Serious questions have emerged about how the federal government is responding. Around the world, countries are beginning to take significant measures, including restricting travel, closing schools, post postponingous religious builder measures and quarantines. Critics say the Trump Administration has been slow to address the coronavirus crisis. The president and his team have been downplaying the risk, saying last week that everything would work out fine because the april,will go away by contradicting the c. D. C. Itself. We need to be it what to trust the information we get from the government and trust that the Trump Administration has best a trust that the Trump Administration exhausted years ago. There is no question that the president and his a administration are mismanaging their response. President trumps personal frustration with in action in the early days, polarizing politics and a lack of Clear Communication has undermined publics confidence. The publics continue to receive mixed messages with few daily briefings and with public and Health Officials often prohibited from making public announcements. So where do we go from here . The Trump Administrations missteps should not stop us from coming up with a few solutions. That is why we are so we 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. Piece of diplomacy this. Ce vetows the piev diplomacy played to really help the ebola arms around epidemic. So when i say National Security threat, i mean that we need to apply full gove approach to this. We have to organize ourselves around it. What does that mean . Identifying a purchase andational security threats approaching and organizing our government from that perspective. Rons that postebola on excellent recommendations. As you heard, he was dubbed the u. S. Ebola response coordinator. I remember his last recommendation to president obama not displaying any internal deliberations state secrets here his deliberation on his way out the door was, you should never, ever have to appoint no future president should have to appoint a diseasespecific czar. President obama took that recommendation. The National Security team as a whole took that recommendation. What did we do . We created a Global Health security and pandemic preparedness directorate withi