COVID-19 Update With Janet Napolitano

FASKIANOS: Good afternoon from New York, and welcome to the Council on Foreign Relations State and Local Officials Conference Call Series. I’m Irina Faskianos, vice president for the National Program and Outreach here at CFR.

We’re delighted to have participants from forty-six states across the country joining us for today’s discussion. As you may know, CFR is an independent and nonpartisan organization and think tank focusing on U.S. foreign policy. Through our State and Local Officials Initiative we serve as a resource on international issues affecting the priorities and agendas of state and local governments by providing analysis on a wide range of policy topics, Foreign Affairs magazine, and briefings with CFR fellows.

We know that many of you on the call are taking the lead on responding to COVID-19 in your communities, which is why we are delighted to have with us today Janet Napolitano leading the conversation. We circulated her full bio prior to the call, so I’m just going to give you a few highlights on her distinguished background.

Janet Napolitano is the twentieth president of the University of California and the first woman to serve in this role. Previously, she held public office as the U.S. secretary of homeland security from 2009 to 2013, and she was governor of Arizona from 2003 to 2009, as well as serving as the state’s attorney general prior to that. She also served as a member of the Board of Directors of the Council on Foreign Relations.

As a reminder, today’s call will be on the record—the remarks, the interactive question-and-answer portion. We will share the audio and transcript on our website after the fact at CFR.org, but we really want to share the information here as I know people really are in need of it.

So, President and Secretary Janet Napolitano, thanks very much for being with us today. I thought you could maybe give us an update of where we are right now with COVID-19 outbreak, how you’re thinking about it as you deal with the response on the University of California system, and talk about your insights and experiences from your previous roles in public office on responding to public health threats and crises.

NAPOLITANO: Thanks, Irina. And good afternoon, everybody, from California, where we have a cruise ship with thirty-five hundred passengers currently being tested and dispersed around California, and then when tests are negative to their home—to people’s home states where they can self-quarantine. So it has been a busy time out here in California.

I thought I would begin just by kind of outlining the problem. The problem is that we have a new form of virus, a coronavirus, that erupted in China and has spread quickly around the world. The World Health Organization is on the cusp of declaring a global pandemic. They use the word “pandemic” when there are multiple countries in which there’s what’s called community transmission—in other words, where the virus appears irrespective of somebody having been a traveler or the like. When there is a pandemic, of course, it requires a global response. In the United States it requires a national, a state, and a local response.

What do we know about the coronavirus? Well, we know that people over the age of sixty are particularly susceptible. We know that it is a virus that, unlike the common cold where the virus attaches to your nasal passages and your upper chest, this virus becomes dangerous because it attaches to the cells deep in your lungs, and that is what is contributing to the mortality rate. We know that the United States has been slow to the ball in terms of having a test and testing for the virus, and that has caused a lot of the concern around the United States because without testing you don’t really know how many people in the county are sick and you also then cannot properly measure your own mortality rate. Slowly but surely testing and testing kits are becoming available around the country, although there’s still a severe shortage.

We know that the virus is easily transmissible by droplets—that is, when people cough—or through feces. And that requires, then, for—to stop the progression of the virus what’s called social distancing. What that means is limitations on large meetings, limitations on travel. It means when people have been exposed that they need to be quarantined, and the recommended quarantine period is currently fourteen days.

The number-one source of information in this circumstance I would recommend is your local or county public health department. They will be the ones that should have the accurate information about transmission in your local area. They should have recommendations on the social distancing that they are suggesting for your locality. They will have information about the availability of testing, where to get tests, and so forth. And they should have information about how particularly your health-care workers and your first responders should be able to protect themselves from the virus in terms of what kinds of personal protective equipment, what kinds of masks, et cetera they should—they should utilize.

At the University of California I’ll just—by way of example—what do you do when you have a large, distributed organization? We are ten campuses, six academic health centers, three affiliated national labs, and a statewide Division of Agriculture and Natural Resources. We have two hundred and eighty thousand students and almost two hundred and thirty thousand employees. We are spread all over California, and we regularly get visitors from all over the country and indeed the world. Our response is underway on three fronts.

First is patient care. We are on the frontlines testing and caring for some of the first patients in California that contracted the virus.

Second, delivering clear and regular communications to our ten campuses and planning for business continuity. What do I mean by that? What I mean by that is at a certain point we will need to probably stop having classes and switch to online courses. It means that we need to plan for keeping our campuses open, but at a reduced activity level. And it means that things are moving swiftly, and so having just clear and regular communications to the university community, very important.

And finally, we’re conducting scientific research directly tackling COVID-19, which is the name of the disease caused by this coronavirus, for purposes of developing a vaccine. UC Health, which are our conglomeration of hospitals and academic medical centers led by Dr. Carrie Byington—she is herself an infectious disease specialist. This has come in very handy. She and I are in regular contact with California’s secretary of health. Dr. Mark Ghaly, as well as other state, local, and federal officials, to deal with this evolving situation and to keep federal and state policymakers updated on what we are doing.

We’re on the frontlines providing health-care services to patients who may be symptomatic or who may have been exposed and are not yet symptomatic. As of today we had six confirmed cases in our hospitals, and we’ve had dozens upon dozens of health-care workers, students, and trainees who are being monitored because they have been exposed. We also treated the first case in California that was the product of community transmission—that is, not somebody who had traveled here from China or on a cruise but who simply contracted the disease. We have extensively trained our emergency-preparedness specialists, who continuously screen patients based on symptoms, on travel history, and up-to-date recommendations, particularly, as I’ve emphasized, from the local health department. We’ll follow each campus’ county public-health guidance in the case of a local virus outbreak. And we are working with state and federal agencies to ensure that we have access to appropriate medical technologies and supplies, including the right kinds of masks, of gowns, and lab tests. And of course, getting access to lab tests has been a real struggle over the course of this virus.

We treat patients in negative-pressure isolation rooms. And health-care providers in contact with those patients are provided with and trained to use appropriate personal protective equipment such as gowns, gloves, fit-tested high-filtration respirators, and face shields or goggles.

We’re also working closely with our unions, particularly the California Nurses Association, which represents nurses in all of our hospitals. One of the things we want to focus on is not only caring for our patients, but also making sure that our employees who are in contact with those patients are able to stay safe.

We’re going to continue to engage with lawmakers in Washington, D.C., so they know exactly what it will take to support our efforts. So we know that Congress last week passed an $8.5 billion emergency supplemental for costs associated with the coronavirus. We estimate direct and indirect costs will reach about $500 million at the University of California over the next six months, and we want to make sure that Congress knows that because other universities and health-care systems are also going to have increased costs, and that means undoubtedly Congress is going to have to increase the size of that supplemental.

On January 30 we issued a directive to avoid all nonessential travel to China. We expanded that on February 26 to eliminate all travel to any country designated with a CDC warning level three. And on March 5 we expanded that again. We suspended our spring semester study-abroad programs in Italy and Korea, as well as spring and summer programs in China, and we are evaluating whether to simply suspend all study abroad for the remainder of the academic year.

For those who must travel we have arranged for employees and students traveling on official business to be covered for a wide variety of accidents and incidents, including illness, while away from their UC location. And we provide this coverage at no cost to the traveler.

We’re working to communicate a straightforward public-health message supporting basic steps as outlined by the CDC, including washing your hands frequently with soap and water, coughing into your elbow, not shaking hands, staying home if you are sick or are showing any symptoms, and disinfecting surfaces at home and in workspaces. The situation is very fluid and so, again, keeping up a clear and steady communications effort is so very, very important. We have urged our campus communities to be calm, yet vigilant. I’m going to stop there and take any questions.

And I will say that I was secretary of Homeland Security during the H1N1 flu in 2009. This was a novel flu that arose first in Mexico, came to the United States, also had a fairly wide and rapid distribution and what we thought early on was going to be a high mortality rate. It turned out fortunately not to be a high mortality rate. But there I learned the importance of regular, clear communications, thinking through what different communities need—be it a university, be it a small town, a city—what your hospitals need, and your first responders need in in terms of training, equipment, and preparation. And so now we’ve moved from H1N1 to COVID-19.

So with that, Irina, I will stop entertain any questions people have.

FASKIANOS: Great. Thank you, Janet. Let’s open up to the group for questions, comments, et cetera.

OPERATOR: Thank you. At this time we will open the floor for questions.

(Gives queuing instructions.)

Caller, your line is live.

Q: Good afternoon. My name is Sherrie Powers. And I’m in Wayne County, Tennessee as a county commissioner.

And the question that we’ve been asked by people are is this flu similar to other flus, in the sense that we will have a flu season and will the onset of warmer weather have an effect on the coronavirus?

NAPOLITANO: Yeah. So what I’m told by our specialists is that we can anticipate that this flu may subside as the temperatures rise in the summer, but it will undoubtably come back in a second wave. So we’re in the first wave now. We may get a bit of a break. And then it’ll be back.

OPERATOR: Thank you for the question. Next caller.

FASKIANOS: Thank you. Next question.

OPERATOR: Caller, your line is live, if you’d please go ahead with your question. State your name and company, please.

Q: Hi. Yes. My name is Jul Calabrese and I’m calling from the New Jersey State Office of Senator Troy Singleton in the 7^th Legislative District.

My question is that Janet touched base on the virus being transmissible by droplets. Can you go over again what those—what that entails? I know you said through coughing and through something else, but I didn’t catch it.

NAPOLITANO: Yes. Through feces. It’s carried both ways. Droplets obviously are more of a risk. And the droplets, of course, are when people cough. And you want to stay at least six feet away from a person who is coughing to avoid being hit by droplets.

Q: OK. Thank you.

OPERATOR: Thank you. Caller, your line is live. Please go ahead with your question. Please state your name and title.

Q: Yeah. Rod Cleveland, county commissioner in Cleveland County, Oklahoma.

My question is, is government buildings like our courthouse—what the question would be is are there people, are there other entities, or what would you suggest as taking precautions to, one, protect our employees, since wea re so open to the public. And the, two, for the public. Although Oklahoma hasn’t had any cases, we are the—you know, the hometown of the University of Oklahoma. And the university is already talking about suspending classes after spring break or going to only online classes for the remaining of the year. So that would be my question.

NAPOLITANO: Yeah. So for public buildings, again, I would take advice from your local health department. But you want to make sure that you’ve got things like hand sanitizer easily available, and that you put up—I would suggest putting up, you know, signs, reminding people to wash their hand thoroughly, to cough in their elbow, to avoid shaking hands. Those simple reminders can do a lot to stop the transmission of this virus. And even though you may not have a case in Oklahoma, you will have a case in Oklahoma.

With respect to the university, they’re doing—a lot of universities around the country, including at the University of California, are shutting down with spring break coming up, and then moving to online courses. Universities, of course, have thousands and thousands of people living in close quarters. They’re kind of ideal petri dishes, not like cruise ships but in their own way they are petri dishes. And so taking action to suspend the transmission of the virus makes a lot of sense, particularly in the university setting.

Q: All right. Thank you.

FASKIANOS: Just, Janet, when you say that you’re going to online courses, are the students going home or are they going to stay in their dorm rooms and do the online courses there, or online, you know, work?

NAPOLITANO: Yeah. We’re going to have students stay in their dorm rooms. They’ve paid for them. We’ll keep food service available. But we’re going to simply suspend the actual classes.

FASKIANOS: Mmm hmm. Got it. Thank you. Next question.

OPERATOR: Thank you. The next question will come from Mary Dunwell with Montana House. Please go ahead.

Q: Hi, there. I’m Representative Mary Ann Dunwell in Helena, Montana.

And we too have not seen a case of COVID-19, but our governor assures us we will, and our taskforce that has been set up. My question, talking about stay home if you’re sick, what can we do—and, Ms. Napolitano, maybe there has been emergency legislation or action in California—for folks who do not have the benefit of paid sick leave, or the benefit of health care? The other day our president recommended a tax break for corporations and companies that are losing money, like airlines, form the virus. However, nothing was said about the folks struggling to make ends meet, who we serve. Thank you.

NAPOLITANO: Yeah. That’s such a good question. At the University of California, as I mentioned, we have about two hundred thirty thousand employees. And we’re simply going to give them all fourteen days of paid leave, which if they become symptomatic will then be extended. But we’re just—we are doing that voluntarily. But I think this will be an area where it will be helpful for state legislatures to get involved and pass legislation that provides for paid leave for those who have to stay at home.

Q: May I have a follow-up, please?

NAPOLITANO: Yeah.

FASKIANOS: Sure. Go ahead.

Q: Yes. Thank you very much. So we have a majority in a certain political party in Montana, that some of them don’t even believe in public health, by introducing bills to do away with vaccines and whatnot. How would you suggest we convince those folks? Two of them were at that conservative conference back east somewhere and had apparently possibly been exposed to the individual who has been diagnosed with a case of this virus. And they’re refusing to stop shaking hands, stay inside. So how do we deal with that? Because that is a problem when we’re trying to manage the public health, the population health. Thank you.

NAPOLITANO: Well, I think—yeah. So there you might remind them that two of the United States senators who are Republican who were at that CPAC conference are staying home now for fourteen days. They didn’t return to Washington, D.C., because they were exposed. So—and that’s the right thing to do, because really to prevent community transmission you need kind of a community effort and a community awareness of how easily transmissible this virus is. And then you might consider reaching out to some of the larger employers in Montana and the universities there and see what they’re doing to provide for leave for all of their employees, particularly their lower-wage employees. And ask them to help lead by example.

Q: Uh-huh. Good idea. Thank you very much.

NAPOLITANO: Welcome.

OPERATOR: Thank you. The next question will come from Kelly Burke with Illinois House. Please go ahead with your question.

Q: Hi. Thanks for the call and all the information.

I don’t recall during the H1N1 that there was this scale of quarantining and social distancing, doing things like suspending classes. At least, I don’t recall it in the United States. Is this a new approach? And is this the result of certain lessons learned? Because it seems it’s a lot of change.

NAPOLITANO: Yeah. I think the difference is this is a different type of disease than H1N1. It’s more easily transmissible and it appears to have a higher mortality rate. And so the amount of social distancing required is greater. You know, during H1N1, there were some school districts that shut down. But it was not the same—how shall I say this—it was not the same type of disease. And so—and we caught it early and were immediately able to head into testing and into individual quarantining. We didn’t have what has occurred now, which is the delay in having an accurate test that was easily available.

Q: So with the efforts on your campus, what will happen to students whose coursework is not easily translatable to just an online class? So students who have practicums, or labs. Will this affect their ability to complete their coursework in a timely fashion? Or how will it affect that?

NAPOLITANO: Yeah. We’re working through that now. We may have to suspend their coursework and let them resume in the summer. We may let them go ahead and view the course they’re in as completed, even though it’s not. And in that situation, we may move them to pass/fail as opposed to a grade for the course. A lot of that will be left to the individual faculty members to work out.

Q: Thank you.

OPERATOR: Thank you. The next question will come from Pamela Pugh with Michigan State Board of Education. Please go ahead.

Q: Thank you. And thank you for this—for organizing this for us. And I got on the call late, so I might have missed part of the questions that were answered or the information that was given. But I am a member of the state board of education. And I worked for local health when we were dealing with H1N1. And just thank you for that leadership and that guidance. And you don’t know how important public health is until you have an issue like this, and the prevention that we do on the ground, and that you all do.

My question is, we’re in the midst of the election season. And I don’t know if this question was asked or answered. But is there anything that is being thought of as we—just in case we’re not able—that becomes an issue? We vote here in Michigan tomorrow. So at the very least, I hope that I can take my own pen into the voting booth. But are there thoughts there?

NAPOLITANO: You know, I don’t know of any. That’s an interesting question. I would hope that by the time we get to November that we are through the first couple waves of this virus and may indeed be on our way to having a vaccine. But it is—it might be something for local election officials to keep in mind. You know, for example, having hand sanitizer at the voting booth. Having—if you vote—if you happen to vote by pen or pencil, having individual ones as opposed to ones that have to be shared. And being able to maintain your lines so that people can stand six feet apart. You know, those are some of the practical things that might be considered during election season with this virus.

Q: Yes. And hopefully that can be passed on to the parties. I will try my best here on our local and state level to do that. Thank you.

NAPOLITANO: Good.

OPERATOR: Thank you for the question. The next question will come from Heather Hilliard with the city of Kenner. Please go ahead.

Q: Great. Thank you so much. And Ms. Napolitano, I also worked at a DHS-affiliate during pandemics. So it is good to have your leadership back in this role. Thank you.

I have two questions. One, I am at the local government level now in emergency management. And we are looking—we have our two plans and are looking to do a payroll system to track our hourly workers who can work at home if they’re not symptomatic, or in preventive case to reduce the congestion of employees. The governor announced today we have our first presumptive positive test, and it is in our region. So we have been thinking about this, and we know now is the time. So the first part is, could you share a little bit about your payroll for hourly workers who are not on your fourteen-day leave, what is your process you’re using?

And the second is because the international airport here in New Orleans is here in town, do you have a consideration for mass transit, given your large student and worker population that commute. We didn’t have ten years ago for pandemics Uber and Lyft, but we do have that now. So I was wondering what your processes are for monitoring those services, because that is part of a transient population that comes and goes on a consistent basis, that we want to monitor as well for practicality and health purposes.

NAPOLITANO: Yeah. So with respect to our payroll for hourly workers, we’re still working through the logistics of that. But the goal is to make sure that they are not penalized from a payroll perspective in they have to either stay home and—for self-quarantining purposes, or if they’re not otherwise able to work. And so how we process those payments we’re still working through. We’ve got thousands of employees, so handling the payroll is above my paygrade, so to speak.

With respect to transit, and Uber and Lyft, and those kinds of things, you know, it seems to me that, again, the key thing is being able to wash your hands, being able to clean surfaces so that it’s—Uber and Lyft drivers ought to be advised to have sanitizer in their vehicles so that people who are riding can wipe off the seat and can wipe their hands, and to keep those kinds of supplies readily available.

Q: Thank you so much.

OPERATOR: Thank you for the question. The next question will come from Phillip Caper (sp) with Monroe County. Please go ahead.

Q: Hi. I work with Monroe County. We have a lot of interface with the public as far as taking things like applications for marriage licenses, passports, voter registrations, appeals for tax claims, et cetera. Our people are concerned about their handling the paper and the possibility of getting the coronavirus from the paper after it’s been handed to them. Where would you stand on that? What recommendations would you make?

NAPOLITANO: You know, I would—I would take advice from your local public health department. One of the things they might advise is for those workers you have, say, in the clerk’s office and so forth, that they themselves wear latex gloves so that they are not actually touching a surface that somebody else may have touched or coughed on. But I would take my initial guidance from the public health department.

Q: Thank you.

OPERATOR: Thank you. The next question will come from Lisa Brown with Oakland County, Michigan. Please go ahead.

Q: OK, thank you. First, I want to make the comment—and Pam, I hope you’re still on the line—as far as in Michigan—so I’m Oakland County, Michigan. Do not use a pencil to vote. Use a blue or black ink pen. So just that on a separate note.

But my other question is to the weather and why warmer weather—because we’ve seen cases in Florida. We’ve seen cases in cruise ships where it’s warm weather. So why does the weather—why would the weather bring it to an end? And then why would a second wave happen?

NAPOLITANO: Right. So it—again, this is from the infectious disease specialists we have. And that is, is that these kinds of viruses can tend to be temperature sensitive, so that when it gets very warm they become somewhat dormant. Now, that may or may not be true with this particular coronavirus. We will have to see. This is a new one. But if past is prologue, with other types of viruses a warmer temperature does tend to put them into some dormancy. And it’s dormancy. They don’t go away. They come back. And that’s why we can anticipate, even as we go through this first wave, that there will be a second wave and, indeed, a third or a fourth. The one way to get control of this virus is to have a vaccine. And we likely will not have a vaccine for a year to eighteen months. That is the way that we will ultimately get rid of this thing.

Q: Thank you.

OPERATOR: Thank you. The next question will come from Stephen Hagerty, a mayor from Evanston, Illinois. Please go ahead.

Q: Good afternoon. Thank you, Secretary, for taking time with us all.

So we have a really diverse socioeconomic community. And when it comes to home isolation, we’re a little less concerned for the affluent families that live in town. We think they have the means to figure out how to do that. But I am worried for lower-income residents who may have, you know, five family members living in a one-bedroom or two-bedroom apartment. And I’m just curious about any thought that’s gone into how you effectively do sort of home isolation when that home is really small, and people are in close quarters. And are there any thoughts of programs either at the state or the county level that would create some sort of housing option for them—for those family members, you know, unaffected but have been possibly contaminated by somebody that has the virus?

NAPOLITANO: Yeah. Thank you. Thank you, Mayor.

I think that housing for lower-income individuals who may need to self-quarantine is going to be potentially one of the larger issues with this pandemic. The only thing I can think of off the top of my head is if you can identify alternative housing arrangements, where some families or family members can be relocated for fourteen days. Again, we’re talking about a fourteen-day quarantine. So if you have access to—for example, if there are hotels in your area where you can take down some rooms, if there are some apartment complexes that have some empty units that you can take down for a couple of weeks, to provide some substitute housing, I think that’s one of the things that local officials will need to be looking into.

Q: Thank you.

OPERATOR: Thank you for the question. The next question will come from Jeff Tibbals. Please go ahead.

Q: Yes. This is Jeff Tibbals, Scott County, Tennessee. I’m mayor here.

My question concerns the schools. At what point—do we wait on the governor? Do we wait on our local health department? Right now there’s one case 160 miles here in Williamson County, near Nashville. At what point do we make the decision, or who makes the decision, it’s time to close the county schools? And secondly would be a question on the jail system. Say we have an inmate that’s put into the jail system and all of a sudden we find out he has the corona. Do we shut down, quarantine the jail, and then not take any more inmates at that point in time? Just thoughts on that, please.

NAPOLITANO: Yeah. So with respect to decisions on school closures, that depends on kind of your local governance of your school system. If it’s done at the county level, then it would be in my view the county superintendent, in conjunction with talking with your county health department, making the decision as to whether the school needs to be shutdown. If you’re in a system that operates by school districts as opposed to by county, again, the same thing. The district superintendent, in consultation with the local public health department, should make that determination.

And they should be talking now about what would trigger a decision to close down the schools. Would it be, for example, you have one identified case, one students who shows up, or a teacher who shows up who is symptomatic? And plan ahead, because when you have to shut down a school, that has all kinds of ripple effects, because the children need to go somewhere during the day. Many of them depend on school for free breakfast, free lunch. You need to handle that. The parents may not be able to go to work if their kids are at home. So closing down a school is something, again, that should be thought through ahead of time.

And then with respect to jails, again, they’re a little bit like college dorms. You have people living in very close quarters. And again, I think finding some alternative locations where you could either move inmates who have been exposed or who are symptomatic, and quarantine them for fourteen days, or you can put the whole jail into quarantine and identify some alternative detention space for inmates who are not yet in detention.

Q: Thank you very much. Thank you.

OPERATOR: Thank you for the question. The next question will come from Ryan herd, the mayor of Pequannock Township, New Jersey.

Q: Good afternoon, everybody. And I want to thank you for your time and all the great questions.

My question is, I guess, clarification. You know, it’s getting to be spring up here in New Jersey. We’ve got little league starting up. You’ve got boy scouts and girl scouts still doing their thing. We have indoor and outdoor activities. So what would be the policy for gatherings, especially if we’re talking about closing down schools that might have fifteen to twenty kids, and let’s say we have a boy scout skill battle with a hundred kids in a room. What should we do with things like that?

NAPOLITANO: Yeah. Again, this should be thought through with your county health department. But for example, in states like California and Washington, where there have been a number of cases already of the coronavirus, there’s—many schools and school districts are simply suspending all those kinds of activities. They’re just not having them. Other places have said no activities where they’ll be more than 150 people at a location. There are different ways to do it. And it depends a lot on your local circumstances. But again, the point is to take whatever regional action you can that will stop the spreading of the virus.

Q: Excellent. Thank you.

OPERATOR: Thank you for the question. The next question will come from Wanda Taylor with Bessemer, Alabama. Please go ahead.

Q: Hi. Thank you for taking my call.

I heard you say that some of your faculty would be traveling sometime pretty soon. What recommendations do you suggest to them of how to protect themselves while traveling on an airplane? And also, would you quarantine them for fourteen days after they return, because they will probably be—maybe be around some people, maybe, that have the disease and not know it? What are your suggestions on that?

NAPOLITANO: Yeah. So there, we look at—the CDC ranks countries by level of a one, level two, level three. And we have terminated all nonessential university travel to any country that’s ranked a level three. And if a faculty member has to go to a level three, and when he comes back he will be in quarantine for fourteen days. And we’re also looking at extending that to any travel to a level two country. And if you go on the CDC website, you can track how they are ranking countries. And it changes all the time, because it’s a function of the number of cases that have arisen in a country.

So—and then with respect to domestic travel, we have tried to discourage all, again, nonessential domestic travel. And again, when you’re flying on a plane or what have you, recommend—you know, take some hand sanitizer. Keep washing your hands. Wash the armrests on your seat and the tray table when you put it down. Those kind of things sound pretty simple, but they have a direct impact on the transmissibility of the virus.

Q: Thank you.

OPERATOR: Thank you for the question. The next question will come from Ginny Dickey, mayor of town of Fountain Hills. Please go ahead.

Q: Hi, governor. One of the CPAC participants, Congressman Gosar, held a meeting at our Fountain Hills community center and two hundred people attended. So we’re trying to get out the information on that. My question actually has to do with having four Scottsdale firefighters who were exposed to a patient, and now they’re staying off the job for two weeks. And don’t first responders—are they going to need to do anything differently now than they usually do on a call? Because you figure they treat every patient as potentially contagious. Thanks.

NAPOLITANO: Yeah. So your first responders, if they’re responding to a call where there’s a suspicion that somebody is showing symptoms of the virus, they need to wear the fight personal protective equipment. That means the right kind of mask. They need to wear gloves. And they should have been trained on how to—how to handle that. And then if they’ve been exposed, they do need to go offline and be in quarantine for two weeks. That’s really the only thing you can do in that circumstance.

OPERATOR: Thank you for the question. The next question will come from Keith Kidwell with North Carolina House. Please go ahead.

Q: Hi. Thank you, Madam Secretary. I appreciate the phone call. My name is Keith Kidwell. I am the state representative in North Carolina for the seventy-ninth district.

My question is actually two parts. One, do we know what the current global mortality has been from COVID-19?

NAPOLITANO: You know, we’ve seen different numbers. Anywhere from two to 3.8 per thousand. The normal flu, normal influenza, is, like, 0.1. So we know that it does have a higher mortality rate based on the numbers we currently have.

Q: My understanding is there is somewhere around four thousand people worldwide that have died. Is that correct?

NAPOLITANO: I don’t know the answer to that question. And, again, it’s hard to get accurate numbers. But that sounds like it’s about right.

Q: The reason I asked the question in two parts is, when I look at the flu that’s going this year, about two weeks ago we had eighteen thousand people in the United States alone that had died from the flu. That number has now risen to approximately twenty thousand. And we’re not seeing these levels of mortality, nor spread, that we see with the flu, I guess we’ll call it the standard flu, this year. So I’m concerned, how do we have this level of alert for the COVID-19 when we don’t see the same level for the flu, which on the average year kills about sixty-five thousand people globally. Can you give me some guidance on that? Why this is such a different level of response?

NAPOLITANO: Yeah. I think the difference is that with the normal influenza, you’re right, we have it every year. We also have a vaccine every year. With the coronavirus it’s new. We still don’t know a lot about it. And we still don’t have a vaccine. And we do know that it is very rapidly transmissible. So it’s a new kind of pandemic, as opposed to the normal flu.

Q: OK. Thank you very much.

NAPOLITANO: You bet.

OPERATOR: Thank you for your question.

FASKIANOS: And, Janet, isn’t part of—isn’t part of it too that we haven’t—there haven’t been enough tests administered, so we don’t really know who has it? Here in the U.S.

NAPOLITANO: That’s why—Irina, that’s why the numbers are all kind of squishy, as I might say, particularly in the United States because we’ve been so slow to the ball on testing.

OPERATOR: Thank you. The next question will come from Steve Barnett with the South Dakota Office of the Secretary of State. Please go ahead.

Q: Good afternoon. This is Steve Barnett from the secretary of state’s office in South Dakota.

Thanks for your time today. You had mentioned, like, to try to avoid, like, large groups and that sort of thing. And we’ve talked about mass transit, and flying on airplanes, and stuff. But just—this is, like, for sporting events. Like, our son’s involved in youth wrestling and stuff. And it’s very obvious they don’t, like, disinfect the mats between matches. And you’ve got over probably three hundred kids wrestling, and over two hundred kids—or, two hundred parents viewing this. Is that something to avoid at this point, or?

NAPOLITANO: Yeah. You know, again, I would consult with your local health department. But I certainly would be a little reticent in that circumstance. That’s an awful lot of people. You know, if just one is exposed or has the virus, that’s a lot of potential contamination.

Q: OK. Thank you.

NAPOLITANO: You bet.

OPERATOR: Thank you for the question. The next question will come from Laura Magnus with Midvale, Utah. Please go ahead.

Q: Hi. Good afternoon, President Napolitano. Thank you for taking the time to help us.

My question—I know someone asked a little bit of what I’m trying to ask. But I’m in Utah, and local governments have many community days throughout the summer and into the fall. Do you think it’s our responsibility as—to lead as an example, to set an example, and cancel these large-scale community events? Or should we push forward? I know you suggest we leave it up to our county, but I’m talking more as in, you know, being responsible and setting the example.

NAPOLITANO: Yeah. You know, I think the judgement that we need to make is we need to take all commonsense steps to prevent transmission of the virus so we can get control over this pandemic. But you know, life still has to go on. And so you know, if you have activities planned—say, for example, later in the summer—you might go ahead and keep them on the calendar and see how this pandemic evolves before cancelling. But if you have a larger event that is scheduled in the next couple of weeks, then I do think—and if it’s, say, more than 150 people—I do think you would be well-served by rescheduling.

FASKIANOS: Well, I am afraid we are at the end of our hour. And I’m sorry that we did not get to all of the questions. You know, but we will be continuing to have these calls to share out information, et cetera.

Janet Napolitano, thank you very much for your insights today, for your service to this country, and to the leadership role that you’re playing in California. We really appreciate hearing your—getting your advice on best practices, et cetera, as well as being a member of our board. We appreciate it.

NAPOLITANO: Thank you, Irina. And thank you all for participating.

FASKIANOS: And to all of you, the Council, CFR.org, we do have a lot of resources on COVID-19 on our website, as well as a new online magazine that we have called Think Global Health. It’s ThinkGlobalHealth.org where we’re tracking COVID-19. Of course, always go to the CDC for the official information. But I hope you will turn to these resources as well. And we will continue to put together these calls to try to get information, sharing information.

So, again, you can also email us at [email protected] if you have specific questions. We’ve got two health experts here. Foremost is Tom Bollyky. And we can see what we can do to give you some answers to—as this crisis—or, this outbreak continues to unfold. So thank you, all. And thank you, Janet Napolitano.

NAPOLITANO: Thank you, all.