Subject: H1N1 Virus (Swine Flu) Update
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MODERATOR: Good afternoon. Thank you for being here. For those of you on the phone, I hope you can hear me. We have Secretary Napolitano for her daily briefing. As you can see, she's joined by Secretary Sebelius and Rear Admiral Schuchat from the CDC.
So they will make some remarks and then open it up for questions.
SEC. NAPOLITANO: Thank you, Sean (sp). And I understand we have about 15 outlets on the conference call or on the speakerphone. But this is the daily briefing to bring everybody up to speed on where things are with respect to the 2009 H1N1 virus.
The three of us just returned from the Hill. We testified -- at least Rear Admiral Schuchat and I testified before the Senate Homeland Security Committee and then the three of us were present for a bipartisan briefing at the United States House of Representatives to make sure that the members of Congress are being kept up to speed.
And, of course, I'm delighted to be joined today by the secretary of Health and Human Services, Kathleen Sebelius, because I have a feeling we're going to be joined at the hip on this for quite a while as we move forward.
As you know, and I'm sad today to report, that today we had our first confirmed death as a result of the H1N1 virus in the United States. It was a 23-month-old child, and our sympathies go out to her family out of this.
But as I said and have been saying, this is a flu. And a flu cycle -- we think we're at the beginning of a flu cycle, which typically brings with it some severe illness and death. Indeed, in a normal seasonal flu cycle, we will have about 36,000 deaths in the United States. That's a fact that surprises many, but it is part and parcel of an influenza cycle.
So the -- our thoughts are with those who have contracted the virus now, and, of course, for the family of the child who died.
We now have 10 states with confirmed incidence of H1N1: Arizona, California, Indiana, Kansas, Massachusetts, Michigan, Nevada, New York, Ohio and Texas. We are likely to see more states, more cases and some more hospitalizations over the coming days, and we are prepared for that.
Every American should know that we are aggressively responding to this outbreak. Antiviral medications are en route to states to supplement their own stockpiles. Indiana, New York, New York City already have their allocations. Several other states will receive their allocations by today, and all states will receive theirs no later than the 3rd of May.
Let me point out an important difference here. There's been some confusion between antiviral and vaccine. A vaccine is administered to prevent the flu from occurring. An antiviral is administered after you get sick to mitigate the symptoms so that you feel better. So it is the antiviral stockpile that I'm referring to now.
We're also actively monitoring travelers at our land, sea and air ports. We're watching them for signs of illness, and we have appropriate protocols in place to deal with those who are sick. Precautions are being taken to protect travelers and border personnel.
Anyone exhibiting symptoms is being referred to an isolation room where they can be evaluated by a public health official before proceeding to their destination.
I know there have been some close -- some calls to close the border. I want to address that directly. First of all, it is important to know that we are making all of our decisions based on the science and the epidemiology as recommended to us by the Centers for Disease Control. The CDC, the public health community and the World Health Organization all have said that closing our nation's border -- borders, is not merited here; that the focus, the public health focus, should be on mitigating the impact of this virus. And so we are following those recommendations now.
As I said, we continue to actively monitor those coming across the borders and at our airports, as we've been doing all week. And we are also distributing fliers and public health information to individuals.
As of today, Customs and Border Protection has referred a total of 49 suspected cases to the CDC or state and local officials. All the results have been negative, except the eight that are still under study. I know that in addition to travelers, many parents across the country are concerned about school closures, and President Obama spoke about this earlier today. The Centers for Disease Control has recommended that schools with confirmed cases of H1N1 virus, or schools with suspected cases linked to a confirmed case, consider closing on a temporary basis. Some schools have already followed that advice.
The best thing parents can do right now is to make sure you have a contingency plan in place, so that you've made arrangements to care for your child in the event of a school closure. This is also a good reminder for businesses, to think about contingency planning as well. We have to -- as I said, we're going to be working through this for a while. You have to anticipate what happens if you have employees who are parents and the schools have closed, and the employees need to stay home.
How do you continue with your business operations? And so all of us should be dusting off our business contingency plans, looking at things such as telecommuting and the like so that operations keep on -- keep on going.
And of course, we advise anyone with flu symptoms to stay home or consult a doctor if you have severe symptoms. This is a problem that every individual can help us with by adopting common-sense solutions or precautions: Cover your mouth or nose when you sneeze; don't go to work or school or go on a plane or a bus if you are sick, so that you don't communicate the disease to others; and wash your hands often.
I know that the secretary of Health and Human Services is going to have more to say on that topic and on others, so let me close here and ask Secretary Sebelius to come forward.
SEC. SEBELIUS: Well, thank you, Secretary Napolitano, for your leadership on this issue, and I'm delighted to have a chance to once again work with you. The secretary and I served for six years together as governors, and now we will serve as secretaries together and work on this issue jointly.
And I'm also pleased to have Dr. Anne Schuchat with us today from the Centers for Disease Control. We promise you that any of the tough science questions she will answer.
And I think that really sets the tone that we would like the American public to understand the decisions made -- on the protocols, on community mitigation, on other issues -- really are led by the science. And so to use our resources effectively, to make sure that we are aggressively taking on this situation but not reacting in a fashion that is not appropriate, really is all about having the scientists tell us the best possible protocol.
Now, we know that many individuals are suffering from the 2009 version of H1N1, and more cases are being identified every day.
Rich Besser from CDC has been actually foreshadowing this. We know that the cases will continue to rise, as the secretary has already said. Today was the first confirmed death; unfortunately, there will be more. And we don't want folks to see this as a sign that things are out of control. It actually is what happens with a flu virus.
There is a lot of activity going on, not only in agencies across government, but within the Department of Health and Human Services, who has the primary responsibility for health response and preparedness. The FDA is working in collaboration right now with the National Institutes of Health on the vaccine development. A strain has been identified. Manufacturers are on the alert that if -- once the testing protocol is done and the dosage protocol is done, they are ready to begin production should that be necessary. And the good news is that that process is not only faster than it's ever been, but there is a protocol, a very stringent oversight, to make sure that if and when vaccine is produced, that it's the appropriate dosage and the right vaccine.
The federal government has 50 million antiviral dosages available. And as Secretary Napolitano says, 25 percent of that stockpile will be in the hands of states by the 3rd of May, at the latest. It first goes to affected states and others, but by the 3rd of May, everyone will have a stockpile. The purpose of that is to make sure that we're deploying the assets closer to the ground. And as you know, disaster response really starts with the local level. They are the first identifiers and first responders, who are well prepared and great collaborative partners, but we want to make sure the assets are there. Tamiflu and Relenza have proven to be effective against this strain, so that, plus protective masks and other resources, are available.
And we're taking steps to inform the American public. This is my first opportunity to join the secretary, but the secretary has been doing a daily briefing. There are briefings across the government.
The president is very much involved and focused on this issue. State and local partners are being briefed on a regular basis. We want to make sure that people understand that the guidance is available to parents, to school districts, to health care personnel at www.cdc.gov, www.cdc.gov.
At 11:00 every day, there is an update on what is happening. And individuals who want to follow the states and want to follow the cases, and parents who are concerned, and employers who are concerned, can get a regular update. This is a dynamic situation. So it will change. It will be one that we are monitoring very, very closely and updating that information.
Tomorrow, we have an opportunity to do a joint broadcast, a webcast, with Secretary Napolitano and me. And Dr. Rich Besser will be joining us by videocamera. And this is an opportunity really to inform again the American public to take some of the questions, from citizens around the country, and have an opportunity to have a dialogue and get information, into the hands of the public, about what is available.
The webcast is scheduled for 1:00 Eastern Time. There are two viewing sites: www.hhs.gov and www.cdc.gov. Either one is available for viewing. If the public has questions or reporters have questions, for the webcast, they can be submitted by e-mail to email@example.com, firstname.lastname@example.org.
So one of the issues is that we do want people. We understand that Americans are concerned. But that concern can be turned into action plans, as the secretary has already described, and really turned into some personal-hygiene steps.
The hand-washing, covering your mouth after a cough or a sneeze, making sure that you keep your children home or stay home yourself, if there are signs of illness, are all steps that people can take and will help minimize the spread of this disease.
The focus is really clear: saving lives, slowing down the spread and severity of the -- of the flu virus and, by doing both of those things, minimizing the economic and social impact of this H1N1 2009 virus.
So with that, we would be pleased to answer questions, if you have questions. And as I said, we do have Dr. Anne Schuchat here who's been the assistant at the Centers for Disease Control. She's been testifying on the Hill today. It was part of a bipartisan -- I hope you all heard that -- bipartisan House caucus. Republicans and Democrats came together to make it very clear this is not a partisan issue; it's an American issue and we all want to get the best possible information out to our citizens.
Q Can you talk about the situation in New York beyond the schools? The World Health Organization has said that it's concerned about further transmission.
SEC. SEBELIUS: Well, I have had a couple of conversations with Dr. Chan and I'm going to have a conversation again when I get back. I would say there has been a great deal of worldwide collaboration that she is very pleased about.
And again, her focus -- and I think appropriately so -- there are a hundred and, I think, ninety-three nations under the World Health Organization. And so they are looking at the global aspect of this flu virus. But there are daily briefings. There is a lot of collaboration and cooperation. And she has been very openly pleased with the dialogue going on.
The WHO decided not to issue a travel advisory. CDC, on the other hand, felt it was an appropriate advisory to issue for Americans who were voluntarily traveling in and out of Mexico to ask that that stop. So there may be situations where WHO's approach is slightly different than agencies here or in Mexico or in Canada or elsewhere. Each government has to look at their own situation. But I would say there's never been the kind of worldwide dialogue and collaboration that there is right now on this particular virus.
Q Secretary Napolitano, could you clarify the numbers that you ran down regarding individuals I think it was detained at the border? You said 49 but eight are still under observation?
SEC. NAPOLITANO: Right.
Q Is that -- can you break those down for me?
SEC. NAPOLITANO: Well, what it's -- CBP has asked 49 individuals to be tested for H1N1.
Of those 49, 41 were cleared. In other words, they may have had -- you know, they may have looked sick, but they didn't have H1N1. With respect to the other eight, they're just not -- the diagnostic test just isn't completed yet.
MODERATOR: Let's go to the phones. Is there a moderator there who can -- has a question queued up?
OPERATOR: Yes. We have a question from Spencer Hsu of The Washington Post.
MODERATOR: Go ahead, Spencer.
Q Thanks. Senator Lieberman this morning, I think, said if you don't consider tighter border checks there will be growing pressure to really close the ports of entry. And, you know, we've been told in the past that, you know, most border crossings are vehicles, not pedestrians; there's limited capacity to pull them into secondary screening; there's not enough time as it is to require detailed ID checks of everyone coming across, much less medical checks.
So I guess the question was, what IS possible to increase medical screening along the lines that senators recommended without costing, you know, billions of new resources or this kind of social and economic damage that people have said would be, you know, as great or greater than the toll of the pandemic -- or the outbreak?
SEC. NAPOLITANO: You know, that's a question we're asking the scientists right now: What kind, if any, additional screening beyond what we are already doing in terms of active monitoring would make sense at the borders? And Spencer, you put your finger on it, because these -- there's a terrific amount of lawful commerce and traffic that goes through these ports, and there would be -- there's huge economic disruption, and jobs-and-so-forth disruption, and -- any time you add a procedure on at the ports.
And so our number-one priority is always safety of the American people. So is there something we ought to be doing at the ports that would make the American people more safe? And that decision, you know, we're -- we are asking for the experts to give us advice on that.
To date, what we have been told by the experts is that any kind of universal closing of a port would have no impact or very, very little impact at all on the spread of this virus. This virus is already in the United States, so any kind of containment theory that you got to keep it out of the United States is really moot at this time.
MODERATOR: Take another question from the phone.
OPERATOR: Our next question comes from Tom Frank of USA Today.
Q Hi, Madame Secretary. I wanted to get a little more detail on the people who -- the 49. First, can you tell, were they -- what can you tell me about where they were -- where they came in? Was it land ports, sea ports? Do you know what states? And what actually happened to them? How long were they held? Were they taken to these quarantine centers? And as far as the eight for whom the test is not complete, where are they?
SEC. NAPOLITANO: Right. We'll follow up, Tom, and give you specific detail about this.
But to my knowledge, they were at land ports and they were picked up by CBP at land ports of entry. We'll give you the latest specificity on which ones. And my understanding is that no one was detained more than a couple of hours.
Q Okay. And one other thing. You mentioned this morning that you had gotten -- as far as the thermal imaging, the cameras that Senator Collins talked about being used in other countries, you said you had gotten recommendations that they would not be effective. Who gave you those recommendations? Is that anything that you might take a second look at?
SEC. NAPOLITANO: Our minds are open on a number of these things, but these are recommendations that were contained in some analyses that were done in 2007 about what makes sense in this sort of a situation. But Dr. Schuchat, you had some information about that.
ADM. SCHUCHAT: Yeah, let me clarify. There are a number of thermal imagers that some governments have opted to use, and during the SARS outbreak these were used quite a bit in a number of airports. The scientific evidence at this point is pretty mixed, and not that impressive. I think, as the secretary said, all of us are committed to keep an open mind and to look at the data and let the data guide us, but thus far, the value of that sort of investment has not -- has not panned out.
MODERATOR: Another question?
OPERATOR: Our next question comes from Cam Simpson of The Wall Street Journal.
Q Hi. Madame Secretary, during your hearing in the Senate this morning, as Spencer alluded to earlier, it seemed like members from both sides of the aisle were pressing for either tighter surveillance or more restrictions. And I'm curious if you heard similar concerns during your briefing on the House side. And are you worried about political pressures sort of overcoming what you believe is justified through the science and the epidemiology at this point?
SEC. NAPOLITANO: Right. No, we did not get similar questions on the House side. But let me again reemphasize, our number-one criteria is the safety of the American people, and are there measures that can be taken that would improve the safety of the American people.
The data we have been given so far is that some of these suggestions would not impact the safety of the American people, given the status of this flu, the spread of this flu and how it spread, and that any of these measures of course would carry with them enormous economic cost. Our minds are open to other suggestions and ideas.
But to do some of these things simply for symbolic purposes, without really nailing down, do they help us solve a problem and improve the safety of the American people, I think, my goal, one of my goals, as we go through this process, is to help us keep all of our eyes focused on the ball. And the ball is, how do we mitigate the effects and the spread of this flu, within our own country?
MS. : And let me just add to that. I think, as the secretary has said, Dr. Besser and the team at CDC is monitoring aggressively, acting aggressively. There have been several steps taken, in the last three days, that have moved to different levels. And so where we are today may be a different story, in four or five days. So this is not a status quo situation. It's a very dynamic situation.
And I think the balance has to be, what the science tells us works, how rapidly it works, on what population it works, and making sure that we're doing -- using our resources to focus on those issues, rather than doing a wide variety of things which may sort of make people feel better but won't make them get better and won't keep people healthier. And so to focus, to let the science guide the mitigation efforts, has really been the priority in the health and safety community.
MODERATOR: Let's take another question from the phone.
OPERATOR: Our next question comes Lauran Neergaard of the Associated Press.
Q Hi. I want to go back to the issue of New York City and the World Health Organization.
Have they been talking with you in particular, about additional steps that are needed, outside of closing some schools, that would perhaps mitigate things in New York, or any of our other clusters? Have things such as travel advisories come up, within the United States clusters?
MS. : Well, we have issued travel advisories, with respect to travel to Mexico, and also a travel health alert. I spoke with Mayor Bloomberg earlier this week about the situation in New York City and closure of some of the schools there.
If there -- we've been on the Hill all day. And so it sounds like, from your question and from the AP question here, that there must be something new out of the WHO on New York City. Is that true? Is there something new?
Q We haven't heard anything specifically today. But they raised that yesterday as the area that they were most concerned of, within the U.S., for community transmission.
MS. : I can't comment to that. But maybe Dr. Schuchat can.
ADM. SCHUCHAT: Yeah, I can make a couple comments.
You know, as people have heard, New York City has reported an outbreak, in a school, with quite a few children affected. And I think that rather than the one or two laboratory-confirmed cases associated with travel, a number of students, without that kind of history, had what I understand so far has been a relatively mild and self-limited illness.
The first thing I want to say is that the New York City Health Department is phenomenal. They do a superb job and they really lead the nation in their capacity and evaluation. CDC is working closely with them in response to the situation there. And I would -- since I didn't hear directly the WHO link with New York City, I would just say that because this school outbreak was a bit larger than what we had been talking about, that may be some of what they're talking about, rather than that New York City isn't doing the right thing.
MODERATOR: We've got time for one more question on the phone.
OPERATOR: Our next question comes from Jeanne Meserve of CNN.
Q It looks as though now this may reach the phase 5 WHO definition. If they ramp it up to a stage 5, does that change your posture? Does it change your messaging? How worried are you about public panic?
SEC. NAPOLITANO: Well, that's why we want to keep the public informed as we go along. We have been preparing all along as if this is going to be stage 6. And so we have been -- our efforts have been to stay ahead of whatever number the WHO assigns. And therefore, our preparations are for a situation in which this does become a full- fledged pandemic. We are preparing for the worst, hoping for the best, but I believe firmly that if we just keep giving people information and access to information, places where they can go every day and get updates, that in and of itself -- and the media can help with this -- that in and of itself prevents unnecessary and undue worry.
SEC. SEBELIUS: I also think as we look at the situation and get the updates, having a perspective on what the seasonal flu year-in and year-out amounts to in America is very important. Thirty-six thousand people, unfortunately, year-in and year-out die from seasonal blue; hundreds of thousands are hospitalized; millions of people get the flu. So what we are seeing is a situation where I would say state and local partners and the federal government is as prepared as they have ever been to deal with a situation. They are out ahead of it.
A part of what we're doing is monitoring it very aggressively. As the secretary says, there was always an anticipation that cases would rise, that the levels would rise, and that collaboration is going forward.
But again, panicking is probably not terribly helpful. What's helpful is turning concern and worry into action steps. So making preparations for what happens if a school is closed and children have to be home for a couple of days. Making preparations for what happens if a child care provider has to shut down the center; what are the contingency plans. For employers to get out their contingency plans; how do we make sure continuity of work goes on if there have to be some limitations on people coming together in congregate sites.
And doing some very simple, basic things -- washing hands on a regular, frequent basis; covering mouths after sneezes or coughs; and staying home if you're feeling sick, and keeping your kids home. That is a sacrifice, often, but it is an important step to take to limit the spread of this viral flu.
MODERATOR: Okay. Thanks everybody. We will talk to you tomorrow.