At Johns Hopkins here to talk about the coronavirus and the response. Lets begin with this virus. Itt exactly is it and how is that it became something that went from an animal to a human . Guest it is a respiratory virus. There are coronavirus is that circulate and are a frequent cause of the common cold, but this is a new one and people do not have immunity, and seems to be reducing more serial beer severe symptoms. It originated in animals and jumped over to humans and became capable of being transmitted to humans. When that occurred, we dont fully know. The initial outbreak was detected in december and it is likely it started a month before then or earlier. Host how does this jump from animal to human . Guest the mechanism is not known but likely a human came in contact with an animal that was infected and the virus mutated so it could live in humans, and became adapted to living in humans and could spread between humans, got the right receptors to bind to the lungs. Host is it ingesting or just touching . Guest it is largely by droplet transmission. Someone can expel directly on you or on a surface that you touch and then your face or mouth. Host is it that they touched this animal or eight it . Ate it . Guest it is unclear. Host is that where all viruses originate, from ingesting Meat Products . Guest we dont know that it was ingested. I should say, the evidence we have is that this virus likely came initially from bats. People think there was an intermediary animal, perhaps a mammal, but we do not know what that animal is or was so we do not fully know and do not know how people were exposed. Host why do these viruses originate from animals to humans . The storyfeels like that you read about new viruses emerging is increasing which is true. The vast majority are wildlife and origin, partially new viruses and partially that people i counter them encounter them and they change in a way and we do not have immunity, that is when these outbreaks occur. Host why dont we have the immune system to combat this virus, or do some people have it . What makes them stronger . Guest this virus is new and it is not thought that people have existing immunity. What has been testing on amount of the population has been affected. Thought ifnk as much you have gotten a cold and had a virus that it would protected from this one. Host what should you do if you think you might have it . Guest it depends where you are in terms of whether you are likely to be tested. It is a little bit tricky, because the virus starts out like many other respiratory viruses, a fever or sore throat, some kind of initial symptoms. The vast majority of people affected, 80 , continue to have mild symptoms throughout the course of the illness, but some go on to have severe illness and some have Critical Illness and some portion dies. In terms of how you could be tested, in the United States if you want to be tested you essentially have to have and have a wuhan lower respiratory infection. That is one city where it is thought this Global Academic epidemic started. It is also in china, possible to be tested. If you do not fall into those categories, you are not being tested. Host even with outbreaks in italy, iran, south korea . Guest we are quite concerned about that, that as this epidemic has evolved, and there has been an app in active debate as to whether we should call it a pandemic, many countries have reported transmission, 34 of them. Many are reporting active, intense epidemics spreading locally so many have suggested that the limited criteria for testing is probably no longer applicable and would be beneficial to expand testing beyond those limited categories. Host what is the definition of a pandemic . Guest you will get a debate among individuals. I an epidemiologist, we look at in the description of global spread or geographic spread, so you have 34 countries , to us that satisfies the definition of pandemic. The World Health Organization has pushed back strongly against that characterization. I personally do not believe that and that is not we learned in epidemiology. I think we can have mild pandemics but also severe pandemics. Host how would you define overseeing . Guest i believe this is a pandemic that we are seeing countries across the globe reporting cases. Surveillance for the virus is limited in places in ways i told you about. To miss cases that have resulted from other exposures. When you have a situation like that and you have a virus that , and peopleoks mild are eventually able to spread when it is mild, that makes it difficult to interrupt and to know where in the world the virus is. Countries that are not reporting cases may have cases but have not found them yet. Seenr, we havent aggressive actions that countries have taken like shutting down travel, have such have stopped the spread. Host what role are you playing in tracking this . Center, weresearch are faculty in the school of Public Health so we teach and mentor students and conduct public research. Our group five us focuses on epidemic andeak what governments and practitioners should do to be ready for it. I also direct a project called the outbreak in servitude or he where we study the operational what services are needed to bat host what is your concern with over 100 cases in iran and the migration in and out of that country into the neighboring ,reas where they have had wars fragile governments, and not a lot of transparency . Guest that is where our biggest worry is, that this virus will turn to places that have weak infrastructure. Who,irector general of the in deciding to declare this time a9 epidemic at the Public Health emergency of international concern, he cited concerns about weak Health Systems in making that designation to make sure they get ready and think about how they will manage potentially an influx of infected patients. Potentially countries are reporting cases and as you mentioned, a number are undergoing many other challenges that could make it difficult to manage this on top of the day to day civil conflict. Host the iran foreign minister a News Conference and it was made public that he tested positive for the coronavirus. Should he have been, or should people be in public if they are feeling sick and from these areas and have tested positive . Guest if you have tested positive, it is important to isolate at home. We think it is possible to spread it relatively early in the course of illness, and this this makes this virus quite different from the sars virus that caused the global epidemic in 2003. That was caused by a coronavirus. We were able to stop the spread in part because when people became infected, they tended not to transmit until they were quite ill and they did not feel up to being out and about. By improving Infection Control processes at hospitals, we were able to stop transmission, but this virus is different and it is critically important that people who are sick stay home. Unfortunately in many places, it is difficult to test people for the virus. As a general rule, any time are not feeling well, it is good for society for you to stay home. Host are you saying you could spread it before you start to feel it . St there is an active they have found virus in people who have not had symptoms. We do not know to what extent they may spread the virus because it is easier to spread when you are symptomatic because you are more likely to expel the virus when you are coughing and sneezing. It is possible people can spread early in their infections before they recognize how ill they are. They thought they had a cold or maybe were coming down with something, but not as severely ill as someone might expect to be with this virus eventually. Host we want to take our viewers questions and comments. Eastern and central part of the country, if you live there, 202 7488000. Mountain and pacific area, 202 7488001. We can read some of your questions if you text us at 202 7488003. Healthcare officials in the government said this could be bad. How bad . What do you think when they say that . Guest there are a few open questions about the virus. It is a certainty that we will see additional cases here in the United States. One of the difficulties right now, we are not testing very many people, so the United States we have tested fewer than 500 people. , whereorea and singapore they are experiencing large outbreaks, they have tested tens of thousands of people, so i think we have a very poor view of whether or not there are cases already here. Certainly, we should expect to see more in the future. In terms of how bad it could be, one of the open questions about this virus is what level of severity is produced by this virus . If you took the number of deaths reported and divided that into the number of illnesses reported, it is about a 2 case fatality ratio, and that probably sounds small to a lot soundsle just because 2 small, but that is on the order of what we saw with the 1918 influenza pandemic, one of the deadliest events in modern history. Myself doe including not fully believe that that 2 calculation is accurate because i think and i think others hold this view there are probably many more mild cases that we are not counting and if we were able to count it, the case fatality ratio would be much lower. Nevertheless, still potentially ore if it were 1 or. 5 even. 1 , when you layer that on top of Health Systems struggling to deal with the flu, it is still quite a challenge to think about how to manage those patients. Far, american Public Health systems have sought to contain the virus by isolating cases while monitoring close contacts of patients for infection. Is that the way to handle this . Guest isolation is important and monitoring contact is important, but there will be a point where the cases are such that we will not be able to do that, and we have to expect that shift in trying to prevent those individuals likely to become quite ill and die, for the most part elderly and people with Underlying Health conditions. If we get many more cases, you will see efforts focusing on trying to mitigate the impact and helping the vulnerable. Host would that be closing schools . What would that entail . Guest it is an open question that was mentioned at the cdc press conference that cities may have to consider these measures. I hope states are considering what actions if any they will take, and it will be important in thinking through those considerations that we not only examine their potential to produce transmission reduce , slow transmission but maybe not affect the total number of cases we see. It is important as they consider taking those measures in an effort to potentially slow the spread of this virus, they examine not only potential itsh benefits but potential impact on society. Although i think a number of people are talking about School Closures, that was something we did during the 2009 influenza pandemic for a short while before we realized the virus was not as severe as we initially feared, but these are very disruptive measures. Working parents have to stay home with their children and that possibly means they cannot go to work. There are people working at Health Care Facilities or power plants or stocking the shelves at grocery stores, that could create a situation where we have potentially more harm than the virus would pose. We have to make sure to balance those and mitigate those unintended consequences. Host nick in illinois, good morning. Caller thank you for taking my call. I am not as concerned as everybody is about the coronavirus. It is bad. It started in china. China has nearly 2 billion people and they have lost almost 2000 people. We have people like Richard Fowler on fox news last night was shannon brain blaming the Trump Administration and the executive branch for this virus that started and another country, from them feeding their people rats, beavers, baby wolves, the list goes on and on. You cannot have 1. 5 billion People Living on top of one another. Inhave lost 14,000 people north america from the flu. Host lets take that point. Compare that to the deaths over the flu. Guest obviously very worried about the flu, it is an important contribution to severe illness and death in the United States, and a frequent cause of hospitalizations, particularly in the season we are in now. It is absolutely worth being concerned about and i encourage anybody who has not gotten the vaccine to get the vaccine, because it is your best chance of not having severe illness and death if you are vaccinated. Also it would be helpful to reduce the number of flu cases. That is less burden for the hospital to manage. One of the reasons this virus is getting the attention it is is not because things like flu are not deadly, but there is an open question as to whether this virus is more deadly than the flu, and from the numbers reported to date, it is far more deadly. I reported i think those numbers are not quite accurate, but uncertainty is still there and we have to prepare. The other challenge is that unlike flu, we do not have the same tools for the coronavirus so we have limited ability to test and diagnose people in the u. S. We do not have a vaccine like for the flu. We do not have medicines like we give for the flu, so the absence of those tools and the weertainty make it essential prepare. We need to face what we need to do. Host when it comes to this disease or any disease, are there things people can do beyond the flu shot or in addition to the flu shot to boost your ma in system . Guest the best thing you can do , take measures to reduce the likelihood of becoming infected in the first place, staying away from people who are sick possibly with respiratory symptoms the best you can. Washing hands is important because if somebody coughs on a surface and you touch it and touch yourself, there is the possibility you could infect yourself. Those are probably the best measures at this point. There may become a point if there are a lot of cases where we will think if going to crowded public spaces is worth it. There is still some planning that needs to be done, and part of that involves peoples risk tolerance. Someone who is elderly or has underlying medical conditions may be less inclined to take those risks. Host pat in new jersey. Caller i am also having a hard time getting into a panic over this. Arent the at risk people, the people with a higher risk of illness and disease the same people at risk in every other infirm, the elderly, compromised immune systems . For 95 of the people, what are we supposed to do . How do i get worried over something that in many people is asymptomatic . How would i know the difference between coronavirus and a cold . Point. That is a fair the elderly and those with Underlying Health care withtions, we see issues flu and coronavirus can cause death in some individuals. This Novel Coronavirus has the ability to cause severe illness and death in previously healthy individuals, so while the elderly and people with Underlying Health issues are most at risk, they are not the only ones who have severe outcomes like i described. I think your point about, why should i worry, i think i agree with you. What we are looking for is preparing the best we can and worry at this point is probably not productive. Nevertheless, it doesnt mean that we should not appreciate the hard work going on in the country to prepare for it, and i want to make sure we are doing as much as we can. Host linda in maryland wants to know, what is being done at the border to prevent someone from bringing the virus into the United States . Of january,e end the u. S. Implemented travel restrictions basically cominging certain people from china from getting visas to come to the United States, and implementing quarantines for americans returning from wuhan and broader china. This is not something a number of countries have also done, but the best effort suggests these will not likely be effective in keeping the virus out. Many countries are now reporting ongoing epidemics of this virus and are not on our list for travel restrictions, and it would be difficult to keep adding countries to the list because Resource Requirements for screening people and implementing the quarantines that have been implemented to date have been burdensome. My great worry about this is that Health Department officials monitor monitorng to and care for individuals under quarantine, it is the same people we would want to prepare communities to think about how we would reduce the impacts of the virus. There is only so much bandwidth. I am deeply concerned it has diverted resources from that Important Community level work that needs to happen. I would also point out a number of countries experiencing large epidemicsepidemic implemented travel restrictions and that did not prevent the epidemics they are experiencing. Host what mistakes did china make in the beginning of this, and when they reacted later by andting down wuhan province restricting travel, did that help . Guest there was an initial lack of understanding of how far the , and i thinkd grow there was not as much information being shared in terms of initial Health Care Workers infected. That would have been important to know. I often study outbreaks like this and i often see that countries make mistakes in the beginning before they know what is happening, so i never truly like to criticize or say, you zould have done x, y, and because it is not productive going forward. There is always missteps. There were certainly mistakes. I think all countries are probably looking back and looking at things they could i do they could do differently. In terms of the restrictions and the lockdowns that china has implemented, i have been deeply worried about these measures. Themugh many are crediting with potentially slowing the incidents of new cases, the number of new cases china is reporting seems to have slowed, i am a bit, first of all, skeptical whether those trends are true. I think there has been some challenges with diagnostic in that country too, but even if you assume they have worked, it is likely those impacts are going to be temporary and when they get back to work, frankly the world needs china to get back to work. It is an important producer of equipment and medicine and supplies the world will need in order to manage the situation. It is important the country does get back to work, but when they do, we would expect to see an increase in the number of cases again. When we think about whether or not a country should do this, we have to examine what are the benefits from a Public Health perspective . Are these benefits sustainable . At what cost do they come . I have been worried about whether there have been additional harms imposed on the people subjected to those restrictions. Has in many places focus its efforts on controlling the virus and that means people with other medical conditions like cancer and hiv have not been able to get the treatments they need. We need to balance the effect of the overall measures and particularly if other countries are looking to china and saying, this is something we should do, it is important to know that china has incredible resources to pull this off, government that may not be effective in other places. Host damascus, maryland, sue, good morning. Caller thank you for taking my call. Died of thesister flu epidemic in 1918. She was two years old. When i started hearing about this, i took this very seriously and i think your guest is being a bit disingenuous with the public, because the communist party in china, i dont think is telling the truth to the world. I dont think that the real truth and i know this because i have someone at nih i am close to that as a molecular biologist in infectious diseases. When i first heard about this pandemic, i was listening to Steve Bannons podcast, and he is having a lot of experts. Smuggled out being of china where the crematoriums thebeing run 24 7, communist party was trying to keep this a secret because they did not want the western world about it. Not to tell the american public, i think this is going to be much more serious than anyone is letting on, and i think your guest really ought to talk about the fact that there is evidence coming forward that this virus lab 20 milese p4 outside of wuhan. This virus is not what the media is saying. It is not just a couple of people who have it in the United States. The test kit is not even the right test kit. The nih says they are using test kits for the sars virus. You do not have any clue what is going on with this virus, where it originated, what we are supposed to do. To tell people not to wash best to tell people to wash their hands and not touch their face and eyes host maybe we can take the p4 lab. Guest i am not eva rolla just, but all credible know it people who have looked at the genetic sequence unanalyzed the genetic tree, the kind of evolution of the virus, have essentially ruled that out. They dont believe that that is a credible hypothesis. Know when i know who studies these issues seriously believes it originated anywhere other than from some animals. In terms of measures that one can take to protect oneself, i completely understand that when i say wash her hands, that feels very underwhelming. I have elderly relatives and they have asked me the same thing. I want to be able to say more than that. But i cant. There arent. Masks,s of stockpiling that is something that is not recommended. You need to be fit tested for a mask to be sure it is actually going to work for you. That is not people can just do themselves, generally. Just to know that you may think you are protected by something that is actually not going to protect you. That false sense of confidence you get from it may actually put you in more harm. The other way you may be more harmed is if everybody goes out and gets those and they are not there for the Health Care Workers who are going to be responsible for saving your life, that puts all of us at risk. I just want to point that out that we will be better served if we make sure that the health care professionals, that are going to be putting their lives on the line to save peoples lives, we need to make sure that they have the tools they need to be able to do that safely. Wes in gainesville, texas. Caller we have an epidemic going on in the United States and the u. S. Has done absolutely nothing. 250,000 hospitalized. We had 15 million who have had the influenza virus. I would like her to address that, that the u. S. Has done absolutely nothing. As far as your referral to the coronavirus, you are saying it only happens in the elderly. That is 100 false. The first doctor who revealed the coronavirus in china died, he was 34 years old. I think it is very disingenuous to come on here and tell us to wash our hands when we should be isolating everybody who has this virus and we should corn time schools quarantine schools just like they did in china. I am a physician, by the way. Also just wanted to say one more thing. Host lets have Jennifer Nuzzo respond. Guest i agree with your concerns about influenza. It is a really important cause of death and illness in the United States each year. With your assessment that the United States is doing nothing. We have learned so much about influenza in the last 10 years because of enhanced surveillance. We also have diagnostic tools and health facilities, doctors offices and in hospitals. Vaccine. It is not perfect, but it seems to be fairly good at preventing severe illness and death. I think we have a lot of tools. I wish we had a better one. I wish we had universal flu vaccine so you only had to be vaccinated once. I wish we did a better job of making sure people get vaccinated, particularly kids. There has been a high number of children that have died this year. As a Health Professional and mother, i think that is a travesty. Believe say i dont that this virus only affects the elderly and immunocompromised. 80,000 cases reported to date, and many of those individuals are young, Healthy People. As she rightly pointed out, young and previously Healthy People have died at this virus. That said, all of the data we have suggest that most of the people who are likely to die are those over the age of 80 with health conditions. I dont want to undersell that. That thinkinggree about washing your hands is probably one of the best ways to protect yourselves at this point is underwhelming, and i think that is one of the reasons communities will be talking about what measures we should be taking to protect those people most at risk. That largely includes the elderly and Immunocompromised People with Underlying Health conditions. It may include others. I think it is important for us to have the conversations about what measures are likely to work, and also understand what consequences these measures can cause. Reatent want to c a situation where you cant get to the hospital if you need to our Health Care Workers cant show up to care for sick patients. We want to make sure we keep the lights on, water running and stores stocked with food because we dont want to create a situation where we implement measures that are worse for our communities than the virus itself. Host arlington, virginia. Linda. Caller hi. I have two questions. One of which is regarding the innate immune system. Im glad that you were talking about preventative measures because i all about prevention. Im in my mid70s, so i also realize that even though i have no Underlying Health conditions, i need to take special care. Washing hands, etc. , and i have actually bought myself a mask, i am planning on getting things that would help boost my innate union system like vitamin c, garlic, turmeric, ginger, oranges, etc. , etc. I want your comments on that. Host lets let her respond. Guest i just want to reemphasize what i said to the earlier caller about it depends on what mask you are using. It is possible they can give you a false sense of security and possibly put you more at risk. It is not recommended that people in the general public use masks. In particular, there is limited evidence we believe that a healthy person wearing a mask is not how mask can protect you. It is potentially better for people who are sick to wear a mask so they dont expel the virus. We dont want to create a situation in which people go out and get masks and we dont have them for our Health Care Workers. In terms of your suggestions for the other things, i dont think there is really strong evidence that they are going to help. I am a mom and i meant a lot of moms groups on the i was talk about garlic and elderberry. I just dont think there is great evidence that they are going to protect. Host did you have a followup . Caller i did. I did see one report, and i have no idea whether it is accurate or not. If it is, it gives me some scarce. Scares. Inre is at least one person china who recovered supposedly from this virus, and then later tested positive and came down with it again. Thenat is indeed true, that tells me that your immune system did not learn and you are not immune to that same virus on a more. If that is the case, then it tells me that there is a big question as to whether or not a vaccine can be developed. Guest i know about that report. I think it is hard to make sense. I think we are going to need more evidence before we understand what that means and whether that was a truly accurate observation or if there were testing issues. That will be an important consideration in the ongoing efforts to develop vaccines. I am heartened that governments and organizations have announced intentions to conduct Clinical Trials. Those are going to be really important for providing the evidence that these measures protect and dont do more harm in the long run. Nebraskave from omaha, texted us. Is the human race a weaker species because of overuse of antibiotics . Guest i dont know that we are a weaker species. I will say that overuse of anabiotics is an Important Health threat and we have to be in concern about the rise we are seeing in Antimicrobial Resistance and want to make sure we are reserving antibiotics for appropriate uses so that we retain these tools in our fight against bacteria. Host bill in albany, georgia. If you are on antibiotics and you test for coronavirus and you show hardly any symptoms, are you more likely to be contagious for a longer period of time and spread it, able to go from place to place and still be able to go from different places and spread the virus . Two, do you think that withholding these sanctions to these countries that need medical care, like drugs very badly, are they killing people and a lot of these places that need these drugs that would help them to fight this . Oxygen, withare on a respiratory virus, is the oxygen making it worse for you by being in an oxygenrich environment . Guest i think a few points there, just to be clear, antibiotics dont have any. Thatu are on antibiotics, should not affect your ability to get the virus or transmit it. He also had a question in there about sanctions. Unfortunately, right now, we dont have specific medicines to treat this virus. There are Clinical Trials the role thatmine some existing drugs are used for other things may have in terms of treating people with the virus. I think the general premise to your point about how we respond and politics in terms of different places, it is in the globes best interest to respond to this collectively, share our resources as needed and as appropriate. Countries have to protect their own, but it is also in our best interest to enable other countries that may have fewer resources to be able to respond to this such that they can reduce the impacts. As we see, something that starts in one part of the globe, i virus like this that spreads silently and rapidly, can be anywhere. It is also important for us to know what is going on in other countries so that we can understand this virus. Ofhink there have been a lot question so far about china and what is happening in china. Part of the challenge is that we dont have a really good window into what is going on there. We are relying on what others are saying and we dont have a direct line into seeing that. The extent to which we can engage in a collaborative manner so we can understand what is happening and understand this virus and its impacts on whether or not they are changing over time, that will clearly be in our best interest. Host bonnie, montauk, new york. Caller i have a couple of questions. I was reading regarding the amount of ards in the initial cohort of 41 people that they looked at, specifically in wuhan, and that 29 of them annd up with ards, which is incredibly dangerous occurrence and a lot of people die from it. I wanted to find out because they said overall, it is about a 3 death rate. However, in this article, about 10 did die. Im curious as to what is being looked at specifically regarding that, but also, i know you talked about the and 95 masks and they have to be fit. They did a too, study supposedly about one of those labs. It is obviously a wet market. It is pretty understandable to understand how that got into the general public. But there is supposedly a lab that was studying specifically that type of that coronavirus, and there was an article that got yanked two weeks ago by the actual researchers. Do you have any information about any of that . Thank you very much advance. Host can you first explain ards . Guest that is acute respiratory distress syndrome. It is important for us to understand the pathology of this disease and what proportion developed this and what proportion are ultimately able to survive it. It is also important to understand a challenge in fully extrapolating from wuhan, is that that is where the start of this situation was. There was some time before maybe it was fully appreciated that this could spread between people and fully appreciated what it was. As of the open questions is, knowledge has improved, and as our understanding of the need to clinically manage these cases, would we see Better Outcomes in patients who are hospitalized just as the system trains and learns about it . Another question is whether resource constraints at all play a role in the proportion of people who develop severe illness and ultimately die. How early in the course of somebodys illness people see care can also play a role. We often talk about proportions of patients who develop severe illness or death as though it affects parameter of a disease pathogen. Cular these numbers arent always fixed. For instance, when we talk about ebola and the places where we have seen epidemics of ebola, it is a fairly fatal disease with 60 70 of people affected ultimately dying. When we see patients treated outside of settings where there are more medical resources available, many more people are able to survive their infections. It is really important when we think about these numbers to think about what medical resources are being brought to bear to help people come through their infection and survive. We probably know in some cases some of those patients who may have benefited from things like mechanical ventilation, may not have gotten it and so we need to understand what that role of those tools are. There was another question about the lab. Again, talked about that earlier. I know they have done various analyses to show that is the origin of the virus. That is not my area of expertise, but there are very thoughtful people who have given careful thought to this. We dont really, not only do we not have evidence, but i think there is very strong evidence to the contrary. I am wondering how trump can say we dont have a problem with the virus if we are not it, and how other countries like iran can test for it but we cant . Guest those are great questions. I think it is important for us to do enhanced testing so that we can understand whether it is here already and to what extent. If it is not here, so that we are ready to find it when it is. It sounds like there have been technical problems with the test the u. S. Is using. Dont fully understand where they are in terms of working that out. They have found it optimistic for a few weeks now. I know state Health Laboratories fda requested from the permission to develop their own test because they very much want to do increased testing. That is somewhat of an extraordinary step, but i think it reflects the degree to which they want to lean in and be forward leaning on these issues. Host conrad, rockledge, pennsylvania. Good morning. Your question or comment . Caller hi. My comment is, im on my computer right now and i am looking at a front cover of a bestsellers book from back about 40 years ago by dean kootz. The topic is the eyes of darkness. It describes some kind of a bacterium smuggled out of the country, i guess and taken to china by a guy name lee chen. Im just and it went to whuan in wuhan in china. Im wondering if anybody knows about this book. It is a bestseller. Guest i dont know about the book, but thank you for the recommendation. Host this is a question from stephen who wants to know why it doesnt seem like children have been greatly affected by the virus. Guest that is a really great question and i think one people are wondering about. We saw this during sars, but it is possible children do get infected, but that their illnesses are more mild. More in adultsit because their immune systems react more strongly to the virus. We dont know, but that said, there have now been, just in the data reported at the cases, not many children. Also, there was a study looking at infants hospitalized in china. They didnt find much infection either. To me, that is encouraging as a mom, but i also think it is important for us to talk about when we talk about things like closing schools. One of the reasons why we talk about closing schools, it is something we did for influenza in the 2009 pandemic. The theory behind that was that children potentially could be at risk of having severe outcomes from the flu, but two, children are known to be important drivers of Overall Community transmission of influenza. Kids get sick and then they give it to their parents and grandparents. So, the thought was, if you could reduce the congregation of children and the ability of children to give the virus to each other, but you could reduce overall transmission and the community. Not clear to me that we are going to have the same benefits from School Closures with the virus given that so few children have been reported among cases. Ul, charles town, west virginia. Caller hello. Host hi. Caller i am a 70yearold er nurse that is not working. I have been watching this morning and ics dancing around dancing around a disease that only has 1 or 2 fatality. I am curious what you think would happen and how to proceed transmission and fatality rates that say occurred 1349, and 1350 in europe. Guest is that the plague . I dont think we are worried about that at this point. I think the highest estimates of fatality that have come out are from wuhan, that is around slightly more than 4 of patients. As i said, that is very high in the modern context. That 1918 influenza pandemic, which is one of the deadliest disease events in modern history, dot had about a 2 case fatality ratio that had about a 2 case fatality ratio. If we think that many, many people on the planet could get this virus because of the way it spreads and the lack of a preexisting immunity and you apply 2 to those numbers, those are very high numbers. Those are very high numbers. As i said, i dont believe that 2 is probably an accurate statistic. I think it could potentially be lower, but we need more evidence. Our understanding of the virus could change as we gather more evidence. Another reason why i think the 2 might be wrong is that often when we see these events, we moreto bias findings severe cases because it is harder to find the mild cases. Nonetheless, i think we have to prepare given the uncertainty. Even if it were 1 or in the order of the seasonal flu, theing that on top of struggle to already keep up with the seasonal flu, think about additional patients coming in seeking care and potentially needing intensive care, that will just be very challenging. That is why this virus is getting the attention that it is. Host the president says we will hear more from him on this topic this evening at 6 00 p. M. Eastern time. He said this morning he plans to hold a News Conference with cdc officials. In just a few minutes, at 930 9 30, alex a star on capitol hill. Alex azar on capitol hill. Atwill also be testifying 1 00 p. M. Eastern time on the budget in the coronavirus. Todaylso is on cspan 2 along with our website and radio app. If you want to learn more about Johns Hopkins center for health security, you can go to centerforhealthsecurity. Org. Cspans washington journal live every day with policy ssues that impath you. January schakowsky discusses the Global Response to the corona outbreak and Warren Davidson will talk about government urveillance programs and louis simon discusses his book contract to unite america. Watch washington journal. Join the discussion. Sunday, book tv features conversations on u. S. President s and race and plus america as a superpower. Started at noon eastern, a live conversation with april rill ryan. I studied at morgan university. I studied for this. This is my vocation not knowing i would be under fire for asking questions. I have asked questions of each president , the same question, except for one, of each president over the last 21 years, but asking questions now has me fearing for my life. Her latest book is under fire. And the presidency in black and white. Squoin the conversation. T 9 00 p. M. Eastern on afterwords, thomas looks at the rise and fall of nations and americas role as a superpower and interviewed by amanda carpenter. We are not each others enemies. We are nt make this, succeeding generations. We are going to expire. There is no guarantee. When things are looking great,. Ryan pril rill ryan and thomas sunday on book tv on cspan 2. View pan, your unfillered of government created in 1979 and brought to you by your television provider. And we are live now at the white house in the Briefing Room where President Trump will hold a News Conference talking about his administrations response to the coronavirus. And got the 2 00 minute warning. Live coverage here on crmp span