COVID-19 Lessons From Washington State

COVID-19 Lessons From Washington State

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Coronavirus

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Vin Gupta, assistant professor of global health at the University of Washington and principal scientist at Amazon Care, discusses the status of COVID-19, lessons learned in Washington state, and the challenges of delivering medical care to underserved groups.

Speaker

Vin Gupta

Assistant Professor of Global Health, University of Washington; Principal Scientist, Amazon Care

Presider

Irina A. Faskianos

Vice President for National Program and Outreach, Council on Foreign Relations

FASKIANOS: Good afternoon and welcome to the Council on Foreign Relations State and Local Officials Conference Call Series. I’m Irina Faskianos, vice president for the National Program and Outreach here at CFR. We’re delighted to have participants from forty-five states across the country joining us for today’s discussion—which, as a reminder, is on the record.

As you know, CFR is an independent and nonpartisan organization and think tank, focusing on U.S. foreign policy. Through our State and Local Officials Initiative we serve as a resource on international issues affecting the priorities and agendas of state and local governments by providing analysis on a wide range of policy topics. We produce Foreign Affairs magazine, and we can also arrange briefings with CFR experts. Many of you are on the front lines of responding to COIVD-19 in your communities, which is—we are thankful for all of your service.

And we’re pleased to have with us today Dr. Vin Gupta. Just let me give you a few highlights of his impressive career, before turning it over to him. Dr. Vin Gupta is an affiliate assistant professor of health metric sciences at the Institute for Health Metrics and Evaluation at the University of Washington. His research includes pulmonary and critical care medicine. He is the principal scientist at Amazon Care, a virtual medical clinic for Amazon employees. He holds an active commission as major in the United States Air Force Reserve Medical Corps. And he recently served as the primary public health consultant on pandemic emergency financing for the World Bank. He is also a term member of the Council on Foreign Relations.

We are really delighted to have you with us, Vin, today. As a reminder to all of you, the call will be on the record. We will share the audio and transcript on our website, CFR.org, and send you a link to those materials after the fact.

Vin, thank you very, very much for being with us. You are based in Washington state. It would great if you could begin by giving us an update on where things stand with COVID-19, talk about the efforts in Seattle and in the state of Washington, how you’ve dealt with the outbreak, and touch on the challenges of providing medical care during this crisis to vulnerable groups, including the homeless.

GUPTA: Irina, thank you for having me. And it’s a true privilege here to be able to talk to state and local leaders across the country as we’re all dealing with the challenges posed by an emerging infection—infectious pathogen, like COIVD-19. It’s, you know, by definition diseases like COVID-19 that are respiratory in transmission are really difficult to prepare for, even though we talk about preparedness. A lot of what government does is response, just because there’s only so much you can predict and prepare for, given the uncertainty.

As Irina mentioned, I am a—hold a few different roles here in Washington state and have seen firsthand from a few different perspectives how our government and other key stakeholders across the public sector, private sector, nonprofit sector have worked really in common cause to respond effectively. And so what I’m going to do in the first ten minutes here is try to succinctly summarize across a few different buckets the current state of affairs with respect to COVID-19 in Washington state, and then what I think have been really effective measures put in place across a few different bucket areas. One are emergency declarations. The second is just social distancing policies and work from home policies that both the government and private companies have taken the lead on. Third, I’ll go into testing. And then a few other comments on PPE and workforce—health workforce needs we were having, that we continue to have, but that I think we’ve put into place ineffective solutions.

So where do things stand currently? We have approximately 8,400 cases now. So went from being the clear epicenter of the crisis here in the country to now being at the bottom of the top ten in terms of burden of disease from COVID, in terms of cases detected. I want to emphasize that regardless of where you’re listening in from, this is—this number’s a gross underestimate. And likely the numbers that you’re experiencing in your community are a gross underestimate because testing is a huge problem and is not nearly at the scale that we need it to be to truly understand the point prevalence of COVID-19 across the country.

So at 8,400 cases, we, again, are wrestling with a true unknown in terms of actual burden. Taking a step back here, what we do know, and I think it is helpful to contextualize our actions moving forward, is on January 21 we had the first indexed case of COVID-19 in the country. It was a thirty-five-year-old gentleman who returned from Wuhan. He was, importantly, asymptomatic initially. Four days later, he developed pneumonia-like symptoms, and then ultimately was found to have COVID-19. We had the first death in the United States at a hospital north of Seattle in Kirkland, Washington on February 26. And then ultimately, we were the epicenter until about mid-March in both absolute and per capita terms with respect to caseload.

Where this changed for us and I think where it changed for the country was on February 28, a local high school student in a suburb north of Seattle had a confirmed case of COVID-19. The student was asymptomatic but was tested. And the exact circumstances around testing are a little unclear to why that person was tested. But that—the individual actually had the same strain of COVID-19 as the indexed case of the thirty-five-year-old gentleman one month prior who had returned from Wuhan. And that was a big shock to not only all of us in the public health community in Seattle, but I think to the country because subsequent to that, on March 2, Dr. Trevor Bedford at the Fred Hutchinson Cancer Center at the University of Washington, who specializes in a field called genomic epidemiology, basically he traced the genetic footprint of infectious diseases like COVID-19 to examine the mutations over time.

He really convincingly showed that it’s likely COVID-19 had been circulating in our ecosystem of the last six weeks, because this high school student had the same type of—the exact same footprint of COVID-19 as the indexed case. He then subsequently was able to get DNA data on a few other individuals who had passed away from COVID-19 in the days immediately ahead. And it showed that there was key differences in the strain of COVID-19 that they died from versus the indexed case from China. And why is that important? It’s important because it lent further credence to this notion that not only had COVID-19 taken root and was in the phase of widespread community transmission, but it was mutating. It was changing. And it usually takes four to six weeks at least for a pathogen like COVID-19, or another virus, to really demonstrate the ability to mutate and change.

So this really took us by surprise. It was a big shock to the greater community and, I think, to the country. What we saw then in the subsequent days in terms of just immediate actions, Microsoft had two employees test positive for COVID-19. My new employer, Amazon, had an incident case detected. And pretty rapidly we saw work from home policies amongst some of the largest employers in the country how to turn Seattle—implement work from home policies, which was a sea change. And by doing so, for example, Amazon when they went work from home basically you went—you saw a downtown that was vibrant and filled with people one day, essentially shut down the next day, irrespective of what the government was doing in terms of social distancing laws that had yet to be put in place at that time.

So that’s a little bit of level-setting on just where we are in terms of burden, at 8,400 cases now. Starting with some of—the indexed case back in January 21, seeing that this epidemic really here in the United States transitioned from—there was a lot of unknown upfront in terms of how long has COVID-19 been circulating in the ecosystem, well, by early March we recognize it had probably been for the last two months because it was changing at the genetic level. And now we’re seeing cases increase here, and nationwide. But again, likely a gross underestimate.

What’s been done? And I think, what can be helpful to help guide responses in your communities? So in terms of declarations, Governor Inslee—and a lot of this is publicly available information, so I’ll try to focus my comments on what’s maybe a little less known. But just at the very top Governor Inslee issued a state of emergency on February 29. Mayor Jenny Durkan followed on May (sic; March) 3 with a simple emergency declaration, which essentially just allotted for increased funding for emergency—public health emergency response. And both of those declarations were well-received by all the public health systems here locally.

Heath screenings—the initial health screen that was recommended—and this has since been revised multiple times, and become more restrictive—is on March 9, once it became clear that the epicenter of deaths and disease burden from COVID-19 was a nursing home facility north of Seattle, Life Care in Kirkland, Governor Inslee moved towards ensuring that visitors of any nursing homes needed health screenings before entering. So there was that initial effort at containment not mitigation, which we’re seeing now. But we contain where the cases are localized to, that nursing facility, and make sure that we minimize transmission in so-called hotspots. As opposed to mitigation, where everybody needs to socially distance because we think this is community spread and everybody is likely at risk.

Can we contain it? And so even in spite of some of the research that was coming out of the University of Washington by Dr. Bedford that suggested there might be some community transmission happening already for the last six weeks, some of the initial regulations that were put in place by Governor Inslee and others were really focused on containment. And so that was on March 9. Really rapidly, that same week we had work from home policies implemented, again, by Boeing, Microsoft, and Amazon.

Testing—just to get to that bucket—testing has lagged, unfortunately. And lagged, and has not kept pace with the realities of case detection, of understanding just the burden in terms of community transmission and what that means in terms of how can we really get ahold of this outbreak? So we have not been able to get testing online as quickly as the realities of the pandemic have changed locally. Things are different now, but they were not—testing was not online as rapidly as we would have liked it to have been a month ago. And I’m going to talk a little bit about what we’ve been doing here that I think could inform different approaches across the country. But we have, just briefly, have rolled out drive-through testing, which I know is happening across the country. CVS just went live with drive-through testing across the country at their various pharmacies.

We have implemented, and I was part of an effort to help lift up the Seattle Coronavirus Assessment Network, which is an effort between the University of Washington, Amazon, our local department of health, and the Gates Foundation to really do home swab and send testing. So the idea was, you would go to a website, you would fill out a brief questionnaire that was designed by scientists at the University of Washington. It would then determine whether or not you qualified to receive a home swab to test for the presence or absence or COVID-19.

Amazon would then be the middle mile, deliver the testing sample and then pick it up, and we would then deliver that sample to the University of Washington for assessment, and then you would get a test finalized, and that would help understand—or, help and individual, of course, understand what measures they should take to minimize transmission and/or implement self-care measures as needed. I can talk more about that in just a bit, but that is a paradigm that we’re hoping could be expanded more broadly. But certainly, some growing pains in terms of getting it implemented.

Finally, just a few comments on social distancing. So on March 11, Governor Inslee banned large gatherings, irrespective of reason. So religious, spiritual, otherwise, for those gatherings greater than 250 people. And there was enforcement. So the Washington Military Department could enforce that edict if necessary. On March 12, there was closure of kindergarten through twelfth grade, leaning establishments. And that was starting March 17. March 15 we had a closure, shut down restaurants, recreation facilities.

On the 16, Mayor Durkan implemented a pretty well-funded grocery store voucher system for those that were dependent on SNAP to the tune of $5 million. So there was some effort to make sure that those who were already food insecure have increased support. And I know—I sit on the board of Northwest Harvest, which is our primary nonprofit organization really trying to get food to food banks across western Washington and eastern Washington. And they have been very active on the public—on the nonprofit side to make sure that food banks and those that are food insecure get the—get the staples that they need. Finally, on March 23, Governor Inslee issued a stay at home order, which he then extended to May 4 just a few days ago.

And so those have been efforts to encourage social distancing, first through just guidelines and then secondarily through actual edicts. And I can—I’m happy to talk about just qualitatively the effect that’s had on Seattle psychologically, economically. But then we are now getting data quantitatively that shows that the prevalence of fever, for example, in the greater Seattle area, that we can detect through connected thermometers—it’s a long story. I can get into it. The idea here is that there’s a lot of fever that happens in the flu season across the country. And there’s companies that are actually measuring the density of—or, the frequency of fever using connected devices. So users actually have a thermometer that can connect to their iPhone and can track whether that user has a fever.

What we’re seeing, this company’s called Kinsa, users of this connected thermometer are funneling up data in aggregate to this company, Kinsa. And Kinsa’s sharing it with the CDC. And what we’re seeing is that fever densities are actually dramatically declining, especially in areas like Seattle that have instituted very strict social distancing measures. And so we’re seeing the qualitative and quantitative evidence that our government leadership’s really working.

A few last comments, just given my military hat. I’ve been really pleased to see that we’ve been on the forefront of planning ahead for hospital triage and capacity. So two field hospitals have been built here in the greater Seattle area, one in a soccer field that worked with Seattle that can house up to 200 coronavirus patients. And that was done by our public health system. So that was a nonmilitary effort. Secondarily, there is another triaging facility that’s being stood up at CenturyLink Field, the home of the Seattle Seahawks. And that decision was made to activate the Army Corps of Engineers and the Washington national guard to help stand that up.

And that was for non-COVID patients, so just essentially to have individuals that—(inaudible)—but need acute care—have acute care needs. How do we house them? How do we minimize their exposure to COVID-positive patients that are largely, or at the time at least, were largely taking up capacity in brick and mortar hospitals across the area? How do we create some degree of physical separation? So the idea was to create a non-COVID triage hospital. And that’s being set up at CenturyLink Field. I think that that is an important piece of any pandemic response. Physical separation, creating more hospital capacity. And so we’ve been really trying hard there to—our leaders have been—to build that.

Lastly, PPE has been a struggle. I can say this as, you know, I’ve been intermittently serving in our intensive care units. And I can say that PPE guidance has changed dramatically for the country. So in all your localities you’re dealing with the same changing guidance as we are here in Seattle. So there’s little local control that can be exercised in terms of what the overarching guidance is on how health care workers can protect themselves, especially in the in-patient side, especially in emergency rooms and intensive care units.

So we’re taking our cues from the very top. I will say on March 16 a letter from our congressional delegation was issued to Secretary Azar to release PPE from the strategic national stockpile. That was then done. And I can anecdotally tell you that the nature of the PPE that I was able to then use when caring for critically ill COVID patients dramatically changed. Just sharing a story, one day I was going into a room with a patient that was intubated with COVID with a surgical facemask. A few days later, an N95 mask, and then an actual hood that creates a negative pressure environment around your face.

So a really dramatic difference between pre-strategic national stockpile being released for our organization and then post getting more resources, what that meant for health care workers on the front lines. Really dramatic difference. And so all the headlines you see, there’s a lot of truth to the impact this could have on people’s health, their risk of exposure. The more we release some of these reserves, the more we make sure that we have more on hand and that it’s of high quality. So there were some concerns about rotting of these masks. And so making sure that we have a stockpile that’s ready, that’s high quality, and can be deployed to areas in need is really critical.

I’ve been talking now for about twenty minutes, so I will pause there. Irina, if there are any points of clarification or if there are questions, glad to try to answer them.

FASKIANOS: Wonderful. Thank you very much, Vin. Let’s go right to questions. There are a lot of threads to pick up on here. And I want to yield the time to our group. So, Brandon, let’s open it up.

Q: Hi, everyone. Thank you so much. My name is Will Mbah. I’m a city councilor here in Somerville, Massachusetts.

I’m really grateful to be part of the conversation, and also learning a lot from what is happening globally. So I guess my question is, how do we limit this community transmission when testing and treatment is being provided just to those who can afford health insurance, who have the means? So what is the thing that other communities—other communities are doing in order to be able to, like, test people without health insurance?

GUPTA: Thank you. It’s a really important question. So I think there’s two reactions I have to that. The first is, there’s—at the proximal end, there is simply just technological bottlenecks, diagnostic supply bottlenecks that are limiting our access to good testing that’s high quality right now. That’s the problem. And so what we’re seeing here is, and it doesn’t get talked about enough, is the types of tests that we need—let me take a step back and just say, what are the tests that we need to get people back to work, to get America back to work? Because all public health experts really universally say, the only way we can get people back to work and get back to normal life is do mass testing?

Well, there’s a problem in that statement is we don’t have enough swabs—nasal swabs, Q-tips essentially, but specialized medical Q-tips, that people have to put into their—into their nostrils. We just—that’s a supply limitation. There are not enough supplies out there for 330 million Americans, or even a healthy majority of Americans, to get tested, not to get tested with frequency. So until that changes, we’re not going to have per capita testing rates that are going to be sufficient and that will give us useful information for us to get Americans back to work.

The financing piece, just a quick comment on that, especially in Massachusetts—and correct me if I’m wrong, City Councilor, but I—now, pretty much universally, certainly here in Washington state, there have been allegations made of state insurers any recipient of Medicare and Medicaid that any copays would be waived when it comes to not only testing for COVID-19 but treatment for COIVD-19. So there should be—in Massachusetts, I would be surprised, I don’t have the latest information on Massachusetts in terms of health care financing for COVID-related issues, but this has been widely adopted in a lot of states across the country. So—and there has also been a federal edict when it comes to CMS. And so any enrollee of Medicare and Medicaid should not have a problem getting tested for COVID-19.

So that, to me, is a—is a distal bottleneck, I’m sure, for still some people who have private insurance where the rules may be a bit more variable. But anybody who’s getting public health insurance should have access from the financial standpoint. But the key piece here, and I think we should all be messaging on this, especially you, this group here, that are state and local leader, is supply. An antibody test, when blood gets drawn to determine the presence of antibodies for COVID-19—so, let me say that another way—the presence of immunity. If you have an antibody against COVID-19, which would then suggest you’ve been exposed and hopefully will have immunity to the disease—that test, while good and important, is not what we need to minimize transmission. We need to know do you have the virus in your nostrils or in your mouth? And that requires swabs, which are in short supply.

FASKIANOS: Thank you. Next question.

OPERATOR: The next question will come from Beth Mason, Ventnor City, New Jersey mayor. Please go ahead with your question.

Q: Hi. I was totally listening to every word you said, and I agree that the other gentlemen that just got on the phone, I actually learned some things. So my one question is, when you talked about March 2, and I think that case showed a different strain of COVID-19. Am I correct?

GUPTA: That’s correct.

Q: OK. So here’s my question: Are the different strains—has any work been done with the different strains related to the different symptoms, and whether it’s a mild, moderate, or severe case, or—I notice over time, I’m sure we’ve all gotten so much information it feels like there’s more symptoms that keep getting added to the list of symptoms. So is there anything prevalent to specific strains? Do you understand what I’m asking you?

GUPTA: Yes. No, that’s a great question. Thank you. And thank you for what you’re doing out in New Jersey. I know you’re seeing in particularly getting hit hard.

Q: We’re getting hit hard, yes.

GUPTA: So, you know, the short answer, and I can—I can delve deeper—the short answer is: We don’t—the strains in and of themselves, we don’t know yet if one is more pathogenic than the next. What we do know is that if you give the same strain to, say, two thirty-year-olds, both healthy, one might end up in the ICU, the other may not have symptoms. So there seems like there is a host response, to use a technical term. There’s a response to the individual—in the individual human being that we think might have a genetic basis, where some people do really well with COVID-19—eight in ten, in fact, do just fine. But the two in ten don’t do well. And usually, what’s interesting, is that if you’re younger with no preexisting conditions some people do really well, others are ending up in the ICU. Again, sort of age blind.

And so the answer to your question is it doesn’t seem like it’s necessarily an issue with the strain—i.e., one strain doesn’t seem like it’s more pathogenic than the other. But it does seem like all of us humans are reacting to this differently. And Dr. Fauci suggested, again, in the absence of, like, any certainty—these are workstreams that are happening as we speak. We’re trying to learn more. And in the absence of any evidence, our—is there a genetic underpinning to why somebody does well while the next person doesn’t, especially amongst our younger population?

In terms of the symptom profile, you know, common things being common, it still seems like largely speaking most people suffer from shortness of breath, cough, and fever. And that if you have all three your pre-test probability of COIVD-19 is enormously high. So, you know, one of the—one of the struggles we had initially, and I think every locality did, was, you know, we were only testing individuals that had that symptom profile, plus a travel history to Wuhan. And it turns out, and then subsequently to Italy and Spain and a lot of other hotspots. It turns out that we shouldn’t have had that sort of criteria. Easy for me to say that now, quarterbacking. But it just now—we’re screening people based on their symptom profile. If you have all three, pre-test probability is quite high. You should be self-quarantining. There is some now—some sense that GI symptoms are coming into play a little bit more frequently. So diarrhea, stomach upset. But usually it’s still just those top three pulmonary and general malaise, fever-type symptoms that are predominating regardless of genetic footprint of this strain that infected you.

Q: Can I just add another quick, short question, if I’m allowed?

FASKIANOS: Quick question, since we have about fifteen queued up.

Q: Real quick question. If someone is tested after—I mean, if someone has, like, those symptoms—the cough, the fever, and not shortness of breath, but then they just lost their taste—weeks later, the taste and the smell. And then they finally decide, OK, I need to go back to the doctor, and they test them, and they show up negative. Is it possible that people that did have the COVID-19, their body just dealt with it, if they get tested weeks later it shows up negative, it won’t show up positive? Does it have to be, like, an active virus in them to be positive?

GUPTA: Such an important question. So I’m going to take sixty seconds on this because I think it’s important for everyone to understand.

Q: I’m sorry. I’m sorry.

GUPTA: No, no, no, no. This is—we still—I don’t think the public debate is talking enough about testing and its implications. So thank you for the question.

So what we need is viral—so, PCR-based testing, that can show—that can test for active virus in your nostril, in your saliva. That’s what we need to determine can you transmit this disease to the next person. Are you coughing it up? Is your—I’m just going to be pretty direct in my terms here—does your snot have it? So that’s why you need the swab test. To get to your point, Beth, what you need also to determine did somebody have it but then they recovered is the antibody test. That’s I do a pinprick on my finger, put a few drops of blood on a piece of paper that’s the right type of medical paper for a blood spot, send it to a lab and they say: Oh, yeah. You know, you have immunity to COVID-19.

That—we need both, because then we need to know who might be immune to this disease, doesn’t have virus, and can go back to work. And the question, the big question from a public health lens, is if you have immunity to COVID-19 now, does that really protect you? We don’t know the answer. So does it—does development of immunity to COVID-19, one, does that last? And, two, is that truly protective? We think it is, because we’re giving plasma, basically antibodies from those individuals that don’t have virus but they do have antibodies, to people that are critically ill in the ICU. It’s called convalescent plasma donation. A few studies are going across the country. And that’s—people are doing well. People are coming off ventilators. They get those plasma donations. And they’re doing well. So it means that these antibodies can actually fight off the disease.

How long they stay in your blood, who knows? You know, we have to get an annual flu shot to kind of rev up our immune system to produce antibodies to flu, because we know it takes about a year and it attenuates. What happens with COVID-19 antibodies that are acquired, either through donation or through an immune response you’ve mounted? We just don’t know. So that’s the big unknown. But we need both tests.

FASKIANOS: Thank you. Next question.

OPERATOR: The next question will come from Jul Calabrese from the office of Senator Troy Singleton. Please go ahead with your question.

Q: Where you get your plasma drawn, you have to find out for sure. They hardly mention that in anywhere that I’ve heard of. So people want to know where can they help and where can this be done? I wanted to know—I think it’s called the Kinsa company. I don’t know if I’m pronouncing it right, the thermometer that’s connected to the app. Who knows about this type of app? Was this app announced publicly? Or is only the government—does only the government know about it?

GUPTA: Yeah, no, I’m happy to answer that question. So the founder of Kinsa is actually a good friend of mine, Inder Singh. So K-I-N-S-A. This is a company that I think you’re going to hear a lot more about in the coming years, because what they’re trying to do is understand—they’re in the space of hot spotting. And what does that mean? That means where are fevers popping up across the country using the latest in geospatial technology so that we can visually see in this specific zip code, at that specific street, in this specific house there’s a fever happening. Obviously—but it requires people to use their device and to use the app to upload the information to the cloud, so that we can get a greater sense that in aggregate across the country: Wow, there’s a lot of fevers happening in New York City right now. And there were a lot of fevers happening in Seattle on March 1, but they’ve attenuated over time.

And to have some sense of geospatial awareness around where fevers are happening in crucially important for disease transmission control, because we know that if you’re close to somebody with COVID-19 who has a fever, you’re likely to get it, just like with flu. And so Kinsa was based on trying to tamp down flu transmission every year by providing geospatial awareness at the city block level of—you know, for example, you’re a user of their device. You have a fever. And, oh, by the way, there’s a lot of fevers happening around you. So the pre-test probability that you have flu is pretty darn high. So that’s the idea.

I can tell you, because we just had a conversation with them last night, that they’re on backorder for six hundred thousand thermometers, which are as cheap as the thermometers that you would buy at a local drug store. That their innovation is that they are providing connectivity to an app that then allows CDC and our government, who is using their data now, to see what’s happening with fevers across the country. And, thankfully, to justify that social distancing is working to draw down—or, you know, to reduce fever transmission, we think to reduce COVID transmission.

I would urge you to Google Kinsa and you’ll come to a website called HealthWeather.org. Don’t quote me on that actual website at the moment. But you’ll actually see over time that the fever curve for the country has dramatically declined since we’ve introduced social distancing. And I’m glad to put any of the folks on the call in touch with Inder Singh and the company, if that’s helpful. And I can do so offline with Irina.

FASKIANOS: Terrific.

Vin, just a quick follow-up here. Do you think it’s necessary for all states to enforce a social distancing policy? There are a handful that have not gone to that yet, in order for us to flatten the curve, you know.

GUPTA: Thanks, Irina. You know, I feel pretty strongly that the answer is yes. And the reason why here is because we don’t have good testing, we really don’t know what the true prevalence of COVID-19 is in urban areas, like Seattle or New York, or in rural towns in the heartland. I’m from Ohio. I don’t feel like we have the true—and, you know, testing isn’t happening at scale back home. And it’s not happening at scale anywhere.

And so that’s a huge problem because we don’t have a good sense of, you know, what’s the true prevalence rate of this disease. And the issue here is if we don’t really reduce day-to-day transmission amongst people everywhere, it’s going to stay somewhere rooted in an ecosystem, in a community, and then come the early when temperatures go back down—since we are hopeful COVID’s not going to prosper in the summer. But if it’s still lying—if it’s still somewhat prevalent, somewhat viable in a few communities across the country, we know it just takes one localized outbreak in one part of the country to create a national catastrophe again. And so that’s why we need to try to root it out of every ecosystem in the country, every zip code. And I can delve deeper into that, if that’s helpful. But the answer—the short answer is, yes. A national lockdown, in my view, has been needed for the last four weeks. And I think that’s the only way to get us back to normal life, you know, as quickly as possible.

FASKIANOS: Thank you. Next question.

OPERATOR: The next question will come from Jason Knight with Montgomery County, Tennessee government. Please go ahead with your question.

Q: Yes. Can you hear me?

FASKIANOS: Yes.

GUPTA: We can.

Q: Oh, yes. I want to say thank you for putting this call on and allowing me to ask a question.

So is there any—or, is there a timeline projected for when the curve is to be flattened for the entire U.S., and how soon individuals can get back to work and get back to a sense of some sort of semblance of normal life?

GUPTA: Thank you for the question. This is a complicated question with no easy answer. So what I can tell you is any modeling forecast—so I’m going to say a few names and would urge you to look these up, and I can send more direct links to Irina. The Institute for Health Metrics and Evaluation I think has the most definitive modeling forecast on what COVID-19’s going to do here in the United States and across the world. And they are suggesting that deaths are likely going to peak in the coming week and we’re going to see hopefully—if continuing policies remain, continued attrition. So the flattening of the curve is actively happening.

There’s a lot of assumptions that are being built into that model, though. And this is where it’s key. And this is where I personally am worried about some of the messaging that’s happening around deaths sort of peaking in New York and elsewhere, and, you know, worry that we’re going to put our foot off the pedal. Any modeling forecast out of IHME or elsewhere presumes that we continue what we’re doing now in terms of social distancing, if anything make it more restricted. And it’s looking at the lessons learned and building them into—so the lessons learned from Italy, Spain and Wuhan, all of which have implemented far stricter social distancing laws than we have here in the United States. To Irina’s point, there’s still about ten states in our union that have decided not to do social distancing, even in terms of recommendation. In the other forty, there’s still somewhat of a patchwork approach.

So we’re definitely doing more middle of the road than what Italy, Spain, and certainly Wuhan did. And they saw pretty extraordinary results, even in two months. So I think we need to be cautious in overinterpreting the peak and depths that we think might be happening in places like New York, or the fact that we feel like we’ve flattened the curve here in Seattle. If we don’t continue to do that, and I think make it stricter, we risk drawing this out, or risk having a second peak more soon, or sooner than we were anticipating.

So that’s where I think any forecast builds in assumptions on policy. And any forecast is basing its forecasts—or, its predictions on what Wuhan, Italy, and Spain did. And it’s really important to understand that they are doing something far greater on social distancing than we are. So we should expect results on a slower scale, and probably continue that continued caseload for a longer period of time than what they’re seeing, because we didn’t—we haven’t been as aggressive with social distancing across the country.

FASKIANOS: Thank you. Next question.

OPERATOR: The next question will come from Sean Smith with the city of Covington, Washington. Please go ahead with your question.

Q: Hi, Dr. Gupta. It’s Sean Smith. I’m the mayor pro tem here in Covington, Washington.

I have two quick questions. Other than what cities are doing related to closing their parks, their city facilities, and sending their workforce home to work remotely, what else can cities do help stop the spread of this virus? And then, two, it’s not so much a question but I’m getting a little concerned about the possibility of an additional emergency coming on top of this. Here in the Puget Sound area, we live in the earthquake country in the United States. And there’s nothing preventing a major earthquake happening in this time. And I’m wondering about our ability to respond to that emergency. Could you speak to both of those?

GUPTA: So just a quick clarification—first of all, thanks for the questions. A quick clarification, is the idea are we—is our ability to mount an emergency in terms of resources and infrastructure, is that limited because so much of our emergency capacity is dedicated towards COVID-19?

Q: I’m getting a little concerned about that. If we had a major earthquake right now there may not be outside assistance to come to the aid of Puget Sound. And I just wonder if we thought about that.

GUPTA: It’s a great question. So what I can say, and I’m putting on my Reservist hat at the very least, is I don’t think we’ve mobilized the full power of our National Guard and our Reserves, at least locally, in response here to the crisis in Washington state. Which is to say, I think there’s a lot of excess capacity to respond if there was a concurrent national disaster, like an earthquake. So and what we’re also seeing, in terms of prediction models on surge capacity for us to use, whether that’s at Harborview or Virginia Mason, like all the major medical facilities in the greater Seattle area, is that we have capacity. We actually just returned 400 ventilators to the strategic national stockpile.

So I would actually be reassured, Sean, that we could respond both in terms of human capital and just needed equipment and infrastructure, military resources, to a national disaster, if one were to occur in the coming months. But I also think that presumes, just building off the last question, that we don’t put—we don’t take our foot off the pedal when it comes to social distancing, that we continue to be aggressive. Because if we’re dealing with a biphasic peak and we have another recrudescence of COVID-19 in the community because we’re going back to work without mass testing, then that’s going to create another crisis that currently I think we’re beginning to control, at least in the Puget Sound area.

FASKIANOS: Thank you. Next question.

OPERATOR: The next question will come from Lolita Jackson with New York City mayor’s office.

Q: Hello. How are you? Thank you so much for this call.

My question is around more of your role as a person who lives in Washington, and just from observation. We are having some issues with particular communities, particularly some faith communities, who are not practicing the social distance to this degree—for example, very large funerals, and that sort of thing. As we approach Easter and some other key holidays, just wondering if there was any success that was observed in the Washington area and Seattle, since they’re the earliest entity to do this, regarding communicating to those communities the importance of the social distancing, and although it’s completely against, for many of them, their practice. And we’ve seen some stories from Florida and other places. Was the health community involved in those communications, or just thoughts of what you’ve seen. That’s it.

GUPTA: Thanks, Lolita. And thank you for all you and the mayor’s office is doing in New York. I know Dave Toskey  and a few of my closest colleagues are DOH and helping hospitals in New York. So I know all the struggles you’re going through right now, and the great response. To answer your question, one thing I really liked about the response locally, Mayor Durkan and then at the state level with Governor Inslee, is that they really emphasized the importance of public health leaders and officials being at news conferences, messaging, right hand-in-hand with both of those leaders.

So Mayor Durkan and Governor Inslee just elevating the role of the secretary of health, of other leaders. Both, you know, major hospital leaders and people on the front line. So while I don’t think we’ve struggled nearly as much with encouraging people, regardless of the reason, whether it’s faith-based or otherwise, to not congregate—and I recognize that New York City just has a—is dealing with a population that’s far greater than Seattle, and multiple more challenges. I do think that we did have health officials message at every news conference.

They’ve been on TV. The Seattle Times has highlighted the importance of social distancing as a key way to keep elderly individuals healthy. And so I think we really try to message on the importance of staying at home to keep your mom and dad healthy. And so I think that messaging was effective. But I’m just noticing what’s happening at the federal level in terms of—you know, in my—this is my opinion—the sidelining of public health officials and WHO, and CDC, and others. I thought the exactly opposite happens here in Washington state.

And I have to say, just seeing Governor Cuomo’s daily briefs, I think he’s doing the exact same thing that Governor Inslee did, if not better, in terms of just making sure that Dr. Zucker and others are present and have the key voice. But we really messaged and tried to make it real and intimate that mom and dad or grandpa and grandad would benefit if you stayed home, regardless of the reason.

FASKIANOS: Thank you. Next question.

OPERATOR: The next question will come from Louis Dekmar with LaGrange Police Department. Please go ahead.

Q: Thank you. Can you tell us if you’ve established any particular protocols for first responders that have been exposed, or may have been exposed, to the virus?

GUPTA: Sure. I can say from my perspective, as an ICU doc, that the protocols that we have at least on the inpatient hospital side are the following. This may not directly answer your question about EMTs, paramedics, folks that are literally going into people’s houses, but I can speak on that in a second. On the inpatient side, this is a patchwork approach. I’ve noticed just from talking to my colleagues in New York, they’re screening health care workers differently than what we’re doing here locally in Seattle. So there’s a—whenever I would walk into the hospital, I would get a vitals check, make sure I didn’t have a fever, and proceed on my way. On the way out, I would get a symptom check as well, in addition to a fever check. And in terms of testing, in the absence of symptoms I didn’t get tested. And that remains true today.

For individuals going into people’s homes—and so, you know, we have mobile team care teams that provide care in house. And I work with CRNAs—not CRNAs—but individuals that go—home health care aides and others that will go into people’s homes for longitudinal reasons, longitudinal care needs. And really, the recommendations are not on testing if you’re not symptomatic. They’re on what’s proper PPE for the home health care aide, or for the mobile care nurse that’s delivering a medication or a vaccine in the home? And that’s the key piece there, and that’s where we’ve struggled. But testing, up until now at least, it remains only if you’re symptomatic do you get a screen, at least here in Washington state and the guidelines I’ve seen and been accountable to.

But the PPE question I think is really where there’s been some debate. So what I can tell you is for anybody that’s interacting with a symptomatic individual in the home, it’s full PPE. So you need to be fit with an N95 mask. You should have gloves on. And then you should also—the question of the gown is always interesting. Because we think particles of COVID are—can still live and sustain themselves on furniture. So if you’re an in-home health care provider, or if you’re a paramedic or a first responder, do you want to be sitting around in the home of an individual that you’re caring for? Or do you want to—the idea is, do you want a gown or do you not want a gown? And if you don’t have a gown, then how do you make sure you’re not bringing in materials or other—you know, an ACLS bag or whatnot that might get contaminated, because we know COVID can live on surfaces?

So it’s been challenging, because ideally somebody that goes into the home of a symptomatic individual needs full PPE, just like you do in an in-patient setting—so N95 masks, eye protection, gloves and a gown. Practically speaking, that’s hard because then do you don that off when you go to the next patient? Let’s say you’re not an in-home deliverer of care, but you’re delivering a package. But you’re still interacting with somebody potentially who’s symptomatic. This is—it’ s really tough. And there’s lots of shades of gray. What we’ve settled on, at least for our purposes, is anybody should have a surgical mask that’s interacting with a patient that’s symptomatic. Anybody should have gloves if you’re out there right now doing anything in the community. You should have just hand protection. And then there’s some nuances here that probably are beyond the scope of this initial call, but I’m happy to share offline.

FASKIANOS: Thank you. Next question.

OPERATOR: Thank you. The next question will come from Michael Radtke, Jr. with the councilman, city of Sterling Heights, Michigan. Please go ahead.

Q: Can you hear me?

FASKIANOS: Yes, sir.

GUPTA: I can.

Q: Wonderful. I had basically two questions, but they’re kind of interlinked.

So we’re talking about on a local level, Sterling Heights in the fourth-largest city in Michigan. We have something like over two hundred concerned COVID patients in our city right now. We’re building two field hospitals in Michigan to take care of them, but something we haven’t talked about is the nationwide federal response to this issue. But going state by state, Michigan is doing one thing, Washington is doing something similar, but other states like North Dakota or Alabama are doing something completely different. So what’s to stop this from just being reignited if we actually stomp out COVID-19 in Michigan, but had someone from a city or state that did not take these steps coming back into our community and restarting the virus, especially because the testing pipeline is not set up yet?

GUPTA: Thank you. Thank you for the question, and for all you’re doing in Michigan. I know, again, another hotspot that’s dealing with a lot of challenges. I’m going to plus-one all your comments because I think you’re right. I mean, this is problem with doing something strong in Michigan, or in New York, or in Ohio, but not doing it in other places that have not acted as they should. I think it’s irresponsible, frankly, if every state is not liable to the same rules on social distancing, on mitigating community transmission, and for the exact reason you just said, which is that if COVID-19 can find a place to hide and go undetected, but still be circulated within the community, that is not social distancing. Then it will—that is sufficient for another outbreak to prosper.

It’s like a wildfire. You know, you just need a few areas that are still hot, maybe amongst people that are asymptomatic, for this to sustain itself. And so that’s a huge concern. And that’s the reason why you hear from most public health experts that we need a national lockdown. That’s why Wuhan, Italy, and Spain I think have been pretty successful. They did something pretty restrictive that frankly, psychologically, is just hard to do in America. This is more behavior—influencing behavior than it is, hey, let’s give you a medication. So that’s why there’s a challenge.

FASKIANOS: Thank you. Next question.

OPERATOR: The next question will come from Jason Hughes, Louisiana House of Representatives, District 100.

Q: Good morning. Thank you all for doing this.

My question is, we’ve seen the data. And there is an alarming rate of death amongst African Americans, particularly here in my state of Louisiana. We’re seeing it in Wisconsin, Michigan, all over. So obviously that will need to lead to another conversation after we can get a grip on this pandemic. But the question is, are we seeing any evidence, once African American patients are diagnosed with COVID, is there anything that we should be doing or could be doing to treat those patients differently? Or is it just a matter that that population already has so many underlying health conditions that it’s complicating the situation?

GUPTA: Thank you for the question and for all you’re doing in Louisiana.

The short answer is I would say we don’t know, right? I can’t say with confidence that COVID-19 doesn’t behave differently across different demographics, ethnic or otherwise. So I think there’s a big unknown there. The hypothesis is, is COVID-19, even though we think it’s race-blind, it doesn’t seem like it’s sociodemographic blind—i.e., the people that are—that tend to be, it seems like, most afflicted in urban areas tend to be people of color, as you’re noting. And do I think there’s a lot of different implications here that should cause us significant pause as a country. But the fact that this is taking root amongst specific demographics does lead me to think—and, again, this is speculative—that if you have poor underlying health, because you have preexisting lung disease, heart disease, you’re exposed to pollutants in the air, whatever reason, that you’re more susceptible to COVID-19. I think that there’s probably a link there, and we need to wrestle with that and reckon with that.

Whether that’s proven in the literature, definitely has not been proven in the literature. Whether there’s something we can do about it once somebody’s admitted, there I can more confidently say no. What we do know is there are no proven therapies. So given hydroxychloroquine, which I know the president likes to message on, or Azithromycin, an antibiotic that many of us may have taken for pneumonia at some point in our lives. None of—there is no proof that any of these medications work. Dr. Fauci, Dr. Birx had messaged on this. There’s really not a lot that we have right now in terms of treatment. It’s all supportive care.

What I can tell you is once a patient comes and sees me in the ICU, eight in ten are—end up dying. So once you need a ventilator, you tend not to do well. And we’re seeing extraordinarily high death rates once you are actually are put on a ventilator, much higher than flu and other ailments, all else being equal. And so I know that that question had a lot of different implications, lots that I could comment on. We could spend a day talking about it. But a lot still unknown. But when it comes to once you hit a hospital, what are the treatments that we can employ were limited, we’re really focused on supportive care. And that’s true regardless of patient demographics or other characteristics.

FASKIANOS: Thank you. Next question.

OPERATOR: The next question will come from Margaret Hebert, chairwoman of Board of Health Easthampton, Massachusetts. Please go ahead.

Q: Hi, good afternoon. My question is related to the recent recommendation of community people to use any kind of mask when out in the community. I just wondered what your thoughts were on that, and if that was implemented in Seattle when things started there. And, you know, what are your thoughts about mask usage in the public—homemade masks?

GUPTA: Thanks for the question. I was hoping we’d talk about this.

So lots of different angles here. What I would say is—so I’ll say this upfront. I think the concern—I have no issue with somebody exercising their personal liberty to wear a homemade mask when they’re at department stores or grocery stores, getting essential items, because I think that’s a personal choice. The CDC has recommended it, and I personally think and I know a lot of my colleagues think that we should respect our public-health institutions and what they say, and message on that. So I have no problems with that recommendation.

Is it science-based? We don’t know. But I think—so we’re basing this on common sense, that, you know, if you have something covering you that’s thick fabric, maybe it’s going to protect others, if not yourself, from exposure to big droplets of COVID if you’re affected and coughing.

Practically, to answer your question, what I’m seeing, I’m seeing a lot of people. I was just—my wife’s a pediatrician. We were just out grocery shopping this morning. Probably one in two individuals were wearing medical PPE and not a homemade facemask made of thick fabric.

And so that’s the problem. The problem is mixed message, lack of clarity, a lack of acknowledging what is known, what’s not known. You know, I’m not trying to make a political statement here, but this—the lack of clarity on this issue should just be acknowledged. And I think people would rather acknowledge—hear we don’t know, but this is the best evidence.

And the president is going to message on this to acknowledge that, but not to undermine the message, because what we’re having here is the confluence of lack of clarity, a president that’s undermining an important message, and it’s causing a lack of trust in the public. And that’s causing people to buy PPE because they don’t trust—they’re not trusting now our public-health officials. You know, why are you wearing a mask? Why shouldn’t I be wearing the same mask? I think that’s the psychology that’s happening.

So I’m seeing a lot of people use surgical masks, in some cases N95s, and I don’t necessarily blame Americans for saying I don’t know what to trust, so I’m just going to get something that’s going to hopefully protect me and my family. So that’s the problem. That’s where I think—I’m of two minds, because personally I don’t know if it’s going to give anybody any tangible benefit. I think the data is very sparse.

But do I think there’s a real harm here if people start leaking away from established guidelines and buying medical PPEs or real harm that we’re going to soak up whatever supply we do have for health-care workers for people to, you know, think they’re protecting themselves in a grocery store? That is the harm. And I think the root cause there is trust, effective messaging at the highest levels.

FASKIANOS: Thank you.

Next question.

OPERATOR: The next question will come from Susan Hairston, city of Summit councilmember. Please go ahead.

Q: Hello, Doctor. Thank you for this critically important call.

I am very interested to hear about how Washington dealt with the homeless population. And even though Summit, New Jersey, is an affluent community, we know we have a vulnerable population hidden away. So I’m very interested in hearing how you dealt with that and any recommendations that you have.

GUPTA: Thank you for the question. And I couldn’t agree more. I was in my early days a primary-care doctor at one of our clinics in Pioneer Square, which is a hub for a lot of our missions. And so what I do know—and this is an area where I certainly need to—I’m happy to provide more resources and connect you with individuals directly dealing with homeless health care in Seattle.

What I do know is that it’s been an all-hands-on-deck approach. We’ve been—our Northwest Harvest, which is the major nonprofit that I referenced earlier, led by Tom Reynolds and an incredible team, have been focused on bolstering supply to food banks across the greater Seattle region, so—(inaudible)—supply, not just for those who are homeless but are on the fringe of being homeless or that are food-insecure just at baseline. So there’s been a focus on food insecurity.

On housing, there’s been not—blind to just COVID, but there have been movements both funded by the private sector and also our government, to house people. And I can give you specifics on how that’s changed. I don’t have them ready on me at the moment. But in terms of increasing durable housing over the long term for our homeless population, those have increased in scope pretty dramatically in the last 12 months in terms of just capital investment from nonprofit foundations like the Gates Foundation. Amazon has put money towards this as a public government. So I can give you specifics there.

But I think maybe the best thing I can do is connect you to individuals that are dealing with this issue day in and day out at Harborview Medical Center, at Northwest Harvest from a food-insecurity standpoint, and then certainly what some of our government officials thinking about how do we earmark funds to get people sustainable housing. But I think it’s been a focus on housing and food insecurity and an all hands on deck.

But I would love to be able to connect you directly with the leaders on those specific issues, because while I’ve been an observer, I haven’t actually been playing a hand on this specific issue.

FASKIANOS: Terrific. And we will put together an email with all of Dr. Gupta’s suggestions and send it out to all of you. He’s referenced a lot during this call, so we’ll put it all together.

All right, so next question.

OPERATOR: The next question will come from Dominique Jackson, Colorado House of Representatives. Please go ahead.

Q: Hi, there. Thank you for having this.

So just a couple of things. I’m interested in this whole home-swab-and-send website and University of Washington-Amazon partnership. I think that we could probably try to duplicate something like that here in Colorado.

But one of the other things I’m interested in learning is, you know, we fully expect to have a second wave as we loosen, you know, social-distancing requirements. And people are looking at all kinds of different modeling forecasts. We’ve done our own work here in Colorado.

So I’m interested in any guidelines you might have on, you know, the psychological impact of not loosening those guidelines or when we should be thinking about doing so.

GUPTA: Thanks for the question.

With respect to the Seattle Coronavirus Assessment Network, that multisectoral effort to scale up home testing, I am more than glad, because I think a lot of what’s going to be useful is in the details. I’m happy to put you in touch with—I mean, this is a—it took a village. It’s still—we’re still iterating on it. Amazon played a small role. The University of Washington, I think, was really the critical driver of innovation, the Gates Foundation on the funding side, and Department of Health oversight and leadership more broadly.

So I will make sure that information gets funneled down to you and to connect you with the right individuals. But I agree. I mean, I think we built that trying to do something right for Seattle. But to me that’s the paradigm of the future, multisectoral approach to bolstering public health and doing as much as we can in the home to minimize transmission of an infectious pathogen so that people can get tested, get the information they need, but not infect others.

To your second question, if I understood it correctly, is the psychological impact of continuing social distancing, and how do we wrestle with the mental-health—(inaudible)—of what we’re all going through right now, which is just unprecedented.

You know, I’m of the mind that we haven’t acknowledged enough just the psychological toll that this has had on the country. And there’s been a lot of shaming of—well, you know, your-grandparents-went-to-war-you-can-sit-on-the-couch type motifs that I’ve seen in the public sphere, and not enough of acknowledgement that this is just—this is difficult, and that we need more of it, not less of it. And I think people are wanting to look for an off ramp, whether it’s masks or testing.

And so I guess the short answer is, if I had a good answer to your question, the psychological impact, how do we deal with that, I would voice it—my personal opinion, what I’ve observed, is that we just don’t—our leaders—so I guess I would ask you as a leader in your community, if you haven’t already been doing this, which I’m sure you have been, is just acknowledging that this is tough, increasing access to mental-health services more broadly.

It’s tough because, you know, you can’t actually go into a clinic and speak to somebody about your anxiety. So thinking about tele-mental-health services and increasing access to that specific piece is going to be important, because ultimately, at the end of the day, providers need to get paid for their services, and tele-mental health is just beginning to be on the radar of what CMS will reimburse. They made a sea change in what types of services could be reimbursed in the tele-ecosystem, but we need more services reimbursed and really bolstered in the tele-environment for mental health so that providers can really deliver the care that they need. And I think you’re going to see tele-mental-health, telemedicine more broadly come to the forefront, because people are going to take time to normalize their life and their behaviors even once we say we can free ourselves from social distancing. I think this is going to have a huge psychological impact on how we think about public health well past COVID-19. And we should be thinking about these issues: How can we deliver in-home care more effectively and more comprehensively now because this is going to happen again?

OPERATOR: Thank you. Next question.

OPERATOR: The next question will come from Deborah Novelli, mayor, city of Patterson, California. Please go ahead.

Q: Hi, can you hear me?

GUPTA: I can.

Q: OK, great. Yeah, thank you.

This is just to circle back around about the information that you provided about masks. So I’m in Stanislaus County, and there are nine mayors here. And previously we did a video asking everyone to social distance, and we all did a video from home and then we posted it on some different channels. So the next thing we’re looking at doing is doing a kind of informercial, if you will, about the facial coverings, right?

And so just doing that—and I understand what you were saying about not knowing the benefit of it, right? Initially we know that it will protect other people from catching anything else if you’re wearing the protective covering. So if we were to do that, what type of coverings would you recommend? And I’m keeping notes, and I love all the information that you’re providing today about wearing gloves. You know, coming home and washing those gloves, or disposable gloves. So if we were to do an informercial, if you will, and put it on YouTube, what type of facial coverings would you recommend?

GUPTA: Thank for the question. So I’m going to give you a quick and dirty look into what I think, and then I’m going to follow up with Irina to give you CDC guidelines, because I know they’ve delineated, so I want to yield to expert opinion.

What’s needed is thick cotton covering. So this could be as simple as a shirt. I’ve seen people actually use men’s underwear to fashion—in places like India, for example, I’ve seen pretty incredible videos of the entrepreneurial spirit of refashioning underwear or undergarments to cover the face because those happen to have a nice combination of cotton and polyester.

And the idea here is you want some combination 60/40 cotton-polyester fabric material to cover the mouth and the nose so that the nostrils and the mouth would be ideal with that type of fabric. So thick fabric, combination of polyester and cotton. I can get you specifics. But then that should be sufficient to do one thing, and one thing alone—so let me just be clear—to cover the person next to you in a grocery store from any large droplet particles you might be emitting through just regular speech or if you’re coughing. That’s the only thing it’s good for.

Because there’s so much variation in terms of how one person will interpret guidelines on home face masks from the next person in terms of supply, how they interpret it, there’s no guarantee it’s going to protect you from incoming. I guess let me be clear. There’s a good chance you can save somebody else because you’re minimizing exposure to whatever you’re emitting in common speak. But the chances it’s actually going to provide robust protection—let me phrase it this way—the chance it’s going to provide the type of robust protection we think is just not the same as with a surgical mask or an N95. So we think it’s going to attenuate some emission of large droplet particles but probably not the way an N95 mask or a surgical mask will, and I think that’s just the key piece.

So let me finish by saying just on that comment—because I just want to be clear—it’s a really confusing topic—the only study that’s been done on fabric masks and the implementation of fabric masks in terms of protection of the public was out of Wuhan. A few scientists actually found that the only places they detected ambient COVID in the air were in large department stores. Not walking down the street, not in your neighborhood, nowhere else. So it’s just to say this specific recommendation of the CDC is based on a few use cases. If you’re going to the grocery store, going to a department store for essential tasks, use a fabric mask, 60/40 percent cotton polyester, and then maybe that’s going to minimize exposure to large droplet COVID particles that you might be emitting. That’s the only evidence that exists out there for this specific recommendation. I’ll stop there.

FASKIANOS: Vin, we are out of time, but I just wanted to ask you to take one to two minutes to talk about the WHO, the World Health Organization, and their role.

GUPTA: Sure, sure.

So Irina and I were talking, and right before the seminar started I just noted the president tweeted about the WHO and felt like the WHO had failed the United States in terms of its support and response on COVID-19, global efforts but even more national efforts here in terms of their recommendations, whatnot. And this is certainly exceeding my role as a clinician or as a military officer, but I will say that I was concerned by that messaging. I was part of the Ebola response. I think WHO had a lot of gaps in the response to Ebola, and they had to go through a reckoning. But I think they’ve changed.

And they’re not perfect. No organization is perfect. The CDC has holes. WHO has holes. But they’ve done better. And messaging that the WHO is an ineffectual organization and didn’t do its job I think is not helpful. We should be listening to the WHO. They’ve provided tests. They actually recommended the types of tests that China then ultimately implemented en masse that helped Wuhan get the outbreak under control. We as a government said we don’t want those tests. But if you look back now three months ago, it would have been great if we had adopted and scaled the test that WHO had recommended.

WHO also recommends not instituting travel bans because there’s no evidence that it actually works, and it actually impedes the flow of essential supplies and diagnostics and technical knowledge that can help combat an epidemic. So it’s just to say there—I mean, this is a loaded conversation. I’m sure we all have an opinion on it. But we really need to trust our public health leaders and experts to help guide us and not try to undermine them. And I’ll close with that.

FASKIANOS: Thank you very much. I think the message is we’re all in this together and we all need to work together.

Dr. Vin Gupta, thank you for being with us, for all of your terrific questions. I know people said they were taking notes. We are also going to post the audio and transcript online so you can refer to it. Some of this information is changing, but it will be a reference point for you. And as we discussed, we will send a follow-up note with all these different resources so that you can look at other places.

We are also going to continue to convene this call to talk about these issues. If there’s specific things you would like us to touch upon, we have a list, and we’ll try to work through it. So thank you all again.

I encourage you to follow Vin Gupta on Twitter at @VinGuptaMD. And again, Vin, thanks for all your service, both as a practitioner, in the military. We really appreciate your service to this country. So thank you.

GUPTA: Thank you, Irina. And thank you to everybody for everything you’re doing across the country.

FASKIANOS: For more information and resources on the pandemic, please go to CFR.org/coronavirus. We also have information at ForeignAffairs.com, which is the website for the magazine that we publish, Foreign Affairs, and an online magazine called ThinkGlobalHealth.org that’s tracking this issue, the social and economic ramifications, as well as the medical implications of it all, updates. So please go there for information. Please, again, feel free to reach out to us by emailing at StateAndLocal@CFR.org with any ideas, feedback, additional questions. And we look forward to continuing the conversation with all of you. Thank you for all the work that you are doing in your communities. This is hard, but we just have to keep at it. So thank you and stay well.

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