Situation that we are in right now . Guest thanks for having me. What we are seeing happen is as a reason region starts to pull down, a new region heats up , and i think we are in this position because we have a lot of advection all around this country. We reopened not just early but aggressively, and that instigated more spread, and now you have a situation where there is just so much infection that to otherng to get parts of the country. The sunbelt is starting signs of improving. Places like texas, florida, southern california. Those states,s in particularly arizona and texas, when you look at the data. It is a little less clear in texas and southern california. At the same time, we see infections pick up in other states, kentucky, indiana, illinois, georgia, ohio, indiana, so the gains that we are making in the states that look like they are starting to peek will now be offset by the other states that look like they are accelerating. Host why are they slowing down and the sunbelt states . Why are they picking up in the states that you mentioned . Guest it is unclear exactly what the ingredient was that caused the epidemic to start to slow in the sunbelt state the policy action was slow to be implemented, but the government did try to take action, for example, to encourage masks or mandate masks. They took action to close certain congregate menus, like bars, reduce headcount in restaurants, close entertainment venues, like movie theaters, particularly in arizona. Consumers drawn back a little bit as they saw infection spreading in their state. More compliance with masks and targeted policy action may have been enough to start to bend the epidemic without a Strict Lockdown like we have had to do in the northeast, largely because the epidemics were more severe or intense, and we had less certainty about which way things were going to head, so it is important i think to look at what is going on in the south, notwithstanding the fact that i think the Political Leadership was slow to take action there. If they are successful in taking these targeted mitigation steps, combined with implementing mask mandates, and consumers just becoming more aware of the risks and trying to be more prudent in what they do on a daily basis, that might be sort of a middle ground, if you will, between Strict Lockdown, which do not seem to be culturally and socially and economically acceptable, does not seem like we are going to go that and sort ofain, pass the spread. Some kind of happy medium, if you will come up between something that is more to conan like a Strict Lockdown and kind of letting the virus course its way through the population, which itself is not acceptable, because of all the diseases that we have, so these kinds of targeted steps where you implement mask mandates and also take targeted mitigation steps may be the middle ground we have to reach for in other states. Host what is the role of the mask in stopping the spread . Guest well, it appears to be more and more effective. All of the incremental data we have gotten around the use of masks in the setting of covid seems to suggest that they are effective at stopping the spread of covid19. This is a respiratory illness. It seems to be primarily spread through droplet transmission, so larger aerosols, and the masks should be effective at reducing the transmission through that route. But also according to the protection of people who wear that mask. The higher the quality of a mask someone has on, the more protection they will be providing to themselves. A level 3 procedure mask, which looks a lot like msa dennis office might wear mask a Dentists Office might wear, or a surgical procedure might wear, that offers a lot of protection. , that affords about 90 of 100 protection, depending on how it is being worn. A cloth mask, deepening on the quality, will provide less protection than the level 3 procedure mask, still less protection, so the Higher Quality they can get, the more protection they will afford themselves. It will protect other people from you if you happen to be an asymptomatic carrier of the infection. The point i want to reiterate is when youre wearing a mask of the presumption as you are protecting other people from you you are also protecting yourself. The Higher Quality of mask, the more protection you are going to provide yourself. Host you write with mark mcclellan, former fda commissioner as well, in todays wall street journal, covid shows the need for todays stockpile. What are you arguing for a year . Guest if you have surge protection, it is always there. What is happening now is the commercial labs, which are holding the mass testing, those labs operate in a highly efficient fashion, so they use capital equipment, their big platforms that they used to do the pcrbased testing that we are doing to detect covid at maybe 70 , 80 capacity. They do not run in at 100 capacity, because you have to take those machines down for servicing, but what we are arguing is the government should effectively subsidize these companies to maintain excess capacity, so instead of running, you know, 2000 machines at 80 capacity, maybe by 4000 machines or 50 them at 60 capacity, so you have extra capacity built in, and youre running all the machines a bit less, and therefore you have Surge Capacity if you have suddenly had a big spike in demand for testing because you have it spreading or some kind of new pathogen. Right now, we do not have that capacity. There are other settings where the government will Pay Companies to build a reserve capacity. The example used in the oped is ne a drug ne nupagin. It is a drug you would want to have an excess supply of and the unlikely event of a radiological attack with a dirty bomb because the radiation when impact the bone marrow, and you would need that, so the government wants make sure theres going to be an unimpeded supply of the drug in the unlikely event of a terrorist attack. So they have built into the amount of money of supplying that drug for stockpiles some extra margins to basically harden the manufacturing facilities, if manufacturing es around theit country, and those asides are very hard and, even in the setting of certain calamities. This takes the appearance of the hurricane, when amit has a facility in puerto rico that is extremely hard and, that has a lot of residual and redundant capacity. That is an example where the government has paid to make sure there is an unimpeded supply of the drug. You can make sure there is an unimpeded supply of excess diagnostic of vasily as well. Host he recently predicted 300,000 deaths of coronavirus by years end if these Current Trends continue. Do you stand by that . Guest well, i hope not. What i said was if we do not get this under better control, if we just look at the trajectory we are on right now, you would read Something Like 300,000 deaths by the end of the year, whereas we were having less week, dipping down over the weekend, as it usually does, because there is less reporting over the weekend, but if we continue on the current trend line, you will see an average of 1000 deaths a day, maybe more, as more people succumb to the infection were currently hospitalized, so if we dont get this under control, you can do the math on the number of days left in the year, and you get some pretty scary numbers. You will see hospitalizations for client in the south. Indicator,lagging even as new cases decline, death may even go up, because it will take time for people to see people with the infection to ultimately succumb to it. But, again, when you look around the country, you will see some outbreaks in the south that is currently the epicenter of the epidemic spread in this country, but you are seeing rises in other states. So all we do is have a rotating series of regional epidemics, and any games we make in one state are offset by increases in other states. This is going to be a very hard fall and winter, and we are going to see a lot of excess death and disease accrual on the way. Host lets get to calls. You lived the line, if in east and central part of the country, your line is 202 7488000. Mountain pacific, 202 7488001. In north carolina, good morning to you. Caller good morning. Good morning, dr. I will tell you, i am really disappointed in the medical and the research community, allowing the virus to get so politicized. I mean, it is almost as if no one is standing up and saying, hey, we have got to stop this. I mean, i knew at the time they opened up a government, it was obvious we could not open up. People were still dying, and people open up the government, and they are opening up the bars, i mean, it was almost commonsense, and yet still the political community, the standists, they did not up and say, no, this should not be done should i remember at time when the cdc was the pearl of the world. They told the world how to stop these kinds of things. And cdc is so politicized. We are talking about people going back to work. They are telling people to go back to work now [laughs] and people are saying, dont give them any extra money. They need to go back to work. And the desire is not out there. You have older people who are at home, some of these rich people who are at home, and younger people who have these lowend jobs, they have to go back to work out here, and none of the scientific or the socalled movers and shakers are saying, we need to stop this mess. Host ok, james, you proved your point. Guest i think on the second point, there are a lot of people who have to work and feel very uncertain about the environment, and that is very concerning to all of us, i think, engaged in public health, that, you know, there are a lot of essential employees can a lot of people in jobs being put at risk, not just First Responders, but people who work at grocery checkout lines, people who come into contact with a lot of people in a daily basis. They have to work, they have to continue to earn money, and they are putting themselves at risk. We need to get control of the infection, first and foremost, but when people do have to go out, that they have proper protective equipment. A lot of us were concerned about the reopening. It is not just the timing of the reopening. If you think back to march and april and may, different parts of the country had Different Levels of spread, and so it is reasonable that, you know, parts of the country that were heavily engulfed took more time to start reopening venues versus part of the country where there really was not as much infection. But it is not just the timing of the reopening, it is what they reopened and sort the pace of the reopening. I think with hindsight, we should have done a better job, is slowing down the reopening of the mostat werent obvious example is bars. If we wanted to keep the epidemic at bay and we wanted to takeudent and cautious and care, like settings that are purely entertainment, that are not a necessary feature of the economy, try to make sure youre in a position to open schools clement open those venues last, if you secure the safety of the public by opening those other, more important sites. That there aree bar owners and Restaurant Owners who hear this and say, my establishment is very important to me, and it is, but on the whole, if you look at a population level and trying to maximize gains to a society as a whole, uf cap those kinds of sites hold. Now that we have had a resurgence in infection, we will keep those close for a period of time. Host rich in ohio. Caller yeah, great discussions. I appreciate your suggestions, that have probably helped save 1000 or more lives. I would point out is handshakes, that would be significant. One thing that comes to my mind to make we could get information on people come and we do have it, can get the test back or less like one day come a could save on ppp. I can save the hospitals having to have extra rooms set aside. The other thing i thought about is, how much if we have real tests come on how much heat canks off viruses, if you heat the classroom to 90 degrees , when no one is in it. Colleges are studying Library Books right now, where you have real data to do that. It seems like we have got to have all the good ideas coming together, and i think when we do cantnd keep it, maybe we do it, but we know where its at, and share between hospitals, you just can see the winning plates coming one after another. I think that is what brought our deaths down. I will hang up and listen to your answer. Guest thank you for the question. I think with respect to talking about different ways to disinfect different classrooms, there are, you know, different chemicals that are being used to clean airplanes, being thought of to use indoors. It does appear that less of the split here is through contact with contaminated surfaces, what ,e call full mites in medicine so if someone touches a surface, and you touch the surface and face, then you touch your face, you would get infected through that route. One thing theyre looking at is retrofitting their hvac systems with different kinds of filters. It does appear that in certain settings, the addition of air conditioning may have been a controlling factor to the spread, and it may have been a around the virus could it was very hot in phoenix, texas, miami, so people, rather than going outside as we get into summer, were going inside, for the benefit air conditioning, and to congregate settings, and that was causing spread. If you look at israel, israel reopened schools about may 17. About 10 days later, they had major outbreaks. What happened during that time period if they had major heat waves, so they allowed children off,ke their masks they close the windows, and they turned on the air conditioning. They created an environment for viral spread. Aerosol transmission or droplet transmission, excuse me, droplet transmission are airborne, the difference is droplet transition is sort of wet, moist droplets. You have to be fairly close to someone to transmit through droplet transmission. Aerosol or airflow transmission means that the virus can sort of get into droplets, small droplets. Goes droplets can evacuate command virus can stay suspended in air, what is called droplet nuclei, for a long period of time. The classic infection spread aerosol transmission, that is airborne, is measles. Covid probably is not airborne in that sense, but it is probably mostly droplet transmission, but it is not a binary thing, either. Spread that are sort of through droplet transmission, under the optimal circumstances, can start to spreader a condition that across made ization. So if you put it in the perfect environment in terms of the temperature, environment, you have airconditioning on, blowing things around, people are sort of grouped together, you start to get a pattern of spread that looks much more like aerosolization, and that is i think what we are seeing. That is what is most important, to retrofit the hvac system. As far as testing, you are absolutely right. We need to be turning around the tests faster. A test that takes six or seven days to get the results back is not that helpful anymore, especially if we are going to be opening schools and try to use testing as a tool to identify and mitigate outbreaks in the local community, you want to be able to get that result back within 24 or 48 hours. Part of that means getting more testing supply into the market. Part of that means getting different kinds of tests into the market, so things like tests that can be done at home are going to be very important to help facilitate testing in the hands of consumers, something where you can ship them a test kit, you know, in the same day, they get the test kit, they swap themselves, send it back in, they can get into the lab the same day or the next day and basically get a result within 24 or 48 hours. Those kinds of innovations in the market will be very important for building out quicker results for patients that are actionable. Host dr. Gottlieb, i want to go back to the classroom. If you are in that optimal condition, as you laid out, where the airconditioning is running in a school, if those children and teachers are wearing a mask in those conditions, are they mostly protected . Guest it certainly helps. I do not want to say they are 100 protected, because the bottom line is we dont know. We dont have good data on this. Certainly wearing a mask is going to help. Most kids in the class are going to be wearing cloth mask. It will afford some protection. I think teachers, especially at risk, should think about wearing better protective equipment, and we should make sure we are getting that kind of protective equipment to teachers. Areremember, all children wearing masks, they are not air aerosolizing the air so much. That is the benefit of the mask in those settings. It will also provide a measure of protection to the children in terms of what they are breathing in. We have seen many studies now, but there are enough an that the virus should have spread but it did not because people were wearing masks. Study that these cdc cited was a case in missouri where you had to hairstylists that, you know, perform services on more than, you know, 100 people. Infected. Were they were masks, the people they were servicing more masks, and nobody got infected. That is pretty instructive, because in that setting, you would have expected at least somethin infecti some infection, and you did not see any infection. Host lets go to tina and remington, virginia. Caller good morning. Cashier inery store a highvolume setting. One of the things about masks is we have been mandated as employees to wear them for quite a while, but we have mandated our customers to wear them as well. We had to hire security to make sure they put them on before they come into the store. But the customers will strip them off when they come in. And by the time they get to us at the cashier stands, most of them are not wearing them anymore. And the people who are wearing them, if they have to cough or sneeze, they are taking them off. They will take them off, so they dont get them dirty, which defeats the whole entire purpose. The other thing we deal with is people are just so angry, you know, they are angry about the choice and whether they should have to wear them or not have to wear them, and, you know, they get confrontational. We have to deal with all of that. I just think there needs to be so much education to make people just drop the anger. Everyone is tired, and everyone is exhausted through this whole process. Everybody just needs to take a breath, and they need to say, what can i do . You know, i have been working tirelessly cleaning and just, i mean, to the point of exhaustion, trying to keep people away from each other and the six feet and it is just a battle. It is a battle every day. , you know, and you get to the point where people just have to upon themselves to take care of other people. One person cannot take care of 100 pe