Dr. Birx exerpt from 4/16/20 Coronavirus Task Force Briefing
This is a very important slide. It talks about the gatekeeping — on the gatekeeping criteria to moving into phase one. It’s very much related to what you just saw about influenza-like illness. And the United States has been tracking influenza-like illnesses through the Centers of Disease Control for years.
Both the state and public health officials are used to watching this, county health officials are used to watching it, and frankly, every family around the United States knows how to access this on the CDC website in order to get update — up-to-date information to the communities.
It also looks at a syndromic emergency room-type visits — again, housed at the CDC — and really is our surveillance program that can be utilized for a lot of different illnesses, but in this case, will be utilized for respiratory diseases.
In addition, we are tracking the number of cases, and it must have a downward trajectory for 14 days — as well as the influenza-like illness and the syndromic illnesses — and a downward trajectory in the number of positive tests with persistence of high levels of testing.
For the hospitals, it’s to ensure that we can treat all patients without resorting to any crisis care and ensuring that there’s a robust testing program in place for at-risk healthcare workers, including frontline responders with the emerging antibody tests. Next slide.
Now, just to show you what this looks like: So what the CDC did for me, under the direction of Bob Redfield, was to chart what would the syndromic illnesses were reporting throughout the early part of March. And you can see, in New Orleans, respiratory diseases were starting to be seen in the emergency room. That is the red line. The cases are shown in the dark blue line. The gray mountain is testing, and underneath that is the blue mountain of positives. And you can see that the early alert was present from the emergency room about early respiratory disease. You can see it predated the cases.
So, throughout the summer, when we do not have flu to contaminate this picture, we’ll be able to follow this syndromic pattern city by city, county by county, community by community, state by state.
Next slide.
In addition, the CDC has the influenza-like illness net distributed throughout the United States — very useful in the wintertime. That first peak is influenza B in the red; that’s this season. I showed you all the seasons here so you could see the seasons as they are displayed.
The first peak is influenza B, second peak influenza A. And then you can see the coronavirus. And you can see its decline, and it’s declining towards the baseline. This will allow us — again, city by city, community by community, state by state — to look for variations and an early response mode in those localities that I described.
Next slide.
So hopefully you see that we’ve brought CDC and their amazing talent of individuals at the Center for Disease Control and Prevention and all of their abilities to this response and also to the surveillance that we need in this response.
But I want to call your attention to the third bullet on this graphic. So we’re tracking those two pieces that I described. But the third bullet is about setting up sentinel surveillance sites to be able to distinguish and find asymptomatic individuals — individuals that you have heard about that may be either pre-symptomatic or asymptomatic throughout their entire disease course. We want to be able to find them in communities of particular vulnerability.
So we’ll be doing sentinel surveillance throughout nursing homes, throughout inner-city federal clinics, throughout indigenous populations, to really be able to find early alerts of asymptomatic individuals in the community. And both for the syndromic cases that are tested, the influenza-like cases, and the asymptomatic cases: doing contact tracing, again, with support from the Centers for Disease Control, working with each state and local government.