For firsttime Unemployment Benefits just in the last week alone. You can see that all over the place. Relaxed certainty on how many people are getting through. If i add this to the millions of other people over the past three weeks that have been asking for help, we could be talking up to 23 Million People in the space of four weeks filing for firsttime benefits. We are looking potentially at an Unemployment Rate in the United States of 17 . Just imagine what were seeing. Just in the space of four weeks. What that means for the people involved and the worst part of this, alisyn, were not done yet. We know states are struggling to process these claims. In the past hour, ive had a number of freelancers contact me and say in my state, i still cant get through. That could be a further 23 Million People. Weve got another hour and a half to wait until we get the numbers. But devastating, again, for everyone involved is the message. Julia chatterley for us. Please keep us posted throughout the morning. Joining us now is the director of Vaccine Research clinic at university of alabama at birmingham. And dr. Richelle wa len ski at massachusetts general hospital. We just got an economic report. But its directly tied to the medical reality in this country this morning. So much so that business leaders, dr. Wolensky told the president , they need to see more testing before theyre comfortable reopening at the levels the president wants to right now. More than 60 of americans are not comfortable returning to old routines just yet. Why is testing, in your mind, so important to reopen an office . Good morning, john. Good morning, alisyn. I think there are two kinds of testing were talking about. We need to understand how much antibody is out there, how many people might have been exposed. Presuming that antibody gives us protection against being exposed quickly again. Before a vaccine were to become available. We need to understand how many might be immune. That helps us understand how crowded we can be, how much protection is out there in the population. We then need the viral swab, the swab everyone has been talking about to understand how many might have the disease right now. Because of these data that in fact people might be able to transmit before they have symptoms or maybe they might get no symptoms at all, we need to understand how many people might be transmitting asymptomatically. For that, we need a lot of tests. Meaning, i might test today because i dont have symptoms. I might test tomorrow and not have symptoms. Were talking about millions of tests. Doctor, lets talk about that. This new study published in nature of medicine has gotten a lot of peoples attention. The idea that the highest viral load a patient exhibits from throat swabs is two days before they exhibit any symptoms. Okay. That sounds to me youre the medical expert. That sounds to me like a game changer in terms of how could we ever know who has the virus if its before they have symptoms. By the way, why were people being tested two days before they showed any symptoms . How do we have this information . Yes. Thank you, alisyn. Those are all great points. This is an interesting study that was done in china, published in nature medicine. It did show that the majority of virus seems to be shedding prior to the onset of symptoms which would explain a lot. That really explains why goes a long way to understand why this is a pandemic. How they got them to test before had to do with context. There were context of people who came down with the infection and they started testing them on a regular basis and found out that they were shedding virus before they developed symptoms. So that really explains why theres so many infections that a lot of people i talked to will who have gotten infected, they tell me, i got infected. I dont know anybody who was sick. That happens a lot. This explains that. Is the answer to the question that alisyn asked, how can we know who has it if youre not seeing symptoms . You have to Start Testing who are asymptomatic. Which means in my office right, the person in the cubicle next to me, in this case, Alisyn Camerota, does she need to be tested even though shes not symptomatic for me to feel comfortable coming back to work . I think thats what were getting at. When you start thinking about people who work in crowded places, who might be in the restaurant industry, who might be teachers, who might be working sporting events, thats the kind of testing were talking. Were not just talking once a month. Were talking potentially once every other day to really be able to detect this really early, isolate those folks, Contact Trace the people who they might have exposed and quarantine them. When were talking about that level of intervention that we need, you need a lot of tests. I find this conversation to be frustrating. I dont mean our exact one at this moment. I mean the one weve been having for weeks. We dont have enough testing. Yes. We all need testing to feel comfortable to go back. We dont have it. We dont have the capacity for it. We dont have the capacity to manufacture it right now. So thats why i always veer, dr. Goep fert to treatment and to a vaccine. Because somehow that feels as though were fast tracking that even more than the capacity for testing. I know your finger is on the pulse of the vaccine and first lets talk about the treatment, your colleagues are working on the remdesivir. Weve heard about that drug and that may be able to be employed. Is that our best hope . Well, recommend did he say dir, were testing people who are hospitalized. Thats a flack shonn of the people out fraction of the people out there with the disease. I dont think it will be much helpful, at least the way were using it right now to sort of get us back to work. However, remdesivir could be a useful drug to help people survive. We should because the trial has been enrolling throughout this country and other parts of world, we should have an answer to that question within a month or so. The Vaccine Development and let me also mention that vaccines are going to be a little bit longer off, unfortunately. I think we can gear up testing much more rapidly than we can get a vaccine. Remember, Antibody Testing, as dr. Walensky mentioned, we dont have a reliable Antibody Test right now. Although thats coming on board, too. That would be tremendously helpful in getting us back to work. To get off this quarantine stuff. But vaccines take a while. Theres several vaccines now, about five that are being tested in phase one, which is just safety. Well know the results of that in a couple months. Month or two maybe. After that, you have to do another phase of testing, which takes a couple months and finally, you have to test for efficacy and you have to have enough cases to test a vaccine for efficahe have kaefficacy. What have your preliminary tests shown of remdesivir . I mean, theres no way to know preliminarily. Half the patients get placebo, half of them get the remdesivir active drug. I dont know who gets what. Theres no way for me to tell whats going on. Thats the way weve enrolled internationally over 700 patients, close to 800 patients now. Thats the way you do testing. Its interesting for people to see it in realtime. Youre agreeing, youre nodding dr. Walensky. I want to reiterate that were in a point right now where the virus is winning, right . We need a multipronged plan of attack. None of them can we let off the gas. We need Antibody Testing, we need vie row logic testing, we need treatment and a vaccine. I think we need to go full steam ahead on all of them. Right now were losing the battle. I mean, that is discouraging, obviously, to hear. That the virus is winning. We can see that with our own eyes from the people that we all know and interview who are getting sickened. The governors saying how hard its going to be to restart the economy and let people go outside. But i mean, again, dr. Walensky, dont you get discouraged by saying the vast, widespread testing youll need and then knowing were nowhere close to it . Well, yes and no. You know, heres sort of the way i see it. We didnt know about this virus until january 1. When you look at the extraordinary scientific discovery that has happened, the tests that we have already, the treatments that were testing in clinical trials, the fact that we have vaccines already in phase 1. Nobody would have predicted that was possible. You look at somebody who has diabetes for example. They test their blood sugars at home four times a day. We know those kinds of tests, we know that testing at a massive scale it possible in other situations. So i think we have the potential to get there. I dont think that that that weve lost that potential. I think we have to if not get there immediately. Really understand that we need to sort of have the social distancing in place until we get there. And be patient with that. Dr. Walensky, i wonder if you can weigh in on a new bit of information received overnight. That comes from south korea. That 114 people there who had recovered from coronavirus and covid19. They were sick and got better. Or at least they had it and got better, recovered. Have now tested positive again for the virus. Can you explain exactly what that means . Because obviously, one of the things were concerned about is the question of whether you can get it again once youve had it. Right. Its really interesting. I think were going to be following this carefully. We know from relatively small Animal Studies that if you rechallenge animals who have had it before, they didnt get it. They were small studies in animals. I think there are a couple of things that could be happening with the south korean study. One is did they document the fact that they cleared virus to begin with . We know people can shed virus on average about three weeks and sometimes over a month after theyve been infected. So is it the case that they actually did completely clear their virus and are now shedding it again, or is it the case that theyve been reinfected or is it the case that they cleared but didnt fully clear . I think we really need to understand where in their disease course and whether it is reinfection or persistent infection . That would be helpful. That changes the alarm bells. Because if these are just traces of the virus that they are still shedding, then thats one story. Thats different than them not having immunity and getting reinfected. Yes. I think its also important to point out that in any type of viral infection, not everybody develops protective immunity. Thats why we need things like vaccines and the community protection. I dont know the details of this study. But it is possible, another possibility is that these individuals didnt develop the type of antibody protection thats necessary to protect them from a sdweubsequent infection. Its possible that the majority of people are developing those antibodi antibodies. We dont know. I think dr. Walensky rightly pointed out, this is a new pandemic. Its been january 1. Were learning a lot very quickly. I feel confident well get ahead of this virus. Were learning a lot thanks to doctors like the both of you. Thank you so much for being with us. We really appreciate it. Be sure to join Anderson Cooper and dr. Sanjay gupta for a town hall tonight at 8 00 p. M. Joe biden will join them. As well as facebook founder and Ceo Mark Zuckerberg and dr. Priscilla chan. 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This morning, doctors and Drug Companies worldwide are racing to develop effective coronavirus treatment. But experts say the efforts here in the United States are disorganized and chaotic and the lack of a centralized National Strategy is undermining the search. One doctor told the washington post, its akah cough any, not an orchestra. My heart aches over the chaos in the response. That doctor, Derrick Angus joins me now. Hes at university of pittsburgh, school of medicine. Hes a lead. Covid19 trial testing multiple therapies. Thanks for being with us. Explain to me what you mean by chaos. Sure, john. First of all, its not just at the national level. Aits the international level. So as you and everyone knows, we have no active treatment for covid19. Weve got plenty of yts about what drugs might work, but we need to test these drugs in trials. Otherwise, were bungling along not knowing what works. The drug you hear about a lot is hydroxychloroquine. Its a synthetic version of quikwie nine. We thought it was a good idea for the spanish flu. 100 years later, we still dont know if it works. We have three problems with trying to do trials. The first is these trials themselves are hard, but when we try to do them, hundreds of people are having ideas about trials, but theyre all in competition with one another, rather than collaborating with each other. Finally, were using trial designs that make people uncomfortable a lot of times at the bedside. No one wants to be 50 50 to get out of an in an active treatment tore placebo group. No one wants to be the place theres a notion its supposed to be the National Institutes of health. The director says i think we have the necessary clout to steer this ecosystem. I want to know what works and i want it answered by june or july. Is that not where the direction is coming from . I cant it would be fantastic. I think they could have the clout. But thats certainly not whats happening right now. Whats happening right now at University Centers all over the country is physicians are being asked to participate in hundreds of different trials. They cant even choose which one to enroll in. There are 94 trials registered for testing hydroxychloroquine. Ive never heard of any drug needing 94 separate trials in the same disease. Do you think thats interesting. I hadnt heard that. Do you think theres an overemphasis at the national, perhaps nonmedical level on hydroxychloroquine and have you seen any evidence in the some 94 trials that youre talking about that it works . We have no evidence at this point and the problem is, if youre trying to do lots of little trials, thats not as efficient or as useful as trying to do large coordinated trials. Weve had over 2 million confirmed cases of covid19, mainly in north america and europe. And yet, barely more than a few thousand of these 2 million patients have been enrolled in clinical trials. Talk to me about what youre doing, the testing youre involved in right now. So we have tried to join in within International Effort to design called a remap effort. Remap trials are adaptive platform trials that test multiple therapies simultaneously and try to give as many patients as possible at least one potentially active treatment. So that theres hardly anyone in the socalled placebo group. This trial then also learns as this goes, getting rid of therapies or combinations of therapies that dont do too well and favoring over time those therapies that are doing better. We feel this is an easier trial design for patients and doctors to get involved in. What weve been doing in pittsburgh is trying to put it right inside the Health Record so the whole thing takes place across the entire system, not just in the big teaching hospitals, but in our Small Community hospitals so that any patient with covid19 can potentially participate in these therapies. Do you have any early signs . I know the way trials are conducted. I know youre smiling already. You get asked this question a lot. Any sense of what has been working in any of these trials . No. Look, that sounds depressing to say i dont know. We can find out there are 2 Million People already who have this disease. If even one in ten has been able to participate in a trial, we could have gone through about 100 different drugs by now and known definitively which ones worked or not. But as it is, at this point, we could be excited about the potential of some but we cant tell among the hundreds of ideas, we have no idea which one is the best. If you could answer one question right now, if you could ring a magic bell and get the answer to one question about coronavirus this morning, what would it be . You mean other than how can we have lots of tests for everyone . Other than that. For treatment, it would still be great to have a safe, easy to take antiviral that patients could take as soon as they have symptoms to avoid getting sick in the first place. That would still be an incredible i take it from your other comment, you still dont think theres enough tests in the country . Theres not enough tests in the country or anywhere in most of the world to effectively engage in smart or precision public health. Dr. Derek angus. This is an education. I really appreciate your time this morning helping us understand. Its been really, really enlightening. Youre most welcome, john. Thanks. What did china know about coronavirus and when did they tell their citizens . If not the world. A live report from china with the facts, next. Wasting time. Thats why Td Ameritrade designed a firstofitskind, personalized education center. Their awardwinning content is tailored to fit your investing goals and interests. 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