My name is Diane Hall and I'm a senior scientist in the

CDC director's policy and strategy office.

I also serve as CDC's point of contact and coordinator

for our rural health bar.

As part of our work on this response we have been in

regular communication with federal partners such as the

federal office of rural health policy, USDA's national

institute of food and agriculture, and the VA office of

rural health as well as nongovernmental partners as

well as the world health information in the world

health information.

We have had tremendous interest in this briefing and we

have received many questions ahead of time.

Please note if the question is not within the CDC

purview we have shared it with the relevant agency and

we will continue to do so.

Also note that CMS launched a website on Medicaid gov

which includes a new checklist to make it easier for

states to receive federal waivers and implement

flexibilities in their programs.

If you search Medicaid COVID-19 you should be able to

find it.

If you have additional questions you may continue to

send them to rural had that CDC dot gov.

I would like to think Scott Miller in my CBC colleagues

working on the coronavirus response reporting is

breathing together.

I would also like to thank CDC's Captain Margo Rick and

the federal office of rural health policy and their

assistants for curating questions and assisting with

talking points.

And thank you to our partners to help disseminate the

invitation.

And I would like to welcome Health and Human Services

Deputy Secretary Eric Hargan, hopefully he is on the

line.

Okay, it sounds like he is not on the line yet.

So I would like to turn it over to Dr.

Jay Butler it was the Deputy Director of infectious

diseases here at CDC and then maybe when the deputy

secretary comes on we can pause.

>> All right, thank you Diane, and I will certainly

yield to the deputy secretary Hargan if needed.

So good afternoon to those of you in the East, good

morning to fellow Westerners, and thank you for taking

time to join this call today.

We are in the midst of a global pandemic of a disease,

COVID-19, caused by a newly recognized virus.

And all evidence is this is a virus that has only

recently achieved the ability to infect humans.

Coronavirus in general exist in nature, particularly in

bats, and certain coronaviruses adapt to infect people.

As some of you are aware if you are in poultry science

or you manage swine, influenza behaves somewhat like

that.

While the epidemic first evolved out of China, it has

spread globally now and some of the real global

hotspots now are in Europe and in the Americas.

All around the world nearly 300,000 cases have been

confirmed and we are sure that many more cases than

that are actually occurring.

Unfortunately nearly 13,000 people have lost their

lives to COVID-19.

It's important to recognize that the experience of

people around the world suggest that people who risk

complication send death are those who are advanced in

age as well as those with chronic heart lung kidney

disease as well as those with diabetes.

However, I want to stress that younger people also may

have more severe disease and while the overall

mortality may be very low among younger people, the

impact can still be significant.

Here in the United States there have been over 33,000

cases and there have been cases reported from all 50

states.

While a significant proportion right now are from New

York City or from New York State, I want to stress that

this is indeed a pandemic that has spread across the

country and across Canada as well, so really all of

North America.

I understand that Deputy Secretary Hargan is on so I am

going to pause and Mr.

Hardin, would you like to say a few words?

>>

>> Well, I apologize for the dead air and if the deputy

secretary is able to join we will let you know and

interrupt again.

Nationally here in the United States that have also

been deaths as well as severe illnesses, over 390

people have succumbed to COVID-19.

A significant proportion of those have been residents

of long-term care facilities which I think again

highlights the fact that those who are at greatest risk

are those who are older and have underlying conditions.

The long-term care facility outbreaks have now been

reported from 27 different states.

We do expect to see a continued increase in the number

of cases both as there is increased transmission and

increased capacity to test.

As of yesterday 91 state and local public health labs

basically representing all 50 states plus the District

of Columbia and Guam had capacity to do testing.

There were also five commercial labs that are

performing these tests as well.

As we looked at the mix of cases around the country,

some are travel related and when I say travel I mean

travel from other parts of the United States.

Others are community associated, and so it is important

to recognize that this is an infection that really is

threatening the entire country.

One of the challenges in controlling the disease is

that it is apparent that some people also have very

mild disease associated with infection and it may be

possible that people are shedding the virus prior to

onset of symptoms, and some people may have no symptoms

at all.

Just today CDC finalized and put out a report on some

of the cruise ship clusters and at least in one of the

cruise ships, 18 percent of people who have documented

infection never developed any kind of symptoms.

Over the past week there has been increasing focus on

social distancing and the things that we can do to

mitigate spread in our communities.

And the reason for that is we want to be able to

protect critical infrastructure, especially our health

care system, recognizing that there is a small but

significant portion of people who will become seriously

ill and we want to make sure that they are able to get

the care they need.

You may see different actions taken in different states

and in different communities, and actually that makes

sense because even though the virus is present around

the country, in some states the transition rates are

higher than in others.

Here at the CDC we are working with all of our federal

partners across the department and also with FEMA, and

our particular role is to collect and analyze data, to

be able to provide technical advice to states,

counties, and other partners to make good decisions.

This is truly a learning curve and it's very humbling

to recognize how despite the best science sometimes

what happens in nature can outsmart us, and in some

ways a viruslike this is like a tornado or a hailstorm.

There is not much that we can do other than be as

prepared as possible and then be ready to mitigate the

impact as much as we can.

Of course as I mentioned we work closely with state,

local, and tribal leaders who are also organizing the

local responses.

We also work with the private sector, particularly

focused on ways we can help support development of

drugs that are effective for treatment, develop new

ways to make the diagnosis, and ultimately to have a

safe and protective vaccine.

So all of this involves us working together.

We recognize that there are particular challenges in

rural areas.

There is a lot of dependence right now on things like

the Internet for communications, whether it is with

family or for teleworking, and in our rural areas as

well as especially in frontier areas, broadband and

Internet access can be quite limited.

We also know that providers are oftentimes already

overtaxed in our rural areas and we want to do

everything we can to help support them.

Also some of the things that are true when it is sunny

and 70 degrees are true now in a pandemic such as how

difficult it can be to transport patients that are in

need of a higher level of care.

So with that maybe I will pause.

I can try to pause one more time to see if Deputy

Secretary Hargan has been able to join us in an unmuted

fashion and if you would like to say a few words.

Otherwise I will turn it back to you, Diane, and we can

begin taking some questions.

>> Great, it sounds like we are having some techie

issues, the deputy secretary is on the line but he is

muted and we will wait to see if we can get that taken

care of.

Do we want to start with checkbox or take questions on

the phone?

>> Sure, we can go ahead with the chat box.

What is the current trajectory and Outlook for patient

search around the country?

>> It is quite variable depending on where you are at

in the country.

In some areas hospitals are approaching maximum

capacity already, but I mentioned earlier New York City

seems to be particularly impacted and there has been a

focus on being able to provide emergency additional

rooms, particularly for people who are only mildly ill

but still needing hospital care.

It's also a chance to point out that most people who

become ill can isolate at home and don't need to be in

the hospital.

So again it is important to understand the vast

majority of people who become sick will have relatively

mild illness and can self manage at home.

However, because we are talking about a virus that may

be able to infect everybody even if the risk of the

overall proportion who develop severe illnesses

relatively small, we may be talking about a significant

number of people.

So we want to make sure that we can provide care for

those who are more severely ill, and he gets back to

the discussion a little earlier about the role of

social distancing and community mitigation.

We are trying to flatten that curve and I think now

everybody has heard that term, it's a household word

now, but to put it another way, if you are, say,

running a hospital and you need to admit 100 patients

over a one week period, that might overwhelm the

system.

But if it is 100 patients over a two month period, that

might be something that can be handled very, very well.

>> Thank you.

Another question, that asks do we know what the

aftereffects are for those who are infected?

Is this like the flu, once it is over or do we have

lasting effects?

>> Well, that's a great question and it's a great

question because that is one of the ones we are

exploring also.

The context of our discussion today, it is important to

keep in mind that we are talking about a disease and a

virus that was unknown to us only three months ago.

We were all getting ready for the holidays and COVID-19

was not in our vocabulary.

Those of us in health care new of coronaviruses but we

only knew of six and now we have 1/7 that we have had

to learn about very quickly.

So at this point in time we don't have a lot of

information.

What information we have is mostly what has come out of

China which has seen the most cases occurring the

longest time back.

So far it appears that many people do recover

completely, although some may have persistent cough