The following is a transcript of an interview with former FDA Commissioner Scott Gottlieb that aired Sunday, March 8, 2020, on “Face the Nation.”MARGARET BRENNAN: Joining us now is former FDA commissioner Dr. Scott Gottlieb. Good to have you back on the program. DR. SCOTT GOTTLIEB: Thanks a lot. MARGARET BRENNAN: I want to pick up where we just left off with the surgeon general who said right there at the end that they are switching strategies. They are no longer looking to contain the virus. They’re looking to mitigate it. Does that me- does that mean they’re acknowledging what they’ve been doing is not working?DR. GOTTLIEB: Well, we have an epidemic underway here in the United States. There’s a very large outbreak in Seattle. That’s the one we know about, probably one in Santa Clara or maybe other parts of the country, other cities. And so we’re past the point of containment. We have to implement broad mitigation strategies. The next two weeks are really going to change the complexion in this country. We’ll get through this, but it’s going to be a hard period. We’re looking at two months probably of difficulty. To give you a basis of comparison, two weeks ago, Italy had nine cases. Ninety-five percent of all their cases have been diagnosed in the last 10 days. For South Korea, 85 percent of all their cases have been diagnosed in the last 10 days. We’re entering that period right now of rapid acceleration. And the sooner we can implement tough mitigation steps in places we have outbreaks like Seattle, the- the lower the scope of the epidemic here.MARGARET BRENNAN: Let’s talk about mitigation because when I asked Governor Inslee what he is doing and I asked him a few ways if he’d consider doing what Italy just did,–DR. GOTTLIEB: Right. MARGARET BRENNAN: –which is essentially trying to- I mean, they’re quarantining a quarter of their population in the most economically vital part of their country. This is a massive decision for them to have made. When I asked him about doing something like that in Washington state, he said, well, they’re talking about more distancing and–DR. GOTTLIEB: Right.MARGARET BRENNAN: — more measures like that. Is it just that it- governors like him don’t want to say out loud that we may have to do something like what Italy did?DR. GOTTLIEB: Well, I think no state and no city wants to be the first to basically shut down their economy. But that’s what’s going to need to happen. States and cities are going to have to act in the interest of the national interest right now to prevent a broader epidemic.MARGARET BRENNAN: Shut down their economy? You mean–DR. GOTTLIEB: Close businesses, close large gatherings, close theaters, cancel events. I think we need to think about how do we provide assistance to the people of these cities who are going to be hit by hardship, as well as the localities themselves to try to give them an incentive to do this. Right now, if there’s no economic support to do this, you don’t want to be the first to go. And I think you’re seeing that. This exposes one of the challenges of our federal system that we leave a lot of authority to state and local officials. And there’s a good- there’s good reasons why. But in a situation like this, we want them to act not just in their local interests, but the national interests, I think we need to think about both trying to coerce them. We can’t force them but also try to provide some incentives in terms of support. And we’re going to end up with a very big federal bailout package here for stricken businesses, individuals, cities and states. We’re better off doing it upfront and giving assistance to get them to do the right things than do it on the back end after we’ve had a very big epidemic.MARGARET BRENNAN: Are you telling the White House to do these things? You used to work in the administration.DR. GOTTLIEB: I’m still having discussions with people in the administration. I’ve been saying this publicly for, you know, weeks now. I think we should try to get ahead of this right now.MARGARET BRENNAN: The president said this morning in a tweet, “We have a perfectly coordinated and fine-tuned plan at the White House for our attack on the coronavirus.” And he said, “the news media is doing everything possible to make us look bad.” I’m asking you this not because I’m a member of the media, but because we were trying to suss out what reality is, versus anxiety for the public. Is this a perfectly fine-tuned plan and is what people are hearing on the news, as the president said, just to make him look bad?DR. GOTTLIEB: We have a narrow window of opportunity to implement tough measures to try to push down the scope of the epidemic. What you want to do is you want to put- put in place mitigation steps to reduce the peak number of cases you have to get them below the point at which the health care system gets exhausted. Because what happened in Wuhan, China, was the health care system got exhausted and fatalities rose quickly. What we need right now in terms of a good plan is a systematic approach to what you do in terms of mitigation steps and when cities should be implementing that. When–MARGARET BRENNAN: And you don’t see that happening yet?DR. GOTTLIEB: There is no systematic plan for when a city should close schools, when they should tell businesses that they have to telework, when they should close movie theaters and cancel large gatherings. We leave these decisions to local officials, but we really should have a comprehensive plan in terms of recommendations to cities and then some support from the federal government for cities that make that step, make that leap, if you will.MARGARET BRENNAN: So- but just on the anxiety question here, the administration has compared this to the flu. Is that how people should be thinking about this?DR. GOTTLIEB: No, this is not the flu. China didn’t shut down their economy because they had a bad flu season. The case fatality rate here is going to be higher all through the age ranges. This is a more severe disease. Now, it’s true that- that you don’t see the full spectrum of disease that you see with the flu where some people get a mild disease, some people get a moderate disease, some people get more severe disease. Here you’re seeing a- a more binary response. Some people get a mild, moderate disease and some people get very sick. But for the people who get very sick, this could be a very dangerous disease. The case fatality rate is probably going to be about 1 percent. And it’s not just older Americans, as tragic as that is. And we shouldn’t dismiss the burden that this is going to place on older Americans. If you look at 40 year-olds, the case fatality rate has been anywhere between point two and point four percent. So that means as many as one in 250 40 to 50-year-olds who get this could die from it.MARGARET BRENNAN: And this data is based on what? On China?DR. GOTTLIEB: This data is based on reporting out of–MARGARET BRENNAN: On South Korea?DR. GOTTLIEB: — South Korea and China. Remember, when you look at the South Korea data, the case fatality rate in South Korea right now is 0.6. But the time to death is three to six weeks. And most of the cases were diagnosed in the last 10 days. Time to hospitalization is nine to twelve days. So, most of these people in South Korea haven’t worked through the severe stages of this- of this disease. The case fatality rate will go up. And I’ll- one more point, you have to make a distinction between the case fatality rate and the infection fatality rate. We talk in medicine about the case fatality rate: how many people who get the disease will die? Some people are talking about the infection fatality rate. How many people who get the infection will die? That’s not what we focus on in medicine because we know that some people will get the infection but not be symptomatic. We typically don’t count those. We count people who get the disease. And for that, the case fatality rate probably- it might not reach one percent in our system, but it might get close to that. It’s not 0.1. And that’s the seasonal flu. And it’s not .05 and that’s a mild flu season.MARGARET BRENNAN: And to get there, you need the adequate number of tests out there and testing to happen–DR. GOTTLIEB: Which we’re getting. MARGARET BRENNAN: Which we’re getting there.DR. GOTTLIEB: Yeah.MARGARET BRENNAN: All right. Thank you very much– DR. GOTTLIEB: Thanks a lot.MARGARET BRENNAN: –for your insight. We’ll be back in a moment with our political panel.
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