eSign Camper Health History Made Easy

Esign camper health history

have started to decline and hit their peak but unfortunately at the same time that's happening the pandemic now is having a resurgence in indiana ohio pennsylvania the mid-atlantic states the southern sun belt also now moving back up into the northeast as well as unfortunately california oregon and washington so we really have a very extensive pandemic now throughout the nation i think many of you probably saw that in the month of november unfortunately we had over a million cases reported each week so four million cases were reported in november unfortunately our hospitalization rates are going up and maybe we'll talk more about that because that's one of our great concerns whereas in the spring we were talking about 20 30 000 people in the hospital now we're over ninety thousand people in our hospital i think one of the most concerning things about understanding the the impact of the pandemic right now and there may be questions on it is to recognize that as we sit here today 90 percent of our hospitals in this nation are actually in what we call one of the hot zones in the red zones therefore at risk for increased hospitalization and potential to negatively impact hospital capacity 90 of all of our long-term care facilities now are in what we call high transmission zones so we are at a very critical time right now about being able to maintain the resilience of our health care system in the spring we were dealing with new york detroit you know new orleans los angeles we could shift healthcare capacity from one part of the country to another um we saw similar when we had the southern wave we could shift healthcare capacity from the heartlands and from the northern plains right now we unfortunately have a pandemic that's really throughout the nation and there really isn't that resilience of healthcare capacity to be able to be shifted this is why it's so important at this time and i know we'll talk more about it is to really embrace the mitigation steps that we've tried to stress in the time for debating whether or not mass work or not is over we clearly have scientific evidence we just recently published an mmwr in kansas when they came out with their mass mandate and certain counties opted out and certain counties opted in and when you compared those that opted in they had about a six percent decrease in the observation period of new cases per hundred thousand another counties that decided that they didn't think this was the way to go and opted out of the mass mandate we found out that they had over 100 percent increase in the cases you couple that with social distancing hand washing being smart about crowds uh doing things more outside and inside these are critical mitigation steps to which many people seem simple and they don't really think it could have you know much of an impact but the reality is they're very very powerful tools they have an enormous impact and right now it is so important that we recommit ourselves to this mitigation as we now begin to turn the corner with the vaccine but the reality is december and january and february are going to be rough times i actually believe they're going to be the most difficult time in the public health history of this nation uh largely because of the stress that's going to put on our health care system it's just it's a it's a sobering it's a sobering and important thought there and i and there are a couple directions i want to go let's start with some of the public health models looking at mortality rates have been really shocking and so my question for you is what what can we do to change that trajectory and is it as simple as math social distancing isolating etc but what do we do to change what looks like a really terrifying trajectory [Music] well i think you're right when you look at the different uh models you know we looked at the original spring we lost about a hundred thousand people some are a hundred thousand people to fall a hundred thousand people these are you know sacred lives that were lost as a consequence of this pandemic we're potentially looking at you know another 150 to 200 000 people before we get into february so this is really a significant time and you ask the right question because we're not defenseless the truth is mitigation works and if we embrace it and the challenge with this virus is it's not going to work if half of us do what we need to do it's not even going to work probably if three quarters of us do what we need to do this virus really is going to require all of us to really be vigilant about wearing a mask you know and unfortunately not just when we're in the public square i mean we're finding now that much of the transmission that's driving i mean who would have believed that you know rural north dakota south dakota wyoming idaho montana these areas in north dakota recently you know over 30 40 percent of the people that got tested were actually positive and the reason this is happening because now one of the major drivers of transmission is not the public square it's actually the home gatherings where people let down their guard uh you know you bring in family members and they don't realize that the major presentation of this virus for individuals say under the age of 40 is it's totally asymptomatic you don't know you're infected and really being able to get a handle on asymptomatic transmission in the family setting which is now driving and frequently we don't necessarily communities don't recognize it until unfortunately that virus thing gets transmitted in somebody that's vulnerable uh older and then they end up developing symptomatic illness and they end up in the hospital so the reality is as you saw just the other day i think in in our reports we were back up to almost 2 2400 deaths uh that were reported yesterday um so we're in that range potentially now of starting to see 1500 to 2000 to 2500 deaths a day uh from this fire so um yeah the mortality concerns are real um and i do think unfortunately before we see february uh we could be close to 450 000 americans have died from this virus but you know that's not afraid of complete if the american public really embraces social distancing wearing masks not letting your guard down in family gatherings limiting crowds maintaining ventilation doing events outdoors rather than indoors making sure you're vigilant and hand hygiene and that coupled with some strategies that we're pushing states to do to begin to diagnose through surveillance the asymptomatic infections will begin to help us i give one example of hope because i used to think that the most difficult group that we were going to have to help contain this pandemic was basically college students that i felt it was going to be very hard for us to be effective in getting them to fully embrace the messages that i just said and in the spring we had significant outbreaks on different college campuses but what happened over the summer and the fall is many of the colleges and universities really stepped up to developing comprehensive mitigation steps that they really engaged the student body to actually buy into and then they coupled that with screening the student body every week so they could identify the asymptomatic silent epidemic that was in in the population and then pull them out for isolation and prevent them from further transmitting if you look at it today say wisconsin governor thompson who's now the acting president university wisconsin um they have a prevalence rate in their 27 campuses all through wisconsin of students in the highest risk group 18 to 25 year olds their prevalence rates less than three percent but when you look in the communities where they live because most of these kids don't live on campus their prevalence rate is between 10 and 20 percent so it reaffirms to me that mitigation can work and even some of the what your biases may be the more difficult group to you know participate i can show you the same is true in the northeastern schools the same was sure true in the south carolina schools the idea that coupling mitigation with routine screening surveillance to be able to identify the asymptomatic carriers these techniques do work and they're powerful the truth is it's our defense against this when you ask me the big question how many people are going to die between now and say february 1st i'm going to really come back and say it's really up to us how vigilant people are going to be about really taking to heart these mitigations i i think i'm disappointed at one thing during my time as cdc director during this pandemic was that there was an inconsistency of the american public embracing the message mask wearing this mass wearing it's not a political decision this is a public health tool a very powerful public health tool very simple but very powerful and yet we have really had you know taken a long time and to the state there are still jurisdictions probably on this uh call that really don't embrace the importance of these mitigation steps and i encourage people to look at the mmwr we put out in kansas i mean it really showed the difference between a six percent decline or 100 percent increase by one simple thing whether the county decided to embrace a mass man that's really remarkable and i think we can help you we should help you get that get that message out i'm going to turn to the first audience question in a minute let me first follow up on something you said about the importance or the efficacy really of surveillance by that do you mean kind of the random testing or do you mean the sewage testing that we've seen on other college campuses or how do you define surveillance well i think it's really important you know if you want to take sort of a hindsight the real question that is out there is how many how much testing capacity do we really need as a nation to optimize our public health response and and i i would say that um that's more tests than we currently have there's been a lot of focus on how many tests we have second thing i will say is how testing is used is it random or is it strategic and we would argue right now one of the big challenges that hit us with this covet pandemic was we had modeled it we had modeled it in our heads like sars or like influenza and sars and influenza the way they work is they make you sick so it's not that complicated for you to have a case identification program that says let's look at people who are sick and find out do they have cobit 19 and then isolate contact trace and to control the pandemic the problem with covid ii it's not like flu it's not like source it's major transmission particularly in those of us say under the age of 45 is it's asymptomatic so you don't know who's infected and who isn't and so all of a sudden that strategy of looking for symptomatic people like we originally did in in january and february and telling symptomatic people to stay home and wear a mask that works for the symptomatic people but the problem is you just miss 50 or more in certain age groups of the people that are carrying this virus and so therefore you've got to say okay well wait a minute how do we then define the silent evidence how do we define asymptomatic transmission and we would argue going back to the college campuses they figured out by doing regular weekly screening of students every week they're able now to identify the asymptomatic carriers or not carriers asymptomatic infections pull them out of the transmission cycle isolate them contact trace around them and isolate those individuals and they've been able to control the outbreak so there there has to be a strategic use of testing we're right now you know you know liverpool recently in england decided you know what they were going to do to get a handle on this silent epidemic they just tested everybody in liverpool and they figured out who was infected and been able to isolate so we have areas now that we're trying to do what we call community-wide strategic testing where there are hot spots to try to understand we're looking uh there'll be a cdc guidance coming out this week on trying to help um institutions and public health groups companies look at how they may be able to use routine screening for example we think it might be useful to offer routine weekly screening for teachers in k-12s others feel it might be useful to look at other people that have a lot of contact in the community with people and set them up for routine screening so that you can start to identify the silent epidemic you'll see in this mmwr we list a number of different strategies none of them you know have been really proven in the sense that we know that this is the tool that's going to now contain the epidemic but we do know it's proven that they do help us identify the silent transmitters and as i mentioned i think the schools of higher learning are teaching us something i think they've been able to use testing strategically it's actually very interesting if you look at the colleges universities that tested everybody routinely every week or you compare that to people that tested everybody in contact traced around symptomatic cases and did that constantly you'll see that the colleges that did the routine screening once a week had a far greater less occurrence of covet within their population so i just want people to know we do have tools uh testing i do think needs to be more strategic one of the challenges is a lot of people that choose to get tested are what we call the worried well i do think it's important for us to be more strategic in our testing in terms of whether you set up a routine surveillance system once a week or employees or some portion of employees so you get a sense of trying to understand is the silent epidemic now working you've mentioned other techniques like wastewater these are important things we've done in the college campuses but i do think the biggest challenge right now um is to identify the silent epidemic and to try to get that silent epidemic out of the transition cycle oh i have so many questions okay so first let me bring in our first audience question this is eric watchman from arizona hi this is derek watchman i am here from arizona i represent and chairman of the board for the national center for american indian enterprise development we represent the native american businesses around indian country here in the united states my question is native american communities have been hit hard extremely by cove at 19. with increasing numbers nationwide is there any evidence that if someone has recovered from covet that they could be reinfected so it's a very good question um and really so far we've seen very limited evidence of reinfection um you know there's been several case reports um we've had other examples that i think really drive the message home we had a uh you know a say a camp that was um very careful about trying to control infection and what they had is all the campers were self-quarantined before they came to the camp for 14 days they were all tested uh and they're all negative and then they were able to go to the camp same with the counselors they were all tested and they were negative the camp decided they wanted to have a great camp experience so they didn't want to have that modulated by something like wearing a mask or not crowding because they felt they quarantined everybody for for two weeks and they tested everybody and what happened in that camp is it was in a huge outbreak over i think close to 90 percent of the campers and the uh the counselors all got infected so just to show you that all that precaution um but what was interesting to get at your question there was a group of individuals who actually had antibody when they went to that camp and none of those individuals got infected so right now we have pretty good evidence that antibody that is is is really protective against reinfection we just don't know for how long we don't know if that's going to be for six months we don't know if it's going to be a year we don't know if it's going to be for two years we're going to learn all those questions right now but it's one of the things that gives us of course great hope before we knew this that the vaccines were likely to work i think it really is a gift that these vaccines many of us had thought if they worked for 70 efficacy we would be excited but to see 95 efficacy for the first two vaccines roughly and all the other vaccines are based on the same what we will call immunological target i think we have a lot of optimism that antibody directed against those vaccines will be protected for some period of time which we are going to learn in the future and infection natural infection is protected for some period of time we have another audience question that's kind of a follow-up to that which is given efficacy of these vaccines do you imagine there's a world where airlines or schools or employers might require proof of vaccination in order to participate live [Music] i think each jurisdiction i talked to the business roundtable recently and that question came up directly and i think each you know institutions are going to make those decisions i mean it's clear i'm a physician and i'm required to take a number of vaccines in order for me to be able to practice in the hospital that i used to work in i anticipate that you know being vaccinated against coven is going to be another requirement for healthcare professionals it's potential that i could see the long-term care facilities uh might require some evidence of of immunity and and and for admission to certain long-term care facilities um uh i think the you know airline industry and you mentioned that uh you know i can see them trying to determine whether they want to make this a requirement uh you know for employment within them since unfortunately even though we get control of of cova which i think we will by the third quarter of this year the pandemic in the world is not going to be controlled for for multiple years and so we'll always have a global risk of reintroduction through susceptibles if they haven't been vaccinated so you know it will be a decision i think each industry will make um but i do think um there are uh certain industries where i think it would be important to protect their workforce and and some other industries where it may be important to make sure that they protect their cons their customers and consumers so i think uh as these vaccines get deployed um groups will will wrestle with that but i won't be surprised if a number of um occupations uh or or situations make vaccination against covet a requirement so one of the examples i used in the question was schools and of course we have another question here that says the cdc the pediatrics association who want to keep this open yet we have districts in the us that won't open um what do we do with it the school transmission has been lower than we were afraid of your first specific schools um what do you think it's going to take to get schools to open and remain open yeah i think it's important um i've tried to say this every chance i get so i'm going to say it again and i think it's important to use data to make those decisions um you know i was very disappointed in new york uh when they close schools when they hit their three percent uh point because as you pointed out we now have substantial data that shows that schools face-to-face learning can be conducted in k-12 and particularly in the elementary and the middle schools um in a safe and responsible way um we've evaluated a number of schools and we're not seeing as you pointed out cluster infections within schools in any any significant way when we see teachers infected we're finding that the teachers are infected from their spouses or their community when we see students in the school infected we find out that that was an infection that occurred in the community we're not seeing intra-school transmission so you know again i've been a big advocate that and i believe this in my heart that the public health interest to kids in k through 12 is to have them in face-to-face learning for all the reasons we talked about whether that's where they get their mental health services where they get food substance programs where that's where they get sadly that's where we do get reporting from child abuse this is where they get significant socialization obviously we've had issues with substance abuse and suicide as you know i just think it's healthy for these kids to be in school that said they got to do it safely and they got to do it responsibly and when this was started over the summer no one really knew for certain they thought that these public health measures would work but now the data clearly shows us that you can operate these schools in face-to-face learning in a safe and responsible way so what i've asked and i say to your chambers is you know don't make the decision based on what i say look at your schools that have been opened and evaluate and see if they've been a source for major transmission and so far when we've looked at this we've not found schools to be a major source of transmission you know we've seen other other other sources of transmission like i mentioned surprisingly uh just family gatherings uh so i do think we should use that data and um and and make decisions you know based on data and right now uh and i do think it's important that the answer to controlling the uh covet pandemic is the answer is not necessarily closure whether it's schools or business etc there may be some strategic closures that make sense i've been a strong advocate that i don't think it's in the best interest of covet control to have bars open until two o'clock in the morning where people are without their mass drinking and crowded bars that maybe should maybe have 100 people that have 200 people in it so i do think looking strategically where there could be but i don't think you know we benefit at all in our nation in controlling covet by and broadly shutting down businesses clearly if schools can learn how to do this safely and responsibly airlines can learn how to do this safely and responsibly businesses can learn how to do the safety responsibly and and again we should use data to define when we've defined an industry that poses a unique risk that may require some type of restrictions rather than these broad restrictions unfortunately that happened in the spring and summer you know a couple of interesting things you said there one was not a physician and not a public health expert but as a mom the other thing i see is that when schools close the kids try to find other outlets for their social energy right which is not as control of the setting is going to go to school where they're more adults make their masks making themselves the distance etcetera so i totally i totally agree with you since then and i think one of the greatest tragedies early on was when schools closed was [Music] the social disadvantaged individuals that really didn't have the or the individuals that were in work forces that didn't have the luxury to telework because they were in some service industry um these mothers single mothers well how they had to deal with it was they had their kids then go stay with their mother which is exactly the opposite of what i want to do in protecting the vulnerable i don't want to see silent asymptomatic infected children to go stay with grandma who might have diabetes or so i think really the the point is that at least we have the data now i and i really want to applaud the the teachers that um had the courage to take a chance on the public health advice that was being given knowing that we were gonna be monitoring this very carefully i also the parents that had the courage to take the risk because in the absence of data it was all opinion but that's what i'm saying now that's what i obviously said in the new york situation that um don't do this you know a priori you know look at your data and i'm glad to see that they're reconsidering winning at least the schools for the elementary schools because the truth is we have enough data now when i say we each of these jurisdictions to show that that elementary schools are not a source of transmission and i think you know i think when the careful studies are done you're going to see kids who are in virtual learning uh probably have a higher infection rate than the kids that do face to face one so um the other thread from that last answer had to do with employers you know you said if uh universities have learned how to do it airlines have learned how to do it and we certainly know a lot of businesses have learned how to do it because there are businesses that have never closed i think this next audience question gets to that can we roll that question please hi good afternoon dr redfield i'm doug loon the president of the minnesota chamber of commerce here in minnesota we have seen growth in community spread that has actually shown up in the workplace and this has caused concerns with availability of workers and threatened certainty among consumers as well what can you offer is for advice to employers who want to work with their employees to limit community spread through their business yeah i think you you raise a really really important question that goes over all of this whether it's schools whether it's businesses that the key to controlling infection in schools or businesses is just what you said it's controlling community spread and how do we control community spread um and i do think it's just gonna come back to you know and i don't know you know whether mandate versus non-mandate but i know leadership matters in terms of messaging and that everyone comes to recognize that you know this is a serious situation you know i know that if i happen to walk outside of my car you know on the way to the airport you know from the parking lot in a nanosecond now i i feel like i i you know i you know i didn't put my pants on if i don't have this mask on you know and i can tell you when it started sometimes i got halfway to the gate before i remembered to work and you know people were looking at me and and then i realized i didn't have my mask on i think making that is such a social norm that uh and i'm remarkable i was uh you know i have 11 grandkids now uh the youngest one is two um the truth is all of the ones that are over two i have three i think three four five they're all they're all wearing their masks when they go do their thing um they're very conscious of it so um the more that the community can embrace these mitigation steps um i think is the more that these businesses can start impacting community spread because that's really where it's coming and if they decide to do the strategic testing that i've suggested in some businesses it also helps them begin to identify in their own workforce where the silent spread is coming into their workforce and that becomes a very important i think tool of identifying the asymptomatic infected individuals so they don't become an amplifier within the workforce which we know this virus unfortunately this virus is really infectious i think it's probably the closest thing and i'm a virologist by training i think this virus is the closest thing we have the measles we've ever said seen it's interesting that the mitigation we're doing in this country right now our influenza rates are at historical lows now you know we're still just about to get into influenza season so i do really encourage everyone to get influenza vaccine but the reality is our spring season of flu or summer season or flu and even our early fall season are historical low so these mitigation steps are really helping even with the fact that we're probably only doing them 50 60 70 percent of the american public for flu but it's not enough to contain coping covet is really really really really infectious and and uh unfortunately the reason it's so infectious as opposed to flu is the instrument of transmission is not a sick person with a cough the instrument of transmission is an acip asymptomatic 23 year old that feels great so let's turn for a minute dr redfield and talk about the vaccine for a minute another thing we get a lot from employers in terms of commerce across the country to associations is okay if early vaccine distribution will go as it should to health care workers to the most vulnerable populations um and then turn to essential workers how should we be thinking about defining essential worker in that context you know that's a very good question as you know technically the department of homeland security you know kind of makes those classifications as you know um but obviously each community in each and i can tell you um that you know someone that supports uh one of my one of my sons who's in recovery i try to help one of my daughters and starting a family um obviously my own family you know if there's no income coming into the household there's a problem so i mean everyone you know i think can we look at what's really essential to them to be able to maintain their livelihood this is one of the reasons i i really feel strongly that the knee-jerk response that to control covets somehow we have to close things or limit the economy or limit business i think no the answer is figure out how to operationalize that business in a safe and responsible way so that um and i do think you know for me you know i actually think teachers are really essential um so i think each community is going to define that there is a technical definition of it by homeland security where they've listed and they now do include teachers so i don't know suzanne if i really answered your question if you want to angle it i mean i think when i when i see a single mother raising four kids and she may be doing um some type of working in a grocery store or she may be you helping provide custodial services i mean for her she's essential for her and her family i do think this you know there is the other aspects of what we need you know when we first got into this essential worker issue where cdc came out with guidance that suggested if you were a central worker and you were exposed and you were asymptomatic [Music] that you could return to that essential job as long as you were asymptomatic and you monitored your symptoms your employer monitored your symptoms and you wore a mask part of that really came out of when we were in the state of washington on a visit there where they had a significant number of policemen and firefighters and rescue squad workers were all being isolated and they didn't have a fire department and so this was part of trying to give balance uh that if uh you know there is essential services that are critical to the function whether it was uh first responders or whether it's hospital workers we had one hospital system in washington had over 600 health care workers out in quarantine or as you know and some of our industrial work meat packing plants etc so uh just what we needed i know i don't think this country knows how close we came to having a uh protein shortage uh because of uh the outbreaks that we were having the meatpacking plants but i think it's important for each family to understand that each group but i think i've become astutely aware that there are a number of people who work that don't have the luxury that some of us have to be able to continue our work as long as we get on zoom or we get on uh you know a webcast a lot of these people have to actually go and and work work in in in in the environment and we need to work hard to figure out how to make that safe and responsible and we need to honor those people i mean you can imagine if all the grocery store workers decided they it was too risky to go to work so i guess i'm a little bit confused i'm a lot confused but in this topic i'm a little confused which is if dhs has the role of classifying essential workers but you seem to refer to some of these decisions being made at the local level who will prioritize who is in charge of prioritizing vaccine distribution yeah oh for vaccine distribution we can come back to that but for essential workers it's it's dhs i was just trying to make you well at least aware that i'm aware that for individual families there's a there's also an arbitrator who they believe is essential i mean dhs clearly has the essential ones okay got it and so i was just i'm trying to show that i've come to understand that the dhs list doesn't necessarily i remember a julie worker that was supporting his family he felt keeping his jewelry store was an essential work because without it he couldn't support his family and i'm sure many of you people in commerce understand that that a lot of the people that have suffered by having businesses closed um and i would argue that probably didn't need to be we didn't do a strategic decision it was a salami decision you know well everybody will do this rather than stepping back i think now we're much more smart we have data behind us these decisions need to be made now when it comes to vaccines um you know clearly the issue first is exciting that we do have a vaccine i do think people should give credit where credit's due when this was first suggested that we'd have a vaccine before the end of the year i don't think people saw that as something that was feasible the reality was the mission was assigned to get a vaccine before january 2021 and as you know we have two vaccines now with eua submissions we have two more vaccines so we have four vaccines now that are really deep into phase three trials um it's very probable before february we'll have i think probably three to four vaccines approved in the united states which is really remarkable and i think we'll have two of them approved before the first of the year uh the challenge will be that it's going to be constrained and supply ultimately there will be enough vaccine for everybody in the united states that wants to get a vaccine to get a vaccine i i've been i've said publicly that i believe that will be somewhere in the second quarter third quarter uh 2021 it's been criticized by others but i think those estimates are probably going to be right on target i do anticipate the vaccine will be start to be delivered to the american public this month currently the way this will work is we have our advisory committee immunization practices that have made some preliminary recommendations and they'll be uh modifying those after the uas are approved in december but more importantly we've worked since the summer with each of the 64 jurisdictions in this nation for them to develop what i call the micro distribution plan how do they they're going to get allotment of vaccine based on a macro distribution plan from the federal government and those allotments have been assigned at least for the first wave of a vaccine that will be uh distributed this month and ultimately the individual governors and jurisdiction leaders are going to decide what i call the micro distribution okay you find the acip makes recommendations cdc makes recommendations uh through the acip but ultimately it's the local uh governors that and are going to make the decision how that vaccine is going to be distributed uh in their community and those vaccine plans have all been developed uh uh and worked through uh over the last three months um and um i anticipate uh you know that will be a an evolving situation as more and more vaccine becomes available uh and i don't think it will be unified uh you know that every jurisdiction is going to do exactly the same thing so you've been pretty clear that you think there's a good chance that we're back at some kind of new normal by the fall um that and yet we have some questions from the business community about how they should be planning for earlier in the year and i think this next question from the audience gets to that could we roll that question please hi dr redfell i'm chris clark president ceo of the georgia chamber of commerce and we are excited and proud to have the cdc headquartered here in the peach state you know a lot of people on the call today are really focused on q1 and q2 of next year a lot of us have programs events receptions that we plan throughout the year and i'm curious what advice do you have for us as we try to plan those events for q1 and q2 thank you very important question i think that we're going to still be heavily in mitigation for limiting crowd size limiting gatherings during that during that time frame so you're gonna i think wanna be um vigilant and smart about it you know outside's better than inside and smaller is better than bigger i wouldn't be surprised if a lot of jurisdictions either at the state level or local level still have very significant uh guidelines for size of crowds um you know uh you can see when i tell you that if 30 percent of the people in say the dakotas that got tested are positive that if you have a crowd side of a hundred people um there's probably a lot of positives in that crowd that you don't know about and so and this virus is so so so easily transmissible so really i think you are going to have to plan virtual's going to dominate the scene for the first quarter of 2021 small limited crowds are going to limit the seed i don't think you're going to have any significant grace from people being vaccinated or people having antibody from previous infections so i do think the first two quarters particularly the first quarter of 2021 and i think most of the second quarter is still going to be a fairly restrictive uh environment for us when it comes to crowds crowd events i don't think we're going to start getting out of that until the fall of 2021. so let me ask you another question um the press was reporting that you may be releasing new guidance on quarantine periods from 14 days to seven days and i think one thing you and i talked about backstage was the clear and consistent guidance is so helpful and as the science evolves and the data evolves it's really important that we're spreading good information so the public is getting a consistent viewpoint so talk to the audience about the corn period if you would yeah i think it's really important i appreciate this is in what you said you know agencies like ours have to have the courage to change when we have data that says we need to change and you know i will say you know i hope not not everybody understands that uh you know you know when we thought this virus was largely transmitted symptomatically we then thought well if you're symptomatic you wear a mask and that will protect my source control teeth so i won't infect you but we didn't realize you know back in early march that a lot of the infection was actually asymptomatic and so therefore i don't know who's infected and so if i really want source control i want everybody to wear and again that got into a lot of controversy how do we change we change based on data so quarantine is uh you know and isolation is a key tool as i mentioned to try to keep this virus from spreading and a lot of people never understood when if i was infected i was told to isolate for 10 days but if i was not infected i was told to isolate for 14 days and a lot of people suggested that maybe i didn't make any sense because why do i isolate for only 10 days if i am infected and i isolate for 14 days if i'm not and the reason for that is if i know i'm infected either i got tested and i was asymptomatic or if i'm got symptomatic and got tested we know that the the virus uh shedding within the body in an individual's infected really that does become negligible in 10 days and that's why we were able to have people test out a quarantine when they were infected in 10 days but the problem with people who were exposed we don't know if you're exposed when does your body start to replicate the virus and originally we had studies that said the average was 5.2 days and then later we had studies it said it was seven point i think something somewhere in the seven days and so we only had data to really look at when was the probability that i was not going to somehow start shutting the virus and it turned out that the greatest probability that we would not miss anybody was 14 days and that's why we had it now we've since done a number of studies because there's you know obviously 14 days quarantine has an impact on productivity 14 days quarantine also has an impact on whether people quarantine and we've done a lot of studies over the spring and summer and that we were able to get enough data then that we could model and we you are right today actually uh the new guidance will be coming out from cdc i think they're doing a press thing as we speak and that guidance is again based on data that we gathered and modeling of that data that if you isolate for 10 days that the probability that you will um start replicating the virus after that is about one percent so it's a balance it's not that 14 days is bad it's just that how does society want to balance it do you want to get 99.9 or if we're 99 is that good enough at 10 days and that model also shows that if you test and we've done this with the sec football leagues uh in in trying to gather all this data and some other college groups um if we test it day five six or seven and you're negative um it's it's about the model would predict that we will we'll define at least 95 so cbc now is coming out with guidance today to allow people to make those those judgments that they can test out at seven days um and they can get out of 10 days but at the same time if they want to be perfect you know closest to perfect they can stay in isolation for 14 days so that will be coming out today i think it's going to make a big impact we found a lot of people really don't isolate for 14 days and you know and i think getting people to commit to this getting out of the transmission cycle um i think is important so that's the data that will be coming out today seven days with the test between day five and day seven and ten days without a test it feels really um important right we especially with the community leaders on this call and the business owners on this call that are getting out the information and that when information changes it's because we've learned more we've studied more you know and that's a good thing and that we're well it's so i think balancing this is so important and so hard and let me try to end on the positive note which is a positive note maybe i'm leading the witness here but do you think that our experiences as a country with code 19 will help us prepare for the next crisis which which seems sure to come in some ways did you feel that we're learning something as a we just talked about how the scientists and doctors are learning as they go do you think the public is learning too i think there's a lot of lessons here suzanne the first one you know that i want to emphasize because my time as cdc director is coming to an end in january um this nation was severely under prepared for this pandemic and i think we have to call it the way it is um when i became cdc director i was um i wasn't prepared to understand how little investment had been made in the core capabilities of public health at what is the premier public health institution in our nation the premier public health nation in the country but we didn't we we really have not invested where we need to be in data data analytics and predictive data analysis we really haven't invested in what i call laboratory resilience to make sure that our public health capacity has multiple platforms when we rolled out our original test despite all the news it was not botched that test worked the day we did it in the day we and to this day what was uh where there was a problem is when we manufactured the test for the public health labs around the country so they didn't have to send it one of the reagents had it had a technical flaw either contamination or actually a design flaw which was corrected over the next five weeks and since then the public health communities had that but we had no resilience we developed that test on a flu platform which was a low throughput platform so none of these public health labs had high throughput uh capacity and there was no resilience in laboratory technicians if they wanted to do any surge in public health workforce i had some states that their public health contact tracing workforce was less than 50 people so there's a huge lack of investment which i hope this pandemic will change on the other hand i am concerned that as the vaccine comes through and we get this behind us people may forget i've had lots of congressional testimonies on this issue um that this pandemic is going to cost this nation straight out probably about eight trillion dollars and then as you all know the indirect cost of larry kudlow and others would say in terms of the economy maybe another 15 20 trillion dollars um it would seem wise for us to invest the you know 100 billion dollars that we need to invest across the nation remember cdc uh most of our funding actually goes to the local state territorial tribal health departments and if you look at in many of the states we're the dominant funder of the public health infrastructure of those state or local community that has to be invested in so that's the first lesson not to let that go by and um and really realize it's time for this nation to have the public health system that uh not only we need but we deserve and uh i hope that's one big lesson second lesson for the public i think and it's a painful lesson um is how critical it is is to have harmony and messaging when you really want to get everybody on board you've got to have clear unified reinforced messaging and i think the fact that we're still we're arguing in the summer about whether or not mass work or not uh was a problem i think the fact that we are arguing about non-surgical i mean the fact that we closed health care we didn't need to close health care we needed to maybe close some electric you know elective cosmetic surgery but we didn't need to have 85 percent of the kids not get vaccine their vaccination series we didn't need to see uh individuals no longer seek emergency care and we saw many more heart attacks at home than we did in in people going to the hospital we didn't need to see cancer screening stuff so it needed to be much more thoughtful much more surgical much more data-driven and i would say the same for the economy you know we didn't need to have a broad shutdown of the american economy we needed to have a surgical thoughtful data driven approach that was able to validate the necessity we didn't need to shut down schools but so i think hopefully what we'll be able to learn is that it's it's important to be thoughtful step back you know not have a tendency to uh as i said the salami approach this we're gonna do it for everything i think you know people that fought to get the schools open like myself we never wanted the schools opened on safely and we never wanted them open irresponsibly we wanted to work to figure out how to keep them open safely and responsibly because we believe they were great public health value i would say the same thing about business you know we there's you know our nation runs on business and probably one of the greatest casualties of the pandemic this year was the impact on the business community and as i mentioned the impact on on just general health care the impact on our children's education uh these to me are extremely significant so i think that's a lesson too consistency and messaging and thoughtful surgical interventions that are clearly designed uh based on data that they're they have a critical role in helping us impact the epidemic but i think you're going to see a lot of books written on this you know you know i know i'm going to do a lot of reflection when i get out in january because i do think that's the key that we owe the next group is what did we learn so what do we learn that works what did we learn it didn't work uh so that the next time this happens and there will be a next time um this happens this nation's much more prepared i will say the last thing i'll just say is we should celebrate we really should celebrate the innovation that was brought to bear on this and when you think about it we have these vaccines now i said two will be approved before the end of the year two more probably very soon after that you know we have five vaccines now that are you know moving through the system when you look at the new therapeutics when i was sitting here um you know last say march and april i don't know how many of you know this but 27 of all deaths in america in april were caused by coving 27 right and now today it's about 11 which is still huge normally uh you know we would think these pulmonary deaths would account for about six percent uh but covet and pulmonary like illness now but it was 27 the mortality in someone over the age of 70 was uh over 25 percent which is not really good you had a one-on-four chance of dying uh and i think enormous impact with the new therapeutics that have been developed both the monoclonal antibodies redesvere some of the anti-inflammatory strategies um and now in the potential for convalescent plasma many of these therapies too and you're going to hear more about it from us i think this week many of these therapies where it's monoclonal antibody or or convalescence plasma they actually and even reduce severe these drugs need these therapies need to be given before you get sick enough to go to the hospital as soon as you get diagnosed you need to be able to get into care and get treated they work to keep you from having to go into the hospital there's two phases of the illness the virus and then there's the inflammation and the time the virus is in charge when you're still out of the hospital that's when we need to hit hard therapy but we now have mortality in the 70 year olds probably somewhere between three and eight percent and then again it's to celebrate the innovation uh that this nation has brought to bear but that innovation won't get us where we need to go if we don't come back to what i said before we need a public health system that's robust and surgical surge can surge and it needs to be throughout the nation and we need to have consistency of messaging so that the american public will come along with us when we're trying to articulate what are the critical mitigation steps that we all need to take to beat this pandemic well thank you so much for all of that i hope you will come back and help us get out clear and consistent messaging about the efficacy of vaccines when it's time in q1 for us all to be thinking about that um in the meantime i think the country also needs more calm wisdom from people like you so we're so appreciative of your message today of your hard work and service for our country and its citizens thank you thanks a lot susan thanks for the time and i just want to say to our audience thank you so much for tuning in uh you can catch past episodes at uschamberfoundation.org or on youtube please stay safe wash your hands wear a mask get your flu shot and uh and take really good care of yourselves and each other we'll see you again soon