Exclusive – Adm. Brett Giroir Details Public Health Infrastructure to Reopen America: ‘Surveillance, Testing, Contact Tracing’

COVID - Adm. Brett Giroir, M.D., Assistant Secretary for Health, speaks during a briefing
Alex Brandon/AP Photo

Adm. Brett Giroir, the assistant secretary for health (ASH), told Breitbart News exclusively on Tuesday that the federal government is developing a broad-based effort consisting of wide-scale testing, surveillance, and contact tracing to be able to control the spread of coronavirus once the president makes the decision to reopen America.

Giroir is a four-star admiral in the United States Public Health Service Commissioned Corps (USPHS), the federal uniformed service of the Public Health Service, and as ASH, a top adviser to the secretary of Health and Human Services (HHS). He is a member of President Donald Trump and Vice President Mike Pence’s White House Coronavirus Task Force and has emerged as the so-called “testing czar.” In that role, Giroir is charged with the logistics of scaling up U.S. efforts to test for coronavirus from about 100,000 when he took over the effort just a few weeks ago to now more than 3 million tests completed as he told Breitbart News on Tuesday.

“Over 3 million as of today,” Giroir told Breitbart News, referring to various diagnostic tests that have been completed testing whether an American has an active coronavirus infection. In the hotspots throughout the United States, Giroir added, the U.S. is leading the world in not just the testing total but also testing per capita—far ahead of places like South Korea and elsewhere worldwide that have been lauded on testing.

“In the places where there’s a lot of disease like New York and Washington, we far exceed South Korea—far exceed South Korea—we have the most testing per capita of any place in the world,” Giroir said. “But if you have states where it’s circulating less, we don’t. But I want to be clear, in the states with really high circulation our testing is extraordinarily good.”

The next stages of combating the outbreak, he explained, will be preparing for the reopening of the country with a multi-pronged public health infrastructure approach including surveillance, expanded testing, and contact tracing, but also an expanded hospital capacity as well as wide-scale serological testing.

“Let me put it into context: All of the testing that we’ve done thus far is testing for the virus in your nose or nasopharynx, meaning you’re actively infected with the virus,” Giroir said when asked about the testing scaling up especially on the serological side. “The antibody test will get us an idea of if you have been infected in the past and are presumably—not 100 percent certain but probably by all known medical computation—that you would be immune to getting the virus again at least in the intermediate term. It is an important component, but it is not really the whole foundation of where we’re going. I call it a component because it will tell us who had the virus and give us a good sort of understanding of what happened, but we still expect only a minority of people will have had the virus and have recovered from it. The outer estimates—and again we don’t know—maybe it’s as much as five or ten percent in some places, and that’s going to be very important to know who those five or ten percent of people are both for themselves and others, but it’s not the total solution.”

Giroir said that to reopen the country there needs to be a number of logistical public health structures in place that the administration is racing to get together as quickly as possible while the disease’s spread levels off. They include surveillance—or monitoring through existing structures that the Centers for Disease Control and Prevention (CDC) uses for other diseases to make sure the government is on top of any emerging potential hotspots before they break out big like right now—as well as expanded testing and contact tracing systems.

“To get everyone back together, and I’m sorry to be geeky; it’s very important to have a number of things in place,” Giroir said. “Number one, surveillance. So is this virus circulating in the country? Right now, I think we had 22,000 new cases yesterday. But as it gets lower, sort of is it circulating and where is it circulating? This is apparent from both testing and what the CDC says would be syndromic surveillance, like if you come in with a cough and a fever and influenza-like illness. This is a very good system to understand. In the summer, if you see people like that, it’s not flu—it’s going to be COVID-19. The second component is actively testing people with symptoms. That’s what we’re doing now. But we need it on a sort of generally available sort of scale. It depends on how many cases there are. If there’s 20,000 cases, or let’s say there’s 10,000 cases a day in the U.S., then you need 10,000 tests and you probably need to oversample. For every positive test, you want five to ten negative tests. So, then for every positive person you’re going to contact trace four to five people. So that’s kind of the milieu of what happens—surveillance, testing, and contact tracing is really defining it, plus the antibody on the other side. As I said last week, we are going to have for a test—we’re going to be in the range of the number of tests that we need to do this in a very short period of time, just a few weeks.”

In addition to those things—the increased testing and the public health infrastructure necessary to monitor and control the spread of the disease—Giroir also mentioned the importance of hospital capacity to treat any new patients.

“There are sort of three big buckets, and again when the president is ready to roll this out and to input all the factors he will do that but I’m just saying as I see it,” Giroir said. “There are three big buckets. Number one is the capacity in the hospitals. We don’t want to ‘open up the country’ if the hospitals are overrun. I think it’s very important for people to understand that if they get sick, and there may be people who get sick even when we open the country back up so to speak, that they can be well taken care of in the hospital. The second piece is the availability of the array and the ecosystem of tests deployed the right way. Again, I think we will have that. Third is the public health sector infrastructure. To me, this is probably the long pole in the tent to make sure the state and local public health departments are fully capable of doing the contact tracing and outbreak investigations that are needed on the downslope of the disease. Again, we can’t wait for three years in our homes to make sure that there’s not a single case out there. The country is going to have to be opened progressively, regionally, based on risk categories of people while it’s still circulating. So again, hospital infrastructure, public health infrastructure, and the array of tests including surveillance that are necessary to do—those are the three factors.”

Regarding the term “surveillance,” Giroir said this is a system that the CDC uses for other diseases to keep the government ahead of the curve of any outbreak in the future.

“Surveillance is kind of what goes on in the background that would identify that there might be COVID cases circulating,” Giroir said. “This is not like actively diagnosing people. This is like taking tests from people in the emergency room who might not otherwise think they have COVID. It’s also about, and there’s a whole network of this already arranged by the CDC—that’s what we do with flu on a normal period, and now that you have a COVID test you can do that with this. Also, there’s what we call syndromic surveillance. This is very effective in how we know where flu is hitting. Indeed, this year, the third wave of ‘flu’ this year was not flu at all—it was COVID. So this is sort of the background—it’s like your radar system out there trying to figure out where there might be cases where you might not even know where the cases are. Or if you see an upsurge in people with cough and fever in, say, San Antonio, we know that instantaneously. That’s something different than active testing. Active testing is when a person is coming in, they have COVID, and I’m testing them for it. It’s not the sort of background surveillance that’s ongoing no matter what’s happening. If that person is positive, and again for every positive we hope people are testing five, seven, eight that we suspect but are negative—because if everybody you test is positive, you’re not testing enough people.”

Giroir also explained how contact tracing works through the CDC in partnership with state and local health officials.

“Contact tracing is for every person who’s positive the CDC says on average there are probably five close contacts that they have interacted with,” Giroir said. “So the idea is to identify and call those people—and this done by local public health officials. Some of those people will need to be tested, and then isolated. If they’re positive or at-risk, we need to keep them chilled away until we determine if they’ve been infected or haven’t been infected and can go back. That’s the idea of contact tracing. You have a person who’s sick, they test positive, you then trace those near contacts who could if infected spread the virus independent of that person. That’s a very, very important component.”

Part of the reason why the strategy shifted to “mitigation,” or the wide-scale national distancing and state-by-state lockdowns nationwide, is because the spread was happening too quickly to handle contact tracing to fight the coronavirus. Giroir said when the numbers of new cases drop to a more manageable number, public health officials will be able to handle it.

“When you’ve got 40,000 or 50,000 new cases a day, your New York City contact tracing program can’t do it because there’s too many people,” Giroir said. “But when you’re on the downslope or at the potential upslope, contact tracing is really critical. When you’re down to 500 or 1,000 new cases in the country, you want to make sure 1,000 doesn’t turn into 50,000—and testing and contact tracing is the way to do that. Those are all there—those are all there from CDC. It just depends on what stage of the outbreak you’re in. If so many people in New York have it, it’s useless to contract trace—you shelter in place, which is what the president asked. But when you get to lower numbers and you’re not doing that, then contact tracing is important as well as if there’s a new upsurge say in the fall or the end of the summer—then identification and contact tracing are really, really important. They’re really important when you have low numbers circulating. When you’re in an all-out full pandemic, you can’t contact trace everybody who’s got it. You got to socially distance and stay away.”

When an area or a region reopens, Giroir said, the tell that it was either successful—or not—will be the numbers of cases that happen in that area.

“You look for new cases,” Giroir replied when asked how officials will know when a place reopens if it was the right call. “If there’s an upsurge in new cases that can’t be controlled in contact tracing, then it’s the wrong decision. So it’s really—how we know if it’s the right decision depends on the surveillance and the identification of new cases. If you open up an area, and the number of new cases continues to go down or smolder at a low level then that’s great. If you have another big upsurge in cases, you have a real problem on your hands. That’s why the contact tracing and testing is so important. But I think it’s really that simple. If you see them going back up again and you can’t control the spread, you got a big problem on your hands and you got to deal with that. In order to avoid that, that’s why we need good surveillance, good testing, and good contact tracing so you don’t get in that situation.”

Giroir also said that serological tests, which tell someone if they have already been infected and recovered and have the antibodies, will very soon be available by the “tens of millions” per month in various places nationwide. He said it is up to the White House Coronavirus Task Force coordinator Dr. Deborah Birx to determine the distribution of those tests—which will be a finger-prick test that can easily be done in many places like a doctor’s office or a pharmacy—when they first come out in the coming weeks.

“We expect that there will be finger-prick tests that can be done in the tens of millions per month,” Giroir said. “The tests will certainly be available and there will be no limiting factors—it really depends on how Dr. Birx and how the task force wants to deploy them. Where do the first 20 million tests go? Where do the first 30 million tests go? But it’s a completely different situation that we’ve seen with this because it’s a finger-prick. It can’t be done at home, but it can be administered at basically any lab and can probably even be administered at pharmacies and nursing homes all across the country. We’ve conducted 3 million tests so far for the virus, which is probably an under-estimate. I would expect the first month of the serologic tests to likely have between 10 million and 20 million done in that first month.”

Giroir added that within the next several months after these serological finger-prick tests are rolled out, as the tens of millions of them per month are distributed, anyone who wants a test will be able to get one nationwide.

“That’s really a decision of the task force under the leadership of Dr. Birx,” Giroir said when asked how and where they will be sent when they come out. “One might imagine that it should be regionally done, and also done where there’s the highest risk. I’m not ready to tell you that because it really is part of the overall comprehensive plan, but one might imagine that regions that have been hardest hit and need to open might be some of those, and for people like healthcare workers who need to know who has been infected, who’s immune and who’s not. There is a strategy here. This is the kind of test that over the next six months basically anyone who wants a test can get a test because it’s going to be out in the tens of millions. But again like everything else, where does the first 10 million or 20 million tests go? How do we deploy that effectively to support the president’s strategy?”

Giroir concluded this interview with Breitbart News by saying that President Trump is making the “absolute right analogy” to consider this fight against coronavirus a wartime effort against an “invisible enemy.”

“I tell you, number one it’s a ‘Whole of America’ approach,” Giroir said. “I didn’t live through World War II, but we didn’t have 10,000 B-17s the moment World War II hit. We didn’t have all the tanks. It took the entire American infrastructure working together to get the supplies to work together what we need. I’m in the uniformed public health service and I’m sitting next to people in the Army and the Navy and FEMA—all working together in a very rigorous military kind of structure, an incident management structure. We have a lot of people dying; we have a lot of people dying and we have a lot of people sick. So I think this is an all-out effort in the country—military, civilians, federal, state, local, the entire American industrial base, and most importantly the American people working together. If the American people did not listen to the president and the Task Force and do the physical distancing, we would be losing this because we don’t have drugs now and we don’t have vaccines, but we do have a weapon—that public health weapon—that we’ve employed for people to physically distance and avoid the kind of gatherings and that’s how we’re getting ahead. In the future, we’ll have better weapons. We’ll have the B-29 bomber; we will have the cruise missiles; we will have the stealth bombers. Right now we don’t. But what we do have we are deploying effectively to get ahead, and we are clearly getting ahead of it. Just listen to the leadership and we will be good.”

Giroir also said he thinks what President Trump is doing by providing lengthy briefings and taking questions from the media daily on this issue is providing an “unprecedented” level of transparency to the public on everything that’s happening with the effort.

“The other thing that’s unprecedented is the president is at the podium every single day answering questions,” Giroir said. “I mean, I can’t imagine a time when the president and the vice president have been so transparent bringing everyone together to answer the questions the American people have and to make sure communication is clear. The Task Force meetings aren’t a media prep, they’re real important meetings about the issues we are facing in America done in a very highly professional, scientific, and multi-disciplinary kind of way and that is being explained to the American people completely transparently. I think that’s unprecedented.”


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