Sweeping order really. Run this through really quickly with our viewers. Governor newsom ordered closures in some sectors, three consecutive days. 19 of these counties. Ones closer to the bay area, sawn joaquin, merced and sacramento. They have to close indoor operations at the following. Restaurants, wineries and tasting rooms. Movie theatres, Family Entertainment centers, museums and card rooms. As for casinos, on tribal land, the governor says hes working with them and will have an update soon. As for the fourth of july weekend, all Parking Facilities and state beaches and Southern California will be closed. The beaches will be open but the states will open where local beaches are closed. State parks remain everywhere and do not gather with people you dont live crowds. That in a nutshell. Thank you for joining us. Good to see you again. My pleasure. Thank you. Lets understand what realities compel the governor, what is californias covid situation by the numbers . We have clearly seen a major spike and its a spike in case numbers. Its a spike in hospitalizations, its a spike in intensive care admissions and so, its an increase in the test Positivity Rate. Hospitalizations, icu admissions and test Positivity Rate all went up by 50 . Any thought this is due to more testing has gone out the window. If it was just more testing, you might expect more cases and a lower test Positivity Rate, you wouldnt see more hospitalizations. These are people, some of whom getting sick to be in the hospital and sick enough to be in the icu. We were doing pretty well for quite a long time. What was the turning point, can you pinpoint who or what is responsible . Yeah, its hard to say one thing. It was increasing through may after we began opening things up and thats not a critique of opening things up. It was expected as we began to allow more normal activities that there would be somewhat of an increase in case rates and part of the reason it was good that we had three pretty benign months that we were ready for that. We had more capacity, more testing, more ppe, more Contact Tracing. Things really started to change and surge starting about ten days ago. If you look at the way it plays out, thats a week or so before then when things started getting out of hand. Thats kind of memorial day and the next ten days after memorial day and what happened then, the bars opened up but it may have been the sum total of things becoming a little bit more open, people just going out again and saying, californias been pretty good so far and i dont see a whole lot of cases around me, i dont know anybody whos gotten really sick or died. Its okay for me not to hang out with my pals. So rather than this being one particular thing by the state or counties, its probably the sum total of a lot of individual decisions decisions. Is the factor the huge outdoor protests this last month . Its a logical thing to wonder about, but when weve looked at the impact, the california but all over the country, he does not see to be associated with a spike. Thats a little bit of Interesting Research question there, because clearly, some people got infected at protests. On the other hand, we also know that while there were protests, a lot of people stayed home, and so it may be that those things kind of cancel each other out. I think it is pretty clear that the protests did not lead to a large part of the spike but also tended to happen a little bit before the spike course that you would say is associated with the spike that really began surging in mid june. Most people wearing masks. Lets talk about the order today. Why these particular activities, what is the common thread. I notice indoors of course but you tell us. We have been opening in a graduated incremental way. And weve been watching carefully each step of the way to see whether weve gone too far. The first message is the answer is yes. Weve gone too far too fast, who knows, didnt seem unreasonable to do what weve done but we now learned its not working and so weve got to scale back. So the first thing you scale back are indoor activities. One of the things thats been clear over the last three months is the virus spreads much more readily in close spaces than in open spaces. Its not that the outdoors is 100 safe but if youre doing the same activity indoors versus outdoors, youre much less likely to catch it if youre outdoors so its an effort to scale back but try to maintain as much of the economy as we can. And well see what happens. I think it needs to be watched the next week or two and if we dont see those curves flatten, then the indoor activities as well. It being indoors and in close proximity with others is a problem, why not also ban gyms or hair salons and then why ban outdoor bars, for example . So is this more than just weighing the risk . Maybe were also putting value or importance on these things . Im not sure. I dont have an insight into thh what the Governors Health advisers are thinking. You know, all of those points are perfectly reasonable. I think they may have wanted a very clear message. I think part of what we have learned is the clarity of messaging and consistency of messaging is very important. I think weve kind of screwed things up on masks with early messaging that they werent all that important and thats been wrong but in weighing all the factors to say, lets do it cleanly and about outdoor is okay, as long as youre distancing and then on or off the list, im not sure. Okay, i want to ask this just come out and say it, but if everybody wore a mask, do you think we would be crushing covid and is there proof . The rate of new cases would go down tremendously. It wouldnt go down to zero, the masks are not 100 perfect but pretty darn good. And the proof, no one has done a study to randomize a city that gets masks or doesnt. But the studies now have come out of the united states, out of italy, out of china, out of other countries very clearly demonstrate that higher rates of mask wearing are associated with less, fewer cases, fewer hospitalizations, fewer patients in the icu and many other scientific studies that demonstrate, one came out a couple of days ago that shows if you cough or sneeze, whats coming out of your mouth will travel five or six feet and if youre wearing a decent mask, it will travel two inches. And we know that in order to catch this virus, you need a decent slug of particles with virus to hit the back of your nose or the back of your throat. So it makes all the sense in the world that if both you and the people around you are wearing masks, we would markedly decrease the risk of transmission. Would you support a federal mandate on mask wearing . Absolutely. We should have had that a month ago or maybe more. The problem with the mandates or mask wearing. There is a state mandate on mask wearing. I think the governor tried carefully to say were not going to be going around arresting people who dont wear masks, but to say that were going to be looking at what the cities and counties are doing and maybe holding out the thread of funding cuts if people are not enacting rule and regulations that get people to behave better. Its, you know, a tricky thing to do. The real hope with mask wearing is rather than somebody arresting you if youre not wearing a mask that it just becomes a normative behavior. Think about 50 years ago when it was normal to go in a room and see everybody smoking. It now would be incredibly weird to see that and its not just because there are rules and laws against it, its because if you did it, somebody in the room would say, dont do that, and we have to get to a place where people are comfortable saying to each other, you need to wear a mask and im not comfortable going into this place if not everybody is wearing a mask. It needs to be a normative behavior and it has not become that yet. Were going to take a short break on the air and when we come back, well talk to dr. Walker about what happened to the california miracle but over on social, the live stream including facebook, im going to ask, who are t we are back with the chair of ucsfs department of medicine, dr. Bob, really good to have you here with the expertise in light of governor Gavin Newsoms rolling back some of the reopenings. You wrote about what happened to the california miracle. We were sort of like the star pupil, we were one of the first states to get cases and then one of the first to enact shelter in place and then get tests and flatten the curve and kind of kept our case load and depth low. In fact, so low people thought why are we giving up all the freedoms and social lives if its not really affecting us. Is that kind of what started the going downhill again . Yeah, i think so. You know, i do want to give us some credit for having done what we did when we flatten the cu e curve, save tens of thousands of lives. People say why did we even bother . We saved tens of thousands of lives, a surge now is happening in an environment where we have more hospital capacity, more icu capacity, more ppe. More testing, more Contact Tracing and a couple of moderately effective medications, none of which we hd three or four months ago. Glad we pushed this back. But i would have been glad if we never had a surge. People got complacent and came to believe that was a new york thi thing, but its just not true. As you mention, now they have a quarantine, hawaii quarantine, the Justice Department was trying to sue hawaii. I was wondering if you think that states should have the ability to, for example, ban visitors from out of state. Or even counties. What if you say, san mateo offering Indoor Dining so go over to san mateo. The fact that its different from county to county and state to state, does that help or not help at a time like this. Its reasonable to have countys specific guidance because for example, San Francisco continues to do fairly well, we are seeing a bump in new cases and a bump in hospitalizations and nowhere ne near, locking things back down here in the same way youre locking down counties hit harder. On the other hand, all very connected and the bump in San Francisco, for example, if you look at the hospitalization, half of the increase is because we get transfers of patients from other counties including imperial counties, the outbreaks of san quentin began with prisoners up here, were all very interconnected but i think the way the governor is handling it is right. State rules to watch carefully and what hes done so far, i have no doubt San Francisco starts to get worse, well be on the list along with the others and start locking us down as well. So you dont think our decentralized Decision Making system has kind of hampered us in the pandemic . I think it certainly hampered us at the federal level. The messaging from the federal government on this has been awful. How scary it is, the important t thing is when people dont believe the masks work and then it increases risk to all of us. Some level of decentralization is appropriate. The rules you would have had in new york and march werent appropriate in california. We were doing so much better and the same thing is true in reverse now. We are surging, texas and arizona and florida, or even worse than we are. So what new york does today is going to be very different than what california does, california sort of is its own country. Its so big with 40 Million People that having a uniform set of rules in california is an imperfect solution. I think the way theyre handling it which is central guidance and standards, some flexibility seems like a reasonable balance to me. You were talking about the mixed messaging when it comes to masks. Wearing a mask this week, do you think that is a big turning point in terms of improving the mask wearing numbers . Its helpful. Its too little and awfully late. Its better than nothing. I mean, we certainly know from surveys and from what we see on the internet and on tv that there are a fair number of people who believe deeply with what the president says. If he says not a mask or now to wear a mask, if you dont look bad, its a sign of strength and not weakness, i have to think thats a good thing and should increase the rate of mask wearing. Masks are one of the most important things we can do. Anywhere close to universal mask wearing, we would be much better off. One thing the president had said even recently is perhaps the coronavirus could just disappear. What have you learned from a scientific standpoint about the virus the last few months thats been with us, could it just disappear and what would it take for us to make it disappear . The answer is no, it cannot just disappear and i wish he would stop saying that, if hes going to move on masks, it would be nice if he moved on that one as well. Theres absolutely no reason to believe the virus will disappear. The only way to get out of this predicament, the effective vaccine people take and allow themselves to get. Or very, very effective treatment that is proven to be safe and effective by the end of this calendar year, the problem with that is then manufacturing hundreds of millions of doses and getting them into hundreds of millions of shoulders is not going to take a week, its going to take many, many months and so, and theres no treatment that has been demonstrated to be effective in anyone other than people already very sick in hospitals. So it is not going to disappear. Were going to have to live with this and i think with california, its proven in the last couple of weeks, if you get complacent and let your guard down, its waiting out there to pounce and does it more quickly than any of us expected. And so were in this for the long haul, it may be another year were like this and it seems like the minute you feels like youre doing well and you can let your guard down is the minute your risk is going up again. We saw that in the past month. Dr. Walker, well take another break on air. When we come back, lets talk about what it would take to reopen schools safely. And then over on live stream platforms right im alex trebek here to tell you about the Colonial Penn program. If youre age 5085 and looking to buy Life Insurance on a fixed budget, remember the three ps. The three what . The three ps . What are the three ps . The three ps of Life Insurance on a fixed budget are price, price, and price. A price you can afford, a price that cant increase, and a price that fits your budget. Im 54 and i was a smoker but quit. Alex, whats my price . You can get coverage for 9. 95 a month. Im 65, retired, and take medications. Whats my price . Also 9. 95 a month. 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One goal for californians myself included is for our kids to be able to go to school back safely in the fall. But when we say fall, thats six weeks from now so is that realistic given where we are now . Well, its a complex set of tradeoffs. There is no way for the kids to go back to school and say that there is zero risk. I think the American Academy of pediatricians came out endorsing inperson school, theyre saying the risk of keeping kids out of school in terms of the kids education, the health, the health of the parents, the ability of the parents to get back to work. When you weigh that risk, its probably higher than the risks in kids going back to school. Theres a bit of happy news about kids, a lot of things the virus has surprises with is unhappy things, but the one happy news is kids are pretty unlikely to get sick, theyre pretty unlikely to get infected and pretty unlikely to spread the virus to adults. None of those things had to be true. Then school out of the question. Because of those things, i think there is a way to send kids back to school trying to do it safely as possible. Not saying its zero risk but were saying the risk of keeping them home may be greater. What can we do to ensure that can happen for our kids . The amount of virus in the communities where we live would be little as possible, i was more confident, but now the virus around, what the adults can do is the amount of virus to be spread around is little around. Its trying to have everybody wear masks where thats possible. May not be possible in all circumstances. Keeping the rooms super clean. Probably some mixture of in person and online schooling. A lot of work to do on tight budgets, i dont envy them but i think its a reasonable thing for us to try to get to. Some testing as well because we have an outbreak in schools, were going to have to go to plan b. I want to go back what you mentioned about not having data that suggested kids are super spreaders. I think weve all heard a lot about theyre less likely to get very ill should they contract covid but ive heard from teachers who are concerned saying, hey, were over 50 here and were at risk. Are you saying the danger of the teachers getting sick from exposure to the children is minimal. Another adult was sick and had the same level of contact. Its not 100 clear, may have something to do with the certain kind of receptor k k adults dont have, its the subject of a lot of study to try and understand. But the data are pretty clear on this. This was surprising. It was not sort of a preordained at the beginning. It was a surprising finding that the kids are not only less likely to get sick but the kids actually less likely to spread the virus to an adult. All right, dr. Bob, always great to talk and learn from you on an important day with ucsfs department of every year, you can see spectacular celebrities at aids walk San Franci