Dr. Tom Frieden: Former Director of the CDC (Raise the Line)
Hello, I'm Doctor Ride, chief Medical Officer at osmosis. And I'm here today with Doctor Tom Frieden, present and CEO of resolve to save lives initiative of vital strategies.
Doctor Frieden is also the former Director of the US Centers for Disease control and prevention and former Commissioner of the New York City Health Department.
Thanks for being with us. I wanna just dive right in and start by asking you, how do you feel our current situation impact impacts our future responses to disease outbreaks?
What lessons do you feel we've learned? I hope this pandemic will result in a stronger society and health care system where we recognize that we're all in this together.
We recognize that time is lives and the quicker we respond, the better off we'll be. And also that we recognize that our public health system in the US and around the world is crucial to all of our safety.
So Dr Frieden with that in mind, are there certain things that you feel like the general media isn't focused on but should be more focused on?
This is a 24 hour a day media cycle and it isn't so much that things are being missed as that there isn't a sense of the priorities, the priorities are to structure the response.
Well, to make sure at the national level, there is clear consistent guidance which is based and then there's support for implementation at the state and local levels that's crucial for an effective response.
What we sometimes see is kind of running to where the ball was a week ago or a month ago rather than going to where we need to go to keep people safe with that in mind.
Do you feel like there are some long term consequences this is gonna have on our US healthcare industry. I think this will help us recognize that we need to make health care much safer.
Far too many health care workers are getting infected in this outbreak and patients are getting infected in healthcare systems in an average year.
At least 70,000 Americans die from infections that they pick up in the healthcare system. This should help us change to become much safer in how we give care.
You know, Doctor II came across a letter you recently wrote to Congress. I'm curious what specific issues led you to write that letter?
What we see is an underinvest in keeping us all safe and within the US, we have had some support for what's called global health security or global health protection.
We're all connected by the air, we breathe the water, we drink the food, we eat the trains and planes we ride on. It's crucially important that the US invest in global health protection.
We invest in our health security by helping countries around the world find threats faster, stop them sooner and prevent them wherever possible will be safer, stronger there, safer here.
So, Doctor Frieden with that in mind, how specifically would that increase funding better prepare us for future outbreaks and pandemics?
And and why is that specifically important and kind of a follow up to that could the rapid spread of COVID-19 have been contained earlier?
If we had currently the funding that you're you're suggesting or requesting with additional investment will be able to help countries find threats when they first emerge.
That means having early warning systems, rapid response systems so that countries can identify a threat, respond to it and warn others before it spreads widely frankly.
If Guinea in West Africa had had core public health services in place in in 2013, the Ebola epidemic of 2014 to 2016 may not have happened.
It could have taken just a few weeks and a few $1000 to stop that cluster. Instead, it became a terrible epidemic that affected three countries and cost tens of billions of dollars globally.
Similarly, if China had closed its bird markets, its wet markets in 2003 after the SARS outbreak, it's possible that this entire pandemic might not have happened and the next threat is just around the corner, whether it's a tick borne disease in Asia or an animal borne disease in Africa, the microbial threats are with us.
It is inevitable that there will be another threat. What's not inevitable is that we will continue to be so underprepared?
Can you offer some insights into how the CDC has handled outbreaks in the past? And was this one handled differently in your opinion, when there's an emergency, the centers for disease Control and Prevention activates its emergency operations center.
It marshals a response which calls on many of the 20,000 professionals who work at CDC. It calls on the long standing relationships that CDC has with all 50 states and with countries all around the world in this response.
As of mid, unfortunately, CDC is not having the kind of central role it has had in every other disease outbreak the US has ever faced.
That makes me worried that makes me feel less safe fighting this disease without CDC at the table when decisions are being made and at the podium when they are being communicated is like fighting with one hand tied behind your back.
What would you say are 3 to 5 lessons we've learned from other governments in terms of response uh to COVID-19, we're learning from countries around the world, both positive and negative.
One thing that we're learning is that time is lives every day matters. If you look at Northern Italy, they were not able to act quickly and they're dealing with a devastating situation.
If you look at the provinces outside of Hubei China, they were able to contain this as have Hong Kong, Singapore and Taiwan with a very aggressive system of case protection contact, tracing isolation that prevented them from having to go into these large shutdowns of society.
That's a critically important lesson. And from South Korea, we're seeing that even when it gets very large, if there's a very extensive effort which uses advanced methods to find contacts, makes testing widely available, you can tamp down what has already become widespread transmission and very hopefully from Singapore, we're seeing the absence of health care worker infections using standard precautions.
It's not a question of super careful or super advanced materials. It's more a question of meticulous attention to every single aspect of infection control.
So Dr Frieden, can you speak a little bit more about testing and your thoughts on where we are with that right now, testing is critically important.
So we can see if it's waning waxing and where it's happening. We need to investigate clusters and stop, stop transmission in healthcare facilities and nursing homes.
If there are clusters using intensive testing and we need to use it for intensive investigations to answer some of the questions I mentioned.
But in areas like New York City today where COVID-19 has spread widely. We need to discourage people with only mild symptoms from getting tested because doing that is unsafe for them, it's unsafe for others and it undermines the effectiveness of the response with time that will change.
As we are able to tamp down the number of cases, we can ramp up testing as Korea has done to try to find every infection and contain every cluster.
Do, do you have any tips for the general public on how they can help flatten the curves, flattening? The curve is really important and there's something that each and every one of us can do.
Wash your hands frequently. Don't go out if you're sick, cover your mouth and nose every time you cough or sneeze using a tissue that you throw out or the crook of your elbow and most importantly, where it's spreading widely follow the local government's advice, avoid all non essential contact within 6 ft of everyone else.
We're all in it together, but we all need to keep separate to do as well as we can in New York City in late March of 2020.
It's crucial that if you're just mildly ill, you not seek care or testing. That's because by doing so, you may infect others in the process of traveling to or getting tested, testing.
You may use up scarce testing supplies including personal protective equipment, you'll add to the overcrowding in health care which makes it less safe for patients and health care workers.
And if you're negative, you may end up getting infected in that process. And if you're positive, it's not going to change what you do.
Stay home, isolate yourself, don't infect others. All of us can play a part in flattening the curve in improving the outcomes for all of us.
What each of us does is important to all of us. Can you speak specifically on, on what role you think online education will play in flattening the curves online and digital resources are tremendously important.
Helping students learn, helping health care workers learn, conveying information about this as we're all hunkered down in our homes.
Broadband is important and online information is important, particularly valid information and ways we can all collaborate online and work together from a distance.
Do you have any tips for healthcare system, administrators and healthcare workers about ways they can help to raise the line or expand healthcare capacity in health care?
The key concept is safer. Surge, health care facilities need to be ready for large numbers of people who are not seriously ill to be rapidly and safely seen.
This can be done, for example, using tents and outdoor areas and parking lots. They also have to surge intensive care capacity capacity to provide oxygen to people who are having trouble breathing.
This is something that's very challenging but it means not just ventilators but material supplies, training, cohorting of patients and creative ways to safely care for as many patients as possible.
We're also going to really have to look carefully at how to maintain our health care system, how to care for people with chronic illnesses such as hypertension diabetes, seizure disorder to make sure that they get the care they need to stay healthy, not just for those conditions, but because we know that people with underlying conditions are more susceptible to COVID-19 and severe disease.
Do. What's your current estimate for when we'll start to see the number of new cases fall in the United States?
There's no way to predict what's going to happen with this virus over time. We can hope that it uh fizzles as warmer weather comes, but there's no certainty that that will happen.
We don't know to what extent it will spread. We don't know when we'll have proven treatments and a vaccine is at least a year or two away if it's developed at all.
Do you believe the general public is overreacting? You know, with buying up toilet paper and hand sanitizer or do you believe the lack of information is contributing to the frenzy?
There are really important things that everyone can do. For example, not going out if you're sick, minimizing contact with others, washing your hands, regularly, coughing into a tissue or the crook of your elbow.
But mass buying of things like paper isn't helping, buy enough for what you need. Easy to say, hard to get people to follow that advice.
We're particularly concerned about health care supplies like surgical masks, those need to be preserved for health care until there are ample numbers for everyone with that in mind.
What advice do you have to offer local state and federal public health workers? The key characteristic of a great public health response is that it uses real time data to make appropriate decisions, to protect people as well as possible.
We need to collect information, use that information, share that information openly. We always want to be first right and credible with the information that we provide to the public.
We also want to be collecting information about the questions that we still don't fully understand. How can we best protect health care workers?
Do people without symptoms or before they have symptoms, spread this infection or not? Do Children spread this infection?
Who is most at risk for severe illness? This kind of question needs to be urgently answered so we can protect people as well as possible.
We need a way to make that happen. And for people who don't have a regular provider, we need to provide them with care so they can continue to get the life saving treatments they need and consultation for COVID if they're concerned that that's a great point.
And I'm curious, what role or other roles do you think online education will play in raising the line and preparing more healthcare workers to join the front lines in fighting COVID-19.
Online education can be extremely important in sharing lessons on how to prevent infection, how to care for patients, how to optimally structure health care.
It may also be important in contact tracing. And we see from Korea and some other places, the very sophisticated use of cell phones and geolocation systems to identify who may have been exposed.
You know, if you could go back and change 2 to 3 ways that the CDC and wh O has responded to the spread of COVID-19 given that you said, you know, time equals lives.
What would you change? I'm not sure it's useful to go back now and say what could have been done different.
Let's wait until we get through it, but let's focus on what we need to do differently. Now, one thing we must do better is get answers to critical questions.
How can we best protect health care workers do asymptomatic and presymptomatic people spread this disease or not, do Children spread this infection or not?
Those are crucially important at answering questions and the sooner we get answers, the better off we'll be, it's also crucially important throughout the United States that we follow the best practice of dealing with emergencies.
And that means using an incident management system where there is one clear person in charge, there are different lines of work and there's frank communications by the scientific experts on the best ways to protect ourselves against this pandemic.
Do fried. We've spoken about a lot of topics on this call.
I'm curious, are there any final messages you would have for the American public? I'm concerned not seeing the centers for disease control and prevention at the decision table and at the podium in every prior infectious these emergency this country has ever gone through.
That's where CDC has been and not having them. There makes me feel less safe.
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