UW Panel: Coronavirus and Pandemic Disease Preparedness - What We know and the Way Forward

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Good evening.
I'm Judy Wasser.
Height can, can you hear?
Yeah.
Okay.
Great.
Um, good evening.
I'm Judy.
Lost her height.
I am the chair of our Department of Global Health here of the University of Washington and the co director of the University of Washington's Metta Center on Pandemic Disease Preparedness and Global Health Security.
And on behalf of my partner, co director and all of us involved my partner, co director Peter Rabinowitz and all of us involved with the Metta Center.
It is a real pleasure to welcome all of you who are here in the room and those of you who have so patiently waited for livestream connection.
Thanks to very generous support from Tai Kramer, who is a member of our leadership council in the Department of Global Health.
We are here this evening Ah, to discuss what we know and equally importantly, what we don't know and what we need to know about the new Corona virus.
Ah, and the health problems that it can cause.
We're here to answer as many questions.
A cz possible to explain what's being done locally to protect people right now to share some of the research.
That's going on to develop in vaccines and improved diagnostic tests and to help connect both those who are already working on this problem and those others who might want to help.
This virus has been moving very quickly.
It's been less than eight weeks since that first cluster of about 40 cases was reported in Wuhan, China, and in that period, um, there has been an explosive epidemic.
This resulted now in about 75,000 confirmed cases.
Um, depending on exactly how you define a case and about 2000 deaths, the majority of both ah still being in China, we've also begun to see profound social and economic impacts around the world.
The good news is that the science has also moved with unprecedented speed.
So in days to weeks, rather than the usual time frame of months or more, um, we have seen ah, new virus identified diagnostic test developed and there are many treatment trials that have already been started.
More are planned and multiple groups are working on a vaccine development and you'll hear a little bit about some of this tonight.
I think.
Equally important, um, global communication has been extraordinarily rapid and robust with this this epidemic.
I think the other piece of good news is that currently there are still relatively few cases here in the United States, and the risk of becoming infected remains low here in the United States.
Preparedness and response efforts have been pretty strong to date, and Washington, ah has actually not only been the home to the first U.
S case, but ah has become a national leader as part of this response.
And that's thanks to the efforts of many people, including some of the people who will be speaking tonight.
However, epidemics, particularly of new viruses and new diseases, can be very frightening, Um, and that fear often gets translated into stigma and discrimination.
Which means that the need for timely, accurate, evidence based information is just as urgent and essential as the need for effective drugs and vaccines.
And that's part of the reason that we're here tonight.
Um, epidemics like this require an ability to manage pretty serious risk in the face of uncertainty and incomplete information, which is pretty uncomfortable.
Actually, um, at times it means navigating the balance and the trade off between the safety of populations and the privacy or freedom of movement of individuals.
Um, and it can require communities toe come together to make very tough choices in order to make sure that as many of us stay healthy as possible.
Um, I'd like to make one last point that I think all of us should be thinking about as we talk tonight.
Um, this this, uh, Corona virus epidemic will not be the last one that we face.
In fact, it's more likely to be a preview of our future unless we start to do something differently.
The frequency, severity and magnitude of outbreaks of organisms with pandemic potential has increased dramatically in the last 40 years.
And it's increased.
They've increased because of changes in the way we live, including the way we interface with animals, the way we use land, the way we travel, the way we change our environment.
Um, and that means that we need to fight this battle on two fronts at the same time that we need to contain this Corona virus epidemic.
Um, we also have to strengthen our ability to prevent, detect and respond to, um, much more broadly to new and re emerging infectious diseases with pandemic potential.
Um, we have to do that using cutting edge, innovative approaches and working very closely with our colleagues in low and middle income countries where these outbreaks tend to emerge.
So that's exactly what the medicine chur is about.
Um, and one of the reasons that we're all here tonight.
So with that, let's get started.
Um, both the University of Washington School of Public Health and the School of Medicine have been very involved in the response to this new Corona virus.
So I'm particularly delighted that Hillary Godwin, who is the dean of our School of public health and Professor of environmental and Occupational Health Sciences, and Tim Delic, um, who is the UW medicine chief medical officer and professor of medicine, are here to join us, tow open the forum this forum, and to share a few of their thoughts.
So, Hillary, please, will you get us started?
So I wanted to start by saying thank you to all of you for coming and joining us tonight and huge thanks to the medicine or folks for organizing this event.
Um, I also want to make sure that we think, um, our public health practice heroes from the local health departments in the state Health Department, Um, who have made time out of their already very full and busy schedules to be with us here today.
These folks have been on the front lines responding to rapidly changing containment needs and making sure that our communities air prepared for future possible cases in this region.
And I know I personally sleep well at night knowing that you guys were out there working for us.
Um, for s what in ah, at the University of Washington.
Um, the outbreak has brought to the forefront of question off.
What's the appropriate role for academic health science schools in a public health outbreak like this one?
Um, we feel very blessed in the University of Washington school Public health to have such great collaboratively relationships with our state and local health partners.
Um, and you'll hear more about that in the second panel and how we've been able to leverage that.
But we're still left with the question of how can we do more?
And so, as we move forward, hopefully after things calm down a bit, we hope to engage with you guys and conversations.
Um, about how we might better engage cooks from across campus in, um, hoping all of you on the front lines, um, and leveraging not only places like the Metro Centre, but initiatives like the Population Health Initiative.
So with that, turn it over to him.
Good evening.
I also want to extend my thanks both to the medicine or as well as everyone who is here in person and those who were streaming online.
I also wanted to follow up on something that Judy mentioned you and I think back as an infectious disease physician when I came here to university Washington, my fellowship and what has transpired since then we've had SARS.
In 2003 we had 2009 h one n one pandemic influenza.
We had murders in 2012.
We had Ebola in 2014.
And although that may not have had the same pandemic potential from a resource intensity and prepared this, it really caused ah lot of us to spend a lot of energy and well spent energy because much of what we did in preparation from 2014 has carried for to our preparation here for now, the novel Corona virus in 2019.
And so I suspect absolutely, we're going to see more and more of these potential emerging pathogens.
When I look at the lineup tonight, it really strikes me how fortunate we are to live in the Northwest.
We have wonderful health care systems.
We have tremendous local health public health jurisdictions, particularly here in King County, but also our partners in Snohomish and the other local surrounding counties.
We have wonderful partners with the Department of Health, and we also have the Northwest Healthcare Response Network.
That really helps coordinate all of our activities across our various health care systems, ensuring our preparedness and particularly communication.
I also think we're very fortunate when you look at the University of Washington and the breath of our activities, both locally and response regionally and then globally.
A CE has been mentioned here as well.
From a school of medicine standpoint, we have wonderful clinical care and in coordination with public health, great epidemiology, along with all the other health science schools within the University of Washington.
We have tremendous research, and we're going to hear more about that innovation, uh, during those panels as we think about emerging pathogens and we also have tremendous education.
And the education is also very important to me as I reflect on one particular individual who is with us today.
Dr.
Jorge Diaz, who is our guest from Providence.
Everett George was infectious disease fellow with us many years ago and from my standpoint, one of those fellows that I very much regret that we weren't able to keep within our system, but also strikes me the importance of our role in educating the next generation of physicians and the leaders and partners that we have within the community as they did an exceptional job in caring for the first patient who was seen in the U.
S.
With this novel Corona virus.
So again, thank you very much for participating this evening.
Thank you both.
Um, all right, it's time to get started.
Now we're gonna hear from three panels of experts um, focusing first on how the virus spreads and causes disease.
Then we're gonna talk about the response to this novel Corona virus and future outbreaks with pandemic potential.
And the third panel will focus on emerging insights and innovations through research.
Each panel will be in a Q and A format starting with the panel itself.
And then your questions, Um, and each one will be moderated by one of the leaders from our meta center in the interest of time, I'm gonna introduce everybody now, so you don't have me coming back and forth up here.
That's more time for questions.
Um, so the first panel will be moderated by Peter Rabinowitz, who is co director of our U W Medicine tres I said Before, and professor of Global health, environmental and Occupational Health Sciences and Family Medicine.
He also directs the U W.
Center for one health, one health research.
The second, um, actually, do you want a wave so people know who you are?
Okay, there we go.
Thank you.
The second panel is gonna be moderated by David Piggott, Um, who leads the Vulnerability Assessment group of the Meta Center.
And he is an assistant professor of health metrics.
Science is based at the Institute for Health Metrics and Evaluation, and the third panel will be led by a West Van Vorhees, um, who leads our Meta Centers Biomedical Intervention group.
He is a professor of medicine and infectious diseases.
Ah, and he is also the director of our center for emerging and reemerging infectious diseases.
After these three panels, we're going to have a closing session which will give time for a few final thoughts and additional cross cutting questions.
And that session will be moderated by Beth Bell, Um, who served as acting director for the medicines or until fairly recently and continues as our senior adviser.
Um, she is a professor of global health here and is the former director of the CDC ease National Center for Emerging in zoonotic infectious Diseases.
So has longstanding experience in this arena.
And with that, Peter, the podium is yours.
Here we go.
Oh, thank you, Judy.
And thanks you all for coming out tonight and for everybody watching this online as well.
Um, so I'm gonna Ravenna laid some the co director of the medicine or for pandemic disease preparedness, and I'm gonna moderate this first session.
The goal is, as Judy said of the first session is to really set the stage with some latest information about the cove in 19 infection and the virus that causes it and how that acts when you're actually taking care of a patient with it and how you are also how it is acting in populations as opposed to just a single patient.
So I'm gonna introduce the panel that's going to be talking about this to talk about the the virus itself and coronaviruses in general.
Um, Dr Jeff Gottlieb is an infectious disease physician professor of medicine at UW, and he's also the interim chair of the U Double Advisory Committee on Communicable Disease, which is really leading the response to Cove in 19 across the U.
W campus.
And Jorge Diaz, as you already heard, is infectious disease physician, trained at UW and since 2005 has been an infectious disease specialist at Providence Regional Medical Center in Everett.
And he was the treating physician for the patient, who was hospitalized in Everett with Cove in 19.
And Kathy Lo Fi is the state health officer and chief science officer for Washington state, and she advises the governor and the secretary of health on a wide range of health issues, and her particular interest is in infectious disease outbreaks and their control, and she will speak about populations.
And before I ask them some questions, I just wanted to talk about one other aspect of this situation that Judy alluded to, which is that we have seen in the last several decades more and more of these, what we call emerging infectious diseases, disease we've really never seen before or diseases that we maybe knew about before, better acting in totally different ways and these emerging infectious diseases.
When you add them all up and there's been merged and SARS and Ebola and West Nile and avian influenza and each one n one when you add them all up, actually, about 2/3 of them end up being diseases that come from animals.
And there's really something going on, as Judy said about the way we're interacting with animals that we still don't quite understand when it comes to Cove in 19.
But it's gonna be very interesting important to understand it, because the other Corona viruses that you've heard about that that the Cove in 19 is related to, um seem to have really fit this pattern of coming from animals originally, so that in 2002 when SARS broke out in China, it broke out in the midst of at live animal markets where these civet cats were being sold for food and had been bred in numbers that had never been bred like that before.
And the workers in the markets were some of the first people getting sick when, in 2012 another Corona virus that, just like SARS, appears to have actually had its origin and bats, Um started breaking out in the Middle East.
It was in camels and people work closely with camels, and somehow the virus had jumped from bats to camels to people.
And it turned out that we're also now raising camels in ways we never raised them before, much more intensively and barns all close together with people working together like that.
And now we have this cove, it 19 breaking out again in the setting of a market.
We don't know everything about what happens.
We really need more research about what exactly happened to start this whole problem.
But there were markets and there were animals being sold, and there was, um, lots of intensive farming of animals happening.
And I think we need to really learn the lessons of how we're interacting with animals as we try to feed a growing global population.
That Cove in 19 is in the animals were trying to tell us something.
And hopefully we'll learn that lesson as we learn the other lessons that we need to learn about how to respond to a problem like this but hopefully be able to prevent the next one as well.
So I'm gonna turn now to our panel and asked Jeff to really kind of just describe what is this?
What is this Corona virus like?
How is it different from other coronaviruses?
And and what is it doing to produce this infection of covert 19?
Uh, thank you, Peter.
And thank you all for coming.
Um, so my job, I hope, is to just give you some information about Corona viruses in general.
And what's new about this particular novel Corona virus that emerged a couple of months ago.
Um, as many of you may know, Corona virus is a large family of our own.
A enveloped viruses that circulate in animals primarily, but also when humans.
There's four human corona viruses that have been with us for a long time.
That caused the common cold and maybe 5 to 20 or 30% of colds every year in you or your kids or your family members are due to these human Corona viruses circulating because relatively mild disease they're ubiquitous on the planet.
But they really have a very low case fatality rate.
And at most they keep people, you know, out of work and hospitalizations and mortality is quite rare.
And as everybody's alluded to, um, we've now seen three animal to human spillover Corona viruses over the last 15 years or so since 2003.
Stars, which was first recognized in 2003 out of China, probably went from bats to civic cats to humans.
Um, the epidemic spread to other parts of the world in many countries, including North America.
Um, in total about 8000 total cases globally with a case fatality rate of about 9 to 10%.
Um, and then, you know, several about a decade later, we saw MERS, which is still sporadically spreading around the country, start in the Middle East.
As Peter alluded to, um um started in bats and then went to camels and humans.
Um, very less fewer cases about 2400 globally over the last seven or eight years, but with a very high case fatality rate of about 35%.
Um, and now we have this new novel, Corona Virus, that has gone under a couple different names.
Cove in 19 for the disease.
What's been renamed SARS cov two as actual virus name as Judy Latitude.
There's been now at least 75,000 cases worldwide, with the case fatality rate estimated at about 2.3%.
Those numbers are very rough, and we're still learning a lot about how this virus spreads and what it's pandemic potential is typical disease features, which I think George will talk about more because he has obviously first and personal experience but fevers, respiratory symptoms, pneumonia in severe cases, causing acute respiratory distress syndrome and requiring intensive care, ventilator support.
And in those patients, often leading to high high rates mortality that progress.
Um, those symptoms are relatively not specific for viral diseases, and we're still learning a lot about the specifics of how this virus is causes pathogenesis and how easily it spreads.
But clearly, based on what we know so far, it is spreading person a person relatively seemingly easily, at least in China, right?
So, George, could you really just tell us kind of what?
What it was like to take care of the first U S.
Patient with Cove in 19.
And what are some of the things that, um, was going through your mind as you were doing it?
And what, you know, what did this disease seem like when you were actually treating, right?
So, um, the large portions of work that we did actually happened before the patient arrived.
When the Ebola outbreak happened in Africa in 2014 15 our hospital began sort of becoming ready for it by setting up a system where we could accept patients with Ebola that required monthly trainings to make sure that our staff was ready to make sure that our partners in the community we're ready to transfer the patient from one location to another to set up our unit in our hospital rapidly and safely with our facilities, folks s o.
All of that prepared.
This happened well before the patient actually arrived.
Is that better?
Um, so So most of the work that we did happened over years before the patient arrived.
And so when we got the call from the CDC that we had a positive patient the first thing that went through my mind in our affection profession, manners Mind was OK.
Do we open our unit or not?
And we thought that since we had recently done training on this actually a full drill a few weeks earlier that we knew that we could get all our protocols and procedures in place and do it reliably, uh, so that we would be able to safely except this patient's we've said, open our unit.
Uh, and once we've made the decision, then we started going through a checklist.
That's really what was on my mind to make sure that we had all the pieces in place, all the nursing staff, that was that is a volunteer staff, you know, come in, have all the facilities folks come in and build the walls that we were building toe wall off our unit to test the air air flow in the room and to make sure we all had only supply sincerity for the patient.
We also had to communicate with the E.
M s folks to make sure that we could safely transport the patient from his home to our unit in a way that wouldn't cause panic in our hospital.
So we had them come through some, uh, loading dock doors and transported through a part of the hospital.
It was lightly used, so there would be no other patients or visitors.
Seeing what?
You know, the transformation of a patient has got a highly communicable disease.
Potentially, uh and then we just got him in the room.
A TTE that point.
We started focusing on the patient and making sure that we're providing him support that he needed to get all supplies in the room.
We used to telehealth system to be able to examine him and talk to him.
The nurses were in the room, but we wanted to limit the number of folks go in the room.
So we had ah, computer set up with a screen in the monitor so we could interact with the patient outside the room, limiting the number folks going in there after that, We, uh we just took care of him supportively.
There's really not any specific treatment other than maintaining his fever, makes your eating and hydrated and really didn't have issues until about a week into his illness, when you did not pneumonia.
Attn.
That point.
We made a decision with the CDC to administer room Deserve Ear, which is a novel antiviral that's currently in clinical trials.
And he had a fairly robust response.
Um, relatively quickly.
Before that time, we also noticed that his liver became inflamed.
And that appears to be somewhat common phenomenon.
Patients who have corona viruses that it seems to be correlated with the development of respiratory distress.
Uh, and after about 24 hours of giving in this medicine, he improved rapidly.
So we're encouraged by that.
And he's now back home and out of isolations s.
So we're very happy about that.
I think the course of our patients fairly typical of the 15 patients that are that have been in the U.
S.
Five have been able to stay outside the hospital, the rest of it in the hospital in most of developed pneumonia.
So I think this is a common feature for this virus on, and thankfully, no one's really become critically ill in the U.
S.
And there's been no deaths so far, and that's a little different from what the experience has been in China so far.
So hopefully are supportive measures.
The way we care for patients here is making a big impact.
Great.
And Kathy, as this was happening, there was beginning to be, you know, the public health system was going into high gear, and you were thinking about what this pattern of spread had been in other countries.
And so what's your take on how how it seems to spread in a population and what to be prepared for when you're doing that.
Right.
Um, so, first of all, thanks for having me and good evening, everyone.
Um, just to follow up, I think in some things that George was saying, You know, our first priority when we found out about the case was Thio, you know, make sure that the case was getting adequate medical care, which we did, and then our second priority was really trying to identify contacts.
Who may who?
The individual may have come into contact with, um, to see if there was spread to anyone else in the population.
And this was a little bit challenging because it was a new disease, a cz You, as you mentioned, you know, we were trying to figure out Okay, Well, how is the disease spread?
because that helps us determine who is at risk for getting the infection.
Um and so we worked with the CDC, and, you know, really decided Thio, you know, make a lot of assumptions based on, you know, other krone viruses.
So Corona viruses in general are primarily spread through what we call droplets spread.
And that is when you know, people cough and sneeze.
They could have respiratory droplets that you know can come out of their mouth, generally land within about six feet of the individual.
And if those you know are, you know, get into the mucous membranes of somebody else than that person can become infected.
So we kind of used we based, you know, our contact investigations on that assumption that it was spread primarily through droplets.
Um and so we tried to identify everybody who this person may have potentially exposed.
And in the end, we have Have we identified it?
About 77 individuals who may have been at some risk.
Um, And then what public health does is we follow these individuals.
We monitored all of them for 14 days.
If anyone if any of them developed symptoms, we got them tested for Cove in 19.
Um, unfortunately, um, none of the contacts that we identified ended up developing Thean affection, you know, which was, I think really good news for us here.
The other thing that we did to try to learn more about this particular virus and how it was spread is that we did what we called an enhanced contact investigation.
So with the help of a team from the CDC, we asked these individuals if they would be willing even if they didn't have symptoms to be tested for the virus.
And about 26 of them did you know, agree to be tested even though they didn't have any symptoms.
And all of them tested negative as well, because we were starting to, you know, trying to start answering some of the questions that we had.
Like, how is these transmitted?
And can people have an asymptomatic infection and cannon?
A symptomatic person spread the illness.
Some of these questions that were, you know, we're kind of grappling with now.
We tried toe, start answering, you know, through our contact investigation.
Right?
So kind of turning to the university where we are now.
Jeff, Can you say something about what it's been like to handle the situation in the university.
What?
What what sort of possible cases have popped up here?
And how has it been to handle that?
Yeah, sure.
So, as you all know, the university is a huge place with about, you know, we have three campuses here in Seattle, on bottle in Tacoma.
We have about 100,000 members of our community students, staff, faculty, ancillary folks, and that's Ah, kind of a small city.
And so thinking about managing a outbreak like this on campus presents a lot of challenges.
As Peter alluded to, There's the Advisory Committee on Communicable Diseases, which tries to coordinate responses to outbreaks on campus and has a long history of doing that.
Um, over the last few decades, um, early on, we learned from our colleagues of public health that we had ah, few patients who had traveled back from Wuhan, China or a few students who had traveled back from Wuhan, China with symptoms.
Um, to date, we've had four and all who were persons under investigation, and they've all tested negative.
The challenges of them was, you know, finding out who they were getting them appropriately tested if they were living in communal living situations with many of our students are and dorms in apartment shared apartments and fraternities and sororities.
Things like that, getting them to a place while we're waiting, testing that get them out of out of communal living situations.
And that can be a challenge in such a big campus.
The campus, fortunately, does maintain some isolation unit housing on a limited basis that were ableto move folks.
Thio sometimes is needed, Um, and then just coordinating with all the messaging with the greater campus community about what steps we were taking.
Anticipating more cases, coming down the road and working with leadership communications are medical colleagues that you don't medicine.
And our colleagues at public health.
Um, Jeff and his group at public have been indispensable, helping coordinate campus Ah, uh, campus coordination of these four cases, and I think we learned a lot about howto um, with these four negative students had a had learnt that we've also looked at travel as you can imagine with such a big campus, we have lots of faculty, students and staff travelling to the affected areas and China and learning about their travel plans to come back.
As you probably heard, if you're a member of the campus community that the university put a travel ban for U Dub travel related business to China until this dissipates, um, and trying to figure out who in our campus community might be coming back on and might be at risk in trying to make sure they are tracked, staying at home and not potentially spreading a virus to the rest of the community.
Um, and so that's taken a lot of partners both in upper campus in you, dumb medicine and our public health colleagues.
We want to leave time for questions, but I just wanted briefly.
George, could you just say something about what's happened to the patient?
And how did you know when the patient when you were done treating right?
So the patient's doing well.
Now he's back at home after he his fever's resolved.
Ah, he felt much better, and he was off of oxygen.
We work with her county health department to get him back home.
Uh, he wasn't yet out of quarantine, and, um and so he had to stay home by himself.
The health District would bring food to him and make sure that he was well cared for at home.
Ah, And then while he was there, they did Cyril testing on him to make sure that he was no longer shedding viral r nay, that potentially could be contagious.
And so, thankfully, those tests of now come back negative on two separate occasions and he's been released from quarantine.
Right?
And, Kathy, could you just sort of give a snapshot of where the Where the health department is right now on what you're expecting in the near future in terms of everything going on in public health?
Yeah.
So after we, you know, help to manage the initial patient, Um, several of you have probably heard in the news about some new measures that our federal government put into place.
Um, currently, they are funneling all passengers who are traveling from China to the United States into 11 different airports here.
Seattle Tacoma is one of them.
And when when travelers come in, they do get screened for symptoms.
Um, and then their names and contact information get handed off to the local health department where they live, and the local health departments have been helping Thio helping these individuals monitor their health and asking them to stay at home away from others for the 14 days after they return.
So that has been a lot of after the first case sort of settled.
We spent about a week and 1/2 just getting that system up and running.
We currently have about 750 individuals who have recently returned from China, who are who have who public health has attempted to contact and who have been asked to monitor their symptoms and stay at home and out of school, right?
So with that, I think we're going to open it up to the audience for questions.
And we were going to take, um, several questions and then have the Panelists answers, answers some of those.
So I think we're gonna have, ah, Mike that people can come up to the mike and ask a question.
Any questions for these Panelists?
They can pass the mic or have you come up to the mike?
There's a mic standing here, and there's one here.
So do you want it?
I got to come up.
We'll take the 1st 3 questions and do some answers and see how much if we have any more time, Uh, in regards to fecal spread, Um, that tested positive.
Um, where do we go from here?
Uh, are we looking at investigating more of the 261 that are under surveillance?
Uh, supervision.
How long have they been back?
I'm taking it that those aren't of the 77 of the first.
We're now the 7 61 Or Travelers.
Is that right?
Inbound.
And there about a week now.
Watched?
Yeah.
So, um, why don't we try to take 3 to 1 would talk about that.
And you're gonna ask another question when I to put your question out?
Yeah.
Matching the questions in threes.
Question for I think.
Kathy Lo Fi.
I understand that, um, there's going to be routine testing for what is it, Cove in 19 or whatever.
The corona virus on flu specimens that are negative for flute.
And I was wondering if you would feeling a little bit more information on where these things they're going to be tested.
And, um, how many?
One question over here.
Yes.
I'm actually review the case.
Study off the first case in the United States, and I'm running that.
What's the difference?
Like a symptoms difference between, like a star's Merced and the covert 19th.
Not because our pop our community really a rural effort of this virus, and they have this questions.
Hey, Kathy, do you maybe want to start?
Sure.
I think I'll start with the last question, which is about you know, how kind of our next phase of surveillance is what we call it in public health.
And that's really detecting, you know, how do we track the virus out in the population?
Um, and we are in conversation now with some of our local health departments about how we could start doing some routine screening to to try to determine, you know, if the virus may be spreading here.
We don't think that that is the That is the case now, one of the problems that we're dealing with is the testing capacity.
CDC has developed an essay that s a has not been released to the States yet.
Um, it was released.
There were some issues with the essay, and we are waiting to get the ass a back again so that we can start doing testing here in Washington because currently, the only laboratory in the country that can do testing is that the Centers for Disease Control and then the other issue that we're trying to work through is that when the essay was approved by the FDA, there were very strict specifications in the emergency youth use authorization that said how the essay could be used on and it was not.
It was really supposed to be used on people who have symptoms.
Um, symptoms that meet the, um you know, the CDC.
Cates, You know, the kind of the criteria that CDC looks for.
So we need to think a little bit about you know, how we can, you know, do testing.
But so plans are in place, but it's gonna be It's gonna be a little while yet before we're not exactly sure when we're gonna get the essay.
And then the second question about fecal spread so the Corona virus and general's rarely can be spread through fecal spread.
I don't believe it's supposed to be Ah a.
But it's something that can occur rarely.
Um, s Oh, um, it's something I think we need to keep in the back of our minds.
Um, And then I think the other question was about, um, the travelers.
And so there are about 750 travelers who have returned from China, and, um, we monitor we are monitoring them in different ways.
If they have returned from the Hu Bei province, they are, you know, they need to stay at home and really cannot leave their house at all.
Um, if thea other travelers that are returning from other provinces in China, um, are asked to stay at home, stay at home, not goto work, not go to school and to monitor their health for 14 days.
And if they become ill, we will get them tested for the novel for covert 19 that I answer them all.
And, yeah, different sweet symptoms between stars, murders and things.
Jeff did.
You are Georgie wants.
Um so I think the symptoms are relatively similar.
People present with upper and lower respiratory track symptoms, fevers, pneumonia.
I think the key differences between the three viruses the amount of people with severe fatal disease.
And and although we don't know what the final number is gonna be for cove it 19 disease um, that appears to be relatively low, you know, maybe 2% at current estimates from data coming out of China, whereas SARS, the mortality case fatality rate was about 10%.
And for MERS, it's about 35%.
So these although the syndrome people present with and clinically look similar disease severity appears to be quite different.
And it may be in the end, that cove in 19 disease has, ah lower case fatality rate than what we're seeing initially early and epidemics things often look worse than they do.
Uh, later on, um, we learned that with h one n one.
Um, but, uh, but really, from a clinical point of view, there would be managed the same way and present very typically the same way theme.
The only thing I would add is that it appears that with Cove in 19 the progression sort of severe disease and pneumonia happens about 10 days after the onset of symptoms, which is a little different from murders and stars.
Different how it's just more delayed lower.
And then there's a question about viral shedding in our patient.
He did shed virus and a stool on one day.
He only a diary one day.
Ah, and it's you know, the CDC has been doing testing.
It seems reliably to be found in deep nasal samples in the throat.
Hasn't really been reliably found in blood Onda and has intimately was found in urine.
So mostly it's respiratory samples where the positivity is reliably found.
Great.
So how are we doing for time?
Three minutes to go.
Um, we could take maybe 11 more question.
So, uh, thank you.
I think you guys are doing an amazing job with all this stuff going on.
Uh, I'm curious what the false, positive and false negative rate is for the testing.
So nobody knows.
Question s way.
Ask the CDC that question, and we just don't know what the difference in the essays in China versus what we're doing here in the U.
S.
So I don't know if I need the Panelists have any idea, but it's unknown.
All question if we don't know how accurate the testing is, should we somehow treated differently than if we knew how accurate it was?
Like Should we do anything about that?
I'm kind of curious.
Yeah.
You know the testing that is being done.
But, you know, based on looking for our day is actually, in general, a fairly sensitive essay.
So I'm sorry, Jeff.
So looking for three targets, and so the case definition?
I don't know.
If you want to discuss, you know how many targets?
Yeah.
So there are three targets, and, Jeff, you'll have to remind me.
I think two of them are, like, kind of conserved corona virus regions.
And then another one is the one that separates it out from the other Corona viruses.
Is that right?
So there's three targets, by the way, Um and so, you know, I would think that three targets would make it a pretty good test, but yeah, like, I don't know, we don't really have a panel for sea of positives and negatives that we know for sure that CDC can test.
Um, but that's part of the reason why it's really important to follow exactly what was approved, You know, in the emergency youth.
Awesome authorization, You know, from the FDA.
I mean, it was approved to test individuals with a higher likelihood of having corona virus, which, which are people who have some epidemiologic link essentially to either China or a confirmed case.
So I just said, if you start testing people in the general population has a very low pretest probability of having Corona, then you're gonna likely Seymour false positives, even for a very specific test.
Um great.
Um, anything else this panel wanted?
Did you absolutely wanted to say we're gonna have more time at the end of for a question and answer.
But I do want to leave time for the other panels to take place and you'll have a chance to ask questions after each of the panels as well.
All right, front, Jeff there.
Yeah.
So as our panel settles, I thought I just introduced myself.
So as Judy mentioned earlier my name is David Piggott.
I'm an assistant professor here in the newly founded department, Health Metrics Sciences and I contribute to the university's Metta Center for Pandemic Preparedness.
Trying to evaluate global vulnerability to outbreaks.
Tryingto identify Geography is where these new viruses could emerge from, and also health systems that are not so well prepared to respond and react and prevent transmission going forward.
So the previous panel gave us a lot of virus names, things like Zika and a bola that previously were rare diseases off in a far flung country that are now becoming more common, being presented in the news on a routine basis and actually a part of day today, conversations will regularly on DDE um, global it globally we are trying to better prepare.
We've got a lot of organizations who now have it as their explicit mandates to think about global health security.
So we have CDC with various country offices across the world.
We've got Africa CDC now that's helping in all many countries in Africa to kind of strengthen and bolster local preparedness.
And we have overarching global legislation to try and understand and provide guidance for implementation of travel bans and quarantines.
There actually are supported by robust scientific evidence and allows for the director general of the World Health Organization to declare something called a public health emergency of international concern, which this over 19 has now been declared.
But that preparedness has not been uniform across the world and even persists health systems that are better prepared, a Douglas will scale we're already seeing in China.
About 1500 medical professionals have already been infected with this virus, so there's a lot that can be done.
So I'm hoping in this session will discuss what's been happening locally over the last few years and how this is set us up to deal with the potential for incoming cases on Dhe.
Consider that with in both clinical and community settings on, we'll discuss what response measures are currently warranted and how you can all pay attention to the information that you need to hear should that situation change going forward.
So on the panel, I've got Dr Janet Baseman, who is professor of epidemiology and associate being for public health practice at U Dub Sport Public Health.
She's let several research projects related to public health, emergency preparedness and response as part of the Northwest Preparedness and Emergency Response Research Center.
And she directs the Student Epidemic Action Leaders, or SEAL team, that contributes Thio, supplementing states and local public health agencies in really with their real time needs.
To her left, I've got Jeff Do Chin, whose Prior Thio, prior to assuming the role of health officer for public health Seattle in King County in June 2015.
He served for over 15 years as chief of the public health's communicable disease Epidemiology and immunization sector aunt.
He was trained at the U.
S.
C.
D.
C.
As part of the Epidemic Intelligence Service and served a variety of roles there prior to coming to Seattle.
And finally, at the end, we got John Lynch, who's an infectious disease physician at Harborview Medical Center and associate professor of medicine at U.
Dub is the medical director of the Harbor View Infection Prevention and Control Program, as well as the Employee Health Program, and leaves hospital based responses to infectious pathogens of all types.
So I'd like to start off with with Jeff, and I'd like you to.
Could you describe to us what?
What Local systems have been developed over the years to counter these newly incoming pathogenic from threats on what are the steps have been taken in King County to prepare for any possibility of cases coming in?
Thank you for the question.
Counter is a strong word.
Um, so you know any response to an emerging infectious disease is based on the the capacity and the quality of the local public health in health care delivery system.
And if you look at the international health regulations or global health security.
It's all based on countries having good public health infrastructure, good emergency response infrastructure and good health care system infrastructure.
So to the extent that we in the U.
S.
Have relatively speaking a very good health care system infrastructure, we were there was recently a global health Security Index study in the U.
S.
Ranked at the top with respect to being able to manage a large scale pandemic, That doesn't mean we would do it easily or do it especially well by our own standards.
But we're at the top of the global scale and in Washington state ranks consistently at the top of U.
S states with respect to emergency preparedness.
And we're in a very fortunate county where we have ah ah, robust health department with watch of experts that are trained here at the university.
And, um, we have very good, long standing relationships with our health care community, which is a very fundamental part of emerging infectious disease response.
So, for example, 20 years ago, um, I started a group called It was at that time called the Outbreak Response Workgroup, where he brought together county hospital executives with our public health team to talk about things like bioterrorism, emerging infectious diseases.
And shortly after we started that the stars outbreak happened and that thing evolved into ultimately, what became the Northwest Healthcare Response Network, which is, Ah, organization that's now statewide but started in the county, which brings together our county hospitals and our public health program to ensure and integrating coordinated response to any sort of emerging disease threat or health Emergency could be an earthquake.
It could be a tch one n one influenza or it could be any other type of emerging disease threat.
So I think what we have here in the county that is valuable is a long standing history of very good relationships with our health care sector.
Um, Jonah, but I'm sure we'll talk about some of some of the collaborations that we've had in the context of this new Corona virus.
A situation, Um, and we've got a relatively speaking on the global scale, well funded health care system and public health sector.
However, I can tell you that no public health system in the U.
S.
Is adequately funded to meet the demands of something like, um, novel Corona virus outbreak or a print pandemic flu?
Um, the, um the funding doesn't allow for any meaningful surge capacity we barely have.
The resource is to do our daily work.
And over the last 10 years, the federal funding for both public health and hospital hospital system prepared.
This has been cut by 30%.
So leave it there.
Thanks.
And John, switching to the clinical context what hospital has been doing to prepare themselves potentially highly highly infectious patients.
Yeah.
Thank you.
I'm sorry.
I'm still reeling from Jeff's comments.
Um, a little bit.
So you know, hospitals want to care for people they want to ride.
Good clinical care for people across our country on bears, a bunch of issues that intersect with issue of new epidemics.
Some extent, we sort of deal with on a year, by your basis, for instance, influenza.
Right now, um, you know, it's killed over 60 people in Washington state, you know, five or more Children and this is something we deal with on a regular basis.
We've had people walked through our burn see department with measles.
We know about the measles outbreak last year, and a lot of those people end up in health care facilities and facilities need to be prepared for patients with flu patients with measles, patients with mumps and other infectious diseases on a regular basis.
At the same time, we don't tend to have a CZ Jeff sort of pointed out surge capacity.
We're not built in health care systems to expand out and all of a sudden accept people with novel infectious diseases.
Um, and we need to be thinking hard about that on we have been.
As George pointed out, I think really, the 2014 West African Ebola outbreak was obviously a hugely devastating epidemic for the people who were in West Africa, who had to deal with that lost loved ones and co workers and so forth.
But it was to some extent transformative for many help hospitals in United States and particularly your in Washington state, and that we started trading as if these folks could show up in our hospitals, either expectedly or unexpectedly.
They walked through our emergency department.
They walk into one of our clinics or weak, contacted by our colleagues of public health, saying, Hey, we need someone to be evaluated and since that time we've done a lot of training.
That training has been different at different hospitals.
Some places, like George's and my facility have done lots of trading over the years.
Other places have really their training's been focused on.
Hey, how do we identify kind of isolate and then get this patient to another facility? 00:58:26.100