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Transcript: Dr. Scott Gottlieb on "Face the Nation," August 22, 2021

The following is a transcript of an interview with former FDA Commissioner Scott Gottlieb that aired on Sunday, August 22, 2021, on "Face the Nation."

MAJOR GARRETT: We turn now to former FDA commissioner and Pfizer board member Dr. Scott Gottlieb, his book, "Uncontrolled Spread: Why COVID-19 Crushed US and How We Can Defeat the Next Pandemic" comes out next month. Dr. Gottlieb, good morning. Do we know in this country how many young people have covid-19 Delta variant? And are we testing enough to get an accurate sense of that number? And how far off might we be?

DOCTOR SCOTT GOTTLIEB: Yeah, we may be very far off, we don't have an accurate sense of that number. Right now, about 4.2 million kids have been diagnosed with COVID. But the presumption is that we're- we're diagnosing just a small fraction of the kids who are ultimately contracting the virus. Maybe as low as one in 10 to one in 20 infections in kids is being turned over right now. So there's been far more infection among children than what we're diagnosing because most of the infection is asymptomatic or mild and mild disease that doesn't necessarily present to a pediatrician for testing. And this is really a critical question because it gets to the heart of whether or not this new Delta variant is more pathogenic in children. We see rising numbers of hospitalizations and ICU admissions among kids. The question is, is that because this is a more dangerous variant in children or are we just infecting a whole lot more kids? So we're not really getting an accurate sense of the denominator. We're only seeing the numerator of kids who are presenting with more severe disease. I suspect it's the latter. I suspect that the number of kids who are getting into trouble with COVID hasn't really changed with this Delta variant. The reason why we're seeing rising hospitalizations and ICU admissions among kids is because we're infecting a whole lot more kids with it.

MAJOR GARRETT: So doing that quick math, we could have 10 million to 20 million cases right now if I- if I heard you correctly.

DR. GOTTLIEB: Yeah, well, there's 50 million school-aged children. We've diagnosed, a little over four million. About eight million have been vaccinated. So the question is how many kids overall have been exposed to this virus and developed some measure of immunity? It could be as high as 25 million or more when you start doing the math around that 4.2 million who have been- who are known to have been infected. We're certainly diagnosing less than one in four cases. In the peak of the epidemic, in the winter, we were turning over probably about one in four cases in adults. We always knew the fraction of cases that were getting diagnosed in kids was less. We're doing less routine screening in children. Children get milder disease on the whole. So they, again, they don't present to their pediatricians for testing. But the ascertainment rate right now may be even lower with this Delta variant.

MAJOR GARRETT: So should school districts be testing on a regular basis when children return? And when you say regular, is that once a week, twice a week, more?

DR. GOTTLIEB: It's once a week or twice a week, and if you Google "Test to Stay," there's now a movement and a lot of districts, North Dakota is doing in some other states as well, to use testing as a way to keep kids in the classroom. So when you identify a case, rather than quarantining the whole class or a large swath of the school, which is happening in a lot of states right now in the south, as the epidemic rages there. What some districts are doing is using testing where they'll test the close contacts of kids immediately to make sure there's not other asymptomatic cases that are going undiagnosed and then test them at some kind of interval, maybe at three days and five days to make sure that there's not an outbreak being triggered in a school. So you can use testing to avoid broad quarantines. I think the combination of kids wearing masks in the classroom to avoid spreading the virus with testing can allow the school year to go on without these large quarantines that we're seeing in some districts while keeping children safe.

MAJOR GARRETT: And on that question of quarantines, is that the proper policy response?

DR. GOTTLIEB: Well, again, I think a proper policy response might be to use testing more aggressively to try to identify infection to make sure you're not having an outbreak in that setting, and also make sure you're taking mitigation steps to avoid that as well, with masks, with proper ventilation, keeping kids in defined social pods. I think the combination of those two measures can create a safer environment, not a safe environment. Schools aren't inherently safe, but they can be made more safe without putting in- putting large groups of students in quarantine. In one district in Hillsborough, Florida, right now, around Tampa, there's been 2,700 kids have been diagnosed with COVID. About 6% of the kids in that district are in quarantine. You're seeing that all across the south right now. It's going to be very disruptive to the school year. And then once these districts, either do go to a hybrid model, or shut down, or put a lot of kids into quarantine, it becomes very hard to restart a normal school year. So you want to prevent that from happening while keeping kids safe? I think testing could be used as a very effective tool to do that in, and some states are leaning hard into that.

MAJOR GARRETT: Are case rates beginning to peak in the south where the Delta variant has hit the hardest?

DR. GOTTLIEB: Yeah, that's definitely the case. If you go to, run by the Harvard Chan School, which looks at whether the epidemics are expanding or contracting they're showing across the south right now, the Rt, the rate of transmission, is below one, which means you have a contracting epidemic across the south. Now there's still very hard weeks ahead because they're still going to continue to accrue more hospitalizations and there's extreme pressure on those health care systems. But there is evidence that the epidemic is starting to slow and the day over day cases are starting to decline. And that's showing up in the national trends. Now, Florida, which has been the epicenter of the epidemic in this country, if you look across different age categories in Florida, every age category shows a declining number of cases day over day, except for school age kids, kids ages six to 19. That's the only category that's still expanding and expanding very quickly, because what's happening is they're opening schools earlier in the south. Schools opened earlier in the south against the backdrop of still a lot of prevalence. And the infection is getting into schools and it's proving to be hard to control schools. Delta is a very contagious variant. And so I think that this is a harbinger of the challenges that we're going to face nationally. As schools reopen, the schools could become focal points of community transmission and can become environments that aren't safe for children if we can't control very large outbreaks from happening in those settings. 

MAJOR GARRETT: Doctor, do you expect the Pfizer vaccine to be approved fully this week? And if so, what difference will that make?

DR. GOTTLIEB: Yes, you know, I'm on the board of Pfizer, there were reports that it's going to be approved as early as tomorrow. I have no reason to believe that those reports aren't accurate. I do believe that once the vaccine is fully approved, that's going to give more impetus to some businesses, schools to mandate vaccination. They've been waiting for full approval. They- they feel they'll be on stronger legal ground to mandate vaccination in that setting. I also think that there are certain consumers that have been waiting for this milestone, waiting for the full approval and an indication that the FDA is done evaluating the data set to give them more confidence about using the vaccine. So I would expect to see some uptick in vaccine utilization, either from voluntary vaccination by consumers who've been waiting for full approval or from some businesses that now are going to move forward with vaccine mandates, although you've been seeing businesses doing that even in the absence of the full approval while the vaccine has been under an emergency use authorization.

MAJOR GARRETT: For your time and expertise. Dr. Scott Gottlieb, we thank you very much. And we'll be right back.

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