Hi everyone, I'm Katie Kurig, and welcome to Next Question. Today, on a special bonus episode, we begin to consider what life after coronavirus might look like. The pandemic will no doubt have an enormous impact on the way we work, learn, travel, or even just interact with each other. But before we can even get to that, we have to answer my next question, when and how can we return to normal? And what will normal even look like. This is going to be a long struggle until we have a vaccine. The virus is likely to be with us and is likely to change the way we have to go about our lives, even when we begin to come back out again. Dr Tom Frieden is the former director of the U S Centers for Disease Control and Prevention a k a. The c d C, and before that was New York City's Public Health Commissioner. He's now the president and CEO of Resolved to Say Lives. He's called this pandemic world War C with the humans against the coronavirus, and while it's daunting to think we're still at the start of this war, Dr fried is thinking about the future we all long for, and he's just released a four point plan that will help the country get up and running as soon and safely as possible. You have stressed that reopening is not about the date, it's about the data. With that in mind, explain for us what you think the data needs to reveal in order to ensure a safer returned to life as we once knew it, or somewhat as we once knew it. To get out to the new normal, we need to look at three things. The first is how widely the virus is spreading and whether it's decreasing. You don't want to go out when it's about to explode again, and you don't want to go out when there's so many cases that they might overwhelm health or public health systems. The second is how prepared our health care systems are so we can prevent healthcare workers from becoming affected and also provide good care to people with coronavirus and continuing continuing to provide care to people who need chronic care, whether it's cancer screening or diabetes care. What we're seeing is people foregoing very important services, So that has to be ready, and our public health system has to be ready to do what I call box it in testing isolation, contact casing, and quarantine four corners of a box. If we get that right, we can limit the spread of coronavirus from cases and clusters so it doesn't explode again and force us to come back in. You're such a well respected public health official. I do think that a lot of people listening may think the numbers, the estimates were we're too high, that the number of cases didn't match what people and scientists were predicting. Why can you help people understand why that was the case, and is it because of the measures that were taken. We're learning more about coronavirus literally every day, but it would be a big and potentially fatal mistake not to take this virus very seriously. Just look at what has happened in New York City, where there have been seventeen thousand confirmed or probable cases and twenty one excess deaths in less than six weeks. That compares with thirty thousand deaths in New York City in two years of the influenza pandemic. This is the worst health threat of our lifetime, and it is very, very dangerous, particularly for people over the age of sixty and for anyone with underlying health conditions, but also just a variety of people in their thirties and forties and get very very ill. So this is an enormously deadly pandemic and unfortunately bad as it has been, this is just the beginning. The virus will be here until we have a vaccine. What about until there's a better treatment. The treatment would make a really big difference. If we had good treatment for this vaccine, and including good preventive treatment, and that could come well before a vaccine, that would make a big difference. That could decrease death rates, decrease overcrowd against care units, help people be safer. So yes, the treatment would be terrific, but we don't have one yet. And and do you see I know there's been a lot of global cooperation among scientists and researchers. Do you see anything that gives you optimism about a potential treatment that may pre come before a vaccine? So far, nothing is working out and a few of the things that have looked at have not proven to be effective. I am encouraged that there's really good global collaboration that the World Health Organization is helping to link together scientists from all over the world. Interestingly, paywalls have come down on scientific publications, and preprints have gone up. These are two big changes in how medical science works. So we're learning more really fast, and I'm encouraged that if we do identify a good treatment, will find out about that quickly and I hope then be able to apply it widely. But we don't have it now, and what we need to do now is to stay home so that the virus doesn't explode again. That's our most blunt weapon against it, and box it in. That's our most precise weapon against it. That's how we can prevent an outbreak. From becoming an academic, I want to talk more about how to restart the economy and some of the things that you have in mind, But first I'm curious Dr. Freedom. Have you been able to or have scientists been able to get a better understanding of some of the mystery surrounding COVID nineteen. The fact that some people are affected so intensely and are incapacitated and often killed by this virus, and others can be completely asymptomatic. It's got to be more than just underlying conditions or or someone's age. What are some of the things that we're learning about how this virus operates. We're literally more every day, but there's still a lot we don't know. We do know that age is the strongest predictor of how bad this infection will be, and kids under the age of twenty rarely get seriously ill from it. On the other hand, people over sixty often do. It's often fatal for them. We don't know which underlying health conditions are riskiest. Diabetes, kidney disease, lung disease, heart disease seeming the most concerning, but that's something will learn more about. We don't know whether some people have more severe disease because they were exposed to a bigger amount of virus what's called the innoculum. And one thing that I'm very intrigued by, although there's no proof of this, is that there may be very subtle genetic differences in different strains of this virus that may be associated with higher or lower severity of illness. That's just a theory at this point, there's no evidence to support it, but it's something that would be a clue as to how we might make a vaccine that might immunize people without making them sick. Can you help me understand that better. When you say a different, a more powerful strain, explain what you made by by that. For people who aren't scientists or doctors listening to this, well, the first thing to say is, we have no idea. We don't know why some people get sicker than others. It could be they're exposed to a higher dose or a noculum of the virus, but we know that if they have underlying conditions that could make it worse. And there is a possibility that there are certain types of this virus. It's all Sarah's cove too, it's all one particular species of coronavirus, but there are already a lot of genetic differences within that species. And one theory that some of us are beginning to wonder about now with no evidence, just something that should be investigated, is whether some of the strains that are circulating are less deadly than others, and might account for the fact that you're seeing a very high proportion of people with no symptoms at all in some outbreaks and a very low proportion with no symptoms at all in others. The New York Times, in fact, had a front page piece about a seemingly healthy guy who was on a ventilator, I believe, for thirty two days and came out the other side pretty miraculously. But he seemed to be very atypical for someone who would be made so seriously from this virus. No one should be overconfident about this virus. Thirty year old doctors, nurses, and others with no underlying conditions have become desperately ill, and some have died from it. Unfortunately, no one is immune from this virus. Maybe people who have been recovered from it, maybe, but barring that, there is no natural immunity. And that's why we're so concerned. Not only have there been more than seventeen thousand COVID deaths in New York City so far, it could get two or three times worse, and other parts of the US, other parts of the world haven't gone through that yet, so they're at risk of explosive outbreaks. When we come back, Dr Tom Threeden on our COVID testing fiasco, We're back with Dr Tom Frieden, former director of the CDC. Testing is such an important factor, Dr Frieden, But gosh, that seems to have been a massive ship show. Excuse my French. In terms of getting the testing up and running. What the heck happened here? We still have far too few tests compared to what we need. The CDC stumbled early on there was a problem with their test kit. Their test kit has worked fine for two months and we still have a major shortage. That's because it's really a three leggedge to it. You need the CDC providing tests, to public health laboratories, hospitals developing their own tests, and the commercial laboratories figuring out how they provide very large volumes of tests. And this has been increasing, but too slowly. And that's why we've just released guidance on who should be tested, because right now we don't have enough tests for everyone, and therefore we really need to scale up testing for those who need it most, including people whose lives may be saved by being tested, or people who when we know they're infected, we can isolate them and prevent a large and deadly outbreak of the disease. So when you say are you talking about elderly people and those with the underlying conditions, I mean who is in this subset of people who should be tested right now? Most important are people with symptoms who are being hospitalized for our overage sixty or who have underlying health conditions. Next most important is anyone in a congregte facility who has symptoms. That's a nursing home or a homeless shelter, or a prison or a jail. Next is health care workers who of symptoms so we can make health facility is safer. And anyone who's a contact of a case who is symptomatic, plus all people hospitalized where COVID is spreading to prevent hospital outbreaks of COVID, it's really important that these individuals get tested because that can greatly reduce the spread of the infection. And when there is an outbreak in a conic facility, then it's important, uh then that all they are get tested, whether or not they have symptoms. But just to test those groups is over a million tests a day and we're doing at most a quarter of that now I know about a hundred and fifty thousand tests a day, so less than a quarter of that certainly. And when are we going to be able to have enough tests available? What about that much? Bally hood Abbott laboratories fast tests that you could get the results in you know, five to eighteen minutes what happened with that. There are tests that are um point of care and they're available right where the patient is, like the Abbot test, but they're low volume. They take less than fifteen minutes, but you only do one at a time, so you can only do four patients per hour on one instrument. In contrast, some of the large tests may take a day to come back, but you can do thousands of hours. When we have the tests that we need at what you say, a million a day. We'll really have to rely on the federal government for getting this right. They have to coordinate it. They have to make sure the entire supply chain is there, from swabs to transport media, to re agents to test kits, to machines for testing, to providing the test results. Remember, testing is just the first step. Testing is really important, but it's not the answer. It's a part of the answer. It's about testing, isolating people who are positive, tracing contacts, and quarantining the contacts. I can do those four things. You can keep the virus in the box so we can go out. Let's talk about contact tracing. Tell us about that. What do you mean by contact tracing? Because I understand you call it an old fashioned shoe leather effort of sending human beings out to ask people who they've been in contact with. But that could require an army of something like three thousand people. So how do you organize an effort like that? Contact tracing is hard work, but it works. It's traditional public health work. In fact, every day, all year round, health departments all over this country and all over the world are doing it for tuberculosis, for measles, or sexually transmitted diseases HIV and other conditions. But we have to do it on a much wider scale now it's specialized work. Contact tracers need to be able to develop a human bond with patients. They need to be able to answer their question is medical, social, emotional. They need to be able to link them to services, whether it's medical services if they're sick, or social services if they have needs, or community supports. That contact tracing process supports patients and those they may have exposed so that the virus can stop with them, so that they can isolate themselves in the case of patients, or quarantine themselves in the pace of case of contact, and if they do develop the illness, they don't spread it to others. That does take time, It takes effort. If we look around the world, Singapore, with the population of five point six million people, has more than a thousand people doing contact tracing. That gives you a sense of the scale of the effort that will be needed. Tens or maybe hundreds of thousands of people will be needed, and that sounds impossible, but it's essential if we're to come out as soon and safely as possible. And that gets sent running back home again because we see an explosion of cases. Well, I was going to ask you about that. When you see the governor of Georgia starting to open up things like bowling alleys and barber shops and nail salmons, what what do you think? I think, first off, if you look at the stay at home orders around the country and the data that's come out since from groups like Facebook and Google that have analyzed what population movements were people stay at home before the rectory statement they heard what was happening, I think you'll see some some people certainly coming right out and other people waiting. We do have to get ready for the COVID world, for the new normal where we're going to use hand sanitizers before we go into a building, we're going to say six ft away from people to the greatest extent possible, where we're going to have masks on to protect others as well as ourselves. Whenever COVID has spread in an environment, certain things are certainly beyond reasonable. You would not want to open movie theaters at this time. That does not make sense. While you've still got a lot of cases. You really try to avoid gatherings of ten people or more. You try to keep people together in one group so that there is so that if there is spread of COVID, it stops there and doesn't explode in society. Remember, if the virus spreads widely, it's not just the people who volunteered or hum of their own accord we're in public that are affected. It's the health workers who they could infect and could die. It's the grandmothers and grandfathers, and brothers and sisters and children of those they in fact who could get very sick. So we have to be careful and do this in phasis understanding that when we loosen the faucet and come out again, it maybe three to six weeks before we see a surge in cases, because it takes about a week from exposure to infection, about another week to get very severely ill. So it'll be weeks before we see the impact of these and we don't know whether whether we'll be on our side or not, and whether warm or weather will be helpful. We hope it will be, but the plain truth is COVID is here to stay unless something surprising happens or we get a vaccine, and that means we have to get used to a new normal where we're going to have to be more careful for our own sake and especially for the sake of those most vulnerable in our communities. Once you get the virus, does that make you immune? That's still a big question Mark two, isn't it Tom? We don't know. There's more information coming out every day, and it may be a few weeks or a few months before we know. First off, there are antibody tests, A lot of questions about those. A lot of the tests that are on the market don't work well, so the results are not reliable. Even if you have a good antibody test, knowing what it means is not clear, doesn't mean you're immune. Even if it does, how long will that immunity last there's so much we don't yet know about this virus. But the more we learn, the more we can do to protect people. What I keep thinking about, which I know I shouldn't, because this is seeing the glass is half empty, is even if there's a vaccine for COVID nineteen, how concerned are you that another virus, even after a vaccine is developed maybe around the corner. Dr Freeden Katie, It is absolutely inevitable that there will be another health threat. Whether it will be as bad as COVID nineteen or worse, we don't know. What's not inevitable is that we will be so woefully underprepared next time. And we can avoid being underprepared by investing in public health in this country and around the world. That means establishing systems to find, stop and prevent health threat where they emerge so they don't spread around the world. That means ending the practice of selling exotic animals for food and markets. That means ending the practice of bush meat consumption in Africa where viruses can emerge. That means strengthening our early warning system so we know where diseases are spreading and can rapidly investigate them and stop them. If at all possible. All of this is within reach, and with the trillions of dollars that we're losing because of COVID, it's clear that it would be the height of irresponsibility not to invest in our public house protection system in this country and around the world. Well, we come back, how to emerge into the new COVID world. Let's return to my interview with Dr Tom Frieden. It seems to me that we're going to need a nine eleven Commission type evaluation about not only this country's response, but the global response. Knowing that you don't want to get too far into politics, you're the former director of the CDC, So how would you assess the government's handling of this crisis, both the administration and other agencies, including the CDC. Let's start with CDC. CC clearly had a problem with the laboratory tests and with responding to that problem. I would like to see an independent investigation of that. I have no confidence in investigations that are done by others who might benefit from selling there was one problem or another. There's an excellent laboratory science unit at CC. I would want to see them do an internal report and then have an external highly expert group through the National Academy of Sciences look at that and provide transparently what went wrong and how to prevent that from going around in the future. That doesn't change the fact that the CDC is a fantastic institution with twenty public health professionals who devote their lives to protecting people from health threats and who are our elite troops in this war against coronavirus. They are working day and night. They are doing an enormous amount to strengthen states and cities around the country. Their website, CDC dot gov remains the best place to go for information, advice, and guidance on how to protect ourselves, our workplaces, and our communities. In terms of the US response, more generally, can I can I interrupt for two seconds? So well? I agree with you. I've done work with the CDC. I have so much respect for the people there. But something did go terribly wrong in this instance. What do you think happened? I don't know. I there. The CDC laboratory itself was able to do testing throughout this process and never got overwhelmed. The problem came in sending out tests that didn't work well and then the bigger problem was not responding to that problem rapidly. I don't know why that happened, but that's one of the things that should be looked at. Tom the current the current CDC director, Robert Redfield, he's defended the agency and said, quote, it was really the responsibility of the private sector and the clinical medicine apparatus to develop widespread testing. That's correct, He's absolutely right. It's a three legged school. You've got CDC providing tests for the public health departments, You've got hospitals developing their own tests, and you've got the commercial sector developing the tests for large numbers of patients. And you can know for certain that it's correct because the CDC test has worked fine for two months and we still have a major shorts of tests because those other two legs got started very late. CDC said on January we have to behave as if this is a pandemic. But it wasn't until more than a month later that the Food and Drug Administration loosened regulations to allow the private sector to begin developing their own tests. And it wasn't until early March. And whose fault was that? I think you've got to look at HHS and FDA for that, and what about the administration and the task force that was well in place before that. I find the organization of this response by the administration very confusing. I don't know what the role of FEMA versus the task Force versus the Vice President versus the White House Coronavirus Coordinator versus the Chairman of the task Force is. In our work at Resolve to Save Lives, we advise countries fall around the world how to respond to an epidemic, and one of the main ways of doing that is to organize so that there is a single incident manager and a single trusted, not partisan spokesperson, and that those people report to the head of state, and that the policy decisions are made by the head of state. But the operational response has a clear line of accountability and a clear nonpartisan communication. I wish we would see that in this country. Well, it's been anything but that. As many people have complained about the nature of these briefings, the role of the CDC has been minimized, if not completely, uh you know, erased from the whole process. Dr Fauci and Deborah Burkes don't seem to have much of a voice. Do you think it's been dangerous that the President of the United States, who is certainly not a scientist, is the one that is talking and communicating with the American people and even making crazy suggestions, even in sarcasm, uh to, about injecting disinfectants. I'll feel safer when we're hearing from this DC regularly, people like not just Dr Redfield, but also Dr shook It, who was the prior director of the National Center for Immunization and Respiratory Disease, Dr Masign, other experts and viral public the public health response to viral lung diseases. These are our top experts, not just in the country but in the world, and we're not hearing from them. Don't you think that's crazy. I'll feel safer when we're hearing from them. You're being very diplomatic here, Tom. So let's just before you go, let's talk about the future. You say COVID nineteen is here to stay. So when you think about the future, do you think do you agree that social distancing will continue for months to come? What about this idea of immunity passports that will allow those who have been affected returning to the workforce, Um you know, tell me what you envisioned for the future. If a VACS scene is not created anytime soon, and there's no treatment anytime soon, we'll be going back to a new normal. That normal will include hand sanitizers at the entrance of every building, mask wearing in public, physical distancing wherever possible. We don't yet have the science to know if community passports will work. There are some countries that have started that we'll need to learn more, but it's inevitable that until there's a vaccine or an effective treatment, you're going to see travel bands. You're going to see quarantine of travelers. We're even seeing countries like Canada and Australia block people from going from one state or province to another. If one state has controlled it and another state hasn't, it's almost inevitable they're going to try to keep people out who are going to bring this in and create another explosion of cases. Have you seen anything positive on Horizon Tom in terms of a vaccine or something that at least is showing promise. The most promising thing I've seen, Katie, is real global collaboration, that people are working together, that we understand that it's us against them here and them as a microbe, us as all humans. And the more we can learn from each other, the more we can partner with each other, the more of us are going to get through this safe and health. Do you see somebody who could be or an organization that could be the head of a global response if this happens again, so that people all over the world have really the most up to date scientific information, that the messages aren't contradicting each other, that people aren't kind of competing for resources, so that everyone can be operating from on the same page. The World Health Organization is essential. We helped create it, were a member of it. It has strengths and weaknesses. It's done relatively well in this outbreak, but clearly there are things that need done better, and how that should be done is something for a discussion in the coming months. We know that we need a better way to track where outbreaks are emerging and a better way to help countries drive down the risk of outbreaks like this and stop them as soon as possible. And what did you think of the President saying he's going to defund the World Health Organization? Since the US is the bigger funder, it's something like four million dollars annually. This is the time to increase, not to decrease, our funding for public health. Dr Tom Freed, and thank you so much for your time. Really really appreciate it. Thank you, and thank you for your interest, knowledge and commitment to health and public health. It's always a pleasure speaking with you. Okay, right back at you, Thanks Tom, Thanks so. Dr Tom Frieden a public health expert, former head of the CDC and now President and CEO of Resolve to Save Lives. And that does it for this bonus episode of Next Question. For the most up to date information on the coronavirus, as Tom Friedman said, go to the CDC and World Health Organization websites and for a look at the people behind the pandemic, from the victims to the heroes and the moments of good news in between. Subscribe to my morning newsletter Wake Up Call by going to Katie correct dot com. Our regular episodes of Next Question with Me Katie Currekt are released weekly every Thursday. You can find those and subscribe on Apple Podcast, the I Heart Radio Act or wherever you listen to your favorite shows. So until next time and my Next Question, I'm Katie Currect thanks so much for listening. Next Question with Katie Couric is a production of I Heart Radio and Katie Curic Media. The executive producers are Katie Currik, Courtney Litz, and Tyler Klang. The supervising producer is Lauren Hansen. Our show producer is Bethan Macaluso. The associate producers are Emily Pinto and Derek Clements. Editing by Derrek Clements, Dylan Fagan and Lowell Berlante, Mixing by Dylan Fagan. Our researcher is Gabriel Loser. For more information on today's episode, go to Katie Kurik dot com and follow us on Twitter and Instagram at Katie Kurik. For more podcasts for my heart Radio, visit the I heart Radio app, Apple podcast, or wherever you listen to your favorite shows.

Hi everyone, I'm Katie Kurig, and welcome to Next Question. Today, on a special bonus episode, we begin to consider what life after coronavirus might look like. The pandemic will no doubt have an enormous impact on the way we work, learn, travel, or even just interact with each other. But before we can even get to that, we have to answer my next question, when and how can we return to normal? And what will normal even look like. This is going to be a long struggle until we have a vaccine. The virus is likely to be with us and is likely to change the way we have to go about our lives, even when we begin to come back out again. Dr Tom Frieden is the former director of the U S Centers for Disease Control and Prevention a k a. The c d C, and before that was New York City's Public Health Commissioner. He's now the president and CEO of Resolved to Say Lives. He's called this pandemic world War C with the humans against the coronavirus, and while it's daunting to think we're still at the start of this war, Dr fried is thinking about the future we all long for, and he's just released a four point plan that will help the country get up and running as soon and safely as possible. You have stressed that reopening is not about the date, it's about the data. With that in mind, explain for us what you think the data needs to reveal in order to ensure a safer returned to life as we once knew it, or somewhat as we once knew it. To get out to the new normal, we need to look at three things. The first is how widely the virus is spreading and whether it's decreasing. You don't want to go out when it's about to explode again, and you don't want to go out when there's so many cases that they might overwhelm health or public health systems. The second is how prepared our health care systems are so we can prevent healthcare workers from becoming affected and also provide good care to people with coronavirus and continuing continuing to provide care to people who need chronic care, whether it's cancer screening or diabetes care. What we're seeing is people foregoing very important services, So that has to be ready, and our public health system has to be ready to do what I call box it in testing isolation, contact casing, and quarantine four corners of a box. If we get that right, we can limit the spread of coronavirus from cases and clusters so it doesn't explode again and force us to come back in. You're such a well respected public health official. I do think that a lot of people listening may think the numbers, the estimates were we're too high, that the number of cases didn't match what people and scientists were predicting. Why can you help people understand why that was the case, and is it because of the measures that were taken. We're learning more about coronavirus literally every day, but it would be a big and potentially fatal mistake not to take this virus very seriously. Just look at what has happened in New York City, where there have been seventeen thousand confirmed or probable cases and twenty one excess deaths in less than six weeks. That compares with thirty thousand deaths in New York City in two years of the influenza pandemic. This is the worst health threat of our lifetime, and it is very, very dangerous, particularly for people over the age of sixty and for anyone with underlying health conditions, but also just a variety of people in their thirties and forties and get very very ill. So this is an enormously deadly pandemic and unfortunately bad as it has been, this is just the beginning. The virus will be here until we have a vaccine. What about until there's a better treatment. The treatment would make a really big difference. If we had good treatment for this vaccine, and including good preventive treatment, and that could come well before a vaccine, that would make a big difference. That could decrease death rates, decrease overcrowd against care units, help people be safer. So yes, the treatment would be terrific, but we don't have one yet. And and do you see I know there's been a lot of global cooperation among scientists and researchers. Do you see anything that gives you optimism about a potential treatment that may pre come before a vaccine? So far, nothing is working out and a few of the things that have looked at have not proven to be effective. I am encouraged that there's really good global collaboration that the World Health Organization is helping to link together scientists from all over the world. Interestingly, paywalls have come down on scientific publications, and preprints have gone up. These are two big changes in how medical science works. So we're learning more really fast, and I'm encouraged that if we do identify a good treatment, will find out about that quickly and I hope then be able to apply it widely. But we don't have it now, and what we need to do now is to stay home so that the virus doesn't explode again. That's our most blunt weapon against it, and box it in. That's our most precise weapon against it. That's how we can prevent an outbreak. From becoming an academic, I want to talk more about how to restart the economy and some of the things that you have in mind, But first I'm curious Dr. Freedom. Have you been able to or have scientists been able to get a better understanding of some of the mystery surrounding COVID nineteen. The fact that some people are affected so intensely and are incapacitated and often killed by this virus, and others can be completely asymptomatic. It's got to be more than just underlying conditions or or someone's age. What are some of the things that we're learning about how this virus operates. We're literally more every day, but there's still a lot we don't know. We do know that age is the strongest predictor of how bad this infection will be, and kids under the age of twenty rarely get seriously ill from it. On the other hand, people over sixty often do. It's often fatal for them. We don't know which underlying health conditions are riskiest. Diabetes, kidney disease, lung disease, heart disease seeming the most concerning, but that's something will learn more about. We don't know whether some people have more severe disease because they were exposed to a bigger amount of virus what's called the innoculum. And one thing that I'm very intrigued by, although there's no proof of this, is that there may be very subtle genetic differences in different strains of this virus that may be associated with higher or lower severity of illness. That's just a theory at this point, there's no evidence to support it, but it's something that would be a clue as to how we might make a vaccine that might immunize people without making them sick. Can you help me understand that better. When you say a different, a more powerful strain, explain what you made by by that. For people who aren't scientists or doctors listening to this, well, the first thing to say is, we have no idea. We don't know why some people get sicker than others. It could be they're exposed to a higher dose or a noculum of the virus, but we know that if they have underlying conditions that could make it worse. And there is a possibility that there are certain types of this virus. It's all Sarah's cove too, it's all one particular species of coronavirus, but there are already a lot of genetic differences within that species. And one theory that some of us are beginning to wonder about now with no evidence, just something that should be investigated, is whether some of the strains that are circulating are less deadly than others, and might account for the fact that you're seeing a very high proportion of people with no symptoms at all in some outbreaks and a very low proportion with no symptoms at all in others. The New York Times, in fact, had a front page piece about a seemingly healthy guy who was on a ventilator, I believe, for thirty two days and came out the other side pretty miraculously. But he seemed to be very atypical for someone who would be made so seriously from this virus. No one should be overconfident about this virus. Thirty year old doctors, nurses, and others with no underlying conditions have become desperately ill, and some have died from it. Unfortunately, no one is immune from this virus. Maybe people who have been recovered from it, maybe, but barring that, there is no natural immunity. And that's why we're so concerned. Not only have there been more than seventeen thousand COVID deaths in New York City so far, it could get two or three times worse, and other parts of the US, other parts of the world haven't gone through that yet, so they're at risk of explosive outbreaks. When we come back, Dr Tom Threeden on our COVID testing fiasco, We're back with Dr Tom Frieden, former director of the CDC. Testing is such an important factor, Dr Frieden, But gosh, that seems to have been a massive ship show. Excuse my French. In terms of getting the testing up and running. What the heck happened here? We still have far too few tests compared to what we need. The CDC stumbled early on there was a problem with their test kit. Their test kit has worked fine for two months and we still have a major shortage. That's because it's really a three leggedge to it. You need the CDC providing tests, to public health laboratories, hospitals developing their own tests, and the commercial laboratories figuring out how they provide very large volumes of tests. And this has been increasing, but too slowly. And that's why we've just released guidance on who should be tested, because right now we don't have enough tests for everyone, and therefore we really need to scale up testing for those who need it most, including people whose lives may be saved by being tested, or people who when we know they're infected, we can isolate them and prevent a large and deadly outbreak of the disease. So when you say are you talking about elderly people and those with the underlying conditions, I mean who is in this subset of people who should be tested right now? Most important are people with symptoms who are being hospitalized for our overage sixty or who have underlying health conditions. Next most important is anyone in a congregte facility who has symptoms. That's a nursing home or a homeless shelter, or a prison or a jail. Next is health care workers who of symptoms so we can make health facility is safer. And anyone who's a contact of a case who is symptomatic, plus all people hospitalized where COVID is spreading to prevent hospital outbreaks of COVID, it's really important that these individuals get tested because that can greatly reduce the spread of the infection. And when there is an outbreak in a conic facility, then it's important, uh then that all they are get tested, whether or not they have symptoms. But just to test those groups is over a million tests a day and we're doing at most a quarter of that now I know about a hundred and fifty thousand tests a day, so less than a quarter of that certainly. And when are we going to be able to have enough tests available? What about that much? Bally hood Abbott laboratories fast tests that you could get the results in you know, five to eighteen minutes what happened with that. There are tests that are um point of care and they're available right where the patient is, like the Abbot test, but they're low volume. They take less than fifteen minutes, but you only do one at a time, so you can only do four patients per hour on one instrument. In contrast, some of the large tests may take a day to come back, but you can do thousands of hours. When we have the tests that we need at what you say, a million a day. We'll really have to rely on the federal government for getting this right. They have to coordinate it. They have to make sure the entire supply chain is there, from swabs to transport media, to re agents to test kits, to machines for testing, to providing the test results. Remember, testing is just the first step. Testing is really important, but it's not the answer. It's a part of the answer. It's about testing, isolating people who are positive, tracing contacts, and quarantining the contacts. I can do those four things. You can keep the virus in the box so we can go out. Let's talk about contact tracing. Tell us about that. What do you mean by contact tracing? Because I understand you call it an old fashioned shoe leather effort of sending human beings out to ask people who they've been in contact with. But that could require an army of something like three thousand people. So how do you organize an effort like that? Contact tracing is hard work, but it works. It's traditional public health work. In fact, every day, all year round, health departments all over this country and all over the world are doing it for tuberculosis, for measles, or sexually transmitted diseases HIV and other conditions. But we have to do it on a much wider scale now it's specialized work. Contact tracers need to be able to develop a human bond with patients. They need to be able to answer their question is medical, social, emotional. They need to be able to link them to services, whether it's medical services if they're sick, or social services if they have needs, or community supports. That contact tracing process supports patients and those they may have exposed so that the virus can stop with them, so that they can isolate themselves in the case of patients, or quarantine themselves in the pace of case of contact, and if they do develop the illness, they don't spread it to others. That does take time, It takes effort. If we look around the world, Singapore, with the population of five point six million people, has more than a thousand people doing contact tracing. That gives you a sense of the scale of the effort that will be needed. Tens or maybe hundreds of thousands of people will be needed, and that sounds impossible, but it's essential if we're to come out as soon and safely as possible. And that gets sent running back home again because we see an explosion of cases. Well, I was going to ask you about that. When you see the governor of Georgia starting to open up things like bowling alleys and barber shops and nail salmons, what what do you think? I think, first off, if you look at the stay at home orders around the country and the data that's come out since from groups like Facebook and Google that have analyzed what population movements were people stay at home before the rectory statement they heard what was happening, I think you'll see some some people certainly coming right out and other people waiting. We do have to get ready for the COVID world, for the new normal where we're going to use hand sanitizers before we go into a building, we're going to say six ft away from people to the greatest extent possible, where we're going to have masks on to protect others as well as ourselves. Whenever COVID has spread in an environment, certain things are certainly beyond reasonable. You would not want to open movie theaters at this time. That does not make sense. While you've still got a lot of cases. You really try to avoid gatherings of ten people or more. You try to keep people together in one group so that there is so that if there is spread of COVID, it stops there and doesn't explode in society. Remember, if the virus spreads widely, it's not just the people who volunteered or hum of their own accord we're in public that are affected. It's the health workers who they could infect and could die. It's the grandmothers and grandfathers, and brothers and sisters and children of those they in fact who could get very sick. So we have to be careful and do this in phasis understanding that when we loosen the faucet and come out again, it maybe three to six weeks before we see a surge in cases, because it takes about a week from exposure to infection, about another week to get very severely ill. So it'll be weeks before we see the impact of these and we don't know whether whether we'll be on our side or not, and whether warm or weather will be helpful. We hope it will be, but the plain truth is COVID is here to stay unless something surprising happens or we get a vaccine, and that means we have to get used to a new normal where we're going to have to be more careful for our own sake and especially for the sake of those most vulnerable in our communities. Once you get the virus, does that make you immune? That's still a big question Mark two, isn't it Tom? We don't know. There's more information coming out every day, and it may be a few weeks or a few months before we know. First off, there are antibody tests, A lot of questions about those. A lot of the tests that are on the market don't work well, so the results are not reliable. Even if you have a good antibody test, knowing what it means is not clear, doesn't mean you're immune. Even if it does, how long will that immunity last there's so much we don't yet know about this virus. But the more we learn, the more we can do to protect people. What I keep thinking about, which I know I shouldn't, because this is seeing the glass is half empty, is even if there's a vaccine for COVID nineteen, how concerned are you that another virus, even after a vaccine is developed maybe around the corner. Dr Freeden Katie, It is absolutely inevitable that there will be another health threat. Whether it will be as bad as COVID nineteen or worse, we don't know. What's not inevitable is that we will be so woefully underprepared next time. And we can avoid being underprepared by investing in public health in this country and around the world. That means establishing systems to find, stop and prevent health threat where they emerge so they don't spread around the world. That means ending the practice of selling exotic animals for food and markets. That means ending the practice of bush meat consumption in Africa where viruses can emerge. That means strengthening our early warning system so we know where diseases are spreading and can rapidly investigate them and stop them. If at all possible. All of this is within reach, and with the trillions of dollars that we're losing because of COVID, it's clear that it would be the height of irresponsibility not to invest in our public house protection system in this country and around the world. Well, we come back, how to emerge into the new COVID world. Let's return to my interview with Dr Tom Frieden. It seems to me that we're going to need a nine eleven Commission type evaluation about not only this country's response, but the global response. Knowing that you don't want to get too far into politics, you're the former director of the CDC, So how would you assess the government's handling of this crisis, both the administration and other agencies, including the CDC. Let's start with CDC. CC clearly had a problem with the laboratory tests and with responding to that problem. I would like to see an independent investigation of that. I have no confidence in investigations that are done by others who might benefit from selling there was one problem or another. There's an excellent laboratory science unit at CC. I would want to see them do an internal report and then have an external highly expert group through the National Academy of Sciences look at that and provide transparently what went wrong and how to prevent that from going around in the future. That doesn't change the fact that the CDC is a fantastic institution with twenty public health professionals who devote their lives to protecting people from health threats and who are our elite troops in this war against coronavirus. They are working day and night. They are doing an enormous amount to strengthen states and cities around the country. Their website, CDC dot gov remains the best place to go for information, advice, and guidance on how to protect ourselves, our workplaces, and our communities. In terms of the US response, more generally, can I can I interrupt for two seconds? So well? I agree with you. I've done work with the CDC. I have so much respect for the people there. But something did go terribly wrong in this instance. What do you think happened? I don't know. I there. The CDC laboratory itself was able to do testing throughout this process and never got overwhelmed. The problem came in sending out tests that didn't work well and then the bigger problem was not responding to that problem rapidly. I don't know why that happened, but that's one of the things that should be looked at. Tom the current the current CDC director, Robert Redfield, he's defended the agency and said, quote, it was really the responsibility of the private sector and the clinical medicine apparatus to develop widespread testing. That's correct, He's absolutely right. It's a three legged school. You've got CDC providing tests for the public health departments, You've got hospitals developing their own tests, and you've got the commercial sector developing the tests for large numbers of patients. And you can know for certain that it's correct because the CDC test has worked fine for two months and we still have a major shorts of tests because those other two legs got started very late. CDC said on January we have to behave as if this is a pandemic. But it wasn't until more than a month later that the Food and Drug Administration loosened regulations to allow the private sector to begin developing their own tests. And it wasn't until early March. And whose fault was that? I think you've got to look at HHS and FDA for that, and what about the administration and the task force that was well in place before that. I find the organization of this response by the administration very confusing. I don't know what the role of FEMA versus the task Force versus the Vice President versus the White House Coronavirus Coordinator versus the Chairman of the task Force is. In our work at Resolve to Save Lives, we advise countries fall around the world how to respond to an epidemic, and one of the main ways of doing that is to organize so that there is a single incident manager and a single trusted, not partisan spokesperson, and that those people report to the head of state, and that the policy decisions are made by the head of state. But the operational response has a clear line of accountability and a clear nonpartisan communication. I wish we would see that in this country. Well, it's been anything but that. As many people have complained about the nature of these briefings, the role of the CDC has been minimized, if not completely, uh you know, erased from the whole process. Dr Fauci and Deborah Burkes don't seem to have much of a voice. Do you think it's been dangerous that the President of the United States, who is certainly not a scientist, is the one that is talking and communicating with the American people and even making crazy suggestions, even in sarcasm, uh to, about injecting disinfectants. I'll feel safer when we're hearing from this DC regularly, people like not just Dr Redfield, but also Dr shook It, who was the prior director of the National Center for Immunization and Respiratory Disease, Dr Masign, other experts and viral public the public health response to viral lung diseases. These are our top experts, not just in the country but in the world, and we're not hearing from them. Don't you think that's crazy. I'll feel safer when we're hearing from them. You're being very diplomatic here, Tom. So let's just before you go, let's talk about the future. You say COVID nineteen is here to stay. So when you think about the future, do you think do you agree that social distancing will continue for months to come? What about this idea of immunity passports that will allow those who have been affected returning to the workforce, Um you know, tell me what you envisioned for the future. If a VACS scene is not created anytime soon, and there's no treatment anytime soon, we'll be going back to a new normal. That normal will include hand sanitizers at the entrance of every building, mask wearing in public, physical distancing wherever possible. We don't yet have the science to know if community passports will work. There are some countries that have started that we'll need to learn more, but it's inevitable that until there's a vaccine or an effective treatment, you're going to see travel bands. You're going to see quarantine of travelers. We're even seeing countries like Canada and Australia block people from going from one state or province to another. If one state has controlled it and another state hasn't, it's almost inevitable they're going to try to keep people out who are going to bring this in and create another explosion of cases. Have you seen anything positive on Horizon Tom in terms of a vaccine or something that at least is showing promise. The most promising thing I've seen, Katie, is real global collaboration, that people are working together, that we understand that it's us against them here and them as a microbe, us as all humans. And the more we can learn from each other, the more we can partner with each other, the more of us are going to get through this safe and health. Do you see somebody who could be or an organization that could be the head of a global response if this happens again, so that people all over the world have really the most up to date scientific information, that the messages aren't contradicting each other, that people aren't kind of competing for resources, so that everyone can be operating from on the same page. The World Health Organization is essential. We helped create it, were a member of it. It has strengths and weaknesses. It's done relatively well in this outbreak, but clearly there are things that need done better, and how that should be done is something for a discussion in the coming months. We know that we need a better way to track where outbreaks are emerging and a better way to help countries drive down the risk of outbreaks like this and stop them as soon as possible. And what did you think of the President saying he's going to defund the World Health Organization? Since the US is the bigger funder, it's something like four million dollars annually. This is the time to increase, not to decrease, our funding for public health. Dr Tom Freed, and thank you so much for your time. Really really appreciate it. Thank you, and thank you for your interest, knowledge and commitment to health and public health. It's always a pleasure speaking with you. Okay, right back at you, Thanks Tom, Thanks so. Dr Tom Frieden a public health expert, former head of the CDC and now President and CEO of Resolve to Save Lives. And that does it for this bonus episode of Next Question. For the most up to date information on the coronavirus, as Tom Friedman said, go to the CDC and World Health Organization websites and for a look at the people behind the pandemic, from the victims to the heroes and the moments of good news in between. Subscribe to my morning newsletter Wake Up Call by going to Katie correct dot com. Our regular episodes of Next Question with Me Katie Currekt are released weekly every Thursday. You can find those and subscribe on Apple Podcast, the I Heart Radio Act or wherever you listen to your favorite shows. So until next time and my Next Question, I'm Katie Currect thanks so much for listening. Next Question with Katie Couric is a production of I Heart Radio and Katie Curic Media. The executive producers are Katie Currik, Courtney Litz, and Tyler Klang. The supervising producer is Lauren Hansen. Our show producer is Bethan Macaluso. The associate producers are Emily Pinto and Derek Clements. Editing by Derrek Clements, Dylan Fagan and Lowell Berlante, Mixing by Dylan Fagan. Our researcher is Gabriel Loser. For more information on today's episode, go to Katie Kurik dot com and follow us on Twitter and Instagram at Katie Kurik. For more podcasts for my heart Radio, visit the I heart Radio app, Apple podcast, or wherever you listen to your favorite shows.