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How Frieden says U.S. states can slow alarming spread of coronavirus

The United States is struggling to hold back the coronavirus. More than 30 states are reporting a rise in infections, and several are now reconsidering their plans to loosen restrictions and reopen economic activities. William Brangham talks to Dr. Tom Frieden, who previously led the Centers for Disease Control and Prevention and now heads a global health initiative called Resolve to Save Lives.

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  • Judy Woodruff:

    As we have been reporting, the summer surge of COVID-19 has left the U.S. and the globe rethinking how to reopen.

    William Brangham has more.

  • William Brangham:

    That's right Judy.

    The U.S., as you were saying before, is clearly struggling to contain this virus.

    I'm joined now by a man who has spent his career fighting viruses and disease. Dr. Thomas Frieden ran the Centers for Disease Control and Prevention from 2009 to 2017. And he's now the head of a global health initiative called Resolve to Save Lives.

    Dr. Frieden, good to have you back on.

    We are about six months into this ordeal. We have seen 2.5 million official cases. Over 125,000 Americans have died. When you look at where we started vs. where we are today, what is your assessment of how we have done responding?

  • Tom Frieden:

    Well, the U.S. is clearly a laggard here.

    There are countries around the world that are getting their economies back because they were guided by public health, they communicated clearly, they fully supported public health.

    And, unfortunately, we are paying the price of a response that wasn't nationally organized and not well-implemented. So, if you lean into a punch, you're going to get hit. And that's what's happening all over the South and in most or much of the country today.

    The numbers we're seeing in the U.S. are high, but they're only part of the story. There are many, many more people who are getting this infection and who have not been tested. So, the 40,000 cases that were diagnosed the other day are not all of them.

    This is creating a huge viral reservoir that's going to take months to deal with. And, really, the truth is, if you look at what people are saying, most Americans get it. We need to do the three W's, wear a mask, wash your hands, watch your distance.

    And government and public health need to scale up the box-it-in approach that we have been talking about for months, test strategically. It's not a question of how many. It's whether you do it right. Isolate people well, contact trace, quarantine supportively.

    There are some tough questions to be asked, but there's so much more we need to be doing. There are parts of the U.S. that are continuing to see progress, New York, New Jersey, Connecticut seeing progress still, but at risk, because if any part of the U.S. is having this kind of rapid increase, all parts of the U.S. are at risk.

  • William Brangham:

    So, if, as you say, the majority of the country does believe in the three W's, as you were laying out, and wants to stamp out the virus, how do we explain this — several dozen states now seeing these dramatic spikes?

    What is going on in those states that is causing that?

  • Tom Frieden:

    I think what you saw was an approach that wasn't data-driven.

    A data-driven approach would not have closed for so long in so many places that didn't have COVID. It's like trying to catch a wave when you're surfing. If you go too early, you don't watch the wave. If you go too late, you get swamped. You have to do it just right.

    So, in many parts in the U.S., you saw closings too soon and too long. Then they opened just as it's increasing. And, again, opening when it's increasing is just asking to get hit hard. So it's no surprise that you're seeing these big increases.

    Places like Arizona, where nearly one out of every four tests is positive, that's an extraordinarily high rate, and that indicates a real increase, not just an increase in testing.

    It's going to take a while. It means a lot more distancing, masks, handwashing, distance, but it also means that bars need to be closed in these areas. You can't do that safely. We have had many outbreaks related to bars.

    It means that indoor space, the more people together with the more crowding, less ventilation and the higher the rate of COVID in that area, the more chance for explosive spread.

  • William Brangham:

    We have been seeing several states that have opened up early, as you were describing, or reversing. Arizona just this evening is announcing that they are going to start closing bars down, in response to the surge of cases there.

    But I want to ask you about one other issue, that the president and the vice president have argued that the real reason we're seeing so many cases is because we're testing more, if you look more, you're going to find more.

    That is — is that a fair depiction of what's really going on?

  • Tom Frieden:

    That's simply wrong.

    As a scientist, as an epidemiologist, as a doctor, I can tell you, when you look at the data, there are one or two states where you're seeing a lot more testing and a similar increase in cases. That's correct. Then it's really about more tests.

    But, if you look, Arizona, Texas, Florida, South Carolina, in particular, and many others, the tests are either up or stable, but the percent positivity is increasing. And that's the key number, because that tells you that the rate of COVID in that community is increasing.

    This is not about increased tests. It's about increased spread of the virus.

  • William Brangham:

    Lastly, the president, the vice president also argue that, yes, we may be seeing an increase in tests, but not as many people are dying, that mortality rates are not rising commensurately with new cases.

    How do you explain that?

  • Tom Frieden:

    There are a few things going on.

    First off, death rates lag case rates by about a month, because people get sicker and sicker, and then need to be cared for. Second, it is true that we're seeing increases especially in young adults, and the death rate of young adults is massively lower than the death rate of older adults.

    But what starts in young adults doesn't stay in young adults. That means the lag may be longer than a month, two or three months, but it's likely to be there.

    We're also seeing some improvements in how to care for patients. And what we have seen all over the world is, when you have a situation like New York City, with just overwhelming numbers, the death rate goes up, because it's harder for the doctors and nurses and respiratory therapists to give optimal care.

    So, I do think that we're seeing a real lower death rate. That's accurate. Some of that is the lag, because it takes longer for people to get severely ill than to get a case. And some of that is the age group. So the death rate may come down, but we still project that, in the next month, the U.S. is likely to have at least 15,000 more deaths.

    And I think we're getting inured to these numbers. This is a huge number, 135,000 deaths, with another 15,000, doctors and nurses, other health care workers, more than 400 of them killed by COVID. That is just a shocking number.

    And we have to do better at protecting our health care workers, shielding our elderly, and making sure that nursing homes, meatpacking factories, homeless shelters, prisons and jails are protected, so we don't see this kind of explosive spread and steady increase.

    It's not just about death. It's about how broadly this virus spreads in our community. It creates the equivalent of a reservoir of virus that's going to take a long time. New York City had to shut down for months to cool it down.

  • William Brangham:

    Right. Some very sobering news.

    Dr. Tom Frieden, thank you very much for your time.

  • Tom Frieden:

    Thank you so much. Nice to speak with you again.

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