17 COVID-19 Cases Related to 2 Gyms on Oahu

Contact tracing by the Dept. of Health has uncovered a total of 17 cases to-date involving two O‘ahu commercial gym facilities. DOH says cases in both gyms are linked to one person who participated in exercise classes at both.

State Epidemiologist Dr. Sarah Park said, “By their very nature, gyms that operate in closed spaces with poor ventilation and without physical distancing can be breeding grounds for all kinds of infections, including coronavirus. It is imperative that all gyms follow the safe practices required by state and county governments. These include proper physical distancing in work-out areas and in group classes, wearing of masks at all times, consistent and thorough disinfection of equipment and all surfaces.”  Furthermore, she said, “It’s important for everyone to stay home if they are ill and not go to work or public areas.”

State Health Director Bruce Anderson commented, “We encourage everyone to exercise regularly, and going to the gym is a good way to maintain both physical and mental health.  However, it is critically important that safe practices are followed and that the gym is well-ventilated. Individuals at a gym are often breathing hard while exercising, which puts them and those around them at increased risk.” COVID is transmitted from person-to-person through aerosols and droplets associated with breathing, coughing and sneezing. “Perhaps most important is to stay home if you are feeling ill.  Don’t try to sweat it out.” said Anderson.

The Centers for Disease Control and Prevention (CDC) offers information for safety in gyms and for their patrons: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/personal-social-activities.html#gyms

TRANSCRIPT: CDC Tele-Briefing Update on COVID-19

Operator: Welcome, and thank you all for standing by.  At this time, I would like to inform all participants that your lines have been placed on a listen-only mode until the question-and-answer session of today’s call.  Today’s call is also being recorded.  If anyone has any objection, you may disconnect at this time.  And I would now like to turn the call over to Mr. Ben Haynes.  Sir, you may begin.

Ben Haynes: Thank you, Sue.  And thank you for joining us today for this embargoed briefing to update you on CDC’s COVID-19 response.  All of the information included today is embargoed for 1:00 p.m.  Eastern time.  We are joined today by CDC director Dr. Robert Redfield and CDC’s COVID-19 incident manager, Dr. Jay butler.  And Dr. Redfield and Dr. Butler will discuss CDC’s updates on who is at higher risk for severe illness due to COVID-19.  Following their remarks, Dr. Dana Meaney-Delman will join us for the questions and answers.  At this time, I’d like to turn the call over to Dr. Redfield.

Robert Redfield: Thank you, Ben, and thank you all for joining us today.  When Dr. Butler and I talked to you last, we spoke about the need to understand and consider your personal risk in the situations in your community.  As states continue to adjust mitigation efforts, I want to remind you about how to protect yourself, your family, and your community in advance of the 4th of July holiday.

While the past few weeks saw cases begin to trend downwards, there are a number of states across the united states, particularly in the Southeast and Southwest that are seeing increases.  Evidence tells us that these increases are driven by many factors, including outbreaks in settings that are particularly challenging, as well as increased testing, and community transmission as well.  In addition, in some instances, the hospitalizations are going up as people seek care for non-COVID-related health issues as well as COVID-19.  CDC is closely monitoring these increases and currently have deployed well over 100 staff to more than 20 or so states, including those states seeing these increases to support the state and local health officials.

We continue to work to get information we need to understand the complexities of this disease and share that with the public.  We can’t lose sight of the fact that this pandemic is caused by a new virus that was totally unknown to us just a year ago.  And we will continue to refine guidelines on how we can best reduce the risk of infection based on data and science.  As we move forward and each of us weigh our risk of infection and make decisions about how to go about our lives, it’s important for all of us to try the best we can to continue to take steps that we know are effective in preventing COVID-19.

For those at higher risk, we recommend limiting contacts with others as much as possible or restricting contact to a small number of people who are willing to take measures to reduce the risk of becoming infected.  In other words, when you must go out into the community, being in contact with few people is better than many, shorter periods are better than longer, and contact at greater distance, ideally, at least six feet, are better than closer.  Everyone can take these steps to protect themselves, their family, and their communities, but they are particularly important for people who are at higher risk and for people who live with and care for individuals at higher risk.  In summary, the keys to COVID prevention remain — number one, social distancing.  Number two, frequent hand washing and hand hygiene.  Number three, staying away from others if you’re ill. And number four, properly wearing a face covering when you’re unable to social distance.

I want to share with you some other important news.  After gathering and thoroughly reviewing the most current evidence, CDC is updating its information that we’re providing about people who are at the higher risk of severe outcomes from COVID-19.  First, we want to be clear about what we think puts people at higher risk for severe disease, hospitalization, intensive care, and even death.  We know that risk is a continuum.  It’s not just the risk of those ages 65 and older.  And based on what we’ve learned, we now understand that as you get older, your risk for severe disease, hospitalization, and death increases.  We also updated the list of underlying health conditions that can put you at higher risk for severe disease, hospitalization, and death, based on the latest review of scientific evidence to date.  A key point is that we want to make sure that people know that as your numbers of underlying medical conditions increase, your risk of severe illness from COVID also increases.  I’d like to turn it over now to Dr. Jay butler, our COVID-19 incident manager, to provide further discussion on these issues.  Thank you.

Jay Butler: Thank you, Dr. Redfield.  And good afternoon, or good morning, everyone.  It’s good to be able to speak with you again.  Let me provide a bit more detail about the update to the underlying medical conditions that increase one’s risk for a severe outcome due to COVID-19.

First, as Dr. Redfield mentioned, we know that the risk of severe illness from COVID-19 increases progressively with increasing age.  Or to put it another way, there’s not an exact cutoff of age at which people should or should not be concerned.

Second, we want to reiterate and update information about which underlying health conditions put people at higher risk.  Part of the reason why risk increases with age is because as people get older, they are more likely to have other health issues that may place them at higher risk.  We reviewed the evidence related to each of these conditions and determined whether there was strong, mixed, or limited evidence whether they were associated with increased risk of more severe illness, which may be measured by hospitalization, ICU admission, or death.  The underlying conditions for which there is the strongest evidence of higher risk are

  • cardiovascular disease,
  • chronic kidney disease,
  • chronic obstructive pulmonary disease, such as emphysema,
  • obesity — that is, a body mass index of more than 30 –
  • any immunosuppressing condition or treatment,
  • Sickle Cell Disease,
  • history of organ transplants and
  • type 2 diabetes.

We also clarified a list of conditions that might increase the risk of severe illness.  Some of these conditions include

  • Chronic lung diseases, including moderate to severe asthma and cystic fibrosis
  • High blood pressure
  • A weakened immune system, as may occur among persons after blood or bone marrow transplant, immune deficiencies, poorly controlled HIV, or use of other immune weakening medicines
  • Neurologic conditions, such as dementia or history of stroke
  • Liver disease
  • And pregnancy

Let me tell you a bit more about that last one.  Today we’ll be publishing an MMWR that compares data on pregnant and nonpregnant women with laboratory-confirmed COVID-19.  Based on analysis of these surveillance data, pregnant women with COVID-19 were more likely to be admitted to the ICU and also to receive mechanical ventilation than were nonpregnant women.  Based on the data available now, it does not appear that pregnant women are at higher risk of death from COVID-19.  We are collecting additional information, and we’re working to find out if COVID-19 is associated with pregnancy complications.

As always, we’re sharing these updates and others as we learn more so that you can have the best, most-current, science-based information to help all of us make decisions about how to protect ourselves, our families, and our communities.  We want to live as safely as we can and minimize the risk of COVID-19 while it is circulating.  As Dr. Redfield mentioned earlier, each person has to make decisions about what level of risk they’re comfortable with as we go about our daily lives.  CDC is committed to providing science-based information about how everyone can reduce the risk.  I’ll turn it back to ben, and I look forward to taking your questions.

Ben Haynes: Thank you, Dr. Butler, and thank you, Dr. Redfield.  Sue, we are now ready to take questions.

Operator: Thank you.  One moment, please.  In order to provide everyone the opportunity to ask questions, we do ask that you limit your questions to one question and one follow-up.  If you do have any further questions, simply reinsert yourself back into the queue, and your additional questions will be answered as time permits.  To ask a question, please ensure that your phone is unmuted.  Press star-1, and record your name clearly.  If you wish to withdraw your question, press star-2.  Again, to ask a question, please press star-1.  One moment for the first question.  The first question is from Eben Brown with Fox News. You may go ahead.

Eden Brown: Good afternoon.  Good morning.  Thank you for doing this.  I’m speaking to you from Florida where we’ve had another day of 5,000-plus new positive cases.  This number has — we’ve seen similar numbers in other southern states.  Now the northeastern states are imposing a mandatory quarantine for anyone who travels from here to there.  It’s something that Florida did to the northeastern states a couple months ago.  Are these quarantines really going to be effective?  Is there that much migration between the two regions that it’s really going to cause a problem?  Or is the problem for these surges elsewhere?

Robert Redfield: You know, thank you for your question.  I think the comment that I will make is that, clearly, we have seen, as you commented, in the Southern states some increases in cases.  You know, I keep trying to remind people that the real focus is the consequence of those cases, particularly hospitalizations, mortality, and death.  Obviously, there are also consequences in terms of the disruption of the economy, education system, et cetera.  So, I don’t think we have any clear evidence.  As you know right now, the individual states are making their individual decisions.  I think the tone of your question, which is good, is I think, but we don’t have any evidence-based data to support the public health value of that decision.  Obviously, it’s an independent decision that independent governors are going to make.

Ben Haynes: Great.  Thank you.

Operator: Thank you.  The next question is from Helen Branswell with STAT.  Go ahead.

Helen Branswell: Hi, thank you very much for taking my question and for doing this.  I’m wondering if CDC is concerned that the public may be getting mixed messages about the risk of COVID-19 transmission at this point.  You know, the president is telling people that the virus is receding, and yet, it clearly is not in parts of the country.  As a consequence, it seems that a lot of people are no longer following the sort of prudent social distancing measures that are really needed to drive back transmission of the virus.  Does this concern you all?

Robert Redfield: I’m going to make a comment and then ask Jay to follow up with his perspective.  I think, obviously, that we’re seeing right now infections that are targeting younger individuals.  As you know, in Florida, a significant number of the infections, and actually in the Southeast and Southwest, are in individuals now that are younger than the age of 50.  I think, Helen, one of the points I want to make is, in the past, I just don’t think we diagnosed these infections.  CDC has completed a series and will continue to do fairly extensive surveillance throughout the nation using antibody testing.  And our best estimate right now is that for every case that was recorded, there actually are ten other infections.  But in the past, we didn’t really aggressively pursue diagnostics in young, asymptomatic individuals.  So that’s the first thing I want to say, is you know, how much of what we’re seeing now was occurring and just not recognized because now we’re getting the younger population to get diagnosed.  But I will say, I remain concerned about trying to understand the effective public health messaging that we need to get to those individuals that are say under the age of 45, under the age of 30, whereas the impact and consequences of COVID-19 infection on them may not be highly associated with hospitalization and death.  They do act as a transmission connector for individuals that could, in fact, be at higher risk.  So, trying to understand the effectiveness.  The last thing I’ll say on this and turn it to Jay, is this is one of the reasons I think it’s important that we really have good data at a granular level.  When you look right now at some of the maps you’ve seen on television, you know, it looks like a substantial portion of the united states is red.  But in reality, we have probably about 110, 120 counties that we consider as having significant transmission.  We refer to them as hotspots.  That represents about 3% of the counties in the United States.  So, when you see that it basically looks like the whole state is red, I do think that that can have a mixed message for the public health response.  I remember, for example, in my days as an AIDS researcher, when the messaging came out to the African American male that happens to have sex with men, that you have a 50% lifetime risk of getting infected.  Many young people just assumed that prevention didn’t really play a major role in their lives because the risk was so high.  I think it’s important that we be very granular in understanding where we’re having this transmission risk.  I think it’s very important we continue to try to figure out effective public health messaging for the younger group.  But let me ask Jay what his comments would be.

Jay Butler: Yeah, thank you, Dr. Redfield.  One of the things that I will add is, as we look at the cases that have occurred over the past month compared to those that occurred in the months before that, we are seeing a greater proportion of cases that are being diagnosed in younger people.  And this could reflect a number of things, including the fact that people actually are hearing and understanding the messages, including the message that people who are at higher risk need to take more precautions.  So, it’s possible that we’re seeing a smaller proportion of infections in older people because there actually is less exposure.  I think the question of how to best communicate these messages to younger people is one that I will defer to health communications experts.  But earlier this week, the MMWR put out a report about a cluster of infections that occurred in college students returning from spring break.  So, I think getting that message out that young people are not somehow naturally immune to this new virus, although they may be at lower risk of death or severe infection, doesn’t mean that they are completely unable to become infected or to potentially transmit it to others.  So, I think being able to get that message out more clearly than probably I just tried to articulate it is very important.  Thank you.

Helen Branswell: Could I follow up, please?  You know, it sounds, Dr. Redfield, like you are actually sort of playing down the significance of the situation that is occurring in the southern and eastern — or western united states?  Texas is now in a situation where they’re deferring elective surgeries again — or not again, in their case, but deferring elective surgeries because of the stress on hospitals.  There’s a lot of virus spreading in parts of the united states.  And if it’s spreading among young people, it won’t stop spreading just among young people.  They will infect other people.  That’s the way this works.  I’m a little surprised that you seem to —

Robert Redfield: Yeah, Helen, I think you’re misunderstanding me.  I’m not playing it down at all.  This is a significant event.  We are obviously concerned.  I was trying to get people to understand, there’s cases and consequences.  It’s not to underplay the cases.  We have significant increase in cases.  We need to understand that.  We need to try to interrupt that.  And we’re going to continue to do that.  What I was trying to do, in contrast to where we were, say, in March, where we had, obviously, cases, hospitalizations and deaths that were greater than now.  If you look back about eight to ten weeks, it was shocking to me that over 27% of all deaths that occurred in the United States occurred in somebody that died of a pneumonia, influenza, or coronavirus.  27%.  One in four.  All right?  Today we’re back to the baseline, which is about 7%.  So, I really hope that you don’t misinterpret or misrepresent what I’m saying.  This is still serious.  It’s significant.  Everything you said, we may have a lag in what we see in hospitalizations and deaths, because that can lag by three or four weeks.  But I’m asking people to recognize that we’re in a different situation today than we were in March, in April, where the virus was disproportionately being recognized in older individuals with significant co-morbidities that was causing significant hospitalizations and deaths.  Today we’re see more virus.  It’s in younger individuals.  Fewer of those individuals are requiring the hospitalizations and having a fatal outcome, but that is not to minimize it.  I think if you listen careful to me, I am one of the individuals that’s highly concerned about the complexity that we’re going to be facing in the fall with the coronavirus and when we have influenza.  I’m also, you know, I think it’s important to recognize, we’re not talking about a second wave right now.  We’re still in the first wave, and that first wave is taking different shapes.  We’re going to continue to respond.  I mean, I’m happy to see that when we have outbreaks like we did in North Carolina and Alabama, CDC provided technical assistance to help the local health departments.  Those hotspots are beginning to turn around.  But these hotspots that we see, don’t minimize them.  They’re significant.  We need to respond to them.  And as you see in certain areas, like in Houston, Texas, in Arizona, these cases are actually now causing challenges, as you mentioned, in terms of hospitalizations.  So, I am not minimizing it.  It’s a significant issue.  I’m just trying to let individuals understand the distinction between where we were in March and April and where we are today.

Ben Haynes: Next question, please.

Operator: Thank you.  The next question is from Leigh Ann Winnick with CBS News.  You may go ahead.

Leigh Ann Winnick: Thank you.  I’d like to touch on two things you just said about the younger people and the prospect of lingering effects in both younger and older people.  What are those concerns and how are you messaging to younger people?  Is there not some kind of advertising campaign that’s specifically targeted to younger people after now three months of grappling with this?

Robert Redfield: Jay, do you want to comment on that, since I spoke on the last one?

Jay Butler: Sure.  So, the question of a long recovery is a very good one.  We hear anecdotal reports of people who have persistent fatigue, shortness of breath.  So, how long that will last is hard to say.  Again, we’re talking about a new disease.  So, whether or not this could be something that could persist for more than a few months, we don’t yet know.  There is work that is ongoing to create a follow-up of people who have confirmed COVID-19 so that we can determine better what some of those long-term effects are.  In terms of messaging to younger people, I think you’re exactly right, that the message needs to include, even if there’s not as much interest in the risk of transmitting to those who are at higher risk, everyone needs to understand that there is some risk of severe illness, including among younger people.  The tools that can be used include social media.  We’re exploring Tik Tok tools, PSAs are a bit older, but that is something that in the right media can help to reach younger people as well.  Thank you.  Next question, please.

Leigh Ann Winnick: Can I just follow up?  If there’s some Tik Toks that are out there, if you could flag those at the press office, supply those to us?

Jay Butler: At this time, we do not have any, but that’s something that we are looking into.  And I’m of the age, I have to stop and think, what is a Tik Tok?  But I’ve learned that over the past month.

Ben Haynes: Next question, please?

Operator: Thank you.  The next question is from Jeremy Olson.  With the Minneapolis Star Tribune.  You may go ahead.

Jeremy Olson: Thank you for taking my question.  I was just wondering, there are tracker apps that now exist, google platforms, android platforms, that could aid with the monitoring of these local hotspots and contact tracing, but it seems like it’s been left to states and it’s really been a  fledgling start with these apps.  I wonder if there’s been any federal or national effort to make use of this technology to improve our tracking?

Jay Butler: So, there has been work to determine the utility of these devices.  One of the challenges has been the willingness of the members of the public to utilize these devices.  So, it’s — it has a lot of promise.  I think it also has some challenges.  There are a large number of apps that are out there, so we don’t endorse any one of those, but the ultimate authority in conducting contact tracing as well as case investigation is going to be at the local, state, or tribal level.

Ben Haynes: Next question, please.

Operator: Thank you.  The next question is from Maggie Fox from CNN.  You may go ahead.

Maggie Fox: Thanks.  Dr. Redfield, I was very intrigued by something you said, that for every case that’s tested positive, there might be ten that weren’t detected.  Can you expand on that?  And I think you probably know, the Wall Street Journal has said that the CDC estimates many millions more cases than has been diagnosed.  Thanks.

Robert Redfield: Yeah.  Thank you for the question.  I mean.  We have one of the realities, because this virus causes so much asymptomatic infection.  And again, we don’t know the exact number.  There’s ranges between 20%, as high as 80% in different groups.  But clearly, it causes significant asymptomatic infection.  The traditional approach of looking for symptomatic illness and diagnosing it obviously underestimated the total amount of infections.  So, now, with the availability of serology, the ability to test for antibodies, CDC has established surveillance throughout the united states using a variety of different mechanisms for serology, and that information now is coming in and will continue as we look at the range, for example, where you have a different range of percent infections, say on the west coast, where it may be limited, say 1% or so, and then you have the northeast, where it may be much more common.  The estimates that we have right now, that I mentioned — and again, this will continue with more and more surveillance — is that it’s about ten times more people have antibody in these jurisdictions that had documented infection.  So that gives you an idea.  What the ultimate number is going to be — is it 5-1, is it 10-1, is it 12-1?  But I think a good rough estimate right now is 10-1.  And I just wanted to highlight that, because at the beginning, we were seeing diagnosis in cases of individuals that presented in hospitals and emergency rooms and nursing homes.  And we were selecting for symptomatic or higher-risk groups.  There wasn’t a lot of testing that was done of younger-age symptomatic individuals.  So, I think it’s important for us to realize that, that we probably recognized about 10% of the outbreak by the methods that were used to diagnose it between March, April, and May.  And I think we are continuing to try to enhance surveillance systems for individuals that are asymptomatic to be able to start detecting that asymptomatic infection more in real time.

Maggie Fox:  May I follow up on that, please?  You’re also talking about younger people becoming infected, and perhaps they’re at lower risk, but you’ve also updated the list of people with the underlying conditions that place them at higher risk.  That includes pregnant women, who, of course, by definition, will be younger.  And we also have a high rate of obesity and diabetes in our younger population.  Can you talk about how not everybody is young and perfectly healthy and that, perhaps, the US younger population might be at higher risk of complications?

Robert Redfield: Yeah, I think it’s a critical question.  I’m going to let dan and Jay chime in on it, but I think you’ve hit it.  And I think we have to recognize the reality.  Our nation isn’t as healthy as some other nations, particularly as you look at the issue of obesity or at some of these chronic medical conditions.  But I think dana may talk about pregnancy?  And Jay, if you want to talk about the existence of co-morbidities in younger populations.

Jay Butler: Sure, Dr. Redfield.  And I think, again, it highlights the fact that younger people in no way are completely immune to the effects of SARS-CoV-2, nor are they at risk of more severe manifestation.  And among young people, that risk is elevated in those with underlying illnesses or health conditions, including things like diabetes or obesity.  As you mentioned, pregnancy, of course, is going to be always in younger people.  And so, the emerging data on the increased risk of more severe illness among people who are pregnant is something that has become more visible as we have increasing numbers of cases occurring.  And I would anticipate that we’ll get more granularity on our understanding of the degree of risk as we continue on and we have additional data.  I’ll turn it over to Dr. Meaney-Delman to see if she has any additional comments on the risks associated with pregnancy.

Dana Meaney-Delman: Thanks for your comment.  We appreciate that.  I think there’s a good news/bad news picture here.  The good news is that at least from the data we have so far, pregnant women are not at increased risk of death.  And to your point, I think that’s because there are — pregnant women are generally a younger population.  So that’s the good news.  But we do see higher rates of admission to the ICU and mechanical ventilation based on this data set that we have to date.  And so, I think it’s very important to get the information out there that pregnant women need to take precautions with regard to coming in contact with others, the number of people they come in contact with, wearing face coverings, social distancing.  So, we really think this is a pivotal moment to emphasize those precautions that people can take as they’re living their lives in the face of COVID-19.

Ben Haynes: Next question, please.

Operator: Thank you.  The next question is from Alison Aubrey with NPR.  You may go ahead.

Alison Aubrey: Hi.  Thanks so much for taking my call.  One question a lot of our listeners are asking is how do I affect my own personal risk?  And one factor of course to look at here is the spread in your community or in your state.  But people are confused about the best metric to look at.  One metric is of the severity of the spread is the positivity rate.  We see rising positivity rates in Arizona, 25%, South Carolina, multiple other sunbelt states.  New York is now down to fatal digits.  Doing more testing.  They say you want to see a single-digit positivity rate.  Does the CDC have guidance?  Is there an agreed-upon threshold of what a good — of what an — positivity rate or what a low positivity rate is?  Would it be 3%, 5%?  Do you have a specific guidance?

Jay Butler: Yeah, I think the answer to that question is lower is better, and that may be obvious.  But again, there’s no magic number above which we would say everyone needs to, basically, stay home, and no number below which we would say don’t worry about this at all, unless that number is zero and there’s a significant amount of testing that’s occurring.  I think it may be more important to look at some of the other metrics as well, such as whether or not your local health department is reporting a significant number of cases occurring.  And also, look at the trends.  Is it on the upward trajectory, or is it coming back down again?  In terms of assessing the risk for getting out into the community, I think you’ve touched on an important factor, what is the amount of transmission occurring in your community.  Also, also the issue of personal assessment, and that’s one of the real areas of focus in the discussion today, thinking about increasing age, increased risk, also the presence of underlying health conditions.  And then finally, where are you going to go when you go out?  Being around fewer people is better than being around a greater number.  Being able to keep a distance of at least six feet is better than being closer.  Probably it’s better to be out of doors than indoors.  And being around people who are using face coverings is likely better than being around those who do not.  There’s a lot of different variables, I recognize, but they all play an important role.

Alison Aubrey: But I just want to help people understand, if the transmissions or cases are growing in their area — you just mentioned several different metrics.  And I think what’s confusing for folks is, like, everyone’s saying, oh, check with your local health people to say, you know, are cases growing?  What’s the risk in your area?  But there’s no easy way for people to do that.  I know that Tom Frieden and others have suggested a sort of green light, orange light, red light for the amount of spread in your area.  Some simple indicator that we know works in public health to signal to people, what is the risk in my area?  Are cases up or down?  I think there’s a lot of interpretation you’re asking people to do that they’re not  capable of doing, and I’m wondering if you might be able to — have you thought about sort of setting a consistent, easy signal for people to know what the risk is in their area?

Jay Butler: Yeah.  I think the challenging words in that question is easy and simple, because we all want those.  And that’s certainly something that we continue to look at the data to determine what are the best metrics.  You know, we’ve never had a coronavirus pandemic before.  We are only a few months into this, so that is a big focus of what we’re trying to do, is to be able to get the data together to give people the best advice possible.  But at this point in time, there is not a simple answer to that question.

Ben Haynes: Next question, please?

Operator: Thank you.  The next question is from Marilynn Marchionne with Associated Press.  You may go ahead.

Marilynn Marchionne: Thank you.  I have two quick questions.  The first is, you’ve reset the list of who is at high risk from coronavirus and add pregnant women.  Why did you also not include Blacks, Hispanics, and Native Americans, given all the findings about higher hospitalization and death among racial and ethnic minorities?  I have a second question as well.

Jay Butler: Yeah, great to hear from you. So, we actually do have some additional information coming out on the risks that are associated with race and ethnicity.  And thank you for raising that question as well.  There are increased risks of infection in certain racial and ethnic groups.  Much of this may be driven by the fact that it is very difficult for people of lower socioeconomic status to be able to do things like telework or to be able to maintain social distancing, at lower socioeconomic levels, certain racial and ethnic groups are overrepresented.  And so, that is likely a major driver to why we are not — we are seeing some inequities in terms of the rates of infection and outcomes in some groups.  Someone said early on that the pandemic is a boat that we’re all in.  I think the pandemic is a storm that we’re out to sea together in, but some of us are able to be in better boats than others.  So, looking at how we can achieve better health equity is a big part of what we need to too.

Marilynn Marchionne: My other question is for Dr. Redfield about the new estimate that was just released, that 20 million Americans had been infected.  Is that a CDC estimate?  Did the CDC come up with that?  And what can you tell us about where those surveys were done, if they were nationally representative or just in hotspots, how you’ve determined this 20 million?  And that would mean about 6% of the population has been infected, and doesn’t that mean the vast majority remain susceptible?  And these are lower than the 25% asymptomatic estimates we’ve been hearing.

Robert Redfield: Yeah, we’re still collecting serological data.  This is happening across the nation and we continue to add samples to those surveys, you know, each month, to continue to look to see what the extent is.  There is great variability, and I’m confident at some time in the near future that that will be collated into information that can be broadly shared through the MMWR.  I think two points are important.  One, the one that you said at the end.  It’s clear that many individuals in this nation are still susceptible.  There are, as I mentioned before, states that are going to have antibody prevalence base of less than 2%, which would mean a majority of those individuals in those regions are still susceptible.  There’s other areas like the New York metropolitan area that clearly had a higher penetration of antibody positivity and will have fewer individuals that remain susceptible.  But all in all, I think you’re in the right range, that somewhere between 5%, 6%, 7%, 8% of the American public has experienced infection, whether they recognized it or not.  The estimate that we have given you at this point is it appears that the rate is — and this is CDC’s serology data — that the rate is approximately ten seropositive antibody individuals for every one case.  Obviously, that will be refined in the weeks ahead, but I think, you’re right, looks like somewhere between 5% and 8% of the American public.  That will be refined.  And it does suggest the critical point that you point out and let me re-emphasize, this outbreak is not over.  This pandemic is not over.  The most powerful tool that we have, most powerful weapon, is social distancing.  The virus doesn’t like — it’s not efficient at going, you know, six, seven, ten feet between individuals.  So, if we can maintain the six-feet distancing, if we can wear face coverings when we’re in public, and particularly when we can’t maintain the distancing, but we recommend them in public, and maintain vigilance in our hand hygiene, so we don’t end up self-inoculating ourselves from certain surfaces that are contaminated, it’s really important, powerful tools.  And as we go into the fall and the winter, these are going to be really, really important defense mechanisms for you, for all of us, because as you pointed out, a significant majority of the American public, probably greater than somewhere — greater than 90% of the American public hasn’t experienced this virus yet, and yet, remain susceptible.

Marilynn Marchionne: The sero surveys that were nationwide, you said they were nationally representative.  Have you done — do you have bloodwork from, you know, half of the states?  Just help us understand —

Robert Redfield: The way this is being done — and we can give you more information — we have surveys that are being done through samples that were collected for other reasons, whether it’s blood banks or laboratory testing, and then they’ve been sampled in a representative way across the nation.  And that process is continuing.  There’s additional projects, protocols that are actually being added to continue to make it more and more representative across this nation so that we’ll have a pretty complete understanding as we get through this over the next month or two.  But we have a pretty good representation already across the country through blood banks and other sampling sites that we’ve done around the country.

Ben Haynes: Next question, please.

Operator: Thank you.  The next question is from Elizabeth Weise with USA Today.  You may go ahead.

Elizabeth Weise: Hi.  Thanks for taking my question and I’m so happy that we get to have these briefings with you all.  I had two questions on pregnancy, and I wanted to get the correct spelling of Dr. Delman’s name.  The first question is, do we have any data on outcomes for the babies yet?  Probably not, because there hasn’t been enough time for many women to actually give birth.  And secondly, do we have any data on where in pregnancy you get sick and whether that affects either your outcome, the woman’s outcome, or the fetus’ outcome?  I’m thinking of things like German measles, wondering if there’s any correlation there.

Dana Meaney-Delman: So, thank you for those terrific questions.  Many of the same ones we’re facing here.  As you alluded to, pregnancy’s nine months, so we don’t have a lot of data that we need given where we are in the outbreak, so I don’t think we know the answer to the outcomes of pregnancy specific to COVID-19.  We do know that other infections increase risk for things like preterm birth.  I wouldn’t be surprised if that’s a factor here, but we need more data and more time to collect that information about outcomes.  In terms of timing, the MMWR that’s coming out shortly did not collect information about trimester.  So, it’s hard to know at this point.  A good move during this pandemic is we’re collecting pregnancy status as part of our surveillance data from states, in a much more robust fashion, and we are going to follow along with more information about gestational age.  Given that this is a surveillance data point, my suspicion is that we probably have more in the mid-trimester or late because it’s easier to identify someone who’s pregnant than in the first trimester, but we don’t actually have the data yet.  And it would make sense, based on the physiology in the third trimester and limitations on respiratory function, since this is a respiratory virus.  I think I emailed you my information, so let us know if you don’t have that.

Ben Haynes: Next question, please.

Operator: Thank you.  The next question is from Roni Rabin with the New York Times. You may go ahead.

Roni Rabin: Yeah, I was curious about — it seems you’re downgrading the risk of hypertension.  This has been up there along with diabetes since the beginning of the outbreak in china as a risk factor that increases the risk for severe COVID-19 illness, and I’m just wondering what’s caused the change, and obviously, also seem to put obesity up higher.  Then if you can discuss that a bit, a little bit more about the concerns for the US. Where obesity rates are so high and also among young people.

Jay Butler: Sure, and I appreciate the opportunity to clarify a bit.  So, we’re really talking about the strength of evidence, rather than the downgrading or upgrading the level of risk.  The question of hypertension is one that came up very early on, even as we were receiving some of the early data out of china.  I think what we’ve been able to do, as more data become available, recognizing that hypertension is a risk factor for other diseases, such as heart disease, chronic kidney failure, we’ve been able to tease apart a little bit more how much just having hypertension alone, as opposed to having some of those end-organ manifestations of hypertension, may be driving the increased risk.

Roni Rabin: So does the same go for obesity, then?  I mean, obesity, you’re actually separating it as a risk factor in and of itself.

Jay Butler: Yes, and it does, of course, interact with some of the other issues, such as diabetes.  But also, I want to just highlight that early on, it was most obvious among people that had severe obesity — that is, a body mass index above 40 — as we have more data, it appears that even obesity at the lower levels, such as the body mass index above 30, may increase the risk as well.  So, obesity is appropriate to include as one of those conditions where there might be at increased risk.

Operator: Thank you.  The next question is from Tom Howell with the Washington Times.  You may go ahead.

Tom Howell: Hi.  Thanks for doing the call.  Just wanted to be clear on the list of underlying conditions.  Can you tell us which conditions are new?  You said it’s an updated list.  Maybe you said it.  I just want to understand which ones have been added.  And also, you mentioned july 4th is coming up.  What are your concerns in terms of gatherings, cookouts, et cetera, fireworks?  And what should people do to take care of themselves?  Thanks.

Jay Butler: Sure.  In terms of what is new, again, it’s a little bit complex because some of it is rearranging based on the strength of the evidence and the stratification there.  So it may be best just to get back with you on that.  Regarding the upcoming fourth of July holiday, again, the issues are the same in terms of how you can reduce your level of risk.  Gatherings that are smaller are better than gatherings that are large.  Being able to maintain social distance or physical distance, at least six feet, is better than being in closer proximity.  Being outdoors is probably better than being indoors.  And being around people who are wearing face coverings is better than not around those — around people who are not utilizing face coverings.  So, we do recognize that families will want to be together over the holidays, but being able to minimize the people that you are around, particularly people that you have not been around in the past, is particularly important.

Robert Redfield: And to reinforce the message, because there are going to be family gatherings, how important it is, you know, what we stressed even back in march — just to re-emphasize that message, that we have responsibility to practice these social mitigation strategies to protect the vulnerable, to protect the elderly.  I will also just say, you know, a lot of us may not even know which one of our close friends have, or even family members may have some of these significant medical co-morbidities.  So, again, I think stressing the importance that we all have a critical role, not for ourselves, per se, but to protect the vulnerable.  And I’ve said it before, I’ve been really proud and congratulate the American public.  I think most of us back in March, when we did the 15 days of slow the spread, I mean the 30 days of slow the spread.  I’m not sure all of us really believed that the American public was going to listen and buy into it.  As a physician, which I am, I’ve worked over my lifetime to help my patients stop smoking or lose weight or exercise more, or you know, do other things to improve their health.  And it’s very hard to be able to affect behavioral change as a physician, when you’re asking someone to do this to improve their own health. But I really think it was remarkable that the American people really did embrace the mitigation steps when the consequence was to protect the health of somebody else.  We’re asking that again, so we really think that’s important.  This is one of the complexities now with the younger individuals.  As we see these infection case numbers go up, it’s just really important.  And so, for the fourth of July, which is a family event, we want to re-emphasize that it’s really important that we get back to being vigilant to our collective commitment to do these social mitigation steps to protect the vulnerable friends, family, community, and those individuals that we don’t know that we’re interacting with, from potentially getting infected and having a poor, negative outcome because of the co-morbidities.

Ben Haynes: We have time for two more questions, please.

Operator: Thank you.  Our next question is from Donna Young with S& P Global News.  You may go ahead.

>> thank you.  Appreciate you taking my question and holding the call today.  This question is for Dr. Redfield.  Dr. Redfield, are you willing to admit that it was a mistake to dismiss Dr. Messonnier’s February 25th warnings, to hold that press conference that HHS held later in the day where the officials there, including Dr. Fauci, tried to minimize what she said, tried to say that it was education for the future but nothing that people needed to be doing at that point, and that you, as well as Dr. Fauci, all throughout January, February, and well into March, were advising Americans that they did not need to make any behavioral changes or any changes to their daily activities, as well as also, I wanted to ask about the masks.  Why did you think later that there was a difference in wearing a cloth mask, later on, that that was okay, but officials were shaming Americans early on for wearing, most of them, you know, cloth masks?  Why was that shaming actually going on?  But if you could, you know, please — it seems like you’re able to say now, well, you know, it’s a new virus, we didn’t know what was going on.  But early on, it seems like you were very willing to say, there’s no need to wear a mask, you know, we’re right about this, and pretty much dismissed Dr. Messonnier for what she — well, actually, did dismiss.  Americans were pretty much told to ignore that for now, that’s something for the future, education for the future, but don’t pay attention to her today, on February 25th.  So, thank you.

Ben Haynes: Donna, this is Benjamin.  I will follow up with you on that question after the briefing.  Sue, can you give us the last question, please?

Operator: Sure.  The last question is from Will Feuer with CNBC.  You may go ahead.

Will Feuer: Hi.  Thanks for taking my question.  I do think that I speak for all of us to say that I am interested to hear the answer to the previous question.  But my question is about contact tracing.  Dr. Redfield, you testified earlier this week there’s about 27,000 or 28,000 contact tracers deployed now across the nation.  I’m wondering, though — and you said you’re going to ramp that up.  What is the goal there?  And I know that number shifts and the goal might shift depending on the epidemics around the country.  But you know, roughly what kind of number are you looking for with the number of contact tracers?  And you know, I understand it’s mostly an effort run by local health departments.  So, what’s the CDC doing to support local health departments in ramping up capacity to conduct contact tracing?

Robert Redfield: Thank you very much.  A very important question.  And it’s important, it’s not just contact tracing, but it’s the consequence of that, to have the ability to isolate individuals.  You know, in January, the estimate of the country was, there was about the health departments collectively had about 6,000 individuals that were in this contact tracing space.  I think the second of January, when the states were polled by intergovernmental affairs, it was now almost 28,000, I think 27,800, approximately.  But if you ask the states, when all polled, it’s close to 77,000, 78,000.  I’ve estimated that I think the nation’s going to need close to 100,000 in this space.  You know, Tom Frieden has estimated he thought as high as 300,000.  I think we have to work, as we begin to build this workforce capacity, to get it in praise and get those individuals.  The efforts that we have — and again, congress has been, you know, I think provided leadership in this regard.  They’ve provided CDC significant resources.  We’ve disbursed $10,250,000,000 to the states to augment their testing, contact tracing and isolation capability.  The states have put together their plans for June and July, which have undergone review and areas of weakness have been discussed so they can correct them.  And then they’ll have their formal plans for basically the rest of the year due on the tenth of July.  Significant human resource.  Significant financial resources to help them.  CDC has, obviously, embedded people.  We have over 650 people embedded now in the state and local tribal territory, also environments we’ve augmented.  We’ve offered the states the opportunity to hire individuals though our foundation.  We’ve obviously given them their own resources to hire.  AmeriCorps now is making AmeriCorps volunteers available.  Some of the states have used other state employees.  Some of the states have looked at different strategies.  So, we’re going to continue.  I think one of the critical things to do in parallel, though, is we can’t just build contact tracing.  You’ve got to build the capacity to isolate people.  And it’s important to be able to isolate people that live in congregate living settings or that live in a setting that would then put another individual significantly at risk, so they couldn’t, in fact, minimize the risk to an elderly parent or grandparent.  Obviously, it’s another issue in isolating individuals that are homeless.  So, this has to be built.  I think the bottom line that I like to tell people is, for decades, this nation has underinvested in the core capabilities of public health, whether it’s data analytics and predictive analysis, whether it’s resilience in the public health laboratories across our country, whether it’s the public health workforce that we just talked about, obviously, whether it’s related to emergency funding to respond in a timely fashion.  But you know, that will continue to be the core.  And being able to effectively operationalize the contact tracing and isolation that’s going to be required.  And yes, it is going to be different plans by different states that are trying to put those, and we will continue to provide guidance, technical assistance, training manuals, training curriculum, to get these contact tracers in place over the summer.

Ben Haynes: Thank you, Dr. Redfield.  Thank you, Dr. Butler.  And thank you, Dr. Delman.  And thank you all for joining us for today’s briefing.  As I mentioned at the start of the briefing, the information we shared is embargoed until 1:00 p.m.  Please check CDC’s COVID-19 website for the latest updates on CDC’s response effort.  And an audio recording and transcript of this briefing will be posted on CDC newsroom at www.CDC.gov/media.  If you have further questions, please call the main media line at 404-629-3286 or email media@CDC.gov.  Thank you.

Operator: Thank you.  That does conclude today’s conference.  Thank you all for participating.  You may now disconnect.

CDC Updates, Expands List of People at Risk of Severe COVID-19 Illness

Based on a detailed review of available evidence to date, the Center for Disease Control and Prevention (CDC) has updated and expanded the list of who is at increased risk for getting severely ill from COVID-19.

Older adults and people with underlying medical conditions remain at increased risk for severe illness, but now CDC has further defined age- and condition-related risks.

As more information becomes available, it is clear that a substantial number of Americans are at increased risk of severe illness – highlighting the importance of continuing to follow preventive measures.

“Understanding who is most at risk for severe illness helps people make the best decisions for themselves, their families, and their communities,” said CDC Director Robert Redfield MD. “While we are all at risk for COVID-19, we need to be aware of who is susceptible to severe complications so that we take appropriate measures to protect their health and well-being.”

COVID-19 risk related to age

CDC has removed the specific age threshold from the older adult classification. CDC now warns that among adults, risk increases steadily as you age, and it’s not just those over the age of 65 who are at increased risk for severe illness.

Recent data, including an MMWR published last week, has shown that the older people are, the higher their risk of severe illness from COVID-19. Age is an independent risk factor for severe illness, but risk in older adults is also in part related to the increased likelihood that older adults also have underlying medical conditions.

COVID-19 risk related to underlying medical conditions 

CDC also updated the list of underlying medical conditions that increase risk of severe illness after reviewing published reports, pre-print studies, and various other data sources. CDC experts then determined if there was clear, mixed, or limited evidence that the condition increased a person’s risk for severe illness, regardless of age.

There was consistent evidence (from multiple small studies or a strong association from a large study) that specific conditions increase a person’s risk of severe COVID-19 illness:

  • Chronic kidney disease
  • COPD (chronic obstructive pulmonary disease)
  • Obesity (BMI of 30 or higher)
  • Immunocompromised state (weakened immune system) from solid organ transplant
  • Serious heart conditions, such as heart failure, coronary artery disease, or cardiomyopathies
  • Sickle cell disease
  • Type 2 diabetes

These changes increase the number of people who fall into higher risk groups. An estimated 60 percent of American adults have at least one chronic medical condition. Obesity is one of the most common underlying conditions that increases one’s risk for severe illness – with about 40 percent of U.S. adults having obesity.  The more underlying medical conditions people have, the higher their risk.

CDC also clarified the list of other conditions that might increase a person’s risk of severe illness, including additions such as asthma, high blood pressure, neurologic conditions such as dementia, cerebrovascular disease such as stroke, and pregnancy.  An MMWR published today further adds to the growing body of research on risk by comparing data on pregnant and nonpregnant women with laboratory-confirmed SARS-CoV-2 infection. Pregnant women were significantly more likely to be hospitalized, admitted to the intensive care unit, and receive mechanical ventilation than nonpregnant women; however, pregnant women were not at greater risk for death from COVID-19.

Protecting yourself, your family, and your community

Every activity that involves contact with others has some degree of risk right now. Knowing if you are at increased risk for severe illness and understanding the risks associated with different activities of daily living can help you make informed decisions about which activities to resume and what level of risk you will accept. This information is especially critical as communities begin to reopen.

Everyone should continue to do their part to implement prevention strategies, such as focusing on activities where social distancing can be maintained, washing your hands frequently, limiting contact with and disinfecting commonly touched surfaces or shared items, and wearing a cloth face covering when you are around people you do not live with, especially when it is difficult to stay 6 feet apart or when people are indoors. By taking these steps, you can help protect yourself, your loved ones, and others around you, including those most vulnerable to severe illness.

CDC will continue to update and share information about risk for severe illness as more information becomes available. For more information on how to prevent getting sick with COVID-19, visit CDC’s website at https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/index.html.

HVNP to Resume Collection of Entrance Fees

Following guidance from the White House, Centers for Disease Control and Prevention (CDC), and state and local public health authorities, Hawai‘i Volcanoes National Park continues to increase community access to park roads, trails and scenic overlooks in phases. 

HVNP Park Entrance

On Monday, June 15, the collection of entrance fees will resume, and these areas will reopen for outdoor enjoyment and exercise by 9 a.m.:

• Crater Rim Drive to Kilauea Military Camp, and to Devastation Trail parking lot
• Kīlauea summit area trails, including Byron Ledge Trail (newly repaired following the 2018 eruption and summit collapse), Devastation, and Halema‘uma‘u trails
• Kīlauea Iki Overlook and trail (one-way counterclockwise loop only)
• Chain of Craters Road to Mauna Ulu parking lot
• Pu‘uhuluhulu and trails near Mauna Ulu, including Nāpau and Nāulu trails (day use only)
• Ka‘ū Desert and Mauna Iki trails (day use only)

Businesses in the park that meet local and federal public health requirements will also reopen with limited services, including Volcano House, Kilauea Military Camp, Volcano Art Center Gallery and the park’s non-profit partner, Hawai‘i Pacific Parks Association. Contact these businesses directly for dates and details. 

Areas already open: 

• Mauna Loa Road to Kīpukapuaulu for vehicles, bicyclists and hikers, including Tree Molds and Kīpukapuaulu Trail. (The pavilion, picnic area and restroom remain closed). 
• Mauna Loa Road past Kīpukapuaulu is open for hikers and bicyclists to Mauna Loa Overlook at 6,662 feet, but is closed to vehicles for wildfire prevention. 
• Footprints Trail from Highway 11 to the Ka‘ū Desert Trail and Mauna Iki Trail junction, including the Footprints shelter. 
• Escape Road, for bicycling, horseback riding and hiking.

All other areas in the park remain closed at this time for public safety, including Nāhuku and Kīlauea Visitor Center. 

“Services are limited, and visitors should bring everything they might need for a safe visit including water, meals, and hand sanitizer. Above all, visitors should pack their patience, avoid crowds, and have alternate destinations planned should parking lots be full,” said Hawai‘i Volcanoes National Park Acting Superintendent Rhonda Loh. 

Visitors are urged to recreate responsibly by planning their visit in advance and acting with care while in Hawai‘i Volcanoes National Park: 

• Practice social distancing. Maintain at least six feet of distance between you and others.  
• Wear a face covering when social distancing cannot be maintained.  
• Wash your hands often with soap and water for at least 20 seconds or use your hand sanitizer. 
• Cover your mouth and nose when you cough or sneeze.  
• Avoid touching your eyes, nose, and mouth.  
• If you feel sick, please visit another day.  
• Let wildlife be wild. Do not feed nēnē, the Hawaiian goose, and look out for them on roadways and in parking lots. 

The health and safety of park users, employees, volunteers, and partners continue to be paramount. While these areas are accessible for the public to enjoy, a return to full operations will continue to be phased and services are limited. Park users should follow local area health orders from the Governor of Hawai‘i, practice Leave No Trace principles, avoid crowding and other high-risk outdoor activities. 

The CDC has offered guidance to help people recreating in parks and open spaces prevent the spread of infectious diseases. Park staff will continue to monitor all park functions to ensure that visitors adhere to CDC guidance for mitigating risks associated with the transmission of COVID-19, and will take any additional steps necessary to protect everyone’s health. 

Details and updates on park operations will continue to be posted on our website www.nps.gov/hawaiivolcanoes and social media channels. Updates about NPS operations will be posted on www.nps.gov/coronavirus

Image caption: Byron Ledge Trail, closed before COVID-19 due to the eruption and summit collapse of Kīlauea in 2018, will be one of the trails to reopen on Monday.

Transcript – CDC Media Telebriefing: Update on COVID-19

Operator: Welcome and thank you for standing by.  At this time all participants are in listen-only mode until the question and answer session.  You may press 1 to answer a question.  This is being recorded.  If you have any objections, you may disconnect at this time.  I will now turn it over to Paul Fulton.  Thank you.  You may begin.

Paul Fulton: Thank you all for joining us today for this briefing to update you on the CDC’s COVID-19-19 response.  We are joined by director Dr. Robert Redfield and CDC’s incident manager Dr. Jay Butler.  Dr. Redfield will give opening remarks and Dr. Butler will discuss an MMWR being released later today as well as suggestions on how to navigate daily life as communities reopen.  They will take your questions later.  Limit your question to one and limit it to the information being presented today.  If you have questions about other topics, contact the CDC media office, media@CDC.gov.  At this time I will turn the call over to Dr. Redfield.

Robert Redfield: Thank you, Paul.  And thank all of you for joining us today.  The CDC’s COVID-19-19 response is now in its sixth month.  While we are making progress, we have a lot of work ahead as we reopen America.  CDC, like the scientific and public health institutions around the world, continue to learn a great deal about this new virus.  We focus on how it’s spread among people, how it’s highly transmissible, and how people who are asymptomatic or presymptomatic can also contribute to spreading. Our recommendations have evolved based on the new information that becomes available, but it continues to be extremely important that we embrace the recommendations of social distancing, hand-washing, and wearing of face coverings when we are in public as some of the key defenses that we have against this virus.

Later during this briefing Dr. Butler is going to discuss the findings of an MMWR that looks at how the American people have responded to these key public health recommendations during the pandemic.  Dr. Butler is going to share specifics, but I wanted to take a moment to really say thank you to the American people for basically being selfless in taking on the precautions that we have requested of social distancing, wearing a face covering, and hand hygiene to protect the most vulnerable from the threat of COVID-19.  I know the people are eager to return to normal activities and ways of life.  However, it’s important that we remember that this situation is unprecedented and that the pandemic has not ended.  As I said earlier, it’s going to be critical to continue to embrace the principles of social distancing, hand hygiene, and wearing a face covering in public.  That is why today we are releasing some commonsense suggestions people can take to reduce their risk as their communities open up and they reengage in daily life and attend larger gatherings.

Each of you have been active responders to this pandemic, making changes in your life and taking on new challenges in the face of this evolving health threat.  We recognize how hard some of these changes have been and the consequence some of them have had on individuals and families and communities.  So, once again, to the American people, I would like to say thank you for being the individual public health heroes that we need right now to fight this pandemic.  Now I’d like to turn this discussion over to Dr. Jay Butler, our COVID-19-19 incident manager, to discuss our recommendation.

Jay Butler: Thank you, Dr. Redfield.  Good afternoon and good morning, everybody.  It’s a pleasure to be able to speak with you today.  We are now deep into a global pandemic caused by a virus that we didn’t even know existed only six, seven months ago.

So I suppose the bad news today is the pandemic is not over, and it’s important to recognize that.  While COVID-19-19 is still making headlines everywhere, we know that the pandemic hasn’t affected everyone everywhere in the same way.  The good news is nationally we have been successful in flattening the curve.  The number of new cases each day has been relatively plateaued over a prolonged period of time.  But right now communities are experiencing different levels of transmission, and this is occurring as they gradually ease up on some of the community mitigation efforts and gradually reopen.  We recognize that we are all getting tired of staying at home.  People long for the life that they had back in December.  As we live — as we head into the summer months, we know that Americans will be looking forward to reconnecting with family and friends and be able to attend events, and we want that to occur as safely as possible.

Today the CDC is releasing two online resources aimed at helping people make decisions about how to resume some activities while continuing to follow many of the public health recommendations that can still help us to all protect ourselves and our communities.  Every activity that involves interacting with others has some degree of difficulty right now.  We want to provide you with the information and suggestions you need to make decisions about which activities may be able to resume and what level of risk you may have to accept.  Here is a general rule of thumb.  The more closely you interact with others, the longer the interaction lasts and the greater the number of people involved in the interaction, the higher the risk of COVID-19 spread.  Understanding these risks and how to adopt different prevention measures can help you protect yourselves and others against the virus.  We continue to ask everyone to follow the guidance of their state and local health authorities and also we all do our part to embrace prevention strategies, including social distancing as much as possible, maintaining a distance of at least six feet from other persons, washing your hands or using an alcohol-based hand cleaner on a regular basis, and wearing a face covering in public where appropriate.  We actually practice what we preach here at CDC.  So for face coverings we get into the building wearing one.  The face covering that I wear, I use this instead of a tie or socks to express my personality.  So I have one, a cloth-based covering made with patterns of grizzly bears and salmon on them to show my homage to my home in Alaska.  I also have one with an Alaska state flag on it.  So these steps of social distancing, hand hygiene, and face covering can help reduce the risk of COVID-19-19 spread and protect those most vulnerable to severe disease.  Today we’re releasing the information on our website to help people make informed decisions about whether to go out and what precautions to take if they do.  These documents give suggestions on things you can think about and questions you can ask both about how much COVID-19-19 activity there is in your community and what type of event or activity you are considering.  We recommend that you get the answers to these questions and consider what they mean when making your decisions.  These suggestions also provide practical tips for given situations.  For example, when dining out, see if there is an option to sit outside or ensure that the tables are at least six feet apart so you can maintain social distancing.  If you hit the gym, don’t share items that can’t be cleaned or sanitized after use, and refrain from high-fives and elbow bumps which involve getting closer than six feet to others.  If your local library is open, see if curbside pickup is available.  If you want to gather with friends for a cookout, as much as possible use single-serve options and remind guests to wash their hands before and after eating.  Maintain social distancing, wear cloth face coverings when possible, practice hand hygiene, and avoid sharing frequently touched items.  I recently was able to get together with some friends for the first time in about ten weeks, and it was nice to reconnect, and we were able to do these things and have a safer gathering that way.  And, finally, for those interested in larger gatherings, we have also added a page or our website with suggestions to help people planning or attending events or gatherings as they prepare for enjoying larger events.

Before we take questions, I want to mention a report that has been published in the MMWR today.  The article underscores the fact that American people have taken mitigation efforts seriously to prevent the spread of sars-cov-2, and it demonstrates our country’s collective spirit in responding to the pandemic.  This was an online survey involving adults nationwide, and particularly those from New York City and Los Angeles, and this was conducted in May to assess adherence to public health recommendations.  Results of the survey showed that respondents generally supported stay-at-home measures and non-essential business closures.  They reported often or always wearing face coverings in public areas, and they believe that their state restrictions were the right balance and not — they believed — sorry, let me try this again.  They agreed that their state’s restrictions were the right balance of being restrictive and not too restrictive.  So I want to thank the American people for helping us get through the last few months.  This represents an incredible public health achievement, and the American people are responsible for that.  The direction of the pandemic is in all of our hands, so let’s wash those hands.  And I ask for your continued efforts.  I know it’s difficult to make changes to our daily lives.  We are not out of the woods yet.  In the coming weeks we could see increases in the number of cases of COVID-19 as states reopen and as there is an increase in public gatherings as we move into the summer across the country.  It’s too soon to tell if this will happen, but the CDC is working closely with state health departments to monitor the disease activity and to support responses to any increases.  In addition, we must look ahead to the fall and winter.  While what will happen is uncertain, we have to pull all our efforts towards gearing up for additional potential challenges that we see every fall and winter, and that is influenza.  If anything, we must be overprepared for what we might face later this year.  Getting a flu vaccine will be more important than ever as flu and COVID-19-19 could be circulating together as we move into the fall and winter months.  So I look forward to taking your questions, and with that I will stop.  Thank you, everyone.

Paul Fulton: Thank you, Dr. Redfield, and thank you, Dr. Butler.  We are going to take your questions now.  Media, please remember to limit your question to one and limit your question to the information being presented today. If you have questions about other topics, please contact the CDC media office by emailing media@CDC.gov.

Operator: Thank you.  We’ll now begin our question and answer session.  If you would like to ask a question, press star then 1 and record your name clearly when prompted.  If you need to withdraw your question, you may do so by pressing star, then 2.  Our first question comes from Mike Stobbe from AP.

Mike Stobbe: Thank you for taking my call.  So there are two sets of guidance.  One of them is about holding or attending mass gatherings.  That includes political rallies.  Can you comment on whether the CDC is saying that political rallies are okay right now?

Jay Butler: Yeah, thanks for that question, mike.  So, first of all, the guideline is really for any type of gathering, whether it’s the backyard barbecue or something larger.  And it’s not intended to endorse any particular type of event, but to be able to be applicable to any type of event that may occur.  So the most important things are some of those issues related to being able to maintain social distancing, having access to hand hygiene, encouraging face coverings, and, of course, not attending events if you are ill or have recently been exposed to COVID-19.

Paul Fulton: Next question, please.

Operator: Thank you.  And our next question comes from Elizabeth Weise from USA Today,  your line is now open.

Elizabeth Weise: Thanks so much for taking my question.  Looking at these guidelines, if the American public were to adhere to these maintaining social distance, hand hygiene, always wearing facemasks when out in public, do you think that we can keep levels of COVID-19 down until we have a vaccine?  Is this a viable plan moving forward?

Jay Butler: Thanks for that question also.  Yes, the whole goal here is to continue to keep that curve as flattened as possible to delay onset of cases for two reasons.  First of all, we want to make sure that critical infrastructure that’s important for societal function as well as the availability of health care services is maintained and that none of these services are overwhelmed by a sudden increase in the number of cases.  The second item is just what you touched on, is it increases the chances that there will be people who would benefit from a vaccination if they can avoid becoming infected before a vaccine is available.

Paul Fulton: Next question, please.

Operator: Thank you.  And our next question comes from Betsy McKay from the Wall Street Journal, your line is now open.

Betsy McKay: Hi, thanks very much.  You know, as you have talked about, there has been a lot learned more about how this virus spreads through contact and large events and so forth.  So I wondered, if cases do start going up again, do you think — would widespread lockdowns be necessary once again?  Or what more targeted interventions could be used in these cases?

Jay Butler: Yeah, thank you for that question also.  So, as we — the most important thing is to be able to monitor what is happening in terms of people’s activity, what are the — what is the degree of adherence, and then also monitoring the degree of transmission that’s occurring through disease surveillance.  If cases begin to go up again, and particularly if they go up dramatically, it’s important to recognize that more intensive mitigation efforts such as what were implemented in March may be needed again.  And that is a decision that really needs to be made locally based on what is happening within the community regarding disease transmission.  Again, I’ll return to my opening comment that we know the pandemic is not over.  Even looking at some of the serology data, the vast majority of Americans still have not been exposed to this virus.

Paul Fulton: Next question, please.

Operator: Thank you.  And our next question comes from Lena Sun from the Washington Sun, your line is now open.

Lena Sun: Thank you very much for taking my call, Dr. Butler, Dr.  Redfield, and I hope we can continue this on a regular basis going forward.  Regarding the mass gatherings, president trump has announced that he is going to hit the campaign trail next week.  The RNC has also announced they are going to hold a convention and they are not going to ask people to wear masks.  Given the considerations that you have put out here about wearing cloth coverings when people are singing or shouting or chanting, I’m wondering whether you need — whether the CDC is concerned about this way of seeding more infections as people are going to be in a closed indoor space and not wearing masks and what additional suggestions you might have.

Jay Butler: Thanks for that easy question, Lena.  So the guidelines I think speak for themselves, and they are not regulations.  They are not commands.  But they are recommendations or even suggestions, is I believe how it’s titled, of how you can have a gathering that will keep people as safe as possible.

Paul Fulton: Next question, please.

Operator: Thank you.  Our next question comes from Dan Vergano from Buzzfeed News, your line is now open.

Dan Vergano: Hi, thanks very much.  You said it’s too soon to tell if this will happen about outbreaks, if people don’t stick to these measures, but we are seeing signs in some states, Arizona notably, have increases that looks like it’s coming back.  Is it too soon to tell if this will happen?  The MMWR is embargoed for 1:00 p.m. But you have already sort of blown the results, so I was wondering if we can go ahead and report that?

Jay Butler: Regarding the question about there are areas, as I mentioned earlier, where there is an increase in the number of cases that are reported and there is a number of different drivers of that as we contact — actually, in some places have staff that are boots on the ground assisting our state, local, and tribal partners.  Sometimes an increase is driven by increased availability of testing, sometimes it’s driven by outbreaks, and we have seen outbreaks in certain occupational settings, in long-term care facilities.  Early on we saw clusters of infections in shelters for people experiencing homelessness, and sometimes there is in-case transmission in the community as well.  In each area where we see an uptick, these are the questions we want to explore to determine whether or not it’s an issue of increased infection in the community or are we recognizing more infections through increased testing.  It’s important to know, of course, that certain proportion of people who become infected never develop any symptoms.  So, as testing has become more widely available, some people are tested without any symptoms.  There are a certain proportion of people who will be diagnosed and will help contribute to that increase in the number of cases in any given location.  In some locations it will be a combination of all of those factors that are driving the increase.

Paul Fulton: Thank you, Dr. Butler.  All information presented during this telebriefing is embargoed to 1:00 p.m. Eastern.  Next question, please.

Operator: Thank you.  Our next question comes from Tom Howell from The Washington Times, your line is open.

Tom Howell: Thanks for doing the call.  I have a question about testing.  I wanted to know, we have heard a lot about the volume of testing and allowing people to get a test if they want one.  Have you seen any strategies though in states or localities that seem to work in actually reducing transmission and amounts of wise allocation of resources?  If so, what do those strategies look like?  Thanks.

Jay Butler: Sure.  First of all, I think it’s important to recognize that testing is not something that in and of itself reduces transmission.  It’s been taking the test results and being able to make sure that people who are infected are then able to be isolated and reduce their exposures to other people.  Right now we are actually in the process of working with the states on their plans for their strategies for testing, and this is using some of the funding that is available to them through some of the appropriations legislation, and there is a number of innovative ideas out there, including using university public health students to be able to increase the access to testing as well as follow-up of contacts of people who test positive.  Other states are using state employees that have recently been laid off.  Not laid off, furloughed.  They are being brought back to work, to work on these issues.  And so it’s really quite a variety of measures that are innovative that have been undertaken by state and local health departments around the country.

Paul Fulton: Thank you.  Next question, please.

Operator: Thank you.  Our next question comes from Rob Stein from National Public Radio, your line is now open.

Rob Stein: Yeah, hi.  Thanks very much for doing this and for taking my question.  I wanted to follow up on a question a little while ago.  So, yeah, so cases are going up in, you know, maybe 20 states around the country, and so what is CDC’s thoughts about why the cases are going up?  As you said, you have boots on the ground.  Is this going up primarily because of increase in testing, or is it more that people aren’t following the guidelines?  And a lot of public health experts say there has not been enough increase in cases, but I’m curious, what is CDC’s analysis of really what the situation is?  Is the virus spreading more right now?  The second question is, the country has flattened the curve.  It’s at a plateau.  That still means 800 or more Americans are dying every day.  Over the course of the summer, thousands more could die by the fall.  Is that an acceptable level?

Jay Butler: Yeah.  So, in terms of the first part of the question, as I was saying earlier, it’s going to be variable in different parts of the country.  There is no one answer to your question that’s going to apply to every area.  So that’s why it takes really a deep dig into the situation to be able to look at that.  So in terms of one of the ways we can begin to tease that apart is also to look at rates of hospitalization.  Also looking at emergency department utilization for COVID-19-like illness because the test results in and of themselves only reflect a bit of the transmission that’s occurring.  We know that some people don’t develop symptoms.  We know that of those who develop symptoms, not everyone will be tested.  And so we have other ways to look at what are some of the metrics for more severe illness.  Are hospitalization rates going up?  Are admissions to ICUs increasing?  Right now, in looking nationally again, the hospitalization rates are going down, and in most of the places where we have looked at the increase in the recent week or two in the number of cases diagnosed we are not confirming dramatic increases in the number of hospitalizations.  This is something that is ongoing and we will continue to monitor very closely.  So that’s by no means meant to suggest that this is not something that we’re not very concerned about and will be working on very closely.

Robert Redfield: Rob, maybe I’ll add one thing.  This is Dr. Redfield. As Jay said, it’s multifactorial.  One of the elements in that, and he mentioned each of the states are putting together their strategy, but because of the asymptomatic and presymptomatic presentation of this virus being much more common than was appreciated in the winter, one of the critical features, particularly in protecting people that are vulnerable, is to institute aggressive surveillance by doing antigen testing, viral testing in individual groups that are considered vulnerable.  So there has been requests that all individuals that are residents of the 15,000 plus nursing homes in the united states undergo testing to see if there is sub-symptomatic infection.  Same with prisons.  It’s also been encouraged to be extended to other risk settings, whether it’s certain meat packing plants, homeless populations, urban clinics, and different states to different degrees have operationalized that.  Some states have almost tested every nursing home resident.  So it’s not explaining everything, but I just, as jay said, it’s multifactorial.  Clearly now there has been able to be expanded testing in what we consider vulnerable surveillance populations that I think is also contributing to some of the number increases.

Paul Fulton: Thank you, Dr. Redfield.  We have time for two more questions.

Operator: Thank you.  Our next question comes from Alexandria Kelly from The Hill, your line is now open.

Alexandria Kelly: Hi, thank you for taking my call.  Really good to hear from you guys again.  I wanted to ask about a yahoo news article published June 10th.  It said through presumably a leaked document from the CDC that coronavirus infections are spiking in the US. Even as they begin to decline in countries like Brazil and Spain, Italy, and Germany.  Do you have any comment on the that?

Jay Butler: I haven’t seen that document.

Paul Fulton: You can follow up with us media@CDC.gov.  Thank you.  Next question, please.

Operator: Our final question comes from Carl O’Donnell from Reuters, your line is now open.

Carl O’Donnell: Hi, this is carl.  So I just wanted to ask, there is a number of states, Arizona, Texas, North Carolina have, you know, significantly relaxed social distancing, and what we have seen is that that seems to have translated not only into higher case counts, which could be a function of testing, but also hire hospitalization rates.  Do you guys have any concern that some states relaxed their social distancing measures too early?

Jay Butler: So I think, first of all, it’s important to recognize that temporal association doesn’t prove causation.  That’s one of the reasons we don’t sit back and look at the numbers, but also try to get visibility in the community of what’s actually going on.  And your question about hospitalization I think is spot on because that is one of the measures of whether or not there is more severe illness occurring or are we diagnosing more asymptomatic people.  So, to reiterate something that Dr. Redfield mentioned, the important surveillance, to be able to understand the evolution of the pandemic is critical.

Actually, if I could maybe return a second to the earlier question about rates of disease in the United States versus other areas.  It’s important to recognize that the degree of testing and surveillance in other nations actually can be quite different than in the United States.  So while there are reports of a number of cases that occur throughout the world, it’s important to note that in some countries there is probably a much greater proportion of cases that go undiagnosed.  And overall those numbers are probably a small proportion of the cases that actually occur.

Robert Redfield: Let me say one thing, if I could, to everyone who tuned in.  I do want to thank all of you.  I said this many years ago when I started, several years ago when I started at CDC, that the public and the media that reports really are a critical partner with us in getting the public health information out that we want to get out to the American public.  I am hopeful that we will continue to have these dialogues.  I just want to thank you for taking the time.  I want to thank you for what you do to help communicate the messages that we feel are important to get to the American public.  So thank you.

Paul Fulton: Thank you, Dr. Redfield.  As a reminder, all the information we have shared today is embargoed to 1:00 p.m.  Eastern.  And we’ll send out an email to the media list including links to these documents.  Please continue to check CDC’s website, CDC.gov/COVID-19-19, for the latest updates on our efforts.  If you have further questions, please call our media line 404-639-3286 or email media@CDC.gov.  Thank you again.

Operator: Thank you for your participation in today’s conference.  All participants may disconnect at this time.

CDC Extends No Sail Order for All Cruise Ships

The Centers for Disease Control and Prevention (CDC) announced today the extension of a No Sail Order for all cruise ships.

“We are working with the cruise line industry to address the health and safety of crew at sea as well as communities surrounding U.S. cruise ship points of entry,” said CDC Director Robert Redfield.  “The measures we are taking today to stop the spread of COVID-19 are necessary to protect Americans, and we will continue to provide critical public health guidance to the industry to limit the impacts of COVID-19 on its workforce throughout the remainder of this pandemic.”

The No Sail Order reinforces the strong action by President Donald J. Trump and the White House Coronavirus Task Force to combat the spread of COVID-19 in the United States. President Trump acted early and decisively to implement travel restrictions on foreign nationals who had recently been to China and Europe and by issuing the 30 Days to Slow the Spread guidelines. These containment and mitigation strategies have been a critical component of the United States COVID-19 response, but despite these efforts, cruise ship travel markedly increases the risk and impact of the COVID-19 outbreak within the United States.

In recent weeks, at least 10 cruise ships reported crew or passengers that tested positive or experienced respiratory symptoms or influenza-like illness. Currently, there are approximately 100 cruise ships remaining at sea off the East Coast, West Coast, and Gulf Coast, with nearly 80,000 crew onboard. Additionally, CDC is aware of 20 cruise ships at port or anchorage in the United States with known or suspected COVID-19 infection among the crew who remain onboard.

There are several public health concerns when crew members become ill while onboard the cruise ships.  As we have seen with the passenger illness response on cruise ships, safely evacuating, triaging, and repatriating cruise ship crew has involved complex logistics, incurs financial costs at all levels of government, and diverts resources away from larger efforts to suppress or mitigate COVID-19. The addition of further COVID-19 cases from cruise ships also places healthcare workers at substantial increased risk.

Some of these ships off the coast of the United States have crew that are not critical to maintain the seaworthiness or basic safe operation of the cruise ships, such as the vessel’s hotel and hospitality staff. The U.S. Government remains committed to humanitarian medevac for individuals in dire need of life-saving support.

The CDC, the U.S. Coast Guard, and the Department of Homeland Security have been working with the industry to determine the most appropriate public health strategy to limit the impact of COVID-19 at cruise ship ports of entry in the United States.  Cruise Lines International Association (CLIA) voluntarily suspended cruise ship operations in March in conjunction with the earlier No Sail Order issued March 14.  The industry has since been working to build an illness response framework to combat COVID-19 on ships with international crew members who remain on board and at sea.

This order ceases operations of cruise ships in waters in which the United States may exert jurisdiction and requires that they develop a comprehensive, detailed operational plan approved by CDC and the USCG to address the COVID-19 pandemic through maritime focused solutions, including a fully implementable response plan with limited reliance on state, local, and federal government support.  These plans would help prevent, mitigate, and respond to the spread of COVID-19, by:

  • monitoring of passengers and crew medical screenings;
  • training crew on COVID-19 prevention;
  • managing and responding to an outbreak on board; and
  • submitting a plan to USCG and CDC for review

This Order shall continue in operation until the earliest of three situations. First, the expiration of the Secretary of Health and Human Services’ declaration that COVID-19 constitutes a public health emergency.  Second, the CDC Director rescinds or modifies the order based on specific public health or other considerations.  Or third, 100 days from the date of publication in the Federal Register.

Additional information in the order includes:

  • Cruise ship operators are not allowed to disembark travelers (passengers or crew) at ports or stations, except as directed by the USCG, in consultation with HHS/CDC personnel, and as appropriate, as coordinated with federal, state, and local authorities.
  • Cruise ship operators should not embark or re-embark any crew member, except as approved by the USCG, in consultation with HHS/CDC personnel, until further notice.
  • While in port, cruise ship operators shall observe health precautions directed by HHS/CDC personnel.
  • The cruise ship operator should comply with all HHS/CDC, USCG, and other federal agency instructions to follow CDC recommendations and guidance for any public health actions relating to passengers, crew, ship, or any article or thing onboard the ship, as needed, including by making ship’s manifests and logs available and collecting any specimens for COVID-19 testing.

For more information about COVID-19 and cruise ships, please visit https://www.cdc.gov/coronavirus/2019-ncov/travelers/cruise-ship/what-cdc-is-doing.html and to view the no sail order go to https://www.cdc.gov/quarantine/cruise/index.html.

CDC Launches New Weekly COVID-19 Surveillance Report

The Center for Disease Control and Prevention (CDC) is modifying existing surveillance systems to track COVID-19, and posted the first of what will be a weekly surveillance report called, “COVIDView.” The report, updated each Friday, will summarize and interpret key indicators, including information related to COVID-19 outpatient visitsemergency department visitshospitalizations and deaths, as well as laboratory data.

The first COVIDView shows:

  • Visits to outpatient providers and emergency departments for illnesses with symptom presentation similar to COVID-19 are elevated compared to what is normally seen at this time of year. At this time, there is little influenza (flu) virus circulation.
  • The overall cumulative COVID-19 associated hospitalization rate is 4.6 per 100,000, with the highest rates in persons 65 years and older (13.8 per 100,000) and 50-64 years (7.4 per 100,000). These rates are similar to what is seen at the beginning of an annual influenza epidemic.
  • The percentage of deaths attributed to pneumonia and influenza (P&I) increased to 8.2% and is above the epidemic threshold of 7.2%. The percent of deaths due to pneumonia has increased sharply since the end of February, while those due to influenza increased modestly through early March and declined this week. This could reflect an increase in deaths from pneumonia caused by non-influenza associated infections, including COVID-19.
  • The National Center for Health Statistics is monitoring deaths associated with COVID-19. Those data are available beginning today and will be featured in this report next week.

COVIDView specifically reports the following:

  • Virus information: This includes COVID-19 diagnostic testing data provided by public health and clinical laboratories. For example, COVIDView will include the percentage of respiratory specimens collected from patients that test positive for SARS-COV-2.
  • Outpatient and Emergency Department Visits: This is syndromic (i.e., not laboratory confirmed disease) data and will be reported as the percentage of outpatient visits for influenza-like illness (ILI) or COVID-19-like illness (CLI) nationally and in each of the 10 Health and Human Services (HHS) surveillance regions across the country. This data is provided through two surveillance systems: the U.S. Outpatient Influenza-like-illness Surveillance Network (ILINet) and the National Syndromic Surveillance Program (NSSP).
  • Severe Disease Information: This includes information on COVID-19-associated hospitalizations and deaths. The hospitalization data is provided by COVID-NET, which conducts population-based surveillance for laboratory-confirmed COVID-19-associated hospitalizations among children and adults through a network of over 250 acute care hospitals in 14 states. Mortality data is provided by the National Center for Health Statistics (NCHS), which reports provisional death counts based on death certificate data received and coded by the National Center for Health Statistics. COVID-NET hospitalization data and NCHS mortality data are summarized in COVIDView each week, but they also each have a webpage where this data is posted (links provided below).
  • Additional surveillance systems and data sources, including expansions of the currently launched systems and sources of data, will be added over time.

Links for additional information:

  • COVIDView (A Weekly Surveillance Summary of U.S. COVID-19 Activity)
  • COVID-NET (U.S. COVID-19 Hospitalization Data)
  • NCHS (U.S. COVID-19 Mortality Data)

New Dengue Fever Map Released – 5 More Confirmed Cases

The Dengue Fever outbreak on the Big Island continues and the total confirmed amount of cases has risen by 5 more cases since the last update bringing the total amount of confirmed cases to 117.

As of December 1, 2015*:

Hawaii Island residents 103
Visitors 14
Confirmed cases, TOTAL 117

Of the confirmed cases, 103 are Hawaii Island residents and 14 are visitors.
88 cases have been adults; twenty-nine have been children (<18 years of age). Onset of illness has ranged between 9/11/15 – 11/20/15.

A new map was released yesterday that only shows the 112 confirmed cases that are now pinpointed.  The previous map showed 88 confirmed cases:

Click to enlarge

Click to enlarge

As of today, a total of 277 reported potential cases have been excluded based on test results and/or not meeting case criteria.

A team from the Center for Disease Control (CDC) arrived on the island today to assist with the outbreak.


  • This map will be updated weekly with location data provided by the State Department of Health. Locations may represent multiple cases.
  • For the most up to date case counts and other information from the Department of Health, visit their website at health.hawaii.gov.
  • Surveying and spraying is being conducted at the residences of all suspect and confirmed cases, in addition to proactive spraying at nearby public facilities.
  • This map should not be used to exclude any areas of the island from proactive mosquito control measures. All residents islandwide are encouraged to Fight The Bite by reducing mosquito breeding grounds and protecting themselves from mosquito bites.

101 Confirmed Cases of Dengue Fever – CDC Official to Visit Big Island

As of November 25, 2015 there were 101 confirmed cases of Dengue Fever reported on the Big Island:

Hawaii Island residents 88
Visitors 13
Confirmed cases, TOTAL 101

Of the confirmed cases, 88 are Hawaii residents and 13 are visitors.
78 cases have been adults; twenty-three have been children (<18 years of age). Onset of illness has ranged between 9/11/15 – 11/17/15.

As of today, a total of 190 reported potential cases have been excluded based on test results and/or not meeting case criteria.

101According to the Hawaii Tribune, an official from the Center for Disease Control (CDC) will be coming to the Big Island on Tuesday of next week:

“…a top CDC official is set to arrive on island next week to assess the handling of the outbreak here.

Lyle Petersen, director of the CDC’s Division of Vector-Borne Diseases, will vet containment efforts and share his analysis with county and state officials during his visit, confirmed Gov. David Ige’s communications director Cindy McMillan.

“(Petersen) will evaluate ongoing efforts based on his visit and analysis of the most current data being captured on a daily basis,” McMillan said.”