CDC News Conference Transcript

Severe Acute Respiratory Syndrome Preparation

September 26, 2003

DR. GERBERDING: It is just a delight for me to be able to introduce Secretary Tommy Thompson, who's here visiting CDC today. I think the Secretary has visited CDC more than any government official from Washington. In fact this is his sixth visit here since he became the Secretary. So we've had a wonderful morning. We've been able to tour some of our new facilities that are in progress here. He's had a chance to learn about some of the programs at CDC. We've discussed the preparedness efforts that are underway and he's going to take a few moments to update you on the Health and Human Services plans for preparing for SARS.

We know that SARS was a very, very serious outbreak, it came to a successful resolution after a few months, but, globally, there were more than 8,400 cases and almost a thousand deaths.

So we've learned a lot lessons from that and one of the biggest lessons is of course that preparedness is absolutely essential, we have to learn to expect the unexpected and the Department has really "stepped up to the plate" to provide the kind of leadership we need to be able to anticipate and respond very quickly, should SARS emerge again.

So Secretary Thompson.

HHS SECRETARY TOMMY G. THOMPSON: Well, first, let me thank all of you for being here. I am delighted to have this opportunity to speak to the Atlanta press as well as to the press around America through teleconferencing and I appreciate very much this opportunity.

I would just like to start off by thanking Dr. Gerberding.

I think everybody now has recognized her tremendous ability, her charm, her intellect, and her niceness. I remember back when I first interviewed Julie and asked who she thought should be CDC director. We went through a bunch of names, and I turned and I looked at her and I said, Well, what about you? And she said, Oh, no, I'm not ready for the position [inaudible]. I said yes, you are. Then I called my friend, Dr. Bill Roper, who was a CDC director, I don't know when the years were, but he's here today, and I called him up and I said, you know, I really want to appoint Dr. Gerberding. What do you think?

He said, well, is she going to have the support of the public health community? Well, I don't know if she does now but she will as soon as she gets the nomination.

He said if you really believe that strongly about it, go for it, and I think it's been one of my best decisions. Every time I'm with her, I'm more impressed by the job she does and more impressed by what's going on down here at CDC.

We've had the opportunity this morning, just to see some wonderful things. This is my sixth visit here --most secretaries come once. I've been here six times in less than three years, and I thoroughly enjoy it each and every time, and I learn so much. Today, we had the opportunity to get an update on the West Nile virus and that of course is a serious problem going across America. We were looking at the projections out this year, and what's going to happen next year. The people here -- the researchers and the scientists -- are just doing an outstanding and exemplary job staying on top of this [West Nile virus].

We had an update on what CDC is doing as far as vaccinating children in the Marshall Islands for rubella [measles], and it was amazing to me, the length and the breadth, and the tremendous involvement that this great Agency, CDC, of the Department of Health and Human Services has worldwide, does so much to save lives, and the quality of health of so many people, so it's truly my honor to be here.

Since my last visit earlier this year, CDC has led the Department of Health and Human Services' response to some very major public health crises. Can you imagine, you know, since I've been Secretary, we've had 9/11, we've had anthrax, we've had smallpox vaccinations, and then we had SARS, and then we ended up with monkeypox. CDC of course has led the way in all of these areas, and it's just, to me, a tremendous tribute to their professionalism, what they've accomplished.

And then of course they've worked with state and local health departments, just recently, last week, preparing for Isabel, the hurricane, and we still have CDC people that are activated in communities, helping out with public waters and public foods, and making sure that they're safe for the consuming public.

They're playing a major role in my Department's preparation for the possible role of SARS, which we're going to talk about this morning.

Let me take a few minutes to briefly mention what the Department is doing.

Although we cannot predict the likelihood of SARS reemerging in the United States and elsewhere in the world, the seasonal reoccurrence of other respiratory diseases calls for us all to be aware of the possibility that the reemergence of SARS could happen again. We hope not, we have no proof that it's going to. The possibility is there.

This disease is very new. We didn't know anything about it a year ago. We can take lessons from our recent experience but we are also learning more as we go, and you've got to understand that CDC has led the way. They're the ones that came up with determining and isolating the virus. Other people around the world thought it was a paramyxovirus, a different family of virus, and it was the wonderful scientists and researchers here at CDC that determined that it was the family of the coronavirus.

HHS has acted quickly on information about SARS since we first became aware of it last spring. In fact, I negotiated with the health minister from China to allow for CDC officials to go into China, and negotiated with the mayor and the chief health minister in the city of Hong Kong, as well as in Thailand in regards to getting people to allow for CDC workers to go in and be able to give us the information and the specimens necessary so that we could help out the world community.

Quick action, when we first learned of the outbreak, helped prevent SARS, I believe, from spreading to the United States. Truly the leaders, the heroes of that endeavor were the public health workers all across America. There has not been enough written about the great job the public health workers in America did preventing SARS.

Close partnership went on between the federal, the state and the territorial health officers to implement public information and public health measures that kept our health care system functioning effectively and safely, while protecting the health of the general public.

Now, HHS has continued to work with the free market medical community as well as the scientific community to make sure that our nation will be fully prepared if SARS reemerges. Combine efforts of HHS agencies, NIH, FDA, HRSA, and of course CDC, give us a comprehensive approach to preparedness. NIH right now is developing vaccines against SARS. They will not be ready this year, but they are working very hard, spending lots of manpower getting ready to come up with a new vaccine. NIH is investigating a variety of current vaccines to determine which approach could be the most effective. NIH is also screening existing antiviral drugs and other compounds to see if any of them will work against SARS.

CDC and NIH together as partners working with the United States Army Medical Research Institution of Infectious Diseases, along with the Utah State University and the Southern Research Institute, have been able to go through more than 1,000 compounds that have already been screened, and we plan to screen as many as 100,000 compounds. And that goes to find out if there are some compounds out there in the marketplace right now that might work effectively against the SARS virus. Some compounds have shown quite a bit of promise so far, and we're continuing to do research on those compounds.

NIH is also identifying new candidate drugs. We have made supplemental grants to coronavirus researchers to support development of drugs that may be effective against SARS. FDA is working to develop both diagnostic tools in safe and effective treatments for patients who do contact and contract SARS. They're also partnering with NIH in vaccine development.

And FDA, of course, is working with our nation's pharmaceutical institutes and medical equipment manufacturers to assure the availability of adequate supplies of various medical products that would be needed if SARS happened to reoccur and spread in our country.

We also are taking a lot of precautions to further safeguard the nation's blood supply. FDA issued guidance to our country's blood establishments in April and again just this month. At this time, we do not know whether SARS can be transmitted through blood, though we continue to take every possible step to ensure the integrity and the safety of the blood supply.

Dr. Gerberding now will touch on what CDC is specifically doing, and then we will take your questions.

But let me just close by saying this: public cooperation is often the key to successfully responding to outbreaks of infectious disease like SARS. HHS will continue to provide the public, especially to reporters, with information as soon as we have it so that you will be able to report it and that we will be able to act quickly should we have another outbreak of SARS in the world, and more specifically in the United States.

Once again I want to thank the people for doing such a great job here at CDC, and once again it's my privilege to be associated and have the opportunity to call back to the podium the Director, Dr. Julie Gerberding.

DR. GERBERDING: Thank you. It is a wonderful pleasure to be part of the family of HHS agencies that are all working on SARS preparation, but we have to start all from the same place. And one of the best ways to do that is to think back about what we learned as SARS was unfolding.

And there are a few themes that I think are shaping our future preparedness. First of all, obviously, this was a global problem, and so we have to be globally connected as we go forward. Second, we have to be prepared to act very fast. That means that we're going to need to be able to detect the very first cases of SARS and make sure they're isolated, and we're going to have health care facilities that can act boldly and effectively to implement the necessary additional precautions to protect themselves as health care personnel, as well as other patients in the facility and contain spread there.

We also learned that connectivity and collaboration are absolutely critical to our success. And so the networks of communication that have gone on among the laboratory scientists, among the public health officials, among the ministers of health in all these countries, have to be continued, and we are all talking about SARS preparedness collectively. One country or one agency can't do this alone. It requires a global connectivity to be successful.

At CDC we have a role to play in this. Our role is to be at the front end of the public health response, and we are framing our response capabilities in four main areas. The first one is plans. We've got to have plans. The second one is we've got to have people, we've got to have the skilled people and the kinds of preparation that we need to go forward with those people. We've got to have the products and tools to be able to effectively develop countermeasures, and then finally, we've got to have practice.

Let me just say a couple of things about each of those four elements of preparedness.

In terms of planning, planning for SARS actually began while we were still in the middle of the epidemic. We have invited expert consultants in on an ongoing basis to review our interim guidance and to constantly update and revise the recommendations about how to contain this problem and how to more accurately diagnose and manage it.

In addition, we've assembled, now, in these summer months, large panels of experts from around the world who are bringing their own experience with SARS in their own country to bear on our preparation efforts here but also their expertise as infection control professionals or infectious disease clinicians or as people who are responsible for health policies.

We are drafting a comprehensive set of documents that really detail the collective wisdom from all of these people, which we will present to Secretary Thompson next week and then release to the relevant customers, including the public and the media, but a major feature in all of this planning is how do we detect the first cases? What do we need to do in health care facilities to isolate the first patients effectively? And, importantly for us at CDC, what do we need to be doing to support travelers or people who are leaving or coming into the country, in a coordinated manner, through our quarantine field stations and through the other kinds of officials that are responsible for the safety of travelers.

We also have implemented, I think, a gold standard plan for emergency communication. I'll just spend a couple minutes talking about that, because, you know, we are first of course a scientific agency but we take information from our scientific experts in the laboratories and in the public health arena, and we need to communicate that information effectively to a whole variety of target audiences.

So we've developed a very comprehensive emergency communication strategy which we did use during SARS but we're refining and updating that, and we have developed specific teams of people, that we have a clinician team who creates the information tools for clinicians, we have a public health officer team that creates the tools that our public health officials need, and we have, for example a media team.

We have a team focusing on international travel, and so on and so forth.

We also have teams that specialize in some unique populations or special populations.

For example, during the last outbreak, we had a special community team that was specifically focusing on how to get information to people in the Asian community who were especially affected by the outbreak. So that plan is well-evolved and well-exercise, and we are continuing to refine it as we go forward.

In terms of products that we need to respond to the potential SARS cases, Secretary Thompson already mentioned the work that NIH and FDA are doing. One of CDC's major responsibilities is to get the reagents out necessary to support laboratory testing in a situation like this, and our laboratories are fast and furiously developing reagents, testing them, and working very hard to make sure that we've got the state of the art available, in the field when we need it to diagnose the first cases.

In terms of people and training, we have many hundreds of investigators at CDC who are working on coronavirus virology in the laboratories, who are also working on developing better tests and better diagnostic capabilities for this family of agents.

We're also learning more about the spectrum of disease and we're doing the genetic work to compare the coronavirus that we've seen in the previous outbreak with families of coronaviruses from animals and other sources, to make sure that we can detect any new strains or any new evolution in this virus, if it should emerge again in the all.

Lastly, in terms of practice, as the Secretary mentioned, we, in the public health system, have had many opportunities to practice our response capabilities over the last several months, more opportunities than we probably would wish, but we are very pleased that our emergency operations center here, at CDC, is closely interfaced with the Secretary's command center, and that we truly have a response capability that has been exercised time and time again.

We'll also say that part of exercising is to learn from the experience of others involved in the outbreak, and I and several of the other officials at CDC have visited the hospitals that have been affected by SARS, visited Toronto. I went to one of the major hospitals in Singapore that had responsibility for containing the outbreak and we are truly engaged in taking the lessons learned from around the world, bringing them back here to the United States and doing everything we can to be sure that people here, in this country, are fully prepared.

We don't know if we're going to see another SARS patient or not. We will be prepared to be able to deliver the best possible response. But I think we're living in the age of the new normal of emerging health threats and this preparedness for SARS is going to pay off sooner or later, because if it's not SARS, it will be something else, and we'll be ready for it.

Now let me just stop here and ask if you have any questions. We'll start with questions here from the floor.

QUESTION: [Audio breaking up.] [inaudible] first time we've gone [inaudible] the threat of SARS [inaudible]?

DR. GERBERDING: There are some clinical differences between flu and the SARS syndrome that we saw last year. However, in a given patient, it is very difficult to distinguish one respiratory illness from another on the basis of symptoms alone.

So what we will be relying on are, first of all, the history and the context in which we're operating.

Right now, we've had no new SARS patients, so if someone comes into the emergency room with a flu-like illness, it'd be safe to assume it's flu, and that's exactly why we are strongly recommending that all Americans who have risks for influenza get their flu vaccine, and that includes anyone over age 50 or anyone with a chronic medical condition.

But, in addition, we have diagnostic tests for influenza, so we can rapidly diagnose flu and we are encouraging laboratories around the country to utilize those tests so that they can make the diagnosis of flu as quickly as possible.

That also helps us, from a public health perspective, to know where we need to step up our energy to--and use the vaccine.

QUESTION: [inaudible] Atlanta. If we did have a SARS outbreak, here, in the U.S., do you think at airports we'd be seeing activity the way we saw it in Asia, with thermometers passed to passengers or--and when it, if it did come in the cold and flu season, how would airlines be instructed to [inaudible]?

DR. GERBERDING: First of all, we can't assume that the past is going to predict the future, but given that the virus arose in Asia the first time out, it wouldn't be surprising if it was also international presentation this time around, and protection of travelers will be important.

I think the approach to managing SARS is one that should be characterized by balance. We want to cast the broadest net to be able to detect patients with the disease as early as possible, and fortunately, they generally do have fever, but we want to do that in a way that respects their privacy and their convenience and the other variables.

So we want to balance between the need to identify patients and get them into isolation quickly versus the logistic complications of unnecessarily intrusive measures. If we have a very limited problem, of course we're not going to go to a full court press with those measures, but we have a scaled-up situation, we'll want to be acting effectively to determine what is the best way to screen people.

The past experience for us, domestically, the history of travel was extremely effective and the fact that we gave out 2 million of the traveler alerts, in retrospect, proved to be a very effective way of identifying people early in the course of their illness, so that they could be isolated and not spread the disease to someone else. If we had a broader epidemic or a much more distributed pattern, then we would have to consider, and, you know, offer the Secretary some strategies to take additional measures at airports and other points of entry.

Can we take a--go ahead.

SECRETARY THOMPSON: Just to quickly add, you probably know that we asked the President to give us expanded powers as far as quarantining. Most of that is usually left up to the states but at the present time we are very appreciative of what CDC was able to do last year along with FDA, the inspectors at all the airports. I think that the public health workers did a wonderful job.

As you know, you were sick and you came into America from China or from some of the other "hot spots" that had SARS, and they were taken off the plane, they were examined quickly, and if they became sick after that, they were each given a little check [an alert card], a pamphlet in which they could check and get back, and a lot of people that did get sick brought this pamphlet back in, so we know it was very effective.

But it depends upon how severe the cases are in the United States as to how we would respond to it.

DR. GERBERDING: Can I take a question from the phone, please.

MODERATOR: Laurie Garrett of Newsday, you may ask your question.

QUESTION: Hi. Good morning to both of you. Thank you for having this press conference.

I'm looking for some hard science, to see if there's anything new on the scientific front in the last few weeks, and that goes to what CDC scientists are up to.

First of all, do we have any further information narrowing down the animal reservoir question and seasonality in the animal reservoirs?

Secondly, do we have any new breakthroughs on trying to come up with a reasonable diagnostic specific to SARS viral infection that has better specificity and sensitivity than the PCR method or immunological methods?

And third, do we have any further information beyond what Toronto was telling us about six weeks ago, about the ability of the virus to colonize on catheter tubing and mechanical ventilators and what that means about the difficulty of controlling it in an ICU versus in a comparatively primitive hospital in Hanoi?

DR. GERBERDING: Let me first address the issue of the CDC scientists and what they're up to. They're up to a lot of things relevant to coronavirus, and keep in mind that prior to March 15th, CDC had no corona virologists and now we have several dozen of virologists who are working full time on this particular problem.

I think that you've identified, Laurie, exactly two of the critical questions.

The first question: “What is the source of the virus?”, and the short answer is “We don't know”. We are continuing to work with our collaborators in Asia and characterize as many of the strains of coronavirus that can be collected, but we have no proof of the specific animal reservoir source of this outbreak and that obviously leads us to be concerned about a potential reemergence, and since we don't know where it came from, we can't say anything about the potential seasonality.

In terms of diagnostic tests, there are both private sector entities as well as government agencies working hard to improve the diagnostics. We know that we have a very sensitive test for finding the virus genome when it's present but the difficulty is that people did not seem to have virus present in the relevant samples early in the course of illness.

So we're still looking for a test that would both be sensitive but also early enough in the course of illness before the patient became contagious.

And I can't remember your last question. Do you remember your last question, Laurie?

We'll come back to you.

Can I have a question here in the room.

QUESTION: Betsy McKay of the Wall Street Journal. Just to follow up on the diagnostic tests, I was wondering if you could tell us what your expectations are for this flu season. How widely available will a reliable diagnostic test [inaudible] the average hospital or doctor, how quickly can they confirm [inaudible]?

DR. GERBERDING: As Secretary Thompson said, the FDA is working very diligently to develop a protocol for a diagnostic test and the test we have right now is still investigational. We do not have any tests that are fully licensed or that we have proven to be accurate enough to make patient decisions about without using the investigational protocol.

That would be a goal. I don't know if we're going to have anything that would be helpful this fall, but we do have a lot of people working on the development of a diagnostic.

That's very different than the situation with influenza tests, where we do have fully licensed tests that are extremely accurate in making a diagnosis of influenza as well as a number of other relevant flu viruses that could be in a differential diagnosis.

Our emphasis here, right now, is on influenza, and making sure that we diagnosis and prevent influenza effectively through vaccine and other measures.

Should SARS emerge, then obviously, depending on where it was and how it was presenting in this country, we would need to broaden our approach to both isolation as well as diagnosis.

SARS tests right now are being performed in the laboratories that are part of the public health laboratory response network and CDC does provide the reagents and the materials to support that testing program.

The Secretary visited the facility under construction that will allow us to continue to do that in a state-of-the-art environment.

SECRETARY THOMPSON: I've got to just add one thing. That is to urge all of you, [inaudible] urge people to go get their flu vaccine, because that would be very helpful to us this fall [inaudible] to get people vaccinated. We have plenty of vaccine, and got a new nasal spray if you're afraid of needles. So I'm just offering that and encourage you to make sure you put that in your reports.

DR. GERBERDING: Another question here in the room.

QUESTION: Hi. David Wahlberg from the Atlanta Journal-Constitution. Another testing question.

I'm just wondering, given the confusion we've had with some of the tests so far, what are the guidelines going be in terms of interpreting test results that may come up soon, that are again confusing?

DR. GERBERDING: Of course I mentioned connectivity and collaboration as being some of the lessons that we learned from SARS, so the scientists in various laboratories around the world, through the efforts of WHO and HHS, and other entities, are continuing to collaborate on developing tests and cross-testing them.

In other words, in order to know if your test is any good, you have to share specimens and samples of the virus, and so on and so forth.

We are lucky, in a sense, that this wasn't a very large epidemic, so we don't have a lot of samples, and it makes evaluating the benefit of a new test very difficult because there simply isn't enough material to check, one way or another, if a new test works.

So that kind of collaboration and prioritization of who should have the samples and what tests look the most promising is something that still is being conducted in the spirit of cooperation.

In the meantime, since there are a variety of tests that people are using, we'll do the same thing we did last time, which is we will explain with a given test what is the criteria for a positive, what is the criteria for a negative.

We will also share samples from one lab to another to see how the tests are performing across different laboratories and we'll have to work very hard to keep that communication clear.

As a general principle, we want to be inclusive, so if we get a test that's positive, we're going to treat that individual as a SARS patient until we have evidence to indicate otherwise.

Can I take a phone question, please.

MODERATOR: Robert Wallgate of The Scientist, you may ask your question. Your line is now open.

DR. GERBERDING: Robert, are you there? Is there another question from the phone? We'll come back to Robert.

MODERATOR: One moment. Ira Dreyfus, AP Radio, your line is now open.

QUESTION: Hi. I'm curious to see how you would rate the odds of a recurrence -- unlikely, somewhat likely, moderately likely, very likely, extremely likely. Where you expect recurrence to pop up first?

SECRETARY THOMPSON: Somewhere in between.

QUESTION: Okay; we'll start with that.

Where also would expect the recurrence to pop up first, if it does, and very specifically, if you could, how much, how many people, and what other resources you have in place to watch for it there.

DR. GERBERDING: We don't know whether this virus is going to come back or not but as an infectious disease expert, I can say in my experience I've never seen a pathogen emerge and go away on its own. So I think we have to expect that somewhere, some time, this coronavirus is going to rear its ugly head again and that's the whole purpose of all this preparedness effort.

We can't say where but given that it showed up once in Asia, it's a good bet that would be the most likely place for it to emerge again, but there's absolutely no proof of that and I think we have to be prepared for the unexpected, and we need global preparedness.

The best way to be prepared is to have the laboratory capacity and an informed clinician frontline in the international community, so that when a collector of unusual patients occurs or whether we see respiratory illness being transmitted in hospitals, or a patient with an unexplained severe pneumonia from an area that's previously been affected by SARS, we'll want to treat that individual as a potential case until proven otherwise. That takes the kinds of support that we're receiving from the Department and from the administration to establish global sentinel laboratories.

We have a program like that in several countries in Asia, for example in Bangkok, CDC has a very large field station that's gearing up and was really the staging area for our SARS response.

We also are working in China. The Secretary is making a visit to China in the upcoming weeks and will be visiting with the Chinese CDC. So we're doing the things that we can to provide the technical support, the laboratory support, and the coordination that we need to communicate effectively and really get out in front of this, I think much more quickly than we did in the past.

I don't want to speak for the Secretary but I think we both feel optimistic, that this time out, we'll be better able to contain the epidemic because we'll likely have earlier detection and earlier reporting.

One last question here in the room.

QUESTION: [inaudible] Petafore [ph] from Fox, here, in Atlanta.

I was wondering if you could go down the numbers again, globally, nationally, of the SARS outbreak--

DR. GERBERDING: I'd be happy to frame that and if you need specific follow-up information it will be available on our Web site.

Last year, WHO reported 8,422 cases of SARS with 916 deaths [WHO’s Summary of probable SARS cases with onset of illness from November 1, 2002 to July 31, 2002 totaled 8,098 cases of SARS with 774 deaths (revised as of September 26, 2003)].

In the United States our final figures were 74 probably people with SARS, eight were confirmed in the laboratory, 38 were negative in the laboratory, and 28 did not get convalescent sera. So, we couldn't say one way or another, whether they were true positives or true negatives.

We also had 344 suspect cases. None of these had a positive laboratory test out of the 169 that were completely tested, and the remainder also didn't send in the follow-up serum, so we were never able to completely ascertain their status, one way or another.

This is common in all outbreak situations, when you rely on blood tests for the diagnosis, looking for an antibody that shows up late in the course of illness.

Very often, we find that people just don't get around to coming back to get that final blood test. So, we always have some unanswered questions about the total case counts and that will probably be the case until we have a different kind of diagnostic testing protocol.

Thank you very much for your attention and we really appreciate your interest in this story.

SECRETARY THOMPSON: Thank you very much.

DR. GERBERDING: Make sure you get your flu shot. Thank you.

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