Worth Reading in Full

Yesterday, some CDC employee gave a conference call which in my opinion has set firestorm of concern, for better or worse. It is suggested that one read the call in toto.

It begins:  

The U.S. has been implementing an aggressive containment strategy that requires detecting, tracking, and isolating all cases.  As much as possible and preventing more introduction of disease notably at points of entry.  We’ve restricted travel into the United States while also issuing extensive travel advisories for countries currently experiencing community spread.  Our travel notices are changing almost daily.  We’ve also enacted the first quarantine of this scale in the U.S. And are supporting the state department and HHS in repatriating citizens from high-risk areas.  We are doing this with the goal of slowing the introduction of this new virus into the U.S. And buying us more time to prepare.  To date, our containment strategies have been largely successful.  As a result, we have very few cases in the United States and no spread in the community. 

 Ok so far so good. Now in my opinion she jumps into the fire:  

Now I’d like to talk through some examples of what community NPIs look like.  These are practical measures that can help limit exposure by reducing exposure in community settings.  Students in smaller groups or in a severe pandemic, closing schools and using internet-based teleschooling to continue education.  For adults, businesses can replace in-person meetings with video or telephone conferences and increase teleworking options. On a larger scale, communities may need to modify, postpone, or cancel mass gatherings.  Looking at how to increase telehealth services and delaying elective surgery.  The implementation of environmental NPIs would require everyone to consistently clean frequently touched surfaces and objects at home, at school, at work, and at large gatherings.  Local communities will need to look at which NPIs to implement and when based on how transmission and disease is and what can be done locally.  This will require flexibility and adaptations as disease progresses and new information becomes available.  Some of these measures are better than none.  But the maximum benefit occurs when the elements are layered upon each other.  Some community level interventions that may be most effective in reducing the spread of a new virus like school closures are also the most likely to be associated with unwanted consequences and further disruptions.  Secondary consequences of some of these measures might include missed work and loss of income.  I understand this whole situation may seem overwhelming and that disruption to everyday life may be severe. 

One would assume that these discussions would have had taken place with at least State and some local Health Care workers. They did 100 years ago with Influenza and TB. Yet we did not close down the US economy. In fact Wilson had us fight a War on top of it all. Also it was not that we did not know about infections. Read any Medical book from that time.

Now consider the following statement:

 So in the short-term, it’s the clinician calls the health department.  And either the health department already has the test kit themselves or if they don’t yet have it stood up, they send it to CDC.  Our turnaround at CDC is within a day.  There is a little bit of shipping time.  But that’s the process.  In terms of timing, I think at this point what I would say is we are working as fast as we can.  We understand the frustration of our partners in the health care sector, in health departments.   

An itsy bitsy bit of shipping time. How about getting the USPS involved, ya think? She continues:

So the answer to the first question is certainly, we’re considering what the spread of illness in other countries looks like and how it impacts the potential risk the Americans traveling abroad in those countries.  Those conversations are going on as we speak.  We obviously are working closely with the partners on those considerations.  And when there is new information in terms of case definitions, we’ll definitely publicize that broadly.  You know, as I said, we are still at the stage of containment, but we are already starting to plan for mitigation.  And part of the mitigation planning is the participation of community spread in the united states.  And as that happens, it would certainly dramatically impact how we’re considering who is on the case.  As you can imagine, the symptoms of novel coronavirus look a lot like other viral respiratory diseases that are circulating this time of year.  So it’s going to be difficult for clinicians to differentiate fully on the basis of those — solely on the basis of the symptoms.  In terms of diagnostic tests, what I would say is we’re working closely with FDA on this.  

So the tests are critical. So where are they? Also travel may have to be carefully restricted. How about Italy, nothing personal.She continues:

What I can say from my perspective is I’ve been at CDC for 25 years and that if you asked public health officials over the course of that time what they feared as an expectation, it was something exactly like this.  And so the idea that we might have a pandemic of influenza or a pandemic of a respiratory viral infection is something that we’ve known about and have been planning and preparing for.  That’s why we at CDC have been exercising with the state and local health departments.  That’s why the whole of government exercise last year, that’s why we’ve invested so much on the foundation we are now responding.  But that being said, we are never going to ever be able to be so completely prepared that we’re prepared for any inevitability.  We always are going to find that diseases surprise us and that there was some consideration that is slightly different from what we planned for.  So have we made a lot of progress in the 25 years I’ve been here?  Yes.  Are we better prepared today than we were 20 years ago?  Yes.  But are we completely prepared?  

Cover all bets folks, no matter how much we spend it is never enough. Some in Congress see this as another sink hole to be filled with our tax dollars. Twenty five years and we do not seem to have an operational plan.

There are times one wonders just what the purpose of this was and by whom it was made. Needless to say there has been a great deal of speculation. The Messenger is often more important than the message. Perhaps there is a great mis-step here. We shall see.