App. Joining us from new york,s in dr. Scott gottlieb, the former head of the food and Drug Administration, served as commissioner in the Trump Administration from 2017 to 2019, a resident fellow at the American Enterprise institution. Here to talk about the response to global coronavirus. Doctor, good morning. Thanks for having me. Can we start with you gauging the response to date. What is working and whats been done well . What would you have some concerns with as far as the u. S. Response . Well, the efforts we made to implement travel restrictions and limit travel from china clearly bought us some time. It slowed the rate of new cases coming into the country. I think the question then becomes what did we do with that time . We did some things well and some things not so well. We prepared the nation, got the Health Care System prepared, able to educate providers. We learned more about the virus and how it spreads and how you can combat it. The one thing we didnt do that we should have was have in place broader screening. We should have implementing screening week agos or a monthing month ago or many. We had problems rolling out a diagnostic test, we took a linear approach in my view and depended upon one test promulgated by the centers for Disease Control and prevention. Rather than working with manufacturers and academic labs. When the cdc test didnt work we had to scramble. So were just getting in place the screening capacity in this country we should have had three, four weeks ago. What that means there are cases in the United States, probably that came in some point in mid january, maybe earlier than that, from china probably, that have been spreading. We probably have at this point certainly hundreds of cases and maybe in the low thousands in certain regions. Theres going to be certain hot spots in the country. Remember, its a country of 330 million people. So several thousand cases is still a small number. So anyones individual risk of getting the coronavirus right now is low. But the challenge is that now that there is spread in the country, its going to make it harder, not impossible but harder to contain those outbreaks. And ultimately mitigate continued spread. Want to look at the outbreaks, factor in the two deaths in Washington State, what does that suggest as far as possible concentrations in the United States . Parts of Washington State look like they might be a hot zone right now. Parts of Northern California appear that way. You know, theres a case in new york. Its hard to believe that there isnt spread in new york city given how much travel comes through new york city. I think when you see cases where people are hospitalized or there are fatalities, that suggests there are a lot of cases underneath those sort of index cases. But those are the ones were going to identify first because the patients who are going to get tested first are the patients who have presented or are right now in hospitals very sick with an undiagnosed form of at the mo fe moan pneumon pneumonia. So the cases are going to be skewed more toward severe patients and as we trace back from the patients and Start Testing other people who might be mildly symptomatic or asymptomatic well find benign cases from coronavirus because we know people dont get very sick from coronavirus and a large group of people dont develop any meaningful symptoms at all. Its a small percentage that develop pneumonia and a smaller percentage that goes on to find themselves in severe illness and finds themselves in intensive care. If you want to ask our guest questions 2027488000. Democrats 2027488000. Republicans 2027488001. And independents 2027488002. I want to play you alex azar on the sunday shows yesterday, we talked about the rate of testing the u. S. Is doing. I want you to listen to what he has to say and then respond to it. With historic speed the cdc developed a lab test. We promum galgated it out in th country. There was a third element to the initial test because we believe in quality testing in the United States. There was a third element to the test that was specific to all coronaviruses. Some labs were able to replicate and validate their performance. Cdc never had trouble with that. Weve always been open at the cdc for testing. We had no delays in testing there. On wednesday we authorized 40 labs to use the test with only the first two elements of it specific to the coronavirus. Yesterday morning we authorized home brewed test by certified Clinical Labs around the country. Listening to that, doctor, your response to that . Well, ill look forward before i look back. Looking forward by the end of the week well have the capacity to test about 10,000 patients a day thats from the Public Health labs. By the end of the next week, if we can get online the academic labs because the fda has given flexibility for the academic labs, high complexity laps to promulgate their own tests. If we can get them online we should have 10,000 patients a day testing capacity. So in two weeks time we could have capacity to test upwards of 20,000 patients a day. Thats a Pretty Healthy capacity. Thats assuming we can get the academic labs, some might be slow to get them online, others might be quick where they might be able to run hundreds of samples a day. It is the case cdc had problems manufacturing a kit that could be used by other labs, the Public Health labs. What the Public Health laws and the emergency use authorization and the laws put in place as part of pandemic preparedness, what they envision is that in the setting of an outbreak, cdc goes first. The first lab up and running would be cdc and cdc would develop kits to advance those kits to Public Health labs to then Start Testing for the pathogen as well. Theres many reasons we do it, but one of the reasons is because of access to samples. If you have a pathogen of significance like this virus, you want to handle it very carefully and cdc is going to be the first to have access to it, to synthesize it and give samples to the other labs, so you want cdc in charge. Thats what happened here. The challenge was the kit that the cdc manufactured, because remember cdc isnt a manufacturer, they run a good, High Complexity Lab in atlanta, but they dont routinely make kits, thats for manufacturers. So when cdc went to manufacture that kit, they had a problem with what we call a reagent. One of the components of that kit. Hindsight being 20 20, what we could have done and what we should probably think about doing next time in this circumstance is cdc should go first is thats the way it ought to work. But si mull tan you to that we should be working with the manufacturers to develop approved kits quickly and working with a High Complexity Labs to let them develop laboratory services. Let them make their own diagnostics inside their lab. Thats, in fact, what fda did last week. They gave permission and over the weekend they announced on saturday they gave permission to the High Complexity Labs inside Academic Medical Centers to make their own tests subject to their own specifications. And all theyre going to need to do is go back and validate the tests, demonstrate they work by sending a certain number of samples to the Reference Lab like the cdc. Thats something we could have done three weeks ago. Thats hindsight. We need to learn from that going forward. But the bottom line is now well have a robust testing capacity. But that also means theres been spread and were going to turn over the card on that spread. Well find theres hundreds and probably in the low thousands of cases in this country right now. We need to find them very quickly, do the contact tracing. Try to contain spread where we can and take steps to mitigate where we cant. Northern california, parts of Washington State i think were approaching mitigation steps to try to control the spread there. The lines are 2027488000. And 2027488001. Our first call is from harry from virginia. Youre on with our guest, go ahead. Good morning. My question is, should we be buying masks and the second question is, i was online to buy a mask to protect myself because im the only one who goes outside of the house and i wanted to buy a mask online, when i saw the prices, it kind of shocked me. A pack of 10 is costing over 100 to 200 bucks on amazon or ebay. And Something Like that would only cost like 4 or 5 bucks before. So should we be worried and what can we do about the prices . What should the companies be doing about these prices . Thank you. Hand sanitizer as well is selling out online. Prices have gone up. Its very important that Public Officials tell people what they can do to lower their individual risk. People are concerned. I think its appropriate people are concerned. The risk of contracting coronavirus right now unless youre in one of those really specific regions where this might be spreading like certain counties in Washington State or Northern California, the risk is pretty low right now. Thats going to increase. That could change quickly, but its going to increase over time. I think its important that people understand things they can do to lower their individual risk. Putting on a mask probably isnt going to help that much. Probably the biggest benefit from wearing a mask is it prevents you from touching your face. A lot of the transfer from coronavirus a lot of transfer is from touching, shaking hands, touching a dirty surface, a doorknob. So hand washing really becomes important. It sounds like something so simple it cant work but it does cut your risks substantially. Ive been mow nigh cal about using hand sanitizer, i imposed that on my family as well. That can really reduce your risk. The coronavirus can probably live on surfaces like a doorknob for a couple of hours. On surfaces like cardboard and plastic, a little bit longer. But passing a glass, touching shaking someones hand and then touching your face, those are the ways were most likely to infect ourselves with this virus. Its not through droplet transmission. Thats a risk. If someone is talking very close, coughs on you, sneezes in your vicinity, thats a risk. But as best we know this isnt air born, so it doesnt remain suspended in the air for a long period of time. You need to be in close proximity to those droplets. So the most likely route of transmission is picking it up on your hands and touching your face. From hampton, virginia, this is donna. Hi. Donna, from hampton, virginia, hello. Hello, good morning. Good morning. Thank you for taking my call. I have a comment and a question for the doctor. I have at least five family members spread across the United States that are in the medical field. And, of course, saying the same thing you said, wash your hands, its very important. What i am concerned with is, you never hear anything in this virus that its affecting small children, its affecting adults which is rather odd. And i am one of these people that believe main stream media has made a bigger deal out of this. If you look back at the records of the regular flu, more people die every year from the regular flu. This is another virus. Basically. The cold is a coronavirus. So i think the panic has been caused by main stream media. Dr. Gottlieb . Well, i dont think this is another virus. I respectfully disagree with the caller. This isnt the flu. China didnt shut down their entire economy because they were having a bad flu season. Therp they did it because they were confronted with a strain of a virus that could be potentially very deadly. We dont fully understand this virus yet. But we have a lot of data now and it looks like the case fatality rate, the number of people who die, who develop disease from coronavirus might be around 1 . That doesnt sound high, but by proportion to other viruses its high. Flu is. 1 or less. So a bad flu season one person will succumb to the flu out of every one thousand that contracts it. Typically with flu, the are not is Something Like 1. 5, 1. 3. For every person who gets the flu you get 1. 5 to 1. 3 new infections. With coronavirus we believe the figure is at least 2. Most people agree its at least 2. And it could be as high as 6 based on some of the analyzes. So it spreads officially and it can be deadly. The thing about this virus, theres not a typical spectrum of disease. With the flu if you give 100 people the flu theyre all going to get pretty sick, some people with mild symptoms, some more severe, but itll be a smooth gradation of illness, some mild, some severe, and a bunch in the middle. With this its more binary. Theres a lot of people who develop very mild or moderate symptoms or are asymptomatic and there are some people who become really sick. About 80 have mild illness or may be virtually symptomatic. And 15 to 20 develop some form of pneumonia from this and about 5 become severely ill. So you see the sharp gradations with not a lot in between. For the cohort developing severe pneumonia from this, theyre developing significant forms of pneumonia in many cases. And people who are compromised or vulnerable for other reasons, maybe theyre elderly or have other diseases, that can be quite serious. The Vice President will address the coronavirus and the u. S. Response to it at 5 00 this afternoon. You can see that live on cspan 3. The president is expected to meet with drug makers today, pharmaceutical companies about the coronavirus. What should these conversations entail, doctor . I think with respect to trying to get a therapeutic vaccine we absolutely need to be putting a robust effort behind a therapeutic or vaccine. We knew when that once in a generation strain came along, this may be that strain, something we havent seen in a generation in terms of its v virulence. We knew when it came along we were going to have to depend on our science, technology and innovation to be our savior. Well probably need a vaccine against this virus. But that may be a year or two away. So i think there needs to be an equal focus on a therapeutic or a pro few lack sis to prevent people from getting this. You might give it on a monthly basis and it could prevent people from becoming infected, you can use it in Front Line Health Care workers or people who are vulnerable. We have a potential for a therapeutic by the fall. Its unlikely well have a vaccine by the fall. Its unrealistic to think well have a vaccine by the fall. So we need a longterm and shortterm strategy. Shortterm is a drug on the shelf that we can scale up quickly. We did that with ebola and some of that with mers. March, april could be difficult months. Well see continued spread, case numbers grow into the thousands in the United States. And then in july and august, infections start to slow down. Thats in part because of the steps we inland vallve taken t spread and in part because coronavirus dont transfer as effectively in the summertime. Typically they dont transfer at all, but with the Novel Coronavirus we havent seen it before, people dont have an immune system against it, people may spread it in the summer. But then in september, as the fall starts it could come back. We need to be ready for it to come back. If you remember in the 2009 swine flu season, the first identification of that was april 15, 2009 was the first case we identified. That continued to spread in epidemic proportion well into june, dissipated in the hottest months of the summer and came back in the fall. In september we had licensed the first vaccine, started vaccinating Front Line Health Care workers, by december we had mass inoculated the population. And the vaccine effectively vanquished h1n1. Two quick questions off our social media feeds, this from lee, does the coronavirus have an incubation period of 14 days or more and another viewer asking, could coronavirus be coming in through products and food coming into the United States . It has an incubation period up to 14 days, theres been reports that it could be longer. You see that variability. Sometimes the reporting isnt precise. But the incubation period is probably more akin to five to seven days. One of the unusual things here is that people a lot of people arent starting out sick. So the time to hospitalization, some of the studies coming out of china is nine to 12 days. So that means people got it, they had symptoms for a week, they werent very sick, and then they became very sick. So the hospitalizations are occurring later in the course of the illness. As far as it coming from on packaging, its extremely unlikely. I wouldnt be concerned about that as a route of transmission. Anything is possible. But this shouldnt live on surfaces for long periods of time. Theres a study cited that coronavirus can live up to 9 days on a surface under optimal conditions, so if you put it on the ideal surface, under ideal hu humidity it can live up to nine days. And even if it lives on the surface, you have a rapid decline in the amount of virus on that surface. And you need a certain amount of virus to become infected. Even if virus has trace amounts on a surface, if its low, its not enough to create an i knock rant and infect you with the virus. I have a comment and a question. My comment is, id like to know why the federal government has not stopped all travel from any country to and from who has this virus, and i would like to know you probably not found it out yet, but do we have carriers would have not developed the disease and may be the people who already had the disease may be can still spread this disease . Like i said, i know in other th carriers maybe get a mild case of it and become carriers and dont really develop it themselves and they spread it to other people. Have you all started considering this . Let our guest respond. If we have people who are very sick from the virus and we know we have people who are very sick from the virus now and we had one fatality over the weekend, we have people who arent very sick from the virus and may be asymptomatic and spreading the virus. Because we know theres a spectrum of disease and what were going to be identifying first are people who present to the Health Care System and people who present to the Health Care System are typically the people who have worse disease. There was an interesting study in the new england journal of medicine about two weeks ago that looked at the amount of virus in peoples mouths and nose. And it looked across the spectrum of disease. Some people who had very mild disease and some people who were very sick. What they found was the amount of virus that people had in their oral fan nix was equivalent whether they were sick or had mild disease. Thats concerning. That suggests people who have mild disease might have the same capacity as those who are very sick to actually spread the disease. And some other diseases what youll see is the amount of virus you have and the amount of virus you can transfer comports with how sick you are in some cases. People who are sick from the virus will have more virus in their body and be able to spread more virus. In this case it appears you can have a lot of virus and spread a lot of virus without being very sick from the virus itself. As far as the travel restrictions are concerned, theyre going to rapidly have diminishing utility, once this is spreading in the United States, simply stopping cases from being imported from other countries isnt going to really have an impact on the scope of the outbreak and a potential epidemic here. Although i think we can avoid an epidemic here. Theres certain regions in the world that are hot spots right now where a lot of people have the virus where you probably shouldnt travel to and we should be more cautious whos traveling from those regions because theres a higher propensity for anyone that comes out of those parts of the world could be infected, so parts of italy, hong kong. But travel restrictions are going to decline in utility over the next two weeks. It appears theres a widespread transmission in france right now, germany. You have to ask what do you do when you have Rapid Transmission in Northern California or Washington State. Do we ban travel . Certainly were not going to do that. Were not going to impose travel restrictions within the country and block people from different regions from traveling. So the travel restrictions themselves are going to have greater usefulness over time. Initially they were useful. Restricting travel from china did prevent additional cases from coming in. Even though there were probably cases here we werent detecting before we put those restrictions in place and probably additional ones that came after we slowed the introduction of the virus into this country and that bought us really important time. This is dr. Scott gottlieb former head of the food and Drug Administration under the Trump Administration. A couple weeks ago you wrote a piece for the washington journal one of the points you made was deploying vaccines. I want to talk about what the plan might look at. A viewer shows us, they say this when it comes to the vaccine, what about cost, is it reasonable to charge for this, how much and would insurance cover it . Could you factor that in as far as potential vaccine . From a cost standpoint we need to be thinking about right now and i suspect people are, about how we can set aside some money inside Public Health programs to make sure people who have challenges getting access to health care because of the cost of the care arent challenged to getting a vaccine. You can do it through medicare and the Affordable Care act. Medicare develop payment codes and set aside funding for a vaccine. If a vaccine does come to fruition i believe its a long way off. I dont think a vaccine is going to be what we have available to us in the fall. What youd likely do is probably vaccinate some proportion of your most Vulnerable People or at risk people so your Front Line Health Care workers initially. But thats going to depend upon how much confidence we have in the vaccine and what we know about its potential risks and effectiveness. In the case of the swine flu in 2009 we did vaccinate our Front Line Health Care workers first. But that was a case it was a flu vaccine. We have a lot of experience manufacturing flu vaccines. Thats why we were able to do it so quickly because h1n1 wasnt a challenge to the seasonal flu we had to just adapt our usual tools. In this case the vaccine we come up with may be a novel platform. Some of the work being done is rna based vaccines that are novel. Weve never used them before on a wide scale to develop vaccines. So theres probably likely to be more uncertainly and an appropriate reluctance to roll out an experimental vaccine widely on people like your Front Line Health Care workers because if its the case that the vaccine could potentiate the illness and theres speculation on why that could be the case with the coronavirus, why vaccines might behave differently in this kind of setting versus this pathogen and other pathogens, you wouldnt want all your Front Line Health Care workers given something to increase their risks. So we have to be more cautious and thats going to slow the development of a vaccine here because were dealing with a lot of novel ground. As far as currently available antiviral medicines, would they have some affect . Right now there are no currently available antiviral medications or any medication for that matter,