senior physician at john hopkins -- johns hopkins. the mat we are looking at, the account from the new york times, their ongoing tracker of covid. at this stage in the virus, they say it continues to spread nationwide. daily reports of new cases increasing threefold since the start of april. what is your take on that? what is your reasoning for that happening? guest: they are socially interacting, many without masks. the virus is not gone. it is going to take that opportunity to spread when it has them. this ba.2, ba 2.1 is another example of omicron that is less forgiving. this is always going to be expected when you have a virus that cannot be eradicated. the key was never about -- we see those who are able to. host: are we there with hospitalizations? we are not seeing hospitalizations as we saw in previous waves? guest: definitely. at the leesburg hospital in pittsburgh, i am going there tonight. we are not in the same position we were december 20 13 one. many of these cases are mild enough they are not requiring hospitalization. all of that helps save his virus and radio much more manageable. host: it allows people to go into places where they haven't gone before. restaurants and concerts. guest: it differently does varied that is not a bad thing. this is in a disease that is going to go away. our goal is to make it like other respiratory viruses. if you are someone who is healthy, has access to drug testing, it is something much more manageable. there were different recalculations when we didn't have a vaccine or antivirals. but that is not the situation we are in now. it is a little bit hard to know exactly what is going to happen. maybe universal coronavirus vaccines. all of that is going to change the landscape of 2019. -- of covid-19. eventually we will have vaccines that are more -- that has three something on the table that we get more approved vaccines. that maybe don't need to be boosted frequently. he wanted -- they may have different vaccine policies. we want to be cover hatching in based on individual risk. host: what does the update tell you about the evolution of the virus we have seen over the last two years? guest: four of those coronaviruses because the common cold. some of the protection our prior infection. some of the vaccines given -- it is going to become evolved to helpfulness rating we welcome your calls and comments at (202) 748-8000. that is a line for you in the eastern and central time zone. (202) 748-8001, mountain and pacific. you mentioned as a physician, you are seeing far fewer covid cases. when i come in, how are the symptoms different than at the head of the pandemic you saw? guest: this weekend i was working as an infectious disease doctor and i saw an incidental case. someone who came into the hospital for a heart attack and tested positive on routine screening. we have seen a moderate version which means -- they are not in the same caliber as they were we were running around. all of that has dissipated in this country. what people have to remember, this virus wasn't going to automatically disappear like a hurricane. we were there for the most part in the united states. are we increasingly going to be dealing with hospitals in crisis? host: what is your recommendation in terms of a fourth shot? a second booster shot for americans? guest: when it comes into booster policy, to me, the goal is to prevent severe hospitalization and death. when we see four boosters, we haven't seen -- for that disease except a fourth bush. other people, it is a very marginal benefit. particularly against infection. we should target the high-risk individuals. it should be a universal -- it shouldn't be a universal recommendation. host: -- news is reporting the white house could run out of covid-19 vaccines -- do you share anything with the vaccine and people who need them? guest: we cannot allow vaccines to be something that can be back and forth between republicans and democrats. we have to be proactive. this also means transitioning the vaccine to the market so that we are not left in a situation where if the government has funds to buy it, there is no access. we have to start looking for transitioning out of that emergency phase. so the politics cannot play this type of role it is playing right now. we recognize dr. amesh adalja. he is a fellow senior scholar at the johns hopkins university. (202) 748-8000, for eastern and foot -- eastern and central. (202) 748-8001, four -- from mountain and pacific. [video clip] >> dr. fauci, i want to ask your insight on when we will not call the pandemic? what kind of process we we go through to make that determination? >> there is no firm, widely acceptable definition. when one talks about the pandemic, you talk about a highly transmissible infection which is why we distributed throughout the globe. when you are in the acute formative stage of the pandemic the way we were in the united states just a few months ago, -- 2000 deaths a day. we have come down to a lower level. now we are unfortunately picking up a bit. when you get down to a level where you have a level that might be comparable to respiratory or parainfluenza. it wouldn't be considered a pandemic in the classic sense. but there is a lot of gray zone about the definition. i don't think you are going to see all -- is more than the pandemic transition mckinley with the. >> where do we stand with that given the open-ended nature? dr. fauci: i am not sure i can answer that with authority, congressman because that is not necessarily what we do. the level of infection and the level of impact in the country will dictate whether or not it is pulled back as an emergency. i don't think i can be able to give you a good answer on that. host: w00t -- we are not there yet. guest: it was always going to go that way. the key thing is -- it has taken some time to get. what dr. fauci is saying is correct. we don't see pandemics causing major disruption, 3000 deaths. we are at a different point now. we still have cases and they still are -- i think we are on our way to in it is not to be an official declaration, -- the risk is always going to be greater than zero. a couple of the tools we have, people will prioritize to it. to me, the biggest thing was hospitals. host: let's hear from our first caller. james in bakersfield, california. you're on the line. caller: good morning. dr., guest: it depends on how you define overwhelm. i worked at three different hospitals and they were overwhelmed. it may mean that they cannot staff operating rooms, they don't have enough nurses, they don't have enough. is, they don't have enough personal protective equipment, they do not have enough icu beds. it is not always easy a big line in the emergency room or the parking learned -- the parking lot. when you look at the number of people in december -- in january 2021, i have never seen anything like that in my life. i do not know that was a representative of all the hospitals. this virus does not hit everyplace at the same time. it is not on the same time scale it could be that some places were hotspot. we have never had hospitals run out of oxygen in the united states but a hospital in florida ran out of oxygen because too many people were on oxygen. that is not normal. host: in what key ways you think u.s. hospitals have changed their operations? guest: they have become much more aware of what a pandemic can do. there was some complacency in the past. this was kind of an afterthought. most managers were focused on like a chemical spill, an accident on the highway, and mass shooting. all those things are what they thought about. they didn't think a pandemic could cause this type of damage. there are people in hospitals that did but it wasn't something really palpable or something they prepared extensively for it. now i think they have become more tomorrow attuned to that risk and not about supply chain, staffing, induction control. boosting infectious disease specialist roles in hospitals. also telemedicine which we are already starting to accelerate, greatly accelerated during the pandemic. things look different after the pandemic them before the pandemic. hopefully this will be better so we are prepared for bad flu season and the pandemic. host: we welcome your calls. (202) 748-8000, eastern and central. (202) 748-8001, mountain and pacific. caller: good morning. i have taken three vaccine shots from under no. can i take the fourth vaccine shot from pfizer? guest: there are some ways they stimulate the immune system differently. i think you can take the pfizer shot if you want for your fourth dose. or you can take the madonna. you might get a little bit different. host: what is your general guideline on mask usage these days? guest: just because the government doesn't have an issue mandated for you to wear a mask doesn't mean you cannot wear a mask. what are your risk factors for disease, what are your tolerance ? are you going to be tested when you come back from going on a cruise? i don't think it is going to be one-size-fits-all. people have to learn what level of risk is susceptible to them and how much they want to try to avoid covid-19 even though covid-19, over time is unavoidable. especially for high-risk individuals, when they are in certain situations, masking is appropriate. it depends on the level of risk tolerance they have. that is something i cannot telegraphs to people. they have to learn -- that is that we should have been doing early on is teaching people to get accustomed to the virus. there's always going to be something that carries the risk when you socially interact people. host: a cnn headline, new -- writing here about the new white houses covert response coordinator. in the fall and winter had a stern warning the u.s. could potentially see 100 million to covid 19 infections if congress doesn't approve federal funding to fight the pandemic. that warning from dr. -- who said -- it even came as a surprise to some biden administration officials. guest: it is important to remember there are assumptions built into those models. there are other assumptions reflective of reality. maybe that scenario might be useful for them when they are trying to get congress to act on some funding bill. it is in the realm of possibility, probably not. people take the biggest number and model spits out and use that for arguments sake. we have to stop looking at the cases we are talking out respiratory virus. we have to keep our focus on hospital capacity. it is a different kind of issue we are dealing with. we need to be clear on that. you see the administration focusing on cases from hospitalizations. let's focus on metrics that really matter. hospital capacity is the best one to use. host: typically in a year, how many cases -- how many influenza cases does the usc? guest: hundreds of thousands of cases. maybe up to a million in certain situations. during the 2000 9h1n1 pandemic, -- of the population got infected. we continue to see hundreds of thousands of cases of the flu every year. and we still have tens of thousands of deaths from the flu. i don't think covid-19 is going to be less than the flu for a couple of years. i still think it is going to have an outside influence. maybe three times the number of deaths for covid than the flu. we are getting to a point where we can start thinking about it in the same way we think about the flu, which we could do for so long. host: let's hear from -- in annapolis, maryland. caller: thanks for having this program.