To make matters worse they didnt provide clarity in terms of what the authority is or is not and thats what unfortunately now we will have to rely a lot on Public Health officials in order to be able to stand up and combat a Global Pandemic on a local level. We are going to be moving forward with rulemaking. Dhs submitted a statement to so today but the court did a great disservice to the state by not providing clarity and somewhat that rule can accomplish. Thank you, emily. Now to jeremy from milwaukee. With confusion around the various regulations, will dhs be doing other than with regard to tracking . Will they be any guidance and what should be included in that . Obviously we start engaging conversations with our local Public Health partners last evening, as folks have looked to us for guidance and help in thinking through those, what they might want to do at the local level and will continue have those conversations as additional local jurisdictions make plans and decisions about what they need and want to do. If folks would find it helpful, we would certainly be open to making sure that there is a source of information that tracks that kind of, the kind of information you are asking about. We have not gotten that far in our conversations yet. Thank you, jeremy. Now to morgan from nbc 15 in madison. Thank you for taking our questions. Theres a lot of talk about support. We no longer have the safe random order in place. In high school, college and professional teams Start Playing again if there organizations chose to . Would you encourage wisconsinites to stay home and not attend sporting events once did he began if were still dealing with the coronavirus . Went to first figure out whether those events are going to happen before we make a comment about who is going to attend those events. At this point in time i know the School Districts and university in ncaa, all those organizations that control those decisions are in the process of discussing them and coming to some conclusion. Its premature for us to say we do want people to go to a Football Game when we dont know if Football Game is going to happen. Thank you. Now to stephanie from west politics. Good afternoon. Thank you for having this call. My question is for governor ivars. Will you still issue your full stay before emergency will today and promise last night . What will that proposal look like . We have released it. I have to make sure everybody understands what a scope statement is. Its a long detailed or long document that meet some legislative needs around the potential roles. Its an overall statement and its available now and you should be look at it. I certainly dont have it memorized. What more important is that scope statement will be published, its available now. It will be published monday and theres a ten day waiting time before we can even talk about and put together a rule. Thats what we discussed, in the process of it with the legislative leaders and what that scopes statement might mean. Its one thing i didnt memorize coming in. One thing i would like to say, and this is offtopic, so im not i dont want people to say, where did this come from . Because its my understanding that senator tiffany just released a statement saying that hes calling for andrea palm to resign because she mishandled the wuhan virus and is killing wisconsin. Senator, please, you just won an election. Just relax. This is an insane statement. We talk about trying to tone down the rhetoric and ive been in the icann today to do that, to make a Statement Like that about someone whos dedicated her life to saving lives, please, sir, give us a break. Your hair to washington, d. C. I know youre better than this. Thank you, stephanie. Dr. Victor from milwaukee. Good afternoon. Governor, you beat me to the punch. I could ask about tiffany. But going on the negotiations with the public in leadership and majority of the legislature, i wanted to get your reaction if you believe that based on your discussions thus far if you believe they are being done in good faith and do you think they are being productive moving parts . Yes, yes. Made it very clear that having multiple jurisdictions operating in this environment is a good thing. I made it very clear that theres no interest in this and a gradual reopening of the economy. That was asked of me and that was our plan and thats what we were doing as recently as may 1. All those things are clear and not saying that in a derogatory way. Im just saying that we have a disagreement there. Do i think we will have, will be able to put together, we put together scopes Statement Today that we released and will continue to have it discussion about what is going to be in that opportunity to have some things for the legislature to look at. Thank you, victor. Good afternoon. This question is for the secretary or the doctor. You talked about how the work you need to do testing and Contact Tracing remained the same, but the conditions under which you doing that work has massively changed overnight the end of the safe at home order. Im wondering specific ways, if any, your strategies with regard to testing or Contact Tracing have shifted or will ship in the coming weeks . I appreciate the question. I think fundamentally, things havent changed. This is a pandemic that we have been working to get an infrastructure up and running to deal with. Wisconsinites have been unbelievable partners in helping us do that. Its really important now more than ever that they continue to help us do that, whether there is an order or not. And we obviously will be tracking and looking at our data on a daily basis as closely as we have been so we can spot potential outbreaks, so that we can understand where things might be headed in a world where there might be less physical distancing that under safe ride home, but the work, the fundamental work that were doing and we continue to do with our partners across the state is only more urgent and will continue to do that work so we can protect the people of the state moving forward. I think with the data, i i agree, our strategy is exactly the same. We have pretty clear goals on what we need the to build the system to do. The system is a collaboration between our Public Health system, state and locals, at our Healthcare System which is a a huge partner in this. The goal is for everyone to a sentence of covid19 which are very broad, into respiratory infection, could be covid19. Is that anyone who has the symptoms gets tested. Right now were at a small fraction of that. The other one is everyone who was diagnosed as positive gets very prompt engagement with a Contact Tracing them to be to understand where the event and who theyve been exposed to. Thats been our goal for the last two months. That still our goal. Were working at it like the secretary said as arduous we possibly can to build the capacity to do that with a high level of effectiveness and comprehensive does. Were making progress but were not there yet. Thats the biggest concern about the risk in the coming weeks. We dont have the system we need yet to be able to prevent small local outbreaks to becoming larger outbreaks. Thats why we need a partnership with residents to work with us and to keep themselves safe to participate in these processes, to support our local institutions to make sure that we have close eye on where these outbreaks are, and we can continue quickly and prevent them from spreading. Thats better strategy the whole time and just need to do it bigger and stronger and faster and were not giving up on that. Thank you, will. Now to rihanna riley. Okay, were going to move on then to ben meyer. Good afternoon. Is your administration actively encouraging county Health Departments to put in the own safe at home orders or extensions . In other words, is the next best thing to not having a statewide order, having as many times as possible have orders . This is brian. We received a number of a question Public Health officers for guidance on this, and so we provided information including examples of what they can look at. But this will be a local decision. Its going to be dependent on local Public Health officers known whats happening in their communities, seeing whats happening around this date we already have 400 wisconsinites passed away, looking at over 10,000 10,000 people having tested positive. They will have to look up with the impact is in their communities and make a decision accordingly. Its not something the state is mandating, not something the state is requiring but its something were seeing a number of communities around the state proactively reaching out asking for information taking action due to the very significant and very deadly risk that covid19 presents the people in their communities, special after the courts reckless decision yesterday. Thank you. Now to casey nelson in green bay. Thanks again for taking the call. Republican leaders were telling us they tried to develop a plan with the governor when he told them to wait for a while. Knowing that the court could overturn the ruling, why was there no backup plan in place . Whos really kind of at blame for Something Like that, not having that backup plan . We had a plan. They didnt. Thats the answer. The idea that a wanted to wait for the Supreme Court, its just not an accurate statement. When we bet met it was clear te that senator fitzgerald absolutely did want to wait. And so i said, well, i guess well wait. But we worked without a plan. We had a plan. We had a plan that is worth, was working. The Supreme Court decided to throw that plant out on very shaky ground, and the republicans now owned that. I dont know what else to say. We had a plan, they didnt. The court didnt agree with our plan on shaky grounds. Its as simple as that. I hope if the next question im asked about this i give you the exacting ansa, but its getting repetitive. Thank you, casey. Now to eric from wisconsin examiner. Eric . Thank you for taking my question. I want to go back to your response, the announcement from, on tiffany. Are you concerned that both this date and in other states the main rhetoric has gotten ramped up . In the Michigan Legislature canceled their meeting today because of concerns there. Are you concerned with the way the rhetoric has gotten ramped up around wisconsin as well as elsewhere around these issues . And its reflected in the Supreme Court ruling language as majority as well . Yes, im very concerned about that. Its against my dna to respond in kind. Occasionally i have to do that in order to make a point. But what does concern me about that level of rhetoric is that we tend to forget about the extraordinary work that is being done in the state of wisconsin, and, frankly, our country, to rid us of this virus. Obviously a vaccine as a long way off but we have thousands of people in our state that our frontline workers that are doing just a hell of a job, and they deserve a better than what they are receiving, that comes from the rhetoric. We have made significant gains, significant gains in meeting some very specific and high standards of metrics. Instead of celebrating that we get this kind of stuff from a a state senator who is headed to washington, d. C. We are better than this. We are better than this. I know we are and thats why Going Forward we understand we lost this, we lost another i think incorrect decisionmaking, but that said we are moving forward as a state. Were going to spend our time as a state making sure that people who are doing that hard work get the equipment they need. We will continue to do testing. We will continue to do Contact Tracing, all the things that will help us. The rhetoric aside, we are going to be focused as a laser on the spacious. Thank you, eric. Not to dan malloy from Spectrum News one. Dan . Spectrum news . Okay. We will move on then to melissa from news three in madison. Melissa . Melissa cam . Okay, moving on then to dylan brogan. Thank you. Doctor westergaard, do you think there is any distance between voluntary guidelines and mandatory Public Health orders . With a situation where dane county is under safe at home still but stark county has voluntary guidelines, and is there, can mandatory guidelines work, to . What is your opinion about that . Well, i guess my opinion or my experience comes from taking care of patients, and i think many situations what had to give advice to a patient about treatment or a vaccine that they disagreed with. I never once told them you going to go to jail if you dont do this. In fact, all of those hard conversations start the same way, which is come as your doctor i care about you as a person. Whether you take my advice or not im going to care about you as a dv the best advice i i c. Your ultimate in charge and my job is to give advice, give information that empowers you to help keep yourself safe. So i translate that same philosophy i think the Public Health which is to say we in Public Health care about our neighbors and our communities. We want them to be safe. Its our role to empower them and help to make the best decisions. I dont think the threat of punishment makes people making their decisions than the ones they do with the trust people giving good advice. I i think i have every faith tht regulations or advice if theyre coming from a place of concern of the well being, from Public Health agency, that is trusted, my hope would be every much the fact and that our hope is that we are seeing people who care about our community and giving the best information so people can make the best decisions. Thank you. Now to jonah in madison. This is shelley filling in for jonah. I know we talked a lot about the Supreme Court decision by want to turn to the nursing home daa that was released yesterday. Im wondering if you can explain all the more about what active investigations look like . Investigation itself . Yes. So this is, investigation is the term we use for when we have suspected or positive case, and it is that Contact Tracing. It is that offering of assets and resources. In this case to a longterm facility to wrap around, like we use them as a priority for us. I could include testing of all residents and staff, making sure that there the Staffing Resources they need to protect answer all the residents who live there, making sure they have adequate isolation capacity within the facility or otherwise, making sure that were getting good Technical Assistance on Infection Control. That is longterm cares best defense, is good Infection Control on the front end to prevent outbreaks. We are doing lots of work as longterm care is doing everything they can an individual abilities to prevent outbreaks and positive cases. This term investigation really is that Public Health work that is triggered my positive case or the suspicion of the positive case that gives us the signal that we need to focus on that facility in partnership with the leadership there and local Public Health to do what is necessary to stop the spread in that facility. Thank you. Now to rachel from milwaukee. Rachel . Hello. You are now advocating stayed the course after safer at home has been deemed unenforceable. What how long should stay the course . This fall if we get a large spike as some experts forecast weather be a plan to quickly through a through a lid back on the state . Of course. We believe that even in this new environment that we inherited yesterday that people stay at home as often as possible and not traveling a lot, you know, mitigating, hoping mitigate this virus is always been a voluntary thing. Obviously we didnt have secret police out there corralling people when they left their homes. We hope they continue to do that. Its proven to work. We save lives and in the people will continue to stay at home. They may leave more often than before because there are more opportunities to interact. We believe we can keep people safe at home. If theres a surge, thats why were doing what were doing. Thats what this is all about is saving lives and all the massive testing were doing along with Contact Tracing where doing and having proper equipment will help us if and when a surge happens this fall. Thank you, rachel. Now to emily from milwaukee public radio. Emily . My question is for secretary palm. Now that more businesses like restaurants, bars and salons are reopening, how are you anticipating that will impact Contact Tracing . If there is an outbreak thats connected to one of those businesses, will that information be released to the public . I would say first off we would encourage folks to stay safer at home. We have not met our criteria. Were not at six green and it is not, would not be safe practice for bars, restaurants and salons open. Having said that, if businesses choose to do that, wdc has offered a number of guidelines in consultation with experts in Public Health at the department of health services, and it is why it is critical for our Contact Tracing assets to grow to that thousand target number that we articulated. Because we certainly want every time there is a positive case to be able to quickly to a Contact Tracing interview and then pivot to all of the close context of that positive case so we can do what we need to do to stop the spread of this disease. Wisconsinites continuing to pitch in and minimize the risk to themselves and to the friends and family by staying safer at home is a critical part of allowing the Contact Tracing assets, the Hospital Capacity that we have not to be overwhelmed by surge in positive cases. It is why badger bounced back in vision a phased reopening so that you could increase the social and physical interaction of people and then be able to watch the data and make sure that it was at a safe level and that we could continue to do the work we needed to do and protect the Health Care System and then turn it a little more and turn it a little more. That was the point of badger bounced back and the phasing and it will be the work we continue to do. It will be be what we continue directed from a Public Health perspective while continue to ramp our testing and Contact Tracing capacity here in wisconsin. Now to Janel Richardson nbc nightly news. Janel from nbc nightly news. Can you talk about the covid test rate in any plan to get the word out to residents . Yes. So we here in wisconsin, one of our significant Success Stories is our Testing Capacity and we had some amazing partners in the private sector and across the state in our clinical labs, and have daily Testing Capacity that fluctuates between 13, and 14,000 test a day which does exceed our goal of 85,000 tests a week. We have as you suggest been executing or actually doing fewer tests than we have the capacity to do on a daily basis. We have over the last number of weeks expanded our criteria for testing and are encouraging anyone who needs a test to get a test, even with the mildest of symptoms. With increased our messaging around the broadening of symptoms that the cdc recently released so that people have a better understanding of the kind of symptoms that you might want to be on that lookout for an order, order to get a test. We also have dramatically increased our target testing as relates to outbreaks. We are focused on our partners in longterm care and making sure that all residents and staff have access to tests over the next month, and a partnership with the National Guard continues to expand so the with Community Testing in a variety of communities all around this state so that we can continue to drive our daily testing numbers closer and closer to our daily target of 12,000 tests a day. Thank you. Now to build from the chicago tribune. Bill. Yes, thank you. Governor, as you know the case levels in northeast illinois at the chicago region have been much higher than in wisconsin. A lot of businesses in lake geneva opening up today drawing a lot of chicagoans. How concerned are you about those folks and this influx across the state line . Secondly, whats your reaction to President Trumps tweet today lauding the Court Decision and applauding have state has been bustling in the last 12 hours or so . Just a quick comment on the tweet. We were following his lead on this. So apparently he doesnt think much of the criteria and the metrics that he set out several months ago because thats exactly the metrics that we are using in order to reopen the state of wisconsin. So apparently he has abandoned that also. The comment about people moving in, coming in from illinois. This has been an issue from the getgo. Ive heard comments from people up north that have concerns that people coming up to the second homes and what sort of impact thats laying on them as far as supporting additional people in their counties. Its going to be a big deal. We will have people coming from minnesota and michigan and illinois to wisconsin because we have opened haphazardly and without much thought, and that is going to be a problem for us because all of the surrounding states have a higher caseload or higher percentage per capita of covid19. It will bring an increase for us. Thank you, bill. Now to molly back from the milwaukee journal sentinel. Molly. Thanks. In yesterdays decision the majority wrote you have to be able to address emergencies like forest fires. Im wondering how you are interpreting that. What constitutes a forest fire Health Emergency under the courts ruling, in your view . And at that point could you issue a new order outside of the rulemaking process . This is ryan nelson. Ill address that. As i mentioned earlier one of the things that is still problematic about the majority decision is that despite the decision overall being 161 pages, we saw from seven justices i believe there were seven different decisions or opinions. The chief justices concurred with her own majority opinion, and the majority opinion itself provides a complete lack of clarity in terms of how the state can respond Going Forward. So while the governor still has the ability to declare a state of emergency wenders a wildfire or or other things like that, the most problematic thing besides their reckless decision to take down safer at home when theres no plan be offered by legislative republicans, when they havent offered their plan despite think they have one for weeks, the big problem with that is the court didnt provide any clarity or guidance on how to move forward. Whether its dealing with a Global Pandemic or youre dealing with a forest fire, sitting down issuing a scope statement on a thursday and then having to wait until next monday for it to be published and administrative code register and then waiting ten days before you can put pen to paper and then having spent however many days to draft and then getting publd in the wisconsin digital, i hope to get one would agree that is sufficient or good process in order to address any type of emergency thats why every state in this country has lost so much what dhs brick fest for the legislature originally enacted these laws and if the governor says despite claiming to be applying the law as written, the majority decision frankly, they had to do some creative editing to the statute to get to the result they wanted. Yet despite being created in that since they didnt provide any guidance on how we could move forward. I think thats whats most problematic with this decision and thats why as the governor and secretary paul indicated, will continue focusing on Contact Tracing and testing in providing guidance for folks on how to best act, but with the lack of that clarity is very problematic. Thank you. Our final question does to tim from Wisconsin Health news. Thanks for the questions. Several county leaders have said the past 24 hours that they are looking at guidelines to decide how to help their businesses reopen. As ryan mentioned today many have reset to the administration for further guidance. It sounds like an official statewide plan is that happen anytime soon. Is the administration considering issuing any additional statewide guidance to help these counties coordinate their response to the . We will work with all the counties that ask our advice, and the wedc has done a Great Service in providing those recommendations were gearing up for businesses that are now suddenly opening. We feel that we will continue to do that, but our main goal is to make sure that our Public Health system continues to be strong and do the job that, the great job, continued to integrate job that theyre doing around testing making sure that we have the proper equipment and Contact Tracing. Cspan has unfiltered coverage of the federal response to the coronavirus pandemic. With White House Briefings, updates from governors in congress, and our daily callin Program Washington journal, hearing your thoughts about the Coronavirus Crisis and if you missed any of our live coverage watch anytime ondemand at cspan. Org coronavirus. Today at 11 30 eastern House Minority leader Kevin Mccarthy would hold a News Conference as housework on a 3 trillion economic aid bill. Watch the News Conference live at 11 30 eastern here on cspan2. Today beginning at about noon eastern President Trump will give an update on the development of a Coronavirus Vaccine. You can see live coverage of his News Conference on the white house starting at noon eastern here on cspan2. Earlier today White House Press secretary came the mechanism hold a briefing as a house debates and votes on a threeton dollars economic aid bill in response to the coronavirus pandemic picky to see live coverage of the White House Briefing starting at 2 p. M. Eastern here on cspan2. Joining us is dr. David kimberly, universality am a Birmingham School of medicine, division of pediatric Infectious Diseases codirector, also the infectiousas disease physician f childrens of alabama. Thank you for joining us this morning. Guest thank you for the opportunity to be here. Host weve heard from many a week about the coronavirus how it impacts adults, young adults and the like. What are the concerns of the public should have about children at the time . Guest we continue to learn a lot day by day, week by week in terms with this virus does. One of the consistent things weve been seeing from the very beginning from china and into europe and into the United States is children generally are less affected by itt if you look at reports from china, but the reports from the United States, about 1 of all people who are diagnosed with the virus with infection with the virus are between one and ten years of age, 1 , 11 19 years of age. The 2 total the pediatric age group. Generally speaking, they have a milder course. Some children can have severe disease, some children die from this but generally speaking for reasons we dont fully understand at all, children seem to have less severe, less complicated, less dire outcome from this infection compared with adults. Thats unusual. A lot of times respiratory infections hit children horta. This one does that. Host we saw yesterday coming from the cdc itself a new warning particularly aimed at children. Can you walk us through that . Guest yes. Theres a newly recognized condition, its not completely clear that its all one condition. In other words, that when Case Definition is applying tods all children with it. At first was recognized in europe at thehe very end of aprl i think april 27 actually was the first time these cases were being brought to public attention and medical attention. Its very, very rare. It appears to be an inflammatory, a hyper inflammatory response where children have informationin on multiple organs and the body and they come in in shock essentially. These are very ill children the indepth and intensive care unit of the local hospitals. Whether or not its late to the covid pandemicin were not is not typically. Temporally it is. Children with these presentation of being noticed three or four weeks after the sars coronavirus to first enters into a community or a population. That doesnt mean its positive in other words, the sars cov2 virus is causing this disease with this condition children but it is suggestive and so people in new york, people around this country, people in europe and england, the centers for Disease Control and prevention are all on heightened alert for this to better understand it pretty remarkable how much we know already just a literally two and half weeks. That said we have a lot more to learn. Host when the cdc puts out an alert likele that what is referred to go professionals like yourself . Guest with the cdc released yesterday was called a health alert notice, and these alerts are meant too raise awareness and meant to bring this to the attention of doctors on frontline as well as doctors more academic standards, some specials the with the consult on patients that are very theically ill come into hospital. The intent is to raise awareness and create a possibility, create a mechanism by which when the patient has this or possibly has it, they can be reported to the local and state and National Health authorities so a database can best built again have as muh information as rapidly as possible and help us better understand what it is were dealing with. One of the things i want to emphasize is based upon what we know now and this is assuming these cases that are being reported are all the same, that theres apples and apples as compared apples and oranges, for example. Even with that in mind this is very rare. Parents have enough to be worried about right now with this pandemic. Generally speaking, their children are potential vectors for the virus but its really unlikely children arefo going to have the same kind of severe disease that we are so worried about with older americans, americans with existinger conditions, diabetes, Heart Disease and so forth. Host our guest with us until 9 00 and is what as questions about the potential children be effective aspects of coronavirus you can ask questions at 2027488000 for the Asian Pacific time zone, 2027488001 for about a pacific time zone and 2027488002 if your medical professional and would ask our guest question. Hud would classify children in this case, doctor . Guest generally speaking children are classified as people under 18. Some classifications are under 21 so you will see the request or notification from the cdc and state and local Health Departments asking for reporting of cases up to 21 years of age. Those final three years between 18 and 21 can sometimes be classified as adult, sometimes as pediatrics. Host could it be possible then if a child does develop aspects of coronavirus can it be confused with Something Else . One of the comparisons that in comparison to the relation between witnessing and kawasaki disease or the like . Could they be confused . Guest what your question is getting at is about this multiinflammatory syndrome, multisystem inflammatory system that again is very, very rare. There are overlaps or can be overlaps with how it presents with a condition called kawasaki disease. We weve known about that for decades. We still know exactly what causes it. Also toxic shock syndrome is another type of presentation that can have a similar appearance to this inflammatoryy multisystemic disease presentation. In conversation with colleagues in england and in europe, and looking at data from kawasaki, from this new condition if its a single condition from toxic shock syndrome, there are differences well. In termsn of initial presentatin there seems to be overlaps. Host weve heard about adults of the underlying conditions that could be severely affected. About those children that people should watch out for . Guest adults with complications of the coronavirus overwhelmingly have pulmonary involvement. They may have kidney involvement or other organ involvement as well especially when theyre in the caring for a long time here in wrestling with this new rare inflammatory multisystem condition that is recognizing children again over this past two and half weeks, lung involvement is less common. Its possible generally speaking the inflammation is in the heart, the blood vessels, the liver, kidneys. It may be in the skin or mucous membranes like the eyes can get read, for instance. There seems to be i guess overlap in away with what adults are experiencing when they have a lot of information as they enter the second week or so of their illness. Lo childrens presentations have less, lease with this kind of a multiinflammatory, multisystem inflammatory condition, less lung involvement and more other organs. There seem to be differences not only within pediatric conditions like kawasaki and toxic shock but also differences with the way adults are presenting with the severe coronavirus illness. Host our first call for you to come some myrtle in missouri. You are on with our guest. Go ahead with your question or comment. Caller yes. I was calling to see if we are having problems trying to figure out what is going on with the adults. How can one expect to know whats happening with children during this pandemic . It should be a forgiven the money given out to people. Guest myrtle, thank you for the question. From the standpoint of broadly how children are affected, the overall observations that are made at local levels, state levels, the National Level in terms of who was testing positive for the virus, who was being admitted to the hospital, how long of in the hospital, how is their illness, those observations i think we have really substantial data on because weve been watching it now since january and were able to see that again its really 2 or so of the overall population at least right now thats testing positive that are in the pediatric age range. The more standard presentations i think we have greater confidence in terms ofer what we know. The very rare multisystem inflammatory condition that were talking about a moment ago, that one is hard because by definition its rare and its very newly recognized. Thats where the cdc health alert notice, the han that was released yesterday, thats why so important because it raises the where is as much among the public or among pairs but among health professionals, people who will be receiving potentially very sick adolescence or younger children in the Emergency Rooms and transporting them to the intensive care units for them to be aware of i this. As time passes we will continue to know more. Im delighted we know as much as we do in only two and a half weeks. Weeks. We need to know more still here. Host from barbara in maryland. Good morning. Go ahead. Caller hello. Thank you for having me on the show. My question is, because children have been factored for a lot of diseases, can we make a correlation between that and dry acid beennd in addition to the fact that as well as other drugs that they been vaccinated for whereas the Older Community has had these vaccinations but maybe those vaccinations have worn off . Can you argue that for me . Guest thank you for that. I want to make a couple of points. I think the first one is more responsive to your question directly. Weve never been able to create a coronavirus virus vaccine before. Children and adults worldwide of nevada opportunity to be protected without own against this new novel coronavirus, the one causing the pandemic, but any coronavirus. That said, coronavirus is cousin to the pandemic strain of the coronavirus are common causes of colds. Children get them, adults get them. We dont think that there is cross immunity between the kind of more common coronaviruses and the pandemic coronavirus. Right now weve got to view the world, the entirety of the worlds population as being at risk for this and not being even more protected or a potentially more at risk because of a prior vaccine or a prior infection with a different coronavirus. We areru all at risk unless we farm had and even then we may be at risk because wee dont know whether getting this pandemic strain once confers longerterm immunity or not. We hope it does but that is yet to be proven. The other thing i want to say though, and im delighted you brought up the issue of vaccine. One of the casualties so far of this pandemic is a plummeting, a dramatic drop in the vaccination rates with our standard vaccines, our recommended vaccines that we should be giving two children at regular intervals, as according to the schedule from the American Academy of pediatrics. There are then some notices released about this as well, pediatricians have been concerned about it for some time. Weve got to get children back in for well child checks to the doctors appointment. It is safe to do so. Indeed, it isit the right thingo do so that we dont end up adding, say for example, measles epidemic on top of a coronavirus pandemic. That would be a medical travesty. Weve got to startrt getting children back into the pediatricians offices. Its safe to do so, so that they can get the r routine childhood immunizations and be protected against those routine, standard childhood illnesses. Host dr. Kimberlin our guest taking your questions about children and covid19. I gained you can calls on our eastern and central time zones, 2027488000. Mountain pacific time zones 2027488001 and if youre a medical professional calls at 2027488002. Alexandria for alexandria, virg. Hello. Caller good morning. As you stated, we dont have a cure for coronavirus and like the cold, children and adults are both susceptible. Theres rumors or theories saying this was manufactured. What would be the benefit of manufacturing of virus that only affects adults and doesnt affect children and does the evidence support being able to debunk that theory or statement . Guest thank you. Theres a lot of misinformation out there. There will continue to be. Weve got to be receptive to what we are hearing but also critical in how we thinking about that. This is not a manufactured virus. This a virus that jumped from bats to an intermediate animal of some kind to humans. It adapted along the way so that it causes really quite readily transmission between humans, and in somean people, it causes very severe disease and death. This is a natural virus. It is not a manufactured or manmade virus. This is been proven by looking at the genetic sequences of the virus and some absolutely brilliant researchers around the globe doing that kind of critical investigative work to show that this was, in fact, a natural virus that made they can transition as viruses have been doing throughout the eons of time. Host of you are asksho from twitter, doctor, axa statement saying sits next to no one in the u. S. Has been tested, how can be possibly say to take a child into a Doctors Office . Guest thats a very good question and a delighted to be able to expand on that. From the very beginning of all of this, physicians, and these are adult positions as well but in my case i talk about pediatrics. Pediatricians have been looking at the flow of patients in at all of their officers, the ingress and egress of patients into their spaces here they have worked very hard to separate out well child or healthy child areas of their offices from sick child or ill visits. Each office is different. I cant speak to every office in the entire country, but the thought has been going into this, as to how can we schedule appointments with spacing between them so that people are not clumped together waiting to be seen, andnd how do we get the will children, children who are not sick, in in a separate ente to separate portion of the office, seen, vaccinated and release back home . And to do that safely. These plans are extensive and theynd will work. Host another viewer, peter saying if there many unknowns here. However, should pairs increase thenc deli and out of vitamin d their children are getting via a supplement . Guest peter raises an issue that ive been seeing as well. Ive not seen much in with scientific literature on it, thats not to say it is incoming. I think it was dr. Fauci who said we are in the second inning of this. In other words, we got a long ways ahead of us, unfortunately. We will know more about the theory that vitamin d may have some protective benefits. Right now i would ask a scientifically that we know that, at least i know i can say dont knownty i that. That said, i think we got to balance when we hear about these potential benefits come with gon to think all right, do we know the benefits are not . With vitamin d the answer is, the verdict is still out. We dont knowwe that. You had to balance it with one of the potential risks . What could we do harm with this . I wouldnt advocate taking massive doses of any vitamin. That can be. Harmful. But generally speaking, taking a multivitamin that includes vitamin d is a good thing, its not bad thing. Whether it helps with the Covid Infection or the sars coronavirus that causes the covid disease, i dont know. It would not be harmful unlike the potential for other drugs where you might hear, well, this drug may work but that drug as xy in c side effects. Thosee side effects without proven benefit or the opportunity to document that can benefit in that hypothetical drug, you want to avoid it. Vitamin d couldnt be different d i think a multivitamin everyday. I certainly see no harmful approach to. I so we dont know helpful. Host tonya is in washington state. Good morning. Caller good morning. I have a question, i wanted to know, i have soviet disease. When you say inflammatory response, is that because they are producing way toouc much cortisol so its shutting the systems down, or is it producing too little cortisol . In is is the cortisol, is thery way that could be playing a role in that or a way we could look at that to stimulate that . Guest tonya, good morning. Its quite early out on the west coast where you are and and i appreciate you being with us this morning. The inflammatory cascade, the inflammatory system is very multifaceted and certainly addisons disease and cortisol as your mentioning is part of the stress response and it makes perfect sense youre thinking about a that. We are learning a lot more about this mold assessor inflammatory condition, this very rare pediatric condition that may or may not be linked to the sars coronavirus two, covid disease. May or may not. We dont know yet. As a learn more about it we are understanding how certain parts of the inflammatory response, cytokines and interleukins that are sort of the foot soldiers if you will in our bodies inflammatory response to different stimuli, how they can go berserk, and they can go way high in these conditions that were seeing in children. To my knowledge cortisol is not part of that, at least as we understand it now. Its more interleukins six and other interleukins that seem to be this regulated in their bodies. The question is why, why is that the case and can we do anything to identify who is at risk for it and potentially with drugs, not drugs like you take for addisons but of the medications that we have, can we potentially intervene to keep it from wrapping up or for child come in with poverty high levels of inflammation, can we bring it back down. The balance, the challenge is we dont fully know to what degree this is inflammation versus this is, assuming there isa a link with the virus, that is being driven by their virus. My suspicion is that in the child in the situation its really more information but does that mean is exclusively information in the virus is play no role . We wouldnt want to blunt down the bodies immune response ascension which is what information is. Want down the response unless we can take care of the virus should the virus the point of all right now. We dont have those answers. We will have them but to a half weeks in we dont have them yet. Host doctor come in washington whatever the debates that took place back and forth among members of congress and the administration is the reopening of school. Two of the larger topic, what should be considered at this time a is for reopening schools and the safety of children . Guest pedro, thats a challenging one. Weve got to reopen at some point. Everybody agrees with that. The question is when and how. Really to emphasize the latter part of what you said, how do we do it safely . How do we keep our children safe . That ensures we keep our older, grandparents, for instance, safe as well or people with diabetes, people who are at high risk of having major complications or death from this viral infection. Its a challenge i dont have absolute answers for. None of us do. What i i can say is this. We need to follow the david. We need to listen to experts. We need to listen to Public Health officials. We need to gradually loosen at a time when our leaders and our scientific leadership say this is the right time to do it. We need to gradually loosen, and then we need to wait and watch and see what happens so that if that loosening doesnt result in a spike in infections, either in children or an adult in a come unity and maybe we note that with the right way to do it. We could maybe think about loosening up a bit more. On the other hand, if we loosen gradually and then three, four weeks later we see an increase in cases we could go look, that was too much, and we can damp it back then. It would not be a good idea in my view is to simply say were contained, is everything is good, lets go immediately back to the way we were before. If we do that, the virus is not gone. This virus is still here. If we go back rapidly to the way it was before, then it is a fact that we will end up back where we were in february and early march. And then we will be essentially these last six, eight weeks of our lives will arguably been for very little. That would be a real shame. We need to do what smart, careful,l, right. What happened to it . Guest great question. Hydroxychloroquine is an example why we have to do things the right way. Involved a test tube that had properties that made it look like it had properties against the coronavirus. It also has side effects and those side effects have been wellknown especially hard with him side effects and what we needed to do and ultimately what we have done is study it in a controlled fashion where patients or equally sick are randomized after following their informed consent. This is a Research Study done under the auspices and oversight of conducting a Research Study and they are randomized to the drug or a placebo or a sugar pill, a medicine that doesnt contain any medicine in it and when those studies are done the studies to date, hydroxy chloroquine is not demonstrating benefit especially when used with an antibiotic also causes heart rhythm problems it actually appears to cause harm. While there was some initial reports of potential benefit those were reports where i will simplify this, but i have 40 people with covid19, give them chloroquine, 36 got better. Did that mean they got better because of the chloroquine or what they have gotten better anyway . We dont know. You dont know until you do the randomized controlled trial like was done by the nih, they gave placebo to some, active drug to others, that the only way to prove that a drug in the case im giving was proven to be beneficial. We have another half hour, the codirector of Infectious Diseases, you can ask questions via the phone lines and twitter. From brian in wisconsin. You are on with the doctor. Go ahead. Caller my question relates to any research for children who have developmental disabilities, intellectual or physical and i will hang up and listen, thank you. I am assuming you mean Research Related to the covid19 disease, to my knowledge there are not such studies being run at this time. The nih released information recently like this week on a study that they are going to be doing in children with asthma. My understanding is just from press releases, i have not seen scientific details but it is a study that is ongoing. A longitudinal study or study over time of this cohort of children with asthma and they are going to be watching for the Coronavirus Infection in that population but that is not an intellectually impaired population and those studies are not being done or not being done yet. Host Stephen Green says how can a parent determine earliest morning of covid19 in a child . Guest right now our understanding of what covid19 looks like in children is based on data from china, europe, and the United States. As i mentioned before that is only 2 of all people who end up with covid19 disease infections. It includes fever, respiratory symptoms the congestion, runny nose along with that. It can cause, this could be the case in adult too but it is more likely in children to cause g. I. Symptoms, nausea, vomiting, diarrhea lose all those things can be a manifestation of the coronavirus. As parents know exceedingly well they can because by common viruses during flu season, the respiratory illness would be overwhelmingly at least prior to this pandemic because it can because by parainfluenza. The gastrointestinal infections can because by rotavirus or other viral diseases that cause g. I. Infection or g. I. Infections. Common colds can cause upper respiratory Tract Infections with congestion so unless we have the ability to test, to test widely and to test in a way where we gather the information needed to know which children in a community have the coronavirus versus common viral infections we are not going to know for sure and that highlights an issue that wasnt directly raised by the question. We need to have a systematic testing approach and plan. The plan needs to be at the community level, the state level and the National Level. We are doing better with our testing. In midmay im delighted we are not where we were in mid february. We were way behind in january and february. We were late to the game in getting Testing Capacity up. We are in a better place now. That is good. Now we can begin thinking lets not just test the most likely infected people, those most sick in the hospital, lets test people who are in the outpatient setting, do testing even with oversight by local health authorities, random testing of asymptomatic people to get a sense how common this viruses in the community at any given period in time. If it is uncommon now, in my Community One or 2 , i dont know that to be the case but lets just make it up and say it is one or 2 which may be pretty reasonable over the next two or three weeks if we dont do our part, we dont each individually do our part to limit its asymptomatic spread that could balloon from one to 10 in as little as two weeks. What do we do individually to not make that happen . Do the five things, social distancing, six feet between you and other people, density reduction, dont be around large groups of people, 10 or more. That will change as we listen up at the principle of density reduction will be critical to us. Number 3, wear a mask. Whenever you are in public. I took mine off sitting here in the studio. When im done with this i will wipe everything down, should i be asymptomatic, number 4, hand hygiene, washing hands really well frequently throughout the day. Every time im speaking, if im a symptomatic, and colleagues such a surface that is infected and then touch their face and not spread the virus. Those five principles as we move over this period, it is important that individuals take the responsibility not only to protect themselves but their children, and colleagues and parents and grandparents. Host we will hear from max. Guest i want to thank you for the very lucid presentation. It is quite understandable and debunks a lot of ideas that were thrown out. My question focuses on the inflammation caused by the reaction to the inflammation, to the infection. I wonder if combining steroids or blood thinners would assist when dealing with that information. Guest that is an insightful question. Studies are being done. You have better opportunity to study things as your question proposes impact be virus, a clinically meaningful way. When that is done with the nhs study of remdesafir is called adaptive design so we dont have to do a hard stop on that study to begin a study of a new combination of drugs, but rather adapt as a single study moves forward and drop the placebo and begin to study remdesafir versus remdesafir plus one of those him you know modulating agents. That particular study is not steroids. It is a different in you know modulator. Can you do something to blunt down the inflammatory response at the same time we are trying to knock down the virus. I know of other studies looking at steroids as well. In terms of blood thinners, the observation is a good one. We know that this virus has a propensity of infecting or damaging a whole host of different types of cells, cardiac cells, lung cells, brain cells, endovascular cells, that line blood vessels throughout the body and we are also seeing as a result of that inflammation of blood vessels, it is important, when patients are presenting covid19 disease, the likely possibility of having blood clots, being put on blood thinners if that likelihood is there and that is not so much to study its impact on inflammation but rather to address its potential impact on inflammation by decreasing the likelihood those clots could spread , at 84,000 people. It has also been reported that doctor birx thought the cdc number was probably 25 too high. Do you think that hospitals are may be financially incentivized to the state death as covid19 even though it might be from Something Else like an opium attic. And in the other thing are you connected to a hospital. The folks in canton and the surrounding region are blessed to have Mercy Hospital available to them. It is a good question and the answer is no. I actually think the number of cases relative to what is happening out there are artificially low. With those influenza numbers, when we see influenza, not the coronavirus. During flu season there was an increased number of mortality, rate of mortality, we know when people die, we dont always know what they die of. Just because some of those, we can go back and look later on in the case of influenza. When we see increased number of deaths relative to what we would expect that time of year based on data going back year after year after year and we know influenza is circulating in the community we are able to then correlate that and say we measured x number of people who died from flu but the excess number of deaths through statistical analyses we can estimate what proportion of those are from influenza in this example and the total number of influenza death are higher than the reported number of influenza death. The same analytics are being applied here with coronavirus in the same thing happening in italy and other countries around the world. I think we are doing a good job reporting coronavirus death but i think when we get x number of months or years in the future and look back we are going to find the numbers are quite a bit higher. Host lets go to virginia, good morning. Caller hello. I have a question for you. You are a pediatric disease doctor. I usually with hst . Guest yes i am. Host my grandson hesitant has been under a nephrologist monthly normality. It struck him at 17. They dont have any cures or what have you. Can you claim a concern i should have regarding this . I understand it can strike the kidneys and im confused about the proteins because you know it does have the protein, that is what we have to be careful of with the levels, proteins in his blood. Host we will let our guest respond. Guest thank you for that. I am sorry about your grandson. Im very glad he is in with a net urologist. There can be longterm outcomes with hsp. Of course, as i have said before we are 2 and a half weeks into recognizing what may be a cluster of pediatric patients with this multisystem inflammatory condition and we are not yet recognizing a predisposition of some children to having it and that includes hst but also patients with kawasaki disease earlier in their lives. I received a call yesterday from somebody who had a child with kawasaki and they want to know if the child was at increased risk and the answer is simply we dont know. Of those being reported there is not a signal that your grandson would be at increased risk of having a complication should he acquire the Coronavirus Infection but the numbers are small and we dont know as much now as we ultimately will. That is the reason it is important for you and everyone in your community and your state and region and across the country to do the five things and wear a mask, washing hands, being mindful of biro and being careful not to bring hands to your face. Since there is so much we dont know about this we all have to do our part to make sure the virus stays contained and does not spread your grandson. Host what are your thoughts on a timeline for a possible vaccine at this stage did you guest months at best, maybe years. I said earlier in the show that we have never made a Coronavirus Vaccine before. That is challenging. I am hopeful, certainly looking at the brainpower of the people at the nih, cdc, companies, Biomedical Companies around this country and around the world, the brilliance of the people involved in those endeavors, i am hopeful that we will get there but it is not going to be fast or soon. I think if and when we get a vaccine and begin to implement it and roll it out into the community then we will be able to adjust the way we are doing things but until then we have got to social distance was we have to be mindful of density reduction. Weve got to mask in public, weve got to do that for surface is not to be contaminated by asymptomatic people who may have the virus and not realize it. We need to wash our hands frequently and wipe down those surfaces and be mindful of them. Until we have the vaccine that is the way we can take control of our lives again. Host as far as the infection, patients that are recovering with covid19 if they are reinfected, is there data that tells us anything . We have data that are confusing. There are reports of people that by testing positive they had swabs in the test is run and cases of patients the test positive positive positive it might have 2 or 3 tests that are negative and a test positive again. Why is it . It could be they are being reinfected with the virus again. It could be the tests that were negative were false negative test. They could have been infected the entire time and the location that was being tested when attested negative was negative but there was virus another part of that particular persons body that got back to the site that was simple and tested positive after that. We simply dont know. What we need to find out a lot of research is being done but we need to identify or correlate of immunity. Is there a particular antibody or a particular amount of antibody that confers immunity to somebody . And you can say i have covid19 previously, my blood was measured and i had x amount of antibodies and i am protected . That would be wonderful information to know, not only for that particular person but also the status of vaccine development. If we get to the point where we have that correlate of immunity then instead of having to wait for people who have the vaccine or a placebo to get infected we could just measure the amount of antibodies they are generating and say this vaccine is going to work because it is getting enough antibodies in the blood. We dont have that information yet. A lot of research working toward that. Host ten minutes left with our guest, richard in springfield, go ahead. Caller i have been listening to the news lately and is real weird disease, this isnt coming from doctors but news people, saying it is caused by corona, causing a big stir up, we cant open schools and that kind of thing, didnt polio take ten years to develop something for that . Eventually there has got to be a Tipping Point where you just have to get things going again. I agree with what you said about protecting yourself but the damage done by keeping the economy completely closed for years is going to do more damage than deaths from corona itself. You raised an incredibly important point, and complete medical safety. And the ability to balance economic productivity and jobs and livelihood, learning for children in schools. I dont have the perfect answer to it. We circled back to an earlier answer but as we listen up we need to do it in gradual fashion and need to be datadriven, we need to have the resources in place to do the testing to know that as we turn the spigot on a little bit and watch for the result over the ensuing two, three, four weeks of time are we seeing a rise in infection we can predict to a rise in hospital patients or are we not . We need to do this smart. We do things smart, we have got to have information and data lacking until this point. I hope leadership will put in place, the systems and programs are able to do that. I dont know when that should be now, four weeks from now in fall and spring but we need data to make those decisions. We have better Testing Capacity. Host barbara in texas. Guest children coming out with this disease, what age group is it affecting the most. Ideas children being tested for coronavirus. Is the immune system being checked, children being affected, what age group . Host guest we dont know for sure yet. Off of europe especially in england it was the 1017yearolds. Mine included much younger children as well, we are not sure about that but in terms of testing europeans are week or so ahead of us and what i heard from colleagues in england on that is a third of the patients with this rare condition, a third will actually test positive for the viral rna itself and two thirds will have either detection of virus or antibodies to the virus in their blood. It is a third of antibodies, what i was told by colleagues was about two thirds had some sort of test for the covid19 virus that existed they had a may have had it in the past. Does that mean the a third did not were picked up on the testing, or is a true true unrelated situation, we dont know. We early in this process but i assure you the scientists and physicians are doing what you are getting at, to understand this as rapidly as possible. Host deborah in roscoe, illinois, we are running short on time, go ahead with your question or comment. Guest deborah from roscoe, illinois, one more time for deborah. As it plays out, what should our audience be watching for. Within children what should we be looking out for. Guest appreciate the opportunity to be with you guys, the most important thing parents need to watch out for is what they are doing and what their neighbors are doing and we need to have social pressure, not shaving but where is your mask, you need one and heres where i got my mask. We each have to do our part. As we move from this absolutely devastating last month and a half to two month into even more uncertain future. The virus is still out there. We have to densely reduce, we have to wash our hands. We need to be mindful of surfaces. If we dont do that individually or within our communities this virus will come roaring back and impact children but even worse it will impact those at the highest risk, older people with diabetes, Heart Disease and so forth. Children play with each other and associate with each other, would you start that practice as well . Guest that is a challenging one. I dont think we should right now get back to where we were before all of this started. I dont think we should have birthday parties with 30 toddlers sharing toys. Also dont know a single toddler in a house without siblings needs to be in complete lockdown either. Look what the American Academy of pediatrics is say or what the cdc, centers for Disease Control or information is saying, how to loosen up and do it wisely, trying to be mindful of numbers, mindful of distancing, as best can be done with children which is challenging, be mindful of washing hands, those are the tools we will use and apply to a given situation getting at that challenge the question. Host because you work in a hospital when it comes to the Research Aspects of looking at this thing by children is your hospital and other pediatric hospitals involved or will they be involved in compiling research. Guest the pediatric Disease Society is very active in this realm as our certain collaboratives that are part of it. There is research at the National Level, or is adding covid19 too. Each individual, not each one but many individual institutions my own including, putting dollars fourth or have scientific leadership in place, in my particular institution leading an effort to get samples from children who test positive for coronavirus in order to better understand what happens to the virus and what happens to their immune responses and we are not alone in that, and pediatric Infectious Diseases is coming in. And getting information guidance out, a lot of ways we scientists and sub specialists are networking with one of the to share information at