Total deaths approaching 35,000. We have been reviewing the u. S. Numbers this morning. The numberssee in and recent trends and other news from recent days. Put this in perspective for us. When i personally try to put this in perspective i think about my 35 years working in Global Health and there are two events that i think i use personally as touchstones in dealing with this current crisis. One is india. I worked in the 1990s in india and saw firsthand in 1994 how the ague crisis brought the country to its knees. It was mismanaged. There was miscommunication. Fear was created. A reactive mode that started. And so the country shut down. It lost millions if not billions of dollars in tourist revenue. But the Indian Government learned from it. An infectioused Disease Surveillance Program best publicy is the Health InfectiousDisease Surveillance Program in the world. Its an amazing story. The other event is haiti. I was Deputy Director of the Panamerican Health organization which is the Regional Office for the world Health Organization and the americas. 2010, january 13, the earthquake struck. Imagine the Nations Capital portauprince being brought to rubble. Imagine a fourstory Building Full of Health Workers working on important initiatives to keep the nations population healthy. Gone in a matter of minutes. You may recall the newsreels of people trying to, humanitarian efforts trying to save people. Taking them out of the rubble days after that crisis. 10 months later, cholera struck resulting in thousands of deaths. What happened was a collective Global Partnership and powering the government of haiti to do the right thing. They empowered the communities to monitor their water sources. To test the water and course correct whenever the water source was contaminated. Later zero cholera cases in haiti. Anybody that has worked in Public Health and knows anything about cholera, they know once cholera establishes a foothold in a country how difficult it is to eliminate it. Dayink of that story every to help me put this all in perspective. Because collective action with global coordination will help. Tot leads me to four points start this conversation that i think are very important. Allow the evidence to be in the drivers seat. Rely on the evidence to make informed decisions that are equitable and serve everybody. The other is to fill the knowledge gaps that we have whether it is vaccine therapeutics, the current practices for protective equipment. Are there innovative approaches. You name it. Cpap ventilators. Weple are working 24 7 so need to continue supporting that effort. Means central coordination and leadership and i think what President Trump has just done is great to read we need more of that. Great. We need more of that. This is not a time to make decisions based on politics. We are all americans and we have to be in this together. My final point is a very important point. That is recognizing the global interrelatedness of these Infectious Diseases. Infectious disease anywhere is a disease everywhere. It, we have about new agent emerging every year. Thats an incredible acceleration of frequency that weve never seen before on this planet. Itss not a matter of if, when the next outbreak occurs. And we have to be better prepared. Forurrently are not fit purpose in my mind. We are doing the best we can but we waited too long to take the corrective action and even those actions we are taking need to be improved. So quality is a key issue here. If you are talking about changing behavior to protect those most vulnerable, we need to do a better job at that at all levels and at each level ask ourselves what else can we be doing. Of georgejon andrus Washington University will be with us for about 50 more minutes. We will put the phone numbers on the bottom of the screen for our guest. We will separate things regionally. For eastern and central time zones. And 7488001 mountain pacific time zones. 202 7488002 for medical professionals. Before we get to calls, take us more inside this country. The experiences of india and haiti. You mentioned some of what you are seeing in this country. Flecked more deeply on the u. S. Response so far. What has worked best and what are the big missing elements in your view . I think what has worked best is where those cities that took urgent steps right from the beginning. They did not wait. On the social distancing thats needed to flatten the curves. So the sooner we do that better. Some have mentioned we have a week. If we go beyond the week its going to be very difficult. Needs to be on the front of our brains everywhere. Wherewill be communities we dont have it yet, we should be ok. Run,n that case you can but you cant hide. This is a smart virus. Its going to find vulnerable population. In epidemiology we use this term susceptibles and by that weaning individuals who have not been exposed to the virus, do not have an immune response to it. And that virus is going to find you. So be prepared. Practice the social distancing. Shelterinplace. Even though your community may not seem at risk, it will be. Attitude andrt of again, its quality. Where you see the epicenter in new york city people are out in the parks playing basketball and so on. Thats not right. We have to do a better job at that. This, there are a lot of lessons out there not just in our own country but across the world. Those countries that experienced sars seem to be doing better. They have been there, done that. They didnt get off the boat yesterday. They were devastated by sars. Youre talking about south korea, hong kong, singapore. Hong kong and singapore are small countries but they took corrective action very soon and used testing to help make their decisions. We are seeing that in germany now. The German Government has done quite well at tackling the problem. It hasnt been perfect. Eventsssed two important where young people congregated. So theres been in interaction of the virus into younger populations. But those younger populations are probably responding better than what we are doing here in the United States. They are sheltering at home. They are practicing social distancing. In germany they dont allow gatherings more than two people. So thats very aggressive and they are using the testing to identify the cases, workup the contacts. We have not had that to that extent here. We are doing the best we can with what we have now. But what i want to keep coming back to his we need to learn from this. It cant be just episodic cyclic attention to a crisis like ebola or west nile in the past. Gue that happened in houston and miami. We need to be prepared to tackle the next event. Its this global interrelatedness of Infectious Diseases tackling it from every angle. Host lets go to the phones for our guest, dr. Jon andrus, adjunct professor of Global Health at george Washington University. Epidemiology,t on vaccines, immunizations and response to emerging Infectious Disease threats. Was Deputy Director of the Panamerican Health organization at one time. Among other assignments in his career. Dennis is calling from texas. You are on the air with dr. Jon andrus. Good morning. Caller good morning gentlemen. People living in new york and new orleans, i think a lot of them are leaving. Theyre just taking their family and moving on. If anybody has ever driven by 10 across the middle of texas, i live in a town of 23,000 that has no cases yet but we are right off the freeway. We are 75 miles from san antonio and 150 miles from anything. So people that need gas, a bathroom, food traveling east west across america. Our four or five gas stations are just packed. Louisiana, florida, illinois. California license plates. They are going in, standing in line, getting gas, using the restroom. I think this is something that needs to stop because i think these are serious places where this disease is traveling. People are getting it and they are traveling somewhere else and i would appreciate any response that you would have to that question. Host thanks for calling. We have seen the same concerns about people in places like the florida keys and the area leading up to new england. People traveling and concerns about spreading the disease further. What is your take . Thats a great comment. It really is. It has historic precedent. Actually in the dark ages when plague occurred or cholera in london, many people left the urban centers to go to rural places. The queen of england had several sites in the country where she would go hoping to escape the ravages of whatever epidemic was going on. Historically its happened through time. And i hope that weve learned from it. But in the case of haiti, one of the challenges was the migration that took place after the earthquake. To thegration led cholera spread. So we will see the devastating consequences of such movement. We need to take until there is a mandate, we need to reflect on our own personal actions and responsibilities. There is an axiom in medicine and Public Health, do no harm. I think that applies in our own family lives, the way we live our life. Do no harm. If getting in the car would potentially put another community at risk, please dont do that. Stay in place. Abouttioned a great point calledoints, they are accelerating points. Transmission is accelerating points. So the button on an elevator. The doorknob. The gas tank handle. The gas pump handle. The bathroom doorknob. Where theall points virus can land and spread to anybody that touches that surface who then itches their eye, puts their finger in their mouth, is not doing the necessary personal hygiene. This all points to practice those personal hygienic measures that weve all talked about. Washing your hands frequently, disinfecting those countertops. If the migration cannot be slowed down or stopped, those businesses, it moves them to behooves them to be very vigilant about keeping those points of contact frequently disinfected. I had to go in and get my medications the other day and one medication was missing so i had to go back a couple of days later and i was standing at the cash register. There was only a couple people. The pharmacies are set up in the back. And then in the front you can buy whatever you need for the household. I needed toothpaste. So im buying the toothpaste and i asked the clerk, when was the last time he sanitized the credit card inserter and he said im doing it frequently. He said im doing it frequently. 20 minutes ago. How many customers have you had . Probably 10. Probably 10. Those are 10 risk occurrences where transmission could potentially happen. So its looking at the weak link in all this. We could be doing great with a lot of efforts that if we forget to do one effort in wiping the gas tank, the pump holder for example, then we put ourselves at risk. I think the bottom line and what you mentioned is that you do not need to travel. There is no emergency. Stay at home. Thats the right thing to do. Its what we should all be thinking about and asking ourselves and telling ourselves. Do no harm. Host ron is calling from novelty, ohio. Thank you for waiting. Go ahead. Much andhank you very kudos. What he is saying is right on the mark. I have two comments. Actually three. Im in the department of anesthesiology and our machines clevelandconverted in , ohio to basically vence. They are vence after all. Vents. They are vents after all. The president has very little to do with whats right in this country. The people behind him, found she and all the other scientists and physicians who really know whats going on in the country should be given the kudos and the good common sense that is basically controlled by their understanding of the real world. Theyre the ones really making the decisions and recommending. And he just gets up there and reads the thing like a little robot. I think dr. Fauci and persons like dr. Jon andrus should be given the credit for helping us get through this. Maybe the last thing i have to say is ive heard from two sources now. Is over the television and other resources we have. The fact is a pandemic playbook and in factked out a simulation in training physicians for crisis management. Had in 2017, 2018, there was in fact a playbook for pandemic management. And i understand that they did some simulation and were going to go forward with that but it was shut off for some reason that perhaps had they looked at that and try to do again, we might have been able to get a little bit ahead of this perhaps dr. Jon andrus could talk about that if he knows about this playbook. Host i wanted to play since the caller mentioned dr. Fauci, a brief bit of sound. Listen to dr. Fauci. The number they gave out is based on modeling. I think its entirely conceivable that if we do not mitigate to the extent that we are trying to do that you could reach that number. Its possible. You could make a big soundbite about it at the fact is its possible. What we are trying to do is not let that happen so instead of concentrating on the upper and the lower we are saying we are trying to push it all the way down. The second part of the question was we feel that mitigation we are doing right now is having an effect. Its very difficult to quantitate. You have the virus going up and you have the mitigation trying to push it down. But the decision to prolong, to extend this mitigation process until the end of april i think was a wise and prudent decision. Dr. Birx and i spent a considerable amount of time going over the data. Why we felt this was a best choice of us and the president accepted it. So in direct answer to your , the idea that we had this many cases played a role in our decision in trying to make sure we dont do something prematurely and pull back when we should be pushing. Andrus, your take on the performance of the leadership of the u. S. Health core in this dynamic. Get yourlly wanted to take on the special challenges they face in interacting with the elected officials to get the right conversations going and ultimately make the right decisions. What can you say about that . Questionsre all great and there are several. I will try to answer the gentlemans first. First off, hats off to the anesthesiologist in cleveland. Youre the treasure of the American Health system. Those frontline workers putting your lives at risk. I have a brother in southern california. A family physician working in an urgent care center. His seeing 70s and and treating patients. I have a sister in sacramento cap california who works in a rehab hospital. Hats off to all of you. You are putting your lives on the line. With regards to the plan, im familiar with the planning process and those blueprints we all have. Theres been a recent very rigorous evaluation of Emergency Preparedness in more than 110 countries around the world. Producing whatrk we know about their preparedness and there are several knowledge gaps and implementation capacity gaps that need to be corrected. The u. S. Scored very high. Whats on a plan into a reallife situation is sometimes fraught with challenges. The issue of practicing i think helps. The experiences between the outbreaks, between the crisis i think helps. Because we have this cyclic attention that has to be changed. We need to sustain efforts and be better prepared for the next pandemic. I totally agree with dr. Faucis anybody that if theres i would like in charge when we have such a crisis would be him. Another one would be tom friedman. We need to be sure that the evidence is again in the driver seat with the people responsible for generating that evidence and communicating it and leading it to did i think those are all important points. We should try to avoid politicizing this. Its in the best interest of the American Public not to politicize it but to think in terms of guiding principles. Our values as americans. Why have we gotten through pearl harbor . Why have we gotten through the 1918 pandemic . I had a grandfather and his twin brother fight in world war ii. I cant imagine them going over on a troopship when that pandemic was happening killing the majority of troops on board survivedhit france and charging machine guns. This daymagine that in and age. The point is lets take a step back and learn from those countries that have and through sars and keep the momentum going in the right direction. Invasion being developed in a world where we dont have the therapeutics or enough of ventilators come the innovation being developed with cpap. To nurture those publicprivate partnerships. I hope i answered most of those questions. Host lets go to jerry from somerset, kentucky. What would you like to say . Would i was thinking now be a good time to start a history of all the people it looks like they are going to have immunity to it they could be recruited to the front lines. So i think right now would be a good time to start working on getting them. Secondly it looks like all the towns and cities that had a airports. Er had large probably that was one of the reasons it got started so quick. Thank you for my time at hope everybody has a great day. Askingo the first point you as an epidemiologist, the caller mentioned some type of registry. What can you say about tracking that means tohat the overall process . I think there is value at the local level to keep track in an industry where you need Health Care Workers and pharmacists. Where you need to keep the stores open. Some sense of who has been infected, who might be able to return to work. But there are also other mitigating measures to prevent infection in the first place. Staffr the hours, rotate in very strategic places. To maintain that six feet distancing and so on. But his point is well taken and i think there are some lessons to be learned from that. We need to learn more about the immunity. How long it lasts. Whether you can get the infection again. This is part of the knowledge gap that i referred to. We just dont know at this point in time. If we look at coronavirus is in general, there are seven. Four of which cause the common cold. We get the common cold over again. Dangerous,wo are more dangerous than the current virus. But they are not as infectious. So we are left with this current dont covid19, and we know how long we will have an immune response because people are recovering but we dont know the memory aspect of that immune response how long it will last. These are valid points. Host are you concerned about whats being called a second wave perhaps leader this year and how does this country prepare for Something Like that . I am concerned. We are seeing a little bit of it although variation of it in china where they have been successful in flattening the curve. Someing very strategically segments of the population to return to their work based on the evidence. More casesw have coming from the outside into china. So its a little bit of a variation. The question i think that you is more related to the 1918 influenza pandemic where there was definitely two or three waves, perhaps three waves of the outbreak where we thought things were Getting Better at that time, where the we was those people at that time thought things were Getting Better and then a second wave would come. Viruses are smart. Viruses like certain conditions better than other conditions. So the measles virus for example tends to circulate in the winter months. We dont know what this virus likes. We are learning about it. And so it could be conceivable ofn given the seasonality many Infectious Diseases around the world that this one may have a seasonality component that will come back and we will see a spike. It all speaks to the importance of not dropping our guard. The importance of sustaining our efforts. Not only for what conceivably in this case be a second wave, but i think im more concerned about the next epidemic, the next viral agent that emerges that andally is more severe perhaps even more infectious. So we are dealing with the crisis as we can given the characteristics of this virus knowing there are a lot of unanswered questions. But thats an interesting one about whether or not we feel there will be a second wave. We just dont know. The bottom line is lets be prepared. Lets not drop our guard and continue doing use the evidence. This the evidence to drive plane that we are flying that has yet to be completely built. Guest. His medical degree at the university of california at davis. Dr. Jon andrus is an adjunct professor of Global Health. Actually joining us from burlington, vermont. What are you doing in vermont this morning . Trying to think in terms of my shelterinplace to be in control of all the factors i can be in control of. Im here because it was my birthday early in march and then when things happened i decided i should stay here and shelterinplace and not get on the road has the gentleman from texas mentioned observing how many people are migrating. I decided i need to stay here. I have some chronic disease issues. So my personal health, this is a time for me to reflect mi on top of every factor that i can control . Whether its exercise, diet, attitude. Maintaining stress. There is good stress. So starting about this outbreak, being involved in it, doing everything i can. But there is bad stress that leads to lack of sleep. Its not good to your heart. Even dental hygiene. There is data to show that if you dont prevent the gum disease, that may be a risk factor for heart disease. Thats what im doing personally. Im sharing this because i think perhaps to a greater extent everybody has this opportunity to reflect what are you doing with your own personal health during these moments of home sheltering. There are so many exercise programs on the internet. For the free. I can help you if you are overweight. Lose weight. If you have a bad back. Strengthen your back. If you need cardiovascular training. In the living room of your apartment. Isolated, but im actually keeping in better contact with my family and my friends. Friends that ive known for years. I told you about my indian experience. An old colleague and dear friend , im in communication with him. Or colleagues from haiti. Time to be able to have this opportunity to reach out, maintain a positive attitude. We will get through this. Thats the human spirit. This time and again as american citizens. So controlling those factors i think are important. It will keep your mind off it and you will be better for it. One final point on that. Having been a parent. Still a parent. I have two beautiful daughters. They are in their late 20s. Parenting is the toughest job on this planet. To be a good parent. People,tories of young you are in your apartment and your home. Everybody is being homeschooled now. Its really an opportunity to set the example. You can be the role model in this time of dire straits. How youshow your kids have adapted to stress. How you are adjusting your habits to be healthier. A better human being. More sensitive. And just being a better parent. Its an opportunity rather than a constraint or problem. Its an opportunity. I would leave you with that message. Host ingrid is calling from here in washington, d. C. For dr. Jon andrus. Good morning. For taking myyou call. Good morning. I just have three questions. Aboutor tweeted sterilizing masks. He gave a couple methods. Are we codifying a procedure to reuse pp . Ppe . And on the speculation on the virus not liking the summer, that doesnt seem to jive with how it drives in the hot and humid human body. Aboutnally, you talked the people that are susceptible in the virus seeking us out. My husband and i are fairly old. We are staying at home. Are we just postponing the inevitable and so really the only thing we can do is try as you suggested to keep ourselves positive and eat well and try to be ready for when it finally finds us . Host three different points. The first point is something the president mentioned last night, the sterilization of masks. Think he mentioned an ohio company that was specializing in that. Is that something you could speak to . It speaks to the broader issue of medical supplies in this country right now. There is a lot of work being masksn the use of these that are in very very short supply and whether or not there are techniques that would allow you to reuse them in a safe and efficient manner. And whatever mechanism that you use i would hope we could evaluate that mechanism to be sure that it works. That its not just a false sense of security. I teach a course on global vaccine knology. Weektaught online and last in the class about half my students across the country are medical practitioners. Physicians, nurses working at the point of service and sharing their stories. Even though the course is on vaccine knology, i use the 15 minutes as an icebreaker to talk about this outbreak. They are all bubbling with experiences to share both good and bad. One nurse in particular i remember her saying that she issued she was issued one n95 mask. They fit better than the surgical masks you can buy overthecounter. They are meant for Health Care Workers. Shes being issued in her institution one mask per week. The standard of care that we live by is that you use one mask per patient. And then all of a sudden because of this crisis and the lack of supplies, they are being told to use it one per week. So what theyve done is they put readilyal cheaper more acceptable mask over that and they change that more frequently over the course of the week. I think that should be studied. I think it probably does diminish the risk. Does it completely eliminate the risk . We need to know that. Their innovative measures being done. Home a clip where women at were working on use of home plastic materials to try to build face shields that could be sanitized or disinfected between seeing patients. So that work needs to be continued. Filter thata protects the provider. About theres an effort where you would use the runofthemill household vacuum cleaner also has a filter. If you stand behind the vacuum, you can feel that air. Filteredhas been inside the vacuum. Will that filter help protect the Health Care Provider . That. Efforts working on with regards to the virus and the potential seasonality, thats only a hypothesis. Thats only a hypothesis. We dont know about this virus. I dont want to be in the mode of speculating, trying to forecast the future. That was not my intent. I was using the analogy of other like seasonal influenza. It likes certain seasons. Coronavirus like the cold. They are also seasonal. By no means do we apply that directly to this virus until the evidence shows that. Was just onker that the line, i want to commend you for doing what you are doing. I use the phrase we can run but we cannot hide. I just want to over emphasize. Clear to make it very this virus is smart. And its likely to find you. Hopefully it will be during the time when we have ventilators available. If we allow this virus and dont do anything and we are on a very steep academic curve and ventilators are consumed and theres not one for you, you know the implications. But in the meantime, we know that exercise boosts the immune system. So personally im doing two workouts a day. Its something i can do. I can guard that time when i wake up. Before this interview i did my workout. This evening before i go to bed i will do my workout. And i sleep at her. Sleep is so important for your health as is exercise. In the diet side of things. Be sure you get enough vitamin d. You are inside now. We are not being exposed to the sunlight. Get enough vitamin d. Eat those foods that are cardioprotective in ways. The data shows the mediterranean diet is beneficial. So do what you can to lose weight. All those other things as well. That way when it happens to are better prepared. Your risk of survival goes dramatically up. And the exercise part of this, being a family physician as well as an epidemiologist, i maintain my board certification. Im currently taking a course on exercise and sports medicine. Needhe data show that you both muscle strengthening and cardiovascular. The diabetics out there, muscle strengthening is better. For a lowers your a1c longer period of time. You need both. Pit one against the other. Do both. Youll find when you couple that with muscle strengthening. If you dont have weights at home, you can lift milk cartons or books. Other things in your household to strengthen your muscles. Read about it online. Exercise regimens that will keep you better prepared when you are exposed. So madame, maintain that positive attitude that you have and be prepared. Host about 15 minutes left with dr. Jon andrus. Ken is calling from here in washington, d. C. , good morning. Caller good morning to both of you. I have a question and statement. I know you mentioned haiti a few times and during my travels on active duty i was often in haiti. Stands out isthat the destitute and impoverished nation of the country which has been around since the colonial times. That if you are already at risk, that is an at risk population as well. That my curiosity for you is we have over half a Million People in this country who are considered in poverty or homeless. Homelessth a lot of individuals in the district of columbia. I dont know if people are for thatncerned population of people. Those that do not have certainly have less. I know you made a statement about the politics of the issue. Just leaving names out of this, would you not at least agree that the previous administrations task force that was already set up to deal with ebola or other pandemic issues should at least stay in place to better mitigate situations that we will eventually deal with . Host thank you. Those are great points. When we talk about vulnerable populations, we often say older people because we know biologically their t cell , the component of cells in the immune response of the human being loses its ability to fight viral infections. As part of the aging process. Reasonshy among many why we are seeing a hired death rate and those older folks with chronic diseases are even more at risk. Anybody of any age with a chronic disease is at risk. If you are in your 40s, obese and have adult onset diabetes, i hope that you listen very carefully on those individual actions that you could be taking. Broaderards to the Bigger Picture of vulnerability, i think that is an excellent point. The vulnerability of for ished, crowded poor. The vulnerability as a couple of people have reflected the migration comment in a rural town of 20,000 which is by no means, thats a significant number of individuals. But they dont have the capacity in my mind to deal with Something Like this. And multiplehat populations of vulnerability whether geographically, economically. And then we do things behaviorally that makes people vulnerable. I have heard stories about ostracized because of this outbreak. Call it the chinese virus as the person commented. I wouldnt call it the trump virus. But i certainly wouldnt call it the chinese virus because it stimulates too many negative thoughts. But your point about vulnerability is absolutely critical. About not point allowing race, color, creed, economic status to drive priorities. The vulnerable population when , like i said, disease anywhere is disease everywhere. If you have a poor segment of town thats in your town, thats your town. You as a more affluent person would be put at risk. So thats a Public Health axiom. Sure youreaking covering all risk groups. I really appreciate that comment and your work in haiti and what youre doing with vulnerable populations. I want to thank you personally. Keep up the good work. The task force. Yes. I jotted it down. I oftentimes forget questions. You know, these kind of to move beyond changes in political leadership. They have to be woven into the fabric of our society. Recognized99, it was that the United States was losing its lead in its research of the biomedical area. We were being outrun by other countries where traditionally we had been the leaders. So what happened, it was a great action. The nih budget i believe was doubled. And thats great. And that is why we are in a better position for a vaccine to be produced all based on nihs great research. Tony found cheese team developing messenger rna. One clinicalhase trial. Outstanding. That improvens upon our capacity to respond have to be sustained. It saddens me. At some point i remember hearing that the cdc budget was cut by 80 million. This is not the time to cut the cdcs budget by any means. Again, its the worlds most eminent Public Health agency in the world. It keeps us on the Playing Field in the global efforts. Toare better positioned tackle these emerging infections that occur every year at the source for it comes across to our citizens. So this is not the time to cut back on our relationship with Regional Office the Panamerican Health organization for the americas. Because these entities are working with governments to do the necessary actions but at the end of the day will minimize the risk to our own communities. Its the voice of reason that we must sustain these efforts. Portland,ie is in oregon. Good morning. Caller good morning. I have two thoughts i would like your opinion on. One is is there any plans for andribution of a vaccine second is who is going to pay for the bills of all the people that have had to be hospitalized . Right questions. With regards to the first question theres been a lot of discussion and meetings of experts. I think the one clear message is you have to prioritize. Vaccine will not become available all at once. It will come out in batches. Thats just the nature of vaccine production until we can get a stock pile where we have significant supply to take universal action at one time. The message is its going to come out in bunches, in lots. And so we have to prioritize. If you think of the fabric of our society, one of the gems as our Health Care Workers. We have to protect them. They would be probably the first to receive the vaccination. And there are other components of the society. The Food Industry by Grocery Stores or the police force that maintains security or the workers that maintain the power supply that keeps us warm and our lights lit. The list goes on and on and there are ways to prioritize the access to vaccines as they become available. That wont happen for at least another one to two years and even if we can get a vaccine in two years, thats going to wire herculean efforts and that is assuming we have no major setbacks in the research. So a lot of assumptions, but we are hopeful because we have learned so much from sars that the technology is being applied. The research being done for vaccines has the example that i is also including multinational manufacturers. There is only a handful of them but they have the capacity. A Smaller Company may not have the capacity to go to scale very rapidly. So you need the multinationals involved because they have large factories, large campuses where they make these products in a safe fashion with good manufacturing practices. I have just learned that one of partneringticular with the u. S. Government is working on what we call a subunit vaccine. Its a recombinant vaccine that has some promise. Are also working with european colleagues to develop the messenger rna type that could be beneficial. They havent put all their eggs in one button bucket. That work is happening and hats off to those people working 24 7 on vaccines, on therapeutics to make them available as quickly as possible. One point that i would like to note you with so we are provided a false sense of security. We cannot overlook the issue of safety. Be these whether they vaccines or therapeutics have to undergo all the necessary safety performance to ensure that they do not cause harm. One of the axioms in medicine and Public Health, do no harm. That will be important. Now paying the bills. Thats an enormous challenge for everyone and im hoping and that some more areally minded companies delaying bill payments and so we need to loosen up some of the requirements that will allow people to get through this crisis in every form and fashion that we can. Theres an economic component to that, the Public Health evidence should be driving this, not dollars and cents. Be the Public Health evidence and certainly there are more cost efficient ways of doing things and we need to understand it from that perspective. I hope i answered your questions. Host david is calling from new mexico. Good morning to you. Caller good morning. Host what would you like to ask the doctor . Aboutas calling to ask the use of personal masks. I used to be in emt and i was taught ppe was for my protection. There are a lot of people out here not listening to the stayathome orders. Stores are packed and no one is wearing a mask. Weve learned that this virus wants to live in our lungs. So why do we all have the door open to allow the virus in . We are not learning. The chinese when it got to italy, first thing they said to them was why arent you Wearing Masks . I have to ask you being an epidemiologist . Would you teach your students not to wear a mask . Would that be your First Response or would you say, weve got to wear a mask. Thank you for the question. Its an excellent question. There is no right or wrong answer to that question. Its not like in white in a world of unlimited supply and there is some reduction in risk, yes. Wear a mask. But we are not in that world. We do not have an unlimited supply of masks. So first and foremost, we must protect those heroes working on the front lines. Run on masksas a and then the Health Care Worker that is trying to save your ,others life is not protected then i think we got it wrong. We have to be able to prioritize. Unfortunately we dont live in a world of unlimited resources. Masks on every counter of every drugstore. And weve all been in the Grocery Stores, drug stores. Youngs are empty. Things are empty. Weve had this run on toilet paper, which is mindboggling. Be that as it may, there have been these runs and there could ,e a minimal reduction in risk then why not. But as an emt, when you are integrating somebody into ting into baiting somebody, you know more than anybody that that patient can gag and aerosolized the secretions that are in the lungs and the pulmonary passage right into your face. Recommend face goggles and other protective equipment. Unless you d gown properly, you take the mask off properly, you use the mask correctly, you can expose yourself. We found that out with ebola. That despite having all this equipment ready, when people did not adhere to the strict policy recommendations on decounting, they did expose himself to risk. I could see that happening here. His sauce aou false sense of security, youre not very careful and so on. Question but the there is no blackandwhite answer to that one. We are out of time. Thank you for your time and your expertise and insight. An adjunct professor of Global Health at George Washington i am wondering if i should theve myself from Just Carryout orders we have at work and stay safe and be home. A leftwingve that National Healthcare system like they have in the United Kingdom and cuba for example could have helped get everybody on the same page . Could you actually get that with the money going through so many hands . Share your experiences with the pandemic and ask experts your questions. Join our live conversation every morning on washington journal at 7 00 a. M. Eastern and more conversation weeknights at 8 00 p. M. Eastern. And we will bring you more coronavirus ws