Good morning to you. What is the perception of what is going on with coronavirus and what is the reality . Guest i guess there are a lot of different perceptions out there because there is a fog around this, what is true, and what is just rumors . Cleart getting really messaging from top leaders, it is tough for us to understand what is the right calibration for preparedness versus fear, versus confidence. This is something surely that is a brandnew virus an emerging outbreak. Will take time to get our hands around it and our heads around it, but we need to see better leadership at this point. What terms of what is the administration not providing in terms of that leadership . Guest i dont know if it is just the administration, but the entirety of the Public Health response into be more robust, more direct talking about what is there role, the officials role, and what can we expect from them Going Forward . It seems there is a lot of room here for better leadership and messaging in terms of, like, what are we doing about diagnostics, travel bans and restrictions what is the future portend for this outbreak in terms of the u. S. Response, and what can people do in their everyday lives . We hear a lot of rogue messaging about isolating yourself, taking washing, and not touching your face, and those are completely true, but at some point people need more than that. Host when it comes to the virus itself, is part of that the information that needs to be provided what it is exactly, the rate of spread, and the things we do not know about on those fronts . Guest some of those things it is not be delivered because we do not know how to package that up and we do not know how far ahead of the data we can go confidently to develop that message. We look at experiences in other country. China was the main experience we had to work with and now we can look at data coming out of south iran, and that tells us about how transmissible it is, what we can expect in terms of more ability and mortality. Every day we get new numbers new ideas about which way this thing is pointing, and i think we need to make sure we are moving along with our messaging, advancing that, so people have confidence we are advancing the plans we need to protect for the american public. Host when it comes to those numbers, what you take from that in terms of where we are heading particularly in the u. S. . Guest the numbers are certainly troubling. Look at the china experience, and their numbers are coming down, and a lot of folks i talked to, especially in the marketplace, they are taking that as a positive. It looks like the china response hasbrouck has broken some of the transmission chaining. We look at the rest of the world and it is growing rapidly. It is spreading geographically and the numbers are going up and up. This is a balance. Can we make a response robust enough to do Something Like what china did, or is that not in our toolkit because they have a much different approach that is available to them than we have been most of the rest of the world then we have in most of the rest of the world . We need to get around numbers the best that we can. Lot morelves a diagnostic testing going on so we can really calibrate what is going on in our committees, whether we have an opportunity to contain, or if we have to draw back and look at this thing in a much broader way. Host dr. Mores will be with us until 9 00 a. M. If you want to ask him questions about the coronavirus exposure in the United States and the federal response it is kitsit comes to the themselves, can you describe what is involved in them, the amount produced by the federal government, and what do you think about that amount . Kitt i have not seen the handson myself, but i have used these in the past and it is a direct attention of virus genome in the sample they take from people. Some of the problems were clearly that it was complicated to some degree in terms of how individual labs would validate the results. They have tried to make repairs to those from the cdcs point of view and now we are waiting to receive those in a much broader scale so we can get the testing rolling. The delays there i am not sure what is causing the. There is a lot of that. There is a lot of consternation in the Public Health community about what is taking so long, and there is concern about is it all the way correct at this point . Are we going to receive something that will be available on the diskette through the testing slog that we have the backlog we have at this point . There have been emergency authorized products by fda that will allow program let some producers provide alternative kits. Those have not been validated either necessarily to the point that we prefer, but at this point we need more or less everything we get our hands on it we will have to do the validations, kind of, in flight, to see if some are better than others. Kits have been developed all along the world around the world for this response, either counting on what the who has provided or relying on their own. Hopefully we will find the best solution. One of the most critical things is trying to get the test time down to as short as possible and out to as close to patients as possible. The quicker we can do those two things, the better we will understand the outbreak, the trajectory and the scope. Host what is the turnaround time for getting the test administered and the results . Guest the results we are hearing about coming out of te laboratories and cdc that still seems like we are looking at 24, 48, even 72 hours. I am sure that could be cut down as things became more efficient, but the fact is that it probably hours ut three four to four hours. Guest you talk host you talk about taking those test on the fly are you worried about the degree to which it is accurate . Guest we want the best test possible, but it will not make a real difference at this point in terms of how a patient with severe disease is being treated. This is about understanding the scope of the outbreak. At some level we can forgive a little bit of test performance if we at least get some results that help us understand just how widespread this thing might be. Comes to the coronavirus itself, we have had several people call into the program over the last several weeks as we have been talking alreadyis and saying we have influenza, it kills a number of people every year why are we so concerned about already haveen we influenza . Guest it does a disservice to compare it to influenza. The comparison stops of the fact that it is a respiratory born, highly transmissible infection. Thekey difference is here totality of the worlds population is susceptible there is no preexisting immunity. No one has gotten a vexing. Everyone is able to be infected with this thing. That provides a lack of back pressure on transmission. Then when we look at all the different data streams we have to try to calibrate fatality rates, we see a number of different scenarios play out. Just a couple of days ago, the who came out with a dramatic statement of something north of 3 . That would be devastating on a global scale. Seasonal flu is on average to have a fatality rate of. 1 , so that would be many, many times higher. When i look at the south korean data, they are Holding Steady at about. 6 , and they are doing a robust diagnostic push that is not just looking at sick people. It is across the community. That might be a good estimate if we take into consideration the mild cases or asymptomatic cases occurring inside this outbreak. At that rate were still talking about six times seasonal flu. On average, it is 30 seven half andahalf 37000 dying every year. Six times that is a big number. Randy is texting us. The expectation is you would be immune, but we do not virus and the immune response. This was one of the many things we have to understand and be on the watch for. This he got outbreak, the ebola outbreak, they taught us to be careful of our dogma and understanding what we think we know. Everything is on the table until we can take it off. Host another text this morning from bakersfield, california, asking the question hadt south korea also delays built into their response. They were right next door to the outbreak and they probably should have been on top of it sooner, but they changed their posture quickly and now i think their response is a bellwether for what the rest of the world should be trying to do. Host lets go to calls. This is from dubuque, iowa. Youre up first for our guest dr. Christopher mores from George Washington university, a Global Health professor. Tom, go ahead. Guest yes. I have a question and a concern caller yes, i have a question and a concern we have prebooked flight tickets from chicago to San Francisco on may 20. I am very concerned. I know we will take where surgical gloves and masks on the flight and try to avoid groups of tourists, but we are really concerned about that and would like your opinion. Guest it is a common question and a common concern. Everyone needs to be thinking about is it the best time to be traveling. Can i push this fall . Certainly i would recommend training yourself before you go on any travel, keep your hands away from your face, keeping good hand hygiene up, washing, using hand sanitizers it is not something you can do right right, iat that is should not be touching my face. It takes a long time to change the behavior. It is something should be trying to do how often do i reach up . Nd rub my nose or my eyes those are moments you can contaminate yourself. Host we have the crew ship off the coast of california not been able to dock. Is that a proper response from the state in your opinion . There is aou notice lot of transmission going on in a particular community or a ship like that not letting them just disembark is a good idea, but holding them on a ship without appropriate supplies, quarantines, Infection Prevention control support that is where some of those ships have run into significant trouble. There is a good way to do that and a bad way to do that and i think it is all in how it is executed. Host keith is up next. Keith in fargo, north dakota. Caller i was just wondering where did coronavirus get started from . Guest it is a brandnew virus. A has been implicated in market in wuhan, china, that did sell wildlife products wild animals. The idea is it is an animal disease that has found an ability to be spread in man, so sometime in recent history that virus made the jump into us, and it reminds us that we have to be careful about our intersection with wildlife, how we treat it, and this is one of the consequences of not paying attention to those warnings. Host a viewer off of twitter this morning how determined on something cases, and do we test the entire population . Guest to get an ace of the medic fraction, you have to do a broad diagnostic push and youre not just looking for sick people, just doing this in clinics. You are trying to understand what is the totality of this transmission iceberg, as people say. That is important because we need to understand how much is going on in the community, because that will then let us know where there are maybe risk groups we need to protect before it gets there. It will also tell us more about calibrating expectations for how many people get sick and how many people will die of this thing. Viewer asks a question off of twitter saying is or any evidence the coronavirus leaves permanent damage . Guest i have not seen any data in terms of longterm followup survivors. Survivors. That is certainly something that has to be watched for carefully, but there is nothing to suggest that is going on at this point. Host b in texas. The morning. Caller i have a twopart question. We are not hearing anything about mexico, and i live near the border, and i am really old. I have this question about why are we not hearing what is happening in mexico with all the people coming waiting to come into the United States, and the other question i have dont you think it is strange that all of a sudden china immediately jumped on started loving pitals, putting people building hospitals, putting people in quarantined, we are sitting here watching, and all of a sudden it is all over the world . On. An, ome come is it airborne . Guest the response has been the same problem we have in this country do the avid technology, do they believe it is a threat, do they need to take it as seriously as countries that are near to the outbreak zone it is a patchwork of responses. In terms of the chinese response to the outbreak, they really didnt amazing job mobilizing National Resources to respond to , andutbreak in wuhan certainly a lot of the world responded with travel restrictions and limitations in an effort to isolate china and that area of china from being able to contaminate the rest of the world, but since that time importantassed, it is that the rest of us get on with our preparations. Host this is bob, bethlehem, pennsylvania. Caller good morning, doctor. Host you are on. Go ahead, bob. Caller good morning, dr. P i have a question pertaining to ebola. When they took patience that recuperated, they had their antibottom antibodies in their serum, and used that as a way of fighting previous people that could come down with ebola. Is there any anybody looking of thee effectiveness serum inside of the people that have recuperated question mark looking forward to your recuperated . Looking for to your answer. Of andi am not aware about a second be used for people that have already survived the Covid Infection being used to protect people going through it now. We have used that over the years. It was not terribly effective for ebola virus, and there are reasons to believe it might not be the most effective therapy here for respiratory virus where a lot of the infection is happening in lung space, which is difficult to get the entire body to that you would otherwise delivered intravenously. Texas asked the question there are reported to be two strains. Guest this is brandnew, and i must say i have not looked at the data on the definition of these two types. It is something we need to be aware of in terms of this is a brandnew virus. It is going through its initial rounds of infection in the human population and it will be mutating as it goes. We need to be aware of the possibility of different types to arrive. Asked is from seattle it more likely that people recover than die . Since this is mainly a mild disease, most people will recover if they have symptoms at all. It is really we are worried about the top fraction of people that have preexisting conditions or advancing in years. Those are the ones we are more concerned about the recovery status from the virus. Host again, our guest is from George Washington university a Global Health professor here to answer your questions. This is deborah, west chester, ohio. You are on. Go ahead. Caller thank you for taking my call. Anda retired microbiologist i am pleased to have the opportunity to speak to you because my question is focused more on the future. You know, in china they have a different culture in the United States regarding food safety. You can have it take 10 in the back of a restaurant you can have a pigpen in the back of a restaurant. In the United States you cannot store raw meat above frozen vegetables. In china they have been affinity for taking live animals and they have live market live animal markets. When you combine that in a city like in wuhan, and you look at their culture, and you look at favoriteone of their Animal Protein sources, which is a mixing vessel, as you all know, you really have to ask yourself, is that a practical good fit. Ure is not a it is an ideal fit for an emerging virus, especially from animals to people. I am wondering, since this is your field, im wondering if the World Health Organization in combination with the wto should forstablishing standards our supply chains. Is it really smart . Caller thank you, deborah host thank you, deborah. Guest it is certainly something we dont really do or allow here in the states or number of other western countries. Really, here, i think the issue is the demand exists, so will this outbreak change that demand within the cultures that use wild animals, bushmeat, or slaughter to table practices. That is something i have seen a lot of your coverage on, and it might be changing because of this outbreak alone. Host you might have seen Media Coverage of a picture going on lysol, the coronavirus is listed on that. Gauge when you see that kind of thing and what should you be telling people about lysol . Guest these products all have some ability to serve as a disinfectant, and this is an envelope virus that is readily disinfectable by a lot of these products. It is not incorrect. What we have to be aware of is how important is the surface versus the respiratory protection versus social distancing all of these things come together to create a complex scenario of how people get infected. Until we know what is the most ways wer most important are transmitting to each other, we need to cover all the bases. Certainly washing your hands and disinfecting services we have to do that until we know for certain that is something we need to continue doing. Guest what kind of international and what kind host what kind of information have you seen on social media . Guest i try to stay off of that stuff as much as possible. Host from new jersey. Jerry is next up. Caller one of the questions i get is i am really getting upset about all the idiot, including cspan all of them media, including cspan, 24 7 discussing this virus with different opinions instead of just giving facts. Letting the press conferences give the facts that they know today, tell the people the best way to protect themselves. By the way, youre not given any answers about nothing. It is just a matter of conversation. My thing is this is set to panic people and i am really upset about that because to do this 24 7 the sky is falling, it is horrible for people. There are elderly people that have really real Health Issues that can get affected by the stress. I believe stress will be more harmful to more people. A bit, notit back abc, nbc, cnn, fox get the facts, tell people how to protect themselves, dont touch your face, wash her hands, and the disinfectant they are charging 50 a bottle could you let people know is not necessary to do those things. Tell people to wash their hands with soap and water. Guest i think the fear is palpable there. I appreciate the fact that we have not yet help people take the next step. What is it they need to do beyond in aware of this . Right now we are putting out a pretty hackneyed message about Something Else is coming we dont know what that is, you need to keep yourself as clean and distant as possible. This is like the first thing i was saying to you we need to , as forward now as a nation a response, to try and find ways to protect people, specifically like the caller is talking about , people that are all higher risk. How will we protect the elderly, the indiancompromise the immunecompromise. Hour, an elderly man with preexisting conditions working in the transportation industry, that guy is spot on in being concerned about his health. How are we going to protect him . The answers are difficult because we are not china we do not have complete control over all population like they do. Andave to find ways to try create spaces for people to isolate themselves without taking themselves out of their ability to take care of themselves in an economic way. People cannot necessarily stay home and not work because it is good for the outbreak, but it does not help them put food on the table, pay their rent. We have to really be looking at waysy with his policy and implementation to protect vulnerable populations will we get through this outbreak. Host i will address your concern ours is not a means of fear mongering. It is information. Have pressuests, conferences without comments from us or anyone else, and weve been members of Congress Talking about this particularly as 8 billion was approved by congress and to be signed by the president. All of that is available on cspan. Org for you to consume for yourself and you can make decisions for yourself about coronavirus. To the 8 billion figure past this week by congress, as a dollar figure, how does that work, and particularly the sectors it will work . Guest that is not entirely clear to me how it will be deployed to greatest effect. It does not seem like a long term longterm, like the right number, given the challenges if this is truly communitydriven transmission at this point, and it is going to go quite broadly through the u. S. , that will be just a first stop. Much to the point i was just talking about, however are we going to enable people to be part of this response because it is going to be all hands every american will have a role in this. The role can be to stay home. However we going to make that happen . I think some of the future funds will have to come to terms with helping those people protect themselves and take themselves out of transmission chains. Host we will go to st. Petersburg. This is michael calling. Aller high, dr. Mores i have a point i would like to bring up that i dont believe anyone has covered yet in the media and then ask you a question about that. The point is thus far, officials, in response to the coronavirus, continue to tell us the risk is low. Additionally, they are instructing us that simple preventative cold and measures h as washing your hands and the flu measures such as washing your hands and specific types of hygiene will prevent the transmission, yet we are seeing governments worldwide shut down portions of society at large when infections occur. In contrast, every year in theds die every year u. S. And the blood from the flu, yet we dont see no same closures of portions of society at large. Is are you to you concerned there is underlying seriousness and underlying points with this that the local and foreign governments are not leading us to believe yet . Guest i think without getting too conspiracy theorist about it, there probably are overreactions happening out of ignorance because we just dont know what we are facing. One we are told numbers like 3 fatality rate that is so dramatically different than any influenza outbreak say for the flu thate for the 1918 it would requires taccone and isolate individuals and hope populations. When we start to talk about the more nuanced rates we talked we discussed on this show earlier maybe 1 or less, it is still dramatically more fatal than seasonal flu would be, and again, like i said, since the whole world is susceptible to this, we have many more people that are going to potentially become infected with this virus. Ultimately, that kind of calculus lends itself to come at this point, an overreaction, probably, in what is the best response. It is not necessarily an overreach if we thought we could still contain it. Until nations get a handle on where their pockets of infection are if there are pockets, and it is not totally widespread then the first pass would be lets see if we can isolate this thing, and crush it out of the population, but if we find that it is really spread too far, that changes how we do this. Rely on isolating whole communities from each other because that is not likely going to be very successful in freedomloving societies. Host dr. , we have heard the president take on the World Health Organization of 3. 4 , saying it is a false number. What do you guess what does that do what does that do when he says statements like that and how do you react to the . Shocked reacted with a response because it is not a nuanced number i do not know anybody that believes that that is the total number of cases china has had, so a lot of what we have done is trying to calculate what is under the hood in terms of total case numbers, and when you open that up, the case fatality rate will drop. That is why we should not be relying on the chinese data to inform that kind of policy decision and that sort of posture. We have much better examples in the global community, such as south korea to help us calibrate more accurately. Text iewer off of guest that is a great question. Coronavirus in general can persist in hours, even days given certain amounts of humidity, but how frequently that results in a retransmit should from that inanimate object to someone else that touches it, it is probably only very efficient in very short periods of time would be my expert opinion. Someone has just touch to that thing, not used good hand hygiene, you come in touch the hand railing next and you inadvertently touch your face, that is probably one of the most efficient moments for inanimate transmission like that. Host what is the value of a mask and wearing a mask at this time . Masks are great for healthcare care workers seeing patients all the time. They have so much contact with potential cases that it makes sense for them to be wearing them. If theyll are working with people and taking swabs from them, they have to wear face , because justl the act of taking a swab will cause people to cough and sneeze, essentially your face. They need that level of protection. For the general public it is best for people that are coughing and sneezing to wear masks so they do not spread droplets to the rest of us. If you felt so inclined, i would appreciate for people that are sick that are still wondering out and about instead of staying home if they should be, too put on a mask of the can find one, but it is not indicated and it is difficult to recommend masks when we do not have enough for the healthcare workers that need them right now. At this point i agree with the guidance that says every day people to 90 to be wearing masks. Save the stocks for health care workers. Is deborah from columbia, missouri. Caller you talked about south being on top of the on top of it. What are they doing that we are not doing, and if you were in charge how would you do things differently with regard to protocol . Guest one of the more dramatic things that south korea has done is really just a massive diagnostic campaign to understand the scope of the outbreak in their country. They have made the bar to entry for diagnosis very low. They have drivethrough clinics where you dont even get out of your car. You, getup, they swab your information and text you the information when they are done, maybe a day or two later. That gives them a fantastic view of the community in terms of who is in active, who is concerned. Bout who is infected through that lens, they are able to get a much more accurate view of what the status is of transmission in their country. Most other countries are not doing that most other countries are still relying on people not feeling well to present for symptom evaluation and potentially testing, and some of that is driven by the lack of available diagnostics, but really that should not be a longterm impediment to the rest of the world rolling out more communitybased diagnosis. Host daniel. Daniel up next from minnesota. I was wondering if there is a concern with the outbreak on a lot of things at once the census being positive on the communication, the use of cell phone, the phone itself carrying a virus, or the outbreak getting to be more airborne. I see they are spraying stuff in be in how would that terms of letting whatever it is get excessively worse than creating something as far as having it in our and the structure or how hospitals being aware of how to remodel, redo health care, and even if you dont have health care how would that circumference of having it or not . It is a circumstance of where you are at, what is going on, and how to look at it at all. Guest there is a lot in there. Let me take a couple of them. We have seen a number of countries teams of people in full spacesuits going around spring chemicals and disinfectants out in the open and in the community. Shocking imagery and it does cause a lot of concerns, and probably some fear among a lot of people and even policymakers. There is not a great indication that that is the most significant way we can react to this outbreak. I think that is why we have not seen that much of that here in the west. Then, too. To concerns about then to give it to concerns about health care, who gets to be tested and treated this is another significant issue that is not being clearly articulated by leadership what the expectations should be by the general public. Are these tests going to be provided free . Or it really reduce costs . Who is responsible for ancillary costs that might be associated with taking the samples . There are many concerns here in this country about who can andrd to actually be tested become counted in this outbreak . That is and that should be able to be resolved and made a part of this public of response and not put the burden on the public. Host what you think about Vice President mike pence being at the head of the White House Task force on this, and how do you think he has performed so far . He is as long as surrounded himself with the right people and they are taking in all the expertise that they can in a transparent, unified way across all the sectors, then they will have to arrive at the best decisions. I dont think there will be any reason to expect there will be a political reason for that cannot be transmitted all the way through the response. Host this is our guest, georgepher mores of washington university, a Global Health professor, here to answer your questions about the coronavirus. Gwen is next. Gwen from silver spring, maryland. Caller good morning. Thank you for taking my call. I have a question about getting tested. Ipersonally thought that possibly had coronavirus and i and i to get tested, called my local clinic, and they did not know where i could get tested. Now, i think i am pretty much tested should i get at this point . If so, i still dont know where. I guess that is my starter question. Not get theu could test before and you have recovered now, at this point there is still a significant limit in the number of tests available and the capacity to run those test, so it would not be recommended you would continue to try to seek that out at this point. In the future, i would expect and i would certainly hope that people like yourself that have that feel like they might have it or feel like they might have been exposed to it by association with other people in the community would be able to quickly get a test done to put themselves at ease, but also more importantly inform the response so we know where it is, how big it is, and where to deploy resources we do have. City, nevada. N john is next. Caller im a first time caller. Thank you for taking my call. I am more concerned about the paranoia in this country and across the world. See if there is something that can be done about that. Guest i think the paranoia is ispable, and i think there so much Media Coverage of this right now. There is so much uncertainty that it turns from paranoia to fear. That is something we need to be confronting. I hope were doing our part here to take care of some of the questions people have about it, but ultimately it does take leadership to show us a way through this thing, and that will come in terms of a response from state, local, and National Leaders in terms of how do we get our hands around this outbreak, how do we help