Cdc director dr. Robert redfield. He is the Nations HealthProtection Agency and defense americans against dangerous threats and the response to inaccurate information on those threats or record of the head of agency data redfield has been one of the nations leading voices. During this pandemic sharing new information, issuing Public Health guidance and advising americans about how to safely return to work, school and daily life. We are glad to have him with us and what has sadly happened as and a sadly Pivotal Moment in this crisis right now as you all know cases are spiking across the country and as a result we are seeing different types of lockdowns like we saw in the initial wave of thekd virus and americans everywhere are hungry for information and guidance about how to navigate the Holiday Season this winter but back to redfield will address thall of these issues and more d well take questions from our audience as well. Without further ado dr. Redfield welcome. What can you tell the audience about the current state of our country . Thank you very much for having me and we are at a very pivotal time in this pandemic. Unfortunately we are experiencing a substantial surge across the nationhere we n have really a significant numbe of our jurisdictio and states that are what we call the red zone and a wide surge that happened in the heartland and the Northern Plains which really lasted a lot longer than say what we had with the spring and summer surge. The other thing that it had a much more steep trajectory so when you look at the spring surge, this was the rate of increase in the summer surge. When we looked at this more recent surge this is really what it was. Its also lasting a lot longer. Usually it took between four or five weeks before we get it to peak and at this time its closer to eight to 10 weeks and in many areas we have notto pead yet. We are at a very serious time and i guess the good news is the heartland of the Northern Plains have started to decline and hit their peak but unfortunately at the same time that is happening the pandemic is having a resurgence in indiana, ohio, pennsylvania, the midatlantiche states, southern sunbelt also now moving back up into the northeast as well as unfortunately california oregon and washington so we really have a very extensive pandemic now throughout the nation. I think many of you probably saw that in the month of november unfortunately we had over 1 million cases reported each week. 4 million cases were reported in november. Unfortunately our hospitalization rates are going up andtete maybe well talk more about that. That is one of our great concerns. In the spring were talking about 20 to 30,000 people in the hospital and now we are over 90,000 people in our hospitals. One of the mostsp concerning things about understanding the impact of the pandemic right now and the question about it is to recognize as we sitt, here today 90 of our hospitals in this nation are actually in what we call one of the hot zones and the red zone. Therefore the risk for increased hospitalization and the potential to negatively impact hospitalca capacity. 90 of all of our longterm care facilities are in what we call high transmission zones. We are at a very critical time right now about being able to maintain the resilience of our health care system. In the spring we were dealing with new york, detroit and new orleans, los angeles. We could shift Health Care Capacity from one part of the country to another. We saw it similar when we have the southern wave. We could shift Health Care Capacity to the heartland and from the Northern Plains. Right now we unfortunately have a pandemic that is really throughout the nation and their scent that resilience of Health Care Capacity to deal with the shifts. This is why its so important as time and i know we will talk more about it, is to increase the mitigation steps we have tried to stress. Its time to debate whether or not mask work. We clearly have scientific evidence. We recently published in mmwr mask mandate and certain counties opted out and certain counties opted in. When you compared those that opted in to have a 6 decrease in the observation period of new cases. 100,000 of the counties that decided that they didnt think this was the way to go on opted out of the mask mandate we found out that they had over 100 increase in cases. You couple that with social distancing,co handwashing stayig out of crowds and doing things more outside than inside, these are critical mitigation steps which many people seem simple and they dont think it could have much of an impact but the reality is they are very powerful tools. They have an enormous impact and right now its so important that we recommit ourselves to this mitigation as we now begin to turn the corner with a vaccine. The reality is december, january and february are going to bee rock time. I believe they will be the most difficult time in the history of this nation n largely because of the stress that its going to put on our health care system. Its a sobering and important thought there and a couple of directions i want to go but lets start with the Public Health model for mortality rates. My question for you is what can we do to change that trajectory and is it as simple as masks social distancing isolating etc. . Will i think you are right when you look at the different models. We looked out the original spring. We lost 100,000 people and in the fall 100,000 people. This signifies the loss of this pandemic. Or potentially looking at a number another 100 to 200,000 people so this is a significant time. You asked the right question. The truth is mitigation works. If we embrace it and the challenge with this virus is its not going to work at half off us do we need to do. Not even going to work if threequarters of this do what we need to do. This virus really is going to require allo of us to really be vigilant about wearing a mask and unfortunately not just in the public square. We are finding now much of the transmission that is driving, i mean who would have a leaked that rural north dakota and south dakota, wyoming, idaho montana these areas of north dakota recently 30 to 40 of people that got tested were actually positive. The reason this is happening is because now one of the major drivers of transmission is not the public square. Its actually the home gatherings where people let down their guard. You bring in family members and they dont realize that the major presentation of this virus for individuals under the age of 40 is totally asymptomatic. Really beingt able to get a handle on asymptomatic transmission in the family setting which is drivingsi it didnt many dont recognize it so unfortunately the virus can get transmitted into someone who is older and amanda developing a symptomatic illness and they ubed up in the hospital. The reality is as you saw just the other day i think in our toorts we were back up almost 2400 deaths that were reported yesterday. We are in that range potentially now, starting to see 1500 to 2000, to 2500. The mortality concerns are real and i do think unfortunately before we see february the could be close to four to 50,000 who die from this virus. That is not a fatal complaint that American Public embraces social distancing, wearing masks, not letting your guard down at Family Gatherings, limiting crowds, maintaining ventilation doing events outdoors rather than endorse making sure you have vigilant hand hygiene and that coupled with some strategies that we are pushing states to do to begin to diagnose surveillance the asymptomatic infections will begin to help. Ill give you one example of hope to coast i used to think that the most difficult group that we were going to have do help contain this pandemic was basically College Students that i thought was going to be hard for us to be effective in getting them to fully embrace the messages that i just said. In the spring we had significant outbreaks on Different College campuses. What happened over the summer and the fall is many of the colleges and universities really stepped up to developing comprehensive mitigation steps that they really engage the student body to actually buy into. And then they coupled that with screening the student body every week so they could identify they asymptomatic silent epidemic that wasnt in the population and pull them out from isolation and prevent them from transmitting. If you look at them today wisconsin governor thompson who is now the acting president of the university of wisconsin they have a prevalence rate in their 27 campuses offer wisconsin of students and the highest risk group 18 to 25yearolds that demonstrate less than 3 . When you look in the communities enwhere they live that most of these kids dont liveus on camps there rate is between 10 and 20. It reaffirms to me that mitigation can work and even some of what your biases may be the more difficult to participate i can show you the same is true in the northeastern schools and here in the South Carolina schools. The idea that mitigation with routine screening surveillance and to be able to identify the asymptomatic carriers, these techniques to work and they are powerful. The truth is its hard to defd against this when he us with a question how many people are going to die between now and therefore he first . Im going to come back and say its really up too us. Vigilant people are going to see about taking to heart mitigation there is an inconsistency of the American Public embracing the message. Mask wearing, this mask wearing is not a political tool, its a Public Health to amend. Powerful health tool. Very simple but very powerful Public Health tool. We have taken a long time and their jurisdictions probably on this call that really dont embrace the importance of these mitigation steps threading courage people to look at the mmwr we put out in kansas. Shows the difference between a 6 decline are 100 in crease by one simple weather the county decided to embrace the mask mandate. It thats really remarkable. We should help you get that message out. Im going to turn t audience questions and folwup on something you saidhere the efficacy of surveillanc. I bet the main ranm testing tesn other colle campuses . The bee defined survelance . Well i think its really portant if you want to have a hindsight the real questn that isl out there is how much testig capacity do weeed as a nation in our Public Health response . I would say thats more test than we currently have. Vanilla oak is on how many tests we have. The second thing i will say is how testing is used. Is it random recent strategic . We would argue right now, one of the big challenges that hit us with this pandemic was we have modeled it, we have modeled it in our heads like a song or like influenza and sars and influenza and the way they work is they make you sick. Its not that complicated for you to have a case Identification Program that says lets look at people who are sick and find out did they have covid19 and isolate contact strays and control the pandemic are the problem with covid is its not like the flu. Its major transmission particularly in those of us under the age of 45 is its asymptomatic. You dont know who is infected and who isnt so all of a sudden that strategy of looking for symptomatic people like we did in january and february and telling symptomatic people to stay home and wear a mask, that works for symptomatic people but the problem is 50 or more in certain age groups of the people that are carrying this virus so therefore we have got to say wait a minute how do we then define asymptomatic transmission and we would argue on the College Campuses they figured out by doing regular weekly screenings every week variable now to identify the asymptomatic carriers of the asymptomatic infections, pull them out at the transition cycle, i salute them, contact trees around them and isolate those individuals and then youll be able to control layout break. Theretr has to be a strategic ue of test. We were recently in liverpool and angling englands. They just tested everybody in liverpool they figured out who was infected and they were able to isolate. We have areas now that we are trying to do the community watch, strategic testing in hotspots to try to understand. The cdc guidance is coming up this weekend trying to help institutions and Public Health groups and Companies Look at how they may be able to use routine screening. We think it might be useful to offer routine weekly screenings for teachers and others feel it might be useful to look at other people who have a lot of contacts in the community with people and set them up for routine screening so you can identify the silent epidemic. Youll see on the mmwr we list a number of different strategies. None of them have been really proven in the sense that this is the tool thats going to now contain the epidemic that we do know it is proven that they the help of the doubt by the side of the transmitters and mentioned i think the schools of Higher Learning are teaching us something. I think theyve been able to us. Its actually interesting if you look at the colleges andac universities that test everybody routinely every week the more you compare that to people who tested everyone in contact trees surround symptomatic cases constantly youllyo see this colleges that did the routine screenings once a week had a far greater less occurrence of covid. I just want peopleof to know weo have tools. Testing i think needs to be more strategic. One of the challenges is a lot of people that choose to get tested or what we call the worried well. I do think its important for us to be more strategic in our tesu set up a routine Surveillance System once a week or some portion of employees they get a sense of trying e to understands the silent epidemic there . You mentioned techniques like wastewater but i do think the biggest challenge right now is to identify thee silent epidemic and to try to get that silent epidemic out of the transmission cycle. Let me bring in ource audiene questions. This is derek lawson from arizona to represent the chairman of the board for the National Centers for American Enterprise that represents the native american businesses in the United States. My question is our committees have been hit hard by covid19 but there increasing numbers nationwide. Is there an incident if someone has recovered from covid that they could beld reinfected . Is a very good question and so far we have seen very limited evidence of reinfection. There have been several case reports. We have had other examples that i think really drive the messagt home. We had a camp thats was very careful about trying to control infection and what they had to solve the campers were so quarantined before they came to the camp for 14 days. They were all tested and they were all negative and then they were able to go to the camp. They were all tested and they werese negative. The camp decided they wanted to have a great camp experience so they didnt want to have that modulated by Something Like wearing a mask or not crowding because they felt they quarantined everybody for two weeks and they tested everybody. What happens to that camp that there is a huge outbreaks . Close to 90 of the campers and counselors all gotten fed it. Just to show you all that precaution but woe was interesting to give it your question there was a group of individuals who actually have antibodies when they went to that camp and none of those individuals got it. Right now we have pretty good evidence thatpr antibodies that are protected against reinfection. We just dont know for how long. We dont know if thats going to bewe for six months. We dont know if its going to be a year. We dont know if its going to be for two years. We will learn all those questions right now but its one of the things that gives us great hope that before we knew the vaccines were likely to work it really is a gift that these vaccines many of us thought they worked with 70 efficacy they would we would be excited but to see 95 efficacy for the first two vaccines now the other vaccines are based on the same what we would call immunological pardon. I think we have a lot of optimism that antibodies directed against those vaccines will be protective for some period of time which we are going to learn in the future and infection when infection is protected for some period of time. Another obvious question which the followup to that is given the efcacy of these vaccines do you imagine airlines or schools or employers might require vaccinations in order to participate . I think each jurisdiction and i talk t the Business Roundtable recently and that question came up and i think each institution are going to make those decisions. Its clear, i am a physician and im required to take a number of vaccines in order for me to be ablele to does in the hospitals that i used to work in. I anticipate being vaccinated against covid is going to be another requirement for health care. Its potential that i could see longterm care facilities might require evidence of immunity or certain longterm care facilities. Re i think the Airline Industry and you mentioned tt, i can see them trying to determine whether they want to make this a requirement for employment. Unfortunately even thoughe get control of covid which i think we will buy the Third Quarter of this year the pandemic and the world is not going to be corolled for multiple years. We will y always have the global risk. It will be a decision each industry will make but i do think there are Certain Industries where i think it would be important to protect their workforce and some other induries where it may be important to make sure that the protect their customers and consumers. E as theses vaccines get deployed groups will wrestle with that but i wont be surprised at the number of occupations or siations make vaccinations against covid a requirement. One of the examples i got w from a school and they are question was [inaudible] you have districts that wont open. Transmission has been lower than we were afraid of. What dyou think its going to take to get schools to open . I think its important. Ive tried to say this every chance i get so im going to say it again. I think its important to use dates to make those decisions. I was very disappointed in new york wednesday close schools when they hit their 3 point because as you pointed out we now have substantial data that shows that schools, facetoface learning can be conducted in k12 are taken in the elementary and middle schools in a safe and responsible way. We have a guy waited a number of schools and we are not seeing as you a pointed out cluster infections within schools in any significant way. Where we see teachers infected we are finding that teachers are infected from their spouses or their community and when we see students infected we find out that wasnt infection that occurred in thehe community. We are not seeing interschool transmission so i have been a big advocate and i believe this in my heart that Public Health interest in k12 is to have them in facetoface learning for all the reasons we talked about. Thats where they get food programs and services and sadly thats where we get reporting from child abuse. This is where they get significant socialization. Obviously as we have had issues of Substance Abuse and suicide as you know. I think its healthy for these kids to be in school. That said they have to do it safely and that did it responsibly and when this was started over the summer and no one really knew for certain. They caught these thought these Public Health measures would work now the data clearly shows us that you can operate the schools in facetoface learning in a safe responsible way. And what ive asked his dont make the decision based on what i have said. Lookn at your schools that have been opened in evaluating see if they have been a place of major transition. We have not found school to be a major source of transmission. We seen other sources of transmission. Like you mention mentioned surprisingly, Family Gathering so i do think we should use that data and make decisions based on datans and right now, and i do think its important that the answer to controlling the covid pandemic is the answers not r cessarily closer whether schools are business. There may be some strategic closures that would make sense. Im a strong advocate that i dont think its in the best interest for Covid Control that the bars are open until 2 00 in the morning where people are without their masks and drinking in private bars and they shouldnt have 100 people that they have 200 people in it. Looking strategically but i dont think we benefit at all in our nation and controlling covid by broadly shutting down business. Clearly if schools can learn how to do this safely and responsibly, airlines can learn how to do this safely and responsibly. Businesses can learn how to do this safely and responsibly. Again we should use data on when we define an industry that imposes a unique race that may require some type of prescriptions rather than the restrictions unfortunate it happened in the spring or summer. Some things you said there, one was as a mom kids try to find other outlets which is not a setting like school. I totally agree with you one of the greatest tragedies early on was when schools closed was the social disadvantage to individuals that were in of workforces that didnt have the luxury to telework or because they were in some service industry. These single mothers and how they had to deal with it was they had their kids then go stay with their mother which is exactly the opposite of what i want to do in protecting the vulnerable. I dont want to see silent asymptomatic infected children stay with grandma who might have diabetes. I think really the point is that at least we have the data now and they really want to applaud the teachers that had the courage to take the chance on the Public Health advice that was being given knowing that we were goingas to be monitoring it very carefully. I also think the parents would have the courage to take the risk because in the absence of day that was all opinion. Thats what im saying now. Inin the new york situation dont do this off of your opinion. Look at your date and im glad to see they are looking at Elementary Schools. The truth is we have enough data now to show Elementary Schools are not the source and when careful studies are done youll see kids in Virtual Learning probably have a higher infection rate than kids who are facetoface. He said universities have learned how to do it in your diversity is a learned how to do it. I t think the next audience questions gets to that. Afternoon dr. Redfield. I amis doug luzader president of the Minnesota Chamber of commerce. Here in minnesota we have seen growth and Community Spread that has shown up in the workplace. This has caused concerns with availability of workers and threatened certainty among consumers as well. What can you offer for a device and what with their employees do to limit the spread to their business . I think you raise a really important question that goes over all of this. Within schools, whether its businesses, the key to controlling infection schools andha businesses is just what yu said. Controlling Community Spread. How do we control Community Spread . I do think its just gng to come back and i dont know what their mandate versus nonband nonmandate that Leadership Matters in terms of messaging and everyone comes to recognize that this is a serious situation. I know that if i happen to walk outside to my car on the way to the airport from the parking lot in a nanosecond now i feel like i didnt put my pants on if i dont havehis mask on. I can tell you sometimes i got halfway tough the gate before he remembered and people were looking at me and i rlized he didnt have my mask on. Think making it a social norm and i have 11 grandkids now. The youngest one is to bury the truth is all of the ones that are or two, three to four, four to five they are all wearing their masks. Th are very conscious of it. The more the community can embrace these mitigation steps i think is the more that these businesses can start impacting Community Spread. Thats really where its happening if they decide to do strategic testing that i suggested in some businesses that help them begin to identify their own workforce where the silence bread is coming into their workforce. That becomes a very important tool of identifying the asptomatic infected individuals so they dont become an amplifier within the work which we know this virusic this virus is really infectious i think itsrobably the closest thing and im overall it is by training. I think this virus is the closest thing we have to measles we have ever seen but its interesting the mitigation we are doing in this country right now our influence a res are at historic lows. We are still just about to get into influenza season so i reallyncourage everyone to get involved but the reality is our Spring Season of the flu under Summer Season of the flu in early fall season are strong. These mitigation steps are really helping and we are only doing them 50, 60, 70 of the American Public for the flu but its not enough to contain covid. Its really really really infectious andnfortunately the reason its so infectious as opposed to the flu is the instrument of transmission is not a sick person with a cough. The instrument of transmission is an asymptomatic 23yearold that feels great. Thats turned from a doctor redfield a talk about the vaccine for aou minute. We get a lot from employers acss the country who ask Early Vaccine distribution will go as it should to help Health Care Workers the most vulrable population and then turn to essential workers how should we be thinking about the finding essential workers in that context . You know thats a very good question. David we the department of Homeland Security kind of makes those classifications as you know. Obviously each community and i n tell you someone that of course one of myons who is in recovery and i tried to help one of my daughter started family obviously my own family if there is no income coming into the household theres a problem. Everyone i think and read look at whats really essential to them to be able to maintain theirr livelihood. This is one of the reasons i really feel strongl to the kneejerk response that control coviis how we have to limit the economy or limit business. The answer is to figure out how operationalize that business in the safe and responsible way. And i do think for many i actually think teachers are really essential. So i think each committee is going to define it and theres a technical definition of it by Homeland Security where they do include teachers so i dont know suzanne fay really answered your question if you want to angle it. When i see a single mother raising four kids and she may be doing some type of work in the Grocery Store or her she may be helping provide custodial services, for her, she is essential for her and her family. I do think there is the other aspect of what we need pple we first got into this essential worker issue we were seeking you are is suggested if an essential worker and yo were exposed and you are asymptomatic that you could return to the essential job as long as you are asymptatic and monitored your symptoms and your employer monitored your symptoms in the wear a mask. Part of that really came out up when we were in a state of washington on a visit there where they had a significant number of police and firefighters and rescue workers who were all being isolated and they didnt have a fire department. This wasnt part of a good balan. There is essential services that are critical to the function whether it was First Responders or hospital workers. We had one Hospital System in washington that had ov 600 Health Care Workers in quarantine or his you know and some of our Industrial Work plants. I dont think this country knows to having a came protein shortage because of the outbreaks we we having. I think its important for each family to understand that each group. Ive become acutely aware that thr number people who work that dont have the luxu that some of us had to be able to continue her work as longha as e are on zoom or a webcast. A lot of these people have to actually go and work in the environment and we need to work hard to make sure how to make that safe and responsible only to honor those people. You can p imagine all the grocey store workers decide it was too risky to go to work. I guess im a little bit confused, a lot confused. If dhs has the role of classifying essential workers but these decisions being made ater the local level who is in charge of privatizing that . Vacci distribution we can come back to that for central workers at dhs. I was just trying to make you at least aware tha im aware that for individualamilies theres also an bitrator who they beeve is essential. Dhs has to disclose it as essential today was just trying to show that ive come to understand that theh is list doesnt necessari a worker supporting his family keeping his Jewelry Store was essential work is without a tea couldnt support his family but im sure many of you people in commerce understand that, aot of people have suffered by having their this iss close and i would argue probably didnt need to be. We didnt make a strategic decision. Rather thanod stepping back andi think now we a much more smarter we have datare behind us and these decisions need to be made. When it comes to vaccines clearly the issue vsus exciti that we do have a vaccine and wthink people should give crit where credits due. One is suggested we have a vacce before the end of the year i dont think people saw at is something that is feasible. The reality was the mission was assigned to get a vcine before january 2021 as you know we have to vaccines now with the submissions. We havtwo more vaccines and we have for vaccines that are deep into phasee 3 trials. Its very probable before february we will have a think obably three or four vaccines approved in the United States which is really remarkable and i think we will have two of them are proven for the first of the year. The challenge will be that its going to be constrainedha in supply. Ultimately there will be enough vaccine for everybody ithe United States that wants to get anohe vaccine. Ive said publicly that i believe that will be somewhere inhe second or Third Quarter of 2021. Its been criticized by hers but i think it will probably be right on target. I do anticipate the vaccine will start to be delivered to the ameran public this month. Currently the way this will work is we have erred by zurich maybe that it made preliminary recommentions and they will be modifying those after the ua is approved in december but more importantly have worked since the summer with each of the 64 jurisdictions of this nation for them to develop what i call a microdistribution point. They will get a lot on a vaccine sed on the macrodistribution from the feder government and those allotments have been assigned for the first wavehe of vaccine that will be distributed this month and ultimately the individualvi governors and jurisdiction lears are going to decide what i called a microdistribution. Find the acf makes recommendations in the cdc makes recommendatis but ultimately its the local governor who imakes that decision on how tht vaccine will be dtributed in their communities. Those vaccine plants evolved and developed and worked through over the last three months and i anticipate that will be an evolving situation as more and more vaccines become available. I dont think it will be unified that every jurisdiction is going to do exactly the same thing. So, u have been clear that you think theres a good chance that we are back in some sort of new normal by the fl. And yet we ve questions about how the shoulde planning for the year and this next question gets to that tree could we roll that question please . . Hi. They are redfield and the ceo of the Georgia Chamber of commerce and we are excited and proud c o have the cdc headquarters here in the peach state. Lot of people are really focused on q1 and q2 of next year. A lot of us have programs events and receptions that we planned throughouten the year and im curious what it buys you have for us as we try to plan those events for q1 and q2 q2 . Ms. Clark dr. Redfield thank you. Important question. I think we are going to still be heavily in mitigation for li tha you for that very good question. We wl be in mitigation for limiting crowd size and limiting gatherings during that timeframe. So you are think going to want to be vigilant and smart abo it. Outside is better than inside andthmaller is better than bigger. I wouldnt beurprised if a lot of jurisdictions either the state or local level still had very significant guidelines for prep. You can see when i tell you that if 30 of the people in the dakotas that if you have a crowd size of 100 people there is probably a lot of positives inn that crowd that you dont know about and so this virus is so, so easily transmissible. You are going to have to plan for the First Quarter of 2021. I dont think you are going to have any significant grace from people being vaccinated or an antibody from previous infections. I think the first two quarters. Ticket in the First Quarter of 2021 and i think most of the second quarterer is going to bea fairly restrict to the environmentor us when it comes to crowds and crowd events. Dont think we are going to start getting out of that until the fall of 2021. Correct we ask you another question. The press is reporting that you mayng be releasing new guidancen quarantine periods to seven days. An issue we talked about backstage was the clearance assistantfu guidance [inaudible] talk toa the audience about the quarantine. Mcafee would. I think its important and i appreciate suzanne what you said. Agencies like ours have to have the courage to change the way of data that says we need to change and i will say not everybody understands that. When we thought this virus was largely transmitting symptomatically we then thought well if you are symptomatic you wear a mask and that will protect it so i wanted that too but we didnt realize in early march that a lot of the infection was asymptomatic. Therefore i dont know who is infected. If i really want source control and want everybody to wear one and that get into a lot ofat controversy. We change based on data so quarantine is in isolation a key tool is imagined it could try to keep this virus from spreading. A lot of people never understood if i was infected i was told to isolate for 10 days but if i was not infected i was told to isolate for 14. A lot of people suggested that maybe i didnt make any sense because why do i isolate for only 10 days if im infected and for 14 days if im not infected . The reason for that is if i know im in fact did either i got tested and i was asymptomatic or if i became symptomatic and got tested we know the virus shedding within the body with the individual who is infected really does become negligible and thats why we are able to have people test of quarantine when they were infected at 10 days. We dont know if you are exposed when does your body start to replicate the virus and originally we had studies that said the average was five days and later. Studies that said it was sevenpoint i think somewhere in the seven day. So we only had data to really look at when was the probability that i was not going to somehow start shedding the virus and it turns out the greatest probability that we would not miss anybody was 14 days. Thats why we had that. We have since done a number of studies because obviously 14 days quarantine has impact on activity in 14 daysti quarantine hasnt factor fact on whether people quarantine. We have done a lot of studies over the spring and summer that we were able to get an update that we could model. You are right today actually the new guidance is coming out from the cdc but i think they are doing a press as we speak and that guidance is again based on data that we gathered and modeling of that data that if you isolate for 10 days that the probability that you will start replicating the virus after that is about 1 . So its a balance. Its not the 14 days is bad, its just how the society wants to balance it . Do you want to i get 99. 9 or if we were 99 is that good enough . Also shows if you test and we have done this with the fcc football leagues and trying to gather this data in some College Groups if we tested and you are negative its about the model would predict we will define at least 95 . The cdc now is coming out with guidance today that allows people to make those judgments that they can test out at seven days and they can get out at 10 days but at the same time if they want t to be perfect as cle to perfect they can stay in isolation for 14 days. Its going to make a big impact. Wet found a lot of people, getting people to commit to getting out of the transmission cycle i think is important so that the data with the test between day five and a seven and 10 days without. It feels really important especially with the Community Leaders that we get out the information when information changes is because we studied more and thats a good thing. They are very intertwined. We have seen people out of work aand out of school. So balancing it is so important. Let me try to end on a positive note and maybe im misleading the witness here but do you think our experience as a country from covid19 will help us prepare for the next crisis which seemed sure to to come in some ways . Do you feel we are learning something . You talk to the scientists learning as they go but do you think the public is learning to . I think there are a lot of lessons in the first one that i want to emphasize his lifetime is cdc director is coming to an end in january. This nation was severely underprepared for this pandemic that i think we have to call it the way it is. When i became cdc there i was not prepared to understand how little investment we had main made in the core capabilities of Public Health whether its premier Public Health and the premier Public Health nation in the country. We really have not invested where we need to be with data analytics. We really havent invested in what i call laboratory resistance to make sure our Public Health capacity has multiple platforms and we rolled out our original test despite all the news. We tested the day we did it and to this day where there was a problem where we manufacture the test for the Public Health labs. One of the regions had a technical flaw either contamination or design flaw which was corrected over the next five weeks. Since then the Public Health committees have that. We had no or soviets. We developed that test on a fluke. None of these Public Health labs have high capacity. There was no resilience and Laboratory Technicians if they wanted to do research. Public Health Care Work tracing was up to 50 a people so there s a huge lack of investment which i hope this pandemic will change on the other hand im concerned if the vaccine comes through people may forget and their a bend testimonial congressional testimonies on this issue and that its going to cost this nation straight out about 8 billion. As you all know the indirect cost would say in terms of economy may be another fit in our 20 billion. Seem wise for us to invest and 100 billion a week to invest across the nation remembers cdc most ofth our funding goes to travel Health Departments and if you look at any of the states where the dominant funder of w the health. Thats the first lesson and really realize its time for this nation to have a Public Health system that not only we need but we deserve and i hope thats the one big lesson for the second lesson for the public i think and its a painful lesson is how critical it is just to have arminian messaging. When you really want to get everybody on board youve got to have clear unified reinforced messaging. Iag think the fact that we are still arguing in the summer about whether m or not mask work or not was a problem. I think the fact that we are arguing about, the fact that we close health care we didnt need to close health care. We needed to maybe close some elective cosmetic surgeries but we didnt need to have 85 of kids not get their vaccinations. We didnt need to see individuals no longer seek emergency care. We saw many more heart attacks at home than we didat in peoplen the hospital. We didnt see cancer screenings so it needed to be much more thoughtful andde much more surgical much more datadriven and i would say the same for the economy. We didnt need to have a rod shutdown. We need to have a surgical thoughtful datadriven approach that was able to validate this. We didnt need the shutdowns. So i think hopefully what well be able to learn is that its important to be thoughtful and stepep back and not have a tendency to as i said the salami approach. We are going to do it for everyone. People want to get the schools open like itself. Whenever one of the schools opened in safely and we never wanted them opened a responsibly. We wanted to work to figure out how to keep them open safely and responsibly because we believed they were great Public Health impact. Id say the same thing about his nose. Our nation runs on business and probably one of the greatest casualties of the pandemic this year was the impact on the business community. As i mentioned the impact on General Health care, the impact on their childrens education. These to me are extremely significant so i think thats a lesson, consistency and messaging and thoughtful surgical interventions that are cclearly designed based on data that they have accrued to world and help i guess mpac the pandemic. I know im going to do a lot of reflection when i get out in january because i do think we owed the next group, what did we learn . What did we learn that works, what did we learn that didnt work so that the next time this happens and there will be a next time this nation is much more prepared. I will say the last thing i will just say is we should celebrate, we really should celebrate the innovation that was brought to bear. When you think about it we have these vaccines and two will be approved before the end of the year into soon after that. We have i vaccines now that are moving through the system. When you look at the new therapeutics, when i am sitting here last march and april i dont know how many of you know this for but 27 of all deaths in america in april were caused by covid. 27 and now today its about 11 which is still huge. Normally we would think these pulmonary death would be 6 but it was 27 . The mortality and someone under the age of 70 was over 25 which is not really good. You have a one in four chance of dying and they finkenauers impact the monoclonal antibodies inflammatory strategies and convalescent plasma. You will hear more about it from us that think this week many of these therapies were Monoclonal Antibody and even remdesivir these therapies need to be given before you get sick enough to go the hospital. As soon as you get diagnoses you get diagnosed to should be it will to get into gear and get treated. They will keep you from having to go into the hospital. Their there are two phases of the illness, the virus and the inclination. The viruses and charged and when you are still out of the hospital thats when you need it. We have mortality somewhere between three and 8 . To celebrate the innovation that this nation is brought to bear. That innovation wont get us where we need to go if we dont come back to what i said before. We need a Public Health system that is robust and it needs to be mutual and we need to have consistency of messaging so that the American Public to articulate the critical mitigation steps that we all need to take to beat this pandemic. Thank you so much for that and i hope youll come back and help us get out the clear message about the efficacy of the vaccines when its time. In the meantime i think the country also needs more calm wisdom from people like you. We are so pursued if of your message today for this country and its citizens citizens. Thanke you so much dr. Redfiel. Thank you redfield. Thank you so much. Into her audience thank you so much for tuning in. He you can catch past episodes at u. S. Chamber of commerce. Org or and youtube. Please stay safe, wash your hands, wear a mask get your flu shot and take really good care of your selves and each other. Well see you again soon. Here we are in this moment after electing the first black president since 2008 the country is responded by Voter Suppression laws voter i. D. Laws the vitrol the tea party and we elected donald trump. We are at a crossroads. Who are we going to be . At the heart of it all theres always been this moral question. Who do we take ourselves to be . Im pleased to be leading our