Summary

  •  Emory University doctors share their personal experiences in treating Ebola patients five years ago, discuss the lessons they and their colleagues learned, and how those lessons prepared them to confront the COVID-19 pandemic.

THE WASHINGTON FOREIGN PRESS CENTER, WASHINGTON, D.C.

MODERATOR:  I will go ahead and get started.  First of all, good morning.  My name is Olga Bashbush.  I am a program officer at the Washington Foreign Press Center.  I want to welcome you today for this on-the-record Zoom briefing.  The topic is: “Lessons Learned from Ebola for Coronavirus Preparedness.”

This briefing is being livestreamed on the Foreign Press Center’s website, which is fpc.state.gov.  We will produce a transcript and video after the briefing and post them on our website.  If you publish a story as a result of this briefing, please share your story with us by sending an e-mail to dcfpc@state.gov.

Just a couple of things to keep in mind while using Zoom.  We have muted all of the participants and turned off your video.  Please ensure that you have clicked on the participant list, hovered over your account, and changed your account to reflect your name and news outlet.

Our briefers will give short opening remarks and then we will open it up for questions.  If you have a question, please go to the chat box.  There is a feature there that allows you to virtually raise your hand.  At that time, we will unmute you and turn on your video so that you can ask your question.

I am honored to introduce our two briefers, who were not only on the frontlines during the Ebola crisis, but are currently working to help those that are affected by COVID-19.

Dr. Colleen Kraft is the Associate Chief Medical Officer at Emory University Hospital, Associate Professor of Infectious Diseases and Associate Professor in the Department of Pathology at Emory University School of Medicine.  She is also a Medical Director of Microbiology Laboratories at Emory and Director of the Medical Microbiology Fellowship Program.  Additionally, Dr. Kraft’s research interests include antibiotic resistance and fecal micro-biodata transplants.  Dr. Kraft was one of the physician leaders in the effort at Emory University Hospital to receive and care for patients who had contracted Ebola virus disease in West Africa in 2014.

Her colleague and our second briefer is Dr. Aneesh Mehta.  He is an Associate Professor of Infectious Diseases at Emory University School of Medicine.  He is also the Chief Infectious Diseases Services for Emory University Hospital.  Dr. Mehta’s research and clinical paths have focused on treatment of and protection against infections in immunocompromised hosts including patients with organ transplants and stem cell transplants.  Dr. Mehta has served as a member of the Emory Serious Communicable Diseases Unit since 2009 and was one of the physicians at Emory University Hospital who successfully treated the first Ebola patients in the United States in 2014.
And with that, I will pass it onto Drs. Kraft and Mehta.  Thank you both for joining us today and thank you for your service to our communities.

DR. KRAFT:  Thank you very much for the kind introductions.  Both Aneesh and I very happy to be here speaking with you.  We’ve spent a lot of time together working on these serious pathogens and we feel like we want to share our experience with you.  We are going to do very limited opening remarks because our preference always, and what has worked the best during this time, is to have questions.  We can give you some high-level overview on our perspectives and what we’re doing, but it’s always better to sort of answer exactly what you want us – what you want to hear about essentially.

And so my role right now – and Aneesh, or Dr. Mehta, can talk about his role during his time – is to really – is preparedness in our hospital.  And so I’m working in our healthcare system leadership group to try to work on general preparedness for our hospital specifically.  I’ve also been very intertwined with our laboratory testing since I’m a clinical diagnostician as well as clinician who sees patients.  That’s my happy place.  And so I’ve worked a lot with how we develop our testing for COVID-19 and also how we’ve done serologic testing – I’ve assisted with that across our system entity.  And then I’ve helped Dr. Mehta on his research study by approaching patients and then obviously, we’ll be taking care of patients in the hospital as well.

What I wanted to just briefly mention were two topics about what we did during the time of Ebola five years ago and what we’re doing today.  So my first topic is really on health care worker safety.  This is something that I became very passionate about, that we became very passionate about, in 2014, that we believed that doing provider-centered care was important to having excellent patient care and outcomes.
We always focus in the healthcare system right now on patient-centered care, which I think is obviously crucial and important, but we believe that protecting our healthcare workers is of utmost importance to be able to then deliver that excellent care to our patients.

So during Ebola, we had a very small group of about 30 people total that ever went in those rooms, and we pretty easily could serve as each other’s support group and support network.  We had a lot of support over time from the health care system and from our community to be able to navigate that time.  And really, if you think about it, that small group of people were the main people affected during that time.  We were the ones that were working long hours dealing with this pathogen, but remember we were practicing containment at the time, and that was effective.

So we knew we could not get any – as long as we kept Ebola in that room, it was not going to spread in the community.  And so that was really a focus of our team, and we were highly successful in that.
We were extremely proud of the fact that all of our patients recovered.  We were also extremely proud that none of our health care workers contracted the disease.  That is something we felt very strongly about and worked to the utmost of our abilities to do that.

How that’s changed during the time of COVID-19 is different.  We’ve had to scale up this incredible machinery of a health care system from just this small cadre of highly experienced individuals.  We’ve now had to scale that up to everyone.  Everyone is on the frontline; everyone must be supported.  And so that has been a new challenge for our health care system.  I think it’s brought us closer together.  We are going to be a different place after this pandemic.  We have done things differently.  We’ve deconstructed some old ways of doing things, and I think – I round daily in our healthcare system just as a leader, and we have happy people at the frontlines. We have people that are going into rooms all day long wearing personal protective equipment that feel supported and proud of what they’re doing.  We also do not have an increased exposure per se in our health care workers, and we’ve very, very proud of that.

There is community transmission in the United States, so our approach is no longer containment, our approach is risk mitigation.  And so we continue to really work to keep our health care workers safe in the processes that we have.  And we have a whole leadership group for our whole system that’s been tirelessly working on supply chain.  So we have not had a lot of supply chain disruptions because we were very proactive in conserving what we had and using very novel ways to wash and reuse our personal protective equipment, and then being extremely resourceful about where we find our supply chains.  So I’m very proud of that.
In terms of diagnostic testing, there was a lot of interesting things that happened during Ebola virus time.  I would love to spend a long time sharing that with you, but there was rapidly became some diagnostics, but it took us a little bit to get those approved, and it was only needed for a few people.

I think one of the things that’s been really underappreciated in this current time is that we have never, ever had a diagnostic as rapidly as we have for a new pandemic virus.  There’s a lot of focus on the lack of test kits and the lack of testing, which of course should be a goal of ours in the United States.  But there is an underappreciation, as I’ve said, for the fact that we created a diagnostic test, that the FDA has allowed us to use these tests on patients and give clinical results in an extremely short period of time.

Again, I’m biased because I work at Emory, I suppose, and I’m intimately involved in this – in these diagnoses, but we have an extremely useful test that we are using in our patients and in the community to diagnose this disease, and we’re really proud that we have not had any interruptions in the supplies to be able to do this testing both rapidly and in sort of batched testing.  We have high confidence in the results that we’re getting.  And so that has been its own journey during this time to sort of figure out how to operationalize that, how to grow that.  We now can test about 800 people, 800 tests a day in the virus testing aspect.  Serologic testing is its own topic.  We are able to test to see if people retrospectively have been exposed to the COVID-19 disease.

So I really wanted to hit the two highlights, which are personal protective equipment and protection of health care workers and how passionate we are about that here, and then also diagnostic testing for COVID and how that’s being ramped up.

So I will pause now, let Dr. Mehta speak, and then take any questions regarding my topics or any other topics.

DR. MEHTA:  Hello, everyone.  Thank you, Dr. Kraft, for those comments.  And Dr. Kraft has been an amazing leader in our preparedness and our implementation for not only Ebola, but also now for the novel coronavirus/COVID-19 infections that we are seeing.

So going back to our times taking care of patients with Ebola, as Dr. Kraft mentioned, we learned a lot in that care of those patients on how to protect ourselves and how to take care of patients at the same time.  As part of that, we needed to communicate that information more broadly.  And during our time here taking care of patients, we were connected with colleagues all over the world in discussing our care of the patients.  But some of these really hard lessons, important lessons on how to protect the – our personnel and how to train and be prepared for these needed to be communicated more broadly.

So under the leadership of Dr. Bruce Ribner and Dr. Kraft, we formed an organization at that time known as the National Ebola Training and Education Center with colleagues from the University of Nebraska and Bellevue Hospital in New York City.  It is now known as the National Emerging Special Pathogens Training and Education Center.

As we’ve moved forward since 2014, we have used these lessons learned from our three institutions to go and train hospitals all around the United States on how to do the things that we did, knowing that we couldn’t always take care of these outbreaks in small biocontainment units, but we would really need to be prepared for a larger outbreak that would affect many hospitals and affect many wards in the hospitals.  And that, unfortunately, came to fruition with the COVID-19 outbreak.

We feel fortunate that we were able to do this training with our colleagues around the country over the past five years, and I feel that we are all in our own institutions but as a network of hospitals around the country better prepared to protect ourselves while taking care of patients because of this community that we have created, the NETEC.

One of the other really interesting lessons that we learned during our days in taking care of patients with Ebola is how to think about therapeutics and managing patients of a novel infection.  So when we received our first patient with Ebola, all of us had read a lot about Ebola, but we had never taken care of a patient with Ebola.  And there was a lack of knowledge on how to do that well and what medicines may or may not be helpful.  In that time, as I mentioned, we leaned on colleagues and we passed our knowledge on to other colleagues, which I think really helped in our care of patients.  But when we looked at the therapeutics that we were using, we were using data from animal studies at best, but usually data from laboratory studies to make decisions about how to treat our patients.  There was very limited availability of any of these medications.  And so while we had one-off or a couple patients who were treated with this experimental medication, we unfortunately did not learn too much about how these medications work and who best to use them in.

So in the interceding years through NETEC, we created the Special Pathogens Research Network, and the goal of this network was to, again, be prepared in an outbreak setting to not only care for patients but really understand what was going on with the patients and what was best to treat those patients with.  So again, during our times taking care of Ebola, we collected many samples from patients, and we learned so much about the virus in our four patients and how the immune system and the other body systems are reacting to the virus.  But again, it was limited to those four patients.

So through the SPRN, the NETEC Special Pathogens Research Network, we created an infrastructure to be able to, one, collect data on the clinical events of our patients and their data, their outcomes data; to also collect samples from these patients that we could distribute to scientists around the world; and most importantly, have a network in a way to evaluate potential medications that may impact the care of these patients.  We did not want to do these one-off experiments on patients anymore.  We wanted to really contribute to scientific knowledge.

And so having this network available when COVID-19 started to hit our shores really made it easy for the NIH to come to us and other networks such as us to say, “We have this medication that we think may be helpful.  We would like to conduct this clinical trial with you to make sure that we can collect data on hundreds of patients instead of just a few patients.”  And so in late February, the NIH launched the Adaptive COVID-19 Trial of Therapeutics, otherwise known as the ACTT trial.  And NETEC and Emory were some of the leading sites.  We enrolled – through Emory University Hospital and Grady Memorial Hospital, one of our affiliated hospitals, we enrolled 103 patients in this clinical trial.  And globally, we enrolled 1,063 patients in less than – or sorry, just over two months.

This is an incredible feat to do in an outbreak setting, and it is something that had not been done before.  And without this preparation that we learned out of Ebola, we learned out of previous outbreaks to not only be prepared to take care of a patient and take care of our providers, but to really be able to do scientific investigation that contributes to the patient that we see the following week is critically important to all of us.  And now, we are seeing that data start to emerge because of having this preparedness to do research, and hopefully that will make an impact for not only future patients with COVID-19 but as we prepare to take care of patients in future outbreaks as well.
So it’s been a real honor to be part of that Ebola experience, but it’s been an even greater honor to be part of this global preparation not only for care of patients, care of our providers, care of our communities, and really contributing to the scientific knowledge base very rapidly.  And with that, I would be happy to turn it back over to our moderators and see how we can answer questions for everyone.

MODERATOR:  Great.  Thank you both.  Before we get started with the questions from our journalists, I did want to ask you, Dr. Mehta, would you be able to go a little more in depth on how your team and your hospital has the bandwidth to conduct research, treat patients, and also take care of your health care workers?  Because obviously, you just mentioned how important that was, and that was one of the lessons learned, and you’re very proud of that work.  But how do you balance all of that with your time constraints and your resource constraints?

DR. MEHTA:  That’s a fantastic question, and I’m going to start with the last part first.  So how do we organize so that we can take care of everyone in the hospital?  And it is through wonderful leadership of our administration, people like Dr. Kraft and many other people across our organization that really believe that over the years we need to prepare for these outbreaks and an important part of preparation is taking care of our health care workers.
And so they have put in all the right teams in place and the right measures in place, and as Dr. Kraft mentioned, we see our administration coming and checking on all of our care teams, seeing what they need and providing that care and finding out how we obtain those resources that are necessary.  And to work in such an environment makes it much easier for us to then take care of patients.

Dr. Kraft and I are both involved in the care of these patients, and so we use our administrative hats, me as being the chief of infectious disease at my hospital and Dr. Kraft as being the associate medical officer for our hospital, to really organize our care teams to make sure that we have the right teams in place to make – and prioritize that we can take care of those patients safely and we can deliver excellent level of care every single day to every single patient, whether they have COVID-19 or they have other medical problems.

And then finally, coming back to that research piece that you talked about.  So again, as part of our preparation, we had a research team in place.  However, this outbreak and this research project turned out to be far greater than we expected.  And this is where it is a wonderful place to be in a community that really understands science and clinical care.  And so we were able to have multiple research teams come together, and in particularly our Emory Vaccine Therapeutics Evaluation Unit team really came in with their wealth of experience in doing these clinical trials and came – and really led the effort to care – to deliver these trials to our patients.  And so using all the resources of a broad institution such as Emory to focus not only on the care of these patients but also doing good research and also at the same time taking care of all of our other patients and all of our providers was critically important for our success.

MODERATOR:  Thank you.  Our first question is from Pearl Matibe.  She’s from NewsDay Zimbabwe.  Pearl, if you can just wait while we unmute you and turn on your video, and then you can ask your question.

QUESTION:  I’m just starting audio.

MODERATOR:  You can go ahead.

QUESTION:  Just audio.  Okay.  Thank you so much, Dr. Mehta and Dr. Kraft.  I really appreciate all your experience from Emory University Hospital.  This is fantastic knowledge and I appreciate your availability here today.  So I’d like to ask you in – with all that you have learned, if you transfer that knowledge in terms of what you learned on Ebola to COVID, we have countries such as Botswana, Mozambique, South Africa, Zambia, and Zimbabwe who have a lot of cross-border returnees of their nationals crossing the border and so on.  Right now – so we have some transmission that way.  Can you relate what you learned from Ebola in terms of how to handle cross-border transmission?

And if you could speak specifically – I know you might talk about measures but access to information in this region can be difficult.  So can you try to be as specific as possible in terms of measures, advice, policy recommendations, possibly any data you might be able to kind of maybe make comparisons?  And also you – even though you are in the medical profession and so on, you cannot do this task alone.  Without government and policy leader political will, you will never accomplish what you’re hoping to accomplish.  How do you balance that civil society, academia, and policy maker and government – that’s – can be a really tough balancing act.  Thanks.

DR. KRAFT:  Thank you for that question.  How long do we have for this answer?  Just kidding.  (Laughter.)

MODERATOR:  That was a very comprehensive question, so —

DR. KRAFT:  I know.  I feel – I’m trying to take notes on the question and make sure that I answer all of it.  So I really appreciate your question.  And having spent – I have a real heart for Africa and the clinical care in Africa.  And so you’re bringing me back to lots of places I’ve been in the last year.  And so there is quite a lot of difficulty between balancing academia, civil society, and policy making.  I cannot pretend to know at all and be an expert on all of this.  I think the main thing that you hit upon, which is something I feel really passionate about in working on contracts to be able to implement infection prevention practices globally, so distilling down what we can do to protect ourselves and our health care workers first and foremost no matter what the setting is something that we’ve been working on for five years.

And Pearl, I’m going to – or would you prefer Ms. Matibe?

QUESTION:  Pearl is fine.  Pearl is fine.  Thank you, Dr. Kraft.

DR. KRAFT:  Pearl, I think that – I think – I’m going to be real honest, and I – this is a perspective – that infection prevention and training is not sexy.  It’s been very difficult for us to raise money even domestically, even after caring for patients with Ebola virus disease, for people to want to make this an innovative and widely accessible set of skills.  This sounds kind of handwaving and maybe excuse-generating, but you would be surprised.  We can raise funds for pediatrics; we can raise funds for cancer, eye disease.  I was a part of some of the eye work in Sierra Leone that Emory did after the Ebola outbreak.  But we have not made this a sexy and globally important training.

So I – one of my goals is to change that.  We’re currently working with some foundations to try – I’ve even worked with the Mutombo Foundation, where we’re trying to figure out how we can best put this information in a low-tech or high-tech way – I mean, everybody has smartphones no matter, almost, where you live – how we can get that information widely disseminated to these porous borders, to the urban capital cities, Kinshasa and others. And so the way that I view this is we’ve got to figure out how to get information into the hands of every person.

And then fortunately or unfortunately, being next to the CDC, I’ve had a lot of colleagues who have gone in and tried to create some of this policy for these regions in Africa.  And so unfortunately, it’s difficult when civil society does not trust the government, such as in the Democratic Republic of the Congo.  That was really a – that was an upside-down world for CDC, who are very used to working with the government locally to be able to educate and support the individuals and the population locally.  When those two aren’t aligned, there’s – that’s a very, very difficult task.

So I would say that the policies need to first and foremost educate and focus on the education of the nation around infection prevention practices.  I think it’s very hard.  We’ve seen that globally.  The containment of this is impossible right now, at least for non-Wuhan located individuals and countries.  Wuhan was able to create a scenario where they actually contained it in their population, which is quite dramatic, and I don’t know that that can be replicated.  So when we are talking about societies that don’t have the ability (inaudible) then we’re really focusing on risk mitigation.  And I think it believes with – it starts with at the very basic level what I just talked about, which is education, and then we build on that with diagnostic testing and triaging.

So I have no idea if I even like approached the answer to your question.

QUESTION:  You did.

DR. KRAFT:  But I would love to have continued discussion about this.  And I am very passionate about how we roll this out.  I’m not interested in just protecting domestic health care workers.  I think if we can create a global culture change where we understand our personal responsibility in the prevention of transmission diseases that we will be in a better place and we’ll take care of people everywhere without having to even do policy.

QUESTION:  Thank you very much, Dr. Kraft.  I’m sure that I will try to reach out to you after this, at some point after this (inaudible).  Thank you.

MODERATOR:  All right.  Thank you.  Our next question is from Ms. Natarajan from Indo-Asian News.

QUESTION:  Hi.  Thank you so much for your time, doctors.  My question is basically – just let me just introduce myself.  I’m Niki with the Indo-Asian News Service and Observer Research Foundation, which is a think tank.  Just as context, I’m from India.  I live and work in the U.S., though.  And there seems to be a dozen varying definitions of a lockdown just between these two countries alone.  Purely from a medical best practice point of view, how would you suggest is the best way to go from here, wherever we are in the U.S.?  My question relates to the U.S.

I also want you to talk a little bit about the possibilities of digital contact tracing where technology is available at scale via smartphones.  Thank you.

DR. MEHTA:  So I’ll try to answer the contact tracing issue, just a little bit.  I think there have been some really nice innovations in the ability to use technology such as smartphones to help epidemiologists trace who’s infected and who is not.  And also here at Emory, our colleagues in emergency medicine created an app that allows people to really say what their symptoms are, what they’re feeling, and understand what the risk for COVID is.  And all of those can feed into our epidemiologic data pools to really understand the impact beyond the testing that we’re rolling out, as Dr. Kraft mentioned.  All of these data can be used together to really help us understand the impact that COVID has had on our communities and also how it’s moving through our communities.  And that’s something that we really need to move on.

And can you repeat your first question for us?

QUESTION:  Purely from a medical best practice point of view, where does the U.S. go from here?  Forget about the politics, all the people that you have to deal with as an epidemiologist.  Assume you were creating policy purely from a medical perspective for immunocompromised populations, for healthy populations, whoever.  What would you say?

DR. KRAFT:  I can answer this one, Dr. Mehta, if you want.  Okay.  So I’m going to say two things.  One, I appreciate that you want to make this a very sliver of the context.  I think it’s impossible to make the medical recommendations be completely out of context to everything else that’s going on.  I think all of us intersect with many different groups of people.  This is a very big struggle in many different ways.  I mean, it’s – we’re intersecting stress at every level.  I’m very involved with refugees near where I live in Clarkston, Georgia, and the intersection there with their abilities and what they can do is a lot different than a middle class family that lives across the street from me potentially.  So it’s – I’m going to just acknowledge that in the beginning before I talk about the policy part.

I’m also going to say – and this is probably going to be unpopular – is that while we’re going to – we should have policy that protects our public, I think that what I’ve seen in the last week in the United States – and again, I’ve been focused on the United States because I’m trying to get this hospital ready to serve the needs of the community given that our governor basically has rescinded our stay-at-home policy starting last Friday – and so I’ve been very ultra-focused on the United States, and I’m sorry about that, everybody.  I will get more global when I have a little bit more time to focus on that.

But I think that it’s really difficult to – I think what we should be doing, for better or for worse, is what I kind of said to Ms. Matibe – sorry, Pearl, I want to say your last name correctly – what I said to her is that there has to be some level of empowerment and instruction to the individual.  I’m not saying that people should be free to make their own choice everywhere, but I think with – we are confusing people with the messages that we’re giving.  People don’t understand how to make these decisions; they have no framework in which to make the decisions.  So what I would like to do if I could wave my wand is to say this is the framework of behavior, you have – you’re immunocompromised, you have end-stage cancer, here’s your framework that you should be – these are the things you should be concerned about, these are the places you should avoid.  Because this idea of saying stay at home, shelter in place – I’ve had colleagues say to me, “I have literally gone nowhere in the last six weeks except the grocery store and the hardware store.”  And so I was like, “That’s actually going somewhere.”

And so we – it’s almost like putting the public health aspects to it, while I think it makes sense to those of us who live and breathe that, we are missing educating people on an individual level how they can protect themselves.  That’s what I think is happening.  We’ve tried to substitute that by saying shelter in place, but we cannot do indefinite shelter in place.  Again, for the reasons that I mentioned earlier, we can’t take medical and health out of context of economics, and that’s really what we’re seeing, right.  It’s literally the competition of economic engine and medical health and public health, right.  I mean, that’s what I think, and so I think we need to be better at trying to engage and empower the individual to make good choices in an individual level as well as having this sort of bigger, bigger response.  I hope that’s helpful.

QUESTION:  Yeah, actually – yes, I mean, I think you’ve answered my question, although you started with a disclaimer.  I think you’ve answered me because this goes back to what I said about the definitions of lockdown can’t be so many.  There are so many across the world, and even in these two geographies which I closely follow.  A geography with 4x the population of the U.S. has a far more stringent lockdown, but there, the messaging has been simple and almost monolithic.  Now, you can say – of course you can push back and say no, that’s draconian or too stringent, but at least there is one single message and everyone gets it.  There’s actually policing where they say look, this is the only time you can go to the grocery store if you want to, and only one person from each household.  There is a – actually a contact-tracing app which is working and 70 millions people have downloaded it, so with a lot less resources, there are slightly better-functioning methods even if you call it too stringent.

And then you have a a la carte menu where you choose.  You can go out for a walk, go out for a – I still don’t know.  I mask up and I do everything, but I’m still free to go out and around every day, and I’m – the question mark is right there in front of my eyes when I’m – even when I’m walking, like, is this okay.  But I don’t know.  Somebody has to tell me that at an individual level, like you said, but yeah, sorry for the long —

DR. KRAFT:  No, no, I think it’s beautiful.  So I think that you – if you’re not going to give people the tools to make good choices, then you need to make the choices for them, but what we’ve done is we’ve said here’s – we’re not going to enforce anything, but we’re not going to tell you what’s good or bad for you either.  And so I mean, I like the idea of saying limit this, limit this, but maybe we don’t enforce it, right.  Like we still have sort of a unified message where we say if you’re this, if you’re this – this is a high risk, this is low risk.  I believe walking outside is very low-risk.  There’s a lot of air exchange in the atmosphere, right?

But if you’re – if you don’t know that, if no one’s sort of just explained some of this like here’s low-risk activities, here are high-risk activities – if you are someone that is chronically ill, avoid all high-risk activities or medium – I mean, however you want to kind of lay that all out.  But you give that a la carte menu, but you also educate the person that’s choosing from the menu, right.  Or you make the menu so accessible that it makes sense to them so they can kind of – they can stay within the framework that maybe you want but haven’t purposefully expressed, right.  Maybe it is stringent even if you say you really shouldn’t be doing X, Y, Z if you’re this.

DR. MEHTA:  So let me add a quick personal perspective to this.  So my mother spent the last three months in India and took an evacuation flight one week ago today.  And while she was there, it was very clear to her what the rules were and what she could and could not do.  However, given that she has lived in the United States for over 30 years, that’s culturally different for her now, so it was hard for her to follow those rules because she’s not used to having rules put on her.  And so now she’s here living with us and she is free to do what she wants, and now she wants to know what the rules are and I can’t tell her what the rules are because it’s not completely clear.

So I understand there are cultural differences, there are differences of understanding, and I think as we move forward and prepare for the next outbreak, we need to have this infrastructure of how we implement these things better in place so that it’s clearer for all of our populations.

MODERATOR:  All right.  I’d now like to pass it on to Ms. Lenka White, and after she asks her question, we’ll pass it on to China Business Network.  Please, go ahead, Ms. White.

QUESTION:  Thank you very much.  I hope you can hear me well.  So thank you for your presentations, Dr. Kraft and Dr. Mehta.  My name is Lenka White and I’m a correspondent at the United Nations for the Mainichi newspaper.  I hope this question is not going to be too broad for you.  Feel free to dismiss it in that case, but I was wondering:  From your point of view, could you comment on the international community response such as the UN, international organizations, or the Security Council to Ebola and now to COVID?  Did you feel the impact back then differently and do you feel any impact now?  Thank you.

DR. KRAFT:  I’m happy to start with Ebola, Dr. Mehta, if you want to take the last part or – you just let me know.  So I think the response with Ebola, again – and you all may have better context for this, so you’re going to hear an American citizen talk about something that happened in the eastern region of the DRC, of which you may have more visibility, so bear with me.

QUESTION:  Thank you.

DR. KRAFT:  So I think the response was quite robust.  We learned a lot from 2014 in West Africa that the longer we sat on providing assistance to the country, whether or not we should be going in and enforcing our sort of different ideas in that country about infection prevention or about quarantine – I think we learned quickly we needed to work quickly and have a global response.  I was very proud of Dr. Tedros and others who spoke up quickly and tried to act aggressively.

I think it needs to be said that that area of the world is full of strife, and I know all of you have read the background of that place, but having been there and experienced some of the overtones, I think with a global response it still took a year to be able to control that because of the government and local strife as I’ve described earlier in the eastern region of the DRC, and then also just – not only that but obviously the intense violence that all of the providers found themselves in.  When you have individuals fleeing into an Ebola outbreak area for safety, I think that should alone tell us what we’re dealing with.  With over 300 attacks on these – on the individuals and the units during even a few months, I think the killing of basically patients and health care workers by local militias in that area, including a WHO official – I think it should show us that even with dramatic international response for containment, it still took us a year because of all the complexities of that particular outbreak.

I’ll move on to Dr. Mehta if he wants to try to answer the COVID aspect of it.

DR. MEHTA:  So any time there is an outbreak, it is very difficult for the international community to gauge how widespread it’s going to be, if it’s going to be a localized outbreak versus a pandemic.  And I think it’s always easy to go back retrospectively and find problems that we could have responded to a little more rapidly.  But I do think that what happened with the COVID-19 outbreak is really a positive overall response.
So very quickly we received information from our Chinese colleagues about what they were seeing.  I remember getting the email just – on New Year’s Eve about the outbreak that the doctors were seeing there in Wuhan, and I think very quickly we got an answer to what sort of virus this was and how familiar it was to other viruses that we’ve seen before.  And I think overall the global medical community response, the public health agencies across the world have had a overall very good response.  I think we learn how these things go as we’re moving through them and we have to adjust our protocols, but I think overall everybody worked very well together to try to respond the best we can.  Of course different countries in different areas implement different procedures for public health responses, and what we’ll learn out of this is what has been successful and what has not been successful, but we won’t know that for several more months or even years.

MODERATOR:  Well, thank you.

QUESTION:  Okay, thank you.

MODERATOR:  We have one final question from China Business Network, as I know our two doctors have to go and treat COVID-19 patients, so please, go ahead, China Business Network.

QUESTION:  Yes, thank you, and good morning.  Can everyone hear me?  Okay.

So I got – two question.  So first one is:  Could you help me to understand the difference – the different death rate, ranging from South Korea and Japan at around two to three points, U.S. and China around 5.5 percent to 5.8 percent, to countries like UK, Italy, and France, which stands around 10, 13, and 14.  If we assume that virus treats us equally, what is the reason behind wide range of death rate, even among developed countries and what we can do?  I mean, U.S. can do more to lower the death rate.

And also I got one more question about usage of the field hospital in the U.S.  I live in New York, and the Javits Center and then USNS Comfort is merely used during the outbreak actually, and actually the Comfort is departing the U.S. – departing New York today with 182 patients treated over three and a half weeks.  This is quite different what – from what we saw in Wuhan, China, so if you can give a little bit of your thoughts on this too.  Thank you.

DR. KRAFT:  Thank you.  So I think that one of the things we’re learning is that I think the whole world is understanding better what epidemiologic tracing is through looking at these death rates as a surrogate.  So I would say that it’s no surprise that South Korea mobilized their excellent testing strategy very early and in a coordinated way were able to triage patients into a COVID unit or a not-COVID unit.  They also had an incredibly robust testing program, so they were testing a lot more of the population.

I don’t know as much about the UK data, except for what you told me.  But again, there was a lot less testing there, much like in the U.S.  I think what we’re going to see – but it’s going to take us a little bit – is that we’re going to have a lot more asymptomatic positives in the United States and that denominator is going to continue to grow.  So I suspect that our death rate, at least for most of the individuals that – most of the states that were not overwhelmed will probably mirror South Korea and China in the fact that – in that 2 to 3 percent range.  That’s certainly what we’re seeing locally here in Georgia.

New York has its own crisis within the crisis within the crisis, probably, if you want to think about it that way.  And so the incredible population that is close together I think contributed too, and the other thing is the probably early introduction of community transmission that went unrecognized in New York allowed a lot of these pockets to kind of bloom all at the same time, which crushed the health care system in New York.  So they are doing much better as there’s been community mitigation strategies.  I know they’ve been really active at least in Manhattan, in the urban areas to do that.  I know they’re talking about opening up other parts of New York from the shelter in place.
And so I think what we’re going to see is that probably the case fatality rate or mortality rate or however you want to call it will probably be the same for everyone across the globe.  It may be worse in places that have less pulmonary or ventilatory ability.  So if it’s in a country that doesn’t have a lot of breathing machines for patients, you probably will see an increased mortality there.  However, I do think that all of these probably have the same mortality; it’s just that the diagnostic testing to be able to see all of the cases in that area is not as robust.

So I believe that it’s a product of diagnostic and wide – like lack of widespread diagnostic testing rather than a true difference in any sort of health care system.  I’ll let Dr. Metha confirm or deny my assumption.

DR. METHA:  No, I very much agree with what Dr. Kraft has said.  I think one of the biggest problems we have is we don’t have great denominator data in many areas of the world.  And as we roll out more testing and we have seroprevalence studies done and have our epidemiologists look, we’ll have a much better understanding of what the attack rate is, so the number of patients, the number of people in our community that are infected or were infected and also what the true mortality is.  So I would look at any mortality data right now with a grain of salt, because we just don’t have great denominator data.

Secondly, I would say what – there is a lot of interest in understanding if different populations are affected differently.  And so we do know that our elderly populations probably have more risk of severe disease and worse outcomes in general.  And so when you see a country that has big numbers of deaths very early on, you need to look to see did the outbreak start occurring in areas where there are a lot of elderly.  And here in the United States, some of our biggest initial outbreaks were in communities where they’re – you’re housing a lot of elderly in close contact.  And so I think that has to be considered.  And again, that will all even out once the outbreak has gone away and we really understand the data.

But there may be ethnic differences as well in not only the acquisition of the virus but also in how severe the disease can be.  And I think that’s going to be another area of interest for epidemiologists and our health services researchers to really look at in the coming months.

QUESTION:  How about the usage of the field hospital in the U.S., in any (inaudible)?

DR. KRAFT:  Yeah.  So I view that as a sign of high concern, and I think all of us would agree that a field hospital is not going to be the same as a acute care hospital.  And so, again, not being intimately involved with how they’re making that decision, we, of course, in the state of Georgia have set up a field hospital.  It’s not been opened.  But our goal was – would have been to send people that just needed oxygen and supportive care at, like, a less acute level to that type of place and convert our entire hospital to basically being an ICU.  So that would have been our strategy, if that makes sense.  So the use of a field hospital signals crisis.

QUESTION:  Got it.  Thank you.

MODERATOR:  All right.  And with that, we will wrap up the briefing.  I want to thank both of the doctors for their time, especially during this pandemic.  Thank you for what you’ve done, what you’re doing, and what you will be doing in the near to long-term future.

So again, thank you, everybody.  After this briefing, we will be posting a transcript and the video to our website at fpc.state.gov.  If you have any additional questions, you can e-mail them to dcfpc@state.gov.  Again, thank you to the two doctors, thank you to Emory University, and to all of our participants.  Have a good day, everybody.

U.S. Department of State

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