Transcripts For CSPAN2 Former Obama Administration Officials Other Experts On Coronavirus... 20240713

Ron klain was the evil Ebola Response cornu during the obama administration. He joint Health Policy experts for discussion on the use response to the coronavirus at the center for American Progress in washington, d. C. Good morning, everyone. My name is neera tanden and im pleased to welcome you to the center for American Progress. I am so glad you could join us for this critically important conversation. The death toll from the coronavirus now exceeds 3200 with more than 200 cases confirmed inside the United States. As Health Officials warn the coronavirus will ultimately become widespread in the United States, serious questions have emerged about have the federal government is responding. Around the world countries are beginning to take significant measures including restricting travel, closing schools, postponing religious pilgrimages and imposing quarantines. Critics say the Trump Administration has been slow to address this impending crisis. The present editing have said to downplay the wrist elastic everything would work out fine because the virus, quote, will go away by april. Contradicting the cdc guidance itself. Most important in a crisis like this we need to be able to trust the information we get from the government, and trust that the Trump Administration has exhausted yearson ago. There is no question the president and his administration are mismanaging this response and fourthly. President trumps personal frustrationns has paralyzed his administration with inaction in the critical early days and poor planning, polarized politics and a lack of Clear Communication has undermine public confidence. The public continues to seek mixed messages with few daily briefings and with public and Health Officials often prohibited from making publicic announcements. So where do we go from here . The Trump Administrations missteps should not actually stop us from coming up with solutions. Find this discussion today so important. We are joined by a distinguished and all of experts who will discuss how to prepare the country and the world to fight this potentially devastating outbreak. Now it gives me great pleasure to turn the conversation over executive Vice President for policy mara , redman. [applause] you, neera. I have very glad to be here and very glad to be having this conversation with all of you because of that terrific experts that we have here today. I am going to be introducing them one by one and asking them to take their seats here, then we will go right into the questions that we have for them. Emanuel, senior fellow here at the center for American Progress, but also vice proposed for global initiatives of chair for the Department Medical ethics at the university of pennsylvania, and was also Senior Health advisor in president obamas administration. Ron klain, former u. S. Ebola response coordinator, and earlier chief of staff to two Vice President s and numerous other experiences at senior levels of government. Lisa monaco, former white House Homeland Security adviser, currently distinguished senior school, andu law again, years of experience at the Justice Department in various senior roles. , professornifer nuzo at Johns Hopkins university and a begin yellow just whose work focuses on Global Health and security, virus by a surveillance, Infectious Disease diagnostics, Operational Research to improve outbreak fairness and response. Cant think of a group that is better suited to help us understand and get to the basic facts and science and explanation about what to do with the situation we are facing today. I should also note that dr. Richar Rachel Levine really wanted to be with us today, but because of the current challenges she is facing in pennsylvania, she was unfortunately unable to join us but is following this closely. With that [indiscernible] we will start with you, jennifer, if we could. , givening to ask you your indepth science background , if you could lay out some of the basics for us. We heard a lot in a lot of maybe, some science, some less than science. I am being generous, what is covid19, how does it transmit to and between humans . Can you help us understand the words pandemic, isolation, quarantine , and a little bit more about how to interpret the severity of this crisis . Things like mortality rates . Things like that. Jennifer covid19 is a disease new they a new recognized human coronavirus. Are viruses that circular the planet, that this is anyone for which it is not fault the world has humanity. All of your logic analysis and genetic analysis of the virus suggested that it started in bats and jumped at some point to humans or to some other animal, likely a mammal, but we dont know what animal it is. It is a respiratory virus. With possibly some exceptions, it is thought to be largely driven through droplet transmission, meaning when someone is sick, they cough or frome and expel the virus their body in large droplets that fall to the ground or surfaces generally within a distance of three feet. I often get questions, can i get the virus when i go running . It doesnt just hang in the air like other viruses and diseases like tuberculosis are known to do. Situationre now is a where we are approaching 100,000 cases reported worldwide. Largely confirmed laboratoryconfirmed cases. I looked up last night how many countries, because it changes literally the hour, 85 countries as of now are reporting cases. We have very imperfect surveillance going on. Just because a country has not yet reported cases does not mean it doesnt have them. In the United States, we have over 200 cases that have been reported. Are than half of them occurring in people who have not traveled. Likely as a result of local transmission. Likewe have a situation that where we have cases on so many in so many countries where we have local transmission in multiple countries, it is not possible for me as an epidemiologist and not to call that a pandemic. I know there has been some debate over the use of the world. The World Health Organization is particularly reticent to use it, particularly if it is misinterpreted to be a signifier is. Ow severe the virus from an eight bit in yellow chick standpoint, i am nearly referring to geographic spread when i use the word pandemic. We are very much in a pandemic. The virus has shown itself capable of spreading quickly, particularly as Surveillance Systems struggle to catch up. In my belief, we are in a situation where the idea of fully stopping the spread, i dont think is a realistic goal. I think we are more at a point where we are trying to mitigate the impacts of the virus in our communities. Thank you very much. I have just been told i need to hold the mic closer to my mouth. I will give her the opportunity on that, maybe as you also described a little more about what kind of surveillance we are currently using, and that we i guess is both the u. S. And some of those 85 other countries. I am guessing there are and among. Between what kind of surveillance are you using to track and test and learn more, what impact does it have . I it follows the word, you used the word mitigate as opposed to contain. I would say globally, surveillance is not perfect but some countries are better off than others. Part of the reason why, first of 85, the fact that we have countries reporting cases, the fact that 85 countries have been able to implement testing for a neverbeforeseen virus is something we should celebrate, there are few opportunities of to Say Something good is happening. There is. And i want to give credit to that. That said, many countries for a very long time, surveillance and testing was contingent on travel from china. Until essentially last week, that was the case in the United States, where you could only be tested unless you were a contacted but known case, you can only be tested if you had a lower respiratory infection and traveled to wuhan and were sick enough to be hospitalized and you had traveled to broader china. As a number of other countries were already showing local transmission, we did not update the case of definition to reflect the fact that the virus could have been coming from those other countries. So our approach in thinking about surveillance, in my view, has been constrained without a view to looking forward to what is likely to come. So if you are only testing people who have traveled to china and you in fact reduce people traveling from china, of course, you are not going to find many cases because you just dont have people in that category to test as much as you could before. So this comes up a lot when we talk about, we bought ourselves time with these measures, etc. , it is possible we reduced the number of people coming in with virus, but we have no way of assessing that from our testing. Many other countries were like that. Because it will probably come up in the course of the other conversations, to define isolation and quarantine, isolation is something we do all the time in medicine and Public Health. ,t means if somebody is sick you put them somewhere so that they cannot spread the disease to others. In the context of this response it will be critically important that people who are sick self isolate themselves, stay home unless they require hospitalization. We should reserve hospitals for the sickest people. That above all will be the most important thing we can do in responding to this virus and reducing its impact on the community. This is where we should be putting the most attention. There is a lot of attention lately on quarantines. This means separating from society, somehow restricting the movement of people who are well. They dont have any symptoms but you think maybe they have been exposed. This is not something we routinely do in Public Health at the degree to which it is happening now is unprecedented and i dont think we have fully examined the consequences. In particular when we do Things Health careine well workers who may have been exposed to a patient. We are going to find ourselves without sufficient resources to respond if we continue to sort of indiscriminately apply quarantine. Mara thank you. I think that might be a natural lead to wrong. You have managed whole government response to mitigate that. Read of evil you have been less than positive attempte white houses to control communications on a variety of issues, specifically by public Health Officials. Thatou have noted publicly an effective Pandemic Response requires trust in government. Can you describe a little bit why government is important issues issue, and the with credibility in this administration right now on this issue with the American People and with our foreign partners, and how that affects how that impacts an Effective Response . Ron thanks. I think we seeing both a failure of confidence and a failure of competence. Second, on the competence part of this, as the doctor alluded to, we are far behind other countries in testing people for this virus. When we hear the viruses in x states, it is y largely because we have not tested in y states. The same for the global map, no cases of coronavirus in it is notn africa, because there are no cases of coronavirus in subsaharan africa, but because we havent tested. Here at home that lack of confidence is causing us to be blind as to where the viruses is, how extensive it is, so on so forth. If our back in my job at the white house i would be pushing to have us do 30 million tests. Test people in nursing homes, people who regularly visit nursing homes, test health care workers. There would be long lines of people we should test. The administration thinks they will hit 35,000 tests by the end of today, maybe one million next week, that is a huge gap. The second competence gap is around hospital awareness. We can talk about what needs to be done to get the system ready to deal with the kind of nuzzo wass dr. New referring to. The Trump Administration seems to be doing everything wrong, which means the obvious things like having the president go out there and say things that are untrue that follow under the categories of both misleading and deliberately unhelpful. Ton he told everyone to go work with coronavirus, that is not only a bad communication, but a very bad communication. What we are seeing really is that even if you accept, and i dont, but president trumps singular goal here is to keep the stock market up during the coronavirus thing, him saying things that are erratic and irresponsible is not reassuring people but making people more anxious. His efforts to just tweet the virus away is actually making public anxiety about the virus worse, not better. So what should he do . What he should do is let the Public Health experts be the voice of the response. Tonydea that they told dr. Faucci, who served six president s, probably the worlds leading Infectious Disease expert, that he should not go on television, and staff in mike pences office say it is okay, is ridiculous. The idea they sidelined senior officials at the centers for Disease Control is ridiculous. That is with the public should hear from this that is who the public should hear from, both to get Accurate Information and to lower the level of anxiety about the disease and at least get it right. That is the biggest problem we have on the communication side. But if they dont fix the competence problems or the all the confidence problems will get worse and worse. Mara you mentioned the stock market. How do you think right now we should be thinking about some of the economic challenges we are facing, supply chain issues . Klain we are already seeing a ripple effects from the anxiety of the coronavirus in the economy. I am not just talking the stock market, the cancellations of travel, cancellations of conferences are going to start to ripple through the economy. We are going to start to see other sectors hit by this. I think it is important for us to focus on who are really going to be hurt by this economically, and that is, as with all things, sadly, the least among us. The hourly wage workers in the hospitality industry, for example, in other industries, who will lose their jobs. We are talking School Closures all over the country already. Some School Closures. That affects people who work in schools. , many ofs the children whom school is their source of nutrition for breakfast and lunch. If we close the schools, how are we going to feed those children . People who are laid off from work for weeks or months at a time, what is going to happen to their income . What this is going to expose is a lot of weaknesses in our economy already on the lower rungs in particular. But what is really interesting is, as jennifer alluded to, a pandemic suggests something that is global and worldwide, and this is. But like a lot of things that are global and worldwide, it affects all of us but differently. We need to be aware of the fact that there will be some people for whom the Economic Impacts are going to be mor most severe. Mara thank you. Lisa, for a number of Different Reasons including the fact that in 2018, you presciently sounded the alarm about failures to prepare adequately for emerging Infectious Diseases. In an article. I am curious as to whether you came up with that title or somebody else did the title was the next pandemic will be arriving shortly. The u. S. Needs to treat pandemic diseases with, urgency with the same urgency it applies to other transnational threats. What should the u. S. Be doing to improve how we treat pandemic thatses like the one according to jennifer, we are facing right now . Ms. Monaco to your question, i did not come up with the oped title, i should say that i was not alone by any stretch of the imagination. Us,ons of experts behind and the 100th anniversary of the spanish flu pandemic to sound the alarm about the dangers posed by pandemic disease. But no, i did not come up with the title. Normally, oped writers decry those who put alarmist and inaccurate titles on their pieces. Unfortunately, not so. Could not make that criticism here. So, what do i think we should do . First, i think we should recognize pandemic disease as a National Security threat, as a transnational threat like we do other things like terrorism, cyber threats. First, let me anticipate some concern with that framing. Say, hee some folks may or we go again, everything is a security issue, we are going to securitize. Pandemic disease that is a lasting we should be doing. Let me allay those fears. When i say we should approach this as a National Security threat that it is, i mean that we should apply a whole of government approach of the kind ron just talked about, just to that threat, just like we do other transnational threats. Diplomacy,ean intelligencedriven approaches, obviously, Public Health and domestic preparedness. I would lean on the diplomacy east of this. Ron knows ron knows very, very well the significant piece that diplomacy played across the administration up to the president ial level to help us get our arms around the ebola epidemic. When i say National Security, we need too apply a a whole of government approach to this. We have to name it. We have too organize ourselves around it. What does that mean . It means identifying and approaching, identifying it as a National Security threat and approaching it and organizing our government from thatt perspective. We did that post ebola. As you heard ron was dubbed the u. S. Ebola response coordinator. I remember clearly his last recommendation to president obama, im not displaying any internal distillation state secrets, his last ase condition the door ins that role was you should never ever have to appoint, and the government and no future president should have to appointav a disease specific czar. President obama took that recommendation. The president National Security team as a whole took on that recommendation. What did we do . We created a Global Health security and pandemic preparedness directorate within the National Security council. To work alongside the other dedicated units within the National Security council that are assigned to an dedicated to other transnational threats. So in a worldna in which experts and nonalarmist people like bill gates have said pandemic disease is likely to kill for most people in the shortest period of time over the next ten years, and thats how he has described pandemic disease, and that kind of world i think we ought to have, and by the way when our Intelligence Community in its annual worldwide threat assessment puts pandemic disease and emerging Infectious Disease as amongst the top threats that we face as a nation, i think its not crazy to say we ought to have a dedicated unit of professionals within subject Matter Experts, im not talking political folks, subject Matter Experts working day in and day out inor the National Security council just like we t have a counterterrorism directorate or a cyber threat directorate. Thats an elementary approach. We did and made a lot of sense. Unfortunately, in 2018 the Trump Administration inexplicably dismantledon that unit or after your oped. Good question. I have done those forensics. They dismantled the unit and expert wellregardeded career official was reassigned. Its that kind of reinventing of the wheel and now of course we have witnessed over the last several weeks not one, not two, but three redefinitions and attempts to organize the government around our Pandemic Response. This isnt just bureaucratic moving things around on an org chart. How you organize yourselves a repair before its emergency before its a crisis can make all the difference in the world and how youre able to approach this. I think if we had a unit and dedicated professional looking at this issue gaming out scenarios well before the last week, we might have identified some of these testing issues. We mightve said, there wouldve been folks sounding the alarm in december when we saw this coming out of china, hey, what do we need to be doing here in this country to address it . In addition to organizing, and i could reference the erasure and sideline of my own former role as Homeland Security advisor, in addition to organizing around it, building capacity both locally and in our own Public Health departments to identify and address the gaps that jennifer talked about, and importantly, raising global capacity and doing what i call defending forward and we can talk about that a little bit more. Thanks. Zeke, let me go to you. Following up on what lisa has said, the director general of the World Health Organization just this morning said this is a time for pulling out all the stops, calling International Leaders for action. You said that americans should not panic at this point, and that said, the number of confirmed cases, deaths continue to rise. You also have been vocal about the current administrations response and the nature of it. What would you say at this point, both the swings we still dont know about thehe coronavis that may bear on how wide it was spread, high dangers of be, and what do you think the government should be doing right now, our government, to address the threat and to keep people from panicking, or should we be panicking at this point . Have you change your view . Panic is never good. Even when you have a very serious situation panic is not going to be good because your not going to have an organized response that can mitigate the problem. Again to echo whats been said, when we have the president making a series of either unhelpful or blatantly false claims, this definitelyy going away, theres going to be a miracle, you know, vaccine in for four months. That doesnt help and it doesnt help people as ron said calm down. So the first thing i think i would agree with jennifer, we have no idea what the prevalence of this thing is in the population, and we need to be able to all that test. Ron subverted knowing. I have done the back of the envelope you wish and but in very specific groups we need a Population Survey in a place like seattle where youve had a big outbreak in some places where we havent had a big outbreak to see what the rate is out there and to follow what so we can see how it is spreading and the time course of that spread. That is critical for knowing what to do. There are whole series of things, eyelid of some of some of them in the Washington Post article but one of the things im particularly worried about is Surge Capacity in our Healthcare System, both physical stuff kind of do we have beds . As already mentioned the Healthcare Worker number. Let me just lay out a similar for he which i think is not far from reality. 20 Million People in this country, get the virus, 20 million, all right . Thats less than 10 of the population, about 6. 5 of the population get this virus. Its less and get the flu and we have the flu with manual vaccine thats about half the population takes. If the death rate is. 5 , which is a probable guess but its only a guess because we dont have data, thats 100,000 deaths. Now thats 100,000 people who have severe respiratory infections. Thats 100,000 people who might need to be on a ventilator. Might need to be isolated and a healthcare facility. For those of you who dont eat, breathe this kind of stuff from our Healthcare Systems capacity is with less than 1 million beds come all throughout the American Healthcare system in hospitals, 1 million beds. That would be 5 of just 20 when people get it and we have less than 100,000 intensive care unit beds and thats all intensive care unit beds, nicu, Neonatal Intensive Care Unit beds, burn beds, et cetera. Well have about 55,000 ventilators. We are underresourced already just out of the getgo and would not talked about a big spread. Were talking about a moderate estimate, and can wee talk about the Healthcare Workers. If Healthcare Workers get expose and they are on quarantine for two weeks we are way underresourced. We only have a quarter million intensive care nurses in this country. We need a very series Surge Capacity. Another issue and again this is been alluded to is when is appropriate to close schools or not . When is appropriate to stop sporting events and when is it not . Political rallies, et cetera. We need a uniform policy or uniform way suggesting what the criteria are two states and localities out there. Ron has already suggesting, what is a whole of government approach . Its a niceug phrase, what doest mean . You cant ignore the department of agriculture and all the school lunchesl and food stamps other things. Cant ignore. They have to be part of the conversation. No evidence or part of the conversation as of now. Department of education, you are closing schools, they have to be in full. How are you going to educate these kids . Are we canceling a whole year because we will close schools too much early . I can tell you, having hard time convincing my colleagues we have to think a threat to close, we are going on spring break in five hours, right . We have a week or nine days. We got to think about what happens if, god forbid they close of the schools in philadelphia, university of pennsylvania to continue its Public Schools are closed or what is going to do . What are we going to do online . What ever going to do in terms of finals . We have to begin planning all that. Department of education has to be part and parcel. Obviously defense, health and human services, Homeland Security. We got a big, big group. I wouldse say we also need to begin developing other tests, serologypi tests. Who was infected . Because not going to have real testing. A lot of people got infected dont know it and it will continue and we need to know who those people are and apply them. The list goes on. Let me ask you one other planning o question. That is maybe tangentially linked but could become very real. This week the Supreme Court announced that it will hear the healthcare repeal lawsuit sometime this fall that could rule the entire Affordable Care act, including Medicaid Expansion comes to you. You mention 29 people earlier when youre throwing outn a number. This case could result in 20 Million People losing Health Insurance coverage. However the lawsuit undermined our ability to bond . Theres nothing like a Communicable Disease to reveal the problems of the Healthcare System. Because not only do we have to get healthcare, we have to worry about everyone else getting Healthcare Worker because they could spread the disease around the special and situation rehab, we can all our hands but theres no vaccine toh protect us. This is a very good example of why we really need universal coverage, and it went to be able to get coverage. They cannot be dissuaded from getting attached because of cost. Cost. They cant be dissuadedte if the are subsequent hospital because the cost will be too high. These high deductible plans, we did do something on the vaccines that preventative treatment, no deductible, no copay. It will be quote free to people. Thats just the start but that doesnt meet the test will be free. We have to make that happen. You have to be able to go to the doctor or the hospital to be able to get treatment if you are very seriously ill. We clearly need not only not, like the aca unconstitutional get from 90 coverage to 100 coverage, urgently. We had some stopgaps that are going to bewi important in terms of getting the vaccine to everyone and getting testing to everyone but those of stopgaps. Let me pick up on something again. We want people to stay home if they are sick. We dont want them working, as the present suggested. That would be a disaster. That would spread to more people especially if the job involves interacting, touching people, say at a supermarket or a restaurant. They can only do that if they have paid time off. But in a geeky economy they dont have paid time off for many, many people. We need to solve it dig economy gap. We need to have employers and not just temporarily but for a long company to have employers contribute to some pool that the government runs for these people to give them paid time off in proportion to the amount that it worked. A stopgap is good but is not a solution. Audience, justhe the frequency of these Communicable Diseases, right, 2009 we had h1n1. Could have exploded. Thankfully not that serious. We had sars. That was in 20032004. We had mers. We have had ebola, two episodes, west africa, congo. Now we have corroded. About every two to three years were having these episodes. Stopgap measures they are stopgap, bandaid but they are not the same as a structural change that would put us in a stronger position to address tht next one. And dont for yourself or we will have an excellent. I dont know what it is. Jennifer doesnt know what it is. Ron doesnt know what it is but its out there. Its going to come and we need to be better prepared socially, medically and politically foro this. I think jennifer might have an idea what it is. Im going to turn the next question you, jennifer, if i can. And that goes to follow up on some of the points about affordability issues and questions andit thoughts. Can you comment at all on issues on how we should be thinking about our government and others ought to be thinking about affordability of vaccines or treatments that would ultimately develop, be developed and how important the question of affordability is for accessibility for all americans . I mean, i know this has come up in the context of the vaccine and quite obviously cost should not be a barrier to getting vaccinated. Wecc depend of people getting vaccinated, so just have to take that off the table. I do think though that that conversation is a bit premature because we dont yet have vaccine and is not a good signal to send to the companies on whom we will depend on to make a vaccine aton this point who made the looking ahead and try to figure out if its worth it for themselves. In 2009 thehe federal government bought a lot of vaccines anticipate that would have to happen where we to want to find yourselves yourself in a situation of a vaccine. But theres been a lot of conversation about vaccines and therapeutics and what we have specifically for this virus, which is in a. 1 threat because we need to prioritize the research and development process. And suddenly it cranks out Coronavirus Vaccines, i mean, you have downne facilities geard towards this so even thinking about creating vaccine and the quantities for which we would likely need it assuming estimates of 40 to 60 of the globe and potentially infected, i mean, thats an extraordinary and never requiring enormous amounts of planning and could take years, i mean, years. In 2009, we had you know when we discovered that pandemic virus we had a network, Companies Already making flu vaccine every year, multiple Companies Making flu company vaccines and they have the ability to tweak the vaccine production process so they could make then pandemic vaccine and we still didnt get it in time to be able you know in the us there were lots of different issues, but we didnt get it and tell largely after the epidemic peaked, but thats with a Seasonal Market where companies have invested because they knowlr its not going to jt be a one time by. Its going to be something every year and they already have the of the structure to not only produce the vaccine, put it in vials, ship it around the world to the places where its needed and this is all the planning that needs to happen. Putting that aside becauseto you know theres this is not anytimeg that happened soon. There are other medical interventions we need to think aboutr. When we talk about how deadly is this virus, its not purely a function of the virus, but also a response. If we have the ability to deliver life saving Supportive Care we could alter the severity of the irs virus, the disease and we see this, ebola patients treated outside the epidemic contact with it usually happens 10 to survive in higher percentages than people treated in situations where healthcare is limited, so i agree with the point about the importance of focusing on capacity and the point of also ensuring access, so there will be some people for whom they will require hospitalization and if they wait to be hospitalized to the point where they are so severely ill, first of all of puts more burden on Healthcare System because that patient is resource intensive and probably creating virus that could result in transmission events, so we dont want to have situations where cost is the barrier for which people who would benefitit potentially from receiving medical care, we dont want cost barriers. Thanks, so underlying everything you have all said, but certainly jennifer, a basic foundation about that import of science based policy decisions. What would you say, jennifer, and then im interesting in hearing the reactions from others are the three most important or two or three most important elements that get us to are looking at how we get to science based policy decisions on this issue. Obviously carries the assumption some of us feel its not happening currently. I study outbreaks. Its one of the things ive done for 20 years and i have always seen them politics enters into the equation and politics isnt by its only bad thing, i mean, half of the Political Leadership and political attention is not only, i mean, its essential, frankly. But, when politics get in the way of an outbreak response, thats when i think we have problems and potentially i believe has the potential to exacerbate the toll of the outbreak. We have the possibility its possible for us to do more harm by the decisions we make, so i believe that the technical experts have to lead in terms of making recommendations for what needs to be done. Ultimately, the four the call will be political particularly when theres insufficientil data but we have to be honest about the data and honest about how the decisions are made in the face of insufficiency insufficient data. Of that, i believe, is absolutely important. Ve i just dont see a way around that. I will say, though, one thing that happened during 2009, but i thought was helpful, number of agencies convened processes where they set up kind of external advisory groups that they would go to regularly, talk about what they were doing, share what they were doing in their thinking and it was under confidential circumstances because many wasth sort of internal deliberations, but there was some level of openness there with the goal of not only making sure they thought of everything because when you are in the midst of a crisis and i have enormous you know sort of empathy for the people in government right now who are working on these issues, incredibly hard work and i dont want to demean the incredible hard work that going on because its very hard when youre in the midst of that and you are just running from putting one fire out to the next, to really have a longrange view and thats why this essential for people who have a little bit more bandwidth and a little bit of a different perspective to be able to wait in and say have you thought about this, why exactly are you doing this it doesnt make sense, just to make sure we are on the right course and to raise to the service any issues that have not been identified. I think the issue of how we are going to do surveillance or when the disease inevitably was found to spread in the us could have likely come up in those conversations think about alternatives to technical glitches that hurt our ability to deploy diagnostic tests, what strategy exists outside an agency that could potentially be brought to bear to address the gaps we were seeing. Thanks and i would be curious lisa and ron about your reaction to that having lived the experience and if i could also leave and one additional point as you think about that, which is often in national emergencies, too often i would say in the us, we see people revert to their worst fears and you can see action through racism and fear as a result of terms of reacting to the other in these context, as people look to have science based decisionmaking and deploy the types of things jennifer is talking about how do we also what should Public Officials be doing to ensure anticipating those issues . I will revert to my prior seeing of having a prior tort prioritized and structured approach looking at a whole government issue as a transnational threat. As with other such threats, your intelligence driven, so the policymakers who has jennifer rightly points out will be the one that has to make the hard calls and thats appropriate, but in other instances whether its terrorism, you name it, the policymakers are asking the subject Matter Experts, intelligence professionals give me the data in this essence of how me understand the threat and how me prioritize what it is we are looking at. Unless you have a structure in place and you have leadership that says thats how i want to think about this, as opposed to kind ofss being pulled from pilr to pillar in terms of responding to new cycles are responding to irrational fears, if you have structure in place and leadership that says i want to be driven by the intelligence and it driven by the data, you have got to send that tone from the top and frankly as with other threats it ought to be i like this plan framing in the intelligence world we call that red teaming. You get other experts to say, let me take the counter view and really test it, but again you need leadership that is open to that thats driving a process that says i want the best thinking, the best factual fact abased thinking help inform a hard policy decision and to get to your second question, that ought to be permeating our response when it comes to illinformed or bias generated responses, see you can imagine a world in our hypothetical scenario where i as Homeland Security advisor or ron as the disease is our, if you will is leading a conversation where we say we are really concerned that we will have an uptick in bias related hate to crime against this particular population who are wrongly viewed as you know the quote perpetrators of said epidemic. Welcome i want my Justice Department who has role in addressing civil rights crimes and i want my attorney general and a lead and have statements from the top saying that will not be tolerated and we are going to deploy our office of Community Relations which operates in these scenarios with regard to other bias related crime andit have to sit the sigl from the top that that type of response a is it rude in any facts or science and wont be and should be tolerated. I will just add three quick points to that. First, i obviously agree with her politics is inevitable, but the question is what Political Choices are the political leaders making and in the Ebola Response president obama made the decision 12 science and evidence based policy be the default choice, so lisa and i set the situation room with the president when we were in a political firestorm of it people saying cut off travel to west africa, let the people over there just suffer without us help because we dont want the disease here in the president a decision that the science of evidence didnt support that b d we sent people to west africa to respond and to save lives and allow them to come home which is the only way to get them to go with appropriate precautions after they came home based on science and evidence. So, theres always politics in that, but political leaders make choices about what values they put at the center of this and that the vital which brings us to the second point, which is the relationship between this and the testing fiasco we see. Theres no question in part, may e the lion share of the testing fiasco is logistics, may be a bad choice by cdc to build their own tests you know technical issues. C and as was said, this s a firestorm and people will make mistakes. I understand that, but also have no doubt part of the fiasco is the president setting as a default bring me no bad news, do nothing to disrupt the economy, dont tell me bad things are happening. I went to minimize the case cow and i really dont want to know whats happening, so the bureaucracy response signal is if you tell people the truth and its bad, you will lose your job or get sidelined, thats a signal, a Political Choice that has an impact on how the government response and i think weve seen that here. Doctor nancy who is a career official at the cdc who has saved to literally millions of lives around the world stood up and said any scientist will tell you the spread of the disease in the us is inevitable and she wanted she went into the president s penalty box as a result, so thats not the way you get the bureaucracy and professionals and experts to respond. To this issue of discrimination, lisa is correct. A good read response should have the justice to spark that step up, but also we can step up and so hate crimes are the most extreme example and we see already tremendous drop in business and chinese americanowned businesses with people basically not willing to patronize chinatown or shop there or buy meals thereof like all of us need to be Civic Leaders and to say this disease affects humans, its not based on your race or ethnicity and you are no more likely to get it eating and chinatown that eating a little italy o or any other pt of town so we need to set an example and delete anthony patronize these bitty dutch businesses and mitigate some of the negative affect its having. Of the scientists who are critical to this response into any Communicable Disease, epidemiologists, biostatisticians, those people are high demand and unless the government respects them and gives them jobs and listens to them they got play of opportunity, you cannot find a biostatistician in the country as they are so stairs, but if you tell themta we are not payig attention if youre bad news or you have something or by the way you are predictions we will ignore them or deep sip deep six them or prevent you from going to a meeting and presenting them, why do i need government . I have 27 job offers outside a government whether its academia or business or pharmaceutical companies, im leaving. Unless we populate our government with those kind of people who are supersmart and creative and thinking, you know, we are going to have the evidence and we know its been the case. People can also take early retirement, so i think its partly how they are received, its the judgment, but also the respect they get and the ability to do their best work regardless of where the chips fall because that is what they do pick they are fundamentally scientist committed to getting the truthge not committed to white watching whitewashing one of it whatever them got. On that point, if you send of the siddle signal that you view this o as a border issue as opposed to a science issue epidemiology issue you are sending the wrong signals and and hurtg to affect the response as we see, i think we lost valuable time in addressing the technical debacle by saying we will just keep this out so the pandemic, any pandemic and any emerging Infectious Disease doesnt respect borders and doesnt respect any walls. Thank you. Before we open it up to questions which we will do shortly , one last area i wanted to drill down his jennifer, you and ron, you may have mentioned this but in the category of forward planning and in understanding that we need to have a search capacity, what would you say either hospitals, states, what should people be doing end out what level i dont know if triage is the right word, but to plan to make sure that hospital beds, capacity supplies or reserves for the most set sick and whether you have telemedicine, you know who does that, how should it happen, how is it happening now, how should it happen because that seems to be where we are headed on this and i dont get a sense of what the rules of the road are. This is something i think we shouldve learned in in 2009 that we havent really incorporated into our thinking or planning, so in 2009 and impart as immediate attention of the pandemic increased naturally their world sorts of additional attention t to the pandemic increase and what you saw because we track things like influenza like illness was that there was a surge of people going to Health Facilities above any kind of historical norms, a surge of people and then when they did the study back shortly thereafter they saw that only a small percentage of the people were actually diagnosed with the flu so that meant a lot of people were showing up for non flu specific reasons and they were there for a number of reasons, one they may hit have thought they had the flu and wanted to get tested and number two they may have had an employer who said im sorry you went to mexico or you were in this county reporting cases and you need your doctors know before you can come back to work and then they would try to find you now connect with their primary care provider who said you want to see me for the flu, go to the emergency room, our office is not equipped to handle an influx of flu patient that we dont want to expose everyone else and maybe people just went because they were concerned and wanted to get information so this puts on a normas strain Health Facilities particularly given the numbers mentioned in terms of anticipated number of people that will require medical attention. Its not a good idea for people to show up because if theyre sick they cannot expose others and if they arent sick they can get sick, but nonetheless we cannot put the burden on Emergency Rooms and so part of the unfortunate aspect of our wanting to expand and improve the diagnostic side i think we also are sending the message that its critical if everyone gets tested in people here then thinkyb now i have to go when gt tested, this is something that we should know and plan for, i mean, i know individual Health Facilities, the Health System is thinking about how they can triage patients because they are deeply worried about patients , at their at the er clinics unannounced and even the they benefit from a valuation they just do want them showing up unannounced, but its difficult for it to be done for individual Health Facilities. From a Patient Perspective there should be one number to call to figure out what to do in this is one thing i think is ultimately government. So many people are seeking y formation, any of us who have spoken on this are probably deluged with frantic emails from people who want information that is because theres no information to be found at me the government websites are utterly dismal. We need to New York Times i think is doing a better job of tracking the pandemic in the United States than any Health Agency ive seen in the us. Singapore is doing a next rainier job. For a model i suggest everyone look at the Singapore Ministry of health website, incredible transparency and Data Available in realtime, really kudos to them, but its absolutely something we need to think about im glad to hell your Health Facilities are trying to take this on and are forwardlooking, but again i just dont think its a great idea for there to be 27 numbers to call, no one knows where to go pick there should be one portal for people to understand how to connect and its not just patients, providers need this they need to be ready for being able to you know so they feel comfortable seeing patients particularly patients who dont require hospitalization. They cant just put a sign on their door that saysys dont coe here because we will be crippled if that is the case and similarly there are other Health Aspects that we should try to work into our response like large employers with Occupational Health services. There are many things out there but this requires planning and coordination and in particular as we think about expanding the amount of places to get testingd im deeply worried we have no plans for understanding whos getting tested where and so we will have a situation where different states for different numbers and we wont know what to make because it could simply be there just testing different populations and if no one is first of all thats not even happening on a global level t, i mean, trying to make sense of one countries numbers versus another you have to do epidemiologic forensics to figure out how you got to that member, but in the use we shoud allow flexibility, but at the very least know what strategy states will use. I dont think they have even developed of those strategies, but when they have we should be able to track it and understand it. Part of that is we have cut back the cdc and for those of you that dont know the cdc does funding of state and local Public Health responsibilities byth giving out grants to them d if you dont give out grants to cut back your sort of pandemic preparedness and you dont give out those grants they are not ready with this and creating a you know modern database so you can do exactly what w jennifer suggested, i think, is critical. You know, there are a lot of facilities that do have disaster plans, but a lot of hospitals dont and have not developed them and this is a place where we can anticipate, we can circulate best practices out there and just have not done it. At the university of pennsylvania Health System we have actually gone to a moderate rationing policy. Medical students dont get out and dont examine those haitians spirit you dont have multiple people going in to these fully counting that we used to do in the old days because you can serve the masks, gallons because that supply is not unlimited in the country and anticipating serious shortages as we get more testing and more people will come into the system, so you sready see in a lot of judgments made at various assistance in anticipation of their are going to be shortages and how do we prevent us running low on masks, the full you know down, the gloves etc. Thats a bad place to be, the start of an epidemic, very bad. Obviously we are in washington and we all have extensive experience of the federal level. I think it cannot be overstated just how much this is about state and local response. State and local public Health Officials, all the people that jennifer described, they are the first responders. Again, going back to my you know terminology from a National Security perspective from a Homeland Security perspective, they are the first responders. The job of the federal government is to support their response, to provide a assistance, to help with best practices, to be you know a Standard Center if needed. The federal government should the and the role of supporting a robustst state and local respone just as we have done to other threatsav you know and providing that assistance, so i love to see the type of state local grant and Public Health Preparedness Plan and grant that we provided in the wake of 911 to help all of the states and local municipalities raise their level of preparedness for other types of disasters and other types of threats. We need to do the same thing when it comes to Public Health and then the other role as the federal government to work with our partners around the globe to raise their capacity, so with the Global Health security agenda that was started in 2014, a network of multinational approach to raising Global Health capacity rather world to keep those diseases at bay before they get to our shores theres a lot more economic and forward thinking to do that than we to do all of the types of things we are talking about here thank you. Why dont we go ahead and turn to folks out there. Lets go here first. Thank you for doing this. My question is about china approach in terms of the epidemic. We have seen countries locking down several cities. On im wondering, is it necessary approach . Will we see something similar in the United States and are there any approach that us or other countrymen learned or copy from china in terms of stopping the outbreak of cov19 . Thank you. So, as we think about what measures to take in response of the virus i think its important to evaluate not only what we think that Health Impacts will be and thats not just looking at case numbersnd, but also with the broader social and Economic Impacts are and we need to hold all of those things in balance because i do believe its possible to take measures that do more harm than good, so i think what we have seen in chint is the result of a situation i got very much out of control, where there was very limited understanding of what was going on and im sure a lot of the uncertainty fueled some of the aggressive actions and i also think the fact that we have not fully acknowledged that this virus, i do not believe is amenable to containment. Its pretty too quickly and too fast it is not like ebola or even the flu, though no one would even attempt about with the flu, sott theres been a lot of celebration i guess over the recent decline in case numbers and china as a result of extraordinary unprecedented c actions. Although, i remain somewhat skeptical about the case numbers , just because i havent fully understood how they are testing and looking for it, not im not suggesting they arent being honest. I do believe there have been other impacts we havent fully accounted for such as the fact that people who are sick with other things like cancer and hiv have been unable to receive care from a response thats been so focused on driving the number of cases down to make zero. I also dont believe we are fully accounted for the social and Economic Impacts and any decline in incidents we see now if it is in fact true is temporary because as people back to work, as we absolutely need them to do unless we run out of essential medicine and personal protective equipment and the other things we know we will need, the virus is still circulating on a planet and the disease the virus is going to continue to circulate and come back so even places like singapore which has reduced their cases and i believe they have reduced their cases is acknowledging the fact the reduction will be temporary and will come back because they cant wall themselves off. So, thats just my point. In the United States, i mean, i very much want to stress that we need to proceed carefully and not act out of you know just because of chaos, so i am top on my mind that i am particularly worried about his School Closures because i dont think we have adequately thought through first of all i think we have limited data to say that they will alter the trajectory of the pandemic, but i also dont think we have thought through the contingencies like what it means what Healthcare Workers cant show up to work and what it means for the nutritional needs of children and the social needs of children, i mean, i have talked to reporters who have been under lockdown in china and i mean just describing their life, one reporter has 29 yearolds at home and said its not healthy for them to be inside this house, this tiny apartment for months on end. We have to account for those things in our decisionmaking, i mean, im an epidemiologist, but its not just about the epidemiology. Its about a broader view, sobri very much want to stress the need to fully evaluate measures before we implement them m. I just had two things. Number one, alluded to this before, its very easy to say well we should just quarantine these peopled , any Healthcare Worker who has had exposure should go home for two weeks and dowill close the schools and all of this, i understand kind of the Service Level appeal of that, but as the doctor said a lot of those measures will make us less healthy, not more healthy. Think about Healthcare Workers. The said we are to have a shortage in Healthcare Workers and if we quarantine large number of Healthcare Workers, not only will that impact our response to coronavirus, but people will show up the hospital with heart attacks or breech birth and other things in the system wont be able to deal with that and if we just say and so the precautionary principle, which is so attractive to us as human beings actually winds up doing more harm than good in these kind of circumstances. Second thing, one thing they ae doing in china we need too think about a messy ability to construct quickly search healthcare capacity. I think if you are mayor or governor or a major Healthcare System administrator and you dont have a plan to add 500 beds on three days notice, you arent ready. You know, again, whether that is through construction or finding facility to equip or whatever, not everywhere in the country, not every city, whatever but we will find a major city where every er bed is filled, every hospital bed is filled where it will become an outbreak and we will need that Surge Capacityy and we need to think about where that capacity is and how you are going to either constructed or repurpose it or whatever to get that capacity. You can see this in seattle a motel ford to buy quarantine or could thats a of kind of desperation and the fact that we dont have not thought this through and have a backup plan. Its very expensive to have bed mothballed at hospital beds only 60 are occupied and we shouldnt be doing that, but we should have a plan for Surge Capacity and whether its putting up quick tense, it tends hospitals which the military has experience in, so we need that and its not clear how much is being done. I do have to say it maybe i will be more forward than jennifer, there is some doubt i have about the chinese numbers and whether the numbersbo have really gonee down, whether they have gone down to it change their testing protocol whatever, without changing transparency, one has to be a little skeptical. I think we need to have procedures to adopt as jennifer said in singapore much more believable that you sort of have been able to turn the corner, but you know the chinese are trying to get their factories back to work here today cant have a negative Economic Growth much less less than 6 fm Economic Growth for the country. So they are trying to get factories back working and that may be premature for their situation and provide a focus for much more rapid spread of sick people going to go to work and spread it around a whole factory. I think that has got to be able serious worry in the circumstance. Why dont we go to the woman here. Excuse my pointing. With the gestation period, what is up with this virus . So, just incubation period is a term for the period from which you have been infected, in some cases to develop symptoms. The best estimate is that somewhere around three to five days, but can range from two days to 14 days. We have a bunch of people Live Streaming and we want to make sure they hear every word. You will hear a lot about 14 because when we do things i quarantine we take the full range of the incubation period and thats where we get the 14 dayse that people are quarantid for and theres ongoing debate about the incubation period. There have been some questions raised as to whether it could be longer than 14 days, but as of now that is the current thinking. [inaudible] right next to the woman we just called on. Thanks. One of you mentioned these pandemics seem inevitable and since we know most are called supposedly by transmission from animals to humans, is there a way of sort of slowing down the transmission process from animal to the human basically . I am not a veterinarian, but we should anticipate future spillover events coming from animals to humans. In fact, it feels like we are having more and more emerging Infectious Disease outbreak epidemics because we are at about two thirds have originated in animals. Of the challenges that we often dont detect when that happens, but nonetheless we should do more to understand what causes it to happen and it was a great kind of Research Program that was being funded by usaid culprit that funded researchers to work in the field to understand not only kind of urologic drivers, but also social and behavioral drivers to o understand like risks and hotspots etc. And its a little bit strange i think that it was a Research Programha funded by them but nonetheless they did interesting work, but unfortunately it just ended. There is one more thing we can do to reduce the risk of spread from animals to humans at mass combat Climate Change. Climate change is driving the problemat, not necessarily coronavirus specifically, but generally because disease spreading factors like mosquitoes have a wider range of habitat now. Next time we have the zika virus in the us we wont just see it in the southern part of the us, but like mosquitoes can live further and further north than that is one effect. Climate change forces humans and animals into closer proximity and places due to habitat destruction, migration patterns. Climate change is forcing refugees off of places into places where they are vulnerable we have thatt ebola epidemic finally coming under control in congo, but one risk factors across the border in south sudan in million refugees account. That wouldve been a disaster that spread across the border, so, i mean, Climate Change has a lot about effects, once we dont think about option is the fact that its a driver of these epidemics, but it is making the risk oh up on the planet. All of these things have been mentioned stress is why we cant view thiss as something that we can deal with domestically as only an inside our borders issue. Increasing the capacity to detect these issues overseas with programs like predict, raising the capacity of other countriesre to detect when that jump happens can greatly improve our ability to get ahead of it and so while its really unfortunate that the original requests for an emergency bill, emergency money from the administration to congress contained no International Aid funding, thankfully congress and the number of really smart thinking Committee Chairs and ranking members but about a little over 100 million, i believe, dollars in this 8 billiondollar emergency supplemental that just got past. We have got to be thinking about this is a global issue that requires programs like predict funding p such as bus stop that was just added. Such as the stuff that was just added. Lets it to the back of the room a little bit for the folks that have been patient back there. I have a question for ron. I was wondering if you could shed light on the response structure within the administration, so the lead is filled with hhs, but the Vice President is in charge and Deborah Burkes coordinator. Rg can you shed external light on this and how does a contrastco with the situation when you were dealing with sars in the white house . Yeah, so its confusing, isnt it . Early on in january, i said they should put someone at the white house in charge. Of the problem isnt that they dont have a coronavirus coordinator, although maybe now they do or dont, but its in july, 2018, when john bolton took over as head of the National Security council he abolished the unit is a set up after i left and as a result there was no team more really want in charge to coordinate preexisting bases and then they went to the structure where they created kind of a committee that alex chair, task force, but it wasnt clear if they were getting a view down the task force and then when things got bad they put Vice President penton charge though they didnt disband the past source and then a day later they brought in Debbie Brooks who i have respect for as a working part time still doing what shes doing in africa, but parttime working for Vice President penton shes on the task force, but on charges the task force, coordinator whateversh look, e point is when you need in the situation is clear lines of accountability, clear lines of authority, clear lines of coronation. Ended this is a big hard problem. Will, we did get everything right in ebola and we were late on many things that we made some wrong choices, so on and so forth, but we had a process that everyone in the government understood how it worked, where decisions needed to come to, where decisions were made, understood how decisions were pressed down to the system, they understood where to bring problems out how to get problems solved. Its obviously very heavily led by science and medicine as the guide, but a lot of this is logistics. A lot is abouts. Just making things happen. Solving problems, you know . This test kit thing is partly a science problem, but partly like no one thought through how to do this and where they would go and how many was needed and so on and so forth so that is still very badly confused in the Trump Administration now and thats why think a lot of the things seem like theyre moving like molasses. You can stand up on monday if they will have a million test on friday and fridays actually the number 75000, thats a lot less than a million, so i think you are seeing the consequences of a lack of accountability, lack of coordination, a lack of really Clear Management for this challenge. One thing that is clear is that it can only in what you have heard can only happen at the white house. The ability to get the departments and agencies to Work Together unified really has to start at the white house because thats Healing Place that can oversee the whole thing and create an accountability in each place coming back to the center. That i that is really critical that the center, the white house work well and work with all the agencies and that is indispensable. I think we have time for one last question for why dont we go to the woman right here in the back. Thank you. My name is scary, an intern at the biden center and a Student University pennsylvania. My question is about supply Chain Disruption in china specifically how that will affect manufacturing of a potential Coronavirus Vaccine or even other really essential drugs crucial to our Healthcare System and whether or notss the supply Chain Disruption will have a longterm impact on the Drug Distribution manufacturing process both in the us and worldwide. You want to start and im happy i have been worried about this, but one thing i have been frustrated by his i dont think we understand the problem at the level we need to understand itd. Supply chain is incredibly complicated and no one seems to have a handle on where it is, the issues, the vulnerabilities. I dont think we are truly examined in the context of not just the hurricane taking out a plan for a rico that makes medical sailing and thinking about where else to source it, but to think in the context where essentially every countries affected at once at every country will clamor for the same thing at once so for companies who will be hard to think about well we will just source x product in white country and i know there are folks in the government who are working harder on the issue, but i just dont feel that a small group of people inside of government have the appropriate view on the issue and i think this is one area where we absolutely need more work and more individuals involved particularly from the private ndsector to really think about game out the issues, what the problems are. I know from the Healthcare Delivery side they are very worried about the issue, but they have no intelligence on what to expect, and what is coming down so you may have heard fda recently announced a critical drug shortage but did not identify what the drug was, so its hard for Health Facilities to hear about the supply chain they are told to conserve, but also told they need to evaluate patients with airborne precautions which is extraordinarily likely to burn through the supplies you have. I just dont think it is one area we have given enough attention and i think that attention has to be multi sectoral has to involve private sector and really i think this is an area of critical work. Just a think about flu vaccine, can we have 11 that now produce flu vaccine, thats it, 11 countries out of 196 whatever the latest number is and that haser to supy the world, so we are going to definitely need capacity built and its not like you can just hijack you know theres a manufacturing facility and we will switch it over so i think that is a critical problem. On the drug shortage problem a high proportion of drugs are made in china, but more important in the Raw Materials that go into drug production of Something Like 90 originate in china we clearly whoever thought that was a good idea for driving prices down to really its a bad idea to sole source as ito such a large proportion f the raw inputs. We need obviously two things, diversify those chemicals to be made in lots of places. China does not have a lock on the chemistry and second of all we need to diversify the sources, but also diversify the production facilities especially for generic drugs. This is going to become a big problem. Its not going to be one of these things that we can wave away. There are 20 drugs on the fda watchlist, but we already know, we had a preexisting drug shortage problem in many different areas, generic for cancer, which i know fairly well, so i think we will have to diversify, but thats not going toll you know, thats not an overnight problem. Its not even a sixmonth problem. That they several your problem and i think we have to start now and we have to make sure the fda stays on this problem and doesnt lose track of it because that will affect all of us whether we have coronavirus were our problem is Something Like i have this generic diabetes drug but theres no supply for it. That would be a real disaster, but that also emphasizes to everyone how interconnected, it may be coronavirus that you could be effective if you have cancer or diabetes or Something Else through no fault of your own because of the complex you know that interconnected interconnectedness of the system , so i think its a really good point and wed do have agencies responsible for this. They just need to stay on it and get the word that they need to solve this problem and we may need to create new authorities. I want to thank everyone for coming. I want to thank our questioners because i think we had some terrific very thoughtful questions that were also evident of the terrific panel is that we have here and your you are incredibly thoughtful answers and comments throughout, all of you, thank you so much for being here. I think in a time and an era and issue when there is a lack of evidence based and call him and thoughtful discussion, you helped to make up for that in major partner today by providing what you did, so thank you very much. I think we are all better prepared as a result of you being here, so thank youou. Appreciate it. [applause]. 2020 democratic president ial candidate Bernie Sanders holds a get out the vote that in st. Louis today. Watch live at 12 00 p. M. Eastern on cspan2, online at cspan. Org or listen live on the free cspan radio app. To follow the federal response to the coronavirus outbreak go to cspan. Org coronavirus to find all of our coverage including hearings, briefings and review the latest events anytime at cspan. Org coronavirus. Comes out to be a campaign in which we have one candidate who is standing up for the working class and middle class, we are going to win that election. [cheers and applause] for those that have been knocked it down, counted out, left to behind, this is your campaign. The president ial primaries and caucuses continue tuesday, four 60 to including idaho, michigan, mississippi, missouri, north dakota and washington. Watch our campaign 2020 coverage of the candidate speeches and results tuesday evening live on cspan. Cspan. Org will listen for from wherever you are in the free cspan radio app