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tv   After Words Deborah Birx Silent Invasion  CSPAN  July 3, 2022 10:00pm-11:10pm EDT

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welcome, dr. burks. i'm going to call you debbie. just you know, i've known you for you know, many decades. we've all known you in in the public health field and it's a real, you know privilege for me to. be here with you to you know to talk about your brilliant new book. i want to just you know start simply. you know explain the title silent invasion and you know the reasons you wrote the book what you talk about a little bit at the beginning of the book.
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yeah, great professor and i'm gonna call you larry. so thank you. it's really an opportunity to be with you again. we've had a long career together battling pandemics around the globe and making sure the most vulnerable are served and i hope we take that message here in this country, but i called it silent invasion to really raise the alert that despite the capacity. we hadn't been diagnosing truly diagnosing respiratory diseases ever in this country. i was confronted that in africa 20 actually in 1998 where fever was treated first as malaria, and then it's something else and then it's something else and maybe it was tuberculosis and maybe it was hiv and it was all perceptive and we didn't know what specifically harming the people of sub-saharan africa and we worked with the private sector and now we can diagnose
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hiv-tb and malaria no matter where you live in sub-saharan africa no matter if you're the farthest end of the road or in a metropolitan area. and to come back to the united states and find out that 90-95-99% of flu was diagnosed for sumptively and that we were only surveying for symptoms of respiratory diseases and making assumptions about what people were infected with i found that really shocking in this day and age something appropriate for the 20th century. not the 21st century. so i really wanted to alert americans to the fact that we still could suffer a silent invasion. this virus came to us silently because we were not testing what our common respiratory diseases are and if you don't know it's flu then you don't know if it's not flu. and so it's really a call to action for definitive laboratory diagnosis of all of our respiratory diseases so that we
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know what's here, and we know what's coming and i think even today the virus is silently moving around our communities and we are not adequately making it visible to the american people. yeah, i'm i want to talk i want to dig in a little bit more as we go along your remarkable career with. you know hiv tb malaria and also, you know, ebola h1n1 influenza sars on zika. so we want i want to get into that kind of rich history that i know that you've had and you've been really leading the public health response in american globally for such a long time, but there was another you know, the idea of silent invasion you make another point of quite forcefully and i think you know in the book about the silence of asymptomatic spread.
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and you talk a lot about the idea that you know, if somebody has flu, you know, they seemed they they have symptoms and their their but you can have a lot of spread before there are symptoms arising. can you talk a little bit about that part of the silence? yeah. so thank you this virus in many age groups is invisible and then very visible in a group of age groups and people with comorbidities that and having severe disease and dying. so if you don't see it, and you don't see it coming then you miss all of the tools that we have to utilize them so that americans not only can survive but thrive and i also use silence invasion because i'm i'm come out of a family of a lot of scientists. we're big science fiction fans, so i want to really give voice to those of you who love science fiction.
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this was not science fiction, but i think in a way many of the science fiction books have been talking about pandemics and global spread for a very long time and that as a societies were not and i think i'm hoping and that's why there's an appendix at the end with clear legislative fixes that need to occur. i just feel like even today with all the tools. we have we we were main vulnerable to silent invasion community by community because we're not up the asymptomatic spread. yeah, i love you know this the science fiction, you know when i grew up it was kind of wasn't science fiction. my favorite book was the microbe hunters. i'm you know, the early story of you know, a people that are looking into anthrax and and and and tb was just you know, it fascinated me at the time. so one of the things that you
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said you wrote the book for you know, i you know, you said you were riding it not to condemn not to commend but to recommend and i and we're gonna i want to get at the very end of our interview debbie the idea of you know what you're what your blueprint for the future. but let me take you back now. i think i want to go back to the beginning both to the early days, but also to something that you said early on that you would compelled to accept the job knowing who donald trump was talk a little bit about why when you got the call you you were reluctant, but you answered that call. well for those those global public health people who have known me for decades know that when i see an injustice when i see an inequity when i see that that results in people's lives
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being altered. it is something i'm a compelled to address and so in january i could see this virus coming and obviously i was responsible for sub-saharan africa and asia and i was very worried about everybody that we serve there community by community and i i looked at the data myself and i was like this is going to be serious. so my first step was to go to the white house to the africa bureau of the nsc the national security council and say to them i need to have an emergency meeting with all of the african diplomats and so before the end of january, we've got all the applicant african diplomats in the indian treaty room, and i'm going through why i'm concerned. i have dr. fauci talk. i have dr. redfield talk about what we were doing domestically. so that africa could know and cable back to their country's two things that we need to rapidly develop tools and that
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they can tell their ministries to utilize the capacity that we built over the last two decades with pepfar and i wanted them to know that our resources were available to them immediately. and so i'm trying to get africa and asia ahead of the curve and we're sending out cables through our state department to all the embassies about my concern and how to utilize pep bar dollars to expand testing and let the ministries of health know the depth of my concerns and i'm assuming that the same things happening in the united states, but then i just watched over february i was over in africa most of february and i'm watching and i'm watching the nightly news and i'm watching the reports of the press conferences. the tours, and the president are holding and they keep talking about the risk being low and that we only have this handful
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of cases and then we're going to close our air i were going to close to china, but we're going to let all of the expats come back and we're only going to screen by symptoms and i was like, the virus is everywhere. so i did have a friend in the white house who's was the husband to obviously in pottinger who i knew quite well and i felt like they weren't acting so i'm sending him all these messages and data about how severe i think this is going to be and he's taking it to the task force and he's telling me they're not listening and i'm like, please tell them again and i'm like pushing out these messages and he's calling me and saying you need to come back and help but of course, you know, my commitment words to the people i was and frankly i knew about the white house. i knew how i frank, i frankly knew how i would be perceived
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even though i was a civil servant and had nothing to do with trump political machine. i knew if i went into the white house to help that all of their perceptions about the president would also become their perceptions of me because most people in america didn't know me overseas people knew me but not in america and we all knew you here for sure in the field so i get saying no, but i i could just see the tsunami coming and i felt like the diamond princess was such a real example to me about how america was misjudging this pandemic by only testing symptomatic people and the people that they were living with and not testing the crew on that diamond princess and only looking for symptoms the crew was much younger. i knew the virus was spreading through the crew. i just i just like we weren't
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utilizing all of what i had learned and others had learned by working globally on pandemic after pandemic to bring that knowledge base to the united states. so finally out of frustration. i answered the call and came back. yeah. do you regret it? all debbie? i mean looking back and seeing what president trump did in downplaying. well, i'm gonna we're gonna get into that because you talk a lot about that in the book about, you know, flu-like illness low risk and other kinds of issues like, you know bleach and so forth. do you do you what do you think when you think back to those days those early days? well, how do you reflect on it? well, the reason i don't regret it is because i know what happened upon my arrival, you know, those people who know me know that doesn't matter who's president. i've worked with presidents
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across the world. i don't care who's president. i don't care who's prime minister. i don't care who's minister of health. i believe that i can assemble the right data to convince them to do the right thing and i had seen that happen throughout my career. i saw african presidents finally. let us address the lgbt community to people who inject drugs to people who are in prisons who let us do the right thing to prevent hiv and to prevent and to treat those who needed our treatment so i believed having worked with so many that with the right data, i could convince the president and the vice president that this was serious. and and so i arrived with my list. i was really happy that first week that immediately when i said to the vice president. here's a list of people to immediately call to the white house. we have to have our commercial
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laboratory developers make tasks not just pcr tests, but antigen tests and antibody tests and we've got to have it immediately and you got to get them all here by wednesday. they were all there and so there was a lot of action that first week both on pushing therapeutics pushing vaccines pushing testing getting people to take this much more. seriously. i just want to thank my european colleagues because obviously i knew a lot of them from working on the global fund for nearly a decade and they helped me they sent me their data they were about two weeks ahead of us and i used that data for the european travel ban the 15 days to slow the spread and the 30 days to slow the spread and if people go back and i think when history is written they'll see that that first wave compared to many other countries was much more contained than any other wave subsequently and i think as
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a country we reacted seriously in those three to four weeks and then we didn't and that was very disconcerting to me on certainly the i talk about the book how the president got very different analyzes from his economic his cea team and really that unraveled the president's confidence that my data was, correct. yeah, you you show. so i mean for me in reading the book the one thing that comes across as your love of data, and you know, you're frustration when it's not there when it's not. accurate when it's not comprehensive when we're having to borrow data from other countries to make decisions here when we should be at the vanguard that really came through before i kind of go on and i want to look more in depth at the us response and also a
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little bit about the early days in china. i can't help but ask you didn't really feature in the book, but you you talk a lot about africa you have you probably you know, the one american in this nation that knows africa and and it's intersection with disease more than anyone else. what do you make of how covid is as transpired in africa? we thinking that it would be cataclysmic and you were warning that early on. and yet they you know, there's that there's some evidence that there's been less severe disease. maybe that's a reporting issue. maybe that's an issue of of just simply having a younger population. what's your how what's your take on africa and covid? well there that's a brilliant question and and it intrigues me and it treats me to today certainly.
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some of it is testing and reporting, but you cannot hide severe covid disease and you can't hide most of the covid deaths and i i've said that across this country to many governors and mayors. there will be a full accounting state by state county by county by what actually happened but in africa they were blessed by three things that were really critical across the main part of africa that most people know around the equator going north. in south from east to west africa, the median age is between 15 and 14. so 15 50% of their population is younger than 14 and we know from data now that this virus was very selective in general for the elderly. and so if you look at the continent and that includes north africa, which is a very different situation i can talk about that separately.
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but africa is a continent has less than 9% of their population over 65. we have almost 20% i think the other big piece of it though is obviously with the history of hiv and tb a lot of the individuals in the 90s in the early 2000 before pepfar on the global funds to come to hiv, you know, millions and millions of people so it emptied out a lot of the people who could have been 30 40 and 50 on at this point. we've changed as a community. ability for people in africa to thrive despite. hiv tbm malaria, i think the second point is much lower comorbidities compared to the united states much less obesity. and that's why if you look across namibia south africa botswana and eswatini where they do have older individuals where they do have more comorbidities. you see a higher fatality rate from covid.
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and so the younger generation the less comorbidities certainly under reporting, but i can tell you when you look at access deaths on you don't see the same level of excess deaths and 2020 and 2021 that you see in the developed world. and i think it's really a wake-up call because like you larry we all thought pandemics would be horrific and low and low middle income countries and in the end this pandemic singled out upper and upper middle income kind of incredible and there was no natural a lions of those countries. we were all focused on low and low and middle income countries. so again, there were no formal channels to really share information between our european colleagues and the us and our central american colleagues and and canada and we would because we thought it was going to be there and it was here and i think this is really opens up a
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glaring a glaring mistake that we all made over the last two or three decades is really establishing clear data exchanges among the upper middle income and upper income countries. yeah, very very important point just very briefly on the early days of you know, china and wuhan and you know, what what the president, you know knew or should have known and when and also just reflect a little bit about you know, there was a significant clash between the white house and and china on a number of issues. but particularly the lack of early reporting and and lack of early. reporting in an honest way in terms of human to human transmission and then that
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ultimately led to the president sending a letter to secretary gutierrez the un secretary general and not giving a 12-month notice of of withdrawal from from who how did you know how did that all unfold in the white house? and how did that play into the early days? of the us covid response and the global covid response you know larry i wasn't here and i could never really understand. so when i arrived at the white house, no one gave me any cia or other cables to suggest that there was information coming in through secure channels about how severe this would be. so when i heard that bob woodward interview, i was as shocked as america was because when i arrived and when i say no
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one i mean no one in the white house from the nsc to the cia to the vice president of the president. no one shared with me. that they hadn't understanding about the severity. you you know, my feeling was they are not taking this as severely i mean as significantly as i think it's going to be and that's why we have to make these changes, but that was very disconcerting to me to find out i think that woodward interview was june or july of 2020. i was shocked on and still no one showed me that that actually existed so do this day i've never seen that document that talks about the severity the reason i knew it was going to be severe is you could see on social media that the hospitals were getting overwhelmed in january and at the same time china saying we don't think there's human to human transmission. so if i'm seeing the social
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media post the who should have been seeing the the social media post and they should have gone to the world and said this virus is highly contagious spreading rapidly and in significant illness. those over 70 and i you know, i i am still surprised by that the data was out there. it may not have been coming from china per se but you know, that was the whole point of putting who representatives in every country is so that you weren't always reliant on just what the national reporting was and after what happened with sars. we i thought we had learned that lesson collectively as a community. but i i think once again that early misleading about human to human transmission, i think resulted in a lot of countries
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making very poor decisions about not developing tasks and not really taking this as seriously as they should have yeah, such an important point. i want to stress what the one of the points you made because you know, you heard dr. burks say that you got to the white house and none of our most sophisticated machinery of government, you know cia intelligence national security white house staff were seem to be aware of the seriousness of it. i mean, that's a stunning. and state the nsc was because that was trying to get me back here, but i don't think the agencies really were acting including cd recently. would you saying would you include cdc in that? you know, i don't know what the cdc was thinking at that time, but i can tell you that they did
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not prepare the country for a a country-wide pandemic that was evident already in china. and what do i mean by that getting up the data streams that you needed bringing in the commercial laboratory developers, you know, it's great that they worked on tasks for the public health lab, but we all know public health labs. they're not what we call high throughput laboratories the platforms that they made the tests for were in general platforms. that could do a handful or less than a hundred tests a day. we were going to need millions of tests a day so we had to bring on board our commercial laboratories until nancy messi'' a made that comment the end of february. i i don't know. i haven't saw our audience knows senior official at cdc. yes, so in nancy said she was worried but that was the end of
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february. i was worried in six weeks earlier so i don't i wasn't here i didn't watch it play out. i i try not. i don't know what data they had or didn't have. i just know when i arrived on the second of march. we were incredibly incredibly flat-footed as a country. yeah, and you know a lot of your book particularly in the you know first, you know third to half was was about the us response. so just i wanted to dig in here a little bit debbie the the you talk about missteps and bright spots and and i thought we would let's start with the missteps and then get on to the bright spots obviously operation more speed but testing was was a big part of the story and you started talking a little bit about. the labs and and just expand on that.
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you know, why was cdc seem to be so off based on its testing kits. i know at the and also talk about their communication with state epidemiologists and others, you know, just take us back through those early very very difficult days in our in our testing capacity in our test kits when i when when who had a test kit when our allies like germany were using better test kits cdc decided to develop its own. just tell us a little bit about that story. yet to this date. i you know, i don't know why it happened. i got so frustrated after i left january of 2021 the covid response. i talked to the laboratories our big commercial laboratories and said to you know, what kind of dialogue were you having with the cdc and hhs and asper and
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you know, how come we didn't have these tests and what was going on? and what they told me was they were actually calling the cdc. in january saying, how can we help? how can we help we can help develop commercial tasks. what do you think you're going to need and cdc told them they weren't going to need help. and i think that i guess from working in resource limited settings. i never turn away help. even if you're not sure you absolutely need it when people say, how can i help i give them a list because yeah, you can't know how bad things are going to get so you prepare for the worse and hope for the best but you prepare for the worst. and in my mind because so many people focus on the contamination in my mind. that is not the problem. the problem was that they made it tasks for low through foot
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flat platforms because they firmly believed that they would only be randomly testing a few samples in each of the public health labs, and they would be able to track this virus solely through symptoms. they had this symptomatic model of how they were going to prepare and how they had sentinel surveillance around the country all based on symptoms. there was nothing in there. about widespread commercial level testing and i think for those of us who have battled pandemics around the globe. we had a leg up because we know most viruses are invisible. and many of the most most of the transmission is occurring in an invisible way and hiv is a great example of that. yeah, so, you know early on i had a meeting with a lot of cdc colleagues and i was talking to
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them about how so much of the spread in hiv is asymptomatic and we weren't able to change the pandemic's course on the continent until we started working with young people and finding the asymptomatic virus and getting them on effective therapy and really working to prevent new disease. we weren't successful until we did that and so what i heard back from the cdc years that we're in that meeting is they went back to the cdc in atlanta and said, well she thinks you know, she doesn't understand how viruses are transmitted. she's trying to use a bloodborne model for a respiratory disease, which wasn't my point at all my point. was you can't see the virus? yes, it's being spread in a different way, but you have to make invisible viruses visible and they completely discounted what i said because they're like, oh she's just worked on hiv tb. malaria and zika and ebola.
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she hasn't worked on flu. well, of course, we all have worked on flu of you working internationally you work on flu, and you're worried about avian flu. so, you know, it was just it was that dismissiveness. that concerned me then that concerns me now that unwillingness to listen to others ideas. i think cdc has gotten quite insular by being in atlanta and i do think they really have to be much more open to really looking transparently at the data and letting the data teach them and get them out of their perceptions and assumptions and into a place that really is data driven? yeah, and the idea of you know, the you know at the beginning there was this resistance against the idea that that asymptomatic spread was was a major factor in the transmission of sars covey too and and larry
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that continued and that was so disconcerting to me because obviously on fda was a proof those of us have worked with fda for very long time understand the limitations of these control panels. and so they have developed a control panel obviously from symptomatic disease because that's the only thing that they were looking for so the control panels to validate the new test we're symptomatic disease. so as late as july, i'm trying to convince them in the cdc that the antigen task can be used in asymptomatic patients. it took an entire 12 months in addition. to convince both of them that you could use antigen test prior to having symptoms and that really held back states because cms and other co-payers were willing to pay for a test that
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the fda and the cdc said couldn't detect and couldn't be utilized for definitive diagnosis. yeah, so we got in our own way several times. yeah, so the testing was really one of the you know missteps i suppose would be an understatement. you know, there were some other areas that i we discuss. what about let's think about personal protective equipment in masks. we remember early on with all the with new york hospitals flooded with cases and cases spreading around the world and and we we ended up with a shortage of personal protective equipment. and also a lot of confusion around around the science messaging in terms of masking and what kind of masks there was. it was in one of the things you said in your book that really i i learned from a lot was you
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know, why did we assume for example the kn95 respirators that people wouldn't wear them that there were less comfortable. where was the data? so talk a little bit about ppe shortages and other shortages of ventilation oxygen and then and then you know zero went on on masks and and the early days of masking and really we're even today masks have become a flashpoint in the united states. so, you know really critical important question larry because we are vulnerable today. to lack of essential medicine and it was clear and it's clear now when there's disruptions in the supply chain, and we don't make any of those essential medicines here. i'll never forget admiral polo check coming into task force one day. i think it was april.
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or may or i it all blurs together sometimes about when we had these supplies shortages. and he came and said i'm out of propathal in days. and for those of you who don't know that's an anesthetic kind of that people use when people have to be on ventilators so that the individual is put into a sleeping state so they don't fight the ventilator it really critically important and we were running out. so not only did we not have mass that we not have gowns. do we not have gloves do we not have ventilators? now we're running out of essential meds for a hospitals. and none of these things are made here except for n95 and that i learned so much about our supply chain and our spun fabric and the same kind of fabrics that are used for mass are used for gowns. and so people who are making gowns switched over to mass then
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we couldn't get gowns. you know, it should be a national security issue that we do not have capacity and this country to make the essential medicines that we need in the time of crisis, and i'm hoping that's why it's in the appendix. we have to have congress address this it is critical for our health and welfare in the future. it will take some time and yes in certain cases. we are going to have to pay a little bit more but in exchange we won't run out of propathol so i just want to thank the supply chain group because they were under enormous pressure from me and i just want to i've never said this before i didn't really talk about it in the book, but when i came back and find found out we only had 12,000 functional ventilators in the stockpile 12,000 total and so
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the innovation that came from our anesthesia colleagues who called us and jerome adams who pointed this out that with a filter change we could use the anesthesia machines. i mean all of this innovation and creativity. i also wanted to give voice to that in the book, but i think the masking issue illustrates what's fundamentally wrong with us in america at times because we get so wrapped up in the the the periphery that we don't make the common sense judgment that a lot of our our friends and family around the world did and asian new that cloth mass worked because they had utilized them during sars and so early on and with this sars covey, too. we know now that cloth mask. we're highly effective when i mean highly effective 40 to 50%
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with the original variant and that we had to rely on data from the -- japanese in october. i mean, this is a study we should have been doing in january to prove the efficacy of the mask. and so when you go out and tell the american people that they think it's they should wear a cloth mask because it's going to hold their droplets back from getting into the air. but then tell him at the same time, it won't prevent droplets from coming in. it's the same piece of cloth on both sides and they're telling people to make two ply at a minimum cloth mask and at same time not telling them that it's bi-directional. that confuses the american people. i mean no one will understand why it only works when you breathe out but not when you breathe in. i mean now we know that you really need a very tight fitting mask that you really do much
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better if you have the the charged fabric layer, that's in kn95s and n95s. and so now those are to the public. but i think we just weren't transparent enough with what we knew and what we didn't know and then make really common sense recommendations to the american people. yeah, and of course early on cdc and who were not recommending masks, correct? and so we we've really you know this kind of the symbol of masks have become a symbol of covid and they still are they're still you know part of what you know, you might call the the covid culture wars. there were some other interventions that we made one of your one of your chapters is called 15 to 30 days and that's about the lockdowns. tell us a little bit about that and what went on at the white house.
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you know. when i came in that was part of my first week, you know to move us from risk is low to risk of serious illness in specific americans is extraordinary high and we were already so far behind and i just want to make it clear you don't do a lockdown unless there is a crisis and we were in crisis we could see what was happening in italy i had modeled out on the case fatality rate in italy and they're excellent medical care and what they were learning and they still had extraordinary case fatality rates. i was looking at our case fatality raids pace fatality rate in those individuals over 70. that means if you were 70 and diagnosed with covid 30% of those individuals were coming to this virus and so we didn't have a treatment. we didn't know about clotting we
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didn't have ventilators and we didn't have ppe and we were barely keeping up and i i just want to be very clear we were behind in the human capacity needed to treat these patients. i mean we didn't have enough human capacity if we had had 25 new york's in our city's greater than a million people without a lockdown. that's and you how you end up with literally hundreds of thousands to millions of people dying. and so that's what the modelers were saying. i took their input and modeled what would happen if we did what italy did or europe did with the lockdown and that's where by limiting it to about 10 metros 10 to 12 meters you hundred thousand people die in the first surge if it goes to 25 metros. you have about 240,000 american lives lost and so it was really modeled by our metros both the
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city itself and the bedroom communities based on what was happening with spread in new york and i think as a country we prevented a catastrophic event and i mean truly catastrophic not enough people to care for the for the sick no ventilators. no ppe for our nurses and doctors and most of the hospitals we had 6,000 hospitals in the end. probably only four to five hundred hospitals had to actually confront this high covid load and that's what america did america stop the spread of that first wave from how much damage it could do, but we probably were not clear enough to the american people how they're proactive behaviors change that course in that first that first wave certainly a lot of european countries did worse in. first wave then we did by a by a
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bit and i'm talking about small percentages and nothing to be really proud about but we could have lost so many more americans with the footing that we were on because i just want to make it clear. we were not preparing. for a pandemic in this country. we were preparing for containing the virus in a very small number of americans based on symptoms which failed us. mm-hmm. yeah for sure. i mean one of the things i was struck by in the book when you when an email exchange you had with a high ranking government official and you'd said to you know, you know that we need that, you know vaccines wouldn't be enough we have to rely on behavior change. and then the answer back was you know, what behaviors and then you just side because of all the things you had been telling them about the behaviors that would
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need to be changed. they didn't seem to get it. well, we've talked about a lot of the the negative things in america, you know the shortages of essential medicines ppes testing masks cruise ships lockdowns. and but you also talk about the bright spots and i think you know if there were any, you know if there were any, you know triumph of america. it's a triumph of american science and particularly operation warp speed which i don't think president trump gets enough credit for and you and and also, you know the fact that we you know, we've got these new messenger rna vaccines that we thought we were going to be super effective and but but are still very good. so tell us a little bit about you know, the success that we had in our science community. so first and foremost, i just want to you know, i'm so
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grateful to the private sector. i mean the one thing that this white house got right and got right for ppe got right for testing and got right for therapeutics and vaccine was they believed if the private sector was supported and their technical capacity on leashed and their innovation and creativity and their relationships with biotech and universities and big pharma if we on unleashed their capacity that they would respond and unprecedented ways and they did and you know the group of that company we had a meeting with the laboratory developers on the first on the fourth of march and i had tests rolling out to hospitals within two weeks. they worked around the clock the abbots the roach the becton dickinson's and the hologic came on board the therm of fishers these people dropped everything
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in their entire corporations moved to churning out these high quality tests and not only you know rapid high throughput pcrs, but these really these critical desktop pcrs that were really helpful in our tribal nations and antigen test and we had all of that with in a matter of weeks to months. and so that public private partnership was extraordinary and then they went above and beyond in that this big testing companies abbott and roche. well, i knew that they could see their equipment because i worked on hiv test my whole life and it's the same equipment and so i knew they could see the data every night and so every night they compiled all the data from that day, so i could see what the test positivity rates were in this country because i had no data streams none the private sector did that for me? the private sector realigned
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their entire supply chain based on data, and i'm just so proud of them they took less profit to ensure that specific hospitals had what they needed to protect their nurses and their doctors and get the patients the drugs they needed and so i would say to them. this is where the virus is. this is where it's going and cardinal health and mckesson and henry schein and all of these big direct supply companies. they realigned everything and senate based on the data based on equity and that was just so amazing to me that i wanted the american people to know that we learn now how to really deal with a pandemic we need the private sector part of the plan. we need them sitting at the table and we need to know what their ramp up capacity is because they did that for us and
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i i just wanted people to be able to see what i saw what the tribal nations did. universities did there were universities that worked that whole summer of 2020 to fully open that fall of 2020 with all of the people pointing fingers to them and say you can't do this. it's not safe. they use the tool of testing and information. just behavioral change information to their students to keep each other safe and those universities and those boards of trustees that believe in their students and open fully. they taught me so much because it was those universities today yesterday and all through 2020 who i was tracking their data and the universities that tested weekly independent of symptoms had much less community spread among their students. so it showed it showed the road
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map of the way through this not limiting students activities, but ensuring students had weekly testing totally changed the amount of the number of students who were impacted. but i think the other thing that universities taught me which was so personally important and why i wanted to get to every state and to most universities is to sit down with their students and their faculty and their administration to go through how they're confronting the pandemic and i was just so impressed by our gen ziers who understood that for many students. that was their only bed their only desk. they're only ability to be in college. they're only ability to work were in those college towns and they supported one another and they supported each other's mental health issues, and i just it was so inspirational to me to see what they did what our tribal nations did what our
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governors did. independent of red or blue or democrat or republican? they answered the call in those days of 2020 and i just america is is stronger than what you see often on the media because people were really doing the right thing across this country and really helping one another. yeah, that's a good point. i mean, you know the the private sector universities states tribal. tribal leaders. i was personally involved a lot of georgetown so i can going to test to that kind of, you know, small laboratory of behavior change. we've only got about 10 minutes and i have a bunch of things. i want to get through one of the things, you know, it would be easy to skip but since you're so global and since i'm so global talk a little bit about our global responsibilities as as the united states, and i'm
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thinking particularly about vaccine in equity in our early decisions about pre-purchase agreements with our vaccine companies and what role that may have played in global scarcity. i know scarcity is not as big an issue now, it's more vaccine infrastructure, but talk a little bit about, you know, global vaccine and other kinds of inequities because i know it's near and dear to your heart. well, and it was just not the inequity of the vaccines. it was inequity in access to gloves access to mass access to gowns access to protective equipment access and what was really worrying me right now is access to therapeutics because we've learned a lot about these vaccines but these vaccines are not going to protect countries from infection reinfection, and we just have to admit that and that's why i'm excited that to look at the subunits because you can change subunit adjivants and
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and potentially increase the durability of protection from infection from four months to to really multiple multiple months, but i mean right now we should be very clear about who needs to be vaccinated and boosted and we ought to be talking with african countries and our asian colleagues around the world about identifying those individuals with diabetes hypertension obesity asthma any kind of steroid dependency cancer treatment and making sure that they're vaccinated and boosted and then we should be working around the clock to do what we did in pepfar on pepfar was brilliant because it worked with the large pharmaceutical companies and the large pharmaceutical companies agreed to this patent protection waiver that allowed new hiv drugs to be made by non-branded suppliers expeditedly approved by the fda
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in a parallel mechanism to ensure that they're safe and effective and allowed us to buy those and so we were able to bring the best treatment to sub-saharan africa and asia around the globe that should be happening right now with covid therapeutics. we know how to do it. we know how to distribute it and we need use the distribution mechanisms that have utilized in pepfire and we can get drugs to the most remote villages. we could get paxilva to the most remote villages. we could get vaccines to the most remote villages. and so i feel like we're still not taking advantage of everything that we've learned through the decades. i find that you know, there's the pandemic people that look at this as this pandemic and then there's the rest of us who have been dealing with pandemics for a decades and know how to confront these and they really need to be talking to those individuals and not people within the united states that
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have never confronted a pandemic before this one because we know how to work with communities and local governments to ensure access and we have significant access problems in this country right now, and it's part of the reason why the red counties which somehow people are thinking if they say that they voted for trump. it's like justification for them not doing well. that public health does not do politics. we should not we should be looking at red counties right now and say what is the problem? i'll tell you what the problem is. i was out there. there's no health care. so don't tell them to go to their primary care physician. there is no primary care physician. they're getting their eye care from walmart. they're getting their healthcare from emergency rooms three hours away. so, you know address what the access and barriers are in reality. not what you think. they are get out there and see what they are and fix it. we should be using data in real
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time. no one should be dying of covid. let's all agree of that. and we take every death figure out why it happened and fix it. fix it then don't publish a study four months later fix it in real time and make the data transparent and available to every american so they're empowered. with the ability to make decisions to decrease their risk and the risk to their vulnerable family members. i saw this for decades in sub-saharan africa. it is possible anyone can learn this information. you don't have to be a phd you don't have to be an md. it's our job to make it understandable. it's not our job to point fingers and imply that if you voted to for trump, you're more likely to die of a disease that's on us if they're in a remote county that's on us i just it is so disappointing to me to see it's still politicized even in the media red and blue
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counties. that should be a call to action. that should be a call to all of us who work in public health to change this. yeah, and you know, i i i've intentionally not broad president trump into this but i think our listeners would want to hear just your reflections about that. you've talked a little bit about. the trump administration in comparing it to to influenza to low risk other things like the virus goes away a sunlight bleach hydroxychloric when it must have been very frustrating for you as a as a world-renowned scientist and public health professional to be in the white house at that time. we've only got a literally a minute or two. do you want to just spend you know say 30 seconds on that and then just tell us about your you know what you what you think and
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hope for the future. well frustrating but not impossible. and and that's the message. i want to leave with all of you. you find yourself in situations and people will say things about you and it really doesn't matter because they're you're there for one reason serve the american people and no matter how frustrating i've been frustrated my whole life in hiv with many leaders who would tell people if you just took a shower or if you slept with a virgin, i mean all of these magical thinking and and this is not unusual pandemics are political and it's our job as public health people to get in there and work every day to do the right thing some of its evidence some of its in evident. it doesn't matter. this isn't about you. it's about what you know and making that translated into saving lives the whole last chapter over 40 pages is on we continue to make missteps in
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2021 and now 2022 because we're doing pandemics by polling. by what? we think the american people are willing to do. give them the data. show them in real time and they will do the right thing. i i just don't understand this unwillingness to put all of the data up county by county by age band and raise an ethnicity. you can blur it enough that there's no violation of hipaa. we do it every day at pepfar.gov and gps map every facility where there is a physician and where there is a nurse practitioner and look at how underserved our red counties. are we have to fix this we can but we have to get the right data and utilize it and magical thinking. was prominent in the trump administration i fear at times it weaves itself into our current administration, and we just can't let that happen. we i know may is coming and what
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people will say is look how low the case counts are. but you know what follows may. a summer at surge in july and august across our southern states. so let's get ready now and do the right thing. well, thank you. i mean debbie just you know a master class and you know, i wanted to thank you for your service. you talked about the importance of public health science data supply chains all the things that america needs to do. i recommend that everybody read this book particularly the appendix about what we need to do and just our hats off to you and and deep. thanks to you debbie, dr. deborah burks. thank you professor.
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if you're very kind. thank you and welcome to all of you in this nearly packed auditorium, but those of you also who have joined online. for a gentleman who needs very little introduction? and who is a great friend of the heritage foundation and no doubt as i scanned the audience a great friend of many of you individually. it still is a pleasure to introduce senator mike lee and i'll introduce him this way n

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