Spending bill with alex bolton of the hill. Com and then your calls and questions for the Stanford University school of medicine dean will be joining us from california. Our phone lines are open. You can join in. You can join us on twitter or on facebook. Good thursday evening. Thanks for joining us for evening edition of the washington journal and will begin as we always do with the numbers from Johns Hopkins university now worldwide are the 530,000 cases 30,000 cases across the globe and nearly 24,000 deaths and the u. S. Surpassing china with 8507 confirmed cases of the coronavirus here the house and Senate Acting quickly on a massive spending bill att the best we joining us in studio is alex bolton. The Senate Passing 960 that bill and i and i think ive evn about total that large church i cant remember the last unanimous vote on such legislation such significance. So itemna is remarkable and ita surprising given all the partisan fighting that was going on over the weekend late into the night it got very acrimonious at times combo side republicans and democrats accusing each other of politicizing the crisis but in the end everyone voted for the bill even though some like senatorr Elizabeth Warren didnt like all parts of it should like what she called the corporate slush fund but she still voted for it and, of course, now to make people who tend to vote against these big spending bills, rand paul of kentucky and mike lee of utah were in quarantine. Question, what would theyve done . Its hard to vote against this bill with a country facing such a crisis of people are in dire economic straits as you alluded to with these shocking and put the numbers earlier today. The n dollars spending package, about 500 billion for Major Corporate liquidity, 367 billion dollars for Small Business loans, hospitals get 130 billion. Also 150 billion for state and local governments. Although, we have heard from mayors and governors that is not enough, especially for new york. Caps on average of about 1200 for those earning 75,000 or less, additional money for each child. 30 billion in emergency indication funding. 35 billion dollars in emergency transit funding. Employee retention will get a tax credit, money for the airline industry, 25 billion, 4 billion for cargo carriers, and 200 billion for domestic priority setting for assistance for Senior Citizens and childcare assistance. Finally, 17 billion for distressed companies. So based on all of that, alex bolton, tell us what will happen tomorrow morning on the house floor for those viewers watching live here on cspan . Vote is expected around 11 00. The house convenes around 9 00. The sergeant at arms has put out guidance to leaders if a vote is necessary. Nancy pelosi is hoping that this can be done by a voice vote, in other words, the chair calls nays. Nd nate, yays and one house member could object and force a roll call vote and that is a tricky thing, because a lot of members are in their home states and districts. It is tough for them to come back, especially if you are from new york. You are facing a 14day quarantine. The question is, if a vote is forced, what do members do to maintain safety . So leadership without precautions tonight, guidelines for what this vote will look like. They are asking every member to use Hand Sanitizer before they go to the chamber. They are asking them to vote in small groups of 30, alphabetically, one at a time, they are not allowed on the floor while the debate is going on if they are not speaking, they are asked to use the stairs and not the elevator, and some of these guys and gals are older and not in the greatest shape. They are hoping to avoid a vote, do a voice vote, and given this past in the senate, i am not sure a roll im not sure i will call vote is messy but there are conservatives who have problems with the amount of money being spent and then they want to put their objections on the record with the vote. Host which members are you keeping a close eye on tomorrow . Guest i would look at members of the Freedom Caucus who might have problems with just the sheer amount of money, 2 trillion. But again we dontt know for sure. The tea party type republicans in the senate might, rand paul have been quarantined because of coronavirus exposure. We dont know whats going to happen. I think its likely i would expect this is going to go by voice vote. That would make it easier. Even though theres still a lot of fighting capital were seeing even cogs people are coming together in this moment of crisis andin thats what we have such an overwhelming vote on this bill late b last night and why also its just incredible, 2 trillion to do was put together in just a couple of days. Thats amazing drama i want to read a statement from cspan because we are going to try to convey the messages of those members who may not be able to vote tomorrow or attend the debate. This is a cspan earlier today. And a first for the 41 year history for network cspan is bonded to a special request from House Majority leader steny hoyer, health help connect members with the public. With any members with many members not able to travel, cspans working with congressional leadership on both parties to dedicated airtime to help members briefed the statements explaining their h positions on the emergency legislation. The network is going to spreading the members stay visible air in block string prime time the week of march 30. Videos will be streamed on our website at cspan. Org and archived in cspans online video liberia creating a permanent historical record of the legislative positions on the time when the house was hampered from gathering in person. This is part of what were trying to do in my question when this is all over, do you think well have remote voting indo te house and the senate . Weve been hearing from lawmakers in both chambers about instituting that. Guest in the Senate Mitch Mcconnell the majority leader and institutionalist, he always describe himself as an thats a fair description, hes against remote voting. And so was white blood, chairman of theem rules committee. A think what they say is remote voting creates as many problems as assault. The problem is when people are scattered around the country and voting by the internet, its tougher to come to agreement on stuff. Thats what the concern is. Plus tougher for the leadership to persuadee them one way or another. Theres a lotou of managing that goes on when people are in person to with or not its tougher to manage them. Probably tough to get consensus. Chuck schumer said last night we should explore. Some of his members are concerned about getting sick. In the house nancy pelosi i think is more open to remote voting that in the senate. To wit, she thought about possibly, theres been discussions about proxy voting on friday if for whatever reason roll call votel is forced and there are negative democrats encounter past it because of peopleis staying in all distric. David overwhelming nature of the senate vote i dont think theres going to be any proxy voting tomorrow but put it this way, its been discussed with something thats an open question in the the senate ande will likely announce that in the senate. Of course announce its are biggr production to get a point in their voting given there are so manyer members. Host look for the sega statements next week primetime you on the cspan networks, way for us to work with members of cogs to share with you their views on this massive 2. 2 trillion stimulus steel. Bottom line, will this be wrapped up tomorrow . Guest yes, it will. You spoke to ourur house report. Whos been on this program before and he thinks the will be done by noon. Thats where the smart money is. Host following to online at kill. Com. We appreciate your time. This is a headline from the New York Times, the u. S. Now surpasses china with confirmed cases of coronavirus and reporting of New York Times includes the following. Scientists warning the u. S. Someday would be, that countries hardest hit by the coronavirus pandemic. That moment arrived today. In the United States more than 81,000 people are know to have been affected by the virus including more than 1000 deaths. More cases in china, italy or any other country. With 330 main residence, the u. S. Is the worlds third most popular station mania provides a vast pool of people who could potentially get covid19 which is the a disease caused by the virus. For our remaining hour of conversation, we appreciate you very much for being with us. Guest thank you. Its good to be a. Host let me begin with that headline, the u. S. Now surpassing china. Guest yes. Its a very sobering headline. I think were dealing with the reality now in our country. I think we are coming together. We all concerned particularly those of us in healthcare because we are here to provide outstanding care to the people by regions and the people of r country and we want to make sure we have the capacity to do that. Host what is the biggest jumps for Healthcare Professionals that you are saying and those are trying to train for this profession . Guest i think there areis many challenges. One challenge is that there still a lot of uncertainty surrounding this virus and . The disease, covid19. We know that the principal mode of transmission is droplet spread. That is, virus particles embedded in mucus that dan is transferred from one person to the next. S but how often that occurs, whether or not you can also occur from droplets on services, how infectious the virus is come with people who are infected with the virus, when theyre most likely to transmit it to others. Those are all uncertainties today. Those uncertainties make it difficult to plan, make it difficult to organize the type of treatment regimens that we would like to have. And it really underscores the importance of research to better understand the virus itself and how it is transmitted from one person to the next. Host one of the big issues of your concern is that testing u. S. And how we compare to the rest of the world. Let me put some figures on the screen and get your reaction. The covert test per million residents, and this is as of march 20, you can see the united emirates with 12,738,000,000. Italy at 3400. South korea at 6100 and the u. S. At 313 per million. Guest as has been noted in the press many times over the past three weeks, its been a slow start in the u. S. Giving testing on board and getting it available in communities to people in need to be tested. Im pleased that we are Stanford Medicine for one of the first institutions in the country to be approved by the fda when the fda announced its new criteria for approving diagnostic tests for the virus that causes covid19. We were approved, we submit our application almost meeting after fda announced those criteria and were approved and then began to test people in our community. We are currently testing over 1000 people a day. We have been really the repository for tests in the bay area, testing patients from the kaiser system, from other Healthcare Systems in the bay area. Now those other systems are bringing their tests online as well which is allowed us to expand our outpatient testing. We now have tense located on parking lots on the stanford campus where people can sign up, make an appointment. They didnt screen through a phone call or video visit. We use the cdc criteria for testing which does require that an that in order for a test to be done, a person has to have symptoms such as fever, cough, shortness of breath. But when a person has no symptoms and is screened by a healthcare professional theyre too, this is dry through testing or test where a person simply gets out of the car and then ten go on home and the test results are obtained and then they are called with the test results or those are sent out to a secure portal. Testing is important in terms of identifying people who have the infection early and then of course having those people self isolate in quarantine so they dont spread the virus to other people. Host as you know dr. Minor all of this put a a huge burden hospitals around the country. We learned earlier today as many as 150 doctors and nurses in boston now confirmed with the covid19 virus. You are quoted in this headline that hospitals are bracing not only for the pressure with personnel but equipment shortages as the number of cases surge. How do hospitals respond toes that . Guest i think preparation is actually important. And back to the surge in patients, we know that the most effective prevention we have for lowering the surge is to shelter in place or to limit exposure to public settings. California put that s into place fairly early on. Now we are seeing in new york and other places. And by reducing the contact that each of us have, the physical contact each of us have with other people, we lower the rate of infection, on the with the rate of transmission of infection. Thats important because it enables us in Healthcare Delivery systems to thenit keepp with the need that people have to receive healthcare. What were seeing in new york and what we have seen in italy and other places is that the rapid surge in the number of people needing healthcare because of infection with the sars virus can win the surge occurred and Healthcare Systems are challenged to provide the care and to provide the type of personal protective equipment that protectsvi Healthcare Providers from themselves being infected. Its also important to keep in mind that when we read data about the number of Healthcare Professionals whoe have the infection, its important to remember that many press come most of those have got their infections in the community. Personal protective equipment is effective at preventing the transmission of the virus am a patient or healthcare provider. And the cdc has issued very thoughtful guidelines for the use of that ppe. But we still have of course healthcare workers have lives outside of thee Healthcare Delivery system and many of them are acquiring thehe infection jt as others are from communitybased exposure. Host su dr. Minor story as from palo alto, california, for a site is, a surgeon of the stanford universe cooled medicine,rd position hes held since 2012. Before that he was a provost and Senior Vice President for Academic Affairs at Johns Hopkins university we want to bring in our callers and viewers and listeners including those on cspan radio. Sam is joining us from van nuys california. Youre on the air with dr. Minor. [laughing] thank you, dr. Minor. Thank you for taking my call. Im currently looking at the charge which is by Johns Hopkins and i see that the mortality rate of the u. S. In spite of having the highest incident rate is very low. And to define that places like china have about 3 and italy is kind of now, kind of almost approaching 10 . In spain is also high. So why do you think theres a difference also i do think that people should not be so concerned about the number of incidences that we here in the United States. Because i think we have a nice infrastructure of now testing the patient and a bright begetting people alone. What is your take on all this . Guest thank you. I think, first of all, we do provide outstanding healthcare in the United States for severe acute diseases like the complications of this disease. But we have to make sure that the Healthcare Delivery system doesnt become overwhelmed. Thats what were talking about before. If hospitals become, if icus become completely full, if there are no ventilators to be used or if the ventilator supply is very we wont be able to provide the type of highquality care that enables us to get most people through this infection. Its also important to remember as the caller pointed out that in many people, in fact, most people, this infection by the sars kobe to virus is analogous to our summer to the flu. But very importantly in in a st of patients the elderly immunocompromisedub but also in some younger people for reasons we dont understand, the infection can be quite severe. And thats a really has is worried andte making sure that e can keep up with the need and the demand posed by the spread of the epidemic around the United States. Host mark, new york your next, i wantt to ask to my questions if i may. I know theres a shortage of masks, but ive heard that, one, wearing one doesnt actually prevent you from getting the disease as much as it prevents of the people who have the disease from spreading it. And, two mac, ive also read and heard from andrew cuomo that if you are vulnerable, you should wear a mask and he cant find one, where a a bandanna. It seems to me you have to wash that event and every time you went outside. So my question is, what is the truth . If you feel like youre vulnerable should you at least where a bandanna . My second question is this. If you have an allergy to things like dust, for example, if im in a room is a dog or a type of bird or somebody sleeping the floor, my lungs a merely fill up and have to move brad asked the person not to sweep or Something Like that. Doesnt put me in that category known as vulnerable . Guest thank you. I think its about remember that the most important, with the most and data h on entrance of e most important way to reduce the transmission of the virus is social distancing. The issue surrounding to wear a mask or not wear a mask, those are going to require further study to really know definitively. The current cdc recommendations do not recommend routine wearing of masks are people can differ in some Delivery Systems have different recommendations. But the social distancing or physicaloc distancing is today e most effective prevention we have in preventing the spread of the infection from one person to the next. Host mike next . Guest regarding go ahead. Host please go ahead . Guest the second question regarding if you have allergies or sensitivity to does, doesnt render you more susceptible to infection with this virus . Probably just routine seasonal allergies i dont know data that suggests that increases the risk of infection with the virus. Certainly someone who is immunocompromised either because they have cancer or they have another disease that causes immunosuppression, people with those conditions would be at greater risk of contracting the virus trend what im curious youre in the classroom with these residents, these future doctors, what questions on asking you . Guest i think theres a lot of concern and anxiety today, relates back to what were talking about before, the uncertainty surrounding this disease in this infection. Anytime theres uncertainty, that leads to anxiety. Also, we have seen where cases really grow exponentially. Thats the way Infectious Diseases spread is through exponential growth. When we see and read about where thats occurreder in italy, nown new york, thats extraordinarily concerning to Healthcare Professionals. We all do what weex do because e want to provide outstanding care to patients. If our ability to do that is compromise because we have more patients patience take care for than the physical infrastructure of our hospitals and clinics can provide, then of course thats going to cause anxiety because thats going to prevent us from doing our very best work in providing that care. G host which goes back to the testing the caller mentioned Governor Andrew Cuomo of new york. He talked about that earlier today in albany. The capacity to test, test, because flatten occur. How do you thought the curve . There are only two ways. Density control, keep people away from each other, and casts. How do china do it . How to south korea do it . How did everybody do it . Density control and testing. If you dont have the capacity to test and you can only test people, for example, who are coming into your hospitals, then you dont have the ability to do it. But if you have the ability to do it, do it, because its way to flatten of the curve. If you dont have the capacity and the ability, then you dont do it. Host that from new york Governor Andrew Cuomo, one of the many we are bring in during the credit virus epidemic. Dr. Minor, your response. Guest i think hes correct the social distancing, physical distancing is certainly the method we can deploy and has been deployed in many different communities. California and new york. As we are able to test more and more people, then we will be able to diagnose infections earlier and then keep those people in an environment where there wont be transmitting the infection to others. The other important point about testing is theres a need to be able to diagnose the infection quickly when it occurs, and thats the need we been talking about. But theres another need that is becoming more and more prominent, and that is the need to identify people who have had the infection and to develop antibodies to the infection. We dont know that those antibodies are protective in terms of preventing people from being reinfected, but we do believe that that may confer some degree of resistance. As whether not its absolute that will have to be determined. Theres a lot of work going on now here at stanford and at private diagnostic companies, and other academicva medical centers, a lot of work done to develop validated antibody tests that can be used to determine if a person has built up an antibody response to the virus. If they have built up an antibody response to the virus, then we believe that the risk of becoming infected is much lower. Thats going to be important as we start to consider how we relax some of the social distancing requirements and bringst people back into work environments and other environments where theyre going to be exposed to the virus much more commonly. Host mike is next in santa cruz california. Thank you for waiting. [inaudible] dr. Minor, thank you very much for your time. The question, you enter part of it was, the manufacturing ramping up of virus tests. Are we days away, weeks away or months away from getting everybody tested . Or is it much longer than that . Just a quick side to it. I was born at stanford hospital like six years ago. Guest great, great. Its hard to predict exactly the goal of getting everyone tested. Thats a while away. But being ablete to test people quickly when they become symptomatically, and you know an important point remember about testing people when theyre symptomatic, in ourte experience as well as other places where testing has been rolled out, most people who are experiencing fever, cough, most of the symptoms are not do to this infection. They are not due to the sars cov2 virus. They are due to seasonal influenza or any of a number of other viruses that are still prevalent in our society today. But will out the testing i think is going to continue to occur. Not you ask us would like to see it occur, but i think the testing willqu become more and more available in communities around the country. I think its probably on the order i weeks and not days but probably also not months when the testing becomes more commonly available. Host from albany, new york, symphony. Youre a medical professional. What is your training . Guest im a registered nurse. I work with the development disable and come of a lot of pe are really compromise, and oftentimes they dont even make it through a flickered sometimes they dont survive the flu. My question is really about the incubation period mac. Were told toin quarantine 14 da, but oftentimes its after somebody finds out that they had an exposure. Maybe the fed up they had exposure to some in march who was positive, and many days have passed by. The Health Department notifies them assess you should self quarantine for another 14 days. So it makes you wonder like what is the incubation period really . Guest first, thank you for the care you provide to patients. Its because of you that were able to deliver outstanding healthcare in this country, and so on the up of all, thank you. The incubation period is thought to be up to 14 days. [inaudible] follow the federal response to the coronavirus outbreak cspan. Org coronavirus. Watch congress, white house briefings and updates from governors. Track the spread throughout the u. S. And the world with interactive maps watch ondemand anytime unfiltered at cspan. Org coronavirus. Questions about that or other stuff . [inaudible question] right now which is going to be people coming through the airport, through airports, flying in from out of state into the two airports are coming in on a train to south station from outofstate. There will be Message Boards and Information Available in rest areas associated with and on the turnpike in areas associated with folks coming south. Basically up from the new york area. [inaudible question] well, i would call it at this point instruction and advisory. There is no enforcement mechanism. [inaudible question] no. No. [inaudible question] well, first of all we obvious he shut down a lot of nonessential operations. And we believe the folks for working in massachusetts at this point in time are pretty clear on the guides that we set out there for the people who are part of the commonwealth. And obviously again its impossible to ensure that everybody complies with all this. If youre working in massachusetts that means youre doing something which is essential to getting attentive guidance and advice thats coming from us and probably from the people you work with inward