Special Briefing Via Telephone
DR. Daniel Singer, Regional Director For Central Asia, Centers For Disease Control And Prevention (CDC)
May 6, 2020
Moderator: Hi, and greetings to everyone from the U.S. Department of State. I would like to welcome the participants joining this discussion. Today we are pleased to be joined by Dr. Daniel Singer, Regional Director for Central Asia, Centers for Disease Control and Prevention.
We will begin today’s call with opening remarks and then we will turn to your questions. We will do our best to get to as many questions as possible in the time that we have today, which is approximately 30 minutes.
As a reminder, today’s call is on the record. And with that, I will turn it over to Dr. Singer.
Dr. Singer: Good afternoon, everyone. It’s a pleasure to be with you today to be able to talk about the U.S. Government and the CDC’s role in combating COVID-19 and our plans to support the people of Central Asia in this fight. The $6.8 million that we are now providing over the next two years will be used to purchase equipment, provide training, facilitate collaboration on understanding the disease, and support the ministries of health in the region in taking all necessary actions to protect their countries’ citizens until we have conquered this pandemic.
Our regional office and the CDC offices in each country will be working with each ministry of health to finalize the plans. We expect to purchase millions of dollars of equipment and supplies for the national laboratories to expand their ability to test for COVID-19. In addition, we are prepared to provide equipment and advanced training to monitor the health of people arriving at borders and ports of entry.
We will build on our longstanding collaboration in emerging infections, HIV surveillance, and laboratory science to be able to support each government in monitoring the spread of COVID-19 and devising more effective response measures.
CDC opened its first office in Central Asia 25 years ago. Today we have staff in over 50 countries, including Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan. We also offer assistance when requested to the ministry of health in Turkmenistan. Unlike other binational programs, we are not a development or assistance organization. We are a health agency, staffed by epidemiologists, laboratory specialists, and other public health experts. Our purpose is to form partnerships with ministries of health to advance public health science and develop programs that prevent, detect, and respond to disease.
The reason the U.S. sees this as a worthwhile investment is now painfully obvious, because diseases – especially infectious diseases – spread globally faster than ever. Our support to Central Asia is not just an investment in the health of those nations; it is an investment in the health of America and the whole world.
The response of countries in the region to COVID-19 and the restrictions of movement have slowed the spread of disease. All countries in the world, including the United States, are now struggling to minimize the impact of the virus while also trying to minimize the impact on their economies. As we move forward, it is more important than ever that we work in solidarity, sharing information, supporting each other, and working under the principles of global health security to make science-based decisions that’ll help us to defeat this disease with minimal loss of human lives.
We’re at a rare moment in history when the attention of the world turns to a health challenge. We have had productive collaborations with each of the countries in the region for many years, and the CDC offices here and at our headquarters in Atlanta stand ready to expand our partnership to address this new threat, activate new funding and the expertise that the U.S. Government regional office will help move us in this direction.
And with that, I’m happy to take your questions.
Moderator: Thank you for those remarks.
Our first question was submitted in advance by Ikhiyor Rakhman with Korrespondent.uz in Uzbekistan. He asks, “What is the reason that the CDC is providing additional funding to the region in the fight against coronavirus? Is this due to the fact that people were in a difficult situation as a result of a specific situation?” And then he asks as a follow-up: “How do you evaluate efforts to combat coronavirus in Uzbekistan?”
Dr. Singer: Okay. So the planning for this funding has been in process for a couple of weeks now. It’s following on additional funding that was provided earlier through our development agency, USAID. This funding, globally, includes almost $800 million that’s being distributed to countries around the world, based on their epidemiologic situation, their needs, and their engagements and partnerships with the United States.
So this is something we’ve been working on for quite some time, and it was important for the United States. Actually, the Central Asian countries were in the first group to be identified for support with this funding.
In terms of their response in Uzbekistan, I think that the government there has taken some important steps early on to limit the spread of the virus through social distancing and limitations on gatherings, and that’s clearly had an effect. We’ve seen the doubling time, which is a measure of how fast the virus is spreading, increase and increase, which means that the policies of the government are having the desired in slowing the spread of the disease.
The important thing now for Uzbekistan, for all the countries in this region, and the United States, is to vastly scale up the number of tests that they’re able to do. It’s only through aggressive testing that we will be able to really understand how widely spread the disease is and to be able to identify clusters of disease where we need to intervene to stop transmission. That’s one of the reasons that the CDC has decided to prioritize laboratory investments with this new money to make sure that countries are able to do testing at scale for large numbers of people.
Moderator: Thanks for that answer. Our next question comes to us from Navruzmoh Vazirbekova with Oila.tj in Tajikistan. They ask, “If a person with COVID-19 treats him– or herself at home, is this dangerous?”
Dr. Singer: It would depend on a couple of factors. Firstly, that the person does know they have COVID-19. You would not want to ignore other potentially serious diseases and assume that you were treating COVID-19. So again, testing is helpful and important.
It’s the practice in many countries and it’s CDC guidance that mild cases of COVID-19 in people who do not have other risk factors – meaning they don’t have a strong history of hypertension or diabetes or other diseases that would put them at high risk for complications from the disease – that those mild cases can be treated at home, and we would recommend symptomatic treatment, which is to say they stay at home, they isolate themself from other people so they don’t make anyone else sick, and that they manage the symptoms of the disease using basic drugs to treat the fever and discomfort, and wait for their immune system to fight off the virus.
So I don’t know from the question what was meant by treatment, but there are no currently approved or recommended drugs that are effective in specifically fighting this virus, at least according to CDC guidelines, and there is no specific medicine that’s used for this disease, but staying at home when you have a mild case is reasonable to do and it helps to ensure that the hospitals are available to take care of the more sick people.
Moderator: Thanks for that answer.
Our next question was submitted in advance by Madina Alimkhanova with KazTAG in Kazakhstan. She asks, “Does the CDC provide millions of dollars to all countries or only to the countries where the U.S. opened dangerous infection laboratories? Can you comment on the idea that COVID-19 leaked from a U.S. infection laboratory in Almaty?”
Dr. Singer: Okay. I’m glad we’re having a discussion about all issues. I think that I – if I understand your questions correctly, you’re asking about a laboratory in Almaty, which is called the Central Reference Laboratory. But we should be clear up front, that laboratory is not and never has been an American laboratory. As I mentioned earlier, the United States is providing assistance in the coronavirus to many, many countries in the world, dozens of countries, and we’re doing it based on our desire to help those countries get through this pandemic.
The laboratory that I think you’re talking about is one of the laboratories around the world that CDC supported the development of that laboratory. The U.S. Government provided funding for the construction of the laboratory. We have provided equipment and we have provided training, but it’s never been an American laboratory. It is entirely run by the Kazakhstan Government. As far as I’m aware, there’s never been an American who’s worked in that laboratory, and we don’t provide any support for the management or the operations of the laboratory. It’s a Kazakhstan entity that we supported the development of because we wanted this country, and other countries, to be able to detect their own diseases and to respond to them.
It is our strong opinion that collaboration across countries is to everyone’s benefit because the disease is spread across countries, and we feel that helping countries develop their public health system, including their public health laboratories, is one way that we can help the citizens of that country and build our relationship with them, and also to protect Americans and other people of the world from diseases that spread from place to place.
So the U.S. has supported laboratories in many countries with equipment and with training, but the CDC does not have a single laboratory overseas, and we purely work under the – at the recommendation or the request of the host government. So your question about whether the virus could have come from that laboratory, I don’t see that as a criticism of the United States. If anything, maybe it’s an attack on the sovereignty of Kazakhstan because it’s their – it’s their facility, it’s their laboratory, and they decide what research is done there.
My opinion as a scientist is that there’s no way this virus could have come from that laboratory. To be able to engineer a virus requires advanced technologies and a BSL-4-level laboratory, and my understanding is that this laboratory is a BSL-3 level. So I don’t believe that it would have the capability to produce a virus like this, and I don’t think it’s a reasonable suggestion at all.
Moderator: Thanks for that answer. Our next question comes to us from Evgeniy Pogrebniak with Vzglyad in Kyrgyzstan. He asks, “Why are most of those infected with coronavirus located in the United States, whereas in India, where the population is 1.3 billion people, there are very few cases of infection?”
Dr. Singer: That is a good question, and I think that it’s important when you talk about the virus to differentiate between those who are infected and those who are diagnosed. I think that the – this virus has been very interesting. It is clearly different from other coronaviruses in the way that it spreads and in its characteristics. But it’s also very clear that many, many people can be infected and not have symptoms, and many people can have mild cases and not realize that they were infected at all with coronavirus.
One reason we have so many cases in the United States is because we are getting more and more aggressive about testing, and we are realizing as we do that that there are many, many people who were not so sick that they would have been in the hospital but they have had mild illnesses that were in fact coronavirus. India, as the example you provided, has not done as much testing per thousand people as the United States has, so they would have no way to know really how many cases they have. The other factor is that if you look at the demographics of those two countries, India is a much younger country. It has many more young people, and young people don’t show signs of the virus as quickly or as strongly as older people do. So there’s a number of factors that would affect the number of people who could be diagnosed with the disease, and I don’t really know how many people are actually infected in any of these countries because we are still scaling up our testing. But I think that the difference that you see between countries like the ones you suggested has more to do with the availability of testing than it does with any other real factors.
Moderator: Thanks for that answer. Our next question comes from Galia Shmyirbaeva with Radio Exclusive in Kazakhstan. She asks about testing methods, and noting that in Korea there was one method with a paper test; in Italy there was a different method. What would be the best method for Kazakhstan, PCR, ELISA, or the express test?
Dr. Singer: Okay. This is an important question and it’s one that we are constantly revising our recommendations as the technologies develop and as the tests are brought to market and used and how effective they are. At the moment, there are many different PCR tests available and many other rapid-type tests available. The important differentiation is to understand that a PCR test is detecting the RNA of the virus. It detects the genetic code of the virus itself, whereas the rapid tests generally detect antibodies, which is the body’s response to the virus. And there’s generally a lag of about seven days before the human who is infected will make the antibodies. So there is a period of time where you can have the infection, you can be spreading that infection to other people, and the rapid test will still be negative.
Because of that, we do not recommend using these rapid tests for diagnosis at this time. The primary diagnosis should be done with a PCR test because it is very sensitive and will detect even mild cases, and because it will detect them earlier than the rapid tests. There is a lot of discussion happening just over the last week or two about the various rapid tests that are coming onto the market. It’s fairly easy to make these types of rapid antibody tests. The problem is that there’s many companies that are doing it, and the quality of the tests that are on the market now are highly, highly variable. So it’s important not just to know the type of test but to know the specifics of the test you’re getting and to make sure that it’s one that is highly sensitive and highly specific for coronavirus, and that it’s being validated to show that it will work properly.
Unfortunately, I know in this region there are rapid tests being sold mainly through private sources that are simply not very effective, and I would caution people to use the rapid test unless they are getting it through a reliable source and they know that it has quality, and again, even then, that test is more used to show that you’ve had the infection in the past; it’s not a – it’s not useful in finding out whether you’re currently infected because it may be negative even if you are infected.
Moderator: Thanks for that answer. We actually just got another question from Ikhiyor Rakhman with Korrespondent.uz in Uzbekistan. He asks, “Last week, researchers from the Singapore University of Technology and Design released the results of monitoring at the end of the situation related to coronavirus. Does the CDC have similar predictions?” if you’re familiar with this study.
Dr. Singer: I’m not – I’m not familiar with that specific study that he’s referring to. I would say that the U.S. Government and the CDC is looking at two factors, two issues. One is monitoring the changes in the mathematical models for how long we think the pandemic will last and how many people will be infected. Those models are constantly updated based on new data and new information. So we work with a number of different groups and work with a number of different types of models to understand what we think will be the time course of the pandemic and how many people will be infected.
On top of that, we have also been developing guidelines for countries to help them make decisions about when it would be appropriate to reduce restrictions on public gatherings, to open businesses again, and to try to move towards life as it was before. The U.S. has published one set of guidelines around that, the European Union has published another set of guidelines, and the World Health Organization published a third set. All have been published about a week and a half ago.
So all of them have some similarities. They all focus on having very good testing in place and seeing that the numbers of cases are declining and that the hospitals are not really full. So there are some differences between them, but I think there are now starting to be good guidelines coming from various sources about what the end of this pandemic will look like.
Moderator: Thank you. Our next question comes to us from Daria Podolskaya with Newsagency24.kg in Kyrgyzstan. She wonders how we assess the efforts of the Government of Kyrgyzstan to combat COVID-19, and if you could comment on any shortcomings or achievements, and then asks: “What do you think is the reason that in Kyrgyzstan, as well as throughout the world, doctors are becoming infected?”
Dr. Singer: Okay. I think Kyrgyzstan has done quite well. One of the – one of the sources of data we have been looking at at CDC is the amount of travel people are doing, the amount they’re traveling to their workplaces, the amount that they’re using public transportation, the amount that they are going to stores and shops. And using publicly available data, it appears that Kyrgyzstan has done better than any country in the region in terms of convincing its citizens to stay home, to protect themselves, and to not engage in travel that might cause them to get infected. So I think that they have done reasonably well in that effort, and like Uzbekistan, like the U.S., they certainly should be focusing on increasing testing now.
The issue around the infection of health care workers is one of the most challenging. I’ll tell you it’s for me personally one of the hardest because I’m a health worker, and I have friends who are exposed, and I have friends who’ve gotten sick. So I think that it’s a characteristic of this virus that it does spread before people are symptomatic, that people who are symptomatic with the disease seem to spread it very easily, and in some countries they are facing lack of personal protective equipment. We know that personal protective equipment does work. We know that it does prevent people from getting infected, and it’s important that health workers be prioritized [inaudible] because obviously you need your health workers to be healthy and be able to work to prevent people from dying from this disease.
So I think that the challenge has been generally this is a difficult virus, and countries are just coming to realize how infectious it is, and that we need to do better in making sure that all of our front line health workers, our ambulance workers and everybody who deals with sick people, have access to personal protective equipment.
Moderator: Thanks for your answer. We have a few questions from Tanya Kovaleva with the outlet Zakon.kz in Kazakhstan. She asks, “Does the situation with the incidence of COVID-19 in Kazakhstan mean that quarantine measures can be lifted in a week?” And then she has a few more questions: “How much money has the U.S. Government, USAID, and other organizations sent to Kazakhstan to combat COVID-19?” And maybe you can address those and then I’ll ask her remaining questions afterwards.
Dr. Singer: Okay. I’ll try to – I don’t want to run too long. I’ll try to be briefer. I think that the Government of Kazakhstan is clearly looking at their case numbers and trying to make the best decision they can about balancing the containment of the disease with the negative impact on society and on their economy from continuing to have people in restriction. So I don’t know if I have all the information I would need to say if this is the right time. I think that we’re working with the government to understand the pandemic and are happy to provide advice to them, but it’s really – it’s more than just a health decision. It’s a – it’s an economic decision, it’s a social decision, and it’s a very, very hard decision for the governments. We will be watching closely as they start to open businesses again to see if there’s an increase in cases. And if so, I’m sure the government would again reconsider imposing restrictions on gatherings and movement.
With regard to the amount of money, first I should tell everyone the amount that is part of this current 6.8 million. CDC has allocated 1.68 million to Kazakhstan, 1.38 million to Kyrgyzstan, $2.07 million to Uzbekistan, and 1.69 million to Tajikistan. Now, that’s only this particular batch of funding from the CDC. The U.S. Government has given quite a bit more. And in Kazakhstan, I believe it’s almost double that amount because it includes some other funding from USAID and other sources that I’m not personally responsible for. But the embassy could give you an update in terms of the money that we’ve given.
All of this is new money. It’s not money that we’ve moved from some other place in our – in our work with Kazakhstan. It’s all new money coming into those countries. And are there other – let me take some more questions.
Moderator: Thank you. Just to go back to Tanya Kovaleva’s remaining questions, I’m not sure if you can answer this one, but she’s asking: “When will international air traffic between Kazakhstan and the United States be restored?” And then she also asks that: “Some people believe COVID-19 is a witch hunt. In your opinion, how serious is this disease?”
Dr. Singer: Okay. On the air traffic question, it’s a very interesting one but not one that is in my area of expertise. I would recommend she talk to the air authorities in Kazakhstan, who could provide an update.
In terms of the severity of this disease, we are always facing different viruses and health threats, but not all of them are this severe. And I’ve worked on many epidemics in my career. I’ve been working for more than 20 years on fighting outbreaks, and I’ve done some of the bigger ones like the Ebola outbreaks in Africa, polio, and many other smaller outbreaks.
I can tell you that the characteristics of this disease, the way that it can be spread by people who have no symptoms, the way that it is so devastating to people who are older or who have health conditions, it is very unusual. And I’ve said in the past that before this is over, every one of us will know people personally who are sick. And most of us will know people personally who died from this disease. That’s my – that’s my belief, based on how easily this virus is spread. So I take it very seriously, and I am deeply worried about my older relatives and also my friends who work in the health system because they’re all at very great risk.
Moderator: We have time for one more question, and that is going to go to Aidana Karibzhanova with Khabar Agency in Kazakhstan. Aidana, please go ahead.
Question: Thank you so much. Hello. Excuse me. Can you repeat what kind of assistance can USA CDS in Central Asia provide, especially to Kazakhstan? And what about the tests? Will it be the PCR test or serological test or rapid express test?
Dr. Singer: Okay. Thank you for your question. So I would – I’ll say that for all of the countries, we’re providing laboratory assistance. And the specific types of laboratory equipment and supplies is being negotiated with each ministry of health. We don’t want to provide anything that the ministry itself does not believe it needs. So our next step is to sit with the ministries and agree on what their priorities are. I believe that we will be providing machines, equipment for doing PCR testing to increase the number of PCR tests that can be done in a day, as well as providing the reagents and supplies to do PCR testing.
At this point there is no rapid test that the United States has enough confidence in that we would feel comfortable providing it. But we will provide viral transport media. We’ll provide other things that are necessary, like RNA extraction kits, to make sure that we’re able to – that the countries are able to do more diagnosis.
There was another part to this question. In general, I think for Kazakhstan, in addition to the laboratory support, we will be doing a number of trainings through the ministry of health, again according to a plan that they have approved, on how to fight coronavirus. We will be providing some support to the public health emergency operations center in Nur-Sultan, which was established several years ago with support from the U.S. Government. And we will also be working on improving the equipment and training at ports of entry, and establishing some joint collaboration or some research to understand how the disease is spread in the country and to improve the ministry of health response.
Moderator: Thank you. I know I said that was our last question, but just – we just did get a question in from Ashgabat, and since we haven’t had the opportunity to take a question from Turkmenistan yet, I’d like to go ahead and ask this one, from Dayanch Konarov with Arzuw News in Ashgabat. He asks, “What do you think – when will the end of this – when will we see the end of this epidemic? They said there might be a second wave of the epidemic in October.”
Dr. Singer: Yes. Hello in Ashgabat. It’s good to be able to talk to people there. This is hard. This is a hard question because we know how virus pandemics go in general. We know how respiratory diseases go in general. And this virus is showing itself to be somewhat different from other viruses. If you just look in the class of coronaviruses, most human coronaviruses are more common in colder weather, but not all of them. One coronavirus is the virus that causes Middle Eastern Respiratory Syndrome, and that’s a virus that comes from camels in the Middle East, where it’s very warm.
So there isn’t a very good rule that will tell us exactly how this virus will behave. And because of that, we really can’t be sure what will happen over the next few months and into the fall season. We are worried that there is the potential for the pandemic to seem to decline, for the number of new cases to decline, and then for it to come back again later in the year. That has happened in many other outbreaks and it could certainly happen in this one. So it’s something we’re watching very closely for, but we don’t have currently enough information to say for sure whether that would happen or when this will finally be over.
Moderator: Thank you. Unfortunately, that was the last question that we have time for today. Dr. Singer, do you have any closing words you would like to offer?
Dr. Singer: I don’t have anything profound. I would first of all thank everyone for their time. I’m grateful to be able to talk through all of you directly to the people in each of these countries. And I just want to emphasize that the U.S. Government maintains a CDC office in these countries because we see it as good for your citizens and good for our citizens, and that we very much value the collaborations that we have with the ministries of health. So we will make every effort we can to provide the support they need to get us all through this.
Moderator: Thank you so much, Dr. Singer, for joining us for a very interesting briefing. And thank you to all of the reporters on the line, both our Russian and English line, for your participation and for your questions.