Below is a transcript of an interview with former FDA Commissioner Scott Gottlieb, which aired on Sunday, August 22, 2021 on “Face the Nation”.
MAJOR GARRETT: We now turn to former FDA commissioner and Pfizer board member Dr. Scott Gottlieb, his book “Uncontrolled Dissemination: Why COVID-19 Crushed the United States and How We Can Defeat the Next Pandemic” next month. Dr. Gottlieb, good morning. Do we know in this country how many young people have the Delta covid-19 variant? And are we trying hard enough to get an accurate idea of that number? And how far could we be?
DOCTOR SCOTT GOTTLIEB: Yes, we may be very far away, we do not have a precise sense of it. Right now, about 4.2 million children have been diagnosed with COVID. But the presumption is that we are, we are only diagnosing a small fraction of children who are finally contracting the virus. Perhaps only one in 10 to one in 20 infections in children is reversing at this time. Therefore, there has been much more infection among children than we are diagnosing, as most of the infection is an asymptomatic or mild and mild disease that does not necessarily present to a pediatrician for testing. And this is really a critical question because it gets to the heart of whether this new variant of Delta is more pathogenic or not in children. We are seeing an increasing number of hospitalizations and ICU admissions among children. The question is, is that because this is a more dangerous variant in children or do we just infect many more children? So we don’t really get an accurate idea of the denominator. We only see the numerator of children with the most serious illnesses. I suspect it is the latter. I suspect the number of children who have problems with COVID has not really changed with this Delta variant. The reason we are seeing increased hospitalizations and ICU admissions among children is because we are infecting many more children.
MAJOR GARRETT: So by doing this quick math, we could have ten million to twenty million cases right now if, if I listened to you correctly.
DR. GOTTLIEB: Yeah, well, there are 50 million school-age children. We have diagnosed a little over four million. About eight million have been vaccinated. So the question is how many children in general have been exposed to this virus and have developed some immunity? It could become up to 25 million or more when you start doing math around those 4.2 million who have been infected. We are certainly diagnosing less than one in four cases. At the peak of the epidemic, in the winter, we were probably giving about one in four cases in adults. We always knew that the fraction of cases diagnosed in children was lower. We are doing less routine screening in children. Children have a milder illness in general. So again, they don’t present to their pediatricians for testing. But the finding rate right now can be even lower with this Delta variant.
MAJOR GARRETT: So, should school districts test regularly when children return? And when you say regularly, is that once a week, twice a week, more?
DR. GOTTLIEB: It’s once a week or twice a week, and if Google “Try to Stay,” now there’s a movement and many districts, North Dakota is also doing some other states to use the tests as a way to keep kids in the classroom. So when you identify a case, instead of quarantining the whole class or a wide strip of the school, it’s happening in many states right now in the south as the epidemic sinks there. What some districts do is use tests where they will immediately test children’s close contacts to make sure there are no other asymptomatic cases that are not diagnosed, and then test them at some sort of interval, maybe in three days. and five days for sure no outbreak occurs in a school. So you can do tests to avoid large quarantines. I believe that the combination of children wearing masks in the classroom to prevent the spread of the virus with tests can allow the school year to continue without these large quarantines we are seeing in some districts, while keeping children safe.
MAJOR GARRETT: And on this question of the forties, is this the right political answer?
DR. GOTTLIEB: Well, again, I think an appropriate policy response might be to use more aggressive testing to try to identify the infection to make sure you don’t have an outbreak in that environment and also make sure you’re taking mitigation measures to prevent this. also, with masks, with adequate ventilation, keeping children in defined social pods. I think the combination of these two measures can create a safer environment, not a safer environment. Schools are not intrinsically safe, but they can be made safer without quarantining large groups of students. In a district of Hillsborough, Florida, right now, around Tampa, there have been 2,700 children who have been diagnosed with COVID. About 6% of the children in this district are in quarantine. Now you see it all over the south. It will be very disturbing for the school year. And, once these districts either go for a hybrid model, or close, or put many children in quarantine, it becomes very difficult to restart a normal school year. So you want to prevent this from happening while keeping kids safe? I think testing could be used as a very effective tool to do that, and some states are very inclined to it.
MAJOR GARRETT: Are case rates starting to rise in the south, where has the Delta variant hit hardest?
DR. GOTTLIEB: Yeah, that’s definitely the case. If you go to covidestim.org, run by Harvard Chan School, which examines whether epidemics are spreading or contracting right now in the south, the RT, the rate of transmission, is less than one, which means that they have a contracting epidemic in the south. Now there are still very hard weeks, because they will continue to accumulate more hospitalizations and there is extreme pressure on these health care systems. But there is evidence that the epidemic is beginning to slow down and that overnight cases are beginning to wane. And that shows up in national trends. Now, Florida, which has been the epicenter of the epidemic in this country, if you look at different age categories in Florida, each age category shows an ever-decreasing number of cases, except children in age school, children from six to 19 years. This is the only category that continues to expand and expand very rapidly, because what happens is that schools open earlier in the south. Schools opened earlier in the south in a context of high prevalence. And the infection is entering schools and is proving difficult to control. Delta is a highly contagious variant. So I think this is a harbinger of the challenges we will face nationally. As schools reopen, schools could become focal points of community transmission and can become environments that are not safe for children if we cannot control very large outbreaks in those environments.
MAJOR GARRETT: Doctor, do you expect the Pfizer vaccine to be fully approved this week? And if so, what difference will that make?
DR. GOTTLIEB: Yes, I know, I’m on Pfizer’s board, there were reports that will be approved tomorrow. I have no reason to believe that these reports are inaccurate. I think that once the vaccine is fully approved, this will give more impetus to some companies, in schools, that force vaccination. They have been waiting for full approval. They believe they will be on stronger legal ground to demand vaccination in this environment. I also think there are certain consumers who have been waiting for this milestone, waiting for full approval and an indication that the FDA has ended up evaluating the data set to give them more confidence about the use of the vaccine. Therefore, I would expect to see an increase in the use of vaccines, either by the voluntary vaccination of consumers who have been waiting for full approval or by some companies that will now continue to move forward with vaccination mandates, even though you have been watching companies do it. even in the absence of full approval while the vaccine has been authorized for emergency use.
MAJOR GARRETT: for your time and experience. Dr. Scott Gottlieb, thank you very much. And we will be back soon.