Talk with us this morning about the u. S. Response to covid19. Dr. Bauchner, good morning. Guest good morning, jesse. Host last time we had you on this show was back in april, when we were at the beginning of the covid pandemic. Six months later, where are we now in the fight against covid19 . What new have we learned . Think someesse, i progress and many remaining challenges lets quickly go over the progress. Clearly, we know what helps to blunts the spread of covid19, social distancing, masking, handwashing, and staying outdoors. In contrast, we know what contributes to spread, indoor activities and not masking. I think that is clearer now than it was in april. That concept has been enforced by the cdc, every state health department, every leading idea expert in the country. There is good evidence that it works. Arizona is a good example, after they put those Public Health measures in place a month later, the number of new cases and deaths dropped. Theres more information now about the treatment of seriously ill individuals and what works. A just published on tuesday the results of seven randomized Clinical Trials that use steroids as well as an analysis that combined all the data. I think it is clear that corticosteroids are seriously ill people with covid19s first therapy. Remdesivir, we have seen some success, but some trials have wn substantially less success. The studies around convalescent plasma, less serven. Clear,llenges are continued spread in the United States, the opening of schools has become hugely problematic around the country, same with universities. I do think theres been a misunderstanding about the number of deaths. This morning we are up to about 180,000 deaths that are attributable to covid19, but i think the real issue is whats the number of excess deaths. That could be closer to 250,000. Theres been two or three reports now that looked at the number of deaths over the preceding four or five, six years versus the number of deaths this year. You want to understand the number of excess deaths, about 50 more than the covid id related deaths. That would bring us to 250,000 or more excess deaths. Its possible by december of this year, we will approach between 400000 and 500,000 excess deaths related to covid. Host understand what you mean by excess deaths. These are deaths over what the normal number of deaths would have been in a calendar year. Is that what you mean . Explain to us what you mean by the excess deaths number. Guest exactly, jesse. You got it exactly right. The cdc puts out the number of people dying in the United States each year. Over the last five years, it has averaged a little over a Million Deaths a year. In 2019, 1 Million People died, and 2018 it was 950,000. You can get an average of have any people died over the preceding five years, then look at the deaths this year and it is 1. 5 million, it averaged one million in the last five years. The excess deaths this year would be 500,000. Some of those will be directly attributable to the virus. Others will be related to just the pandemic, people not coming in for early treatment of stroke or early treatment of heart attacks. I think the figure people really need to understand is not just relatedd id 19 deaths, but the number of excess deaths. If indeed it reaches 400,000 or 450,000, that would exceed the number of deaths for the vietnam war, the korean war, even world war ii. Host one of the things that has concerned me, i went to get my flu shot this year and had my children get the flu shot. I was talking with one of the nurses and she was talking about how the flu mutates every year to a new strain. Do we have any concern about the coronavirus, covid19, mutating into a new strain inside this country . Guest theres really generally good news about that. Na virus. N r there are minor mutations of the rna virus, but none of the experts feel any of these mutations will impact either treatment or impact the development of a vaccine. I think there is generally good news about this issue, so we do know theres different strains, but it is somewhat different so i thinknza, flu, people can generally be reassured about this issue. Host let me remind our viewers that they can take part in this conversation as well. We are going to open up regional lines for this conversation. That means if you are in the eastern or central time zones, your telephone number is going to be 202 7488000. If you are in the mountain and pacific time zones, your telephone number is going to be 202 7488001. If you are a medical professional, i am going to open up special lines for medical professionals this morning. I want you to take part in this conversation. Medical professionals, your number is going to be 202 7488002. Keep in mind, you can always text us at 202 7488003, and facebook at facebook. Com cspan. We are coming up on Labor Day Weekend this weekend. We have seen top u. S. Health officials warned that labor day is going to be essential for containing the coronavirus this fall. Do you agree . Guest i dont think it will just be labor day. I think it will be the coming months. I think the great concern for the fall is as it gets colder outside, people are more likely , andnt to come back inside that will be a struggle. Ofs clear that the spread disease is greater inside than is why, and that virtually every Public Health official has raised concerns about what the fall will bring. Obviously labor day kicks off the fall, so that is one of the issues people have raised. Or people get together with families and friends, hopefully that will be outside. It is the coming four months, september, october, november in the United States that is a much greater concern. Thats why i was pleased to hear that you have tried to get your children and yourself the flu vaccine. That is why this year, particularly, virtually every group is recommending the flu vaccine. We would like to see flu vaccination rates in the 70 , 80 , or 90 range. Host we have a question from a social media viewer already, and it relates to something we were talking about earlier, the excess deaths. The question is, what is the number of people who have actually died of coronavirus . People were having the virus, but they died of other causes. Cause of death is a far more complicated issue than people think. Or 68, and has7 a heart condition, and then gets coronavirus and they die, in general that will be attributable to coronavirus. Obviously they had underlying conditions. To date, most authorities believe that about 180,000 directlyve died because they got coronavirus infection. If they had not gotten coronavirus infection, they would still have underlying heart disease, but they would be alive. Host lets go to our phone lines and let our viewers take part in this conversation. We are going to start with bill, calling from virginia beach, virginia. Good morning. Caller hello. Quick question. I have often wondered, to what extent does the onus from the virus take place illness from the virus take place . There are college kids on the beaches in spring break and summers, people in demonstrations and close together in streets in our nation. Even though they are outside, they are still congregating relatively close together in some instances. I was wondering to me, it is just carelessness on the part of the general public. Do you have any comments about that . Thank you. Its a provocative question far more than you think. There is not a great deal of highquality information to answer your question. We have seen reports in the popular press, in the last few days, about spread on college campuses. I am assuming that spread occurred largely outside, since most colleges have been very, very careful about how they have allowed individuals to live within dormitories. We know for example, some of the spread in colleges has clearly occurred outside. That is in contrast, for example, to a wedding in maine in which many people believe most of the spread occurred because of inside activities. Theres been reports from korea where they had to close certain areas around bars, and there have been similar reports in the United States again, inside activity. We know outside activities are safer than inside activities, but i think many people are not masking outside and are certainly not practicing social distancing. That adds to spread outside. Host howard, you have worked at Boston University school of medicine, so you have been in those educational environments. Ande had universities open then be forced to closed. Locally, James Madison university, if im not mistaken, hatched to close back down. University of north carolina. These schools who tried to reopen had to turn around and close because of spread of coronavirus. Do you think that we can hold in person schooling in america this semesterthe entire with this coronavirus still going through the country . Well, ive watched the reports from different universities, and how other universities that have opened have responded. Its possible, i just dont think we have an answer to that question yet, jesse. For example, i have followed what some of the universities have done in boston. Of associate editor Infectious Diseases is chief Health Officer at the university of michigan. I think some of the universities that have opened the after those that have opened after those muchhave closed have stricter guidelines around students on campus. There is some optimism that that will be successful, but it is unclear if it will. More importantly, schools need to develop a response to when there is a case, how much tracking, tracing and quarantining can they do with students . That is not a question we can yet answer. That is in contrast to schools 8, becoming increasingly complicated. The life of mayors has been increasingly difficult over the last 4, 5 months as they have tried to negotiate a way to open in person rather than in person rather than distant learning. The decisions will be far more local. If you are in a small town in the midwest where there is no disease, i think those schools likely can reopen. Again, they will have to monitor the amount of disease that occurs within the school or potentially within a local community. I think it will be far more difficult in large urban areas, where there are many, many more children. I think the answer for colleges and schools is somewhat different. Host lets go to mike, calling from iowa. Good morning. Caller how are you doing today . Host just fine, go ahead. Caller this is my take on the virus, ok . I have had the virus and it aint no big deal. It is not as big a deal as people are raising. My son rode in a car with me and my wife seven hours, we did not know we had the virus at that point. He rode in the car with us for seven hours, ok, and he didnt get it. He did not get the virus. Let these kids go back to school. Let them catch the virus. Because if you catch it, you get immunity, ok . If you get immunity, that is the way you wipe the damn thing out. Lets confront this virus and had this thing on the right head this thing on the right way. Host go ahead and respond, howard. Guest mike, you raise a number of interesting issues in your comments. First, you are correct. Many people do quite well in the sense that they recover or have mild disease. Theres been well over 5 million cases in the United States, 200,000 deaths, but hundreds of thousands of individuals have had to be hospitalized. You were fortunate in interacting with people that either had mild illness, no illness, or did not need to be hospitalized. But that is not true for everyone. We know who the highrisk groups are. The other issue that you were commenting on was the concept of whether or not, by just allowing people to be infected, could the United States develop something called herd immunity . Theres about 300 25 Million People in the United States. It is somewhat debatable how many people we would need so that other people wouldnt get infected, so called herd about 60 ,ut it is 70 , we need almost 200 Million People to get infected. Sweden has tried that approach and their mortality rates were quite high. Someone once commented to me on a show that i was doing through a, that when we talk about children or young adults, we think far more about the number of cases of serious illness, so if one College Student dies because theyve gotten coronavirus, is that one too many . Friendsparents or the of that individual, absolutely. And so that is the calculus that we have to think about. You certainly are putting College Students at risk when they go back to campus. Its true, the majority will recover, but it is quite possible that some will not, and some may need to be hospitalized. To read you, i want a quote about testing for coronavirus in the United States, and i want you to respond to it. Its great to talk about this utopian kind of idea where everybody has a test every day and we can do that. I dont live in a utopian world. I live in the real world, and the real world had no tests for this new disease when this first started. There is no stone unturned, there is no technology we are not looking at or investing in if its promising. We can turn to society return to Society Without everyone having a test every single day. We can do that. We are showing we can do that. Testing in america can we test every day . Is it realistic for everyone to get a test . Guest it is not realistic nor appropriate that Everyone Needs to be tested every day. The admirals statement is somewhat misleading. It is quite clear that it took us months to get to adequate testing for Health Care Facilities and for highrisk individuals. What do i mean by that . So medicalmonths, centers or hospitals or Nursing Homes could test those who hadals to know disease and who did not have disease. It has clearly gotten better, both for hospitals and for other highrisk areas. Testing on demand isnt at the moment available it probably isnt necessary, but its quite clear and virtually all individuals agree that the u. S. Did a poor job in rolling out a sufficient amount of testing to protect the population, and this is in contrast to other countries that have simply done a better job. We know its possible. He is right in saying that every individual does not need to be tested every day, but i think it is somewhat misleading to suggest that the u. S. Has had adequate testing. Host lets move from talking about testing to talking about a possible vaccine. Do you think the u. S. Will have an effective vaccine by the end of this year . Guest this is without doubt one of the more complicated and controversial areas. Ongoingthat many, many trials are enrolling patients in the United States and around the world. They are accumulating evidence as you and i are talking today. These are so called phase three trials. Five or six have been supported by the u. S. Government, but there are many others ongoing in the United States. It is quite clear that they will begin to report out data or accumulate data, as they have already, but certainly by october. That will probably not provide a sufficient enough time to know whether or not the vaccine was effective, but there will be scientific oversight committees who will help the companies who are developing the vaccines to make those decisions. At some point, that data will be presented to the food and drug administration, who will have to make a decision about whether they approve or do not approve a vaccine. There has certainly been a substantial amount of concern raised in the last couple weeks, couple months that the fda may ae a mechanism to approve vaccine called emergency use authorization. Thats currently under much discussion and debate within the scientific community. I do think there are safeguards that the fda could employ that would allow the public to be reassured about a potential eua for a vaccine. Host another question for you window vaccine when a vaccine is eventually produced, what do you expect to be the rate of americans who actually take it . There was a gallop poll gallup poll that came out recently, from july 20 to august 2, where 65 of people said they would take an fda approved vaccine, but 35 , more than a full third of people in that poll, said they would not take an fda approved vaccine. What is the concern about whether people will actually take a vaccine or not, and or not once it is produced . Guest people have