COVID-19 Pandemic : Emails from 2021 FOIA request of Dr. Anthony Fauci (7)
dfdsfdsDate: February 24, 2020 at 3:48:33 PM ESTTo: CbH6)Hi Dr. Fauci:I have been a long time admir er of you in the field of modern med icine.This ques tion I have re lates to the current Coronavirus circu latingaround the world. For many years I have infom1ed people that the waysa virus can be passed from person to person isn't always by a sneeze,cough or by touching someones face with their hands. Has anyone inyour medica l community thought that if someone were smok ing andwas an infected person that once they expel the smoke particles into theair that those micro smoke particles may contain vi.ruses that were in therespiratory system of an infected person. Everyone I mention this todon 't believe that this is possib le. What are your thoughts on thismatter? If so why hasn't the medical community warned the publicabout this possibility as I stay away from all establishments that allowsmoking on their premises.Thank you,Daniel Gagnon(b)( 6)NIH-000762From: (b)(6)Sent: Mon, 9 Mar 2020 13:18:14 -0400To:Subject:Lerner, Andrea (NIH/NIAID) [E);Auchincloss, Hugh (NIH/NIAID) [E)Fwd: Question re: coronavirus infection & pneumococcal vaccinationFrom pattyCan one of you pls respond. ThxSent from my iPhoneBegin forwarded message:From: Manon Cox (b)(Date: March 9, 2020 at 1 :06:33 PM EDT --------. ;..,...,-= To: "Fauci, Anthony (NIH/NIAID) [E]" (bH 6JSubject: Question re: coronavirus infection &pneumococcal vaccinationDear Dr. Fauci,This is Manon Cox, former CEO of Protein Sciences, the developer of Flublok® .First of all I would like to thank you for your realist ic comments around the ongoingcoronavirus outbreak. I am glad to see that not everyone is presenting a "Spanish Flu"- likescenario.I am reaching out to you b/c I am noticing that so many people including professionals(MD's!) appear to be think ing that people with a coronavirus infection are dying from acytokine storm whereas my understanding is that pneumonia (whethe r viral or bacterial) isgenerally the underlying of the lung failure.My question to you is: Do we know whether people that have previously received apneumococcal vaccinat ion might be better protected from death after contracting a severecoronavirus infection? i.e., would it be possible that the coronavirus causes tissue damageresulting in a secondary pneumococcal infection?I know bette r than anyone (after work ing over 15 years on Flublok approval) that it is notrealistic to expect a coronavirus anytime soon but if we could message that apneumococcal vaccine could be beneficial in ultimate outcome it would be good forvaccines in general as we do have pneumovax and Prevnar available.Thank you for your consideration.NIH-000763NIH-000764Kind regards, Manon CoxSent from Mail for Windows 10From:Sent :To:(b)(6)Mon, 9 Mar 2020 13:16:15 -0400Oplinger, Anne (NIH/N IAID) [E]Subject : Fwd: Time for an interview with Ame rica Magazine?This is from pattyPis decline.Sent from my iPhoneBegin foiwarded message:From: Kevin Clarke <clarke@americamedia.org >Date: March 9, 2020 at 1: 07:02 PM EDT- ------ ---.-.-, . To: "Fauci, Anthony (NIH/NIA ID) [E]" CbH6JSubject: Time for an interview with America Magazine?Dear Dr. Fauci,America magazine is the flagship effort of America Media in New York. We are a min istryof the Jesuits of the United States and Canada. America magazine may be the best knownCatholic publication in the United States, publish for more than 100 years .I realize you must be supremely busy under the circumstances, but I thought I would ask ifyou could spare a few minutes for an interview in New York, over the phone or on remotevia Skype for one of our internet programs to talk about the coronavirus landfall here inthe United States, how the public can best respond. We would also love to hear how yourfaith is helping you cope personally, perhaps how your Jesuit background is assisting yourdecision-making in this drama.Let me know if you think anything might be possible.Thanks,Kevin ClarkeKevin ClarkeSenior Editor and Chief Correspondent1212 Sixth Ave, 11th FloorNew York, NY 10036Phone : 2 12-515-0130 (office)NIH-000765Phone: (b) (6) (mobile)Phone (b)( (Friday)Email: clarke@americamedia.or gWeb: www. americamedia.or gAmerica 111~.Ri!~Join the conversation: Twitt er <http://twitter.com /Amer icamag> I Facebook<http ://facebook .com/Americama g> I YouTube <http://youtube .com/Americamag > I Tumbl r<http ://americaliterary .tumblr .com/>NIH-000766From:Sent :To:Fauci, Anthony (NIH/NIAIO) [E)Mon, 9 Mar 2020 16:07:16 +0000Alison GalvaniSubject: RE: In press paper about impact of travel restrictions attachedThanks, Alison.Anthony S. Fauci , MDDirectorNational Institute of Allergy and Infectious DiseasesBuilding 31, Room 7A-0331 Center Drive, MSC 2520National Institutes of HealthBethesda , MD 20892-2520Phone : (b)(6)FAX: (301 496-4409E-mail Cb) (6)The information in this e-mail and any of its attachments is confidential and may contain sensitiveinformation . It should not be used by anyone who is not the origina l intended recipient . If youhave received this e-mail in error please inform the sender and delete it from your mailbox or anyother storage devi ces . The National Institute of Allergy and Infectious Diseases (NIAID) shall notaccept liability for any statements made that are the sender 's own and not expressly made onbehalf of the NIAID by one of its represent atives .From: Alison Galvani Cb) (6)Se nt: Tuesday, March 3, 2020 4:04 -P-M-- ---~~ To: Fauci, Anthony (NIH/NIAID) [E) (b)(6)Subject : In press paper about impact of travel restrict ions attachedHi Tony,It may not be as pertinent as it was when we submitted it, but I thought you might be interested in ourmodeling on the global spread of COVID-19. It is in press at PNAS.We also have a paper submitted to them about ICU and ventilator inadequacy in the US. I'd be happy tosend it to you now or wait until after the peer-review process .Thank you for everything you do to lead us th rough these crises.All the best,AlisonAlison Galvani, PhDDirector , Yale Center for Infectious Disease Modeling and Analysis (CIDMA)NIH-000767Burnett and Stender Families Professor of EpidemiologyYale School of Public HealthYale School of MedicineNew Haven, CT 06520(b)(6)htt p:// cidma.yale.edu/NIH-000768From:Sent:To:Subject:Fauci, Anthony (NIH/NIAIO) [E)Mon , 9 Mar 2020 16:02:31 +0000Jacquelyn (Jackie) Madry-Tay lorRE: Dr. Marilyn Madry LightfooteThank you .Anthony S. Fauci , MDDirectorNational Institute of Allergy and Infectious DiseasesBuilding 31, Room 7A-0331 Center Drive, MSC 2520National Institutes of HealthBethesda , MD 20892-2520Phone : (b)(6)FAX: (301 496-4409E-mail Cb()6 )The information in this e-mail and any of its attachments is confidential and may contain sensitiveinformation . It should not be used by anyone who is not the origina l intended recipient . If youhave received this e-mail in error please inform the sender and delete it from your mailbox or anyother storage devi ces. The National Institute of Allergy and Infectious Diseases (NIAID) shall notaccept liability for any statements made that are the sender 's own and not expressly made onbehalf of the NIAID by one of its represent atives .From: Jacquelyn (Jackie) Madry-Taylor --------(b)(6)> Sent: Tuesday, March 3, 2020 11:04 AM ------~~ To: Fauci, Anthony (NIH/NIAID) [E)- ------- (b)(6) Subject: Dr. Marilyn Madry LightfooteGood Morning, Dr. Fauci,I am CbH6) Dr. Jacquelyn Madry-Taylor. Iknow she would want me to congratulate you on the outstanding informationyou are providing the nation about the Coronavirus. The success of CbHcareer was directly related to you allow ing her to work in your labs as shebegan her career in molecular immunology . Your name was mentioned quitefrequently during those early years and throughout her work in the federalgovernment. I, CbH6) and othe rfam ily members miss her so much and know that she would be on top of theinformation about this new virus as you present it. Thank you so much forbeing such a cata lyst for her success and we applaud your efforts inidentifying the source of the virus and finding a vaccine.Sincerely,NIH-000769NIH-000770Jacquelyn Madry-Taylor , EdDFrom:Sent :To:Fauci, Anthony (NIH/NIAIO) [ElMon, 9 Mar 2020 13:18:02 +0000Kate DickmanSubject: RE: Thank YouThank you!Anthony S. Fauci , MDDirectorNational Institute of Allergy and Infectious DiseasesBuilding 31, Room 7A-0331 Center Drive, MSC 2520National Institutes of HealthBethesda , MD 20892-2520Phone : (b)(6)FAX: (301 496-4409E-mail Cb) (6)The information in this e-mail and any of its attachments is confidential and may contain sensitiveinformation . It should not be used by anyone who is not the origina l intended recipient . If youhave received this e-mail in error please inform the sender and delete it from your mailbox or anyother storage devi ces. The National Institute of Allergy and Infectious Diseases (NIAID) shall notaccept liability for any statements made that are the sender 's own and not expressly made onbehalf of the NIAID by one of its represent atives .From: Kate Dickman ----------(b) (6) > Sent : Monday, March 9, 2020 9:00 -A-M- -----:a ~aa, To: Fauci, Anthony (NIH/NIAID) [El (b)(6J> ________ ,.Subject: Thank YouDear Dr. Fauci,I have been reading about your efforts to learn quickly about COVID-19, and subsequently educate theAmerican public about its risks. I wanted to say how grateful I am for your expertise, perseverance andcandor.Updates about what Americans should do to keep safe, and understanding what may be deemed riskyfor personal and community health, are greatly needed in these days of information (and possiblymisinformation) overload. Giving American people current information and clear, updated guidance isthe best way to create grassroots, coordinated, widespread effort, while the CDC, NIH, and othergovernment health organizations organize the tops-down approaches to regional screening, emergencycare, and COVID-19 research/testing for hopeful vaccination or treatment protocols .I'm very relieved and assured to have strong voices of reason, experience, and merit helping 'us'navigate these murky waters . I'm grateful for your courage.Thank you again.Kate DickmanNIH-000771(b)(6)resident of ------- Cb()6 ) Northern CaliforniaSent from PostboxNIH-000772From :Sent :To:Subj ect :Anthony S. Fauci , MDDirectorFauci, Anthony (NIH/NIAIO) [E)Mon , 9 Mar 2020 12:57:57 +0000Eisinger, Robert (NIH/NIAID) [E]FW: Containment MeasuresNational Institute of Allergy and Infectious DiseasesBuilding 31, Room 7A-0331 Center Drive , MSC 2520National Institutes of HealthBethesda , MD 20892-2520Phone : (b)(6)FAX: (301 496-4409E-mail : (b)(6)The information in this e-mail and any of its attachments is confidential and may contain sensitiveinformation . It should not be used by anyone who is not the origina l intended recipient . If youhave received this e-mail in error please inform the sender and delete it from your mailbox or anyother storage devi ces . The National Institute of Allergy and Infectious Diseases (NIAID) shall notaccept liability for any statements made that are the sender's own and not expressly made onbehalf of the NIAID by one of its representatives.From: Alex Wolf, Esq. (212)717-2510 <awolf@wolf lawyer.com>Sent : Monday, March 9, 2020 8:43- -A-M- ---~~ To: Fauci, Anthony (NIH/NIAID) [E (b)(6)Subject : Containment MeasuresDear Dr. Fauci,Why doesn't CDC counsel entire country on need for conta inment measures as indi cated by t hefollow ing study:black box appears in ori .NIH-000773Rapid Response was Crucial to Containingthe 1918 Flu PandemicHistorical Analyses Help Plan for Future Pandemics.(b)(6)Would you know whether pulmonary sarcoidosis which has been in remission for years withoutmedication puts one at greater risk of Covid-19 hospitalization as an underlying condition, or would onlybe higher risk if it was active and one was taking immunosuppressive drugs?Thank you.Alexander Wolf, Esq.60 East 42nd StreetSuite 4600New York, NY 10165(b)(6)NlH-000774From: (b)(6)Sent: Mon, 9 Mar 2020 06:49:10 -0400To: Handley, Gray (NIH/NIAID) [E]Cc: Conrad, Patricia (NIH/NIAID) (E];Barasch, Kimberly (NIH/NIAID) (C];Erbelding,Emily (NIH/NIAID) (E];Lane, Cliff (NIH/NIAID) (E]Subject: Fwd: CoV collaboration with Polish Medical Research AgencyGray:Please work with Emily to see what we can do for this person, if only with advice.Thanks ,TonyBegin forwarded message:From: Rados law Sierpinski Cb><Date: March 9, 2020 at 6:42:08 AM EDTTo: "Fauci, Anthony (NIH/NWD) [E]" --------. .--.,-,-=Cc: "Gupta, Ranjan (NIH/FIC) [E]" _______ _Subject: Co V collaboration with Polish Medical Research AgencyDear Doctor Fauci,I hope this e-mai l is finding you well and your efforts in fight against Coronavirus epidemicsis giving some effects. As you know in Poland we have currently 15 cases of CoV infectionand we are also fighting mostly with general society worries than epidemics. We would likealso to take part in research on CoV vaccine or drug and Polish Medical Research Agency isplanning to start financing some project on it as soon as possible. Both polish medicaluniversities and institutes are fully prepared to take part in such project.On behalf of Polish Minister of Health Prof. Lukasz Szumowski I would like to kindly ask youfor some support and collaboration options with NIH in this very delicate issue. Maybe NIHcan take some advisory role in our scientific project or Polish scientists may take some partin your work bilaterally .Looking forward to hearing from you,Radosfaw Sierpinski MD, PhDPresident of Medical Research Agency in Poland(b)(6)AGENCJASADANMEOYCZNYCHNIH-000775NIH-000776Medical Research Agencyul. S. Moniuszki lA00-014 Warszawawww .abm.gov.plFrom:Sent :To:Fauci, Anthony (NIH/NIAID) [ElMon, 9 Mar 2020 09:57:48 +0000Cassetti, Cristina (NIH/NIAID) [ElCc: (b)(6JSubject: FW: Connecting with Tony FauciAttachme nts: Baricitinib as potential treatment for 2019-nCoV acute respiratory disease .pdfPlease take a look and respond-----Original Message-----From: Collins, Francis (NTH/OD) [E] (b)(6) >Sent: Monday , March 9, 2020 5:29 AM- -----~~ To : Fauci , Anthony (NTTI/NIAID) [E] (b)( >; Erbelding , Emi ly (NTTI/NlAlD) [E]-=-....,,,,-,--,-..,,...---,(,b..). (,6.,),>,,;. .A_ ustin, Cbristopher (NIH/NCA TS) [E] (b) (6)Cc: Tabak, Lawrence (NIH/OD) [E) (b) (Subject: FW: Connecti ng with To ny Fauc iPassing this on in case Bill Chin's idea mignt be of interest.Franc is-----Original Message- ----From : William Chin ________ (b)~( = >Sent: Sunday, March 8, 2020 10:48 PMTo: Collins, Francis (NIWOD) [E] ------~~Cc: Baker, Rebecca (NIH/OD) [E] ; Austin, Christop her (NIH/NCATS) [E]_______ (b_) _(6_J, ; Roger Glass ________________ (b_)_(6_J,Subject: Connecting with Tony FauciHi Francis et al, I write to get a message to Tony, who clearly is on the COVID -19 front lines of these days and"everyw here." At this early stage, you may agree that it is possible that containment and/or mitigation will notcompletely solve the current pandemic . Instead, effect ive treatmen t or amelioration of the worst complications isnecessary. 1n this spirit, I have an idea that was spurred by a letter in Lancet last month authored by Al Benevolent(attached ). In this communication they suggest that baricitinib (Oluminant ; a JAK 1/2 inhibitor regis tered by Lillyfor the treatment of rheumatoid arthritis ), using in si lico techniques . might be useful in the treatment adva ncedCOVID - 19 pneumon ia/ ARDS identified . Baric itinib could possibly blunt the cytokine storm seen in the mostseverely affected patients via inhibiti on of JA K 1 /2, but also decrease viral en try in A T2 pulmonary cells andmyocard ial cells via inhibition ofGAK and AAKI. It is has a relatively short plasma half-life and hence could bemore useful than Roche 's tocilizumab / Actemra). Baricitinib has a good safety profile although as a drug to treatautoimmunity it is fonnally contraindicated in patients with infections, this could be offset by treatment patientswith anti-viraJs such as Gilead's remdesivir, etc. Perhaps you folks have already thought about/discus sed its use butif not J'd like a chance to chat about my additional thoughts. Thanks. BillNIH-000777From:Sent :Fauci, Anthony (NIH/NIAIO) [E)Mon , 9 Mar 2020 03:10:28 +0000To:Subject:Glenda Gray;Rancourt, Anne (NIH/NIAIO) [E];Dieffenbac h, Carl (NIH/NIA ID) [E]RE: 'You don't want to go to war with a president'Thanks, Glenda!From: Glenda Gray <Glenda.Gray@mrc.ac.za>Se nt: Tuesday, March 3, 2020 9:37 AMTo: Fauci, Anthony (NIH/NIAID) [E]-------=- (bc)(-=6c)>; Rancourt, Anne (NIH/NIAID) [E](b)(6)•>; Dieffenbach, Carl (NIH/NIAID) [E] (b)(6) _______....._ _Subject: FW: 'You don't want to go to war with a president'DearTo nywonderful art icle, proud to be associated with youSubject: 'You don't want to go to war with a president 'https ://www .polit ico.com/ news/2 020/ 03/ 03/a nt hony-fauci-trump -coronavirus -crisis-118961regardsGlendaGlenda GrayPresident & CEO South Afr ican Medical Research Council : Executive ManagementSouth African Medical Research CouncilTel: +27 21 9380905 I Cell: (b)(6)Francie van Zijl Drive, Parow Valley I Cape Tow n I Western Capeww w .samrc.ac.zasaMR9 i YEARS19 9-201 9&lIDisclaimer - The information contained in this communication from the sender is confidential. [t is intended solely for use by therecipient and others authorized to receive it. lf you are not the recipient, you are hereby notified that any disclosure, copying, distributionor taking action in relation of the contents of this information is strictly prohibited and may be unlawful. This email has beenautomatically archived by Mimecast SA (Pty) Ltd This e-mail and its contents are subje ct to tbe South African Medical ResearchCouncil e -mail legal 11otice available at http://www.samrc .ac.za/about/EmailLcgalNoticc .htm.NIH-000778From:Sent :To:Subject :Linda;Fauci, Anthony (NIH/NIAID) [E)Mon, 9 Mar 2020 03:04:02 +0000Birnbaum, Linda (NIH/NIEHS) [VJRE: Thank youThanks for the note. I wou ld cancel if I were you .TonyFrom: Birnbaum, Linda (NIH/N IEHS) [V] _______ C_)b_C_6, )Sent : Sunday, March 8, 2020 1:28 PMTo: Fauci, Anthony (NIH/NIAID) [E) ----- -= (b=H=6J>Subject: Than k youHi Tony,Just wanted to say thank you as a fo rmer colleague and friend for speak ing truth to power during thiscoronavirus crisis.So, am I right in thinking t ravel ing to California for my major science meeting and some universitylectur es in a week should be canceled? I am, (b)( ~ThxLindaNIH-000779From:Sent :To:Subject:Fauci, Anthony (NIH/NIAIO) [ElMon, 9 Mar 2020 02:59:07 +0000Thomas R. FriedenRE: FYI - guess which ---(b-)(6JIw as thinking of ....Great article. Glad to be the anonymous subject of your discussion. QFrom: Thomas R. Frieden (b)(6)Sent : Sunday, March 8, 2020 3:32 PMTo: Deborah Birx (b)( ; Deborah Birx CbH6J; Fauci, Anthony (NIH/NIAID) [El(b)(6J;R edd, Stephen (CDC/DDPHS.I':S:"/-::-0:--D:--): .==== (~b),,(.=.,.>; Schuchat, Anne MD"('C .-'"-D-C-/:0-- D-.,====~ (b-)(= >Subject : FYI - guess whic li.__ _ C)b(.6..i) I was thinking of ....New article re nursing home restrictions and more here.From: Tom Frieden (b)( >Date : Sunday, March 8, 2020 at 2:35 PMTo: Tom Frieden (b)(6)Subject: Nursing homes are ground zero for COVID19 -- and what more we can do to save livesin the pandemicDear Colleague,Two weeks ago it was clear that COVID-19 would become a pandemic , and, sadly it has.Now the United States is in the acceleration phase and cases, clusters, and large outbreaks will occur inmany parts of the country.I outl ine steps we can take to reduce the harms. The core concept to protect the most vulnerable. First,restrict visits to nursing homes. All of us can play a part reducing infections. Medically vulnerable peoplecan protect themselves by reducing social contacts . I'm not sure I'd go quite as far as my good friend BillSchaffner and say they should become semi-hermits . but that 's certainly a helpful frame of reference.Health care needs to get much safer, and ready to surge safely. And we need to stop mass gatherings,consider telework, figure out whether closing schools will help, and more.Read what I've posted about ground zero in the COVID-19 pandemic in the US here .I've shared on Twitter if you'd like to disseminate.We'll all be working together to protect as many people as quickly as possible.Thank you,TomNIH-000780Tom Frieden, MD, MPHPresident and CEO(b)( tTOS AVEL IVESANl fllTIATIOVFEV ITAlS TRATEGIESRESOLVE TO SAVE LIVESAn initiative of Vital StrategiesSTAY CONNECTEDwww.resolvetosavelives.org facebook twitterNIH-000781From:Sent:To:Subject :Mark:Fauci, Anthony (NIH/NIAID) [E)Mon, 9 Mar 2020 01:49:23 +0000Mark FeinbergRE: Thanks so muchThanks for the note. Much appreciated.Bet,Tony----- Original Message- ---- ------ ~= From: Mark Feinberg (b) (6)>Sent: Sunday . March 8. 2020 9:48 PM ______ ~=To : Fauci , Anthony (NTH/NIA ID) [E] ______ C>b<_.Subject: Tha nks so muchDear Tony,J hope you are doing well despite your extraordinar ily busy schedule address ing the COVID-19 outbreak.J just wanted to send you a note to ofter sincere thanks and deep admiration tbr your tremendous efforts 10 providethe public with clear, insightful and accurate iufonn ation about this very ser ious public health threat and for yourgreat leadership in helping to guide efforts to respond to it in the most effecti ve and scientifically grounded way.Our nation is so fortunate to have your full and expert engagement in this response.I can only ima gine how busy you are and you need not worry about responding to this note. However, l did want toshare one voice of appreciation and thanks.Very best ,MarkNIH-000782From:Sent:To:Subject :Fauci, Anthony (NIH/N IAID) [ElMo n, 9 Mar 2020 01:37:26 +0000Cassetti, Cristina (NIH/NIAID) [ElFW: Countering COVID-19From: Clayton Conger (b)( 6)>Se nt: Sunday, Marc h 8, 2020 9:36 PM To: Fauci, Ant hony {NIH/NIAID) [E]-- --------~-~---- (b)(6=) > Subject: Coun t ering COVID-19Dr. An thony FauciDirector of the National Institute of Allergy and Infectious DiseasesDear Dr. Fauci:It occurred to me that if viruses contain an iron atom, perhaps a form of magnetic treatment mightstop or reduce the severity of the COVID-19 virus, so I investigated and found thatviruses have one atomof iron. My suggestion is that experimentation on victims of the vims be conducted, perhaps by insertinga tiny magnet into their lungs to see if it might gather up the vu.uses circulating in the victim . Perhapsexterna l application of magnetism would work as well, J'm sw-e yom scientists will have even betterapproaches to so lv ing this problem. I'm a probl em so lver, having pub lished a book that solves many ofthe Earth's problems: "Thinking Outside The Oven -- Concomitan t Concepts and Synergi stic Solutionsfor the 21st Century" (available at Barn es & Noble and Amazon ). I'm working on a sequel and if youfind my idea useful I'll include a chapter on it.(b)(6)C.N. Con er(b)(6)NIH-000783Very respectfully,Ned CongerFrom:Sent :To:Fauci, Anthony (NIH/NIAIO) [E)Mon, 9 Mar 2020 01:33:55 +0000Eisinger, Robert (NIH/NIAID) [E]Subject: FW: Record a short interview with me for a UPenn course?Sorry no.From: Scheyder, Elizabeth C- --------- (b)(6)> Se nt: Sunday, March 8, 2020 6:03 PMTo: Fauci, Anthony (NIH/NIAID) [E]--------=- (b')"("=6' )>Subject: Record a short interview with me for a UPenn course?Dear Dr. Fauci,I am embarrassed to admit that I was not familiar with your name when I read the story about you intoday's NY Times, but I was most impressed by the statement in the first sentence that you are "widelyrespected for [your] ability to explain science without ta lking down to [your) audience" .I'm putting together the first offering of CLCH 300: Communicating Science, as part of the University ofPennsylvania's new online Certificate in ClimateChange. {https :ij lpsonline.sas.upenn.edu/academ ics/certificates/climate -change) A brief recordedconversation wi th you about your strategies for communicating without being patronizing would bemost enlightening for my students .The students in this course will be coming from a wide variety of backgrounds, and potentially from allover the globe. I think they wou ld love to hear from a scientist who is so good at communicating his fieldof study to diffe rent audiences. And let's face it, as soon as you say "NIH" as COVI0-19 swirls around theglobe, their ears will certainly perk up! I think the students would find our interview very engaging andinformative .The first run of the course will be from May 26 to July 20, 2020, but we can record the interview (on line)any time, since I know you are already over-extended right now . I think 15 minutes would be plenty, andI would be happy to send you questions that I plan to use to guide the conversat ion in advance. If asynchronous conversation is impossible given your schedule, I would be happy to just send you a coupleof questions and ask you to use them to guide a 10-15 minute video that you record yourself .Please let me know what you think of this, and I will send you the syllabus when it's finalized , includingwhere our interview would fit. Then I can begin the process of coordinat ing this with the AssociateDirector of our Online Learning Studio.Sincerely,ElizabethElizabeth C. Scheyder, Ph.D., P.E.SAS ComputingSenior Instructional Technology Project LeaderNIH-000784NIH-000785& Lecturer in SASWilliams 441 BFrom: Fauci, Anthony (NIH/NIAIO) [E)Sent : Mon, 9 Mar 2020 01:32:52 +0000To: Cassetti, Cristina (NIH/NIAID) [E]Subject: FW: can you use a miRNA-seq assay to detect covid-19 in blood samples?Attachment s: GSE81852 MERS vs Mock control PCA p=2.le-8 q=7.79e-7 2 variables8March2020.tif, GSE81852 MERS vs Mock control Hierarchical clustering heatmap p=2.le-8 q=7.79e-7 2variables 8March2020.tif, GSE81852 MERS vs Mock control PCA p=6.4e-7 q=4.2e-5 10 variables8March2020.tif, GSE81852 MERS vs Mock control Hierarch ical clustering heatmap p=6.4e-7 q=4.2e-5 10variables 8March2020.tifFrom: Hellmich, Helen (b)(6)Sent: Sunday, March 8, 2020 5:52 P-M-- ----c.c .-.-= To: Fauci, Anthony (NIH/NIAID) [E] -------- (b)(6)> Subject: can you use a mi RNA-seq assay to detect covid -19 in blood samples?Dr. Fauci, how are you sir?Long ago, in the early 90's, I was a post -doctoral fe llow in the Laboratory of Viral and MolecularPathogenesis at NIH. I don't know if the same lab is st ill there. Now I work on brain injury andAlzheimer's but my interest in viruses and mechanisms of viral pathogenesis has not waned and therecent covid-19 outbreak prompted me to do a little investigation on my own.My studies of blood microRNA changes after TBI and AD suggest that principal component analysis ofdistinct changes in circulating miRNAs can identify the patient population. MicroRNA alterations can bemeasured by real-time PCR which I presume is the basis of the test that is developed for this disease butI am analyzing blood mi RNA-seq expression profiles and now it is possible to quickly sequence bloodsamples in a few hours and get accurate results. Blood gene expression in my studies was more var iable(lots of RNases in blood) so I found that microRNAs are much more stable in blood and serum samples.I attach an example of a PCA/hierarchical clustering heatmap analysis of a GEO dataset for MERs-coVfrom 2016 https ://www .ncbi.n lm.nih.gov/geo/query/acc.cgi?acc=GSE8l852I performed the PCA and heatmap analyses at two differen t stringencies and you can see that thepatients can be unequivocably distinguished from the controls at very significant p and FDR values.Just a thought but many clinical centers, hospitals, academic institutions can quickly perfo rmtranscriptome-wide sequencing. Blood RNA can be isolated in 1-2 hrs, sequencing libraries made in afew hres and one mi RNA sequencing run can handle up to 48 samples and the data can be quicklyanalyzed.Just my two cents on how NIH could accelerate the analysis of new blood samples for this new strain ofcoronanvirus . You could mob ilize hundreds of sequencing centers to help in the analysis.RegardsNIH-000786Helen Hellmich, PhDAssociate ProfessorDepartment of AnesthesiologyUniversity of Texas Medical Branch(b)(6)NIH-000787From:Sent:To:Fauci, Anthony (NIH/NIAID) [E)Mon, 9 Mar 2020 01:32:20 +0000Erik BlutingerSubject : RE: Fighting the fightThanks, Erik.From: Erik Blutinger (b)(6)Sent: Sunday, March 8, 2020 7:02 PM To: Fauci, Anthony {NIH/ NIAID) [E] -----------~-~-- (b)(6)> Subje ct: Fighting the fightTony,It's been so inspiring seeing you fight tirelessly against COVID-19, sticking to the facts and stepping up toexplain on a daily basis.If there's anything I can do to help from the world of emergency medicine beyond patient care, pleaselet me know . Whether that means taking on a new project or pushing my specialty organization, theAmerican College of Emergency Physicians (ACEP). I sit on their board and keep look ing for ideas to helpfight this pandemic .Best wishes,ErikErik J. Blutinger, MD, MScDepartment of Emergency MedicineMount Sinai Queens Hospital(c (b) (6)NIH-000788From:Sent :To:Subject:Fauci, Anthony (NIH/NIAIO) [E)Mon , 9 Mar 2020 01:30:35 +0000Cassetti, Cristina (NIH/NIAID) [E]FW: COVID-19 modelFrom: William Schiesser (b)(Sent : Sunday, March 8, 2020 6:53 PM ------- .----..-.= To: Fauci, Anthony (NIH/NIAID) [E) (b)(6)_:.:...__...:...::....:.!~~-------Cc: William Schiesser (b)( >Subject : COVI0-19 modelHello Dr. Fauci,May I bring to your attention a prototype computer -basedmathematical model for C0V ID-19 dynamics . I will beglad to send some details if you think they would be ofinterest .Thank you for your consideration of this query.W. E. Schiesser, PhD, ScDhtt p:// ww w.lehigh.edu/~wes1/id cover2.pdfNIH-000789From:Sent :To:Subject :Fauci, Anthony (NIH/NIAID) [E)Mon, 9 Mar 2020 01:27:36 +0000(b)(6)RE: Californ ia DMV Coronavirus exposure dangerI recommend that you keep trying to work with Governor Newsom's office since this is veyspecific for the state of California.From: (b)(6)>Sent : Sunday, March 8, 2020 8:12 PMTo: Fauci, Anthony (NIH/NIAID) [E] ------ -(-b==)-(=6)Cc; Conrad, Patricia (NIH/NIAID) [E] (b)(6)Subject: Californ ia DMV Coronavirus exposure dangerDear Dr. Fauci,I am writing to alert you to what I believe is a serious coronavirus health threat in Californiathat is being posed by the California Department of Motor Vehicles .It has long been the policy of the California OMV that all drivers OVER 70 YEARS OLD mustrenew their drivers licenses IN PERSON at DMV offices.DMV offices are notorious for being extremely crowded and requiring long wait times where people arebreathing on each other touching each other and undisinfected surfaces and touch screens for hours.As far as I am aware DMV offices are never sanitized so germs from thousands of people can remaintherefor weeks on end.This is obviously a dangerous environment for anyone in the current worldwide coronavirus emergancyyet nobody in the news media is reporting on it or even seems aware of the danger.In light of your recent statement warning people over to 60 to avoid crowds this California OMV policyseems to be incredibly irresponsi ble and even life threatening but nobody is doing anything about it.(b)(6)"N".,e._.w._s_o_m_ _________ __ . Only one day earlier on March 4 California Governor Gavindeclared a State of Emergency in California to prevent the spread of coronav irus.I find this situation to be utterly absurd since Newsom is allowing California citizens to be exposed toexactly the kind of coronavirus danger he claims to be preventing and apparently does not even knowthat the DMV is totally contradicting his emergency declaration , the CDC recommendations, theCalifornia State Health Department, the Los Angeles County Health Department, and the Pasadena CityHealth Department.(b)(6)I am concerned that nobody seems to seethe obvious public health threat. None of the relevant public health agencies have any information aboutthisNIH-000790on their websites and the Californ ia DMV website makes NO MENTION WHATSOEVER of Coronavirusas a health threat in there overcrowded offices.I would sincerely like to know what you make of this dangerous DMV policy. I also want to tell you thatthe Californai OMV is currently advertis ing on the radio asking even more people to crowd OMV offices inorder toget the REAL ID license.REAL ID further exacerbates the danger by drawing in more than NINE MILLION Californians toleave their germs in OMV offices over 1he next few months at the exact time we are in the midst of thegreatest health emergency of this century and 1he most important recommendation is to AVOIDCROWDS and stay at least six feet away from other people. Try staying six feet away from anyone in acrowded OMV office where hundreds of people are stuffed in like sardines.Obviously a rational policy would be to suspend the requirement for drivers over 70 to renew in personand simplylet them renew by mail until the coronavirus emergency is over.The same should be done for REAL ID. A total suspension to protect public health in a crisis is the onlysane thing to do.If I were the Director of the California OMV I would close all offices immediately and disinfect every inchof them, and not reopen until the coronavirus emergency is over.I would require that all OMV business should be done by mail or internet until the coronavirus threat isover.Please tell me what you think about all this and I will forward your response to local Pasadena officialssince state level officials are almost impossible to contact even in an emergency when they most needto get this kind of information from the public but apparently do not want to know about bad news.I greatly appreciate your voice of reason in these scary times. I wish the officials of the State ofCaliforniawere as reasonable but they are apparently oblivious to a serious and unnecessary danger beingcreated byone of their own state agencies.SincerelyRobert Maine(b)(6)NIH-000791From:Sent:To:Fauci, Anthony (NIH/NIAIO) [E)Mon, 9 Mar 2020 01:24:37 +0000Cassetti, Cristina (NIH/NIAID) [E]Subject : FW: URGENT: ----------------------- (b)( 4) (b)(4)Att achments: (b) (4)Please handle.From: Michael Matin <michael.matin@hdltherapeutics.com>Sent: Sunday, March 8, 2020 8:01 PMTo: Fauci, Anthony {NIH/NIAID) [E]_ _____ ('"b'~..(-=6. )>Subject : URGENT: --------------------------- (b) (4} 1 mp or tan c e: HighDear Dr. Fauci:Please contact us at your earl iest convenience so that we may provide you with further data andinformation concerning this treatment.Best,Michael M. Mat inChairman & CEOHDL Therapeutics, Inc.60HDL Theapeu t icsl 21st Street , Suite 300Vero Beach, FL 32960(b)(6)From: (b) (4) -------------------- Dat e: Friday, March 6, 2020 at 6:18 PMTo: (b)(4)===============~------c ("b")-(-4=)-Dear (b) (4):: ----------NIH-000792(b)(4(b)(4l(b) (4)NIH-000793(b)(4lNIH-000794(b)(4lNIH-000795(b)(4lNIH-000796(b) (4)NIH-000797From:Sent :To:Fauci, Anthony (NIH/NIAI0) [E)Mon, 9 Mar 2020 01:23:24 +0000Krasne, RobertSubject: RE: Thank you!!!Bob:Many thanks for your note.Best,TonyFrom: Krasne, Robert <rkrasne@steinmancommunications.com>Sent : Sunday, March 8, 2020 7:59 PM ------ ..-.-,= To: Fauci, Anthony (NIH/NIAID) [E] (b)(6J>Subject: Thank you!!!Tony,Thank you for the science-based sani ty you are bringing to the COVID - 19 challenges. I followyour public comments with great interest (and publish them in our newspapers here inPennsy lvania) and find solace that you are leading the efforts to address this extraordinary healthcare challenge.I cannot imagine the challenges you are facing, from disinformation to pure exhaustion, not tomention the sc ientific challenges that this virus brings. However , if anyone is capab le ofwrestling these challenges to the ground, it is you.You have my profound appreciation and admiration.Best wishes to you, ---Cb)-( 6) and your family.BobRobert M Krasne I Chief Executive OfficerSTE INMAN COM MUNI CATIONS.,,..,.,.,._..,.C.,.b~,_..(6-!).. I SteinmanCommunications.com8 West King St, Lancaster, PA 17603NIH-000798From:Sent :To:Subject:Please handle.From: Barb EFauci, Anthony (NIH/NIAIO) [E)Mon , 9 Mar 2020 01:19:21 +0000Cassetti, Cristina (NIH/NIAID) [E]FW: Coronav irus Treatment Question(b)( 6) ------------ Se nt: Sunday, March 8, 2020 7:26 PMTo: Fauci, Anthony (NIH/NIAID) [E] -------= (b-)c(-c6-)=Subject: Coronavirus Treatment Question3-8-2020Dr. Ant hony S. Fauci;I have attached an article I read online about a doctor in Taiwan treating patients with Coronavirus, witha combina t ion of ant i-viral drugs. Since the treatment helped the patients, I was won dering why theyare not t reating patients in the United States with those drugs.Thank you.Sincerely,Barbara Eaganhttps ://www.yah oo.com/news /cockta il-flu-hiv-drugs-appears - 124753996.htmlBy Parm Wongcba- umReuters•Februa ry 2, 2020Cocktail of flu, HIV drugs appears tohelp fight coronavirus: ThaidoctorsRe•uFteberrusar2,y 2 020NIH-000799NIH-000800By Panu W ongcha-umBANGKOK (Reuters) - Thai doctors have seen success in treatingsevere cases of the new corona virus with combinat ion of medications forflu and HIV, with initial results showing vast improvement 48 hoursafter applying the treattnent, they said on Sunday.The doctors from Rajavithi Hospital in Bangkok said a new approach incoronavirus treatment had improved the condition of several patientsunder their care, including one 70-year -old Chinese woman from Wuhanwho tested positive for the coronavirus for 10 days.The drug treatment includes a mixture of anti-HIV drugs lopinavir andritonavir, in combination with flu drug oseltami vir in large doses."This is not the cure, but the patient's condition has vastly improved.From testing positive for 10 days under our care, after applying thiscombination of medicine the test result became negative within 48hours," Dr. Krian gska Atipornwanich , a lung specialist at Rajavithi,told reporters."The outlook is good but we still have to do more study to determinethat this can be a standard treatment."Chinese health officials have already been administering the HIV and fludrugs to fight the corona virus. The use of the three together in a cocktailseemed to improve the treatment, the Thai doctors said.Another doctor said that a similar approach in two other patients resultedin one displaying some allergic reaction but the other showedimprovement."We have been following internat ional practices , but the doctorincreased the dosage of one of the drugs ," said Somsak Akkslim ,director-genera l of the Medical Services Department, referring to the flumedicine Oseltamivir .Thailand has recorded 19 cases of corona virus. Of the Thai patients ,eight have recovered and gone home while 11 are still under treatment inhospitals .NIH-000801Somsak said the health ministry will meet on Monday to discuss thesuccessful treatment in the case of the 70-year-old but said it is still toosoon to say that this approach can be applied to all cases.Initially we will apply this approach only to severe cases," he said.(Reporting by Panu W ongcha-um; Editing by Peter Graff)NIH-000802Sent from Mai l for Windows 10• Virus-free . www.avast.comFrom:Sent :Fauci, Anthony (NIH/NIAIO) [E)Mon, 9 Mar 2020 00:45:58 +0000To:(NIH/NIAID) [E]Collins, Francis (NIH/OD) [E];Erbelding , Emily (NIH/NIAID) [E];Cassetti, Crist inaCc: Austin, Christophe r (NIH/NCATS) [E];Tabak, Lawrence (NIH/OD) (E];Conrad,Patricia (NIH/NIAID) [E] (bH 1·Marston , Hilary (NIH/NIAID) [E]Subject: RE: ACE2Emily/Cristina:Please contact Chris Austin and see if there is anything that we can do to he lp/coordinatewith them.Thanks,TonyFrom: Collins, Francis (NIH/OD) [E] -------- (b)(6)Se nt: Sunday, March 8, 2020 2:13 PMTo: Fauci, Anthony (NIH/NIAID) [E] <-l------=-c-c=Cc: Austin , Christopher (NIH/NCATS) [E] -------- >; Tabak, Lawrence (NIH/OD) [E]Subject: FW: ACE2Hi Tony,team help?Best, Francis(b)(6)From: Austin, Christopher (NIH/NCATS) [E]Sent : Sunday, March 8, 2020 1:51 PM-------- (b) ~ >To: Collins, Francis (NIH/OD) [E) ----- -(=b")'(""=6J>Subject : RE: ACE2Hi Francis,Very interesting paper . Larry likely let you know about the enclosed exchange, but enclosed if not.(b)(5NIH-000803ChrisFrom: Collins, Francis (NIH/OD) [E] ______ CbH_6>>Sent : Saturday, March 7, 2020 11:07 PM To: Austin , Christopher (NIH/NCATS) [E]- _-_-_-_-_- ~~ CHb6)Subject: RE: ACE2Structure of the coronav irus spike protein and ACE2 interaction is j ust out...From: Collins, Francis (NIH/OD) [E]Sen t: Saturday, March 7, 2020 10:58 PMTo: Austin, Christopher (NIH/NCATS) [E]--------=- (b,.)(,=6)Subject: ACE2Yo Chris,-FrancisNIH-000804From :Sent :To:Fauci, Anthony (NIH/NIAIO) [E)Mon , 9 Mar 2020 00:37:42 +0000Greg SimonCc:Subject:Erbelding, Emily (NIH/NIAID) [E];Cassetti, Cristina (NIH/NIA ID) [E]RE: TXA127 for COVID-19 pneumonia --CONFIDENTIALGreg:Thanks for this. I will bring it to our group. I hope that all is well with you.Warm regards,TonyFrom : Greg Simon (b) ( >Se nt: Friday, March 6, 2020 7:22 PM ------~= To: Fauci, Anthony (NIH/NIAID) [E] (b)( >Subject: Fwd: TXA127 for COVID-19 pneumonia --CONFIDENTIALhere is the paper i ment ioned from a friend of mine for your consideration. Thank you for all you'redoingGreg---------- Forwar ded message ---------From: Rick Franklin (b)(6)>Date: Mon, Mar 2, 2020 at 5:46 PMSubject: TXA127 for COVID-19 pneumonia- -CONFIDENTIALTo: Greg Simon (b)(6)>Here's the paper. Let me know what you think .Best, RickGreg Simon(b)(6)NIH-000805From: Fauci, Anthony (NIH/NIAIO) [E)Sent : Sun, 8 Mar 2020 23:55:07 +0000To: Redd, Stephen (CDC/DDPHSIS/OD);Birx, Deborah L ( (b)(6)J);Grigsby,Garrett (HHS/0S/OGA);Kadlec, Robert (OS/ASPR/IO);Redfield, Robert R. (CDC/OD)Cc: Marston, Hilary (N IH/NIAID) [E] (b) (6) ;Eisinger, Robert{NIH/NIAID) [E]; Lerner, Andrea {NIH/NIAID ) [E] ----------------------~ = Subject : FW: (b)(5) -Attachments:Team:Thanks,TonyPaper attac hed.SSRN-id3549276.pdf(b) (5)Dalton, Craig and Corbett, Stephen and Katelaris, Anthea, Pre-Emptive Low Cost SocialDistancing and Enhanced Hygiene Implemented before Local COVID-19 Tran smission CouldDecrease the Number and Severity of Cases. (March 5, 2020). Avai lable at SSRN:https ://ssrn .com/abst ract=3549276 or http ://dx.do i.org/10 .2139/ssrn .3549276NIH-000806From:Sent :To:Subject :FYIFrom: IPJ::J~lli-1-Fauci, Anthony (NIH/NIAID) [ElSun, 8 Mar 2020 22:56 :20 +0000Cassetti, Cristina (NIH/NIAID) [ElFW: For Novel Coronavirus of Ant iviral Treatmen t.(b) (6)> ________ __,Sent: Sunday, March 8, 2020 9:58 AM -------=-:--:= To : Fauci, Anthony (NIH/NIAID) [E] (b)(6) ________ _,Subject: For Novel Coronavirus of Antiviral Treatment.Dear Director of NIAID, Anthony S. Fauci MD . :Potential inhibitors aga inst papain-like protease of novel coronav irus (SARS-CoV-2) from FDA approved drugsVersion 2Preprintrevised on 20.02.2020, 00:05 and posted on 20.02.2020, 16:51 by Rimanshee Arya Amit Das Vishal PrasharMukesh KumarThe cases of 2019 novel coronavirus (SARS-CoV-2) infection have been continuously increasing ever since itsoutbreak in China last December. Currently, there are no approved drugs to treat the infection . In this scenar io,there is a need to utilize the existing repertoire of FDA approved drugs to treat the disease. The rationalselection of these drugs could be made by testing their ability to inhibit any SARS-CoV-2 proteins essential forviral life-cycle .We chose one such crucia l viral protein, the papain-like protease (Plpro), to screen the FDA approved drugs insilico. The homology model of the protease was built based on the SARS-coronavirus Plpro structure, and thedrugs were docked in S3/S4 pockets of the active site of the enzyme. In our docking studies, sixteen FDAapproved drugs, including chloroqu ine ard formoterol, was found to bind the target enzyme with significantaffinity and good geometry, suggesting their potential to be utilized against the virus.FUNDINGDepartment of Atomic Energy, Government of IndiaDear Dr . Fauci :NIH-000807We are an individual researcher from Taiwan Biochemical Papain, my name is Terry Wang. Withoutfunding support , (b)(4(b) (4)I am willing to participate in the process in the United States.@@@There are many ways to perform the trea tment !Sincerely,Terry Wang in Taiwan .Please contact me :Email: (b) (6)Address: (b)(6)Cell phones: (b)(6)Line ID (b)(6)NIH-000808From:Sent :To:Subject:Gregg:Fauci, Anthony (NIH/NIAIO) [E)Sun, 8 Mar 2020 18:55:46 +0000Gregg GonsalvesRE: We Are Desperate for AdviceUnderstood . I appreciate your note . I will keep pushing .Best regards,TonyFrom: Gregg Gonsalves- ----------(b)(6) Sent: Sunday, March 8, 2020 2:54 P-M-- --- --.~ To: Fauci, Anthony (NIH/NIAID) [E]- ------- (b)(6J> Subject: Re: We Are Desperate for AdviceTony, that part of the message was not directed at you. Peter Staley and I have seen you in action on TVand I've forced (b)( to watch you talking about social distancing, since shesays the President says she has nothing to worry about. Bob Redfield and Secretary Azar haven't been asforth right as you have.The main thing that concerns many people I know : the roll-out of testing, surveillance has been botchedand we're likely to have cases of COVID in our communities already without knowing it. Meanwhilesome corporations, some universities, some other institutions have started to put social distancing intoplace, with a few municipa lities doing the same, but there is no real guidance from CDC on when to actfor most of us. There are plenty of instructions about getting prepared, but all seem to point towardswaiting until there is an outbreak in one's community to do anything substantial, which seems if you'llexcuse my language, ass-backwards, as one you see multiple cases, you're likely to already havewidespread community transmission .I think this piece by Bill Hanage at Harvard explains where a lot of us are right now:https ://www.washingtonpost .com/outlook/co ronavirus-test ing-united -states/2020/03/0S/a6ced5aa Sf0f-llea-9055 -5fal2981bbbf story. htm lStay well, we need you more than ever (and I mean that from the bottom of my heart). Most of thecareer civil servants on the email were copied not to chastise, it's the political appointees that mostthink got us into this mess.gFrom: Anthony Fauci (b)(6)(b)( >Date: Sunday, March 8, 2020 at 1:50 PMTo: Gregg Gonsalves ------------ Subject : RE: We Are Desperate for AdviceGregg:I am surprised that you included me in your note. I genuflect to no one but science andalways, always speak my mind when it comes to pub lic hea lth. I have cons istent ly correctedmissta t ements by others and will con t inue to do so. I am including two links from SundayNIH-0008 12Shows today where I am extremely explicit and forceful. I would be happy to chat with youabout this.https ://ap p.crit icalment ion.com/app/#/c lip/publ ic/2beb07d0-f72d -45b9-9ed6-60754bd93fa7?show sentiment=falseht tps://app .cri ti calmention .com/app/#/c lip/publ ic/183207e9 -e6e1 -4164 -ble5 -53e0dddbc363?show sentiment=fa lseBest regards,TonyFrom: Gregg Gonsalves- ----------(b)(6)> Sent: Sunday, March 8, 2020 11:17 AM ------~~ To : Fauci, Anthony (NIH/NIAID) [El (b)(6)>; JeffTrammell ---- == ":'--:---~--=-::=====(b)(=6) ->;~ R~ed-fie-ld, Robert R. (CDC/OD) (b)(6J> ; Collins, Francis (NIH/OD) [El- ======(~b)(~6J>-; Lane, Cliff (NIH/NIAID) [E} (b)(6J>; Schuchat, Anne MD (CDC/OD) (b)(6b; Messonnier, Nancy (CDC/DDID/NCIRD/OD) (b)(6) Birx,_De_b_ora h_ L_ _,!====(b)=(6)~>; ~Az ar, Alex (OS/IOS) (b)(6); Redfield, Robert-----------(b)(6)>; Harrison, Brian (HHS/IOS) CbH6J> Subject : We Are Desperate for AdviceDear Tony, Bob and Deb et al,The AIDS experts among you know me well. We've been first adversaries then colleagues for over 30years.They also know I can't keep my mouth shut, which is a virtue and a failing, depending on the context.Now :There are thousands of people waiting for advice from our federal government on broader socialdistancing measures in light of the fact that our failure in early testing and surveillance means thecoronavirus is likely already spreading in our communities .If you thought the ire of AIDS activists 30 years ago was tough, the anger now spreading amongresearchers, scientists, clinicians and activists is going to be a conflagration.All we see is genuflection in word and deed fr om most of you to a White House that wants this all tomagically go away.Yes, I know you're all doing your best and behind the scenes our federal government is hard at work . Forthose I know, I don't doubt your commitment to publ ic service.But time is running out.We need vocally, unequivocal leadership now, that offers real guidance to communities about what todo, what might happen next.Your own legacies will be defined by this moment, what you do and what you don't, what you shy awayfrom saying because you fear for your jobs or your short-term fortunes in the eyes of the President.The status quo is untenable.It's going to get people killed by this virus.GreggNIH-0008 13Gregg Gonsalves PhDAssistant Professor, Epidemiology of Microbial DiseasesYale School of Public HealthAssociate Professor (Adjunct) and Research ScholarYale Law SchoolCo-Director, Yale Global Health Justice PartnershipCo-Chair, Global Health Studies Faculty Committee, Yale CollegeAffiliated Faculty, Add iction MedicineAffiliated Faculty, Jackson Institute for Global Affa irs(b)(6)NIH-0008 14From: Fauci, Anthony (NIH/NIAID) [ElSent: Sun, 8 Mar 2020 17:06 :22 +0000To: Conley, Sean P. CDR USN WHMO/WHMUCc: Munster , Vincent (NIH/NIAID) [E];Marston, Hilary (NIH/NIAID) -----~~ [El (b)(6);Lerner, Andrea (NIH/N IAID) [El;Eisinger, Robert (NIH/NIAID) [El;Birx, Deborah L(b) (6))Subject:Attachments :Sean:FW: Stability data - spoke to Vincent.2020 -03-03 Manuscript Stability_MASTER .docxAs per our recent conversation , here is a paper that is under review at the NEJM . It is fromDr. Vincent Munster who works in my institut e. It confirms what we surmised that after almosttwo weeks, the chances of viable virus being present in the facility is extremely low based onhis stud ies reported in this paper. Figure 18 in the paper is of particular relevance regardingour discussion of surfaces.Best regards,TonyFrom: Marston, Hilary (NIH/NIAID) [ElSent: Saturday, March 7, 2020 3:40 PM(b)(6)To: Fauci, Anthony (NIH/NIAID) [El -------------::--:-:-:(-b)=(6)> ; Lane, Cliff (NIH/N IAID) [El (b )( 6) >Cc: Lerner, Andrea (NIH/NIAID) [El ---------(b)(6)Subject: Stability data - spoke to Vincent.Talked to Vincent. Attaching his manuscript, unde r review with NEJM. Vincent is available at- if you need him.How the experiments were done:(b)(6)Aerosol -A solution of live virus was made and aerosolized in a rotating drum (kee ping it in aerosolform) ; at various time point s, air was removed and amount of virus measured (using end-poin t titrationon Vero cells).Surface - A base solutions of live virus was made and placed on specific surfaces (plastic, etc) and atvarious time points, coating was taken away and virus contained was titrated.Note t hat surface experiments with proteinaceous material (e.g., respiratory secretions) are underway,as are variations in relative humidity and temperature.How do you interpret aerosol data?Decay in aerosols occurs over three hours, so if the virus is aeros ol ized (via aerosol-generat ingprocedures or cough), the moment it drops below a certain threshold, it would be hard to get aninfect ious dose/infection. Of course we do not actually know the infectious dose, which limits our abil ityto give firm guidance based on this data.NIH-000815NIH-000816How do you interpret the surface stability data?Copper seems to have some virucidal effect, as is seen with other viruses. Plastic and stainless steeldon't have much of an effect on the virus itself, and the virus persists for some time. As for cardboard,difficult to interpret because the surface absorbs a good deal, but there is some immediate decay.Should we be concerned about packages based on your data?This is of far lower concern than droplet and other fomite transm ission. Typical shipping wil l allow ampletime for viral decay, and the cardboard itself seems to have some direct effect on the virus (eitherthrough absorption or other effect) . For example, in the experiment, Vincent appliedlOeS viral particles/ml and it drops 2 logs to 10e3 immediate ly, ind icating that either due to absorptionor direct effect on the virus .Of course, if a mail carrier coughs on a package and then someone touches it directly after, there maybe a risk. The typical shipping situation is likely not a concern.Why are SARS-CoV-2 vs. SARS-CoV-1 different?For the cardboard data in particular, there is a difference seen between SARS-CoV-2 and 1, which islikely due to error/variation in surface.From:Sent:To:Subject :Fauci, Anthony (NIH/NIAID) [ElSun, 8 Mar 2020 14:30 :13 +0000Cassetti, Cristina (NIH/NIAID) [ElFW: A Coronavirus Deterrent?From: Ron Jacobs (b)(6)>Sent: Sunday, March 8, 2020 10:13 AM To: Fauci, Anthony {NIH/NIAID) [E]-- ---------~-~-- (b)(6) Subje ct: A Coronavirus Deterrent?Would the use of a facial steam inhalator cause nonviability of the virus in someone who had contractedthe virus?Would spending time in a steam room have a similar effect?NIH-000817From: Fauci, Anthony (NIH/NIAID) [E)Sent : Sun, 8 Mar 2020 14:29:44 +0000To: CbH6l;'Birx,D eborah L';Redfield, Robert R. (CDC/OD);Kadlec,Robert (OS/ASPR/IO);Redd, Stephen (CDC/DDPHSIS/OD)Subject: FW: Hazardous use of Remdesivir in CoV-19Attachments: COVIO19 linee guida trattamento 0lMAR.pdf .pdf.pdfThere may be nothing to this, but we shou ld at least be aware.From: rosario leopardi -------- (b) ~ >Sent: Sunday, March 8, 2020 9:04 AM -----~~ To: Fauci, Anthony (NIH/NIAID) [E] ------- (b)(6)> Subject: Hazardous use of Remdesivir in CoV-19Dear Dr Fauci,I am copying below a let ter I just sent to the ed itors of Lancet and NEJM t hat I th ink you shouldalso read. It's informal as it is not meant for publication but ju st as a concern. Since I no longe rwork as a virologist, I am forma lly out of the fie ld. I am however active as chief psychiatrist inStockholm, Sweden. If you have doubts as to my expertise as a virologist or a physician, DrBernard Roizman at U of C knows me very well, as Markus Heilig does here in Sweden ."I have noticed a striking difference in mortality by Co V-19 in different countries.China and Italy have a morta lity that 's at least 6-fold higher than that in South Korea.So far Germany and Scandinavia , totalling over 1300 cases, have not rep orted a singledeath. That's over a 35-40 fold difference.Loo king at the data more closely, I have found that China and Italy have been usingthe antivira l Remdesivir (Gilead Sciences) extensive ly on many patients in intensivecare , ju stified as "compassionate use" . In the epidemic areas of Italy this drug is nowpart of treatment guidelines for hospitalised patients , used on every single patient in"criti cal conditi on". (see attachment). The "rationale" is simp ly that the first two casestreated at the SpaHan.zan.i Hospital in Rome rec eived this dn1g, and ... we ll, actuallysurv ived.NIH-000818Remd esivir has never passed a Phase 3 trial, but has already made big head lines inmajor international newspaper s. Neither South Korea nor Germany or Scandinaviancountries have yet used this drug.I unde rstand that this is a (relatively) long shot, but given the number oflive s at stake,I would recommend that a carefully scrutiny by the scientific community on the use ofthis drug is warranted.I have no conflict of interest.Thank you for your attention".Sincerely ,Rosario Leopardi , MD, PhDForensic Psychiatry Care ClinicCb)C6) Sweden ____ ,cell : (b)(6)Sent from OutlookNIH-000819From: (b)(6)Sent: Sun, 8 Mar 2020 09:59 :21 -0400To: Conrad, Patricia (N IH/ NIAID) [E);Folkor s, Greg (NIH/NIAID) [E);Mar ston , Hilary(NIH/NIAID) [E];Lerner, And rea (NIH/ NIAID) [E]; t isinger, Robert(N JH/NIAID) [E];Barasch, Kimberly(NIH/N IAID) [CJSubject: Fwd: BIO Coronavirus Collaboration Initiative March 12th Summit - POSTPONEDBegin forwarded message:From: Phylli s Arthur <parthur@bio.or g>Date: March 8, 2020 at 9:51 :46 AM EDTTo: Phyllis Arthur <parthur@bio .org>Cc: Jenni fer Alton <jenn .alton@pathwaypolicy .com>, Ellen Carlin---------- (bH6>), Amy Walker <awalker@bio.org>, Grego1yF rank < g frank@ bi o. or g >, Hannah Dorsey <hdorsey@bio.org>Subject: BIO Coro navirus Collaboration Initiative March 12th Summit -POSTPONEDDear Colleagues,BIO is heartened that so many of you have expressed interest injoin ing us for the BIO Coronavirus Collaboration Init iative Summitplanned for March 12, 2020. Given the evo lving circumstancessurrounding the COVID-19 outbreak, and afte r discussions withour Board leadership, we have decided to postpone the BIOSummit so that we can make adequate arrangements to hold themeeting virtual ly. We made this decis ion out of an abundance ofcaution , so as to avoid placing anyone at unnecessary risk ofexposure whi le we work together to improve our nation's ability torespond to this outbreak. We will re -schedu le this virtua l meetingwithin the next two weeks using a digital techno logy that can allowfor robust discussion among the participants.In the inter im, we plan to send out a short questionnaire onMonday to all company participants requesting information on yourproduct, technology or serv ice, which we plan to compile in adigital "book" and share with all participants in advance of themeeting . We believe this approach wi ll help to make the meet ingmore efficient, allowing us to quickly shift to discussions of theNIH-000820most impo rtan t shared challenges and potential opportunities thatexist between industry members, government leaders and nongovernmentpartners.Please feel free to reach out to me with any questions. We willmove qu ickly to establ ish a new date for this meeting andappreciate your flexibility in this regard. We look forward to talk ingwith many of you then .Thanks again for your commitmen t to enhancing the health andsafety of people facing this outbreak around the globe.Sincerely,Phyllis A ArthurVice President, Infectious Diseases and Diagnostics PolicyBiotechnology Innovat ion Organization (BIO)1201 Maryland Ave SW, Suite 900Washington, D.C. 20024T: 202 -962 -6664C (b) (6)parthur@bio.orgJoin us at the 2020 BIO International ConventionJune 8-11, 2020 in San Diego, CAwww.convention.bio .orgPhyllis A ArthurVice President, Infectious Diseases and Diagnostics PolicyBiotechnology Innovat ion Organization (BIO)1201 Maryland Ave SW, Suite 900Washington, D.C. 20024T: 202 -962 -6664C: (b)(6)parthur@bio.orgJoin us at the 2020 BIO International ConventionJune 8-11, 2020 in San Diego, CAwww.convention.bio.orgNIH-000821From: (b)(6)Sent:To:Subject:Sun, 8 Mar 2020 09:50:00 -0400Cassetti, Cristina (NIH/NIAID) [E]Fwd: COVID19. ACEls and ARBsPlease handleBegin forwarded message:From: Martin Engman (b)(6)Date: March 8, 2020 at 9:30:51 AM EDT- -----~~ To: "Fauci, Anthony (NIH/NIAID ) [E]" --------- (b)(6J: Subject: COVID19, ACEis and ARBsIs there any evidence to suggest that patients already on treatment with angiotensinreceptor blockers have a better or worse COVID-19 outcome than patients not onthese medications? Similar question for initiating ARB treatment once COVID-19has been diagnosed. And similar questions for ACE inhibitor s. Thank you.NIH-000822From:Sent:To:Cc:(b)(6)Sun, 8 Mar 2020 09:23:28 -0400Kristian G. AndersenJeremy Farrar;Collins, Francis (NIH/OD) [E];Robert Garry;EdwardHolmes;Andrew Rambaut;lan Lipkin;Chris EmerySubject: Re: SARS-CoV-2 article to be published in Nature MedicineKris tian:Than.ks for your note. Nice job on the paper.TonyOn Mar 6, 2020, at 4:23 PM, Kristian G. Andersen ---------(b)(6) wrote:Dear Jeremy, Tony , and Francis ,Thank you again for your advice and leadership as we have been working throughthe SARS-CoV-2 'origins' paper. We' re happy to say that the paper was just acceptedby Nature Medicine and should be published shortly (not qui te sure when).To keep you in the loop, I just wanted to share the accepted version with you, aswell as a draft press release. We're sti ll waiting for proofs, so please let me know ifyou have any comments , suggestions, or questions about the paper or the pressrelease.Tony, thank you for your straight talk on CNN last nigh t - it's being noticed.Best,KristianKristian G. Andersen, PhDAssociate Professor, Scripps ResearchDirector oflnfectious Disease Genomics , Scr ipps Resea rch Translational InstituteDir ector , Center for Viral Systems BiologyThe Scripps Research Institute10550 North Torrey Pines Road, SGM-300ADepa1tment of Immunology and Microbial ScienceLa Jolla, CA 92037(b)(6)NIH-000823<Andersen Coronavirus Nature 2020 Press Release Draft 4.docx><Manuscript.pdf>NIH-000824From:Sent :To:(b)(6)Sun, 8 Mar 2020 09:04 :10 -0400Lane, Cliff (NIH/ NIAID) [E]Subject: Re: COVID-19 Real Time, Sensitive Detection BreakthroughPlease take care of this yourself ThanksOn Mar 7, 2020, at 11 :30 PM, Lane, Cliff (NIH/NIAID) [E]-------- (b) (6) wrote:They claim to have an improved diagnostic developed through DoD funding. It is aDNA platform that they claim to have adapted to COVID-19. They prov ide no data,o_)Jyl _c_Jaims_ ________________________ ~(b) (5)On Mar 7, 2020 , at 10:03 PM, Fauci, Anthony (NIH/NIAID) [E](b) (6) wrote:Please read this and figure out what the heck he is talking about andact according to your jud gment. Only 498 emails to go tonig ht.From: (b)(6)Sent: Saturday, March 7, 2020 4:09 PM -----~~ To: Fauci, Anthony (NIH/NIAID) (E] (b)(6)Subject: COVID-19 Real Time, Sensitive Detection BreakthroughTony--It has been awhile since we have worked together since my timeas the senior SES standing up DTRA (with the help of JoshLederberg M.D. &Dave Franz DVM who you know), atArgonne/UofChicago establishing your NIAID RBL with OlafSchneewind M.D., and as the OHS Director of Researchreporting to SEC Michael Chertoff &U/S Jay Cohen (RADMret).Michael &Jay brought me aboard when Jay was our Chief ofNaval Research at ONR and I was ONR's Executive Director&Chief Scientist. I know you have your hands very full with theNIH-000825COVID-19 threat, so I wanted to give you a heads up that agame changer for enhanced detection of COVID-19 hasemerged. Thanks to DARPA &OHS S& T sponsorship in yearspast of ANOE developing a real time Rapid DNA microfluidicssystem for human identification, the ANOE group has abreakthrough for detection of COVID-19 and to the future , otheremerging threat viruses.As you may know the ANOE system for human identification (e.g.CT &OHS missions) is mature and now deployedoperationally/tactically by CENTCOM , DIA, the IC and used mostrecently by OHS in their recent test bed in EI Paso todemonstrate its effective capabilities to determine familyrelationship in undocumented minors. Additionally ANOE is inuse by law enforcement and by officials responding to masscasual ty events (CA 2018 Camp Fire disaster , 2019 Conceptiondive boat fire, and the very recent 2020 tragic helicopter crash) toID the victims .The ANOE system now provides 2 hour turnaround with nospecial training requirements as a stand-alone system for all theabove users . Our warfighters and special operators are usingthe ANOE system now in field forward operations and it meetsMIL specs &is the only system certified for data submission to theOoO AB IS/DIA DNA reposi tory and FBI CODIS data base. The(b) (4)executive summary and a more in-depth document for yourteams review . Hope the above is helpful and I stand ready toprovide any additional information . I have cc'd Jim Davis (ANOEChief Federal Officer) . Additionally since it has been some timesince we have worked together I have attached my bio and thatof ANDE's Chief Scientific Officer &Founder , Richard SeldenM.D., Ph.D .Tony thanks for considering this in your very busy life now and Iwill look forward to seeing you again.Best regards--StarnesDr. Starnes E. WalkerNIH-000826Member-Homeland Security Experts Group, MITREGlobal Strategy Officer -Defense &Homeland Security/IntelligenceANDE Corporationp: (b)(6) m:e: (b)(6) ------- >!: II.iiANOE ' ~Rap id DNA for a Safer World<CUsersstarnDesktopSEW Bio, October 2019.docx><CUsersstarnDesktopANDE BiosRFS CV 05 March 2020.pdf>NIH-000827(b)(4lFrom:Sent:To:(b)(6)Sun, 8 Mar 2020 07:41 :41-0400NIAID Public InquiriesSubject: Fwd: Ems Personnel & Ambulance TeamsSent from my iPhoneBegin forwarded message:From: "Nabial, Nasir M" (b)(6)Date: March 7, 2020 at 10:54:39 PM EST To: "Fauci, Anthony (NIH/NlAID) (E]" ---------------= (b=H Subject: Ems Personnel &Ambulance TeamsDear Dr. Fauci:Im a first responde r, and I believe an oral vaccine platform is the bestdelivery method for situations of national emergency like thecoronav1rus.lf the vaccine is a tablet, we would be able to keep them on ourambulances and get medical authorization whenever the situation arises.First responders can then treat patients before doctors and nurses andalso instead of having the patient make an appointment Or having themwait in line for a shot, which can ultimately cause more spread .This me thod that will enable the EMS teams of the nation to combatoutbreaks because you would allow EMT (Emergency MedicalTechnicians) and Paramedics to diffuse situations through ourAmbulances. This will lead to more control and get a hold of thesituations as fast as possible and lower the spread of the virus on ourpeople.Thank you.NIH-000832From: (b)(6)Sent : Sun, 8 Mar 2020 07:40:53 -0400To: Cassetti, Cristina (NIH/NIAID) [E]Subject: Fwd: from Dr Mike Meyer ( CEO - Sensible Biotherapeut ics) Finding the answerto halting replication of COVID-19Pis respondSent from my iPhoneBegin forwarded message :From: Michael Meyer CbC)Date: March 8, 2020 at 12:28:03 AM ES-T- ----~~ To: "Fauci , Anthony (NIH/NIA ID) [E]" CbH > , philip meyerCbH >, "Perkins, Miriam (NIH/NIAlD) [E]"(b)(6)Subject: from Dr Mike Meyer ( CEO - Sensible Biotherapeutics) Finding theanswer to halting replication of COVID-19DR ANTHONY FAUCI(b)(6)Dear Dr. Fauci ,I am a Neuro logist and Nuclear Medicine Physician who has a passionate interest indeveloping antisense medications to treat disease and have formed a drug discoverycompany here in Buffalo New York (SENS IBLE BIOTHERAPEUTICS , LLC).(b)(4)NIH-000833I very much appreciate any advise you may be able to provide about this projectSincerely,Michael A. Meyer MDcell Cb) (6)NIH-000834(b) (4)From:Sent:To:(b)(6)Sun, 8 Mar 2020 07:39 :47 -0400NIAID Public InquiriesSubject: Fwd: Set up county hotline for people to contact if they think they havecoronavirus or are sick instead of going to hospita lSent from my iPhoneBegin forwa rded message:From: rebecca hagenberg (b)(6)Date: March 8, 2020 at 3:06:34 AM EDT -------~~ To: "Fauci , Anthony (NIH/NlAID) [E]" (b)(6)Subject: Set up county hotline for people to contact if they think they havecoronavirus or are sick instead of going to hospitalDear Sir,I am sending this message to assist in an idea to help minimi ze the impac t ofCoronavirus. Instead of people going to the hospital or urgent care. Each countyhealth department needs to have a direct number of a national number thatdistributes information to local county governmen t health department. If you aresick and show or exhib it signs of the coronavirus you shou ld call the appropriatenumber , a technician will come to your home, draw lab specimen needed. Of courseif someo ne is extremely ill they shou ld call 9 11 and advise 911 they are exhib itingsigns of the virus. The re sho uld be special protocols in place for how to transport thepatient into the hosp ital as well ( to limit exposure to everyone involved. This meansfinding alternat ive entrance at hospi tals for a suspected coronavirus patient. Thesepatients shou ld be brought in by a least used locat ion of the hospital into a spec ialunit that has a barrier from the rest of the emergency department.Home lab work will keep someone from sitting in a waiting room for 3_ 5 hours.The county unit to conduct lab work will act in response much like calling 911 orthe po lice. Each hospital needc; to set up an emergency entrance for Coronaviruspatient s only, and the unit must be sealed from the remainder of the unit. We beginhaving a coronavirus team that does not cross contaminate to any other unit on theemergency room floor. I am thinking of the best plausible way to minin1izeoutbreak. This helps .Rebecca Hagenbe rg(b)(6)NIH-000835From:Sent:To:Subject:Fauci, Anthony (NIH/NIAID) [E)Sun, 8 Mar 2020 03:34 :45 +0000Michael OldstoneRE: itemThanks, Michael. I appreciate your note.From: Michae l Oldstone <mbaobo@scripps.edu>Sent: Friday, March 6, 2020 2:12 PM -----~~ To: Fauci, Anthony {NIH/ NIAID) [E] (b)(6)Subject: itemDear TonyA note to let you know how much over the years I have appreciated youractive support of biologic research, public health and your directorship ofNIAID . Impressive, intelligent, high integrity and management skills hasplaced you at the head of the curve. I reached this conclusion frompersonal observat ions of your work and style as wel l as having served as aconsultant for NIAID and several other NIH Institutions, WHO, Pasteur andKarolinska .After nearly 50 years of continuous research from my original AI09484grant studying viral pathogenesis[ acute and persistent infections] using theLCMV model, I decided to close my laboratory. I have had other generousNIH support as well especially for investigations of other negative strandviruses[ primarily measles and influenza, Lassa ,arenavirus receptor] ,Ebola, cytokine storm and autoimmun ity. The AI09484 grant was creditedby 300 peer reviewed papers, training of 61 postdoctoral fellows[ includingRafi Ahmed , Christine Biron, Persephone Borrow, Ray Welsh, Ian Lipkin,Dorian McGavern and other successes including the late Patrick Sissonswho was the Reagent Professor of Medicine at Cambridge. Over 85% ofthese folk are in academic medicine/b iology at research institutes oruniversities.Good luck and smooth sailing with the current coronavirus pandemic. Withyour involvement this work is in good hands .Best wishesMichaelNIH-000836From:Sent :To:Fauci, Anthony (NIH/NIAIO) [E)Sun, 8 Mar 2020 03:26:22 +0000Liz CheneyCc: Conrad, Patricia (NIH/NIAID) [E);Barasch, Kimberly (NIH/NIAID) [C);Greg Folkers-------- (~b)~(6=)Subject: RE: Test KitsSorry, Liz. In White House all day. Will try to call tomorrow.From: Liz Cheney CbH6)>Sent: Friday, March 6, 2020 2:14 PMTo: Fauci,A nthony (NIH/NIAID) [E] -----~ (b).-(.=6J>Cc: Barasch, Kimberly (NIH/NIAID) [C) CbH ; Conrad, Patricia (NIH/NIAID) [E)--------- Cb)( ; Haskins, Melinda (NIH/NIAID) [E)- -------- (b) ( '> Subject : Re: Test KitsDr. Fauci - Who can I speak w ith about the status of the test kits? I am also concerned about reportsfrom CDC that there are six states, including Wyoming, with no certified lab in which to conduct tests.Thank you,Liz Cheney(b)(6)On Tue, 25 Feb 2020 at 10:28 PM, Fauci, Anthony (NIH/NIAID) [E)- ------- (b)(6J> wro te :Liz:Thank you for your note. I would have been very happy to provide remarks at the weeklymeeting of the Republican Conference. However, I have a late afternoon 2nd panelCongressional Hearing with Secretary Azar followed by a meeting with the President in theRoosevelt Room of the White House, which over laps with the time frame of your meetingtomorrow. I would be most happy to do this at another time. If you could have your officecontact my Special Assistant, Patty Conrad (copied here) , she will help arrange setting upsomething at a mutually convenient time.Best regards,TonyAnthony S. Fauci, MDDirectorNational Institute of Allergy and Infectious DiseasesBuilding 31, Room 7A-0331 Center Drive, MSC 2520National Institutes of HealthBethesda, MD 20892-2520Phone (b) (6)FAX: (301) 496-4409E-mail Cb()6 )The information in this e-mail and any of its attachments is confidential and may containsensitive informa tion . It should not be used by anyone who is not the original intendedNIH-000837recipient. If you have received this e-mail in error please inform the sender and delete it fromyour mailbox or any other storage devices . The National Institute of Allergy and InfectiousDiseases (NIAID) shall not accept liability for any statements made that are the sender 's ownand not expressly made on behalf of the NIAID by one of its representatives .From: Liz Cheney (b) (6)Sent: Tuesday, February 25, 2020 6:43 PMTo: Fauci, Anthony (NIH/NIAID) [E]Subject: House GOP Conference Mtg(b)(6)Dr. Fauci - I am the House Republican Conference Chair and we are holding our weekly mtg at S pmtomorrow in the Capitol. I wanted to see if you'd be available to provide remarks and an update onCoronavirus. It is by far the topic in which our members are most Interested, and you would be thebest person to provide an update .I realize th is is short notice . If tomorrow doesn't work , let me know if we could arrange another time.My eelI is ------ (b)(6), office is ._ (b)(6) ____ _.Thank you,Liz CheneyNIH-000838From:Sent :To:Subject :Hila ry:Fauci, Anthony (NIH/NIAID) [E)Sun, 8 Mar 2020 03:23 :05 +0000Hilary RosenRE:You!Thanks for your note. I would postpone it. The situation is very fluid.best,TonyFrom: Hilary Rosen (b)(6)Sent : Saturday, March 7, 2020 9:01 AM ------~~ To: Fauci, Anthony (NIH/NIAID) [E]- ------- (b)(6) Subject: You !Tony,I am so proud of you . It is so comforting to see your face on TV explaini ng the world of coronavirus .know it is exhausting for you but it is so important . Your dedication my friend has always been soadmirab le.Quick question, CDC isn't giving much guidance on this. Our company has its annual retreat this week.About 80 people coming from NYC and LA meeting in a DC Hotel ballroom for two days with anadditional 100 people from DC. SO approximately 180 in total. Would you postpone this if you wereme?XOHilaryHilary RosenVice ChairSKDKnickerbo cker202.4 64.69 69 w(b)(6) m2019 Holmes Report Public Affair s Agency of the YearNIH-000839From:Sent :To:Cc:Subject :Cannot do. No t imeFauci, Anthony (NIH/NIAIO) [E)Sun, 8 Mar 2020 03:06 :52 +0000Conrad, Patricia (NIH/NIAID) [E)Greg Folkers (b) (6)FW: media request from spain an old journal ist friend , patricia mateyFrom: Patricia Matey Corada <pmatey@elconfidencial.com>Sent : Saturday, March 7, 2020 3:31 PM -------=---c-c= To: Fauci, Anthony (NIH/NIAID) [E) (b)(6)Subject: media request from spain an old journalist friend, patricia mateyHi doctor Fauci, Can you remembe r me. I am a Patricia Matey, oldest journalist of health from spa in. Iwork in the past in El MIU ndo, now I am a chief editor in El Confidencial, the first newspaper online inSpain. Can you give me little time for answer some questions. I want to do an article of the coronavirus,but the eyes of science, I read three days ago te article in New Yor Times by Gina Kolata, the bestwoman health journalist of the world, I want to do an art icle without panic and false conceptI send you some questionsWhat is really the differen ce in this conoravirus and the past?Can one of the muteate, change in one strain more aggressive in short timeThe flu always affect a all the count ries in same time . Why the new coronavirus only star enChina,Is because became from one animal,,,What are your opinio n for the really impact of this virusWhat are you opin ion for the press and the paper in this problem.What are you opinion for the evolut ion in the next monthBest regard for all, but best regard for yourtimetCPatricia MateyJefa de Alimentewww.e lconfidencial.comVia de las Dos Castil/as, 33. Edificio 7. Planta 1- Oficinas E,F, G, H28224 Pozuelo de Alarcon (Madrid)(b)(6)NIH-000840From:Sent :To:Cc:Subject:Fauci, Anthony (N!H/NJAID) [E)Sun, 8 Mar 2020 03:03:28 +0000(b)(6)Conrad, Patricia (NIH/Nit1ltD. } [E]FW: COVID-19 Real Time, Sensiti ve Detect ion Breakth roughCUsersstarnD eskto pSEW Bio,October 2019.docx, CUsersstarn Desktop ANDE BiosRFS CV 05 March 2020 .pdfPlease read th is and figure out what t he heck he is tal king about and act according to yourjudgm ent. Only 498 em.::iils to go tonigh t .From: (b)( 6) ----------------- Sent: Saturday, March 7, 2020 4:09 PMTo: Fauci, Anthony (NIH/N IAID) [ E] -------= (b,.),(.=.6)Subject: COVID-19 Real Time, Sensitive Detect ion BreakthroughTony--(b) (4)It has been awhile since we have work ed together since my time as the senior SESstanding up OTRA (with the help of Josh Lederberg M.O. & Dave Franz DVM who youknow), at Argonne /UofChicago establishing your NIAID RBL with Olaf SchneewindM.D., and as the OHS Direc tor of Research reporting to SEC Michael Chertoff & U/SJay Cohen (RADM-ret) . Michael & Jay brought me aboard when Jay was our Chief ofNaval Research at ONR and I was ONR's Execu tive Director & Chief Scientist. I knowyou have your hands very full with the COVID-19 threat, so I wan ted to give you aheads up that a game changer for enhanced detection of COVID-19 has emerged .Thank s to DARPA & OHS S&T sponsorship in years past of ANOE developing a realtime Rapid DNA microfluidics system for human identificat ion, the ANOE group has abreakthrough for detection of COVI0 -19 and to the future , other emerging threatviruses .As you may know the ANOE system for human identification (e.g. CT & OHS missions)is mature and now deployed operationally /tactically by CENTCOM , DIA, the IC andused most recently by OHS in their recent test bed in El Paso to demonstrate itseffective capabil ities to determine family relationship in undocumente dminors. Additionally ANOE is in use by law enfor cemen t and by officials responding tomass casualty events (CA 2018 Camp Fire disaster, 20 19 Conception dive boat fire ,and the very recent 2020 tragic helicopter crash) to ID the victims .The ANOE system now provid es 2 hour turnaround with no special trainingrequirements as a stand-alone system for all the above users. Our warfighters andspecial operat ors are using the ANOE system now in field forward operation s and itmeets MIL specs & is the only system certified for data submission to the DoDABIS/DIA DNA repository and FBI CODIS data base. The CbH4>NIH-000841(b) (4)attac liecJ an executive summary and a more in-dep th document for your teams review.Hope the above is helpful and I stand ready to provide any additional information. Ihave cc'd Jim Davis (ANOE Chief Federal Officer). Additionally since it has been sometime since we have worked together I have attached my bio and that of ANDE's ChiefScientific Officer & Founder, Richard Selden M.D., Ph.D.Tony thanks for considering this in your very busy life now and I will look forward toseeing you again.Best regards--StarnesDr. Starnes E. WalkerMember -Homeland Security Experts Group , MITREGlobal Strategy Officer-Defense & Homeland Security/IntelligenceAp:N OE Corp(bo)(r6a)t iomn : -------(b-)~(6) w: www.ANDE.com e: (b)( 6) ______ _. '\71 /A ...ANO E ' 2~?Rapid DNA for a Safer WorldNIH-000842From:Sent:To:Subject:Please respond.Fauci, Anthony (NIH/NIAIO) [E)Sun, 8 Mar 2020 03:00:50 +0000Cassetti, Cristina (NIH/NIAID) [E]FW: Corona Virus plann ingFrom: K.A. Traul (b) (6)Sent: Saturday, March 7, 2020 4:42 PM To: Fauci, Anthony (NIH/NIAID) [E] -------------- =(b)=(6) Subject: Corona Virus planningDear Dr. Fauci;I am a toxicologist and have spent time, years ago, working in the arena of oncogenicvirology as part of NCI programs. I am very concerned about what I see in the newsmedia about the NIH approach to the COVID-19 pandemic (yes, pandemic) that hasarrived in our country. There is much talk about development of a vaccine , however , Ibelieve that this is a long-term strategy. You and I both know, from working asscientists, that the development and trial of an antiviral vaccine is a months-longprogram, at best. I am surprised, even disappointed , that there seems to be no visiblefocus on the part of the NIH on the development of anti-viral treatments (drugs etc) . It ismy professional opinion that anti-virals would take a shorter time to develop thanvaccines, yet it appears that this may be a back burner focus of NIH.I realize that there are many political pressures on your office and I support your strongefforts to apply science to the resolution of this growing problem . Please do not giveshort shrift to the potential of antiviral treatments in favor of the longer-term promise of avaccine.Respectfully yours,Karl A. TraulK.A. Traul , Ph.D.K.A. Traul Pharmaceu tical Consulting(b)( 6)NIH-000846From:Sent :To:Subject :Fauci, Anthony (NIH/NIAID) [E)Sun, 8 Mar 2020 02:59 :37 +0000Conrad, Patricia (NIH/NIAID) [E)FW: Interview requestI really do not have time for this.From: Kopelman, Hannah <Hannah.Kopelman@bmc .org>Sent: Saturday, March 7, 2020 5:19 PM ------~~ To: Fauci, Anthony {NIH/NIAID) [E] (b)(6)>Cc: Ross Kopelman _________ C_b>_C_6 )Subject: Interview requestDear Dr. Fauci,My name is Dr. Kopelman. I am currently a resident at Boston Medical Center. I am reaching outbecause I would like to interview you on my podcast along with (b)(6)·, on ourpodcast called MedChatMonday wh ich reaches thousands of millenn ia ls a day. We want to discussCoronavirus. I know you are very busy so any of your time would be appreciated. I want to discuss theimplications of Coronavirus, symptoms, understanding of why it has become a global scare, what peopleshould do to combat and lower their risks. Podcast will be done remotely through Skype.I hope to hear from you soon.Best regards,Dr. Hannah Kopelman and Dr. Ross KopelmanHannah B. KopelmanThis electron ic transmission may conta in information that is privileged, confidentia l and exempt fromdisclosure under applicable law. If you are not the intended recipient , please notify me immediate ly asuse of this information is strictly prohibited.NIH-000847From:Sent:To:Fauci, Anthony (NIH/NIAID) [E)Sun, 8 Mar 2020 02:58:52 +0000(b)(6)Cc: Marston, Hilary (NIH/NIAID) [E];Conrad , Patricia (NIH/NIAID) [E];Barasch,Kimberly (NIH/NIAID) [C]Subject: FW: One Step COVID-19 test kitS - IMMEDIATE AVAILABILITYAttachments: DoN SARS-CoV tests 200305.pdf, IFU One Step COVID-19 Test.pdf , 002.png,0005.jpg , 0099.jpg, 9999.jpg, 0001.pngWhat do you think of this. Do what you need to do.From: (b)( >Sent: Saturday, March 7, 2020 6:26 PMTo: vice.president@whitehouse.govCc: secretary@hhs.gov; Hahn, Stephen (FDA) (b)( ; Redfield, Robert R.(CDC/OD) (b)(6) ; Fauci, Anthony (N.. I.H- /7N:--I-A--I:D-'):.-[:~E]:.=====::::::.:...--....;_---=- (b'")("=6' );secreta ry@state.govSubject: One Step COVID-19 test kit$ - IMMEDIATE AVAILABILITYDear Mr. Vice President & Task Force Members -My name is Jeffrey "Scott" Smith . I live in CbH KS. For the past 35 years I havebeen a Purchasing Agent in the private sector. Much of my career has dealt with Chinasourcing and supplier development. I have established a wide network of suppliers andcontacts throughout China. You can see from my US Passport number CbH6) thatI have traveled to China for the past 20 years ... including spending nearly CbH6Jm ytime in 2018 & 2019 visiting China suppliers . (Thankfully I returned on 15-Nov-2019 ,prior to the outbreak... CbH6) .)I was invited by one of my trusted suppliers to offer One Step COV ID-19 test kits to theUnited States. The Guangzhou based s~as CbH4> test kits available now forimmediate shipment. They can produce ~ kits per week at their factory . Pleasesee the information below and the materials attached for more information. This is avery cost effective test - and provides results in 15 minutes. I will trust you to determinethe efficacy of the diagnostics.To be clear - this is not my business. I will profit in no way from providing these kits tothe American healthcare public -- except for the sat isfaction of doing my patriotic duty toassist my fellow Americans. I fully understand the gravity and seriousness of thisdisease. All of my factories in China have, and are , suffering from the effect and fallout. My business in CbH6) is dealing with the effects of the supply chain disruptions.I hope that this offer , and availability of a additional test kit pipeline, will help ease thetest kit shortage that we are experiencing in the USA . If you and your ProcurementNIH-000848Offices would like more information or would like to secure these test kits, pleasecontact me. I can assist in arranging supplier contacts and immediate air shipments.I certainly thank you and the many dedicated leaders in the USA for your great work tocombat COVID-19 - and for the care that you are showing the American public.Best regards,Scott SmithM: (b)(6)-------- Original Message -------Subject:One Step COVID-19 test kitDate: 2020-03-07 2:41 am(b)(6)From: "Jack Scientek" <info@scientekpower.com>To: (b)(6)Reply-To: <info@scientekpower .com>Dear Scott,How are you? It was a great pleasure talking with you on Wechat, As we discussed, I have afriend who works in Wandfo Biotech Company in Guangzhou (a public listing company).They have developed a One Step COVID-19 test kit to screen the Corona virus in only 15minutes. This test kit is been massively used in China and it's been suppl ied to Japan,SouthKorea, Ukraine and Iran to cope with the Corona Virus, It has also been certified by Chinesehealth organization and EU. I am wondering if you have any connection with any medicalorganizations, if they need this kit, Wondfo is able to supply. CbH4>- • Wondfo provide international shipping worldwide. Maybe this can be helpfulfor some people.Here below please refer to the most concerned informat ion:Name of the test kit: One Step COVID-19 Test (Chromatography Assay)Manufacturer: GuangZhou Wondfo Biotech Co.,LtdNIH-000849K:arton ~olume(CB K;rossName Quantity Unit Price PackagesMeasurement M) h,veight(Kgs)One Step COVID-19 TestKitOne Step COVID-19 TestKitOne Step COVID-19 TestKitOne Step COVID-19 TestKitPrice availability : 1 weekPayme nt terms:Delivery termA vai la bi lity: ----(b) (4)productio n capacity ---------(b) (4)For your information, this testing kit has been supplied to Japan, and south Korea ,lran,Ukraine , their production schedule is very tight, the factory may raise up price aweek later.Other Available documents are attached for your reference.Best Rega rdsJack Jiang~ScientekScientek Electrical Co.,Ltd. I Danzao . I Nanhai District I Foshan,Guangdong I China 528216~ 86- 189-4246-9075 Q (b)(6) -1J www .scientekpower.com l8l info@scientekpower .comI Mob/WhatsApp/Wechat : CbH6JNIH-000850(b) (4)From:Sent :To:Cc:Subject:Fauci, Anthony (NIH/NIAID) [ElSun, 8 Mar 2020 02:57 :55 +0000Marston, Hilary (NIH/NIAID) [El(b) (6)'RE: NSC inquiry on treatment studySee my changes in RedFrom: Marston, Hilary (NIH/NIAID) [E] (b)(6)>Sen t: Saturday, March 7, 2020 6:37 PMTo: Fauci, Anthony (NIH/NIAID) [E]------ -= (b=H=6); Lane, Cliff (NIH/N IAID) [E](b)( >Cc: Conrad, Patricia (NIH/NIAID) [El (b)( ·>; Lerner, Andrea (NIH/N IAID) [E)-------- (b)(6)>; Eisinger, Robert (NIH/NIA ID) [El (b)(6) Subject : NSC inquiry on t reatment studySorry to add to the in box.NIH-000851(b) (5),(b) (5)From:Sent :To:Fauci, Anthony (NIH/NIAIO) [E)Sun, 8 Mar 2020 02:08:47 +0000Gregory KlompSubject: RE: COVID-19 treatmentWe are pursu ing th is idea.From: Gregory Klomp (b)(6)>Se nt: Saturday, March 7, 2020 8:06 PMTo: Fauci, Anthony (NIH/NIAID) [E] -------= (b-)c(-c6-)=Subject: COVI D-19 treatmentIt seems COVID-19 causes greater problems for the elderly and those with chron ic illnesses, as you havesaid.Why not try giving those with active disease, or those at risk, gamma-globu lin, to ameliorate the effectsof the il lness?It would be especially interesting to prepare batches of gamma globulin using the blood (2,000- 3,000dono rs) of people who have, or who have recovered from, COVID-19 infection.There is ample precedent for using Gamma-globulin to prevent or treat viral illnesses (Hepatitis A, B) ordiseases of unknown etiology (ie Kawasaki's).This could be useful especially while we wait for the development of a vaccine.What do you think?Gregory Klomp, MD(b)(6)(I trained at Columbia-Presbyterian HospitalI see you were at Weil Cornell)NIH-000852From:Sent:To:(b)(6)Sat, 7 Mar 2020 17:06:39 -0500NIAID Public InquiriesSubject: Fwd: From ER Provider, Some Common sense COVID-19 addl. suggestionsSent from my iPhoneBegin forwarded message:From: (b)(6)Date: March 7, 2020 at 4:08:23 PM EST,------- --;;-~To: "Fauci, Anthony (NIH/NlAID ) (E]" (b)(Subject: From ER Provider, Some Common sense COVID-19 addl. suggestionsDr. Fauci:I have been following you and others on CSPAN with appreciation.1) Please ensure you are all getting adequate sleep.(There is too much yahoo-machismo in our field) Please put forthrecommendations for providers and their employe rs.2) I see the CDC warning about herbals, which I agree with except for one:echinacea, just about the only herbal with proven medical usefulness, not as it isrecommended on the bottles or websites, but as only a single 2 capsules, on dayone of viral illness. Echinacea demarginates the matured bone marrow leukocytes.Used as a "one shot deal"may decrease COVID-19 duration/severity as eg.: "take right away on day one,drink plenty of water and sleep as long as necessary".Please at least study the use of Echinacea in this manner for COVID-19. (Google issuddenly missing Echinacea's mechanism/use info, so please have this corrected, iffor nothing else to prevent hoarding. One bottle can be for a whole neighborhoodand please ask the drug stores to offer "two packs" with proper instructions.eg.: "take only two as soon as ill with cold or flu and not take more, but toreplenish the immune system follow up with fresh fruits and vegetables, etc.3) Make sure we have enough Ventolin, Proventil available so those with newasthmatic component due to COVID-19 can call their Dr. for RX if they cannot blowout a match, forinstance, and use the drive through instead of goin into the pharmacy. Considerhazmat for drive through testing and Rx pharmacy staff (as in S. Korea). I would beinterested in knowing the percent of COVID-19 respiratory sufferers who can stayhome but will need Ventolin.10%? (just a guess from seeing bronchitis in the ER).NIH-0008544) Ensure all the medical providers with offices, give out their office telephonenumbers and have staff trained to triage calls so people can stay home until theyare well.5) Ensure levothyroxine (the US most common Rx) is made in the USA fromingred ients made in the USA. Ditto for down the line of the most necessary andcommon RX, including Ventolin, and the antibiotics that would treat bacterialsuperinfection of COVID-19 (particularly the ones that can be used at home:macrolides, etc.)6) Encourage prevention of superinfection with clean respiratory toilet, hydration,chest PT preferred over suctioning, clean environment, including cleaning floorsdaily. One of the most successful methods of chest PT involves the patient lying onthe bed with their face near the floor. Decreasing the load of pulmonary sputum iscritical.7) There is very large number of semi-retired physicians, such as myself who wouldprobably like to be utilized (an paid a little) for te lemedicine to assist with triage.We can do telemedicine at home. I am not set up to do this but will soon be setup and able. We need to know which companies we can trust to hire us.There should be telemedicine training and tracking coming from the CDC orother state and national governments.8) Is the 3/3/20 John Kehoe Financial Times art icle correct? Is it not best to predictmortality so as to more realistically prepare for post-COVID-19 recoveryeconomically and socially and give confidence by being transparent?I see recovery jobs being the young taking care of the old after most have had itand been cured or succumbed. Then the other half of the people will get it, too ...Is there some stigma attached to the word "infrastructure" that would preventrecovery of our economy?9) I do not wee the recommendations for Flu and both pneumovax vaccines, butthe recommendation needs to get out broadly right away.10) Wuhan had to truck in food ... how are we planning? Canned food decreasesone's immu ne system. Fresh fruits and vegetables, frozen or dried are needed.11) China closed all the theaters ... and we should also start closing the use of publicplaces, particularly asking folks in their 60's and older to stay home now.12) Recommend providers write three month supply of Rx for all patients,to decrease visits out and ensure availability.13) The closure of schools might spread COVID-19 unless children have food to eatat home and the parents comply.14) Will census takers spread it? Should the census be postponed or performed viahazmat suit or in another fashion?This is a long list. Please look into 2-packs of Echinacea with instructions .Get enough sleep/stay wel l.Thank you.Best regards,Gretchen Boise, MDLL (b)(6) (caller must announce who they are)NIH-000855(b)(6)NIH-000856From:Sent:To:(b)(6)Sat, 7 Mar 2020 16:15:52 -0500Lane, Cliff (NIH/NIAID) [E)Subject: Fwd: Covid-19 Pandemic -- updateFYI. I get 100 of these per day.Begin forwarded message:From: David Katz Cb()6 )Date: March 6, 2020 at 7 :46: 18 PM EST -----~~To: "Fauci, Anthony (NIH/NIAID) [E]" ,___ CbH6J _____ __Subject: Covid-19 Pand emic -- updateDear Tony:As I continue to follow the evolution of this disastrous calamity, 1continue to think of possible approaches to dealing with therapeuticoptions that might be "off the beaten trail" but nonetheless worthconsidering - especially for those patients who are at high risk fordebilitation and, possibly, death . I share one such thought with youhere.Several years ago, recombinant Human Growth Hormone (rHGH)was reported to be significantly effective in restoring/ enhancing Tcell anti -viral act ivity in patients infected with HlV (citation below):Growth hormone resurrects adult humanthymus during HIV-1 infectionKiki Tesselaar, Frank MiedemaJ Cf in In vest. 2008; 118(3):844-847. http s://doi.org/1 0. l 172/JCI351 l 2.My thought is that since, in many ways, elderly patients afflictedwith COVID-19 fall into a similar category, that treatment withNIH-000857NIH-000858rHGH might be an effective treatment alternative to employ duringthis immediate time frame while you are exploring more specificalternatives.I look forward to your thoughts on this, and best wishes,David(PS: I think you have handled yourself magnificently during theseincredible press conferences, etc.!)From:Sent :To:Fauci, Anthony (NIH/NIAID) [E)Sat, 7 Mar 2020 19:06:14 +0000Megan 8.Cc: Conrad, Patricia (NIH/NIAID) [E);Eisinger, Robert (NIH/NIAID) [E];Greg Folkers-------- (~b)~(6=)Subject : RE: Thank you, Dr. FauciMs. Fender:There is no such a th ing right now as "no risk" given the uncertainty of the current situation .However, in t he context of what we do know, since you are H years old, you haveGo about your usual business. You have no reason to panic.I hope that this is helpful.Best regards,A.S. FauciFrom: Megan B. CbH6)>Sent : Saturday, March 7, 2020 11:10 AMTo: Fauci, Anthony (NIH/NIAID) [E] CbH6J>Subject: Re: Thank you, Dr. FauciDr. Fauci,-----I apologize to reach out, I know how extremely busy you must be. But I have always invested a greatdeal of trust in you .Thank you greatly.Sincerely,Megan FenderNIH-000862(b)(6)On Sun, Feb 9, 2020, 6:27 PM Fauci, Anthony (NIH/NIAID) [E] --------- CHb 6J wrote :Megan:Many t hanks for your kind words. They are much appreciated.Best rega rds,TonyAnthony S. Fauci, MDDirectorNational Institute of Allergy and Infectious DiseasesBuilding 31, Room 7A-0331 Center Drive, MSC 2520National Institutes of HealthBethesda, MD 20892-2520Phone : (b)(6)FAX : (301) 496-4409E-ma il: (b)(6)The information in this e-mail and any of its attachments is confidential and may containsensitive information . It should not be used by anyone who is not the original intendedrecipient . If you have received this e-mail in error please inform the sender and delete it fromyour mailbox or any other storage devices . The National Institute of Allergy and InfectiousDiseases (NIAID) shall not accept liability for any statements made that are the sender 's ownand not expressly made on behalf of the NIAID by one of its representatives .From: Megan B. CbH6J>Sent: Sunday, February 9, 2020 4:53- P-M-- ---=-c-c= To: Fauci, Anthony (NIH/NIAID) [E] (b)(6JSubject: Thank you, Dr. FauciDr. Fauci,As a citizen and mother , I would just like to take a short moment to say thank you for all of your greatwork and service to the American people . I have admired your work for many years, and appreciatedyour transparency during the Ebola crisis, as we ll as this most recent situation . As a citizen, Iappreciate that you relay facts, both good and bad, and have established a sense of trust w ith thepeople .(b)(6)- · With the Ebola crisis, and with Coronaviru s, I feel better when I see your press conferences andhear all of the work you and your team do to protect both US citizens, and the world commun ity .Friday I was very happy to hear you announce the extreme progress that's been made in just twoweek's time on the vaccine, and that there have been no roadblocks . This has been done atunprecedented speeds, by what I'm sure are very talented scientists.Again, thank you for your lifetime of service in disease prevention, and for making citizens like myselffeel better knowing we have people like you and your team working tirelessly for the people. ) (6)11111111________________ , but I take comfort in knowing we have such great,talented individuals leading our public health system.Dr. Fauci, you are truly a saint. Thank you for all that you do.NIH-000863NIH-000864Sincerely,Megan FenderFrom:Sent:To:(b)( 6)Sat, 7 Mar 2020 13:37:51 -0500NIAID Public InquiriesSubject: Fwd: a questionSent from my iPhoneBegin forwarded message:From: Leonard Trudell (b)(6) --------- Date: March 7, 2020 at 1: 34: 34 PM EST To: "Fauci, Anthony (NIH/NlAID) (E]" ------------~-~- -- (bH6J · Subject: a questionDr. Fauci,May I suggest a question that you might ask of COVID-19 identifiedpatients? Could you ask them if they had received a current flu shot for thisseason? Since the COVID-19 corona virus basic construct is a basic fluversion with a bio-engineered HIV or other(?) component , is it possible thatour flu vaccines might have some degree of protection agains t this newCOVID-19 viral construct? I think it is important to ask this question!Dr. Len Trudell(b)(6)NIH-000865From:Sent:To:Subject:Fauci, Anthony (NIH/NIAID) [ElSat, 7 Mar 2020 18:36:42 +0000Cassetti, Cristina (NIH/NIAID) [ElFW: a questionPlease have someone respond.From: Leonard Trudell (b)(6) --------- Sent: Saturday, March 7, 2020 1:34 PM To: Fauci, Anthony {NIH/NIAID) [E] ---------~-~- - (b)(6)> Subject: a questionDr. Fauci,May I suggest a question that you might ask of COVID-19 identified patients? Could youask them if they had received a current flu shot for this season? Since the COVID-19corona virus basic construct is a basic f lu version with a bio-engineered HIV or other(?)component, is it possible that our flu vaccines might have some degree of protectionagainst this new COVID-19 viral construct? I think it is important to ask this question!Dr. Len Trude ll(b)(6)NIH-000866From:Sent :To:Subject:Rich:Fauci, Anthony (NIH/NIAIO) [E)Sat, 7 Mar 202018:10:15 +0000Richard CarmonaRE: KudosMany thanks for your kind note. Much appreciated . I hope that all is well with you .Best regards,TonyFrom: Richard Carmona (b)( > ----------- Sent: Saturday, March 7, 2020 11:56 AM ------ --.~ To: Fauci, Anthony (NIH/NIAID) [E]- ------- (b)(6J> Subject: KudosTony, as always and for many decades and most importantly now, thank you for being the voice ofreason and integrity that emanates from the political swamp to quell uncertainty and fear . Ironicallyyour words now as a "vaccine" against the disease of public fear and uncertainty may be as importantas the eventual immunologically derived vaccine against coronavirus you are working on.Be well,Rich CarmonaRichard Carmona17th Surgeon General of The United StatesChief of Health InnovationsDistinguished Professor University of Arizona8600 E. Rockcliff Road I Tucson , AZ 85750CANYON RANCH. 0: 520.749.7754M: ___ C...b,).,.(6_)_.canyonranch.comNIH-000869From:Sent:To:(b)(6)Sat, 7 Mar 2020 11:19:16 -0500NIAID Public InquiriesSubject: Fwd: university coronavirusFrom patty on asf phone.Pis handleSent from my iPhoneBegin forwarded me ssage :From 1<Date: ~ -ar-ch- 7,-2-0-20- at_l_0_:0-6-:2_1_A_M_ E_S_T __To: "Fauci, Anthony (NIH/NIAID) [E]" ---------::-,:-(b:)(-6)= --------- Subject: university coronavirusHello and thank you for all of your tireless efforts in dealing with the coronavirus.I have a concern about the universities and the spread of this virus. Many schoolsbrought back students from study abroad before the 14 day quarantine was putinto place, and even after the quarantine was put in place, many students did notfollow the quarantine rules. Also, with shared dorms and apartments it was notpossible for student's who returned to campuses and not their homes. By the timesschools came up with a plan for quarantining the student's it was well over a weekafter some were back. Therefore, there is potential for widespread infection.The vice president said the elderly and those with underlying medical conditionsare at risk and should take caution in where they go, avoid crowded placesetc..Millions of students have asthma, diabetes, auto-immune disorders, and theydo not have a choice other than to go to class. The government does not seemedconcerned about the potential spread among campuses and what a disaster thiscould be. They have voiced why grade schools are not closed (since younger arenot at risks better for them to be at school) but they are ignoring college kids areat risk and the impact of widespread infection on a campus could be huge.Students i~ colleges travel back and forth to the city all the time , and I amconcerned schools are not temporarily closing until more testing is available andwe see where this goes. At minimum , giving student's with underlying medicalconditions the option to go home and work remotely. Right now they do not haveNIH-000870any option other than to go to class. When questioned they say they are listeningto the CDC and state government. (b)(6)and students are not following the advice to stay home sick and nobody seemsconcerned about trying to prevent infection.Can the government please look at a temporary ban on classes at Universit ies instates where infection is rapidly spreading, especially knowing there are notenough test available yet. The schools are not taking action on their own and this isa frustrating situation seeing delays in decisions making.Thank you for your time in consideration in addressing these concerns,Prefer to remain anonymous for the protection of ---------- (b)(Sent from Mail for Windows 10NIH-000871From:Sent:To:(b)(6)Sat, 7 Mar 2020 11:16:57 -0500Auchincloss, Hugh (NIH/NIAID) [E]Subject: Re: Plasmapherese pediatricians to obtain anti-corona virus antibodiesSorry this is from patty. I have an iPhone just to manage h is emails so some of these are fromme. Will add the letter p to the ones I send you so you know they are from me.Sent from my iPhoneOn Mar 7, 2020, at 10:46 AM, AuchincJoss , Hugh (NIH/NIAID) [E](bH6J > wrote :Tony, as I told Pany yesterday, I am handling all that you send me but I'm notgoing to fill your inbox with an acknowledgement each time.Sent from my iPadOn Mar 7, 2020 , at 9:15 AM, Fauci , Anthony (NJH/NTAID) [E](b) (6) > wrote:Pls handleSent from my iPhoneBegin forwarded message:From: David Chung (b) (6J>Date: March 6, 2020 at 12:45: 17 PM ESTTo: "Fauci, Anthony (NIH/NIAID ) [E]"(b)(6) >Subject: Plasmapherese pediatricians to obtain anticoronavirus antibodiesDr. Fauci,I appreciate the efforts of the WHO taking a look intothe temperature question. It is helpful to understandthe virus and know what to expect. (b)(6) is aprofessional data analyst of large datasets like censusNIH-000872data, for example. I was wondering if it would bepossible to obtain the WHO dataset to see if therewere any angles not considered. I am certain that theWHO's biostatisticians know what they are doing, butdata is a funny thing. You get the answers to thequestions you ask. If the right questions were notasked, you may miss useful information.Regarding the subject line, if the theory is true thatchildren have some cross-reactive protection due toantibody production to the harmless coronaviruspopulation , that would mean that pediatricians wouldalso carry very high levels of protective antibody. Ifthis is true, then plasmapheresis might provide anticoronavirusantibody as potential treatment. I do notknow enough about plasmapheresis to know if thiscould be applied to scale but I wanted to pass alongthe thought CbH6)David ChungOn Monday, March 2, 2020, 07:46 :51 AM EST, Fauci, Anthony(NIH/NIAID) [E) (b)(6)>wrote:Thank you for your careful and well thoughtout note. Worthy of consideration.Anthony S. Fauci, MDDirectorNational Institute of Allergy and Infectious DiseasesBuilding 31, Room 7A-0331 Center Drive, MSC 2520National Institutes of HealthBethesda , MD 20892-2520Phone: Cb)(FAX: (301 496-4409E-mail: Cb) (The information in this e-mail and any of its attachments isconfidential and may contain sensitive information. Itshould not be used by anyone who is not the originalintended recipient. If you have received this e-mail in errorplease inform the sender and delete it from your mailbox orany other storage devices. The National Institute of Allergyand Infectious Diseases (NIAID) shall not accept liability forany statements made that are the sender's own and notexpressly made on behalf of the NIAID by one of itsrepresentatives.NIH-000873From: David Chung (b)(6)Sent: Sunday, March 1, 2020 9:44 PM__ ___ ~ =To: Fauci, Anthony (NIH/NIAID) [E] (b)(6)Subject: Pis advise to allow return air travel only , stop all otherair travelDear Dr. Fauci,Thank you for your leadership and guidance in thisdifficult time. I am a pediatrician in Massachusetts,and as you know , direct-linkage from travel cases arepopping up on the East Coast. In order to keep thecommunity viral load down, keeping new cases frommoving around the country and the world will delaythe spread and amplification of the vira lload. According to my observations, hot climatesseem to be having a favorable new case rate . Basedon the city of Qom versus the experience inSingapore and Australia, it appears that the transit iontemperature for efficient spread is somewhere abovewhen there are highs around 50 degrees F, similar toH1 N1. According to my observations, prior toseasonal flu, the transition temperature was closer tohighs of 40 degrees F. This theory should betestable . For example , there are new cases in Kuwaitand Bahrain. If I am right , if you tested a subset ofthese populations , you would find a very high rate ofasymptomatic infection, probably 80-90%, becausethat's how many people it would take to shed smallamounts of virus to create a community viral load tomake someone sick enough to get tested. If this istrue , this bodes well for the virus burning itself out toendemic status relatively quickly. This would be veryreassuring data you could provide to reduce panic - ifyou can tell people you know how long this pandemicis going to last rather than saying that we don't know.Although some experts may say that restricting travelwill only delay the inevitable, this is not a validstatement if the transition temperature for effectspread really is 50 degrees. A delay of significantcommunity spread in the US until highs reach the 50sfor the Northeast where the population is the mostNIH-000874NIH-000875dense would have a massive life-saving effect , but ifthis is to occur, the flight restriction needs to happennow.Stopping all flights would be impractical andinhumane, but allowing return flights only andstopping all other air travel would be effective . Itwould have a massive effect on the economy, but sowill overwhelming corona virus infection. No one willdie because they can't take a vacation or businesstrip. Financial losses would need to be settled later,so this would require emergency declarations , etc. Ifyou wanted to take it in a step-wise manner , youcould start with international flights and then move onto domestic flights if necessary - this would probablybe wise and would have a less severe impact on theeconomy.Thank you again, and I am sure this is one ofthousands of unsolicited emails . I wish you the verybest and God grant you wisdom.Best,David ChungPediatric Associates of BrocktonFrom: (b)(6)Sent : Sat, 7 Mar 2020 09:17:55 -0500To: Cassetti, Cristina (NIH/NIAID) [E]Subject: Fwd: ACE2 neutraliz ing antibody from R&D SystemsAttachments : SARS-CoV-2 cell entry depends on ACE2 and TMPRSS2 and is blocked by aclinically-proven protease inhibitor.pdf , ATTOOOOl.htm, Crystal structure of the 2019-nCoV spikereceptor binding domain bound with ACE2 receptor .pdf, ATT00002.htmSent from my iPhoneBegin forwarded message:From: Hung Trinh (b)(Date: March 5, 2020 at 11 :04:51 PM EST -------= = To: "Fauci , Anthony (NIH/NIAID ) [E]" (bH6JSubject: Fwd: ACE2 neutralizing antibody from R&D SystemsNIH-000876From: (b)(6)Sent: Sat, 7 Mar 2020 09:12:07 -0500To: Auchincloss, Hugh (NIH/NIAID) [E];Folkers, Greg:(NHf/i\llAlD) JE]Subject: Fwd: Blog Clearance Request: COVID-19: Potent ial lrfrp!icati6hs for Hfdividualswith Substance Use DisordersAttachments: COVID SUD blog ebe3 ew6 sw2 ndv4 CLEAN.docx, ATTOOOOl.htmPls handleSent from my iPhoneBegin forwarded message:From: "Volkow , Nora (NIH/NIDA) [E]" (b)( >Date: March 6, 2020 at 4:46:06 PM EST -------~~ To: "Fauci, Anthony (NlH/NlAID ) [E]" (bH6J·Cc: "Hobin , Jennifer (NIH/NIDA) [E]" (bH6J>, "Volkow, Nora(NIH/N IDA) [E]" (bH6J>Subject: Blog Clearance Request: COVID-19: Potential Implications forIndividuals with Substance Use DisordersDear Toni. John Burklow asked NIAID to review a Blog I wrote on the need to evaluatevulnerabilities among patients with substance use disorders to COVID-19. Let me know if uor your staff have concerns or suggestions. I realize u are totally swamped and I apologizefor burdening u with it. Best noraNIH-000877From: (b)(6)Sent :To:Subject:Sat, 7 Mar 2020 09:11:12 -0500Auchincloss, Hugh (NIH/ NIAID) [E]Fwd: JID 2006, 193:1244 -1249Attachments : SARS & gd T cells.pdf, ATT00001.h tmPis respond if requiredSent from my iPhoneBegin forwa rded message:From: MIRO SLA V MALKOVSKY ....,_.... ____(b_)(_6)Date: March 6, 2020 at 4:46:28 PM ES-T- ---=-:--=- To: "Redfield, Robert R. (COC/OD)" (b)( 6)Cc: "Fauci, Anthony (NIH/NJAID) [E]" _______ (b_H_6JSubject: JID 2006, 193:1244-1249Dear Bob,Long time, no see. Our SARS study (JID 2006, 193:1244-1249; see theattachmen t) showed selective expansions of Vy9Vo2 T cells in survivors ofSARS-CoV infection. Interestingly , stimulated Vy9V62 T cells also displayan interferon-y-dependent anti-SARS-CoV activity and are able to directly killSARS-CoV-infected cells. Since it is very easy to activate human Vy9Vo2 Tcells in vivo (e.g., using FDA-approv ed and relatively non-toxic drugs fortreating bone-demineraliza tion) and given the simi larities between SARSCoVand SARS-CoV-2, I thought that it could be potentially useful to bringthese facts to your and Tony's attention , in spite of knowing that both of youare probably slightly busier these days than you would like to be.All the best and good luck with everyth ing,Yours as ever,MirekM. Malkovsky , MD, PhD, FRCPathProfessor Emeritus, UW School of Medicine and Public HealthMobile: (b) (6)Office telephone and fax: (b)(6)E-mail: (b)(6)NIH-000878From:Sent:To:(b)(6)Sat, 7 Mar 2020 09:07:07 -0500Auchincloss, Hugh (NIH/NIAID) [E]Subject: Fwd: Pneumococcus vaccination in relation to coronavirus infection .Pls respondSent from my iPhoneBegin forwarded message:From: Lars Nie lsen (b)(6) >Date: March 6, 2020 at 8:07:37 PM EST ,-------- ~= To: "Fauci, Anthony (NIH/NlAID ) (E]" (b)(Subject: Pneumococcus vaccination in relation to coronavirus infection.Dear Anthony Fauci,As l understand the fa tal cases of covid-19 develop pneumonia after severa l days ofsymptoms of the acute viral infection.In this way the present conoravirus infection is very like our present and previousfatal influenza virus infections. In the 1918 pandemic many if not most of the fatalcases were caused by bacterial superinfection with hemolytic streptococci andpneumococci. The former is rather se ldom now, but the pneumococcal infections arecommon.Should we advice persons over >65 y as well as people with chronic diseases withincreased risk of fatal coronavirus diseases to be vaccinated against pneumoco ccinow?My best regards and thank you for your significant contribut ion to inflammato rymedicine and infections.Lars P. Nielsen, M.D .Specia list in Medical Microbiology and VirologyForme r head of the Danish National Influenza Laboratory.NIH-000879From:Sent :To:Subject :Ms. Stevens:Fauci, Anthony (NIH/NIAID) [E)Sat, 7 Mar 2020 13:25:29 +0000Elizabeth StevensRE: Thank you for staying front and center, and in the public eye re COVID-19Thank you for your kind note .Best regards,A.S. FauciFrom:E lizabeth Stevens ---------- (b)(6) Sent : Friday, March 6, 2020 10:30 PM -------~~ To: Fauci, Anthony (NIH/NIAID) [E] --------- (b)(6) Subject: Thank you for staying front and center, and in the public eye re COVID-19Dear Dr. Fauci,I am so happy to continue seeing you in press conferences and on news broadcasts.Please keep making those public appearances. Amer icans need to hear the facts from someone who istrustworthy .I am sure that tiptoeing around Donald Trump has dramat ically complicated your life . I hope that youwill find ways to "correct" or "clarify" the constan t stream of misstatements that he makes- our livesdepend upon it . (Maybe Trump could wear a hazmat suit - to protect his frag ile ego from any possiblebruising caused by a collision with the truth. Just kidding.)Seriously, Doctor, it is a huge relief to see and hear you and your expert colleagues . It is to the point thatwe cannot believe a single word tha t comes out of Trump's mouth.Very sincerely,Elizabeth Stevens(b)(6)NIH-000880From:Sent:To:Fauci, Anthony (NIH/N IAID) [E)Sat, 7 Mar 2020 13:23:54 +0000(b)(6)Subject : FW: (b) (4) _________________ ___.fyiFrom: Lipkin, Ian W ------------" (b)( >Sent : Saturd ay, March 7, 2020 8:20 AM ------~= To: Fauci, Anthony {NIH/NIAID) [E] (b)(6)Subject: ___________________ ___. (b)( 4)Tony,Happy to connect you w ith Zhu.NIH-000881(b)(4(b) (4)(b)(4 lNIH-000882(b) (4)NIH-000883(b) (4)NIH-000884(b)(4)NIH-000885»» Wit h best regards,>>>>»» Zhu>>>>>>>>>»> ~1~ A: Lipkin, Ian W. --------------(b)( » » ~3!Bt fsJ: 2020~2)=19 8 23 :01»» ~~i4A: Zhu Chen>»> :t'J>i!G: eorge Gao; zhangzongwei»» ~~: Re: important info>>>>>>>> Zhu,»» Please call me on -----(b)(6) >>>>>>>>Ian>>>>>>>>>>>>»>> W. Ian Lipkin, MD»» John Snow Professor of Epidemiology and Director»» Center for Infection and Immunity>»> Mailman School of Public Health>>>>>»> Professor of Pathology and Neurology»» College of Physicians & Surgeons>>>> Columbia University»» 722 West 168th Street, 17th Floor»>> New York, NY 10032»» Voice: (b)(6)>»> Fax: (212) 342-9044>>» Email: (b)(6) -----------NIH-000886(b) (4)>>>>»» Administrative Coordinator>»> (b)(6)>>>> Voice: ~====::::!!:,=_ _~ »» Email: (b)(6)(b)(6)--------- > > > >»» www.cii .columbia.edu»» Follow CII on Twitte r: CII_Columbia I Facebook: Cl I.Columbia>>>>>>>>>>>>>>>>>>>>>>>>>»> On Feb 9, 2020, at 9:43 AM, ZhuChen ------- (b)(6)> wrote: >>>>>>>> Dear Ian,»» I have an important info to be shared with you. According to the latest report fromthe National Health Commission, the number of confirmed cases of NCP (2019-nCoVpneumonia) in other Provinces than Hubei {Wuhan is the capital city) was decreased from890/day on Feb 3rd to 509/day on Feb 8th . So it is still possible for this outbreak to bebasically contained in China.»» Therefore, my suggestion is that we support the current public health policies andstrategy to concentrate quality medical human resources and other resources to savemore life of severe pat ients, even though the cost is high, very high. And then, we shallcontinuously analyze the situation for possible adjustment of policies and measures.>>>> Best,>>>> Zhu>>>>>>NIH-000887From:Sent:To:Subject :We have thought about it.-----Original Message -----Fauci, Anthony (NIH/NIAID) [E)Sat, 7 Mar 2020 13:23:10 +0000Lorne BrandesRE: Coronavirus immunityFrom: Lorne Brandes ______ r-(:b';";)"'"("6=)Sent: Saturday, March 7, 2020 12:51 A-M-- ---~~= To: Fauci, Anthony (NIH/NIAID) [E]..._ ____ C>b<.. ..Subject: Coronavims immunityHi Dr Fauci ,Has anyone considered the possib ility that previous coronavims infection(s) associated with common colds mayresult in at least partial immw1ity to the COVID-19 virus? This may expla in why the disease is generally mild in80% of adults and apparently rare in children (most of whom get more frequent colds than adults). I would bepleased to hear your thoughts.Sincerely,Lome Brandes, MD, FRCPCProfessor, University of Manitoba (b)(6)NIH-000888From:Sent :To:Subject :Ms. Job:Fauci, Anthony (NIH/NIAID) [E)Sat, 7 Mar 2020 13:21:56 +0000Ann JobRE: 2020 Census and COVID-19Thank you for your note.,Best regards,A.S. FauciFrom: Ann Job (b)(6)>Sent : Saturday, March 7, 2020 12:18 AM ------~= To: Fauci, Anthony (NIH/NIAID) [E] --------- (b)(6) Subject: 2020 Census and COVID-19Dear Dr. Fauci ,Today I wrote and mailed a letter to both you and Dr. Redfie ld.I will not duplicate nor attach it here, but I did want you to make you aware of my letter in case itdoesn't reach your desk on Monday. In it I ask you and Dr. Redfie ld to explore the possibility ofusing 2020 Census Enumerators as an "on-the-gro und army" to help stop COVID-19 .Because as you know better than anyone else that time is of the essence, I thought it useful togive you a heads-up about my letter via this email.I am probably being na ive, but just in case it makes sense to you, I thought it couldn't hm1 towrite you .Thank you for being there for us. We really need you .Yours,Ann E. Job (pronounced like the Book of Job in the Bible)(b) <~(iPhone)(hom e)NIH-000889From:Sent:To:Subject:Attachments:Fauci, Ant hony {NIH/ NIAID) [E]Sat, 7 Mar 2020 13:13: 58 +0000Eisinger, Robert {NIH/ NIAID) [E]FW: A vaccine with ant i imm unosuppre ssive prope rties(b)(6)Please respond on my behalfFrom: Avr aham Halbrei ch --------- (b)( 6)> Sent: Satur day, March 7, 2020 7:00 AMTo: Fauc i, Anthony (NIH/NIAID) [E] ..------ -(,b.'H-""=' >Subject: A vaccine with anti lmmunos uppressive propertiesImportance : LowDear Dr Fauci ,Common wisdom tells us that the inabili ty to immunize against HIV, malaria etc. as wellas the need torepeat evry year anti flu vaccination result from the excessive , or limitless, geneticvariability of the underlying pathogens. While not doubting the reality of this geneticvariability , best observed in an orderly manner in the case of HIV, I considered thepossibility that these pathogens are endowed wiith an immunosuppressive capacitythat is not inactivated during vaccine production, and that current vaccines do notinduce immunity against suchimmunosuppression. I applied this reasonning when I worked on an AIDS vaccine in1991 in Zagury's lab(Halbreich A et al. (1992) Vaccine Research,4 :397-412 ). Indeed, we tested then , insuitably immunized animals , the effect of the various preparations on the cellularresponse to tuberculin and the capacity of animals to beImmunized against tuberculin and tetanus as a function of the exrent of treatment. Theimmune response to these agents was indeed higher in the presence of hivionscompared to heat inactivated preparations . This HIVION preparat ion was used on 6patients in Zaire (Zagury et al. ( 1992) J Acquired Immune Deficiency Syndromes,5 :676-681).NIH-000890Unfortunately, when I tried to make a greater prep for a phase I trial, the viral preparationturned out (too late),by SOS gel elecrophoresis , not to contain any viral protein, due either to degradat ion oranother mishap . I left Zagury 's lab soon after and it was impossib le for me later to obtainmaterial (either viral or from recombinant protein) to further advance the matter. I dobelieve that tuning vaccine preparation to counter immunosuppressive effect of the virus(parasite) while preserving its capacity to induce anti viral immunity should resolve theneed to revaccinate every year against the same virus. In fact, identifying the epitopes ,acting for immunity and thoseacting against immunosuppression, at a later stage should allow a better result than weobtained. (It is not yet known whether corona virus also mutates rapidly, but I heard thata woman was reinfected after having recovered from covid-19 infection and this mightindicate a capacity of the virus to counteract the host's immune response.In CbH6) I have been itching ever since to go back tounfinished projects , but did notfind an avenue. Now, with the outburst of the corona virus pandemic this surfaces again .SincerelyAvraham HalbreichNIH-000891(b)((;JFrom:Sent:To:Subject:Fauci, Anthony (NIH/NIAIO) [E)Sat, 7 Mar 2020 13:06:00 +0000Anderson, Jennifer (NIH/NIAID) [E]RE: unit headsIf I am available, I would be happy to discuss COVID-19From:A nderson, Jennifer (NIH/NIAID) [E]- --------- (b)( Sent: Saturday, March 7, 2020 8:03 AMTo: Fauci,A nthony (NIH/NIAID) [E] ------=-c (b')"("=6')Subject: Fwd: unit headsGood morning Dr FauciWe are - for the momen t - scheduled for a Unitheads meet ing on Tuesday. Tae Wook is next topresent but suggested (see below) that we make it a round table and discuss COVID-19.Question: IF Unitheads isn't canceled how do you feel abou t having a Roundtable instead of TaeWook presenting? Or would you prefer to take a break from Coronavirus for a moment andhear about HIV!ThanksJenSent from my iPhoneBegin forwa rded message:From: "Chun, Tae-Wook (NIH/NIAID) [E]" --------- O ate: March 6, 2020 at 9:53 :11 AM EST ---------~~ To: "Anderson, Jennifer (NIH/NIAID ) [E]" ----------- CbH6J> Subject: Re: unit headsCan we do round table? I want to talk to him about corona not to mention the MTAwill get canceled anyway . If you want me to I wi ll present .On Mar 6, 2020, at 9:47 AM, Anderson, Jennifer (NIH/NIAID) [E](b)(6) wrote :Hi Tae Wook,NIH-000892I thin k you are up for Unit heads? It's been so long, I've lost tr ack. I think youwere supposed to present back on Jan 14th but it got canceled and I don 'tth ink we've had a pre sentation since. Im being t old we might have a UH onTuesday-ASF is free so far . Can you present ?JenJennife r M. Anderson, PhDDeputy Branch ChiefIAMB/OAS/N IAIDScientific Operations ManagerLIR/DIR/NIAID9000 Rockville Pike, Bldg. 10 Rm. 6A19ABethesda, Mary land 20892Office Phone : (b) (6)NIH Cell: (b)(6)Personal Cell: -----(b)(6) FAX: 301-402 -4122NIH-000893From:Sent:To:Subject :FYI-----Original Message -----Fauci, Anthony (NIH/NIAID) [ElSat, 7 Mar 2020 13:02:34 +0000Cassetti, Cristina (NIH/NIAID) [El;Lane, Cliff (NIH/NIAID) [ElFW: Plasma therapyFrom : Lipkin, Ian W. _-_-__-__-__-_- --- C_=>b<_=,Sent: Saturday , March 7, 2020 7:50 AM-- ----~~ To: Fauci, Anthony (NIH/NIAID) [E] ...__ _____ C_)b_(6..).Subject: Plasma therapyTony,Just reviewed paper (b) (4 on pi lot study of plasma therapy for COVlD -19. Sufficiently encouraging thatJ' d begin collecting p lasma for compassionate use as well as larger randomiz ed trial.JanJanNIH-000894From:Sent:To:Subject :Than.ks, Ian-----Orig inal Message -----Fauci, Anthony (NIH/NIAID) [E)Sat, 7 Mar 2020 13:02:18 +0000Lipkin, Ian W.RE: Plasma therapyFrom : Lipkin, Ian W. _-_-__-__-__-_ ----, C_~)b(6=.l>Sent : Saturday, March 7, 2020 7:50 AM-- ----~~ To: Fauci, Anthony (NIH/NIAID) [E]...__ _____ C_)b_(6..).Subject: Plasma therapyTony,Just reviewed paper (b) (4 on p ilot study of plasma therapy for COVlD-19. Sufficiently encouraging thatJ' d begin collecting p lasma for compassionate use as well as larger randomized trial.JanJanNIH-000895From:Sent :To:Cc:Fauci, Anthony (NIH/NIAID) [E)Fri, 6 Mar 2020 23:44:54 +0000Folkers, Greg (NIH/NIAID) [E)Crawford , Chase (NIH/ NIAID) [E]Subject: Re: ASF ------- AIPAC reports that two people who attended its conferencetested positive for the co ronavirusAttachments: imageOOl.jpgYikes!On Mar 6, 2020, at 6:23 PM, Folke rs, Greg (NIH/NIAID) [E](b)(6) wrote:Just fyi -folks from this delegation wer e in the hallway on the Hill when you andChase were the reFrom: Folkers, Greg (NIH/NIA ID) [El (b)(6)Sent : Friday, March 6, 2020 6:18 PMSubject: JTA: AIPAC reports that two people who attended its conference tested pos itivefor the co ronav irusAIP AC reports that two people who attended itsconference tested positive for the coronavirusMARCH 6, 2020 5:45 PM<image0Ol.jpg>Outside the American Israel Public Affairs Committee( AIP AC) annual conference in Washington, DC onMarch, 01, 2020. (J\1arvin Joseph/The Washington Postvia Getty Images)NIH-000896WASHINGTON (JTA) - The American Israel Public AffairsCommittee said that at least two people who attended thelobby's p.o licy conference have tested positive for the coronaVIrus.The conference, which ran from Feb. 28-March 2, drew18,000 activists to Washington.The AIPAC statement posted late Friday on Twitter said thetwo people who tested positive are from New York. Theoutbreak has been especially hard on the Orthodox Jewishcommunity in Westchester County, and AIP AC listed thecounty's health department as among the authorities withwhich it is in communication.The others are the New York Health Department, nationalhealth authorities and the District of Columbia HealthDepartment. The statement also said the lobby wasconsulting with Edward Septimus, a professor of internalmedicine at Texas A&M University.The statement posted on Twitter said an email was going outto all attendees as well as to congressional offices. Theconference routinely attracts a majority of Congress membersand their staffers.BY RON KAMPEASNIH-000897NIH-000898From:Sent:To:(b)(6)Fri, 6 Mar 2020 18:35:49 -0500NIAID Public InquiriesSubject: Fwd: Important & Emergency Nature (COVID-19) RelatedSent from my iPhoneBegin forwarded message:From: Udita Katugampola (b) CDate: March 6, 2020 at 6:29: 16 PM EST,------- --;;-~To: "Fauci , Anthony (NIH/NlAID ) (E]" (b)(Subject: Important &Emergency Nature (COVID-19) RelatedDear Dr. Fauci,I saw that you are discussing the steps we need to take to make the impact ofCOVID-19 a minimum in CNN and decided to write to you what we did as faculty inthis aspect.I believe that prevention is much more important than treatment later. As apreparation for the COVID-19 outbreak, two days ago, I made a personal decisionto make all my homework on line submission so that we may avoid the spread ofthe virus anymore .Students work on homework for hours and can easily spread the virus withoutknowing it. Once it goes to graders (my TAs), they then spread it to the rest of theclass, again without knowing it. Thus, an innocent act can be devastat ing. So, insimply two-three days it may spread to another 100 new indiv iduals easily.Graders may act as hubs in this case. The danger is, it may have spread to anotherhundred or more new individua ls even before it comes to a detectable level f romany test.I also want to emphasis the following points:1. We hear in all news that elderly people are the most vulnerable. But I thinkit should be corrected as people with immunodeficiency are the mostvulnerable and elderly are in that category. Some one who is 10 years oldand have diabetic or HIV has the same danger as an elderly person .2. We should come up with a test such as a pregnancy test, which can be doneat home without leaving their homes. This stops further spreading.3. We should discuss foods that help cure it fast and th ings that we should notdo.NIH-000899I have shared my thoughts with CNN (Dr. Sanjay Gupta and Anderson Cooper aswell). Thank you for your time and everything you do to our community at thiscritical moment .Best,UditaUdita Katugampola, Ph.D.Assistant Professor of Ma themat icsFlorida Polytechnic UniversityOffice: !ST 2015Tel: (b)(6)Email. (b) (6'eid, uWeb: https ://sites. go ogle. com/site/uditanalin/NIH-000900From:Sent:To:(b)(6)Fri, 6 Mar 2020 18:32:06 -0500NIAID Public InquiriesSubject: Fwd: MOSQUITOESSent from my iPhoneBegin forwarded message:From: JAME S NUTILE (b)(6) ---------- Date: March 6, 2020 at 5:58:58 PM EST,------- --;;-~To: "Fauci , Anthony (NIH/NlAID ) (E]" -------- (b)( Subject: MOSQUITOESDr. Fauci,No ones addressing the possibi lity of the Coronav irus being transferred bymosquitoes this summer. Is that a possib ility?Thank you,James NutileSent from my iPhoneNIH-000901From:Sent:To:(b)(6)Fri, 6 Mar 2020 18:31:39 -0500NIAID Public InquiriesSubject: Fwd: I am not spam. Possible consideration for CoronavirusSent from my iPhoneBegin forwarded message:From: Karen Bender (b)(6) >Date: March 6, 2020 at 6:07:58 PM EST -------~~ To: "Fauci, Anthony (NIH/NlAID ) (E]" (bH6J ·Subject: I am not spam. Possible consideration for CoronavirusGood Evening Dr Fauci,I have an idea for your consideration for the Coronavirus vaccine/treatment.Noting that the virus is attacki ng our elderly more and knowing their lungs are o lderand not as functional to fight this infection. Have you conside red artific ial surfactantto boost lung function. (b) (6)Perhaps if their lungs are stronger to expand they could fight the virus better.Thank you for listening, My prayers are with our Healthcare Professional s toachieve a treatment/vaccine.Karen BenderNIH-000902From: (b)(6)Sent: Fri, 6 Mar 2020 18:28:43 -0500To:Subject:Lerner, Andrea (NIH/NIAID) [E);Auchincloss, Hugh (NIH/NIAID) [E)Fwd: Kidney Disease (NS-MCD) and Covid-19 CoronavirusCan one of you take this?Sent from my iPhoneBegin forwarded message:From: Raja R (b)(6) >Date: March 6, 2020 at 6: 15:37 PM ESTTo: "Fauci, Anthony (NIH/NlAID ) (E]" <{,----~- (b~Subject: Kidney Disease (NS-MCD) and Covid-19 CoronavirusDear Dr. Fauci,I live in the United Kingdom and listen to your recent press briefings from White House.First of all, I want to convey my sincerest thanks to you for providing valuable informationto the general public.I would greatly appreciate it if you can advise on what precautions I should take --. Should he try toavoid all social contact, and of course avoid any cruise, air or public transport to preventhim from gettin g the infection?I would greatly appreciate your advice on thi s.RegardsRajaNIH-000903From:Sent :To:Subject:Fauci, Anthony (NIH/NIAIO) [ElFri, 6 Mar 2020 15:26:21 +0000Dzau, Victor J.RE: URGENT - GPMB COVID-19 FUNDING NOTEPlease leave m name off . Thanks.Anthony S. Fauci , MDDirectorNational Institute of Allergy and Infectious DiseasesBuilding 31, Room 7A-0331 Center Drive, MSC 2520National Institutes of HealthBethesda , MD 20892-2520Phone : (b)(6)FAX: (301 496-4409E-mail Cb) (6)The information in this e-mail and any of its attachments is confidential and may contain sensitiveinformation . It should not be used by anyone who is not the origina l intended recipient . If youhave received this e-mail in error please inform the sender and delete it from your mailbox or anyother storage devi ces. The National Institute of Allergy and Infectious Diseases (NIAID) shall notaccept liability for any statements made that are the sender 's own and not expressly made onbehalf of the NIAID by one of its represent atives .From: Ozau, Victor J. (b)(6)Sent : Friday, March 6, 2020 10:02 AM -------::-::-=, To: Fauci, Anthony (NIH/NIAID) [El (b)((;)>Cc: Alex Harris (b)( ; Jeremy Farrar ---------- (b) (6)> Subject: Re: URGENT-GPMB COVID-19 FUNDING NOTETony,I know you are extremely busy. I am following up on GPMB business.Given our conversation 3 days ago, would you like to sign on the statement or do you prefer us to leaveyou name off? Please let us know ASAP.Best,VictorOn Mar 5, 2020, at 9:31 AM, Alex Harris ---------- (b)(6)> wrote:Dear Board Members,NIH-000904With many thanks,AlexAlex HarrisHead of Global Policy & AdvocacyWellcomeT: (b)(6)(b)(6)G7 leaders and SherpasCountry RepCanada Justin Trudeau,Prime MinisterFrance Emmanuel Macron ,PresidentGermany Angela Merkel,ChancellorIt aly Giuseppe Conte,Prime MinisterJapan Shinz6 Abe,Prime Minis terUnited Kingdom Boris Johnson,Prime Min isterUnited States Donald Trump,NIH-000905(b) (4)Sherpa (amendments welcome) GPMB lead(s)(b)(6)Jeremy Farraru~Jeremy FarrarVictor DzauPresidentParticipants(b}(vEuropean Union Charles Miche l,President of theEuro12ean CouncilEuropean Union Ursula von der Le~en, Victor DzauPresident of the Jeremy FarrarEuro12ean CommissionInternational financial institut ionsInstitution Leadership Sherpa/equivalent or GPMB leadsuggested contacts(b) (6), (b) <4Y Victor DzauAs SyJeremy FarrarNIH-000906From: Alex HarrisSent: 03 March 2020 23:06To: 'Amelie RIoux• -------""' C"'>b"<"='6">) ; Dzau, Victor J. (b)(6)-:---:-.:======~(b)~(6); J-e-re-m:-y Farr-a-r ====~~-:---(b-)(: ->-; Anthony Fauci (b)(6)> ; Fore Henrietta (b)(6)>; Gao Fu--~===: (b~)~(~ >-; G- as-humba Diane (b) (6) Ilona(b)(6)> ; Suzuki Yasuhiro (b)(6) ; -K-ie-k-b-us!c:h= ====~~-- ::.=======~---------------(b)(6); Vega Morales Jeanette (b)(6); V ij a y Rag ha van Krishnaswamy (b)(6J>; Skvortsova Veronika(b)(6)>Cc: Gro Brundtland CbH6)>E; lhadi SY(b)(6)>; Tore Godal ______ ; Godal, Tore::========~~-(:b-)('6.)"; S'C:"HW"A:"RT"L ANDERB, ernhard F. (b)(6J>; RYAN, Michael J. (b)(6J>; Pate Muhamed(b) (6)>;~======~~- (b )( 6) >; Kanarek, Morgan (b)(6); 'Sheila Austria'":"":":7:'"""---:---:-:----::;========;__---=-; -W-c-il=li am Hall .__ _______ (b_)(_6 ); TeresaMiller de Vega (b)( >; 'Marston Hilary'Subject: RE: GPMB: COVID-19 FUNDING NOTEDear Board Members,Ahead of the GPMB Board call on Wednesday, I'm pleased to attach a note (on behalf ofJeremy Farrar, Victor Dzau and a small working group) setting out the urgent need for newfunding for the global COVID-19 response.You will have seen the strong announcement today from the World Bank of up to $12bn tosupport country response, wh ich we warmly welcome . We are asking for your feedback onthe call and (b) (4)(b) (4)NIH-000907We look forward to the discussion.With best wishes,AlexAlex HarrisHead of Global Policy & AdvocacyWellcom eT: (b)(6)(b)(6)(b) (4)NIH-000908From:Sent:To:Fauci, Anthony (NIH/NIAIO) [E)Fri, 6 Mar 2020 15:23:33 +0000Stover, Kathy (NIH/N IAID) [ElCc:(NIH/NIAID) [ElSubject:Billet, Courtney (NIH/NIAID) [El;Folke rs, Greg (NIH/NIAID) [El;Conrad, PatriciaRE: FOR ASF REVIEW: Draft PR re: Phase 1 mRNA coronavirus vax launchLooks fine. Thanks.Anthony S. Fauci , MDDirectorNational Institute of Allergy and Infectious DiseasesBuilding 31, Room 7A-0331 Center Drive, MSC 2520National Institutes of HealthBethesda , MD 20892-2520Phone (b) (6)FAX : (301) 496-4409E-mail : (b)(6lThe information in this e-ma il and any of its attachments is confidential and may contain sensitiveinformation . It should not be used by anyone who is not the original intended recipient. If youhave received this e-mail in error please inform the sender and delete it from your mailbox or anyother storage devices . The National Institute of Allergy and Infectious Diseases (NIAID) shall notaccept liability for any statements made that are the sender's own and not expressly made onbehalf of the NIAID by one of its representatives .From: Stover, Kathy (NIH/NIAID) [El (b)(6)>Sent: Friday, March 6, 2020 10:20 AM ------ ::;..,..-,= To: Fauci, Anthony (NIH/NIAID) [El (b)(6J>Cc: Billet, Courtney (NIH/NIAID) [El (b)(6) >; Folkers, Greg (NIH/NIAID) [E]_______ Cb _><6l; Conrad, Patricia (NIH/NIAID) [E) (b)(6)Subject: FOR ASF REVIEW: Draft PR re: Phase 1 mRNA coronavirus vax launchGood morning, Dr. Fauci,Please find attached for your review a draft press release about the launch of the Phase 1 studyof the mRNA COVID-19 vaccine. We are tentative ly planning to issue the release on Wed .,March 11 once we 've received confirmation that the first participant has been vaccinated. Forease of reference, the following is the q uote we have crafted for you :"Finding a safe and effective vaccine to prevent infection with SARS-CoV-2 is an urgentpublic health priority," said NIAID Director Antho ny S. Fauci, M.D. "This Phase 1 study, launchedin record speed, is an important first step toward achieving that goal."Thanks,NIH-000909KathyKathy StoverBranch ChiefNews and Science Writing BranchOffice of Communications and Government RelationsNational Institute of Allergy and Infectious DiseasesNational Institutes of Health31 Center Drive, Room 7A17FBethesda, MD 20892(b)(6)Media line: (301) 402-1663NIH-000910From:Sent :To:Subject:Fauci, Anthony (NIH/NIAIO) [ElFri, 6 Mar 2020 14:50:15 +0000(b)(6)FW: Developing Immunity to SARS-CoV-2 and lvlgPlease respond to th is person.Anthony S. Fauci , MDDirectorNational Institute of Allergy and Infectious DiseasesBuilding 31, Room 7A-0331 Center Drive, MSC 2520National Institutes of HealthBethesda , MD 20892-2520Phone : (b)(6)FAX: (301) 496-4409E-mail (b) (6)The information in this e-mail and any of its attachments is confidential and may contain sensitiveinformation . It should not be used by anyone who is not the origina l intended recipient . If youhave received this e-mail in error please inform the sender and delete it from your mailbox or anyother storage devi ces . The National Institute of Allergy and Infectious Diseases (NIAID) shall notaccept liability for any statements made that are the sender 's own and not expressly made onbehalf of the NIAID by one of its represent atives .From: Dr. Art Kamm <art@kammconsultinginc.com>Sent : Friday, March 6, 2020 7:47 AM -------::-:-:-= To: Fauci, Anthony (NIH/NIAID) [El (b)(6>l>; Lane, Cliff (NIH/NIAID) [E](b)(6)>Subject: Developing Immunity to SARS-CoV-2 and lvlgDear Dr. Fauci and Dr. Lane:I have been fo llowing the growing international outbreak of COVID-19 and wanted to share a thought withyou, understanding that this may have already been thought of. My early academic research (referenceprovided, PNAS) involved cancer immunology where it contributed to a growing body of info rmation thatcertain tumor cells could possess unique surface antigens that could be used for immunologi c therapy(https://www .pnas.org/co ntent/pnas/7S/12/S9 12.fu ll.pdf ). My career then too k me to executive and seniorexecutive/corporate officer positions in publicly-held pharmaceutical corporations (Glaxo and Salix,respectively) overseeing R&D of therapeutic agents. My experience has included both pharmaceuticals andbiologics.(b)(6)Our current understanding of COVID-19 mortality is that it appears to be concentrated in the elderly andthose with underlying medical conditions. In healthy indiv iduals (although still early) it appears that many ofNIH-000911those infected with SARS-CoV-2 may remain symptom free or develop mild disease, or recover from moresevere illness. Currently there are tens of thousands of individua ls who have been identified as having beeninfected but are considered 'recovered' . That being case it wou ld seem plausible that they have mounted anantibody response to the vir us.The question is whethe r these individua ls are being tested for ant ibody titre to the virus, and if that isoccurring whethe r they are being approached to donate plasma to move into lglv production. With thisillness still in its early stages and being international, I would imagine that such an effort would involve apublic/private sector endeavor. Understanding the difficulty in developing a vaccine for 'cold viruses', lvlGmay be a way to at least reduce the mortality in our most vulne rable patients . So, the slow start we have hadin t esting the US population for this virus goes beyond disease prevention - it would certa inly be affecting ourability, to some degree, of rapidly developing a more ta rgeted intervention for high risk patients .Again, you may have already thought of this, but as a concerned citizen having some background and an---------(-b)(6) ,I wanted to share these thoughts . Understanding your busy schedules, I have copied both the Director and Deputy Di rector for Clinica I Research and Special Projects.Respectfully submitted,Arthur R. Kamm, PhD(b)(6)NIH-000912From:Sent:To:Fauci, Anthony (NIH/NIAIO) [E)Fri, 6 Mar 2020 14:48:03 +0000Corey MD, LarrySubject: RE: A queryVisit where?Anthony S. Fauci, MDDirectorNational Institute of Allergy and Infectious DiseasesBuilding 31, Room 7A-0331 Center Drive, MSC 2520National Institute s of HealthBethesda, MD 20892-2520Phone: CbH6)FAX: {301) 496-4409E-ma il: (b)(6) -------- The info rmation in this e-mail and any of its attachments is confidential and maycontain sensitive information . It shou ld not be used by anyone who is not theorig inal intended recipient . If you have received this e-mai l in error please informthe sender and delete it from your mailbox or any other storage devices. TheNational Institute of Allergy and Infectious Diseases (NIAID) shall not acceptliability for any statements made t hat are the sender's own and not expresslymade on behalf of the NIAID by one of its representatives.-----Original Message----- From: Corey MD, Larry -_---_-- ___(_b) (_6,),> _ _Sent: Friday, March 6, 2020 8:18 AM ------ ---..---.--.,= To: Fauci, Anthony (NIH/NIAID) [E] CbH6J>Subject: A queryShould i and I the younger Glenda Gray give these 702 tal ks at CROI on Thiscoming Tuesday in Bosto n. If I fly East for this Tuesday evening t alk are you at allfree Wednesday to come visit and talk about HIV antibodies? Or are you soprogr ammed with coronavirus thi s is not realistic . ?Sent from my iPhoneNIH-0009 13From: Fauci, Anthony (NIH/NIAIO) [E)Sent :To:Fri, 6 Mar 2020 12:56:55 +0000McNeil, Donald (mcneil@ nytimes .com)Subject: FW: NYT: Inside China's All -Out War on the CoronavirusDonald:Your interv iew with Bruce Aylwa rd was the best di scussion of COVID-19 t hat Ihave seen thus far. Great job!Best,TonyAnthony S. Fauci, MDDirectorNational Institute of Allergy and Infectious DiseasesBuilding 31, Room 7A-0331 Center Drive, MSC 2520National Institutes of HealthBethesda , MD 20892-2520Phone : (b)(6)FAX: (301 496-4409E-mail (b)(6)The information in this e-mail and any of its attachments is confidential and may contain sensitiveinformation . It should not be used by anyone who is not the or iginal intended recipient. If youhave received this e-mail in error please inform the sender and delete it from your mailbox or anyother storage devices . The National Institute of Allergy and Infectious Diseases (NIAID) shall notaccept liability for any statements made that are the sender's own and not expressly made onbehalf of the NIAID by one of its representatives .From: Folkers, Greg (NIH/ NIAID) [E] CbH >Sent : Thursday, March 5, 2020 11:19 PMSubject: NYT: Inside China's All-Out War on the CoronavirusQ&AInside China's All-Out War on the CoronavirusDr. Bruce Aylwa rd, of the W.H.O., got a rare glimpse into Beijing's campaign to stop the epidemic. Here'swhat he saw.NIH-0009 14Dr. Bruce Aylward, leader of the W.H.O. team that visited China to assess the country's response to thecoronavirus outbreak.Cred it ... Salvatore Di Nolfi/Keystone , via Associated PressBy Donald G. McNeil Jr.• March 4, 2020As the leader of the World Health Organization team that visited China, Dr. Bruce Aylward feels he hasbeen to the mountaintop - and has seen what's possible.During a two -week visit in early February, Dr. Aylward saw how China rapidly suppressed thecoronavirus outbreak that had engulfed Wuhan, and was threatening the rest of the country .New cases in China have dropped to about 200 a day, from more than 3,000 in early February. Thenumbers may rise again as China's economy begins to revive . But for now, far more new cases areappearing elsewhere in the world.China's counterattack can be replicated, Dr. Aylward said, but it wil l requi re speed, money, imaginationand political courage.For countries that act quickly, containment is sti ll possible ''because we don't have a global pandemic -we have outbreaks occurring globally," he added.NIH-000915NIH-000916Dr. Aylward, who has 30 years experience in fighting polio, Ebola and other global health emergencies,detailed in an interview with The New York Times how he thinks the campaign against the virus shouldbe run .This conversation has been edited and condensed.Do we know what this virus's lethality is? We hear some estimates that it's close to the 1918 Spanishflu, which killed 2.5 percent of its victim s, and other s that it's a little worse than the seasonal flu,which kills only 0.1 percent. How many cases are missed affects that .There's this big panic in the West over asymptomatic cases. Many people are asymptomatic whentested, but develop symptoms within a day or two.In Guangdong, they went back and retested 320,000 samples originally taken for influenza surveillanceand other screening. Less than 0.5 percent came up positive, which is about the same number as the1,500 known Covid cases in the province . (Covid-19 is the medical name of the illness caused by thecoronavirus.)There is no evidence that we' re seeing only t he tip of a grand iceberg, with nine-tenths of it made up ofhidden zombies shedding virus. What we're seeing is a pyram id: most of it is aboveground.Once we can test anti bodies in a bunch of people, maybe I'll be saying, "Guess what? Those data didn'ttell us the story ." But the data we have now don't support it.That's good, if there' s little asymptomatic tr ansmission. But it's bad in that it implies that the deathrates we've seen - from 0.7 percent in parts of China to 5.8 percent in Wuhan - are correct, right?I've heard it said that "t he mortali t y rate is not so bad because the re are actua lly way more mild cases."Sorry - t he same number of people th at were dying, still die. The real case fatality rate is probably whatit is outside Hubei Province, somewhere between 1 and 2 percent.Patients wait ing t o be t ransferred from one hospital in Wuhan to Leishenshan Hospit al, a newly bui ltmedical center to address the epidemic t hat is also in Wuhan, China.Credit ... Agence France-Presse -Getty ImagesNIH-000917What about children? We know they are rarely hospitalized . But do they get infected? Do they infecttheir families?We don't know. That Guangdong survey also turned up almost no one under 20. Kids got flu, but notthis. We have to do more studies to see if they get it and aren't affected, and if they pass it to familymembers . But I asked dozens of doctors : Have you seen a chain of transmission where a child was theindex case? The answer was no.Why? There's a theory that youngsters get the four known mild coronaviruses so often that they 'reprotected.That's still a theory. I couldn't get enough people to agree to put it in the W.H.O. report .Does that imply that closing schools is pointle ss?No. That's still a question mark . If a disease is dangerous, and you see clusters, you have to closeschools. We know that causes problems, because as soon as you send kids home, half your wor k forcehas to stay home to take care of them. But you don't take chances with children .Are the cases in China really going down?I know there ' s suspicion, but at every testing clinic we went to, people would say, "It's not like it wasthree weeks ago." It peaked at 46,000 people asking for tests a day; when we left, it was 13,000.Hospitals had empty beds.I didn't see anything that suggested manipulation of numbers. A rapidly escalating outbreak hasplateaued, and come down faster than would have been expected . Back of the envelope, it's hundredsof thousands of people in China that did not get Covid-19 because of this aggressive response.Is the virus infecting almost everyone, as you would expect a novel flu to?No - 75 to 80 percent of all clusters are in families. You get the odd ones in hospitals or restaurants orprisons, but the vast majority are in families. And only 5 to 15 percent of your close contacts developdisease. So they try to isolate you from your relatives as quickly as possible, and find everyone you hadcontact with in 48 hours before that.You said differ ent cities responded differently. How?It depended on whether they had zero cases, sporadic ones, clusters or widespread transmission.First, you have to make sure everyone knows the basics: hand-washing, masks, not shaking hands, whatthe symptoms are. Then, to find sporadic cases, they do fever checks everywhere, even stopping cars onhighways to check everyone.As soon as you find clusters, you shut schools, theaters, restaurants. Only Wuhan and the cities near itwent into total lockdown.How did the Chinese reorganize their medical response?First, they moved 50 percent of all medical care on line so people didn't come in. Have you ever tried toreach your doctor on Friday night? Instead, you contacted one online. If you needed prescriptions likeinsulin or heart medications, they could prescribe and deliver it.NIH-000918Grocery delivery to a quarantine area in Wuhan, China.Credit ... Agence France-Presse - Getty ImagesBut if you thought you had coronavirus?You would be sent to a fever clinic. They would take your temperature, your symptoms, medical histo ry,ask where you'd traveled, your contact with anyone infected. They'd whip you through a CT scan ...Wait - "whip you through a CT scan"?Each machine did maybe 200 a day. Five, 10 minutes a scan. Maybe even partial scans. A typical hospitalin the West does one or two an hour. And not X-rays; they could come up normal , but a CT would showthe "ground-glass opacities" they were look ing for .(Dr. Aylward was referring to lung abnormalities seen in coronavirus patients .)And then?If you were still a suspect case, you'd get swabbed. But a lot would be told , "You' re not Covid." Peoplewould come in with colds, flu, runny noses. That's not Covid. If you look at the symptoms, 90 percenthave fever, 70 percent have dry coughs, 30 percent have malaise, trouble breathing. Runny noses wereonly 4 percent.The swab was for a PCR test, right? How fast could they do that? Until recently , we were sending all ofours to Atlanta.They got it down to four hours.So people weren't sent home?No, they had to wait . You don't want someone wandering around spreading virus.If they were positive, what happened ?They'd be isolated. In Wuhan, in the beginning, it was 15 days from getting sick to hospitalization . Theygot it down to two days from symptoms to isolation . That meant a lot fewer infected - you choke offthis th ing's ability to find susceptibles .What' s the difference between isolation and hospitalization?NIH-000919With mild symptoms, you go to an isolation center. They were set up in gymnasiums, stadiums - up to1,000 beds. But if you were severe or critical, you'd go straight to hospitals. Anyone with other illnessesor over age 65 would also go straight to hospitals.What were mild, severe and critical? We think of "mild" as like a minor cold.No. "Mild" was a positive test, fever, cough - maybe even pneumonia, but not needing oxygen."Severe" was breathing rate up and oxygen saturation down, so needing oxygen or a ventilator."Critical" was respiratory failure or multi-organ failure.So saying 80 percent of all cases are mild doesn't mean what we thought .I'm Canadian. This is the Wayne Gretzky of viruses - people didn't think it was big enough or fastenough to have the impact it does.A sports stadium converted to a makeshift hospital in Wuhan, China.Credit...China Daily/ReutersHospitals were also separated?Yes. The best hospitals were designated just for Covid, severe and critical. All elective surgeries werepostponed. Patients were moved . Other hospitals were designated just for routine care: women stillhave to give birth, people still suffer trauma and heart attacks.They built two new hospitals, and they rebuilt hospit als. If you had a long ward, they'd build a wall at theend with a window, so it was an isolation ward with "d irty" and "clean" zones. You'd go in, gown up,treat patients, and then go out the other way and de-gown . It was like an Ebola treatment unit, butwithout as much disinfection because it's not body flu ids.How good were the severe and critical care?China is really good at keeping people alive. Its hospitals looked better than some I see here inSwitzerland. We'd ask, "How many ventilators do you have?" They'd say "50 ." Wow! We'd say, "Howmany ECMOs?" They'd say "five ." The team member from the Robert Koch Institute said, "Five? InGermany, you get three, maybe. And just in Berlin."(ECMOs are extracorporeal membrane oxygenation machines, which oxygenate the blood when thelungs fail.)Who paid for all of thi s?The governmen t made it clear: testing is free. And if it was Covid-19, when your insurance ended, thestate picked up everything .In the U.S., that's a barrier to speed. People think: "If I see my doctor, it's going to cost me $100. If I endup in the I.C.U., what's it going to cost me?" That'll kill you. That's what could wreak havoc. This is whereuniversal health care coverage and security intersect. The U.S. has to think t his through.What about the non medical response?It was nationwide. There was th is t remendous sense of, "We've got to help Wuhan," not "Wuhan got usinto this." Other prov inces sent 40,000 medical workers, many of whom volunteered .In Wuhan, our special train pulled in at night, and it was the saddest thing - the big intercity tra ins roarright through, with the blinds down .We got off, and another group did. I said, "Hang on a minute, I thought we were the only ones allowedto get off ." They had these little jackets and a flag - it was a medical team from Guangdong coming into help .How did people in Wuhan eat if they had to stay indoors?Fifteen million people had to order food on line. It was delivered. Yes, there were some screw-ups. Butone woman said to me: "Every now and again there's something missing from a package, but I haven'tlost any weight ."A yoga class being taught on line from a studio in Beijing.Credit ... Roman Pilipey/EPA, via ShutterstockLots of government employ ees were reassigned?From all over society . A highway worker might take temperatures, deliver food or become a contacttracer. In one hospital, I met the woman teaching people how to gown up. I asked, "You're the infectioncontrol expert?" No, she was a receptionist. She'd learned.NIH-000920How did technology play a role?They're managing massive amounts of data, because they're trying to trace every contact of 70,000cases. When they closed the schools, really, just the buildings closed. The schooling moved online.Contact tracers had on-screen forms . If you made a mistake, it flashed yellow. It was idiot -proof.We went to Sichuan, which is vast but rural. They'd rolled out SG. We were in the capital, at anemergency center with huge screens. They had a problem understanding one cluster. On one screen,they got the county headquarte rs. Still didn't solve it.So they got the field team. Here's this poor team leader 500 kilometers away, and he gets a video call onhis phone, and it's the governor.What about social media?They had Weibo and Tencent and WeChat giving out accurate informat ion to all users. You could haveFacebook and Twitter and lnstagram do that.Isn't all of this impossible in America?Look, journalists are always saying: "We ll, we can't do this in our country." There has to be a shift inmind-set to rapid response thinking . Are you just going to throw up your hands? There's a real moralhazard in that, a judgment call on what you think of your vulnerable popul ations.Ask yourself: Can you do the easy stuff? Can you isolate 100 patients? Can you trace 1,000 contacts? Ifyou don't, this will roar through a community .Isn't it possible only because China is an autocracy?Journalists also say, "We ll, they're only acting out of fear of the government," as if it's some evil fi rebreathingregime that eats babies. I ta lked to lots of people outside the system - in hotels, on trains, inthe streets at night .They're mobilized, like in a war , and it's fear of the virus that was driving them. They really sawthemse lves as on the front lines of protecting the rest of China. And the world.NIH-000921NIH-000922A medical worker in a hospital in Wuhan working with traditional medicines to treatpatients.Credit ... Agence France-Presse - Getty ImagesChina is restarting its economy now. How can it do that without creating a new wave of infections?It's a "phased restart ." It means different things in different provinces.Some are keeping schools closed longer. Some are only letting factories that make things crucial to thesupply chain open. For migrant workers who went home - well, Chengdu has 5 million migrantworkers.First, you have to see a doctor and get a certificate that you're "no risk." It's good for three days.Then you take the train to where you work. If it's Beijing, you then have to self-quarantine for twoweeks. Your temperature is monitored, sometimes by phone, sometimes by physical check.What's going on with the tr eatment clinical trials?They're double-blind trials, so I don't know the results. We should know more in a couple of weeks.The biggest challenge was enrolling people. The number of severe patients is dropping, and the re'scompetition for them. And every ward is run by a team from anothe r province, so you have to negotiatewith each one, make sure they're doing the protocols right .And there are 200 trials registered - too many. I told them: "You've got to prioritize things that havepromising antiviral properties."And they're te sting traditional medicines?Yes, but it's a few standard formulations. It's not some guy sitting at the end of the bed cooking upherbs. They think they have some fever -reducing or anti -inflammatory properties. Not antivirals, but itmakes people feel better because they're used to it.What did you do to protect yourself?A heap of hand-sanitizer. We wore masks, because it was government policy. We didn't meet patientsor contacts of patients or go into hospital dirty zones.And we were socially distant. We sat one per row on the bus. We ate meals in our hotel rooms or elseone person per table. In conference rooms, we sat one per table and used microphones or shouted ateach other.That's why I'm so hoarse. But I was tested, and I know I don't have Covid.NIH-000923Dr. Aylward offered an elbow in lieu of a handshake during a briefing in Geneva on the W.H.O. missionto China.Credit.. .Salvatore Di Nolfi/EPA, via ShutterstockDisclaimer: Any third-party material in this email has been shared for internal use under fair use provisionsof U.S. copyright law, without further verification of its accuracy /veracity . It does not necessarily representmy views nor those of NTATD, NIH, HHS, or the U.S. government.From:Sent :To:Fauci, Anthony (NIH/NIAIO) [E)Fri, 6 Mar 2020 12:31:28 +0000Conrad, Patricia (NIH/NIAID) [ElSubject: FW: Nicolle Wallace/ MS NBC interview request for today or next week ...FYIAnthony S. Fauci , MDDirectorNational Institute of Allergy and Infectious DiseasesBuilding 31, Room 7A-0331 Center Drive, MSC 2520National Institutes of HealthBethesda , MD 20892-2520Phone : (b)(6)FAX: (301 496-4409E-mail : (b)(6)The information in this e-mail and any of its attachments is confidential and may contain sensitiveinformation . It should not be used by anyone who is not the original intended recipient . If youhave received this e-mail in error please inform the sender and delete it from your mailbox or anyother storage devices . The National Institute of Allergy and Infectious Diseases (NIAID) shall notaccept liability for any statements made that are the sender 's own and not expressly made onbehalf of the NIAID by one of its representatives .From: Robinson, Querry (NBCUniversal) <querry.robinson@msnbc .com>Sent : Friday, March 6, 2020 7:17 AM ---------=-=-= To: Conrad, Patricia (NIH/NIA ID) [E) (b)(6); Fauci, Anthony (NIH/NIAID) [El(b) ( >Subject: Nicolle Wallace/ MSNBC interview request for today or next week ...Hi Patricia,This is Querry Robinson with Nicolle Wallace at MSNBC's 'Deadline: White House' in NewYork again.I am writing to request an interview with Dr. Fauci today during the 4 pm ET or at somepoint next week if his schedule may allow.Nicolle is hoping to speak with Dr. Fauci about growing concerns over the spreadcoronavirus and what the public should be doing now in the wake of this pandemic .We would gladly have Dr. Fauci join us from the NIH camera if his schedule may allow ..Please let me know if today may be a possibility or if another day next week may be betterfor the schedule when you may have a moment.All the best,NIH-000924QuerryQuer ry Robinson'Deadline: White House' with Nicolle Wallace30 Rockefeller Plaza, NY, NY 10112W - 212-664 -3923C - (b)(6)querry .robinson@ nbcuni.comSent from my iPhone - please overlook any misspellings or grammatical errorsNIH-000925From: Fauci, Anthony (NIH/NIAID) [ElSent : Fri, 6 Mar 2020 11:02:56 +0000To : Cassetti, Cristina (NIH/NIAID) [ElSubject: FW: Emergency Preparedness , Coronavirus , and Products from MPIAttachments : MPI - CloroxPro_Scrubs_2019 (1).pdf, MPI - Cloro xPro_LabCoats_2019.pdf, MPI- PrimeMedical _Curtains_Flyer.pdf, MPI - POW_HOSP _Barrier_Protection_28update29.pdf, MPI -EvaClean Tri Fold 2019 .pdfPlease take a look and handle if necessaryFrom: Brad Wicklas (b)(6)>Sent : Friday, March 6, 2020 3:46 AM -------=:-:-=, To: Fauci, Anthony (NIH/NIAID) [E] (b)(6)Subject: Emergency Prepared ness, Coronavirus, and Products from MPIHi Anthony Fauci,I know you're busy, but I wanted to introduce our Company, Medical PartnersInternation al, and talk for a quick minute about what we do and how it can help you.As you know, the CDC has asked all healthcare facilities to prepare for the "worstcase scenario" around the Novel Coronavirus. As much of our medical supplymanufacturing in the US comes from overseas , it is of critical import to look atpotential shortages of key products that will be needed to perform basic IP functionsin your facility . We have already seen challen ges with N95 masks, and I have heardabout potential shortages of items like disinfection wipes . We at MPI have a coupleof unique solutions you need to consider:PureTabs and PureOne NaDCC tablets that are diluted in tap water to create HOCl forsurface disinfection. They are currently used in electrostatic sprayers to offer greatercoverage around your equipment. If, for some reason , there's a challenge getting theelectrostatic spray ers in the future ( and we've already seen shortages and delays ingetting new units), simply use our NaDCC tablets with spray bottle s from your localstore to apply the HOCl for disinfe ction. Our tablets have kill claims for C. diff infour minutes, and like a number of other cleaning agents , we believe we can beeffective against the Novel Coronaviru s. The prob lem with the other products outthere comes down to availability, particularly of the N95 masks that are required ontheir IFU's. With our product, an N95 mask is recommended, but not required, whichis a huge distinction if you have run out of N95 masks.Secondly , we have our protective scrub s, lab coats and privacy curtains from PrimeMedical. Co-branded with Clorox, these products create a 3 log (99.9%) barrieragainst bacteria and viruses when washed with bleach. The barrier lasts for 12 weeks,NIH-000926so there's a dramatically lower chance of passing something along. These are a greatprotective measure for your staff. The CDC mentioned that sodium hypochlorite(bleach) may be effective against Novel Coronavirus, so it stands to reason that ourscrubs will help against unwanted spreading as well.Finally, we have our Path-0-Wrap, which protects mattresses and gurneys from theharsh chemicals used during cleaning. It also can help dramatically when acatastrophic event happens, as you simply put these on a gurney or mattress andremove them between patients. It was invented by an EMT for just this purpose , andmay be exactly what you need for your Emergency Preparedness Program.We also have other great IP products such as:• UV Disinfection Boxes to create a "touch-less check-in" to protect staff andpatients alike• HealthySole UV solutions for the bottom of feet for OR and other sensitiveareas• Bowman Cover Your Cough StationsI have attached a couple of brochures for your review. We can provide you with aquote, or have our local representative bring in samples of some of the products toshow. Simply write me back with what you would like more information on. We feelour products will make a difference for your facility; let us know how we can help.Sincerely ,Medical Partners InternationalBrad WicklasManaging PartnerCell: CbH6)Websi te: www.bwicklas@medpint.comNIH-000927NIH-000928Medical Partners lnt'IFrom:Sent:To:Subject:Fauci, Anthony (NIH/NIAID) [ElFri, 6 Mar 2020 11:00:51 +0000Corey MD, Larry;Dieffenbach, Carl (NIH/NIAID) [ElRE: coronovirus vaccine testingAnything that works is fine with me.From: Corey MD, Larry (b)(6)>Sent: Friday, March 6, 2020 12:23 AM To: Dieffenbach, Carl (NIH/NIAID) [E)-- ---------------- r(b,)(6a); -Fasuc-i, ,A~ntho ny (NIH/NIAID) [E) (b )( 6) >Subject: coronovirus vaccine testingI know the VTEU's are first in line but I am sure the HVTN sites would be quite willing toparticipate in any coronavirus vaccine testing and if you need international populations the subSaharan African sites will I am sure be interested . so our informal polling of sites revealedenthusiasm.NIH-000929From:Sent :To:Subject :Attachment s:Please handle.Fauci, Anthony (NIH/NIAID) [ElFri, 6 Mar 2020 04:07:20 +0000Cassetti, Cristina (NIH/NIA ID) [ElFW: SARS CoV entry inhibition for the massesNovel Inhib itors of SARS CoV Entry .pdfFrom: Chris Sorg (b)(6)>Sent: Wednesday, March 4, 2020 4:24 PMTo: Fauci, Anth ony (NIH/ NIAID) [E] ------ -(-b==)-(=6)Subject: FW: SARS cov entry inhibition for the massesDear Dr. Fauci: I really think you should look at this emai l trail. I can't seem toNIH-000930(b) (4)Respectf u I ly,John C. Sorg, M.D.Cell: (b)(6)Chris SorgHospit alistNor th Arkan sas Region al Medical Ce nt er620 North Main Str eet, Ha r rison, AR 72601Offic e: ...__ ....:--"....-.il NORTH ARKANSAS....... RfG lONALMI DI OAL ClNfU'IFrom: Chris SorgSent : Monday, March 2, 2020 1:16 PMTo: (b)(6)~~ ~ 4~;fO;yR' S AwardSubject : FW: SARS CoV entry inhibition for the massesContinuing to think outloud.J.C. Sorg, M. D.Chris SorgH ospit alistNorth Arkan sas Regional Medical Center620 Nor th Main Str eet, Harri son, AR 72601NIH-000931(b) (4)Office: (b) (....-.il NORTH ARKANSAS ~~ REGlONAL GOVERNOR'S• • u , c AL c •" T • R Quality AwardFrom: Chris SorgSent : Monday, March 2, 2020 12:11 PMTo: (b) (6)Cc: (b)(6) -------------------------------- Subject : SARS CoV entry inhibition for the massesRespectfullyJJ.C. SorgJ M. D.Internal MedicineChris SorgHospitalistNorth Arkansas Regional Med.ical Center620 North Main Street , Harrison , AR 72601Office (b) (6) '....-.il NORTH ARKANSAS ~~ REGlONAL GOYER OR'S.. ■ DI c • i. c • 11 T • R Quality AwardConfidenlialit~ ~olic~:(b) (4)I hi- 1:111,11n1n d lll\ l1k, lransn1111~Jw 1•h 11, , c-,1 1fak1nal 111J1 111<11d,ds C1kl\ hH !he 11·,~t• l lh, 1•1d1,1 d11,ilo r~ 111\1 r,11 ,h em lite\ ir, 1d< rc-,cdTh" n.upl\.:llt \ r11i.~ JlilUl"JlldtH.lll ~ H:(JUIJ\ ..J In t.k:-.tn>) 1h..:r nJo,m...ilh.JII ,t.lh.·1l l~ !\l,1,1..·tJ 1-.;~J ha-. bc..:n lullt,lctl 1J )UU Jll 11111l hl JJ1ll..:nJ1.1.·~dup 11-..·1uofl t• I ~n .. 1111-.,101 1J1 ,lit ·111rlny·c H :H• 1\1 ti.:,pn11,1hl1.. I lrdch\.•flllt 1 11u. ..1 r:llhll11,,1n111., 1h. ..1 11h...·11..d.o. FL•up1e111 \01111111,11ml IL\I \rdru1,n11t ..:<1nvcr1h • 1 r<, u•p\ u>p~ uru,e 1h1~ lrs1sn is,1,111, r Jlll a11,11.n111,111lr'. ltNnllttd \\1lh111 lf",u 1.1,~ r~~cl\ed 1hi- rtln,1111s,11•1~1 1c1Tc,rl ti, c ,,m prcblcni~ l\'tlh •his ll"m<1111<s1onrn ,n c,d Jdd11wnnlm form non. plc,1sc1 101t1\ the ongmJ ,,r ol Ilic nicss,gc unmcdnwh h1 ph inc(X '') 41 1·4<100,1 11l pcm1 1101•11\ li:lc< M1' ~111:11f'1k ~,c note lh.u ,lll\', IC\\ <'r ,1ni111,mpr,c ,.·111et.,1,, lhls ,;;m1 1 :11e s,•ldv lho co: tile au hill,t11dd ,J 1ot m,' ..: s.ud) r\..•('f\! cul l11o~i; \; I t\.<,nh \1k.u1~ h R f.1011,1~1 Ji:du;:..Il \ni...1·NIH-000932From:Sent:To:Subject:enhanced diseaseFauci, Anthony (NIH/NIAID) [E)Fri, 6 Mar 2020 04:06:51 +0000Eisinger, Robert (NIH/NIAID) [E)FW: Meeting to Assess Evaluation of COVID-19 vaccine candidates for risk ofAttachments: March 12th -Tentative list of questions to be discussed_JPC mg-sb[ 16212]-version4March-1239 -CLEAN.docx, Draft agenda.Ace Assess ED.4Mar20201l_with annexes.pdfPlease handle. I cannot meet with them.From: Steve Black --------- (b)(6) Sent: Wednesday, March 4, 2020 4:26 PM -------=-=--== To: Fauci, Anthony (NIH/NIAID) [E] (b)(6)>Cc: Robert Chen (b)(6)Subject: Meeting to Assess Evaluation of COVID-19 vaccine candidates for risk of enhanced diseaseDear Doctor Fauci,I am writing to you as a member of the SPEAC project which CEPI has funded to assist with theevaluation of the safety of vaccines in their portfolio. As part of this effort, we are assistingwith developing preclinical and clinical test ing criteria to evaluate the risk of enhanced diseasefol lowing vaccination with COVID-19 vaccine candidates. As you know, this had been an issuewith some prior SARS vaccine candidates.We are convening a two day virtual meeting of experts via video conference next week onMarch 12 and 13 between 8 am and 1 pm Eastern time each day. Participants in the meetingare shown in the attached agenda but include Paul Henri Lambert from Geneva and BarneyGraham from NIH. The meeting will actively involve the participants on the agenda the first dayand on the second day the meeting will be open for several peer reviewers including StanleyPlotk in and Andy Pollard to review and comment on possible small and NHP animal models aswell as appropriate immunologic testing to be done in early phase one trials.I am wanted to make you aware of the meeting so that you could attend all or part as anobserver if you wish but also to invite you to consider joining on day two as one of our formalpeer reviewers. The goal of the meet ing would be to share recommendations with CEPICOVID-19 developers as well as other interested part ies.Any comments you have on the agenda or draft questions for consideration would be greatlyappreciated.I look forward to hearing back from you.ATTACHMENTS: DRAFT AGENDA; DRAFT QUESTIONS FOR CONSIDERATIONNIH-000933NIH-000934SteveSteven Black MDSPEAC Project work package lead for CEPIFrom: Fauci, Anthony (NIH/NIAIO) [E)Sent : Fri, 6 Mar 2020 04:04:44 +0000To: 00~Subject: FW: medRxiv: Detectable serum SARS-CoV-2 viral load (RNAaemia) is closelyassociated with drastically elevated interleukin 6 (IL-6) level in critically ill COVID-19 patientsfyiFrom: Folkers, Greg {NIH/NIA ID) [E) Cb)( >Se nt: Wednesday, March 4, 2020 4:27 PMSubject: medRxiv: Detectable serum SARS-CoV-2 viral load (RNAaemia) is closely associated withdrastically elevated inte rleu kin 6 (IL-6) level in critically ill COVID-19 patientsDetectable serum SARS-CoV-2 viral load(RNAaemia) is closely associated withdrastically elevated interleukin 6 (IL-6) level incritically ill COVID-19 patientsXiaohua Chen, Binghong Zhao, Yueming Qu, Yurou Chen, Jie Xiong, Yong Feng, Dong Men, QianchuanHuang, Ying Liu, Bo Yang, Jinya Ding, Feng Lidoi: ht t ps://doi .org/10 .1101/2020.02 .29.20029 520This article is a preprint and has not been peer-reviewed [what does this mean?]. It reportsnew medical research that has yet to be evaluated and so should not be used to guide clinicalpractice .• Abstract• Info/ History• Metr ics•• Preview PDFAbstractBackground: Although the SARS-CoV-2 vira l load detection of respiratory specimen has been widely usedfor novel coronavirus disease (COVID-19) diagnosis, it is undeniable that serum SARS-CoV-2 nucleic acid(RNAaemia) could be detected in a fraction of the COVI0-19 patients. However, it is not clear that if theincidence of RNAaemia could be correlated with the occurrence of cytokine storm or with the specificclass of patients. Methods: This study enrolled 48 patients with COVID-19 admitted to the GeneralHospita l of Central Theater Command, PLA, a designated hospital in Wuhan, China. The patients weredivided into three groups according to the Diagnosis and Treatmen t of New Coronavirus Pneumonia(version 6) published by the Natio nal Health Commission of China. The clinical and laboratory data werecollected. The serum viral load detection and serum IL-6 levels were determined. Except for routinestatistical analysis, Generalized Linear Models (GLMs) analysis was used to establish a patient statusNIH-000935NIH-000936prediction model based on real-time RT-PCR Ct value. Findings: The Result showed that cases withRNAaemia were exclusively confirmed in critically ill patients group and appeared to reflect the illnessseverity. Further more, the inflammatory cytokine IL-6 levels were significantly elevated in critically illpatients, which is almost 10-folds higher than those in other patients. More importantly, the extremelyhigh IL-6 level was closely correlated with the incidence of RNAaemia (R=0.902) and the vital signs ofCOVID-19 patients (R= -0.682). Interpretation : Serum SARS-CoV-2 viral load (RNAaemia) is stronglyassociated with cytokine storm and can be used to predict the poor prognosis of COVID-19 patients.Moreover, our results strongly suggest that cytokine IL-6 should be considered as a therapeut ic target incritically ill patients with excessive inflammatory response.Disclaimer: Any third-party material in this email has been shared for internal use under fair use provisionsof U.S. copyright law, without further verification of its accuracy /veracity . It does not necessarily representmy views nor those of NT AID, NTH, HHS, or the U.S. government.From:Sent :To:Fauci, Anthony (NIH/NIAID) [E)Fri, 6 Mar 2020 04:01:59 +0000James KrellensteinSubject: RE: 2019-nCo\/ Testing fo r Public Health LabsJames:Thanks for the note. Be ass. ~red that I am trying to break this log jam.Best,TonyFrom: James Krellensteih (b)(6)sent: Wednesday, March 4, 2020 6:46 PMTo: Fauci, Anthony (NIH/NIAID) [E)_ _____ _(.b,.,),.(.=6)Subject: Re: 2019-nCoV Testing for Public Health LabsTony:I am loath to contact you given that I am sure you are overwhelmed . However, we are now beingcontacted by sources at tertiary academic hospita ls with CUA-high complexity clinical labs who arealarmed about their inability to scale up SARS-CoV2 qRT-PCR testing in t heir facilities in the time framethey feel is neccesary, even after Saturday's FDA regulatory guidance and the availability of IntegratedDNA Technology 's testing reagents. (An example of such an email is below.) I am passing th is along withthe hopes that if you can do something about it, you will. From an email:"We have experience bringing up laboratory deve loped tests. We have never submitted anEUA before. For our current LDTs, they are typically for pathogens that we have someexperience with, positive clinical samples are readily available, and/or appropriate controlmaterials (e.g. bact eria, viral genomes) are read ily commerc ially available. None of thoseare true for SARS-Co V2. There is tremendous concern about deploying a suboptima l testinto a challenging envirom11ent.The EUA guidance from FDA is not unreasonable for the validation of a new respiratoryvirus test, and it gives an accurate picture of the amount of testing that is required to bringon a new test by the lab. Federal law requires us to perform accuracy, reproducib ility,analytical sensitivity / LOD, and analyt ical specificity (cross reactivity) studies. Thosestud ies require pos itive contro l mater ial includingintact v irus or RNA. Clinica l labs are notprepared to generate RNA transcript , and we don't usually source these ourselves. Wecan't get the virus without filling out extensive paperwork that requires multiplesignatures. Getting control material for validation one of the biggest issues .NIH-000949Prior to the EUA change, the calculus for our labs was that it would take 3 to 4 weeks toactually validate a test, and then we would submit to the FDA for EUA (a process none ofus has ever done), and then we wou ld wait for the FDA to respond (hopefu lly in theaffirmative). I think we all expected the FDA EUA review to be at least 4 weeks. Based onthat time-line, many commercial vendors would have reagents available with their ownEU As that would be able to be performed on large automated instruments includingpotentially STAT. None of the LDT assays (or CDC assay) can be performed STAT or ondemand.With the EUA change, the proc ess to va lidate the test is st ill the same and will still take 3or more weeks. Once validated, we can perform clinical testing (like any other LDT) whilewe submit the EUA. This would likely allow us to begin testing several weeks beforecommercial vendors have EUA reagents available based upon our best currentinfonnation. Most of us expect to transition a commercial EUA at some point.The recent statement that IDT reage nts can be used under the EUA from CDC ismisleading. It applies to a very limited number of lots ( cunently 1, likely 2 soon), itassumes reagents are available, and it requires strict adherence to the CDC protocol usingidentical extraction methods (2 choices) and amplification/ detection methods ( linstrument). It still specifies the use of an Nl, N2, and NJ reactions, but CDC has droppedthe N3 reaction. The EUA has not yet been updated. Neither of our hospitals have thecomplete extract ion or amplifi cation instruments so we have to do the EUA anyway."Hope you are coping ok,JamesJames 8. Krellenstein109 S 5th St,Brooklyn, NY 11249(b)(6) (mobile)(b)(6)On Sun, Feb 2, 2020 at 7:36 PM James Krellenstein ---------(b)( > wrote:Tony:I hope this email finds you well. Over the past 48 hours, PrEP4AII has received multiple requests fromleaders of public health departments and public healt h practitioners to begin publicly pressuringNIH-000950CDC/HHS to ensure that properly equipped publ ic health labs (besides CDC's lab in Atlanta) canperform real time reverse transcr iption PCR (qRT-PCR) testing for 2019 Novel-Coronavirus (2019-nCoV).Our understa nding is that given the public health emergency declared by HHS, an emergency useaut horization (EUA) from the FDA is required for public health labs to perform their own labdeveloped test for 2019-nCoV, even if it is using the CDC's published qRT-PCR protoco l andprimer/probe sequences (https://www.cdc .gov/coronav irus/20 19-ncov/down loads/rt -pcr-panel-for -detection -instruct ions.pdf), and the lab is capable of handling BSL3+ samples.We understand the extreme delicateness of this situation, and also that it is outside of our normalwheelhouse. But given the concerns of our colleagues in the public health sector, we thought it wasimportant to give you a heads up regard ing this request .Let us know if there is anyway we can help .Sincerely,James KrellensteinData, Science and Policy CommitteeThe PrEP4AII Collaboration109 S 5th St, Brooklyn, NY 11249(b)(6)James B. Krellensteinhe- him - his(b)(6)(Sent from a mobile device)NIH-000951From:Sent :To:Subject:Attachment s:FYIFauci, Anthony (NIH/NIAIO) [E)Fri, 6 Mar 2020 04:00:31 +0000(b)(6)FW: Covid-19 causes CRS (and source of mortality)Ruan2020 Article_ Clinical Pred ictorsOfMorta lityD. pdfFrom: Pavletic, Steven (NIH/NCI) [E) -------- (b)(6)>Se nt: Wednesday, March 4, 2020 10:18 PM ------~~ To: Fauci, Anthony (NIH/NIAID) [E] -------- (b)(6)> Subject: FW: Covid-19 causes CRS (and source of mortality)Dear Dr Fauci, this is not an area of my expertise, but given the urgency of situat ion with the Covid-19and some of our experiences with treating CART induced cytokine release syndrome in cancer patients,just wanted to share this email with you in case you find it of interest . Dr Betts is my brilliant junior BMTcolleague at University of Minnesota. I realize this may be old news to you but wanted to share just incase.Warm regardsSteve PavleticFrom: Brian Betts (b)(6)>Sent : Wednesday, March 4, 2020 2:06 PM ------ --~ To: Pavletic, Steven (NIH/NCI) [E] (b)(6)>Subject: Covid-19 causes CRS (and source of mortality)Hi Steve,This is an interesting paper from intensivists in Wuhan. The IF of the journal is 18 too .Looks like covid-19 causes an IL-6 mediated CRS with myocarditis, which is associated with mortality(more so than the pneumonitis) .This suggests we should be more concerned with getting tocilizumab for critically ill covid-19 patients,rather than tam iflu and ARVT ...Do you have a friend at the CDC that could use this info?Thanks, BrianBrian C. Betts MOAssociate Professor of MedicineDivision of Hematology, Oncology and TransplantationUniversity of MinnesotaNIH-000952NIH-000953The infor mation transm itte d in this e-mail is intended only for the person or entity to which it is addressed and may contain confidential and/orprivileged material, Including "protected health informa tion ." If you are not th e inten ded recipient, you are hereby notified that any review,retransmission, disseminat ion, distribution, or copying of this message is strictly prohibited. If you have received this communication in error, pleasedestroy and delete th is message from any computer and contact us immed iately by return e-mail.From:Sent :To:Fauci, Anthony (NIH/NIAIO) [E)Fri, 6 Mar 2020 03:57:38 +0000Conrad, Patricia (NIH/NIAID) [E);Greg Folkers (b)(6)Subject: FW: COVID-19 event Friday @CSIS Tony March 20, 1:30pm-3:30pmLet us discuss.From: Stephen Morrison <SMorriso@csis.org>Sent : Thursday, March 5, 2020 7:02 AMTo: Fauci, Anthony (NIH/NIAID) [E]-------= (b-)c(c-6-)=Cc: Conrad, Patricia (NIH/NIA ID) [El- -------- (b)(6)>; Samantha Stroman <SStroman@csis.org>Subject: Re: COVID-19 event Friday @CSIS Tony March 20, 1:30pm-3 :30pmHi TonyWill March 20 work for you?Best SteveOn Mar 2, 2020, at 10:07 AM, Stephen Morrison <SMorriso@csis.org> wrote:TonyI know the demands on you have skyrocketed, so I am circling back to confirm you are stillavailable on Friday March 20 for the COVID-19 event, and also to seek your advice, as weamend the layout of the event, including possibly having it run a little longer .I am still hoping you can do a big picture scene sette r {15-20 minutes with slides)(i) The state of the science surrou nding the virus, what we know and do notknow,(ii) Progression of the outbreak(iii) Testing(iv) Status of accelerated early work on vaccines, antiviralsWe wi ll have a panel that covers China, and we may add a panel on the epicenters in Italy,ROK, IranI would like to carve out ample space for discussion of the United States. In your view, is itadvisable to put a request forward to Secy Azar or VP Pence? Neithe r needs a platform tohave thei r voices heard. But perhaps they would see this sort of sett ing as an opportunity.If not the Secy or VP, is there anyone else you might propose? I had reached out earlier toSteve Biegun to speak on the foreign policy dimensions, especially regarding China, buthave not heard back.I have separately reached out to the NGA about possibly enlisting a governor to speak.NIH-000954If you are free and wish to speak by phone a bout any of this, please let me know.Best of luck with everything. You seem to be making progress!Best SteveCell- ----(b)(6)NIH-000955From:Sent :To:Subject:Domenico:F.aucl, Anthony (NIH/NIAID) [ElFri, 6 Mar 2020 03:56:47 +0000MAVILIO Domenico ICHRE: CiaoThanks for the note. Indeed, this outbreak has changed the lives of many people, includingme. I am doing nothing else but coronavirus. I cannot predict when the travel restriction forNorthern Ita ly will be removed. I hope soon, but I doubt that. STAY WELL.Best regards,TonyFrom: MAVILIO Domenico ICH (b)(6) ------------- Sent: Thursday, March 5, 2020 7:49 AM To: Fauci, Anthony (NIH/NIAID) [El-- -----------::--:-:-:(-b)=(6)> Subject: CiaoHi Tony,ju st a short notice to tell you that you are becoming even more popular in Italy as your face andinterviews are everywhere on the main Italian broadcasting news and journals .It seems like to be in USA again for me, as I see you every day and I can tell you are doing well althoughyou must be overwhelmed with all this. I was supposed to be at NIH in tre weeks from now, but I havecancelled the flight and travel due to highest restrictions from CDC and HHS for Italian travellers fromLombardia and Veneto (and I live in Milan).Can we estimate how long all this will last? Weeks or months according to you knowledge?Hope to see you soon anyway and I really hope U.S. outbreak will not turn as bad as the Ita lian one.Indeed, Milan is living a real unprecedented (for modern t ime) and surrealistic situati on with a mix offear, panic and incredulity among people. It almost seems a movie! The government shut down halfcountry by closing all schools and universities, by not allowing meetings of any kind, by limi ting travels inmany places and by placing severe restrictions in social life. They even stopped the Fashion week inMilan that is a big thing here.Maybe too late, but they didi it and we hope it will work somehow to reach a plateau in contagious.have a nice dayCiaoDomenicoDomenico Mavilio, M.D., Ph.D.Associate Professor of Translational MedicineNIH-000956Department of Medical Biotechnologies and Translational MedicineMedical School of Milan University , Milan, ItalyPrincipal InvestigatorHead, Unit of Clinical and Experimental ImmunologyHumanitas Research Hospital, Rozzano, Milan, ItalyAdjunct InvestigatorLaboratory of Cardiovascular Regenerative Medicine,Nationa l Hearth, Lung and Blood InstituteNationa l Institutes of Health, Bethesda, MD, USA(b)(6)Phone: (b)(6)Fax: +39 02 8224 5191emai ls: (b)(6).J========= (b~)(=6X(b)(6)webpage: http ://www . human itas-research.org/ category/p ri nci pa I-investigator /mav il io/h m YNIH-000957From:Sent :To:Cc:Subject:Kyra:Fauci, Anthony (NIH/NIAID) [E)Fri, 6 Mar 2020 03:51:21 +0000Phillips, KyraConrad, Patricia (NIH/NIAID) [ElRE: Hi Tony ! Univ of Nebraska .....Thank s for the note. You would .have to go through my Special Assistant, Patty Conrad, who is copied on this email.Best,Tony----- Original Message- ----From: Phillips , Kyra <Kyra .Ph illips@abc.com>Sent: Thursday, March 5, 2020 9:30 A-M- -----,:,,:-:= To : Fauci , Anthony (NTH/NIAJD) [E] --------- (b)( Su~ject: Re: Hi Tony! Univ of Nebraska .....Good morning! I made contact and it's in the works! We even have them in our 20/20 spec ial tomorrow night!Question: do you think you could go live with me from NIH or WH one day next week for our Noon Coro navirusshow? it 's live steamed so we have millions of viewers . We would take viewer questions (1 would give you ahead oftime) and you would answer only those you want to.I t's a half hour show , but we would do whatever amowlt of time your sched ule allows.It would be so impactful for the average viewer.V/RKyra@KyraPhillips , ABC NewsJnvestigative CorrespondentKyraPhillips.Com(b)(> On Mar 3, 2020, at 10:32 PM, Fauc i, Anthony (NTH/NJATD[)E ]>> Kyra:-------- (b) (6)> wrote:> They very well might let you do it. It is worth a try. The containment there is exce llent and there is noevidenc e ofcommuniLy spread in Omaha.> Best,> Tony>> -----Original Message-----> From: Phillips , Kyra <Kyra.Phillips @abc.com>> Sent: Tuesday, March 3, 2020 6:21 PM- -----~~ > To: Fauci, Anthony (Nlli/NIAID) (E] Cb) ( >> Subject: Hi Ton y! Univ of Nebraska .....>> Ton y,> Do you think the University of Nebraska would let me in to do a story for ABC News on the therapeutics they areworking on?> Would it even be safe for me to do it?NIH-000958> Appreciate how you are holding court during this crisis.> Respectfully ,> Kyra>>> @KyraPhillips, ABC News> Investigative Corre spondent> KyraPhillips.Com> (b) (6)>NIH-000959NIH-000688From:Sent:To:(b)(6)Tue, 10 Mar 2020 14:57:59 -0400Short, Marc T. EOP/OVPSubject : Re: White House Coronavirus Task Force Meeting at **3:30pm** on 3/10/20Marc:I likely will be several minutes late since 1 have to come down from Bethesda by Metro and the time changethrew me off. Sorry.Tony> On Mar l 0, 2020 , at 2:49 PM, Short , Marc T. EOP/OVP (b) (6) wrot e:> ---------->> <White Hou se Coronavirus Task Force Meeting at **3:30pm** on 3_10_20>NIH-000708NIH-000711(bX5)-PCENIH-0007 12From:Sent:To:Cc:Subject:Natalie:Fauci, Anthony (NIH/NIAIO) [E)Tue, 10 Mar 2020 15:59:26 +0000Hurst, Natalie R. EOP/OVPMarston, Hilary {NIH/NIAID) [E]RE: Important Updates - White House Coronavirus Subtask Force CallsPlease add my Assistant, Dr. Hilary Marston, to the list of invitees to theSubtask Force Calls. She reports directly to me and is my source of de-briefingafter the calls. I am copying her on this e-mail. Many thanks.Best regards,TonyAnthony S. Fauci , MDDirectorNational Institute of Allergy and Infectious DiseasesBuilding 31, Room 7A-0331 Center Drive, MSC 2520National Institutes of HealthBethesda , MD 20892-2520Phone : (b) (6)FAX: (301 496-4409E-mail , (b)(6)The infor mation in this e-mail and any of its attachments is confidential and may conta in sensitiveinformat ion. It shou ld not be used by anyone who is not the original intended recipient . If youhave received this e-mail in error please inform the sender and delete it from your mailbox or anyother storage devices . The National Institute of Allergy and Infectious Diseases (NIAID) shall notaccept liability for any statements made that are the sender's own and not expressly made onbehalf of the NIAID by one of its representatives .From: Hurst, Natalie R. EOP/OVP (b)(6)Sent: Tuesday, March 10, 2020 11:22 AMSubject: Important Updates - White House Coronavirus Subtask Force CallsImportance: HighGood morning all,I wanted to send a note to clarify the White House Coronavirus Subtask Force Calls moving forward.There will be a Whit e House Coronavirus Subtask Force Call every day, unless otherwi se directedby Olivia Troye , Dr. Debi Birx, or me.• Monday - Friday, the call will take place at 9:00am• Saturday - Sunday, the call will take place at 10:00amStart ing this evening, I will send a new calenda r invite for the rem ainder of this week's calls(Wednesday , March 11 / Thursd ay, March 12 / Friday, March 13). On Friday, March 13, I will send aca lendar invite for this weekend's calls (Saturd ay, March 14 & Sunday, March 15).NIH-000718Looking ahead -• Invites for weekday calls will be sent on Sunday nights .• Invites for weekend calls will be sent on Friday nights.• Please note : Call-in numbers for Saturday & Sunday will be different from the numberused Mondays - Fridays.** If you would like to be removed from this distributio n list, please respond to this email before5:00 pm ton ight, so that you will be removed starting Thursday morni ng.*"Please do not hesitate to reach out with any quest ions or concerns.Thank you,Natalie HurstOperat ions Coordinator, White House Coronavirus Task ForceExecutive Assistant to the Chief of StaffThe Office of the Vice Pres ident(b)(6)NIH-000719(bX5) -PCP.NIH-000809(b)(5) - PCP.NIH-000810NIH-000811NIH-000843NIH-000844NIH-000845From:Sent:To:Fauci, Anthony (NIH/NIAID) [E)Sun, 8 Mar 2020 01:38 :49 +0000Conrad, Patricia (NIH/NIAID) [E)Subject: FW: White House Coronavirus Task Force Meeting on 3.8.20 at 4:00pmI need WAVES, please. Thanks.From: Hurst , Natalie R. EOP/OV P- ---------- (b)(6) Sent: Saturday, March 7, 2020 8:30 PMSubject: Whi te House Coro navirus Task Force Meeting on 3.8.20 at 4:00pmImportance: HighAll-There will be a White House Coronavirus Task Force Meeting on Sunday , March 8 th at 4:00 pmin the White House Situation Room. Agenda will be forthcoming .Thank you ,Natalie HurstOpera tions Coordinator, Wh ite House Coronaviru s Task ForceExecutive Assistant to the Chiefo f StaffThe Office of the Vice Pr es id ent(b)(6)NIH-000853From:Sent :To:Subject:Fauci, Anthony (NIH/NIAID) [E)Fri, 6 Mar 2020 04:03:24 +0000Greg Folkers (b)(6)FW: 2020 03 03 SC POTUS NIH Roundtable. Email #1Attachments : P20200303SC-0059.jpg, P20200303SC-0066.jpg , P20200303SC-0088.jpg,P20200303SC-0109 .jpg, P20200303SC-0123.jpg, P20200303SC-0182.jpg, P20200303SC-0272.jpgFor the fi leFrom: Hansen, Daniel E. EOP/WHO (b)(6)>Sent: Wednesday, March 4, 2020 6:36 PM ----~~ To: Fauci, Anthony (NIH/NIAID) [E] (b)(6)>Subject: FW: 2020 03 03 SC POTUS NIH Roundtable. Email #1Photos from POTUS visit Tuesday NIH For Your PersonalArchives2020 03 03 SC POTUS NIH Roundtable. Email #1P20200303SC 0088President Donald J. Trump listens as Dr. Francis Collins, director of theNational Institute of Allergy and Infectious Diseases, addresses hisremarks during a coronavirus roundtable briefing Tuesday, March 3,2020, at the National Institutes of Health in Bethesda, Md. (OfficialWhite House Photo by Shealah Craighead)P20200303SC 0066 0109NIH-000937NIH-000938President Donald J. Trump participates in a coronavirus roundtablebriefing Tuesday , March 3, 2020 , at the National Institutes of Health inBethesda, Md. (Official White House Photo by Shealah Craighead)P20200303SC 0059 0123 0182President Donald J. Trump listens as Dr. Anthony S. Fauci, director ofthe National Institute of Health , addresses his remarks during acoronavirus roundtable briefing Tuesday, March 3, 2020, at the NationalInstitutes of Health in Bethesda , Md. (Official White House Photo byShealah Craighead)P20200303SC 0272President Donald J. Trump answers questions from reporters during acoronavirus roundtable briefing Tuesday, March 3, 2020, at the NationalInstitutes of Health in Bethesda, Md. (Official White House Photo byShealah Craighead)Please note that these photos are being sent to you for personal useonly. If you share them with friends or family, make sure to include thedisclaimer below. Thank you.If posting to social media the following byline must be used: OfficialWhite House Photo by Shealah CraigheadThis photograph is provided by THE WHITE HOUSE as a courtesy andmay be printed by the subject(s) in the photograph for personal useNIH-000939only. The photograph may not be manipulated in any way and may nototherwise be reproduced, disseminated or broadcast, without thewritten permission of the White House Photo Office. This photographmay not be used in any commercial or political materials ,advertisements, emails, products, promotions that in any way suggestsapproval or endorsement of the President, the First Family, or theWhite House.Dan HansenWH Photo OfficeNIH-000940NIH-000941From: Fauci, Anthony (NIH/NIAID) [E)Sent : Fri, 6 Mar 2020 04:02:46 +0000To: Greg Folkers (b)(6)Subject: FW: 2020.03.03 WH bSouth Lawn Arrival from NIH and Press gaggleAttachments : P20200303JB-t34 7 .jpg, P20200303JB-1380.jpg, P20200303J 8-1393.jpg,P20200303JB-1473.jpg, P20200303JB-1531.jpg, P20200303JB-1554.jpg, P20200303JB-1606.jpg,P20200303JB-1630.jpg, P20200303JB-1708.jpg, P20200303JB-1742.jpgFor the fi leFrom: Hansen, Daniel E. EOP/WHO (b)( >Sent: Wednesday, March 4, 2020 6:42 PM -------=-:-= To: Fauci, Anthony (NIH/NIAID) [E) (b)(6)Subject: FW: 2020.03.03 WH bSouth Lawn Arrival from NIH and Press gaggleSubject: 2020.03.03 WH South Lawn Arrival and Press gaggle for Personal ArchivesP20200303JB-1347, 1380, 1393President Donald J. Trump, joined by Dr. Anthony S. Fauci, director of the National Institute of Health,and Secretary of Health and Human Services Alex Azar, disembarks Mar ine One on the South Lawn ofthe White House after attending a coronavirus roundtable briefing Tuesday, March 3, 2020, at theNatio nal Institutes of Health in Bethesda, Md. (Official White House Photo by Joyce N. Boghosian)P20200303JB-1473President Donald J. Trump, joined by Dr. Anthony S. Fauci, director of the National Institute of Health,listens as Secretary of Health and Human Services Alex Azar answers a reporter's question followingPresident Trump's return from attending a coronavirus roundtable briefing Tuesday, March 3, 2020, atthe Nation al Institutes of Health in Bethesda, Md. (Official White House Photo by Joyce N. Boghosian)P20200303JB-1531, 1554, 1606President Donald J. Trump, joined by Secretary of Health and Human Services Alex Azar, listens as Dr.Anthony S. Fauci, directo r of the National Institute of Health answers a reporter's question followingPresident Trump's return from attending a coronavirus roundtable briefing Tuesday, March 3, 2020, atthe National Institutes of Health in Bethesda, Md. (Official White House Photo by Joyce N. Boghosian)P20200303JB-1630,1708President Donald J. Trump, joined by Dr. Anthony S. Fauci, director of the National Institute of Health,and Secretary of Health and Human Services Alex Azar, speaks with reporters following his return to theWhite House after attending a coronavirus roundtab le briefing Tuesday, March 3, 2020, at the NationalInstitutes of Health in Bethesda, Md. (Official White House Photo by Joyce N. Boghosian)P20200303J B-17 42NIH-000942President Donald J. Trump, Or. Anthony S. Fauci, director of the National Institute of Health , andSecretary of Health and Human Services Alex Azar, walk to the Oval Office Tuesday, March 3, 2020, atthe White House. (Official White House Photo by Joyce N. Boghosian)Dan HansenWhite House Photo Office(b)(6)NIH-000943NIH-000944NIH-000945NIH-000946NIH-000947NIH-000948From:Sent :To:Cc:(b)(6)Mon, 2 Mar 2020 08:32:20-0500Tabak, Lawrence (NIH/OD) [E)Collins, Francis (NIH/OD) [E];Marston, Hilary (NIH/NIAID) [E];Conrad, Patricia(NIH/NIAID) [E]Subject: Re: TIME SENSITIVELarry:Let Hilary do this. I am on a conference call.Thanks ,TonyOn Mar 2, 2020 , at 8:27 AM, Tabak , Lawrence (NIH/OD) [E]Cb()6 )>wrote:Tony-Could one of your folks give me a quick read out on this please? (should I reach out toHilary Marston?) . This is the paper that DOE alluded to in the initial conference call we hadwith OSTP. I will respond informed by your staff's guidance.LarryFrom: "Mango, Paul (HHS/10S)" Cb()6 J>Date: Monday , March 2, 2020 at 8: 19 AMTo : Stephen Hahn CbH6>J, "Lenihan, Keagan (FDA/OC)"--------- Cb)( >, Anthony Fauci Cb)( ·, "Tabak,Lawrence (NIH/OD) [E]" Cb(>6) , "Redfield, Robert R.(CDC/OD)" CbH6")M cGowan, Robert (Kyle) (CDC /OD/OCS)"------- CbH>6J, "Berger, Sherri (CDC/OCOO /OD)" CbH> Cc: "Harrison, Brian (HHS /JOS)" Cb<) 6>JSubject: TIME SEN SITIVEDr Hahn and the FDA team in particular , but with input from relevant SMEs at CDCand NIH, please give the brief attached doctunent and quick read on comment on theusefulness of us sett ing up a sess ion with the folks at DOE today to discuss further .Many thanksSent from my iPhoneBegin forwarded message:NIH-001047From: ".Harrison, Brian (HHS/1OS)"Date : March 1, 2020 at 6:15:54 AM EST(b)(6)To: CbH6J(O S /1OS)" CbH6J --~ =Cc: "Steck er, Judy (OS/IOS)" ------- (b)(6) , "Mango, Pau l (HHS/IOS)" Cb>< >Subject: FW:With attachment. I've asked CDC, FDA, NIH, and ASPR to review .From: Brouillette, Dan ---------- (b)(6) Sent: Friday, February 28, 2020 9:58 PMTo: Harrison, Brian (HHS/IOS) ______ "("b'.H.,.=.6. )Subject:Bria n:As we discussed earlier this evening, here 's a preliminary finding fromscientists at Oak Ridge National Laboratory using the Summitsupercompute r system. We stand ready to assi st in any manne r helpfulto you and Secretary Azar. Very best,DanSent with Black.Berry Work(www.b lackberry .com)<coronavirus.pdf>NIH-001048From: Fauci, Anthony (NIH/NIAID) [E)Sent: Mon, 24 Feb 2020 11:15:02 +0000To: Kadlec, Robert (OS/ASPR/IO);Redd, John (OS/ASPR/SPPR);YeskeyK, evin(OS/ASPR/IO);Shuy, Bryan (OS/ASPR/IO);Phillips, Sally (OS/ASPR/SPPR)Cc: Redfield, Robert R. (CDC/OD)Subject: RE: Red Dawn Breaking, COVID-19 Collaborative, Feb 16 startWe really need to discuss this.From: Kadlec, Robert (OS/ASPR/10)- --------(b)( > Sent: Sunday, February 23, 2020 11:31 PMTo: Redd, John (05/ASPR/SPPR)------~ (b~)(=,; Yeskey, Kevin (OS/ASPR/10)(b)(6)>; Shuy, Bryan (OS/ASPR/10) (b)( ; Phillips, Sally(OS/A SPR/SPPR) (b)(6b----:---:---:-:.:==!--~Cc:R edfield, Robert R. (CDC/OD)- ----- (b)(6); Fauci, Anthony (NIH/NIAID) [E] (b)(6)Subject: Fwd: Red Dawn Breaking, CO\IID-19 Collaborative, Feb 16 startRead this! This is unsettling if true efficient spreading in asymptomatics with negative test . Is thatpossible? Report is intermittent shedding is that true or artifact of poor sample collection or lack ofsensitivity of per testing?From Dr Eva Lee Ga Tech"Means of spread A study from AMA confirmed many of the parameters assumed in ourmodels:- A 20-year old infected wi th COVID-19 left Wuhan and went on infecting 5 relatives. Whenthey tested positive, she was finally isolated , but tested negative still, and later testedpositive , and remain normal on chest CT with no fever, stomach or respiratory symptoms(cough or sore throat as late as Fen 11 (time of the papert study duration).So spreading and its wide scope is unavoidable because the re exists these very healt hyindividuals who can spread effectively -- even during incubation per iod -- while theyremain perfectly healthy . It also showcases difficulty in testing-- negative test -- may notbe the end of it. "Sent from my iPhoneNIH-001465Begin forwarded message:From: "Dr. Eva K Lee" (b)(6)>Date : February 23, 2020 at 7:37:12 AM ESTTo: Carter Mecher (b)(6)>Cc: Richard Hatchett (b) (6)>, Tracey McNamara=========(=b)( ::>,: ":C.a.n.e :va.,. .D uane" (b)(6), ...(;b,.~._=c.6, )>, "Dodgen, Daniel (OS/ASPR/SPPR)"-=======:::-(b:),(6:)=>, :";D:e-B-ord, Kristin (OS/A SPR/SP-P-R-") ----~~ (b)(6)>, "Phillips, Sally (OS/ASPR/SPPR)" (b)( >,David Marcozzi (b)(6)>, "Hepburn, Matthew J CIV USARMY(USA)" (b)(6)>, Lisa Koonin (b)( "Walters,Will iam (STATE.GOV)" (b)(6) , "HARVEY, MELISSA"(b)(6), "WOLFE, HERBERT" (b)(6)>,"Eastman, Alexander" (b)(6)>, "EVANS, MARIEFRED"(b)(6), "Callahan, Michael V.,M.D."(b)(6)>, "Johnson, Robert (OS/ ASPR/BARDA)"(b)(6)>, "Yeskey, Kevin" (b)(6), "Disbrow, Gary(b)(6)>, "Redd , Johnt(OS/ASPR/SPPR)".,;_..;___...;_ __ ~,::;;-""'.'.'"'---:-:--~-:-:--.---------- >, "Hassell, David (Chris) (OS/ASPR/1O)" (b)(6) "Hamel , Joseph (OS/ASPR/1O)" (b)( >, "Dean, Charity A@CDPH"(b)(6)>, "Lawler , James V" (b)(6), "Kadlec,Robert (OS/ASPR/1O)" (b)(6) "'Martin, Gregory J':':'"""--:-~--"'.-:.:=====(=b)(=6)>=, ":B~or;io-,: :L-uc-ia-n-a-" ,_ ____ (b)(6.),. ._"H_an fl_ing_:, :_D:_:.a.n~." .=_====-:=(~b)(6 ) "McDonald, E-r-ic-" -----~= (b)(6) "Wade, David" (b)(6)"TARANTINO, DAVID A" (b)(6)>, "WI LKINSON, THOMAS"(b)(6)>, "David Gruber (b)(6) " ===========~c:;---7."."" """".'":'.~========:=;.~ (b)(6) , "KAUSHIK, SANGEETA" (b)( >,Nathaniel Hupert (b)(6)>Subject: RE: Red Dawn Breaking, COVID-19 Collaborative, Feb 16 startReply-To: "Dr . Eva K Lee" (b)(6)>A few things I want to highlight --1. Means of spread A study from AMA confirmed many of the parameters assumed in ourmodels:- A 20-year old infected with COVID-19 left Wuhan and went on infecting 5 relatives. Whenthey tested positive , she was fina lly isolated, but tes ted negative stil l, and later testedpositive, and remain normal on chest CT wit h no fever, stomach or respiratory symptoms(cough or sore throat as late as Fen 11 (time of the papert study duration).So spreading and its wide scope is unavoidable because there exists these very healthyindividuals who can spread effect ively -- even dur ing incubation period -- while theyremain perfectly healthy. It also showcases difficulty in testing -- negative test -- may notbe the end of it.NIH-0014662. Iranian cases, though mysterious since the origin was not traced to China, may very wellshow that COVID-19 vi rus is very adaptable and mutating rapid ly.3. Long recovery The long recovery period is troubesome and must be taken seriously byhealth providers as they prepare for hospitalization. Therei snot much surge capacity inhospitals. So they must be innoative in the staggering process and isolation is ofparamount importance. Government/Local should be readied for supplementing medicaltents outside hospitals when needed (clearly extra staff too) .4. Citizes' view I was traveling so I did a real-time on-the-road analysis of human behaviorand anxiety level. I overheard many people-- (a) asked when CDC would tell us more on what to do.-- (b) wish they could pull their kids out of school but there is no such option as part of thepreventive measure (not announced by CDC).-- (c) wish CDC wou ld recommend tele-work options so they don't have to travel andexpose themselves and their family to unneccessary risk.-- (d) have no clue what the government is doing to keep the risk low as it is now. Whatexactly is being implemented to keep it low.5. Resource-limit ed countri es I pray that it would not reach the resource-limited countrieslike many in Afri ca (though it seems unavoidable). I cannot imagine the consequence.6. What we must do: We must leverage the knowledge from other countries to betterprepare ourselves. Japan's Crusis shows the importance of TIMELY proper isolation andSTRATEGICo perations logist ics in testing and in quarantine . South Korea (contrasting withHong Kong, Singapore) demonstrates critica l importance of EARLY social distancing andhigh compliance community NPI intervent ion. China's latest lockdown of 1/2 billion peopletruly signifies that gravity and unchartered terrority of this virus. No country would take tosuch extreme measure.7. CFR Since over 90% of influenza is never recorded/known, this COVID-19 seems to fallinto similar spirit now, with so many cases of asymptomtic and transmission whileincubating . While the true CFR remains unknown, the CFR of tested positive cases shouldoffer a good comparison to the CFR of tested positive flu cases. That gives us a clearerestimate of health-resource burden.(b)(6)mobile: ----(b)-(6)Sent with ProtonMail Secure Email.------- Original Message-------On Saturday, February 22, 2020 10:19 PM, Carter Mecher --------- (b)(6)> wrote:UpdatesNIH-001467South Korea (+123 with +2 deaths)- Total cases 556; Total deaths4https://www. cdc. go .kr/boa rd/board. es?mid=a3 0402 0O0O0O&bid=003 0Singapore (+3)--Total cases 89; Total deaths 0Hong Kong (unchanged)--Total cases 69; Total deaths 2Japan- Total cases 135; Total deaths 1Sent from Mail for Windows 10From: Carter Meche rSent: Saturday, February 22, 2020 6:28 AMTo: Richard Hat chett ; Dr. Eva K LeeCc: Tra cey McNama ra; Caneva, Duane; (b)(6); Dodgen , Daniel(OS/ASPR/SPPR); DeBor d, Kristin (OS/ASPR/SPPR); Phill ips, Sally(OS/ASPR/SPPR); David Marcoz zi; Hepburn, Matthew J CIV USARMY (USA);Lisa Koo nin; Wargo Mi chael ; Walte rs, Willi am (STATE.GOV); HARVEY,MELISSA; WOLFE. HERBERT; Eastman , Alexander ; EVANS, MARIEFRED;Callahan, Michael V.,M .D.; (b)(6);Johnson , Robert (OS/ASPR/BARDA); Yeskey, Kevin; Disbrow , Gary(O5/A SPR/BARDA); Redd, Johnt(OS/ASPR/SPPR); Hassell, David (Chris)(OS/ASPR/IO); Hamel, Joseph (OS/ASPR/1O); Dean, Charity A@CDPH; Lawle r,James V; Kadlec, Robert (OS/ASPR/1O); 'Mart in, Gregory J(b)(6) '; Borio, ------- -- Luciana; Hanfli ng, Dan; McDonald, Eric; Wade , David; TARANTINO, DAVID A; WILKINSON, THOMAS; David Gruber_________ Cb>_<_6J,; KAUSHIK. SANGEETA; Nathan iel HupertSubject: RE: Red Dawn Breaking, COVID-19 Collaborative, Feb 16 sta rtRoundup this morning .NIH-001468NIH-001469Singapore and Hong Kong are holding steady- both have implementedNPis pretty early and have good surveillance .Things are really accelerating in South Korea. Case count increased to433 with 2 deaths.https :/ /www .cdc. go .kr/board/board .es?mid=a30402 000000&bid=0030Report below of COVID hitting Samsung's mobile device factory,which has now been shut down. This is what will happen here. Thegreatest concern is what this would mean for critical infrastructuresectors (including components of our healthcare system), The strateg iesI outlined for outpatient clinics could be used by business (mostespecially CI sectors) to maintain business continuity. It is as simple asthe old saying, "Don't put all your eggs in one basket." It is bothcontingency planning ( continuity of operations /continuity of business)and application ofNPis/fLC (especially social distancing in thecommunity supported by home isolation and home quarantine).We now have COVID in several countries across the ME (Iran, Israel,Egypt, Lebanon , UAE) . We added Iran the day before yesterday and 3countries yesterday (Israel, Egypt and Lebanon). Iran already appearsto have a well established outbreak that will be tough to slow downgiven the estimated size with 5 deaths already (that is where Wuhanwas by Jan-20). Japan is also seeing acceleration with localtransmission (119 cases).Italy is another area to watch.htt ps://p rotect2.fi reeye.com/ url?k=c92f3372 -957b2a0e -c92f024d-0cc47adc5fa2-9270 140238 19d8ec&u=htt ps://www .ilgazzett ino. it/no rdest/. .. D0yaq109ac4o84 Numerous infected in the hospital of Schiavonia (Padua)"And unfortunately, what the experts feared since yesterday has occurred,when it was discovered that two patients had been hospitalized for about tendays at the Schiavonia hospital (Padua) without knowing that they hadcontracted the Coronavirus: since yesterday evening everyone those whoattended the hospital were subjected to a swab to detect any infections, andthe examination gave positive results in numerous cases. It means that thereare other people, probably among those who attended the ward where twopatients were hospitalized , who are now positive for the virus andconsequently could in turn have spread the infect ion. Already yesterdayevening the Governor of Veneta Luca Zaia ordered the progressiveevacuation of the Padua hospital which should take place within 5-6 days."NIH-001470'The hospital is surrounded by a 'sanitary cordon', with Carabinieri ,workers of the Red Cross and Civil Protection . Cardiology chiefGiampaolo Pasquetto aITived outside the hospital for a few minutes andreported the results of the swabs 'as far as I have been able to knowfrom my colleagues so far,' he said. The modern structure is locatedbetween the towns of Este and Monselice and was recently inauguratedto serve the Euganean Hills area ."https://www.reuters.com /article/us-china-health-southkorea -samsung elec/samsung-electronics -confirms-coronav irus-case-at-phone-factorycomplex-in-south-korea-idUSKCN20G0CGSEOUL (Reuters) - Samsung Electronics said on Saturday that onecoronavirus case had been confinned at its mobile device factorycomplex in the southeastern city of Gumi, causing a shutdown of itsentire facility there until Monday morning.Samsung Electronics, the world's top smartphone maker, said the floorwhere the infected employee worked would be shut down until themorning of Feb. 25."The company has placed colleagues who came in contact with theinfected employee in self-quarant ine and taken steps to have them testedfor possible infection," Samsung said in a news release.Samsung's factory in Gurni accounts for a small portion of its totalsmartphone production , and it makes high-end phones, mostly for thedomestic market. Samsung produces most of its smaiiphones inVietnam and India.Gumi is close to the city of Daegu , home to a church at the center ofSouth Korea's largest coronavirns outbreak.South Korea said on Saturday that the number of people infected withthe coronavirus in the country had more than doubled to 433.Samsung said production at its chip and display factories in other partsof South Korea would not be affected.Sent from Mail for Windows 10From: Carte r MecherSent : Friday, February 21, 2020 6:52 PMTo: Richard Hatchett ; Dr. Eva K l eeCc : Tracey McNama ra; Caneva, Duanei (b)(6); Dodgen, Daniel(OS/ASPR/SPPR); 0eBord, Kristin (OS/ASPR/SPPR); Phillips, Sally(OS/ASPR/SPPR); David Marcozzi; Hepburn, Matthew J CIV USARMY (USA);Lisa Koonin; Wargo Michae l; Walters, William (STATE.GOV); HARVEY,MELISSA; WOLFE, HERBERT; Eastman, Alexande r; EVANS, MARIEFRED;Callahan, Michael V.,M .D.; (b)(6);Johnson, Robert (OS/ASPR/BARDA); Yeskey, Kevin; Disbrow. Gary(OS/ASPR/BARDA); Redd, Johnt( OS/ASPR/SPPR); Hassell, David (Chris)(OS/ASPR/1O); Hamel, Joseph (OS/ASPR/ 1O); Dean, Charity A@CDPH; Lawler,James V; Kadlec, Robert (OS/A SPR/1O); 'Mart in, Gregory J(b)(6) · Borio, --------- Luciana; Hanfli ng. Dan; McDona ld, Eric; Wade. David; TARANTINO, DAVID A; WILKINSON. THOMAS; David Grube r----------- CbH6); KAUSHIK. SANGEETA; Natha niel Hupert Subject: RE: Red Dawn Breaking, COVID-19 Collaborative, Feb 16 startWuhan to add 19 addi tional hospital (when combined with the other 3hosp itals, this would add 30,000 beds).Just to put that in perspective.• There are 2.8 hospita l beds in the US per 1,000 population.• 30,000 beds is about the number of beds we would have for apopu lat ion of 11 M.When you add the 30,000 beds plus the 13,348 other beds added (totalof 43,300 beds)• There are 4.5 hospita l beds in China per 1,000 populatio n• 43,300 beds is about the number of beds in China for a population of9.6 M• Wuhan will have nearly doub led its bed capacityHow hard wou ld that be for us to double bed capacity in any major UScity? (Really isolation beds for mild illness)https: //www .straitstimes .com/ asia/east -asia/coronav irus -wuha n-toactivate -one-more -ternporary-hosp ita l-with -3690-beds?fbclid=lwARlotfl4xNxKiuB RuODJzoTDMJWHueF9gTc06u lIM9nM2u-3 VTpohO tFt7 sNIH-001471WUHAN (XINHUA)- Wuhan, the epicentre of the coronavirusoutbreak, plans to build another 19 makeshift hospitals to rece ive moreinfected pat ients, local authorit ies said Friday (Feb 21).Upon their completion, all the makeshift hospita ls in Wuhan areexpected to offer 30,000 beds on Feb 25, said Mr Hu Yabo, deputymayor of Wuhan at a press briefing on epidemic prevention andcontrol.To date, Wuhan has converted 13 existing venues into temporaryhosp itals, with a total of 13,348 beds, and about 9,313 beds have beenput into use to treat patient s with mild symptoms, said Mr Hu.Sent from Mai l for Windows 10From: Carte r Mec herSent: Friday, February 21, 2020 1:59 PMTo: Richard Hatche tt ; Dr. Eva K LeeCc: Tracey McNa mara; Caneva, Duane; (b)(6) Dodgen, Daniel(OS/ASPR/SPPR); DeBord, Kri st in (OS/ASPR/SPPR); Phillips, Sally(OS/ASPR/SPPR); David Marcozzi; Hepburn, Matt hew J CIV USARMY (USA);Lisa Koonin; Wargo Michael; Walte rs, Will iam (STATE.GOV); HARVEY,MELISSA; WOLFE. HERBERT; Eastm an. Alexande r; EVANS, MARIEFRED:Callahan, Michael V.,M .D.; (b)(6);Johnson , Ro bert (OS/ASPR/BARDA); Yeskey, Kevin; Disbro w, Gary(OS/ASPR/BARDA); Redd, Johnt(OS/AS PR/SPPR); Hassell, David (Chris)(0S/AS PR/10); Hamel, Joseph (OS/ASPR/ 10) ; Dean, Charit y A@CDPH; Lawler,James V; Kadlec, Robert (OS/ASPR/10); 'M art in, Gregory J(b)( ' ; Bo rio, Luciana; -------- Hanfli ng, Dan; McDonald, Eric; Wade, David; TARANTINO, DAVID A; WILKINSON, THOMAS; David Gruber_________ Cb>_<_6>,; KAUSHIK. SANGEETA; Natha niel HupertSubject: RE: Red Dawn Breaking , COVID-19 Collaborative, Feb 16 startWeekly CDC update looks like flu might be on the downs lope (goodnews). Watch ing the curves of% posi tive flu tests and ILi (should trackone another as flu is receding). Trouble is the data reported today is forthe week ending Feb 15 (so a week old).NIH-001472Our inpatient nursing sick leave is tracking ILI ( current thru 2/20)nothingunusualSent from Mail for Windows l 0From: Carter MecherSent: Friday, February 21, 2020 10:54 AMTo: Richard Hat chett ; Dr. Eva K LeeCc: Tracey McNamara; Caneva, Duane, CbH6)1; Dodgen , Daniel(0 S/ASPR/SPPR); DeBor d, Krist in (OS/ASPR/SPPR); Phillips, Sally(0S/AS PR/SPPR): David Marcozzi; Hepburn. Matt hew J CIV USARMY (USA):Lisa Koonin; Wargo Michael: Walt ers, William (STATE.GOV): HARVEY.MELISSA; WOLFE, HERBERT; Eastm an, Alexander ; EVANS, MARIEFRED:Callahan, Michael V.,M .D.. (b)(6)Johnson, Robert (05/AS PR/BARDA); Yeskey, Kevin; Disbrow, Gary(OS/ASPR/BARDA) ; Redd. Johnt(OS/ASPR/SPPR); Hassell, Dav id (Chris)(OS/ASPR/10) ; Hame l, Joseph (OS/ASPR/10) ; Dean , Charity A@CDPH; Lawler ,James V; Kadlec. Robert (OS/ASPR/10 ); 'Mart in, Gregory J(b)(6) '; Borio, Luciana; -------- Hanfli ng, Dan; McDonald. Eric; Wad e, David; TARANTINO. DAVID A; WILKINSON. THOMAS; David Gruber------------ (b)(6) KAUSHIK, SANGEETA; Natha niel Hupe rt Subject : RE: Red Dawn Breaking , COVID-19 Collaborative , Feb 16 startSingapore and Hong Kong are holding the line. Both implementedNP ls early. No change in numbers from Hong Kong and Singapore sawits case count increase by only 1 for the past two days.Japan reported to have 107 case s. First reported case in young children(se below)Hokkaido boy 1st Japan case of coronaviru s infection under 10February 21. 2020 (Mainichi Japan)NIH-001473SAPPORO -- Two elementary school brothers and a woman in her 40s inHokkaido have been infected with the new coronavirus, wi th the youngersibling becoming the first infection under 10 in Japan, Hokkaido Gov.Naomichi Suzuki announced on Feb. 21.Some graphics of the drop off in travel in China (pretty dramatic)Jan-23Feb-13Sent from Mail for Windows 10From: Carter Meche rSent : Friday, February 21, 2020 10:28 AMTo: Richard Hat chett ; Dr. Eva K LeeCc: Tracey McNama ra; Caneva, Duanei (b)(6); Dodgen, Daniel(OS/ASPR/SPPR); DeBord, Kristin (OS/ASPR/SPPR); Phillips, Sally(OS/ASPR/SPPR); David Marcozzi ; Hepbu rn. Mat thew J CIV USARMY (USA);Lisa Koo nin: Wargo Mich ael; Walters , William (STATE.GOV): HARVEY,MELISSA; WOLFE, HERBERT; Eastman , Alexander ; EVANS, MARIEFRED;Callahan, Michael V.,M .D.; (b)(6);Johnson, Robert (OS/ASPR/BARDA); Yeskey. Kevin; Disbrow, Gary(OS/ASPR/BARDA); Redd. Johnt (OS/ASPR/SPPR); Hassell. David (Chris)(OS/ASPR/1O); Hamel, Joseph (OS/ASPR/1O); Dean. Char ity A@CDPH; Law ler,James V; Kadlec. Robert (OS/ASPR/1O); 'Mart in, Gregory J(b)(6); Borio. Luciana; -------- Hanfli ng. Dan; McDon ald, Eric; Wade. David; TARANTINO, DAVID A; WILKINSON. THOMAS: David Grube r( CbH6XKAUSHIK, SANGEETA: Nathan iel Hupe rtSubject: RE: Red Dawn Breaking , COVID-19 Collaborative, Feb 16 startNIH-001474https://www.cdc.go.kr/board/b oard.es?mid=a3040200000 0&bid=0030Here is the best link to track cases in South Korea. South Korea is nowup to 204 cases and 1 death (South Korea is where Wuhan was 1 monthago).Sent from Mail for Windows l 0From: Carter MecherSent : Friday, February 21, 2020 10 :02 AMTo: Richard Hatchett ; Dr. Eva K LeeCc: Tracey McNamara ; Caneva, Duane (b)(6); Dodgen, Daniel(OS/ASPR/SPPR); 0eBord, Kri stin (OS/ASPR/SPPR); Phillips, Sally(OS/ASPR/SPPR); David Marcozzi; Hepburn, Matthew J CIV USARMY {USA);Lisa Koonin; Wargo Michael ; Walters, William (STATE.GOV); HARVEY,MELISSA; WOLFE, HERBERT; Eastman , Alexander ; EVANS, MARIEFRED;Callahan, Michael V.,M .D.; (b)(6)Johnson, Robert (OS/ASPR/BARDA); Yeskey, Kevin; Disbrow. Gary(OS/ASPR/BARDA); Redd, Johnt(OS/ASP R/SPPR); Hassell, David (Chris)(OS/ASPR/IO); Hame l, Joseph (OS/ASPR/1O); Dean, Charity A@CDPH; Lawler,James V; Kadlec, Robert (OS/ASPR/1O); 'Mart in, Gregory J-------- (b)(6) · Borio, Luciana; Hanfl ing, Dan; McDonald, Eric; Wad e, David; TARANTINO, DAVID A; WILKINSON, THOMAS; David Gruber----------- CbH6JK; AUSHIK, SANGEETA; Nathan iel Hupert Subject: RE: Red Dawn Breaking , COVID-19 Collaborative, Feb 16 startOn a totally diffe rent note. Others have been plying with andmodify ing the notiona l conops for a healthcare system.I set up some simple rules :1. Protect uninfected patients and staff from infectious patients andstaff (using all the tools that we have includin g home isolation andhome quarantine , cohorting/physical separation, PPE, telehealth,etc.)2. Provide acute care for COVID pat ients (cont inuum of ER-inpatientcare-intensive care)3. Support mildly ill COVID patients in home isolation --telehealth4. Support patients in voluntary home quarantine- -te lehea lthNIH-001475NIH-0014765. Continue to address the usual mix of healthcare needs for patients(from outpatient care to acute care to mental health care to longterm care)a. Outpatient clinics and providers focus on wellness tominimize ER visits/hospitalization to unburden the acutecare system-leverage telehealthb. Continue to provide acute care and inpatient mental healthcare (continuum of ER-inpatient care-intensive care) for nonCOVIDconditionsc. Protect high-risk patients in residential/long term care(nursing homes, hospice, long term psychiatry, etc.)The notional conops divides the healthcare system into hot and safeareas. The hot area is only acute care: ER-acute inpatient care-ICUcare. The safe areas include a separate acute care area (ER-acuteinpatient care-ICU care), all the outpatient clinics/care, other inpatientcare areas such as mental health, as well as long term/residential care(nursing home, hospice , long term psychiatry, etc.).Triage will not be easy (between hot and safe). Best I could come upwith would be: ( 1) anyone already on home isolation or homequarantine (may need a medical record flag); (2) anyone with ILI ( couldnarrow that down with a negative rapid flu test); (3) anyone with a sickhousehold member with suspected COVID. Could be very difficult foran unconscious /confused, or trauma patient etc., but would probably erron the side of hot and think of additional layered strategies to minimizepatient risk within that area (private rooms, patient PPE?). Triagewould need to err on the side of keeping the safe area safe.The mitigation measures are our best tools to reduce communitytransmission and reduce the probability of an infectious patient gettinginto a safe area. If we have a breach in a safe inpatient area, it prettymuch converts that inpatient area into a hot area. That also means thatwe have the staff in that area exposed (because of limited availability ofPPE, the staff in the safe area would not be PPE-PPE would have beendirected to the staff in the hot area). Those staff would likely need to beplaced on quarant ine. The effect is we now have a much larger hot areawith even fewer staff. That would really be a mess.NIH-001477You have the same problem in the outpatient areas. Have a sick patientslip through and come in contact with a number of the clinic staff (notin PPE), and we now need to quarantine all those staff. In contrast to abreach for the inpatient area, the outpatient area can still operate as asafe area (just minus those staff who would now be on quarantine). Butdo that a few times and pretty soon you have nobody left to fight. Oneway I thought about dealing with this scenario is to take the outpatientstaff and split them in two. One group works the clinic (physicallypresent) for the usual clinic hours for a 14 day stretch (1 incubationperiod) . Another group works from home (and practices socialdistancing, etc., really acting as if they are on home quarant ine) andleverages telehealth technology to care for patients and help withmonitoring those patien ts in home isolation and home quarantine. After14 days the groups switch. [All along we monitor employees daily(whether at work or at home) for symptoms or sick householdmembers] In the event of a breach, the groups immediately switch andthe group that was working is placed on actual home quarantine (butstill continues to work from home leveraging telehealth). That way if abreach does happen, we have a fallback response (that we are constantlypracticing) that allows us to sustain outpatient care.For the inpatient areas, I thought about the lone survivor model (holdingback 1 Secretary and staff in the event that the government isdecapitated). So think of a small group (would need to think thru whatthe composition of that team would look like for each area (acute care,inpatient mental health, long term care) that would at least provide thenucleus of the expertise necessary to reconstitute the service in theevent of a major breach). This smaller group would vary in teammembers every 2 weeks and would rotate to work from home for 14days stretches and pract ice social distancing ( acting as if they were onhome quarantine). They could also assist via telehealth (inpatientconsultation , etc., while out of the hospital).Is anyone thinking along these lines (really continu ity of operations forthe healthcare system)?Sent from Mail for Windows 10From: Carter MecherSent: Friday, February 21, 2020 8:35 AMTo: Richard Hatchett ; Dr. Eva K LeeCc: Tracey McNamara ; Caneva, Duane; (b)(6); Dodgen, Daniel(0S/ASPR/SPPR); OeBord, Kristin (OS/ASPR/SPPR); Phillips, Sally(0S/ASPR/SPPR); David Marcozzi ; Hepburn, Matthew J CIV USARMY (USA);Lisa Koonin; Wargo Michael ; Walters, William (STATE.GOV); HARVEY,MELISSA; WOLFE, HERBERT; Eastman, Alexander ; EVANS, MARIEFRED;Callahan. Michael V .• M.D.; Cb)(Johnson, Robert (0S/ASPR/BARDA); Yeskey, Kevin; Disbrow, Gary(0S/ASPR/BARDA); Redd, Johnt(OS/ASPR/SPPR); Hassell. David (Chris)(0S/ASPR/ 10) ; Hamel, Joseph (OS/ASPR/10) ; Dean, Charity A@CDPH; Lawler,James V; Kadlec, Robert (OS/ASPR/10) ; 'Mart in, Gregory J(b)(6) ------- -'; Borio, Luciana; Hanf ling, Dan; McDonald, Eric; Wade , David; TARANTINO, DAVID A; WILKINSON, THOMAS; David Gruber_________ Cb>_C_6),; KAUSHIK, SANGEETA; Nathan iel HupertSubject: RE: Red Dawn Breaking, COVID-19 Collaborative, Feb 16 starthttps: // www.cbc.ca/news / canad a/ ottawa /diamond -princ ess-coronavirustrenton-comw all-l .54 70386Canada flies home passengers from cruise line.Data in article :47 of 256 Canadians contracthttps://protect2.fi reeye.com/url?k=96ebd7bc -cabfcec0 -96ebe683-0cc47adc5fa2 -16a39afbe c00c653&u=https ://www.t imesofisrael.com/israe l ... neediagnosed/Israel confirms first coronavirus case as cruise ship returnee diagnosedOne of 11 Israel is who arrived in the morning after quarantine aboardDiamond Princess ship tests positive, after entering 14-day isolation at ShebaMedical CenterTrying to track cruises ship passenger /crew by country (data is sketchy)Total ICUCountry Passengers/Crew Confirmed Admissions DeathsCasesus 434 58 l?NIH-001478%Infected13%Hong Kong 330Canada 256Australia 241UK 78Ita ly 35South Korea 14Israel 11JapanSubtotal 1,399Tota l 3,711Sent from Mail for Windows 10From: Carter MecherSent : Friday, February 21, 2020 5:46 AMTo: Richard Hatchett ; Dr. Eva K Lee4748612160634Cc: Tracey McNamara; Caneva. Duane; (b)(6); Dodgen. Daniel(0S/ASPR/SPPR; )DeBord. Kristin (OS/ASPR/SPRP); Phillips. Sally(0S/ASPR/SPPR); David Marcozzi; Hepburn. Matthew J CIV USARMY (USA);Lisa Koonin; Wargo Michael; Walters. William (STATE.GOV); HARVEY.MELISSA; WOLFE. HERBERT; Eastman. Alexander; EVANS. MARIEFRED;Callahan, Michael V.,M.D.1 (b)(6);Johnson, Robert (05/ASPR/BARDA); Yeskey, Kevin; Disbrow, Gary(0S/ASPR/BARDA;) Redd, Johnt(OS/ASPR/SPPR; )Hassell, David (Chris)(0S/ASPR/10); Hamel, Joseph (0S/ASPR/10) ; Dean, Charity A@CDPH; Lawler,James V; Kadlec, Robert (0S/ASPR/10) ; 'Mart in, Gregory J(b)(6) '· Borio, Luciana; Hanfl ing. Dan; McDonald, Eric; Wade, _______ _...David; TARANTINO. DAVID A; WILKINSON, THOMAS; David Gruber---------- (b)(6); KAUSHIK.S ANGEETA; Nathaniel Hupert Subject: RE: Red Dawn Breaking, COVID-19 Collaborative, Feb 16 startChina has again modified its reportin g (first it added clin ical cases tolab confirmed cases on Feb-12). Now it is subtracting out those clinicalcases and limiting numbers to lab confirmed). Have continued tofollow the hospitalization data from Hubei (see below).NIH-00147918%20%8%9%17%NIH-001480Here is the data being reported by Hubei and Wuhan. Data is prettysketchy prior to Jan-21.Hubei 2019-nCoV Confirmed Hospital DataHubei and Wuhan Cases &Hospi talization RatesHubei WuhanTotalMild Sever Critic Cum Cum Cum HubeiWuh Cum Cum ¾HubeDateCurrentDisea ely ally Discha Death Inpatie Cuman Hospitali Hospitali i CasesInpatie Case zation zation Hospitase Ill Ill rges s nts casesnts s Rate per Rate per lized100,000 100,0001/ 14/6 6 6 41 41 0.01 0.5201/15/5 5 2 7 41 41 0.01 0.5201/ 16/5 5 2 7 45 45 0.01 0.5201/17/8 8 2 10 62 62 0.02 0.7201/ 18/136 100 33 3 3 139 121 121 0.2 1.4201/ 19/170 126 35 9 4 174 198 198 0.3 2.4201/20/239 176 51 12 7 246 270 258 0.4 3.1201/21/15 375 320 0.0 3.8201/22/399 304 71 24 17 416 444 390 0.7 4.7201/23/494 365 106 23 31 24 549 549 495 0.9 5.9 100%201/24/658 472 129 57 32 39 729 729 572 1.2 6.8 100%201/25/915 221 85 52 1,052 J ,052 618 1.8 7.4 100%201/26/1,645 1,013 563 69 44 76 1,423 1,423 698 2.4 8.3 100%201/27/2,567 1,877 563 127 47 100 2,714 2,7141,594.6 19.0 100%20 01/28/3,349 2,450 671 228 80 125 3,554 3,5541,906.1 22.8 100%20 51/29/4,334 3,346 711 277 90 162 4,586 4,5862,267.8 27.0 100%20 11/30/ 5,486 4,392 804 290 116 204 5,806 5,806 2,63 9.9 31.5 100%NIH-001481,- -20 9l /31 I6,738 5,444 956 338 166 249 7,153 7,1533,2112.2 38.4 100%20 52/1/28,565 7,0031,118444 215 294 9,074 9,0744,1015.5 49.l 100%0 92/2/29,618 7,9171,223478 295 35010,263 11,177 5,1417.5 56.4 92%0 22/3/210,990 8,8571,557576 396 41411,800 13,522 6,3820.2 66.6 87%0 42/4/212,62710,10 1,809711 520 47913,626 16,678 8,3523.3 81.6 82%0 7 l2/5/214,31411,23 2,328756 633 54915,496 19,665 10,126.5 95.3 79%0 0 172/6/215,80411,80 3,161841 817 61817,239 22,112 11,629.5 108.3 78%0 2 182/7/219,83514,64 4,188 1,0071,113 69921,647 24,953 13,637.0 141.1 87%0 0 032/8/220,99315,74 4,093 1,1541,439 78023,212 27,100 14,939.7 153.4 86%0 6 822/9/222,16016,65 4,269 1,2361,795 87124,826 29,631 16,942.4 169.3 84%0 5 022/ 10/25,08718,74 5,046 1,2982,222 97428,283 31,728 18,448.3 196.7 89%20 3 542/11/26,12118,88 5,724 1,5172,639 1,06829,828 31,728 18,451.0 207 .4 94%20 0 542/12/33,69326,60 5,647 1,4373,441 1,31038,444 48,206 32,965.7 314.6 80%20 9 942/13/36,71927,08 7,953 1,6854, 131 1,42642,276 5 1,986 35,972.3 349.9 81%20 ] 912/ 14/38,10727,95 8,276 1,8764,774 1,45744,338 54,406 37,975.8 369.4 81%20 5 142/15/39,44729,05 8 439 1,9575,623 1,59646 666 56,249 39,479.8 39 1.4 83%20 1 622/ 16/40 81431,01 8,024 1,7736,639 1,69649, 149 58,182 41,184.0 415 .6 84%20 7 522/17/41 95730,98 9,117 1,8537,862 1 78951,608 59,989 42,788.2 439 .7 86%20 7 522/ 18/43,47132,22 9,289 1,9579,128 1,92154,520 6 1,682 44493 .2 469 .3 88%20 5 122/19/43 74532,56 9,128 2,050 10.3372,02956,111 62,013 45,095.9 487 .0 90%20 7 272/20/42,0563 1,05 8,979 2,018 11,7882, 14455,988 62,422 45,395.7 486 .2 90%20 9 46Sent from Mai l for Windows l 0From: Carte r MecherSent: Friday, February 21, 2020 5:09 AMTo: Richard Hat chett ; Dr. Eva K LeeCc: Tracey McNama ra; Caneva. Duane; (b)(6); Dodgen . Daniel(OS/ASPR/SPPR); DeBord , Kri stin (OS/ASPR/SPPR); Phill ips. Sally(OS/ASPR/SPPR); David Marcozzi ; Hepburn, Matthew J CIV USARMY (USA);Lisa Koonin; Wargo Michael ; Walte rs, William (STATE.GOV); HARVEY,MELISSA; WOLFE, HERBERT; Eastman, Alexande r; EVANS, MARIEFRED;Callahan, Michael V.,M .D.; (b)(6)Johnson, Robert (OS/ASPR/BARDA); Yeskey, Kevin; Disbrow , Gary(OS/ASPR/BARDA); Redd, Johnt (OS/ASPR/SPPR); Hassell, David (Chris)(OS/ASPR/1O); Hamel, Joseph (OS/ASPR/1O); Dean. Char ity A@CDPH; Lawler .James V; Kadlec. Robert (OS/ASPR/1O); 'Mart in. Gregory J(b)(6) Borio. -------- Luciana; Hanfl ing. Dan; McDona ld. Eric; Wade , David; TARANTINO, DAVID A; WILKINSON, THOMAS; David Gruber_________ Cb)_(6) ,; KAUSHIK, SANGEETA; Nathan iel Hupe rtSubject: RE: Red Dawn Breaking , COVID-19 Collaborative, Feb 16 startMore on South Korea (sounds just like what happened at JeffersonBarracks, just outside St. Louis, in 1918, armed with the exact sametools they had more than 100 years ago to control an outbreak ). Iassume they must also be taking measures within the base to limitspread (keeping infect ious individuals apart from those not yet infectedwith isolation and quarantine and social distancing).https://en.yna.co.kr/view/ AEN2020022 l 003000325 ?section=national/defenseSEOUL, Feb. 21 (Yonhap) -- The military is making all-out efforts toprevent the new coronavirus from spreading further into the barracks,offic ials said Friday, after the country's first infections in the armedforces were confirmed .Earlier in the day, a Navy sailor on the southern island of Jeju wasconfirmed to have contracted COVID-19 in the first such case amongservice_ personnelh ere.NIH-001482Follow ing the confirmat ion, the Navy has checked the temperature ofall personne l at the base where the infec ted sai lor served andquara ntined all those who had contacts with the pe rson, it said."We have carried out disinfec tion work at the base and are devoting allour efforts to preventing the spread of the new virus," the Na:vy said in arelease.An officer each from the Army and the Air Force were also confirmedto have the virus the same day.The military is now working to ident ify personnel who have visited thesoutheastern city of Daeg u and the suffound ing North Gyeong sangProvince since Feb . 10, as these areas have rece ntly seen a surge in thenumber of infected people.More than 5,000 service persom1el are estimated to have visited theregion during their vacat ion accord ing to the military's preliminaryinve stigatio n.On Thursday night the defense ministry said all personnel will bebarred from vacationing, staying outside their bases and meetingv isitors starting Saturday.The decision was made at a meeting of top defense officials presidedover by Defense Minister Jeong Kyeong-doo, during which he calledfor "extraordinary measures" to contain the s read of the virus .Amid growing fears over the disease , the govemment called off aplanned ceremony to mark the 60th ann iversary of a pro-democracymovement in Daegu, which was designa ted a "special care zone" overthe virus earlier in the day.Sent from Mail for Windows l 0From: Carte r Meche rSent : Thursday, February 20, 2020 9:21 PMTo: Richard Hat chett ; Dr. Eva K LeeCc: Tracey McNama ra; Caneva. Duane; (b)(6); Dodge n. Dani el(OS/ASPR/SPPR); DeBord. Kristin (OS/ASPR/SPPR); Phillips. Sally(OS/ASPR/SPPRl: David Marcozzi: Heob urn , Matt hew J CIV USARMY (USA);Lisa Koo nin ; Wargo Michael; Walt ers, William (STATE.GOV); HARVEY,NIH-001483MELISSA; WOLFE. HERBERT; Eastman , Alexander ; EVANS. MARIEFRED;Callahan, Michael V.,M .D.; (b)(6)Johnson, Robert (0S/ASPR/BARDA) ; Yeskey, Kevin; Disbrow, Gary(0S/ASPR/BARDA) ; Redd, Johnt(OS/ASPR/SPPR); Hassell, David (Chris)(0S/ASPR/ I0) ; Hame l, Joseph (OS/ASPR/10) ; Dean, Charity A@CDPH; Lawl er,James V; Kadlec, Robert (OS/ASPR/10 ); 'Mart in, Gregory J(b)(6) · Borio, Luciana; ------- - Hanfli ng, Dan; McDonald, Eric ; Wad e, David; TARANTINO, DAVID A; WILKINSON, THOMAS; David Gruber----------- (b)(6)· KAUSHIK, SANGEETA; Nat hanie l Hup ert Subject: RE: Red Dawn Breaking, COVID-19 Collaborative, Feb 16 startS. Korea reports 52 new viruscases, total now at 156Welfare/Medicine 10:3 7 February 21, 2020SEOUL, Feb. 21 (Yonhap)-- South Korea reported 52 new cases of tbenew coronavirus Friday, bringing the total numbe r of infections in thenation to 156, with the potentially fatal illness spreading fast across thecountry.The number of COVID-19 infections here has almost tripled in justthree days, with most new infections traced to church services in thesoutheastern city of Daegu.Of the 52 new cases, 41 are in Daegu, 300 kilometers southeast ofSeoul, and the neighboring North Gyeongsang Province. Another threewere reported in Seoul, the Korea Center for Disease Control andPrevention (KCDC) said in a statement.Tour buses are parked at a logistics terminal in Daegu, 300 ki lometerssoutheast of Seoul, on Feb. 20, 2020. Thirty-eight new coronaviruscases were reported in the city on Feb. 21, 2010. (Yonhap)The spike of infections in Daegu and several cases in Seoul, whereroutes of infections are not immediately traceable , have prompted healthoffic ials to declare that COVID-19 has begun spl!_ading locally.The KCDC said two new cases were reported in South GyeongsangProv ince . In a sign that the virus may broadly spread nationwide , sixprov inces, includ ing Gyeong gi, Jeju , Chungcheong and North Jolla,each repo rted one case.NIH-001484Of the 52 new cases, 39 are linked to the Shincheonji Church of Jesus inDaegu , where the 31st patient, the country 's probab le "super spreader ,"attended worship serv ices, the KCDC said.A 61-year-old South Korean woman, who tested positive for the virusearlier this week, attended worship services at the church on Feb . 9 andthis past Sunday.KCDC Director Jung Eun-kyeong told reporters Thursday that theagency is uncertain whether the woman, known as the 31st patient , wasa "super spreader" of the virus but asked 1,001 membe rs of the churchto self -isolate to stem the spread of the virus .The government decided to designate Daegu and neighboring Cheongdoas "special management zones," following the spike in the number ofinfected people and the nation's first death from the virus.Sent from Mai l for Windows 10From: Carte r MecherSent : Thursday, February 20, 2020 5:38 PMTo: Richard Hat chet t; Dr. Eva K l eeCc: Tracey McNama ra; Caneva, Duane; (b)(6) Dodgen , Danie l(OS/ASPR/SPPR); DeBo rd. Kri stin (OS/ASPR/SPPR); Phill ips. Sally(OS/ASPR/SPPR); David Marcozzi : Hepburn. Matthew J CIV USARMY (USA);Lisa Koonin; Wargo Mi chael ; Walt ers, Will iam (STATE.GOV); HARVEY,MELISSA; WOLFE, HERBERT; Eastman, Alexande r; EVANS, MARIEFRED;Callahan, Michael v .,M .D.; (b)(6)Johnson , Robert (0S/AS PR/ BARDA); Yeskey, Kevin; Disbrow, Gary(OS/ASPR/BARDA) ; Redd, Johnt( OS/ASPR/SPPR); Hassell, David (Chris)(0S/ASPR/ I0) ; Hamel, Joseph (OS/ASPR/ 10) ; Dean, Charity A@CDPH; Lawler ,James V; Kadlec. Robert (OS/ASPR/10); 'Mart in. Gregory J(b)(6J 1; Borio. -------- Luciana; Hanfli ng. Dan; McDona ld, Eric; Wade. David; TARANTINO, DAVID A; WILKINSON, THOMAS; David Gruber__________ Cb _) (6J; KAUSHIK, SANGEETA; Nathan iel Hupe rtSubjec t: RE: Red Dawn Breaking, COVID-19 Collaborative, Feb 16 startFrom Feb-15 to Feb-20 the number of confirmed cases increased from355 to 634 (increase of 279). The number of asymptomatics increasedfrom 73 to 322 (increase of249) . So from Feb-15 to Feb-20 , 249 of theNIH-001485NIH-001486279 confirmed cases (89%) were asymptomatic. Seems a little odd.Also, read reports that all passengers and crew have beem tested (butreport s only note that 3,066 of the 3,711 have been tested) .CumulativeNumber ofDate EventConfirmedCases20-JanCruise ship depa1is from YokohamaJapan25-Jan80 year old passenger disembarks inHong Kong80 year old passenger confirmed tohave COVID-19When results known, certificate oflanding canceled and ship under1-Feb quarantine. Tests for the virus wouldbe administered to three groups : thosewith symptoms, those who got off inHong Kong , and those who had closecontact with the infected passenger.3-FebShip arrives in port of YokohamaJapan5-Feb 10 passengers and crew confirmed + 106-Feb31 more passengers and crew41confinned +7-Feb30 more passenger and crew61confinned +8-Feb9 more passenger and crew confirmed70+10-Feb66 more passenger and crew136confinned +11-Feb39 more passenger and crew175confinned +12-Feb28 more passenger and crew203confirmed+13-Feb15 more passenger and crew218confomed +14-Feb67 more passenger and crew285confinned +70 more passenger and crew15-Feb 355confirmed+CumulativeNumber Notesof Deaths439 tested492 tested4 in ICU713 tested927 tested1,219tested; 73asymptomatic329 American evacuated from cmiseship (14 of the evacueesfound to be16-Feb+) 61Americans remained onboard44 Amer icans remained hosp italizedin Japan85 more passenger and crew17-Febconfirmed+18-Feb167 more passenger and crewconfirmed+19-Feb 2 deaths13 more passenger and crew20-Febconfirmed+Sent from Mail for Windows 10From: Carte r Mec herSent : Thursday, February 20, 2020 4:49 PMTo: Richard Hat chet t ; Dr. Eva K Lee369454621621634Cc: Tracey McNamara; Caneva, Duane; (b)(6); Dodgen, Daniel(OS/ASPR/SPPR); DeBo rd, Kri stin (OS/ASPR/SPPR); Phill ips, Sally(OS/ASPR/SPPR); David Marcozzi ; Hepburn , Matthew J CIV USARMY (USA);Lisa Koon in; Wargo Mi chael; Walte rs. Will iam (STATE.GOV): HARVEY.MELISSA; WOLFE, HERBERT; Eastman, Alexande r; EVANS, MARIEFRED;Callahan, Michael V.,M .D., (b)(6) _;Johnson, Robert (OS/ASPR/BARDA); Yeskey, Kevin; Disbrow, Gary(OS/ASPR/BARDA) ; Redd, Johnt(OS/ASPR/SPPR); Hassell, David (Chris)(OS/ASPR/I0) ; Hame l, Joseph (OS/ASPR/ 10) ; Dean, Charity A@CDPH; Lawler,James V; Kadlec, Robert (OS/ASPR/10); 'Mart in, Gregory J(b)(6) · Borio, -------- Luciana ; Hanfli ng, Dan; McDona ld, Eric; Wade, David; TARANTINO, DAVID A: WILKINSON. THOMAS: David Gruber---------- (b)(6); KAUSHIK, SANGEETA; Nathan iel Hupe rt Subjec t: RE: Red Dawn Breaking , COVID-19 Collaborative, Feb 16 startNIH-0014871,723tested;19 serious ly ill3,011 tested23,066tested;2 28 seriouslyill; 322asymptomaticThis is new• Now 634 cases confirmed on the cruise ship (3,063 tested) (so not allthe ship and crew have been tested 3.711)• Slightly more than half are asymptomatic (previously we heard that73 of 355 are asymptomatic)• 28 in serious condition (4.4%)Japan's Health Min ister Katsunobu Kato told Parliament the t\vo peoplefrom the Diamond Princess cruise ship who died had "received the bestmedical treatment" but couldn't be saved after catching the novelcorona virus on board. As of Thursday, 634 passengers and crewmembers were diagnosed with the virus out of 3,063 tested. Slightlymore than half have no symptoms at all, officials said, and many of theremainder have only mild fever or a cough. Among patients who testedpositive for the virus, 28 were reported in serious condition Thursday.Doctors have said the vims can be particularly harmfu l in elderlypatients , and one of the two fatal cases from the Diamond Princess, aJapanese man in his 80s, had pre-exist ing bronchial asthma and hadbeen treated for angina. The other, a Japanese woman in her 80s withoutunderlying illnesses, came down with a fever on Feb. 5, the same daypassengers were told they would be quarantined in their cabins for twoweeks, according to health ministry offic ials. The next day, she startedsuffer ing from dianhea and saw a doctor on board.She wasn't taken to a hospital until Feb. 12 when she started sufferingshortness of breath. Her virus test came back posi tive the following day,and despite treatment with antivira l drugs normally used to treat HIVinfection, she died Thursday.Asked about the woman's case, health ministry official Hiroshi Umedasaid, "I believe it was hand led promptly." He said the ship was adifficult environment for medical staff but they worked day and nightand tried to prioritize the most serious cases.Sent from Mai l for Windows l 0From: Carter MecherSent : Thursday, February 20, 2020 11:00 AMTo: Richard Hatc hett ; Dr. Eva K LeeCc: Tracey McNamara; Caneva, Duane; (b)((;); Dodgen, Daniel(OS/ASPR/SPPR); DeBord, Kristin (OS/ASPR/SPPR); Phillips, Sally(OS/ASPR/SPPR); David Marcozzi; Hepburn, Matt hew J CIV USARMY (USA);NIH-001488Lisa Koo nin; Wargo Mich ael; Walters. William (STATE.GOV); HARVEY.MELISSA; WOLFE. HERBERT; Eastma n. Alexander; EVANS. MARIEFRED:Callahan, Michael V.,M .D.; (b)(6)Johnson, Robert (OS/ASPR/BARDA); Yeskey, Kevin; Disbrow, Gary(OS/ASPR/BARDA); Redd, Johnt(OS/ASPR/SPPR); Hassell, David (Chris)(OS/ASPR/IO); Hamel, Joseph (OS/ASPR/ IO); Dean, Char ity A@CDPH; Lawler,James V; Kadlec, Robert (OS/ASPR/IO); 'M art in, Gregory J,.._ _____ C_b>_<_6,J,_' ·, Borio, Luciana; Hanfl ing, Dan; McDonald, Eric; Wade,David; TARANTINO, DAVID A; WILKINSON, THOMAS; David Gruber----------- (b)(6) KAUSHIK, SANGEETA; Nathaniel Hupert Subject: RE: Red Dawn Breaking, COVID-19 Collaborative, Feb 16 startKeep an eye on South Korea too. Seeing rapid growth in cases in SouthKorea (see story below)South Korea now reporting 104 cases and 1 death today. South Koreanow implementing NPis. This story is eerily remini scent of the actionstaken at Jefferson Barracks near St. Louis in 1918.Also attached are update for Singapore (85 cases; 46 in hospital/4 inICU; 4 kids, only l in hospita l) and Hong Kong (69 cases, still no kidsreport ed). Both have implemented NPis (small increases in casestoday). Japan has reported 10 new cases today-total now is 94.South Korea reports first virus death as Daegu struggles to contain outbreakhtt ps://p rot ect 2.fi reeye.com/ur l7k=3b907Sda-67c46ca6-3b9044e5-0cc47adc5fa2 -08635f0e3 1f1241 a&u=https://www .stri pes.com/news/p acific ... break-1.619407SEOUL, South Korea - South Korea reported its first coronavirus-linkeddeath Thursday, while the U.S. military tightened restrictions on travel to thesoutheastern city of Daegu due to an outbreak in infections in the area.Daegu also urged residents to stay home as the city of 2.5 millionpeople and surrounding areas struggled to contain an outbreak of thepneumonia-like disease .The Army garrison in Daegu also restricted access and announced thatschoo ls and nonessential business would be closed for a second day onFriday.NIH-001489NIH-001490In an exception to policy, U.S. service members were authorized towear face masks in uniform "regardless of air quality condit ions,"according to the ga1Tison' s F acebook page.Fast-moving developments this week were a blow to South Korea'shope that the crisis was easing.Instead, dozens of new cases were confirmed in recent days, with thetotal number of infections soaring to 104 on Thursday, according to theKorea Centers for Disease Control and PreventionU.S. Forces Korea said, "there remains zero confirmed cases ofUSFKpersonnel with COVID-19."The virus first appeared in December in Wuhan, China, and spread tonearly 30 countries. More than 2,000 people have died - most inmainland China.A South Korean man in his 60s died Wednesday at a hospital in thesoutheastern city of Cheongdo and posthumously tested positive for thevirus , the KCDC said Thursday. It was South Korea's first death fromthe virus.USFK raised the risk level for the military communit y to moderateon Wednesday and banned all nonessential travel to Daegu due to anoutbreak linked to a church near the Anny garrison in the city.On Thursday, USFK added that all travel by American troops to, fromand around Daegu requires authorization from their leadership. Theprecaution was "highly encouraged" for all family members, civiliansand contractors as well."All off-insta llation travel for all USFK populations should beminimized to reduce potential contam ination," USFK announced on itswebsite.U.S. Army Garrison Daegu, about 200 miles southeast of Seoul, alsosaid visitors not performing mission essential or official business wouldbe denied access as it implemented health checks at the gates.Nonessential personnel were not required to go to work on Friday andmost activities would be suspended , including the schools , it said.The garrison also recommended that members of the militarycommun ity avoid public places and transportat ion in the city, includingstores, restaurants and other heavily congested areas until the situat ionis brought under control.Self-quarant ine measures were ordered for any American troops whohad visited the affected New World Church, but garrison commanderCol. Edward Ballanco said earlier Thursday that no Americans wereknown to have done so.He also urged Americans to avoid a local hospital where the womanbelieved to have been a carrier was treated.The garrison also lifted limits on wearing face masks for Americantroops in uniform, who normally are only allowed to wear them on dayswith extreme pollut ion.Sent from Mai l for Windows 10From: Carte r Mec herSent: Thursday, February 20, 2020 8:20 AMTo: Richard Hatche tt ; Dr. Eva K LeeCc: Tracey McNa mara; Caneva, Duane; (b)(6); Dodgen, Daniel(OS/ASPR/SPPR); DeBord, Kri st in (OS/ASPR/SPPR); Phillips, Sally(OS/ASPR/SPPR); David Marcozzi; Hepburn, Matt hew J CIV USARMY (USA);Lisa Koonin; Wargo Michael; Walte rs, Will iam (STATE.GOV); HARVEY,MELISSA; WOLFE. HERBERT; Eastm an. Alexande r; EVANS, MARIEFRED:Callahan, Michael V.,M .D.J (b)(6);Johnson , Ro bert (OS/ASPR/BARDA); Yeskey, Kevin; Disbro w, Gary(OS/ASPR/BARDA); Redd, Johnt(OS/AS PR/SPPR); Hassell, David (Chris)(0S/AS PR/I0) ; Hamel, Joseph (OS/ASPR/ 10) ; Dean, Charit y A@CDPH; Lawler,James V; Kadlec, Robert (OS/ASPR/10); 'M art in, Gregory J(b)( ' ; Bo rio, Luciana; -------- Hanfli ng, Dan; McDonald, Eric; Wade, David; TARANTINO, DAVID A; WILKINSON, THOMAS; David Gruber_________ Cb>C6) KAUSHIK. SANGEETA; Natha niel HupertSubject: RE: Red Dawn Breaking, COVID-19 Collaborative, Feb 16 startLast thing. Keep a very close eye on Japan. The outbreak is starting totake off there with numbers of cases scattered across the country withno link to known cases. We are also seeing nosocomial transmission (anumber of healthcare workers infected). There is also a large number ofcases hospitalized in Japan related to the cruise ship, and now therelease of large mLmbers of passengers from the cru ise ship into thecommunity. Yesterday they reported a total of 84 cases-caught up toNIH-001491Singapore. But unlike Singa pore , Japan has been slow to implementNPis. The other concern is that Japan's popu lation isdisproportionately aged (it has the highest% age 65 of any country). InJapan, 27% of the population is :::6 5; in the US, 15.6% of thepopulation is~ 65. And Japan can also claim the largest city in theworld (metro Tokyo with 38 M people - pretty much the populat ion ofCalifornia crammed into an area smaller than the size of Conn ecticut).Japan also has the 1 oth largest city in the world (Osaka with 19 Mpeople).Sent from Ma il for Windows 10From: Carter Mech erSent: Thursday, February 20, 2020 7: 15 AMTo: Richard Hat chett ; Dr. Eva K l eeCc : Tracey McNam ara; Caneva, Duane; (b)(6) Dodgen, Dani el(OS/ASPR/SPPR); 0 eBord, Kri stin (OS/ASPR/SPPR); Phillips, Sally(OS/ASPR/SPPR); David Marcozzi; Hepburn , Matth ew J CIV USARMY (USA);Lisa Koo nin; Wargo Michael; Walte rs, Wi lliam (STATE.GOV); HARVEY,M ELISSA; WOLFE. HERBERT; Eastman, Alexan der; EVANS. MARIEFRED;Callahan. Michael V .• M.D.; (b)(6)Jo hnson. Rober t (OS/ASPR/BARDA); Yeskey, Kevin; Disbrow, Gary(OS/ASPR/BARDA); Redd, Johnt (OS/ASPR/SPPR); Hassell, Dav id (Chris)(OS/ASPR/IO); Hamel, Joseph (OS/ASPR/1O); Dean, Charity A@CDPH; Lawler,James V; Kadlec, Robert (OS/ASPR/1O); 'M art in, Gregory J-------- (b)(6) Borio, Luciana; Hanfli ng, Dan; McDonald , Eric; Wade, David ; TARANTINO, DAVID A; WILKINSON, THOMAS; David Grub er_________ Cb _H_6) KAUSHIK. SANGEETA; Nathaniel HupertSubject : RE: Red Dawn Breaking , COVID-19 Collaborative, Feb 16 startWhat has me worried is what happened on the crui se ship is a previewof what will happen when this virus makes its way to the US healthca resystem (no t to mention institutionali zed high-r isk population s in theUS, like nur sing homes) . I'm not sure that folks understand what is ju stover the hor izon.Remember the story about Mann Gulch? We are at the equiva lent ofabou t 5:44. I anticipate that when we reach 5:45, th ere is go in g to bechaos and panic to get anything in place. I doubt that what we wouldNIH-001492NIH-001493then hurriedly put in place will be any better than what they did on thatcruise ship. As a conseq uence, would expect much the same results.I listened to the discussion yesterday. After listening to James andMichael describe the conditions on and around the cruise ship, Iwondered whether anyone in healthcare leadership ( outside theexpert ise at our biocontainment facilities) is thinking about infectioncontrol practices for any staff entering areas of a hospital caring forCOVID patients (like changing clothes before entering and perhapswearing scrubs, not bringing personal items into the area like iphones,ipads, stethoscopes, white coats, purses, briefcases , etc .)? Andinstituting policies that require all patients to phone for clearance toenter prior to presenting at safe acute and non-acute areas includingcommunity based clinics? Are we confiden t of the infection controlpractices of acute care staff (that they know the basics of how to donand doff PPE and behavior while in PPE?) Would HCWs in outpatientclinics or long tem1 care facilities be any better prepared than the crewon board the cruise ship or the responders in Japan? I'm no expert ininfection control and would defer to the expertise in this group. I wasjus t a little smprised how little this seemed to be a concern for thehealthcare leaders gathered yesterday.I think we are getting close to the point where we need to drop thosethings that are not critical and focus on the most imp01tant things.We are going to have a devil of time with lab confirmation - it is justtoo slow (they had a 2 day turnaround on the cruise ship) and we justdon't have the capacity for the volume of tests we would anticipate.Charity has stressed this point again and again. That means we aregoing to have to fly blind early on. Perhaps the best we are going to beable to do in the near term if things begin to acce lerate is screen allsuspect cases (pretty much anyone with ILi symptoms) with a quick flutest and assume anyone who tests negative is suspected COVID untilproven otherwise; and treat everyone who tests positive with Tamiflu.It will prove problematic early on, but as the epidemic barrels along,COVID will displace everything (at that point we will just assume thatanyone with a fever or ILi has COVID). The problem is in thebeginning . It is going to be so hard to sort things out. Matt, James andothers are pushing for more rapid screening- but we ju st aren't thereyet. The consequence is that we will be placing patients with respillness (that is not flu and presumed to be COVID) in areas with actualCOVID patien ts. I hate to do that, but not sure how it could be avoidedearly on. But we would only do that for those who are ill enough to behospitalized. The large number of asymptomatic and mildly ill patientswould be under home isolation (so no worries about mixing confinnedand suspected patients). The downside is that we would have largernumber of people is isolation and home quarantine than is reallynecessary (and the consequence of increased workplace absenteeism).And it is because home isolation and home quarantine are so important,healthcare systems (and not ju st public health) have to grab a hold ofoperationalizing those NPi s with both hands. A while back, I createdsome prescriptions (tongue in cheek), just to underscore that physiciansdo have a role in isolation and quarantine (it is not limited to publichealth). We might not have pharmaceutica ls available to treat COVID,but why can't we write prescriptions for non-pharmaceutica ls? I don'tthink healthcare leaders appreciate this point. Every COVID pat ient weadmit or see in the ER will require us to follow up with householdmembers to make sure they know to home quarantine (need to do thesame anywhere in our system we find a patient who is infected). Youcould not imagine the pushback I have received when I proposed thatwe must have an active role-people seem to think that state and localpublic health is alone respons ible for this. I would think public healthwill be overwhelmed and taking charge of this is our best strategy tokeep our safe areas safe.I would be interested to hear how other healthcare systems and publichealth leaders are thinking about this.Sent from Mail for Windows 10From: Carter MecherSent: Thursday, February 20, 2020 6:39 AMTo: Richard Hatchett ; Dr. Eva K LeeCc: Tracey McNama ra; Caneva. Duane (bH ; Dodgen. Daniel(OS/ASPR/SPPR); DeBord, Krist in (OS/ASPR/SPPR); Phillips, Sally(OS/ASPR/SPPR); David Marcozzi ; Hepb urn, Matthew J CIV USARMY (USA);Lisa Koon in; Wargo Michael ; Walters, Will iam (STATE.GOV); HARVEY,MELISSA; WOLFE, HERBERT; East man, Alexander ; EVANS, MARIEFRED;NIH-001494Callahan. Michael V.,M .D.; (b)(6);Johnson, Robert (0S/ASPR/BARDA) ; Yeskey, Kevin; Disbrow, Gary(0S/ASPR/BARDA) ; Redd, Johnt(OS/ASPR/SPPR); Hassell, David (Chris)(0S/ASPR/ I0) ; Hame l, Joseph (0S/ASPR/ 10) ; Dean, Char ity A@CDPH; Lawler,James V; Kadlec, Robert (OS/ASPR/10); 'Mart in. Gregory J------- (b)(6-) '; Borio, Luciana; Hanfling, Dan; McDonald, Eric; Wade, David; TARANTINO, DAVID A; WILKINSON. THOMAS; David Gruber----------- (b)(6); KAUSHIK, SANGEETA; Nathan iel Hupert Subject: RE: Red Dawn Breaking , COVID-19 Collaborative, Feb 16 startKeeping track of the outbreak aboard the cruise ship. The latest updateis the announcement of 2 deaths (both patients in their 80s). An 87-year-old man and an 84-year-old woman, died on the 20th. Both wereJapane se (the 87-year-old man was hospitalized on Feb-11 and the 84-year-old women on Feb-12). So time to death from recognition ofinfection was 8-9 days. On Feb-12 , the total number of confirmed caseswas 203. So estimated CFR back dating the denominator to Feb-12 is1 %. Assuming a denominator of 621, the CFR is 0.3%. if death s arelagging by 8-10 days ( and con finned cases plateau), we should have apretty good estimate of CFR for he entire group in another week or so.Will need to peel off the number of cases involving the crew member toget a better estimate of CFR in the elderly. These numbers are withinthe range we have been estimating.The 2,666 pass engers are similar in age (and likely in co-morbidities) tothe population we see in a nursing home or residential care faci lity. The1,045 crew are a proxy for a young healthy population. It will beimportant to look at the outcomes separately. One of the concerns ishow a 'remake of this movie' could play out in similarly confinedpopulations of elderly frail Americans. Here are the numbers of longterm care facilities /programs in the US that care for the frail elderly. Alarge number of loc ations and a large numbe r of residents /p articipa nts. Iknow that healthcare leaders were engaged yesterday, is anyoneengaging this sector (long term care)? The healthcare leaders seemedmore concerned about critical supply shortages (akin to the IV fluidshortage). Listening to them, it felt like their concerns seemed almostdivorced from the threat ofCOVID.NIH-001495NIH-001496Number of Number ofNumber of Number of Number ofFacilities / Agencies ICommunities CentersBeds Residents ParticipantsNursing Homes 15,600 1,700,000 1,300,000Residential Care 28,900 996,100 811,500Hospice Care 4,300Adult Day Care 4,600Source: https :/ /www. cdc. gov /nchs/ fas tats/nursing -home -care .htmThe outbreak on the cruise ship should be the wake up call for leaders inlong tenn care (and I would think healthcare overall).Here is a sununary of the cruise ship data (as of Feb 20)1,400,000286,300CumulativeCumulativNumber ofDate Event eNumberConfirmedof DeathsCases20-JanCruise ship departs from YokohamaJapan25-Jan80 year old passenger disembarks inHong Kong80 year old passenger confnmed tohave COVID-19When results known , certificate oflanding canceled and ship under1-Feb quarantine. Tests for the virus wouldbe administered to three groups : thosewith symptoms , those who got off inHong Kong, and those who had closecontact with the infected passenger.3-FebShip arrives in port of YokohamaJapan5-Feb 10 passengers and crew confinned + 106-Feb31 more passengers and crew41confirmed+7-Feb 30 more passenger and crew 61NotesNIH-001497confirmed+8-Feb9 more passenger and crew confirmed70+10-Feb66 more passenger and crew136 439 testedconfirmed+11-Feb39 more passenger and crew175 492 testedconfirmed+12-Feb28 more passenger and crew203 4 in ICUconfirmed+13-Feb15 more passenger and crew218 713 testedconfinned +14-Feb67 more passenger and crew285 927 testedconfirmed+7315-Feb70 more passenger and crew355 asymptomatic;confirmed+1,219 tested329 American evacuated from cruiseship (14 of the evacueesfound to be +)61 Americans16-Feb 369remained onboard44 Americans remained hospita lizedin Japan1,72317-Feb85 more passenger and crew454 tested;confinned +19 serious ly ill18-Feb167 more passenger and crew621 3,011 testedconfirmed+19-Feb 2 deaths 621 2Data by country is a bit sketchyTotal ICUCountiy Passengers Confirmed Admissions DeathsCasesus 434 58 1Hong Kong 330Canada 256 32Australia 241 46UK 78 6Italy 35South Korea 14JapanSubtotal 1,388 142New virus cruise ship disembarks and kills two Japanesepassengers in hospitalFebruary 20, 2020 11:38Two Japanese men and women in their 80s who were hospitalized andtreated for the virus were killed on the 20th in a cruise ship passenger whowas confirmed to be infected with the new coronavirus . This is the first t imea cruise ship passenger has died and three peop le have been killed in thecountry .As of the 19th, 621 cruise ships out of approximately 3,700 crew membersand passengers on the cruise ship where outbreaks of the new coronaviruswere confirmed were confirmed.Accord ing to government offi cials, two of them, a 87-year-old man and an 84-year-old woma n, died on the 20th.Both were Japanese and had a basic illness and were confirmed to have beeninfected with the virus, so it was said that men were hospitalized on the 11thof this month and women on the 12th to be treated.This is the fir st time a cruise ship passenger has died .In addit ion, three people have been killed in Japan, following the death of awoman in her 80s living in Kanagawa Prefecture on the 13th of this month.Sent from Mail for Windows 10From: Carter MecherSent: Wednesday, February 19, 2020 10:05 PMTo: Richard Hat chett ; Dr. Eva K LeeCc: Tracey McNama ra; Caneva, Duane; (b)(6); Dodgen, Daniel(OS/ASPR/SPPR) ; DeBord. Kristin (O5/ASPR/SPPR); Phillips. Sally(O5/ASPR/SPPR) ; David Marcozzi; Hepburn. Matthew J CIV USARMY (USA);Lisa Koonin; Wargo Michael; Walters. William (STATE.GOV); HARVEY,MELISSA; WOLFE, HERBERT; Eastman, Alexander; EVANS, MARIEFRED;NIH-001498Callahan. Michael V.,M .D.; CbH6JJohnson, Robert (0S/ASPR/BARDA); Yeskey, Kevin; Disbrow, Gary(0S/ASPR/BARDA) ; Redd, Johnt(OS/ASPR/SPPR); Hassell, David (Chris)(0S/ASPR/ I0) ; Hamel, Joseph (0S/ASPR/ 10) ; Dean, Charity A@CDPH; Lawler,James V; Kadlec, Robert (OS/ASPR/10); 'Mart in. Gregory J(b)(6) ------- -'; Borio, Luciana; Hanf ling, Dan; McDonald, Eric; Wade, David; TARANTINO, DAVID A; WILKINSON. THOMAS; David Gruber----------- CbH6JK;A USHIK, SANGEETA; Nathan iel Hupert Subject: RE: Red Dawn Breaking, COVID-19 Collaborative, Feb 16 startMore puzzle pieces.Italy https: //protec t2.fireeye.com /url?k=e5d0524 7-b9844b3b -e5d063 78-0cc47adc5 fa2-el6553f827677d60&u=htt ps ://www .joumalgazette .net/news/wor ld/202002 16/ g uarantine -ends- for-germans-italy-to-fly -citizens -from-s hipItaly plans to evacuate 35 Italians from the cruise ship• 25 Italian crew members (including the ship's captain)• 15 passengersUK https: //www .telegraph.co.uk/g lobal -health/sc ience -and disease/coronav irus-news-uk- china-s ingapore-death-to ll-Jatest /UK plans to evacua te British passengers Friday 2/2178 British passengers on board4 confirmed COVID the Fore ign Office2 passeng ers on board say they are infect edHong Konghttps ://www .japantimes.co . jp/news/2020 /02/ 16/nationa l/science health/canada-evacuat e-passenge rs-coro navirus-covid l 9-diamondprincess-cruise-s hip/There are around 330 Hong Kong resident s on board, including 260holding Special Administrative Region of Hong Kong passpo1ts androughly 70 people with foreign ones .NIH-001499NIH-001500South Koreahttps ://www. japantime s.co. jp/news/2020/02/18/nationa l/science heal th/ sou th-korea-evacua te-diamo nd-princess /The South Korean government is sending a presidential plane to Japanon Tuesday afternoon to evacuate several citizens on a coronavirusstrickencruise ship docked in Yokohama, a government official saidTuesday.14 South Koreans - nine passengers and five crew membersCanadahttps ://www. j apantimes. co. jp/news/2 020/02/18/national/sciencehealth/ canada-diamond-princess-covid 19/Global Affairs Canada had confinned that 32 out of 256 Canadians onthe ship had tested pos itive.Canadian passengers are set to be evacuated from the virus-hit boatsoon, passengers will be screened before boarding the evacuationaircraft , and those who exhibit symptoms of COVID-19 will betransferred to the Japanese health care system,Australia https: //www.news.com.au/ travel /travel-updates/healthsafety/unusual-rescue-fli gb t-ahead-for-a us tralian-evacuees -o f-thediamond-prince ss/news-story/ 564e590bec70b 7182 5c897 df85d0bc24Austra lia evacuated passengers from the cruise ship today.• ~180 evacuated• 15 declined evacuation• 36 confirmed COVID hospitalized in Japan• 10 newly confirmed had to stay behindSo there were a total of ~241 Australians aboard the ship; 46 tested +(19%)The story from Australia sounds familiar (see below).NIH-001501Australian cruise passengers arriveto Darwin after Diamond Princessvirus outbreak ordealFeb 20A rescue mission of Australian cruise ship passengers from Japan hasofficially landed in Darwin, but the ilight wasn't free from drama.Thousand s of people sharing toilets, pools and buffets - is thi s the petridish of the sea?The Qantas coronavirus rescue flight, carrying about 180 citizens andpermanent residents on board from Japan, has landed in Australia.Qantas flight 6032 touched down in Darwin at 8.11am local time, afterbeing slightly delayed from takeoff our of Haneda.The last-minu te drama hit the rescue mission when 10 Australians, whowere set to leave the coronavirus-hit Diamond Princess ship and head tothe airport , were told they had tested positive to coronav irus and had tostay behind.About 180 citizens and permanent residents , who have spent the pastfortnight on the quarantined cruise ship off the coast of Japan, had takenup the Federal Government' s offe r of a seat on the repatriation flight toAustra lia.They join another 36 Australians who contracted coronavirus on theDiamond Princess and are being treated in Japan. About 15 of theirrel atives declined the offer of repatriation to stay with them.The Australians on board will be screened for coronavirus five timesbefore they are taken to a quarantine facility at HowardQantas boss Alan Joyce praised the crew who took part in therepatriation flight as well as two previous Qantas chartered flights thatbroug ht Austra lians home from virus epicent re Wuhan ."It took literally thousands of hours to plan complex operations likethese," Mr Joyce said at t press conference today."T he crew were all volunteers and they did us proud ."NIH-001502Yesterday , Australians who were cleared to finally disembark theDiamond Princess were driven by bus to Haneda Airport for thechartered flight home.They first needed to pass a health check to receive an approval ofdisembarkation notice by Japanese quarantine officials.They were then screened several more times before they could boardthe Qantas 7 4 7.On the plane , they had no contact with Qantas crew, who remainedupstairs for the flight. Food for passengers was already waiting for themat their seats when they boarded.If they passed the latest health check, they would have been given"approval of disembarkation" notices by Japanese quarantine officials ,which grant them permission to enter Japan.From Yokohama Po1t, where the ship was docked, they boarded busesto Haneda Airport.Brisbane student Tehya Pfeffer, 18, who has been quarantined on theDiamond Prin cess with her grandmother Cathy, was among them."At 10.30am (local time, 12.30pm AEDT) we will start to be screenedand given luggage tags and wrist bands," Ms Pfeffer told news .com.auyesterday."At 5pm we have to have our luggage put outside, and at 6pm we willdisembark the ship and go through a makeshift customs . This is wherewe use our wrist bands."And then we will take a bus to the airport and at around 12amThursday we will fly to Darwin."On the evacuation flight , cabin crew would not be making direct contactwith evacuees .Meals were already waiting for passengers at their seats when theyboarded, and Qantas staff remained upstairs.All those retw·ning to Austra lia on the Qantas flight will spend twoweeks in quarant ine at the Howard Springs facility, in add ition to thetwo weeks in lockdown they've had on the ship.Sent from Mail for Windows l 0From: Carter MecherSent : Wednesday, February 19, 2020 8:36 PMTo: Richard Hatchett ; Dr. Eva K LeeCc: Tracey McNamara ; Caneva, Duane; (b)( ; Dodgen. Daniel(OS/ASPR/SPPR); DeBord, Kristin (OS/ASPR/SPPR); Phillips. Sally(OS/ASPR/SPPR); David Marcozz i; Hepburn, Matthew J CIV USARMY (USA);Lisa Koonin; Wargo Michael ; Walters. Will iam (STATE.GOV): HARVEY,MELISSA; WOLFE, HERBERT; Eastman, Alexander ; EVANS, MARIEFRED;Callahan, Michael V.,M .D.; (b)(6)Johnson, Robert (OS/ASPR/BARDA); Yeskey, Kevin; (b)(<;>w: , Gary(0S/ASPR/BARDA) ; Redd, Johnt(OS/ASPR/SPPR); Hassell, David (Chris)(OS/ASPR/10) ; Hamel, Joseph (OS/ASPR/10) ; Dean, Charity A@CDPH; Lawler,James V; Kadlec, Robert (OS/ASPR/10); 'Mart in, Gregory J-------- (b)(6) ; Borio. Luciana; Hanfling, Dan; McDonald. Eric; Wade, David; TARANTINO, DAVID A; WILKINSON, THOMAS; David Gruber----------- (b)(6) KAUSHIK, SANGEETA; Nathan iel Hupert Subject: RE: Red Dawn Breaking , COVID-19 Collaborative, Feb 16 startSouth Korea cases are taking off.S. Korea reports 31 more cases on 2/20; total now at 82Singapore, Hong Kong, Japan, and South Korea are the new front lines.Matt er of time before travel from those areas will raise concerns.Sent from Mai l for Windows l 0From: Carter MecherSent : Wednesday, February 19, 2020 4:45 PMSubject: RE: Red Dawn Breaking , COVID-19 Collaborative, Feb 16 startWas listening to the discus sion today. There was a discussion about theshortages of PPE . There was also discussion re NP Is, but I'm not surethat most folks appreciate that the NPls that have been arrayed as partof the TLC strategy to reduce disease transmission in the communityNIH-001503NIH-001504can be leveraged to create safer compartments or spaces by shuntingdisease toward the home. By implementing these interventions, onecould reduce the likelihood of disease in workplaces (by home isolationand home quarantine-- keeping sick employees at home and keepingemployees who are well but potentially infected because someone issick in their household, at home). Adding in other social distancingmeasures including social distancing at work, helps to reducecommunity transmission (adds additional protection to the workplace).The consequence is shunting disease to the home--120 M differentcompartrnents in the US, and making the workplace the safe place.That is potentially very important for critical infrastructure. Theanswer is not PPE for these employees. And why would we expect thatemployees in these sectors would have any better IPC with the use ofPPE than we saw with staff on the Diamond Princess?Healthcare is a key critical infrastructure. It is different from the othersectors in that it will be attracting patients with COVID like a magnet.It is hard to imagine how one could makes healthcare a safeworkplace. But it is only hard to imagine how one could do that unlessyou begin to look a little closer at the different components of thehealthcare system and the roles each component might play during thispandemic .To illustrate this, I took a stab at developing a conops or roadmap tolook at the various pieces of the healthcare system. The shunting ofdisease is really fractal. Just as we can look at shunting disease across acommunity into one compartment (the home) to make othercompartments safer, we can do the same within our healthcare systemshuntdisease to the acute care area where COVID patients will beconcentrated. What are the strategies to do that?This conops is notional. It is purposely designed for a severe outbreakwith severe disease and assumes that the hea lthcare system mustsomehow continue to limp along and continue to care for thebackground disease we see during normal times (strokes, AMis,fractures and trauma, appendicitis, other serious infections, CHF,diabetic emergencies, psychotic episodes, preeclampsia, complicateddeliveries, end stage renal disease and dialysis, etc.) as well as sustainoutpatients with chronic conditions that require monitoring and care tokeep them well and out of the ER and out of the hospital.Sent from Mail for Windows 10From : (b)(Sent : Wednesday, February 19, 2020 2:36 PMTo: Richard Hatchett ; Dr. Eva K LeeCc: Tracey McNamara ; Caneva, Duane; (b)(6); Dodgen , Daniel(OS/ASPR/SPPR); DeBord. Krist in (O5/ASPR/SPPR); Phillips. Sally(OS/ASPR/SPPR); David Marcozzi; Hepburn . Matthew J CIV USARMY (USA);Lisa Koonin; Wargo Michael ; Walters , Wil liam (STATE.GOV); HARVEY,MELISSA; WOLFE, HERBERT; Eastman, Alexander ; EVANS, MARlEFRED;Callahan, Michael V.,M .D.1 (b)( ~ ;Johnson , Robert (OS/ASPR/BARDA); Yeskey, Kevin; Disbrow, Gary(OS/ASPR/BARDA); Redd, Johnt(OS/ASPR/SPPR); Hassell, David (Chris)(OS/ASPR/IO); Hamel, Joseph (OS/ASPR/1O); Dean, Char ity A@CDPH; Lawle r,James V; Kadlec, Robert (OS/ASPR/ 1O); "Mart in, Gregory J(b)(6) · Borio. Luciana; Hanfling, Dan; McDona ld. Eric; Wade. _______ ..,.Qilld.QT.;A RANTINO, DAVID A; WILKINSON, THOMAS; David Gruber---------- (b)(6]; KAUSHIK, SANGEETA; Nathan iel Hupert Subject : RE: Red Dawn Breaking , COVID-19 Collaborative, Feb 16 startUpdate for South Korea (see attached) 51 cases; l childColombia confirms first case of Coronavirus -citizen on Japan cruise shipFebruary 17th, 2020, 09:06 AM@Stats AlertsBREAKING: Colombia conf irms first case of Coronaviru s Colombia confirm sfirst case of coronavi rus: citizen was on a Diam ond Princess cruiseSent from Mail for Windows l 0From : Carter MecherSent : Wednesd ay, February 19, 2020 10:05 AMNIH-001505To: Richard Hatchett ; Dr. Eva K LeeCc: Tracey McNama ra; Caneva, Duane; (b)(6); Dodgen, Daniel(0S/ASPR/SPPR); DeBord , Kri stin (0S/ASPR/SPPR); Phillips, Sally(0S/ASPR/SPPR); David Marcozzi ; Hepburn, Matthew J CIV USARMY (USA);Lisa Koonin; Wargo Michae l; Walters, William (STATE.GOV); HARVEY,MELISSA; WOLFE, HERBERT; Eastman, Alexander ; EVANS, MARIEFRED;Callahan, Michael V.,M.D.; (b)(6JJohnson , Robert (0S/ASPR/BARDA) ; Yeskey, Kevin; Disbrow, Gary(OS/ASPR/BARDA); Redd, Johnt(OS/ASPR/SPPR); Hassell. David (Chris)(0S/ASPR/ I0) ; Hamel, Joseph (OS/ASPR/10 ); Dean, Charity A@CDPH; Lawler,James V; Kadlec. Robert (0S/ASPR/10 ); 'Mart in, Gregory J------- (b)(6) -' ; Borio, Luciana ; Hanfling, Dan; McDonald, Eric; Wade, ~ TARANTINO, DAVID A; WILKINSON, THOMAS; David Grub er_________ Cb>_<_6J,; KAUSHIK, SANGEETA; Nathan iel Hupe rtSubject: RE: Red Dawn Breaking , COVID-19 Collaborative, Feb 16 startUpdate on HK (65 cases; no children) and Singapore (84 cases; 49currently hospitali zed/4 in ICU; still only 4 children (2 asymptomatic /2hosp ita lized).Sent from Mail for Windows 10From: Carte r MecherSent : Wednesday, February 19, 2020 8:20 AMTo: Richard Hatche tt ; Dr. Eva K LeeCc: Tracey McNamara ; Caneva, Duane; (b)(6J; Dodgen, Danie l(OS/ASPR/SPPR); DeBord, Kristin (OS/ASPR/SPPR); Phill ips, Sally(0S/AS PR/SPPR); David Marcozzi; Hepburn. Matt hew J CIV USARMY (USA);Lisa Koonin; Wargo Michae l; Walte rs, William (STATE.GOV); HARVEY,MELISSA; WOLFE, HERBERT; Eastman , Alexander ; EVANS, MARIEFRED;Callahan, Michael V.,M .D.; (b)(6);Johnson, Robert (OS/ASPR/BARDA); Yeskey. Kevin; Disbrow. Gary(OS/ASPR/BARDA); Redd, Johnt(OS/ASPR/SPPR); Hassell, David (Chris)(OS/ASPR/I0) ; Hamel. Joseph (OS/ASPR/10) ; Dean, Charity A@CDPH; Lawler,James V; Kadlec, Robert (OS/ASPR/10); 'Mart in, Gregory J------- (b)(6)- ' ; Borio, Luciana; Hanfling, Dan; McDona ld, Eric; Wad e, David; TARANTINO, DAVID A; WILKINSON, THOMAS; David Grube r_________ Cb>_<_6.J,; KAUSHIK, SANGEETA; Nathan iel Hupe rtSubject: RE: Red Dawn Breaking , COVID-19 Collaborative, Feb 16 startNIH-001506As of yesterday, there are 251 Canadians on board the DiamondPrincess , of whom 34 have tested positive.https://global news.ca/ news/6567907 / c ... hi p-canadia ns/Canada walks back expected departure date for evacuees of Japanese cruiseshipBy Staff The Canadian PressPosted February 19, 2020 7:47 amUpdated February 19, 2020 7:49 amGlobal Affairs says the departure date for a plane that will carry Canadianshome from a coronavirus-stricken cruise ship in Japan is yet to be confirmed.Spokeswoman Barbara Harvey says the departure wil l be settled once finalarrangements are made with the Japanese government and the cruise shipcompany . A news release from the company operating the Diamond Princesscruise ship says the Canadian flight has been "shifted 11 to early Fridaymorning .Sent from Mail for Windows l 0From: Carter MecherSent: Wednesday, February 19, 2020 8:09 AMTo: Richard Hatchett ; Dr. Eva K LeeCc: Tracey McNamara; Caneva, Duane: (b)(6): Dodgen. Daniel(OS/ASPR/SPPR); DeBord, Kristin (O5/ASPR/SPPR); Phillips, Sally(OS/ASPR/SPPR); David Marcozzi; Hepburn, Matthew J CIV USARMY (USA);Lisa Koonin; Wargo Mich ael; Walters, Will iam (STATE.GOV); HARVEY,MELISSA; WOLFE, HERBERT; Eastman, Alexander; EVANS, MARIEFRED;Callahan, Michael V.,M .D.f (b)( 6)1Johnson. Robert (OS/ASPR/BARDA); Yeskey, Kevin; Disbrow, Gary(OS/ASPR/BARDA); Redd, Johnt(OS/ASPR/SPPR); Hassell, David (Chr is)(OS/ASPR/IO); Hamel. Joseph (OS/ASPR/1O); Dean, Charity A@CDPH; Lawle r,James V; Kadlec. Robert (OS/ASPR/1O); 'Mart in, Gregory J.___ _______ C_)b_(_,,'_·, Borio, Luciana; Hanfli ng, Dan; McDonald, Eric; Wad e,David; TARANTINO, DAVID A; WILKINSON, THOMAS; David Grub er------------ (b)(~; KAUSHIK, SANGEETA; Nathaniel Hupert Subject: RE: Red Dawn Breaking , COVID-19 Collaborative, Feb 16 startNIH-001507621 cases on cruise ship (17% of the passenge rs and crew have beeninfected).https://www.channe lnewsasia.com/news ... it ive-1245049879 more people test positive for COVID-19 on Diamond Princess cruise ship19 Feb 2020 06:21PM(Updated : 19 Feb 2020 06 :30PM)TOKYO: An additional 79 cases of coronavi rus have been discovered aboardthe Diamond Princess cruise ship in Japan, the health ministry saidWednesday (Feb 19), bringing the total to 621.Sent from Mai l for Windows l 0From: Carte r MecherSent: Wednesday, February 19, 2020 6:06 AMTo: Richard Hatchett ; Dr. Eva K LeeCc: Tracey McNama ra; Caneva, Duane; (b)( ; Dodgen, Daniel(OS/ASPR/SPPR); DeBord, Kri stin (OS/ASPR/SPPR); Phillips, Sally(OS/ASPR/SPPR); David Marcozzi ; Hepburn, Matthew J CIV USARMY (USA);Lisa Koonin; Wargo Michael ; Walters, William (STATE.GOV); HARVEY,MELISSA; WOLFE, HERBERT; Eastman, Alexander ; EVANS, MARIEFRED;Callahan. Michael V .• M.D.; (b)(6);John son, Robert {OS/ASPR/BARDA); Yeskey, Kevin; Disbrow, Gary{OS/ASPR/BARDA); Redd, Johnt{OS/ASPR/SPPR); Hassell, David {Chris)(OS/ASPR/1O); Hamel, Joseph (OS/ASPR/1O); Dean, Charity A@CDPH; Lawler,James V; Kadlec, Robert (OS/ASPR/1O); 'Mart in, Gregory J( (b)( 6Yil:_; Borio, Luciana; Hanf ling, Dan; McDonald, Eric; Wade,David; TARANTINO, DAVID A; WILKINSON, THOMAS; David Gruber---------- (b)(6-) -; KAUSHIK, SANGEETA; Nathan iel Hupert Subject: RE: Red Dawn Breaking , COVID-19 Collaborative, Feb 16 startI saw a news s101y yesterday (WashPost) that testing was completed.So we should know in the next coupe of days.Also saw a story abou t the 100 or so Americans left behind ( 44 inhospitals and 61 who declined evacuation) .https ://mainichi.jp /english/articles/20200219 /p2g/00m/0in/028000cNIH-001508Hard to find data on the stah1s of those still hospita lized in Japan.James made a very important point yesterday. Altho ugh the passengersare elderly (2,666 passengers) , the crew membe rs are relatively young(1 ,045 crew members). James also expected the attack rates to be veryhigh among the crew member s (they were housed together in arelatively small space aboard the ship, perfect condit ions for explosivedisease transmission). So this combined data on passengers (elderly)and crew (young and healthy) will be invaluable in terms of helpingunderstand seve rity. I would think that Japan also realizes howinvaluable this data is. Japan will be in the best position to assess theimpact on the crew, since they will know the results oflab screeningand hospitalization of all + crew members (as well as the monitoringqua rantine of the rest of the crew over the next 14 days). But now thatthe passengers are being dispersed, it will be important for severalnations to share the data on these passengers - it is really our bestchance to understand severity (would need collabo ration of the US,Canada, Australia, Hong Kong, Japan).Sent from Mail for Windows 10From: Richard Hat chet tSent: Wednesday, February 19, 2020 4:47 AMTo: Dr. Eva K Lee; Carte r Meche rCc: Tracey McNama ra; Caneva, Duane; (b)(6) Dodgen , Daniel(OS/ASPR/SPPR); DeBord, Kri st in (OS/ASPR/SPPR); Phillips, Sally(OS/ASPR/SPPR); David Marcozz i; Hepburn, Mat t hew J CIV USARMY (USA);Lisa Koon in; Wargo Michae l: Walte rs. Will iam (STATE.GOV): HARVEY.MELISSA; WOLFE, HERBERT; Eastman, Alexander ; EVANS, MARIEFRED;Callahan, Michael V.,M .D.1 (b)(6) ·Johnson, Ro bert (OS/ASPR/BARDA); Yeskey, Kevin; Disbrow , Gary(OS/ASPR/BARDA); Redd, Johnt (OS/ASPR/SPPR); Hassell, David (Chris)(OS/ASPR/10) ; Hamel, Joseph (OS/ASPR/ 10) ; Dean, Charity A@CDPH; Law ler,James V; Kadlec, Robert (OS/ASPR/10); 'Mart in, Gregory J(b)(6) '; -------- Borio, Luciana; Hanfli ng, Dan; McDonald, Eric; Wade, David; TARANTINO. DAVID A; WILKINSON. THOMAS; David Grube r----------- (b)(6); · KAUSHIK, SANGEETA; Nat haniel Hupert Subject : RE: Red Dawn Breaking, COVID-19 Collaborative, Feb 16 startNIH-001509I understand from contacts at WHO that Japan is testing everyone onthe Diamond Princess , so we should have a complete accounting of thatclosed population (and thus a nice dataset to inform severity estimate s).From: Dr. Eva K Lee (b)(6) ---------- Sent: 19 February 2020 03:54To: Carter Meche rr------- C=>b=c=6~JCc: Tracey McNamara I (b)(6))>; Caneva, DuaneCb()6 ))>;R ichard Hatchett======:::,~;-::--:--======:(:b:)(:6!)jD. .o.d~-ge~n, Daniel (OS/ASPR/SPPR) (b)(~ DeBord, Kristin (OS/ASPR/SPPR)=======;~::,;--~(b)(6) ]>; Phillips, Sally (OS/ASPR/SPPR)=-=-==-=-==-~-':;-;:' - CbH6)D] avid Marcozzi ---------~~ CbH6)]>; Hepburn, Matthew J CIV USARMY (USA) CbH6J>;Lisa Koonin f (b)(6)J>; Wargo Michae lCbH6)}>; Walters , William (STATE.GOV)-:.======= ('=b)=(='6'5tJi·-' -H--::A--~'.R-V:-:E':.:-Y::,--M:-- :ELIS SA! CbH6))>;WOLFE, HERBERT! CbH6);) >Eastman, Alexander-------'=====; (b,):(:~(::6,);:>-)-; =E-V:A-:-N:-:S-:-,-M:--:A-:'-.R:~IEFRED(b)(6)j; Callahan, Michael V.,M.D.(b) (6)};(b)(6) , Johnson, Robert (05/ASPR/BARDA) =======~= CbH6))>Y; eskey, Kevin! (b)(6)j--------- ,:..;_ __ -=======~~~,.......-----Disbrow, Gary (OS/ASP.R,,:/.B..A. RDA.:). ......::==:::::::;,:;;------:C-:b--H-6J>R; edd,John t (OS/ ASPR/SPPR) (b)( >; Hassell, David (Chris)(OS/ASPR/I0) (b)( >; Hamel, Joseph (OS/ASPR/10)(b)(6)>; Dean, Charity A@CDPH ~======:=!!'======..::::-..::::-..::::-----_--~-~=~ ---------- (b) (6))>; Lawler, James V (b)( 6})>; Kadlec, Robert (OS/ASPR/10)1 (b)(6J:>; 'Martin, Gregory J(b) (6)) Borio, Luciana(b)(6,)>; Hanfling, Dani CbH61>); McDonald, EricTARANTINO, DAVID ArTHOMAS((b)(1)>J>; Wade, David I (b)(6b;CbH6))>W; ILKINSON,Cb()6 ]); David Gruber'-:-:---:--::-:'.::-:.:========='c~;;---:--:--:--:- (-b)_(6_>,v.:.>..;. KAUSHI K,-S-A-N-G!E:E=TAI= ==~=":"---- (b)(6)_ ; Nathaniel Hupert (b )( 6)jSubject: RE: Red Dawn Breaking, COVID-19 Collaborative, Feb 16 startJust talked to a lab director in Hong Kong U. They tested 3,600passengers and crews on World Dream in 24 hours , all using the definitiveRT-PCR test. The tests were performed in government labs . Theydisembarked everyone after 3 days (all came back negative). And they arestill performing contact tracing and monitoring on all at the moment.NIH-001510old news:https://www.scmp.com/news /hong -kong/healthenvironment/article/3049714/coronavi rus-3600 -passengers -and-crewmembersFor surveillance , regional hospitals do an initial screening , then suspectedcases are tested by a governmental lab for confirmation.Schools are still closed for another month.(b)(6)mobile: (b)(6) -----Sent with ProtonMail Secure Email.------- Original Message -------On Tuesday , February 18, 2020 7:56 PM, Carter Mecher-------- (b) < ·> wrote:Japan inching toward mitiga tionAbe urges people with coldlikesymptoms to avoidwork, schoolToday 06:30 am JST 24 CommentsNIH-001511NIH-001512TOKYOPrime Ministe r Shinzo Abe on Tuesday advised peop leacross the country not to go to work or schoo l if theydevelop cold-like symptoms, as the country grapples withthe spread of a new coronavirus origina ting in China.Workplaces in the country, known for their long hour s,need to encourage people to take days off withouthesitation if they do not feel well , Abe said."The first thing that I want the people of Japan to keep inmind is to take time off school or work and refra in fromleaving the house if they develop cold-l ike symptoms suchas fever," Abe told a meeting of a government task force onthe viral outbreak.Te leworking is an "effect ive alternative" to help prevent thevirus from spreading fmther, Abe said.He made the remarks as the governmen t is scrambling tocontain the virus that originated in Wuhan, with morepeople with no obvious link to Ch ina gett ing infected inJapan.The global outbreak of the disease called COVID-19 hasprompted some even t organizers in Japan to rethink theirplans for hosting mass gather ings.The number of confi rmed cases in Japan has topped 600,including over 500 passengers and crew on the DiamondPrincess , a quarantined cruise ship docked at Yokohamanear Tokyo with more than 3,000 confined.The steady rise in infections in various pa1ts of Japan hasraised public concern , prompting the health ministry to askpeople who develop symptoms such as a temperature of37.5 C or higher for at least four days to cons ult loca lhealth care centers and go to designated hospital s. Theperiod is set shorte r for the elderly , those with underlyingcondi tions and pregnan t women.As Tokyo and othe r major cities in the country arenotorious for packed rush-hour trains, commute rs havebeen encouraged by a government panel of medical expertsto go to work earlier or later than usual as the risk ofinfect ion is increased in crowds .On Tuesday, Fujitsu Ltd and Hitach i Ltd said they areexpanding teleworking , though Japane se companies overallhave been slow to introduce it.Sent from Mail for Window s 10From: Tracey McNama raSent: Tuesday , February 18, 2020 4:38 PMTo: Dr. Eva K Lee ; Canev a, DuaneCc: Cai1er Mecher; Richar d Hatchett ;------- (bH6;) Dodgen, Daniel (OS/ASPR/SPPR t DeBord, Kristin {OS/ASPR/SPPR ): Phillips. Sally(OS/ASPR/SPPR) : David Marcozzi ; Hepburn . Matthew JCIV USARMY (USA) ; Lisa Koonin ; Wargo Michae l;Walters, Will iam (STATE.GOV) ; HARVEY . MELISSA ;WOLFE, HERBER T; Eastman. Alexander ; EVANS,MARIE FRED ; Callahan, Michael V.,M .D.;---------------- (b) (6) Johnson . Robe rt (OS/ASPR/BARDA) : Yeskey. Kevin ; Disbrow.Gary (OS/ASPR/BARDA ); Redd. Johnt(OS/ASPR/SPPR ):Hassell, David (Chris) (OS/ASPR/1O) ; Hame l, Joseph(OSI ASPR /1O): Dean, Charity A@CDPH ; Lawler, JamesV; Kadlec, Robe rt (OS/ASPR/1O): 'Martin, Gregory J--------- (b)(6) •; Borio, Luc iana; Hanfl ing. Dan; McDon ald, Eric; Wade, David; TARAN TINO, DAVID A;\VILKINSO N, THOMAS ; David Gruber---------- (bH6); KAUSHIK, SANGEETA ; Nathaniel HupertSubject: RE: Red Dawn Breaking, COVID-19Collaborat ive, Feb 16 sta1tI must be psychic. This just cameout. Like I said - Oxford NanoporeNIH-001513Sequencers are being sent toChina!Traceyhttps: //protect2f.i reeye.c om/url?k=0a860669-56d21f15-0a863756-0cc47adc5fa2-4 fc 7 adc96dfbde59&u =https ://g lobalbiodefense.com/newswire/oxford-nanopore-sequencershave-left-uk -for-chni a-tosupport-rapid-near-samplecoronavirus-seq uencing-foroutbreak-surveila nce/To: 'Caneva, Duane'Cc~-C-bH > · Carter Mecher ; Rich'a rd HatchettCb><6l ; Dr. Eva K Lee(b)(6)> Dodgen, Daniel(0 /ASPR/SPPR) ________ Cb> _<6);DeBord, Kristin (OS/ ASPR/SPPR)Cb<>6 ) ; Phillips , Sally(OS/ ASPR/SPPR) CbH6);David Marcozzi---------- CbH6>) ; Hepburn , Matthew J CIV USARMY (USA)CbH6•) Lisa Koonin ..------ 'Cb<>6 )>; Wargo MichaelCb>< • Walter s __________ , 'NIH-001514William (STATE .GOV) _________ C_>b_<6J;HARVEY, MELISSACb><6WJ·O LFEHERBERT ' ' CbH6),. ____________ ,Eastman, AlexanderCb><6)E>V; ANS, ------------ MARIEFRED(b)(6>). -------------- ' Callahan , Michael V.,M .D.(b)(6)Johnson , Robert (OS/ ASPR/BARDA)Cb>>< - Yeskey Kevin' ' Cb><6)D>i;s brow, Gary(OSI ASPR/BARDA) _______ Cb<>6J>;Redd, John (OS/ASPR/SPPR)Cb><6)H>a; ssell, David (Chris)(OS/ASPR/IO) _______ Cb<>6);Hamel, Joseph (OS/ASPR/1O)Cb>>< · Dean Charity' 'James V -----CbH6J>L-awler r--- , ,CbH6;) K ad l ec,Robert (OS/ ASPR/1O) (b)(6)'Martin, Gregory J Cb<>6 )Cb><> · Borio LucianaCb>< ; Han'f ling, D' anCb>p<6; JMcDonald , Eric---C-bH}6>). Wade David CbH6T);A RANT' INO ,'DAVID A -------------- Cb><6• J> 'WILKINSON, THOMASCb>><· DavidGrub er Cb>)< 'Cb>p<-6; )KAUSHIK,SANGEETA Cb>t<6; )Nathaniel Hupert Cb><Subject: RE: Red Dawn Breaking, COVID-19Collaborative, Feb 16 startNIH-001515NIH-001516Hello all - Clearly , the most importantthing of all is a reliable , real-timediagnostic test that can differentiatebetween flu and COVID-19. CDCs testkits were recalled because states saidthey were not working. Now they haveto remanufacture the faulty reagent.How long will that take? If and whenmore kits are available , will they beavailable in sufficient quantity that allhealth care providers will have access?In all of this, I have not heard anyonetalk about the Nanopore MinIONtechnology that has been used forEbola. What gives??? It is fielddeployable and can be run in-house.Hospital labs can run thousands ofsamples at once. It gives results of allviruses, bacteria, protozoa , fungi, in 2hours. We all know this technology isquite promising. Why aren't we goinggangbusters to validate this rapidtechnology and get it to alldiagnosticians? If ever there was a timeto invest in a diagnostic technology ,this is it!TraceyFrom: Dr. Eva K Lee (b)( >Sent: Tuesday , February 18, 2020 1:06 PMTo: Caneva, Duane ---------- (b) (6)Cc: Carter MecherHatchettCb)(6) ; RichardCbH6);> ; Tracey McNamara(b) ((ij• _________________ ,Dodgen, Dan iel (OS/ASPR/SPPR)Cb) (6) >; De Bord, Kristin(OS/ASPR /SPPR) Cb)C6)> ; Phillip s,Sally (OS/ASPR/SPPR) Cb)C6); DavidMarcozzi Cb) (6); Hepburn, Matthew J- C-N- -US-A-R-M-Y- (U-S-A-) ----------C-b)( >; Lisa Koonin ; Wargo Michael(STATE . V)MELISSAHERBER(b)(6) Walters , WilliamCb)(6) ; HARVEY ,CbH6)> ; WOLFE,Cb) (6); Eastman,;EVANS,(b)( >· ______________ ,Callahan, Michael V.,M.D.(b)(6)Robert (OS/ ASPR/BARDA)Yeskey, Kevin ----....,,(OS/ASPR/BARDA)Johnt(OS / ASPR/SPPR)David (Chris) (OS/ASPR/ IO)Hame l, Joseph (OS/ASPR/ 1O)Dean, Charity A@CDPHLawler, James V ....,..._,...,Robert (OS/ ASPR/ 1O)Gregory JCb) (6) Johnson,(b) (6) . ..------ ' (b)(6) ; Disbrow, GaryCb(>6) ; Redd,Cb()6 ) ; Hassell ,(b)(6) > ;(b)((b)(6) p ;Cb<) 6=dY-u>~'· ~K adlec 'Cb) C6)v > ; 'Martin,(b)(6)Borio, Luciana Cb) C ; Hanfling , DanTHOMAS(b)(6) > ; McDonald, Eric--C-b()6 ) ; Wade, David (b)(6) > ; TARANT INO , DAVID ACb)C6)> ; WILKINSON,(b)(6)• ___ ,(b) (6))NIH-001517Cb><6JK; AUSHIK, SANGEETACb()6 ); Na thani el Hu pert ========~ (b~(~)6-)Subject: RE: Red Dawn Breaking, COVID-19Collaborative, Feb 16 startCarter,Just listened in to our state COVID-19 response effortupdat e. Georgia has no COVID-19 cases yet, and hencethey remain in the conta inment period where they placemedium-risk individuals on supervised monitoring of homequarantine, advise them to take temperature daily andreport any respiratory symptoms (24/7). Educate them notto show up in ED, or any place without facilitation. Toavoid potential disease spread, they are advised to remain athome.The next stage will be mitigation when a confirmed case isreported. That will initiate the pandemic planning andcommunity-based NPI will be considered. This includessocial di stancing -- telework , teleclass , etc.I assume at cities where there are confirmed local COVID-19 cases, the public health leaders have already begun themitigation phase now and hence are practicing some degreeof social distancing and rolling out telework, and variousstrategies to protect health in the population and tomaintain business continuity already. Is that true or theyare still waiting to execute their operations?There are not many tests needed here in Georgia. But rapidrobust and reliable testing kits (Tracey's reporting ofcurrent bottleneck) remain critical in all communities withpositive cases. If we have such means, test ing can also beconducted (sampli ng) on some flu-like cases at strategicselec ted cities also.NIH-001518------- Original Message -------On Tuesday , February 18, 2020 2:20 PM, Dr. Eva KLee---------(bH > wrote:Duane, Yes. ( asymptomatic or mild symptoms)this is the worry at the very start, and itremain s the most critical. Hence even 1 % ofinfection for us -- can balloon out of proportionand we can't handle . Shedd ing not only duringinfection period, bur also post-recove ry. It's avery long timeline that we have to deal with.Then you have all the university siudents .Students travelled to China and came back toschool, they asked hea lth service if theyneeded to quaran tine or take any action,theadvice -- no need. Those are missedopportunities. Again, seasonal influenzaaffects 8-10% Americans, 0.7% of thoseinfected requir ed hospitalization , and moralityis roughly 0.1 %. So it is easy to "calculate" allthese numbers backwards ... So 20% ofCOVID-19 infected may need hospitalization, mortalityis 10-30 times higher than seasona l flu. Howmuch can we tolerate before anyone wouldspring into action? Keep in mind, some beginto infect rapidly upon contracting the virus, theincubat ion is so short (and so long) andinfectious too dming that period (with muchbeing unknown).Ca1ter, I think you will expect hetero geneousapproaches from different communit ies in theoverall response strategy, since it depends onthe socia l setting and the demographics andmore importantly the local resources. We haveto optimize for sure.NIH-001519------- Original Message -------On Tuesday , February 18, 2020 1:51 PM,Caneva, Duane Cb) (6)wrote:Seems to me a big challenge willbe asymptomatic or mildsymptoms in kids, spread throughthe schools, shed to parents whostaff both categories acute andnon-acute care clinics. If there areseveral days of asymptomaticshedding, how do you preventspread to the vulnerable, high riskpatients in each category?WiH mi ld symptoms drivecomplace nt compliance?From: Carter Mecher(b)(6) >Sent: Tuesday , February 18, 20201:32 PMSubject: RE : Red DawnBreaking, COVID-19Collaborative, Feb 16 startCAliTIO~: This email originated fromoutside of OHS. DO NOT click links oropen attachment s unless you recognizeand/o,r trust the sender. Contact yourcomponent SOC with questions orconcerns.NIH-001520NIH-001521My thinking is evolving in termsof healthcare system response.Initially I described how I wouldrefocus the outpatient clinics awayfrom COVID care and leveragethe NPis of isolation andquarantine to help keep theworkplace safe (for the clinic staffand other patients) rather than astrategy that employs PPE. Iwould only use the outpatientclinic staff to help withtelephone /home care support ofthose patients under homeisolation or home quarantine--tohelp with compliance /adherence toisolation and quarantine,monitoring their health, andoptimizing the care of their otherchronic medical conditions (tokeep them out of the ER and thehospital). But as I thought moreabout this, it occurs to me that thiscan be generalized beyondoutpatient clinics.I would think about dividing ourhealthcare system into two bigpieces: ( 1) acute care (EDs, acuteinpatient care, critical care); and(2) non-acute care includingoutpatient clinics (PC/FamilyPractice , pediatrics , OB/GYN,medical specialty, surgicalspecialty , dental, mental health,rehab, etc.), as well as otherinpatient areas (inpatient mentalhealth, substance abuse, nursinghomes , hospice care, memorycare, assisted living, etc.).Inpatient surgery (and I supposelabor and delivery) is part of acutecare, but for this outbreak, itprobably best belongs bundledwith the other non-acute inpatientareas. I would anticipate that thetripwire for implementing NPis( community transmission), willalso be the trigger for healthcaresystems to dial down or tum offelective admissions (primarilysurgical) to free up acute care andICU/monitored meds. The mosteffective way to protect these nonacuteareas is by shuntingpotential COVID pat ients awayfrom these areas and eitherproviding this type of care whilethe patients is hospitalized in acutecare or thru telephone care/homecare for patients with mild illnessreceiving care at home. And themost effective way to shunt thesepatients away from non-acute careareas is thru the implementation ofearly and aggressive NPis ofisolation of the ill and homequarantine of household contacts( and not fit testing the world andpassing out PPE that we don'thave) .Sent from Mail for Windows 10From: Carter MecherSent: Tuesday , February 18, 202011:02 AMTo: Richard Hatchett; Caneva,Du ane; Tracey McN amara; Dr.Eva K Lee ; (b)(6)(b)(6)--------- ; Dodge n, Daniel (OS/ASPR/SPPR) :NIH-001522DeBord. Kristin(OS/ASPR/SPPR) ; Phill ips, Sally(OS/ASPR/SPPR) ; DavidMarcozzi; Hepburn, Matthew JCIV USARMY (USA) ; LisaKoonin; Wargo Michael; Walters,William (STATE .GOV) ;HARVEY, MELISSA; WOLFE ,HERBERT ; Eastman, Alexander ;EV ANS, MARIEFRED ; Callahan,Michael V.,M.D.;(b)(6) ------,----J-oh-nson,Robe rt (OSI ASPR/BARDA) ;Yeskey, Kevin ; Disbrow, Gary(OS/ASPR/BARDA) : Redd, John(OS/ ASPR/SPPR) : Hassell, David(Chli s) (OS/ASPR/10) ; Hamel,Joseph (OS/ASPR/ 10) : Dean,Charity A@CDPH; Lawler, JamesV; Kadlec, Robert (OS/ ASPR/10) :'Martin, Gregory J--------- (b)( ' ; Borio, Luci an a; Hanfli:ng, Dan;McDonald , Eric ; Wade, David ;TARANTINO, DAVID A;WILKINSON , THOMAS; DavidGruberKAUSHlK , SANGEETA ;Na than iel Ru pertSubject: RE: Red DawnBreaking, COVID-19Collaborative, Feb 16 start(b) (6);More puzzle pieces re the cruiseship outbreak.• About2/3rds ofthepasseng ersNIH-001523NIH-001524have beentested so far(2,404 outof 3,711).• 61Americansopted toremamonboard andnot beevacuated.Japan has completed tests for allpassengers and crew aboard theship as of Monday, but theresults for the last batch of testsaren't expected untilWednesday, the day that thequarantine is slated to end. So far,results are back for 2,404passengers and crew, out of the3,711 who were on board the shipwhen the quarantine began on Feb .5.Japanese Health MinisterKatsunobu Kato said Tuesday thatpeople who have tested negativefor the virus would start leavingon Wednesday, but that theprocess of releasing passengersand crew won't be finished untilFriday , according to theWashington Post.The remaining 61 Americanpassengers on the DP who optednot to join the evacuat ion will notbe allowed to return to the USuntil March 4, according to theAmerican embassy in Tokyo. Thegovernments of Australia, HongKong and Canada have also saidthey would evacuate passengers.Elsewhere, Japan confirmed threemore cases of the virus. This tim e,they were confirm ed inWakaya ma, a prefec ture in eas ternJapan.Sent from Mail for Windows 10From: Carter MecherSent: Tuesday, February 18, 202010:50 AMTo: Rich ard Hatchett; Caneva,Duane ; Tracey McN amara ; Dr.Eva K Lee ; Cb) (6)..,__ ____ __> ; Dodgen,Daniel {OSIASPR/SPPR);DeBo rd, Kristin(OSIASPR/SPPR) : Phillips, Sally(OSIASPR /SPPR) ; DavidMarcozz i; Hepbu rn, Matthew JCIV USARMY (USA) ; LisaKoonin ; Wargo Michael ; Walters.William {STATE.GOV) ;HARVEY, MELISSA ; WOLFE,HERBERT ; Eastman, Alexander ;EV ANS. MARIEFRED ; Callahan,Michael V.,M .D.;(b)(6)------- ; Johnson,Robert (OSI ASPR/BARDA) ;Yeskey , Kevin ; Disbrow, Gary(OSIASPR/BARDA) ; Redd, John(OSIASPR/SPPR) ; Hassell, David(Chris) (OSI ASPR/10) ; Hamel,Jose ph (OSI ASPR/ IO); Dean.Charity A@CDPH; Lawler, JamesNIH-001525V ; Kadlec, Robert (OSI ASPR/1O):'Martin, Gregory J--------- (b)(6l '; Borio, Lu ci an a; Han fling , Dan;McDon ald, Eric; Wade, David;TARAN TINO, DA YID A;WIL KINSON, THOMAS ; DavidGrube rKAUS HIK , SANGEETA ;Nath aniel Rupe rtSubject: RE: Red DawnBreak ing , COVID-19Collaborative, Feb 16 start(b)(6)Maybe he was misquoted or it wasa typ o- perhaps what was meantwas 4 per 100 (and that would be alow estimate)Sent from Mail for Window s l 0From: Richard HatchettSent: Tuesday, Februaiy 18, 202010:45 AMTo: Carter Mecher; Caneva ,Duane; Tracey McNamara ; Dr.Eva K Lee ; (b)(6)>; Dodgen,'----'------..JDanie1 (OSI ASPR/S PPR);DeBo rd, Kristin(OS/ASPR/SPPR): Phi llips, Sally(OS/ASPR/S PPR) ; Da vidNIH-001526Marcozz i; Hepburn, Matthew JCIV USARMY (USA); LisaKoon in; Wargo Michae l; Walters ,William (STATE.GOV) ;HARVEY , MEL ISSA ; WOLFE ,HERBERT; Eastman, Alexan der;EV ANS , MARIEFRED ; Callahan,Michael V.,M.D. ;(b)(6)-------- Johnso n,Robe rt (OSI ASPR/BARDA) ;Yeskey, Kev in; Disbrow, Gary(OS/ASPR/BARDA): Redd, John(OSI ASPR/SPPR): Hassel l, David(Chr is) (OS/ASPR/ 1O): Hamel,Joseph (OS/ASPR/ 1O): Dean ,Charity A@CDPH ; Lawler, JamesV ; Kadlec, Robert (OS/ASPR/ 1O);'Martin , Gregory J--------- CbH '; Borio, Luci an a; Hanfling. Dan ;McDo nald, Er ic; Wade . David ;TARAN TINO, DAV ID A;WILKINSON, THOMAS ; DavidGruber,__ (b) (6). _________ ,KAUSHIK, SANGEETA;Nathanie l Hupe rtSubject: RE: Red DawnBreaking, COVID -19Collaborative , Feb 16 startNote that 4/ 100,000 would implythat only 440 peop le have beeninfec ted.From: Carter Mec her(b)(6)NIH-001527Sent: 18Febmary202015: 26To: Caneva, Duane(b)(6)Tracey McNamaraCb)(6) ; Dr.EvaKLee-------- >; Dodgen, Danie l (OS/ ASPR/SPPR)(b)(6) > ;DeBord , Kristin(OS/ASPR /SPPR)(b) (6).;Ph illips, Sally (OS/ ASPR/SPPR)-------- Cb)< >; David Marcozzi>; Hepburn, Matthew J CNUSARMY (USA)>; Lisa Koonin(b)(6)(b)(6)-------- Cb)( 6) ; Wargo MichaelWalters , William(STATE .GOV)(b)(HARVEY, MELISSA)(6)(b)(6) >• ,WOLFE, HERBERT(b)(6)Eastman, Alexander(b)(6) >; EV ANS, MARIEFRED)(6)Callahan , MichaelV. ,M.D.; Johnson,Robert (OS/ ASPRJBARDA)(b)(6) > · _________ ,NIH-001528Yeskey, Kevin(b)(6)Disbrow , Gary(OS/ ASPR/BARDA)--------- Cb(>6) > ; Redd, John (OS/ ASPR/SPPR)------- Cb(>6 )> ; Hassell , David (Chris) (OS/ASPR/ IO)(b) (6Ji;Hame l, Jos eph (OS/ ASPR/IO)--------- CbH6)>; Dean, Charity A@CDPHCbH >·' Richard Hatchett(b)( > ;Lawler, James V(b)( ;Kadlec , Robert (OS/ ASPR/IO)(b)(6)'Marti n, Gregory J(b)(6)Luciana ------ Hanfling, Dan(b)(McDonald, Eric; Wade , David(b)(6)(b)( >;TARANTINO, DAVID A(b) (6)> ;WILKINSON , THOMAS(b)(6)David GruberKAUSHIK , SANGE ETA----------- (b)( >· ' Nathaniel Rupert(b)( >Subject: RE: Red DawnBreak ing , COVID-19Collaborative , Feb 16 startNIH-001529NIH-001530WHO estimates 80% of patientwith COVID-19 have mild diseaseand recover; that implies that 20%have severe disease. WHOestimated that 14% developpneumonia and 5% are consideredcritical. [We were estimating that12% of cases neededhospitalization (so 88% did not)and 2% needed ICU care (withmortality of patients withpneumonia in the ICU generallybetween 15%-50% so a CFR of0,3%-1.0%). Also noet hiscomment on sparing children. Thelatter comments are reminiscent ofthe early comments of publichealth leaders during the 1918pandemic-always minimizing. Ihave no idea where an attack rateof 4 per 100,000 comes from.]https://www.channelnewsa sia.com/news/world/covid-19-coronavirus -who-china -patien tshave-mild-disease-124450 10GENEY A: The new novelcoronavirus only causes milddisease for 80 per cent of infectedpatients, said the World HealthOrganization on Monday (Feb17). Speaking to reporters , WHOchiefTedros AdhanomGhebreyesus said that 14 per centof patients would have severediseases such as pneumonia."Around five percent of cases areconsidered critical with possiblemulti-organ failure, septic shockand respiratory failure and, insome cases, death," he added.NIH-001531Tedros also said there were"relative ly few cases" amongchildren and more research wasneeded to understand why.The WHO chief also warnedagainst "blanket measures" overthe novel coronavirus outbreak,pointing out the epidemic outsideof China was only affecting a"tiny" proportion of thepopulation.Ryan said that even at theepicentre of the crisis in the city ofWuhan in centra l Hubei Province,the "attack rate" - a measure of thespeed of spread of the virus - wasfour per 100,000."This is a very serious outbreakand it has the potential to grow,but we need to balance that interms of the number of peopleinfected . Outside Hubei thisepidemic is affecting a very, verytiny, tiny proportion of people," besaid.T edros also referred to an apparentdecline in new cases of the diseasein recent days but said that thetrend "must be interpreted verycautiously".Sent from Mail for Windows 10From: Carter MecherSent: Tuesday, Feb ruary 18, 202010: 15 AMTo: Canev a, Du ane; TraceyMcNamara ; Dr. Eva K Lee ;(b)( 6),__ ______ ..z->; Dodgen,Danie l (OSI ASPRJSPPR ):DeBord , Kr istin(OS/ASPR/SPPR) ; Phill ips, Sally(OS/ASPR/ SPPR) ; DavidMarcozzi; Hepburn, Matthew JCIV USARMY (USA ); LisaKoonin ; Wargo Michael ; Walters ,Wi lliam (STA TE.GOV) ;HAR VEY. MELISSA ; WOLFE.HERBERT ; Eastman, Alexander ;EV ANS, MARIEFRED ; Callahan,Michael V.,M.D.;(b)(6) ;------- Cb)( ; Johnson, Robe rt (OS/ASPR/ BARDA) ;Yeskey, Kev in; Disbrow, Gary(OS/ASPR/BARDA ): Redd. John(OS/ASPR/ SPPR) : Hassell. David(Chris) (OS/ASPR/1O): Hamel,Joseph (OS/ASPR/1O): Dean,Charity A@CDPH ; Rich ardHatchett ; Lawler, James V;Kadlec , Rober t (OS/ ASPR/1O);'Martin, Gregory J--------- CbH6'); Borio, Luciana; Hanfling. Dan;McDonald, Eric: Wade. David;TARANTINO , DAVID A;WILKINSON, THOMAS ; DavidGru berKAUSHIK, SANGEET A;Nathan iel Rupert(b)( 6);Subject: RE: Red DawnBr eaking, COVID -19Collaborativ e, Feb 16 sta1tNIH-001532NIH-001533Update on cruise ship, Japan(implementing NPis) and SouthKorea ( evacuating passengers)https://www.channelnewsas ia.com/news/asia/covid l 9-japan-virus testing-complete-quarant inecruise-ship-1244578888 more people test positive forCOVID-19 on Diamond Princesscruise ship.The new cases take the totalnumber of confirmed cases on theDiamond Princess to 542 - thebiggest cluster outside theepicentre in China . [ Almost 15%of the crew and passengers havebeen infected.]Japan has also confirmed at least65 cases domesticalJy, includingmany involving people with nohistory of recent travel to China.Author ities have said the virus isbeing transmitted locally now, andhave asked citizens to avoidcrowds and non-essentialgather ings. On Monday, theamateur portion of the TokyoMarathon, which had beenexpected to attract some 38,000runners, was cancelled. Only eliteathletes wilJ now be able to takepart. The public celebration forEmperor Naruh ito's birthday hasNIH-001534also been scrapped over virusfears.South Korea will send apresidential aircraft on Tuesday tofly back four nationals and oneJapanese spouse, an official toldreporters. There are 14 SouthKoreans on board in total, but theother ten have declined to beevacuated from the ship becausethey live in Japan, the Yon.hapnews agency reported.Vietnam NPishttps:/ /protect2.fireeye . com/url ?k=5a2fa482-067bbdfe-5a2f95bd -0cc4 7adc5fa2-a5b86bc 1581 cf39c&u=https ://saigoneer. com/sai gon-health/ ... ue-tocovid-19Due to COVID-19: As ofFebruary 15, all 63 provinces andcities in Vietnam have extendedtheir school closing time, 56 ofwhich - including Saigon -have announced that schoo ls willbe closed until the end ofFe bruary. Ho Chi Minh City'sPeople Committee proposingstudents stay at home until the endof March.Sent from Mai l for Windows 10From: Carter MecherSent: Tuesday, February 18, 20207:10AMTo: Canev a, Duan e; TraceyMcNamara ; Dr. Eva K Lee ;(b)(6)Cc·< \,.__ .i- _____ _._>; Dodgen,Daniel {OSIASPR/SPPR) ;DeBord, Kristin(OSI ASPR/SPPR) ; Phillips, Sally(OS/ASPR/SPPR) : DavidMarcozzi; Hepburn, Matthew JCIV USARMY (USA) ; LisaKoonin ; Wargo Michael; Walter s,Willi am (STATE.GOV) ;HARVEY, MELISSA; WOLFE ,HERBERT; Eastm an, Alexande r;EV ANS, MARIEFRED ; Callahan ,Michael V.,M.D.;(b)(6)------- ; Johnson,Robert (OS/ASPR/BARDA) ;Yeskey , Kevin; Disbrow , Gary(OSI ASPR/BARDA) ; Redd, John(OS/ASPR/SPPR) : Ha ssell, David{Chris) {OS/ASPR/1O); Hamel,Joseph (OS/ ASPR/1O); Dean,Charity A@CDPH; RichardHatchett; Lawle r, James V;Kadlec, Rober t (OSI ASPR/1O):'Martin, Gregory J-------- CbH6) Borio, Luci an a; Hanfling , Dan;McDonald. Eric ; Wade, David ;TARANTINO . DAVID A;WILKINSON , THOMAS; DavidGruberKAUSHrK, SANGEET A;Nathan iel R upertNIH-001535(b)(6);NIH-001536Subject: RE: Red DawnBreaking, COVID-19Collaborat ive, Feb 16 startMore things to keep an eye on( attached links of stories andtrans lations of news reports):Yesterday a 5th flight of evacueesfrom Hubei arrived in Japan.There were 65 on board and 7peop le were symptomatic (11 %).Watch for the number ofconfirmed - it will provide a pointestimate of prevalence of COVID-19 in Hubei as of yeste rday.Sounds like this is the last flightjapan will accept.Yesterday , Japan provided anupdate of all cases in Japan:• 53 peoplewereinfec ted inJapan andtrave lersfrom China• 454passengersand crewmembers oncruise ships,and• 13 peoplereturned onNIH-001537charteraircraft.• 520 peoplein tota l.• 23 peopleweredeterminedto beseriously illWatching for other countr ies toevacuate passengers from cruiseship• 256Canadianson theDiamondPrince sscruise ship• 32 tested +(as of Feb-17)• A planechartered bytheCanadiangover nmenthas left forJapan toevacua te itsnationalsaboard avirus -hitcruise shipoffYokohama ,TV Asahireported onTuesday,citing atweet byCanada'sforeignministerCan't find anything about othercountries evacuating passenge rs(UK, Hong Kong, Italy, etc.)Last thing . Am seeing storiesfrom Japan re patients going fromclinic to clinic with respsymptoms and fever and beingconfomed . They are findingnosocomial transmission- sounderscores the concerns outlinedin the proposal I outlined for realigningoutpatient clinics .Sent from Mail for Windows 10From: Carter MecherSent: Monday, February 17, 202010:39 PMTo: Canev a, Duane ; TraceyMcNamara: Dr. Eva K Lee:(b)(6)(b)(6)--------- Dodgen,Dan iel (OSI ASPR/SPPR) :DeBord, Kristin(OS/ASPR/SPPR): Phillips, Sally(OS/ASPR/SPPR): DavidMar cozzi ; Hepbu rn, Matthew JCIV USARMY (USA); LisaNIH-001538Koonin ; Wargo Mic hael ; Walters .William (STATE.GOV) ;HAR VEY , MELISSA ; WOLF E,HERBERT ; Eastman, Alexander ;EV ANS . MARIEFRED ; Callahan,Mich ael V.,M.D.;-------- ; Johns on ,Robe rt (OSIASPRJBARDA) ;Yeske y, Kevin ; Disbrow, Gary(OSI ASPR/BARDA) : Redd , John(OSIASPR/SPPR) ; Has sell. Davi d(Chris) (OSIASPR/10) : Hamel.Joseph (OSI ASPR/ 10 ): Dean ,Charity A@CDPH ; Rich ardHatchett ; Lawle r. James V;Kad lec. Rober t (OS/ ASPR/IO) ;'Martin, Gregory J-------- Cb)( 6); Borio, Luci an a; Hanfling. Dan;McDo nald, Eric; Wade. David ;TARANTINO , DAVID A;WILKINSON, THOMAS; Davi dGruberKA USHlK, SANGEETA ;Nathan iel HupertSubject: RE: Red DawnBreaking, COVI D- 19Co llaborat ive , Feb 16 stait(b)(6)I really need help thinking tbru thetesting piece (screening forCOV ID-19). How do we protectthe staff in outpatient clinics(where all the ILI is typicallyseen) and conserve PPE byshifting all the mi ld illness awayfrom clinics and toward patien ts'homes using telephonecarelte lehealth and homehealthcare and emp loying homeNIH-001539NIH-001540isolation for those who areinfected and voluntary homequarantine for otherwise well (butexposed and potentially infected)household contacts? Having allthe suspected patients coming into clin ics to be screened rea llydefeats the purpose. So howwould very large numbers ofoutpatients get screened? Homescreening? Drive thru screening?Or creating a free standingscreening facility for rapidscreening? Has anyone thoughtthis thru (how you screen fordisease plus promoteadherence /compliance to homeisolation and home quarantine andshift outpat ient care of patientswith mild disease totelephone /home care to protectoutpatient clinic staff? Looking forpractica l solutions .Just to remind you, here are theestimates of demand (assuming wewould need to screen all ILI)about88K per day in primary careclinics across the US.US DataUS populationHospital BedsICU BedsHospital AdmissionsER VisitsFamily Practice/PC VisitsTotal DeathsA Day in the USHospital AdmissionsI325,700 ,000924,10781,79036,353,946.00145,600,000481,963,0002,813,50399,600Inpatient Census (85% occupancy) 785 ,491ICU Census (85% occupancy) 69,522ER Visits 398,904Family Practice /PC Visits 1,320,447Deaths 7,708Current Background of Illness Simila r to COVID-192019-20 Flu Season MMWR Week 5 ILI Rate 6.7%1 .4M hospitalizations annually for pneumo niaMedicare Average LOS Pneumonia 6 days55,672 pneumonia & influenz a deaths annuallyDaily Hospital Admissions PneumoniaHospital Census PneumoniaDaily ILI cases seen in ERsDaily ILi cases seen in FP/PC clinicsDaily pneumonia & influenza deathsSent from Mail for Window s 10From: Carter MecherSent: Monday, February 17, 20209:04 PMTo: Canev a, Duane ; TraceyMcNamara ; Dr. Eva K Lee;(b)(6)Cc:Cb.___,_ _____ ..,r->; Dodgen,Dan ie I (OS/ ASPR/SPPR) :DeBord , Kr istin(OS/ASPR/SPPR) ; Phill ips, SallyNIH-0015413,83623,01426,72788,470153(OS/ASPR /SPPR) : DavidMarcozzi ; Hepb urn, Matthew JCIV USARMY (USA) : LisaKoonin ; Wargo Michael ; Walters,William (STATE.GOV) :HAR VEY L MELISSA; WOLFE,HERB ERT ; Eastman , Alexander ;EVANS, MARTEFRED; Callahan,Michael V.,M.D .;,_ ______ ; John son,Robert (OS/ASPR/BARDA) ;Yeskey, Kevin ; Disbrow, Gary(OSI ASPR/BARDA) : Redd , John(OS/ASPR /SPPR) : Ha ssell, David(Chr is) (OS/ASPR/IO) : Hamel,Joseph (OS/ASPR/IO) : Dean,Charity A@CDPH ; RichardHatchett; Lawle r, James V;Kad lec, Rober t {OS/ASPR/10) ;'Marti n, Gregorv J-------- Cb)( 6) ' ; Bo rio, Luci an a; Hanfling. Dan ;McDonald, Er ic; Wade. David;TARAN TINO, DA YID A;WILKINSON, THOMAS; DavidGruberKAUSHIK, SANGE ETA ;Nathan iel HupertSubject: RE: Red DawnBreaking, COVID-19Collaborative, Feb 16 start(b)(6)•I tinkered with the strategy forintegrating outpat ient clinics andhospital s for the care of COVID-19 patient s. Proposing this for mysystem.NIH-001542Sent from Mail for Windows 10From: Car ter MecherSent: Monday, February 17, 20207:17 PMTo: Caneva , Duane ; TraceyMcNamara ; Dr. Eva K Lee;(b)(6)(b)(6)--------- Dodgen,Danie l (OS/ASPR/SPPR) ;DeBord, Kristin(OSI ASPR /SPPR) : Phill ips, Sa lly(OS/ASPR/SPPR) ; DavidMarco zzi; Hepburn, Matthew JCIV USARMY (USA); LisaKoonin ; Wargo Michael ; Walters,William (STAT E.GOV) ;HARVEY, MELISSA ; WOLFE,HERBER T; Eastman, Alexander ;EV ANS, MARIEFRED ; Callahan .Michael V.,M.D .;(b)(6)-------- Johnson.Robe rt (OS/ASPR/ BARDA) ;Yeskey, Kev in; Disbrow, Gary(OS/ASPR/BARDA) ; Redd , John(OS/ASPR/SPPR) : Hassell, David(Chris) (OS/ASPR/ 1O); Hamel,Joseph (OS/ASPR/ 1O); Dean,Charity A@CDPH; RichardHatchett; Lawler, James V;Kadlec, Robert (OS/ASPR/IO) :'Martin, Gregory J---------- Cb)( '; Borio, Luci an a; Hanfl ing. Dan ;McDonald, Er ic; Wade . David ;TARANTINO, DAVID A;WILKINSON, THOMAS ; DavidGruberNIH-001543(b)(KAUSHIK, SANGEETA ;Nathan iel HupertSubject: RE: Red DawnBreaking, COVID-19Collaborative, Feb 16 startMore details on evacuation ofAmerican passengers aboa rd thecru ise ship .Total evacuated: 177 + 151 = 328bttps: //www.usatoday .com/story /trave l/cruises /2020/02/ 17/coronavirus -diamond -princess -evacuees test-pos itive -allowed-fly-unitedstates/ 4 783787002 /Fourteen evacuees from theDiamond Princess cruiseship quarantined in Japan wereallowed to fly back to the UnitedStates Sunday de spite testingpositive for coronav irus, the U.S.State Departme nt and Health andHwnan Services said in a jo intstateme nt. The evacuees were notsymptomatic."These individuals were mov ed inthe most expeditious and safemanner to a specializedcontainment area on theevacuat ion aircraft to isolate themin accordance with standar dprotoco ls," thestatemen t, pub lished Sunday ,read.NIH-001544NIH-001545The State Department wasunaware the individuals hadcoronavirus when they were beingremoved from the ship; they hadtested negative just a few daysbefore, Robert Kadlec, theassistant secre tary forpreparedness and response at theU.S. Department of Health &Human Services, said on a phonecall with repmiers."If those results had come backfour hours earlier before we'dstarted to disembark the ship andbefore these people were evacueeswithin an evacuation system, thenit would've been a differentdiscussion." Dr. William Walters,director of operational medicine atthe U.S . Department of State, saidon the call.Kadlec said that individualsreceived multiple screenings whenmoving from ship to bus toplane and a more extensivemedical assessment upon arrival.Two charter flight s carry ingthe Diamond Princ ess passenger slanded at military bases inCalifornia and Texas overn ight,starting the clock on a 14-dayquarantine period to ensure thosepassengers don't havecoronavirus . In tota l,approximately 380 Americanswere on board the DiamondPrinc ess ship for the duration ofthe cruise and quarant ine at sea.'Something went awry': Why didUS break Diamond Princesscoronavirus quaran tine?NIH-001546One plane carrying Americanpassengers touched down at TravisAir Force Base in northernCalifornia just before 11 :30 p.m.Sunday local time. A second flightarrived at Lackland Air ForceBase in Texas around 2½ hourslater, early Monday.The California flight had 177people on it, seven of whom testedpositive for coronavirns, Walterssaid. An additional three peoplewere isolated during the flight forfever. Upon arrival, 171 stayed inTravis while six traveled toOmaha.It's unclear which passengers weretransferred there and whetherinitial tests were positive orwhether they were at risk for thevrrus.The Texas flight had 151 peopleboard and included the other sevenwho tested positive forcoronavirus. Two additionalpassengers were isolated onaccount of fever . All passengerswho tested positive forcoronavirus then moved on toOmaha.The aircraft design allowedpassengers to sit in isolationthanks to a plastic divider at thetail of the aircraft.13 high-riskpassengers awa it testresults at NebraskaMedical CenterNIH-001547Officials from the University ofNebra ska Medical Center andNebraska Medicine confirmed thatthey are assessing 13 adults attheir quarantine andbioconta inment facility in Omaha."Late last night at about 2 or 3a.m., we were asked to bring someindividuals here who had eithertested posit ive or had a highlikelihood of testing positivebecause of symptoms they wereexhibiting ," said Dr. ChrisKratochv il, the exec utive directorat the Univers ity ofNebraskaMedical Center ' s Global Centerfor Health Security.Twelve of them are housed in thequarant ine center while one manwas transferred to the hospital'sbiocontainment unit for testingand observat ion because ofsymptoms including cough, fever,shortness of breath,lightheadedness and anundisclosed chron ic condition thatwould make him particularlyvulnerable to the COVID-19VITUS."He is doing good and in stablecondition at this time," reportedShelly Schwedhelm , NebraskaMedicine's executive director ofemergency management andbiopreparedness .She went on to note that "the folksin the quarantine center have allbeen tested, and we're waiting forthose results ."She added that the other 12 areisolated in "very nice rooms withWiFi , TV and a small refrigeratorNIH-001548- a lot of the amenities at hotelsbut with engineering contro ls" toprevent contaminated air fromescapmg.Their test results , which are dueback Monday afternoon, willdetermine whether the patientswill be allowed to see theirspouses or leave their rooms.Regardless of whether they testpositive or negative, all of the newarrivals will spend at least 14 daysin the facility , and any who testpositive will likely stay longer,said Dr. Mike Wadman, the comedicaldirector of the NationalQuarantine Unit.Kratochvil says it's possible thatthey may be asked to take morepatients should more of theDiamond Princess passengers nowin quarantine at the airbases testpositive.Dr. Anthony Fauci , director of theNationa l Institute of Allergy andInfectious Diseases at the NationalInstitutes of Health, told the USATODAY editorial board andreporters Monday that the originalidea to keep people safelyquarantined on the ship wasn'tunreasonable. But even with thequarantine process on the ship,virus transmissio n still occurred."The quarantine process failed,"Fauci said. "I'd like to sugarcoat itand try to be diplomatic about it,but it failed. People were gettinginfected on that ship. Somethingwent awry in the process of thequarantining on that ship. I don'tknow what it was, but a lot ofpeople got infected on that ship."USA TODAY reached out toPrincess Cruises for clarificationon how many Americans from theship have the virus.Sent from Mai l for Windows 10From: Caneva, DuaneSent: Monday, February 17, 20204:51 PMTo: Carter Meche r; TraceyMcNamara ; Dr. Eva K Lee ;(b)(6)Dodgen,Daniel (OS/ ASPR/SPPR):DeBo rd, Kris tin(OS/ASPR /SPPR) ; Phill ips, Sally(OS/ASPR/SPPR) ; DavidMarcozzi; Hepburn, Matthew JCIV USARMY (USA); LisaKoonin; Wargo Mic hael ; Walters,William (STATE.GOV):HARVEY, MELISSA ; WOLFE,HERBERT ; Eastman , Alexander ;EVANS , MARIEFRED ; Callahan ,Mic hael V.,M.D. ;(b)(6)------,----J-oh-nson, Robert (OSI ASPR/BARDA);Yeskey , Kevi n; Disbrow , Gary(OSI ASPR/BARDA) : Red d, John(OS/ASPRJSPPR); Hassell, David(Chris) (OSI ASPR/ 1O); Hame l,NIH-001549Joseph (OSI ASPR/ 1O); Dean ,Char ity A@CDPH; Rich ardHatchett; La wler, James V;Kadle c, Rober t (OSI ASPR/1O);'Martin , Gregory J---------- CbH6'l; Borio, Luci an a; Hanfling. Dan;McDonald, Eric; Wade, David ;TARAN TINO, DA YID A;WILKINS ON, THOMAS ; DavidGruber(b)(KAUSHIK, SANGEETA;Nath an iel HupertSubject: Re: Red Dawn Breaki ng,COVID- 19 Collaborative , Feb 16start+ Bob GlassGet Out look for iOSFrom: Carter Mecher(b)(Sent: Monday, February 17, 20204:47:38 PMTo: Tracey McNamaraCbC) 6>J ; Dr.EvaKLeeDuaneDodgen, Dan iel (OS/ASPR/SPPR)Cb)Cb6);DeBord, Kristin(OS/ASPR/SPPR)NIH-001550(b) (6) . ________ ,Phillips, Sally (OS/ASPR/SP PR)-------- Cb)< >; David Marcozzi>; Hepburn, Matthew J CIVUSARMY (USA)>; Lisa Koonin(b)(6)(b)(6)--------- Cb()6 ) Wargo Michael>; Walters, William(STATE.GOY)(b)( >·'HARVEY, MELISSAWOLFE , HERBERTEas tman, Alexande r(b)(6)(b)((b)(6)(b) (6)>; EVANS, MARIEFRED>; Callahan , MichaelV.,M.D.Johnson, Robert(OS/ASPR/BARDA)Yeskey, Kevin(b)(6) > ;(b)( >· ________ ,Disbrow , Gary(OS/ASPR/BARDA)(b)(6)-------- Cb(>6) > ; Redd, John (OS/ASPR/SP PR)-------- Cb(>6 ) Hassell, David (Chris) (OS/ASPR/10 )(b)(6)Hame l, Joseph (OS/ASPR/ 10)-------- Cb()6 ) ; Dean, Charity A@CDPH(b)(6)NIH-001551Richard Hatchett(b) (6} .'Lawler, Jame s V(b) (6) ;Kadlec, Robert (OS/ASPR/10)(b) (6)1 • ___________ ,'Martin, Grego ry J(b)(6)Lu ciana ------- Hanfling , Dan(b)(6) > •McDonald,E ric '(b)(6); Wade , David(b)(6)TARANTINO, DAVID A(b)(6) > •' WILKINSON, THOMAS(b)(6)David Gruber(b)(6)------------ >· ' KAUSHIK , SANOEE TA(b)( >·Nathan iel Hupert(b) (6)Subject: RE: Red DawnBreaking, COVID -19Collaborat ive, Feb 16 stait'('AL Tl o:-,,i: This email originated fromoutside of DHS. DO NOT click links oropen attachments unJess you recognizeand/or trust the sender. Contact yourcomponent SOC with questions orconcerns.A correction . Shou ld not haveincluded breakdown ofhospitalized since we have spottydata 9or could have used a range).Only solid data we have is numb erNIH-001552NIH-001553confirmed (58), number inhospital (44), and number in ICU(.:::1 ). Mix of hospital pat ients isunknown (from the Singapore datathe ratio of hospitalized to ICUhas ranged from 6: 1 to 13: 1 fromtwo data points).So estimates of severity lookingonly at the American passengers :~400 total American passengers58 confirmed to have COVID-1912 Asymptomatic(20%)46 Symptomatic (80%)( 44 cases actually hospitalized)~2% of totalcases requiring ICU admiss ion ( 1case)Expected mortalityfor patients withpneumoruaadmitted to ICU(15-50%) ;assuming 2% ofthose who becomeinfected withCOVID-19 requireICU care, thesemortality ratesequate to a CFR of0.3%-1.0%Sent from Mai l for Windows 10From: Carte r MecherSent: Monday , Februa ry 17, 20204:15 PMTo: Tracey McNam ara ; Dr. Eva KLee(b)(6)-------- Caneva,Duane; Dodg en , Daniel(OS/ASPR/ SPPR) ; De Bord,Kri stin (OSI ASPR/ SPPR) ;Phi llips, Sally ( OSI ASPR/ SPPR):David Marcozz i; Hepburn,Matthew J CIV USARMY (USA) :Lisa Koon in; Warg o Michael ;Walters, William (STATE.GOV) ;HARVEY. MELISSA; WOLFE.HERBERT ; Eastm an, Alexande r;EV ANS, MARIEFRED; Callahan,Michael V .,M.D.;(b)(6)-------- John son,Robe rt {OS/ASPR/BARDA) ;Yeskey . Kevin ; Disbrow . Gary(OS/ASPR/BARDA) : Redd, John(OS/AS PR/ SPPR) ; Ha ssell, David{Chris) {OS/ASPR/1O): Hamel,Joseph (OS/ASPR/1O): Dean,Charity A@CDPH ; Ri chardHatchett; Lawler, James V;Kad lec, Robert (OS/ ASPR/1O);'Mart in, Gregorv J---------Cb-)<- ; B-orio, Luciana; Hanfling. Dan;McDonald , Eric; Wade, David;TARAN TINO. DAVID A;WILKINS ON, THOMAS ; DavidGrube rKA USHIK. SANGEE TA ;Na than iel RupertNIH-001554(b)(6) ;NIH-001555Subject: RE: Red DawnBreaking, COVID-19Collaborat ive, Feb 16 startLatest data from Singapore (77cases; 4 children, 2 areasymptomatic) and Hong Kong(60 cases; no children)More puzzle pieces .Singapore status:h ttps://protect2 . fireeye . com/url ?k=f6750fe4-aa21 1698-f6753edb-0cc4 7 adc5 fa2-7 6d29cc40fd8c03f&u =https: / /www.moh .gov.sg/newshighligh... tion-confirmedUpdate on condition ofconfirmed casesTo date, a total of 24 cases havefully recovered from the infectionand have been discharged fromhospital. Of the 53 confirmedcases who are still in hospital,most are stable or improving. Fourare in critical condition in theinten sive care unit.[Ratio of hospitalized to ICU of53/4 or ~ 13:1] Consistent withestimates in earlier emai l. [OnFeb - 12 Singapore reported that 8patients were in ICU.]Sent from Mail for Windows 10From: Carter Mecl1erSent: Monday, February 17, 20202:57PMTo: Tracey McNam ara ; Dr . Eva KLeeCc: Canev a, Duan e; Dodgen,Daniel (OS/ASPR/SPPR) :DeBord, Kristin(OS/ ASPR/SPPR); Phillips, Sally(OS/ASPR/SPPR): DavidMarcozzi; Hepburn, Matthew JCIV USARMY (USA ): LisaKoonin ; War go Michael; Walters ,William (STATE .GOV) :HARVEY, MELISSA; WOLFE,HERBERT; Eastman, Alexander;EVANS . MARIEFRED; Callahan,Michael V.,M .D.;(b)(6)-------- Johnson,Robe rt {OS/ ASPR/BARDA) ;Yeskey, Kevi n; Disbrow, Gary(OS/ASPR/BARDA): Redd, John(OS/ASPR/SPPR): Hassell, David(Chris) (OS/ASPR/1O): Hame l,Jose ph (OS/ ASPR/ 1O): Dean,Charity A@CDP H; Rich ardHatchett; Lawler, James V;Kadlec, Robert (OS/ ASPR/1O):'Marti n, Gregorv J--------- Cb)( 6) Borio, Luci an a; Han fling, Dan;McDo nald, Er ic; Wade, David;TARAN TINO, DAVID A;WILKINSON, THOMAS; DavidGruberNIH-001556KAUSHIK, SANGEETA ;Nathan iel Hupert;(b)(6)Subject: RE: Red DawnBreak ing, COVID-19Collaborat ive, Feb 16 start(b)(6);Try ing to estimate severity bybringing a number of piecestogether.The Diamond Princess CruiseShip had a crew of l ,745 and2,666 passengers (total pf3 ,7 11)Approximately 400 of thepassengers are Americans (11 %).Several days ago (Feb-13) weattempted to estimate diseaseseverity using the current databeing reported by the media(number of confirmed cases andICU cases) as well as data on theoutbreak in Singapore (number ofconfinned cases, numberhospitalized , and number in ICU)(see attached Word file).Given the additional informationbecoming available (includ ingmore specific information beingreported by the media on thenumbers of Americans infected), Iwas interested in an updated crudeestimate of severity (and to seehow well the early predictions ofseverity matched with what wasbeing reported by the media onillness in the Americans. SeeNIH-001557NIH-001558latest re the cruise ship outbreakbelow (two stories). We can gleanfrom these stories that the numberinfected is now up to 454. And 14positive passengers were includedamong the Americans who wereevacuated to the US. Canada,South Korea, Italy and Hong Kongannounced Sunday that theywould also an-ange charter flightsto evacuate their citizens. A fewadditional pieces of data. Newsreports yesterday stated that 73 ofthe 355 confirmed cases from thecruise ship were asymptomatic(20%). Also, yesterday the mediaquoted Dr. Fauci that the totalnumber of Americans who wereconfirmed to have COVIDyesterday and who remained athospitals in Japan at 44.Assuming that this number doesnot include the 14 confirmed casesthat were evacuated, suggests thatthe total number of Americanswith confirmed COVID is 58. Anear lier news report from Feb-12 rea couple from California, notedthe husband was in the ICU inJapan (so at least 1 American inthe ICU). [" ... remained in ahospital intensive care unit andhas been able to communica tewith his family, his wife said in aphone interview from the ship,where she remained inquarantine. "https ://protect2 . fireeye. com/url ?k=5b0 l 4cc3-075555bf -5b0 l 7dfc-0cc4 7adc5fa2-5be62cfl a816fc6d& u=https: / /web.archive.org/web/202002 12093725/https://www .ocregister .com/2020/02/11/sout hern-california -man-oncruise-sent-to-a-hosp ital-in-tokyoNIH-001559with-a-high-fever-tested-forcoronavirus/ ]So, piecing all the data together:The ~400 Americans account for11 % of the 3,711 passengers andcrew of the Diamond Princess.The 5 8 confirmed cases amongAmericans account for 12% of the454 total confirmed COVID casesAssuming that proportion ofasymptomatic cases in Americansis similar to the proportion ofasymptomatic cases for the entireship (73/355 or 20%), we wouldestimate the number of Americanswith asymptomatic infection at~12. Symptomatics would be 46.If 2% of cases result in ICUadmission (based on earlierestimates on Feb -12 where 4 ICUcases were reported with 203 totalconfirmed cases), we wouldexpect ~9 ICU cases overall with454 infected. Media repo1ts fromtoday note 19 of the passengersare "seriously ill, with some ofwhom treated in intensive careunits." (Would be helpful toquantify "some" - from the earlierdata, we would estimate about halfthat number would require ICUcare at some point). For the 54Americans confirmed to haveCOVID, we would estimate 1would require ICU care if 2% ofcases required ICU care (we arealready aware of at least 1American who was receiving ICUcare in Japan).NIH-001560So estimates of seve 1ity lookingonly at the American passengers:~400 total American passengers58 confirmed to have COVID-1912 Asymptomatic(20%)46 Symptomatic (80%)~55% of totalcases mildly ill (hospitalized forisolation only) (31 cases)~25% of totalcases acute ly ill requiring inpatientcare ( 15 cases)~2%of total cases requiring ICUadmission ( 1 cases)ExpectedmortalityforpatientswithpneumonlaadmittedtoICU(15-50%);assummgNIH-0015612%ofthosewhobecomeinfectedwithcoYID-19requireICUcare,thesemortalityratesequate toaCFRof0.3%-1.0%Those estimates fit pretty wellwith the estimates from Feb-13 .To firm up these numbers it wouldbe useful to have actual numbersfrom Japan on ICU admissions,number requiring mechanicalventilation, number in the hospitalbecause they are acutely ill, andnumber in the hospital because ofisolation only (mildly ill orasymptomatic). Also would behelpful to have more granularNIH-001562information on the Americans(hospita l data in Japan includingnumber acutely ill, numberneeding ICU admission , andnumber only in the hospital forisolation). Would also be criticalto gather/compile the sameinfonnation from Canada, SouthKorea, Italy, Hong Kong, andother nations as they also evacuatetheir citizens. The cruise ship is acircumscribed population where itis possible to get a handle onseverity fairly early in anepidemic . The limitat ion though,is the population on board thatship is elderly (so need to becareful about genera lizing to theentire population). But it is thebest data we have.The reason why th is is soimportant is decisions re theimplementation ofNPis dependupon severity (the more severe themore intense the NPis). Thesooner we have a more accurateassessment of severity , the betterfor making plans for NPis.Sto1y #1https :/ /protect2 . fire eye . com/url ?k=fb4e 1 b73-a7 1 a020f-fb4e2a4c-0cc4 7adc5fa2 -6b 70ca 7 6908c 81 a4&u=https: //www3.nhk.or.jp/news/html/202002 17NIH-001563/kl 00 12289341000 .html?utm int=news contents news-main 00 ITranslationNew virus cruise ship confirmed99 new infectionsFebruary 17, 2020 18:54A new outbreak of the coronaviruswas confirmed on February 17,with 99 new passengers and crewmembers infected on a cruise ship.As a result, 454 passengers andcrew members of cruise shipshave been infected, of which 19are severely affected.According to the Ministry ofHealth, Labor and Welfare, a totalof 99 new passengers, including85 passengers and 14crewmembers, were revealed onMarch 17 on the cruise ship"Diamond Princess" anchored inYokohama Port. Among them,there are 43 Japanese.This means that a total of 1723passengers and crew memberswere inspected on the cruise ship,and a total of 454 infection s wereconfirmed.According to the Ministry ofHealth , Labor and Welfare, 19 ofthe confim1ed individuals areseriously ill, some of whom arebeing treated in intensive careunits.According to the Ministry ofHealth , Labor and Welfare, theMinist1y of Health , Labor andWelfare said that infections wereconfirmed one after another onNIH-001564cruise ships. Need to be analyzedquickly."The Ministry of Health, Labor andWelfare has a policy to conduct avirus test on all passengers andcrew members remain ing onboard, and those who have anegative result will be asked toleave the ship after the 19th.Story #2Fourteen people who wereevacuated from the DiamondPrincess cruise ship and flownback to the United States oncharter flights tested positivefornovel coronavirus , according toa joint statement from the USDepartments of State and Healthand Human Services.The passengers are among themore than 300 people removedfrom the ship, which is docked offthe Japanese port city ofYokohama , Sunday night andflown to milita1y bases in theUnited States.US officials were notified thatthey had tested positive forcoronavirus during the evacuationprocess, after passengers haddisembarked the ship, the agenciessaid in the joint statementMonday . The passenge rs had beentested two to three days before theNIH-001565evacuation flights, the statementsaid."After consultation with HHSofficials, including experts fromthe HHS Office of the AssistantSecretary for Preparedness andResponse, the State Departmentmade the decision to allow the 14individuals, who were in isolation,separated from other passengers,and continued to be asymptomat ic,to remain on the aircraft tocomplete the evacuation process,"the agencies said.One charter flight carryingevacuated Americans arrived atTravis Air Force Base nearFairfield, Californ ia, around 11 :28p.m. local time Sunday. A secondanived at Joint Base San AntonioLacklandin San Antonio, Texas at3:56 a.m. local time Monday.The passengers who testedpositive were isolated from theother passengers during theflights, the statement said. And allpassengers are being "closelymonitored" throughout the flight."Any who become symptomaticwill be moved to the specializedconta inment area, where they willbe treated," the statement said.After the flights land, anypassengers that developedsymptoms on the flights and thosewho had already tested positivewill be transported to "anappropr iate location for continuedisolation and care ."NIH-001566The remaining passengers willremain under quarant ine for 14days.Passengers arriving to Travis AirForce Base will be housed in thesame facility as evacuees whoarrived from Wuhan ear lier thismonth, a spokesperson for thebase told CNN. New evacuees willbe kept in a separate area of theWestwind Inn on the base, thespokesperson said.Before the announcement aboutthe infected flight passengers,some Americans aboard theDiamond Princess said they didn'twant to take a chance beingevacuated for fear they would besubject to possible infect ion.Sacramento resident MatthewSmith told CNN affiliate KOVRthat he would rather deal withissues in Japan than be evacuatedand quarantined in the UnitedStates."We decided we would j ust facewhatever consequences here ratherthan exposing ourselves to thatsituation ," Smith told theaffi liate. "It kind of didn't makeany sense if the us was fearful thatthese were infected people whichis why they're going to quarantinethem for another 2 weeks to havethrown them all together"Smith's wife Katherine Codekaswas met with some surprise whenshe told authoriti es that she andher husband weren't going to gowith the other American evacuees,KOVR reported."They came back around againand I said no we're not going andthey very sincerely wished us luckbut there was a little look ofsurprise on their face ," Codekasexplained to the affi liate."You know, it's not like we're thelast helicopter off the roof top inHo Chi Mihn City," she toldKOVR. "We're on a boat andwe're watching peop le go awayand people just make differentchoices about how they want toconfront the virus."Sent from Mail for Windows 10From: Carter MecherSent: Monday , February 17, 202011:00AMTo: Tracey McNa mara ; Dr . Eva KLeeCc: Canev a, Duane ; Dodgen,Daniel (OSI ASPR/SPPR );DeBord , Kristin(OS/ASPRJSPPR) : Phill ips, Sally(OS/ASPRJSPPR) ; DavidMarcozzi ; Hepb urn, Matthew JCIV USARMY (USA): LisaKoonin; Wargo Michael; Walters,William (STATE.GOV):HARVEY, MELISSA; WOLFE ,HERBERT ; Eastm an, Alexander ;EV ANS. MARIEFRED ; Ca llahan .Michae l V .,M.D.;(b) (6) . ________ ,NIH-001567-------- CbC) ; Johnson, Robe rt (OS/ASPR/BARDA) ;Yeskey, Kevin ; Disbrow, Gmy(OS/ASP.R/BARDA) ; Redd, John(OS/ASPR/SPPR) ; Hassell, David(Chris) (OS/ASPR/10); Hamel,Joseph (OSI ASPR/10) : Dean ,Charity A@CDPH ; RichardHatchett ; Lawler, James V;Kadlec, Robert (OS/ ASPR/ IO) ;'Martin, Gregory JCb()6 ); Bor io, -------- Luci an a; Han fling, Dan;McDona ld, Eric; Wade, David ;T ARANTfNO, DAVID A;WILKINSON, THOMAS ; DavidGruberKAUSH CK, SANGEE TA;Nathaniel Ru pertSubject: RE: Red DawnBreaking, COVID-19Collaborat ive, Feb 16 stait(b)(6);Attac hed is Bob Glass' origina lpaper- his co-autho r was hishigh-school age daughter.Here is a link to anothe r pape r.Glass RJ, Glass LM, Beye ler WE,Min HJ. Targeted socialdistancing designs for pandemicinfluenza. Emerg Infect Dis [serialon the In ternet]. 2006 Nov [datecited].http: //dx.do i.org/ 10.3201/eidl 211.060255NIH-001568Sent from Mail for Windows 10From: Carter Mecl1erSent: Monday, February 17, 20209:59 AMTo: Tracey McNam ara ; Dr . Eva KLeeCc: Canev a, Duan e; Dodgen,Daniel (OS/ASPR/SPPR) :DeBord, Kristin(OS/ ASPR/SPPR); Phillips, Sally(OS/ASPR /SPPR) : Da vidMarcozzi; Hepburn, Matthew JCIV USARMY (USA ): LisaKoonin ; War go Michael; Walters ,William (STATE .GOV) :HARVEY, MELISSA; WOLFE,HERBERT; Eastman, Alexander;EVANS. MARIEFRED; Callahan,Michael V.,M .D.;(b)(6)-------- Johnson,Robe rt {OS/ ASPR/BARDA) ;Yeskey, Kevi n; Disbrow, Gary(OS/ASPR/BARDA) : Redd, John(OS/ASPR/SPPR) : Hassell, David(Chris) (OS/ASPR/1O): Hamel,Jose ph (OS/ ASPR/1O): Dean,Charity A@CDP H; Rich ardHatchett; Lawler, James V;Kadlec, Robert (OS/ ASPR/1O):'Marti n, Gregorv J--------- Cb)( 6) Borio, Luci an a; Hanfling, Dan;McDo nald, Er ic; Wade, David;TARAN TINO, DAVID A;WILKINSON, THOMAS; DavidGruberNIH-001569KAUSHIK, SANGEETA ;Nathan iel HupertSubject: RE: Red DawnBreaking , COVI D-19Collaborative , Feb 16 start(b)(6);This is the original graph of BobGlass' data. He modeled thevarious interventions alone or incombination. Along one axis arethe social distancing measuresfrom doing nothing, to ju st closingschools but allowing kids to mixin the community , to socialdistancing of kids in thecommunity but keep ing school sopen, to only social distancing ofadults in the community , toclosing schools and adults socia ldistancing, to kids and adultssocia l distancing in thecommunity, to closing schools andsocia l distancing of kids in thecommunity, to a combo of all 3.Along the other axis are otherinterventions including doingnothing, to quarantine (Q) ,treatm ent of the ill with antivirals(T), proph ylaxis of contacts (P),and variou s combinations. Weobserved what we called a " cliffeffect" or phase transition or adiscontinuity once you closedscho ols and implemented socialdistanc ing among kids. The effectwas non -linear and dramatic. As aconsequence we began a deep diveto better understand the sch oolenvironme nt (includi ng theNIH-001570NIH-001571transportation system half theschool age kids use each day) andschool age kids. An unsung heroin all this was Lisa Koonin (whowas at CDC at the time). IfRichard birthed TLC, Lisa keptthe baby alive in the neonata lICU.We still have much to learn aboutthis virus. Thus far, it seems to besparing kids (just like SARS). Wehave been monitoring the reportsfrom China as well as the detaileddata we can see from Hong Kong ,Singapore , and Japan - thenumbers of kids remain very lowand disease appears to be mild.Nonet heless, TLC (and the NPis)is focused on reducing diseasetransmission ( effective lydecreasing Ro )- the interventionsare rea lly agnostic to sever ity. It iswhy CDC had to scale theimplementation of TLC (latercalled CMG) to severi ty. Despi tethe abse nce of severe disease inkids , we really are still in the darkin tem1s of the amount ofasympto matic disease or mild subclinicaldisease in kid s becau se wejust haven 't been able to look.I never forgot this graph of thedata from Bob Glass and theinflection point that was observedwhen the combo of closingschools and social distancing ofkids was implemented in hismodel. Although closing schoolsis complicated by its 2nd and 3rdorder impacts , it is actua lly apretty clean intervent ion in tennsof actually pulling the trigger(much cleaner than the othercomponent s ofTLC) . If thisoutbreak proves to be as severe asour initial estimates, we shouldthink long and hard beforedismi ssing the earlyimplementation of th is strategy( closing schools and socialdistancing of kids).Sent from Mai l for Windows 10From : Cart er MecherSent: Monday, February 17, 20208:57 AMTo: Trac ey McN amara ; Dr . Eva KLeeCc: Caneva, Duane ; Dodgen,Danie l (OS/ ASPR/SP PR):DeBo rd, Kristin(OS/ASPR /SPPR) ; Phill ips, Sally(OS/ASPR/ SPPR) ; DavidMarcozz i; Hepburn , Matthew JCIV USARMY (USA) : LisaKoonin ; Warg o Michael ; Walters,Willi am (STA TE.GOV) :HARVEY , MELISSA ; WOLFE,HERB ERT; Eastman , Alexander ;EV ANS, MARIEFRED ; Ca llahan,Michael V.,M.D .;(b)(6)--------- ; Johnson,Robe rt (OS/ASPR/BARDA) ;Yeskey, Kevin; Disbrow , Gary(OS/ASPR/BARDA ): Redd, John(OS/ASPR /SPPR) ; Ha sse ll. David(Chr is) (OS/ASPR/ 1O): Hamel,NIH-001572Joseph (OSI ASPR/ 10 ); Dean ,Char ity A@CDPH; Rich ardHatchett; La wle r, James V;Kadle c, Rober t (OSI ASPR/1O);'Martin , Gregory J'-------- (b)(6~) ' ; Borio, Luciana; Hanflin g. Dan;McDonald, Eric; Wade, David ;TARAN TINO, DA YID A;WILKINS ON, THOMAS ; DavidGruberKAUSHIK, SANGEE TA;Nath an iel HupertSubject: RE: Red DawnBreaking, COVID-19Collaborative, Feb 16 start(b) (6);NPis are going to be central to ourresponse to this outbreak( assuming our estimates ofsever ity prove accurate). Th isemail group has grovvn since webegan (not quite epidemic-levelgrowth, but getting there) .Looking ahead, I anticipate wemight encoun ter pushback overthe implemen tation ofN Pls andwould exp ect similarconcerns/arguments as were raisedback in 2006 when this strategyfirst emerged. It was one of thereasons I shared the updated dataon US household s from AmericanCommunity Survey, data onUSDA programs for nutrit ionalsupport (inc luding schoo l mealprogram s), data on schoo ls andenro llment, and even data onjuvenile crime. The data that wasgathered back in 2006 on socia ldensity in var ious environmentsNIH-001573NIH-001574(homes, offices /workplaces,schools, daycare , etc., isunchanged) . For additionalbackground and context, weattached are 3 papers on NPis andTLC for those who are interested.Richard Hatchett deserves fullcredit for birthing the idea of TLC(it was actually developed inresponse to the threat of HSN 1 andlater adopted for pandemicinfluenza response). Duane,perhaps you can store thesedocuments on MAX for safekeeping and access?The first paper is an historicalreview of the 1918 pandemic (thecomparison of Philadelphia andSt. Louis is emblematic of thelesson from 1918 that timingmatters when deploying NPlsneedto be early) . The secondpaper is modeling work that wasdone to evaluate these strategies.At the time, modelers werefocused on how best to contain anoutbreak overseas (really focusingon using antivirals primarily fortreatment and prophylaxis). Theyfocused their models to evaluatethe effectiveness of variousstrategies and quantities ofantiviral medications required toquench an emerging outbreak .There were 3 groups who weredoing this work back then. Theyeach present their data in thatpaper. A few things to note. In allthe model runs, they did not modelperfection or 100% adherence(actually far from it). You will seescenarios from 30/60 (meaning30% compliance and 60%ascertainment) on up to 90/80 ).(See figures 1) Even leakyimplementation can reduce overallNIH-001575attack rates. The modelers alsolooked at timing ofimplementation (see figure 3). Atthe time there was a great deal ofskepticism-was hard for peopleto believe this was possible . Oreven if TLC could be effective,was implementation practicalgiven the challenges trying toimplement and the 2nd and 3rdorder consequences ( especially ofclosing schools). But themodeling data combined with thehistolical data was the tippingpoint. Marty Cetron from CDCand Howard Markel from U ofMichigan, published a moreextensive historical review of the1918 pandemic showing much thesame. Since then, a group withinCDC continued to work on this( collecting additional data fromthe 2009 pandemic andelsewhere). They published anupdate of CMG in MMWR in2017.h ttps:/ /protect2 .fireeye . com/url ?k=3985fc87 -65d l e5fb-3985cdb8 -0cc4 7 adc5 fa2-bb4a28 993 b5aa9e0& u=https:/ /www.cdc.gov/media/dpk/cdc-24-7 /preven ting-pandemic influenza/community -mitigation guidelines-for-preven tingpandemic-flu.htmlThe third paper, is a more recentpaper ( from 201 7) that Richardshared with me. The paper is alittle dense, butI found this paper useful because itprovides a vocabulary forstrategies that we have raised(Symptom Monitoling vsNIH-001576Quarantine of potentially infectedbut symptom-free contacts duringan epidemic). This paperidentifi es those conditions whereSM or Q is preferred. Figure 1 isuseful for und erstanding thechallenges given the picture thatseems to be emerging with thisvirus. This outbreak seems closerto pandemic flu than SARS interms of transm ission dynamics( and hence the NPis we wouldneed to employ).Lastly, another person, Bob Glassat Los Alamos, also did work onthis separately from the MIDASgroup. He actually began thiswork as pa1t of a science fairproject for his daughter (usingsocial contacts of his daughter andher classmat es at school to modeldisease transmission). He knewsomeone at VA who forwarded hiswork to us ( chain oftransmission). Early on ( evenbefore the MIDAS group modeledTLC), we had a "Eureka" momentwhen we graphed his data in Excel(I can share that single graph toanyone interested). Bob Glass wasalso interested in trying todetermine when you could let upon the NPis during a pandemic.Here is a story about Bob Glas sand that work published in FastCompanyhttps: //protect2.fueeye. com/url ?k=3862f880 -6436e l fc-3862c9 bf-0cc4 7adc5fa2-9ce5afJ 1 e3c2cd6 4&u=https :/ /www.fastcompany .corn/3058542 /thescientists-who-simulate-the-endof-the-world I will see if I canfind his work on when to reopenschools. Deci sions in terms ofletting up on NPis could be criticaldown the line.Sent from Mai l for Windows 10From: Tra cey McNamaraSent: Sunday, February 16, 20207:10 PMTo: Carter Mecher ; Dr. Eva KLeeCc: Canev a, Duan e; Dodgen,Dan iel (OS/ASPR/SPPR ):DeBo rd, Kristin(OS/ASPR/SPPR) ; Phill ips, Sally(OS/ASPR/SPPR) ; DavidMarcozzi ; Hepburn , Mat thew JCIV USARMY (USA) : LisaKoon in; Wargo Michae l; Walters ,William (STA TE.GOV) :HARVEY , MELIS SA; WOLFE,HERBERT ; Eastma n, Alexan der;EV ANS, MARIEFRED ; Ca llahan,Michael V .,M.D. ;(b)(6)-------- Johnson,Ro be rt (OS/ ASPR/BARDA) ;Yeskey, Kevin ; Disbrow, Gary(OS/AS PR/BARDA ); Red d, John(OS/ASPR /SPPR) ; Hassell , David(Clni s) (OSI ASPR/IO) : Hamel,Joseph (OS/ ASPR/1O) ; Dean,Charity A@CDPH ; Rich ardHatchett ; Lawle r, James V;Kad lec, Rober t (OS/ASPR/IO) ;'Martin, Gregory J--------- Cb)( ' ; Bor io, Luci an a; Ha nfling , Dan;McDonal d, Er ic; Wade. Davi d ;NIH-001577TARAN TINO, DAVID A;WILKINSO N, THOMAS ; DavidGrube rKAUSHIK, SANGE ETA ;Nathan iel Rupert(b)(6)Subject: Re: Red Dawn Breaking,COVID-19 Collaborative , Feb 16startHere is the link to a town hallmtg at the Munich SecurityConference. Shared by DrChristian Haggenmiller ,Dorector of the GermanDefense Institute.https://pro tect2.firee ye.com/url?k=ec4e0592-b01a1cee ec4e34ad-0cc4 7 adc5fa2-c00af41a186 719a2&u=https://securityconference .org/en/medial ibrary/asse t/town hal 1-on-thecoronavirus-o utbreak-20200215 -1000/TraceyGet Outlook for AndroidFrom: Dr. Eva K Lee --(b-)(6) >Sent: Sunday, February 16, 20203:05:43 PMTo: Carter Mecher(b)(6) >Cc: Caneva, Duane(b)(6)Dodgen, Dan iel (OS /ASPR/SPPR)NIH-001578(b)(6) > • _________ ,DeBord , Kristin(OS/ ASPR /SPPR)(b) (6) ;Phillips , Sally (OS/ASPR/SPPR )-------- Cb(>6 ) ; David Marcozzi>; Hepbu rn, Matthew J CIVUSARMY (USA)>; Lisa Koonin(b)(6)(b)(6)-------- Cb(>6 ) Wargo Mich a elWalters, William(STATE.GOV)(b)(6)HARVEY, MELISSA(b)(6)WOLFE, HERBERTEastman , Alexande r; EV ANS , MARIEFRED>; Callahan , MichaelV. ,M.D.Johnson, Robert(OS/ASPR/BARDA)(b)(6)(b)(6)>(b)(6)(b)(6)Yeskey, Kevin(b)(6)>;Disbrow , Gary( OSI ASPR/BARDA)--------- CbC> 6)Redd, John (OS/ASPR/SPP R)-------- Cb() 6)>; Hassell, David (Chris) (OS/ASPR/ 1O)(b)(6)Hame l, Joseph (OS/ASPR/1O)NIH-001579(b) (6) ;Tracey McNamara(b)(Dean, Charity A@CDPH(b) (6);Richard Hatchett(b) (6);Lawler, James V(b) (6) ;Kadlec, Robert (OS/ ASPR/IO)(b)(6)'Martin, Gregory J(b)(6)Luciana ------ Han fling, Dan(b)(6)>;McDonald, Eric(b)(6)Wade, David(b)(6)TARANTINO, DAVIDA(b)(6)WILKINSON, THOMAS(b)(6)David GruberKAUSHIK, SANGEETA(b)(6)Nathaniel Rupert(b)(6)Subject: RE: Red DawnBreak ing, COVID-19Collaborative , Feb 16 sta 1tHi Carter, great points.l. Separate current ED/ICUpatients from COVID-19 is amust.NIH-001580NIH-0015812. Migrating current ED/ICU(non-COVID) patients to othercare sites is great idea .3. Caring for COVID-19patients: leveraging ED/I CUpersonnel for high comp liance andusage of limited resources (PPEeverything that goes with it) isvery critical. Strategic usage andminimizing non-medical staff isnecessary --- either these operatorsare well-trained and protected, orthey cannot be there.4. Concentrating care withinED/ICU for COVID-19 ensuresrap id learning and sharing ofknowledge among workers as theytake care of these patients.Clearly from the standpoint ofdata collection and clinicalsymptoms record ing andorganization, it is more feasibleand allow for immediate analysisand feedback.5. Strategic prioritization oflimited resources is extremelyimpo1tant. We must do it now,because the supp ly chain isalready being affected and it cango worse.6. Primaiy care and call centersare good. If you want to dostrategic testing , this is also a goodplace to involve .7. So few children are reportedamong the confirmed positivecase s. They may be goodspreaders (not necessarily have tobe super) and the more vulnerablepeople would be ones show upwith symptomatic diseasecharacteristics (or no/mildsymptoms).Best, Evamobi le (b)(Sent with ProtonMail SecureEmail.------- Original Message ------OnSunday, Febmary 16, 20204:30 PM, Carter Mecher(b) (6)> wrote:Wanted to bouncesomething off thisgroup.I have been concernedabout some of thepreparedness effortsof healthcare systemsNIH-001582(b)(6)NIH-001583as they are rampingup their capab ilit ies tocare for patients withCOVID-19 presentinganywhere in theirsystem. Staffworking in ERs andICUs are prettyfamiliar with the careof these types ofpatients and the use ofappropriate PPE(standard contact andairborne precautionsincluding eyeprotection). The staffat the hospitalsundergo fit test ing forrespirators, etc. Staffin outpatient clinics( especially remotecommunity basedoutpatient clinics)don't typicallyundergo fit testing forrespirators. So ERsand ICUs havemuscle memory forisolating patien ts andprov iding care topatients withinfectious respiratorydisease. Communitybased outpatientclinics do not.As part of thepreparedness efforts,there has been interestin fit testingoutpatient clinic staffand supp lying theseclinics with PPE andestablishingprocedures forNIH-001584evaluating COVID-19patients in thecommun ity basedclinics. Given theprojected shortages ofPPE, that just doesn'tseem like the mostprudent approach.Rather than expandthe care of potentialCOVID-19 patients tocommunity basedoutpat ient clinics, Iwould focus onhospital care--ERsand inpatient areas(especially ICUs). Iwould not pursue fittesting for staffworking in outlyingclinics. As a strategy,I suggested dividingCOVID patients intotwo categories-(1 )those with illness thatis mild enough to becared for at home( self care or care byother familymembers); or (2)those who are sickenough to be seen inthe ER for possiblehospitalizat ion. Iwould refocus theefforts of outlyingclinics away fromCOVID and towardkeeping non-COVIDpatients with the usualmix of acute andchronic illne sses wesee from hypertensionto CHF to diabetes,NIH-001585etc., out of the ER andout of the hospital.That is what they cando to help unburdenERs and hospitals forthe surge in COVIDpatients in ERs andhospitals. I wouldleverage telephonecare as much aspossible to handlepatients with milddisease seeking carerelated to COVID(and quickly developalgorithms todetennine who hasmild disease and canbe managed bytelephone at homeand who needs toevaluated in the ER) .Think of it like theprogram Lisadeveloped forpandemic influenza(Nurse On Call) onsteroids , minus theantivira l piece. Couldwe repurpose andleverage that programfor COVID? Such astrategy would help toconserve om PPEsupply (avoid theexpansion of fittesting and theredirection of alreadylimited supplies ofPPE to outlyingclinics) and not askoutlying clinics to dosomething they don'ttypically do (thatusually doesn't outturn out very well). IfNIH-001586the outlying clinicsfocused on what theynormally do (caringfor patients withchronic diseases),they could help theER and hospitals copewith the demands ofCOVID. I wouldthink about UrgentCare centers in thesame way- to help todecompress ERs.I also think that weneed to start thinkingabout strategies toconserve PPE forhospitals. I'mconcerned about theprojected burn ratesand the supply chainsfor PPE. Click onAmazon and checkout the prices now.Or click on WalMart(can't pick up anymasks from WalMartnow). I saw onesupplier selling 200surgica l masks onWalMaii's site foronly $459.99. Such adeal.As a conservationstrategy, we mightthink about limitingthe amount of staffinteracting withinfected patients andcohorting patients( even thinking ofstrateg ies to minimizeneed forNIH-001587housekeeping or foodservice or lab servicesfrom enter ing areaswith COVID patients-think Ebola-likestrateg ies (not out ofconcern of diseasetransmission butsimply to limitnumber of staff toconserve PPE).Could do somethingsimilar with ERs( akin to whatpediatricians do toseparate sick callpatients from otherappointments). Ihave recommendprioritizing PPE forEDs and ICUs as wellas specific inpatientareas where we wouldlikely initially cohortpatients , not pursuingfit testing ofoutpatient clinic staff,and shifting patientswith mild COVIDdisease to telephonecare and away fromoutpatient clinics.I know several of youare part of largehealthcare systems.Am curious howothers areapproaching thischallenge.I am also resendingthe questions I posedfor handling sickER/hospital staff orstaff members with aconfinned case ofCOVID in theirhou seho ld. Ca11erSent from Mai l forWindows 10From: Caneva,DuaneSent: Sunday,February 16, 20203:24 PMTo: Dodgen , Daniel(OSI ASPR/SPPR) ;DeBord, Krist in( OSI ASPR/SPPR);Phi llips, Sally(OS/ASPR/SPPR) ;Dav id Marcozz i;Hepburn, Matthew JCIV USARMY(USA); Lisa Koonin ;Wargo Michae l;Walters, William(STATE.GOV) ;HARVEY,MELISSA ; WOLFE,HERBERT; Eastman,Alexander; EV ANS,MARIEFRED;Ca llahan, Michae lV.,M.D. ;)(6); Johnson. RobertNIH-001588(OSI AS PR/BARDA) :Yeskey, Kevin;Disbrow, Gary(OSI ASPR/BARDA) :Redd, John(OSIASPR/SPPR) :Hasse ll, David (Clu-is)(OS/ASPR/10 ):Hamel, Joseph(OSIASPR/JO) :Tracey McNamara ;Dean , CharityA@CDPH ; Ric hardHatch ett; Lawler,James V; Kadlec,Robert(OSI ASPR/10) ;'Ma11in, Gregory J(b)(6):t; Borio , Luciana ;Hanfling, Dan ;McDonald, Eric;Wade, David ;TARAN TINO,DAVIDA ;WlLKINSON,THOMAS ; DavidGruberKAUSHIK,SANGEET A; Dr . EvaK Lee ; Nathan ielHupert; CarterMecherSubject: Re: RedDawn Breaking,COVID-19Collaborative , Feb 16startSorry for spam.+ CarrerNIH-001589Get Outlook for iOSFrom: Caneva ,DuaneSent: Sunday,February 16, 202010:21:38 AMTo: Dodgen , Danie l(OS/ASPR/SPP R)(b)(6)>; DeBord,Kristin( OSI ASPR/S PPR)(b)(6)>; Phillips , Sally(OS/ ASPR/S PPR)(b)(6)David Marcozzi(b)(6)Hepb urn, Matthew JCIVUSARMY(USA)(b)(6); LisaKoon in(b)(6)Walters, William(STATE.GOVJ(b)(6)>; HARVEY ,MELISSA(b)(6)WOLFE ,HERBERT)(6); Eastman,AlexanderNIH-001590)(6)EVANS,MARIEFRED(b)(6)Callahan, MichaelV.,M.D.l> ;Johnson, Robert(OS/ ASPR/BARDA))(6)>; Yeskey,Kevin)(6)Disbrow, GaryS/ ASPR/BARDA))(6)>; Redd, John(OS/ ASPR/S PPR)(b)(6)>; Hassell, David(Chris)(OS/ASPR/ 1O))(6)Hame l, Joseph(OS/ASPR/1O)(b)(6)>; TraceyMcNamara)(6)Dean,Char ity A@CDPH; RichardH tc ettLawler,James V)(6))(6))(6); Kadlec, RobertNIH-001591(OS/ ASPR/IO))(6); 'Martin,Gregory J(b)(6)>; Borio, Luciana(b)(Hanfling , Dan(b)(; McDonald , Eric(b)(6)Wad e, Dav id)(6)TARANTINO,DAVID ARalph S)(6)Barie ,(b)(6)■ WILKINSON,THOMAS>; Hassell,David (Chris)(OS/ASPR/10)(b)(6)>; David Grub er(b)(KAUSHIK ,SANGEETA(b)(6)KLeeNathaniel Rupert>Subject: RE: RedDawn Breaking,COVID-19NIH-001592)(6)Collaborative , Feb 16startSome Mark LipsitcbTweets copied.Sorry, might not be inthe right order . .."So far, we haveconducted tests for1,219 individuals. Ofthose, 355 peopletested positive. Ofthose, 73 individualsare not showingsymptom s," Japan 'shealth minister saysMarc Lipsitch (@mlipsitch)14/02/2020, 17:42I did actually say the quote that is going around , butthe article contained vital context -- we don't knowwhat propor tion are symptomatic. Also we have onlya rough estimate of what proportion of symptomat icpeople will have severe outcomes .pie. twitte r.comic W zvINSZBm14/02/2020, 17:43MarcLipsitch(@mlipsitch)Why do I think a pandem ic is likely? The infect ion isin many parts of China and many count r ies in theworld, with meaning ful numbers of secondarytransmissions . The scale is much larger than SARSfor example (where the US had many introduct ionsand no known onward transmissio n)NIH-00159314/02/2020, 17:45MarcLipsitch(@mlipsitch)Why do I think 40-70% infected?Simple math models with oversimp leassumpt ions would predict far morethan that given the RO estimates in the2-3 range (80-90%). Making morerealistic assumptions about mixing,perhaps a little help from seasonality,brings the numbers downMarc Lipsitch(@mlipsitch )14/02/2020, 17 :48pandemic flu in 1968 was estimated to_symptomatically_ infect 40% of thepopulation, and in 1918 30%. Thoselikely had RO less than COVID- 19.Below is fromstacks .cdc.gov /view/cdc/ 11425pic.tw itter .com/EMwjEpA49sMarc Lipsitch(@mlipsitch )14/02/2020, 17:49What could make this scenario nothappen? 1) cond itions in ·wuhan couldbe so different in some fundamentalway from elsewh ere that we aremistaken in expecting furtheroutbreaks to have basic aspects incommon. No reason I know of tothink that but a forma l possibilityNIH-001594Marc Lipsitch(@mlipsitch)14/02/2020, 17:532) There could be a higher degree ofsuperspreading than has beenappreciated ("dispers ion in RO")which could mean that many locationsoutside Wuhan could "get lucky" andescape major onward transmission.hopkinsidd.github.io/nCo VSandbox/D ... .14/02/2020, 17:53Marc Lipsitch(@mlipsitch)2) There could be a higher degree of superspreadingthan has been appreciated ("dispersion in RO") whichcould mean that many locations outside Wuhan could"get lucky" and escape major onward transmission .hopkinsidd. github .io/nCo V-Sandbox/D ... .Marc Lipsitch(@mlipsitch)14/02/2020 , 17:553) Control measures could be extremely effectivein locations that have had time to prepare. Maybein a few, but seems unlikely that is the case in all,especially countries with stretched healthsystems.NIH-001595Marc Lipsitch(@mlipsitch)14/02/2020, 17:564) Seasonal factors could be much morepowerful at reducing transmission than wecurrently expect. That doesn't help theSouthern hemisphere , and is not consisten twi th behavior in China (preprint in queuefrom D @Ma uSantil lana D et al.)From: Caneva,DuaneSent: Sunday,February 16, 20209:39 AMTo: Dodgen , Daniel(OS /ASPR/S PPR)(b)(6)>; DeBord,Kristin(OS / ASPR/SPPR)(b)(6)>; Phillips , Sally(OS / ASPR/S PPR)(b)(6)Hepburn , Matthew JCIVUSARMY(USA)(b)(6); LisaKoonin(b)(6)Walters, William(b)(6)HARVEY ,MELISSANIH-001596)(6)>; WOLFE,HERBERT(b) (6)_11111; E1a>stman,Alexa nderEVANS,MARIEFRED(b)(6)__.. (b)(6);Callahan, MichaelV.,M.D.; Johnson, Robert(OS/ ASPR/BARDA)(b)(6)11111; Y1e1s>key,Kevin(b)(Disbrow , Gary(OS/ASPR/BARDA)(b)(6)1111R edd, John(OS/ ASPR/SPPR)(b)(6)>; Hassell, David(Chris)(0S /ASPR/IO).>; (b)(6) Hamel, Joseph(0S /ASPR/IO)Ill>; TraceyMcNamara(b)(6)(b)(6)>; Dean ,Char ity A@CDPH(b)(6)Caneva,DuaneNIH-001597)(6); RichardHatchett; Lawler,James V)(6)(b)(6)>; Kadlec, Robert(OS/ASPR/10)>; 'Martin,Gregory J)(6)(b) (6),>; Borio, Luci ana(b)(Hanfling, Dan(b)(6)>; McDonald , Eric)(6) _Wade, David)(6)TARANTINO,DAVID A(b)(6)>; Barie,Ralph S)(6)WILKINSON,THOMAS(b)(6)>; Hassell,David (Chris)(OS/ASPR/10)(b)(6)David Gruber(b)(KAUSHIK,SANGEETANIH-001598(b)(6)Subject: Red DawnBreaking , COVID-19Co llaborat ive, Feb 16startPurpose: This is anew Red Dawn Stringto cut down the sizefrom the previousstring, opportunity toprovide thoughts,concerns, raise issues,share informationacross variousco lleagues respondingto COVID-19.Including all fromprevious string plus afew additional folks.Duane C. Caneva,MD,MSChief MedicalOfficerDepartment ofHomeland SecurityExecutive Assistant:(b)(6)NIH-001599(b)(6)(b)(6)(U) Warning : Thisdocument isUNCLASISFIED/!F OROFFICIAL USE ONLY(U//FO UO). Itcontains informatio nthat may be exemptfrom public releaseunder the Freedom ofInformation ActNIH-001600From:Sent:To:Cc:Fauci, Anthony (NIH/NIAID) [E)Mon, 24 Feb 2020 11:08:54 +0000Gilman, James (NIH/CC/OD) [El;Tabak, Lawrence (NIH/OD) [ElDavey, Richard (NIH/NIAID) [ElSubject: RE: 3 COVID-19 Asymptomatic Positive Individuals Identified at Travis AFBWe should probably also inc lude Rick Davey on all commun ication regarding such patientsFrom: Gilman, James {NIH/CC/OD) [E] ______ CbC)_6>> rSent: Monday, February 24, 2020 12:40 AM -------~~ To: Tabak, Lawrence (NIH/OD) [E]- -------- (b)(6J; Fauci, Anthony (NIH/NIAID) [E] (b) ( >Subject: Re: 3 COVID-19 Asymptomatic Positive Individuals Identified at Travis AFBLarryBest POC is Dr Palmore.JimFrom: "Tabak, Lawrence (NIH/OD) [E]" --------- (b)(6)>Date: Sunday, February 23, 2020 at 10:02:41 PMTo: "Fauci, Anthony {NIH/NIAID) [E]" -------=- (b")"(="6l, "Gilman, James (NIH/CC/OD) [E]"(b)( >Subject: FW: 3 COVID-19 Asymptomatic Positive Individuals Identified at Travis AFBWho is P-O-C, related to transfer? PiusFrom: "Kadlec, Robert (OS/ASPR/ 1O)" --------- (b)(6J>Date : Sunday, Februa ry 23, 2020 at 9:56 PM -------~= To : "Harrison, Brian (HHS/ 1OS)" (b)( >, "Stecker, Judy (OS/10S)"CbH6J>", Mango, Paul (HHS/ 1O5)" CbH6J>", Mu rphy, Ryan(OS/ASPA)" <" ".":::===C=bH=6J>=", Ar~bes~, S arah (HHS/ASL)" _A_nt hon_y_ _F:a, uci- ====.;~:::-::----:C-:b:H::6-J->:-", -Tabak , Lawrence (NIH/OD) [E]"----------- (b) ( 6)" Red fie Id, Robert R. (CDC/OD)" -------- CbH61, J"McGowan,(b)( >,Robe rt (Kyle) (CDC/OD/OCS)" CbH6J>Cc: "Lee, Scott (OS/ASPR/EMMO)" CbH6J>, "Yeskey, Kevin (OS/ASPR/1O)"CbH6J", Waters, Cicely (OS/ASPR/OEA)" CbH6J", Shuy,Bryan {OS/ASPR/10)" CbH6J", Greene, Jonathan (OS/ASPR/EMMO)"CbH6,>J, " Imbriale, Samue l {OS/ASPR/SIIM)" CbH6J, _________ _,"Austin, Meredith (uscg.mil)" (b)(6) "Herrmann, Jack (OS/ASPR/OEA)"(b)(6jSubject: 3 COVID-19 Asymptomatic Positive Individuals Identified at Travis AFBNIH-001601Initial CDC testing of the 100 individuals repatriated from the Diamond Princess yielded three individualsCOVID-19 POS who are currently asymptomatic at Travis. These individuals are being transferred tolocal hospital for evaluation and admission. Currentl Y.,ASPR TEAM at Travis is asce_rt""a_in_i_n~g, _____ ..,._.,.,,.,(b)(5)My team is working the details of transfer via aeromedical aircraft. Dr Kevin Yeskey and CAPT Scott Leecopied here are leading the operational planningnr_3_oc1u.:se.co;_f_actio.,..·, .______________________________ ..,.,.""'(b) (5)Will advise as these course are pursued in parallel.WILL NEED A POC at NIH to connect with Dr Yeskey and CAPT Lee ASAP to begin arrangements .NIH-001602From:Sent :To:Subject:Thanks, Garrett.Fauci, Anthony (NIH/NIAIO) [E)Sat, 22 Feb 2020 14:01:20 +0000Grigsby, Garrett (HHS/0S/OGA)RE: CDC L2 THN KoreaFrom: Grigsby, Garrett (HHS/OS/OGA) --------- (b)(6) Se nt: Saturday, February 22, 2020 8:56 AMTo: Fauci, Anthony (NIH/NIAID) [E] --------=- (b')""('=6)>Subject: Re: CDC L2 THN KoreaDr F,Here it is: (b)(6) ---------Sent from my iPhoneOn Feb 21, 2020, at 9:41 PM, Fauci, Anthony (NIH/NIAID) [E) (b)(6) _______ _,wrote:Garrett:Please send me the call in number for tomorrow's call at 11:00 AMThanks,TonyFrom: Grigsby, Garrett (HHS/0S/OGA) (b)(6)Sent: Friday, February 21, 2020 9:24 PMTo: Phil Ferro (b)(6); Fauci, Anthony (NIH/NIAID) [E](b)(6)>Cc: Zebley, Kyle {HHS/OS/OGA) (b)(6)>; Harrison, Brian {HHS/10S)--------- (b)( >; Shuy, Bryan {OS/ASPR/10) < (b)(6) Subject: Fwd: CDC L2 THN KoreaGentlemen,Can you please circulate this for discussion at the 11am call tomorrow?Many thanks!!Sent from my iPhoneNIH-001656Begin forwarded message:From: "Cetro n, Marty (CDC/DDID/NCEZID/DGMQ)" ------- (b)(6) Date : February 21, 2020 at 9:01 :06 PM ESTTo: (b)(6) {OS/10S)' (b)(6)>, "Harrison, Brian (HHS/IOS)"(b)(6) "Grigsby , Garrett (HHS/05/0GA) "========' (~b)=(:6~-) >Cc: "Redfield, Robert R. (CDC/OD)" CbH6)",C etron , Marty(CDC/DDID/NCEZID/DGMQ·-.).":.....:::== (=b)=:(::6c:c:)>;-- ...Subject: CDC L2 THN KoreaPer WHTF request CDC l2 THN RoK. Please share w Sec Biegun at DOS. Wewill post when he is ready presumably SatThksMSC<Coronavir us L2 - South Korea.docx>NIH-001657From:Sent :To:Subject:Fauci, Anthony (NIH/NIAIO) [E)Sat, 22 Feb 2020 02:40:45 +0000Grigsby, Garrett (HHS/OS/OGA)FW: CDC L2 THN KoreaAttachment s: Coronavirus L2 - South Korea.docx, ATT0O0Ol.htmGarrett:Please send me the call in number for tomorrow's call at 11:00 AMThanks,TonyFrom: Grigsby, Garrett (HHS/OS/OGA) (b)(6)Sent : Friday, February 21, 2020 9:24 PMTo: Phil Ferro (b)(6)>; Fauci, Anthony (NIH/NIAID) [E] _______ CbH_6)Cc: Zebley, Kyle {HHS/OS/OGA) CbH6>!H>a;r rison, Brian (HHS/IOS)--------- (b)(6) Shuy, Bryan (OS/ASPR/IO) (b)( > Subject: Fwd: CDC L2 THN KoreaGentlemen,Can you please circulate this for discussion at the 11am call tomorrow?Many thanks !!Sent from my iPhoneBegin forwarded message:From: "Cetron, Marty (CDC/DDID/NCEZID/DGMQ)" (b)(6)>Date : February 21, 2020 at 9:01:06 PM ESTTo: (b)(6) (O5/IOS)" (b)(6)>, "Harrison, Brian (HHS/1O5)" ---------.., ~ (b)(6), "Grigsby, Garrett (HHS/OS/OGA) (b)(6)> _________ , ---------Cc: "Redfield, Robert R. (CDC/OD)" (b)(6), "Cetron, Marty(CDC/DDID/NCEZID/DGMQ)" (b)(6)Subject: CDC L2 THN KoreaPer WHTF request CDC L2 THN RoK. Please share w Sec Biegun at DOS. We will post whenhe is ready presumably SatThksMSCNIH-001680From:Sent:To:Subject :Bob:Fauci, Anthony (NIH/NIAID) [E)Fri, 21 Feb 2020 10:55:47 +0000Kadlec, Robert (OS/ASPR/10)RE: Good morningNo problem . Got you covered .Best,TonyFrom: Kadlec, Robert (OS/ ASPR/10) --------- (b)(6)> Se nt: Friday, February 21, 2020 5:53 AM ------~~ To : Fauci, Anthony (NIH/N IAID) [E] -------- Cb)( > Subject : Good morn ingImport ance: HighTony during today's t able top as we walk through the placement I will ask you to walk throughthe Critica l Info rmation Requirements and ask you to highlight what we know, don't know andwhat we th ink about the this coronavi rus. l et me know if you have any questions . Best BobNIH-001697From: Fauci, Anthony (NIH/NIAIO) [E)Sent: Thu, 20 Feb 2020 21:26:05 +0000To: Eisinger, Robert (NIH/NIAID) [ElSubject: FW: HHS COVID 19 Response TIX Concept Placemat_SeniorLeader _19Feb2020 v2.pptxAttachments : HHS COVID 19 Response TTX Concept Placemat_SeniorLeader _19Feb20 20v2 .pptx , ATTOOOOl.htmHere it isAnthony S. Fauci , MDDirectorNational Institute of Allergy and Infectious DiseasesBuilding 31, Room 7A-0331 Center Drive , MSC 2520National Institutes of HealthBethesda , MD 20892-2520Phone : Cb()6 )FAX: (301 496-4409E-mail : (b)(6)The information in this e-mail and any of its attachments is confidential and may contain sensitiveinformation . It should not be used by anyone who is not the original intended recipient . If youhave received this e-mail in error please inform the sender and delete it from your mailbox or anyother storage devices . The National Institute of Allergy and Infectious Diseases (NIAID) shall notaccept liability for any statements made that are the sender 's own and not expressly made onbehalf of the NIAID by one of its representatives .From: Kadlec, Robert (OS/ASPR/10) <- ------- (b)( > Sent: Wed nesday, February 19, 2020 6:15 PM -------::--:--;= To: Fauci, Anthony (NIH/NIAID) (El (b)(6)Subject: Fwd: HHS COVID 19 Response TTX Concept Placemat _Senior Leader_19Feb2020v2 .pptxSent from my iPhoneBegin forwarded message:From: "Mackay, Thomas (OS/ASPR/EEAA)" (b)(6)>Date: February 19, 2020 at 5:55:17 PM EST ---------=c-= To: "Kadlec, Robert (OS/ASPR/10)" (b)(6), "Yeskey, Kevin(OS/ASPR/10)" (b)(6)>Cc: "Ford-Barnes, Arwent hia (OS/ASPR/10)" CbH6J>"H, ol land,Tara (OS/ASPR/EMMO)" (b)((;)>, "Callahan, Victoria (OS/ASPR/10) (CTR)"(b)(6)>Subject : HHS COVID 19 Response TIX Concept Placemat_Seniorleader_19Feb2020v2 .pptxNIH-001712NIH-001713Gentlemen - attached is the latest version of the Placemat . The reason there are fourslides is to give you the option of how the backside is laid out . Slide one and three areidentical, the information on slides two and four are also identical just laid out differently .Standing by for corrections as necessary.v/rTomFrom: Fauci, Anthony (NIH/NIAID) [E)Sent : Thu, 20 Feb 2020 04:02:40 +0000To: Jernigan, Daniel B. (CDC/DDID/NCIRD/ID);Giroir, Brett (HHS/OASH);Shuy, Bryan(OS/ASPR/IO);Schuchat, Anne MD (CDC/0D);Cetron, Marty (CDC/DDID/NCEZID/DGMQ);McGowan,Robert (Kyle) (CDC/0D/OCS);Grigsby, Garrett (HHS/0S/OGA);Zebley, Kyle (HHS/0S/OGA);Redfield,Robert R. (CDC/OD)Subject: RE: Updated Draft in Track ChangesAttachme nts: Phases of USG nCoV Response _WHTF 13 Feb_PCC_Master.Final ASPR Edits -CDC BG.docxHHS Team :I have been following these various iterations closely over the past couple of hours and I agreewith Dan. It looks like we have actually finally arrived at a good place and a point ofcomfortable agreement between ASPR and CDC. Am I correct and do we all agree with thelatest tracked document (see attached)?Thanks,TonyFrom: Jernigan, Daniel B. (CDC/DDID/NCIRD/ID) (b)(6)Se nt: Wednesday, February 19, 2020 10:54 PMTo : Giroir, Brett {HHS/OASH) CbH6J>; Shuy, Bryan (OS/ ASPR/I0)------- (b)( >; Schuchat, Anne MD (CDC/OD) (b)(6)>; Cetro-n-, -M-a-rt~y ~ (CDC/DDID/NCEZID/DGMQ) (b)(6)>; Fauci, Anthony (NIH/NIAID) [E) (b)( >;McGowan, Robert (Kyle) (CDC/00/0CS) (b)(6)>; Grigsby, Garrett (HHS/0S/OGA)(b)(6)>; Zebley, Kyle (HHS/0S/OGA) (b)(6)>; Redfield, Robert R.7( C::D---C: -/:0-:-D--)-=:-==::,:: (b:);:(~: >Subject : RE: Updated Draft in Track ChangesHere with Adm Giroir's input as well. I think we may have arrived?Dan.From: Giroir, Brett (HHS/OASH) (b)(6)Sent : Wednesday, February 19, 2020 10:06 PMTo : Shuy, Bryan (OS/ASPR/10) CbH6)>; Schuchat, Anne MD (CDC/OD) (b)(6);Cetron, Marty {CDC/DDID/NCEZID/DGMQ) <q" CbH§ >; Jernigan, Daniel B. {CDC/DDID/NCIRD/ID)CbH6)>F; auci, Anthony (NIH/NIAID) [E) CbH6)>M; cGowan , Robert (Kyle)(CDC/0D/OCS) CbH6)>; Grigsby, Garrett (HHS/0S/OGA) CbH6J>; Zebley,Kyle (HHS/0S/OGA) (b)(6)Subject: RE: Updated Draft in Track Changes(b) (5)Please include me on the emai l exchange .NIH-001726I am happy to point force the issue, which I can and will, but I assume it was an accidentalom missionBGBrett P. Giroir, MDADM, US Public Health ServiceAssistant Secretary for Health (ASH)200 Independence Avenue, SWWashington, DC 20201Office Phone: (b) (6)From: Giroir, Brett (HHS/OASH)Sent: Wed nesday, February 19, 2020 10 :02 PMTo : Shuy, Bryan (OS/ASPR/I0) (b)(6)>; Schuchat , Anne MD (CDC/OD) (b)(6)>;Cetron , Marty (CDC/DDID/NCEZID/DGMQ) (b)(6)>; Jernigan, Daniel 8. (CDC/DDID/NCIRD/10)____ Cb_><6)>; Antho ny (NIH/NIAID) Fauci [E] (b)(6)> ;McGowan, Robert (Kyle) (CDC/00/0CS) (b)(6); Grigsby, Garrett (HHS/0S/OGA)--------- (b)(6)>· ; Zebley, Kyle (HHS/OS/OGA) (b)(6)> Subject: RE: Updat ed Draft in Track ChangesImportance: HighBrett P. Giroir, MDADM, US Public Health ServiceAssistant Secretary for Health (ASH)200 Independence Avenue, SWWashington, DC 20201Office Phone: (b) (6)Begin forwarded message:NIH-001727(b) (5)From: "Kadlec , Robert (OS/ASPR/IO)"Date: February 19, 2020 at 9:03 :33 PM EST(b)(6)To: "Schuchat, Anne MD (CDC/OD)" ---~~ CbH6>J, "Cetron, Marty(CDC/DDID/NCEZID/DGMQ)" CbHp6,), "Jernigan, Daniel B.(CDC/DDID/NCIRD/ID)" ----- CbH6}, "Fauci, Anthony (NIH/NWD) [E]" (b)(Cc: "McGowan , Robert (Kyle) (CDC/OD/OCS)" Cb><,6 "JShuy , B1yan(OS/ASPR/1O)" CbH6>J, "Grigsby, Garrett (HHS/OS/OGA)"Cb>< , "Zebley , Kyle (HHS/OS /OGA)"(b)(6)>Subject: Updated Draft in Track ChangesPlease accept my apologies for the delay I had a competing priority action but please findattached .NIH-001728From :Sent :To:Fauci, Anthony (NIH/NIAIO) [E)Wed, 19 Feb 2020 01:38:52 +0000Billet, Courtney (NIH/NIAID) [E]Subject : RE: CDC Media Statement: Update on the Diamond Princess Cruise Ship in JapanFrom : Billet, Courtney (NIH/NIAID) [E]Sent : Tuesday, February 18, 2020 8:23 PM(b) (6) >To: Fauci, Anthony (NIH/NIAID) [~E]:-.=-==-=-=-=-=-=-:-(:b:=)-(:=-6 ~)>Cc: Folkers, Greg (NIH/NIAID) [El --------- (b)(6); Conrad , Patricia (NIH/NIAID) [E] (b)(6)Subject : Fwd: CDC Media Statement: Update on the Diamond Princess Cruise Ship in JapanFrom : "Hall, Bill (HHS/ASPA)" (b)(6)>Dat e: Tuesday, February 18, 2020 at 4:52:06 PMSubject : FW: CDC Media Statement: Update on the Diamond Princess Cruise Ship in JapanFrom: MMWR Media List <MMWR -MEDIA@LISTSERV.CDC.GOV> On Beha lf Of Media@cdc .gov (CDC)Sent: Tuesday, February 18, 2020 4:46 PMTo: MMWR-MEDIA@LISTSERV.CDC.GOVSubje ct : CDC Media Statement : Update on the Diamond Princess Cruise Ship in JapanMedia StatementFor Immediate ReleaseTuesday, February 18, 2020Contact: CDC Media Relations(404) 639-3286NIH-001766NIH-001767Update on the Diamond Princess Cruise Ship in JapanWe commend the extraordinary efforts by the Government of Japan to institute quarantinemeasures onboard the Diamond Princess. While the quarantine potentially conferred asignificant public health benefit in slowing transmission, CDC's assessment is that it may nothave been sufficient to prevent transmission among individuals on the ship. CDC believes therate of new infections on board, especially among those without symptoms , represents anongoing risk. Therefore, to protect the health of the American public, all passengers and crew ofthe ship have been placed under travel restrictions, preventing them from returning to the UnitedStates for at least 14 days after they had left the Diamond Princess.Currently , there are more than 100 U.S. citizens still onboard the Diamond Princess cruise shipor in hospitals in Japan. These citizens have been placed under the restrictions, as have the ship'sother passenge rs and crew .After disembarkation from the Diamond Princess, these passengers and crew will be required towait 14 days without having symptoms or a positive coronavirus test result before they arepermitted to board flights to the United States.If an individual from this cruise arrives in the United States before the 14-day period ends, theywill still be subject to a mandatory quarantine until they have completed the 14-day period withno symptoms or positive coronavirus test results.Because of their high-risk exposure, there may be additional confirmed cases of COVID-19among the remaining passengers on board the Diamond Princess.CDC is committed to protecting the health and safety of all Americans. We continue to believethat the risk of exposure to COVID-19 to the general public in the United States is currentlylow. The U.S. Government is taking these measures to protect the Diamond Princess passengersand crew, their loved ones, the traveling public, and communities within the United States.###U.S. Department of Health and Human ServicesCDC works 2417 protecting America's health, safety and security. Whether diseases start athome or abroad, are curable or preventable , chronic or acute, or from human activity ordeliberate attack, CDC responds to America's most pressing health threats. CDC isheadquartered in Atlanta and has experts located throughout the United States and the world.If you would like to unsubscribe from this ListServ LIST, please send an email toLIST@cdc.gov, enter CDC in the email Subject, and include the following "one" line in theBody of the email: signoffMMWR-MEDIAFrom:Sent:To:Bee:Fauci, Anthony (NIH/NIAIO) [E)Mon , 17 Feb 2020 20:16:44 +0000Tabak, Lawrence (NIH/OD) [E)Marston, Hilary (NIH/NIAID) [E]Subject : RE: Larry, does NIH have a single point person through which all Coronavirusintel bubbles up?Larry:Thanks for the note .(b)(5)--------------------------- CbH5> The person who us u a1 1y subs for me when I cannot be on a call or at a meeti ng is Hilary Marston .She is up to speed on virtually all this stuff and is the name that you should sendto Paul. You can t ell Paul that he should channel everything t hrough me and Ican turf to Hilary when necessary and appropriate. Hilary is right here in myoffice and is very close to me.Best,TonyAnthony S. Fauci, MDDirectorNational Institute of Allergy and Infectious DiseasesBuilding 31, Room 7A-0331 Center Drive, MSC 2520National Institutes of HealthBethesda, MD 20892-2520Phone : (b)(6)FAX : (301 496-4409E-mail : (b)( 6)The information in this e-ma i l and any of its attachments is confidential and may contain sensitiveinformation . It should not be used by anyone who is not the original intended recipient . If youhave rece ived this e-mail in error please inform the sender and delete it from your mailbox or anyother storage devices . The National Institute of Allergy and Infectious Diseases (NIAID) shall notaccept liability for any statements made that are the sender's own and not expressly made onbehalf of the NIAID by one of its representatives .From: Tabak, Lawrence (NIH/OD) [El (b)(6)Sent: Monday, February 17, 2020 2:56 PM ------~= To: Fauci, Anthony (NIH/NIAID) [E]- ------- (b)( > Subject: Fwd: Larry, does NIH have a single point person th rough which all Coronavirus intel bubblesup?TonyDo want this to be one of your folks or me?ThanksLarryNIH-001820Sent from my iPhoneBegin forwarded message:From: "Mango, Paul (HHS/10S)" (b)(6)>Date : February 17, 2020 at 2:45:52 PM ESTTo: "Tabak, Lawrence (NIH/OD) [E]" <------- =(b.H.,=6)Subject: Larry, does NIH have a single point person through which all Coronavirus intelbubbles up?Larry- we are trying to integrate some of the department communications channels. DrFauci is on just about every call, but do you have someone else as well who is representingNIH and would be aware of any developments?Sent from my iPhoneNIH-001821From:Sent:To:Fauci, Anthony (NIH/NIAIO) [ElSat, 15 Feb 2020 18:57:22 +0000Harrison, Brian (HHS/10S)Subject: FW: WaPo - fact check on coronavirus storyFYI. See below.Anthony S. Fauci , MDDirectorNational Institute of Allergy and Infectious DiseasesBuilding 31, Room 7A-0331 Center Drive, MSC 2520National Institutes of HealthBethesda MD 20892-2520Phone : (b)(6)FAX: (301 496-4409E-mail : (b)(6)The information in this e-mail and any of its attachments is confidential and may contain sensitiveinformation . It should not be used by anyone who is not the original intended recipient. If youhave received this e-mail in error please inform the sender and delete it from your mailbox or anyother storage devices . The National Institute of Allergy and Infectious Diseases (NIAID) shall notaccept liability for any statements made that are the sender's own and not expressly made onbehalf of the NIAID by one of its representatives .From: Fauci, Anthony (NIH/NIAID) [E]Sent: Saturday, February 15, 2020 1:50 PMTo: Oakley, Caitlin B. (OS/ASPA)--------,;-- =Cc: Stecker, Judy (OS/IOS) Cb)( ; Conrad, Patricia (NIH/NIAID) [El--------- (b)(6) >; Billet, Courtney (NIH/NIAIO) [El (b)(6) Subject : RE: WaPo - fact check on coronavi rus storyCaitlin/Judy:I had a long and good conversation with Yasmeen Abutaleb and went over (andcountered) all of the issues that had any negative connotations for the Secretaryand/or the President. I spoke on the record and gave her permission to use myquotes as she so wishes. Mission accomplished.Best regards .,TonyAnthony S. Fauci , MDDirectorNational Institute of Allergy and Infectious DiseasesBuilding 31, Room 7A-0331 Center Drive, MSC 2520National Institutes of HealthBethesda , MD 20892-2520Phone : (b)(6)NIH-001858FAX : (301) 496-4409E-mail : (b)(6)The information in this e-mail and any of its attachments is confidential and may contain sensitiveinformation . It should not be used by anyone who is not the original intended recipient. If youhave received this e-mail in error please inform the sender and delete it from your mailbox or anyother storage devices . The National Institute of Allergy and Infectious Diseases (NIAID) shall notaccept liability for any statements made that are the sender's own and not expressly made onbehalf of the NIAID by one of its representatives .From: Oakley, Caitlin B. {OS/ASPA) (b)(6)Sent : Saturday, February 15, 2020 11:31 AMTo: Fauci, Anthony {NIH/NIAID) [E]------= (b')"("=6)>Cc: Stecker, Judy (OS/1O5) (b)(6); Conrad, Patricia {NIH/NIAID) [E]--------- Cb)( >; Billet, Courtney {NIH/NIA ID) [El (b)(6) Subject: FW: WaPo - fact check on coronavirus storyDr. Fauci- Thank you for the chat. Here is the reporter's contact info and she is expecting your call.Yasmeen AbutalebThe Washington PostHealth policy report-e-r -~~ o: 202-334 -8387 c: -----(b) ( Yasmeen.Abuta leb@washpo st .comCaitlin B. OakleyDeputy Assistant Secretary, National SpokespersonOffice of the Assistant Secretary for Public AffairsU.S. Department of Health and Human Services(b)(6)From: Abutaleb, Yasmeen <Yasmeen.Abutaleb@washpost .com>Se nt: Friday, February 14, 2020 4:40 PM --------~~ To: Oakley, Caitlin B. (OS/ASPA) CbH6J>M;c Keogh, Katherine {OS/ASPA)(b)(6)Subject: WaPo - fact check on coronavirus storyHey Caitlin and Katie,Happy Friday! I'm working on a story about the coronavirus response, aim ing to publish tomorrow. Thestory is about how President Trump has praised China and President Xi, but that has made some of hisadvisors uncomfortable given the lack of transparency from China and the inability to get CDC scientistsin to the country. We also have some details about the response and the task force , and somedisagreements that have arisen. I've listed the points we have in the story that pertain to HHS- wouldyou be able to take a look, let me know if there are any issues and potentially provide a comment? Iincluded some quotes from Sec. Azar's interviews on Friday with CNN and CNBC but also happy toinclude a quote from the agency.NIH-001859I realize I'm sending this at the end of the day, so would it be possible for you to get back to me by 1 pmtomorrow? Let me know what works on your end. Thanks so much.• President Trump has lavished praise on China and its ruler, Xi Jin ping, for its handling of thegrowing coronavirus outbreak - a posture some in his administration are growing increasinglyuncomfortable with as his advisors remain concerned about China's transparency and handlingof the epidemic .• Trump's praise towards Xi has irked some advisors, who say those comments and others abouthow the virus wil l likely behave reflect how the president is being briefed, underscoring tensionswithin the admin istration over its handling of the outbreak and the message it should besending to the American public.• Worries about the market and tenuous negotiations with China over a trade deal have played alarge role in influencing Trump 's friendly posture .• Trump has told advisors he does not want the administration to do or say anything that wouldfurther spook the markets, but remains worried that any large-scale outbreak in the U.S. couldhurt his reelection bid.• For weeks, the administration's messaging was that the th reat to the American public remainedlow and the virus was not spreading within communities. But some advisors pushed for a morebalanced message because they expect there to eventually be some commun ity spread as theoutbreak grows, and the administration has since adjusted its message to reflect that.• In an effort to keep Trump calm and restrained, Azar has been briefing the president that"everything is under control, totally under control," which has kept Trump from doing or sayinganyth ing drastic.• HHS officials have also told Trump that the number of infections could go down in the springwhen it gets warmer, which is mainly an educated guess.• Some officials have complained that Trump's comments emanate from his briefings with Azar,who they say has sought to control the response. He has told other doctors , including AnthonyFauci, not to get too far into the details of the virus and outbreak with Trump . Instead, Azar hasinstructed doctors to let him handle it.• Azar has also wanted to be the one to announce major updates about the administ ration'sresponse to the virus . On Thursday, he briefed the Senate Finance Committee that the CDCwould use public health labs in five cities that normally test for infl uenza to also test forcoronavirus, taking state health officials by surprise.• Some officials said the response has become smoother and better coordinated in recent weeks.Yasmeen AbutalebThe Washington PostHealth policy reportero: 202-334-8387 c: ----~----(~b)~(6=) @yabutaleb7NIH-001860From: Fauci, Anthony (NIH/NIAID) [E)Sent : Sat, 22 Feb 2020 21:07:26 +0000To: Messonnier, Nancy (CDC/DDID/NCIRD/OD)Cc: Redfield, Robert R. (CDC/OD);Cetron, Marty(CDC/DDID/NCEZID/DGMQ);Jernigan, Daniel B. (CDC/DDID/NCIRD/1D)Subject : RE: Wpost: New developments suggest coronavirus incubat ion could be longerthan 14 days, as global infections riseSou nds good to me. Thanks.Anthony S. Fauci, MDDirectorNational Institute of Allergy and Infectious DiseasesBuilding 31, Room 7A-0331 Center Drive , MSC 2520National Institutes of HealthBethesda , MD 20892-2520Phone : Cb()6 )FAX: (301 496-4409E-mail : (b)(6)The information in this e-mail and any of its attachments is confidential and may contain sensitiveinformation . It shou ld not be used by anyone who is not the original intended recipient . If youhave received this e-mail in error please inform the sender and delete it from your mailbox or anyother storage devices . The National Institute of Allergy and Infectious Diseases (NIAID) shall notaccept liability for any statements made that are the sender 's own and not expressly made onbehalf of the NIAID by one of its representatives .From : Messonn ier, Nancy (CDC/DDID/NCIRD/OD) (b)(6)Sent : Saturday, Februar y 22, 2020 4-:-06- -PM- - --=-<~ To: Fauci, Anthony (NIH/NIAID) (E] (b)(6)Cc: Redfield, Robert R. (CDC/OD) (b)(6)>; Cetron, Marty (CDC/DDID/NCEZID/DGMQ)