Good evening. The house will gavel back in tomorrow at 9 00 a. M. Eastern time to vote on the massive, 2. 2 trillion bill to help americans during the pandemic. So far more than 3 Million People have already filed for unemployment benefits. And now the u. S. Is leading the world in cases of coronavirus. It is thursday evening, march 26, and this is a prime time in ofition edition washington journal we get the latest on the spending bill, then your calls and questions for the Stanford University medical dean, dr. Lloyd miner, joining us from california. Our phone lines are open. 202 7488000, 202 7488001, we also have a line for medical professionals. 202 7488002, and you can join on facebook. Or good thursday evening. Thank you for joining us for an evening edition of the washington journal. We begin with the numbers from john hopkins university, now worldwide more than 530,000 cases across the globe, 24,000 deaths, the u. S. Surpassing china with more than 8700 cases 8507 confirmed cases of the coronavirus. The house and senate, acting quickly on a massive spending bill. Joining us in studio is alex bolton of the hill. Com, the Senate Passing 960 that bill, and i dont think i have ever seen a vote total that large. Alex i cant remember you unanimoust remember a vote on legislation of such significance, and it is remarkable, especially given partisan fighting over the weekend and late into the night. It got acrimonious. Republicans and democrats accusing each other of politicizing the crisis, but in the end everyone voted for the bill, even though some like sure a the senate, not roll call vote is necessary, but there are conservatives that have a problem with the amount money. They put their objections on the record. Which members are you keeping a close eye on tomorrow . I would look at members of the Freedom Caucus who might have problems with just the sheer amount of money, 2 trillion, but again, we dont know for sure. The tea party type republicans in the senate, rand paul, they have been quarantined because of coronavirus exposure. We do not know what is going to happen. I would expect this is going to go by voice vote. Even in Congress People are coming together in this moment of crisis. It is just incredible. To trillion dollar bill in just a couple of days. I want to read a statement from cspan. We are not going to convey the messages of those members may not be able to vote tomorrow. This from cspan earlier today. It is a first in the 41 years of our cable network. Cspan has responded to a question a special response from steny hoyer to connect members of congress with the public during the unprecedented Public Health crisis created by covid19. With many members unable to travel to washington for the friday boat, cspan is working with congressional leadership of both parties who have dedicated their time to help members with brief video statements explaining their positions on the coronavirus legislation. The network anticipate member statements will air in blocks and primetime the week of march 30. The videos will also be streamed on our website at cspan. Org and archived in the cspan online video library, creating a permanent, historical record on the time when the house was hampered from gathering in person. So this is part of what we are trying to do. My question, when this is all over, do you think we will have remote voting in the house and senate . We have been hearing from lawmakers in both chambers about instituting that. Senate, an institutionalist, i think that is a fair description. He is against remote voting. Remote voting creates as many problems as it solves. People are scattered around the country and voting by the internet. Its tougher to come to agreement on stuff. Its tougher for leadership to persuade them one way or the other. Chuck schumer, the democratic leader, he said last night we should explore it. Some of his members are concerned about getting sick. In the house, nancy pelosi i think is more open to remote voting than the senate. You know, she is talking about possibly there has been discussion about proxy voting on friday if, for whatever reason, a roll call vote is forced and there are not enough democrats to pass it. Because of the home districts. But giving the overwhelming nature of the senate vote, i dont think there is going to be proxy voting tomorrow. It is an open question in the senate, more likely in the house. In the house it is a bigger production to get everyone in there voting, given there are so many numbers. Steve this video statements Begin Next Week primetime on cspan, members of Congress Sharing with you their views on this massive, 2. 2 trillion dollar stimulus bill. Bottom line, alex, will this be wrapped up tomorrow . Alex yes, it will. I just spoke to our house reporter who has been on this program before and he says it will be done by noon. That is where the smart money is. Steve we will follow your work online at the hill. Com. This is the headline from the new york times, a sobering headline as the u. S. Surpasses china with confirmed cases of coronavirus. The reporting includes the following, scientists warning the u. S. Someday would become the country hardest hit by the coronavirus pandemic. That moment arrived today. In the United States, more than 81,000 people are known to be infected by the virus, including more than 1000 deaths, more cases than china, italy, or any other country. With 330 million residents, the u. S. Is the worlds thirdmostpopulous nation, meaning it has a vast pool of people that could potentially get covid19, the disease caused by the virus. For our remaining hour of conversation from the Stanford University campus and the dean of the medical school, dr. Lloyd minor. We appreciate you being here with us. Thank you, its good to be here. Dr. Minor, let me begin with the headline, u. S. Now surpassing china. Yes, it is a very sobering headline. I think we are dealing with in her country, i think we are coming together. We are certainly concerned, particularly those of us in health care, because we are here to provide outstanding care, and we want to make sure we have the capacity to do that. Steve what is the biggest challenge for Health Care Professionals and those you are trying to train for this profession . Dr. Minor one of the biggest one challenge, there is a lot of uncertainty surrounding this virus and the disease covid19. We know the principle mode of transmission is droplets spread, virus particles embedded in mucous that then is transferred from one person to the next. But you know, how often that occurs, whether or not it can also occur from droplets on surfacesservices , when people with the buyers are most likely to transmit it to others, those are all uncertainties today. Those uncertainties make it difficult to plan, difficult to organize treatment regimens, and it really underscores the importance of research to better understand the virus itself and how it is transmitted from one person to the next. One of the issues of your concern is the testing in the u. S. And how compared to the rest of the world. Let me put some figures on the screen and get your reaction. The covid19 tests for one million residents as of march 20, United Arab Emirates has 12,738 per million, italy at 3400, south korea at 6100 and the u. S. At 313 per million. Dr. Minor as has been noted many times over the past three week, it has been a slow start in the u. S. Getting tested, getting testing on board and getting it available in communities that need to be tested. I am pleased that we here at Stanford Medicine were one of the first institutions in the country to be approved by the fda when the fda announced new criteria for approving diagnostic tests for the virus that causes covid19. We were approved, we sent our application almost immediately after the fda announced criteria and were approved and then began to test people in our community. We are currently testing over 1000 people per day. We have been a repository for tests in the bay area, testing patients from the kaiser system, from ucsf, other Health Care Systems in the bay area. Now those systems are bringing their tests online as well, which has allowed us to expand our outpatient testing. Tenants tents located on the stanford campus where people can get screened. We use the cec criteria for require ich is does require a person has to have symptoms such as fever, cough, shortness of breath. When a person has those symptoms and is screened by a Health Care Professional, they are given a time to come, this is drivethrough testing or testing where a person simply gets out of their car and can go home. The test results are obtained and then they are called with the results or those are sent out through a secure portal. Testing is important in terms of identifying people who have the infection early, and then of course having those people selfisolate and quarantine so that they dont spread the virus to other people. Steve and as you know, all of this putting a huge burden on hospitals around the country. We learned today as many as 150 doctors and nurses in boston are confirmed with covid19 virus. You are quoted in this headline as, hospitals are embracing not only for the pressure with personnel, but equipment shortages as the number of cases surge. How do hospitals respond to that . Preparation is extremely important. And back to the surge in patients, we know the most effective prevention we have for filterg the surge is to shelter in place or to limit the exposure to public settings. California put that into place fairly early, now we are seeing it in new york and other places, and by reducing the contact each of us has, the physical contact each of us has with other people , we lower the rate of infection , the rate of transmission of infection, that is important because it enables us in Health Care Delivery systems to then keep up with the need people have to receive health care. What we are seeing in new york and what we have seen in italy and other places is that the rapid surge in the number of people needing health care because of an infection with the sars covid ii virus, when the surge occurs, Health Care Systems are challenged to provide the care and provide the type of personal protective equipment that protects Health Care Providers from being affected. It is important to keep in mind that when we read data about the number of Health Care Professionals who have the infection, remember that perhaps most of those have gotten their infections in the community. Personal protective equipment is effective at preventing the transmission of the virus from a patient to Health Care Provider. And the cdc has issued very thoughtful guidelines for the use of that ppe. But we still do not have of course Health Care Workers have life outside the Health Care Delivery system, and many of them are acquiring the infection as others are, from communitybased exposure. Steve dr. Lloyd minor is joining us from palo alto, california, a scientist and the dean of the Stanford University school of medicine, and before coming to standard he was a provost at Johns Hopkins university. We want to bring in our collars lers, viewers, and listeners. Sam joins us from van nuys california on the air with dr. Minor. Good evening. Thank you, dr. Minor. Thank you for taking my call. Im looking at the chart by Johns Hopkins and i see the mortality rate in the u. S. , in spite of having the highest incidence rate, is very low. I do find that places like china have about 3 . Almost approaching 10 . Spain is also high. So why do you think there is a difference . Also, i do think that people should not be so concerned about the number of incidents over here in the United States, because i think we have a nice infrastructure of not testing the patients, and that might be getting people along. So what is your take on all this . Steve thank you. Dr. Minor we do provide health care the United States for severe acute diseases like for complications of this disease, but we have to make sure the Health Care Delivery system doesnt become overwhelmed. That is what we were talking about before. If hospital icus become completely full, if there are no ventilators to be used for if the supply is very limited, we will not be able to provide the type of highquality care that to get most people through this infection. It is also important to remember that in many people, in fact most people, this infection by the sars covi ii virus is analogous to or similar to the flu. But in a subset of patient, very importantly, the elderly may be immunocompromised in young , people for reasons we dont understand, the infection can be quite severe. That is what really has us worried, and making sure we can keep up with the demand posed by the spread of the epidemic around the United States. Steve mark from new york is next. Good evening. Thanks, steve. I want to ask two questions if i may. I know that there is a shortage of masks, but i have heard that wearing one does not prevent you from getting the disease as much as it prevents other people who have the disease from spreading it. And two, we have heard from andrew cuomo, for example, but if you are vulnerable, you should wear a mask, and if you cant find one, you should wear a bandana. It seems you would have to wash the bandana every time you went outside. My question is, what is the truth . If you feel vulnerable, should you at least wear a bandana . My second question is this. If you have allergies to things like dust, for example in a room where there is a dog or a bird, my lungs immediately fill up and i have to move or ask a person not to sweep or Something Like that. Does that put me in the category known as vulnerable . Steve mark, thank you. We will get a response. Dr. Minor . Is important to remember, what we have the most data on in terms of the most important way to reduce the transmission of the virus is a social distancing. The issues surrounding Wearing Masks or not Wearing Masks, requiree going to further study to really know definitively. Current cdc recommendations do not recommend routine wearing of masks. People can differ in some Delivery Systems have different recommendations, but the social distancing more physical distancing is today the most effective prevention we have, in preventing the spread of infection from one person to the next. The second question, regarding if you have allergies or sensitivity to dust, does that render you more susceptible an infection with this virus . Probably just routine, seasonal , i dont knowgies of data that increases the risk of infection with the virus. Certainly someone who is immunocompromised, either because they have cancer or another disease that causes immunosuppression, people with those conditions are at greater risk of contracting the virus. Steve im curious, when you are in the classroom with these residents, future doctors, what questions are they asking you . Dr. Minor there is a lot of concern and anxiety that relates back to what we were talking about before, but uncertainties surrounding this disease. Anytime there is uncertainty, that leads to anxiety. Also we have seen where cases really grow exponentially. That is the way Infectious Diseases spread, through exponential growth. And when we see and read about where that has occurred, and italy, now in new york, that is extraordinarily concerning to Health Care Professionals. We all do what we do because we want to provide outstanding care to our patients. If our ability to do that is compromised because we have more patients to care for that the physical infrastructure of our hospitals and clinics can provide, of course that is going to cause anxiety, because that is going to prevent us from doing our very best work. Steve which goes back to the testing. The caller mentioned Governor Andrew Cuomo of new york, and he talked about that today in albany. Governor cuomo the capacity to test because, flatten the curve. How do you flatten the curve . Only two ways. Density control, keeping people away from each other, and tests. How did china do it, how did south korea do it, how did everybody do it . Density control and testing. If you dont have the capacity to test, and you can only test people, for example, who are people, for example, who are coming into your hospitals, then you dont have the ability to do it. But if you have the ability to do it, do it, because it is a way to flatten the curve. If you dont have the capacity and ability, then you dont do it. Steve that is from new york Governor Andrew Cuomo, one of the many briefings we are bringing you during the coronavirus epidemic. Dr. Minor, your response . Dr. Minor i think he is correct. Social distancing, physical distancing is certainly the method we can deploy and has been deployed in many different communities, california and new york. As we are able to test more people, then we will be able to diagnose infections earlier and then keep those people in an environment where they wont be transmitting the infection to others. The other important point about testing is being able to diagnose the infection quickly when it occurs, and that is the need we have been talking about, but another need is becoming more prominent, and that is the need to identify people who have had the infection and who developed antibodies to the infection. We dont yet know whether those antibodies are protective in terms of preventing people from being the infected, but we do believe that that may confer some degree of resistance. As to whether or not that is absolute, that will have to be determined. There is a lot of work going on right now here at stanford and at private diagnostic companies and other academic medical centers, a lot of work to develop validated Antibody Test of that can be used to determine if a person built up an antibody response to the virus. If they have built up antibody response to the virus, we then we believe that their risk of becoming infected is much lower. That is going to be important as we start to consider how we relax some social distancing requirements and bring people back into work environments and other environments where they are going to be exposed to the virus much more commonly. Steve mike is next in santa cruz, california. Thank you for waiting, sir. Dr. Minor, thank you for your time. The question i have, you actually answered part of it. Manufacturing ramping up virus tests. Are we days away, weeks away, or months away from getting every body tested, or is it much longer than that . A quick side note, i was born at stanford hospital, like, 60 years ago. Dr. Minor great. Great. Well, it is hard to predict exactly. I think that is a while away. The goal of getting everyone tested i think is a while away. But being able to test people quickly when they become symptomatic, an important point to remember about testing people when they are symptomatic, in our experience here, as well as other places where testing has been rolled out, most people who are experiencing fever, cough, most of those symptoms are not due to this infection. They are not due to the sarscov2 virus. They are due to seasonal influenza or other viruses prevalent in our society today. But rolling out testing is not going to occur as quickly as we would like, but i think the testing will become more available in communities around the country. I think it is probably on the order of weeks and not days, but also probably not months, when testing becomes more commonly available. Steve from albany, new york, cynthia, good evening. You are medical professional. What is your background . What is your training . I am a registered nurse. I work with the disabled, and we we have a lot of people that are really compromise, muscle skeletal wise, swallowing problems. Oftentimes they dont even make it through a flu, dont even survived a flu. My question is about the incubation period. We are told to quarantine for 14 days, but oftentimes it is after somebody finds out that they have had an exposure. Maybe they found out they had an exposure to somebody in march who was positive, and many days have passed by, the Health Department notifies them and says you should selfquarantine for another 14 days. So it makes you wonder what is the incubation period. Steve cynthia, thank you. Dr. Minor cynthia, first of all, thank you for the Outstanding Health care you provide to the country. On behalf of all of us, thank you. Now, incubation period is thought to be up to 14 days. It can be sometimes difficult to determine. It is one of the many uncertainties we have right now about the virus, is it 14 days, 18 days, seven days . And it may differ from one person to the next. I think the recommendation, therefore, that Health Departments oftentimes give, is going to be a recommendation that, given the uncertainty, is more on the conservative side. And that is, if there is a possibility that someone could develop symptoms at therefore and therefore transmit the virus to someone else, then it is best for them to selfisolate during the period where that occurs. Right now, current guidelines are 14 days. That may change as we learn more, but those are the guidelines that serve as a benchmark today. Steve from newport beach, california, alex, good evening. Good evening. Dr. Minor. Thank you for taking my call. We heard the task force mentioned that we should be at 5 1 million tests, 5 million tests in the coming days and weeks, and i think that was last week. It sound like we are only at 500,000 thus far. Is there any reason we are not further along in seeing those millions of count tests . If we are notp, able to do that many tests, and if our Health Care System is not up to handle all these cases, why havent we decided to shut down . I know that is a big word, but in some ways, shut down . Dr. Minor for the first part of your question, what is the difficulty in scaling up the number of tests . There are several difficulties. One has been the reagent, but that is improving as manufacturers make more and more wanted to ease of the reagent needed to do the tests. The other is things like the swab used to take mucus from the nose. Nasopharynx the nose. , those swabs are not just qtips that we get from the local drugstore. They actually have to be made out of a special material, and those, in some places, have been in short supply. Again, the supply of those is increasing dramatically. We have seen that here and in other parts of the country. I think it is though supplyrelated challenges, if they get addressed and resolved, then we will see increased testing availability around the country. Now, the second part of the question, why not just shut things down and lock things down, that is a question to be considered by governments, by leaders of counties, states and , and of our nation. There is no really easy answer here, and there is uncertainty about what is needed to do to slow the growth in the instance, in the number of cases, and therefore enable everyone to get the health care they need when they do become infected. Steve every morning, this program spends three hours bringing leading experts your calls, comments, and questions. And as we deal with the coronavirus issue, both the Health Effects and impacts on the economy, we ask you to join us here in the evening hours on cspan. Philip is next from los angeles with dr. Philip minor. He dean of the Stanford School of medicine. Thank you very much for taking my call. I am 78 years old. I have hiv. And i have a real concern, because i was released from the hospital last week, everything and thats far as fever sort of thing. But i have to go back to see this doctor next week. And i am very concerned, because i am trying to figure out how i can protect myself as much as possible, because i had a situation, like i have a catheter in me, and they have to remove it. Hopefully they will be able to do that. I have a medical van scheduled to take me, and i have assured their standards are very clean, coming and going, but i will have some exposure when i am at the hospital. How would you recommend that i protect myself . Steve ok, philip, stay on the line, too, if you would like a followup. Thank you for the call. Dr. Minor . Dr. Minor philip, thank you for your question. First thing is to talk to your Health Care Professionals about your situation, and about what can be done to protect you, both as you are going to end from the and from the facility, as well as in the facility. The other thing you might want to ask is the possibility of doing a virtual visit or video a video visit. In our Health Care System during february, we did about 1000 patient visits by video, virtual visits. In one day this week, we did over 2500 virtual visits. A virtual visit allows you to communicate directly with a Health Care Provider, allows you to interact, allows a limited examination, but oftentimes that is all you need to make a limited examination, the kind of examination that can be done in a virtual visit, not always, but that is something you want to talk to your medical professional about, if not this visit, perhaps future visits could be done through a secure video set up. Steve dr. Minor, do you think that is one of the Silver Linings in all of this, as we change the way we deal with Health Care Providers . Dr. Minor i think doing more and more health care virtually is something we should have moved to a long, long time ago. Most other aspects of our daily lives have been changed by Digital Technology the way we order goods and services, the way we perform Financial Transactions but we in health care have lagged behind that. In the past, people have still called up, waited on the phone in order to make an appointment, come in physically, wait in the office before they see a healthcare provider. We can do a lot better than that. Virtual visits or when we can improve the effectiveness of our delivery system. And i think our response to this epidemic is accelerating our move toward those virtual visits. They dont work for every complaint and every problem a person is having, but they will work for many problems that they will improve the way we deliver health as a result. Steve philip is still on the line from los angeles. Your response to what the doctor said . Well, i understand virtual visits, but the only way they will truly know whether i am healed is to remove this catheter and see if i have normal urinary tract reaction. So this is something the the doctor, the urologist actually has to see, so i actually have to physically go there for this procedure. And i just want to go as protected as i can possibly be. Steve philip, thank you for the call. Dr. Minor . Dr. Minor thank you. Talking to your Health Care Provider about exactly those concerns is the right next step. Do they recommend, for example, that you come in early in the morning, before there are other people in the clinic environment . Is there a special entrance that you could use . Those details are important in terms of minimizing your exposure, your potential exposure to the virus. Steve next is carol joining us in medford, oregon. Good evening. Hi, thanks for taking my call. I have a question. How does covid19 impact people that have underlying, rare, autoimmune disease . Dr. Minor autoimmune diseases, most of them would fit into the category of immunocompromised patients. You should consult with your Health Care Professional about whether your autoimmune disease makes you at higher risk of developing covid19, and if so, then i think social distancing, the physical separation, is the most important measure that we have today to prevent the transmission of the infection. Steve we go to tyler, texas next. Lauren, good evening to you. Hi there, thanks for taking my call. Steve certainly. Thatu mentioned earlier symptoms like coughing, shortness of breath, and fever are not unique to covid19, but if you have those symptoms and dont have a fever, is it possible that you could still have it . Dr. Minor it is possible that you can have covid19 and not have a fever or have a very low grade fever that you might not notice if you didnt take your temperature. But if you have specific questions about your symptoms, then it is appropriate for you to talk with a Health Care Professional and decide, if testing is available, whether you should have a test. Steve you mentioned earlier we really are a nation on edge. This is cold and flu season, and it seems even if you have that, people are beginning to panic and saying, i might have covid19. I might have coronavirus. What you tell those people . Dr. Minor well, i think anxiety is understandable in a situation like the one that we are in. And in fact, we have never been in this type of situation in the United States before, in my lifetime. I think therefore it is important that, even though we have to physically separate to respond effectively to this epidemic, it is important that we are still joined in terms of our values, in terms of how we come together to respond to the epidemic. Physical separation does not mean that we should be separated from one another in terms of how we are looking out for one another, in terms of our concern and care for the greater good in our society. And it has been encouraging, i think, to see so much evidence of how people have come together. We realize that a lot of things that have occurred thus far have not been optimal in terms of the way testing has been rolled out, but around the country, there is a lot of concern forcing the country come together to respond to this and to make sure we are doing our best to protect citizens. Steve on cspan we are talking with dr. Lloyd minor, a scientist. He is also dean of the Stanford University medical school joining us from palo alto, california. Alan in garland, texas, you are next. Please go ahead. So what do i do now . Steve you are on the air. Ok. Dr. Minor, i have a question about hydroxychloroquine medication that our president introduced to the people. That particular drug i understand that a man died from that. He took it and wasnt supposed to, not that i am aware of, and to, andwas not supposed his wife is also having the virus. Now, just the other day, i heard that someone has was introduced to the hydroxychloroquine, and they didnt want to give it out to a lot of people. Is that particular drug, since it has not been no one has tested it, and it is for malaria, and i went on the computer, i looked at the computer and i looked at the drug, and it is said it is for malaria. Is that a good drug to take . Steve alan, thank you. I will listen to your question or your answer. Dr. Minor it is a great question, and the answer underscores a lot of uncertainty that surrounds the disease. There are many Health Care Professionals that are recommending using hydroxychloroquine at various stages of the treatment of the infection. Others are preferring to see more evidence about its efficacy. There also may be particular subgroups of patients or symptoms for whom the drug is more effective. I would encourage everyone to talk with your doctor, consult with your Health Care Professional, and discuss the pros and the potential cons of hydroxychloroquine. We just dont have the type because this is a new infection remember that six months ago, this virus did not exist in humans, and therefore our base of knowledge just isnt where it needs to be in order to be able to give definitive answers. But yes, there are some physicians and Delivery Systems that are using hydroxychloroquine to treat patients with the infection. There are other very thoughtful doctors who are preferring to wait or see it studied in a clinical trial. There is really no right or wrong answer here today until we have more evidence. Steve alex is next from richfield springs, new york. You are on with dr. Lloyd minor. Thank you. I have been concerned about people in larger cities like los angeles and new york, where they livingeless and they are on the street. A lot of them are camped around each other. How is this being dealt with . I have heard zero on the media, and i thank cspan for the coverage that they are giving it, the broader question. But i have a followup, if you want to respond to my first part. Steve you, alex. Stay on the line. Dr. Minor welcome i think your well, i think your point, your question underscores a reality about health and welfare, health and wellbeing, and that is that societal and behavioral determinants play such an Important Role in determining health care outcomes. And certainly people who are homeless, people who live in confined spaces, in close proximity to others, that is where the transmission of the virus from one person to the next through this droplet spread that we spoke about before, that is where it occurs most commonly. So it would stand to reason that people who live in those environments are at higher risk of acquiring the infection. Will have underlying diseases and furthermore, many of them will have underlying diseases that render them more likely to have a severe outcome from the reaction. So it is important that we address the societal and behavioral determinant that may reverse the ability of someone to fight off this virus or to recover from it in the best possible way. Steve alex, did you want to follow up . Yes, i do. Im 83 and am copd and have been on oxygen since 1999, and i have underlying problems as well. But at the end of the day, i think to be contacting my doctors with the computer, i think, is a great idea, but certainly not for elderly people with the type of problems that i have, and that prior folks have thats talked about their situations. And i wonder if, with all the great knowledge we have, with stanford and these other universities in california and new york state, why dont we have more field inspections with those people who are working in those areas of study and understanding . And i mean no disrespect to you, doctor, or your institution, and i want to thank cspan for your patience and the privilege of giving me the opportunity to have my word. Thank you. You, alex, good luck to you. Dr. Minor . Your response . Dr. Minor i think it is important for all of us to address social, behavioral, and environmental term in its of environmental determinants of health. We know those determinants account for roughly 70 of health and wellbeing. And in the past, we in the United States havent devoted as much attention to the societal, behavioral, and environmental factors of health than we have other factors such as genetics. The emergence of this virus and its spread demonstrate the need for great science, great diagnostics and great therapeutics, but we also need to devote more attention to the other determinants of health. Steve sean is next from conover, North Carolina. Good evening. Good evening. I would like to let you know, so i left conover, North Carolina, three weeks ago, and i traveled through new england, and i went to work in massachusetts. My work was cut short due to the pandemic, and they had a lock in up there. And as i traveled back down south, every state that i went to close down. They just shut everything down. Im back in North Carolina now , and they are business as usual, and there are people out, running around. And i am selfquarantined now, because i know that i went through the epicenter. But what i dont understand is how people do not get the fact that this is coming here, it is coming to america. We are the third the state is not doing anything, but the government didnt shut everything down, which blows my mind, because we had plenty of time to repair. To prepare. An, i will let you go. Thank you for the call. Your response, dr. Minor . Dr. Minor state and local governments are going to make decisions on went to specifically recommend the closing of businesses, and that is a decision each community is going to have to weigh, the pros and cons. It is not trivial to come forward with the type of social distancing and closing of businesses and prohibiting gatherings greater than 10 people. Those are not trivial interventions to be taken, but in many communities, that will be the only way that the growth of the number of cases can slowed, thereby allowing the Health Care Delivery systems in those communities to provide outstanding care to patients who need it, who acquire the infection. Steve we will go next to mary. She is on the phone from wayne, new jersey, welcome to this edition of washington journal. Thank you for taking my call, cspan, and thank you, dr. Doctor, for everything you do. Can you get this virus from cash . I am from the city, but new york is kind of closed down a little bit. Do they spray the streets like other countries . Steve and your first question was do you get it from cats, just to be clear . Cash. Cash. Like money. Steve thank you, mary. Dr. Minor Great Questions and questions for which we dont have a specific answer. The transmission is mostly through droplets of the spread of droplets from one person to another directly from a cough, from a sneeze, and this is what why we are emphasizing washing your hands very frequently, because we touch a surface or someone coughs, and droplets get on our hand or on our face, and then the spread is through the nose or the mouth or through the eyes, and then the infection starts. We dont know how long the virus can survive on a surface like a dollar bill or a table. Surface ofthe there is some evidence the virus can survive in those droplets for several days, and that is why cleaning surfaces but again, even for transmission through a dollar bill or through touching a tabletop, that requires us to touch our face. It requires our hand to transmit the droplet from wherever it is to our face, and then the virus travels in through our nose or our mouth. That is why handwashing is critically important in reducing the risk of infection. And in countries that have gotten the infection under control, it has principally been through judicious handwashing on and the type of physical separation that many communities in the United States are doing today. Those have been the principal mechanisms for controlling the spread of the virus. Steve and of course, the Hand Sanitizer works, but nothing is as good as soap and water . Dr. Minor thats right. Havesanitizer if you dont the means to wash your hands immediately after touching something. Steve sal joined us from new york, one of the epicenters of the virus. And thank you for taking my call. The person that called you from texas, and he mentioned the person who died from taking this medication for malaria or whatever it was, that he died. Were you aware or did you just ignore the question, that the person didnt die of that medication, the person died of some aquarium cleaner. So were you aware of that, or did you just ignore the question . Because i feel that if we are going to get information to the people, i mean, we would like the true, honest information. Steve thank you, sal. We will get a response. Yeah. Dr. Minor thank you. I think it is important to know the side effects of every medication, and every medication is going to have some side effects. And also, as you very correctly mentioned, there are complexities to every story. No, i am not aware of the specific case mentioned earlier in the program this evening, but it is important to get the fax, important, ifis you are going to take a medication, it is important to understand what is it intended to do and the possible risk factors. Steve lets go to mike in keynote harbor, washington. Mike. Im curious about the 19 in covid19. What is the significance of the number, was there a covid 18 and a covid 17 . Thank you. Steve thank you. Dr. Minor i think it has to do with the number of coronavirus is in the environment, and where this disease fits relative to other diseases that have been identified due to this family of viruses. I dont think there is anything significant about the number 19, although it has become very significant because of the illness that the virus causes, which is called covid19. Steve dr. Minor, as warmer weather arrives, what does that do to coronavirus . Dr. Minor we dont know. Some coronaviruss have a seasonality, they replicate more rapidly in cooler temperatures than they do in warmer temperatures, but we are not sure that this particular iironavirus, the sars covi virus, is going to behave in the same way. In we have seen outbreaks warmer environments, so we have to wait and see. Steve dr. Lloyd minor is the dean of the Stanford University school of medicine joining us from palo alto, california. We thank you for your time and expertise and hope you will come back here on cspan. Dr. Minor thank you, very much. It has been a pleasure being here. Steve joining us on the phone is congressman peter king representing new yorks second congressional district. Each night we check in with members of congress, and congressman king, you are in the epicenter. Really am. King i i wasnt expecting this. I was on vacation until about a week ago. Right now it is obviously doubling every single day, the number of patients in the number of people testing positive. I think the governor is doing a good job and i think people are complying. I walk around my neighborhood and virtually nobody is out. People so far are not complaining. As that i willrd probably be leaving at 4 00 in the morning driving back to washington because we expect one of our members to object to a voice vote and there will be a roll call vote. So i will drive down there for four or five hours but i dont know how they are going to get people from all over the country flying in from states that weston down south, how are they andg to get there west down south, how are they going to get there . To me it is totally responsible, driving, flying from all of the country, the germs they could take their with them and bring them back to their districts. In new york, we are on a lockdown and here we are going back to washington, plus the rules and regulations that we have to stay six feet apart, we have to walk into the capital pretty much separate, you have to sanitize your hands as you go in, the microphones have all been readjusted and they will be sanitized after each speaker, but to be calling for a roll call vote knowing what the result is going to be, this is no big deal for me, i can go down there in four or five hours by car, but other people are getting plane reservations, flying in, to me it is irresponsible. That what members objection coming from in particular . Have heardive king i the name unofficially because i dont want havesentative king i heard the name officially but i dont want to give the name out because they could change their mind. We were put on notice by our whip, and there is a procedure of groups that will walk in six assume if hend i does it, there will have to be a roll call vote and we will have to suggest the absence of a quorum, so we will have to have 216 people there tomorrow they have to get 216 there. And it is important because it is on a friday. If we dont have the 216 there and it is punted to saturday, i could see the stock market crashing tomorrow. So this is totally irresponsible. I wonder how many people are actually going to become sick from this, weather is one of the store whether it is one of us are one of the people on the train with the plane, and some people carrying it back into the district. It is being strictly enforced in new york, and to see what is going to go on tomorrow in washington, it is really disgraceful. Steve we are talking with republican congressman peter king of new york, the second congressional district. You have been critical of china and call them are responsible for the virus. Explain. they reallye king are. Two not tip off to tip off or want the rest of the world, and actually took action against the doctor who reported it come if they want to be the family of nations if they want to be in the family of nations, they have to cooperate. Had talked about it earlier and open it up earlier and had us coming and work with the doctors and scientists, we could have gotten to it earlier. Right now that is the past. I am not being critical of senate democrats, President Trump or anyone. We have to go forward. Tomorrow could put so many people at risk. We have to win this war and do everything we can. Blame for last month. We have to be united like world war ii. We have to do whatever we have to do and go forward. Tomorrow is the ultimate disgrace. Steve we will be live tomorrow morning with the proceedings as they get underway at 9 00 eastern a. M. What are your constituents biggest concerns . Rep. King i think the biggest it is going to be over. Everybody is helping that no one in their family or neighborhood or friends come down with the coronavirus. People want to see some light at the end of the tunnel. There were a few angry phone calls. They have questions, when can they open. So far, the average person i find realizes how serious this it is notey realize just them who will get sick, but they could spread it to their families and community. How many other individuals can infect . That is resonating with people. Television political people in both parties, the average person is not interested in the politics. They want to find what they have to do to get through this. We did not realize we would be the epicenter. It was in rome and northern italy, china before that. Then i caught up on us. I give Governor Cuomo a lot of credit. The police are doing a great job. Like a wartime effort, everybody is cooperative. Tomorrow will create chaos and put innocent lives at risk. Steve safe travels. Congressman peter king, a friend of this network, gracious with your time, we appreciate it. Rep. King thank you very much, good luck to everybody and stay healthy. Steve we will be back tomorrow morning at 7 00 a. M. Eastern time with another edition of washington journal. 5 00 for those of you on the west coast. All of our coverage is available at cspan. Org coronavirus. You. Coming up, dr. William shatner professor discusses the latest developments in the coronavirus outbreak. Watch cspans washington journal live at 7 00 eastern this morning. Join the discussion. Next, the head of the European Commission talking about the Coronavirus Response within the european union. Then jay inslee on the outbreak in his state. Later President Trump speaking to reporters at yesterdays House Coronavirus Task force briefing