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>> with congress and recess until labor day lawmakers are meeting with constituents to discuss health care issues and c-span is covering many of these events including this be a senator chuck grassley one of several congressional panels working on health-care legislation. senator grassley also is part of an informal bipartisan group of senators working on a compromise you can see his town hall meeting at 6:50 p.m.

eastern. interest groups are running ads on health care here are two of them. >> illness does not care real live. if you're always sick. or if you lose your job. your health insurance so let's fix healthcare. if everyone is covered we can make health care as affordable as possible. the word pre-existing condition becomes a thing of the past. we are america's health insurance companies supporting bipartisan reform. >> what we strip rate of 13 billion-dollar insurance company profit? the $119 million cbo pay, and less denials and copays and premiums and it was between you and your doctor? that is the president's plan to keep your coverage or choose including a public health insurance option to

lower costs and keep insurance companies on is. tell congress to support reform now it is your health. it should be your choice. >> in the event on retirement issues and social security obama's national director lawrence summers hosted by the social security minister edition of retirement and disability policy is 45 minutes. >> good afternoon it is my great privilege to local larry summers to this year retirement consortium which in its history has become the premier gathering of researchers and policy makers interested in the core questions it is a great honor to have larry with us. he is of course, one of the most distinguished economist and economic policy makers in

the world. he currently serves as director of the national economic policy and assistant to the president of his past positions it includes presidency of harvard, secretary of treasury, the metal for an economic association for research contribution and the list goes on. above for a tough audience that does not cut the ice. i wanted to remind you of his contributions in the area of retirement security. to remind you his early work on lifecycle savings and the quest that helped to launch a three decade-long research program assessing the extent lifecycle motives can explain household savings patterns in the u.s. economy and remind you he was one of the first to suspect there may be a long-term tendencies with asset prices which may play a fundamental role in the asset

allocation and decisions as they think about saving that for major year's record three baidu as a policy maker in the mid-90s, larry help to a champion the cause of index bonds which for many years in their retirement savings discussion was pointed to as a lack for u.s. households as they tried to prepare for retirement and we cannot do that anymore. and finally in the late 1990's tv of the treasury department and labor department he helped to make it easier for firms to adopt the fall plans and other ways to encourage or does a patient and contribution and voluntary retirement savings plans. i remember getting a call from the secretary of the treasury asking if i could speak for a few minutes -- moments and when he came on the line he said jim i am looking at this new working paper that says the default plans encourage participation in the 401(k)

what does the research community say? is this holding up? that brief conversation crystallized what i think has been a key hallmark of larry work as a policy maker and researcher per as a policy maker he has been extraordinarily successful a drawing on the latest cutting edge research to inform the policy issues of the day and as a researcher he has been incredibly successful at focusing on the key policy questions to direct the research that he is carrying out along with those around him. i have been fortunate to know larry a long time we met when i was the under gradually he has been a mentor to me from my career. nablus profited to him from his analysis on economic issues the last time we're on a podium together with tristan for the first week of march 102000 a very delivered a strikingly negative assessment of the state of a

global financial and macro economic environment. pointing to large and growing real-estate losses fragility of the financial sector that had not been noticed and concluded his remarks by saying we're facing the most serious combination of macroeconomic and financial stress the u.s. has faced a generation and longer that was the morning when bear stearns was trading at some of our dollars per share i remember flying home thinking maybe larry has just bought 10 pessimistic. [laughter] and maybe that is earlier headed those doubts only lasted for 10 days because we were together on a friday then one week it was taken over for $2 per share and we began writing a new chapter in the global financial and economic history. he will talk about the administration's economic program and i am delighted to welcome him to the platform. [applause] >> jam, thank you very much

for that generous introduction in. can we be a tag team wherever i go? for every reintroduce the? that was terrific. it reminded me of the old lyndon johnson line about the wish my parents had been here for that my father would have appreciated its and my mother would have believed it i really do appreciate what you have said and i have valued our friendship what i am thinking now must me more than 30 years since you came to

work as a research assistant for me in the late 1970 is. there has been an enormous amount of research assistant with augmenting change if you think about with the computer's. [laughter] but i do not think there is still to this date a research assistant who could do so much in that so little time, so accurately, as jim poterba could in the 1970's it was quite remarkable. he had remarkable leadership with marty feldstein and now he can look forward to a longer-term of leadership from

jim poterba 00 and economics profession are fortunate to have in that position. and i would say the country is fortunate to have this or shut and groups and conferences like this one. it is not the case that your average senator curls up on the average evening with the npr paper sorry to tell you. [laughter] and it is the case that the president walked into my office one day and observed a copy of the papers on economic activity sitting on my table, picked it up and looked

at it and said you know, , larry, i don't think i will be taking this home for the weekend. [laughter] but the story that jim told about research on defaults and universal bunch of mission and movements with changes in the i.r.a. rules is a true story. and as one who now adds responsibility for a daily briefing as the president on economic policy where we take up the economic subject each day in addition to reporting on that news, i can tell you

that the kind of research done at this conference whether work establishes that 70 is the new 6d, or whether it is work that looks at the surprisingly large number of people who have a surprisingly low levels of of financial assets. or whether it is work that explores and tries to bring honesty to the question of funding of adequacy of funding of defined benefit pensions plan. it has an enormous impact over time on the course of public policy. just because the causal chain is long and variable does not mean the impact isn't very

real. and one of the very great strength of american economic policy that i think is actually an area where the united states is stronger than almost any other country is the cross fertilization between a rich and firebrand community with universities and think tanks and the actual process of public policy. with the movement of individuals of which i and several other people in this room have been an example, or whether it is simply the example that comes from the reading and communication and come it really does make a big difference. i thought what i would do for a few minutes this afternoon is a talk about the

administration economic strategy. and touch on house on retirement security issues relate to it. priority number one for the of ministrations, following the president's election, during the transition was rescuing the american economy from what paul krugman had captured as the prevailing sentiment what he wrote january 2009, let's not mince words. this looks awful lot like the beginning of a second great depression. the country lost 700,000 jobs per month in the quarter ending for a very, gdp had fallen faster than any time since 1958 and the budget deficit was projected to be in

excess of $1 trillion. the market at one time was at the same level with inflation adjusted that had been 1966 and options' implied one in six chance the dow would fall below 5,000 and the 38% of investment-grade corporate bonds would default over the coming decade large numbers of cities and states could issue debt despite tax exemption at rates only significantly greater than the treasury. frankly, from the point* of view of asian-americans as from the point* of view of other americans, one single issue, stopping the decline, bringing about in reversal establishing an element of normalcy was

central importance. without a halt to the free fall, and no other economic paulson -- policy would succeed and no other economic goals whether the incorporation of technical change for the reduction of poverty, whether the promotion of old age security or the strengthening of access to higher education and, whether it was the restoration of budget balance or the return of banks. no other objective had any chance both being matched if the free fall was not contained. that is cited frustration moved immediately to contain the free fall. with a diagnosis that started

from the premise that what we had was a vicious cycle in which a weak economy contributed to a weak financial system and a weak financial system contributed to a week the economy. and it was necessary to intervene strongly. with a strong program of at fiscal expansion to raise incomes, increased ability to repay the loans, create demand in the economy. with a strong set of measures to address access or closures and promote transparency and encourage capital raising on the part of the major financial institutions. we put that program in place

unless the recovery act was legislated in less than 30 days after the president of office already has obligated more than $200 billion and led to the commencement of several thousand project. the financial recovery has been manifest if one looks at indicators or credit spreads many of which have returned to the pre-lehman brothers laughed. -- left. we have long way to go. problems were not created in a

week or in a month or in aa year. they will not be resolved in a week or a month or a year. but looking at prevailing forecast word gdp growth in the second half of this year which i am a part of almost all professional forecasters are now positive. looking at the rate of job loss which is running at half or less of earlier rates. looking at market indicators not because policy can be judged by the market because there is information and markets were obvious indicators like stock markets, less obvious indicators like credit spreads spread between libor and federal funds, a federal

markets and what they suggest about housing prices and the future. what they see is a substantial return to normality. in that context, it is reasonable to say that we're in a very different place than we were six months ago. that the sense of freefall of vertical declined has been contained pratt and we are beginning to lay a foundation for future growth. and at that point* it becomes crucial to think of the kind of foundation we want to lay and a the kind of growth that we want to have going forward. if one looks carefully, at the

last two recoveries, the last two expansions come and even to some extent, the expansion before, those were supported in very substantial part by asset bubbles that drove consumption and housing most recently, technology and the broader stock market and in the previous case. they were associated with the substantial financial as asian of the economy, as the shooter perhaps in consequence with significant increases of inequality. and they coincided with

imports and legs and crucial systems within the economy that are essential for our future, health care, education, energy, and i would suggest periods in which the economy move forward but related to those substantial increases in inequality we did not make the progress in promoting retirement security that we might have hoped to make during a period of substantial expansion. so the president was very clear. this was something he was very clear on from the beginning in the -- even the darkest days. he was very clear that we could not pursue and his

judgment and a strategy of simply trying to restore employment. and leave questions of economic structure for the future. as we were stimulating the economy we had to think about what kind of stimulus we were providing. how could it not be a good idea at a time when fiscal stimulus was necessary and large numbers of people were out of work not to create jobs remedy a situation where the average hospital uses less information technology than the average supermarket. how could it not be right at a time when we needed demand in the economy not to be engaged in substantial weatherization

of buildings that the federal government owned with the payback within three or four years. how could it not be right to be seeking to catalyze investments and high-speed rail, other key areas of infrastructure and in particular, and in renewable energy. how could it not be right to take steps that would be desirable at any time, but were essentials as we were pursuing stimulus, i just on the brink of the time that the baby-boom generation was going to begin to turn 65? that is why the president has recognized the crucial

relationship were retirement security issues and the long run health of the federal budget. what is true if you study the federal budget closely, it is this. if you look not over three years or five years by over 15 or more. if you don't get health care costs under control, the budget will not be under control of no matter what else you do. and if you do get health care costs under control, if you do make substantial progress in slowing the growth of health-care cost, the stakes are very large. evens several tenths of 1% as peter orszag likes to point* out regularly, even several tens of 1% contained reduction in the growth rate of health care costs.

if it is sustained larger than the impact of the assault security deficit on a 75 year basis. that is why the administration has done something that is unusual. we're doing something this city has seen many times with a new progressive of penetration pushing for measures that would substantially change health-care and one access because the question of cost is at the center of the debate the programs that the administration has proposed you can debate the particular compromises in the future but what you cannot debate is the

cost is that the center of the health-care debate and you can dispute or you cut taxes without doing in some balanced-budget way banking on the pavement in 2001 or 2003. we expanded prescription benefits, a prescription drug benefits without anybody considering the issue of a what it was and wasn't right and we did not think about the question. we launched a major war in the middle east without anybody thinking about what the cost was. so let's have the best possible debate on all of this but let's remember for the first time we have a debate were cost will be absolutely

at the center. second. we have crucial issues and the king about the savings aspects of retirement security if somebody said they have a policy that would lift the personal savings rate from zero up at 6% i think most people would say that is pretty good. i have people in this room one way or another have written papers saying it is hard to lift the personal savings rate by very much. we show them. [laughter] now i would not recommend in a city and depression as an especially attractive strategy

for trying to change in the savings rate i don't think there's such a thing as adjusted is too radical but there is an aspect to this that i think has too little attention over time but no but doubt in -- researchers have thought about it carefully. you can imagine people having a wealth and income ratio of four because they have no debt, assets equal to four times their income or imagined a ratio of four because they have six times their income and assets and two times there and come in liabilities. from the point* of view by 1980 hour paper or a lot of

other analysis is basically the same thing because what matters is the network to income ratio. then the volatility of their wealth is the much@@@@ substantially greater stigma today. i am not sure of what financial

asset the same cannot be said. in a world of more leveraged households and substantially greater leverage on the part of households i think we need to think very carefully about target asset income ratios, about target savings rate, and about retirement security. and that the more traditional static view, focused only on the ratio of net assets to income, may not be appropriate. a related aspect that is receiving substantial policy attention right now is if you like the microeconomics -- the

microeconomics of saving. we have much more extensively -- we have extensive issues around the transactions costs, the undisclosed risks associated with a range of savings vehicles. while credit cards have been much in the news and we have legislated in that area while overdraft fees have seized the headlines in the last several days there is in my judgment

room for considerable policy attention to the fraction of the return on individual savings. that is produced in one way or another by marketing, administrative, and other kinds of transactions costs. and one crucial area of exploration as we pursue financial regulation will be preserving the range of choice that we have, but making sure individuals are given a fair opportunity to understand what they buy and that the forces of the market are properly channeled to contain transactions costs for the benefit of retirement security.

finally, there will be the set of questions and these are also implicated by a recent trend if one looks at the data, one of the surprising features of recent data is labor force participation among the relatively aging has been strikingly robust during the current recession. normal pattern is there is a cyclical with the among those who do not absolutely have to be working and part of that has traditionally manifested itself in some quality and the older and labor force. i don't think anybody understands why one natural hypothesis is depleted assets and increased uncertainty lead to delete retirement from the labour force. i happen to know from prior

experience from the very atypical segment of the population university professors that there is very substantial sensitivity of retirement behavior to the ntia crafts -- tiaa kref. if you extrapolate current trends and recognize consequences of increased financial uncertainty, if you recognize the consequences of the longer lifespans and increased health and ability and reduce disability on the part of the the aging that more people are going to be working blunder. and i think this will push us to think very hard about our labour market institutions and the traditional pattern on many large organizations in this

country where an individual works through their lifetime in an organization periodically being promoted to a position of higher responsibility and pay and then at a certain plant leaves and stop working altogether. that is a list typical pattern today than it was a to migration ago, and i think it is going to be substantially less typical pattern, a generation from now. how we adapt to take a vantage of the tremendous human resources that we have at our disposal as and vegetables adjust their effort over the life cycle will life and be a very substantial challenge. i don't think there will have been a more consequential decade in economic policy than the decade we are now entering.

at least not in more consequential decade since the 1930's. i think retirement security issues are a crucial part of that and i think the contribution of research like that represented here will be very substantial. thank you very much. [applause] i would be happy to answer a couple of questions. yes, sir. >> mike wind, drawing down a little further what you see as a possible consideration to amending the tax law in terms of encouraging phased retirement so people can retire and take a pension eligible and not be taxed as such vintage if they

should go to work or work part-time somewhere else. >> how do i answer that question? the [laughter] experience teaches me something like that is difficult. if i say we are open to all possibilities you will write a headline that says summers open the possibility of pension reform. [laughter] if i say no that is not something we are considering you will write summers writes out alternative so that the question of how to give an answer that will not change your prior probable blood on that question at all. [laughter] is a very difficult one but i think the answer has just occurred to me you should continue to believe whatever prior probability you attach. [laughter] [applause] to that question as we move forward. yes, sir.

>> are there any differences -- >> what is your name? >> [inaudible] >> wait mic. >> al mulken, a and media. are there any differences looking towards a retirement and investing that you feel safe in talking about differences between men and women? [laughter] [laughter] you have just put at substantial risk the health of my staff. [laughter]

the watch my introductory remarks with considerable anxiety. they've just been breeding i suspect a sali of relief because i had not announced my intention to be provocative and now you have just put their health at risk. i think i will move to the next question. >> i would like to give you -- [inaudible] when is the administration going to address social security [inaudible] >> over the course of the president's term the administration will i am confident address social security and i think it will address social security from the perspective that in an increasingly uncertain world, on certain because the greater volatility in financial markets that we spoke of, on certain

because the greater leverage in households find themselves with, on certain because if you want to speak in a blunt way about the value of people's human capital is much, much more on certain in a volatile economy that the protection of what is the bedrock of the system has to be an absolutely central value, and so reforming social security in a way that will assure people that is something they can rely on, that is a base from which they can build their retirement, there'd retirement security what i am confident to be at the center of any approach that

would be -- and the approach that would be taken. >> one last question. >> yes, sir. >> wait for the mic. >> i would like to point out the social security. i have been studying the actual basis of social security for about ten to 15 years, and my conclusion has been that the actuary of the social security with the backing of the trustees who are normally conservative came up with a set of assumptions which made the cost higher than they should be in use an appropriate set of assumptions then there is a slight profit and not a deficit in social security. secondly you have to take into account the intermittent, what you're thinking about in future social security that there has been a tremendous demise of the ability for people to have retirement plans through their corporations or through their

own efforts. a lot of plans are being terminated, people are thrown out on the stock market as you point out is so volatile and that contrary to the normal i think that you should be considering raising the social security benefit to the current 41% of the average worker up to 70% and it wouldn't cost that much for a variety of reasons and i would hope you think about these things and not think it in negative terms but the mix of volatility in human capital going down, think about it positively what could be accomplished. >> 41-70. i am not the person to make the most provocative suggestion. [laughter] at this session. more seriously, sir, with respect to the projections there is a range of view and i appreciate stores and others have different views. i see my friend, steve ross,

who's got so much experience with how these projections played out and obviously any effort at 75 years forecasting is has to be viewed with enormous uncertainty. i think you're absolutely right and i should have said when i spoke about the increased uncertainties in the world the movement from defined contribution, from defined benefit to defined contribution plans and the increased uncertainty defined with benefit plans is something that i should have -- that i should have mentioned as well and that's obviously a factor in the equation as one thinks about social security. thank you very, very much. [applause]

larry, thank you very much for joining us today. i will report back when i get back to cambridge teachers at mit and harvard proud with using posterior in answering questions from the media. we will try as best to continue to write the kind of working papers you and your staff will find productive and useful in the future. i believe we now take a brief break to return to the regularly scheduled program and we will rejoin very soon. thank you all. [applause] [inaudible conversations] [inaudible conversations]

[inaudible conversations]

help is c-span funded? >> donations. >> federal funds or grant funds. >> mabey private contributions. >> honestly i don't know. >> i but say commercials. >> advertisement. >> something from the government. >> 30 years ago america's cable companies created c-span as a public service. a private business initiative, no government mandate, no government money. and now, getting ready for the h1n1 swine flu event with the white house director of medical preparedness and officials of the federal emergency management agency. this is about an hour. >> me i have your attention please? thank you, glass-clinkers.

good afternoon everyone. i hope you've enjoyed your lunch. we are going to start the luncheon presentation today to pleasure to introduce the next speaker to do, dr. richard hatchett. dr. hatchett is the director of medical prepared this policy of the white house national security staff, and he is here today to teach us more about the h1n1 virus, to provide some historical perspective and to discuss what goes into a community of resilience. in addition to his role in the white house, he's also been the associate director for radiation countermeasures research and emergency preparedness at the national institute for allergy and infectious disease overseeing a program that develops drugs and devices to prevent or mitigate the effect of radiation exposure. and 2005, 2006 he served as director for why you defense policy on the white house homeland security council and was a principal author of the

national strategy for pandemic influenza implementation plan. dr. hatchett served as the director of preparedness where he worked on a wide range of bigler defense issues including the delivery of mass prophylaxis to urban populations, malling and public health policy. dr. hatchett completed his undergraduate and education at vanderbilt cornell medical center and fallujah and medical oncology at duke university medical center. so as you can see we are in very good hands. we are extremely fortunate to have him with us today. i give you dr. richard hatchett. [applause]

>> karen, thank you for that kind introduction and to fema and the administrator fugate and deputy administrator manning for a inviting me to address you on this very important topic. unfortunately, this is the only part of this conference i have been able to attend. it looks like a fabulous conference. i've been to the annual conference for the medical research corporation on a couple of occasions in the past and i always found this to be terrifically inspiring. a great opportunity to learn, to hear from people working in local communities about what they were doing and i am sure that this conference will fulfill the same function for all of you and i am sorry i have not been able to participate or will be able to participate in the session is going forward. it is terrifically inspiring. in thinking about the conference and looking over the sessions i was reminded of justice louis brandeis comment that the only

title in the democracy superior to that of president is that of citizen. all of us are citizens and all of us contribute to the wellbeing of our communities and ultimately to nomination, and that is what i am going to talk to you about today in the context of thinking about h1n1 influenza, the unfolding pandemic we have been observing for several months now and that we anticipate will result in increased disease and illness and unfortunately def and our communities in the months to come. at the national security staff i belong to something called the the resilience director, it is a new director at within the national security apparatus that focuses on preparedness and response to disasters and in this case public health crises. resiliency has been a buzz word in the preparedness and response community for several years now but it's not necessarily

something that is easily defined and we talk about a lot. we tried to foster it and hope to augment the we often don't have a terrifically clear idea or fixed idea what we are talking about. i want to just start to my remarks by referring to an attempted definition by a fellow named meshaal brenau, the director for the center of earthquake engineering research at this date of new york buffalo. he has devised a framework he calls the four r's, he talks about robustness to withstand stress with minimal loss of function. he talks about redundancy as the availability of substitute, things that can be switched and if a particular aspect or component of the community or critical infrastructure fails.

he underscores the importance of resourcefulness, the capacity to identify problems and mobilize responses and finally he talks about rapidity which is the ability to address priorities in accomplish goals in a timely fashion. i think we are going to have to draw on all four of these elements as we move into the fall and i am sure all of your organizations, the constituencies you serve, and republics will contribute in their own unique way to enhancing the capabilities in this regard. >> would you advance the slide, please? a little bit of technical

difficulties. the advice to me, they said blackberrys can interfere with your remote and i said there are probably 700 blackberrys in the room. [laughter] that doesn't bode well. so, please bear with me as we move through this. i'm going to talk about four things basically. i'm going to get an overview of the current situation. but i will not do is make predictions. it is anybody who is and the flu business knows it is unpredictable. it is a dangerous business to be in the business of flu prediction so i will talk about where we are now, and i will look to some historical examples to tell you how these things have unfolded in the past and the hope that will inform your understanding what we might face or at least what we think we should be prepared to face potentially. i will spend some time talking about the vaccination program. it is by no means the only part

of our response, but it is a very important part of the response and likely to be part of the response in many of you and your organizations may become involved in in a volunteer capacity going forward and then i will just complete with overarching thoughts and comments. >> so the current situation i am going to show you a couple of maps. i will walk you through them individually. these are the maps prepared by the who. they listed the remarkable speed in this case with which the virus is spread. the orange colored countries are countries that have now officially confirmed cases of h1n1. the circles represent according to the legend in the lower left the number of deaths that have occurred in each country. what you can see is that today to the virus has spread

globally. the blank spots in africa are a little difficult to interpret. africa is a area. it doesn't mean the disease is not necessarily there but almost every effort disease in the world we have documented disease. the western hemisphere has been most affected to date, not surprisingly because of the origin of the virus in central america probably early in the spring. this is a chart prepared by w.h.o. and i draw your attention to the fact that the data is only from july 19th. ordinarily if i were standing up to prison data from january 95 would say this is hot data. and any case this is merely an

eon ago and the terms of how fast it is spreading but there has been widespread disease particularly in the western hemisphere almost all of the western hemisphere has now experienced widespread disease, and at that time australia and new zealand were not clear, apparently they were not reporting data but now there is widespread disease and new zealand, thailand, and certainly great britain. this as a slide that represents an effort by w.h.o. to illustrate the intensity of spread, meaning of the burden of acute disease that has been observed in the affected countries. lots of the countries are now reporting so this is kind of an incomplete mad and again this is data through july 19. you can see the united states has been deemed by w.h.o. to

have a low or moderate intensity today. we have had lots and lots of disease but we are a very big country, and except for a few local outbreaks like the outbreak and new york city and and milwaukee the general intensity of transmission that we have seen has not been overwhelming yet. canada has seen a little bit more, mexico certainly had a large outbreak in the spring that has continued to perk along and they are now seeing increased disease transmission and the southeastern states in the yucatan peninsula. in particular, the nations of the southern hemisphere have demonstrated very high intensity of transmission to date. that is not surprising. the flu seasons are reversed seasonally said they are in the middle of their high transmission flu season right now. we've been watching the nations of the southern hemisphere during closely particularly nations like australia, new zealand, argentina, chile,

uruguay to some extent that have similar social demographics and standard of living to the united states trying to discern patterns that might help inform planning and prepared this for the fall. .. and people go skiing and do the sorts of things that you do in the winter. argentina took a quite aggressive stance in tomorrow -- terms of their winter break. actually extended it.

ordinarily would have been about two weeks. they started it early on july 6th and they extended it through august 3rd. so the schools were out for almost a month in argentina. and they have gone back into session and we continue to watch. they are still in their high transmission season. it will be very interesting to see and they had quite intense disease. it will be interesting to see what happens going forward so we continue to observe that closely. i should warn you actually before we get too much farther into this talk, i belong to the band of what we call flu walks and flu walks like to put up lots of curves of lines going up and coming down. and so you will see lots of curves of lines going up and coming down and i will try to explain what those mean. but it is a unfortunate habit of people like me. so you'll have to forgive me. there will be a walkish element to this, but i'll

try to keep it at a high level. a little bit about what's going on in the united states. we have had disease transmitting in the united states really actually since early april. the first cases of h1n1 influenza were diagnosed in the united states in california and texas before the mexico outbreak was reck nitsed to be an influenza outbreak and those samples were collected early in april so we have hamed haddadi zev -- we have had several months of flu transmission. flu transmits rapidly 2-4 days of a person getting sick they have transmitted it on to others. at this point it is very difficult to know how many cases we have had in the united states. cdc some time ago publicly estimated there had been greater than a million cases. if you talk to people in the flu modeling business and

there is a minor industry of flu modeling you'll get various estimates as to the number of cases we've seen to date. i have heard privately estimates ranging from 1.5 to 10 million cases in the u.s. to date. no one knows for sure. but it's been a lot. we now have cases in every state every jurisdiction. we have seen to date as of august 6th we have seen about 6500 hospitalizations where h1n1 has been confirmed and we have also seen 436 deaths. that suggests to us given the estimate of the cases, that suggests that the overall case fatality rate, the risk of any given individual actually perishing from flu is quite low which is reassuring but the aggregate numbers as the disease spreads through the community and spreads throughout the nation you know will grow. in a way that we unfortunately

would not like to see. one of the defining characteristics of this virus is that it seems to be targeting our younger populations. the attack rates in younger populations or rather not the attack rates necessarily but the percentage of total cases observed in younger populations is quite high. this is a chart showing some cdc data as of a couple of week ago. showing that about 60% of the cases have actually occurred in people younger than the age of 24. influenza is a disease transmited to populations for a variety of reasons. even with seasonal flu we see more cases in younger people. we don't necessarily see more deaths or more sopt -- hospitalizations because the people who tend to have a problem with influenza are

people with other medical conditions. the aged whose immune systems decline. people with immunosuppression. so on and so forth. and those people there are greater concentrations of those people in older age groups this is very, very striking what's particularly striking is the low number of people even after the virus has been transmitting in the united states for months over the age of 50 who who have been documented to have illness and the informed scientific speculation there. is some data to support this. informed speculation people who were born before 1957 likely had exposure to previously circulating h1n1 viruses that circulated between 1918 and 1957 which appear to be a little more closely related to this particular virus than the h1n1 viruses that have been circulating since 1977. and so just to be very clear, h1n1 viruses have been

circulating in the united states for 30 years this is a very different h1n1. it is genetically quite distinct from the h1n1 viruses that we've had circulating for the last 20-30 years and immunity to the viruses that we've had circulating does not seem to provide a great deal of immunty to the current virus but exposure to the viruses that circulated before 1957 the guess or the informed guesses i was saying is they do provide some immunity which may explain why the attack rates are so low in oldser populations. that same phenomenon might explain why we have seen a disproportionate number of hospitalizations in younger populations. as i said with seasonal influenza the usual pattern that we see is that the burden of severe disease, the burden of mortality tends to cluster at the extremes of the age spectrum. either in the very young.

those younger than the age of about four and in those over the age of 65. both for hospitalizations and for deaths. what we are seeing with this virus is among those hospitalized the lrnest -- largest proportion ant 50 -- about 50% are younger than the age of 24 and there are a substantial proportion in the age range of 25-49 who are also being hospitalized. this does not necessarily mean that the absolute numbers of people in those age groups who are being hospitalized is greater than with seasonal influenza we simply don't know yet because we don't know how many cases we're going to have. this is something we'll figure out retrospectively. but there is a striking absence or not complete absence but a striking reduction in the number of hospitalizations and deaths occurring in the older populations.

just to give you a sense of the burden of disease that we have seen to date and that we may seen in the fall this is some data from new york state. what you can see here, the four curves represent the number on hospitalizations by week so week one is the first week of january you know, so on and so forth. week 52 is the last week of december. number of hospitalizations by date in new york state with confirmed influenza over the last four influenza seasons and what you can see is that the 2008-2009 season up until the spring had like 2005-2006 and 2006-2007 been a relatively mild year as far as influenza was concerned in new york state. 2007-2008 was a bit more

intense in new york state and you had more cases of influenza hospitalization mostly occurring in the february-early march timeframe. this is what happened after h1n1 came out. as i said, new york city had particularly large outbreak. the new york city department of health and mental hygiene based on some subsequent surveys that they did estimated that about 10% of the population of new york city actually fell ill with h1n1 during their spring outbreak. what you can see is that the large outbreaks in the new york city area and that spread into other parts of new york state resulted in a striking increase in the number of people who were hospitalized. just to, reference point to frame this up we formally would expect 5-15% of the population to develop influenza during a typical seasonal flu year.

they had about 10% roughly. again, these numbers are not certain. these are best estimates at this point. but they estimated about 10% of new york city's population developed influenza. that was almost like a winter's worth of flu in the spring. historically when we look at previous pandemic we have estimated that the overall attack rate. the overall percentage of the pop that -- population that will become ill during course of the pandemic somewhere on the order of 25- 35%. so the outbreak in new york state while it was a substantial outbreak, doesn't really compare in its extent or intensity with what we have seen with previous pandemics. as i said, i'm not going to hazard any prediction because influenza is inherently unpredictable.

come to the issue of the mortal patterns that we are seeing. again, as hospitalizations we are seeing an unusual distribution of mortality. i want to underscore that is distribution of mortality. i don't want to -- e don't want any of you to walk away saying we know we are having more death inaggregate than we would have in these age groups with seasonal influenza but look at the total numb boefr deaths and which age groups they fall into. this is not a pattern that we see with typical seasonal influenza. there is as i said a striking reduction in the elderly population. this is a slide from mexico comparing h1n1 distribution of mortality. again not absolute numbers but the distribution of mortality with the last two seasonan -- seasonal flu

years the last two flu years are the white and blue bars and show the typical pattern of seasonal influenza mortality roughly 90% of the mortality is observed in the people who are 65 and older and a large portion of the rest of the mortality is observed in the population between the ages of 0 and 4. that is as you can see with the orange bars which represent the distribution for h1n1 not what we are seeing with this virus. the last issue i want to touch on is certainly the issue i think everyone is most sensitive to. which is if this is a virus that is largely affecting young people unfortunately it is also causing some deaths in the pediatric populations. typically and i show this slide to illustrate what wove seen to date with what

we've seen for the last few years. this is cdc data. cdc has under taken to trying to keep track of pediatric influenza deaths as a result of the 2003-2004 flu year where there was, i don't know if any of you remember this, but there were stories about increased number of deaths in children from influenza that year and the vaccine was late. there was some scarcity issues with the vaccine initially so it produced a lot of anxiety. in 2003-2004 we had 150 or so deaths in children that were directly attributed to influenza and the average number of deaths that we see during a normal typical season of flu year in the pediatric population is somewhere on the order of 60- 100. it varies year to year. depends on what the dominant strain that's circulating is. but it is somewhere in that

ballpark. the curves in purple and the one yellow slot represent the pediatric deaths that have been reported to date for one one. -- h1n1. so we have had roughly 29 or 30 pediatric deaths so far. and we again, we don't know how large of an outbreak we've had. we don't know how large of an outbreak is coming but there is reason to be concerned we will see sub stan,ly larger out breaks in the future. so we don't know where this number will end up but it will certainly be -- these are very poignant deaths they aa lot of attention. they typically are report certainly in local or regional newspapers. this is something we'll be keeping a very, very close eye on as we go forward. it certainly contributes to public perceptions of severity of the outbreak. for obvious reasons. talk very briefly about some

of the social disruption that we saw in the spring. when the pandemic began the reports that were emerging from mexico initially were very concerning. we were hearing stories about hundreds or thousands of young people who were becoming seriously ill requiring hospitalization many young people on venn tilllators. many young -- ventilators and many young people dying. at that point in late april, it was i believe april 23rd when we got confirmation back about the first mexican islets. it was not clear how large the outbreak in mexico was. so cdc took a -- they erred on the side of caution in terms of making recommendations about school closures and they recommended that schools close at relatively low burdens of disease and what you can see, the blue kurp -- curve represents the number of schools that were closed on

a day by day basis in late april and early may. it peaked around 726 schools that were closed because of influenza affecting almost 470,000 students. this was obviously quite disruptive. and i have to say that cdc is to be commended for working very, very rapidly to gain a better understanding of the virus and to understand that the disease was much more widespread than we had initially understood and that the actual average case of h1n1 disease was much less severe than we had initially feared might be the case. so taking that context they adapted their guidance very, very rapidly and i believe on may 4th or may 5th provideded guidance saying it was not actually necessary to close schools at first sign of influenza and you can see the sharp decline in the number of

schools that were closed. that kind of contextual adaptation i think is going to be very, very important as we go forward into the fall. i mean, we in the government are bureaucrats and we don't typically work at lightning speed but cdc worked very, very rapidly to sort out what was happening and to provide the best guidance and best science and form guidance that they could. as many of you have heard they release their new school guidance on friday where the goal will be to keep schools open but safe. and to focus on ways to protect both the general student population particularly the vulnerable populations within schools. and we will continue to look at our guidance and revise our guidance as contexts change and we'll continue to adapt and you and your local communities will have to do the same thing. you'll have to look at the situation in your community and make adjustments as we

go along and you need to be ready to adapt in that rapid fashion as circumstances dictate. i should point out one other interesting thing about this chart is that even after the guidance to reopen the schools was released, it was still necessary all the way through may to close some schools. there were reasons to close the schools. the number of students or teachers who were absent were simply too high to allow useful educational instruction to occur so school closures were observed throughout the rest of the spring but at a much redpes -- reduced rate and thus with much less social disruption than we witnessed in the early part of may. i would anticipate that we are likely to see even the guidance you know; is to try to keep schools open and make sure they are safe environments for our students. i would expect that we will see some school closures in the fall and i think it is important for all communitys to anticipate that they may occur and to work with

students and families with the educational community to try to ensure that useful instruction will continue. that parents are able to adapt if and when they need to in the event that a school here or a school there or even perhaps school district were to close. so being prepared for that doesn't mean having to implement it. it just means that it is something that may happen. may be forced upon us by circumstances. so just to summarize that's kind of the end of the situation update. the good news, if there is some good news is the overall case fatality rate appears to be quite low. we can't really put a fix on that, but it seems to be somewhere in aggregate of the range what we see with seasonal influenza the challenge going forward into the fall is we may see a substantial increase in the burden on disease perhaps by

as much of a factor of two or three. not to say we're totally out of the woods but we are certainly not dealing with the strain or 1918 virus. so what we also are seeing from our viral logic surveillance both domestically and abroad sequencing new viralized islets and the viralized islets we've seen before. virus is not mutating in any significant way that would increase its severity or transmisability. seems to be behaving best was we can tell as it behaved here. transmitting perhaps more efficiently because in flu season but the virus seems to be the same virus. with the exsubpoenaings of a few isolated instances the virus continues to be sus acceptable -- susceptible to tamiflu and the other main

anti-viral drug which is good news. so i want to talk a little bit about historical since i sad i wouldn't make any predictions i want to talk about our historical persistence. these charts i hope everybody can see. we'll try to have the arrow to walk you through this. but they are basically illustrations of the epidemic kufrp -- curves of the last four pan dem ix in different locations. there was a pandemic in 1889. obviously you heard about the 18 pan -- 1918 pandemic one that started in 1957 and one that started in 1968 the reason i'm putting this slide up is to illustrate something that's very important to understand about pan dem ix. pan dem ix are multiwave -- pandemics are multiwave, multiyear events. we are heading into what will likely be the fall wave

of the 2009 pandemic. but previous pandemics have returned over several years to cause enhanced mortality. higher rates of hospitalizations and death over several years. the 1957 pandemic you can see there was in the lower left corner in 1957 in the fall there was a sharp spike and then a fairly dramatic decline in the number of deaths that were observed and then it returned in the spring. so we need to mentally prepare ourselves for the duration of the campaign we're about to face. we are racing against the fall wave in an effort to develop a vaccine that we hope we can get to people to protect large part of the population. but even if the fall wave beats the vaccine it doesn't mean that we were too late because this is likely to be an event that will occur. we may see a spring wave. we may see a wave next fall.

we may see a wave the following spring. we don't know and so the effort to immunize the public will be critical even if the virus happens to get here before the vaccine does. we are moving as fast as we possibly can to make sure we have the vaccine available. but it is not all about the fall. just to illustrate another point about pan dem ix -- pandemics this is deep into the won i can part of this talk. i'll try to get away from these curves that go up and go down. in previous pandemics just so dwlu know we have seen -- so you know we have seen this same skewing of attack rates towards younger populations. it is very characteristic of influenza because of the social environments that we live in because of the social environments that our children live in that attack rates are higher in children. there's nothing peculiar about this epidemic except

perhaps the amplitude of the case burden we're seeing in younger populations if the reason i show this to you is the blue curve is, represents the age specific clinical attack rates of the 1957 virus which was actually different from the 1918 and the 1968 viruses. the red and the green curves. in the striking propensity for attacking younger populations. 1957 for the people who lived through it and experienced it was a pandemic that was triggered by the opening of the schools in the fall. a lot of us now are look to the 1957 pandemic as a potential guide to what we might expect because of the way this virus seems to be behaving. so inted of looking to 1918 which is everybody's worst-case scenario. a lot of us are now trying to learn more about the 1957 pandemic and trying to understand the dynamic of

that event. so a lot of the slides i'm going to show you actually relate to the 1957 pandemic not to the 1918 pandemic. i'm sure all of you have seen lots of presentations about 1918 before. these are mortality curves the dotted line represents mortality. in england the solid line represents mortality and in the united states. the only reason i show this is just to point out the fact again as i said this is likely to be around. the 1957 pandemic was a pandemic which caused higher rates of mortality for about six or seven months once it actually started. 1957 and 1918 actually are important examples for us historically because they were the two pan dem ix where we knew that the pandemic virus was circulating in the united states in the late spring and early summer and sort of

percolated through the summer. in 1957 there were as this year there were a number of outbreaks in camps boy scout jamboree. there was a big outbreak at the boy scout jamboree and that was observed throughout the summer. i had an opportunity to spend a couple of hours with dr. da henderson most noted for leading the who smallpox eradication program. but in 1957 chief operating officer for alex at cdc in performing epidemiology and surveillance related to the 19 a 7 -- 1957 virus and he gave a wonderful metaphor for what they experienced. he said it was like the virus laid down a bed of roots throughout the summer and then when conditions were right, in this case when schools reopened the virus just came up like the grass in spring. it just came up everywhere at the same time. he said it was just almost overwhelming how quickly it happened.

and that is a useful analogy i think. it certainly is governing our efforts to prepare for what we might see in the fall. again, we can't know anything for certain. this is a chart to illustrate how quickly the virus spread. this is how they tracked its spread in 1957 in real-time was actually just counted the numbers of counties reporting out breaks. so this chart shows how the virus over september and october peaking around the week of october 19th rapidly spread to hundreds and hundreds of counties and each county would then have an out break that lasted 6 to 8 to 10 weeks. so that by the time you were at the peak you were probably looking at 1500 or 1800 counties that were having simultaneous out breaks. that just absolute diffusion of disease would place

insurmountable burdens on the federal government's ability to respond to all the communities at the same time and this is a message everyone has heard the communities are going to have to draw deeply on their own resources if and when this actually occurs. subsequently in 1957 they through the use of survey tools they went back and tried to recreate the actual case curve and they estimated that that week of of course 19th the week when the epidemic peaked about 12 million people actually became sick and had to stay home in bed for at least one day during the peak week of the 1957 pandemic and that was over a denominator of a total population in the united states of about 170 million people. so that was i don't know 7-8% of the population becoming sick in one week. this is kind of a complicated chart. it shows absenteeism in

schools. i think this is an issue people will be very concerned about this fall. in 1918 there were actually very few cities in 1918 that left their schools open. only three that i'm aware of. new york, chicago, and new haven. and chicago kept the best records and they looked at absenteeism in the different parts of the city over time and what you can see look at the chart is absenteeism in the chicago schools peaked around 40% right at the peak of the epidemic. it actually peaked as the number of deaths were peaking and because deaths are delayed by a week or more after cases, a lot of the absenteeism in chicago kols was problem pi -- schools was probably driven by parental fear and anxiety not by student illness. those anxietys and concerns were dramatically reduced in 1957 because the vie -- virus was much less lethal in its effects and absenteeism in 1957 peaked in most

schools around 20-30% in the schools that were studied. it was a little bit higher in high schools than it was in elementary schools. wasn't more -- weren't any absolutely clear patterns about which types of schools were affected first. slight preponderance of high slight -- schools affected before elementary but some where elementary were affected first so likely to be a mix this fall. at&t was one of the largest industrial concerns in the united states in 1957 and actually went back and looked at the average absenteeism for at&t across the nation over the course of the 1957 pandemic and the average absenteeism spread out across the whole country peaked at around 2-3% above base line. but that was averaging across the entire country. in specific locations. they saw absenteeism up to 8-10% above their base line absenteeism.

i want to move quickly to talk about the vaccination programs. our vaccination program. we've got a couple of historical analogys to look at in terms of semi emergency vaccination programs. i'll talk briefly about three of them. one of the most famous many of you may have heard stories about this was the 1947 smallpox vaccination program in new york city. a traveler came back from mexico developed a form of small pock that was not -- smallpox that was not as easy to diagnose as classical smallpox. moved around the city for several days. caused a few more cases of smallpox so they implemented a crash program to vaccinate the entire city. new york city succeeded population then was probably about 8 million people. they claimed to have vaccinated around 6 million people within about a month. there are others who have gone back. infectious disease specialist in new york city

has gone back and looked at it he thinks they may have only vaccinated three or four million people. we don't know for sure. but it is certainly part of our collective memory in the emergency preparedness and response community as to what can be achieved when the population is with you and has incentive to be vaccinated. another example that bears scrutiny is the 1954 polio vaccine trials this was the largest clinical trial ever conducted in the united states. it involved about 1.3 million students. in the spring of 1954. david wrote a book called polio an american story that won the pulitzer prize for history in 2006. all about how this stood up. very interesting study. it's not a perfect example and of course it was a successful campaign. it was not a perfect example because it was a clinical trial so there was lots of additional recordkeeping but i should say that in

standing up a vaccination program where you were targeting 1.3 million students they had to get the assistance of something like 50,000 physicians. almost 200,000 volunteers to stand that trial up. that is just to give you a sense of the magnitude of what we might be facing going forward we talk about trying to vaccinate 100-150, even 200 million people or as many people as want to be vaccinated actually. the last example that we have looked at and many of you have heard or remember the swine flu fiasco as it is known popularly. in 1976 there was h1n1 outbreak at fort dix. a young soldier 22-year-old young man died. this was the first time that h1n1 had been seen in the

>> espn's michael smith on what's next for donte' stallworth. >> now that it's official and donte' stallworth knows that he's out for the entire 2009 season, where does he go from here? in life i think it's two things. one, i think he continues the try the heal and come the grips with the fact that he caused the death of another human being. also look for him to be an advocate, a spokesperson, trying to prevent others from making the same mistake he did, drinking and getting behind the wheel of a car. in terms of his playing career, obviously he's out for all of 2009. no one knows what the browns will do with his rights, but i do expect donte' stallworth to play in the nfl again after roger goodell reinstates him following this season. he's very well regarded in terms of his character and the type of person that he is. this mistake notwithstanding, he's a talented player, hasn't always lived up to it, but he'll get that opportunity i believe after his suspension is completed. >> in a statement stallworth said:

we're going to show you his e60 interview with michael smith coming up in moments including watching dante listen to the 911 called he made after striking mario reyes. first some afternoon baseball. the games themselves allow us a respite from the serious news. red sox looking for a four-game sweep of detroit after getting swept by the yankees, but justin verlander, who hadn't been a great stopper in his career, e.r.a. 5.94 when detroit was facing a sweep, he was great today. struck out eight. top of the fifth, boston getting some good defense. chris woodward, casey kotchman tags polanco. red sox stick around, but ryan rayburn crushes clay buchholz's offer in the top of the seventh, 2-0 the final score.

the tigers prevent the sweep. boston going to go to texas this weekend for a game that might shake up the a.l. wild card because the red sox went into today a game and a half up. they lose, guess what, the rangers win in cleveland to wrap up their ten-game road trip. josh hamilton 4-4, hit .486 on this roady. el vin andrews goes yard, as well. the rangers half game behind boston in the wild card standings. they'll host the red sox this weekend. the chicago cubs' g.m., manager and chairman have all apologized to shane victorino after a "fan" threw beer on him last night while playing. the phillies' center fielder has filed an official complaint with police in chicago and says he will press criminal charges. cey on the field today, phillies looking for their first sweep at wrigley field in 25 years.may didn't get any help from jim belushi. had trouble deciding to -- where

to throw the first pitch and flip or somersault. ryan howard, a three-run homer, his 27th of the season. in the fourth, more damage. dempster serves it up to pedro feliz. the phillies coming off the sweep at the hands of the marlins come around and turn it on against the cubbies. it helps when you got cliff lee on the mound. now 3-0 since coming to the city of brotherly love. he shuts down chicago, 6-1 the final score.ng. the phillies are in atlanta this weekend. the cubs host the pirates. the padres looking for a sweep in milwaukee. prince fielder, first pitch he sees, that goes to pretty much deloitte where he used to play for the snappers. but the major league brewers up 1-0. j.j. hardy sent down to the minors. bill hall demoted.

opposite field in the fifth inning, his fourth multihomer game this season. mike rivera the camper had two homers, as well. milwaukee wins it 12-9. up next, donte' stallworth, the e60 interview with michael smith. it is gripping television and it's next on