate the innovation that has been brought to bear on this. When you think about it, we have these vaccines now, two will be approved before the end of the year, two more soon after. We have five vaccines now that are moving through the system. When you look at the new therapeutics, when i was sitting and april, ich dont know how many of you know this but 27 of all deaths in america in april were caused by covid. 27 . And now today, it is about 11 , which is still huge. Normally we would think these pulmonary deaths would account for maybe 6 . 20 7 . Id, it was the mortality in someone over 70 was over 25 , which is not really good. You had a one in four chance of dying. I think an enormous impact with the new therapeutical strategies, the antiinflammatories, and the potential for convalescent plasma, many of these therapies, and you will hear more about it from us this week, many of these like convalescent plasma, and even remdesivir, these need to be given before you were sick enough to go to the hospital. As soon as you get diagnosed you need to get into care and get treated. They work to keep you from having to go into the hospital. There are two phases of the illness, the virus and then there is the inflammation. Youre still out of the hospital, that is when we need to hit hard. We have mortality in 70yearolds summer between three and 8 . It is to celebrate the innovation this nation has brought to bear. That innovation will not get us to where we need to go if we do not come back to where i said before. We need a Public Health system surgical. Bust and we need to have consistency in messaging so the American Public will come along with us when we are trying to articulate, what are the critical medication steps that well need to take to be this pandemic . Much forthank you so all of that. I hope you will come back and help us get out clear and consistent messaging about the efficacy of vaccines. Thethe meantime, i think country also needs more, wisdom from people more calm wisdom from people like you. We are appreciative of your hard work. Thanks for the time. I want to say to her audience, thank you so much for tuning in. Episodes ath past u. S. Chamber foundation. Org or youtube please stay safe. Wash your hands. Wear a mask. Take carelu shot and of yourselves and each other. We will see you again soon. Cspans washington journal. Every day, we take your calls live on the air on the news of the day and we will discuss policy issues that impact you. Coming up thursday morning, a discussion on next years defense spending bill. A Maryland Democratic congressman jamie raskin will talk about election legal challenges and white house transition. And a Tennessee Republican congressman on the pandemic response. Watch cspans washington journal live at sea live at 7 00 a. M. Eastern sunday morning. Thursday on cspan, the house is back at 10 00 a. M. Eastern for general speeches followed by general legislative business at noon. On s begin legislation on cspan two, the Senate Returns a 10 00 a. M. Eastern to consider judicial and executive nomination. On cspan3, the
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