Host our first guest of the morning, dr. Robert bollinger. He is with Johns Hopkins a , professor of infectious disease. Good morning. Guest good morning. Host what is the best way to think about these reports we are seeing in upticks in cases across the u. S. . Guest i suppose anyone that has been listening to dr. Fauci dr. Birx and other experts across the country should not be surprised. What people have been saying is if you dont maintain social distancing and masking and handwashing recommendations, we should expect this uptick as people begin to socialize and have more contact with each other. This is a highly infectious disease. I guess, we should not be surprised. Host do you make a direct correlation with the reopening of states and the loosening of stayathome policies, or are there other factors to consider . Guest even in some places where there has been loosening, there have been recommendations that people physically distance. I prefer that term over socially distancing. And wear masks to protect others. There are certainly people out there that are not following through on that. If you look at some other societies around the world, south korea and some places in europe, when things were loosening up, people were actually following those recommendations more than any of us are. Host the current death toll when it comes to covid19 cases, put that in context with influenza and other viruses that have killed people. Guest at the current rate, we are seeing 25,000 to 30,000 deaths per month, which is approximately the number of influenza deaths we see every year, so that puts that into perspective. Host would you say that because of that rate, is there still the level of alarm if that is what it is being compared to as far as influenza deaths . Guest certainly those of us in Public Health are alarmed and continue to be. We will have to see how the public responds. If you talk to people in other parts of the world, italy, spain, and communities in new york and new jersey and now here in baltimore, we are alarmed by the incredible impact this has had. Host if you are a medical professional, such as our doctor, 202 7488002. If that is the rate of people covid19, chart out the rest of the year, what are your concerns . Guest we will continue to see spikes. We have an opportunity to flatten the subsequent spikes if we follow the recommendations of Public Health officials and continue to physically distance. Wear masks in public and handwashing. Im particularly concerned about the masking issue because i think there is a lot of confusion about why we should be Wearing Masks. There may be some preliminary information that suggests masks can protect ourselves, but the primary reason is to protect others. I think if people really understood that, recognizing that many of us, if we have the infection, we dont know we have it, we should wear a mask to cap them iris the virus in our mass. I think if we can understand that and begin to practice that more consistently, we could have an impact on mitigating some of this spike. Host is testing better today and is that giving us more accurate numbers . Guest testing is much better today than it was weeks ago. Early on, we were testing around 10,000 to 20,000 People Per Day in the United States. Now we are well over 250,000 per day and increasing. So yes, it is much better and that gives us much more information and allows us to track the epidemic more accurately. Host because he spoke about face masks, because you spoke about face masks what is your , impression when you have watched over the last few weeks of protests across the u. S. Taking place with the proximity of the people involved . Guest anytime you have a large gathering of people close together, particularly if they are not Wearing Masks, it is a concern. I have to be honest, i have been too busy this week to watch a lot of the television, but what i did see suggests people were close together, but i saw a lot of people Wearing Masks. I saw a lot more mask wearing in some of the shots of the protests than i did on the beaches of florida and the lakes of arkansas. And some other gatherings over the last month or so. We will have to wait and see. We will know in a couple weeks if there is a spike due to the protests. It takes a couple of weeks for the data to come in. Seeing upticksre now which are not related to protests, they are probably related to things that happened two weeks ago. It takes a week or so for people to develop symptoms. So the people we are diagnosing today were probably infected a week or two weeks ago. Host the first call for you comes from mark in fort lauderdale, florida. Mark, you are on with our guest, dr. Bollinger of Johns Hopkins university. Go ahead. Caller great. Good morning. Im the first caller on this segment. I just tuned in and was afraid i was going to be near the end. I did not want to example on anyone elses statements. Im a coronavirus survivor. It is a subject that is near to my heart. I go all over town. Im not going to let having had it stop me from doing anything. But im very careful. I wear a mask everywhere. It is amazing that the only place where people wear masks around here is when they go into stores where they are required to. You walk on the beach, along the beach, weeks to go before the beach was opened and they had us walking along the sidewalk, people stopped wearing the things. I think what has happened or what is happening is, to turn it into a political angle, the republicans and especially the president , they want to forget about covid19, coronavirus and , just go on with life like it does not exist. Meanwhile, here we are. Host tell us about your experience contracting the disease. What was it like for you . Caller i had it. I lived with it for a month. I got over it. Im a lucky person. But that is not what i called to talk about. The worry is, if it is allowed to continue, pretend it does not exist, it is just like the flu and it comes around and is here, you live with it and move on with life, that is so backwards. You have hundreds of thousands of people every few months dying from this. Host thank you. Go ahead. Guest im glad you covered and glad you are feeling better. I want to congratulate you for wearing the mask. You are doing it for the right reasons. You are doing it for the reason you should be wearing a mask, to protect others. I think there are a lot of people that dont understand that. I would like to believe the majority of us care about other people. That is the reason we should wear a mask. We care about others we dont , want to spread the virus from ourselves to other people. I think there is a lot of misunderstanding. People feel like they are wearing a mask to protect themselves. There may be some benefit but , the primary benefit is to protect other people. I think people care about others. If they understood that, perhaps we and Public Health need to do a better job explaining that. I think there is certainly going to be some people that do not care about others and do not wear a mask because they dont care about themselves or other people. What i think the majority of people just do not understand why we should be wearing a mask. We need to do a better job of communication. Thank you, mark. In texas, we will hear from kenneth, good morning. Caller good morning. Im a 62yearold africanamerican male. I have preexisting conditions. I have sickle cell anemia. I have a brain hemorrhage, i have had a blood clot, heart attack, and now i am on disability. I wear my mask and gloves, and so am i really at risk of getting covid because of preexisting conditions . Guest thank you for that question. Your risk of getting infection is similar to anybodys risk. The problem for someone like yourself with underlying conditions is you are at risk for getting much sicker if you get infected. I hope you understand that distinction. You want to do everything you can to protect yourself and people like yourself who are at higher risk of getting very ill. You should do a lot to protect yourself by sheltering in place and when you go out, where a mask yourself, but be careful going into any closed environment where others around you are not Wearing Masks. The reason we wear masks is to protect others. If you go into a store or church or closed building and there are other people in that environment close to you not Wearing Masks, they are putting you at risk. Unless you are wearing one of the n95 masks that i have to wear around patients, the regular masks are hopeful to some degree but not as protective as n95 masks. The primary thing i recommend for people like yourself, before you go into it in environment, look around and see if people are distancing themselves. If you dont see that, i think you should be careful about going into that kind of environment. Host lee from jacksonville, florida. Caller thank you for having me. I wanted to comment on the Global Health security act that passed on march 4. Representative Gerald Connolly made the statement that diseases do not respect borders. Host do you have a comment or question for our guest . Caller how vital do you think the Global Health security act will be in helping prevent the future spread of coronavirus . Guest thank you for that question. I have to admit i have been busy , this week at the hospital. I have not been tracking details like i normally would. This is a topic that is important to me. I have been working in Global Health for 40 years. I think anybody who has looked historically as well as at the Current Situation who understands how these viruses transmit knows that we have to have ways of protecting ourselves and protecting our neighbors because these viruses dont respect borders. This virus spread around the world. It was amazing. It spread around the world in a matter of weeks. None of us in Public Health were particularly surprised that there was a respiratory virus that could spread quickly. Some of us were surprised at just how quickly this thing spread. It spread into many countries. I think anything we can do to Work Together to fight off these pandemics and address them is important. Host we heard the president of the United States threatening to pull funding from the world health organization. If that were to take place, what is the impact . Guest im very concerned about the effort of not collaborating with the world health organization. We are increasing our own Health Security risk. Host from new castle, indiana, we go to tommy. Good morning. Caller i was wondering what the implications of the fact that this is a slippery virus that mutates easily and whether we will be seeing this on a yearly basis. Guest thank you. Like a lot of viruses, this virus is mutating, but it is not mutating as quickly or as drastically as other viruses. At least so far. We are very early into this process. If it continues to mutate, that has implications, for example, in our use of vaccines and convalescent plasma and other immune therapies. Thatcientists are tracking pretty carefully as we move forward. If the virus does not mutates enough to require a different vaccine every year like we see with influenza, we have new vaccines every year to track the strains circulating in the world, even if that does not happen, if the mutations are such that we can use the same vaccine, we may find ourselves requiring boosters every year. We are not exactly sure how long immunity will last. We are waiting to see what the vaccine trials tell us. They are just beginning. We will learn more about that over six to 12 months. Is that the timeframe you would tell people, if we are seeing trials now, it is still six to 12 months before we see something definite . Guest we will see results in six to 12 months, but we may not have a vaccine. The vaccines may not work. Are shootingay we a lot of pups at the goal. Dr. Fauci he likes to say we are shooting a lot of pucks at the goal. We do not have a guarantee that any of the current vaccines we are evaluating, and there are over 100 in the pipeline. There are eight to 10 in human clinical trials. We are moving quickly. There is no guarantee we are going to get a grand slam with this. We have to do the studies. It will take us six to 12 months to analyze the data from the larger vaccine trials, which are slated to start in july. Then we will know whether this vaccine is protective. What we want for a grand slam is that people who get vaccinated are protected from the infection itself and therefore will not get sick and spread it to others. It could be that the vaccine protects people from getting sick but not from getting infected. They may be protected themselves , but still able to transmit to other people. We dont know how effective these vaccines will be until we test them. Then the manufacturing and distribution is going to take months. We are talking about billions of people needing to be vaccinated, hundreds of millions of people in the United States. This is a huge logistical challenge. We are moving really fast. We are able to do this in the next 12 to 18 months, this will be a world record. The previous world record going from a concept to vaccine was the mom vaccine, that took the mumps vaccine, that took four years. This is certainly an accelerated process. Host do you foresee a vaccine that is done in one shot . Is it a two stage . What do you foresee . Guest among the 100 plus vaccine candidates being developed and in trial, there is a combination. Some of them require or recommend or evaluate two shots. Some are one shot. It depends on the vaccine. We dont know what will be successful. Host washington, d. C. , otis. Hello. Caller how are you doing . Thank you for that last comment. People are acting like a vaccine is a given. It is not. Until we have rapid, accurate, and widespread testing, that is the most important thing we can do. In terms of the face masks, i think it is giving people a false sense of security. The studies show that face masks really just redirect the air that is coming out of your mouth. What you need is a full on respirator. You need goggles as well, to guard your eyes. I think people need to be educated on that to fully protect yourself. It is not just a face mask. Guest thank you. You are absolutely correct. If your goal is to protect yourself, the best way to do it is with a respirator and face mask. Right now, that is primarily because we have had limited resources, we have been focused on people at highest risk, such as First Responders and people working in the hospital who are exposed to patients every day. What i think again, there is confusion about why we wear masks in public. Anybody who has put their mouth close to a mirror has seen the water vapor that condenses every time we breathe. If you have the virus in your system, and you dont have symptoms, and you do not know you are infected, and that happens to be an issue with this virus, you could go around, every time you breathe as that water vapor comes out of your respiratory tract, it spreads in the air six feet around you as an invisible cloud. When you wear a physical mask you are tracking that water , vapor in the mask so that the cloud around you is less intense and less likely to infect other people around you. Whenever you are out in public, and you are wearing a mask, you are reducing your vapor cloud, and that is protecting other people around you. Otis is correct, those physical barrier masks might reduce your risk to some degree, but if someone else is not wearing a mask around you and you are, the virus from their cloud can still get around that physical barrier mask and affect you. That is an important point. Host we have a couple of people texting questions. One is fun florida one is from florida. Are there statistics that the actual percentage of those tests are positive . Absolute numbers are important, but with higher testing rates, we get higher positive result. If the percentage of positive results decreases, wouldnt that give a better understanding . Guest the distinction is important. When we do more testing of any disease, you will find more cases. That is certainly true. What she is talking about is the percentage of those tests that are positive. If that percentage goes down, that means that the transmission rates may be declining as well. We do track that. A lot of states are using that percentage as one of the indicators to help track the trajectory of the pandemic. Host michelle in illinois asks, do those that minimize the virus as only killing the elderly, can you explain who the other 60 are . Guest this is a personal topic for me. I have been taking care of patients this week at Johns Hopkins. We have 36 year olds, 50yearolds, not the majority of our patients, but there are people younger without a lot of underlying conditions who are getting very sick. Some of them are dying. The risk is higher if you are older with underlying conditions. But we are seeing really serious disease in some young people. Also related, not just to the virus itself, but what some people may have heard about recently, what we call inflammatory syndrome. Some young people, when they get infected with this virus that is not unique to coronavirus, we have seen other viruses in young people where it can stimulate the immune system so much that the immune system and its affect attempt to fight off the virus can damage the body itself. That has caused some serious problems, particularly in some children. Some people may have heard about reports out of new york. We are seeing children like that in baltimore and elsewhere. This is not a virus that cares what age you are when it affects you. We are seeing serious illness in younger people as well. I dont think that is fully appreciated. Oxide youthd nitric as a covid19 treatment, the user seems promising, would you agree . Guest i dont know much about that. Im not an expert in that field. I will have to defer to others who are. Host from california, salinas, mike. You are on with our guest. Caller good morning. There were something remarkable for a time when we had dr. Fauci and dr. Birx speaking to us, and as a country, we all heard the same thing at the same time. It was remarkable. Unfortunately, that stopped. I dont think there is any doubt that the medical profession knows a lot more now than they did three months ago. Unfortunately, it is as if it is every person for themselves. I dont know what we can do about that. Opinion, is where we can get the best information as to what is happening today . I dont mean the number of cases, but just to understand this disease. Our children carriers . Are surfaces really transmitting the disease as we feared originally . That type of thing. I really miss that. I think it is unfortunate that we dont have that anymore. I would like your opinion. Guest ive known dr. Fauci for 30 years. I have known dr. Birx for a long time as well. I would have to say i dont know , too many people on the planet that know more about Infectious Diseases then both doctors. Dr. Fauci and dr. Birx. I think all of us should be listening to experts like that and what they say about this pandemic. But i think there are places to get information, and i think the cdc website has valuable and Accurate Information about environmental cleaning and things like that, so i think there are places you can get information out there. I agree, the more transparent and open we can be with our data and information, the better all of us can make decisions about what we need to do with this pandemic, whether you are in the public or in Public Health. Host kentucky, go ahead. Caller good morning. There is a large prostitution, homosexual gang in louisville, kentucky. My question is, does that produce some sort of virus that might cause or kill the virus, covid19 . Guest this covid virus came it originated in china, in a market. This is the seventh coronavirus we have had in human history. We have had four others that cause the common cold. This is the third serious pneumonia virus. All three of those originated outside of the United States in people who had contact with animals. In china, it was the markets. The mers virus, it was the middle east. A lot of the origination of these viruses probably began in bats and spread to other animals. People came into contact with these animals. Just like influenza, these things spread. We call it zoonosis, which means the virus has come from animals to humans. The more contact we have with animals, the more we will be infected. It has nothing to do with the issues that you just raised. Host dr. Bollinger will be with us for the next half hour. 202 7488000 for the eastern and central time zones. 202 7488001 for the mountain and pacific time zones. 202 7488002 four medical professionals. We have talked about the world health organization. The issue came up from the who regarding a sum the medication is. Tomatic cases. Symp it was a top official clarifying that scientists have not determined how people with asymptomatic cases spread the virus. Talk about the Science Behind where we are with asymptomatic cases. Guest we are learning something new about this virus every day. Looking at some of the outbreaks that have occurred around the world, particularly in some nursing facilities and other Office Facilities and other high transmission events, it appears that there are a number of people, and the estimates are anywhere from 10 to 40 of people who are asymptomatic but are spreading the virus before they develop symptoms. Between a distinction what the who was making between asymptomatic and presymptomatic. I think that confuses people to some degree. What it really means is there are some people who get infected and spread the virus and never develop symptoms and some people who get infected and dont develop symptoms for some time and they are transmitting during that asymptomatic period. Bottom line is there is transmission to this virus to others when people do not know they have symptoms. That is why all of us should be Wearing Masks in case we are one , of those people. We could have the virus and not know it and spread it to others. We should wear a mask and be and keep our distance because we do not want to spread the virus to other people. Particularly our Vulnerable People that we care about, our elderly relatives, neighbors, friends, people in the supermarket or church you might be at higher risk. We could be asymptomatic spreaders and not know it and that is why we should wear a mask and keep physical distancing from others. Host from sioux city, iowa, here is lois. Good morning. Caller good morning. My question is, if i read correctly some years ago, eventually it just became less dangerous as time went on. I wonder if this coronavirus has the possibility of eventually changing or mutating in that regard. Guest we talked earlier about the fact that the virus is mutating, but it is mutating relatively slowly. It certainly could happen, but i think it is unlikely that it will happen in time. We will see too many people get sick and die because i think it could take too long for that kind of mutation to occur if it were going to occur at all. I am not counting on that happening. Host what is the best way to think about the rate of spread of coronavirus as we get into warmer months . Will there be changes . Guest i have a lot of colleagues and friends in india who are seeing a huge increase in the last month in the rates in india. Relatively warm, into the monsoon season now. I dont see much indication it is slowing down. We are seeing outbreaks in brazil. The rates are going way up. It is warm there as well. I dont think we can count on that either. It is possible there may be some mitigating effect, but it may have more to do with us being outside and further apart from each other instead of cooped up in buildings during the warmer months that is responsible for reduced transmission. What im seeing in india and brazil is not giving me a lot of confidence that there is a huge impact on the spread of this virus from temperature. Host from buffalo, new york, ronald is up next. Caller the u. S. Has a hugely disproportionate infection rate. I know about contact tracing. Im wondering what efforts are being done about demographic tracing. To me, intuitively, knowing the precise associate not make precise socioeconomic backgrounds of people getting this disease and where they were when it occurred and that could create pockets of where these things occur and how and what communities. We have heard about the black community and the disproportionate level of infections. Why do you think that is . That is my question. Guest ronald, i think what we are seeing is a Health Disparity we have had for a long time reflected in the current covid epidemic. There are communities around the world and around the country that have always been disproportionately affected by Infectious Diseases and comorbidities and malnutrition issues and socioeconomic barriers. Any time you have communities that are disproportionately affected by these things, you should expect to see them at greater risk for diseases like covid. We see it all over the world and we see it in our own community. It has everything to do with the fact that, for example, not only are africanamerican and latinx communities at greater risk because of Underlying Health conditions, but they are people that are essential to our economy that have been forced to work despite the fact that this epidemic is spreading in conditions that put them at much greater risk. We, as a society, have always had those disparities. We have to address them. It has become clear again through this epidemic that we have a lot of work to do to address those disparities. Host new york, dale. Hi. Caller i just wanted to say thank you for your excellent comments today on cspan. I have watched you on other channels as well. My question today has to do with resource allocation. These tests are expensive, and some of the protective equipment is expensive as well. We have to be judicious. As far as testing goes, how often, who, and when . Guest thanks. The cost of the tests is declining. We have a lot more tests and different tests than we did months ago. That has helped. There are newer tests being developed all the time that are going to make it easier and cheaper to do more testing. Im in favor of testing anybody that needs a test whether they are symptomatic or not. Early in the pandemic, we did not have enough tests, so we limited them to the people that were sick so we can make a diagnosis for those coming into the hospital. Now that we have more testing available, we should have much more widespread testing. I think anybody that needs a test should be able to get a test. We are not there yet, but were making progress in that direction. Host what is the protocol you follow not only when it comes to testing, but when you actually interact with patients . Guest the patients i interact with are typically diagnosed in the emergency room or outside. If they need to be hospitalized, that we see them after that diagnosis. In the community and Emergency Rooms and other settings where the testing is being done routinely, they are using the pcr test, which is taking a swab of peoples nasal secretions or the back of their throat and sending that test for an assay. That will determine whether the virus is present or not, that is how it is done. We are getting pretty efficient about how we do that. I think the people that are doing the testing, the Health Workers doing the testing hopefully are protecting themselves with n95 masks and shields. They are at great risk. I think we are seeing a lot of benefit from scaling up that kind of access to testing. Host how often are you required to take tests . Guest i have not been tested yet. If i were to have a breach, if i were exposed unknowingly or unexpectedly, i would consider being tested at that time. At this point, i have not been tested. Host because you are at the forefront of what you do what is , your Comfort Level engaging in normal activities . Guest when i go out in public and see people not Wearing Masks around me, i see my risk as higher than when i am in the hospital. If you walk through the halls of hospitals, everybody is wearing a mask. Everybody is trying to social distance. We are well aware of what the consequences are of not doing that. When im out in public, i see a lot of people not doing that. So ironically, i think statistically, my risk might even higher in those settings. Host i dont need to be personal, but from your perspective, i would like to see what your personal practices are compared to what other people are doing at home. Guest because i work in the hospital, i want to reduce my risk, id wont i dont want to get infected and expose my patients. I have been careful. I have done curbside and Home Delivery and avoided as much as i can and have only gone out when absolutely essential. Host brooklyn, new york, karen. Hello. Caller good morning. I appreciate this opportunity. My question is about the care and maintenance of n95 masks for those people with underlying conditions and for the older population, the 40 that may not have the time to wait forever for vaccination and testing. The n95 masks are back on the market to buy if one budgets. Since we are not going out to eat anymore, we can buy some of these and also goggles. , i dont hear anything. Is there any reason why the Health People are not talking about the fact of risk versus safety and maybe the older people can get out of their houses and those with high Blood Pressure can if they are careful and do everything they are supposed to do . Guest that is a great point. I think the availability of n95 masks is increasing, and people at high risk, if they have them available, as long as they are not taking those resources away from others, i can tell you one of our sons is an emt in chicago, and they dont have n95 masks available for every run they go on. There is still a shortage of n95 masks for people of high risk. I would urge the public to recognize the need to put our First Responders in a position where they have supplies they need first. If older folks or people who are vulnerable have access to an and 95 mask and have to go out i , think that is a reasonable thing. Im more concerned about the people they come in contact with. As i mentioned earlier, if they can wear an n95 mask and be careful when they go out, that is great, but they should be looking around at what others are doing in that environment and make sure the other people they come into contact with our are protecting them by wearing a mask and keeping social distancing. Host iris from michigan. Good morning. Caller good morning, everybody. Caller i would like to know if it can be sexually transmitted , if guard is so would work. I think older people get healthier as they get older because we have built up our immune system. I would like to know if it is transmitted by air and if long nails could transmit it and furniture, mattresses on cruise ships. All of the sanitation products, doesnt it eventually wear you out as far as your immunization towards things . Is it blood transfer . Where did dr. Fauci get his playbook from echo host it is a long list, we will let the doctor take that on. Guest thank you for your questions. A nice, long list. I will remind people that this virus is a respiratory virus. It is transmitted through the air and through touch into our respiratory tracts. If the virus gets into her mouth and nose and throats, through breathing it in or touching our face after touching something with the virus on it. That is how we get infected. As far as we know, it is not a sexually transmitted disease. It is a respiratory disease. Host from michael, grand rapids, michigan. Caller thank you very much. At work, im on the disinfection and sanitation crew. I am 57 years old. With hospital gray disinfectants, we are doing common areas. Im doing all of the walls and stalls and toilets at work. Am i wasting my time and the sacrifice im making with these chemicals and potential exposure . Is this helping my fellow coworkers . Thank you very much. Guest thank you. Thank you for your service. You are on the front lines. Absolutely, you are doing a service for all of us. Thank you and thank you to all of your crew that are working hard to keep the environment safe. Host rod from michigan. We will take you live to a discussion on Civil Liberties during the covid19 pandemic. This is hosted by the federalist society. Live coverage is here on cspan. Detailedl more biographies as well more detailed biographies of the speakers. To moderate our panel on Civil Liberties and covid19, we have a fellow and montane president of aei and longer time