Of the virus, we do have a grasp of who is at moderate risk and who is at severe risk. Understanding who needs to be most protected from ongoing disease transmission and understanding enough about the virus to really start putting together diagnostics and begin the process of developing vaccines and other countermeasures. It is a long process, but we have enough now, knowledge to get on that pathway. Host what is the most important thing to learn about the virus . Guest i think the important thing is to understand what terms mean. We are throwing the words around. I think because they are technical terms, they have a different meaning to people who are working in epidemiology and Public Health than when they they might have when they echo in different settings. The most important thing to understand is we think most young, otherwise healthy people, are at risk of infection, but not necessarily at risk of very severe disease. Their risk is lower. But people who are older, who have underlying conditions, cardiovascular disease, heart disease, diabetes, they appear to be at higher risk of more severe disease. That is in the most affected parts of europe, italy, china. Those are the people who seem to be at highest risk of severe pneumonia. That is what we clearly understand right now. When we throw around terms of case fatality rate of 2 , 3 , it gives the impression that we have a strong grasp on a ratio n odds ratio that is still an estimate, and we are trying to understand it and who we need to protect most. Host another term thrown around. Coronavirus has been genetically sequenced. What does that mean . What do we do with that . Guest so that is actually an interesting and Exciting Development that happened quite early. The chinese researchers published a full genetic sequence of an isolated coronavirus from a patient relatively early in the outbreak. They sequenced it from a patient it came from a patient, and they published the full sequence in january. What that means is we have a map of the full genetic complement of the virus. It helps us understand, first, immediately which viral family , belong to, which sounds academic, but it really helps you understand what the characteristics of that virus are likely to be. The second thing is that genomic sequence, the letters that make up the full genome of the virus, the blueprint of the virus, or a template we used to make diagnostic testing kits using molecular diagnostic testing, which is a very rapid way of testing that viruses that does not require you to need a lot. Isolates from the patients. Virus, it lets us do several things. We can understand characteristics about the virus isolateets us compare from different times to understand if the virus is changing. Host are there different strains . When we say we have the full genome of the virus, it lets us do several things. One, we can understand characteristics about the virus, and it lets us compare isolate from different times to understand if the virus is changing. Host are there different strains . Guest the isolates that are being sequenced and being published in databases suggest the virus is not changing rapidly. There are enough viral clues that tell us when a virus has been introduced into a population and use it as a clock but that there does not look like a huge amount of variation. It suggests it is the Underlying Health of the population being affected or something about the way the outbreak is being managed. Host Julie Fischer is our guest, associate Research Professor at Georgetown Universitys Center for Global Health science and security. She is with us to take your questions as we try to understand coronavirus, the outbreak and the response. Phone lines are split up regionally. If you are in the eastern or central time zones, it is 202 7488000. If youre in the mountain or pacific time zones, it is 202 7488001. And then that line for medical professionals is 202 7488002. For medical professionals is 202 7488002. The phone lines are open, so you can start calling in. Julie fischer is here. South korea being lauded for its Testing Capacity. What had they been able to do right and why cant we replicate that, or are we replicating that . Guest just to begin with what south korea is doing and why we are looking to them, south korea was very aggressive right out of robuste in developing a diagnostic Testing Capacity the ability to test a lot of people accurately and quickly. About trying to learn their diagnostic tests out the door. What they have done is they have really pushed a positive Risk Communications message and done a good job figuring out how to manage cases and test them outside of hospitals and other health facilities. Message, if you think you have been exposed, if you have symptoms, if youre even work, here are testing stations. Pictures,e have seen they are drivethrough testing stations. Come here and get tested. We will collect your contact information. We will let you know in a few hours what the results are. And then they are following up aggressively with people tested. You can get a message via text or other electronic good news, or you have tested positive. If you have these symptoms, here is what you should do. You can selfquarantine, try to keep yourself from infecting others. If you are not comfortable with that, and you need to be with people, they have set up care facilities that are not necessarily medical facilities, they are converted government facilities, Community Center like approaches, like we do in a disaster like a hurricane, or you give people shelter. People can have meals and they can be sheltered with others so they dont feel isolated, but are still quarantined, but not putting a big burden on the Health Care System. Hospitals toing provide care for the most severely ill. What is fascinating about what south korea has done, they have pushed testing, have been transparent, they are letting people know on a micro geographical level on where cases have occurred near them and urge them to take precaution and be aware. They are giving people options for care with clear instructions about what requires followup. Host on testing, how do you read the story from bloomberg . The emergency approval approval from the u. S. Government potentially speeding up the ability to test patients. The food and drug demonstration granted in emergency use authorization for the test. He tool is available in europe there is a lot of jargon in there. What does it mean . Guest emergency youth authorization is a key term. Early 2000ven in the after anthrax with the recognition that we need a better way to get diagnostic test kits out quickly for diseases or conditions that might not have been a priority before. We have not had to use them. Procedure is a regulatory procedure that takes some time to go through all of the testing. That emergency youth authorization allows the fda to say in a Public Health emergency, we can use diagnostic tests that are demonstrated to work without the full licensing process because we dont have anything else to offer right now. It is basically an acceleration ,hat lets Government Agencies state Public Health laboratories and the private sector bypass some of those slow approval processes to meet an immediate need. That is one of the many has been that identified by the private sector did issue because fda that emergency use authorization, it allows the private sector to offer up testing kits with the hope they can be rapidly effective. During the seek outbreak, there were more than during the zika outbreak, they were more than a dozen kits approved. Host we are giving our viewers a platform. If they have questions about coronavirus, Julie Fischer is our guest, a professor at georgetown university. If you have questions, now is a good time to call in. She will be with us for about 45 minutes. Woodbridge, illinois. Good morning. Caller good morning. I called in earlier but i was disconnected. Would you think that the government has a certain role to states have a bigger player in dealing with the people in those states and they are failing to do that . Agoinstance, three weeks with the president was talking, telling us about this, i am 55 and i have copd. I had to go to the doctor every three months and she checked me out. I called, she called me back and she thanked before. She does not want me to come in. She has all my medicine and wants me to stay out of public. I listened to the president and the medical field that was around him at that time. On south korea, she was talking about how fast they have gone. I dont know if they have a parliament or Congress Like we have. Do you think when they have these hearings, if they have them, and the witnesses come in, all they do is beat these people up, point the finger at the administration. I feel they should have more closed hearings and lets talk about the subject and see what we can do. Lets get the funding to them and go forward with it. Host thank you for bringing those up. Your point that you used the information to identify you are in a High Risk Group and work with your medical partners to cigarette how to diminish our risk is a good listen lesson. Two states have a role to play . Absolutely. The federal government has resources, technical assets and the decisionmakers who can help move money and people around to where they are needed most. Ultimately, it is to states and your local government who are dealing on the ground with the reality of people at risk, people who need to be tested and people who need both medical care and followup care that might not necessarily be medical, like making sure if someone is selfquarantined they have food, access to prescriptions and someone there to check on them. None of those things can happen from the federal level. They require cooperation from local government and state health departments. Point, letting the state and Public Health officials and scientists who can do the Laboratory Work proceed with resources they need and the knowledge they need is the most critical thing we can do. And everyone playing together on the federal level helps make that possible. In ondo you want to weigh how helpful these hearing set been . Right what is important now is transparency. We know in Public Health that the most important thing that we can do as leaders and spokespeople is to be absolutely, 100 honest and frank. That is the role of public say, what do we know, what do we not know and what can we do to close that gap . We have a lot of Health Authorities in our country that are knowledgeable and capable of speaking on these issues and letting them speak and answer and address those questions is important. Politics creeps in because politics will creep in. As long as we focus on what are the questions, what do we know, what do we not know and what do we have to do to close that gap . Host louisville, kentucky. This is richard. Good morning. Fischer, you have a calming effect and i appreciate you speaking. People are running around with their hair on fire. How many people will die this year from the flu . You are think what talking about is the risk comparison, why people are panicking in the face of coronavirus. We do have in any given year tens of thousands of deaths from the flu. It has been a bad flu year and it does not make people afraid in the same way. I think you are absolutely right that we are looking for parallels and ways to manage concern. The real difference is in the year were tens of thousands of people die from the flu and no one brings it up, it is because we are familiar with the flu. We have tools to deal with it. The public does not take the risk as seriously as a child, particularly those at high risk. But they feel it is familiar and they understand it. Coronavirus is. The biology is new and 100 of people on earth are susceptible to infection. I get your point and you are 100 right. This year, there will be tens of thousands of people who die from the flu and no one will get alarmed because they feel they have the knowledge and tools to manage their concerns. With coronavirus, there has been conflicting information. There are a lot of risks we dont understand and people are alarmed but, sir, i completely get your point. We can have 36,000 deaths from the flu in a season and nobody gets particularly alarmed while this is provoking a lot. Host if and when we get a vaccine for coronavirus, will that be shots people have to get when they go and get vaccines before flu season starts . Is that something we should expect who are struggling to maintain to have oxygen. Is the ammoniant. The number of people being and only if ace. Ercentage come l ill. Calls . Meantime, your thank you for your calmness. I was wondering if you have any guidelines. What about Wearing Masks or gloves . Is it irresponsible for me to those are some really important question. F you are symptomatic. The recommendation is to. Void exposing others it does not sound like you were boat. Ally in that work,ms of shinji go to there was some clear guidance ism your employer, but it important. What should you do . You quarantine until your symptoms are . These are conversation that among be happening employees and every setting, particularly in places where we are depending. Help peoplelanes to to make clear how they will be paid and supported . These are really important questions. I can say this is the place where i recommend working out a plan for people who are symptomatic. In terms of should you be Wearing Masks, the general recommendation does not do a lot by others. Infection i think even though we feel like an washing is not particularly helpful andit is. Ffective at protecting you we touch our faces so often , so theeven noticing handwashing is an important intervention we touch our faces so often without noticing. The handwashing is an important intervention. The most important intervention is trained to encourage people who are sick to not expose others. I commend you for thinking forward about your role in protecting other people at your workplace. We are all depending on each other right now. The tools that we have, social distancing tools, the hand hygiene tools, the selfquarantining tools, those are oldfashioned, nontechnological interventions. They are what we have right now and they can help slow the spread of this disease, so that everyone in the workplace, in the community does not become sick at the same time and overwhelm the ability of our Health System to provide care to those who are the highest risk of most severe disease. Host when people talk about flattening the curve, can you explain that . Guest the epidemiological curve. The full way of presenting what an illness looks like. When people in Public Health talk about the epidemiological curve, they are talking but the number of cases over time. Right now, when there is a sharp increase in the number of cases, the curve looks like this. Host we can show viewers the chart that is on the editorial page of usa today of the curve without protective measures over time. Guest what that curve is showing us is we predict many of cases would occur in a very short time. The concern about that is our Health Care System only has so many intensive care unit beds, we only have so many respirators and we only have so Many Health Care workers. If all of those cases occur in that sharp peak, we might find ourselves in a position or we dont have enough resources to provide care to those most severely ill. Flattening the curve means slowing down the number of new cases in that epidemiological curve, instead of all the cases occurring in a few days, it is spread out over a number of days. That does it necessarily reduce the number of people infected overall, it might, but most importantly slows down the number of new cases so that the number of people who become severely ill are spread out and we can free up hospitals and Health Workers to provide them with the standard of care we expect for ourselves and loved ones. Host new jersey is next. You are on with Julie Fischer of georgetown university. Caller good morning. I am so happy i am able to talk to you. I have two questions for you. I am a 64yearold grandmother. I adopted by beautiful granddaughter and retired early as 62 to be a fulltime stayathome mom. My husband all of us just got over the flu and it was a monster. The baby brought it home first she is six years old. And then he got it, and he almost died from it. I got it after both of them recovered, but i had a flu shot, and the baby had a flu shot and he did not and he got the worst of it. My question to you is, first, say, if i get the virus, or the baby brings the virus some, what do we do . Do i have to separate myself from her . Do i have to make alternate plans . And my other question for you is, how do they treat this disease if you are positive . Host thank you for the questions. Guest thank you so much. I know that recovering from influenza and facing this again, it is a lot to deal with in a short time. You have some really good questions. Going backward from your last question, what did they do to treat this . If infected and they have a mild disease, coughing, fever, but they are not severely ill, they are not having problems breathing, no other impact on their other organ systems, then the treatment right now is very noninvasive, supportive care. Asking people to stay home and make sure they have plenty of liquids, make them more comfortable and help them breathe, like they would for any other respiratory infection. It is not specialized care. For people who are severely ill, the hospital treatment is to help them breathe, make sure they get enough oxygen, so there other organs are not damaged, they can continue to breathe until the virus has cleared. Right now, it is like caring for other respiratory infections we dont have good medical therapy. In terms of what you do if your baby brings it home if your granddaughter brings it home, this infection, there are guidelines for care that have been developed and published. They give the best available Technical Advice on how to care for someone who has covid19 without becoming infected. It is about having the infected person wear a mask that might be hard with a sixyearold, but it can be done and helping advise the people providing care on how to get rid of the waste that the infected person produces when they sneeze and cough. Frequent handwashing, disinfecting surfaces at your home. It is tough. You are in the quandary of potentially having to provide care for someone and putting yourself at risk. That is something we are all having to think about and plan for. My advice is to go to the cdc website, read about it, make yourself comfortable and knowledgeable about the guidance. Talks about achievable and commonsense measures, getting someone to wear a surgical mask so they are not coughing and sneezing on you. If they cant wear the mask, there are measures to protect yourself, cleaning all of the services in your house, keep them isolated as much as possible so you are not disinfecting every surface, every minute. Just try to contain the spread of infection so you, yourself, are not infected. I wish you the best and i hope you are all able to get through the next couple of weeks without anyone having to deal with the situation. Host our guest is Julie Fischer, a Research Professor at Georgetown Universitys Center for Global Health science and security until the house comes with us at 9 00 this morning. We are expecting a vote today as negotiations continued into the night last night on the Economic Relief package. Negotiations between the democrats and President Trump over what should be included in the Economic Relief package. Here is the story from last night about the house being close to striking a deal with President Trump on coronavirus response. President trump weighing in about six minutes ago on one of the aspects of the relief package. He said if you want to get money into the hands of people quickly and efficiently, let the people have the money they earn. Approve a payroll tax cut until the end of the year. You are doing something meaningful. Only that will make a big difference. We are expecting votes today on capitol hill. Unclear if that tweet will change anything. The house will come in at 9 00 a. M. Julie fischer, this is greg here in washington, d. C. Caller you should be the one that is talking, because what is coming up from the administration is totally, totally unacceptable. They have political people try to talk about this, it is terrible. You know, coming from the guide that is sitting there, it is not helpful. You are the people who know and can inform people and i really want you to get out there and let people know. My mom has cancer. I have talked to her. She knows she is really, you know, could be in that group. It does not matter if you are black or white. You are the people who should be talking. Not these other guys who were trying to do this politically. It is not a political issue. It is a health issue. I commend you for doing this. Guest thank you, sir. I really appreciate your kind words about what i am contributing. I am doing my best to be part of the Public HealthRisk Communications effort and i appreciate your kind words. I agree 100 that this should not be political. This is a crisis we should be facing together. One of the most important things is having the technical experts upfront. There are people in the administration who are technical experts, who understand the challenges being faced at the federal level and it is good to see them outfront communication. I agree that this is a time to not talk about the politics of this and focus on what we can do together and i wish you and your mother the best of luck. Host what is the center for Global Health science and security besides coming on this show in this conversation are you involved in the official response . Guest like other academic groups, our role is to fill in the gaps that the government does not necessarily have time to fill during an overwhelming response. We can analyze data and try to identify trends, understand what is happening, identify gaps. The biggest role for academia during this covid19 outbreak has been the realization that we can as a group academics can pull together a lot of information quickly about the actual situation and what is happening, in terms of new cases and responses. Understanding what interventions are being taken in different places and trying to identify the best practices. While the federal, state and local Health Officials are filling an absolutely Critical Role of making sure that diagnostic tests are available to those who need them, that there is good communication about what people should do and how they should protect themselves, and what they should do if they find themselves sick. Our role is to look at the big picture, identify what works, the best practices, and share that information with the state, local and national Public Health officials. Host tim in wisconsin. Good morning. Caller good morning, cspan. Good morning, professor. My questions are about Paper Products the mail. Would it help when you go to your mailbox so you are wearing gloves you put your mail in a plastic bag, put it in a freezer, with the freezer kill the virus on the mail . Second question, money. How should we handle money . Third question is, if the u. S. Post office was to use ultraviolet light on the mail, would it kill it . Do you think it would help if the federal government would help funding of new doctors and nurses, because obviously they will be needed . Thank you. Host i have mail, money, uv light and funding for new doctors and nurses. Guest there has been a study that is coming out soon that has been shared from federal researchers that did show it asked the question, how long can the virus really last . They did some careful work and showed that the virus, just in droplets, lasts for a number of short hours. If it is sitting on a surface like steel or plastic, or if it is sitting on cardboard, the virus can last for several hours, and on hard services, may be couple of days. They did not look at paper. What they demonstrated is you might be able to find a live virus. If someone sneezed on their hand and touched paper, envelopes, dollar bills, it is theoretically possible there could be live virus on those surfaces. There has been nothing to suggest if someone sneezed on their hand and handled your mail or money and you picked it up, you are unlikely to put it back in the air in a way you could present in. The worst thing would be touching it and then touching your own eyes or nose. Handwashing is important. It is not impossible there might be traces of virus in the community on dollar bills are envelopes, but if you wash your hands carefully, it should offer you adequate protection. You should not have to take any major measures. In terms of uv light at the post office, the virus is very easily eliminated by applying uv light in our laboratories. In some place you are dealing with large amounts of mail, there are other ways the mail could be treated. It would be pretty intensive and it might give you a false sense of security. Even if they could treat the mail at the point it is being handled, it will be taken back out in the community and handled to your mailbox. The careful attention the postal workers are paying attention to their own hand hygiene. The most important thing is thinking about the simple interactions the interventions you can take. If you have interacted with mail or dollar bills, wash your hands afterwards and avoid touching your eyes and nose. It is something that is effective. It really is biologically the best protection. Washing your hands carefully so for 20 seconds. Host can virus spread in swimming pools or the beach . Guest i do not think there is any evidence the virus can spread in swimming pools. Swimming pools usually have good chlorine amounts. This virus is not that durable. It does stick around on surfaces if not disinfected, but if treated with a disinfectant, it is easily destroyed. Swimming pools are large and there would be a lot of dilution. People who are outside in the sun at the beach, that is probably the best place to be with a virus affected by uv light. Interacting with other people is your big risk, not the virus spreading in the environment. Host steve in asheville, North Carolina on the line we set aside for medical professionals. Good morning. Caller good morning. Thank you, professor, for your wonderful discussion. In my humble opinion, you come across very knowledgeable and i think more people can relate. My question to you, maam, i used to work as an Infection Control nurse and it really bothers me to see that nursing home up in seattle to have such an outbreak. My question to you, i am still working in a different area as a nurse, my question to you is my friend is that a local nursing home in nashville and what i would like to introduce you do clinical research, so you are the perfect person to ask. Why dont they put the most vulnerable patients, the ones debilitated with associated diseases, why cant they isolate them in the Nursing Homes in certain parts, and have limited access because exposure is the key to it . That would help the elderly from maybe getting infected because they are more vulnerable to dying. I dont see anyone in the asheville area, or no one has talked about it, about keeping the elderly people more protected because the normal vulnerable. Host thank you for the call. Guest you are absolutely right. You raise the essential role of Infection Control nurses. This is our first line of defense against not only covid19 but any of the transmissible diseases. Understanding what our options are for minimizing the spread of disease between Health Workers and patients and among patients and visitors, Health Workers and support staff in health care settings. You are 100 correct. Our most vulnerable populations are concentrated in Nursing Homes and longterm care facilities. I think there has been some good advice from the cdc published that is applicable and publicly available on how best to manage populations that are at high risk when you have a finite health care staff. Some of the interventions proposed by professional associations that look at Infection Prevention and control, and Health Care Workers and by researchers, is the idea of having a dedicated staff for expected covid19 cases that does not come into contact with patients who are not exposed and infected. In the case you are talking about, in a longterm care facility, where you have many people at high risk, the idea is you are basically functionally separating the staff working with people who are potentially infected and people working with people who are at risk in unexposed. Administrative controls, depending on how we manage the flow of people potentially infected and prevent them from interacting with those who are the highest risk, that is the huge issue right now. That is something, we have had a heads up since december that there is a crisis unfolding and spreading. At this point, the people who are managing health care facilities, including longterm care facilities, should, if they have not already, develop a plan for using engineering controls, ways of moving air differently, to keep people who are infected from inadvertently affecting others. Using engineering controls like putting them in separate areas, using administrative controls, thinking about how you miniature people to decrease the chance those who are infected mixed with those who are not. And then using personal protective equipment. The masks and the gowns, how to use those effectively and make the most efficient use of them, if they have not come up with a plan, they should. Health care workers, making sure your administration and leadership have communicated clearly to you what the plans thank you very