Anne Schuchat, MD, Principal Deputy Director of the Centers for Disease Control and Prevention (CDC), discusses evolution of CDC guidance and latest developments in the COVID-19 pandemic. Recorded on Friday May 1, 2020.
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Topics discussed in this interview:
0:00 Introduction
0:20 Background on Dr Schuchat
0:53 How is the coronavirus different from the flu?
2:18 What do you anticipate in the fall? What preparations are the CDC making this summer?
5:03 What will happen to schools and colleges in the fall. Will the CDC make recommendations?
7:52 Flu vaccine for the fall – how effective are you predicting it to be?
9:38 What levels for flu vaccination do we reach in a good year?
10:25 What is the target level for influenza vaccination?
11:02 COVID-19 PCR testing
14:21 How accurate is PCR testing?
15:58 Do you have to test negative to go back to work?
19:06 Serology testing
22:13 How long does immunity last
23:57 Droplets and aerosolization. What are the patterns of transmission that the CDC is seeing?
26:08 How should we be testing new COVID-19 vaccines?
29:21 Do we have the capacity to test, track, trace, and quarantine.
34:42 What do we know from MERS and SARS that could help with a vaccine?
36:22 How long do people shed virus? When can people be released from isolation?
38:07 Consulting with Kate Winslet on the 2011 movie Contagion
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>> Howard Bauchner: Hello and welcome to Conversations
with Dr. Bauchner. It’s Howard Bauchner, Editor and Chief of JAMA. And I’m here with a prize
guest today, Anne Schuchat. Anne thanks for joining me today. >> Anne Schuchat: It’s my pleasure. Thanks. >> Howard Bauchner: So Anne is Principal Deputy
Director of the CDC. She joined the CDC as an EIS Officer in 1988. And she’s played key
roles in the 2009 H1N1 pandemic. And 2003 SARS outbreak in Beijing. And she’s also been
acting director of the CDC twice if I’m not mistaken Anne. >> Anne Schuchat: That’s right. >> Howard Bauchner: So Anne, let’s start with
some big pictures and then we’ll go to the future, then we’ll go to the back. I have
so many questions for you. >> Anne Schuchat: Sure. >> Howard Bauchner: How is this the same,
and how is this pandemic different from flu? >> Anne Schuchat: The virus is very transmissible.
And it can be severe. And like flu, it seems to be the most severe in the elderly. Unlike
flu, we’re not seeing a lot of disease in young children. And we don’t know yet whether
children are really important reservoir for transmission. And of course, unlike flu this
is new. We haven’t – we haven’t known this virus for decades or generations or you know
millennia the way we have influenza. And so most of the world’s population has never been
exposed to this virus until December or so. And most of us are susceptible to it. And
so it’s capable and is causing a pandemic right now. Of another issue is we don’t have
a vaccine yet. And you know with influenza we’re vaccinating more than half of all of
Americans every year, and so right now the most important tools we have are social distancing,
the mitigation. Of course as we go into the warmer months maybe transmission will slow
a bit, and we’ll be able to get back to the containment and cluster recognition and really
intensive isolation and quarantine measures, versus the larger scale community mitigation
that we’re doing right now. >> Howard Bauchner: So let’s fast forward
to the fall, and the reason I’m focused on the fall and in some regards, this live stream
is part of our Covid 19 the sequel series. You know I’m not sure many schools will open
up. Businesses, states are beginning to open up. I think, you know somewhere around July
most states will be open. There still may be other substantial limits. We move into
summer vacation, schools are naturally closed. Now we get to the fall. And it’s colleges
and its schools. And I looked at the number, between the two it’s somewhere around 60 million
young people between schools and colleges. A lot of debate about this. I know you don’t
have a crystal ball Anne, but everyone wants to know from you what do you anticipate in
September, October and November? >> Anne Schuchat: I wish that I knew. But
I do think that what we do this summer is going to be critical. The more we intensify
the testing and expand the public health capacity and assure that our hospital capacity and
material to support the hospitals is adequate or has excess, the better we’re going to be
in the fall. The other thing is the other things we can deal with. So making sure that
when influenza vaccines are available, everybody gets them, will help us weather whatever happens
in the fall. So I don’t know whether we’ll have a resurgence as soon as you know, the
– that crisp temperature is in the air. A lot of the seasonality of respiratory viruses
may relate to the way we work, the way we interact. And – and in the fall people go
back to school. Whether it’s school or colleges and we don’t know how much that is driving
that upsurge that we see. In 2009 with the H1N1 pandemic we had a spring wave. In the
summer it didn’t go away completely. We had outbreaks in summer camps. We had low level
disease in a lot of the parts of the country. But as soon as schools opened again it took
off. A little bit different in different parts of the country and it took off earlier in
the parts of the country where schools opened earlier. So if schools don’t reopen or schools
are at partial attendance, and there’s more online and you know not the recesses and assemblies
that bring a lot of kids in close quarters, maybe it won’t take off right at the same
time as the influenza pandemic did. But I don’t think we know. We really don’t know
how this virus is going to behave. And I think what we need to do is take advantage of the
lower level transmission that we’re starting to see in parts of the country, to really
up our game in terms of the individual responses. >> Howard Bauchner: Anne I’m sure that schools
and colleges are going to look to the CDC for advice. I know it’s a – it’s a state issue.
But schools are going to want to know is it safe for us to open? Either for the students
or for the teachers who are often older and unlike flu, we – either kids don’t get infected
or they – if they do they have very mild disease. College is pretty much the same. Do you have
any sense of what’s going to happen with schools? You know, kindergarten, day care to 12th grade
or colleges? Do you anticipate knowing or making recommendations, or will the CDC stay
out of that? >> Anne Schuchat: Well we’ve been working
hard to take the evidence base that we have, and come up with guidance and sort of tool
kits that you know, you’re a school administrator, what are the factors that you want to consider?
What are you going to do to support people being able to stay home if they’re ill? What
are the conditions in the classroom or in the assemblies that you have control over?
Is there some distancing between the desks that you can do? How are your online programs
working? Is that going to be part of your package going forward? And as you mention,
the staff and faculty are really important because often they’re the ones who are more
vulnerable. And might have severe complications of the virus. So what’s the way that you’re
going to manage? Do you – do we learn a lot from the other parts of the world that are
opening up before us? Or some of the places that never even closed their schools. Wil
we understand that there is a safety level for having schools resume? But I think there’s
you know, obviously there’s a lot of fear and a lot of concern right now. So what CDC
is doing is organizing information around you know the environment, the physical distancing
advice and the ways that you can understand what’s going on in your institution, or your
community, so that you can get an early jump on dialing up mitigation should you need to.
I think the – for schools it may be a little easier than for the – the colleges and universities.
Where they’re debating do we bring people together? Or do we – where we might have to
send them home? Or do we start sort of slow with an online curriculum for a while? You
know very, very difficult. I think the – the mantra is there’s a lot of uncertainty, and
prediction is really you know we’re going to know when we see what happens. And we’re
trying to balance the safety and the health with the – the aspects that are really destructive
about the social distancing that we’ve had to go through. So we would like to see as
much flexibility but we really don’t want to get into that point where the healthcare
system is overwhelmed or the public health system can’t keep up with things. >> Howard Bauchner: Now very few people in
the United States know as much about flu, flu pandemic and flu vaccination and you are
– then you do. Currently the flu vaccine is being developed to be – to be given in the
fall, correct? It usually starts around this time. Can you say anything about the match?
Because the flu vaccine sometimes is really effective, sometimes a little less effective.
Do you have – you must have some already information about what you think it will be like for the
fall, which will be very important vis e vie this pandemic? >> Anne Schuchat: Yeah one thing to say is
that prediction with flu is tricky. And one of the unintended consequences of the Covid
pandemic has been there’s been a lot less influenza testing. The same agents that you
use to test for influenza are often needed for the – some of the PCR testing for Covid
19. And so we will look to late season strains with influenza to see is there anything that’s
emerging or that’s starting to you know, something that isn’t a match with what we had in the
vaccine that we’re worried about. And some of the times the things that we see emerging
fade out way before the fall, and some of the times they actually take off. But I have
no information about – about likely matches or concerns about drift. I think we’re sort
of planning for that idea that they’ll be a flu season and it may be a bad one or not
a bad one, but it’s going to be a more complicated one if it happens at the same time as Covid
19. And I know there’s a number of companies developing tests that can look for flu as
well as Sars Cov 2. CDC has got a mass in it, we’re developing and I think the ability
to diagnose both is going to be important. >> Howard Bauchner: What – what levels of
vaccination for flu do we reach in a good year? >> Anne Schuchat: It varies quite a bit by
age. So in – in seniors we get at 70% or more. And in children we’re getting pretty good
in the – in the kids under five we’re again about that 75% almost. In those under two
it’s very high. But in older kids and healthy young adults we’re not doing as well. So the
overall percent is about 50%. But I – it is higher after a bad flu year, you know? People
– we had that really bad ’17-’18 season and uptake was greater after that. I – we’re expecting
pretty good demand for influenza vaccine. And we hope the companies will make more than
usual. >> Howard Bauchner: Do you have a number in
mind that you’d like to see? >> Anne Schuchat: A percent cover – I mean
we are – our target is to get over 70% for everybody. >> Howard Bauchner: Okay. >> Anne Schuchat: But you need the supply
to do that. And – and so the supply has been going up each year as demand has increased.
And you know we hope that we’ll have of course, manufacturers are producing and the yield
is always going to be different. And they’ve had – been able to produce more and more each
year; so we’re optimistic. But what I would say is for clinicians, for your patients really
important for everybody six months and over to get a flu vaccine this year. >> Howard Bauchner: So now let’s back up.
Let’s go the other way. Testing comes, I think of it as in two forms, PCR for acute disease
and then serology and just over the last week or two we’ve been reading much more about
serology as we’ve moved out of some of the concern about acute disease around the country.
Although I – I would point out that Massachusetts, Michigan, Illinois numbers of new cases really
unchanged in those three states. New York thankfully has come down. I think New Jersey
continues to struggle. Different reports about testing. I said when we started on Tuesday
and we got interrupted, what’s great is that these are conversations in which I don’t give
you questions. And nothing is off limits. What’s your sense of how we’re doing with
PCR and testing? >> Anne Schuchat: The numbers getting tested
and the supplies to be able to test are increasing. But we’re not where we want to be in terms
of really using all of the testing capacity that we have. You know early in the year we
– everybody wanted to be tested and we had nowhere near the supply that we needed. We’re
really improving in terms of the different kinds of PCR or – or acute diagnostics that
are available. And the ability to test large numbers and get results quickly, you know
Lab Core and Quest have really come online with large scale high throughput testing.
The university labs, a lot of different companies and then the point of care tests as well.
So there’s a lot more capacity. CDC right now is working with each of the state health
departments to help them really optimize their lab capacity and their testing plan. So that
more and more people who are symptomatic can get tested. And public health can do more
of the cluster investigations and really get ahead of some of these amplifying events.
And that it’s easier for consumers you know, even with a home test for instance. That there’s
not as much dependence on PPE to collect the tests. That can really speed up access and
you know the ability for many more testing sites to pop up. So we do think that the PCR’s
that are out there are accurate and they’re useful and it’s really having enough tests
done, and a rapid result so that action can be taken And what we want is if you’re positive
you know stay home. Have your family members stay home. You know really isolate and quarantine
the contacts so that we don’t get into amplified and further spread. The – so the accessibility
is increasing and I do think by the fall it’s going to be really good. But what we need
to get is the distribution of the laboratory capacity with where the need is. And the – the
reimbursements and the systems to work. Part of the CARES Act, part of the most recent
Congressional Appropriations was a lot of money going to the states, so that they’ll
be able to develop a testing plan and implement it, you know? More than $10 billion really
going so that states could diagnose the disease and follow up on – follow up and control the
disease that way. >> Howard Bauchner: A lot of questions, but
I know one is definitely going to be the same. It comes up every time I do a live stream.
So two, they’re very related, how accurate is the PCR? >> Anne Schuchat: Yeah the PCR – well of course
they’re all – you know there are a lot of different tests out there. The PCR is – there
are – they are good, so a positive is a positive. Now there’s of course, you know with PCR’s
in a particular lab if there’s you know, things are all over the place and there’s not a good
quality management system you might get a false positive just because the specimens
aren’t being handled right. But if done according to the right swab, the right transport, the
lab according to plan the sensitivity should be very good. But that is for – you need to
step back and say well, this is not a – an individual who has Covid 19 will not be PCR
positive you know forever, and the timing of the test collection in terms of the presentation
of disease is important. Unlike some other viral infections, the viral load is higher
early on, you know? Perhaps the day or two before you develop symptoms, when you have
symptoms the first couple days. And later your viral load decreases. So the – the sensitivity
of the PCR late in infection won’t be as good as early in infection. The other thing is
that PCR test isn’t going to tell you that the thing I had last month was this. It’s
– it’s an acute diagnostic. >> Howard Bauchner: The other issue that comes
up which is comes up repeatedly is you know you’re ill. You get tested, you’re PCR positive.
And then you’re 10 days down the line and you either get – and you’re well. You’ve been
well for a week. You’ve been well for 10 days. And you can get tested or you can’t get tested,
and you’re not a healthcare worker. I want to take healthcare workers or people who work
in nursing homes off the table. I think they’re treated very, very differently. Can you go
back to work? And do you have to be PCR negative to go back to work? Can you please explain
to people? I read repeatedly about this, what the PCR test means at 7 or 10 days after you’re
well. >> Anne Schuchat: Yes so let me – let me first
say at CDC.gov we’ve just updated our guidance about you know, when can I get out of isolation?
The idea that I was PCR positive. I was diagnosed with this. I’m supposed to stay home. Can’t
go – can’t be around other people, like when do I get out of jail? When can I get – get
out and circulate again? And we’ve updated this to what we call 10 and 3. Ten days after
you’re symptom onset. If it’s at least three days since you’ve recovered or since you’re
no longer febrile you can get out of jail. You can go – you can go out of isolation and
circulate. It used to be seven plus three and what we’ve learned from a variety of studies,
really good study from Germany, other studies that individuals have done, is that well sometimes
you can find a PCR positive after 10 days. The culturable virus isn’t – isn’t clear after
that. It’s really up to nine days where we’ve seen this culturable virus. Now we had those
reports from China and Korea about recrudescence disease, PCR positive, you know months later.
And the person has a cough. Is it really a new infection? A persistent infection? Or
is it just a low level PCR that’s not culturable? So based on what we know right now. Based
on the larger numbers of the population and so forth, we don’t think that those tale – the
PCR a couple months out, or even a month out, we don’t think those people are likely to
be contagious. And so we’re really sticking with this 10 plus 3. We have a few exceptions
as every CDC guidance always does. You know the immunosuppressed person that might really
no be able to clear their infection. But in general we’re thinking that isolation can
be lifted at 10 days. >> Howard Bauchner: Right, and I just want
to emphasize that for people who work in healthcare facilities or nursing homes, they may have
– those – those facilities may have their own standards. >> Anne Schuchat: Absolutely and this is not
to preclude what the institution has said. You know the testing based release was at
least two negatives or two negative PCR’s at least four hours apart was predictive of
not being contagious anymore. We’ve – we’ve also got this recommendation that’s based
on not requiring the testing. Obviously there’s more testing availability now and many institutions
are – are requiring people to get tested. >> Howard Bauchner: Not surprising, I have
a lot of questions. But let’s – let’s – so we did the PCR. Now let’s go to serology. >> Anne Schuchat: Absolutely. >> Howard Bauchner: So can you talk a little
bit about serology Anne? >> Anne Schuchat: Yes serology is a big topic.
So the – there’s the use of serology for the population, which is really important and
interesting right now. We’re seeing reports out of New York, reports from Washington,
Santa Clara County. How many people got infected in this wave that they’ve been through? That
population level sero testing or sero epidemiology is helping us get an understanding of just
how much this wave has infected. And you know the idea is not that there’s a yes/no result
to this. But an understanding that not everybody who is infected, got diagnosed. Some people
who were infected, didn’t even have symptoms or had such mild symptoms that you know, they
really didn’t know if they were infected or not and they didn’t come to get reported.
And so in the New York State sample, which included New York City they found about 15%
higher in New York City. But in Santa Clara County it was just a couple percent. That’s
really telling us that even in New York City where they had such a bad epidemic, the majority
of people haven’t been infected yet. And that is information that to an epidemiologist or
a policy person suggests we are vulnerable to a lot more infections. Because the virus
is still out there and most people haven’t gotten infected yet. At the individual level,
we all want the antibody measurement to be meaningful. Each of us wants to know “Did
I already have this infection?” “Do I have to worry about it?” And there’s a couple problems
with that. One is that some of the antibody measurements at the individual level may not
be specific enough for you to be sure that that antibody is definitely a true positive.
You know when a condition is rare, my chance of having gotten this infection is really
low, the prevalence of infection for people like me is really low. Then a positive might
be more likely to be a false positive then a true positive. The other thing is the durability
of the antibody. Is my antibody, yes – is the yes that I got on the antibody testing
mean that I’m immune and I’m never going to get this infection? Well we don’t know yet,
because we don’t know if antibody that’s specific against this virus is long lasting. And if
it’s the key to protection. So we hope it is, we think it probably is but we don’t know
for sure and we don’t know for sure enough to say that for you who is a healthcare worker
you don’t’ need to wear an N95, if you’re in close contact with a person that is Covid
– has Covid 19. So it’s information and in months we might learn more about the durability
of the antibody and the sum of the antibody test may be more and more specific. But right
now those are the limitations we have. >> Howard Bauchner: Yeah, and I think there’s
enough data to know people are responding. They’re developing IgM and IgG titers. IgG
– IgM first then IgG. The question is how long does IgG last? And then if you have a
response if you have an IgG titer does that necessarily equate to having a neutralizing
antibody, and does it last long? And that knowledge I think we’ll learn a little more
over the coming months about that. >> Anne Schuchat: Yeah there’s – but there’s
also complexity to it. So I think there’s some information about perhaps milder disease,
may or may not lead to antibody IgG production. But maybe it leads to IgA production, or maybe
there’s mucosal protection that’s different. And so perhaps – is mild disease predictive
that whatever your immunity is, you’re probably not going to get a bad infection again. Or,
no you are vulnerable to a severe infection in the future. So we’re really – we’re in
the infancy with the immunology for this disease. But there’s a huge thirst to you know, understand
everything that we can. Because of course we want a vaccine, understanding the immunology
will help us understand whether these vaccines are going to work or not. As part of the story,
and of course you know the – the experience that the nation has been through already,
the more we understand you know, how much of the population really is still clearly
susceptible because there is no antibody. That will help us understand just – just how
much we need to you know, hunker down and plan for the long – a long battle with this
virus. >> Howard Bauchner: So many questions, so
let’s – I hope you have a few more minutes because there’s a lot of questions. Droplets,
aerosols, fomites. You know we’ve had a few articles on it. Other journals have had articles
on droplet aerolization and then does it live on your mail? Does it live on your grocery
bags? Can you say something about what we think is the dominant form of spread and what
people need to be concerned about? >> Anne Schuchat: Yeah, I think that the – the
patterns of transmission that we’ve seen are consistent with the vast majority of spread
being through respiratory droplets. Particularly because we know now from some very well documented
cluster investigations that pre-symptomatic and probably asymptomatic individuals can
spread. So you don’t really need to invoke airborne transmission to understand the great
transmissibility of this disease. The fomites may or may not be a big thing, but it certainly
matters you know, just as with influenza, to you know clean the surface – the commonly
touched surfaces and to you know, cleaning and disinfection is a part of getting our
environment protected for you know, even if that’s a minor component for most of the transmission
it makes sense to do cleaning and disinfection But doing it carefully not over doing it as
we’ve seen in the desire to really make sure we had clean an disinfected environments.
We saw all those calls to poison control that you know we needed to alert the public about. >> Howard Bauchner: Yeah I noted this morning
in the newspaper that the New York subways are going to be closed from 1:00 a.m. to 5:00
a.m. so that they can clean the subway cars. So I think that’s an acknowledgement that
we’d like to do more rather than less around that possibility. >> Anne Schuchat: Yeah and just thinking of
you know how crowded those subway cars can be and how many people are there you know,
that’s – the relative role of fomites isn’t so clear, but cleaning and disinfection is
a reasonable idea. >> Howard Bauchner: Again so many questions,
but let me stay focused. So Anne a huge debate has erupted about how to test new vaccines.
You’re probably more familiar with the traditional model phase I, phase II, phase III, people
thinking we can combine phase II, phase III. Potentially inoculate healthy volunteers with
the – with a vaccine and then expose them to organisms. What you’re sense of this? Tony
has been pretty clear. He thinks longer. Other people think we can do it shorter. Late fall,
early winter. What are your instincts Anne? You know more about this than virtually anyone
else in the country. >> Anne Schuchat: You know I think that the
research community and the public are at a new level of connectedness. That this is a
disease that has disrupted life for the whole planet. And vaccines, while not a panacea,
are – are really – will likely be in great demand depending you know, what we know about
them and when we get them. And we also have really moved the research community in the
past, I guess about the past five years in terms of fast tracking research. And adaptive
trial design. The pharmaceutical industry, the biotech industry has just exploded in
terms of new platforms and new approaches. And the ability to scale up some of them that
used to just take forever. You know you could get a good product, but it would take like
many, many years before the manufacturing capacity could be there for such a large population
as we – as likely we’ll need a vaccine. So I think that the timelines of the past are
gone. But I’m – I’m on the side of doctor fact, Tony is right, that we just cannot expect
this to be tomorrow. And you know, with everything going right, it’s going to take time. So I
do think that the – acceptance of participating in a vaccine trial on a large scale will be
much more like the polio vaccine trials in Dr. Salk’s day than like recent vaccine trials.
That we can probably get volunteers at a very large scale to be part of studying vaccines,
not waiting for phase III until enormous numbers of safety results are in, or immune response
results are in. But I think that you know the answer doesn’t come over night. And the
studies have to be carefully done. So I’m much more optimistic they’ll be a fast timeline.
But I think we need to see what the data are and there’s – there’s planning, aggressive
planning assuming some of the products will pan out, to be able to deliver a vaccine on
large scale. But I think we need to see how they perform. >> Howard Bauchner: Some people have argued
that the US is incapable of, I call it the three T’s, plus Q. Test, track, trace and
quarantine. That for testing is still not where it should be. Maybe we’ll get there.
Do we have a public health service that can actually track and trace? And then if we quarantine
people can we provide services when you quarantine people? You know people have highlighted how
Singapore and Taiwan, Korea those are countries that have one-tenth the population of the
US. And a very different political climate. Do you think we have the capacity to do test,
track, trace and quarantine, Anne? >> Anne Schuchat: We need to get that capacity.
So the public health system in the country is underfunded, under staffed, over stretched.
But has you know, worked really hard in this response to do what’s needed. And in this
period of mitigation they’re working really hard. The commercial platforms, and supplies
and distribution of the lab testing capacity has really been increasing. So I’m more optimistic
about that now than you know two weeks ago, and definitely more than two months ago. The
issue of contact tracing and I think that steps are in process now with the states and
jurisdictions and with partners and with private sector to really amplify what that public
health capacity is. So we’re right now in the midst of calls with every state, with
the state public health leaders, and really understanding what are their gaps? What’s
their lab testing plan going to be, and how can the government help with that, the federal
government? What’s the logistics? Re-gaging the equipment and supply needs in each state,
with what’s coming down the pike or is already available. A lot of the – it’s sort of improving
the distribution within a state, so that the testing needs can be met. And then what’s
that staffing gap that they have to be able to really up the game on contact tracing?
Especially as numbers come down and it’s more feasible; how do we really scale up to staff
the partnership? You know Census, Americore; you know universities, students and so forth?
How can we get call centers, whoever engaged in that contact tracing? Including incorporating
technology, the apps and some of the other approaches to really automate or improve the
efficiency of the contact tracing? It’s not that hard really to do contact tracing right
now because everybody has got no contact. Because they’re staying home. Except the one
designated person who is going to the grocery store. But you know as people do get out and
about, the contacts will increase that will be very important. We have a report coming
out today and probably came out four minutes ago, about the amplification phase. What happened
in the United States in February and March that led us to this stage? And a lot of the
events that were involved in initiation and amplification, are insightful in terms of
the kind of events that will be really critical in resurgence. If we can slow spread and really
reduce transmission, we want to keep transmission down. You can see in that report that gatherings,
the professional meeting in Massachusetts, Mardi Gras in Louisiana, a funeral, a birthday
party. These different events and definitely the cruises that many people returned to America
from. Those – those gatherings and social contact led to amplification that we didn’t
have the testing capacity or the recognition about pre-symptomatic transmission to be able
to keep – to get ahead of. But if we do reduce transmission in the weeks ahead, before we
head into fall that increased testing, increased contact tracing, immediate isolation and quarantine
of contacts can really help us keep rates low. And so I think that we hope to learn
from what happened the last few months, to really not repeat history. And keep the rates
low, hopefully so that the healthcare capacity can be sufficient, and that we can buy time
until there are better treatments, and until there’s a vaccine. >> Howard Bauchner: Yeah, I don’t like campaigning
for money for anyone, but somehow I feel like either more money or some of the $2 trillion
we have to give a quarter of a billion dollars, $250 million to public health. It’s the only
– from my standpoint you need personnel. They need to be well trained. You need to support
them. And you need to support the families that are quarantined. And somehow I think
it’s going to take a huge influx of resources to hire appropriate personnel to do it. So
I’m campaigning no your behalf. I know you can’t campaign for the dollars Anne. >> Anne Schuchat: I think people recognize
that a strong public health system is national security. And that all of our lives are disrupted
when we don’t have the infrastructure that we need. >> Howard Bauchner: So a couple – not a couple,
a lot of questions so I’ll go through them now. MRS and SARS and immunity, what do we
know from that, that could help us around Covid 19? >> Anne Schuchat: Yeah, you know some of the
SARS work led to early vaccine trials. And some of those vaccine candidates are platforms
that are being explored now. In MRS there was some information about the mild illness,
not necessarily leading to antibody production. And so the – but MRRS is a very different
disease in terms of you know pretty much sporadic, not – a couple of the huge nosocomial outbreaks.
But you know they give us a clue that it’s – it’s important to pursue vaccines. Some
question about antibody enhanced disease. But I think the scientists think that we understand
the molecular pathway of that, and that’s we’re avoiding – avoiding that approach, that
concern. But I think that we unlike Ebola where there were – there were candidates that
had been pretty far along by the time we got the big Ebola outbreak in 2014-2015. The SARS
and MRS vaccine didn’t get as far. So I’m optimistic that the vaccine research and development
is going to go really well because there’s a lot being invested in it and there’s some
really excellent researchers involved. But I think we didn’t – we didn’t take Sirs and
Mars – SARS and MRS far enough to get that really promising leading candidate. >> Howard Bauchner: Link question so I’ll
put them together, makes it easier. How long do you – how long do people shed virus? And
then could you go over the 10 plus 3 rule because someone is saying the website seems
unclear and it could still be 7 plus 3? And I know those are link questions; so if you
could kind of talk about that. >> Anne Schuchat: So the – there have been
a variety of studies and some are still ongoing. The household studies where we’re retesting
people over and over who are – who are shedding. There’s a difference between finding PCR positives,
which can be weeks and weeks out. And finding PCR – finding positives that can be culturable.
And one of the things that the team has done is sort of – and the different scientists
have done is sort of compare what was the cycle time of the PCR positive that correlated
with culturable virus. And that’s where really I think the best data is maybe nine days – you
know the PCR – that you could predictably have the cycle times down – the cycle times
up to a certain place, or the viral load down to a certain place. >> Howard Bauchner: Right the opposite direction. >> Anne Schuchat: By day 10 that the – that
the levels wouldn’t be culturable. And so the website – we might have updated a couple
of the places. There’s a lot of places where the seven plus three has to be changed to
the 10 plus three. But I believe – I thought it went up yesterday. If it didn’t, it’s imminent.
And we are trying to get our – to get the different sites harmonized. And so that idea
is that for a non-test based approach to release from isolation, if it’s been at least 10 days
since onset, and at least three days since recovery or afebrile that you can be released
from isolation. >> Howard Bauchner: Okay. I’m being asked
to wrap it up. You have another appointment – >> Anne Schuchat: That’s true. >> Howard Bauchner: Anne I just have to ask
one question. >> Anne Schuchat: Okay. >> Howard Bauchner: So you had a brush with
Hollywood. So how involved were you with Kate Winslet and Contagion? >> Anne Schuchat: Yeah Contagion at the time
people asked is that realistic? And we said yeah it actually is realistic that you could
have a virus that changes you know, life for people all over the world. And I think right
now everybody agrees it’s realistic. You know a virus that comes from animals and to people,
very contagious. That really disrupts life in many different cultures, in many different
ways. So the – the developers of that movie were in touch with CDC as they were – they
had official full time ID consultants for the movie. But they visited a few times and
on one of the visits Kate Winslet came and met with a number of us. So it was – it was
really interesting to speak with her as she was preparing for the part. And certainly
we – we’re big fans of the movie. >> Howard Bauchner: Will there be Contagion
II? >> Anne Schuchat: No, I just hope the world
gets over this pandemic; so I have to say that – that this is just such a serious pandemic
and people are working so hard to fight it. And we know how disruptive it is for everybody.
You know I think everybody wants to find some light at the end of the tunnel or some humor,
some levity and you know certainly the connectedness that we all feel across the public health
community, or with the medical community is something. I’m sure that Hollywood would find
a way to do something with this, but hope they’ll take a few years and pause. And we’ll
all have to decide who is going to play us in that next movie. >> Howard Bauchner: This is Howard Bauchner,
Editor in Chief of JAMA. This has been Conversations with Dr. Bauchner. What a privilege to talk
with Anne Schuchat, Principle Deputy Director of the CDC. Anne I’ve wanted to interview
you for a few weeks. I hope you’ll come back in the next couple weeks to do part II. Thank
you for everything you do to try to make the United States and the world, a safer place
to live in. Really, thank you so much. >> Anne Schuchat: It’s a pleasure taking with
you. And all of CDC is – is working hard and really wants to make sure that they get the
best information out there. So just last moment, is CDC.gov. If I said anything wrong, the
correct information should be there. And really appreciate the – the ability to speak with
you today. >> Howard Bauchner: Right, and new information
about cats and dogs, very, very important. >> Anne Schuchat: That’s right. You go there
we got – how to keep your cat or your dog safe. And how to keep – how to care for them
if they are ill. >> Howard Bauchner: Stay healthy Anne. >> Anne Schuchat: Thank you, you too. Take
care. >> Howard Bauchner: Bye bye.
