In, vice dean for public practice at the John Hopkins School for Public Health. The cases we talked about at the beginning of the show were reported cases, jumped by 5000 since yesterday. When you compare this to other Public Health crises, other viruses, i should say, what sort of jump is that . How concerned are you by that jump . Guest it is consistent with spread of a virus through a susceptible population. Some of that is testing is becoming more available. The reason testing is finding so many cases is so many people are infected. We are talking about a virus no human being has seen before, before a few months ago. We are all susceptible. That makes the spread fast. Host do you think the approach, the nationwide approach at least, in terms of prioritizing social distancing of people isolating, staying at home and secondarily, ramping up testing is the right approach . Do we need to be more aggressive with testing nationwide . Guest we are trying to be more aggressive with testing. Social distancing would be necessary under any circumstances. Look at the countries that have had more success than the u. S. They have done both, aggressive social distancing. China, there is still a lot going on, for example. Sorry about that. Turn that off. Host that is ok, we still have you. Guest no problem. Of social distancing going on there. The idea behind testing is to try to be more focused, efficient about figuring out who has covid19 and what they can do keep safe. It allows you to offer more things to people who are sick, like if they dont want to be at home, offer them a place to go. It is what you do when you find people who are positive, who are not ready to go into the hospital but you can then reduce the chance they will pass it to others. Host you have served in the past as Deputy Commissioner for the fda, you are the director of the Bloomberg American Health initiative. As you look at it in terms of capacity, the number of tests, the number of individuals to run those tests in the u. S. , even before the coronavirus, were really ready where we ready for this sort of pandemic . Host there is no country in the world that was ready for this. The u. S. , among the countries that was not ready for this pandemic. That has different dimensions. Right now, one of the most notable ways is the lack of personal protective equipment, the shortage is coming. That is a huge challenge. With respect to testing, i think there were a couple challenges. We have a lot of Testing Capacity in this country. The administration chose a narrow testing strategy from the beginning, which is how the cdc developed the tests, make the tests up, and send them to the state labs. That was a narrow strategy. They focused on people who were traveling. People who had known exposure. Even if that had worked, you would have had state labs testing, which is a modest number of cases. That was the strategy that was appropriate for ebola. You are not going to get why transmission of a bola in the u. S. You need to be 100 sure youre getting a quality test for each patient. That worked for ebola. This is a different kind of challenge. At the time they were picking the relatively narrow testing strategy, the former fda commissioner, scott, was on social media writing oped saying this is not going to work, we need to bring everyone in now, we should not do a, b, c, we should do all of the above. He was one of the loudest voices at the point. It was not too much avail for another month. At the end of february, fda switched strategy to jumpstart some of the other testing resources we have in the u. S. I think we will get a lot of testing. We missed some valuable time. Host our guest joining us from the John Hopkins Bloomberg school of Public Health, joining us by skype. We welcome your calls and comments. Line for8000, the eastern and central time zones. Mountain, pacific time zones, 202 7488001. If you are a medical professional, that line, 202 7488002. Let me ask you about the antiviral, the ways to treat the virus now. Do we have an idea of the most effective method ahead of getting an actual vaccine . Solving the vaccine issue . What is the best way to approach curing, at least ending this virus in individuals . Guest we dont know. There is a lot of research. A study published in the new and the journal of medicine showed one particular antiviral medicine did not have much effect. There are other studies going on. This is an example where we cannot rely on rumor. We have to rely on evidence. That underc, difficult circumstances, people are able to do these studies. By studying, you figure out what works. At the John Hopkins Bloomberg school of Public Health, we have a professor who is very focused on an interesting kind of treatment that really comes from more than a century ago, which is to use antibodies from people who have recovered and give it to people who have not been infected or people infected. If you give it to someone not infected, it prevents infection. If you give it to someone who is infected, it may make it less serious. There will be a study, like everything else, they just filed an application to do the study with the fda. Host work has started on Vaccine Development in the u. S. , most notably on the west coast. Typically, what is the timeframe for developing an antivirus vaccine . Guest typically it is measured in years. The goal here is for it to be measured in months, not like 2, 3, but maybe 12, 18 months. The desperate global need for vaccine will make this as fast as i possibly can. There are challenges at every step. Theyre doing this faster than it has been done before. Is this your transfer, virus behaving like antivirus you have seen . See that anyone can say they have seen a virus like this. It is insidious, in some ways. It is slower moving than the flu but more deadly. Flu usually takes 1, 2 days to infect the next person, then 6, 7 days, then that person may get sick over a period of time. We are seeing a wave of infections now. We dont know how big the wave is but we know it is bigger than the wave is now. Hospitals will get busier. Are they going to be unable to handle the number of patients . That is what everyone is worried about. We are seeingwhy social distancing measures and all sorts of things because the idea is to reduce the peak of the wave, if it can be managed. Host school of Public Health at johns hopkins, what do you know of the hospital complex there in terms of potential anticipation of that wave, however big it might get in baltimore . Podcast, Public Health oncall, which people can look up if they are interested. We interview leaders of the john hopkins medicine. Dr. Lisa, dr. Gabe. They moved very quickly into emergency mode as this was playing out in asia. They have set up a command. They are canceling elective surgery. They are making their own face shields, all kinds of things happening at the hospital. They already have patients. There thinking, x number of patients, how do we conform the hospital . If we get double the number, what do we do . They are working collaboratively with maryland to figure out if there are truly a huge swell of patients, what they can do. There are a number of paths. That is the case for every hospital in the world. They are imploring people to Pay Attention to social distancing. Host cspan and other media dashboard, the covid19 dashboard created by the Hopkins Center for science and engineering, huge data crunch each day. What is your knowledge of how they do that . Guest amazing. They have gotten billions of clicks. This was started by dr. Lauren gardner. She and her team have done a phenomenal job keeping that up under all kinds of stress. People can see it for themselves. Coronavirus. Jhu. Edu. That gives a lot of information from johns hopkins, including access to the maps. Host plenty of calls and questions coming in. Ron, nashville, tennessee. Caller good morning. I work for a Major Grocery chain throughout america. I will tell you about the supply chain, if you would like. My store opens at 6 a. M. Every morning. P. M. Oses now at 10 that is most retailers in my area, grocery. Heres the problem im seeing. With 2030ting off people in my Neighborhood Store standing at the door, crowded and. The first thing they do, they go to the toilet tissue aisle, then the cans. Here is what is missing on the store on a daily basis. One day you are out of chicken. Ground beef. That is the meat department. Next day, the dry good department, youre out of toilet paper, tissue, wipes, sanitizers, which come from china, is backordered, it is not there, it has not been there for weeks now. You go to the produce department, fruits and vegetables are moving off the shelves. In, westerday, i went were full in the produce department. The Grocery Department was lacking. Wheeler we18 get three of them a night most grocery retailers in my neighborhood, which is all of the big boys we know about, they get trucks every night. Now, by the time they stop the shelves, stocking, next morning, people are inundating stores to a point to where it is offtheshelf the shelf by 9 30 a. M. Now we have to wait on another truck. Lets say mye, Neighborhood Grocery store on has 2000 People Per Day shopping, throughout the day. All of a sudden, you have 4000 shopping. Trucks cannot keep up. What is going to happen is we are going to run the warehouses dry if we dont quit buying in bulk. Host a couple of points. Dr. . Importanthink it is to hear that story. Food supply chain is generally intact. Trucks are coming. This is not a question of whether there is enough gas. People will be driving the trucks. Food is being produced. Hand sanitizer is a challenge. We are using more. Just like personal protective equipment. Demand has gone up. As a nation, demand for food has not gone up. It is still the same number of people and we are still eating. People tortant for cut back on the hoarding of food. I have started to see messages about that. There may need to be stronger thatges in order to reduce because it is the fact that people are over buying. They are not eating as much. They are still eating, they are just fearful. Good crisis communication, helping them to understand the plan. We should be talking more to the people who make the food and deliver the food to reassure them. The food will be there. They do not have to hoard. It is understandable why people are doing that, it is just also, people can understand that may not be necessary. The issue of Infection Control in stores is important. If it is possible, you can take bleach, create a solution to clean off the carts in between people. It may make sense to put little marks outside the store when people are lining up, where they should stand in line so they are not all bunched up like that. Those sorts of solutions may make sense. The real answer here is to provide reassurance. Hopefully, federal government can do this. It may be appropriate for states and cities to do this, to put store owners and distributors and others and say, look, the supply chain is intact. That might help reassure people. Host red feather lakes, colorado, wayne. Caller thank you for the opportunity. I am a u. S. Army veteran. News, i also the have a compromised immune system from my service at fort mcclellan. I saw on the news this morning, the v. A. Has 9 million veterans in the system. They are only given 1200 test kit. What is going on . Worse than that, they are opening the v. A. System to the general public and throwing all of us veterans down the tubes i dont understand why we should be taking care of we are not host dr. . Guest this is a challenge facing every community in the u. S. I think testing is going to be widely available, much more, for veterans. Each community has to figure out resources it has available. Helpally, rally to everybody. Heres the thing. Theres no way to protect one population completely when there is an epidemic. An epidemic is contagious. What you want is a smart strategy to limit infection and for someone of his age, staying home as much as possible is going to be the smartest thing to do in order to reduce the chance of getting infected. Host what defines a compromised immune system . If someone is in doubt, what would be your guidance . Switch, it isoff not, the scale. Has been aage significant predictor. Over 80, patients have had the hardest time. 60s and 70s, people are drawing the line over older age. For a chronic condition, lung diabetes,ike copd, part disease, all of which are factors for more severe disease part disease heart disease, cancer, hiv, other immune deficiencies, potentially could be at higher risk. At this point, everyone should be following social distancing. People in those categories really should be following super extreme social distancing to the extent possible, getting people to bring them food, as much limited social contact as possible. Pause. This is a stressful situation to be giving that advice. It is not all social contact needs to be restricted. It is social contact in person. This is a moment for people to connect with people in that situation. If you are not in one of those groups, two things. First of all, i realize even if you are not at super high risk, you can pass it onto someone who is. It is important to follow key instructions. Second, there are people in your lives you care about, who are in this group and they are scared. Reaching out to them and talking to them is important. Just like the food supply is intact, the phone lines are working, the internet is up. It is possible to connect. There are things we can do to make the burden less for everyone. Host alecia, redford, michigan. Caller good morning. I feel like because of how rapid this virus is spreading across the country, has it ever occurred that this could possibly be some type of biochemical weapon released in the atmosphere and could possibly be an attack from a terrorist or something . It just spread too fast. I am really afraid for our country. I would hate for it to get to the point it is in italy. That is my statement. Thank you. Guest thank you. The italy situation is such a concerning situation, something that we certainly do not want to see in the u. S. I totally agree. That is the reason for these measures. Andvirus emerged in china has been studied. Extensive study of the genetic code of the virus. To all appearances, it looks like a naturally occurring virus. There are very serious viruses, naturally occurring, that harm many many people. This looks like another one like that. What is happening is that these viruses are coming from animals, jumping over the species barrier. They are trying to do that every day. It is like losing the lottery. One day. That is what happens. This virus has insidious characteristics, it is easily transmissible between humans. We have had deadly viruses travel animals to humans but the humans cannot pass it onto each other so that limits spread. The other thing is that it can be passed on without symptoms. The virus makes you sick and you can only pass it on to someone else, like ebola, it is relatively easy to contain. As soon as someone gets sick, he put them aside and they cannot pass it on to someone else. You isolate them, care for them, that is how you control ebola. This is tough. People are not showing symptoms and passing it on. People have mild symptoms and they are passing it on. If you think about the different ways the world has lost the lottery on this virus, it is difficult to control for that reason. Host aaron, greensburg, pennsylvania. Caller good morning. This virus is frightening for everybody. What is really frightening, being exposed in this situation is how unprepared we are for Something Like this. Believe we do not have equipment. Boggling the mind. There was an article last week in the New York Times about how china and south korea were hoarding masks. They stopped exporting them to us. That is why you dont have that many right now. I do not think that is fair. I think someone should look into that more. Heard the way the virus originated in china was they have these open markets where they slaughter animals, very strange animals that we do not is over here but, that creating unsanitary conditions over there. So i would hope, country should get together, if you were to prevent Something Like this from happening again host thank you for your call. The preparedness of the u. S. And her point about markets, open markets in china. Is that a problem . Could it have been a source of the virus . Guest one of the challenges in our world is that pressing problems in front of you are much easier to provide resources to and understand. There was every reason to believe Something Like this could happen, there were actual simulations again and again in the federal government showing how unprepared the country would be for this, it just seemed too abstract to policymakers. They focused on whatever their agenda is, tax cuts, rather than for example, spending money to put together a much bigger stockpile of gowns, gloves, masks. Part of a systematic underinvestment in Public Health generally. This is not the only area where we underinvest in prevention. There are many other areas where we could be making much better investments and be healthier. It is something this country has not done. Maybe this crisis will change that over time. It was not for lack of warning, Public Health experts saying this needed to be done it was a lack of commitment. The value people placed on other agendas rather than prevention and health. Why we feelreason so unprepared. It is important for the country to learn this lesson, in order to be better prepared for situations like this. The next question was about the markets. Yes, it is believed the virus may have come out, jumped the species barrier in different ways in these markets. I think there are a couple challenges. Markets can drive them underground and make it less sanitary. Really figuring out how to handle that is an important priority for china. Then you have the fact that they really played it down for the early part of the epidemic, which lost us valuable time. Host half an hour left with our best, the vice dean of Public Health practice, John Hopkins Bloomberg school. 202 7488000, eastern and central time zones. 202 7488001, mountain and pacific. If you want to text us a question, 202 7488003. If you are a medical professional, 202 7488002. You mentioned your concerns over preparedness. The president was asked about that as well in his briefing in the Coronavirus Task force yesterday at the white house. [video clip] when can americans expect their lives to go back to normal . Will that not happen until there is a vaccine . I hope very soon, we will see. This is uncharted territory, as you know. We think we have ideas. Does it help to say what the ideas i would hope very soon. We pulled together as a nation. People for the most part i doing what they are supposed to be doing. The social distancing is very interesting, a whole new term, has become somewhat of a hot term. People are listening and really doing a great job. This country is an amazing country. 141 Different Countries now. It is uncharted territory. Could have been stopped, could have been stopped pretty easily if we had known, if everyone had known about it, a number of months before people started reading about it. Excuse me. Excuse me. It could have been stopped in its tracks, unfortunately they did not decide to make it public. The whole world is suffering because of it. You said you had a sense this was a pandemic two days ago. Why was the u. S. Not prepared for more testing . We were very prepared. The only thing we were not prepared for was the media. The media has not treated fairly. I called for a ban for people coming in from china long before anyone thought it was, in fact, it was your network, i believe they call me a racist, because i did that. Many of the people in the room called me racist and other words because i did that, because i went so early, so when you say we were not prepared, had i left these tens of thousands of people coming from china a day, we wouldve had something right now that would have been, you would not have even recognized it compared to where we are. Comedy people have passed away, have died as of this moment . How many people have passed away, have died as of this moment . You could have multiply that by many. Now other countries are following what i did. The media does not acknowledge that. They know it is true. They know it is true. They dont want to write about it. , the dr. Joshua sharfstein president theyre saying this could have been stopped at early stages, assuming it means china, could it have been stopped . Guest it is possible. At this point, not top of mind, because we are dealing with the situation we have to deal with now. I do not know if i can answer that question. People have to look back and reconstruct the original events. It is concerning people raising alarms in china were silenced or even called in for questioning. That is not the right way to respond to a new disease. The right way to respond is to really jump on it and do Everything Possible to limit spread. We dont know for sure what would have happened. I terms of the travel ban, think it probably helped somewhat but obviously it is not enough. Even if it delayed for a little while, it did not delay for long. We are in the middle now. The gaps in preparedness including tests and personal protective equipment are becoming obvious now. Host when you first heard reports of this, late december, january, what were some of your initial thoughts . Reactions, to the news . Guest you hear that in Public Health and say, ok, what are we going to get . Sars . Killed a few thousand people around the world, caused a huge scare in asia, then got controlled. Are we going to get a condition that does not travel between humans . A few cases, then sputters out. Something more mild that travels the globe like h1n1 . Are we going to get the one we feared . All these other things that have happened. We have not had something quite like this. People say we are lucky with sars because people got very sick and you could isolate them and eventually extinguish the contagion. We were lucky with h1n1. It was not as deadly as we had feared. Maybe we wont get lucky with the. Here we are. Anytime you hear it, you sit up. The last few before this, there was always something that allowed us to wiggle through and not learn the lesson. The Asian Countries, which have been better prepared, they really had the existential threat with sars. They were very scared with sars. That led them to put in place a bunch of things and be quite prepared for the next one, in case it was bigger. That is how they were able to do better with covid19. Host medical professionals line, 202 7488002. Beverly, corona, california. Caller good morning. , thank you so very much for your excellent expertise advice. Why ispuzzling me this not a mandatory evacuation by the cdc and Public Health . Look at the spring breaks going on in florida and georgia, to see the bars and establishments open, i just cannot understand it. I even understand there are schools that have not closed in certain states. What is your opinion about that . Guest thank you for that question. Very good question. Government is pretty diffused. We dont have quite, particularly when it comes to Public Health, states play the lead role, not the federal government. That has strengths and weaknesses. It makes it harder to coordinate big responses like this. Breathlly, i take a deep when i see pictures of the beaches. That is not good. Especially because people are coming from all over, they can give it to each other and go home. Those kids need to stay away from everyone else for a while when they get back. ,ou are passing it, parents siblings, grandparents, themselves, you are at risk. In terms of closing k12 schools, that is a more controversial issue, i think, because there are definitely strong reasons to do that, to reduce the spread within schools, to reduce the spread overall. Cdc recommends doing that when there is moderate risk of transmission. When there had been no cases or a few cases, there are different opinions about what to do. The need for people to go to work, particularly healthcare workers and school is really important for kids, nutrition and other things. We are coming around. 30 plus states have closed school so far. There will be a lot of attention that needs to be paid to the needs of the kids and for parents to get into work. Flu, clear that for closing schools helps. The evidence is more debated for covid19. Some Asian Countries did not close schools. Particularly, as there are more cases, pretty much, universal recommendation at this point is it is a good idea. Host what about your school . You mentioned one of your colleagues working intensely on antiviral regime. What are you doing about classes, students at the school of Public Health . Guest classes are all online. Online learning on a regular basis, flipped the switch, made everything online. Students remotely, classes remotely. I taught a class, crisis and response in Public Health, i read a book called the Public Health crisis survival guide, leadership in trying times, and i teach every term about the nature of Public Health crises and responses. We have been talking about the Novel Coronavirus in every class and the last class we did remotely. It was an interesting experience for students. I asked of them in the last class, we have a Washington Post reporter who wrote a story about them but i asked them, at what point did you realize there was a crisis that was more important than the class . It started in january. People told me which day they realized the crisis was more important. It was very timely, unfortunately. Host morgantown, West Virginia caller good morning. I have some questions for the doctor. Intor one, can you go more the science of social distancing . One, how does the Public Health official evaluate whether social distancing is working . Then at what point do you go people,herings of 100 only 50 people, down to 10 . Ie second question i have is, know pharmacies are allowed to do compounding on a state level. Is that something possible for Clinical Trials at state level rather than the fda being the metric for everything . Host thanks. Guest sure. Social distancing. Aboutncept, you can think reproduction number of virus as the number of people the average person with the virus passes it on to. So for some viruses it is very high, over 10, for some viruses it may be around 2. People are debating what it usually is, coronavirus, maybe 2, 3 range. Every person gives it to three people, that is where you get a sharp curve. That is not a fixed biological property. That is a biological and social property. That is sort of what happens when you have a virus existing in the world. If youre living by yourself you cannot pass it on to anyone. The idea is to put in place measures to reduce that reproduction number. Some of the best ways to do that if you can, find someone who is contagious, isolate them, they have no one to pass it on to. The idea behind social distancing is we cannot find everyone who has it, so we will reduce the number of opportunities the virus has to jump from person to person. I am not aware of detailed tables to tell you what happens, 500 versus 250 versus 50 versus 10. I think the concern really shot up when we saw italy. The fear of having Something Like that in the u. S. Because Public Officials to say, if you are telling us we should shut down, lets do as much as we can during this time to give us more options later to get more protective equipment for our healthcare workers and to have more of a gradual rise in cases so hospitals are not seeing too many patients. I think this is a little difficult on science. Pharmacies, when it comes to treatment and studies, fda can move extremely quickly. The agency, i am sure, is really looking to prioritize anything related to covid19. If there is a reasonable justification for a study, i am sure they will let it go forward. The advantage of having fda review is there are incredibly talented people at fda. We need them now more than ever. They are the people that can look at protocol and say, this will actually answer the question or wont. If you change it just this way, we will get a real answer about whether something works or it doesnt. The idea is to do a rapid review. The law about fda. It is not the usual approval law. There is a usual timetable for approval, takes about eight years for a drug to get approved. All these different things, then the review is over 69 months. Situationt the legal in a crisis like this. There is a separate law. Fda is permitted to authorize treatment, not approving, but has the same effect of allowing them to be sold and scaled up and manufactured. That authorization is a supremely flexible tool for fda to look at a situation and say, under the circumstances, it is good enough for us, it is good to go. They have flexibility. It has a lot of knowledge. The point of fda is not to be a chokepoint. It is to help. To help in the situation. There,ing h1n1, i was and during a matter of hours, for example, scientists at the agency figured out how to do tamiflu for little babies. That was the first dosing. It had never been submitted for babies before, children under one. We were able to share with scientists who understand how little babies metabolize drugs. They looked at it quickly and said this is our best estimate of the right way to dose. Regulatory agencies and doctors around the world used that for tamiflu. That is the kind of quick thinking and expert input fda brings to the task. That is at the fda repository of what the doctors might be throwing at this virus across the country whether tamiflu, other protocols, actual treating people with covid19 . Guest not really. Doctors can do things and not report them to fda. The fear i have is people will try a million things, maybe a patient gets better, they go, i am sure this made them better. You dont know for sure. Some patients get better. The only way to know a treatment really works is to do adequate study. That is why fda has to approve quickly, make sure they are good and stand them up so we know people getting treatments are getting better. Host north carolina, a medical professional, welcome. Caller how are you . Host fine, thank you. Caller i have a question for the doctor. Does this affect pets . Guest not that i am aware of. I saw a couple stories maybe dogs get a mild illness. I understand people are very worried about anything that is valuable to them in their lives, including pets. I have not seen major concerns. Host question from patricia, westminster, california. Have any older patients on ventilators recovered and gone home after that recovery . Guest absolutely. Yes. Some people recover. It is important to do social distancing so we do not have so many patients that they outnumber ventilators. People can recover with Supportive Care and hopefully we will get treatments proven to work. Host the reason ventilators are so important with this, it is much more of a upper respiratory disease . Guest well, it is called lower respiratory. It affects the lungs. People cannot Exchange Oxygen effectively, so a breathing machine, a ventilator helps them do that and allows them to get oxygen. Host morgantown, pennsylvania, stanley. Caller regarding this malaria drug, over the weekend, they said some dr. , infectious doctor in Southern France was going to test this tablet that cost five bets and patients would given 600 milligrams i dont know how many times a day, but he is supposed to be a top infectious doctor in the south of france. He was going to test a few dozen who had the virus. Yesterday, all 100 people were like cured. Did you hear anything about this . Guest i know people are thinking about hydroxychloroquine but this is a good example of needing to see the data and science to know what to make of this. Theyre all kinds of rumors and internet stories. We will only know for sure when there is a good study. I am sure there are studies going on. We will find out. People saying, we have this antiviral drug, it is working, working, then when they actually did the study, it did not work. You really have to do the study. Younot rely a doctor cannot just rely on a doctor in the south of france. Host andy, bloomington, indiana. Doing Great Britain was a herd immunity thing, 70 of the population get it. You have to think about this, this might come back also include season next year. There is no cure for it. Second question, what about the dsp workers . Special needs people. They have nowhere to go. You have to have workers to take care of them. I live in indiana. Is there any kind of place for those people . What if workers, who make low wages, get sick . What are they going to do . Thank you. Host thank you, daniel. Guest excellent questions. It is unclear what people mean by herd immunity strategy. If the strategy is letting 70 of people get infected, that is very dangerous. Everybody is at risk live now to a Coronavirus Briefing from Ohio Governor mike dewine. Enteredine we have now a new phase of our battle against the coronavirus. This phase is not unexpected. But it is tragic. Yesterday ohio had its first death from the coronavirus. Someone who both john and i knew very well and liked very much and respected very much. , a prominentsenior attorney in toledo