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CDC Telebriefing Transcript

CDC's Response to Atypical Pneumonia in
Southeast Asia and Canada

March 15, 2003

MR. SKINNER: Thank you, Gwen, and thank you all for joining us. We're going to get right to it, and with us on the call is the Secretary of the Department of Health and Human Services, Mr. Tommy Thompson, who's going to deliver some brief remarks, and then he has to run. We'll then turn the call over to Dr. Julie Gerberding, and then we'll take your Q's and A's.

So Secretary Thompson, please go, please.

SECRETARY THOMPSON: Thank you very much Tom, and Gwen, and Julie, and Jerry. Thank you very much for allowing me to come on this teleconference. I'm at O'Hare Airfield, and I'm going to be on a plane in six minutes to go back to Washington, D.C. But I want to thank all of you today for taking time today to join us for this telebriefing for an update on the outbreak of what we consider a very severe acute respiratory syndrome in Asia. We decided to have this telebriefing on Saturday because this is a situation that we wanted to involve you in very quickly, and we want you to have the most updated information.

Health officials around the world are taking this situation very seriously. In fact, I had a teleconference with the World Health Organization on Thursday at early morning, and I'm going to have another one either tomorrow afternoon or Monday morning with the people at World Health Organization. But under the great leadership of Dr. Julie Gerberding at the CDC. the Department of Health and Human Services is applying a full court press to learn more about this outbreak and how it might impact on the United States.

Staff in the HHS Department and CDC Emergency Operations Center are already working around the clock to assist officials from the World Health Organization, as I mentioned, as they respond to this outbreak. We've also contacted the Ministry of Health, my counterpart in China, and I had a face-to-face meeting with the Deputy Minister of Health about a week ago, a week to 10 days ago, asking them to make sure that they would cooperate with us because we have to have their willingness and their access into China to make sure that we can get to the root causes of this particular disease.

We are doing everything humanly possible to learn what is causing this outbreak, how to treat patients and how to prevent the spread to others. I hope we're able to get to the bottom of this as soon as possible, as I know all of you are and, certainly, the people and the wonderful efforts at CDC.

Now, I'd like to turn this to Dr. Gerberding to provide you more specifics on how the department is going to respond to this outbreak and be able to give you updated information. Thank you very much, Julie, for giving me this opportunity to address this group, and I wish you luck, and I'll be talking to you as soon as I land in Washington, D.C.

ANNOUNCER: Thanks, sir. We really appreciate you joining in. Have a safe journey home.

MR. SKINNER: Now I'd like to turn it over to Dr. Julie Gerberding, Director of CDC. The name is spelled G-E-R-B-E-R-D-I-N-G. And she's going to take just a few moments to talk a little bit about what we are doing to organize our response to this outbreak.

DR. GERBERDING: Thank you. I wanted to start by explaining why we are doing this on a Saturday. I'm fully aware this is not the optimal time to do a media briefing, but as the Secretary said, the situation is evolving very quickly, and we really do need to get the information out. And, hopefully, you will appreciate that getting information out any time is better than no information.

So we're going to tell you what we know today and recognize that this is ongoing, and we'll be updating you as regularly as we have new information. You will also be able to find information on the WHO website, which is their main mechanism for providing international summaries of these health data. And we will have links and so forth on our website as we go forward.

The situation today is that WHO has received reports of more than 150 new or suspected cases of a syndrome called Severe Acute Respiratory Syndrome, which is basically a very severe pneumonia-like illness that is being reported from a growing list of countries, including China, Hong Kong, Indonesia, Philippines, Singapore, Thailand and Vietnam. In addition, the case reports from Canada. No cases have been identified in the United States, but travelers through the United States who have been in contact or have traveled to the affected areas are under investigation to be sure that their time here did not result in exposure and an opportunity for persons to acquire the illness in this country.

Obviously, this is a very early stage of the investigation, and given the high prevalence of travel through Southeast Asia, we are alerting our public health communities and our clinicians to be on the lookout for cases, and I'll say in a couple of minutes what some of the other steps that we are taking are at this point in time.

We have activated CDC's Emergency Operation Center to manage this complex international multijurisdictional outbreak. Our role is to assist WHO and health officials in the affected countries, in particular in the area of epidemiologic investigation, laboratory diagnosis, and assessment of prevention intervention. We have as our current priority the detection of new cases using WHO case definition which I'll just briefly review for you.

WHO is defining a case as someone with a fever greater than 38 degrees Celsius (Editor's Note: 100.4 degrees Fahrenheit), respiratory symptoms which could be cough, shortness of breath or difficulty breathing, and either close contact with someone who's already been diagnosed with this syndrome or recent travel to areas reporting cases of the syndrome.

We recognize, because we do not have an etiologic diagnosis or a laboratory test for this illness right now, that this is a nonspecific case definition and may include people who really don't have the syndrome at all, may have some other more common respiratory illnesses, but it is a starting point for investigation. And as we either rule in or rule out cases as we go forward, the number of cases meeting the syndrome is expected to change.

Our priority also is on communication. And you can expect us to be providing you with regular updates as we go forward. As I mentioned, the Web sites will be good resources, but we are also taking a number of steps to put information out to a variety of collaborating partners. These steps include sending health alerts to the public health and the medical community. Later today we will be issuing guidance to clinicians about the case definition, the isolation recommendation, and what we can say about treatment and prophylaxis at this point in time.

We assume that this is spread person to person because we're seeing a large proportion of the cases in Asia among health care workers who were caring for the ill patients or household contacts of ill patients. We are recommending precautions to prevent airborne spreads, droplet spread and direct contact spread until we have further information. And so that means we're erring on the side of caution until we can be more specific.

We are also not recommending prophylaxis at this point in time since we don't have an etiologic agent, and our treatment recommendations are nonspecific, basically, utilizing the kinds of empiric treatment that would be appropriate for any patient with an unexplained pneumonia, including anti-microbials or anti-virals depending on the clinical judgment of the treating physician and the isolation and supportive care that I've already mentioned.

We're also preparing a health alert for passengers returning from areas where SARS has been diagnosed. The health alert basically advises travelers that if they become ill with fever within seven days following their return from the affected area, they should consult their physician. And, likewise, we're advising physicians where to get information either through our health alerting mechanism, our hotlines, or our Web sites where we are supporting the clinical community.

There is no WHO recommendation for travel restriction at this point in time, but we are advising persons planning nonessential or elective travel to affected areas that they may wish to postpone their trip until further notice. So we will provide additional information about travel advisories at www.cdc.gov/travel, and that will be updated periodically as we go forward.

So I think again this is an ongoing problem. We're at the very early stages of the investigation. We have received only a few laboratory samples at CDC, so we're only in the preliminary stages of looking for common and atypical organisms that could be contributing. And we're working with laboratories around the world to give the most expeditious diagnostic opportunities here a chance to solve this problem.

MR. SKINNER: All right, Gwen, I think we're ready for questions, please.

GWEN: Ladies and gentlemen, if you have a question, please press the "1" on your touch tone phone. You will hear a tone indicating you have been placed in Q. If you press "1" prior to this announcement, please do so again at this time. You may remove yourself at any time by pressing the pound key. If you're using the speaking phones, please pick up the hand set before pressing the numbers. Once again, if you have a question, please press the "1" at this time. One moment please for the first question.

We have a question from Marian Falco with CNN. Please go ahead.

QUESTION: Hi, Dr. Gerberding. Do we know what the--hello, can you hear me?

MR. SKINNER: Now we can hear you.

QUESTION: Good, I'm sorry. What about the time difference between infection and severe illness and in the couple of cases that we know about? Do you have any indication--I mean how quickly are people getting very, very sick?

DR. GERBERDING: Again, this is very preliminary, but the investigation in Hong Kong and Hanoi suggests that the incubation period is somewhere between two and seven days on average. You know, we're right now probably identifying the most severely ill patients, and so we want to be open to modifying that if we have better data in the future.

QUESTION: And just to get this right, you do not know yet if it's bacterial or viral infection, correct?

DR. GERBERDING: Correct. We do not have information about the etiology right now.

CALLER: Thank you.

MR. SKINNER: Next question, please.

GWEN: We have a question from the line of Tom Watkins, CNN. Please go ahead.

QUESTION: Do you know what conference the man in New York was taken off the plane in Germany was attending, and where he was staying or any of his contacts?

DR. GERBERDING: That investigation is being coordinated by the New York City Health Department and New York State Health Department, and so those details will be forthcoming from them. But I can assure you that they are aggressively evaluating all potential contacts and exposures.

MR. SKINNER: Next question, please.

GWEN: We have a question from the line of Marilyn Chase, Wall Street Journal. Please go ahead.

QUESTION: Hi, Dr. Gerberding. Can you tell us the number of confirmed deaths, and are you ruling out--are you trying to rule out Avian influenza?

DR. GERBERDING: With respect to your first question, we know that this can be a fatal disease, and we have documentation of specific individuals that died and with an illness attributable to this. But the exact number of deaths is not confirmed at this point in time. There are several, and we are, obviously, putting a high priority on investigating patients in those areas.

With respect to the Avian flu question, you know that earlier this year there was documentation of two patients in Hong Kong who had H5N1 influenza, and that was confirmed at CDC in our laboratories as well as other laboratories globally. However, the test for that virus or for other influenza viruses so far have not been reported to be positive from the situation that we are investigating now. So we have no evidence that this is Avian flu.

MR. SKINNER: Next question, please.

GWEN: We have a question from the line of Rob Stein, Washington Post. Please go ahead.

QUESTION: Yeah, hi, Dr. Gerberding. I understand that one of the patients from Canada had just returned from a visit to Atlanta, and I was wondering what was happening there in response to that.

DR. GERBERDING: You are correct. One of the family members of a patient in--who traveled to Hong Kong did visit Atlanta and is reported to have developed respiratory symptoms as they were leaving this country and returning to Canada. The Georgia State Health Department is investigating the exposure potential here among contacts and people who were co-workers of the individual.

In addition, we are working with the airlines to assess the passengers who may have been on the plane when the individual returned to Canada to be sure that we're not overlooking an opportunity to test illness or alert them that they need to seek medical attention should they develop a fever or other symptoms of illness. So that investigation is being coordinated by the Georgia State Health Department. We're in touch with them, and they are very aggressively pursuing all of these lines of investigation.

MR. SKINNER: Next question, please.

GWEN: We have a question from the line of Elizabeth Cohen, CNN. Please go ahead.

QUESTION: Thanks for having this press conference. Dr. Gerberding, can you tell us, is there any reason to think that this is or is not terrorism?

DR. GERBERDING: No, what we know so far about this outbreak is that the people who appear to be most at risk are either health care workers taking care of sick people, or family members or household contacts of those that are affected. That pattern of transmission is what we would typically expect to see from a contagious respiratory illness or a flu-like illness. But we have an open mind, and let me emphasize that we have an open mind and will be keeping an open mind about this as we go forward. We don't know the cause of this, and until we have laboratory information to point this in the right direction, we cannot jump to any conclusions one way or another.

QUESTION: So it sounds like what you're saying is that it's not necessarily--you don't have any reason to think it's terrorism but you can't rule out that it's terrorism?

DR. GERBERDING: We're just keeping an open mind.

QUESTION: And also, do we know how contagious? I mean if I was on a subway car with someone who was ill, could I get it from them, or do you need to have that close like I'm-taking-care-of-me kind of contact.

DR. GERBERDING: What we know so far from the investigations in progress are that it's very close personal contact of the type defined by WHO as having cared for, having lived with, or having had direct contact with respiratory secretions and body fluids of a person with the diagnosis. So there is no evidence to suggest that this can be spread through breath contact or through assemblages of large people; it really seems to require a fairly direct and sustained contact with a symptomatic individual.

CALLER: Okay, thank you.

MR. SKINNER: Next question, please.

GWEN: We have a question from the line of Barbara Garcia, ABC News. Please go ahead.

QUESTION: Hi, Doctor. I have, actually, two questions. How is this particular strain responding to the antibiotics? And is there an emergency response plan, domestically?

DR. GERBERDING: What we can say right now about treatment is that there is no consistent utilization of antibiotics or antiviral therapy in the areas that have had the most cases, and so we have no real information to help tell us whether or not anything is having a clinical impact. At best we could just provide anecdotal suggestions and no data or advice.

So as I said before, our recommendation right now is that patients presenting with severe pneumonia be treated empirically with the same anti-microbial regimens that we would normally use when we have an undiagnosed patient with pneumonia. And we would put a great deal of emphasis on supportive care and isolation precautions to prevent spread in those environments.

In terms of the domestic situation, as I said, we're taking steps today to be on the alert throughout the public health and the medical community for suspicious cases among people who have traveled through these areas or who have had direct contact with known cases. And we are also preparing very specific guidance for clinicians and have assembled our experts here at CDC with Dr. Hughes and the National Center for Infectious Disease to bring together the individuals with clinical perspective as well as epidemiologic perspective to constantly review and update the guidance that we can issue.

So interim guidance today, ongoing advice and information as we know more.

MR. SKINNER: Next question, please.

GWEN: We have a question from Markie Becker, New York Daily News. Please go ahead.

QUESTION: Hi. Thanks, Doctor. I have a question about the doctor who was in New York. Can you tell us exactly when he was in New York and when, exactly, he was taken off the plane? And also, if other--if anyone else is showing symptoms at this point?

DR. GERBERDING: Let me just emphasize again that we have no cases under evaluation or suspicion in the United States at this point in time. That individual is being evaluated by the New York Health Department, and they really are the best resource for providing that level of detail.

QUESTION: Okay. Can you tell us anything about the U.S. businessman in Hong Kong who started presenting with symptoms?

DR. GERBERDING: Very difficult for me to distinguish one patient from another at this point in time because we have more than 150 patients under evaluation, so I can't answer that question off the top of my head.

MR. SKINNER: Next question, please.

GWEN: We have a question from the line of Mary Ann Young, AP Washington. Please go ahead.

QUESTION: I'm on a broadcast line, so first I have to make sure you can hear me.

MR. SKINNER: Yes, we can hear you just fine.

QUESTION: My question is--it's not a question, Dr. Gerberding. If you could please, restate those symptoms converting the Celsius degrees of fever into Fahrenheit.

DR. GERBERDING: The WHO case definition includes a temperature greater than 38, which is a temperature above 101 degrees (Editor's Note: The exact conversion from 38 degrees Celsius is 100.4 Fahrenheit), and cough, shortness of breath, and trouble breathing, and either close contact with someone who's been diagnosed with this illness or recent travel to the areas in Asia that are reporting cases.

MR. SKINNER: Okay, does that answer your question?

QUESTION: Yeah, that's great. I needed the correct conversion.

MR. SKINNER: Next question, please, Gwen.

GWEN: We have a question from the line of Martin Ensurink (ph), Signs Magazine. Please go ahead.

QUESTION: Hi, and thank you. Dr. Gerberding, do you know how many agents have been definitively ruled out as the culprit in these outbreaks?

DR. GERBERDING: As I said, the laboratory assessment is ongoing, and we are having an open mind. We have not completely excluded any pathogen at this point in time. It would be too premature to draw any conclusions until we have the kinds of specimens and blood, respiratory secretions, and autopsy samples that we need to really be conclusive.

QUESTION: Does CDC have any of those specimens yet?

DR. GERBERDING: We have a few specimens, and we're in the process of evaluating them as quickly as we can. But, as you may know, for some tests--for example, virus cultures that take several days for the definitive information to become available--and we're working with WHO to get more specimens. And also the WHO collaborating labs around the world as well as the Canadian laboratories are in the process of evaluating samples. We have confidence that these laboratories can do very sophisticated testing, so, hopefully, information will be coming forth in the next few days.

MR. SKINNER: Next question, please.

GWEN: We have a question from the line of John Verelli (ph), WCBS. Please go ahead.

QUESTION: Actually, my question was on the specifics of the New York case, and I've gotten my answer, basically. I need to call the health department, so thank you anyway.

MR. SKINNER: Okay, thank you. Next question, please.

GWEN: We have a question from the line of Tom Watkins, CNN. Please go ahead.

QUESTION: Can you describe the course of the illness? What are the symptoms that start out, and do people get better or have they all just remained sick? And do you know how many of those 150 odd cases are on respirators?

DR. GERBERDING: We're in the process of looking into the entire clinical spectrum with the CDC scientists who are on the ground in the various affected areas. Some people have recovered from this illness. In addition, some people have had a very rapidly deteriorating course, and others appear to gradually get ill and then stay more or less in a steady state for a period of time. So what we can say right now is it appears to be variable, and we'll be able to say more in terms of numerators and denominators when we have more thorough clinical assessment.

QUESTION: And did the cases in China, did that initial outbreak in, what, February, or in China, has that ended?

DR. GERBERDING: We have very little information about the details of what occurred in the mainland China outbreak during the winter months. And as per the Chinese government, we understand that that outbreak is over.

MR. SKINNER: Next question, please.

GWEN: We have a question from the line of Verena Dodnick, Associated Press, New York. Please go ahead.

QUESTION: Hello, Doctor, and whoever's there. I'm just--I was going to ask about the New York case, and where is this man now and what were the dates of his stay in New York, do you know?

DR. GERBERDING: I'm not going to be able to provide you with the specifics of his travel schedule, but I can tell you that as of this morning he was in Frankfort where WHO has boarded the airplane that he was traveling on and is in the process of interviewing him and other passengers. I believe he's in medical care at this point in time.

QUESTION: Can you tell us what airline he was using?

DR. GERBERDING: No.

MR. SKINNER: Next question, please.

GWEN: We have a question from the line of Mariam Falco, CNN. Please go ahead.

QUESTION: Thanks for the opportunity for a follow-up. Dr. Gerberding, Secretary Thompson mentioned that he had been in consultation with some folks 10 days ago and had a meeting as recently as Thursday. What has happened in the past three days that made you have this press conference now and maybe not on Thursday? Has something significantly transpired in those past three days?

DR. GERBERDING: Yeah, the main urgency for getting information out today is that the cases are now being reported from a growing number of countries in Asia, and the case count is going up quite rapidly. But in addition, we have concerns about movement out of Asia into North America as we learned about the family in Canada and the travelers to the U.S. It was important for us to put the domestic public health system and clinical system on high alert to watch for cases and take necessary steps.

In addition, the travel alert that WHO has issued, has an impact on domestic travelers, and people will be having questions, so we felt it was very important to get this information out so that they would be able to look at these international events in context and not be alarmed about an exposure risk if they don't fall into the categories where we're concerned about potential spread.

CALLER: Thank you.

MR. SKINNER: Gwen, I think we have time for one more question, please.

GWEN: We do have a question from the line of Carol Kingstahl (ph), CNN. Please go ahead.

QUESTION: Thank you, Dr. Gerberding. I actually have two questions. One, you have mentioned that you're investigating people who have come through Georgia and through New York. Are there other states where you have things under investigation? Also, I wish you could speak for a moment about our global society and how disease travels, it seems like much more quickly now, and who you feel like you're addressing it now versus how you would have addressed it, previously?

DR. GERBERDING: The investigations of the patients in Georgia and New York are the only two cases that we are investigating in the United States at this point in time. So as of this moment those are the only two situations that we are aware of. We will not be surprised if additional situations evolve, and that's part of the reason for putting our system on alert.

With respect to the global village, I actually am sitting here with Dr. Jim Hughes, who really is the person is the nation's leader of our global response to emerging infectious diseases, and I'll just ask him to answer the last question.

DR. HUGHES: Well, that's an excellent question. This is a very good example of the sort of global threat that infectious diseases can pose. And you can see just in the information here as it's developing, you see the rapidity with which patients can move from one geographic area to another. So this is a wonderful illustration of the importance of rebuilding the global disease surveillance and response capacity.

MR. SKINNER: Gwen, I think Dr. Gerberding has something to say in closing, and then we'll end the call. Dr. Gerberding?

DR. GERBERDING: Yes, thank you. I again just appreciate your doing this on a Saturday afternoon. I think we would all like to be someplace else today, but I want to make sure I emphasize one point, and that is that we have not identified any cases in the United States at this point in time, but we're thoroughly investigating, and we will be taking aggressive steps to reach those who have traveled to the affected areas. And if anybody who's traveled to parts of Asia implicated in this syndrome has a symptom of fever with respiratory illness, it's very important that they contact their medical care provider.

MR. SKINNER: Okay. Gwen, this concludes our call. Thank you very much.

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