Thread by @V2019N

From @AspenInstitute w/ @HelenBranswell
thread
@DrNancyM_CDC : disease can be very severe, more severe disease in older ppl, comorbidities, don't know full spectrum, of #COVID19.
cautious about est. CFR
how much mild disease?
would like to do serological studies

@DrNancyM_CDC: has been spectrum in US cases, all improving
Fauci: Wants more info from China. Needs to know scope, due to ease of transmissibility suspect # of asx cases may be very high. What is degree of asx transmission.
Asx not usually driver of outbreak in resp. illness

Fauci: Asx transmission matters re: policy for screening.
More data from China not just numbers.
@RonaldKlain: let science and expertise not politics drive response. 1) think hard about travel policy 2) public officials should take crediblity seriously (messaging!)

@DrNancyM_CDC : on restricting travel, can't seal US against disease, if asx or mild can transmit, we can't keep from spreading in US, goal to slow down. window of opportunity needs to be used to prepare for worse pandemic.

@DrNancyM_CDC Q: Should we have not banned but shored up public health system, public expects action.
@RonaldKlain : action should be science and medicine based, quarantine (cruise ship example) has complex effects. careful about what you do, and BE CANDID WITH AMERICAN PEOPLE (emphasis mine)

@RonaldKlain : We require daily import from China. People and goods coming in all the time.
Fauci: You are never going to exclude everyone who is a risk from coming in country. Trying to buy time. You can't stop outbreak, can delay. People will come in. There will be leakage.

Fauci: trying to slow importation from epicenter (Wuhan) to not let those people in w/travel ban. (All #US cases but two from travel) By the time we have sustained transmission, travel bans don't make sense. Wanted to buy window of time to prepare better.

Q: how is pandemic preparation going?
@DrNancyM_CDC : people like responding, they don't like preparing.
Guidance for sectors on infection control, PPE online.
State and local health departments getting ready

@DrNancyM_CDC @RonaldKlain : everything about this inevitable (people don't like to prepare, they like to act) We need to stop boom and bust cycle for epidemics.
After ebola 60 hospitals upgraded for special pathogens. Requires funding from policy perspective. Only sure thing, more disease

Q about Singapore local transmission and PM address public
at what point do you switch from prevention to containment to mitigation
Fauci: when there is **sustained transmission in country** still hoping mitigation. Short term risk low,

Q Branswell: explain how this is low risk? when very contagious, what is happening in China.
Fauci: Risk of global pandemic: Absolutely yes.
@DrNancyM_CDC: only so much worry you can do in US.
no signs of community spread.
We are preparing because we do think there is a risk

@DrNancyM_CDC : we won't probably have a vaccine for at least a year.
Not a specific countermeasure to deploy other than
social distancing
@HelenBranswell : Q; why still on "low risk messaging"
comparing to SARS that went away quickly.

Fauci: "at present" risk low. situation could change.
Concern about credibility if warning high risk
@RonaldKlain : Lack of countermeasures, if worse, will be inflicted on healthcare system. No command and control healthcare system. Part public and private....

@RonaldKlain :
We don't have federal healthcare system. States/localities. US complex. Requires funding to help state and local gov'ts. Invest in helping get hospitals ready challenging.
CDC/NIH very fast.
But hospitals complicated mix of private.

@RonaldKlain Q: vaccine
Fauci: have started work, in general vaccines take 5-8 years, in acute situation challenging.
Doing vax research at NIH.
Phase I trials in humans (unless glitch) in 2 1/2 mos.
Takes 3 mos to determine safety (now at 6 mos)

Fauci cont
Then a phase II trial, if works, that's 6 mos.
Then scale up time
So vaccine as part of deployable countermeasure is not in the mix for at least a year.
If it's bad, we get to end of 6 mos, proceed at risk.

Fauci: At risk: 100's of millions to scale up on something that may not work.
FDA can do emergency use auth
@RonaldKlain : should use policy to take some of "risk" out for vaccine makers

@RonaldKlain @RonaldKlain
If vax quickly made, legal and policy barriers to use. Need changes.
Q: could have vax, how to scale? produce?
Fauci: will need pharma to help, will be a challenge to get vaccine company to do this since past issues
Industry steps up, makes, gets "burned"

@RonaldKlain Q: what kind of measures, school closures?
@DrNancyM_CDC : rests on planning for influenza, new respiratory pathogen without vax. social distancing.
hypothesis about why kids aren't having illness, something they are getting but mild, might seed households

@DrNancyM_CDC : avail of tele working, tele school, tele medicine to operationalize social distancing.
hard to operationalize stopping mass gatherings.
can help to buy us more time
frequently lowers peak of disease
don't want everyone getting sick at once
to manage

Q: best guess on cfr ?
Fauci: don't know, but relative mortalities, China 2%
believes it may be less, 1%, or less than 1%
if 2x more that are mildly sick or asx, then 1%
could be multiple other versions of that. We don't know b/c not prior experience.
@DrNancyM_CDC won't predict

@DrNancyM_CDC How many deaths reflect the societal disruption of Wuhan? (won't predict CFR)

@DrNancyM_CDC Video of the Aspen Institute conference today on #COVID19 moderated by @HelenBranswell with @DrNancyM_CDC , Anthony Fauci and @RonaldKlain h/t @Fla_Medic