Addition of washington journal, on cspan. Senate is expected to vote tomorrow on additional coronavirus funding totaling 500 billion dollars. As states looked to gradually reopen, we talk to a leading Infectious Disease doctor about how to get there with treatment methods of covid19. And later, Public Policy antivirus, with former Senate Republican leader and a trained frist. , dr. Bill numbers, 202 7488000 for the eastern half of the country, for the western half, 202 7488001, and if you are a medical professional, 202 7488002. Johns Hopkins University says worldwide coronavirus cases have cap in the u. S. Totaling the u. S. About 840 5000, just over 47,000 confirmed deaths in confirmed the u. S. Across all 50 states. Is ang us from tennessee Infectious Disease expert from Vanderbilt University. Dr. , thank you. Good to be with you. Steve let me begin with therapeutics and other medicines that will allow us to get to know normalcy in this country. . Hat will it take things. One is better treatments. We dont have a single documented treatment for coronavirus, other than the Supportive Care we are giving, but we need an antiviral drug or a drug that will impede the immune mechanism, which get involved in making those pneumonias. There are any number of drugs now in conical trials that patients are volunteering for with fully informed consent, and we hope that within a few months, we will get preliminary information about which drugs patientich dont, which populations they may be better suited for, and side effects of the drugs. Most laypeople dont focus on side effects. The doctors do. We dont want to harm the patient while we are trying to cure the patient. Steve how does contact how does Contact Tracing work . We are seeing that in a number of state, including the announcement today from new york, new jersey and connecticut. How does that work . How does it work in treating the disease . We would like to diminish the spread of infection and to do that, first of all you do casebycase investigation and find the individuals investigated. Since this is easily transmissible and they are contagious by the time we make the diagnosis, we go back about a week to get names and addresses of absolutely everybody they have had contact with, find those patients and then test them. And if they are positive, put them in isolation, treat them to mixer that they are doing well, either at home or in a hospital and then further, get their contacts. That is the way we can get our arms around this virus and reduce its transmission. Publichealthcal technique for many Infectious Diseases. Steve this has been such a lesson in pandemics and Public Health for all americans. In a multiple path approach, the other avenue is a longterm vaccine. How does testing work on a vaccine . And based on your estimate, what is a timeline . Dr. Schaffner i am a vaccine guy. I love that scenes because they prevent disease at their best. First you develop the vaccine and a laboratory. And we had a head start on that. So vaccine candidates are kind of ready. And then you, in a gradual way, introduce the vaccines under careful supervision by the food and Drug Administration to a small group of volunteers, then a larger and larger group of volunteers, to mixer the vaccine is both safe and is boosting the immune response, we tested in the blood, test it in the blood, that we expect the vaccine to do. The last thing we do is give a large number of people either the vaccine or a placebo, the dummy solution, a fake vaccine. Nobody knows what they have gotten. All of these are in volunteers. And then we see who gets sick. And at the end of the experiment, we look and see if the rate of sickness in the vaccine people is much lower than the rate of sickness and the people who didnt get the vaccine. Then we are reasonably assured that this vaccine is going to work when we offer it to the public. This has to be done in a rigorous way, because we dont want to give a vaccine that doesnt work, and we dont want to give a vaccine that might be safe. Very, veryto be careful in evaluating the vaccine before we open it up to the public, let everybody in on getting the vaccine. Steve i am going to ask a very lame in question. In terms of the blood you are looking at, explain why that is significant in determining whether the vaccine is successful . Dr. Schaffner the vaccine, like the real coronavirus infection, causes a response in the bodys immune system, and the bodys immune system produces proteins that flow to the blood called antibodies, that fight off the actual virus. Fakes out the vaccine the immune system. It is not the real infection, it is kind of a substitute. So we will test the light of individuals to see if the vaccine has produced these antibodies, which we think are correlated then with protection, which then is demonstrated in the large, clinical trial. Steve lets get to phone calls. Bill is on the line from chattanooga, tennessee. Good evening, bill. Dr. Er how are you doing, doctor . I used to do some work way back in the 1990s with vanderbilt about 70e county, miles south of nashville. Coffee county medical center, where i was administrator, we a 130beded hospital, longterm care center, longterm care facility. And we worked out a contract to break offlt convert our beds and them into what people at vanderbilt call subacutecare fromso we can send people Coffee County after vanderbilt, where they would get the main, primary care that they need for and wey intense care, could get them back into the community as quickly as possible. Steve is that something we are seeing today, based on what bill is saying in chattanooga . Dr. Schaffner from one bill to another, that is a very nice example of medical centers collaborating with Community Hospitals in rather rural areas, supporting them in every way, good munication, firststage care, close to home in that hospital, but the patients acuity of illness gets to the point were more expensive care is needed, then vanderbilt has good communication, as other medical centers are, to receive those patients. Good medication between eight Major Medical center in local hospitals. I love it. Steve we go to ronald in chicago. Good evening. I was going to ask about transmission from covid19 to humans, but i heard what you said about vaccines. Are you absolutely insane, giving largescale vaccines to the general population . Or is this just something you said to say it . You seem stupid. Dr. Schaffner well, i hope not. Vaccines are designed to prevent disease completely, and we have brilliant successes. I will just mention the vaccine for one, the polio vaccine is another, then we have vaccines such as the influenza vaccine that are good, but i wish we could improve it. What we hope is that the various research attempts will provide a vaccine that is both safe, and i must emphasize safety, and to a degree, effective. We dont know how effective, but we would love to prevent many, many of these covid19 infections. Benjamin franklin had it right. An ounce of prevention is worth a pound of cure. Steve let me follow on the announcement from Great Britain this week, they are spending upwards of 20 Million Pounds in research on a vaccine. So how do you make sure this is a collaborative, global effort . Dr. Schaffner you know, science is global today. Everybody is in communication with each other. The british have a little hubris. They are working very, very hard and some of their scientists have said, you americans, we are going to beat you at this race. They think they may have a vaccine available this fall. Good luck to them. I would wish that 100 success. I hope they are right. I am little skeptical that they can carry it off, but wouldnt it be wonderful if they did . Steve why the skepticism . Dr. Schaffner because the development of a vaccine usually takes years. At what we are trying to do in the rest of the world is compress it to a year and a half or two years. Are tryinghe brits to put it down to three quarters of a year. I hope they are faster than the rest of us. Broke thetheir man fourminute mile before anybody else, that was roger bannister, and i hope they will beat us all in the vaccine race, because we need that vaccine as soon as we can get it. Fner isdr. William schaf with the Vanderbilt School of medicine and served as past president for the National Foundation of Infectious Diseases and is on the board of the Infectious Disease society of america. Tracy from blue earth, minnesota, good evening. Good evening, thank you for taking my call, and thank you for cspan. Doctor, i was hoping they would have you want again. You explain things very well and i imagine your students love you. My question is, what is the covid 2 and between covid19 . Dr. Schaffner you are from blue earth, today is earth day, i think, and it is aptly named. We ought to think about the environment. Sarscovi is the name of the virus. Covid19 is the name of the disease. Virus produces covid19, which is the name of the disease. It is a cumbersome nomenclature. Only scientists with think of it. Steve you are in tennessee. I want to ask about plans to open parts of the state at least. They could open as early as april 27, state parks reopening this friday. Counties with Health Departments could extend lockdowns at their discretion, at a massive increases in testing, even to those without symptoms. I mentioned that because earlier jiang of cbs news put this question to dr. Anthony fatty states reopening. What happens when governors kemp are not following this careful, measured plan and are moving forward without meeting the criteria . Dr. Fauci if i were advising the governor, i would tell him he should be careful. And i would advise him not to just turn the switch on and go. Because there is the danger of a rebound. I know the desire to move ahead quickly. That is a natural, human nature desire. But going ahead and leapfrogging into phases where you should not be, i would advise him as a Health Official and as a physician not to do that. Steve dr. Anthony fauci earlier tonight at the white house. Reaction . Ner, your dr. Schaffner i heard tony when he said that and i agree with him completely. Here in tennessee, our governor has a wonderful Advisory Committee on covid19. Im not on it, but a lot of my friends are. They are providing him good advice. He is listening very carefully. You would like to open the state in phases. ,e may open parts of the state others have to shelterinplace for a longer time. We are looking at our data very carefully, and all of us recognize the governor said this we have to maintain social distancing. The mask is going to be an ongoing fashion statement. Lets all get used to it, folks. And staying apart from each other . We are going to be doing much more of that going into the future. If you go too fast, as my kids used to tell me, dad, you are bruisin. R a you will have that second wife. Steve what would force the mayor or a governor or a president to say, we must pull back . Dr. Schaffner well, i couldnt speak to that. But things we would look at very, very carefully are frankly, the number of nations admitted with diagnosed covid19 into hospitals. Tennessee, we can see they are plateauing just a little bit. We are still on the plateau, hoping they would dip, but we are hanging tight. And they are not going up in any sustained way, so we are guardedly optimistic. If cases anywhere in the country obviouslytick, everybody would have to think about it again and perhaps retrench. So nobody wants to do that, lets do it right the first time out, slow and steady wins the race. Steve keith is here from wayland, iowa, on the air with dr. Schaffner. Good evening. For taking my call. I have a statement followed by a question. Trump made a statement that it was a democratic hoax, so there is a lot of people who think that this is a hoax out there. I hear from a lot of people, im 62 and stay in my house all the time. I have been inside my house for a long time, and i want to be safe. Whenuestion ive got is, they first had the outbreak of a flu, and now we have this outbreak of this virus, and people are putting it together and saying, it wasnt bad that time, so its got to be a hoax. I hope everything open up, but that is my understanding. Thank you for taking my call, and if you can answer that, i would appreciate it. Dr. Schaffner thank you, friend. You and i have both inspected the interior of our house much more than we both expected, but it clearly is not a hoax. I would take some of those people by the hand and bring them to our emergency room, where they could see patients gravely ill with this illness. It is really there. It is very serious. This coronavirus is going to be with us for a while, im afraid. This is not a short sprint kind of response. We are in this for a bit of a marathon. Steve the cdc director addressing this at the white house. How does the world deal with the flu season in the fall and winter of this year, as well as the coronavirus epidemic . Dr. Schaffner dr. Redfield is right. We have to buckle our seat belts and be prepared. I would say several things. The first is, when it becomes time to get your flu vaccine, i know it is not a perfect vaccine, we could go on and on about that, but it is better than nothing. Even if you get the flu, if you have gotten the vaccine, you are going to have a milder pace. Milder case. We should all in september and october get ourselves and everyone in our family vaccinated, so we at least get as much protection as we can against influenza while we are also coping with covid19. So it will be a challenging winter, most of us think. Steve michelle next in ofallon, missouri. Good evening. When were just wondering, my son was in second grade, the h1n1 came out. And i remember taking him to get that immunization. It seemed very quick, like we didnt have to wait a long time. Why is that . Was the h1n1 vaccine already being worked on . Why is there a difference . Dr. Schaffner one thing is very easy to explain. We make millions upon millions of doses of influenza vaccine each year, so all the manufacturing plants who are out there, they knew how to do this, they did it every year. And when we brought them the request to make a new vaccine, they stopped making the old vaccine and immediately went work producing millions of doses h1n1, socalled swine fluke, vaccine. And they did it in very short order. We wont have that advantage this time. So that is at least one of the reasons it is taking longer. Steve you hear this every season, but for those that say, i dont want the flu shot because i am going to get sick, you tell them what . Dr. Schaffner [laughter] urban and ait is an rural meth. You dont get sick from the flu vaccine. Of course, my arm gets a little sore for a few hours. And there are some people, about 1 , 2 , who at a degree of fever. That is not the flu, that is just the body working with the vaccine in your arm to build up your protection. So the vaccine, which we have given millions of doses around the world each year, is extraordinarily safe. It is a good vaccine. It is not as perfect as we would like, people are working on that vaccine is definitely a everyone older than six months of age in the United States should get. That is the recommendation. You dont have to think about it. Just roll up your sleeve and get the vaccine. Steve joshua is next, medford, new york. Good evening. I have a question. Steve you are on the air. A we get a search, surge, i would events like the macys day parade the macys thanksgiving day parade in the Christmas Parade take place . Steve new york is still planning on the july 4 celebration in new york city. Chaffner, your advice is what . Areschaffner joshua, those people for long periods of close those are congregations of people for long periods of time. I think that although those celebrations are still on the books, i will bet those mayors are thinking about that every day to see whether they will all go on. We have closed concerts, we have closed movie houses, religious services are now kind of held at home rather than congregating together. Group events are the last things we open up, because they are such a place that the virus to spread from one person to another. Steve so can you envision baseball games this summer, College Football in the fall, or political conventions in august . Dr. Schaffner i can imagine them, steve, but im not sure they are all going to happen. Im a baseball fan. I would love to see the yankees play again. I am a big collegiate football fan. If there is a collegiate sport i can be certain of, it is the one i participated in high school, participated in an icicle, crosscountry no big crowds, no spectators, and i was always way behind, so i was six feet apart from everybody else. Steve the caller from vermont sching us with dr. William ner from founder built from Vanderbilt University. I have been researching diseases for a number of years and before covid19 hit, i was conducting conversations with the state epidemiologists and toxicologist related to methanol becausehyde, formaldehyde and cigarette smoke its into the lungs, mixes with water come becomes a hydrate version which can create formaldehyde polymers. And with cigarette smoking being the number one fourth of number one source of menthol formaldehyde in the human bloodstream, are epidemiologists tracking histories of patients to see if there is a correlation of smoking and an increased risk, as well as the autoimmune disease . Dr. Schaffner silas, i would love to know the answer to that. Your chemistry is beyond me. You will have to give me a seminar on a later occasion. Know whats really hit know, you haunt was really hit hard, more men than women, so a simple epidemiological observation is that smoking is more common in wuhan among men than women so we wonder if they history smoking predispose due to a more severe disease. Beyond that, i havent seen data, but i assure you that is a question of intense interest to the epidemiologists at the cdc. I hope we can get answers for you. From lisa is next virginia. Good evening. Good evening. Dr. Schaffner, thank you for your time. I just read an article in richmond, virginia. Patient jones had a from another doctor in richmond, he was treating him for the virus, and you stay drug that cycked site ticking tokines that were causing inflammation, and within 45 minutes he started feeling better, got it got a because the next day on the following day he went home. I was wondering what your thoughts are, using this drug for treatment for the virus . Dr. Schaffner lisa, just so everybody is up to date on what you are talking about, the number you caused by covid19 is caused by the virus but also by the bodys inflammatory response. We fight the virus, but we over fight and there is collateral damage, so our own inflammatory canonse, those cytokines, damage tissue in the lungs. We want to modulate that end control it. Immunemodulating drugs that are currently under investigation. That is a provocative anecdote. I hope it pans out for lots of people. From bonneyjoins us lake, washington. Good evening. Caller good evening. Wasntracted the virus and in the hospital for, like, 28 days. I was ventilated, intubated, ventilated, and when i was released i selfquarantined at my house for two weeks. I was told today i am not now contagious, but i am wondering if the virus is staying within me and is in me, or what should i do . Steve before we get an answer, how are you feeling tonight . Caller i am feeling great. The only thing i am dealing with is that i was in a hospital bed for 28 days. So i am trying to get the stamina for my heart rate and just take care of that. Thank you and thank you for sharing your story. Good luck. Dr. Schaffner juan, good for you. Do those physical therapy exercises around the house, doing occasional pushup or something, to get your fitness back. You do lose muscle tone when you are lying in bed for a long time. What we hope is that, with time, the virus disappears in your body. You were in the hospital a substantial period of time. The tests are correct as well as your doctor, the virus is gone from your system and you are no longer contagious to anyone else. I can say that with about 99 assurance, and that is as good as we can do in medicine. Steve and those who do contract covid19, including juan, what are the chances it could recur six months, a year from now . Dr. Schaffner all these hard questions. We think that once you have at the virus under covered, whether a mild infection or serious, you have some protected immunity. How long it lasts, we dont know. Now, there are human coronaviruses that caused us common colds. Once we get over those, we do have protection. But after a year or so, it begins to wane, and after several years you are susceptible all over again. This is all the more important that we develop a good vaccine, so if we all get ourselves vaccinated, perhaps periodically, every three or five years, whatever it takes, then we can maintain that protection and keep the coronavirus from our doors. Steve with nearly five decades at Vanderbilt University school of medicine, professor of preventative medicine and Infectious Diseases, dr. William schaffner joining us from nashville, thank you. Dr. Schaffner my pleasure. Stay healthy, everyone. Steve we agree. Thank you. Time magazine has a piece out this week by former senator bill frist, three ways policymakers can help our nurses and doctors. But first, this from Governor Andrew Cuomo in albany, a plan to figure out who has the disease in new york, new jersey, connecticut, and steps forward. More from albany and governor cuomo. Governor cuomo you cannot trace someone within the environs of new york city, because once someone goes outside new york city, that would be a westchester person. Pick me. I live in westchester. I work in new york city. New york is going to trace me, how . I am in westchester, a different county. You cant trace me. In we will trace people westchester. No, westchester is going to say, that is my resident, dont come here and trace my resident. Ok, lets forget the jurisdictional fight and the political fight. We will coordinate everyone. This is a monumental undertaking. Who is going to do it . We are all going to do it, city, state, jersey, connecticut. How do we do it . I dont know. We have never done it. Michael bloomberg will design the program, designed the training, he is going to make a andncial contribution also, put together an organization that can help hire the people. Because we have to expand this number tenfold, and get this all done like this. [snapping fingers] you dont have months to plan and do this. You have weeks to get this up and running. A super ambitious undertaking. Help r luber will mayor bloomberg will help coordinate the entire effort. He will be working with the suffolk,ty, nassau, jersey and connecticut. Steve the briefing today from new york Governor Andrew Cuomo, who met with the president yesterday to talk about testing. From time magazine, this is the article, three ways policymakers can help our doctors and nurses. Joining us his former senator and doctor bill frist. Great to have you with us. In a battlewe are with a cagey, deadly virus enemy, but we send our soldiers to war without armor or ammunition. The president should make dyer shortage of masks, shields, downs and quick tests a national priority. Secondly, a portal conveniently accessible, doctors need realtime information at their fingertips about the virus, where it is, how to test immediately, the timely return of results, which treatments will work, what intensive care where theare nearby, ventilators and how much diseases in the neighborhood . Points youthose mentioned that i wrote about center on the importance of testing. As we begin to think about reopening and getting back to some degree of normalcy after wes vast, total shutdown, need to focus on the individual. And to do that requires testing. Number one, we need to get the tests out there, nurses and doctors need them, hospitals need them, to know who has the infection, who has had it in the past and may have infection now, and you might get it in the future, because if you havent had it, you are going to be susceptible to it. We have not enough tests today. I know people in washington are saying testing is not a problem. But if you are healthy today or have mild symptoms, in most places across this country, you cant get a test today. So we need to increase testing. The second point was that as they are seeing patients, and nurses as they are seeing patients, they need to know who has the virus on who does not. To Hospital Personnel need be tested because they are going to be moving patients around and operating on patients, and right now there are not enough tests. How do we get there . In washington, every News Conference needs to say we need to make testing a priority. Alexander, lamar others in the United States senate to understand it, and may will be passed. The private sector and Public Sector is partnering. Nih announced this week they are coordinating a partnership with pharmaceutical companies, universities and research people, and hopefully that will expedite testing. Testing, testing, testing. Steve your third point in that article was to expand tele health. What else needs to happen . Dr. Frist it is interesting. What we have done because of this trend moving toward what we call Virtual Health, and that is not necessarily having to see a doctor in person, but seeing a doctor like we are communicating skype,videoconference or privacy protected skype. So there is a certain amount of telemedicine going on today, but of the 1. 4 billion dr. Patient interactions a year, probably less than 1 of those precovid19 were being done by video, telephone, conferencing. What we knew precovid19 was that if you deliver medicine, not for everything, i am a surgeon, we are not going to do that by telephone, but through routine things, asthma, sinusitis, urinary tract infections, headaches, you can take care of about 90 of that on telemedicine. What covid19 has done, one of the positive things that will come out of this, it accelerated that process where, in the past we had to drive an hour to the Doctors Office, wait 45 minutes in the waiting room, weight to see a nurse or practitioner, then see the doctor, then go to the pharmacy. We can do most of that by telehealth today. Processccelerated the hel of having Virtual Health by three years, five years. So in large part because of washington and states have done, is we have relaxed restrictions and regulations which scourged suchealth in the past, things as allowing doctors in one state, say virginia, and to see, to be able to treat patients through Virtual Health, telemedicine, if they are licensed in those states and port certified. Certified. D in the past, you had to treat people just in your state. That is one example. Number twos reimbursement. In the past, telemedicine has not been reimbursed by commercial payers, state government, medicaid, medicare, the government this has accelerated the government. This has accelerated. Commercial payers on the government have now come in and said, we will reimburse. Telemedicine makes so much sense for an Infectious Disease like covid19, where if you have a question, instead of going through that process of finding a doctor and going to see them and going to a testing facility, and if you have the virus, potentially infecting other people, you can do 95 of that over the videoconference. They can tell you were to go. You dont just show up. You go to a particular facility. And for other types of illnesses, the pharmacy consent the medications to your home. That is the third point. Telehealth is here to stay, virtual care is here to stay, not for everything, but we know it is more affordable, more convenient, equal quality are sometimes maybe better quality of care, for Mental Health and Behavioral Health as well as physical health. Steve trained as a surgeon, dr. Bill frist was elected to the senate from tennessee in 1994. I want you to put on your senate hat for a moment there is a debate on right now over remote voting in the house and senate. If you were in the senate today, how would you vote . What needs to happen . Dr. Frist it is interesting. I wrote aeace piece about a week ago. When i was majority leader, i looked carefully at that. Remember, at that time we had sars and the potential of sars, we had anthrax, it hit the capital in 17 people died of that biological disease, anthrax, in the early to 2000s. Ds early and you can vote not being present in the senate, but you have to have what is called unanimous consent. The problem is, if one senator objects, the whole process has to come to a stop. And the resolution of things that are not going to get 100 of votes in the senate is a problem. I am just a private citizen, i have been out of the senate for 12 years, but i feel that in this time, with the realities of pandemics and, it is going to be here for 10 years, 20 years, 30 years, it is time to have the senate and house modernize and have remote voting when it is necessary. To the 19181919 spanish flu, which had a a global,of 3 or 4 , this was addressed in the house of representatives that they did allow remote voting at that time. For more information, i will refer you to my forbes article on this issue. Steve available at forbes. Com. Howard is on the phone from florida. Good evening. I am lookingrist, at a comprehensive report by the Florida Department of health. It breaks down the number of confirmed cases ih group by age group. Of thoseest percentage cases are in the 4555 age group. I am in my 70s. I am concerned some of the younger people havent taken this seriously. Can you say anything to them that might convince them to pay closer attention . Steve howard, thank you. Dr. Frist great question, howard. Thank you. Because a lot of people will say, from the experience in asia, predominantly china, we know this is a disease, covid19 antivirus, that in particular affects people above the age of 60, usually what people say. But it gradually increases after 6070, but in particular 7080 and above 80. It disproportionately takes people to what is called a third phase of the disease, which has a much higher mortality rate. That leaves a lot of people to say, instead of having this massive shutdown that we have today, it is called population mitigation, it is done at the federal level and state level, why didnt we just focus on quarantining and separating older people and seniors from everybody else, and thereby protecting them . It canwer to that is, andck people of all ages, the carriers of the virus can be of any age. Nobody has an immunity. Young people didnt quarantine and didnt stay at home, and by young people, im saying less than 50 people of less than 50 years of age, and will allow the virus to spread and spread route commuter spread throughout communities and increase hospitalizations, it would infect our seniors, infect people with chronic disease, the other big risk category, to the point that our hospitals would be overrun, just as we have seen in new york. We have seen it on television and video playing out in continuing to play up today. Single hospitals have 12 people die of this disease a day. We saw it in seattle and some indoor lens. So this whole idea of flattening the curve required this massive mitigation of all ages, and schools being closed because they can become a hotbed of this virus circulating around, and that virus would be taken home to the parents, even if they are not seniors, and it would infect grandparents and overrun our hospitals. Your question is really pertinent and what is interesting is, how do we reopen and get back to society . You cant lock society forever. We are getting ready to go into a big recession, and that may well be the biggest recession we have had since the great depression. And that is the price we are paying for this wholesale population mitigation, which was absolutely necessary, absolutely necessary, to contain this virus, which you heard me describe as a cagey virus which could attack all 350 Million People of us. Now we need to focus on the individual. We need to know the testing status. What category does the individual fall in . Age is very important, but we need to know if you have never had the virus, do you have the virus now, are you sick now, contagious now, and that that third category, if you had the virus, how long does that protect you . You may be protected for a month or three months or 12 months, it one of those unknowns. So it is a great question. And this is important, howard. As we reopen, and this is what doctors and publichealth epidemiologists are saying, as we reopen, the infection will increase across the country. There will be more fidelitys. And unfortunately, the fidelitys are going to be predominantly in older people, number one. Number two is people who have preexisting conditions, chronic diseases, heart disease, lung disease. And the third, and people dont peopleout this as much, with the Robert JohnsonFoundation Talk about it, and that is that this virus disproportionately, in addition to the old, affects certain vulnerable populations. Africanamericans are more likely to die of covid19 that others. Latinos are more likely to die than others. People in prisons, people in nursing homes, these categories of vulnerable populations, including the very poor, who will also be disproportionately affected. Steve dr. Rick spencer will join us next week on our prime time addition of washington journal. Bill frist, republican from tennessee, served as Senate Majority leader. Patricia is in excelsior springs, missouri. Go ahead, please. Dr. Frist dr. Frist, thank you for taking our questions. Ith that videoconferences, toder how you will manage take the vitals, blood pressure, temperature, respiratory . How would you manage that on video . Would that be something that at some point you would send a Home Health Nurse to gather information and bring it back . Steve thank you, patricia. Dr. Frist patricia, great question. And this is where technology really comes into play. We havent talked about that much, but incontact racing for covid19, all this instrumentation is getting out of hospitals and brickandmortar facilities, and being moved closer to the home, where people are more comfortable, they trust the environment, it is a secure environment, they tend to be more open, they tend to heal less vulnerable to infections that exist in hospitals and Doctors Offices that conscious that that continuously have Infectious Disease coming through them. It hurt my feelings initially when i was a clinical physician, and my dad was a physician, when i felt it was important that i use my hand, that i touch somebody, sit down next to them, touch their hand, take their pulse, and i use my stethoscope today. And i learned ultimately got a lot of times, you dont have to do that in person. Feelings, but in truth, you dont. People have thermometers at home. They can hook their thermometers up to their iphones or androids and get a readout. A great thing we have today that we didnt have four or five years ago are the pictures in your camera, the camera in your that givesour device you photography, pictures and images that are two or better than a microscope or magnifying glass or being in a Doctors Office today. So almost all of the platforms i have found that if you take a picture of the lesion on your hand, send it immediately, if you have a stock in your eye, you could look into the ear with a device that you hook up to your phone, so the patient today with that technology is able to get most of that information. You can teach people to take the pulse in a very easy way if that is important its all that data is there. The other interesting thing is Behavioral Health, health. This loneliness and isolation is wearing on everybody, even people who say, i am ok. Being locked into your house for four weeks and not being able to get out and socialize as a huge impact on your psyche and Mental Health and spiritual health. ,he interesting thing there what has been documented again and again and again, it is not intuitive, but for Behavioral Health issues, just like you and i are looking at each other, you are in my library, i am in your living room, we can see each other, see our facial expressions, and you tend to open up more and you have that computer or that television, or that anonymity, that if you are in the presence of a doctor, you are nervous, see them for 30 minutes and talk about these behavioral issues. So in some cases, like Behavioral Health, it has been demonstrated you get better care, there is more trust and anonymity that is there. Steve scott from essex, massachusetts, quick question senator bill rest. Caller thank you for taking my call. I have a question regarding telehealth. Followingned patricias question. Take variousc and drugs. I am 60 years old and have had asthma for 35 years. How was a doctor supposed to look at my lungs and see how i am doing telehealth . Dr. Frist you probably would not. But i will ask you, and i will bet that you are more in tune with your body and your needs needs that your in with your body and your needs than i am, as a physician. You typically know what medicines you will respond to. If this is a first asthmatic attack you have ever had, you are up so lewdly right. The last thing i want to say is that Virtual Health can treat or disease, evenost today. Absolutely right. But if you were to call me and say, i think i am having an asthma attack, and i would ask you, have you had this before, and you said no, i would tell you, and that is the advantage of the technology, i would tell you the closest Urgent Care Center that is open, if it happens to be in the middle of the night. In addition to that, i could tell you right now while we are talking with the closest pharmacy is that is open at 3 00 in the morning. Then i can say which will be open at 8 00 and whether they will deliver that medicine you. So you seek the advantages that are there. For the Telemedicine Companies that have been out there, they will tell you that probably 90 and onealls they have, company does 8 million visits a year, and they will say that if they can take care of 90 of the cases to resolution, and get your medicine to you, they dont take care of addiction and addictive drugs and that sort of thing, that is put aside, the other 10 , they will tell you where to go, how to access that care, and the most affordable and convenient way, even if it is the middle of the night. Steve dr. Bill frist and former senator, as this policy debate continues, we would love to check in with you from time to time. He joins us from virginia. Senator, we appreciate your time. Dr. Frist great to be with you. Thank you. Scene we have a tennessee tonight. Joining us on the phone is senator lamar alexander, republican from tennessee, on the labor and health committee. Editor, thank you for being with us. Alexander steve, thank you for having me. Steve you wrote a piece for the Washington Post with the headline, we need more covid19 testing. You are proposing a shark tank to get there. Please elaborate. Need tensexander we of millions of screening kits, tests as simple as a pregnancy test that you get at the drugstore and administer yourself. August as we come up on and have 50 million kids wanting to go back to school, 20 million back to college, we are going back to work, we are going to need test a lot of people to build confidence to come out of the hole and go back to school and back to work. We dont have that test. Testing more than we have for almost any other kind of disease like this. Let me not say it that way. Let me compare it to hiv, where we do 3 million tests a year. We have already done three. 5 million for covid19, but need a simpler screening test. And a shark tank at the National Institutes of health, we will have two dozen earlystage concepts swimming around, put them in competition and try to get them into the market, producing liens of tests a day by august, a test like one you take ase a foam swab, photograph with your iphone, it would light up if it registered positive and it would send that information to essential health authorities. You might goitive, in and have a sophisticated test and see a doctor. Or if you are testing everybody in a nursing home, a school class, everybody in a factory once a month to build up confidence to go back to work, we are going to need tens of millions of these. And we dont have them. Steve you mentioned august. Would you feel comfortable attending the Republican National convention in charlotte, North Carolina . Alexander that is a good i dont even know if we will have a Republican National committee in charlotte, North Carolina. We will see. This depends on what happens each week. Dr. Fauci and dr. Birx telus every day, it depends on data. It is hard to predict. If we do what is recommended and stay away from each other, stay in our homes as long as we can, and have enough tests to identify the 4 or 6 of us that have this disease, we can quarantine them and the people they might have exposed. Then the rest of us dont have to be quarantined. We need the kit, the screening kits, lots of them, in order to have any chance of going to the Republican National convention or any other big event. Steve i know this is personal for you. How was your doctor . She contracted covid19 a month ago. Senator alexander she did, she had her husband both did, in westchester county, a hot spot in new york. But she is fine. They were sick and they are in their 40s and they are a couple of healthy 40 years old with three young kids 40yearolds with three young kids. They went through a rough couple of weeks. Now they are ok. She had a couple of tests, the first to see whether you had it at the second tee say whether you might have added and then developed antibodies that probably, almost certainly, create immunity for a time. And they are experimenting with donating blood from people like my doctor, who have antibodies, and using that as a treatment like my daughter, who have antibodies, and using that as a treatment for someone who is sick. Steve does she have a theory on how she contracted the coronavirus . Senator alexander she thinks she got from her husband. He thinks he got it taking an uber to a shop there in westchester county. They dont know for sure, but it was all over the place. They were being pretty careful, but apparently not careful enough. Dr. Birx says it is the most contagious virus she has ever dealt with. Steve how are you dealing with the new normal . You are used to being backandforth in washington and our home in knoxville, tennessee tonight. How are you and your wife dealing with this . Well, we arender getting to know each other really well. [laughter] we live at the edge of the great smoky mountains, at she built me an office to get my piano and computer and telephone out of the house them years ago, and it has come in pretty handy. I am in this building that was once a stable, looking out the window. I cant see anything because it is dark, but i can hear the whippoorwills. I spent most of my day on the phone talking with people and the owner of the local cannell, who applied for a paycheck protection loan because no one is traveling and no one is leaving pets with him. Next sixat will the months look like in terms of the senate. As chair of the health committee, and another multitrillion dollar bailout plan, will we see that . What is the sense with your colleagues . Enough, i suspect the other thing is busy or busier at home and we were in washington. Like everyone else, we dont know what the future will be. With this has turned everything upside down. We were going to take to the floor a bill to take care of the deferred maintenance in national parks, do the land Water Conservation fund. We have number of things, Lower Health Care costs, making it easier to go to college. I think we will go back and in may in the u. S. Senate. We need to look at this money we have spent to see if it is working or not. What is important, and the most week,ant 1 billion this not for the programs that help people but for the shark tank at the National Institutes of health to see if we can within a few weeks or by the end of the summer produce millions of tests a day so people can know whether they have the disease. We can isolate them, the people they contact, quarantine those people in the rest of us will feel more comfortable going back to work, school and to each. Steve how confident are you . Sen. Alexander we dont know. It could all fail. We are talking about earlystage concepts. They are not proven. They are new ideas, a new way of doing tests. If only one or two succeeds, that is all we need. The nationalng institutes of health, we have dr. Francis collins we forget group of very talented people. Dr. Fauci, dr. Birx on television, a number of others, dr. Fauci works for francis collins. He will be heading that up. Im a lot of confidence in him to identify these earlystage oneepts, see if we can find to produce enough of those. I think when that happens, people will begin to relax. Steve you are talking to the senate leadership, what will the senate floor look like . Your own Community Committee hearings . Sen. Alexander i suppose we could have a virtual hearing, but will be awkward. Those will spread out, and when we vote in the senate, you have to vote in person. They call your name, but you can spread that out over 30 or 40 minutes. I think whatever we do, we ought to stay away six feet away from each other. Even as we go back to work, and we hope we can is rapidly as it is safe, we will have to follow the hygiene and smart safety procedures while we identify the people who are sick. They will not be out of this until we have a treatment, and we will not be out of it until we have a vaccine. We have never gotten one in less than a year. Steve we wish the best to your daughter, your soninlaw, grandchildren and your wife. Thank you for spending time with us. Sen. Alexander we wish you the best. Steve senator lamar alexander, joining us from tennessee. The numbers, courtesy of johns Hopkins University, new , 2836. De infections in the u. S. , the majority. Deaths in the u. S. Tomorrow we are back with another primetime edition of the washington journal. Will be joined by new guests. A reminder all of our coverage is available on cspan. Org coronavirus. Thank you for joining us this wednesday edition of the washington journal. We are back tomorrow evening. [captions Copyright National cable satellite corp. 2020] [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] announcer 1 cspans washington journal live every day with news and policy issues that impact you. Thursday morning we look at the u. S. Response to the covid19 pandemic with the assistant professor of epidemiology at the yale school of Public Health. And the federal response to and the author on the impact in his district and legislation moving through congress. Be sure to watch washington journal live 7 00 eastern thursday morning. Join the discussion. Up next, todays white house reaping with President Trump briefing with President Trump. And legislation that will be voted on tomorrow to provide money for small business