“No [Chinese] province had more than fifteen hundred cases outside the Hubei province,” Gottlieb said, referencing the epicenter of China’s outbreak. “In the United States right now, there’s nine cities that have more than 1,500 cases to date.”
Gottlieb’s list of U.S. cities he’s “very worried” about include New Orleans, Atlanta, Detroit and Los Angeles, based on a mix of factors.
For instance, Texas has allowed local officials to take the lead on coronavirus response, and that’s meant “we’ve seen slower decisions and not a lot of testing,” Gottlieb said, suggesting that the extent of the outbreak in that state is under-counted. “I’d be worried about Dallas.”
Meanwhile, “you have to worry about a city with a mass transit system because of what we’ve learned about the transmissibility of shared surfaces,” Gottlieb added, pointing to Chicago and Boston as cities where the virus could spread on buses and subways.
“Parts of California, Seattle, I don’t think are out of the woods,” he added, noting that he’s worried about a slow response in the Miami area too.
Gottlieb, who practiced in New York City earlier in his career, said he’s upset to see the city’s health workers and hospitals be overwhelmed by surging demand — with the worst yet to come.
“It’s the best health care system, I think, in the country,” Gottieb said. “But we’re going to see it, in about a week, be maxed out.”
“This is like nothing anybody’s ever seen before who’s practicing medicine, who’s alive today,” he added.
However, Gottlieb said he agrees with President Donald Trump’s goal of trying to “open” the country back up in the coming weeks.
“We can gradually take off some of the most onerous [restrictions] in parts of the country where we’ve broken transmission, where the virus isn’t circulating anymore or circulating at a low level,” Gottlieb said. But he subtly broke with Trump’s goal of ending social-distancing restrictions by Easter on April 12, suggesting that the U.S. outbreak would peak “probably more likely late April, but maybe mid-April if you believe the optimistic scenario.”
“We’ll be coming down that curve hopefully in May and into June,” Gottlieb added, suggesting that it could be months before disease spread is truly under control.
The former FDA commissioner has maintained a line to the Trump administration throughout the crisis, offering private advice to senior officials. POLITICO last month reported that the White House considered tapping Gottlieb to be the administration’s “coronavirus czar,” before opting for AIDS expert Deborah Birx in a similar role. Birx on Thursday said that some predictions about the outbreak are overblown, warning against worst-case scenarios that she says aren’t reflected by current data.
Gottlieb disputed that he was a “shadow coronavirus czar,” saying that White House officials are “dealing with a much broader range of issues than I am” and that his work was “narrowly focused” on long-term planning to fight the outbreak, like the need to get treatments online and take preventive measures like using copper on shared services, which works to curb coronavirus transmission.
“I’m trying to think about August. I’m trying to think about the fall,” Gottlieb said. “I’m trying to think a little bit about the future, about when this immediate crisis passes.”
Gottlieb also dodged a question about whether he’d formally join the administration’s response. “It’s terribly hard to be on the outside and not supporting my former colleagues and doing and participating [in] the things that I know can help improve the outcome,” said the former FDA commissioner. “As far as the role I’m going to play, we’ll see.”
“Everything I’m saying on the inside, I’m saying on the outside,” he added. “You want to know what I’m telling policymakers, follow me on Twitter.”