We would like to welcome you all to our update for private sector

organizations.

on the 2019 coronavirus response or COVID-19.

We are grateful for all you are doing to keep your employees and

communities safe and we are pleased to have Dr. Jay Butler here to give

updates from CDC and thank you all for who submitted questions in

advance.

We approximately appreciate your engagement.

I would like to introduce Dr. Jay Butler.

He brings a lot of expertise.

You probably heard him from previous phone calls as well.

He is the deputy director for infectious diseases.

he provides leadership to the three infectious disease centers and hopes

to -- and he brings experience, 30 years of experience both in the field

and here at CDC so has a lot of great perspective.

I will turn it over to him to provide an update on where we are at with

the coronavirus

>> Good afternoon and good morning to those on the west coast.

Today is March 30th.

It's interesting to think it was December 31 that the world was first

notified of the cluster of.

pneumonia cases that occurred in but, China -- but- Wuhan China.

We are here to talk about a pandemic caused by a virus and disease that

we didn't know existed only three months ago.

It's both humbling and fairly stunning to think how much the world can

change.

in only three months.

Of course, as of today, the virus has spread pretty much around the

world.

There are laboratory confirmed cases in over 200 countries now.

There is almost certainly some bias in that depending where testing

capacity is, but the virus has now been documented for several weeks on

all the -- all of the inhabited continents of the earth.

The majority of cases right now are being reported in Europe, but also

every jurisdiction in the Americas is involved now.

The United States actually has the most laboratory confirmed cases of

any country.

including more than were confirmed in China as well.

Here in the United States, there have been over 140,000 confirmed cases,

probably closer to 150,000 by now.

Unfortunately there have been over 2400 deaths.

Every state has seen cases.

Some more than others.

There are certainly hot spots.

New York City, the chief among them.

Also seeing some fairly dramatic increase in the activity in the Boston

area New Orleans and in other areas around the country.

I recognize that depending where you are at, it may look very different,

but there is a slough of information that's available on the status of

the epdicking at CDC.gov/COVID-19.

And also that page will be getting considerable remake later in the

week.

We want to provide useful data in a graphically -- in way that

graphically.

is presented to be able to facilitate communication.

Please do keep an eye on that website.

We continue to find that the people at highest risk of severe illness

and fatal.

outcome are those who are older, particularly over age 70 to 80.

And that people with underlying heart/lung/kidney disease are at higher

risk as well as those with diabetes.

There will be a descriptive paper coming out in the MMWR later this

week.

highlighting some of the risk factors for more severe disease.

Now that said, I think it is a couple of paradoxes here that are always

tricky in the communications.

The vast majority of people who are infected with the SARS COV2 virus

will recover completely.

We are learning more and more about the mild manifestations in some

people and also asichmatic infection.

However, younger people are not completely immune to more severe

disease.

We occasionally learn of unfortunately people in their 30s and even 40s

winding up in the ICU with COVID-19.

Let me walk through some of the emerging hot topics.

One of the issues that I just touched on is what appears to be a more.

likely roll of pre-symptomatic transmission, and even asymptomatic

transmission where we have data from cohorts of people who have been

exposed with testing.

We are finding it's not uncommon to have fairly high amounts of virus

present in the nose and throat before onset of symptoms.

In fact, people who develop symptoms, the highest amount of virus is at

the time.

of the onset of symptoms with some decline afterwards.

It may be a bit of a game changer for us as we look forward in terms of

trying to determine what are the best ways to mitigate transmission and

to slow the spread of the virus.

I think everyone is aware of the goal of flattening the curve.

That's become a household term now.

The overall goal there is to distribute the impact of the pandemic over

as long a period as possible in order to maintain critical

infrastructure, and particularly to keep the health care system from

becoming overwhelmed.

So one of the issues that we are also looking at because of that is

whether or not.

use of face covering might be of utility in the community to prevent

transmission from people who are either not yet symptomatic or

asymptomatic.

We don't know what role asymptomatic infection might play, but as we

look at some of the experience around the world in areas where face

masks are oftentimes worn more often for the wearer's protection, there

may be a benefit because of source control with this particular virus.

So we are looking hard at the possibility of using face covering or non-

medical masks as a method to basically as an environmental control, if

you will.

Again, not something that necessarily protects the wearer, but something

that would be an additional tool in the toolbox of community mitigation

measures in addition to what's been done already for social distancing.

I imagine everyone is aware, speaking of social distancing that

guidelines coming from the White House task force have been extended

through the month of April.

As we look around the country, I think there are 17 states now that have

had some type of stay at home order statewide.

49 states that have closed schools statewide.

9 only state that hasn't -- the only state is -- 99% of the schools have

closed based on decisions made at the local level.

These community mitigation measures are part of what we do -- an

important part of what we do to flatten the curve until we know more

about the status of any chemo prophylactic agents.

right now there are basically none.

There are therapeutic agents that are under study.

we certainly can talk more about that if you would like.

A vaccine that's probably at best 12 to 18 months down the road before

that would be available for more widespread use.

I was talking about face covering.

It's important to recognize the importance of maintaining personal

protective equipment for health care workers.

There has been a lot of work done and the response that's now led out of

FEMA and the national response coordination center to be able to tap

into the strategic national stockpile and also to be able to receive

donations of PPE and other equipment such as surgical masks to be able

to get them out into the communities where they are needed by health

care providers.

Another real hot spot of concern is the long-term care facilities.

I was mentioning earlier, the persons at highest risk of severe illness

are older persons and persons with chronic underlying conditions.

Many people in long-term care facilities are both older and have under

lying conditions.

Some of the worse situations we've seen in terms of outbreaks have been

in long-term.

care facilities.

As of now we are aware of over 400 long-term care facilities.

that have had cases in a large number of states.

It's an area where we are doing everything we can to provide technical

assistance to our partners at the state and local level.

Regarding testing, testing using the PCR and other nucleic acid assays

continues to become more available there are 20 platforms that have

emergency use auto sx granted by the FDA.

The number of tests that the test results that have come back are over

400,000 so far.

There is a lot -- the capacity in the commercial labs is greater than in

the public health labs.

So far about a third of all of the tests that have been completed have

been in the public health labs.

So I really want to acknowledge the important role that commercial labs

have played in terms of meeting the demand for testing.

There are in addition to more than just traditional PCR, I was

mentioning nucleic acid assays, this is helping us move toward being

able to push testing as far out into the health care system as possible.

And also get a faster turnaround on results.

The latest EUA granted is for a nucleic acid assay that can be performed

in many laboratories that are present in larger community centers, and

perhaps in the larger specialty clinics and can return a result in as

little as 15 minutes.

Ultimately the goal will to be have some sort of true point of care test

that would be performed by a provider and have a result back before the

patient leaves either the emergency department or the clinic.

There is a lot of work that is occurring now to move us in that

direction.

Of course, that is normally how influenza is usually diagnosed in this

country.

Also, HIV and hepatitis C testing is performed that way also.

We also have a lot of interest in serlogical testing.

Here at CDC we have an ELISA assay developed and serology is not going

to be.

very useful in terms of diagnosing acute infections.

It will be more useful for epidemiological assessments that answer the

questions about how often sub clinical or asymptomatic infection occurs

and to be able to assess population based immunity levels as the

pandemic continues to spread.

There are some -- there is some interest in the commercial sector to be

developing serlogical assays as well.

I would have to defer to FDA to discuss any saitous of emergency use

authorization applications.

I know there has been some development of rapid serlogical tests that

have been marketed in other countries.

A question we often get, are they any good?

At this point we don't have a lot of data or assessment on those.

It's a very pressing issue we know, and we are very much involved in

being able to evaluate the utility of serologic assays as well.

So at this point in time, maybe this is a good chance for me to stop

talking and start going through some of the questions.

>> Great.

Thank you.

I would like to remind folks this call is intended for partners in the

private sector if you are media, we won't be answering media questions

and you get questions that should be sent to the media @CDC.gov

>> A very clever web address

>> So I have some questions here about mail and incoming packages.

Are they safe?

Should business being doing anything particular in those

>> Excellent question.

So people may be aware that there was a paper published by both CDC and

NIH a couple of weeks ago looking at what are the maximal survival times

for the SARS COV virus in the environment on various surfaces at various

temperatures on different materials.

And it's important to recognize that this paper really looked at

maximizing the opportunity for the virus to survive.

So it's an important paper, but also has to be interpreted in light of

the real world situation.

In that paper it was possible tounder the right conditions could get

virus that could be recovered from cardboard or paper.

The epidemiology of COVID-19 doesn't point to rapid dissemination.

of the virus through the mail.

Given the amount of mail and various produced goods that come out of

China in particularly out of the province where Wuhan is located, if

this were an important mode of transmission, I think we would have seen

earlier popping up of, if you will, metastatic foci of transmgs around

the world.

what we saw during January and the first half of February was spread

outside of China primarily by way of travelers who had become infected

in China and who had traveled while asymptomatic but developed symptoms