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Press Briefing by Members of the President's Coronavirus Task Force

January 31, 2020

James S. Brady Press Briefing Room

3:42 P.M. EST

SECRETARY AZAR: Well, good afternoon, everyone. I'm Alex Azar, Secretary of Health and Human Services, and Chairman of the President's Task Force on the Novel Coronavirus.

I'm going to start by turning things over to Dr. Robert Redfield, the Director of the Centers for Disease Control and Prevention, to discuss the current situation on the novel coronavirus. Dr. Redfield.

DR. REDFIELD: Thank you, Mr. Secretary. Let me give you an update on the current situation of the novel coronavirus. First though, I want to emphasize that this is a serious health situation in China, but I want to emphasize that the risk to the American public currently is low. Our goal is do all we can do to keep it that way.

Second, I want to recognize the concern that the American public may have. And I want to reiterate what I just said: Currently, the risk of the American public is low.

As of today, there are nearly 9,700 cases in China, with more than 200 deaths. Additionally, currently there are another 23 countries that have confirmed, totally, 132 cases. This also includes 12 individuals who have been confirmed in six countries who did not travel to China.

CDC has launched an aggressive public health response focused on early case recognition, isolation of those cases identified, and contact tracing around those individuals. This response is a layered response, which includes both targeted airport screening, as well as heightened education and awareness of the American healthcare community to be vigilant in ascertaining the possibility of recent travel to China when they are evaluating patients with upper respiratory tract infection.

To date, we have confirmed six cases of this novel virus in the United States. The most recent case had no travel history to China, but was a close personal contact of one of the previous cases that we had identified through our aggressive contact tracing. In addition, there are currently 191 individuals that are under investigation.

Once again, I want to emphasize that this is a significant global situation, and it continues to evolve. But I also want to emphasize again that the risk at this time to the American public is low.

Mr. Secretary.

SECRETARY AZAR: Thank you, Dr. Redfield. I would now like to invite Dr. Anthony Fauci, the Director of the National Institute of Allergy and Infectious Disease, to discuss the underlying rationale for the actions that I will be discussing after he concludes. Dr. Fauci.

DR. FAUCI: Thank you very much, Mr. Secretary. The concept that's underlying the action that you'll hear about shortly is the issue of the unknown aspects of this particular outbreak. So let me enumerate just a few of these.

I can start off by putting it into perspective by telling you I often get asked — we have an influenza outbreak here. We have about 8,000 deaths already. We have about 100,000 hospitalizations. Why are we paying such attention? And why are we doing the kinds of things we're doing here right now?

Well, the reason is, despite the morbidity and mortality with influenza, there's a certainty, for example, of seasonal flu. I can tell you all, guaranteed, that as we get into March and April, the flu cases are going to go down. You could predict pretty accurately what the range of the mortality is and the hospitalizations, as we've done over the years.

The issue now with this is that there's a lot of unknowns. As you can see just from the media, the number of cases have steeply inclined each and every day. You know that, in the beginning, we were not sure if there were asymptomatic infection, which would make it a much broader outbreak than what we're seeing. Now we know for sure that there are.

It was not clear whether an asymptomatic person could transmit it to someone while they were asymptomatic. Now we know from a recent report from Germany that that is absolutely the case.

There are a number of countries outside of China that have travel-related cases. And now what we're seeing is that there are secondary cases from them, and, as Bob mentioned, we also have that in this country. The WHO has issued, as you know, a Public Health Emergency of International Concern declaration.

If you put all these things together, I underscore what Bob said: We still have a low risk to the American public, but we want to keep it at a low risk. And because there are so many unknowns here, we're going to take the action that the Secretary will describe, in a temporary way, to make sure we mitigate, as best as we possibly can, this risk. Thank you.

SECRETARY AZAR: Thank you, Dr. Fauci. Today, President Trump took decisive action to minimize the risk of the spread of novel coronavirus in the United States. Since taking office, President Trump has been clear: His top priority is the safety of the American people. In addition to the steps that the doctors have outlined, we continue to operationalize a multi-layered, cross-agency, public health response.

Following the World Health Organization's decision to declare the 2019 novel coronavirus a Public Health Emergency of International Concern, I have today declared that the coronavirus presents a public health emergency in the United States. The actions we have taken and continue to take complement — complement the work of China and the World Health Organization to contain the outbreak within China.

In accordance with the declaration, beginning at 5:00 p.m., Eastern Standard Time; Sunday, February the 2nd, the United States government will implement temporary measures to increase our abilities to detect and contain the coronavirus proactively and aggressively. Any U.S. citizen returning to the United States who has been in Hubei Province in the previous 14 days will be subject to up to 14 days of mandatory quarantine to ensure they are they are provided proper medical care and health screening.

To be clear, this applies only to U.S. citizens who have been in Hubei Province in the past 14 days prior to their attempted entry into the United States.

Any U.S. citizen returning to the United States who has been in the rest of Mainland China within the previous 14 days will undergo proactive entry health screening at a select number of ports of entry and up to 14 days of monitored self-quarantine to ensure they've not contracted the virus and do not pose a public health risk.

Additionally, the President has signed a presidential proclamation, using his authority pursuant to Section 212(f) of the Immigration and Nationality Act, temporarily suspending the entry into the United States of foreign nationals who pose a risk of transmitting the 2019 novel coronavirus.

As a result, foreign nationals, other than immediate family of U.S. citizens and permanent residents, who have traveled in China within the last 14 days will be denied entry into the United States for this time.

Once again, these actions will become effective at 5:00 p.m., Eastern Standard Time; Sunday, February 2nd. These prudent, targeted, and temporary actions will decrease the pressure on public health officials screening incoming travelers, expedite the processing of U.S. citizens and permanent residents returning from China, and ensure resources are focused on the health and safety of the American people.

I want to stress: The risk of infection for Americans remains low. And with these and our previous actions, we are working to keep the risk low. All agencies are working aggressively to monitor this continually evolving situation and to keep the public informed in a constantly transparent way.

The United States appreciates China's efforts and coordination with public health officials across the globe, and continues to encourage the highest levels of transparency.

It is likely that we will continue to see more cases in the United States in the coming days and weeks, including some limited person-to-person transmission. The American public can be assured the full weight of the U.S. government is working to safeguard the health and safety of the American people.

I'd now like to invite Deputy Secretary of State Steve Biegun for an update.

DEPUTY SECRETARY BEIGUN: Good afternoon. And thank you, Secretary Azar. My name is Steve Biegun, and I am the Deputy Secretary of State, and I represent the State Department on the President's Novel Coronavirus Task Force.

Let me describe briefly the role of the Department of State in the proceedings of this task force and our contributions. Our first responsibility is to monitor events on the ground in China where we have the presence of U.S. diplomats, and to give clear and accurate advice to American citizens and, in particular, American travelers considering visiting or staying in China.

In this particular case, this includes identifying any health or safety risks to which they may be subjected, but also, very importantly, identifying their access to essential services such as healthcare in parts of China that are affected by this coronavirus.

China has an excellent healthcare system, but, in parts of the country, it is simply overwhelmed and the accessibility to that healthcare for any reason — including potential infection, but also any other type of accident in need of medical care — may be compromised during the Chinese government's own treatment of the consequences of this virus.

Finally, we also make our judgments based upon any obstacles, particularly obstacles to movement that American citizens might face in the country. And in China, we have seen barriers to travel, both within and without China, as well as between the United States and China. And so we've given prudent advice, over the course of the week, to American citizens in order for them — to allow them to make the best possible choices for themselves.

Our second responsibility is to assist U.S. citizens in the affected areas as much as possible. Because we have a presence on the ground, we can provide advice and, in some cases, we can make other arrangements. But I want to emphasize this is "as possible," and we will continue to review what we can do in certain circumstances.

Finally, and very importantly, the core mission of the Department of State is to work closely with our international partners. And in this case, we are working very closely with the Chinese government in order to address a number of related matters.

But let me start, on behalf of the President and the Secretary of State, by extending our deepest compassion to the people of China. This has been a very difficult time for the Chinese people. It came at a point of their peak holiday season. Many are affected. Many have lost loved ones or are enduring the illness of loved ones. And I want the Chinese people to know that they have the deepest sympathies of the United States of America.

Let me also say and echo what Secretary Azar said, which is we are deeply appreciative of the close cooperation we have with the Chinese government as we work together to try to find appropriate ways to address any risks and challenges from this virus.

And finally, the United States will continue to cooperate with China in ways that we could potentially provide assistance, including technical assistance, and also, to the extent possible, any critical supplies that the Chinese need in order to address this virus. And we are working very hard to find donors and make arrangements so that we can — we can undertake a robust effort to help the Chinese people get their arms around this outbreak.

Thank you.

SECRETARY AZAR: Thank you, Secretary Biegun. Let me — let me next invite the Acting Deputy Secretary of the Department of Homeland Security Ken Cuccinelli to take the podium for some comments.

ACTING DEPUTY SECRETARY CUCCINELLI: Thank you, Mr. Secretary. I am Ken Cuccinelli. I'm the Acting Deputy Secretary at the Department of Homeland Security, and I'm the Department's representative on the task force led by Secretary Azar.

Several elements of the Department of Homeland Security are engaged in implementing the medical strategy you heard described here, including Customs and Border Protection, which stands at our land ports, seaports, and airports — and I'll come back to the airports in a moment — particularly the Office of Field Operations personnel who you see when you come back into the country from your travels. They're the first line of defense when you land and come to the country.

Additionally engaged is TSA — the security and the engagement with the airlines. Our chief medical officer in the department is in CWMD and they're — we were providing medical support at the airports.

So we're using contract authority that we have to backfill the CDC personnel, so they can be freed up for other missions at the airports where medical screening is being focused.

FEMA continues to prepare and support HHS preparations themselves. And then the United States Coast Guard, of course, commands the ports of the United States and deals with incoming shipping, which is obviously slower than the airplanes but coming nonetheless, and we are prepared to deal with each of those.

The President's proclamation will have Customs and Border Protection ensuring that United States citizens, legal permanent residents, and their immediate families continue to enter the United States, though they — those coming from Hubei Province, as you heard from the Secretary, will be subject to quarantine and the others from China to screening.

We will be implementing a funneling effort at the airports. This is done under the authority of the Customs and Border Protection, and it will include seven airports. So starting five o'clock on Sunday, Eastern Time, incoming flights from China will be funneled through seven airports. Those airports are JFK, Chicago's O'Hare, in San Francisco, Seattle, Atlanta, Honolulu, and LAX.

This is done under CBP's authority. It will be executed by the Secretary the Department of Homeland Security, consistent with the President's proclamation and in support of that effort — again, so we can focus the expertise of the medical professionals that will do the screening to implement this.

We'll continue to support the medical efforts across the country both at our ports — our land, sea, and air — as well as with personnel standing up some of the resiliency measures that HHS has been working on for some time. Thank you.

SECRETARY AZAR: Thank you, Secretary Cuccinelli. At this point, we'd be happy to take some of your questions. Kevin, would you like to get started?

Q: Thank you, Mr. Secretary. If the risk is really low, could you talk about why go to such an extreme as a public health emergency? If the risk is that low, why are we taking such measures?

SECRETARY AZAR: So these are actually fairly incremental, measured steps, on top the steps we've already progressively been taking. You'll notice that many airlines have already stopped direct flights from China. They have pulled that down. We're seeing a significant — and the Department of Transportation could comment on the numbers we're seeing or Homeland Security. We've seen a significant reduction in people from the U.S. going to China, people from China coming to the U.S., already.

This just helps us focus our efforts so that we — as we're dealing with the unknowns that Dr. Fauci spoke about earlier — unknowns around incubation period, unknowns about the speed of transmissibility, unknowns about asymptomatic transmission, unknowns about severity — that we take appropriate, measured, prudential steps so we can focus our resources. Because it's the bread and butter — I've talked to you before about — the bread and butter of public health is: identify people who might be symptomatic or might have the disease, diagnose, isolate, treat, contact trace.

That's a significant undertaking, as we have already done with the six individuals in the United States who've been positively identified. We have to focus those resources.

John.

Q: Mr. Secretary, the mandatory quarantine for people coming in Hubei Province — will that be home quarantine or will that be in an institutional setting?

SECRETARY AZAR: That would be at an appropriate quarantine facility of some kind for those individuals. For the U.S. citizens returning to the United States from having been in China within the previous 14 days, they would be funneled, as Secretary Cuccinelli spoke of; they would be screened appropriately to see if they present any type of symptoms of the disease; and then they would be asked to self-isolate at home over the 14 days.

But for individuals from Hubei — because that is the epicenter of this, with such high immediate transmission — we feel that these additional measures of quarantine for up to 14 days are appropriate.

Q: And can I just follow that: Have you selected specific quarantine centers?

SECRETARY AZAR: We have selected them. We're — we will announce those as DHS implements, with the airlines, that funneling activity.

Q: To follow up on John, what does self-quarantine look like for the people who are self-quarantining? How do you enforce that? What are the mechanisms surrounding that?

And if you could you also speak to — you just described this as sort of an incremental step, I believe. This is obviously significant: the quarantine of citizens in this country.

What is your message to Americans who are watching this on the news, who are seeing this, who are feeling really alarmed by the steps that this administration is taking and by the spread of coronavirus in general? They hear you say the risk is low, but then they see this action being taken, and I think some people might be freaked out by that.

SECRETARY AZAR: I hope not. I hope that people will see that their government is taking responsible steps to protect them. These are — these are preventive steps. The risk is low in the United States. The risk is low of transmissibility, the risk of contracting the disease is low, but our job is to keep that risk low, as much as we can, by taking appropriate preventative steps.

So that's — that's the approach we're taking.

Let me ask Dr. Redfield if he can talk a bit about — we — this is — we do this type of quarantine and self-isolation work basically every day, working very closely — I want to stress something that we've not mentioned enough — working very closely with our state and local public health partners. They're — just as we do with emergency response, we serve as a backup and expertise and a border-type force, but the state and local authorities are the backbone of our public health infrastructure and we work with them to daily to help with our quarantine stations and activities.

So, Dr. Redfield, could you talk a bit about self-isolation?

DR. REDFIELD: Thank you, Mr. Secretary. Clearly, we've stratified the risk groups here, as it was already alluded to, from Hubei Province, where there really is aggressive transmission. Those individuals are going to come and be required to have 14 days of — up to 14 days of (inaudible) transmission.

Then, there's a large category of individuals coming back to China. As we stand here today, over half of the reported cases in China now are not in Hubei, but when you look at their history it's — they got infected — probably over 80, 85 percent of them got infected from Hubei.

Those individuals will then be actively screened when they come into one of the seven airports, for significant risk, as well as any evidence of any symptoms. In the absence of any reason to advance them into a clinical evaluation at that port of entry, they will be allowed to complete their travel back to their home, where they then will be monitored by the local health departments in a self-monitoring situation their home.

We did this in the West Africa Ebola outbreak.

Q: That sounds Ebola. Right.

DR. REDFIELD: We did it in the — but I want to emphasize: At that time, over 98 percent of the American public voluntarily accepted the importance of this. And we think and we continue to believe the American public will see this as something to their benefit, to their family's benefit, obviously their community's benefit. So that's the current situation.

DR. FAUCI: There's one other aspect of this that I think is important. Very recently, there was a case of a woman who was in China, and came to Germany, and had an interaction — professional interaction — with a professional partner.

She had no symptoms at the time. She went back to China and got sick. This individual, with whom she had an interaction, contracted the coronavirus at a time that she had no symptoms. He then transmitted it to two of his colleagues, so they now have four cases. One of the problems with when the virus is transmitted in an asymptomatic way and has its implications — it puts a terrible burden on the screening process. How do you screen somebody?

You know, remember back with Ebola? Ebola doesn't get transmitted unless you're actively very ill, and you know that. It's very, very clear. When you can transmit a virus at a time when you're asymptomatic, that just puts that extra burden on screening. And as a lot of people come in, it's going to be very difficult.

Q: Dr. Fauci, can I follow up on that? I — just what he was just saying. Given that Germany data that you just cited, are the 195 people being quarantined right now — are they getting tested every day for coronavirus?

SECRETARY AZAR: Let's ask Dr. Redfield to describe their care.

DR. REDFIELD: Clearly, they're all isolated and will be for the 14 days. We have done virus isolation, but I want to be clear: The current tests that we developed at CDC is not — we're not sure of the natural history of how the virus is isolated. Can you isolate it one day, then three days later you can't? And we are seeing — in the cases that are in the hospital, we've seen people who had detectable virus, then they didn't have detectable virus, and then three days later they had detectable virus.

We're using the virus cultures right now in these individuals more to help us learn about this virus. How much asymptomatic carriage, in fact, is there? So I want people to understand that distinction. We're not using it as a release criteria because we don't know the natural history of how this virus is secreted, and this is what we're continuing to learn.

Q: And are you comfortable that the thousands of people that pass through the U.S. screening so far are not car- — that they don't have coronavirus?

DR. REDFIELD: So this is why it's such a layered approach. We are going to see additional cases in this country. We've already seen, in the six cases we've defined: A number of them came in asymptomatic. So this is why we have that multi-layered approach and have really worked hard to engage the medical community in the United States.

Of the six cases that we diagnosed so far, one was picked up by hospi- — airport screening. Four were picked up by astute doctors. And the most recent one was picked up by CDC doing aggressive contact tracing.

Q: Thank you, Mr. Secretary. Jeff Mason from Reuters. Can you — you referenced airlines earlier. Can you or your colleague from the Department of Transportation give us an update on the administration's thinking about a travel ban on airlines, in general, being prohibitive for flying to and from China?

ASSISTANT SECRETARY SZABAT: There is no travel ban — Joel Szabat, Assistant Secretary of Department of Transportation. I think many of you who've been following this are aware: All of the three U.S. carriers who've flying between the U.S. and China have announced that they are taking down all of their passenger flights, and they announced that before any action by the administration.

So we are working closely with our counterparts in the — our Chinese aviation counterparts. And we'll be working, going forward, with both the U.S. and the Chinese passenger airlines about their flight plans going forward.

Q: Are you considering more drastic action beyond the voluntary measures that the airlines have taken so far?

ASSISTANT SECRETARY SZABAT: As Secretary Azar mentioned earlier, this is an evolving situation — but, at the moment, no.

SECRETARY AZAR: Would you mind giving some numbers on — I don't know if you or Ken can talk a bit about what we're seeing on air traffic numbers, perhaps.

ASSISTANT SECRETARY SZABAT: So I'll start it off and then turn over to Acting Deputy Secretary Cuccinelli.

So, in terms of passengers traveling between United States and China, as you might expect, over the course of the last couple of weeks, the passengers loading in the U.S. to fly to China have dropped to almost none. Passengers continue to have a high, what we call, "load factor" — a high rate of passengers coming from China to United States. However — so the U.S. carriers, though, as they're (inaudible) they represent just under 40 percent of the passenger capability.

So with that, we have been seeing already, in the course of the last week to 10 days, a significant decrease in the number of passengers that have been going between United States and China. And the Department of Homeland Security does an excellent job of tracking those numbers day to day.

ACTING DEPUTY SECRETARY CUCCINELLI: So, just to speak to the numbers: Since the Chinese have locked down Wuhan and the Hubei Province — which was eight days ago, if memory serves — travel from China to the United States, as of yesterday, had dropped by close to 20 percent
Travel from the United States to China had dropped by well more than 50 percent, and this is with the sort of market response that Joel referenced by the airlines and the voluntary actions taken by travelers.

I would note for you all that it's not a lot of data, but over the last five days, the number of American citizens traveling from China back to the United States has been rising. So even while the total number is going down, it does look to us, initially, like Americans, at least some of them, are returning back home.

Q: Dr. Fauci, how confident are you in the accuracy of these tests? If somebody is testing negative and then they later test positive, can you have confidence, if you're testing negative for something, that you don't have it?

DR. FAUCI: So, you mean — I think the question you ask is really one of the fundamental bases of why this decision was made. If we had an absolutely accurate test that was very sensitive and very specific, then we could just test people and say, "Okay, we're good to go."

I want to get back to that broad concept that I mentioned when I made my brief introduction about the unknowns. We don't know the accuracy of this test. We haven't done enough — people who came in with negative, then all sudden they were positive. You could have virus in your nasal secretions or you couldn't and still be infected. I mean, it isn't like it's a horrible test, but it is not a test that's absolute.

I spoke to a reporter the other day, talking about tests. So when you're talking about HIV, if a person has HIV and I draw their blood, I can tell you 100 percent whether they have HIV or not — 100 percent. That's not even near where we are with this.

Q: You talk about a gradual approach, Mr. Secretary, in terms of what you're doing right now. What measures do you have, sort of, in the toolkit if this gets worse?

SECRETARY AZAR: Well, let me ask, perhaps, Dr. Kadlec to talk a bit about our approach. Obviously, at this point, as I've said, the risk here in the United States is quite low for any individual. The risk is low. Our job is to work to keep that that way.

But we have public health tools that we use, we exercise constantly in the event of larger-scale infectious disease outbreaks. And that's what we would — that what we would rely on should we end up seeing more cases in the United States. But it's exactly these measures that help make any additional cases more manageable to use the tools Dr. Kadlec will talk about.

DR. KADLEC: Well, thank you very much, Mr. Secretary. And my role in this is really precautionary at this stage. And everything that's been done at this point has been incremental, proportionate, and precautionary. And so my responsibilities are to work across the federal government, as well as within HHS, to ensure that we're postured should this virus, kind of, continue to expand.

And so, domestically, we're working on — working with our private sector healthcare preparedness. We're working specifically around supply chain resilience because much of our healthcare products come from overseas. And we're also working actively with NIH and our DOD colleagues, as well as our DARPA colleagues and the private industry to develop better diagnostics, possible therapeutics, as well as vaccines, which Dr. Fauci can speak more about.

So we're really taking a very — I wouldn't say cautious — but deliberate and methodical approach to ensure that, come what may, we're prepared. Thank you.

SECRETARY AZAR: Kristen.

AIDE: I'm going to call the last question so that we can ensure we get you guys out for departure. So last question.

SECRETARY AZAR: Kristen.

Q: Any concerns about legal challenges, international travel, in general, to the region? What's the message to people who need to travel to the region, and what benchmark will you have for when this gets lifted?

SECRETARY AZAR: So let me ask Dr. Redfield if he could talk a bit about — just giving your assessment as a health professional about international travel generally. And then the types of factors — maybe for Dr. Fauci — that we'll be looking at as we, again, temp- — hopefully, temporary measures, titrated, try to just keep a pause on the situation.

DR. REDFIELD: Thank you, Mr. Secretary. I think, as Dr. Fauci said, right now there's a lot of unknowns. Obviously, almost every other day, we're learning something we didn't the day before about this. And we'll continue to do that.

Probably the most important thing, from our perspective, is whether or not there's expansion of what I call "sustained community human-to-human transmission." Right now, that is limited, in large part, to Hubei area and the broader China.

We've had some isolated human-to-human transmission in some of the cases that have gone internationally. I mentioned we've had 12 so far that have been defined in the whole world. So that's going to be important to see if there's broadening of sustained human-to-human transmission. I think that's going to really be the major — the major thing that we're going to be looking.

And, as the Secretary said, these precautionary messages and actions that have been put out today, it really is intended to keep this virus from causing significant consequences to the American public.

SECRETARY AZAR: Thank you all very much. And again, I just want to stress: First, the most important thing that we can be doing is what we are doing, which is offering to help the Chinese government and assist them in helping them to control the spread of the novel coronavirus in China — working with them as closely as possible, as well as with the World Health Organization.

Second, the risk to Americans is low. You have a team here. You have an experienced, first-class — the world's best public healthcare system, infrastructure, and professionals looking out for you, making judgments like this, scaling them up, as appropriate, to work to keep this from becoming an issue that would be of concern for you — to keep that risk low.
So thank you all very much.

Donald J. Trump, Press Briefing by Members of the President's Coronavirus Task Force Online by Gerhard Peters and John T. Woolley, The American Presidency Project https://www.presidency.ucsb.edu/node/335361

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