Experiencing at any one time, its different for your peers and you need the very best information, the best guidance you can get but you need the ability to understand your communities, your stakeholders, hospital capacity, Public Health capacity to make the very best decisions for your communities. Cdc has been on it since the beginning but we want to be a resource to you, your Public Health, staff and the city and the state Public Health and government and leadership as well but you, as mayors are playing an incredibly Important Role in amplifying the collective voices on major issues. As you know, your realities have really changed, for many of you since january and more of you since march when the pandemic really got here in the u. S. We know youre on the front lines, implementing the process of reopening our nation, city by city, for some of you it might be neighborhood by neighborhood and we know you are taking priority in this to do things in the manner best for your local area. Will you heard from doctor fauci is kind of where we are and unfortunately, were not in a good place right now, unfortunately, the National Tally is trending upward. We have different patterns and i think youre probably aware of them. Northeastern states and cities were hardhit march and april but they are trending downward. The southern cities and states and western cities and states have been trending upwards. Its not a simple situation, its not the same thing going on in every community but here are a couple of the factors contribute to the increases we are seeing. In some cases, its local outbreaks. Meatpacking plant, correctional facility, a workplace and even a Birthday Party in some places have led to a new member of the fire that needs to be put up. In other places, expansion of testing and it can explain increased numbers but unfortunately, in a lot of places we are seeing an increa increase positive among the cases so that means these increases are real, not just a function of getting out there and checking people and finding them. In other places, workplace associated and in some places its still nursing home outbreaks but in a lot of places we are seeing community transmission. Many of the newer cases we are seeing are increases are younger people, not the elderly over 65 or 85 population dominating hospitalizations early on. Nursing increases in people in their 20s, 30s, 40s. Increases in certain racial and ethnic groups. We thinks these may be individuals who cant stay at home who have essential work were out and about, doing errands for everybody else in some communities, they may be people who have gotten fairly relaxed about the seriousness of the virus. While most younger people have mild or a some dramatic infections with the virus, young people can be severely affected and im sure each of you is aware of some of the death, hospitalizations we seen in otherwise healthy young people. Cdc has been responding to the needs of cities over the past several months and currently, have people in more than 20 states, more than 150 people, i think, assisting in these hotspots or areas where there is increased cases occurring. We are trying to take these increases very seriously and learn as much as we can about the best ways to control them and to support local and state officials in areas like surveillance and Laboratory Activities and the Community Mitigation efforts. In the past two weeks alone, weve deployed Rapid Response teams to arizona, arkansas, california, florida, north carolina, texas and utah. These are areas where cases have been increases to help local officials to the bottom of whats going on and turn the tide as quickly as possible but beyond providing that on the ground, cdc is also working on guidance and taking the best available information to pull together an update the website where we have information on tools and Higher Education and businesses and workplaces and recreational facilities. You name it. I think we have about 1900 there. There are working hard to translate them. It can be adopted by organizations and workplaces and how to safely reopen and care for their neighbors as well as some of their workers. We recognize each community is different and you, as mayors, are really in charge and need the best resources so you can adapt to your circumstance. One of the things weve done over the last few weeks is pull together the evidence and updated information who is at risk and the underlying diseases we think increase the changes a person will have a severe outcome, hospitalization and fatality from the virus. One of the updates includes pregnancy. We didnt have data about that but now we do. Pregnant women are at higher risk of intensive care unit admissions, for sure. They dont seem to be at higher risk for hospitalization but if they get the infection, the icu and ventilation. Much of the strategy is about reducing the spread when one person or another person by limiting the Mass Gatherings and ensuring physical distancing, wearing cloth face coverings when we go out and about and really trying to protect the Healthcare System so it can handle an increase in cases and does not overwhelm it and to protect the vulnerable, elderly, underlying diseases, people from certain race and ethnicity that we do believe have a higher risk of hospitalization. Communities may have high risk people and the demand on the Healthcare System when a lot of people are sick at the same time this is where understanding guidance and getting the best advice would be important and i think most of us dont feel that we are out of the woods at all and we are not in the second wave yet and the increases we are seeing in the south and west may be a first wave in those areas while the northeast is in recovery mode. We need to be resilient and resolute and stick with it. Cdc facilitated funding of about nearly 12 billion to states, tribes and territorial entities in some cities. For most cities your resources would come from the Health Departments and those billions of dollars were to help expand testing to increase Contact Tracing and to help with slowing the spread and to help with that mitigation in the work that is needed when a case is identified so they can be isolated and so their contacts can be traced and contacts can be asked to self quarantine, stay at home and away from other people. That is a lot of work to do between now and the months ahead we heard just now about the exciting progress in vaccine and we dont have vaccines yet and we are not going to have it on a large scale for many months so case identification through lab testing, Contact Tracing, isolation, quarantine and physical distancing including wearing face coverings when we can have a physical distance are the tools we have that will keep your communities safe and keep your business is open, we hope. Right now we think we had about 30000 or so contact razors around the u. S. And eu may know what the numbers are for your jurisdiction but doctor redfield probably thanks we need 100,000 of these contact tracers. Funds that we have provided to the state Health Departments were meant to help them staff up on that. Cdc is also supplying additional staff and developed a variety of training materials and guidances to help new hires be able to do that important Contact Tracing. One thing i want to say is Contact Tracing is a local issue. It requires trust. People who can be the most accepted can talk to someone who has recently been infected about who they were in contact with and who might be at risk needs to develop a relationship of trust in order to get that information and be able to follow up with other contacts. Your jurisdictions may have fantastic people, possibly people who have lost their jobs recently, who might be able to sign on as contact tracers or other support staff to the Health Department to help them sustain the kinds of control measures that we need. Its really critical that we find people who are at risk and that we keep them and take care of their health they made to provide them with the support so they told spread further and we find whoever else they may have spread the virus to or where they got the virus to keep them separate. We arent linking with a lot of partners, not just the Health Department and cdc, but universities and jurisdictions all around the country, Cdc Foundation is in on this and a number of private sector groups really trying to build that workforce to help be the boots on the ground to snuff out the spread of this virus before it takes off further. That 12 be in dollars was really meant to help with the increase and lab testing and help with the Contact Tracing and help with the isolation and to get the data as strong as possible so they know where the disease is and spreading in your community. Unfortunately the pandemic is not over and the improvements began with some parts of the country and they are not being seen in others and we really need to be resolute and continued the hard work we are doing. We want to do it smarter than we did in the first couple months and really reopen wherever we can to do things gradually so that we dont have the sort of seesaw of everybody that everyone can do whatever they want but we really know the economy and our health proposed vitally is important, both to protect the most vulnerable and to sustain the Healthcare System and to have the Public Health investments in capacity that can keep the virus at low levels until we get a vaccine. I think together with your leadership and Community Groups and neighbors i think we can defeat this pandemic and in so doing build a Public Health system that ensures health and prosperity for nation and generations to come. Right before close i do want to say that tomorrow is national hiv testing day and hiv is another pandemic that we had for more than 30 years now but that we are at a critical phase in right now here in the United States for in the national hiv testing day is the power of knowing, knowing the risk, knowing your age and hiv status and your prevention or treatment option. There are more than 160,000 people with undiagnosed hiv in the United States. The only way to get to know their hiv status is to get tested. Obviously, with covid19 this made it more difficult to access traditional places or testing is provided like the nuclear based sites or communitybased organizations or Healthcare Settings but the benefit of knowing what hiv status continues the cdc is encouraging people at risk for hiv to get tested in ways that can follow social distancing practices. This could include self testing one facility based Test Services and inpatient testing is not available. When you know your status and you are empowered with the information to keep yourself and your partners healthy and once you know your status you can consider many different Treatment Options to help with long, healthy Productive Lives but cdc stands with all the support and message to the communities for national hiv testing day and we absolutely stand sidebyside with you supporting you into that battle. I appreciate the imitations for cdc participating in the meeting and again i dont [inaudible] thank you, and nine. Any other questions for dr. Schuchat . Hello, thank you dr. Schuchat are joining us. I just wanted to ask a question. Im in southeast florida and we have had increased numbers and spread and we are being told that the deaths are not going up and we have plenty of room in the hospital so my question would be would you be able to tell me what the timeframe is on the lag indicating for those two for hospitalization, icy hospitalizations and also so absolutely, its an important question. A couple qualifications before we get into the timing, as i mentioned the increased cases that we have been seen in a lot of jurisdictions have been in younger people and so if youre new cases are 20, 30 yearolds they are not as likely to need to be hospitalized or die as a few new cases are 60, 70, 80 yearolds. That said the 20 and 30 yearold spread to the 60 and 70 yearolds and that is the risk that could take off exponentially. I thank you will remember the numbers in march and april and in new york city where we over saw it double every day or two so once you get into the hundred of thousands of doubling every two days is a pretty scary phenomenon. People who have severe episodes of covid19 often will have a week or so where it is not that bad and then that second week there is this basic pattern where they get respiratory problems after a week or so. With death that can be a couple of weeks. We think there is really a two, three week lag at least before the fatalities occur in some of the individuals who do end up dying from covid and up having very long hospitalizations that were essentially on the ventilators for quite some time. Some of the patterns we saw earlier in the pandemic may be changed over the future because we have learned that this drug that doctor Anthony Fauci mentioned could appear in the first study for britain that it can reduce fatality among people who are on the ventilators and that might mean longer hospitalizations so, as you all no, its about longer hospitalizations but you survived and thats great and thats an intensive care that is not opening up. The healthcare capacity varies. Youve probably had your Health Officials report to you and here is what we think we have. I was struck that new york city has about the lowest population healthcare capacity in the country because the population is so dense and they have a lot of hospitals for the icu beds and healthcare capacity to handle people was not as robust as some other places where its not as dense a population. This varies quite a bit. Cdc has a system called the National HealthSafety Network where we are working with hospitals all around the country and looking at their inpatient beds in the inpatient beds that are occupied by Covid Patients and their intensive care unit beds and intensive care Covid Patients in them. We are tracking what is going on. Weve seen an increase all around the country in inpatient beds occupied for all kinds of causes because of lots of places have opened up in their procedures and doing surgeries again and more people in the hospital and some who were scared to go to the hospital are now going to the hospital for other things. We are seeing an increase in a lot of jurisdictions, particularly the southwest, and hospitalizations for covid. They are longer than the capacity to be threatened. Over the nation as a whole we are not at that limit now but there are a couple places on the country that are getting worried in arizona theyre getting close to capacity. Florida is jurisdiction to jurisdiction but, as you know, florida is a state or some jurisdictions there are more elderly people, more at risk and if the young people start to, the virus and silently spread to others theres a really horrible story of a family Birthday Party, multi generation Birthday Party two weeks ago, i believe, that spread outward to the grandparents and both grandparents are on ventilators in the hospital now. I think our young people fear nothing but they also loved the grandparents. We got to get that message out to them. Its not just about me but about people i love and as mayors you really have an important voice in that. Sorry for such a long answer. Thank you, dr. Schuchat. Any thing else to share with the committee . Good i just say, dr. Schuchat, thank you for the meeting but thank you for highlighting the hiv testing and awareness as well. There are a lot of lessons in the Current Situation and mayors of the United States were among the first in the history of the hiv epidemic to step forward to take progressive action because when others did not see it or others do not want to look and as mayors we cant avoid our people who are sick and dying in our communities. Mayors have always been at the vanguard of that issue and one thing weve learned about it is we have treatments now that not only can result in normal lifespans and health but also prevent inpatient of the virus so treatments can make a bit difficult or impossible to transmit the virus for those able to achieve certain level of on detectability of the virus in their bodies. And so, with adequate testing folks can get treatment and we can completely defeat the virus. Testing has been a challenge in parts because social stigma is surrounded and the fear the people had that if i get tested and im positive that i will know and i dont really want to know and im seen that phenomenon in covid as well. If i have it i dont really want to know so i think its instructive with the hiv space going on around how critical it is that our local quotations and messages and our own examples that we look up in our communities around the need and the safety of testing and how essential asymptomatic testing is for everyone in order to help the system and all of us to defeat that virus and allow to celebrate grandmas birthday again. Thank you very much. Thank you. I thank you raise important issues that i agree with. One thing to say is that if what happens when i get a test result is going to be intolerable for me i will not want to be tested. If we can build the wrap around services that an individual needs so they can safely isolate and still eat and their family can still have food on the table so they can be isolated or separated from all the family members some of the countries have been able to get people have gone all the way in many different extremes on this and some jurisdictions have been able to weather this better but if you are in a crowded home with a lot of other people its hard for you to protect spreading to others. If you are the breadwinner and if you cant go out and do that essential function you dont want to be out of work for two weeks and have nobody bringing funds in. At the national level, the government and the local level, could try to figure out how we get around these terrible barriers the more people go about their business spreading the virus and the worst the pandemic is in the better we can make the incentives for them to isolate or for their family members or those to self quarantine the easier it can be. Some of those dollars that went to your state and local Health Authorities were so that they could do the quarantine, isolation, Wraparound Services that some might need. We know that many, especially at the lower income levels will delay seeking care when they are sick. That doesnt help the families either. We are all in this together and that local level where you know how to social services, committee groups, i thank you of all seen incredible volunteers that are stepping up in the middle of this pandemic and we want to encourage them. I think my acquaintances and family and friends who were not involved in the response are just trying to figure out how they can help so tapping into that spirit at every local level is good. And the others who have anything to share . Once again, thank you dr. Schuchat for making time for us and please give doctor redfield our best. Thanks so much. Real pleasure to be with you. Take care. Again, thank you to all the mayors, speakers and guests who showed up today. This meeting is now adjourned. Thank you. Thank you. Cspan has unfiltered coverage of congress, the white house, the Supreme Court and publicpolicy events. You can watch all of cspans Public Affairs programming on television, online or listen on our free radio app and be a part of the National Conversation through cspans daily Washington Journal Program or through our social media feeds. Cspan created by americas Cable Television companies as a Public Service brought to you today by your television provider. Binge watch book tv for summer. Saturday at 8 00 p. M. Eastern settle in and watch several hours of your favorite authors, saturday we are featuring twotime Pulitzer Prize winning author and historian david mcauliffe, author of over one dozen books including the wright brothers, the american spirit and his most recent, the pioneers. Watch saturday july 11 as we feature commentator, author and founder of the National Review william s buckley. Binge watch book tv all summer on cspan2. First ladies, influence and image, on American History tv examines the private lives and public roles of the nations first ladies through interviews with top historians. Monday night we look at helen taft and Edith Roosevelt along with her husband theodore began the first president and first lady to travel abroad while in office when they made a trip to panama and helen taft was the first first lady to arrive with the president in the inaugural parade but watch first ladies, influence and image, monday at 8 00 p. M. Eastern on American History tv on cspan3. Glad to look back to our program, doctor ira brights. Host for sirius xm, doctor radio, throughout the pandemic hes been helping listeners better understand coronavirus. Doctor bright, you were last on this programhi back in late mar. I wonder how far have we come in understanding this disease since then andme what has been the biggest breakthrough . Guest we have come to understand a lot more than we did before and i think one of the most important things to say is there has not been a breakthrough. Its not like you can use whatever is the magic cure but we have both learned a lot more about managing