Transcripts For CSPAN2 After Words Deborah Birx Silent Invas

Transcripts For CSPAN2 After Words Deborah Birx Silent Invasion 20221021

For many decades. Weve all known you in the Public Health field, and its a real privilege for me to be here with you to talk about your brilliant new book. I want to just start simply, you know, explain the title silent invasion and the reasons you wrote the book, what you talk about all of it at the beginning of the book. Guest great, professor. And im going to call you larry, so thank you. Its really an opportunity to be with you again. We have had a a long career together battling pandemics around the globe and making sure the most vulnerable are served, and hope we take that message here in this country. But i called it silent invasion to really raise the alerts that despite the capacity we hadnt in diagnosing truly diagnosing respiratory diseases ever in this country. I was confronted that in africa in 1998 where fever was treated first as malaria and then a Something Else and then a Something Else, and maybe it was tuberculosis and maybe it was hiv, and it was all presumptive and we didnt know what was specifically harming the people of Subsaharan Africa. And we worked with the private sector and now we can diagnose hi tv malaria no matter where you live in Subsaharan Africa, the matter if youre the farthest end of the road or in the metropolitan area. And to come back to the United States and find out that 90, 95, 99 of 9 of flu was diagnosed presumptively and that we are only surveying for symptoms of respiratory diseases and making assumptions about what people were infected with, i found that really shocking in this day and age. Something appropriate for the 20th century, not the 21st century. So i really wanted to alert americans to the fact that we still could suffer a silent invasion. This virus came to a silently because we were not testing what our common respiratory diseases are. If you dont know its flu and you dont know if its not flu. So actually a call to action for defendant Laboratory Diagnosis of all of our respiratory diseases so that we know whats here and we know whats coming. I think even today the virus is silently moving around our communities and we are not adequately making it visible to the American People. Host yeah. I want to talk, they get a little bit more as we go along about your remarkable career with hiv, tb, malaria and also ebola, h1n1 influenza, sars one, zika. I want to get into that, the rich history i know youve had and youve been really leading the Public Health response in america and globally for such a long time. But theres another, the idea of silent invasion, you make another point quite forcefully and i think in the book about the silence of asymptomatic spread and you talk a lot about the idea that if somebody has flu they have symptoms and, but you can have a lot of spread before their symptoms arising. Can you talk a little bit about that part of the silence . Guest thank you. This virus in many age groups is invisible, and then very visible and a group of age groups and people with comorbidities that end up having severe disease and dying. So if you dont see it and you dont see it coming, then you miss all of the tools that we have to utilize them so that americans that only can survive but thrive. I often use silent invasion because i come out of the family of a lot of scientists. Were big sciencefiction fans so i wanted to really give voice to those of you who love sciencefiction. This was not sciencefiction but i think in a way many of the sciencefiction books have been talking about pandemics and global spread for a very long time, and that as societies we are not ready. And i think, im hoping, at us when theres an appendix at the end with clear legislative fixes that need to occur. I feel like even today with all the tools we have we remain vulnerable to silent Invasion Community by community because we not picking up the asymptomatic spread. Host i love the sciencefiction. When i grew up it was kind of, my Favorite Book was the microbe hunters, the early story of people that are looking into anthrax and tb was just, you know, fascinated me at the time. One of the things you said you wrote the book for, when you said you were writing it not to condemn, not to command but to recommend. And i want to get at the very end of our interview, debbie, the idea of what your blueprint for the future. But let me take you back now, i think i want to go back to the beginning, both to the early days but also to something that you said early on that you are compelled to accept the job knowing a donald trump was. Talk a little bit about why, when you got the call, you were reluctant to answer that call. Guest well, for those global Public Health people who have known me for decades now that when i see an injustice, when i see an inequity, when they see that that results in peoples lives being altered it something i am compelled to address. And so in january i could see this virus come, and obviously i was responsible for Subsaharan Africa and asia, and i was very worried about everybody that we serve their immunity by community, and a look at the data myself and i was like this is going to be serious, so my first up was to go to the white house to the Africa Bureau of the nse, the National Security council, and say to them i need to have an emergency meeting with all of the african diplomats. And so before the end of january with could all the applicant, african diplomats in the indian treaty room at them going through why im concerned, dr. Fauci fox hunter found utah, dr. Redfield about what were doing domestically so that africa could no and cable back to the country to things. That we need to rapidly develop tools and that they can tell their ministries to utilize the capacity that we built over the last two decades with pepfar. I wanted them to know that our resources were available immediately. So im trying to get africa and asia ahead of the curve and were sending out cables for state Department Come to all the embassies about my concern and how to utilize pepfar dollars to expand testing and let the ministries of health know the depth of my concern. Im assuming that the same thing is happening in the united unitd states, but then i just watched over february, i was over in africa most of february, and im watching and im watching the nightly news and im watching the reports of the press conferences that the task force and the president are holding, and to keep talking about the risk of being low, that we only have this handful of cases, and then were going to close our, we are going to close to china but were going to let all of the expat come back and only going to screen i symptoms. And i was like, the virus is everywhere. So did have a friend in the white house who was the husband to and pottinger who i i knew quite well and it felt they werent acting sun city him all of these messages and data about how severe i think this is going to be and is taking it to the task force and is telling me theyre not listening and im like please tell them again. Im like pushing up these messages and is calling me and say need to come back and help but, of course, my commitment was to the people i was serving and, frankly, i knew about the white house. I knew how, i frankly knew how i would be perceived, even though i was a Civil Servant and had nothing to do with trump political machine, i knew if i went into the white house to help, that all of their perceptions about the president would also become their perceptions of me because most people in america didnt know me. Overseas people to meet but not in america. Host we all know you here, for sure, in the field stretches so i kept saying no, but i could just see the tsunami coming and i felt like the diamond princess with such a real example to me about how america was misjudging this pandemic by only testing symptomatic people and the people they were living with and that testing the crew on that diamond princess and only looking for symptoms. The crew was much younger. I knew the virus was spreading through the crew. I just felt like we were not utilizing all of what i had learned and doesnt learn by working globally on pandemic by pandemic to bring that Knowledge Base to the United States. So finally out of frustration i answer the call and i came back. Host do you regret it at all, debbie . I mean, looking back and seeing what President Trump did in downplaying, were going to get into that because you talk a lot about that in the book, about flulike illness, low risk and other kinds of issues like use bleach and so forth. What do you think when you think back to those days, those early days . Well, how do you reflect on it . Guest the reason i dont regret it is because i know what happened upon my arrival. You know, those people who know me know that doesnt matter whos president. Ive worked with president s across the world. I dont care whose president , i dont care his prime minister, i dont care whose minister of health. I believe that i can assemble the right date to convince them to do the right thing, and ive seen that happen throughout my career. I saw african president s finally let us address the Lgbt Community to people who inject drugs, to people who are in prisons, who let us do the right thing to prevent hiv and to prevent and to treat those who needed our treatment. So i believe having worked with so many that with the right data i could convince the president and the Vice President that this was serious. And so i arrived with my list. I was really happy that first week that immediately when i said to the Vice President , heres a list of people to immediately call to the white house, we have to have our commercial laboratory developers make tests, not just pcr test but antigen test an antibody tests and weve got to have it immediately and youve got to get them all here. By wednesday they were all there. And so it was a lot of action that first week both on pushing therapeutics, pushing vaccine, pushing testing, getting people to take this much more seriously, i just want to thank my european colleagues because obviously i knew a lot of them from working on the global fund for nearly a decade. And they helped me. They sent me their data. They were about two weeks ahead of us, and i used that data for the european travel ban, the 15 days to slow the spread and the 30 days to slow the spread your kind of people go back and think when history is written they will see that that first wave, compared to many other countries, was much more contain than any of the wave subsequently i think as a country we reacted seriously in those three to four weeks and then we didnt. That was very disconcerting to me, certainly i talked out and about how the president got very different analyses from his economic, his cea team, and really that unraveled the president s confidence that my data was correct. Host yeah, you show so, i mean, or me in reading the book the one thing that comes across as your love of data and your frustration when it is not there, when its not accurate, when its not comprehensive, when where having to borrow data from other countries to make decisions here when we should be the vanguard, that really came through. For i kind of go on and want to look more in depth at the u. S. Response and also a little bit about the early days in china i cant help but ask you, didnt really feature in the book but you talk a lot about africa. You probably, you know, the one american in this nation that knows africa and its intersection with disease more than anyone else. What do you make of how covid is as transpired in africa . We were thinking it was cataclysmic end engine warnt early on, and yet theres some evidence that theres been less severe disease. Maybe thats a reporting issue, maybe thats an issue of just simply having a younger population. Whats your take on africa and covid . Guest well, larry, thats a brilliant question and it intrigues me and it intrigues me to today. Certainly some of it is testing and reporting, but you cannot hide severe covid disease and you cant hide most of the covid deaths. Ive said that across this country to many governors and mayors. There will be a full accounting state by state, county by county by what actually happened. But in africa they were blessed by three things that were really critical. Across the main part of africa that most people know around the equator going north and south, from east to west africa, the median age is between 15 and 14. 50 of the population is younger than 14. And we know from data now that this virus was very selective in general for the elderly. And so if you look at the continent, and that includes north africa which is a very different situation, i can talk about that separately, but africa as a continent has less than 9 of the population over 65. 65. We have almost 20 . The other big piece of it though is obviously with a history of hiv and tb, a lot of the individuals in the 90s, in the early 2000s before pepfar and the global funds succumbed hiv, millions and millions of people, so it emptied out a lot of the people who could invent 30, 40 and 50 at this point. We exchanged as a community the ability to people in africa to thrive, despite hiv tb and malaria. I think the second point is much lower comorbidities compared to the United States, much less obesity and thats what if you look across south africa, botswana where they do have older individuals, where that you have more comorbidities use a higher fertility rate from covid. And so the younger generation, the less comorbidities certainly underreporting but but i cal you when you look at access of death you dont see the same level of excess deaths in 2020 and 2021 that you see in the developed world. And i think its really a wakeup call, because like you, larry, we all thought pandemics would be horrific in low and low middle income countries, and in the end this pandemic singled out upper and upper middle income countries. Host incredible. Guest and there was no Natural Alliance of those countries. Because we were all focused on low and low and middle income country. So again there were no formal channels to really share information between our european colleagues and the u. S. And our Central American colleagues and canada. I mean, because we thought it was going to be there, and it was here. And i think this really opens up a glaring mistake that we all made over the last two or three decades is really establishing clear data exchanges among the upper middle income and upper income countries. Host yeah, very important point. Just very briefly on the early days of, you know, china and wuhan, and what the president , you know, knew or should have known and when. And also just reflect elizabeth about, you know, there was a significant clash between the white house and china on a number of issues, but particularly the lack of early reporting and lack of early reporting in an honest way in terms of human to human transmission. And then that ultimately led to the president sending a letter to the secretary, u. N. Secretary general, not getting a 12 month notice of withdrawal from w. H. O. How did the all unfold in the white house and how did a plate into the early days of the u. S. Covid response and the global Covid Response . You know, larry, i wasnt here and i could never really understand. So when i arrived at the white house, no one gave me any cia or other cable to suggest that there was information coming in through secure channels about how severe this would be. So when i heard that bob woodward interview, i was as shocked as america was. Because when i arrived, when i say no one, i mean no one in the white house from the nsc to the cia to the Vice President to the president , no one shared with me that they had an understanding about the severity, you know. My feeling was they are not taking this as severely, i mean as significantly as i think its going to be and thats why we have to make these changes. But that was very disconcerting to me to find up, i think that woodward interview was june or july 2020. I was shocked, and still no one showed me that that actually existed. So to this day ive never seen that document that talks about the severity. The reason i knew it was going to be severe is you could see on social media that the hospitals were getting overwhelmed in january. And at the same time china saying we dont think theres human to human transmission. So if im seeing the social media posts, the w. H. O. Should evincing those social media posts and they should have gone to the world and said this virus is highly contagious, spreading rapidly and result in significant illness in those over 70. I am still surprised by that. The data was out there. It may not have been coming from china per se, but that was the whole point of putting w. H. O. Representatives in every country is so that you werent always reliant on just what the National Reporting was. And after what happened with sars, i thought we had learned that lesson collectively as a community, but i think, once again, that early misleading about human to human transmission i think resulted in a lot of countries making very poor decisions about not developing tests and not really taking this as seriously as a should of tricky at such an important point. I want to stress one of the points you made because you heard dr. Birx say that she got to the white house and none of our most sophisticated machinery of government, you know, cia, intelligence, National Security, white house staff seemed to be aware of the seriousness of it. I mean, thats a stunning statement. Guest i think nsc was because matt was trying to get me back there. I dont think the agencies really were acting host including cdc. Would you include cdc and that . Guest you know, i dont know what the cdc was thinking at that time, but i can tell you that they did not prepare the country for a countrywide pandemic that was evident already in china. And what do i mean by that . Getting up the data streams that you needed, bring in the commercial laboratory developers. Its great that he worked on tests for the Public Health<\/a> field, and its a real privilege for me to be here with you to talk about your brilliant new book. I want to just start simply, you know, explain the title silent invasion and the reasons you wrote the book, what you talk about all of it at the beginning of the book. Guest great, professor. And im going to call you larry, so thank you. Its really an opportunity to be with you again. We have had a a long career together battling pandemics around the globe and making sure the most vulnerable are served, and hope we take that message here in this country. But i called it silent invasion to really raise the alerts that despite the capacity we hadnt in diagnosing truly diagnosing respiratory diseases ever in this country. I was confronted that in africa in 1998 where fever was treated first as malaria and then a Something Else<\/a> and then a Something Else<\/a>, and maybe it was tuberculosis and maybe it was hiv, and it was all presumptive and we didnt know what was specifically harming the people of Subsaharan Africa<\/a>. And we worked with the private sector and now we can diagnose hi tv malaria no matter where you live in Subsaharan Africa<\/a>, the matter if youre the farthest end of the road or in the metropolitan area. And to come back to the United States<\/a> and find out that 90, 95, 99 of 9 of flu was diagnosed presumptively and that we are only surveying for symptoms of respiratory diseases and making assumptions about what people were infected with, i found that really shocking in this day and age. Something appropriate for the 20th century, not the 21st century. So i really wanted to alert americans to the fact that we still could suffer a silent invasion. This virus came to a silently because we were not testing what our common respiratory diseases are. If you dont know its flu and you dont know if its not flu. So actually a call to action for defendant Laboratory Diagnosis<\/a> of all of our respiratory diseases so that we know whats here and we know whats coming. I think even today the virus is silently moving around our communities and we are not adequately making it visible to the American People<\/a>. Host yeah. I want to talk, they get a little bit more as we go along about your remarkable career with hiv, tb, malaria and also ebola, h1n1 influenza, sars one, zika. I want to get into that, the rich history i know youve had and youve been really leading the Public Health<\/a> response in america and globally for such a long time. But theres another, the idea of silent invasion, you make another point quite forcefully and i think in the book about the silence of asymptomatic spread and you talk a lot about the idea that if somebody has flu they have symptoms and, but you can have a lot of spread before their symptoms arising. Can you talk a little bit about that part of the silence . Guest thank you. This virus in many age groups is invisible, and then very visible and a group of age groups and people with comorbidities that end up having severe disease and dying. So if you dont see it and you dont see it coming, then you miss all of the tools that we have to utilize them so that americans that only can survive but thrive. I often use silent invasion because i come out of the family of a lot of scientists. Were big sciencefiction fans so i wanted to really give voice to those of you who love sciencefiction. This was not sciencefiction but i think in a way many of the sciencefiction books have been talking about pandemics and global spread for a very long time, and that as societies we are not ready. And i think, im hoping, at us when theres an appendix at the end with clear legislative fixes that need to occur. I feel like even today with all the tools we have we remain vulnerable to silent Invasion Community<\/a> by community because we not picking up the asymptomatic spread. Host i love the sciencefiction. When i grew up it was kind of, my Favorite Book<\/a> was the microbe hunters, the early story of people that are looking into anthrax and tb was just, you know, fascinated me at the time. One of the things you said you wrote the book for, when you said you were writing it not to condemn, not to command but to recommend. And i want to get at the very end of our interview, debbie, the idea of what your blueprint for the future. But let me take you back now, i think i want to go back to the beginning, both to the early days but also to something that you said early on that you are compelled to accept the job knowing a donald trump was. Talk a little bit about why, when you got the call, you were reluctant to answer that call. Guest well, for those global Public Health<\/a> people who have known me for decades now that when i see an injustice, when i see an inequity, when they see that that results in peoples lives being altered it something i am compelled to address. And so in january i could see this virus come, and obviously i was responsible for Subsaharan Africa<\/a> and asia, and i was very worried about everybody that we serve their immunity by community, and a look at the data myself and i was like this is going to be serious, so my first up was to go to the white house to the Africa Bureau<\/a> of the nse, the National Security<\/a> council, and say to them i need to have an emergency meeting with all of the african diplomats. And so before the end of january with could all the applicant, african diplomats in the indian treaty room at them going through why im concerned, dr. Fauci fox hunter found utah, dr. Redfield about what were doing domestically so that africa could no and cable back to the country to things. That we need to rapidly develop tools and that they can tell their ministries to utilize the capacity that we built over the last two decades with pepfar. I wanted them to know that our resources were available immediately. So im trying to get africa and asia ahead of the curve and were sending out cables for state Department Come<\/a> to all the embassies about my concern and how to utilize pepfar dollars to expand testing and let the ministries of health know the depth of my concern. Im assuming that the same thing is happening in the united unitd states, but then i just watched over february, i was over in africa most of february, and im watching and im watching the nightly news and im watching the reports of the press conferences that the task force and the president are holding, and to keep talking about the risk of being low, that we only have this handful of cases, and then were going to close our, we are going to close to china but were going to let all of the expat come back and only going to screen i symptoms. And i was like, the virus is everywhere. So did have a friend in the white house who was the husband to and pottinger who i i knew quite well and it felt they werent acting sun city him all of these messages and data about how severe i think this is going to be and is taking it to the task force and is telling me theyre not listening and im like please tell them again. Im like pushing up these messages and is calling me and say need to come back and help but, of course, my commitment was to the people i was serving and, frankly, i knew about the white house. I knew how, i frankly knew how i would be perceived, even though i was a Civil Servant<\/a> and had nothing to do with trump political machine, i knew if i went into the white house to help, that all of their perceptions about the president would also become their perceptions of me because most people in america didnt know me. Overseas people to meet but not in america. Host we all know you here, for sure, in the field stretches so i kept saying no, but i could just see the tsunami coming and i felt like the diamond princess with such a real example to me about how america was misjudging this pandemic by only testing symptomatic people and the people they were living with and that testing the crew on that diamond princess and only looking for symptoms. The crew was much younger. I knew the virus was spreading through the crew. I just felt like we were not utilizing all of what i had learned and doesnt learn by working globally on pandemic by pandemic to bring that Knowledge Base<\/a> to the United States<\/a>. So finally out of frustration i answer the call and i came back. Host do you regret it at all, debbie . I mean, looking back and seeing what President Trump<\/a> did in downplaying, were going to get into that because you talk a lot about that in the book, about flulike illness, low risk and other kinds of issues like use bleach and so forth. What do you think when you think back to those days, those early days . Well, how do you reflect on it . Guest the reason i dont regret it is because i know what happened upon my arrival. You know, those people who know me know that doesnt matter whos president. Ive worked with president s across the world. I dont care whose president , i dont care his prime minister, i dont care whose minister of health. I believe that i can assemble the right date to convince them to do the right thing, and ive seen that happen throughout my career. I saw african president s finally let us address the Lgbt Community<\/a> to people who inject drugs, to people who are in prisons, who let us do the right thing to prevent hiv and to prevent and to treat those who needed our treatment. So i believe having worked with so many that with the right data i could convince the president and the Vice President<\/a> that this was serious. And so i arrived with my list. I was really happy that first week that immediately when i said to the Vice President<\/a> , heres a list of people to immediately call to the white house, we have to have our commercial laboratory developers make tests, not just pcr test but antigen test an antibody tests and weve got to have it immediately and youve got to get them all here. By wednesday they were all there. And so it was a lot of action that first week both on pushing therapeutics, pushing vaccine, pushing testing, getting people to take this much more seriously, i just want to thank my european colleagues because obviously i knew a lot of them from working on the global fund for nearly a decade. And they helped me. They sent me their data. They were about two weeks ahead of us, and i used that data for the european travel ban, the 15 days to slow the spread and the 30 days to slow the spread your kind of people go back and think when history is written they will see that that first wave, compared to many other countries, was much more contain than any of the wave subsequently i think as a country we reacted seriously in those three to four weeks and then we didnt. That was very disconcerting to me, certainly i talked out and about how the president got very different analyses from his economic, his cea team, and really that unraveled the president s confidence that my data was correct. Host yeah, you show so, i mean, or me in reading the book the one thing that comes across as your love of data and your frustration when it is not there, when its not accurate, when its not comprehensive, when where having to borrow data from other countries to make decisions here when we should be the vanguard, that really came through. For i kind of go on and want to look more in depth at the u. S. Response and also a little bit about the early days in china i cant help but ask you, didnt really feature in the book but you talk a lot about africa. You probably, you know, the one american in this nation that knows africa and its intersection with disease more than anyone else. What do you make of how covid is as transpired in africa . We were thinking it was cataclysmic end engine warnt early on, and yet theres some evidence that theres been less severe disease. Maybe thats a reporting issue, maybe thats an issue of just simply having a younger population. Whats your take on africa and covid . Guest well, larry, thats a brilliant question and it intrigues me and it intrigues me to today. Certainly some of it is testing and reporting, but you cannot hide severe covid disease and you cant hide most of the covid deaths. Ive said that across this country to many governors and mayors. There will be a full accounting state by state, county by county by what actually happened. But in africa they were blessed by three things that were really critical. Across the main part of africa that most people know around the equator going north and south, from east to west africa, the median age is between 15 and 14. 50 of the population is younger than 14. And we know from data now that this virus was very selective in general for the elderly. And so if you look at the continent, and that includes north africa which is a very different situation, i can talk about that separately, but africa as a continent has less than 9 of the population over 65. 65. We have almost 20 . The other big piece of it though is obviously with a history of hiv and tb, a lot of the individuals in the 90s, in the early 2000s before pepfar and the global funds succumbed hiv, millions and millions of people, so it emptied out a lot of the people who could invent 30, 40 and 50 at this point. We exchanged as a community the ability to people in africa to thrive, despite hiv tb and malaria. I think the second point is much lower comorbidities compared to the United States<\/a>, much less obesity and thats what if you look across south africa, botswana where they do have older individuals, where that you have more comorbidities use a higher fertility rate from covid. And so the younger generation, the less comorbidities certainly underreporting but but i cal you when you look at access of death you dont see the same level of excess deaths in 2020 and 2021 that you see in the developed world. And i think its really a wakeup call, because like you, larry, we all thought pandemics would be horrific in low and low middle income countries, and in the end this pandemic singled out upper and upper middle income countries. Host incredible. Guest and there was no Natural Alliance<\/a> of those countries. Because we were all focused on low and low and middle income country. So again there were no formal channels to really share information between our european colleagues and the u. S. And our Central American<\/a> colleagues and canada. I mean, because we thought it was going to be there, and it was here. And i think this really opens up a glaring mistake that we all made over the last two or three decades is really establishing clear data exchanges among the upper middle income and upper income countries. Host yeah, very important point. Just very briefly on the early days of, you know, china and wuhan, and what the president , you know, knew or should have known and when. And also just reflect elizabeth about, you know, there was a significant clash between the white house and china on a number of issues, but particularly the lack of early reporting and lack of early reporting in an honest way in terms of human to human transmission. And then that ultimately led to the president sending a letter to the secretary, u. N. Secretary general, not getting a 12 month notice of withdrawal from w. H. O. How did the all unfold in the white house and how did a plate into the early days of the u. S. Covid response and the global Covid Response<\/a> . You know, larry, i wasnt here and i could never really understand. So when i arrived at the white house, no one gave me any cia or other cable to suggest that there was information coming in through secure channels about how severe this would be. So when i heard that bob woodward interview, i was as shocked as america was. Because when i arrived, when i say no one, i mean no one in the white house from the nsc to the cia to the Vice President<\/a> to the president , no one shared with me that they had an understanding about the severity, you know. My feeling was they are not taking this as severely, i mean as significantly as i think its going to be and thats why we have to make these changes. But that was very disconcerting to me to find up, i think that woodward interview was june or july 2020. I was shocked, and still no one showed me that that actually existed. So to this day ive never seen that document that talks about the severity. The reason i knew it was going to be severe is you could see on social media that the hospitals were getting overwhelmed in january. And at the same time china saying we dont think theres human to human transmission. So if im seeing the social media posts, the w. H. O. Should evincing those social media posts and they should have gone to the world and said this virus is highly contagious, spreading rapidly and result in significant illness in those over 70. I am still surprised by that. The data was out there. It may not have been coming from china per se, but that was the whole point of putting w. H. O. Representatives in every country is so that you werent always reliant on just what the National Reporting<\/a> was. And after what happened with sars, i thought we had learned that lesson collectively as a community, but i think, once again, that early misleading about human to human transmission i think resulted in a lot of countries making very poor decisions about not developing tests and not really taking this as seriously as a should of tricky at such an important point. I want to stress one of the points you made because you heard dr. Birx say that she got to the white house and none of our most sophisticated machinery of government, you know, cia, intelligence, National Security<\/a>, white house staff seemed to be aware of the seriousness of it. I mean, thats a stunning statement. Guest i think nsc was because matt was trying to get me back there. I dont think the agencies really were acting host including cdc. Would you include cdc and that . Guest you know, i dont know what the cdc was thinking at that time, but i can tell you that they did not prepare the country for a countrywide pandemic that was evident already in china. And what do i mean by that . Getting up the data streams that you needed, bring in the commercial laboratory developers. Its great that he worked on tests for the Public Health<\/a> labs are we on the Public Health<\/a> labs. They are not what we call high throughput laboratories. Platforms that they made, the tests were in general platforms that could do a handful or less than 100 tests a day. Were going to need millions attests a day so we had to bring on board our commercial laboratories. Until nancy mess and they made that comment the end of february, i dont know host at the cdc at the time so our audience does come cdc senior official. Guest when nancy said she was worried, but that was in e february, i was worried in six weeks earlier, so i wasnt here, i didnt watch it play out. I try not, i dont know what data they had or didnt have. I just know when i arrived on the second of march we were incredibly flatfooted as a country. Host a lot of your book particularly in the first third to half was about the u. S. Response, so just wanted to dig in here a little bit, debbie. You talk about missteps and bright spots, and i thought lets start with the missteps and then get on to the bright spots, obviously operation warp speed. But testing was a big part of the story and you Start Talking<\/a> a little bit about the labs, and just expand on that. Why was this cdc seemed to be so offbase on its testing kits . And also talk about their communication with state epidemiologists and others. Just take us back to those early very, very difficult days in our Testing Capacity<\/a> and our test kits when w. H. O. Had a task it, when our allies like germany were using better test gets. Cdc decided to develop its own. Tell us a little bit about that story. Guest yeah, to this date, you do, i dont know why it happened. I got so frustrated after i left january 2021, the Covid Response<\/a>. I talked to the laboratories, our big commercial laboratories and said to them, what kind of dialogue were you having with the cdc and hhs and aspr . And how calm we didnt have these tests and what is going on . And what they told me was they were actually calling the cdc in january saying, how can we help . How can we help . We can help develop commercial test. What do you think youre going to need, and cdc told them they werent going to need help. And i think that, i guess from working in Resource Limited<\/a> settings i never turn away help. Even if youre not sure you absolutely need it, when people say how can i help, i give them a list because you know, you cant know how bad things are going to get so you prepare for the worst and hope for the best, but you prepare for the worst. In my mind because so many people focus on the contamination, in my mind that is not the problem. The problem was that they made a test for low throughput platforms because they firmly believed that they would only be randomly testing a few samples in each of the Public Health<\/a> labs and they would be able to track this virus solely through symptoms. They had this symptomatic model of how theyre going to prepare and how they had sent no surveillance around the country all based on symptoms. There was nothing in there about widespread commercial level testing. And i think of us who have battled pandemics around the globe, we had a leg up because we know most viruses are invisible. And most of the transmission is occurring in an invisible way. Host hiv is a great example of that. Guest yet. So you know early on i had a meeting with a lot of cdc colleagues and i was talking to them about so much of the spread in hiv is asymptomatic and we were not able to change the pandemic on the continent until we started working with young people and finding the asymptomatic virus and didnt get on effective therapy and really working to prevent you to succeed. We were not successful in to we did that. And so what i heard back from the cdc in that meeting is a went back to the cdc in atlanta and said well, she thinks, you know, she doesnt understand how viruses are transmitted. Shes kind use a bloodborne model for a respiratory disease, which wasnt my point at all. My point was you cant see the virus. Yes, it is being spread in a different way but you have to make invisible viruses visible and they completely discounted what i said because they are like oh, shes just worked on hiv, tb malaria and zika and ebola. She hasnt worked on flu. Well, of course we all have worked on flu. If you work internationally, you work on flu and youre worried about avian flu. It was just, it was that dismissiveness that concern me then, that concerned me now, that unwillingness to listen to others ideas. I think cdc has gotten quite insular by being an atlanta, and he do they will have to be much more open to really looking transparently at the data and letting the data teach them and get them out of their perceptions and assumptions and into a place that really is datadriven. Host yeah. And the idea, you know, at the beginning there was this resistance against the idea that asymptomatic spread was a major factor in the transmission of sarscov2. Guest and larry, that continued. That was what was so disconcerting to me because obviously fda was approved those of us of work with fda for very long time understand the limitations of these control panels. And so they have developed a control panel obviously from symptomatic disease because thats the only thing that they were looking for. So the control panels, to validate the new tests, were symptomatic disease. So as late as july im trying to convince them and the cdc that the antigen tests can be used in asymptomatic patients. It took an entire 12 months in addition to convince both of them that you could use antigen tests prior to having symptoms. And that really held back states because cms and other coplayers were willing to pay for a test that the fda and the cdc said couldnt detect, they can be utilized for definitive diagnosis. So we got in our own way several times. Host yeah. So the testing was really one of the missteps i suppose of being a misstatement. There was some other areas that we should discuss. What about, lets think about personal protective equipment and masks. We remember early on with new York Hospitals<\/a> flooded with cases and cases spreading around the world and we ended up with a shortage of personal protective equipment. Also a lot of confusion around the science messaging in terms of masking and what kind of mask. One of the tngs you said in your book that really i learned from a lot was why did we assume, for example, they came n95 respirators that people wouldnt wear them, that they were less comfortable . Where was a data . Talk little bit about ppe shortages and other shortages, ventilation, oxygen. And then zero in on masks and the early days of masking and really even today masks have become a flashpoint in the United States<\/a>. Guest you know, really critical, important question, larry, because were vulnerable today to lack of essential medicine. It was clear and its clear now when theres disruptions in the supply chain and we dont make any of those essential medicines here. Ill never forget the admiral coming to Task Force One<\/a> day, i think it was april or may, at all blurs together sometimes it when we had the supply shortages. And he came and said im out of propofol in days, for those of you who dont know, thats an anesthetic kind that people use when people have to be on ventilators so that the individual is put into a sleeping state so they dont fight the ventilator. Really critically important, and were running out. So not only do we not have masks, did we not have gowns, did we not have gloves, did we not have ventilators, now we running out of essential meds for our hospitals. And none of these things are made here except for in 95. And that i learn so much about our supply chain and are fabric and the same kind of fabrics that are used for masks are used for gallons. And so people who are making gallons switched over to masks and we couldnt get gallons. It should be a National Security<\/a> issue that we do not have capacity in this country to make the essential medicines that we need in the time of crisis. And im hoping thats why its in the appendix, we have to have congress address of this. It is critical for our health and welfare in the future. It will take some time, and yes, in certain cases we are going to have to pay a little bit more. But in exchange we wont run out of propofol. So i just want to thank the supply chain group because they were under enormous pressure from me and i just want, ive never said this before, i didnt really talk about it in the book, but when i came back and found out, well had 12,000 functional ventilators in the stockpile, 12,000 total. So the innovation that came from our anesthesia colleagues call this, jerome adams, who pointed this out that with the filter chain we could use anesthesia machines. All of this innovation and creativity i also want to give voice to that in the book. But i think the masking issue illustrates what is fundamentally wrong with us in america at times. Because we get so wrapped up in the periphery that we dont make the common sense judgment that a lot of our friends and family around the world did. And asia knew that cloth masks worked because that utilize them during sars pixel early on and with this sarscov2 we know now that cloth mask are highly effective, when i mean highly effective, 40 to 50 was the original variant, do we had ry on data from the japanese in october. I mean, isnt this a study we shouldve been doing in generative prove the efficacy of the mask . So when you go out until the American People<\/a> that they think, that they should wear a cloth mask because its going to hold their droplets back from getting into the air, but then tell them at the same time it wont prevent droplets from coming in, its the same piece of cloth on both sides and they were telling people to make to apply at a minimum cloth mask, and at the same time not telling them that bidirectional. That confuses the American People<\/a>. I mean, no one will understand why only works when to breed out but that when you breathe in. I mean, now we know that you really need a very tight fitting mask, you really do much better if you have the charge fabric layer thats in k n95 and a 95 as of as of now those are available to the public. I think we just were not transparent enough with what we knew and what we didnt know and then make really commonsense recommendations to the American People<\/a>. Host yeah, and, of course, early on cdc and w. H. O. Were not recommending masks, and so we really, this kind of, this symbol of masks have become a symbol of covid, and they still are. They are still part of what we might call the covid culture wars. There was some other interventions that we made. Of your chapters is called 15 to 30 days, and thats about the lockdowns. Tell us a little bit about that and what went on at the white house. Guest you know, when i came in that was part of my first week, you know, to move us from risk is low to risk of serious illness in specific americans is extraordinarily high here and we were already so far behind. I just want to make it clear, you dont do a lockdown unless there is a crisis. And we were in crisis. We could see what was happening in italy. I have modeled out the case for totally rate in italy and their excellent medical care and whatt you are learning, they still had extraordinary case the telly rates. I was looking at our case the telly rates, case the telly rate in those individuals over 70. That means that you were seven and diagnosed with covid, 30 of those individuals were succumbing to this virus. And so we didnt have treatment. We didnt know about clotting. We didnt have ventilators, and we didnt have tpe, and we were barely keeping up, and i just want to be very clear, we were behind in Human Capacity<\/a> needed to treat these patients. I mean, we didnt have enough Human Capacity<\/a>. If we had 25 new yorks in our cities greater than a million people, without a lockdown, thats how you end up with literally hundreds of thousands to millions of people dying. So thats what the modelers were saying. I took their input and modeled what would happen if we did what italy did our europe did with a lockdown, and thats were by limiting it to about ten metros, ten to 12 metros you at 100,000 people people die in the first surge. If the ghost of 25 metros, you have about 240,000 american lives lost. It was really modeled by our metros, both the city itself and the bedroom communities based on what was happening with spread in new york. And i think as a country we prevented a catastrophic event. And i mean truly catastrophic. Not enough people to care for the sick, no ventilators, no tpe for our nurses and doctors in most of the hospitals. We had 6000 hospitals. In the end probably only four or 500 hospitals actually had to confront this high covid load, and thats what america did. America stopped the spread of that first wave from how much damage it could do, but we probably were not clear enough to the American People<\/a> how their proactive behaviors changed that course in that first wave. Certainly a lot of European Countries<\/a> did worse in that first wave than we did, by a bit. And im talking small percentages, nothing to be really proud about but we could have lost so many more americans with the footing that we were on because, i just want to make it clear, we were not preparing for a pandemic in this country. We were prepared containing the virus in a very small number of americans in a system which failed them. Host for sure. One of the things i was struck by in the book when an email exchange you had with a highranking Government Official<\/a> and you had said that we need, that vaccines wouldnt be enough, we have to rely on behavior change. And then the answer back was, you know, what behaviors . And then you just sighed because all the things you been telling them about, behaviors that need to be changed. They didnt seem to get it. Well, we talked about a lot of the negative things in america, you know, the shortages of essential medicines, ppps, testing mass, cruiseship lockdowns. But you also talk about the bright spots. So in any tribe of america its a triumph of american science. And particularly operation warp speed would you dont think President Trump<\/a> gets enough credit for, and you, and also the fact that weve got these new messenger rna vaccines that we thought were going to be super effective, but are still very good. So tell us a little bit about the success that we had in our science community. Guest so first and foremost i just want, im so grateful to the private sector. I mean, the one thing that this white house got right and got right for ppe, got right for testing and got right to therapeutics and vaccine was they believed if the private sector was supported and their technical capacity unleashed and innovation and creativity and the relationship with biotech and universities and big pharma, if we unleashed the capacity that they would respond in unprecedented ways, and they did. The group of that company, we had a meeting with the laboratory developers on the first, on the fourth of march, and i had tests rolling out hospitals within two weeks. They worked around the clock. Abbott, roche, the whole logic came on board, the thermal fissures. These people drop everything and their entire corporations moved to churning out these highquality tests. And not only rapid high throughput pcrs but really hes critical desktop pcrs that were really helpful in our tribal nations, and antigen test. And we had all of that within a matter of weeks to months, and so that Publicprivate Partnership<\/a> was extraordinary. And then they went above and beyond in that it testing companies, abbott and roche, i i knew they could see their equipment because i worked on hiv test my whole life and its the same equipment. And so i knew they could see the data every night. Answer every night they compiled all the data from that day so that i could see what the test positivity rates were in this country. Because i know data streams, none. The private sector did that for me. The private sector realign their entire supply chain based on data. And im just so proud of them. They took less profit to ensure that specific hospitals had what they needed to protect their nurses and their doctors and get the patients the drugs they needed. And so i would say to them this is where the virus is, this is what its going, and Cardinal Health<\/a> and mckesson and henry shine at all of these big direct supply companies, they realign everything and said that based on the data, based on equity. And that was just so amazing to me. I wanted the American People<\/a> to know that we learned now how to deal with a pandemic. We need the private sector part of the plan. When given sitting at the table and we need to know what the ramp up capacity is because they did that for us. I just wanted people to be able to see what i saw what the tribal nations did, what universities did. They were universities that worked that whole summer of 2020 to fully open that fall of 2020. With all of the people pointing fingers to then say you cant do this, its not safe. I used the tool of testing and information, just behavioral change information to their students to keep each other safe, and those universities and those boards of trustees that believed in their students and open foley, they taught me so much because it was those universities today, yesterday, and all through 2020 who i was tracking the data, and the universities that tested weekly, independent of symptoms, had much Less Community<\/a> spread among their students. So it showed, it showed the roadmap of a way through this. Not limiting students activities but ensuring students had weekly testing totally change the amount, the number of students who are impacted. But i think the other thing that universities taught me which was so personally informed and why i want to get to every state and emotion of her cities is a sit down with the students and the faculty and their administration to go through how they are confronting the pandemic. I was just so impressed by our gen z years who understood that for many students that was her only bed, their only desk, the only ability to be in college, the only ability to work were in those college towns. And they supported one another and the supported each other to Mental Health<\/a> issues. And i just come it was so inspirational to me to see what they did come what our tribal nation did, what are governors did. Independent of red or blue or democrat or republican, they answered the call in those days of 2020. And i just, america is stronger than what you see often in the needy because people were really doing the right thing across the country and really helping one another. Host yeah, thats a good point. The private sector, universities, states, tribal, tribal leaders. I was personally involved a lot in georgetown so i can attest to that kind of Small Laboratory<\/a> of behavior change. Weve only got about ten minutes and i have a bunch of things i i want to get to. One of the things, it would be easy to skip but since you are so global and since im so global, talk a little bit abot our global responsibilities as the United States<\/a>. And the thinking particularly about vaccine and equity in our early decisions about prepurchase agreements with our Vaccine Companies<\/a> and what role that may have played in global scarcity here kind of scarcity is not as big an issue now. Its more vaccine infrastructure but talk a little bit about global vaccine and other kinds of inequities. Because i know its near and dear to your heart. Guest well, and it was just not the inequity of the vaccines. It was inequity and access to gloves, access to masks, access to gowns, access to protective equipment, access and what was really worry me right now was access to therapeutics. Because we have learned lot about these vaccines but these vaccines are not going to protect countries from infection, reinfection. And we just have to admit that and thats why im excited to look at the subunits because you can change subunit adjuvants and potentially increase the durability of protection from infection from four months to really multiple, multiple months. I i mean, right now we should be very clear about who needs to be vaccinated and boosted, and we ought to be talked with african countries and are asian colleagues around the world about identifying those individuals with diabetes, hypertension, obesity, asthma, any kind of steroid dependency, cancer treatment, and making sure is that they are vaccinated and boosted. Then we should be working around the clock to do what we did in pepfar. Pepfar was brilliant because it worked with the Large Pharmaceutical Companies<\/a> and Large Pharmaceutical Companies<\/a> agreed to this patent protection waiver that allowed new hiv drugs to be made by nonbranded suppliers. Expedite elite approved by the fda and a parallel mechanism to ensure their safe and effective and allowed us to buy those. So we were able to bring the best treatment to Subsaharan Africa<\/a> and asia around the globe. Globe. That should be happening right now covid therapeutics. We know how to do it. We know how to distribute it and we need to use the distribution mechanisms that weve utilized in pepfar. We can get drug to the most remote villages, we can get pepfar to the most remote villages. We can get vaccines to the most remote villages. I think were still not taking advantage of everything we have learned through the decades. I find, you know, theres a pandemic people that look at this as a pandemic and then theres the rest of us who have been dealing with pandemics for decades and know how to confront these, and it really need to be talking to those individuals and not people within the United States<\/a> that it never confronted a pandemic before this one. Because we know how to work with communities and local governments to ensure access, and we have significant access problems in this country right now and its part of the reason why the red counties, which some people are thinking that they say they voted for trump its like justification for them not doing well, Public Health<\/a> does not do politics. We should not be we should look at the returns right now and ill tell you what the problem is. Theres no healthcare. So dont tell them to go to the primary care physician. There is no primary care physician. They getting their eye care from walmart. Theyre getting their health care from emergency room three hours away. So i i dressed with access and barriers are in reality, not what you think they are. Get out there and see what they are and fixed it. We should be using data in real time. No one should be dying of covid. Lets all agree of that. And we take every death, figure out why it happened, and fix it. Fix it then. Dont publish a study for months later. Fix it in real time and make the data transparent and available to every american so they are empowered with the ability to make decisions to decrease the risk and the risk to their vulnerable family members. I saw this for decades in Subsaharan Africa<\/a>. It is possible. Anyone can learn this information. You dont have to be a phd. You dont have to be an md. Its our job to make it understandable. Its not our job to point fingers and imply that if you voted for trump youre more likely to die of a disease. Thats on us. If theyre in a remote county thats on us. I just, it is so disappointing to me to see its still politicized even in the media about red and blue counties. That should be a call to action. That should be a call to all of us who work in Public Health<\/a> to change this. Host yeah. You know, i intentionally not brought President Trump<\/a> into this, but i think our listeners would want to just your reflection about that. You talk a little bit about the Trump Administration<\/a> in comparing it to influenza, to low risk, other things like the virus goes away, sunlight, bleach, hydroxychloroquine. It mustve been very frustrating for you as a world renowned scientist and Public Health<\/a> professional to be in the white house at that time. Weve only got literally a minute or two. Do you want to just spend say 30 seconds on that and then just tell us about what you think and hope for for the future . Guest well, frustrating but not impossible. And thats the message i i wao leave with all of you. You find yourself in situations, people will say things about you and it really doesnt matter, because you either for one reason, serve the American People<\/a>. And no matter how frustrating, i have been frustrated my whole life in hiv with many leaders who would tell people if you just took a shower or if you slept with a virgin. I mean, all of these magical thinking and, and this is not unusual. Pandemics are political and its our job as Public Health<\/a> people to get in there and work every day to do the right thing. Some of it is evident, some of it is in evident. It doesnt matter. This isnt about you. Its about what you know and making that translated into saving lives. The whole last chapter, over 40 pages, is on we continue to make missteps in 2021 and at 122 because we are doing pandemic by polling. By what we think the American People<\/a> are willing to do. Give them the data. Show them in real time and they will do the right thing. I just dont understand this unwillingness to put all of the data up county by county, by age and race and ethnicity. You can pour it enough that theres no violation of that the mac. Do it every day pepfar. Gov. Gps map every facility where there is a physician and where theres a a nurse practitioned look at how underserved are red counties are. We have to fix this. We cant but we have to the right data and utilize it. Magical thinking was prominent in the Trump Administration<\/a>. I fear at times it reads itself into our current administration, and we just cant let that happen. I know mays, and what people will say is look alone the case counts are. But you know what follows may . A summer surge in july and august to our summer states. So lets get ready now into the right thing try and well, thank you. I mean debbie, just a master class and i wanted to thank you for your service. You talked about the importance of Public Health<\/a>, science, data, supply chains, all the things that America Needs<\/a> to do. I recommend that everybody read this book, particularly the appendix about what we need to do and just our hats off to you and deep thanks to you, debbie, dr. Deborah birx. Guest thank you, professor. Collins dexter looks at blackness and our political future. Watch book tv every sunday on cspan2 and find the full schedule in your Program Guide<\/a> or watch anytime online at book tv. Org. Middle and High School Students<\/a> its your time to shine. Youre invited to participate in this years cspan student cam documentary competition. In light o upcoming midterm election, picture yourself as a newly elected member of congress. We ask this years competitors, what is your top priority and why. Make a five to sixminute video that shows the importance of your issues from opposing and supporting perspective. Be bold. Among the prizes is a 5,000 grand prize. Videos submitted by january 20th, 2023. Visit our website at student cam. Org for rules, tips, resources and the step by step guide","publisher":{"@type":"Organization","name":"archive.org","logo":{"@type":"ImageObject","width":"800","height":"600","url":"\/\/ia804705.us.archive.org\/22\/items\/CSPAN2_20221021_120200_After_Words_Deborah_Birx_Silent_Invasion\/CSPAN2_20221021_120200_After_Words_Deborah_Birx_Silent_Invasion.thumbs\/CSPAN2_20221021_120200_After_Words_Deborah_Birx_Silent_Invasion_000001.jpg"}},"autauthor":{"@type":"Organization"},"author":{"sameAs":"archive.org","name":"archive.org"}}],"coverageEndTime":"20240619T12:35:10+00:00"}

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