Joining us from seattle, washington. Officerhief strategy for the Health Initiative and a professor of Global Health at the institute for Health Metrics and evaluation. Dr. Ali mokdad. Thank you for being with us. It is a pleasure. Host as you look at the trends tonight, what do they tell you . Dr. Mokdad we peaked on april 10 and they are coming down for the whole country but there are states that are still going up and others are going down. Host how do you do your study . What is the methodology . Dr. Mokdad we decided to model mortality on a daily basis and death rate and we used experience we have seen in wuhan, italy, and spain. We reversed the mortality how many beds we will need in the hospital and how many ventilators. We know in the United States for every death how many patients were admitted. Host at one point there was an expectation we could have 230,000 deaths and that number has come down, correct . Dr. Mokdad true. Our numbers have always been less than 100,000. First released march 26 the , numbers have been coming down because of social distancing is working. Host can you look ahead at hotspots like new york city and south dakota and in the south in miami and in Nursing Homes . How do you incorporate that into your data . Dr. Mokdad we get the data on mortality by age and sex on a daily basis and we are trying to adjust some things in the models. A couple things we are finding to adjust. One is the exact reporting of deaths. Anybody. For departments are doing an amazing job addressing the pandemic and sometimes it is reported the next day. For previous day. The second one, hospitals are good about reporting deaths but in Nursing Homes, there is a delay in reporting the deaths. We add them when they come to us. Host part of what you did was educating the public and this has been a monthlong education in how to deal with pandemics. Is the message getting through, and do you worry if the government begins to reopen the economy, we could become lax in the months ahead . Dr. Mokdad the message is getting through. We have two epidemics going on. One that has peaked already in new york and now we are seeing a decline in cases and demand in the hospital. We see states who have delayed implementation of social distancing measures and they are still going up. They will peak in late april and early may. By june, the first set of states will be back to normal. So the message is getting out and more states are adopting these but the positive news, americans even in states where measures have not been implemented are staying at home and adhering to the message. Am i concerned if we go back and open businesses and we have a surge . Yes, we are susceptible for the disease, if we open measures too early, we could have a setback but at the same time, if we do proper testing and allow them to go back, we know we can relax more. How we can monitor them to make sure the virus is not circulating. We could send another wave of employers to do their jobs. Host as a doctor that heals with Health Metrics, a lot of the information is available on your website, how does state and local government use the data . Dr. Mokdad this is valuable for local officials by distributing resources. We peaked in new york before we did in florida so we had ventilators sent to new york and then the next wave to florida. So, maximizing resources at a time where early on we did not have as many and as we got more, we know where to allocate them and social distancing measures are working. If you stay at home, you help us by reducing the number of mortality. Most important, reducing the demand on hospital resources and making sure physicians have enough to treat the patient and provide medical care. Host you are part mathematician, statistician and physician. Mokdad i am not a physician, i am a numbers person, but i have been in Public Health for a long time. 20 years with the centers of disease control. The members do not mean anything unless you put them to good use and used wisely. Host our first caller joins us from orlando, florida. Good evening. Please turn the volume down on your set, otherwise we will get a delay and have to move on to someone else. Caller quick question. Will the medicine name ever be released to the public . Dr. Mokdad i do not get it. Caller if there is a zpak or injection name for the virus, will it be released to the public early so they can get ready . Dr. Mokdad i am not sure i follow. You are asking me if there is a new medication available, would we tell the public . Of course. Caller ok. Host thank you, robert. Charles joins us from michigan. Caller good evening. Today in lansing there was a huge demonstration with thousands of people protesting or as mr. Trump would say, millions protesting the way the state is shut down. I do not understand these peoples thinking. Are they not scared of dying . They think they are all bulletproof . Hospitals and you will see it is time to get serious about this. Not let up until it is time to stop. You cannot spend money if you are not alive. Host thanks for the call. This is one of the photographs, courtesy of npr, about the crowds in michigan. The frustration from the governor and in other states around the country. Dr. Mokdad it is time to be compassionate. We have to understand many people are hurt and losing their jobs and many of us have paid a price by losing loved ones so we have to be compassionate and come up with Solutions Rather than telling people to stay at home and only stay at home and what my message would be to the people we heard you, you want to go back to business. If you stayed at home at our advice, we are working on solutions to reopen the country again by testing and letting people go to work but please, lets not sacrifice the gains so far by releasing the workforce early. Be patient, a few more weeks and we will have the solution. Host the next caller is from seattle, washington. Good evening. Caller good evening. Host you are on air. Caller oh, hello. For the doctor, i am here in your neighborhood in seattle. Yes, good evening. Right here in seattle. I used to be associated with university of washington and that was probably long before dr. Had arrived. I was in the Immunology Department and my question is host we are getting feedback. Go ahead with your question or we have to move on. Caller how can he explain, or will he explain, why the u. S. Is the number one in the highest number of deaths . Over 26,000. Host it is now over 32,000. Dr. Mokdad you cannot compare us to italy and france because they are smaller. You have to look at death rates. We are a bigger country. We have to remember a place like new york where new york city is the Financial Capital of the world and the u. S. This is people coming from all over the world and spreading the virus. Especially in new york, where there is public transportation. You cannot compare it as simple as it is and as far as i am concerned, the United States has done a great job at reducing the number of deaths and addressing the pandemic. Host pat is calling from newbury park california. ,caller good evening. My question is what level of testing will we need in order to start opening up the economy . One in a 1000, for example . One in 10,000 . Dr. Mokdad good question. Wave, weent the first need to do this in phases. We have to make sure everyone is negative and has antibodies. We say go to work and we monitor to make sure there is no infection circulating. Stage fashion. Testing of people who go to work and when we notice there are no problems, we can relax a little more. We do not need to test everybody, but we need to test the first wave of people to make sure they are not spreading the virus around. Host can you explain the significance of that in plans of reopening the government . Dr. Mokdad let me give you an example. Right now the university of washington is having a discussion about fishermen going on a boat. They have to fish and have to come to port to give the fish back. This is a very important industry for our country. So we would test these employees for 14 days to make sure they are negative and stay home before going on the boat. But when they come to port, test them to make sure they are not spreading the virus among the employees. That is a main source for food. That is the example to keep in mind. So if you allow a company to come to work, you have to test employees before and then allow them to go to the factory or wherever and monitor them to make sure there is no circulation of the virus. That is why we are being cautious. Because having a second wave would be more damaging on the economy than waiting another week or two and to have a plan to roll out the first wave of people going back to work. Host a number of states today, new york, maryland, washington, dc, the mayor announcing if you are out in public, you need to have your nose and mouth covered. Why . Dr. Mokdad this is very important. One of our strategies to prevent circulation. We are asking people, assume you are infected. Cover your mouth and nose with a mask so you do not spread it to someone else. We want the public to know it will not prevent you from getting the disease. The mask. You have to practice social distancing and wash your hands and other things we have advised. But that is one way of stemming the spread of the virus. Host john is on the phone from illinois. Caller when watching world news, japan, spain, italy, you see they are spraying the streets and inside of buildings. What kind of cleaner is effective in doing that . I do not see news of us doing that. Is it effective or is it not doing anything . Dr. Mokdad every country is doing different measures. For us, it is practicing social distancing and staying at home as our first wave of defense. Other countries have been spraying alcohol 60 and above to kill the virus in public places. We will be doing this as we open our buses and trains, you will see more of that when we start opening businesses. Host dr. Mokdad is the Global Health professor and joining us from seattle. Joe is on the phone from east hampton, connecticut. Caller good evening. Dr. Ali, it is a privilege to talk to you. I wanted to bring to your attention a famous epidemiologist of 30 years, he says we have done everything all wrong. Wachowski. Newt for co he says by social distancing and taking kids out of school, we stopped what he called the herd immunity from building up. He says the reality with the disease is 50 to 75 of our population are making it anyway, but by not letting it run its course, he is predicting on the basis of a lot of studies that we will have the biggest outbreak ever in july. What do you think of that idea . Dr. Mokdad that is a good question. In england, united kingdom, there was the same discussion about not imposing social measures, and look what happened. Look what happened. They are facing an overwhelming problem overwhelming the Health System so they went back and imposed social distancing. When you face a pandemic like this that i do not know anything about, one way is to check for herd immunity but the first wave of defense is social distancing. We have the best scientists in the country to find a way for us to prevent a lot of mortality. It is not the first line of defense because as far as we know right now, we do not know how long someone who has been infected carries antibodies, and for how long. So lets be careful until we know more about the disease. Some of the patients who have had it, we are monitoring them to see how long immunity lasts before we make any such decisions. Host dr. Ali mokdad joining us from seattle. I wanted to share with you the headline getting a lot of attention today from the l. A. Times. Essentially, canceling any concerts or sporting events until 2021. That idea on the table according to the mayor. Dr. Mokdad that is a good decision to cancel. We can revisit later on but it is prudent right now not to have these events. Host let me ask you about the party conventions. Democrats and republicans meeting in milwaukee. Do you think the conventions will go on as planned . Dr. Mokdad not today. When i look at the data today, no. I do not imagine conventions happening. But we are monitoring the data and it will tell us when we can relax. Host jackie from washington, you are next. Caller hi, dr. , i am very happy to see you involved in this. And the university of washington. I have a connection. I would like to see us find a way to help people learn to support and help each other and adjust to the limitations we have on our lives. Maybe through Television Ads or something so that we can help people understand that they can adjust to this. Thank you. Dr. Mokdad thank you. This is a good point. I have been talking about this. Some are suffering more than others. I am one of those who have a job and i think all of us who have jobs have a bigger responsibility to help others who do not have food or cannot get out to get food. That is why i keep saying it is time to be compassionate. We can come out stronger from this, i have no doubt in my mind. It is time for all of us to take care of our own community. Help those who need right now. Thank you for reminding us that it is time to be compassionate and love one another. Host leslie, you are next up from lady lake, florida. Good evening. Caller hi, it is a pleasure to listen to someone who has good advice as opposed to listening to the president every day. Two questions. One question is, is this a manmade virus . I read an article that said it was. That it was sars and corona were combined. Stay on the line, we will come back to you for the followup. Dr. Mokdad we do not have any evidence that the virus is manmade and nothing proves that. We are looking at data and there is no sign that this is manmade. Caller ok, thank you. The other question, do you think, because medical people were not put in charge from the beginning getting us equipment from overseas and the defense act wasnt done at the beginning, would people that make equipment in the u. S. That send people off to war and they make it and know how to do it as opposed to Jared Kushner who did not know how to make equipment . Host thank you. Dr. Mokdad i look forward, not backward. I cannot change the past and we all have to be united at this time and help one another. We need a plan to how to get out of this as fast as we can and we have to put all of our resources. This is something that should unite us and we should be compassionate and look forward, not backward. Host dr. Peter li joins us tomorrow to talk about the china connection to coronavirus and his expertise in wet markets, believed to be the original source from china. Tomorrow night on washington journal primetime edition. North carolina, line for medical professionals. Caller i am a fourthyear medical student. Duke university. Im currently doing additional stuff but a lot of community and telehealth things right now. Host good luck to you, go ahead. Caller about medical resources, students, interns, i wanted to ask a question about what advice or wisdom you could impart to people in the middle of this . My colleagues are in the trenches trying to figure this out and they are working hard. The courage exemplified is just amazing. We are trying our best as medical students to volunteer and help out and do things to help protect the others, but i think there is some potential medical student involvement and i am wondering what thoughts you have. What words of wisdom you could pass to future doctors and current residents and interns about getting through and having the courage at this time . Dr. Mokdad through all of this, faced, the staff in hospitals have been heroes. They are endangering their lives in order to take care of patients. I cannot say enough to thank them and acknowledge what they have been doing. The sacrifice. When this is over, some of them have experienced some difficult times and we need to keep in mind to make sure we take care of them after all of this. As for advice for medical student or Public Health professional, nurse, right now we are looking at reopening the economy and looking at Contact Tracing if there is a positive case and checking on people. We need Public Health to do the investigation. Volunteering is the best thing to do. I appreciate your intention to volunteer. We need to remind everybody that eventually, many people who have delayed medical scans and routine screenings or immunizations, we have to be ready to reopen the hospitals and clinics and we will need help because we will be overloaded by people who delayed services. Please volunteer. Give blood, as well. We will need it once we open our institutions. Host our next caller is from michigan. Caller good evening. I have a question for the doctor. You hear about testing of drugs but you never hear about results about how they are doing. Otherher countries are countries using this stuff . We using it . Are i was looking over the drugs and a lot of them contain zinc. So i figured i would check out zinc. I went to walgreens and there is none on the shelves. The stores dont have any. Druggists told me as soon as it gets on the shelf, it is gone. Is it fairytales . Is there anything on that . Dr. Mokdad this is a good question. People ask a lot about this. Let me look back on history. We need to learn from the history. This is a new disease and we do not have a reference but the spanish flu spread all over even when we did not have that much travel. Samoa island people died from it even when we did not have planes. There were two waves. The first wave hit the elderly, the second wave the younger people. At that time, a study was published that aspirin would help and people overdosed from aspirin and some people had severe conditions that led to their death because they were on aspirin. So we have to be very careful right now not to promote a drug until we are confident through Clinical Trials that it is working. In the u. S. , including my university, we have Clinical Trials right now on several drugs and we are pushing as much as we can and will release the findings when they are ready. Keeping safety. The other thing from the history of the spanish flu. States and places who shut down early during the spanish flu saved more lives. They were better and rebuilding their economies than places who did not do it. So there are lessons to learn from what happened before. The short answer we do not have a drug right now and our staff is participating in trials for the vaccine. One of our staff is participating. Host helen from wisconsin is calling. On the line for medical professionals. What is your background . I currently am retired. I am formerly a banker and now retired. Host go ahead. Caller it seems as though they are so concerned about covid during someones lifetime, but you dont hear about after death mortality and whether or not burying people in a manner traditional manner ensures there is no spread after the fact. Does the virus die when the body dies . Dr. Mokdad excellent question. A lot of things we do not know with this virus. Many religions and places have changed the way they bury their loved one at this time and precautions are taken during the burial. We do not know how long the virus stays in someone after they die. We do not know if it will come back as a resurgence or not. We will learn more as we monitor and treat more patients. Host diane from winter park, florida. Good evening. Caller thank you for taking my call. My understanding is that some states have peaked and some have not. I am wondering, if you are in a state that has not peaked, is it a good idea to open up the schools . Host thank you, diane. Dr. Mokdad that is a good question. I have a daughter and definitely, i dont like it. My university was the First University to switch classes to online. It is not time to open schools and i know it is hard, especially for the students who rely on meals from schools. We have to be compassionate and make sure we get them through. When we open our businesses, i would say, we do not open the schools. The first wave of opening, we should focus on some basic industries that are crucial for the rolling out of the economy and get back online as soon as possible. Schools, concerts, that is not something we should consider at this time. Host bonnie in miami, good evening to you. Sir, i amod evening, a registered operating room nurse for many decades. My son is a neurosurgeon. I have been married to two physicians. My question is, why is the American Medical Association or similar organizations with clout and influence not furious and speaking of forcefully when people advocate and promote and pander drugs that have not been tested properly . And this goes right up the line to the president of the United States, who has no medical authority to do that. I feel like people should be speaking out forcefully to prevent others from taking drugs that could be serious. Deleterious. Thank you. Dr. Mokdad again, in the medical system, we wont recommend a drug unless we have a Clinical Trial that says it is effective and safe to take it. I am sorry, i am not dodging your question, but it is time to be united, it is time to look forward, it is not time to pick fights right now. We have a bigger problem at hand. The more united we are, the more compassionate we are, the stronger and the faster we come out of this. Host the doctor is with the university of washington. The website is healthdata. Org if you want to check it out. Kathy in michigan. Grand rapids. Good evening. Thank you for waiting. Caller hi, doctor. I have a question. I have been looking at the numbers lately. What it looks like to me is that there is a significantly higher death rate in michigan than there are another states. Im wondering, am i seeing that curve correctly . And if that is true, why would that be . Dr. Mokdad this is a very good question. There are several factors that explain a higher mortality in one place compared to another. One of them is the social distancing we talk about. How fast it was implemented in the state. There is an unfortunate status in the system in the United States. Many places in the u. S. , we have a lot of disparities. People with higher risk factors, people with more diseases. When you look at states similar to michigan, you have some that cannot work from home, and some jobs make them more exposed to the disease. We are noticing right now africanamericans are dying more from the disease at a higher percentage even in places where the percentage of the total population is lower. I keep talking about looking forward, as we rebuild our country, we have a chance to do it right and address the disparities that have caused a lot of problems in our society and do it right and make sure the most vulnerable population gets the aid to make sure they get the best medical care moving forward. Host john from connecticut. Mansfield center good evening. , i have allergies so it iso normal early to tell. I canwer your question give you an example from my university. Before this pandemic happened