Coronavirus in Context: The Pandemic: View from the CDC

[MUSIC PLAYING]

You're watching Coronavirus in Context. I'm Dr. John Whyte, Chief Medical Officer at WebMD. I'm joined today by Dr. Anne Schuchat, the principal deputy director at the Centers for Disease Control and Prevention. Dr. Shuchat, thanks for joining me.

It's my pleasure.

Let's talk a little bit about facial masks and-- and facial coverings. Some folks still are a little confused about that policy. Can you help guide viewers as to what they should be doing?

Yeah. This pandemic is caused by a virus that has some unusual features. It turns out that the, um, COVID-19 disease can be spread through pre-symptomatic transmission. People who are feeling fine, who don't think anything is wrong, can actually spread the virus to other people, just by, um, breathing, talking, and so forth.

And so we realized that the-- the virus was spreading so fast, it was easily transmitted, and that the use of a cloth face covering might be able to prevent that pre-symptomatic transmission from one person to another. So we like to think about these face coverings as protecting other people. I like to say, um, I've got you covered by the face covering that I'm using.

OK.

And so the more people that are wearing them or using them, the-- the potentially more protected the community will be. But we're really not trying to make claims that they protect, uh, the individual who's wearing it.

Sure.

We also want to differentiate from those surgical masks or the special N95 respirators. As-- as clinicians know, those are so important for medical personnel, health care providers, to use. And so the idea of the cloth-based covering, something that everybody can make in their house with noth-- no extra supplies, really-- an old T-shirt and scissors or a sack or a bandanna and some rubbers bands is enough to-- to create them, and, you know, maybe give you something-- something to do in the downtime--

That's right. That's right.

ANNE SCHUCHAT: --of your shelter-in-place or staying home.

And you have information on your site. We do as well. And the surgeon general has demonstrated, uh, how to make one of these masks. Have we learned anything new about transmission? There's been some discussion about, you know, is it aerosolized. Um, Anything that you've been watching, in terms of that-- that might change how we're-- we're thinking about different, uh, countermeasures?

The modeling and the study of the virus so far has shown us that it's quite transmissible when you're not doing inventions, like mitigation, or, you know, the social distancing.

Mm-hmm.

The R0 really is pretty high in an unmitigated situation. The, um-- we know that a lot of people are asymptomatic and can have the virus detected, including culturable virus. And in an assisted living investigation we did in Seattle King County, we found that an-- asymptomatic residents had very high viral loads, suggesting that they-- they likely could transmit. Um, the issue of airborne transmission is a little bit, uh, unclear at this time.

Mm-hmm.

But I can say that aerosol-producing procedures, like nebulizers or intubation, are-- are a problem. And we have seen in some health care worker infections-- you know, health care workers who got infected on the job before they were wearing the N95 respirators--

Yep.

--were around nebulizer procedures. So we think aerosolization of the virus is a problem. We think most of the transmission is through respiratory droplets. Perhaps some is through airborne transmission. But because we know there are high viral loads in the upper airway--

Mm-hmm.

--differentiating this from other, uh-- many other viruses, the idea that it's just respiratory droplets in high concentrations could, especially with pre-symptomatic transmission, is enough to explain most of the patterns that we're seeing.

Sure. And we've been seeing a lot of cases throughout the epidemic in nursing homes. And there's always that issue, should we be doing more, in terms of strategies, to reduce transmission and in cases to those that are most vulnerable in nursing homes?

Yeah, I mean, the tragic piece of this-- one of the tragic pieces is this just, um, really disproportionate severe disease in the elderly and in congregate settings, and you put the two together in a nursing home or skilled nursing facility. And we saw what happened in Seattle King County, that one facility really seeded the whole-- the whole city.

So we think that protecting the vulnerable and protecting the health care workers in nursing homes is going to be really important.

Mm-hmm.

CDC has stood up something called tele-ICAR, the telehealth Infection Control Assessment and Response.

Hm.

We're working with state health departments so that they can really surge and support all the nursing homes in their, um-- in their jurisdictions. We have a tool kit. We actually have people on the ground, but we have a technical team back here supporting this, really trying to train the trainer so that the health departments will be able to surge in response.

There is interest in getting, uh, broader testing in nursing homes. You know that our investigations so far have shown, many elderly who are infected don't have the usual symptoms. Some may not have symptoms at all. Health care workers may not have the usual symptoms. And health care workers going between facilities or between wings in a-- in a nursing home can spread the virus. We know there's not enough PPE to go around for everybody who needs it.

And so we really want to find ways to recognize infection in a nursing home quickly and shut it down. Basically isolate the individuals who are infected, separate them from others. Make sure that the health workers are getting screened with temperature checks and so forth, and put in place all of the best infection control practices so that these facilities don't, uh, lead to large outbreaks.

I think it's going to be a challenge for the weeks ahead. I think this problem is under-detected. And we know that every nursing home that's had a problem, it's been a tough one to-- to deal with.

Yeah. I want to hear your perspective on the role of tech, especially in terms of contact tracing. We know that's a critical component when someone tests positive, especially because of asymptomatic spread. Um, I've been involved in public health in past lives. We don't have enough public health officials to do the amount of tracing that one would like to do.

And we're starting to hear some work, potentially, by Apple and Google, in-- in terms of the ability, perhaps either to upload that one has been infected. And then through the use of Bluetooth or location trackers to send messaging to folks. What's the CDC'S role in this and-- and what are you hearing? And do we expect there to be a role for tech?

Yeah, I am really excited about this. You know, I've been in public health a long time and contact tracing is an important tool. But usually where you're using it, you know, in a much smaller scale situation.

Yes.

Even in Ebola, it was a much smaller scale situation. And it wasn't a situation where pre-symptomatic, uh, transmission was occurring. Speed is everything in contact tracing for an infectious disease like COVID-19. And so I think tech has a lot to offer.

CDC is working with state and local jurisdictions right now to pilot a variety of means to enhance the contact tracing, to more rapidly identify cases, perhaps with point of care testing, to rapidly, um, scale up contact tracing. This may be through a big, what we're calling a COVID response core. That could be CDC staff, could be students in the jurisdiction, could be Peace Corps volunteers who were brought back, or census-takers. We're really looking at all of those different pools. And the CDC Foundation, as well as many states and jurisdictions, are hiring people right now to help with this effort.

We're thinking about the tech issue in three ways. One is to really improve the traditional contact tracing thing. More automation, you know, can I get my spreadsheets so that they automatically feed back to the people I found? You know, I have a contact list, but can I automatically check in on them every day, remind them with text messages, have you taken your temperature, do you have any symptoms, here's who to call, you know, just the frequent reminders. We're already using that with our own deployers. Um, a TIM system that's really taking, uh, daily check-ins with individuals who are trying to monitor.

The second is the idea of apps, where you, um, opt in, in the United States. In other places, you may just have this, you know, done to you. But you opt in to basically find-- you know, get a buzz, get a notification, when there's a, um, individual near you who has been identified to be a case. And this is really done phone-to-phone with the Bluetooth technology.

Mm-hmm.

ANNE SCHUCHAT: The third approach, um, which is part of the Google-Apple collaboration, but also other technologies, is using other means besides the-- the iPhones or the-- you know, the Androids, to use GPS and other means to understand who could be contacts.

Mm-hmm.

And that's kind of what the Chinese or Hong Kong was doing, a little bit of Big Brother. But I have to say that, in the United States, the extent to which we've gone to try to slow the spread of this virus makes a lot of, um-- a lot of people more open to things that we might have found intrusive or invasive. So what we're doing right now is working with jurisdictions in areas that are low incidence, areas that never saw the big, high rates, and trying to, um, pilot different kinds of contact tracing that work for that jurisdiction, community engagement, understand what's acceptable in Kentucky or in New Mexico, to try to figure out what would be a solution, really piloting a couple different things. And then-- and then hopefully, having a menu that states or jurisdictions could follow.

Yeah.

Right now, you know, New York City can't get to individual contact tracing today. They just got way too many cases every day now to do that, even with tech. But we hope that, as we flatten the curve, as things get better, it'll be possible for us to really scale up case identification through more testing and contact tracing through the enhancements of tech, as well as that public health core that really needs to be built up.

I've got a two-part question for you, if I may. We know this is, uh, you know, a pandemic. But many ways, it's an infodemic. There's so much information out there. Both of our sites work very hard to try to provide the most credible, evidence-based information.

So the two-part question is, what do you think is the biggest misconception that people have about COVID-19? And what can we all do to provide credible scientific information out there, that, you know, just because someone tweets it, doesn't mean it's accurate, and just because someone has a blog doesn't mean they're providing scientific information? So what's the biggest misconception, and how can we work together to make sure people get good information?

Wow, those are really great questions. Um, one thing I want to say is that, um, the speed of information today is incredible. And the speed of misinformation is as well.

Mm.

And it is really difficult for a consumer or a member of the public to know what to think, you know? Is this the end of the world? Is this an overreaction?

Mm-hmm.

How do I protect myself and my family? Can't we just go back to work, you know? So I think that one-- one-- perhaps one misconception is, we can just turn a switch and this is going to be over. It's just going to have been a really bad nightmare and life will return to normal tomorrow.

Unfortunately, this virus has so many features that are really confounding, very difficult. It's easily spread. It can be severe, not just in the elderly and people with underlying diseases. We've seen these health care workers who are young and healthy who have really bad disease occasionally.

And so I think that the idea that, um, this is going to be a quick thing is, perhaps-- you know, we all wishful-thinking want it to be over quick. But it's going to-- it's going to take some time. We have been, um-- I've been really gratified to see the impact that the social distancing's had, that it really has slowed the spread, even though in some communities it started after there was a lot of spread. But I think that we have to be really careful as we open things up. We may need to do periodic, intermittent social distancing to really flatten this curve and slow the spread until there are effective treatments, until, perhaps, we get a vaccine. So you know, I have, um, a lot of respect for all the different information sources--

Mm-hmm.

--yours and others that are keeping up with this. One thing I want to say is, um, CDC hasn't kept up as quickly as we would have liked to. I-- I wish we'd had more information more quickly to everybody who needed it. And I think the private sector has done a good job to a great extent in innovation and technology, innovation and information sharing. But it leaves consumers sometimes really having to figure out, do I trust this site or that site--

Mm-hmm.

--the site that's getting all the-- all the, um, hits right now because it's got some sensational comments.

Yes, provocative comments, yes.

Yeah, or the site that's saying like, no, that doesn't work either. They're so chaotic. So we all want a miracle cure.

Sure.

But um, please be careful with what you think is a miracle cure. I know the scientists are working really fast to evaluate new drugs, treatments, and preventions. And try to follow the-- the sites that you trust. CDC, we were gratified at-- a recent poll said that the CDC website was the most trusted source for COVID-19 information. We work hard to keep it that way.

Sometimes it's not as fast as everybody else's, but it's because we're really trying to check the data and make sure it's right. But, um, I appreciate that we're all in this together, the public sector, private sector, universities, media, you know? The consumers need to know how to keep themselves healthy and safe.

Thank you, Dr. Schuchat for all that you and your colleagues are doing. And thank you for watching Coronavirus in Context. I'm Dr. JOHN WHYTE.

[MUSIC PLAYING]