WASHINGTON -- U.S. public health agencies are prepared to respond to "novel coronavirus" outbreak emanating from China, from public health guidance on travel to clinical involvement in new diagnostics and therapeutics to combat infection, Health and Human Services (HHS) department officials said Tuesday.
In a press conference that replaced the CDC's daily press briefing on the situation, HHS Secretary Alex Azar reiterated that the current tally of novel coronavirus cases in the U.S. remains at five, and the overall risk to Americans remains low.
During the press conference, the World Health Organization released a statement that says to send experts into the country to help with this outbreak, a goal Azar had emphasized.
"More cooperation and transparency are the most important steps we can take towards an effective response," he said, adding that has been the reason for the number of briefings held on this novel coronavirus by public health officials.
Azar responded to the recently reported news that both the CDC and the State Department issued a Level 3 travel alert, recommending U.S. travelers avoid all non-essential travel to China, and that there will now be quarantine stations in 20 U.S. airports.
"All steps have to be on the table, including travel restrictions. Diseases are not good at respecting borders," Azar said.
CDC Director Robert Redfield, MD, warned of the possibility of person-to-person spread, adding that the CDC's goal is to prevent "contain the outbreak and prevent sustained person-to-person transmission here in our country."
He said healthcare professionals caring for patients with novel coronavirus should follow CDC's recommended infection control procedures.
Nancy Messonnier, MD, director of the CDC's National Center for Immunization and Respiratory Diseases, noted that while the overall risk of transmission is low, risk is dependent on exposure. Thus, healthcare workers caring for patients with confirmed infection "need to be vigilant."
While the CDC has been the public face of this outbreak, Azar reviewed the steps that other public health agencies are taking, including HHS's office of preparedness and response, which is assessing national stockpiles of drugs and other necessary medical supplies.
CDC's molecular diagnostic test is expected to be more widely available in the coming weeks, but Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, said that the NIH and CDC are also collaborating on rapid point-of-care diagnostics.
He added that while there is no proven therapy for this infection, there are ongoing studies initiated, based on prior experience with SARS and MERS, with "a number of antiviral drugs tested in vitro, in animal models, and even in the field."
Fauci elaborated on two existing antivirals receiving media coverage: remdesivir, an investigational agent originally developed for Ebola patients, as well as lopinavir/ritonavir (Kaletra), an HIV antiretroviral. Kaletra is already being used on a "compassionate basis" in China, he said, but Fauci cautioned that efficacy remains unproven for both drugs.
There is also the hope that NIH scientists may be able to develop monoclonal antibodies based on B-cells of infected patients, Fauci added.
And work has already begun on a vaccine. The NIH is working in collaboration with Moderna on a vaccine with a messenger RNA platform, though media reports indicate that other companies, , are also working on vaccines against novel coronavirus.
Fauci said "with some cautious optimism," the NIH vaccine will be in phase I trials within the next three months, and phase II trials will be dependent on what happens with the outbreak.
But HHS officials acknowledged that the outbreak is rapidly evolving, as 18 countries now have confirmed novel coronavirus cases, and Azar added that "50% of cases in China are outside Hubei province [where Wuhan is located]." News reports Tuesday also indicated that person-to-person transmission had occurred in at least three countries outside China.
Reporters pressed HHS officials about reports out of China suggesting the possibility of asymptomatic transmission of the virus, but Redfield said he was not persuaded.
"We haven't been able to confirm by data ... transmission during the asymptomatic phase. The Chinese believe [they] have that data, [but] we are going to present the data that we have, not affirm someone else's interpretation," he said.
Fauci said it shouldn't be a major concern anyway: "In the history of respiratory viruses of any type, asymptomatic transmission has never been the driver of outbreaks," he said.
Azar, asked if he would declare a public health emergency in the U.S., replied that he would only "use that authority when directed by public health officials [...] but I won't hesitate to do anything I need to protect the American people."
Azar also weighed in on President Trump's response, saying that he and the president have been "speaking regularly" about the outbreak.
"The president is highly engaged in this response and closely monitoring the work we are doing to keep Americans safe," Azar said.
Update: On late Tuesday night, the evacuation of over 200 U.S. citizens from Wuhan, China, in collaboration with the State Department.
"Our primary objective is to facilitate the safe return of these Americans while protecting the public's health," the agencies stated. "These individuals will be screened before they take off; monitored during the duration of the flight by medical personnel on board; screened again on landing to refuel in Anchorage, Alaska; monitored on the last leg of the flight by medical personnel on board; evaluated upon arrival at March Air Reserve Base in Riverside County, California; and then monitored for symptoms post-arrival."