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Adm. Brett Giroir Talks to Dr. Sanjay Gupta; Trump Acknowledged Dangers of Coronavirus to Woodward Even as He Continued to Downplay Risks Publicly; Dr. Ashish Jha Fact-Checks Giroir Conversation with Dr. Gupta. Aired 11-11:30a ET

Aired September 10, 2020 - 11:00   ET




JOHN KING, CNN ANCHOR: Hello, everybody. I'm John King in Washington. Thanks so much for sharing this day with us.

It's a busy news day. And in a few moments, we'll hear live from Admiral Brett Giroir, the point man for coronavirus testing. He's taking questions from CNN's chief medical correspondent, Dr. Sanjay Gupta, at the American Research Forum.

One certain topic is the new Bob Woodward book and the recorded interviews in which the president makes clear he knew early on how dangerous the coronavirus was and that he deliberately and repeatedly played down the threat on purpose.

Today, the president insisting there's nothing to see or nothing to read here tweeting that, "If his words were so bad or dangerous, Woodward who have shared them sooner and not waited for his book to be done."

Good and proper -- you see it right there. "Good and proper" is how the president frames his answers.

Well, there's an election just a few weeks ahead that allows you to settle this debate. Is it good and proper, for example, for the president to tell Woodward in early February that COVID-19 is far more deadly than even the worst flu but then tell you for weeks and weeks not to worry? It is just like the flu.

Is it good and proper for the president to make clear to Woodward he knew about airborne spread early on but did nothing at that moment to ramp up testing or mask supplies and kept telling you China was on top of it and it would soon all go away?

Is it good and proper to hear your president to tell Woodward, quote, "I still like playing it down?" And then look at the numbers right there on your screen and think maybe, just maybe, playing it straight might have changed the course of this disaster. The president even now doesn't seem to think we can handle the truth.


DONALD TRUMP, PRESIDENT OF THE UNITED STATES (voice-over): I want to show a calmness. I'm the leader of the country. I can't be jumping up and down and scaring people. I don't want to scare people.


Democratic nominee, Joe Biden, sees this differently. Listen here. He tells CNN's Jake Tapper early action would have been a far better way to keep people calm.


JOE BIDEN, DEMOCRATIC PRESIDENTIAL NOMINEE: Let's assume that he didn't want to worry people. Why in god's name didn't he move quicker on the Defense Production Act to provide PPP, you know, the protective equipment for doctors and first responders? Why didn't he --


KING: Let's go live now to our conversation with Sanjay Gupta, CNN's Dr. Sanjay Gupta and Admiral Brett Giroir. Listen.

DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: -- months for you. And you are the unofficial sort of testing czar in the country.

So let me just say that this is Research America. So I spent the last couple of weeks gathering the research and evidence to help inform this interview.

And I would like to start with that hand something that's been in the news lately, just really about the importance of testing. As you probably know, the World Health Organization saying testing is the key to halting a pandemic.

But we've also heard from the president recently in Bob Woodward's new book where he says he wants to downplay things. He talked about the fact that testing, doing more testing would make us look bad.

How has that translated to your role?

ADM. BRETT GIROIR, ASSISTANT SECRETARY FOR HEALTH, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES: So I thank you also for the opportunity to be here. Research America is such an important organization. And, of course, research is the foundation of everything that we do and all that we're really achieving.

Testing is a very important part of combating the virus. And we've said this all along. It's smart policies with smart testing that really go hand in hand.

What we've tried to do is build a testing ecosystem that provides the right test to the right person at the right time. Now when we started -- I came here March 12th. I think it's very

important for people, particularly in this audience, to understand that diagnostics were not emphasized at all.

The national stockpile, it's not a Trump administration. It's not an Obama administration. It's been a long-standing practice that diagnostics were really not emphasized. I think we see the importance of them now.

I have never been told to slow down testing or to reduce our efforts. In fact, we built on testing every single month.

And I think where we are right now is really an infliction point. And I know you'll get into that, is we're now at a point in time that all the investments in research that we've done over the past few months and indeed over the past few years, we're representing those benefits now with point-of-care testing.

This month, we should have the availability of over 100 million tests. And between 55 percent and 60 percent of those, 55 million to 60 million, will be rapid point of care.

This really puts us as an infliction point that we can protect the elderly and protect the vulnerable and we can do the screening testing for schools and work that we've opinion talking about for months. Now we have the tools to do that.

GUPTA: Admiral, you know, so March 12, you sort of came into it. We're in the middle of a pandemic at this point. And you say diagnostic testing was really in the existent at that point.

You know, why not? I realize, and I don't mean to minimize the challenges in developing diagnostic testing.



GUPTA: But this is, you know, a -- a month and a half and two months into things. If testing is the key, why were you walking into a job where testing had not been emphasized at that point?

GIROIR: So, let me clarify that. I want to talk about in the stockpile. You know, before I came in on March 12th, I think we know -- we know what was happening with the CDC. And the CDC developed tests and working on.

What I was really talking about is that, for example, on March 12th, how many swabs did we have in the stockpile? Well, there were no swabs in the stockpile. How much PPE did we have to support testing?

When we -- when we, on march 13th, developed the drive-through testing sites, the community-based testing sites that we had out in the field within a week, we looked and we saw that if -- without a technological breakthrough, and that -- that being as simple as doing an interior nasopharyngeal swab instead of the interior swab we'd blow through the 80 percent of the national stockpile of PPE in the first month.

And we couldn't do that. So we needed more technological breakthroughs. And when I talk about that, some things are whizz bang and some are just as simple as validating a nose swab instead of a nasopharyngeal swab

So what I meant to say is, I think it's very important for this audience, we need to invest over a long-term period over time in diagnostics. Very, very important. I think we'll reap a lot of benefits.

Information systems. In February and march and in April, we found out how many ventilators were being used and what the need was in New York City because every night and every morning I called up the hospital systems in New York City along with a lot of the other clinicians and understood how many ventilators did you have available, how much anesthesia machines, how you did the stockpile.

So there's just a lot of things we're going to have to do over a period of years that, no matter how hard you try in a matter of months, you can't re-do that.

And that's what I want to emphasize. Pandemic preparedness five years from now really begins today. And we've got to make those investments.

Just like we have to have consistent investments in research. If we want, you know, new cures for cancer in five years. We've got to lay that foundation today. Same thing for pandemic response.

GUPTA: And I want to -- to get to the specifics of who should be tested and when they should be tested and all of that.


GUPTA: But one more question about this. You know, there's an Operation Warp Speed with a lot of focus on vaccines and therapeutics, as you know.

A lot of people have said to me shouldn't there have been a similar Warp Speed event for testing. And if you look at 3-M, for example, $500,000 was invested in the company. Was -- was that enough?

Should the Defense Production Act have been enacted to make up for some of these shortfalls of nasal swab and even help manufacture some of these tests and reagents at a faster rate? Did we -- did we do enough?

Now we're not through this so we're not doing the retrospective on this yet. But did we do enough in the early days with regard to testing?

GIROIR: So I'm glad you asked that as well. We've used the EPA 34, 35 times related to testing. Just in terms of swabs, it seems obscene.

But we put $170 million into swab production domestically to get swabs from literally a few million per month to upwards of 40 million to 50 million a month, which we absolutely need. And it will go higher than that, upwards of 100 million per month.

We've invested over $100 million in antigen point-of-care testing. Across the board, we really have made these investments.

So I -- I think it's inaccurate if people say we haven't done it. We really have.

Now, there are some companies that literally did not need the money, that everything was being done that they could. They were capital rich. We had domestic production. We needed to deregulate the field to make sure that they were available.

But we really have done that. And with -- with the RADx Program at NIH and BARTA, there's a tremendous amount of investment, like $2 billion of investment in new technologies for diagnostics, some of which we're going to reap.

Next generation sequencing, which your audience may be familiar with. That's really just hitting the market this month, using next generation sequencing platforms for something they were never designed to do, diagnosis, but, yes, they can do that. So we've really leveraged a lot.

And I can tell you every day I look at the data, I call companies, I know what every manufacturer is doing. I think we have great situational awareness.

And when -- when there's an opportunity to invest we've done it. There's been no barrier to do that. Some come from the DPA, like we did with B.D. and Quidel to get those purchases from nursing homes.

Some come from other investments, like care sources, from the CARES Act. Some come from the NIH and some from BARTA.


We sit around the table and if there's an investment opportunity, we do it. And if there's an acquisition opportunity, like buying 150 million of the Binax tests, we did that.

We announced a $760 million deal the day after the authorization. That didn't happen by random. This has been planned for over a month to -- to do that to buy it and to distribute did in a way that supports reopening.

GUPTA: There's a lot of sort of stories of people wanting tests but not being able to get tested. And it does raise this question, which has come up as well, is who should get tested? When should they get tested?

There were recently guideline changes that were made at the CDC saying people without symptoms, asymptomatic people do not necessarily need to be tested, that should be left up to public health officials in that particular area.

But that's confusing I think to me and to a lot of people because we know so much of the spread of this virus in this country comes from people who don't have symptoms or don't yet have symptoMs.

Why shouldn't asymptomatic people get tested?

GIROIR: I'm real glad you asked that because I do want to clarify it. And I'm sure you've heard Dr. Redfield clarify it as much.

We do need to test asymptomatic people. There's no doubt about that. Full stop.

And, in fact, so many of the actions I've been involved with is laying the field to test asymptomatic people.

For example, getting the FDA to clarify that even though a test may not be authorized for asymptomatic people it's perfectly appropriate to use it in congregate settings.

CMS clarified that they will use enforcement discretion under CLEA. So if you test asymptomatic people, and even though it's not authorized, they will not enforce.

And I issued, in my role as assistant secretary, guidance under the PREP Act that provides liability protection and also supersedes all state regulations to allow all asymptomatic testing.

So, trust me, we want to test asymptomatic people because, as you know and everyone knows, you can have asymptomatic people who spread the virus. And indeed, that's been the biggest issue with this.

It's not like Ebola where you get sick and you know who has got it and you can contact trace. There are at least half the people who have the virus who are asymptomatic.

Back to the CDC guidelines. I want to be clear -- and we all need to read them. And I appreciate Dr. Redfield restating them in certain ways.

They didn't say that asymptomatic people who were exposed did not need to be tested. The intent was to get them tested within a number of some kind of medical supervision.

And the reason why, if I'm exposed today, and I go get tested tomorrow and I'm negative, we don't want people to believe that, OK, I'm negative, therefore, I'm free to do whatever I want to do.

A negative test in that context has -- has a lot of, you know, nuance to it. You can still become positive in three days in, five days. We now know that the median time is 7.7 days.

And the intent -- and I understand there's been a lot of misinterpretation or understandable misinterpretation. I'm not blaming anyone for it.

But -- but the fact is this. Asymptomatic people who are exposed probably should be tested within the context of supervision of some public health or medical.

And very importantly, when there's outbreak areas, we need to test a lot of asymptomatic people.

We've just sent surge sites to over 17 cities. We've tested over 250,000 extra individuals above and beyond what the normal testing is, most under 35, most asymptomatic. Because we've got to detect that asymptomatic spread.

So -- so I know I've nailed it about four different times, but I want it to be clear. We support asymptomatic testing. We've really done a lot of regulatory hurdles to make sure that asymptomatic people can be tested so we want to support that.

GUPTA: Yes. And, look, I don't think that anybody should take away that if you get a test that means you should -- you can -- you can abandon all the other public health practices that have been talked about, I think, to your point.

But you have said in the past, including to me, you know, it would be utopian to think that we could test everybody every day or with some degree of regularity.

At the same time we know that there are organizations, including professional sports, even at the White House, that is doing just that.

So what -- what should the average citizen expect, both in terms of their ability to be tested regularly and also the cost? I mean, should this be a public good for people ultimately?

GIROIR: Yes. So -- and I really appreciate you letting me clarify that.

You know, I'm one of the most idealistic optimistic people, you know, on the planet, you know. I was the first person in my family to go to college, got to run the science office at DARPA. I mean, we really create the future. We create the future utopia. And what I want to do is create as many tests as possible.


There will be a day where there will be at-home tests that are widely available in the hundreds of millions that are cheap that we can test as frequently as we want. We're just not there right now, right?

And so we have to use the tests that we have in a strategic manner. And that strategic manner really changed with the infliction point that we have that we've been driving to about point-of-care testing.

So clearly, I think we all know that if you're sick and you're in the hospital, you need to be tested. If you're a contact and you are tracing, you need to be contacted. And now there's surge areas.

Now because of the availability of point-of-care testing, we can widen that circle, right? And we've widened it to nursing homes. And now, as of this week, we'll have completed shipments of point-of-care tests and machines to every single eligible nursing home in the country, 13,500 of them.

With the Binax test, we'll move to assisted living, to home health care to protect the vulnerable.

But also, now that we have $5 easy tests to do, we're going to deliver millions every week to governors to support reopening of schools and critical infrastructure. We now have that available and we need to use it.

The Rockefeller has a report that they came out yesterday with Duke. We've worked with them on it. You know, clearly, there needs to be testing within all environments. And we've created the situation now that we can do that, with the point-of-care tests.

And we're not stopping there. There are no home tests now available. But the technology -- they are not authorized yet. They are not sensitive enough. They are not reliable enough to be read. But we're almost there.

And you'll be seeing a lot of actions over the next few weeks to spur that development even more so that we can get true at-home tests, not tests that you need to do under a medical supervised situation.

GUPTA: You bring up schools and colleges. And I've got to tell you I've been dealing with this myself.

I have three kids in school that we've decided to -- to, you know, start virtual learning because it was very hard to -- to be sure about their status and whether or not people in the community were positive or negative. There just weren't enough tests out there.

Every state now has a college where you're having positive tests and some small, some very large outbreaks. We're in the middle of this now, Admiral.

Does this surprise you that we still can't do what I guess is defined as more like assurance testing?

It's not that they are symptomatic, not like they are in contact with somebody with symptoms, that they just want the assurance that they are not going to be in an environment with people who are carrying the virus.

Are we -- when is that going to happen?

GIROIR: So, I think it's really happening now. And it's going to happen more in the future. Again, with the Binax tests, we'll have 50 million of those per month. And we hope to expand that even further.

And when I talk about school-based testing or other critical infrastructure, I think most of that have can be under a number of assurance testing. It's really screening testing to make sure there isn't a widespread outbreak we're not seeing because so many people are asymptomatic. I really think we're there right now.

In terms of colleges, we've had four major calls. We've talked to literally thousands of individuals at colleges. And -- and colleges do need to step up. There are many colleges who do

this very, very well, like the University of Illinois, that uses a saliva-based test. They do pooling. They are testing their students very frequently. And most colleges have that available to them and they could use it.

The university -- Colorado State University is really doing wastewater surveillance. And we've been urging that, and put a whole wastewater infrastructure in. Because it's possible to test a dorm all together by testing their wastewater at very early sensitivity.

So, again, universities I think are in a different ballpark because they can turn on their research infrastructure. They have incredible capability there. They can pool and do wastewater surveillance. Many universities are doing that well. K-12 not so much.

You don't have PCR machines in a fifth-grade laboratory, at least in most. That's why we want to put the rapid point-of-care testing there.

And if you want to call it assurance testing or screening, it's really the same thing. It's testing asymptomatic individuals to give an idea that we know that there isn't widespread circulation, that we need to up the game and really test everyone at that point.

We're doing it for nursing homes and for assisted living and home health care. We're going to start doing it for K-12.

We'll also deliver more to tribes and HCBUS. HCBUS, historically black colleges and universities, we know that African-Americans are at high risk of hospitalization. And their faculty are African-Americans in general. They tend to be older and in the high-risk group.


You'll see this expanding more and more and more as the tests become available, and they don't become available by accident. It's because we invest in them.

GUPTA: Right.

GIROIR: We have, in the research to make them happen.

GUPTA: I know we're running out of time. But let me just ask --


GIROIR: So quick.

GUPTA: Yes, quick.

Last point, the idea of having regular at-home testing, a test that is accurate that can give you actionable information on a regular basis, maybe even a daily basis.

Michael Mina, who I know you know, said it would be like putting in your contact lenses in the morning. You can get a test, and if you're negative fine. But if you're not, you can stay at home and isolate until you are negative. That would require hundreds of millions of tests potentially every month.

Again, you've said that utopian. And I know it is a contentious issue, contentious discussion point.

But is it -- is it feasible? I mean, can we get to that point? And, you know, again, should we have been at that point?

GIROIR: So, I think we can get to that point. We are not there now. We couldn't have been here now. I mean, there's been no limitations on money, research, motivation.


GUPTA: You've had everything that you need. You've gotten all the resources that you need in order to do whatever you needed to do?

GIROIR: Right. There are very technical limitations.

And don't get caught up on utopian views. That was a very specific question about, why don't we have everything now. It takes time, as the research community knows. Why haven't we cured all of cancer yet? Well, it takes time. We've compressed the time as much as possible.

We're not in a situation now where we have a highly accurate home test. We're getting close. We really are getting close. There are a number of innovators, some supported by the RADx Program and some by BARTA and some under private support that we're getting close to that.

Not to 100 million level a day, but we're getting very close to having a home test or home tests that are very available. The Binax is a test that we can work with, $5 a test.

No one thought six months ago we'd have a $5 test that's 92 percent sensitive and 92 percent specific, but we do. So we're getting close to that.

Don't expect it in the next month or two. Yes, a miracle could happen. There could be an a-ha moment, but we're moving science forward.

It's within the realm of possibilities that we have that. It's just that we don't have it today. There's no barriers, just the technology and the development.

GUPTA: Got it.

And just to be clear, the Binax test is currently authorized for symptomatic people within seven days of symptoms. But you're saying they can potentially use that off label for asymptomatics.


GUPTA: Admiral -- go ahead.

GIROIR: And we intend -- that's why we did the PREP declaration and the CLEA and the FDA guidance.

It's expedient to get the approval for the people because you get all the positives. But the loads of virus from symptomatic and asymptomatic people overlap. So there's no reason to believe it shouldn't be used in asymptomatic. And that's how we're promoting it.

We're doing the studies to back that up right now. But we feel very comfortable and very good about the fact that a rapid test with a very high sensitivity really adds to our testing ecosystem.

And we're not going to delay. We want that out to the American people, you know, immediately, and that exactly what we're doing.

GUPTA: Admiral, thank you.

My humble sort of input is that I hope that we can take a test hike that and use the resources of this country to manufacture as many of those tests as possible. Because, I've got to tell you, people want them, they need them. It's part of returning this country to come sort of normalcy, as you well know.

GIROIR: Absolutely.

Thank you for your service, Admiral, sincerely.

We're on a tight ship so we're out of time.

And, Mike, I'll hand it back over to you.

UNIDENTIFIED MALE: Thank you, Dr. Gupta.

And thank you, Admiral Giroir and Dr. Sanjay Gupta for being with us.

KING: You've been listening to a conversation with CNN's Dr. Sanjay Gupta talking to Admiral Brett Giroir, the testing czar for the White House Coronavirus Task Force.

We wanted to bring you that conversation in full, as you heard Dr. Gupta test press him about testing for the coronavirus seven months into this pandemic.

Let's talk about what we just heard, put it into context, and run it through a little bit of a fact-check.

Dr. Ashish Jha is the dean of the Brown University School of Public Health.

Dr. Jha, grateful to have you at this moment.

If you listen to Admiral Giroir, and we've talked several times about this over the months, he tends to be optimistic. He tends to give a best-case scenario. He also has inherited a difficult job, came in in the middle of march.

As you were listening there, number one, he was making the point, we've done everything we could from the beginning. Yes, nobody is perfect. And we've tried and done everything that we could.

And he said we're about now, the country, is in a position to finally reap the benefits of months and months of research in expanded testing.

What jumped out at you most listening to that given ought time you've spent studying the testing issue?



I thought that was a fabulous conversation between Dr. Gupta and Dr. Giroir.

Second kind of big-picture point, I agreed with much of what Admiral Giroir had to say.

It was terrific for him to talk about the value of asymptomatic testing, the value of surveillance testing.

The problem is a couple of faults. One is, it is in fact, it contradicts the guidance out of the CDC. The CDC still, as of five minutes ago, says they do not recommend surveillance testing in schools, even though most public health officials think, especially in places with large outbreaks, say that we need surveillance testing in schools.

So there's a bit of a confusion within the administration and a lack of clear guidance that persists.

The second issue on this is no one believes that we have done everything we could.

I think Admiral Giroir has a very difficult job. He has been trying his best.

But he's in an administration that has not wanted to put the full force and U.S. industry towards testing.

The idea that this is the best America can do, I reject that. This owes a lot of things we could have done better.

KING: Let's continue on that point. This is the United States of America.

And we're having this conversation 24 hours after the revelations in Bob Woodward book. You can hear the audios tapes and hear the president in his own words making clear that he knew in early February that this was airborne spread, that it was out of control in China, that it was way more deadly than any -- even the most strenuous flu.

The president of the United States told that to Bob Woodward and told the people of the United States something completely different. Forgot what he said. What did he do? Admiral Giroir came in in the middle of march and he tried as quickly

as he could to try to get the diagnostics testing up to speed.

What did the United States do from February 7th, say, when the president had that conversation with Bob Woodward through the middle of march when Admiral Giroir took that job?

Is there any evidence that there was an urgency in the United States government to say, you know what, look what's happening in China, ramp up testing, ramp up PPE production, this wave is coming to us?

JHA: No. And in fact, February was the month that set us so far back that we have never caught up to this virus. We wasted the month of February.

We did not build up anything remotely resembling a halfway decent testing infrastructure. We didn't ramp up PPEs and sent our doctors and nurses into harm's way without the equipment that they needed.

But the bottom line is, even in March, when Admiral Giroir came in, again, inheriting a very difficult job, the message out of the White House and the message that he has been delivering multiple times is we have enough testing. Everybody who needs a test can get a test.

He himself has put out estimates of testing of what the country needs that always end up coinciding with what the country has, and a message that says we don't need to do much more.

And that actually is detrimental because it sends a signal to the market that says, hey, don't bother investing in testing expansion because we have all the tests that we need, when all of us knew we didn't.

A much better strategy would have been to come in, lay out what we need, then lay out a plan for how we're going to get there. Acknowledge to American people what American people knew, which is we didn't have enough testing, and go about delivering that.

That would have been that much better. But the mixed messaging and confusion and bad signaling to the marketplace, none of that have has been helpful.

I'm thrilled to hear Admiral Giroir and the things he had to say today. Great to get him on board with the public health message. Got to get the CDC on board. And we have to put the force of the U.S. government on delivering it.

KING: I think your point about the continued mixed messaging between CDC guidelines and how they then tried to explain them or explain them away in the public conversations is a critical point.

One last point, as we listen to this point seven months in. You heard the admiral talking about where are we now.

Where are we both in terms of capabilities and in how we use those capabilities compared -- you and I have talked about this in the past -- if you look at Taiwan and South Korea and look at Germany, for example.

Where are we in the United States of America in terms of our capabilities to test? And how we use those capabilities compared to others in the world?

JHA: Yes, so I agree with Admiral Giroir that we are getting better. I would say we've been limping along, getting a little bit better every month.

One part of the problem is the credibility gap. Not on his part alone, but the administration has been saying we're sending out millions of tests and those tests don't arrive.

I do think we'll have a lot more testing this fall, but I say it with some trepidation because we've had actually seen the tests arrive.


But there are so many missed opportunities. The first antigen was approved and got an EUA back in March. They should have gone into full rump-up testing so it could have gone into the schools for this fall so that we could do antigen testing as much as possible across America. It would have been much easier to get back to school this fall.

I'm timely hopeful we've gotten our action as a nation together. The scientific community is very long.