Updated at 8:25 p.m. ET
Federal health officials issued a blunt message Tuesday: Americans need to start preparing now for the possibility that more aggressive, disruptive measures might be needed to stop the spread of the new coronavirus in the U.S.
The strongly worded warning came in response to outbreaks of the virus outside China, including in Iran, Japan, South Korea and Italy, which officials say have raised the likelihood of outbreaks occurring stateside.
"It's not so much a question of if this will happen anymore, but more really a question of when it will happen — and how many people in this country will have severe illness," Dr. Nancy Messonnier of the Centers for Disease Control and Prevention told reporters during a briefing.
While aggressive measures such as travel restrictions and the first federal quarantine in a half century have probably slowed the arrival of the coronavirus in the U.S., Messonnier said even more intrusive steps will likely be needed.
"We are asking the American public to work with us to prepare with the expectation that this could be bad," Messonnier said.
"I had a conversation with my family over breakfast this morning. And I told my children that while I didn't think that they were at risk right now, we, as a family, need to be preparing for significant disruption of our lives," she said.
Those measures could include school closings, workplace shutdowns and canceling large gatherings and public events, she warned.
"I understand this whole situation may seem overwhelming and that disruption to everyday life may be severe, but these are things that people need to start thinking about now," Messonnier said.
So Americans need to do things like start making plans to care for their children should schools and day care centers close, she said. They should talk to their employers about how they could work from home. And they should find out whether there might be a way to get medical care remotely, such as through telemedicine, Messonnier said.
She stressed that the current risk remains low. Almost all the cases that have occurred in the United States have been among travelers who have been infected overseas. In addition, there's always the chance that the coronavirus could begin to subside as spring and summer arrive.
Infectious disease experts say that 80% of infections are mild, no more severe than the common cold.
So far, there have been 14 confirmed cases of the coronavirus illness COVID-19 in the U.S. and 40 other cases among people from the Diamond Princess cruise who were repatriated to the U.S., according to the CDC. There also are three cases among people who were repatriated from Hubei province in China, where the respiratory virus emerged months ago.
Hand-washing with soap and water continues to be a top recommendation to protect against the virus, since the abrasiveness of soap helps remove infectious particles from the hands. Experts say that commonly worn surgical masks aren't very effective protection. A heavy-duty mask called an N95 respirator is considerably better protection, but it is uncomfortable to wear and can make breathing more difficult.
The CDC has advised against nonessential travel to China and South Korea, countries that have seen the highest numbers of cases.
But because there are so many unknowns, state and local officials and average Americans need to be prepared, Messonnier said.
"I continue to hope that in the end, we'll look back and feel like we were overprepared. But that is a better place to be in than being underprepared," she said.
U.S. Health and Human Services Secretary Alex Azar said in a media briefing Tuesday that the immediate risk to the general American public remains low, but that could change quickly.
He pointed to the recent community transmission of the disease in countries outside Asia, which he called "deeply concerning."
On Monday, the White House requested $1.25 billion in new funding from Congress and authorization to move other money to get an expected $2.5 billion for emergency preparedness and response. Azar said the money will go toward virus surveillance, state and local preparedness, the development of therapeutic treatments and vaccines, and the building of a stockpile of personal protective equipment such as masks.
CDC Principal Deputy Director Dr. Anne Schuchat said that the precautions in the U.S. have been working, as evidenced by the low number of cases in the country so far.
This is the time to prepare for the event of community transmission in the U.S., she said. For most patients who develop COVID-19, Schuchat explained, appropriate care would mean home isolation, using health care facilities only as needed for the elderly and for those with severe cases or other medical conditions.
"Current global circumstances suggest it's likely that this virus will cause a pandemic," she said, in which case specific local strategies would be implemented to slow the spread.
Schuchat said authorities have long been preparing for such threats. She pointed to strategies such as hand-washing, social distancing and staying home when you're sick – the same recommendations from bad flu seasons or the H1N1 pandemic in 2009.
"There is literally a playbook for the use of these tools – one that the states and local public health have exercised," she said.
Both Azar and Schuchat used the phrase "radical transparency" to describe their approach to the outbreak, and promised frequent media briefings.
"We have said from day one we can't hermetically seal off the United States. We've always said we expect to see more cases," Azar said.
"People shouldn't panic when they see new cases. They should know their government predicted we would have them, and we have plans in place," he added.
In a statement late Tuesday, the White House said it had met with health officials from more than 30 states and territories to thank them for their leadership in responding to coronavirus.
"The discussion focused on the importance of the public health partnership at various levels of government and underscored the importance [of] community preparedness," White House spokesman Hogan Gidley said.
AILSA CHANG, HOST:
Federal health officials issued a blunt warning today. They say it's only a matter of time, likely, before the coronavirus starts spreading in the U.S., so Americans need to start preparing for that possibility. And more aggressive measures might be necessary to fight the dangerous new germ in this country. NPR health correspondent Rob Stein joins us now with the details.
ROB STEIN, BYLINE: Hey there.
CHANG: So what specifically prompted these tougher new warnings today?
STEIN: You know, federal health officials have been saying for a while that the virus could start spreading in this country, but those concerns have intensified as the outbreak started occurring outside of China in places like Italy, Iran, South Korea and Japan. Here's Nancy Messonnier from the CDC.
NANCY MESSONNIER: It's not so much a question of if this will happen anymore but rather more a question of exactly when this will happen and how many people in this country will have severe illness.
CHANG: OK, so what are these more aggressive measures that officials say might become necessary?
STEIN: Yeah. You know, the U.S. has already taken some pretty aggressive measures. They've banned pretty much anyone who isn't a U.S. citizen from entering the country from China, imposed the first federal quarantine in a half-century on hundreds of people who might have been exposed to the virus. But they're saying that's probably just bought the U.S. time, and more aggressive steps that affect people's everyday lives will probably become needed at some point. Here's Dr. Messonnier from the CDC again.
MESSONNIER: We are asking the American public to work with us to prepare in the expectation that this could be bad. I had a conversation with my family over breakfast this morning, and I told my children that while I didn't think that they were at risk right now, we as a family need to be preparing for a significant disruption of our lives.
CHANG: Significant disruption - what kinds of disruptions is she talking about exactly?
STEIN: Yeah. What she's talking about is things like, you know, schools closings and closings and workers being asked to stay home or even maybe telework from home if they can and maybe staying away from big public events, maybe even large gatherings being canceled altogether. Here's Dr. Messonnier one more time.
MESSONNIER: I understand this whole situation may seem overwhelming and that disruption to everyday life may be severe, but these are things that people need to start thinking about now.
STEIN: And what she means by that is, you know, they should think about, you know - what would you do if - you know, for child care if the schools and day care centers started to close? And could you work from home if you had to? And would there be any way to get care from your doctor - for example, through something like telemedicine - if that became necessary? You know, and public health officials say they know this sort of thing could be a real hardship for people - people missing paychecks, school, that sort of thing.
CHANG: Wow. I'm trying to think. Has this sort of thing on this level ever happened in the U.S. ever before?
STEIN: Well, you know, we know that we've seen other countries do this sort of thing for the coronavirus. You know, China's had this massive lockdown, affecting millions of people. And countries like Italy and South Korea are now starting to take pretty aggressive steps. And, you know - but it's been a long time since we've seen anything like this happen in this country. Some schools closed at the beginning of the so-called H1N1 flu pandemic about 10 years ago.
STEIN: But you have to go back a lot further in history for when this sort of thing happened on a large scale in this country, maybe as far back as the 1918 Spanish flu. You know, during that, schools did close. Churches and theaters and dance halls closed. Weddings and funerals were banned in some places. Some factories, they did things like staggering shifts. And similar steps were also taken at times to fight polio - you know, things like closing movie theaters, pools and bowling alleys.
CHANG: So I'm just trying to keep all of this in context. I mean, how worried should people be right now?
STEIN: Yeah. So public health officials stress that the coronavirus is not spreading in this country right now, so it's not a big risk at the moment by any means. In fact, you know, the regular old flu still poses much more of a risk by far. So people should be doing things that they would do to protect themselves from that - you know, common sense things like wash your hands a lot and, you know, stay home if you're sick and cover your mouth when you cough. That would also help if the coronavirus does start to spread.
And, you know, the Trump administration is clearly trying to walk a fine line here. You know, the stock market has been falling because of concerns about coronavirus. And during a news conference in India this morning, the president said the situation is under control. And then late this afternoon, other health officials had another briefing that had a much more measured tone, and they were saying they just wanted people to know what kinds of things might happen, not necessarily what would happen.
CHANG: That's NPR's Rob Stein.
STEIN: Oh, sure. You bet. Transcript provided by NPR, Copyright NPR.