Trump puts VP Pence in charge of COVID-19 response

In a televised speech to the nation tonight, President Donald Trump addressed the growing threat of COVID-19 and put Vice President Mike Pence in charge of a task force to lead US response efforts.

The speech comes a day after officials from the Centers of Disease Control and Prevention (CDC) said community spread was all but inevitable in the United States, while Trump said during a press conference in India that the situation was under control stateside.

Trump's remarks also coincided with a new case in California that may indicate local spread of the novel coronavirus

"The risk to the American people remain very low; we have the greatest experts in the world right here," Trump said in the speech, as Pence stood behind him. Trump was flanked by several public health officials, including Department of Health and Human Services (HHS) Secretary Alex Azar, CDC Director Robert Redfield, MD, CDC Principal Deputy Director Anne Schuchat, MD, and National Institute of Allergy and Infectious Diseases (NIAID) Director Anthony Fauci, MD.

Overplayed threat?

On Twitter this morning the president suggested the media were overplaying the threats of the virus.

"Low Ratings Fake News MSDNC (Comcast) & @CNN are doing everything possible to make the Caronavirus [sic] look as bad as possible, including panicking markets, if possible. Likewise their incompetent Do Nothing Democrat comrades are all talk, no action. USA in great shape," he said.

Sixty Americans have been diagnosed as having the disease to date, with almost two-thirds connected to the Diamond Princess cruise ship that was quarantined in Japan.

"The level we have had is very low, and of the 15 people, 8 returned home, 5 have fully recovered, 1 is in hospital, and 1 is in pretty good shape," said Trump. The 15 cases he referred to were Americans who had contracted the virus through travel and close case contact, not the 45 Americans who have been repatriated with the disease, 42 of them from the Diamond Princess.

"Our president took unprecedented steps to protect Americans from the disease, including aggressive quarantine, and travel restrictions," said Pence, former Indiana governor. "My role will be to continue to bring the task force together. We will also be continuing to reach out to governors."

Azar said he was "delighted" with Pences appointment, adding that Trump's decision to restrict travel from China in January allowed the United States to buy "valuable time" to prepare for COVID-19.

Azar also laid out several key priorities for the task force, including expanding surveillance, supporting state governments, developing therapeutics and vaccines, and buying personal protective equipment for hospital workers.

Trump compares COVID-19 to flu

President Trump remained optimistic and resolute throughout the press conference, reminding people that the flu kills more than 20,000 Americans each year, and saying he believes cases in China have gone down in the last few days.

"We will essentially have a flu shot for this very soon," said Trump. "View this the same as the flu."

Fauci, however, clarified that a vaccine would take several months to develop, and would not be ready for use for at least another year to 18 months.

Trump also said money would not be a concern. "We're going to spend whatever is appropriate; we have had tremendous success," he said.

Experts underscore low testing rate

Marc Lipsitch, DPhil, a professor of epidemiology at Harvard University, watched the press conference. He was encouraged by Trump’s naming of Pence, and said Azar listed positive priorities.

"There was a lot of good news. I hope the appointment of someone who will listen to experts is a good sign," Lipsitch said, referring to Pence. He warned, however, that the 15 cases cited by Trump as evidence of limited transmission in the country are more reflective of limited testing.

Michael T. Osterholm, MPH, PhD, director of the University of Minnesota's Center for Infectious Disease Research and Policy, which publishes CIDRAP News, echoed Lipsitch's concern.

"There are so few cases because there are so few tests being done," he said. Osterholm said the CDC's message in the last few days has been on the mark, and he was happy to see that money is moving through Congress to address the threat of COVID-19.

"We should all be on one team," Osterholm said. "This should not be political; we are all against the virus."

Osterholm also shed additional light on vaccine development. "What has been happening is people are confused between a vaccine for research versus a licensed vaccine for commercial use. A licensed product is years off, not months off."

Possible community spread in California

During the press conference, the CDC confirmed via a media email a new COVID-19 case in California, in a person who did not have relevant travel history or exposure to another known patient with COVID-19.

"It's possible this could be an instance of community spread of COVID-19, which would be the first time this has happened in the United States," the CDC said. "Community spread means spread of an illness for which the source of infection is unknown. It's also possible, however, that the patient may have been exposed to a returned traveler who was infected. "

In a news release today, the California Department of Public Health said the patient is a resident of Salano County and is being treated in the adjacent Sacramento County.

The Enterprise, based in Davis, California, reported that University of California-Davis officials said today in an email that the patient arrived at UC-Davis a week ago but was not tested till Feb 23. The delay was because the patient did not fit CDC criteria for at-risk patients.

The patient had arrived from another northern California hospital and was already intubated, on a ventilator, and given droplet pretection orders because of an undiagnosed but suspected viral infection. On Feb 23 the patient was put on airborne and strict contact precautions.

"This is not the first COVID-19 patient we have treated, and because of the precautions we have had in place since this patient’s arrival, we believe there has been minimal potential for exposure here at UC Davis Medical Center," said David Lubarsky, vice-chancellor of human health services at UC-Davis, and Brad Simmons, interim CEO of the medical center.

In spite of those precautions some medical center staff have been asked to stay home and monitor their temperatures, the two said.

Yesterday San Francisco Mayor London Breed declared a state of emergency in that city to prepare for coronavirus.

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