Transcript of 2019 Novel Coronavirus Response Telebriefing

Operator: Good afternoon, and thank you for standing by, as a reminder, today’s conference is being recorded, if you have any objections, you can disconnect at this time.  Your lines are in a listen only mode until the question and answer session of today’s conference.  At that time, you may press star followed by the number one to ask a question.  Please unmute your phones and state your name when prompted.  It is now my pleasure to turn the conference over to Benjamin Haynes.  Thank you, you may go ahead.

Ben Haynes: Thank you, Michelle, and thank you all for joining us for today’s telebriefing regarding the 2019 Novel Coronavirus and the proactive action the CDC is taking.  We’re joined today by Dr. Nancy Messonnier, director of CDC’s National Center for Immunization and Respiratory Diseases, and Dr. Marty Cetron, director of CDC’s Division of Global Migration and Quarantine. Drs. Messonnier and Cetron will provide opening remarks before taking your questions.  I would now like to turn the call over to Dr. Messonnier.

Nancy Messonnier: Great.  Good afternoon and thank you for the opportunity to provide you with an update regarding the outbreak of pneumonia in Wuhan City, China, which has been identified as being caused by a novel coronavirus.  This is a serious situation.  We have faced this challenge before first with SARS and later with MERS.  Both outbreaks were complex and required a comprehensive public health response.  Because of that experience, we know it’s crucial to be proactive and prepared.  Frist, outbreaks of new diseases among people are always a public health concern.  Second, while the discovery of a new virus can be exciting, we are still learning about it.  This means our recommendations will continue to evolve as we learn more about the virus.  Since the outbreaks of MERS and SARS, we have made improved in our capacity in the United States and around the world.  We’re now better poised to respond to this new threat quickly and collaboratively.  Based on the information that CDC has today, we believe the current risk from this virus to the general public is low.  For a family sitting around the dinner table tonight this is not something that they generally need to worry about.

Now I would like to provide you with the most current information we have.  Please know that we are still early in this response and the situation is still evolving hour by hour and day by day.  On December 30th, China reported an outbreak of respiratory disease in Wuhan City, it’s a major transportation hub about 700 miles south of Beijing with the population of more than 11 million people.  An investigation led by local officials identified a new coronavirus as the cause of the outbreak.  Coronaviruses are a large family of viruses, some causing illness in people, and others that circulate among animal, including camels, cats, and bats.  Rarely animal coronaviruses can evolve and infect people and then spread between people.  This was the case with MERS and SARS.  There have been a lot of developments in this outbreak over the last few days, and I want to share what we know based on the latest public health reports.  Regarding the source, most of the patients in the outbreak have reportedly had some link to a large seafood and live animal market which does suggest animal to human spread.  The market was closed early this month for disinfection and cleaning.  In terms of severity, China has reported 45 cases to date.  The most recent four cases were just reported within the past hour or two.  And there have been two deaths.  Those patients who died were older adults.  And one of the two patients had known serious underlying medical conditions.  Some patients have been described as being seriously ill, while others have recovered and been discharged from the hospital.  As relates to the spread of the virus, we’re still learning more.  While most of these infections seem to be happening from animals to people, there is some indication that limited person-to-person spread is happening, including outside of Asia.  Just this week, three cases outside of China have been identified, two in Thailand, one in Japan, all in travelers from Wuhan.

Now I’d like to talk a little bit about what CDC has been doing.  Last week we established an incident management structure to coordinate our response.  We’re monitoring the international situation with our teams on the ground in China, Thailand, and Japan as well as working closely with colleagues at the World Health Organization.  We have been updating the CDC web site daily to include new information and I would direct you there for the latest case counts and updated information in terms of our response.  We issued a level one travel notice first, which reminds travelers to practice usual cautions for Wuhan City, China, that was earlier this month and we’ve continued to update it based on new information.  We sent out a health advisory via the Health Alert Network updating health care workers and public health partners on this outbreak and will be sending out additional guidance either later today or tomorrow.  Our laboratory is using genetic sequences provided by the Chinese and already has the ability to identify this pathogen were it to occur in the United States.  We’re working on a specific diagnostic test to detect this virus and we’ll be distributing this test to state health departments.  I’m going to stop there and hand over the briefing to my colleague, Dr. Marty Cetron, the Director of the Division of Global Migration and Quarantine.  He’ll talk to you about the precautions we’re taking at airports to identify possible novel coronavirus cases.  Marty.

Marty Cetron: Thank you, Nancy.  To further protect the health of the American public during the emergence of this new coronavirus, beginning today CDC will be screening passengers on direct and connecting flights from Wuhan.  This will begin tonight at New York, JFK airport, the first of the three main airports and one of the two that receive direct arriving flights from Wuhan.

While a remarkable amount has been learned since the first detection of this virus last month, it’s still early and much remains unknown as Dr. Messonnier pointed out. The investigation into this novel coronavirus is ongoing and dynamic, and CDC is actively engaged on the many fronts that Dr. Messonnier outlined.  We are preparing across the public health and health care system to prevent, detect, and respond to this novel coronavirus.  The earlier we detect a case, the better we can protect the public and the more we can understand about this virus, and its risk for spread.  CDC will implement public health entry screening at San Francisco airport, New York JFK and LAX airport.  These airports receive the vast majority of travelers from Wuhan.  As I mentioned, JFK and also San Francisco are the only two airports in the United States with direct flights from Wuhan.  LAX was included because of the equivalent large volume of passengers coming from indirect flights.

Entry screening is only one part of a layered approach that includes alerting the nation’s public health system and health care delivery systems.  When used with other public health measures already in place for rapid detection of ill arriving travelers, we can slow and reduce the spread of disease into the United States.  It is early in this outbreak.  The virus is novel, and while we have experience with SARS and MERS, humility is important.  There is much work to be done as the outbreak investigation unfolds and is very dynamic as you heard.  As we learn more about this newly emerging virus, CDC will adjust its screening and response procedures appropriately.  Thank you.

Ben Haynes: Thank you, doctor and doctor, Michelle, we are ready to open up for questions.

Operator: Thank you, sir.  At this time, if you would like to ask a question or if you do have any comments, you may press star one.  Please unmute your phones and state your name when prompted.  Again, that is star one for any questions.  One moment, please.  Andrew Joseph from STAT, you may go ahead, sir.

Andrew Joseph: Hi, thanks very much.  With three exported cases identified already but only 45 identified in Wuhan, are you working under the assumption that the outbreak is actually bigger than that in Wuhan, that you think there might be more unidentified cases so far?

Nancy Messonnier: Yes, this is Dr. Messonnier, and I would say that this is the stage of the investigation we need to proceed cautiously and be prepared to respond quickly to any eventuality.  So of course we’re generally concerned that there might be more cases, but we need to wait until our colleagues in China complete their investigation.  That said, that is one of the reasons we’re standing up screening in the United States to make sure that we have the means to detect a case early here so that we can detect it early and learn more about it.

Andrew Joseph: Thank you.

Operator: Thank you, our next question comes from Mike Stobbe with the Associated Press, you may go ahead.

Mike Stobbe: Thank you for taking my call.  Just a couple.  I wanted to make sure to clarify, CDC is trying to develop the diagnostic test to determine the virus, but when you all will be screening people, you’ll be looking at symptoms.  You won’t be able to actually test for the virus, is that correct?  And I also wanted to ask, just want to make sure I have the most current information.  There’s not screening planned at the Wuhan airport or in China or underway right now.  It’s screening on the receiving end, not before they get on the plane?  Thank you.

Nancy Messonnier: I think we’ll trade off on those questions.  The diagnostic one is mine.  We actually do have laboratory diagnostics here at CDC that are stood up.  The first diagnostic that we’d be relying on is based on sequence.  My compliments to our colleagues in China.  They identified this pathogen very quickly and quickly put that sequence up where it’s publicly available to all the scientists around the world.  That is how our colleagues in Japan and Thailand identified cases.  They compared the sequences that they found in their patients to the sequence that the Chinese collaborators posted.  So we at CDC also have the ability to do that today, but we are working on a more specific diagnostic.  We expect to have that imminently, and samples from patients who are appropriately identified with screening both at the airports or elsewhere in the United States, CDC stands ready to actually do laboratory diagnostics tests to identify whether they do have novel coronavirus.  Marty.

Marty Cetron:  Yeah, so Mike, your question about what, I think you were asking whether we’re going to be doing any diagnostics at the airport, and the answer to that is no.  We will do symptom-based screening in persons that have the epi link to Wuhan, and we will take a temperature, and then we will triage for evaluation those patients of concern where they will be referred to a facility that can do a regular diagnostic work up and collect the specimens that Nancy was referring to in terms of sending to CDC for reference testing for coronavirus.  So that’s the basic sequence.  Regarding exit screening in Wuhan, to the best of our knowledge, it is not ongoing at this time although there have been many people who have pointed out that the efficiency of exit screening obviously on a global perspective is an important step that compliments entry screening activities.  So, one is hopeful that that will move but as you can imagine, Wuhan is a dealing with a lot of issues at the present and will continue to, you know, apply the requests through formal channels that exit screening also be added to the compliment of the tool box.

Ben Haynes: Next question, please.

Operator: Thank you, Denise Grady from the New York Times, you may go ahead.

Denise Grady: Hi, thank you very much.  I just want to specify a little more, what exactly does screening involve.  Is there also any kind of question, are you looking only at temperature, are you looking at coughing, how do you tell apart somebody who’s coughing and has got a runny nose to someone who might be of concern, and once you do decide a person is of concern, where exactly are they going to be taken?  And what about people traveling with them?  What kind of plans are in place to deal with this if somebody is thought to be a possible case?

Marty Cetron:  Thanks for that question.  Excellent question.  We will be capturing the information of the person who comes, in addition we will be asking questions about symptoms, and we will be taking a temperature check.  And those that have symptoms that are compatible and a fever will be moved to what we call a tertiary screening by our quarantine medical officers for further investigation regarding exposures and contact and family issues.  But all members of the family will go through the same screening.  The sick individual will be triaged to evaluation in preidentified designated facilities and we have been working with our public health partners and our clinical partners as well as the transport services and we have been through this type of protocol before in 2014 and 2016, during the Ebola entry screening which lasted many months, over a year.  And those individuals will be transported safely, without exposing others, and evaluated under CDC guidance for infection control precautions and recommendations.  And that’s the basic sequence.  The ability to make the — refine the diagnosis and your point is well taken, we’re in the middle of respiratory virus season.  It will be far more likely that these symptoms will be caused by the common circulating winter viruses, including influenza, parainfluenza, RSV, and many others than it will be this novel virus.  While we have been in contact with some of our partners that are screening in other countries, it is our understanding that they have screened thousands before they found these one and two individual cases.  So, we are expecting that, you know, this is going to be a triage scenario, and there is the capability in these referral centers for doing rapid diagnostics for the other causes of respiratory illness.  So, thank you for your question.

Denise Grady: Thank you.  Are you able to tell us where the facilities are, where people are going to be taken in these cities, New York, San Francisco, LA?

Marty Cetron:  We generally — we generally don’t, you know, pre-identify publicly those institutions>  But needless to say there’s extensive preparedness network that has gone on for a very long time to identify the facilities that have the appropriate precautions and capability to deal with patients like this.  And I have been just updated that perhaps as of today or this morning, Wuhan may be beginning exit screening.  We’ll confirm that, but some of the media reports are indicating that.

Ben Haynes: Next question, please.

Operator: Thank you.  Leana Sun from the Washington Post, you may go ahead.

Lean Sun: Yes, hi.  I have a couple of questions.  Thank you.  Dr. Messonnier, do we know more about whether people are in the limited human-to-human transmission, if they can only spread when they’re symptomatic, and also Dr. Marty Cetron, could you please give us a sense of the volume of flights coming directly or connecting from Wuhan to these airports?  I believe the top 20 airports from Wuhan are all in Asia, but of course, from Bangkok, Hong Kong, Taipei, a ton of them come here.  Where do the US arriving flights sort of fit in that volume space?

Nancy Messonnier: Okay.  That was only two questions.

Lean Sun: I have a follow up, but I’m holding it.

Nancy Messonnier: The answer to the first question is we don’t know.  MERS and SARS, which are similar to this novel coronavirus, we know from investigation of those two viruses that they are more likely to spread when somebody is more contagious and that asymptomatic people can spread, but at a much lower rate.  So, it certainly is reasonable to ask the same question of this coronavirus, but it really would be premature to conclude that because we frankly don’t have enough information yet and that’s why we are taking this cautious approach.

Lean Sun: Okay.  Again, just ask a quick follow up to that related question, you know, the Chinese have been giving out some information but they haven’t given any kind of time line when people were symptomatic, how long they were sick for, any of that detail.  Have you guys pressed them for that, or do you already have that information?

Nancy Messonnier: We don’t have all the information at the level of detail that our scientists would prefer.  You know CDC scientists and we want to see every tidbit of data ourselves and that’s not the situation we’re in right now.  We are in more of a waiting mode, waiting to see what our colleagues from China are releasing.  It is a fast-moving situation, again, as identified, you know, again within the past hour, four more cases have been reported.  Things are still moving fast and information is still coming on.  We generally know that the incubation period is around 2 to 14 days, and there’s nothing that we’ve seen with this outbreak that is not consistent with that, but we really don’t have the level of detail that would allow us to be really completely confident that this virus is behaving the way that we expect.

Marty Cetron:  About the travel volume, just to give you some feel.  So we have data, we look at data from the past year, and then we actively are getting data from each day’s arrivals confirming not only the capacity of a flight but how many bodies are in seats.  And the annual data in general arrivals for the past year from Wuhan with itineraries originating in Wuhan and ending in the United States is over 60,000, probably ranging from 60 to 65,000 per year.  There’s some asymmetry in that not all months are equal, the peak seasons in China travel to the U.S. are January and August; January being the largest.  About 10% of that total usually arrives in January due to the Chinese Lunar New Year which is up coming. And we also have weekly estimates for these three airports and we’re expecting that the screening over the next couple of weeks could include as many as 5,000 people across the three airports [editor’s clarification: there are about 5,000 people per month with direct or indirect flights from Wuhan]. But it will really vary, and this is something each day that we get sort of an updated number.  What’s different and unique about this is the two, the two direct flights which happen three times a week, and those are full planeloads of people that will originate.  Recall that during 2014-16, there were no direct flights from West Africa to the United States, they were all indirect.  So, we’ll be screening episodically these large volume of arrivals three times a week from JFK and San Francisco in particular.

Ben Haynes: Next question, please, Michelle.

Operator: Thank you.  Nurith Aizenman from NPR.

Nurith Aizenman: I have a question from each of you and also a follow up.  The first question is from the test.  I’m trying to picture this.  Someone comes in, they do have symptoms.  Maybe they have something that makes you think they really should be screened.  They’re taken to this location, you know, and then the test is done, how quickly, if they’re testing for the things that are easily known, you can easily identify if it’s something other than this new coronavirus, how quickly would that occur realistically, are we talking an hour, like all day, overnight, just some sense of like the time line that someone might be detained.  The other question is, again, on this issue of the incubation period, are we seeing, I mean, there’s been dribs and drabs about when the last symptoms were — onset of symptoms were reported by these cases but it sounds like it’s limited to kind of early January.  Are we — are you seeing, you know, is it normal to expect kind of a gap in cases and then a reemergence of new cases if there is a lot of human-to-human transmission going on?  In other words, like, 14 days on basically around now, we’d start to see like suddenly a new flourishing of cases?

Marty Cetron: So, let me take the issue just to clarify about where the diagnostic testing is going to go.  People that come to the secondary screening and we have surge CDC staff to these ports obviously, and when they answer the questionnaire, if there’s no concerns about signs or symptoms and they’re afebrile, they’re going to be given a card that they can carry with them as to what symptoms to be alert for in the ensuing 14 days, and how to safely contact and interact with the health care system for care.  Those folks would be moving on, and we’ll expect we’ll be able to process them in moving on quite quickly without significant delays.  For the folks that actually have suspicious signs and symptoms and concerns, they will have a more detailed exam and an inquiry about exposures in tertiary at the airport.  Many of those folks will likely end up being referred for further evaluation.  It is unlikely that they will be able to make an immediate connecting flight if they had one, and so the types of diagnostics, screening diagnostics for common viruses can be done quite quickly but it’s still sort of an amount of hours of turn around in that process.  The specimens can then be collected at the same time if there’s indications for the novel coronavirus.  Currently they have to be shipped to CDC and tested here in reference labs.  And the speed with which that turn around occurs will continue to improve over time as we get these laboratory processes up and running for throughput.  But perhaps Dr. Messonnier can talk about what the expected time frame is in the screening process.

Nancy Messonnier: We’re sort of on the verge of having a more parsimonious laboratory test, and that will improve things right now.  If it was right now today it might be as much as a day but it’s going to get rapidly faster as we work so rapidly on our diagnostics.  The second questions of sort of a, I would take it as a theoretical question about incubation periods and waves as opposed to a specific question because I mean I think what you’re asking is, is it possible for there to be one wave and then a lull and then a second wave.

Nurith Aizenman: Exactly.  I mean, essentially as we’re looking at what’s happening, right, and we’re trying to figure out what does this tell us, and is it possible that the fact that we haven’t seen a whole lot of cases yet out of Wuhan, doesn’t necessarily tell us much because maybe you would expect to see the next wave like around now is when you would start to expect to see the next wave if there is indeed significant human-to-human transmission?

Nancy Messonnier: Yeah, I think what I would say about that is, you know, we’re trying — I mean, of course we’re hypothesizing and like you, trying to put this story together and see if we can find an easy explanation, but at the same time, even as we speak, more information is flowing in as the Chinese investigators continue their investigations in terms of familial clustering and what exact exposure, what proportion of these cases actually were in the market and what weren’t.  So I think it’s a little hard to completely feel confident that we have every bit of information and what I would generally say is I think that this is a situation where we’re going to see additional cases all around the world as folks look for it more.  Respiratory illnesses in general have a spectrum of illness, and generally we tend to find people who are more on the severe end of illness, but as we start testing more, and as lots of countries stand up diagnostic testing, I expect that we’re going to see more cases, and I think it’s highly  plausible that there will be at least a case in the United States, and that’s the reason that we’re moving forward so quickly with this screening that Dr. Cetron is talking about.

Ben Haynes: Next question, please, Michelle we have time for two more.  Sorry.

Operator: Thank you.  Dan Vergano from Buzzfeed News, go ahead.

Dan Vergano: Thanks for doing this.  Why a virus that starts in animals and spreads to people, and shows signs of spreading from people to people, it might be a particular concern in an outbreak like this, you know, like why the concern?

Nancy Messonnier: I think we are concerned anytime there is a new virus or a new pathogen emerging in a population that hasn’t seen it before because what it means is that populations don’t have existing immunity, and we don’t have specific treatments or vaccines.  So we’re always concerned about that.  In this particular situation, we are especially concerned about a novel coronavirus because we have the precedent of MERS and SARS, and those were quite complicated, difficult outbreaks with many people getting ill and deaths, and so understanding that this pathogen looks, at least from a genetic perspective, like those pathogens makes us especially worried.  It doesn’t take much for a virus in general to go from being worrisome to being extremely worrisome because they tend to morph and mutate a lot, and so that’s why in this class of viruses, we are especially worried and we’re taking a very cautious proactive approach.

Dan Vergano: Thank you very much.

Ben Haynes: Last question, please.

Operator: Thank you.  Elizabeth Cohen from CNN, you may go ahead.

Elizabeth Cohen: Hi, thank you so much for having this teleconference, I have two nuts and bolts questions for Dr. Cetron, I want to make sure I heard two things correctly, you said over the next few weeks we’re expecting 5,000 passengers from Wuhan, and two I think you said the JFK screenings start tonight at SFO, and LAX tomorrow, did I get those two things right?

Marty Cetron:  Yes, so the first direct flight from Wuhan scheduled arrival is around 10:00 p.m.  Tonight at JFK, and that will be the first fully screened flight.  The — we will serially roll those out.  The next direct flight arrives at San Francisco I believe around 11:00 a.m. tomorrow morning, and some of the indirect flights will be screened in LAX also beginning tomorrow morning.  So, we have surged as I indicated, you know, over a hundred CDC staff to these three airports and rough numbers I gave you around travel was across all three.  In terms of that, we’ll actually see realistically how many bodies are in the seats, this is projections based on some carrying capacity.  And then I believe it was either you or somebody else that asked about where does the U.S. sort of fit in that total scheme.  The — there was a report out that modeled that based on, I think it was 2018 data, the top destination countries, Thailand, Japan, and Malaysia.  These may have evolved a little bit in 2019, and they may be influenced a little bit on a monthly or seasonal basis as to what those orders are, but in general, the U.S. is, you know, not in that top tier as somebody indicated.  Most of these — most of this travel is in southeast Asia, and so the experience of screening that is going on in many southeast Asian countries right now will also be very ill illuminative, both about early detection of cases and the proportion of cases that trigger the screening, you know, as positive screening that actually get confirmed with the novel coronavirus will also help us a lot to find a little bit the scope and the magnitude of exportation.

Nancy Messonnier: Well, thank you for joining us today.  In closing, I do want to remind you that we’re still in the early days of this investigation.  Things continue to evolve.  We’re monitoring the situation closely.  We’re working to keep you informed every step of the way.  I also want to take a moment to thank the many partners with whom we are completely dependent and collaborating on this response.  The we here is not CDC in isolation, but clearly our state, local, territorial partners, CBP, FAA, the airlines.  Our ability to stand up this kind of response and our ability to intervene this quickly is entirely dependent on those collaborations as well as the many international collaborations in countries in which we’re working.  The risk of these outbreaks depends on the characteristics of the virus, including if and how well it spreads between people, the severity of resulting illness, and the medical or other measures available to control the impact of the virus such as antiviral treatments or vaccines.  The situation could indeed change quickly.  Therefore, we are taking a cautious approach to this outbreak and we’re preparing ourselves to respond quickly to any new developments, thank you again.

Ben Haynes: Thank you Dr. Messonnier and Dr. Cetron.  And thank you all for joining us for today’s briefing.  Please visit the 2019 novel coronavirus web page found at the bottom of the press release for continued updates.  If you have further questions, please call the CDC media office at 404-639-3286 or e-mail media @CDC.gov.

Operator: Thank you, this concludes today’s conference call.  You may go ahead and disconnect at this time.

###
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CDC works 24/7 protecting America’s health, safety and security. Whether disease start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America’s most pressing health threats. CDC is headquartered in Atlanta and has experts located throughout the United States and the world.