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Covid danger low for many People to assemble over Fourth of July weekend, Gottlieb says

Dr. Scott Gottlieb told CNBC on Friday that most Americans should be comfortable gathering together safely on Independence Day weekend, citing high Covid vaccination rates and low virus infection rates in many parts of the country.

However, the former Commissioner of the Food and Drug Administration said there are certain places where people should be more careful.

“There is a very low prevalence across the country. You have to be based on where you are, ”said Gottlieb in“ Squawk Box ”. He noted that in his home state of Connecticut, new daily cases are small, “so it’s a pretty safe environment to get together right now.”

“In some parts of the country where prevalence is increasing – Missouri, parts of Nevada, Arkansas, Oklahoma – I think people should exercise more caution,” added Gottlieb, who sits on the board of directors at Covid vaccine maker Pfizer.

Gottlieb’s comments come before the July 4th weekend as U.S. health officials closely monitor the Covid Delta variant, which is believed to be significantly more transmissible than dominant strains earlier in the pandemic.

Coronavirus cases in the country are dramatically lower than their peak in January when the country recorded over 300,000 new infections in a single day, but has been trending upward in recent days, according to a CNBC analysis of Johns Hopkins University data.

The US recorded an average of about 12,700 new Covid cases per day in the past week, the analysis showed. That’s 9% more than a week ago.

“We don’t want to worry people, but we’re following these numbers very, very carefully,” said CDC Director Dr. Rochelle Walensky NBC News after a White House briefing Thursday.

The number of deaths continues to decline. The seven-day average of new Covid deaths is 249, according to CNBC analysis, a 19% decrease from a week earlier.

“There are kind of isolated parts of the country where the number of infections is increasing. The rest of the country looks very good,” said Gottlieb. “I think what you are seeing is a decoupling between places with high vaccination rates and places with low vaccination rates. You also see, frankly, a decoupling between the cases and extreme death and the disease that caused this virus.”

In countries with high vaccination rates, but also increasing cases due to the Delta variant, such as Great Britain and Israel, “hospitals and deaths are no longer increasing” as they did earlier in the global health crisis, said Gottlieb.

“For a while, we thought it was just the delayed effect where hospital admissions weren’t seen until three or four weeks after the number of cases rose, just like deaths,” said Gottlieb, who headed the FDA from 2017 to 2017 2019 in the Trump administration.

“But at this point we have enough trending to suggest that now you will only see decoupling and not see the extreme results of the virus in parts of the world where vaccination rates are high. and that includes the United States. “

Because of this, Gottlieb said, it’s important to make sure more Americans get a coronavirus vaccine, which will reduce both the spread of the virus and the risk of getting seriously ill or dying from the disease.

Nearly 156 million Americans are fully vaccinated, according to the CDC. Just over 181 million people have received at least one dose; Pfizer and Moderna vaccines require two vaccines while Johnson & Johnson’s are a single dose.

However, there are geographical gaps in vaccination coverage. CDC’s Walensky said Thursday that fewer than 30% of residents are vaccinated in about 1,000 U.S. counties, most of which are in the Southeast and Midwest.

Overall, 47% of the US population is fully vaccinated.

“Preliminary data for the past six months suggests that 99.5% of deaths from Covid-19 in the US have occurred in unvaccinated people … the suffering and loss we see now are almost entirely preventable,” Walensky said .

Gottlieb said despite being fully vaccinated, he is still looking for ways to be cautious as the pandemic is not completely lagging behind the country.

“For example, if I am going to a restaurant and there is an opportunity to sit outside, I will eat outside. I think where you can be a kind of nervous Bayesian and lower your statistical probability of coming into contact with the virus, why not? ”Said Gottlieb. “But I wouldn’t hold back from meeting friends and family on this holiday because the virus is spreading in very small numbers in certain parts of the country.”

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The White Home is taking proper method in preventing the Covid-19 delta variant, Gottlieb says

The Biden government is taking the right approach in tackling the highly contagious Covid-19 Delta variant by deploying response teams to vulnerable communities, said Dr. Scott Gottlieb on Thursday.

“I think the government is doing the right thing when it comes to changing its strategy,” Gottlieb, the former FDA chief under former President Donald Trump, told CNBC’s “The News with Shepard Smith” about the grassroots approach new government.

Gottlieb explained that the targeted response can help teams focus on vaccinating the communities prone to Covid and the Delta variant.

“Right now we need to move to a grassroots strategy and try to put resources into local communities so that local groups can encourage people to get vaccinated, put the vaccines in the hands of doctors, and find ways to get more vaccines to get into the hands of small providers who can encourage their patients to vaccinate, “said Gottlieb.

The Delta variant is driving a sharp spike in new Covid cases across the country and currently accounts for about 25% of the new cases sequenced in the US. Officials believe it will become the dominant strain in the country, dwarfing the currently dominant alpha variant.

Rochelle Walensky, director of the Centers for Disease Control and Prevention, attributed the increase in part to delayed vaccination rates. The CDC director added that about a third of all counties across the country have so far vaccinated less than 30% of their population. She said most of them are in the South and Midwest.

Disclosure: Scott Gottlieb is a CNBC employee and a member of the board of directors of Pfizer, genetic testing startup Tempus, health technology company Aetion Inc., and biotechnology company Illumina.

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New Covid research hints at long-term lack of mind tissue, Dr. Scott Gottlieb warns

Dr. Scott Gottlieb warned on Thursday of the potential for long-term brain loss related to Covid, citing a new study from the UK.

“In short, the study suggests that there could be long-term loss of brain tissue from Covid, and that would have some long-term consequences,” said the former FDA chief and CNBC employee.

“You could compensate for that over time, so the symptoms of it may go away, but you will never get the tissue back if the virus actually destroys it,” said Gottlieb, serving on the board of Covid vaccine maker Pfizer.

The UK study looked at brain imaging before and after coronavirus infection, specifically looking at the potential effects on the nervous system.

Gottlieb told CNBC’s “The News with Shepard Smith” that the destruction of brain tissue could explain why Covid patients have lost their sense of smell.

“The decrease in the amount of cortical tissue happened by chance in regions of the brain that are near the places responsible for the odor,” he said. “What it suggests is that the odor, the loss of smell, is just an effect of a more primary process that is going on, and that process is actually the shrinking of the cortical tissue.”

Disclosure: Scott Gottlieb is a CNBC employee and a member of the board of directors of Pfizer, genetic testing startup Tempus, health technology company Aetion Inc., and biotechnology company Illumina.

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Dr. Scott Gottlieb on uncommon coronary heart irritation in younger Covid vaccine recipients

Rare instances of heart inflammation in young people after receiving their second Covid vaccine dose require further inquiry, Dr. Scott Gottlieb told CNBC on Friday.

However, the former Food and Drug Administration commissioner said the cases have mostly been mild and should not dissuade people from signing up for the two-shot regimens from Pfizer and Moderna.

“At this point, the risk/benefit still favors vaccination certainly in this age group,” Gottlieb, a Pfizer board member, said in an interview on “Squawk Box.” “That’s what CDC and FDA have also affirmed.”

A day earlier, the Centers for Disease Control and Prevention indicated it has seen a higher-than-projected number of cases of heart inflammation in 16-to-24-year-olds following their second Covid shot—  275 recorded occurrences compared with expectations of 10 to 102.

In people age 30 and below, there’s been 475 total reports of myocarditis or pericarditis, which according to the CDC involves inflammation of the heart muscle or the lining around it. Men make up the vast majority of reported instances of post-vaccine myocarditis or pericarditis.

Of the 270 people who developed the conditions and have been discharged from the hospital, 81% have fully recovered, according to CDC data. The remaining 19% either still have symptoms or their status is not known. Fifteen people are still hospitalized, the CDC said.

Symptoms, which include chest pain and shortness of breath, typically develop when a few days of receiving the vaccine, according to the CDC.

Gottlieb said many questions remain about the connection between the heart inflammation and the Covid vaccines from Pfizer and Moderna.

“I think at this point you need to assume there’s a causal relationship between the vaccine and these observations until you can prove otherwise,” said Gottlieb, who led the FDA from 2017 to 2019 in the Trump administration.

Gottlieb said what’s not known yet is whether there’s something specific about the vaccines that are causing heart inflammation. “We know the vaccine induces inflammatory response. That’s why you get a fever. That’s why you get injection-site pain because your immune system is stimulated.”

“Is this a more generalized inflammatory response from the vaccine that’s localizing in the heart in some patients?” Gottlieb asked. “Or is this something that’s more direct, where the vaccine itself is triggering some kind of very targeted immune reaction and it’s manifesting in this way? We don’t have the answers to these questions.”

It’s possible additional cases haven’t been recorded, Gottlieb said, but “we are probably capturing most of the severe cases.” He added, “When you look at the number of people who are having severe cases of pericarditis, it’s very small numbers right now.”

Roughly 141.5 million people in the U.S. have been fully vaccinated against Covid, according to CDC data. The vaccines have been critical in driving down the number of coronavirus cases in the U.S. to their lowest levels since early in the pandemic.

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Rise in adolescent Covid hospitalizations is reflection of latest variants, Gottlieb says

Dr. Scott Gottlieb pointed on Friday to the highly transmissible Covid-19 variants as a potential cause behind an increase in adolescents being hospitalized with the virus in March and April. 

“It’s concerning, the trends on hospitalizations” among teenagers, said Gottlieb, the former Food and Drug Administration chief during the Trump administration. “I think it’s a reflection of the new, more contagious variants.”

“We are seeing that these variants are more contagious across all age groups, so they’re affecting adults more, but they’re also affecting kids more, so you’re seeing more kids contract symptomatic Covid and more kids get hospitalized, as a consequence of that, particularly B. 117,” Gottlieb told CNBC’s “The News with Shepard Smith.”  

The B. 117 variant is currently the most prevalent strain in the U.S., with 20,915 reported cases, according to the Centers for Disease Control and Prevention.

In the first three months of the year, CDC researchers found that nearly one-third of adolescents hospitalized with Covid required admission into an intensive care unit. Meanwhile, 5% needed invasive mechanical ventilation. To be sure, CDC data shows no teenagers in the U.S. died of Covid in the first quarter of 2021.

CDC director Rochelle Walensky on Friday urged parents to vaccinate their teenagers against Covid, citing more teenagers being hospitalized with Covid.

Disclosure: Scott Gottlieb is a CNBC contributor and is a member of the boards of Pfizer, genetic testing start-up Tempus, health-care tech company Aetion Inc. and biotech company Illumina.

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Dr. Scott Gottlieb agrees with new CDC masks steerage

The CDC’s updated face mask instructions are likely to induce vaccine-reluctant Americans to get a Covid shot, said Dr. Scott Gottlieb told CNBC on Friday.

“This will be a pretty strong incentive for many people who may have been on the fence to get vaccinated to get vaccinated,” the former commissioner for the US Food and Drug Administration told Squawk Box.

In most indoor and outdoor areas, fully vaccinated people are currently not required to wear face covering or maintain a social distance of 6 feet from other people, the Centers for Disease Control and Prevention said Thursday. Masks still need to be worn in businesses that need them, according to the CDC, as well as on airplanes and public transportation.

Still, the health department’s laid-back demeanor is a major development in America’s efforts to fight the coronavirus. According to CDC data, 36% of the US population has been fully vaccinated against Covid. Approximately 47% of Americans have received at least one dose of Covid vaccine.

The pace of new vaccinations has slowed in recent weeks, causing government officials to look for ways to encourage more Americans to sign up for a Covid shot. This includes efforts to build trust in the vaccine, expand availability to hard-to-reach communities, and create incentives. In Ohio, for example, Governor Mike DeWine unveiled a plan that would give five state residents $ 1 million through a lottery. The recipient must be vaccinated to qualify for the prize.

According to Gottlieb, who headed the FDA in the Trump administration from 2017 to 2019, the loose guidance from the CDC alone could be enough to boost vaccinations. Today he is a board member of the vaccine manufacturer Pfizer.

“I wouldn’t be surprised if the number of people getting vaccinated increases because now there is more value to vaccination. You can walk around in a mask in an honest way,” he said.

Gottlieb acknowledged the concerns of some public health experts who believe that unvaccinated people will use the new CDC guidelines as cover to forego a mask in businesses. However, he said, “I think people who are going to do this would have done it anyway.”

In general, Gottlieb said the CDC’s mask decision is now correct, as the country has seen a continued decline in new coronavirus infections and a significant portion of the population has been vaccinated to protect against serious illness and death.

He specifically pointed out the high vaccination rates among older Americans who are at increased risk of dying from Covid. Almost 72% of America 65+ is fully vaccinated.

“I think the worst thing you can say about the measures taken by the CDC is,” Well, maybe you could have waited another week, “said Gottlieb.” At some point we have to move past coronavirus and live normally again “he added.” We are at this point right now. We’re about to take off masks and return to normal activities. “

Dr. Ashish Jha, dean of Brown University’s School of Public Health, told CNBC on Thursday that the new mask line was “really great news” for people who are fully vaccinated. However, Jha said he believes states should keep their inner mask mandates for another month. This would allow people who received their first Covid shot on April 19 – the day all U.S. citizens aged 18 and older were eligible – to get a full vaccination, he said.

Disclosure: Scott Gottlieb is a CNBC employee and a member of the boards of directors of Pfizer, genetic testing startup Tempus, healthcare technology company Aetion, and Illumina biotech. He is also co-chair of the Healthy Sail Panel for Norwegian Cruise Line Holdings and Royal Caribbean.

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Gottlieb says circumstances will decline, vaccinations monumental achievement

A vaccination center displays signs and age groups for Pfizer and Moderna vaccines as California reveals eligibility to vaccinate all residents 16 and older during the coronavirus disease (COVID-19) outbreak in Chula Vista, California, United States on April 15 2021.

Mike Blake | Reuters

Former Food and Drug Administration Commissioner Scott Gottleib said Sunday that a steep decline in new Covid-19 cases in the US is likely to continue and predicted a “relatively calm summer in terms of the spread of coronavirus” .

“Look, the situation in the US continues to improve, and I think the decline in cases will accelerate in the coming weeks,” Gottlieb said on CBS News’ Face the Nation.

The doctor credited the mass vaccination campaign launched under President Donald Trump and continued under President Joe Biden to help stem the spread of the disease.

“This was a monumental achievement – the introduction of this vaccine, the vaccination of so many Americans – and it will go on,” said Gottlieb. “We will keep working on it. The vaccination rate will slow down in the coming weeks. But we will continue to take in more people when we come into the summer.”

To date, more than 100 million Americans have been fully vaccinated against Covid-19, according to the Centers for Disease Control and Prevention, or nearly a third of the population. Approximately 146 million people, or 44% of the population, received at least one dose.

The rate of vaccine administration has declined slightly in the past few weeks after months of spike after receiving one for most of the people who were most likely to want a shot.

As more Americans got vaccines, cases of Covid-19 have fallen sharply. As of Saturday, the 7-day average of daily new cases fell to below 50,000, a decrease of 17% compared to the previous week. Hospital stays and deaths due to the disease are also decreasing.

To get a feel for what might be coming up for the US, Gottlieb said it might be helpful to check out heavily vaccinated San Francisco.

“About 71% of the people in San Francisco had at least one dose of the vaccine, 47% were fully vaccinated. They record about 20 cases a day. You have about 20 people hospitalized,” Gottlieb said.

“They have dramatically reduced Covid in this city and it is largely the result of vaccinations,” he added.

From a financial point of view, Gottlieb suggested that the profits from vaccination were “stalled” and “fairly sustainable”.

“We are entering warm months in which this will create a setback against the spread of the coronavirus, and we are securing these profits,” said Gottlieb.

Even if the health situation in the USA is on the verge of normal, it is deteriorating in other countries with fewer resources. In India, the new daily cases exceeded 400,000 on Saturday, a record.

Disclosure: Scott Gottlieb is a CNBC employee and a member of the boards of directors of Pfizer, genetic testing startup Tempus, health technology company Aetion Inc., and biotech company Illumina. He is also co-chair of the Healthy Sail Panel for Norwegian Cruise Line Holdings and Royal Caribbean.

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Dr. Scott Gottlieb expects little impression on U.S. Covid instances

The restrictions recently announced by the Biden government on travelers from India are unlikely to play a significant role in limiting new coronavirus cases in the US, said Dr. Scott Gottlieb told CNBC on Friday.

“Will it have an impact? Perhaps a minor impact on margins in terms of reducing introductions. This will not affect our trajectory dramatically at this point,” the former Commissioner of the Food and Drug Administration told Closing Bell. “It will probably do more harm to India than any good it attributes to us.”

Gottlieb, who sits on the board of directors at Covid vaccine maker Pfizer, believes the White House’s main reasons for restricting travel from India are concerns about the variant of coronavirus known as B.1.617. It was first discovered in the country and is considered highly contagious.

“But that variant is here anyway, and frankly the best way to reduce the risk of this variant is to get more Americans vaccinated,” said Gottlieb, who headed the FDA in the Trump administration from 2017 to 2019, the best Backstop against the spread of this variant without restricting travel at this point. “

White House press secretary Jen Psaki announced the travel restrictions on Friday, which will go into effect on Tuesday. India has seen a sharp spike in Covid cases in the past few weeks and weighs heavily on its health system as the daily death toll hit new records.

According to someone familiar with the matter, the travel order is likely to be for non-US citizens or permanent residents who have recently been to India. This means that the restrictions will have a similar format to those put in place on many trips to the US from China, Brazil and the European Union, effectively excluding most of the visitors from India to the US

“There are some studies that show that implementing travel restrictions can delay the introduction of a virus to a new area – and most of the studies that have been done have looked at pandemic influenza-related introduction and perhaps reduction the height of the epidemic that another country will experience, “said Gottlieb.

If the US had introduced travel restrictions earlier in the pandemic, “which weren’t that leaky,” Gottlieb said, it would be possible that the coronavirus would have taken longer to penetrate the country and limit the severity of the outbreak.

“But at this point we have enough viruses here in the US not to prevent the virus from being brought in from India,” he said.

The White House did not immediately respond to CNBC’s request to comment on Gottlieb’s comments.

Coronavirus cases in the US have continued to decline as more Americans are vaccinated against Covid. On Friday, data from the Centers for Disease Control and Prevention showed that more than 100 million Americans were fully vaccinated.

However, the pace of daily re-vaccinations has slowed, and states are working to find ways to target Americans who are not particularly eager to get a Covid shot.

“I think we can keep working on it,” said Gottlieb, suggesting that a decrease in the average number of shots per day “doesn’t mean we’re doing a bad job.” He added, “I think it’s inevitable that it slows down when you get into weaker demand.”

“Things like vaccination buses, where they just drive up to communities and people can show up on site without waiting and get vaccinated. That way, more people are vaccinated,” added Gottlieb. “Delivering vaccines through construction sites will also help.”

Disclosure: Scott Gottlieb is a CNBC employee and a member of the boards of directors of Pfizer, genetic testing startup Tempus, health technology company Aetion Inc., and biotech company Illumina. He is also co-chair of the Healthy Sail Panel for Norwegian Cruise Line Holdings and Royal Caribbean.

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New CDC masks steerage is complicated, however the fitting step: Scott Gottlieb

Dr. Scott Gottlieb said Wednesday that the Centers for Disease Control and Prevention will need to update their coronavirus policies faster if the pandemic situation improves.

The day before, the U.S. Department of Health issued new, relaxed guidelines that require fully vaccinated people to wear masks outdoors.

“The guidelines issued by CDC are a step in the right direction, in my opinion, but relatively confusing,” Gottlieb, a former commissioner for the Food and Drug Administration, told CNBC’s Squawk Box. “It is not very clear what they prescribe. I think we need simpler rules if we want to prescribe something about society.”

People who have been fully vaccinated – two weeks after their final dose – can safely exercise and go to small outdoor gatherings without wearing a face mask, according to the new CDC guidance. However, the agency recommends that those who are fully vaccinated continue to wear masks when attending a crowded outdoor event, such as an outdoor event. B. a parade, a sports game or a concert.

The CDC also said that if those other participants are fully vaccinated, it is safe for unvaccinated Americans to forego wearing a mask while attending a small outdoor gathering with friends and family.

The CDC needs to better define what it wants to achieve at this stage of the pandemic when national infection rates are falling and more than 54% of adults in the US have received at least one dose of vaccine, said Gottlieb, who sits on the board of directors at Covid vaccine maker Pfizer.

“I think the public health goal should be to try to protect vulnerable populations in gathering environments. So keep focusing on nursing homes, day care centers where young children live, and trying to prevent major outbreaks and overarching events to prevent.” he said.

According to CDC data, around 68% of US citizens age 65 and over have been fully vaccinated, while around 82% of the most at-risk populations have received at least one dose.

“We won’t be able to prevent a single rollout where a single person spreads a virus to a single person, but against the backdrop of the decline [coronavirus] Prevalence, rising vaccination rates and more vulnerable Americans protected by vaccinations, we have to lean forward, “said Gottlieb, who headed the FDA in the Trump administration from 2017 to 2019.

The 7-day average of new coronavirus cases per day in the US is around 53,800, according to a CNBC analysis of Johns Hopkins University data. That is 17% less than a week ago.

The US has an average of 676 new Covid deaths per day based on a seven day moving average. This is evident from CNBC’s analysis of the Johns Hopkins data. This corresponds to a decrease of 6% compared to a week ago.

Gottlieb, who called for an end to outdoor mask requirements earlier this week, said he was concerned about the impact of the CDC, which continues to be overly cautious with its guidelines.

“I think the risk to CDC as an institution – it’s a hugely important institution – is that it will lose its relevance and people will stop listening,” he said, warning those in the US to the coronavirus guidelines establish.

“The challenge is that if we do not lift these restrictions with the same speed and efficiency that we have placed on them, we will lose credibility as public health officials to reintroduce them in the future because more of the rest of the world People will worry that this is the case. ” a one-way street, “he said.

The CDC did not immediately respond to CNBC’s request for comment.

Disclosure: Scott Gottlieb is a CNBC employee and a member of the boards of directors of Pfizer, genetic testing startup Tempus, health technology company Aetion Inc., and biotech company Illumina. He is also co-chair of the Healthy Sail Panel for Norwegian Cruise Line Holdings and Royal Caribbean.

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Dr. Scott Gottlieb says carry them for open air

Dr. Scott Gottlieb told CNBC on Monday that outdoor masks mandates are no longer required at this point in the coronavirus pandemic.

Public health officials should generally be more relaxed about outdoor activities, said Gottlieb, who serves on the board of directors at Covid vaccine maker Pfizer.

“People could choose to wear a mask if they want. I think there shouldn’t be any requirement that they wear masks outdoors,” the former commissioner for the Food and Drug Administration said on Squawk Box.

Steps should be taken “to allow more outdoor gatherings, larger groups, sporting events and the like,” he added. “The weather is warming up. We have the ability to take more activity outside. We know that outdoor activity is less of a risk than indoor activity.”

The Chief Medical Officer of the White House, Dr. Anthony Fauci, agrees to the risk of coronavirus transmission outdoors. In an interview on Sunday, he suggested that the Centers for Disease Control and Prevention could change their attitude towards wearing masks outdoors.

“What I think … the country will be hearing soon are updated guidelines from the CDC,” Fauci said on ABC’s “This Week with George Stephanopoulos.” “The CDC is a science-based organization. You don’t want to make guidelines unless you look at the data and back it up. However, if you look at the common sense situation, the risk is obviously very small, especially when You are vaccinated. “

President Joe Biden is expected to announce new CDC guidelines for wearing masks outdoors as early as Tuesday, a source familiar with the discussions told NBC News. However, the source cautioned that the recommendations are still being finalized and are likely to provide guidance for people who are fully vaccinated versus those who don’t.

The CDC’s current guidelines on face covering state the following: “Masks may not be required when traveling alone outside of others or with people in your household. However, some areas may have mask mandates when out in public. Please check the rules in your region (e.g. in your city, your district or your state). Also check whether federal mask mandates apply to your whereabouts. “

In their respective mask requirements, several states say people do not need to wear them when outside and keep a physical distance of at least 6 feet from anyone who is not in their household.

Gottlieb said he believes it is time to end the requirements for external masks as vaccination levels in the US reduce the number of new infections. More than 42% of the US population have received at least one dose of vaccine, according to CDC data, including 28.5% who were fully vaccinated.

As of Monday, the 7-day average of new daily coronavirus infections in the US was 58,160, according to a CNBC analysis of data compiled by Johns Hopkins University. That number is down 14% from a week ago.

“The gains we are currently seeing against the virus are solidified by vaccinations and immunity in the population, while before we saw people, they were the result of behaviors that people were more careful about what they were doing,” Gottlieb said . who headed the FDA during the Trump administration. “Now it’s the result of immunity. We can be sure that these will solidify.”

Disclosure: Scott Gottlieb is a CNBC employee and a member of the boards of directors of Pfizer, genetic testing startup Tempus, health technology company Aetion Inc., and biotech company Illumina. He is also co-chair of the Healthy Sail Panel for Norwegian Cruise Line Holdings and Royal Caribbean.