(Part 2 of 2)
Operator: Thank you. The next question is from Mike Stobbe with the “Associated Press,” you may go ahead.
Mike stobbe: Hi, thank you for taking my call. My initial question is I need to ask about this, the reports out of China, the cases reported dropped down significantly the last couple of days. I know it’s just two days, but they were in the 3,000 range and now they’re 2,478 and 2,050, that dropped, what if anything do you make of that, and my follow-up question is about you discussed the kits going out to the states, could you say a little more about did kits go to all 50 states and were you expecting that they’d be up and running this week but now it means it’s going to be two weeks from now. Could you help us better understand the impact of what’s going on and what kind of delay it entails, thank you.
Dr. Nancy Messonnier: Sure. It’s only two questions this time. Good. So, the Chinese cases dropping down, I’m going to be optimistic that that is a sign that their aggressive efforts have been effective, but I really do think it’s too soon to say that for sure, not having hands on the data ourselves. There is a WHO advanced team in China now, and I’m hopeful that they will have access to the data themselves and be able to validate those findings. It would certainly be reassuring if we were now seeing at least a slowdown of this outbreak in China. So that’s the first question. The second question is a little complicated but what I would say is that of course we hoped that everything would go smoothly as we rushed through this, you know. We moved quickly, that’s appropriate under these circumstances but it’s equally appropriate to do quality control which is what we do, and where these — where this issue was caught, it is part of the normal procedures. Of course, I hoped that this week every state — and every state did receive a kit — every state would be up and running. How long is it going to take? I can’t tell you that for sure because I understand that not every state has completed their verification yet. And it won’t be until we have results from every state that we know which states can continue and which states we need to — we need to get new reagents to. We’re working closely with FDA. Again, we do expect this week that some states may move forward. Other states may need to get additional reagents from CDC, and I don’t have an estimate yet from our laboratory staff as to how long that takes, and when we do, we will definitely be, first, letting the states know and then letting you all know. Next question.
Operator: Thank you. The next question comes from Denise Grady with “New York times.” You may go ahead.
Denise Grady: Hi, thank you very much. I’ll ask you both questions. One is could you please go over the criteria, so we understand exactly who is being tested, who’s qualified for testing and then if the result is negative, does it mean anything?
Dr. Nancy Messonnier: I’m sorry, I’m going to just pause because there’s an ambulance going through. Just wait. Okay. So, let’s see, the criteria for testing in the United States focuses on people who are ill with the spectrum of symptoms that we have associated with this, which is fever, respiratory symptoms, cough, shortness of breath who have had appropriate travel history or who have been identified as contacts of a confirmed patient. And so, in each of the states where these cases have been identified, we’ve been looking at potential contacts of patients as to look to see if it spread, that contact tracing did identify the two cases that we say weren’t directly associated with travel. Those are in close contacts of two patients who traveled but outside of those close contacts around confirmed cases, our focus right now is on people who have a travel history that is consistent with where this outbreak is spreading. And we’re comfortable with that as the basic criteria because so far, we are not seeing widespread community spread in the United States. That is that the cases we’re seeing are all directly linked with travel to Hubei and China. It is also true that we did some testing of asymptomatic people, but it wasn’t in the setting of trying to make a clinical diagnosis. It was in the setting of using that to try to learn more about how this is being spread, and I think people may have misunderstood it. We did that in the first 195 people who were repatriated into the United States, but we have not been testing asymptomatic people who have returned on the other repatriation flights. And that relates to this question of what being negative means. If we have a patient who is symptomatic and has the right travel history, a negative means that at least at that point we don’t think they have disease. If a patient is at very high risk in clinical discussions with their health care provider and health department, they may be tested again. If they’re at very high risk. But in general, in a symptomatic patient, a negative, we think means that they’re negative. The difference is that when we were using it at march air force base to learn more about how this was being spread, it is possible that someone could be negative and still be incubating the virus and therefore we, in that setting, didn’t judge a negative to let us be confident that somebody was able to be released from quarantine. So that’s the distinction that we’re making. Next question.
Operator: Thank you. The next question comes from Julie Steenhuysen with “Reuters,” you may go ahead.
Julie Steenhuysen: Thanks, I have a couple of questions. First off, we know now that the w.h.o. Has a team in China. Are you — are any representatives from the CDC a part of that team? And can you say a little bit more about what kinds of problems the state labs encountered in validating the tests and why you need to send new reagents and finally are there any more flights expected from China carrying U.S. citizens? Thanks.
Dr. Nancy Messonnier: Okay. The advance team is three WHO staff. They’re staff that are well known to us. They have a lot of experience. They are being articulated as an advance team, and I heard a report from them this morning. They’re getting access to data, and doing the things you would expect them to do and as you all know, CDC stands ready to send staff to the affected areas in China to work on this investigation and as soon as we’re given the invitation, we are happy to do that, but we haven’t been invited yet. More planes, I think there is continued conversation that Americans who are still in Wuhan or other parts of China, so those conversations are ongoing, and I don’t have any specific information right now as to whether there will be additional folks repatriated in groups like we saw with these planes. So, I don’t have any specific information on that. In terms of the test problems, it gets a little weedy, but I can give you a little more detail. When a state gets the test kits, they have to verify that it works the same in their lab that it worked at CDC. And when some states were doing this, we received feedback that they weren’t — that it wasn’t working as expected, specifically some public health labs at states were getting inconclusive results and what that means is that test results were not coming back as false positive or false negatives, but they were being read as inconclusive. Now, these were not tests being run on actual clinical specimens from potential patients. These were part of the verification process, and because of that we are — when we evaluated what the issue is, we think that there might be an issue with one of the three assays and we think that maybe one of the reagents wasn’t performing consistently, so it’s a long story to say that we think that the issue at the states can be explained by one reagent that isn’t performing as it should consistently and that’s why we are re-manufacturing that reagent, obviously a state wouldn’t want to be doing this test and using it to make clinical decisions if it isn’t working as well as perfectly at the state as it is at CDC, so this is part of a normal process and procedure and redoing the manufacturing is the next step. Next question.
Operator: Thank you. The next question comes from Erika Edwards with NBC news. You may go ahead.
Erika Edwards: Yeah, just to follow up on that, are all the tests still coming through the CDC in Atlanta for conclusive results while the states work out their issues? And separately, I just wanted to learn more about your thoughts on that growing number of cases on the cruise ship docked in japan. I mean, is there anything that CDC is even able to do to help the Americans on board? Thanks.
Dr. Nancy Messonnier: Yeah, thanks for the clarification and yes, all clinical specimens are still being sent to CDC for validation. I think you would expect nothing less from us as obviously the results of this test are so meaningful, and we’ll continue to provide that backstopping frankly even after states are up and running. I would ask that you — that the right language wouldn’t be a problem with the states. It’s a collective problem, so I don’t want this to be seen as something that the states are doing incorrectly. That is certainly not the situation here. This is really part of a normal process and procedure, and, you know, we have the quality control set up specifically to allow us to identify these kinds of problems. In terms of the cruise ship, I know that there are Americans on board, there are certainly Americans that are ill and it’s certainly concerning the high number of cases on that cruise ship. We are working closely with the embassy in japan, and the state department to help with thinking through what’s the right actions. Somebody from the state department may be on the phone, and if so, I’ll ask them if they want to make a comment on this. Ben, is somebody there?
Benjamin Haynes: No, Nancy, sorry, nobody from —
Dr. Nancy Messonnier: Okay. So, I guess they’re probably not on the phone because they’re helping — working with us to think through what to do. Obviously, it’s a high priority to make sure that the people that are already sick or the people that are still on the ship and asymptomatic are getting the best care possible. We want to protect their health, and we’re working closely, again, through the embassy on thinking through what the right next steps are, and when there’s more information, we will clearly make that available as quickly as possible. Next question.
Operator: Thank you. The next question comes from Tom Howell with the “Washington Times.” You may go ahead.
Tom Howell: Hi, thanks for doing the call. Just branching off the question about the cruise ship, do you have any numbers of how many Americans are on board and how many of them might be infected if any?
Dr. Nancy Messonnier: I actually don’t have those numbers in front of me but what I would say is there are definitely Americans on board who have been diagnosed with and now I have to get this name right, nCoV 19. Excuse me for not getting it right. I’m still working on it. There are Americans on board that have been diagnosed with nCoV 19, but I don’t have the numbers on me right now, and we can certainly follow up. Next question.
Operator: Thank you, the next question comes from Nate Wetzel with “The Hill,” you may go ahead.
Nate Wetzel: Hi, thanks for doing this call. I’m just wondering, there have been reports that the virus might either weaken or sort of die out as the weather gets warmer. Do you have any evidence for that? Has that been officially confirmed?
Dr. Nancy Messonnier: So, I think I would caution overinterpreting that hypothesis. I think what folks are saying, which I think is a valid point is that most viral respiratory diseases are seasonal, and we’ll use as an example influenza. Influenza has a season. It can alter a little bit but it’s generally, we know what time of year is going to be the peak of influenza and in general, as we head towards spring and summer, we expect the cases of influenza in the United States to fall off. That’s true for other viral respiratory diseases also that have a winter season. So, if this behaves similarly, it may be that as we head towards summer and, I guess, spring and summer, the cases would go down, but this is a new disease. We haven’t even been through six weeks of it, much less a year, and so I certainly would, I mean, I’m happy to hope that it goes down as the weather warms up, but I think it’s premature to assume that, and we’re certainly not using that to sit back and expect it to go away. The aggressive actions were taken or we’re taking are because we don’t think we can count on that since again, we haven’t been through even a single year with this pathogen. Next question.
Benjamin Haynes: Sue, we have time for one more question, please.
Operator: Thank you. Our last question comes from Steve Baragona with “voice of America,” you may go ahead.
Steve Baragona: Hi, thanks for doing the call. You mentioned a couple of times about information you’re getting from the Chinese. I know that’s been an issue throughout this outbreak. How is your access to data? Are you getting all the information you need, and if not, what’s the hold up? What impact does that have on your ability to respond?
Dr. Nancy Messonnier: I’m happy to talk about this. I’ll start by saying there’s nothing really new in this space compared to what we have said previously. There has been a lot more data coming out of China in the recent weeks, compared to perhaps from the very beginning, and there have been meetings, for example, hosted by w.h.o. Where Chinese authorities have presented their data. As an epidemiologist seeing a graph that somebody else produced is never as good as touching the data yourself. Being able to look at it yourself and being able to ask the questions and run the data directly, so having that distance from the actual ongoing investigation in China or anywhere is never the best way for us to be able to be completely confident that we understand the situation. That is the — part of the reason that we want to have folks on the ground. I’m working specifically on this investigation, the other is that I would say that CDC scientists are certainly some of the best in the world and our scientists have a lot to offer in terms of looking at what’s going on right now in terms of the analysis. We also find that when you’re in the midst of doing an investigation yourself, sometimes it’s hard to step back and folks coming from outside who haven’t been so enmeshed in the day-to-day sometimes can pick up things you didn’t think of or have a different perspective. That’s the other reason that it would be helpful to have a broader set of folks being able to look at the data itself. I have nothing new to say in terms of the data coming out. There is more coming out in the published literature but CDC staff themselves haven’t yet gained direct access to the data and we continue to be hopeful that we’ll be invited to do that. Thank you.
Benjamin Haynes: Thank you, Dr. Messonnier, and thank you all for joining us for today’s briefing. Please check CDC’s 2019 novel coronavirus web site for the latest updates on CDC’s response efforts and if you have further questions, please call the main media line at 404-639-3286 or e-mail
media@cdc.gov, thank you.
Operator: Thank you, that does conclude today’s conference. Thank you all for participating. You may now disconnect.