How Have We Handled Swine Flu? The danger from swine flu may not be over, but many complain that the threat was overblown. Students have returned to their desks, and the World Health Organization sees no signs of the virus going from person to person outside of North America. Neal Conan talks with medical experts about how the outbreak has been handled.
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How Have We Handled Swine Flu?

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How Have We Handled Swine Flu?

How Have We Handled Swine Flu?

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This is TALK OF THE NATION. I'm Neal Conan in Washington. According to the World Health Organization, 30 countries officially reported 5,251 cases of Influenza A H1N1, more popularly known as the swine flu. Fewer than 100 people have died from the disease worldwide.

Given that, many now wonder what the fuss was all about. Was it really necessary to close hundreds of schools and cancel cruise ships and airplane flights to Mexico? Some people avoided flying anywhere: this from Vice President Joe Biden on NBC's "Today" program.

(Soundbite of television program, "Today")

Vice President JOE BIDEN: I would tell members of my family, and I have, I wouldn't go anywhere in confined places now. It's not that it's going to Mexico. It's you're in a confined aircraft. When one person sneezes, it goes all the way through the aircraft. That's me. I would not be, at this point, if they had another way of transportation, suggesting they ride the subway.

CONAN: Which might sound a little panicky right now, but many experts warn we should not use the past tense to talk about this virus. It could mutate in a matter of months and still has the potential to infect tens of millions of people. But with mostly mild cases and relatively few deaths so far, at least compared to past influenza outbreaks, was this overblown?

How has the swine flu affected your life? If you're listening in Mexico or along the border with Mexico, we'd especially like to hear from you. Give us a call, 800-989-8255. Zap us an email. That's at You can also join the conversation on our Web site. Go to Click on TALK OF THE NATION.

Later this hour, Rachel Lehmann-Haupt joins us to talk about the debates that attended her decision to freeze her eggs, but first, how did we handle swine flu? We begin at the Centers for Disease Control and Prevention with Rear Admiral Anne Schuchat, the interim deputy director for the Science and Public Health Program at the CDC. And Dr. Schuchat, nice to have you today on TALK OF THE NATION.

Rear Admiral ANNE SCHUCHAT (Interim Deputy Director, Science and Public Health Program, Centers for Disease Control and Prevention): It's a pleasure to be here.

CONAN: And how would you gauge the government's response to this outbreak thus far?

Rear Adm. SCHUCHAT: You know, I think that the government has worked aggressively and actively to learn what we could about this new virus and to try to take steps to protect the American public and work in partnership with those around the world. I'll look forward to the reviews from others who are less biased than I am about how we've done.

CONAN: But it sounds as if, at least thus far, you think you did the right thing.

Rear Adm. SCHUCHAT: You know, we've been thinking about pandemics of influenza for several years now and trying to strengthen our preparedness should a new virus emerge that was a risk for a potential pandemic. Many of the circumstances of this particular new virus were worrisome, and I think we did really learn from our preparedness training to learn as much as we could about what was going on and intervene where we thought it was appropriate.

CONAN: And I know from your point of view, it's still going on. From the point of view of the American public, though, it seems to be over. Given that situation, is there anything, looking back over the past few weeks, that you wish you'd done differently?

Rear Adm. SCHUCHAT: I would like to say that I think it's still going on, with hundreds new cases being investigated each day and spread of the virus into new areas. So because of the way that influenza works - the way that it can evolve, mutate, change, get worse or milder - I think we're really not out of the woods as a world. And we need to pay serious attention to the ongoing transmission to what happens in the southern hemisphere and to whether this virus will re-emerge in the fall here in the northern hemisphere in similar form or perhaps even in worse form.

CONAN: Because the flu is a seasonal affliction, and it's flu season now below the equator and will be again, come the fall, north of the equator.

Rear Adm. SCHUCHAT: That's right.

CONAN: And as we look at this particular - one of the things that - you obviously have to make plans for pandemics, that's your job, and then you have to execute them. Nevertheless, you have to be concerned about the public's reaction, as well, and if the next time you warn of a pandemic or some outbreak of flu or something else - could be this one, could be another - and if everybody says oh, you know, the last time it just turned out to be nothing. I'm not going to pay attention.

Rear Adm. SCHUCHAT: The public participation in public health is vital. Informed individuals and citizens can protect their own health, the health of their families and strengthen the health of their communities. This has been a really challenging time for the public. You know, we have, unfortunately, lost a few people with the three people who died from this new virus and more than 100 people who have been hospitalized.

There have been so many questions that people had about what's going on. Will this affect me and my family? Will the school that my child goes to be closed? You know, those are tough, tough moments for people with so much uncertainty.

Here at CDC, we've just been committed to share what we know when we know it and to help people know what they, themselves, could do, and I think looking forward, there are certainly going to be emergencies in people's lives, whether they're hurricanes, tornadoes, strikes, things that you really need to be prepared for.

So I hope that people will realize the need to plan ahead and to be able to take steps to improve their own families' health and that in their community.

CONAN: And that is wise advice. Nevertheless, there were a lot of complaints, about the school-closings in particular, at this time of the year, when final exams are up, people are taking SATs, that sort of thing. Was this disruption necessary?

Rear Adm. SCHUCHAT: You know, I take those concerns very seriously. Each of the public health interventions that was taken during this outbreak has been taken trying to incorporate the best information available at the time.

There were local decisions made with additional information about the context, and of course we at CDC tried to issue national guidance that could inform those local decisions. Each intervention needs to be put in context with the potential benefits and the potential risks. And as we had been planning for preparedness for pandemics, we went through issues like school dismissals and other social-distancing steps that might be very disruptive.

In our planning efforts, we actually carried out public engagement exercises in a number of communities around the country to try to get a sense from people about what they would be willing to do, faced with a potential pandemic, what kinds of disruptions would be acceptable, what kinds would not be.

The planning exercises suggest that with a very severe pandemic, something like the 1918…

CONAN: Mm-hmm.

Rear Adm. SCHUCHAT: …interventions like school dismissals could be quite effective in slowing transmission, and we learned from those public engagements that people were willing to go through that kind of disruption.

What we learned, though, as we went through this outbreak is that this strain was not of the same severity of the 1918 strain and that the type of disruptive interventions like school dismissals would not be needed going forward. Our actions were more aggressive at the beginning, when we knew very, very little, and were lightened up as we learned more.

CONAN: Yet some people inevitably got caught in the switches. They say we were told to close for two weeks and then for one week, and now we're told we can open again.

Rear Adm. SCHUCHAT: Absolutely, and you know, the thing to remember with influenza is that it's very unpredictable. It's very dynamic, and while we wish we had all the answers, we wish we knew exactly what was going to happen in the weeks or months ahead, unfortunately we don't and so we try to take the best information available and work in partnership with the stakeholders that are really going to be affected by these things and move forward in ways that are prudent for the communities.

You know, the Department of Education has been a great partner going forward in terms of sharing information and trying to understand what are the kinds of things that we can do to, you know, strengthen the health of kids in school and avoid these dismissals wherever possible.

CONAN: Our guest is Rear Admiral Anne Schuchat, M.D., who is the interim deputy director for the Science and Public Health Program at the Centers for Disease Control and Prevention. And we're trying to figure out how we did in the swine flu, though she warns us it isn't over. We shouldn't use the past tense.

800-989-8255. How was your life disrupted? Was that acceptable? Email us, And Nine(ph) is on the line, Nine calling from Tucson.

NINE (Caller): Yeah. This is something that my wife and I had discussed with each other before, sort of what our plan would be if something were to come up, and we have five children, and we kept them all out of school for a week and a half, and I've heard of that happening a lot.

I've heard we had, in some of our schools around here, up to 30-percent absences, just people keeping their kids out, and maybe that might be the reason why it didn't get out of control as much as people thought it might.

CONAN: And so the school was not closed, you just decided to keep your kids out.

NINE: Right, right, and the reason we do that is we do have one child who is susceptible to lung infections and stuff. So the rest of the kids being at school would just bring it home.

CONAN: And could infect him or her. I understand the thinking. Dr. Schuchat, was there a lot of evidence of people just deciding to keep their kids home, whether the school was closed or not?

Rear Adm. SCHUCHAT: You know, we have information about school closures through our partnership with the Department of Education, and we've also been working with the Harvard Opinion Poll to understand the impact on people around the country.

One thing I'd like to say is that we're committed to learn the impact of the interventions that we've taken, both here in the U.S. and working in partnership with a Mexican investigation, to understand whether some of these interventions had benefits or risks that we could measure and to see whether we can go forward with better information for a future concern.

CONAN: Nine, I'm glad everything worked out.

NINE: Yeah, thank you.

CONAN: Bye-bye. Let's see if we can go next to Melissa(ph), Melissa calling from Chicago.

MELISSA (Caller): Hi.

CONAN: Go ahead please.

MELISSA: I'm a medical student, and I just had the opinion that it did seem overblown to us, just for no other reason than, you know, every day during the beginning of the news, when it was starting to come out, we were getting emails from school officials. And you know, we've taken microbiology, and we've learned about the flu, and I'm not saying that I have a huge amount of practical experience of dealing with, you know, epidemics, but the same people who were going to get the flu anyway were the people that were at the highest risk for swine flu: the young, the old, the immuno-compromised. And I don't know that having news outlets broadcasting this reaction that caused so much panic was very effective in creating an atmosphere that was helpful in dealing with it.

CONAN: Where did you see panic, Melissa?

MELISSA: News, you know, CNN, when you know, when that's all there is on the news.

CONAN: Okay, but you saw it on the news. You didn't experience it in your life. You didn't see anybody you know panic.

MELISSA: Well, I did experience it in my life because every time there was a new case of swine flu in Cook County or in Lake County, we got an email about it at school.

CONAN: I see. Well Dr. Schuchat, you can understand how somebody in Melissa's position might feel that this was, well, excessive. She could be blaming us more than you.

Rear Adm. SCHUCHAT: Well, I think there's a such a balance, you know, the need to inform and to help people be aware and to help people channel their concerns into constructive action. That's really a focus of the kind of communication we've been doing.

It's true that we can't say exactly what was going to happen and really going forward whether we'll have a worse season next fall. You know, that partnership with the public is vital, and I think the confidence people have that we're communicating what we know when we know it, and we're trying to offer people ideas about what they can do to help protect themselves.

CONAN: Melissa, thanks very much.

MELISSA: Have a good day.

CONAN: We'll talk more in a moment with Anne Schuchat at the Centers for Disease Control and Prevention and find out how the response in this outbreak compares with previous cases, also more of your calls. How did swine flu affect your life? 800-989-8255. It's the TALK OF THE NATION from NPR News.

(Soundbite of music)

CONAN: This is TALK OF THE NATION. I'm Neal Conan in Washington. According to the CDC, of those who came down with swine flu, officially Influenza A H1N1, the symptoms are similar to those of the seasonal flu bug. About 90 percent report fever, more than 80 percent a cough, 60 percent report a sore throat, roughly a quarter of people report more unusual symptoms, including vomiting and upset stomach.

Our focus today: how well did we handle the swine flu? Was this overblown? How did the outbreak affect your life? If you're listening in Mexico or along the border with Mexico, we'd especially like to hear from you, 800-989-8255. Email You can join the conversation also at our Web site. That's at Just click on TALK OF THE NATION.

Here's an email from Andrea(ph), a school librarian. I live in San Antonio, Texas. We closed down schools. The ones that weren't were wiped down every night. I don't think it was overdone. Awareness is the key, and those actions certainly made everyone more careful.

I know this was the case of everyone around me. It is better to be safe than sorry. I think the heightened efforts made everyone safer and saved a lot of people. It didn't spread because we did everything right.

Well, our guest is Dr. Anne Schuchat. She's the interim deputy director at the Science and Public Health Program at the Centers for Disease Control and Prevention. She joins us from a studio there.

Also with us is Howard Markel, the director of the Center for the History of Medicine at the University of Michigan. He's at the studios of Michigan Radio, WUOM, our member-station in Ann Arbor. Nice to have you back on TALK OF THE NATION.

Dr. HOWARD MARKEL (University of Michigan): Thank you for having me.

CONAN: And if you had to give the CDC and the government a report card for this outbreak of swine flu, what would you give them?

Dr. MARKEL: Well how about if I can give them a progress note instead of a report card because as Anne just mentioned, it's not over yet. But I'd give them an A. They're doing a wonderful job, and we're learning both from the past, and the immediate past. And the CDC, along with the WHO and public-health workers around the country if not the world, have been planning for this and thinking about these issues very hard, and they're giving it a great effort.

CONAN: And anything that you would suggest be done differently next time?

Dr. MARKEL: Well less differently than, you know, because flu is so predictably unpredictable, even our best-laid plans, we will find new holes or new rents in the fabric that we're creating to protect us.

So we're already finding issues, for example, about reportability. Reportable diseases doesn't mean that we report it to the news. It means you report it to the Public Health Department, and they act on it. Now, 100 years ago, a public-health officer would quarantine or isolate you, but now we use that data, as Dr. Schuchat said, to really think about issues of how severe this epidemic is, who's dying or becoming hospitalized so that we can ratchet up or down our public health responses.

And what we're finding is that not every state makes, in this case, H1N1 a reportable disease, and we're working on that; has the lab facilities to actually process all the cases of bona fide flu and also what's called influenza-like illnesses. We found other issues, as well, in our legal fabric that needs to be bolstered in the months to come as we prepare for another wave, if it indeed comes.

CONAN: Dr. Schuchat, let me ask you. There are new technologies or uses of technology that can be applied in these kinds of situations, one of them, of course, the application of Google's efforts to map flu outbreaks. Did you use those? Were they useful? Might you try them next time?

Rear Adm. SCHUCHAT: You know, there was a partnership between Google Flu and the CDC that took information about influenza surveillance from many years going backwards, and Google used algorithms to try to mirror the kind of laboratory-based surveillance that we did, using search words that people would put in during the regular flu season.

Then they found a very nice correlation with increases in influenza detection from their search words and what we were finding with our laboratory system. That type of system, though, breaks down completely when you have a public outbreak and concern about a new strain of influenza because, as you know, there were eight million Web hits a day on CDC's Web site for influenza, and so the Google collaboration wasn't something that we could use going forward.

On the other hand, there have been innovative approaches to understand the situation and certainly innovative approaches to get information out. I think you know we were using Twitter to get messages to some of the younger people. This was an outbreak that, so far, has disproportionately affected young people under 18. So we were using information-sharing with some of the newer media approaches.

CONAN: Let's get another caller on the line. This is Pam(ph), Pam calling from South Bend in Indiana.

PAM (Caller): Yes, hi.

CONAN: Hi, go ahead please.

PAM: Well, I wanted to share. About May 1, about 12 days ago, we got word that my mother was dying. She has Alzheimer's disease and had taken a turn. I got tickets for my son and I to fly to Phoenix, and my son, young adult, 20 years old, was with his father, my ex-husband, and the family, his step-family, were afraid to let him travel with me. They were afraid to have him in an enclosed airplane and to be exposed to people as we traveled.

So I had to leave a decision up to my son as to whether or not he wanted to go, and unfortunately, we were right at the peak or the height of the hype at that point, on May 1. And my son decided to stay home, even though he wanted to see his grandma one more time, because he was afraid the family would hold him responsible should he come back with the flu.

What was interesting is a student at Notre Dame, near us, had just been diagnosed. So I felt that it was more the hype of the media than anything the CDC or WHO was giving out. I felt they were very responsible and told us that they really just didn't know what to expect, and you know, as information became available, they'd let us know. But because of all the - as one of your listeners mentioned, all the information on Fox News and all the other stations that didn't seem to have anything else to broadcast at the time, it really scared people, and unfortunately it impacted my family.

CONAN: I'm sorry to hear about that, and your mom is - what happened?

PAM: Well, my mom is still living, but I went to see her by myself, and we don't expect her to be around much longer. I doubt there'd be time for my son to go out and visit her.

CONAN: Well, I'm sorry to hear about that. Dr. Markel, I wonder. We asked you earlier for a grade as to the administration and the CDC. What about the media, as far as you can tell?

Dr. MARKEL: Well, I guess it depends on what media you access. You know, this is not a new issue. Media's been around for quite some time, and during the 1918 pandemic, while there wasn't the same multiplicity of media outlets, you had many newspapers who had many editions a day who were reporting it.

For example in Milwaukee, the mayor, Big Dan Hoan, made a deal with the newspapers not to report outside news so as not to incite panic. In New Orleans, on the other hand, the newspapers were saying that the commissioner of health in 1918 was raising a panic so he could assert more power. And in Newark, after the mayor closed down all sorts of public gatherings, such as theaters and the like but not saloons, the Newark Evening News complained about that, and the mayor threatened to close them down.

So this is not new. Since we've had the printing press and the telegraph, we have had this media hype, and I guess the important thing for listeners is to avail themselves of the best possible media to stay informed.

CONAN: Pam, again I'm sorry for your situation.

PAM: Well thank you.

CONAN: All right, thanks very much for the phone call. Let's see if we can go next to David(ph), David calling from Denver.

DAVID: Yes, hello Neal. Thank you for taking my call.

CONAN: Go ahead please.

DAVID: Yes, I own a tutoring center in Denver, and I was fully prepared to close down and follow the school action, should they close down, and completely supported that. My question for your guests is about the government's decision to close down commercial air traffic. And you know, this thing is ridden with analogies, but you know, I look at spreading grass seed on a lawn. The more seeds you spread, the quicker it's going to take hold and the denser it's going to take hold. So I was wondering if your guests could comment on that.

CONAN: Well, Dr. Schuchat?

Rear Adm. SCHUCHAT: You know, there have been a number of plans made about the role of transport and travel in spreading infectious diseases like influenza, and of course the particular circumstances here with the H1N1 virus were the emergence of illness in Mexico and on cases that we had in the U.S. in multiple locations. And so while some of the planning had concerned certain air traffic patterns, the land-border issue was more of a focus in this situation.

You know, humans are traveling all the time right now. And even before there were airplanes, influenza would circle the world in a pretty short period of time so that we don't think we can totally interrupt travel or trade, and one of the challenges in intervening in an infectious disease outbreak like this is how to balance the benefits to health and risks to health with the benefits and risks to other sectors because society is more than just the health component.

So I think, you know, as we saw with the school dismissals, the unintended consequences of that were difficult in some communities. The issue with canceling airplane flights isn't what we would recommend.

During a certain period, we did issue an advisory for nonessential travel to Mexico, urging people who didn't need to travel to Mexico to defer, postpone their trips there. But usually these kinds of circumstances can be handled in ways that are less disruptive than canceling travel or trade.

CONAN: We have a couple of emails on those points. Ee-tee(ph), Ettie(ph), perhaps, in Ann Arbor, Michigan: It spoiled a big surprise for my niece. She was graduating for Menlo College and as a surprise we were flying her dad, my brother-in-law, from Africa to her graduation last Saturday. At the last minute my brother-in-law's employer refused to authorize any of their personnel to travel to North America and Mexico. Because it was a surprise, my niece was not crushed. But I was. I thought it was an overreaction to this epidemic to prevent people from traveling.

And this from Kenny in Overland, Kansas: The panic over swine flu allowed my wife's parents to get standby tickets from Hong Kong to the United States. Many other passengers had cancelled their flight because the Hong Kong media made it sound like the U.S. was totally inundated with cases. So I guess it can cut either way.

David, in the event, was your work disrupted at all?

DAVID: It was not. But I had several students, despite the warnings, travel to Mexico with their families on vacation. And you know, I just had the thought in the back of my mind, if they come back and they are infected, you know, that's a few more seeds, so to say, planted in my center, where, you know, the disease could spread. So that's the result of the question. But no, I was not disrupted.

CONAN: Okay, David. Thanks very much for the call.

DAVID: Thank you.

CONAN: Bye-bye. Now, let's see if we can go next to Tania. Tania calling us from Wiesbaden in Germany.

TANIA (Caller): Yes, hello.


TANIA: I think that it shouldn't be not over-exaggerated. It should be heightened because I work in a military facility and soldiers come in and out from the States and Germany. And my son is an asthma and bronchitis patient. So if I was to catch it from a soldier or a civilian coming in, there's my son.

CONAN: So you think the reactions were appropriate and well-judged?


CONAN: All right. Tania, thank you very much. Appreciate it.

TANIA: You're welcome.

CONAN: This from Judith, emailing us from Mexico: I live in Vera Cruz. At the beginning of the outbreak I came down with a bad soar throat, headache, runny nose. I was convinced it was a bad cold. Friends urged me to go to the doctor because they said if I waited for treatment, it would be too late.

When I went to the clinic, I had to wait over four hours in a crowded hallway with others who probably feared they have the swine flu too. I thought if I didn't have it before, I would have a good chance of getting it then.

I was disappointed when the doctor who saw me took no throat swab to verify what I had. She gave me symptomatic relief medicines. Thankfully, it was all I needed. My family in the States, of course, were very concerned and afraid I would not be able to return to the States if I wanted to. And that was a concern that a lot of people worried about.

We're talking about how we handled the outbreak of swine flu, which may not be over. We're talking with Rear Admiral Anne Schuchat at the CDC, and with Dr. Howard Markel of the Center for the History of Medicine.

You're listening to TALK OF THE NATION from NPR News.

And let's see if we can go to John. John calling from San Francisco.

JOHN (Caller): Hi. I think the CDC did an outstanding job with responding to this outbreak, given the fact that this is following - I'd like the Admiral to comment on this - the outbreak of 1918, which started out mild and went through five iterations before became a pandemic. And given the transcription of the RNA virus is one mutation per kilabase pair(ph) transcription, what's the probability that this is going to follow the same steps as the 1918 and mutate into something more severe?

CONAN: And Doctor, before you answer, I just wanted to say that what I think he meant to say is it mutates very quickly, but go ahead.

Rear Adm. SCHUCHAT: Yeah. Thank you, John, for that outstanding report; also for raising the question of multiple waves of influenza. The 1918 pandemic was, as you said, multiple waves with the first a mild one and the next one much more severe.

Unfortunately, we don't know exactly how this virus will change, whether it will persist at more severe or less severe. So far, there's been quite a bit of scientific study of the virus. Multiple isolates have been sequenced and they've been - information on the sequences has been shared widely in the scientific community.

So far we know that the virulence markers, the severity marker that was present in the 1918 strain, isn't present in this. But we don't know all that we need to know about virulence. And we certainly don't know whether this particular virus will mutate or re-assort to become more severe.

So that's the kind of thing that we are working on, that we're, you know, taking steps to prepare for really intensive evaluation of what happens in the Southern Hemisphere, where we expect that this virus might start to circulate during their winter season, our summer season, and of course to be ready for what may happen here in the fall.

So you know, with influenza viruses, they change all the time, they can re-assort with other ones. And this is why this very intensive laboratory study of isolates over time is going to be a big priority for us.

JOHN: And how this affected me was four days after the epidemic, there was not a box of Tamiflu to be found in the Bay Area, even from the wholesalers.

CONAN: Well, we're happy to report there is Tamiflu now, and you could probably even get Purell.

JOHN: (Unintelligible) med student (unintelligible) and why that was important because she obviously doesn't know that. All right. Thank you very much.

CONAN: Thanks, John, very much. Bye-bye.

And let's see if we can go quickly to Luce. And Luce is with us from Raleigh in North Carolina.

LUCE (Caller): Hey. How are you doing?

CONAN: Good. We just have a few second left. Could you go quickly, please?

LUCE: Yes. Does (unintelligible) realize how much impact has economical (unintelligible) the information the flu in Mexico City and outside for Hispanic populations?

CONAN: The economic impact and the impact on many millions of people's lives in Mexico and - well, that's not Rear Admiral Schuchat's concern. She's concerned about this country. Let's ask Dr. Markel.

Dr. MARKEL: Well, I think the jury is still out, but it'll certainly cost their economy a great deal. And we and several other groups are studying precisely those issues of stigmatization of barriers to care, both in Mexico and the United States.

But I just like to echo what Dr. Schuchat's said, that this is really remarkable because we're working on a preemptive strike to a potential pandemic. We won't know what's going to happen in the fall until it happens. But we have learned from history and that we're watching it very closely, and we'll be watching it in the months to come to see if it does re-assort or mutate, brings on more virulence or not. And then we can ramp up or ramp down our scale of aggression as needed. That's truly a change over time.

CONAN: Doctor - Luce, thanks very much for the call. And Dr. Markel, thank you so much for your time today.

Dr. MARKEL: Thank you.

CONAN: Howard Markel directs the Center for the History of Medicine at the University of Michigan. He joined us today from the studios of Michigan Radio, WUOM, our member station in Ann Arbor. And Dr. Schuchat, thank you again for your time today too. Rear Admiral and Dr. Anne Schuchat, interim deputy director for science and public health at Centers for Disease Control and Prevention.

Coming up in just a moment, we'll be talking about - with a woman who froze her eggs.


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