Coronavirus in Context: U.S. Surgeon General Outlines What We Can Do to Control Spread

JOHN WHYTE, MD, MPH: Hello I'm Dr. John Whyte, Chief Medical Officer at WebMD. And welcome to "Coronavirus in Context." My guest today is the 20th US Surgeon General, Dr. Jerome Adams. Dr. Adams, thanks for joining me today. I know there's a lot going on.

JEROME ADAMS, MD, MPH: A lot going on, but it's, uh, great to be here and to share information with the American people about how they can stay safe.

JOHN WHYTE: Well, let's start about this new prescription that you have for us, which is about knowing your risk, knowing your circumstances, and taking action.

JEROME ADAMS: Well, absolutely. When we think about health -- health messaging, we try to break it down for people, uh, in ways that are memorable and that really, uh, inspire them to take action to protect themselves. And so one of the important things that I, uh, first want people to understand is that when you look at the data that we have right now on the novel coronavirus -- and we're learning more each and every day -- but the average age of people who need medical attention because of coronavirus is 60-plus.

JOHN WHYTE: OK.

JEROME ADAMS: The average age of people who've died from coronavirus is 80. And so we want people to know that those individuals, uh, who are older and especially with underlying medical conditions are at particularly high risk. Those are the folks who, no questions asked, need to be hunkering --

JOHN WHYTE: Mm-hm.

JEROME ADAMS: -- down, need to be protecting themselves and whom we need to be protecting. Now there's some emerging data coming out of Europe that suggest that, uh, the percentage of young people, particularly in the millennial age, who are needing medical care is higher than, uh, what we saw in China and South Korea. So I don't want young people to think they're off the hook. And another important point is that young people, even though they aren't as at high of a risk, are the ones who are spreading the disease, are the ones who, unfortunately, are going to the bars, to the restaurants --

JOHN WHYTE: The beaches.

JEROME ADAMS: To the beaches --

JOHN WHYTE: Sure.

JEROME ADAMS: -- and spreading it, and then bringing it back home to grandmother or grandfather or taking it into the nursing homes. But it's important, first of all, that you know your risk so that you can then figure out what you're going to do and not do based on that risk, which leads to number two, uh, understand and control your circumstances. A -- and, uh, when we say that, if you're 80, and you have a chronic medical condition, you should not be getting on an airplane. You should not -- you should be minimizing your time in public in any way, shape --

JOHN WHYTE: Sure.

JEROME ADAMS: -- form, or fashion. If you --

JOHN WHYTE: And the big health conditions, would they be heart disease, diabetes, high blood pressure, cancer?

JEROME ADAMS: Exactly, and people who are immunocompromised.

JOHN WHYTE: Sure.

JEROME ADAMS: So people who have HIV, people who are getting chemotherapy. But once you know your risk, you can, uh, think about your circumstances. Should I be going to the store? Should I be taking a plane trip? And very few people should. One of our recommendations is, uh, no essential travel. But again, if you're grandma, and you've got diabetes, uh, it's probably better for you to -- to avoid traveling at all costs, at least for the next couple of weeks. So understand and control your circumstances. And then number three, get the facts to take action. And that's why we're here today, but there's a lot of misinformation --

JOHN WHYTE: Absolutely.

JEROME ADAMS: -- out there. And the two best resources I send people to are, number one, coronavirus.gov. It is a federal one-stop shop for information that includes, uh, guidance for specific audiences, faith-based communities, schools, businesses, and families, but also your State Department of Health website is critical, because you want to know what's going on in your community. I -- I mentioned understand and -- and control your circumstances. Well, you may react differently if you're in New York City, where they're having, uh, quite an outbreak, than if you're in Omaha, Nebraska.

JOHN WHYTE: Sure.

JEROME ADAMS: And so you're going to get that information most quickly and most -- uh, most accurately updated at your State Department of Health website.

JOHN WHYTE: And we want to control what we can control. There -- there are some things beyond, uh, our ability to have an impact. But we want to impact those things that we can in this context of what you -- some people are describing as an infodemic as well as an epidemic.

JEROME ADAMS: Exactly.

JOHN WHYTE: All this misinformation.

JEROME ADAMS: And there's a lot of fear out there, because people get scared when they don't feel like they have control. And one of the things that you and I have talked about is how everyone initially wanted to go out and get a mask --

JOHN WHYTE: Right.

JEROME ADAMS: -- even though there's no scientific data that suggests that wearing, particularly the surgical mask, will -- uh, will protect you from getting a coronavirus as a member of the general public. Those are really designed to prevent you from spreading disease to other people.

JOHN WHYTE: Yeah.

JEROME ADAMS: And there are the N95 masks, the cone-shaped things that we talk about all the time, but those are really designed for health care workers to use. An, uh, there are a lot of, uh, scientists out there that believe that people who don't know how to wear them properly and don't get them fit tested actually touch their face often and can introduce coronavirus --

JOHN WHYTE: Right.

JEROME ADAMS: -- or the flu --

JOHN WHYTE: Doing exactly the opposite. They're increasing the risk.

JEROME ADAMS: -- or other diseases. Exactly. And it can do more harm than good, a -- as well as pull from the national stores that we need for health care providers.

JOHN WHYTE: Yeah. And we're seeing stories about, uh, scarcity of supplies in those hard hit areas. Let's talk about 15 days to slow the spread.

JEROME ADAMS: Mm-hm.

JOHN WHYTE: What exactly should Americans be doing over these next two weeks?

JEROME ADAMS: Well, we're really leaning into the next two weeks, because when you look at the -- the international numbers, our numbers are about where Italy's were two weeks ago. And, uh, for folks who may not be aware, uh, Italy actually has had a precipitous rise in infections and also deaths. And their trajectory looks very different than, uh, the trajectory of China and South Korea, which aggressively leaned into mitigation efforts and saw their case counts hit a peak, but then come back down. And so we want to look like South Korea. We want to look like China. We don't want to look like Italy. And, uh, the way we do that is by avoiding large gatherings, and so one of the things in our guidelines that came out from the president is that, uh, no -- social gatherings of over 10 people should come to a halt. You should avoid bars and restaurants. You should work from home, if at all possible, so you're not exposing yourself at work and moving back and forth to work. And you should avoid unessential travel. Uh, the final point -- and we talked about control earlier -- the most important thing for people to know is that there is something you can definitely control, and it's the number one way you can prevent coronavirus. That's with good hygiene -- frequent handwashing, uh, making sure you don't touch your face, making sure you're cleaning surfaces is the number one way to prevent coronavirus. The number two way to prevent coronavirus is with social distancing, staying at least six feet or two arms length apart, and people will see that you and I are --

JOHN WHYTE: Yes, we usually sit closer.

JEROME ADAMS: -- about at that distance right now. But those are the two most important things you can do, and you can control that. You, uh, can -- can do the things that will protect you and your community from coronavirus. And I want people to understand, there is definitely a federal role. There is definitely a state role. But we're not going to solve this coronavirus crisis from Washington DC. It's going to be solved at the community level. It's going to be solve -- solved in our homes, and it's why we really want people to lean into this 15 days to slow the spread initiative so that over the next two weeks, we could hopefully put ourselves on a trajectory that doesn't overwhelm our health care system.

JOHN WHYTE: Let's talk about some practical tips, because people are asking, you know, questions on our site. They want to know, can we still have playdates?

JEROME ADAMS: The guidance from the CDC is that you should not have social gatherings over 10. And I actually just had a conversation with Tony Fauci and Robert Redfield from -- from the National Institutes of Health and from the CDC, and it -- it was a good discussion. And we -- we were asking ourselves, what's the difference between 50 --

JOHN WHYTE: Mm-hm.

JEROME ADAMS: -- and 10 and 2? And what I would say to folks is at the end of the day, every person who comes in and out of your house is the person who could be bringing coronavirus in.

JOHN WHYTE: Why -- I asked you earlier, should we be checking the temperature of people that come into our home? Should we stop them at the door?

JEROME ADAMS: Well -- well, and that's a great question. We want to minimize the people who are coming in and out, because every person who comes in could be a potential case. As far as checking temperatures, I would say it's a good idea to, uh -- to just inquire about people's symptoms. We know that the top symptoms for coronavirus are fever, cough, and shortness of breath. And while you don't have to stand there and take someone's temperature, it is a good idea, if you do have someone coming in and out of your house, to say, uh, well, have you had any of these symptoms? Have you had any cold or flu symptoms recently? And if you have, probably not a good idea to have them over. And to answer your question directly, my kids, uh, 15, 14, and 10, have asked about having people over. And I've said, no. For the next two weeks, uh, I would avoid playdates. We can reassess in two weeks --

JOHN WHYTE: Sure.

JEROME ADAMS: -- and figure out where we are. But we want to stop the spread. We want to lean into this. And the fewer, um, physical connections we have with people, the fewer opportunities --

JOHN WHYTE: OK.

JEROME ADAMS: -- we have to spread the disease.

JOHN WHYTE: So no playdates. What about for those that have their elderly parents living with them in their home? Do those parents need to be quarantined in a certain area of the house? Do we need to treat them differently? We've been asked that question by a lot of viewers.

JEROME ADAMS: And -- and -- and it's a great question. Again, older people, especially those with underlying medical conditions, are at particularly high risk for, uh -- for complications and death if they get the coronavirus. And so we need to be very careful about hygiene with those folks. We need to make sure if you have a child living in an environment with an older person, that every time they go to see Grammy or Pop Pop, they're washing their hands. We need to make sure that's the house for sure that shouldn't be having playdates and having people come back and forth. We don't need to isolate them from the rest of the world and their -- or from their family, um but we do want to make sure we recognize they are at risk and that we're understanding and controlling their circumstances --

JOHN WHYTE: Sure.

JEROME ADAMS: -- so that they can stay safe.

JOHN WHYTE: Can grandparents be the caregivers for children? A lot of folks are having challenges with child care right now. Can grandparents care for them?

JEROME ADAMS: That -- that is a -- that's a really difficult question. And one of the things that -- that comes up when you look at closing schools is now, where do the -- where do the kids go?

JOHN WHYTE: Sure.

JEROME ADAMS: A lot of the kids stay with grandparents. When you look at shutting down work sites, well, the parents come home. They may not have the ability to -- to generate an income. And so we're looking at all these social issues as well as the infectious disease and medical issues. To answer your question directly, uh, we should do everything we can to, um, avoid putting older people with risk factors around younger people who are going back and forth. But at the end of the day, you've got to do what you've got to do. And if that's your only option, then you should really be leaning into hygiene in that environment and making sure you're wiping down surfaces and making sure everyone's frequently washing their hands.

JOHN WHYTE: And -- and we know there's been some challenges with testing, and now we're going to have this new capacity to test. Um, what do you say to those folks that have been hearing this that get a test, test negative, so they feel they're out, you know, free and clear.

JEROME ADAMS: [LAUGHS]

JOHN WHYTE: So they don't have to change their behavior, because they don't have the virus.

JEROME ADAMS: Well --

JOHN WHYTE: Is that an accurate assessment on -- on their part?

JEROME ADAMS: Well, I'd love to unpack testing a little bit. It's important to understand we have diagnostic testing, and then we have surveillance testing. And diagnostic testing means looking at the people who are most at risk, most likely to have the disease, people with symptoms, and people who are going to be, um, um, most severely affected. We want to make sure those are the people who are getting tested first and foremost. If you are young, if you are healthy, if you don't have symptoms, you don't need to get a test. The flip side of that is that it can actually give you a false sense of security, because the coronavirus can have an incubation period of up to 14 days, which is why we have the 14-day quarantine, if you've been around someone who has had, uh, coronavirus. And so what we don't want is for someone to get a negative test, and then think, OK, it's time to go party.

JOHN WHYTE: Right.

JEROME ADAMS: And to give you an analogy that -- that we talk about all the time, it's like HIV. If you get a negative HIV test, that doesn't mean you go out and have unprotected sex or start sharing needles, because, hey, I got a negative test. In this instance, if you get a negative coronavirus -- coronavirus test, it doesn't mean you're scot-free and that you should go out to the bars and restaurants. It's important for people to know that a negative test or a positive test shouldn't change our mitigation strategies. We should still be social distancing to make sure we're not getting the disease from someone else --

JOHN WHYTE: Absolutely.

JEROME ADAMS: -- well as not spreading it to someone else.

JOHN WHYTE: It's the same rules that apply all the time to everyone.

JEROME ADAMS: Exactly.

JOHN WHYTE: Let's talk a little bit about our blood supply and blood banks.

JEROME ADAMS: Mm-hm.

JOHN WHYTE: You were talking earlier today about that. Can you fill us in on what's happening with our nation's blood supply?

JEROME ADAMS: Well, we're really worried about unintended consequences. And that's why, from the start, I told people to prepare but not to panic. I really do worry that there is the potential for more people to be impacted by our reaction to the coronavirus. There's discrimination going on. Uh, there -- there are people hoarding. There are people pulling knives on each other in grocery stores over hand sanitizer. Uh, there are people losing their jobs. And, uh, it's really important for us to -- to think through, uh, how we can still stay socially engaged while we're practicing social distancing. And, uh, the -- the blood donation system is one of those. The majority of blood -- all of the blood, quite frankly, that is donated for surgeries, for people who have traumatic injuries, for people who have sickle cell anemia, for people who have cancer and need blood transfusions comes from volunteers. And, uh, we've seen that over the last week, over half of the blood drives have been pulled down. There's not a shortage yet, but, uh, there could be a shortage if people do not go out and donate blood. I've talked to several of the, uh, major organizations that collect blood, and they say they've taken measures to make sure people are six feet apart, to make sure surfaces are wiped down frequently and in between customers, and to make sure that, uh, people can make appointments, so there's not crowding going on. So I would say to people, please one blood donation can save three lives. And you're home from work. You're home from college maybe. It's a great way to go out and do something for the good of your community. You'll feel better about it. A lot of people are complaining about being home bored. And again, you could save a life. So social distancing does not mean social disengagement. And it's important to know that just as you go to the pharmacy still, just as you're going to go to the grocery store still, you should still thinking about going to donate blood.

JOHN WHYTE: Well, Dr. Adams, I -- I want to thank you for taking the time from a very busy day to -- to help inform us about what we need to be doing to protect ourselves against the coronavirus.

JEROME ADAMS: Absolutely. Know your risk. Understand and control your circumstances. Get the facts at coronavirus.gov. And understand that this is going to get worse before it gets better. But if we do the things that the playbook tells us to do -- and we've seen the playbook in -- in -- in South Korea and in China -- then we will hit our peak. We'll start to see cases go down, and we'll get back to life as normal in short order. But if we don't, we could go the direction of Italy and see many more infections and many more lives lost. It's all about the American people coming together.

JOHN WHYTE: At the end of those 15 days, we'll reevaluate? Is that the plan?

JEROME ADAMS: We will reevaluate at the end of 15 days, and hopefully, there'll be good news. Uh, important to know, and I know -- know we're -- we're finishing up here, but the things we're doing now, you're not going to see the results of them in a day or two days or five days. What we're doing now, the infections we're seeing right now are people who got infected two weeks ago. And the interventions that we lean into right now, we're going to see the benefits from two, three, four weeks down the road. So we may have to have another 15 days. But we want to break this up and go one day at a time, one week at a time, and in this case, getting through two weeks, and then reassess -- looking and saying, OK, did we bend the curve compared to Italy? Are we going in the right direction? Do we need to continue this? Do we need to do more? Do we need to be more aggressive, or can we back off a little bit?

JOHN WHYTE: Well, thank you.

JEROME ADAMS: Thank you, Dr. Whyte.

JOHN WHYTE: So we've been talking about these 15 days to stop the spread, and what will happen in 15 days?

JEROME ADAMS: Well, in 15 days, we will reassess. We know, again, that we are about two weeks behind what Italy's numbers were. So hopefully, by aggressively leaning into these mitigation efforts, in 15 days, we'll compare ourselves to Italy, and we will say, OK, we're on a better slope. We've got fewer cases. And then we can make a decision about whether we continue what we're doing, whether we decrease what we're doing and pull back a little bit, or whether we may need to increase what we're doing. But my best advice to people is to take it one day at a time. We will get through this. We'll reassess each and every day and call each day a victory that we successfully make it through, and in two weeks, again, hopefully, we've started to see the curve bend. And by the end of a couple of months, which is what we've seen in China and South Korea, hopefully, we will have been over our peak and seen our cases start to come down, and we can get back to life as normal.

JOHN WHITE: Well, we started with your prescription, which was about knowing your risk, knowing your circumstance, take action, really becoming informed, and thank you for taking the time today to inform our viewers. I'm Dr. John Whyte. Thanks for watching.

JEROME ADAMS: Thank you.