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Center at the National Institutes of Health in
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IN 2019 FOR HIS CAREER
CONTRIBUTION TO HHS IN 2019 HE
RECEIVE THE AMERICAN COLLEGE OF
PHYSICIANS AWARD FOR CAREER
TRAFFIC TO CLINICAL
EPIDEMIOLOGY.
DR. HENDERSON IS A FELLOW OF THE
AMERICAN COLLEGE OF PHYSICIANS,
THE INFECTIOUS DISEASE SOCIETY
OF AMERICA AND PUBLISHED MORE
THAN 180 PEER-REVIEWED JOURNAL
ARTICLES AND MORE THAN 80 BOOK
CHAPTERS.
HE ALSO SERVED AS A COMMITTED
CAREER MENTOR IN THE FIELD OF
EPIDEMIOLOGY AND INFECTION
CONTROL INCLUDING ME AND JOIN ME
IN WELCOMING DR. HENDERSON FOR
HIS TALK, COVID-19 PANDEMIC
LOOKING BACK AND FORWARD.
>>HER PRESENCE WAS A SURPRISE I
HAD TO TAKE ALL THE TERRIBLE
THINGS I WAS GOING TO SAY ABOUT
TARA OUT OF MY TALK.
THANK YOU FOR THE KIND
INTRODUCTION.
I'D LIKE TO BEGIN BY THANKING
DR. MERKO AND HIS TEAM FOR
INVITE MEG TO PARTICIPATE IN
THIS LECTURE SERIES.
I'M CERTAINLY PLEASED AND
HONORED TO DO SO.
AND I'M AWARE PEOPLE WHO STOOD
AT THIS PODIUM IN THIS SERIES
AND QUITE HUMBLED BY IT.
WE'RE GOING TO TALK ABOUT
SOMETHING WE LIVED THROUGH, THE
COVID-19.
HAVE NO DISCLOSURES ONE OF THE
SAD THINGS IN MOST OF MY CAREER.
THIS PRESENTATION WILL NOT
ADVOCATE FOR THE USE OF ANY
UNAPPROVED OR OFF LABEL DRUGS
THOUGH I MAY MENTION OTHER
PEOPLE ADVOCATE FORG THEM.
I HOPE AT THE END OF THE TALK
YOU'LL BE ABLE TO RELATE THE
COVID PANDEMIC IN CONTEXT FROM
ONE PANDEMIC FROM THE PAST TO
DISCUSS SUCCESSES AND
IMPROVEMENT FOR OUR RESPONSE TO
THE PANDEMIC AND HOPE WE'LL BE
ABLE TO DESCRIBE THE PRINCIPLES
ON WHICH A SUCCESSFUL RESPONSE
MAY BE FORMULATED AS THE GOSPEL
ACCORDING TO HENDERSON.
I'D LIKE TO START WITH A MAJOR
DISCLAIMER.
THAT IS THE OPINIONS I EXPRESS
IN THIS DISCUSSION ARE MINE AND
MINE ALONE.
THEY DON'T REPRESENT THE
LEADERSHIP OF THE CLINICAL
CENTER FOR NIH, HHS OR THE
U.S. FEDERAL GOVERNMENT.
I ALSO WANTS TO APOLOGIZE IN
ADVANCE AND PRESENTERS SHOULD
TAKE NOTE OF THE FACT YOU SHOULD
NEVER DO THIS, BUT I APOLOGIZE
FOR THE TEXT HEAVY NATURE OF MY
SLIDES.
THE TALK CONTAINS A LOT OF
INFORMATION AND WANT THE TO BE
CERTAIN TO USE LANGUAGE THAT
PRECISELY CHARACTERIZES MY
MESSAGE RATHER THAN RELYING
WHOLLY ON MY ENFEEBLE BRAIN TO
CALL UP TERMS ON THE FLY.
I'D LIKE TO ABOUT OUR INITIAL
RESPONSE WHEN WE LEARNED ABOUT
IT IN 2020.
SOME SUCCESSES AND OPPORTUNITIES
FOR IMPROVEMENT AND PRINCIPLES I
THINK ARE AN IMPORTANT PART OF
ANY PANDEMIC RESPONSE, A FEW KEY
LESSONS LEARNED AND PREPAREDNESS
AT THE INSTITUTIONAL LEVEL AND
FINDING A NEW NORMAL.
IT'S THE KIND OF EPICURVE WE'VE
SEEN THE PAST THREE YEARS
LOOKING AT THE EARLY SLOPE AND
HOPING IT WOULD NEVER GET HIGHER
THAN THE FIRST PEAK AND THEN
WAITING FOR THE DOWNWARD SLOPE
AFTER THE PEAK OF A SURGE.
SOME MAY HAVE GUESSED IT'S NOT
SARS.
THIS IS THE EARLY PANDEMIC CURVE
FROM INFLUENZA PANDEMIC OF 1918.
THE 1918 INFLUENZA PANDEMIC
AFFLICTED OVER 25% OF THE
U.S. POPULATION.
MORE THAN 25 MILLION PEOPLE.
IN THE U.S. MORE THAN 675,000
PEOPLE DIED ROUGHLY 0.5% OF THE
U.S. POPULATION AT THE TIME.
THE INFLUENZA PANDEMIC OF 1918
KILLED AN ESTIMATED 50 MILLION
PEOPLE WORLDWIDE, ONE-FIFTH OF
THE WORLD'S POPULATION WAS
ATTACKED BY THE DEADLY VIRUS AND
WITHIN MONTHS OF THE FIRST
APPEARANCE KILLED MORE THAN
PEOPLE THAN ANY OTHER ILLNESS IN
RECORDED HISTORY.
IN ONE YEAR THE AVERAGE LIFE
EXPECTANCY IN THE UNITED STATES
DROPPED BY 12 YEARS.
THINK OF THAT.
LIFE EXPECTANCY FELL SO FAR, SO
FAST IN PART BECAUSE IN THE
MIDST OF THE PANDEMIC IT WASN'T
THE TYPICALLY YOUNG AND VERY OLD
PEOPLE THAT YOU CAN SEE DYING
BUT IN 1918 IT WAS ALSO I GUESS
I DON'T HAVE THIS POINTER, MAYBE
I'M POINTING IT THE WRONG WAY,
JUST GO BACK.
IN 1918 YOU SEE THE PEAK IN 25
TO 34-YEAR-OLD AGE GROUP LOTS OF
DEATH AND OUT SOCIALLY AND
WORKING AND TO THE VIRUS.
THE SO-CALLED W-SHAPE CURVE AND
THINGS REALLY AREN'T SO
DIFFERENT.
HERE'S AN ARTICLE FROM THE
WASHINGTON TIMES BACK IN
SEPTEMBER 27 OF 1918 WITH THIS
WOMAN DEMONSTRATING THE USE OF A
NEWLY DESIGN MASK TO DESIGN TO
HALT THE SPREAD OF THE PLAGUE.
YOU SEE THE SEATTLE WASHINGTON
POLICE OFFICER GOING OUT ON
THEIR BEATS WEARING THEIR MASKS.
I FOUND THIS INTERESTING GIVEN
THE CONTRIBUTION TO THE STATE OF
WASHINGTON TO THE EARLY PART OF
THE PANDEMIC FOR COVID-19 AND
LAST BUT NOT LEAST IN THE
PICTURE IN THE LOWER RIGHT
BECAUSE THIS ALSO HAS A LITTLE
BIT OF A BASEBALL THEME THREE
PEOPLE ALL WEARING MASKS, ALL
DIFFERENT BUT ONLY ONE OF THOSE
MASKS LIKELY HAS ANY IMPACT ON
THE TRANSMISSION OF RESPIRATORY
VIRUSES.
THE PICTURE ON THE LEFT HERE IS
FROM A U.S. ARMY CAMP IN FRANCE.
I'M NOT CONFIDENCE THE CURTAINS
YOU SEE HAD MUCH IMPACT ON
MANAGING COT-TO-COT SPREAD.
THE FIRST TRANSMISSION LIKELY
WAS AT FORT KANSAS WHERE 500
TROOPS AT FORT RILEY WERE
QUICKLY INFECTED.
IT'S A SMALL BUT SOPHISTICATED
AUDIENCE.
I KNOW FOR SURE.
WHO IS THIS MAN?
YOGI IS A PLAYER WON 10 WORLD
SERIES CHAMPIONSHIPS.
THE MOST IN MAJOR LEAGUE
HISTORY.
HERE YOU SEE HIM IN A VARIETY OF
OTHER POSES.
MY FAVORITE WHICH IS THE SECOND
FRAME WHERE YOU SEE YOGI IN THE
ARMS OF DON LARSON WHEN HE
PITCHED THE ONLY PERFECT GAME IN
THE WORLD SERIES HISTORY IN GAME
FIVE OF THE 1956 WORLD SERIES
AGAINST THE THEN BROOKLYN
DODGERS OCTOBER 8 OF 1956.
WHILE YOGI'S BASEBALL PROWESS IS
UNDENIABLE AND PUT HIM IN THE
BASEBALL HALL OF FAME HE'S BEST
KNOWN FOR HIS APHORISMS OR MORE
PRECISELY YOGIISMS.
THE BEST KNOWN QUOTE IS
APPLICABLE BETWEEN THE 1918
INFLUENZA PANDEMIC AND COVID-19
PANDEMIC I THINK IF HE WERE
ASKED ABOUT THE SIMILARITIES AS
HE SAID ABOUT ROGER MARIS AND
MICKY MANTLE IT SEEMS LIKE DEJA
YOU ALL OVER AGAIN.
LET'S TALK ABOUT EARLY DETECTION
AND EARLY RESPONSE.
YOU SEE THE TIME LINE IN CHINA
ON DECEMBER 30 OF 2019 A CLUSTER
OF CASES OF PNEUMONIA WAS
REPORTED TO THE CHINA NATIONAL
HEALTH COMMISSION.
THERE'S BEEN SOME INTERNET
CHATTER PRIOR TO THE REPORT
MOSTLY FROM PHYSICIANS WHO HAD
DONE TRAINING IN THE UNITED
STATES AND HAVE COLLEAGUES OR
MENTORS IN THE UNITED STATES
ASKING ABOUT CARE OF PATIENTS
WHO HAVE UNKNOWN RESPIRATORY
INFECTIONS.
AND THERE WAS A WHOLESALE MARKET
THEY THOUGHT MIGHT BE THE
EPICENTER FOR THE PANDEMIC AND
SOME PEOPLE STILL BELIEVE IT
WAS.
SIX DAYS LATER A NOVEL CORONA
VIRUS WAS ON JANUARY.
IN JANUARY 11 THE FIRST FATAL
CASE WAS REPORT AND THE CHINA
SHARED THE WHOLE GENOME SEQUENCE
OF THE VIRUS WITH SCIENTISTS AT
THE WORLD HEALTH ORGANIZATION.
ON THE 13th THE FIRST CASE WAS
REPORTED IN THAILAND.
ON THE 19th THE FIRST CASE
REPORTED IN KOREA AND TWO IN
BEIJING AND ONE IN THE PROVINCE
AT THE 16th THE FIRST CASE WAS
REPORTED IN JAPAN AND THE 20th,
THE CHINESE REPORTED THE HEALTH
CARE WORKERS WERE COMING DOWN
WITH THE INFWEKS AND BY THE 24th
THE CHINESE REPORTED 835 CASES
IN CHINA, 549 FROM WUHAN AND 286
FROM THE OTHER 31 PROVINCES,
MUNICIPALITIES OR SPECIAL
ADMINISTRATIVE REGIONS.
HERE'S THE EPICURVE MOST ARE
FAMILIAR WITH.
PUBLISHED DAILY FROM FEBRUARY OF
2020 UNTIL MARCH 23 OF 2023 BY
THE NEW YORK TIMES AND SHOWS THE
INITIAL EPIDEMIC AND DELTA WAVE
AND THE OMICRON WAVE AND TWO
SUBSEQUENT SMALLER WAVES.
IT'S BEEN A REALLY ROCKY ROAD.
MORE THAN 108 CASES OF COVID
OCCURRED IN THE UNITED STATES
AND THAT IS ASSUREDLY AN ARE
ESTIMATE.
ASYMPTOMATIC AND MILDER CASE
NEVER REPORTED AND BEGINNING IN
EARLY 2022, HOME TESTING BECAME
PREVALENT AND FEWER CASES WERE
REPORTED.
TO DATE, 1,174,109 PEOPLE DIED
IN AMERICA AND THE MORE THAN 1.1
MILLION WHO DIED REPRESENT
ROUGHLY 0.35% OF OUR ENTIRE
POPULATION.
SO CONSIDER THIS, IN A TIME WHEN
SCIENCE AND MEDICINE HAVE MADE
ASTOUNDING DIAGNOSTIC,
THERAPEUTIC AND PREVENTIVE
INTERVENTIONAL STRIDES, WE DID
NOT FARE MUCH BETTER WITH THE
COVID THAN 1918 WHEN WE DIDN'T
HAVE ANY DIAGNOSTIC TESTS OR ANY
THERAPEUTIC INTERVENTIONS OTHER
THAN SUPPORTIVE CARE.
AND DESPITE THE PROVISION OF
CRITICAL AND CLINICAL CARE MORE
THAN 1.1 MILLION AMERICANS ON.
EARLY ON EXPERTS HOPED NO MORE
THAN THE TYPICAL FIVE TO 50,000
PEOPLE WHO DIE ANNUALLY FROM
INFLUENZA WOULD DIE FROM COVID.
IT'S FAIR TO SAY ALL OF US WERE
SORELY DISAPPOINTED.
HERE'S THE TIME LINE IN THE U.S.
JANUARY 3, THE CDC DIRECTOR
DR. ROBERT REDFIELD WAS NOTIFIED
OF A MYSTERIOUS ILLNESS
SPREADING IN WUHAN.
THREE DAYS LATER HE MADE CONTACT
WITH THE CHINESE GOVERNMENT AND
OFFERED TO SEND A GROUP OF
SCIENTISTS FROM CDC TO HELP THEM
INVESTIGATE THE PROBLEM TO MY
KNOWLEDGE THAT OFFER WAS NEVER
ACKNOWLEDGED.
ON THE 8th OF JANUARY, CDC
ISSUED ITS FIRST PUBLIC ALERT ON
THE 17th THEY BEGAN AIRPORT
SCREENING IN NEW YORK, LOS
ANGELES AND SAN FRANCISCO BEHIND
THE JANUARY OF 20 THE FIRST
U.S. CASE WAS REPORTED AN
AMERICAN CITIZEN TRAVEL FROM
WUHAN TO WASHINGTON STATE.
THE 23rd, CDC SOUGHT AND FDA
EMERGENCY USE AUTHORIZATION FOR
THEIR PCR TEST ON THE 31st THE
DEPARTMENT OF HEALTH AND HUMAN
SERVICES DECLARED PUBLIC HEALTH
EMERGENCY LASTING TO MARCH 23,
2023.
ON FEBRUARY 4th, THE FDA ISSUED
THE PCR TEST BUT TWO DAYS LATER
THE CDC TEST KITS WERE FOUND TO
BE DEFECTIVE.
ON THE 15th, YOU PROBABLY ALL
RECALL THE 338 U.S. NATIONALS
STRANDED ON THE DIAMOND PRINCESS
CRUISE SHIP.
ON THE 20th THE FIRST INSTANCE
OF COMMUNITY TRANSMISSION WAS
CONFIRMED IN CALIFORNIA AND AT
THAT TIME MOST OF US WHO HAD
BEEN WATCHING FROM AN
EPIDEMIOLOGIC PERSPECTIVE FELT
THE HORSE HAD ALREADY RUN.
BY THE 28th, THE CDC TEST KIT
WAS REVISED AND IT WASN'T UNTIL
MARCH 3 THEY LIFTED RESTRICTION
ON TESTING FROM THE CDC AND THAT
PUT US A MONTH AND A HALF OR TWO
MONTHS BEHIND THE CURVE.
ON THE 11th OF MARCH, THE WORLD
HEALTH ORGANIZATION DECLARED A
PANDEMIC.
ON THE 12th, COLLEGES AND PUBLIC
SCHOOLS BEGAN TO CLOSE.
ON THE 16th, BOTH DHHS AND CDC
ISSUED GUIDELINES ABOUT THE NEW
DISEASE AND BY THE MARCH 31,
2020 THE U.S. EXPERIENCED 370
DEATHS, 164,000 CASES AND USED
MORE THAT BE 1.07 MILLION TESTS.
THAT WAS NOT NEARLY ENOUGH.
SO WHERE DID IT COME FROM?
THERE'S A VARIETY OF THEORIES.
THE MOST PREVALENT IS IT EVOLVED
AND ADAPTED ITSELF FROM NATURE.
THERE'S A FAIR AMOUNT OF
EVIDENCE FOR THAT AND A LOT'S
WRITTEN ABOUT IT AND SOME
BELIEVE IT'S A LABORATORY
INSTITUTE OF VIROLOGY IN WUHAN
AND SOME BELIEVE IT WAS
INTENTIONALLY RELEASED BY THE
CHINESE GOVERNMENT.
WE DON'T HAVE DEFINITIVE
EVIDENCE OR PROVING EVIDENCE FOR
ANY OF THOSE THEORIES AND WE MAY
LIKELY NEVER KNOW PRECISELY
WHERE IT CAME FROM.
BASED ON ALL I READ I'M
REASONABLY CONFIDENT THE PRIMARY
HYPOTHESIS THAT IS EVOLVED AND
ADAPTED FROM NATURE IS PROBABLY
MOST LIKELY.
THAT'S THE CASE WE KNOW FOR SARS
COV1 AND MERS TWO CLOSELY
RELATED CORONAVIRUS.
I HAVE NO EVIDENCE THAT IT WAS
INTENTIONALLY RELEASED AND THERE
IS SOME THAT SAYS A LABORATORY
INCIDENT IS POSSIBLE.
THE EARLY SPREAD CHINA WAS
DRAMATICALLY UNDER REPORTED.
SO WHAT WENT WELL FOR US.
THE RAPID IDENTIFICATION AND
SEQUENCING OF THE VIRUS GAVE US
A LEG UP AND GAVE US GREAT
OPPORTUNITIES.
I THINK ONE OF THE BIGGEST
SUCCESSES CAME FROM THE
DEPARTMENT OF HEALTH AND HUMAN
SERVICES GENERATING OPERATION OF
WARP SPEED WHICH CALLING ON THE
LEADERSHIP OF THE AGENCIES WITH
FRANCIS COLLINS HIMSELF TAKING A
SIGNIFICANT ROLE IN OPERATION
WARP SPEED AND QUICKLY MADE A
PARTNERSHIP WITH BIG PHARMA AND
ENCOURAGED REPURPOSING OF
ANTIRETROVIRALS AND THEY
ENCOURAGED AND HELPED TEST AND
MOVE TOWARDS EMERGENCY USE
AUTHORIZATION FOR NEW ANTIVIRAL
AGENTS, THE FORMER IS PAXLOVID
AND ENCOURAGES MONOCLONAL
ANTIBODIES THAT WERE OF GREAT
BENEFIT LESS SO OF THE VARIANTS
WHERE THE MONOCLONAL VARIANTS
DID NOT ATTACH AND HELPED PROVE
THE BENEFIT OF CONVALESCENT
PLASMA OF PEOPLE ILL WITH THE
DISEASE.
THEY ENCOURAGED THE DESIGN AND
DEVELOPMENT OF DRUGS TO TREAT
THE CYTOKINE STORM A SIGNIFICANT
PART WHEN PATIENTS GET SICK AND
IL6 RECEPTOR BLOCKERS AND
INTERMERS WERE USEFUL.
VACCINE DEVELOPMENT WAS ALSO AN
ASTOUNDING SECOND HAUCCESS IN M.
YOU'RE ALL FAMILIAR WITH THE
mRNA PLATFORM WHERE SCIENTISTS
HAD A SIGNIFICANT PART OF
DEVELOPMENT FROM THAT PLATFORM.
THE ADENOVIRUS VACCINES WERE
HIGHLY EFFECTIVE AND ENDED UP
HAVING UNANTICIPATED
CONSEQUENCES BUT WE NOW HAVE
PROTEINS SUBUNIT VACCINES ON A
VARIETY OF OTHER PLATFORMS ALL
OF WHICH HAVE EFFICACY BUT THE
REMARKABLE THING IS THE VIRUS
WAS ISOLATED ON THE 7th OF
JANUARY, SEQUENCED ON THE 12th
AND THE FIRST EUA WAS GRANTED ON
DECEMBER 2 LESS THAN A YEAR OF
THE SEQUENCING OF THE VIRUS.
THE EFFICACY OF THE VACCINES AT
FIRST WAS ALMOST UNBELIEVABLE.
THE EFFICACY DATA GREATER THAN
95%.
AND THE VARIANT SPUN OFF WAS
LESS AND LEGS EFFECTIVE IN TERMS
OF PREVENTING INFECTIONS BUT
REMAINED EFFECTIVE AT PREVENTING
BIRTH MORTALITY AND
HOSPITALIZATION.
THIS IS THE GOSPEL ACCORDING TO
HENDERSON AND MY TAKE AND
EXPRESSES MY OPINION.
THERE WAS NO CENTRALIZED
COORDINATED FEDERAL RESPONSE.
RESPONSE WAS DECENTRALIZED TO
THE STATES AND MUNICIPALITIES
AND AS MANY APPROACHES AS HEINZ
HAS VARIETIES.
WE HAD THE ABILITY TO IMPLEMENT
TESTING.
WE LACKED UNIFORM STANDARDS FOR
REPORTING DATA AND THAT PREVENT
THE TIMELY AND ACCURATE TRACKING
OF SPREADING.
REPORTING SYSTEMS AT THE START
OF THE PANDEMIC WERE
INCONSISTENT AND ANTIQUATED.
A SUBSTANTIAL FRACTION OF PEOPLE
WERE REPORTING TO CDC AT THE
START WERE REPORTING BY FAX AND
AND THERE WERE A FEW CASES, WE
HAVE THEM AT HAND.
THE POPULATION DOESN'T NEED TO
BE CONCERNED AS REPORTS WERE
TRIVIALIZED AND AS THE PANDEMIC
BEGAN TO UNFOLD WE HAD ALSO
ACCESS TO PPE AND COUNTED ON THE
STOCKPILE FOLLOWING NOVEL H1N1
BY THE TIME WE GOT TO THOSE MOST
ERROR OUT OF DATE AND REALLY NOT
USABLE.
WE HAD PROBLEMS WITH MASKS AND
GOWNS AND CRITICAL SHORTAGES OF
REAGENTS FOR TESTING.
WE HAD PROBLEMS WITH THE INITIAL
INTERPRETATION AND DELINEATION
OF COVID-19 EPIDEMIOLOGY.
THINK THE TRUE PANDEMIC
POTENTIAL MAY HAVE BEEN
INITIALLY DISCOUNTED IN PART
BECAUSE OF THE EXPERIENCE WE HAD
WITH BOTH SARS 1 AND MERS.
THOSE DISEASES BALM MORE DISEASE
AS THE PATIENT BECOMES MORE
INFECTIOUS.
AND THERE'S PEOPLE IN HOSPITALS
PROVIDING CARE AND THAT'S WHAT
WE SAW ESPECIALLY WITH SARS COV1
IT WASN'T AS TRANSMISSIBLE IN
THE COMMUNITY BECAUSE PEOPLE
WEREN'T THAT SICK WITH IT AND BY
THE TIME THEY WERE THEY WENT TO
THE HOSPITAL.
IT'S NOT THE CASE FOR SARS COV2.
TRANSMISSION WAS INITIALLY AS A
DROP LET SPREAD, NO WORD OF
AEROSOL TRANSMISSION BUT IN THE
RIGHT CIRCUMSTANCES AND WITH THE
RIGHT PATIENT IT'S PROBABLY THE
CASE AEROSOL AND IF THE AIR
HANDLING IS POOR MAYBE AIRBORNE
TRANSMISSION MAY OCCUR.
A BIG PROB WAS ASYSTEMATIC --
ASYMPTOMATIC TRANSMISSION WAS
DISCOURAGED THAT AND MASKS AND
WE NEEDED ENOUGH MASKS WITH THE
HEALTH CARE PROVIDERS.
MANY PROBLEMS COULD HAVE BEEN
OBVIATED WITH TESTING AND
QUARANTINE.
THOUGH THE VACCINE WAS PRODUCED
WITH BREAK NECK SPEED THE
LOGISTICS AT THE START WERE LESS
THAN STELLAR RESULTING IN
INEQUITIES.
WE HAD PROBLEMS FROM THE
NATION'S MULTIPLE RESPONSE FALSE
STARTS.
POLITICAL OPINIONS ENTIRELY VOID
OF FACTUAL EVIDENCE WERE
REPRESENTED AS FACTUAL NEARLY
EVERY DAY AND RECOMMENDATIONS
WERE HIGHLY POLITICIZED.
THE EARLY TESTING PROBLEMS AT
CDC LIKELY CAUSED THE PUBLIC TO
LOSE SOME CONFIDENCE AT THE
INCREDIBLE AT THE TIME WE NEEDED
THEM MOST.
GOVERNMENTAL COMMUNICATION AND
TRANSPARENCY WAS OBLITERATED.
SPEAKING TRUTH TO POWER I'LL
CALL A COLLEAGUE, TONY FAUCI LED
TO GAGGING OF EXPERTISE AND YOU
LOOK AT THE TASK FORCE TO SEE
WHAT HAPPENED WHEN THEY SPOKE
UP.
THE INTERFACE BETWEEN SCIENCE
AND POLICY WAS SEVERELY DAMAGED
AND I HOPE NOT INEXTRICABLY.
HERE'S EXAMPLES OF
MISINFORMATION SPREAD ABOUT
COVID AND SARS COV2.
THE EXTENT OF EARLY SPREAD WAS
MINIMIZED.
WE ONLY HAVE 18 CASES AND WE
KNOW WHERE ALL ARE.
YOU DON'T HAVE TO BE WORRIED.
THE SERIOUSNESS OF THE DISEASE
WAS VASTLY UNDERESTIMATED.
IT'S JUST LIKE THE FLU.
YOU'LL GET IT AND GET OVER IT.
IT'S NOT A PROBLEM.
PEOPLE ARGUED MASKS WERE
INEFFECTIVE BUT THEY'RE NOT 100%
EFFECTIVE SO IF YOU FIND ONE
INSTANCE THEN YOU CAN REDUCE THE
ARGUMENT TO SAY NAR -- THEY'RE
NOT EFFECTIVE AT ALL.
PEOPLE ADVOCATE FROM THE USE OF
UNPROVEN THERAPIES.
FOR EXAMPLE, HYDROXYCHLOROQUINE
AND ON ONE OCCASION ON NATIONAL
TELEVISION EVEN THE USE OF
INTRAVENOUS CHLORIDE OR LIGHT TO
HELP RID THE BODY OF THE VIRUS
AND SOME LEADERS EXPRESSED
SUPPORT FOR THE CONSPIRACY
THEORIES.
THERE WAS AN EQUAL AMOUNT OF
VACCINE EFFECTIVENESS.
THERE'S ALWAYS RISK.
THEY WERE UNBELIEVABLY SAFE IN
COMPARISON TO OTHER NEW
VACCINES.
THERE WAS THE ASSERTION ALL OVER
THE INTERNET THAT VACCINES CAUSE
INFERTILITY.
THERE WERE ALLEGATIONS mRNA
VACCINES CAUSE IRREVERSIBLE
HARM.
THERE WERE SUGGESTION THE
VACCINE RECIPIENTS WERE AT
INCREASED RISK FOR SUDDEN DEATH,
ALSO UNTRUE.
THERE WERE FINANCIAL
MOTIVATIONS.
A GROUP CALLED AMERICA'S FRONT
LINE DOCTORS GARNERED $15
MILLION BY IMPLEMENTING A PLAY
TO PAY CONSULT SERVICE THAT
CHARGED $90 TO PRESCRIBE
HYDROXYCHLOROQUINE.
WINSTON CHURCHILL SAID IT BEST,
A LIE HAS HALFWAY AROUND THE
WORLD BEFORE THE TRUTH HAS A
CHANCE TO PUT ITS PANTS ON AND
HAS SAID, SOMETIMES WE FIND
WE'VE MET THE ENEMY AND IT'S US.
HERE A PAPER FROM THE JAMA
NETWORK OPEN THAT DID A DETAILED
ANALYSIS OF HOW A FAIRLY LARGE
NUMBER OF PHYSICIANS COMMUNITIES
TO COVID-19 MISINFORMATION ON
SOCIAL DETERMINATE.
LET'S TURN TO THE FIVE
PRINCIPLES I'LL TALK ABOUT
PRIMARILY.
THEY'RE NOT THE ONLY PRINCIPLES
BUT THESE ARE ONES I THOUGHT
WERE WORTHY OF EMPHASIS.
FIRST, THE UNIFIED EFFECTIVE
CENTRALIZED NATIONAL RESPONSE IS
ESSENTIAL AND EFFECTIVE
COMMUNICATION IS REQUIRED.
PUBLIC HEALTH SYSTEMS AND
LABORATORY SUPPORT SYSTEMS ARE
CRITICAL TO IDENTIFY TRACK AND
CONTAIN NOVEL PATHOGENS AND
SCIENCE MUST BE THE DRIVING
FORCE FOR INTERVENTIONS.
THE CONNECTION BETWEEN SCIENCE,
SOCIETY AND POLITICS HAS NEVER
BECOME MORE CLEARER THAN IT IS
TO ME RIGHT NOW.
FOR THE COVID PANDEMIC FOR AN
APOLITICAL VIRUS, POLITICS
PLAYED A FAR TOO PROMINENT ROLE.
WE HAVE TO CAPITALIZE ON
SCIENTIFIC DISCOVERIES AS
RAPIDLY AS POSSIBLE.
FIRST ABOUT THE RESPONSE.
IN MY VIEW, AGAIN THIS IS MY
VIEW, THE FEDERAL GOVERNMENT
MUST LEAD THE RESPONSE WORKING
CLOSELY WITH STATE AND MUNICIPAL
HEALTH DEPARTMENTS.
LEADERSHIP SHOULD BE THE
LEADERSHIP OF DHHS, HOMELAND
SECURITY, CDC, NIH, FDA AND
OTHERS DIRECTLY CONNECTED TO THE
WHITE HOUSE WITH EVERYBODY FOR
THE SAME PAGE.
AND FOR EMERGENCY PREPAREDNESS
DISCIPLINES AND THE TEAM SHOULD
BE SCIENCE AND EXPERTISE BASED
INCLUDING EXPERTS IN
COMMUNICATION FOR ONCE THEY HAVE
A MESSAGE KNOW HOW TO
COMMUNICATE TO THE PUBLIC AT
LARGE AND SHOULD INCLUDE POLICY
ADVISORS FROM BOTH SIDES AND
WORK FROM THE START OF THE
PANDEMIC TO GET EVERYBODY TO THE
SAME PAGE.
WE'RE ALL FACING THE SAME FOE.
I THINK IT HAS TO BE CENTRALIZED
OTHERWISE WE WOULD HAVE WHAT WE
HAD IN THIS PANDEMIC WHICH IS
REALLY A NUMBER DID, 50 OR 60
APPROACH AT THE STATE LEVEL
RANGING FROM THE RIDICULOUS TO
THE SUBLIME.
I THINK YOU HAVE TO INTERPRET
NEW DATA WITH CAUTIOUS AS NEW
DISEASES ARE RUNNING WITH
SURPRISES AND ASYMPTOMATIC
TRANSMISSION WAS A SURPRISE OF
THE DISEASE.
YOU HAVE TO REACH CONCLUSIONS
DELIBERATELY AND NOT ALL
PRONOUNCEMENTS WERE CORRECT.
TRANSPARENCY IS CRUCIAL AND MUST
BE COGNITIVE OF AND ADJUST TO
CUSTOMER INPUT.
WE HAVE LOTS OF CUSTOMERS.
SUCH SITUATIONS REQUIRE
DIRECTION BY STATE DEPARTMENT
LEADERSHIP AT LEFT DAILY OR AT
THE START OF THE PANDEMIC TWO OR
THREE TIMES DAILY
.
IN ADDITION, FREQUENT
COMMUNICATION WITH THE PUBLIC
AND PRESS IS CRITICAL.
CLEARLY DIFFERENTIATING BETWEEN
WHAT WE KNOW AND WHAT WE THINK.
I THINK ON SEVERAL OCCASIONS
DURING THIS PANDEMIC OUR
COMMUNICATIONS AROUND THE TWO
DIFFERENT THINGS WHAT WE KNOW
AND WHAT WE THINK WAS BLURRED.
I THINK POPULATION-LEVEL
GUIDANCE SHOULD BE ACCOMPANIED
BY IDENTIFYING FACTORS THAT
INFLUENCE INDIVIDUALS' RISKS SO
INDIVIDUALS CAN CREATE THEIR OWN
INDIVIDUALIZED RISK ASSESSMENT.
FOR THIS PANDEMIC WE LEARNED
QUICKLY THAT PEOPLE OLDER THAN
65 AND PEOPLE WITH CHRONIC
OBSTRUCTIVE LUNG DISEASE OR
KIDNEY DISEASE WERE AT
EXTRAORDINARY RISK FOR SERIOUS
CONSEQUENCES OF THE DISEASE.
GETTING THAT INFORMATION OUT AS
QUICKLY AS POSSIBLE IS CRITICAL.
PUBLIC COMMUNICATION SHOULD
ALWAYS BE QUALIFIED.
CANDIDLY ACKNOWLEDGING THE
LIMITATIONS OF OUR CURRENT
KNOWLEDGE AND MAINTAIN PUBLIC
HUMILITY.
IT'S EASY FOR THE AGENTS TO MAKE
US ALL HUMBLE.
IT'S EASY.
WE HAVE TO MAINTAIN THAT
HUMILITY AND WE SHOULD
ACKNOWLEDGE WHEN WE MADE
MISSTEPS OR ERRORS IN JUDGMENT
EMPHASIZING THE NEW KNOWLEDGE
THAT RESULTED IN THIS SET OF
RECOMMENDATIONS OR NEWER
RECOMMENDATIONS.
I CAN'T EMPHASIZE THIS ENOUGH,
EFFECTIVE PUBLIC HEALTH SYSTEMS
ARE CRITICAL.
DECADES OF NEGLECT HAVE LEFT OUR
PUBLIC HEALTH SYSTEMS LIGHT
YEARS BEHIND WHERE THEY NEED TO
BE.
EXISTING PUBLIC HEALTH SYSTEMS
ARE UNDER STAFFED, UNDER
RESOURCED AND UNDER INCENTIVIZED
AND THE UNITED STATES NEEDS A
CONSISTENT, SUSTAINABLE
LONG-TERM COMMITMENT TO PUBLIC
HEALTH.
THE CURRENT STRATEGY OF DUMPING
MONEY IN FOR A CRISIS AND
WITHDRAWING IMMEDIATELY WHEN THE
CRISIS
CRISIS EASES IS NOT SUSTAINABLE.
COUNTRY NEEDS AN ADDITIONAL
80,000 PUBLIC HEALTH
PROFESSIONALS.
ALMOST HALF OF ALL EMPLOYEES
WORKING AT STATE AND LOCAL
PUBLIC HEALTH AGENCIES LEFT
THEIR JOBS BETWEEN 2017 AND
2021.
A 2021 SURVEY OF STATE AND LOCAL
GOVERNMENTAL HEALTH WORKERS
FOUND 27% INTENDED TO LEAVE
THEIR POSITIONS WITHIN A YEAR
AND NEARLY 40% OF THOSE SAID
THEY'RE DECISION TO LEAVE WAS
INFLUENCED BY THE PANDEMIC.
ACCORDING TO THE OUTGOING CDC
DIRECTOR AT THE PANDEMIC START
THERE WERE 187 HEALTH CARES
REPORTING ELECTRONICALLY TO THE
CDC.
THAT NUMBER NOW EXCEEDS 25,000.
A HUGE INCREASE THAT STILL
INCLUDES ONLY 25% OF U.S. HEALTH
CARE FACILITIES.
SIMILARLY, AT THE START OF THE
PANDEMIC, ONLY A HANDFUL OF
U.S. EMERGENCY ROOM DEPARTMENTS
WERE SUBMITTING REPORTS OF
SYNDRO
SYNDROMIC SURVEILLANCE AND
NEITHER IS ENOUGH TO ADDRESS A
RAPIDLY SPREADING PANDEMIC.
THE INFRASTRUCTURE FOR UNITED
STATES IN THE UNITED STATES IS
WOEFULLY INADEQUATE AND NEEDS
INFUSION OF HUMAN CAPITAL AND
RESOURCE FUNDING.
THE COUNTRY NEEDS A NATIONAL
BROADBAND REAL TIME ELECTRONIC
SYSTEM SYNDROMIC SYSTEM
EVALUATED DAILY BY QUALIFIED
SCIENTISTS AND NEW STRATEGIES
SUCH AS WASTE WATER SHOULD BE
EXPANDED TO INCLUDE THE WHOLE
COUNTRY NOT JUST A FEW PLACES.
THE AMERICAN COLLEGE OF
PHYSICIANS CALLED FOR A NATIONAL
DATA HEALTH INFRASTRUCTURE THAT
PERMITS REAL-TIME BI-DIRECTIONAL
DATA SHARING AMONG HEALTH
DEPARTMENTS, PHYSICIANS AND
LABORATORIES.
IT WILL BE TRICKY BECAUSE PEOPLE
WILL WORRY ABOUT THE SECURITY OF
THEIR DATA BUT WE HAVE TO MEET
THAT PROBLEM AND SOLVE IT.
CDC'S LABORATORY RESPONSE
NETWORK COMPRISED OF NATIONAL
REFERENCE AND SENTINEL
LABORATORY OFFERS A REASONABLE
TESTING INFRASTRUCTURE TO
ADDRESS PANDEMIC THREATS.
THERE'S ACCESS TO TESTS WITH A
STOCKPILE OF SUPPLIES AND
REAGENTS TO IDENTIFY THREATS.
THE NATIONAL LAB WAS RESPONSIBLE
FOR A MAJOR MISSTEP.
WE NEED TO KEEP THAT IN
CONSIDERATION.
THEY ADVOCATED FOR A TEST THEY
DEVELOPED THAT WAS FLAWED
DESPITE THE AVAILABILITY OF AN
EFFECTIVE W.H.O. DEVELOPED TEST.
THE NATIONAL LABORATORY AND
LABORATORY RESPONSE NETWORK HAD
AN URGENT MANDATE CREATE A TEST
AND REDISTRIBUTE TO ALL AGENTS
AND LABORATORIES IN THE COUNTRY.
RAPIDLY AVAILABLE ACCURATE TEST
CRUCIAL TO A RESPONSE.
IF THIS IS IMPRACTICAL FOR THE
LABORATORIES WE HAVE I WOULD
ADVOCATE FOR BUILDING A WARP
SPEED LIKE PARTNERSHIP WITH THE
LARGE LABORATORY CONCERNS IN THE
COUNTRY TO USE THEIR RESOURCES
AND THEIR EQUIPMENT AND REAGENTS
AS A PARTNERSHIP VERY MUCH LIKE
WARP SPEED AND IF THAT'S
POSSIBLE I THINK WE SHOULD
ESTABLISH THOSE RELATIONSHIPS
NOW AND GET THEM ON THE BOOK TO
GET READY FOR THE NEXT PANDEMIC
AGAIN ACCORDING TO DR. WAL EN
SKI LABORATORIES LACKED
EQUIPMENT AND SKILLED PERSONNEL
AND STRATEGIES MUST FLOW FROM
SCIENTIFIC UNDERSTANDING.
YOU PROTECT THE HEALTH OF ALL
LIVING IN THE UNITED STATES
WHILE MINIMIZING DISRUPTION TO
NORMAL SOCIETY FUNCTIONING.
THERE HAS TO BE A BALANCE.
I ALWAYS ADVOCATE WE BEGINNING
-- BEGIN WITH CONSERVATIVE
ADVICE AND THEN IT'S NECESSARY
YOU'RE IN A BETTER PLACE.
DISCOURSE MUST BE BIDIRECTIONAL
AND FILLED WITH PATIENTS AND MUE
-- HUMILITY AND SHOULD
FORTUNATE WE SHOULD PROVIDE DATA
FOR COVID AND WE HAD AGGRESSIVE
TESTING WE WERE LIKELY TO LEARN
QUICKLY THE VIRUS COULD BE
SPREAD PRE OR ASYMPTOMATICALLY
AND COULD HAVE PROVIDED ROUTES
OF TRANS MISSION.
DETAILS OF THE HOST PATHOGEN
INTERACTION AND RELATIONSHIPS
SHOULD PROVIDE AVENUES FOR
THERAPEUTIC AND PREVENTIVE
INTERVENTIONS.
WHAT HAVE WE LEARNED?
AGAIN, THE GOSPEL ACCORDING TO
HENDERSON.
BEWARE OF PRESYMPTOMATIC SPREAD.
ALWAYS BE AWARE IT COULD BE OUT
THERE.
IN THIS PANDEMIC WE GOT BEHIND
THE CURVE IN PART BECAUSE OF
THAT.
SECONDLY, GENOMIC SACRIFICE IS
IMPERATIVE TO TRACK RNA VIRUSES
THAT MUTATE OFTEN.
WE HAVE TO KNOW WHAT'S
CIRCULATING IN THE COUNTRY AND
THEN WE NEED TO WORK WITH BIG
PHARMA TO DEVELOP MONOCLONAL
ANTIBODIES THAT ADDRESS NOT JUST
THE ORIGINAL STRAIN BUT NEW
STRAINS AS THEY'RE SPUN OFF.
THE SPIKE PROTEINS WERE
ASTOUNDING AND EXHIBITED
REMARKABLE OVER ALL EFFICACY
WITH SOME ASPECTS AS I MENTIONED
EARLIER WANING AS IMMUNOEVASIVE
VARIANTS SPUN OFF.
AND FINALLY A HUMAN CHALLENGE
STUDY I THINK I PROBABLY WOULD
NOT HAVE VOLUNTEERED FOR
DEMONSTRATING ONLY A MINORITY OF
PEOPLE RECEIVING A STANDARD
INNOCULUM SPREADING THE SUPER
SPREADER THIGH BOTH SIS AFTER
THE -- HYPOTHESIS AND THOSE WHO
NEVER SAW COVID HAD HAD NEVER
BEEN INFECTED, THE TIMING EXTENT
AND ROUTES OF VIRAL EMISSIONS
WERE ENTIRELY HETEROGENOUS.
DESPITE ALL RECEIVING IDENTICAL
INNOCULA THEY PROVIDED SUPPORT
FOR SUPER SPREADING.
INTERESTINGLY, TWO INDIVIDUALS
OF THE 36 INFECTED EMITTED 86 OF
THE AIRBORNE VIRUS THE
INVESTIGATORS DETECTED AND
CURIOUSLY THOSE WHO REPORTED THE
HIGHEST TOTAL SYMPTOM SCORES
WERE NOT WHO EMIT THE MOST
VIRUS.
INVESTIGATORS FOUND FEW VIRAL
REMISSIONS OCCURRED BEFORE THE
FIRST REPORTED SYMPTOMS THOUGH
THEY WERE CHECKING FOR SYMPTOMS
DAILY AND THAT MAY NOT BE
ENTIRELY RELIABLE BECAUSE WE
DON'T DO THAT AT HOME.
IF YOU WAKE UP WITH A SLIGHTLY
RUNNY NOSE YOU MAY NOT
ACKNOWLEDGE THAT BUT THEY WERE
ASKING ABOUT THAT IT.
70% HAD VIRAL EMISSIONS BEFORE
SYMPTOMS AND THERE WERE HOME
TESTS IN THE STUDY ONLY 2%
PROVIDED A MAJOR ARGUMENT FOR
HOME TESTING.
A BIT ABOUT PREPAREDNESS.
MOST ANTICIPATED NOVEL H1N1 AND
RESURRECTED IT FOR SARS, IF YOU
HAVEN'T DUSTED IT OFF NOW, DUST
IT OFF NOW AND IMPROVE THEM
BASED ON COVID.
ONCE HAVE YOU A PLAN, TEST IT.
AND DON'T JUST TALK ABOUT IT.
YOU HAVE TO PRACTICE AND DRILL.
AND WHEN WE WERE GOING TO
PROVIDE CARE FOR ONLY PATIENTS
FOR WEST AFRICA.
WE HAD FOR A LONG TIME
INTERACTING WITH SCIENTIST AS
THE FORT DETRICK AND THE PLAN
WAS IF ONE OF THEIR EMPLOYEES
HAD AN OCCUPATIONAL EXPOSURE
THEY WOULD BE BROUGHT TO THE
CLINICAL CENTER AND WE'D PROVIDE
CARE AND WE USED TO DO THAT
REGULARLY.
THE DRILLS WENT SOMETHING LIKE
THIS MOST OFTEN.
THEY'LL CALL AND SAY WE HAVE A
PATIENT WITH PLAGUE OR ANTHRAX
EXPOSURE AND WE'D MEET THEM AT
THE DOOR AND GET THEM TO SDSU
AND SAY IF A PERSON HAD AN
EXPOSURE I'D DO THIS OR IF THEY
HAD THE PLAGUE WE'D DO THIS.
WHAT WE DISCOVERED WITH PATIENTS
WITH EBOLA THAT STRATEGY MIGHT
NOT WORK.
WE WERE FORTUNATE WHEN OUR FIRST
EBOLA PATIENT HAD AN
OCCUPATIONAL EXPOSURE BUT NEVER
BECAME INFECTED.
DURING THE COURSE OF PROVIDING
CARE WE FOUND THINGS WE THOUGHT
WOULD WORK AND KEEP PEOPLE SAFE
DIDN'T WORK.
SO WE HAD TO CHANGE THAT ON THE
FLY.
YOU HAVE TO DRILL IN PERSON
HANDS ON TO LEARN WHETHER THE
THINGS YOU'RE ARGUING FOR AREN'T
GOING TO BE EFFECTIVE.
BY THE TIME WE GOT AN EBOLA
PATIENT BECAUSE WE MET EVERY
AFTERNOON AT 3:00 FOR A MONTH OR
TWO DESCRIBING WHAT WENT RIGHT
AND WRONG BY THE TIME WE GOT A
SICK PATIENT THE STAFF WITH YOU
UNBELIEVABLE IN PROVIDING
SPECTACULAR AND SAFE CARE.
WHEN YOU THINK SOMETHING IS
BREWING LOCALLY, CALL YOUR
COLLEAGUES, FIND OUT WHAT
THEY'RE SEEING.
ALSO FOLLOW THE CDC WEBSITE
CLOSELY AND FOCUS ON THE
EMERGING EPIDEMIOLOGY OF ANY NEW
PATHOGEN IDENTIFIED.
ONCE YOU HAVE SUCH A PATHOGEN,
WORK WITH YOUR HOSPITAL
EPIDEMIOLOGY AND CLINICAL CARE
PROVIDERS TO DEVELOP PREVENTION
STRATEGY.
THE GOSPEL ACCORDING TO HER --
HENDERSON CONSERVATIVE
STRATEGIES BEFORE PROCEEDING AND
INSTITUTIONAL LEADERSHIP DAILY
AND TAKE STOCK OF THE
INSTITUTION'S STATUS.
DR. GILLMAN AND HIS TEAM DID A
FANTASTIC JOB DURING THE COVID
PANDEMIC.
WE MET FREQUENTLY AT THE START
AND BY THE END OF THE MEETINGS
YOU KNEW WHAT WAS GOING ON IN
THE BUILD.
YOU HAVE TO COMMUNICATE WITH THE
STAFF THEY'RE THE CORE OF ANY
SUCCESS YOU'LL HAVE AND I
LEARNED THIS FROM MY EXPERIENCE
YOU MAY HAVE HEARD ME SAY
EARLIER DURING THE EARLY DAYS OF
THE AIDS PANDEMIC THERE WAS
MISINFORMATION ALL OVER THE
PAPER ABOUT WHAT THE RISKS WERE
AND HOW MUCH RISK THERE WAS AND
SO TO DEAL WITH IT I USED IT
START EVERY DAY ON 13 WEST IN
THE CANCER UNIT GO THROUGH THE
NURSING STATION, TALK TO PEOPLE
AND ANSWER THEIR QUESTIONS AND
TELL THEM WHAT WAS ON THE FRONT
OF PAGE OF THE WASHINGTON POST
WASN'T CORRECT OR WHAT IT REALLY
MEANT AND THEN GO ON DOWN TO 13
EAST AND DOWN THROUGHOUT THE
WHOLE HOSPITAL ANSWERING
PEOPLE'S QUESTIONS AND TRYING TO
KEEP US ALL ON THE SAME PAGE.
IT WAS A TRYING TIME BECAUSE FOR
THAT PATHOGEN WE DIDN'T KNOW THE
VIRUS OR ITS SEQUENCE AND WE
WENT TWO OR THREE YEARS BEFORE
WE KNEW THE DISEASE AND THERE
WAS ANGST IN THE STAFF ABOUT
HAVING PATIENTS IN THE
HOSPITALS.
YOU NEED CONTINGENCY PLANS IF A
PANDEMIC IS DECLARED AND IT WILL
BE A CRITICAL SUCCESS FACTOR AS
IT WAS DURING THE PANDEMIC.
NOT ONLY DO YOU HAVE TO FIGURE
OUT HOW TO BEST TAKE CARE OF
YOUR STAFF BUT HOW TO BEST
SUPPORT THE STAFF.
AND I THINK A GREAT EXAMPLE OF
SUPPORTING THE STAFF WAS
DR. GILLMAN'S DEVELOPMENT OF
ASYMPTOMATIC TESTING AS AN
EXAMPLE.
WE HAD TWO TESTING.
THE CORE LINE FOR PEOPLE WITH
SYMPTOMS AND ASYMPTOMATIC
TESTING FOR STAFF AND MOSTLY FOR
REASSURANCE AND IT WORKED
REMARKABLY.
WE HAD AN UNBELIEVABLE NUMBER OF
PEOPLE ROTATE AND THE PROGRAM
WENT ASTOUNDINGLY WELL.
AT THE START YOU COULD WALK IN.
BY THE END YOU NEEDED
APPOINTMENTS TO GET THE TESTS
DONE BUT TOLD THE STAFF WE WERE
SUPPORTING THEM.
IF VACCINES ARE DEVELOPED FOR
THE NEW DISEASE, IF YOU CAN
PROVIDE IT, PROVIDE IT IF YOU
CAN'T FIND A WAY TO FACILITATE
ACCESS FOR STAFF AND PROVIDE
ACCURATE INFORMATION AND
PERSISTENT LEADERSHIP PRESENCE
ANSWERING QUESTIONS AND
DISPELLING RUMORS AND CORRECTING
DISINFORMATION WILL BE KEY.
ON THE OTHER HAND AT THE
CLINICAL CENTER TO THE EXTENT
POSSIBLE DON'T LOSE TRACK OF THE
MISSION.
THERE WILL BE SCIENTISTS IN ANY
PANDEMIC THAT'S GOING TO WANT TO
STUDY THE PATIENTS.
THEY'LL WANT TO LEARN MORE ABOUT
THE DISEASE AND DETECT IT OR
TREAT IT AND AN EQUAL NUMBER OF
SCIENTISTS WHO WILL NOT LET THE
PATIENTS NEAR THE BUILDING.
I GOT READY TO GET SARS PATIENTS
IN 2000.
THE SARS AND MADE IT AS FAR AS
TORONTO.
WE HAD INVESTIGATORS IN HEART,
LUNG AND BLOOD INSTITUTE WRITE
PROTOCOLS TO BRING PATIENT TO
STUDY THEM.
WE HAD INVESTIGATORS AT THE SAME
TIME IN INSTITUTES THAT SERVE
SERIOUSLY IMMUNOCOMPROMISED
PATIENTS AND TRANSPLANT PATIENTS
WHO ARE NOT THAT KEEN OF HAVING
THESE PATIENTS IN THE HOSPITAL
SO YOU HAVE TO WORK WITH ALL OF
THEM AND ASSURE THEM WE CAN DO
IT AND DO IT SAFELY.
THE FIRST THING YOU NEED TO DO
IS ENSURE THE INFRASTRUCTURE
SUPPORTS THESE STUDIES AND THIS
IS WHAT THE CLINICAL CENTER GETS
PAID FOR AND WHAT THE COUNTRY
REALIZE ON US FOR AND HAVE TO
FIGURE OUT A WAY TO GET THE WORK
DONE.
YOU HAVE TO PLAN WITH THE
WORKING STAFF AND PRINCIPLE
INVESTIGATORS AND ANYONE ELSE
INVOLVED IN THE STUDIES.
FOR SARS IT WAS AN EFFECTIVE
TOOL FOR IDENTIFYING CRITICAL
RISK POINTS.
YOU NEED TO ENSURE THE
OCCUPATIONAL MEDICINE IS ENGAGED
IN MEDICINES.
IT'S THE MOST CRITICAL PARTNER.
SUPPLIES MAY BECOME A CRITICAL
ISSUE.
YOU HAVE TO ENSURE THE SUPPLY
CHAIN FOR PERSONAL PROTECTIVE
EQUIPMENT.
IF THE SUPPLY SHORT FALL OCCURS
YOU SOMETIMES NEED TO BE
CREATIVE.
MY FAVORITE EXAMPLE OF
CREATIVITY IN A PANDEMIC CRISIS
WAS EM PLIFIDE BY A COLLEAGUE,
DR. HASLER THEN THE HOSPITAL
EPIDEMIOLOGY AND NOW THE CHIEF
OF MEDICINE AT THE UNIVERSITY OF
MASSACHUSETTS BAY STATE IN
SPRINGFIELD, MASS.
HER HOSPITAL QUICKLY RAN OUT OF
GOWNS.
WHEN SHE COULDN'T FIND A
SUPPLIER TO SEND GOWNS SHE
CALLED THE BOSTON RED SOX AND
PURCHASED HUNDREDS OF THE
DISPOSAL PONCHOS IN THE BALLPARK
AS A STAND-IN FOR GOWNS.
SHE THEN WENT TO LOCAL PRISON
AUTHORITIES ANDS CONVINCED THEM
TO GET THE INMATES TO SEW GOWNS
TO HAVE A CONTINUOUS SUPPLY OF
GOWNS.
SIMILARLY PEOPLE AROUND THE
COUNTRY LEARNED HOW TO REUSE,
SAVE AND PRESERVE THE LIFE OF
N95 MASKS EXTEND THEIR USEFUL
USE.
SO YOU SPLAY TO MAKE CONTINGENT
PLANS TO PROVIDE CARE FOR
PANDEMIC PATIENTS, A UNIT MAY
NEED TO BE DEDICATED.
DR. GILLMAN DID THAT HERE ON THE
SIDE OF BE AN ICU AND DEPENDING
ON THE SCENARIO YOU MAY HAVE TO
PAUSE ELECTIVE SURGERY AS MOST
HOSPITALS DID THROUGHOUT THE
PANDEMIC.
LABORATORY SUPPLIES ARE LIKELY
TO BE EQUALLY SCARED.
IN THE COVID INSTANCE, OUR
DEPARTMENT OF LABORATORY
MEDICINE DEVELOPED COVID TESTS
ON SEVERAL PLATFORMS.
IF WE DIDN'T HAVE REAGENTS FOR
ONE PLATFORM THEY USED THE OTHER
PLATFORM TO RUN THE TESTS AND
GOT ALL THOSE TESTS VALIDATED
FOR CLINICAL USE AND DEVELOPED
STRATEGIES SUCH AS BATCH TESTING
FOR PREVALENT SAMPLE THAT WERE
AN ASSET.
THEY VALIDATED TESTS USING
DIFFERENT SWABBING TECHNIQUES OR
NASO PHARYNGEAL SWABS THAT
ENSURES ROBUSTNESS OF TESTING.
HOW DO WE FIND A NEW NORMAL.
PEOPLE WHO WORK IN OFFICES CAN
WORK AS EFFECTIVELY AT HOME AND
THERE'S PEOPLE WHO PROBABLY
DON'T NEED TO BE HERE THOUGH IT
FLIES AGAINST MY OWN THOUGHT.
I'M NOT TALKING ABOUT CRITICAL
CARE DOCS BUT WE HAVE PEOPLE WHO
WORK FOR THE HOSPITAL WHO CAN DO
AN EFFECTIVE JOB OF WORKING FROM
HOME AND WE SHOULD TAKE V
ADVANTAGE.
IT'S GOOD FOR THE EMPLOYEE AND
HOSPITAL.
WE'LL BE USING SOURCE CONTROL
MASKING MORE FREQUENTLY.
OF ALL THE SURPRISES FOR ME IN
THE PANDEMIC THE EFFICACY OF
SOURCE CONTROL MASKING ACTUALLY
STUNNED ME.
AT THE BOTTOM OF THE SLIDE I
LEFT A REFERENCE TO PAPER
PUBLISHED BY MICHELLE WOBURT
LOOKING AT HOW MANY SOMETIMES
RESPIRATORY VIRUSES WERE SPREAD
IN THE FIRST YEAR OF THE
PANDEMIC COMPARED TO LOTS OF
SPREAD IN YEARS PRIOR.
SO SOURCE CONTROL MASKING WORKS
AND THAT'S WHY WE'RE STILL DOING
IT AT THE BEDSIDE AND AT THE
CLINICAL CENTER.
I THINK HAND HIGH GEEJ IS NOT
JUST FOR HOSPITALS.
HOPEFULLY IN THEATERS, GROCERY
STORES, OTHER PLACES AROUND THE
COUNTRY BECAUSE HAND HYGIENE HAS
EVERYONE WORKING IN EPIDEMIOLOGY
KNOWS IS THE SINGLE BEST WAY TO
PREVENT TRANSMISSION OF
INFECT
INFECTION.
THE RISK ASSESSMENT NEEDS BECOME
PART OF OUR NEW NORMAL.
WE NEED TO FOCUS ON VULNERABLE
POPULATIONS MINDFUL OF HEALTH
DISPARITIES.
FROM THE GET GO WE HAVE TO
EMPHASIZE PREVENTION AND
BOOKMARK THE CDC WEBSITES AND
NOT JUST BOOKMARK IT BUT GO
VISIT IT FREQUENTLY.
BASED ON THE ACTIVITY AND THE
COMMUNITY SHOULD MAINTAIN A LOW
THRESHOLD FOR INTERVENTIONS
SOCIAL AND MEDICAL.
IF WE'RE HAVING A BIG SURGE OF
RSV IN A LOCAL COMMUNITY WE
MIGHT WANT TO CONSIDER GOING
BACK TO MORE AGGRESSIVE MASKING
IN BUILDING 10.
JUST AN IDEA WORTH CONSIDERATION
AND I THINK WE FINALLY HAVE TO
FOCUS ON CONGREGATE SETTING FOR
THOSE WHO BORE THE BURDEN OF THE
PANDEMIC WITH THOUSANDS OF
PEOPLE DYING IN FACILITY AND HAS
TO BE PART OF A NEW NORMAL IS A
FOCUS ON CONGREGATE SETTINGS.
WE HAVE TO REVITALIZE PUBLIC
HEALTH AND MODERNIZE AND
INTEGRATE DATA SYSTEMS AND
IMPROVE CAPABILITIES AND ONES
THERE'S A QUESTION, TEST EARLY
AND OFTEN.
WE NEED TO EXPAND OUR
SURVEILLANCE ACTIVITIES.
LOOKING AT TESTING TRENDS IN THE
COUNTRY AND IF THERE'S A
PATHOGEN CIRCULATING LOOKING AT
GENOMIC SURVEILLANCE.
WE HAVE TO INTEGRATE RESPONSES
FROM EPIDEMIOLOGIC AND CLINIC
SOURCES IN REAL TIME.
YOGI BERRA MAY HAVE SAID IT
BEST, YOU CAN OBSERVE A LOT BY
JUST WATCHING AND HE ALSO SAID,
YOU HAVE TO BE CAREFUL IF YOU
DON'T KNOW WHERE YOU'RE GOING
BECAUSE YOU MIGHT NOT GET THERE.
ALSO WISE WORDS FOR THE
PANDEMIC.
THERE ARE A SET OF PROBLEMS FOR
WHICH I HAVE NO PROPOSED
SOLUTION.
THE MAJOR TREND TOWARDS SCIENCE
DENYINGISM -- DENIALISM IS
CONCERNING TO ME AND THE BAYLOR
COLLEGE OF MEDICINE AND THE
CO-DISTRICT OF THE CHILDREN'S
CENTER WROTE A BOOK A DEAD LIE
RISE IN ANTISCIENCE IT'S A
CHILLING READ AND ADVOCATE TO
ALL OF YOU IT SHOULD BE REQUIRED
READING FOR ALL OF US IN
SCIENCE.
HE BELIEVES IF WE ALL RAISE OUR
VOICES THAT IT CAN MAKE THIS
SCIENCE DENIALISM GO AWAY.
I DON'T HAVE A LOT OF CONFIDENCE
IN THAT MYSELF.
HAND IN HAND IS THE UNBELIEVABLE
ANTI-VACCINE PREVALENT IN THE
COUNTRY.
NOT JUST COVID VACCINES BUT NOW
MEASLES VACCINE AND MY COLLEAGUE
LET ME KNOW ABOUT THREE WEEKS
AGO THAT FOR THE FIRST TIME IN
HER INFECTIOUS DISEASES CAREER
MADE A DIAGNOSIS OF MEASLES AND
AS AN EPIDEMIOLOGIST HAS TO WORK
OUT PLAN FOR A MEASLES OUTBREAK.
AND THE THIRD IS THE PROBLEM OF
PRESENTEEISM.
PEOPLE COME TO WORK WHEN THEY
SHOULDN'T WE HAVE THE LOVELY
ASYMPTOMATIC TESTING SERVICE AND
USUALLY 1% TO 3% AND WE FOUND
PEOPLE WHO WERE ASYMPTOMATIC AND
ASKED THEM IF THEY HAD SYMPTOMS.
ABOUT HALF HAD SYMPTOMS BUT
THEY'RE ALREADY AT WORK WITH
SYMPTOMS IN THE MIDST OF A
PANDEMIC.
THEIR REASONS FOR COMING ARE
MYRIAD AND SOME IMPORTANT.
I DON'T WANT TO LET DOWN MY
STAFF.
I HAVE TO TAKE CARE OF MY
PATIENTS BUT IN A PANDEMIC YOU
CAN'T HAVE IT.
THE DISSEMINATION OF
MISINFORMATION IS BEYOND ME AND
THE BIGGEST PROBLEM IS A SET OF
POLITICAL LENSES THROUGH WHICH
OUR POLARIZED COUNTRY VIEWS
VIRTUALLY ANY ISSUE.
I THOUGHT I'D CLOSE WITH
SCIENTIFIC FOOD FOR THOUGHT.
THESE ARE SOME QUOTES THAT HAVE
SOME OF MY FAVORITES RELEVANT TO
THIS TOPIC AND PRESENTATION
EINSTEIN SAID ALL OF OUR SCIENCE
AGAINST REALITY IS PRIMITIVE AND
CHILD LIKE AND YET THE MOST
PRECIOUS THINGS WE HAVE.
AND BROSLIN FRANKLIN SAID
SCIENCE IN EVERYDAY LIFE CANNOT
AND SHOULD NOT BE SEPARATED.
NEIL DE GRASS TYSON SAID THE
THING ABOUT SCIENCE IS IT'S TRUE
WHETHER YOU BELIEVE IN IT.
THE GREAT SCIENCE FICTION WRITER
WROTE THE SADDEST ASPECT OF LIFE
RIGHT NOW IS SCIENCE GATHERS
KNOWLEDGE FASTER THAN SOCIETY
GATHERS WISDOM.
AND I HOPE DURING THIS
CONVERSATION WE'VE BEEN HAVING
WHERE I EXPRESSED A LOT OF
OPINION I HOPE I'VE NOT BEGAT
IGNORANCE.
SCIENCE KNOWS NO COUNTRY BECAUSE
SCIENCE BELONGS TO HUMANITY AND
IS THE TORCH WHEN ILLUMINATE THE
WORLD AND MY FAVORITE AUTHOR
SAID SCIENCE IS MAGIC THAT WORKS
AND EINSTEIN SAID TWO THINGS ARE
INFINITE, THE UNIVERSE AND HUMAN
STUPIDITY AND ISAAC NEWTON SAID
IF I'VE SEEN FURTHER IT'S FROM
STANDING ON THE SHOULDERS OF
GIANTS.
I'VE STOOD ON THE SHOULDERS OF
GIANTS FOR THE LAST 44 YEARS.
THIS IS A PARTIAL LIST OF THOSE
WHO GAVE MY CAREER MEANING AND
MY MENTOR AND JACK BENNET WHO
RECRUITED ME HERE AND PROBABLY
REGRETS IT NOW AND TARA PALMORE
AND THIS IS THE LIPSETT
AUDITORIUM AND HE WAS THE
DIRECTOR OF THE CLINICAL CENTER
WHEN I CAME HERE.
LASTLY, THIS IS A LIST OF
EVERYONE WHO HAS PARTICIPATED IN
THE HOSPITAL EPIDEMIOLOGY
PROGRAM AT THE CLINICAL CENTER
SINCE ITS BEGINNING.
IT'S NOT A VERY LONG LIFT.
STARTING WITH JACK BENNET
TELLING ME HE WAS DOING HOSPITAL
EPIDEMIOLOGY WITH 5% OF HIS TIME
AND MY FIRST DEPUTY HOSPITAL
EPIDEMIOLOGIST AND OUR NEW
EPIDEMIOLOGIST IS OFF TO A
TERRIFIC START AND WARE PROUD OF
HER.
THERE'S THREE PEOPLE WITH
ASTERISKS WHO AREN'T PART OF OUR
PROGRAM BUT I RELIED ON FOR
YEARS.
THE PEOPLE'S WHOSE NAMES ARE IN
YELLOW ARE STILL WANDERING THE
HALLS AND STILL WORRIED ABOUT
THE SAFETY OF YOU AND OUR STAFF
DURING AN ONGOING COVID-19
PANDEMIC.
I'D LIKE TO THANK THEM ALL FOR
THEIR HARD WORK DURING THIS TIME
AND HOPE IF YOU SEE ANY OF THEM
IN THE CORRIDOR IN THE NEXT WEEK
OR TWO, THANK THEM AS WELL FOR
THE EXTRA HOURS AND EFFORT THEY
PUT IN AND THEIR INCREDIBLY
UPBEAT ATTITUDE AS WE DEAL WITH
THE PANDEMIC FROM THE GRET GO
THESE ARE THE PEOPLE WHO DID THE
WORK.
THANK YOU FOR YOUR TIME AND
ATTENTION.