Newswise Live Expert Panel discussion of unique angles to the COVID-19 outbreak of interest to the public and the media, including public health, testing, business and financial markets, 2020 elections, and more. 

Experts from institutions including Binghamton University, AACC, Rutgers, Cornell, University of Virginia, and more will participate in a two-part series of moderated expert panels covering a wide variety of topics, with questions prepared by Newswise editors and submissions from media attendees. 

Who:

Thursday

  1. XinQi Dong, MD, Rutgers University (Epidemiology)
  2. Zhaohui Chen, PhD, University of Virginia (Finance)
  3. Ali Khan, M.D., M.P.H, University of Nebraska Medical Center (Public Health)
  4. Valerie Reyna, PhD, Cornell University (Psychology)
  5. Tom Ewing, PhD, Virginia Tech (History)

Monday

  1. Carmen Wiley, PhD, President, American Association for Clinical Chemistry (Lab Testing)
  2. Dean Headley, PhD Wichita State (Airline Industry and Travel)
  3. Jennifer Horney, PhD, University of Delaware (Epidemiology)
  4. Dawn Bowdish PhD, McMaster University (Immunology)
  5. Daniel McKeever, PhD, Binghamton University (Finance)
  6. Dr. Jennie Kuckertz, Ph.D, from McLean Hospital (Psychology)
  7. W. Graham Carlos, MD, Indiana University (Pulmonology)

When: Thursday, March 12 at 2 PM EDT and Monday, March 16 at 2 PM EDT

Where: Newswise Live event space on Zoom - https://newswiselive.zoom.us/j/7459578068

Registration for media, as well as colleagues from participating Newswise member institutions

 

The following is a transcript of the Newswise Live Expert Panel on Thursday, March 12, including the following experts:

  1. XinQi Dong, MD, MPH, Rutgers Institute for Health 
  2. Zhaohui Chen, PhD, University of Virginia 
  3. Ali Khan, M.D., M.P.H, University of Nebraska Medical Center
  4. Valerie Reyna, PhD, Cornell University 
  5. Tom Ewing, PhD, Virginia Tech  

Thom Canalichio:  Welcome, everyone, my name is Thom Canalichio here at Newswise, and this is one of our Newswise live expert panels. So we've invited these five wonderful experts from several different universities and other organizations that are working with us to be available today to talk about the coronavirus and the COVID-19 outbreak that's currently happening. We have experts on topics related to health and medicine, as well as things like psychology, history and business, to try to answer a lot of questions that they feel should be discussed in the media more widely and give our media participants here logged in an opportunity to ask questions. 

So a reminder again, for the media who are logged in, please, chat any questions that you have directly to me, or feel free to chat it to the whole room and as we go through the process, I will relay those questions to our experts. We'll start with a couple of questions for Dr. XinQi Dong and then move on to another expert with breaks to invite the media to ask further questions. Well, we have some prepared already to kind of get things going and then we'll certainly circle back to everyone again at least one more time and try to see if there's any discussion amongst our experts that they'd like to respond and build on what each other are saying, we'd certainly find that interesting if that can happen. 

So without further ado, I want to introduce Dr. XinQi Dong from Rutgers University. Dr. Dong I believe is an expert in epidemiology among many other topics. So I'd like to ask Dr. Dong, if you can talk a little bit about what we know about the COVID-19and Corona virus and the contagion factor. This is something that's been covered a lot in the news and I don't think there are clear answers yet, but maybe you can point us in the right direction about how long someone may be contagious, about the virus, surviving on various surfaces and how we measure and monitor what infection rate may ultimately look like as that happens. What could you tell us about that Dr. Dong?

Dr. Dong:  Thom, thank you for hosting this and for Newswise as well and to our esteemed colleagues. My background, I'm a geriatrician by training and epidemiologist and I direct the Institute for Health Care Policy and Aging research at Rutgers University. COVID-19 virus, you know, this pandemic, there's various different hypothesis, we really don't know as much as we ought to know. Some of the things that we do know that this is, you know, contracted by close contact proximity for people coughing, sneezing, bodily fluids, and really are factors that drives the communication of the spread and when you look at or rather that the factor that drives the spread of one person to the next set of person, those numbers are quite a bit of variability as well. So you know, when you look at a comparison to other SARS, MERS and Influenza related viruses, really we don't know what our denominator really is in terms of percentages and mortality and the risk for spreading. 

However, I do think that despite all of this, how we measure, COVID-19virus and how we detect it are really important. I think, having social distance it is something that we've been suggesting to our patients, if you're sick call your physician first, before you come to the clinic, especially having specific set of symptoms; you know, high fever, cough are some of the symptoms that we often talk about but the geriatric patients, are not often the same as, for example, in older adults, they may not be up to [Inaudible 03:44] the high fever as a younger adult or a child who may be able to. So signs and symptoms are really different and I think keeping the healthcare providers family being cognizant of that it's really an important factor to understand the difference between what's allergic reaction, what's COVID-19and what's influencing that.  The social distancing is something that we really have been recommending specially for those with co-morbidities, people with lung disease, people with diabetes and people with underlying immuno compromised conditions, and really to reduce the spread of the virus as well.  In terms of detection on surfaces, Thom, it's a bit of a controversial question in the sense that just because we measure a fragment of a virus or bacteria on the surface does not necessarily mean that's infectious per se. A typical example that I give to patients is that if you look at the treadmills you can often consider them some of the most contaminated places does not necessarily mean it's the most infectious because bacteria and virus can only live outside of the host for so long and just because he detect protein fragmentations does not necessarily mean they're contagious in nature. Let me pause here.

Thom Canalichio:  Thank you, Dr. Dong. I want to dig into a little bit more about some of the questions on geriatric patients and others who might be at risk because of age and other immuno-compromised conditions. I want to remind our media participants that you can submit questions on the chat, and we'll relay those to each expert. So I want to give Dr. Dong a chance to answer a little bit more about that. If you can describe what are some of those conditions that might cause a patient to be immuno-compromised? And what are some of the strategies for prevention as well as treatment of those? Obviously, there's no cure specifically for this disease, that's been mentioned pretty widely in the news, but treatment in terms of supportive care, I understand is the name of the game so what can you tell us about those concerns?

Dr. Dong:  Sure, thank you in terms of the prevention and treatment, and well let me get to the vulnerability, anyone with, for example, with ongoing pulmonary disease like Emphysema, as Diabetes, people who have history of cancer, who are taking chemotherapy, people with immunological conditions, such as Hepatitis or, you know, Lupus, or take medication that suppresses immune systems, they're really those are the patients who are the most vulnerable as well and I think in terms of prevention, really, I think, as you've heard, again, and again, wash your hands and sing two Happy Birthday equivalents, to be able to clean your hands and we think about social distance, recommending in a one and a half arm's length from the people next to you, but in elderly patients are very different because often they're the people who are mostly in need of care and especially for elderly who have needs for activity of daily living, they need dressing help, feeding help, going to the bathroom, and when a nurse's aide or a family member comes into the house, they really should be washing their hands and wearing gloves and trying to have the same people come into the house all the time, so you know whether that person is having symptoms over time.  The mounting of fever and the immune system are things we do need to consider because elderly as I said earlier may not mount the same fever or the immune response may be different. As you get older, your immune system does weaken as a sort of a normal part of aging and I think really needs to be taken into consideration, treatment in terms of treatment symptoms, and I think the most important thing, Thom is to differentiate between what is a factor in pneumonia, what it's a viral pneumonia, what is allergic rhinitis? What is a flu, for example, and understanding the signs and symptoms really the most important point of thinking about treatment because for someone that's really having a high fever, having lower respiratory symptoms, that's short of breath, you don't want them to stay home, you actually want them to call their physicians and to understand this outside of the norms, of the symptom that he or she experiences as a respir symptom and when they should be tested and those are really important questions to consult with the healthcare providers.

Thom Canalichio:  Thank you so much, Dr. Dong, any other questions for Dr. Dong from our media participants, please chat those and when we circle back around, we'll relay those to him and have him answer. I'd like to move on next to Dr. Ali Khan from the University of Nebraska Medical Center. Dr. Khan is an expert on public health and infectious disease in a number of other topics and I'd like to invite you to answer some questions now to Dr. Khan. Thank you so much for joining us.

Dr. Khan:  Thank you, Thom, and as a little bit of a way of introduction. So I spent 20 years at CDC, chasing SARS and other highly contagious infectious diseases detailed that book Work in the Next Pandemic and here at the university, we've been receiving patients for weeks now from the Diamond Princess and other sites since we're the premier bio containment unit in the United States.

Thom Canalichio:  As many people may recall from the Ebola crisis just a few years ago, the University of Nebraska Medical Center was one of the main places where patients were being sent when they were brought to the US for treatment. With your knowledge about, obviously your own medical center, as well as the hospital system at large. Dr. Khan, how do you assess the capacity for a large volume of admissions if the infection rates were to spike? What's our capacity there? And how are hospitals preparing?

Dr. Khan:  So we're clearly unprepared and we don't even need to talk about a pandemic during a really bad flu year, we know that we see ER and hospital diversions because we can't handle a really bad flu year in the United States, let alone this pandemic. So our main focus is on helping healthcare prepare for a potential flood of patients. So what they're doing is they're looking at those two scenarios. How do I take care of patients coming in the door, make sure we do it safely. Let's not infect our healthcare workers, not infect any other patients in our hospital and then also, how do we make sure that in addition to one or two coming in, if dozens of patients came in, how do we take care of them and we already see healthcare as being very proactive and innovative in approaches. So for example, one of the key things we want to do is make sure that we identify and isolate patients very early and Dr. Dong was very eloquent talking about calling your doctor beforehand when you come into the ER so they know that you're coming but some ER's have now sort of started screening people even outside the emergency room in the hospital, so they can quickly triage them based on where they need to go and they're less likely to infect other people. We know hospitals in Washington are already doing Doc drive through testing of their healthcare workers, which is now being extended to other people. So you don't have to go to a healthcare setting to get tested because a) if you're infectious, we don't want you to infect anybody else and b) if you're absolutely fine, we don't want you to get infected by somebody else who's in the healthcare setting. So these are all the conversations going on across America to get ready for a potential flood of patients coming in.

Thom Canalichio:  And what would you say would be the best course of action based on the current numbers and infection rates that we should start doing here in the US? And would you think that something along the lines of a kind of lockdown that was just announced a few days ago in Italy, would be effective and that now might be the right time to take those sorts of actions?

Dr. Khan:  So what we need to do in every community in America based on what disease looks like in that community, is think about what are called non pharmaceutical interventions, or social distancing is a colloquial term for that, so what we're trying to do is slow the spread of disease into the community and spread it out over a longer time and what that does a couple of things. So if you slow that large increase in cases, that's less likely to be a burden on hospitals, which is important and if you spread it out over time, you're giving public health time to do what they need to do to try to contain this disease and you're also buying yourself time for potential vaccine or therapeutics or drugs in the future.

Thom Canalichio:  Thank you, Dr. Khan. If anyone has any questions for Dr. Khan, please chat them to us. I want to move on next briefly to Zhaohul Chen, who is a Professor at the University of Virginia Macintyre School of Commerce, to talk about a couple of topics related to business in the global economy. Thank you for being with us, Zhaohul Chen.

Dr. Chen:  Thank you, Thom

Thom Canalichio:  I want to ask you to tell us a little bit about what your knowledge is of the Chinese economy, and in particular as they really clamped down to get the outbreak under control. We saw their stock market; in fact rise and I think you have some interesting views about that. Tell us what your take is on how we can assess the response of the Chinese economy and the Chinese government.

Dr. Chen:  Sure, so as we know that this disease started in China and is still going on, even though the report comes to us that this situation is getting much better, but still people are suspicious of the accuracy and maybe we worry that the government may actually underestimate the severity of this disease. Having said that, it's clear that the government made a choice, rather than sort of stop or slow down the spread of disease, they actually chose another direction that is to make everybody to go back to work, okay? So that may, by the conventional wisdom, make the spread of disease worse but on the other hand, you have to go back to work to keep the economy growing again and most of the household activities run out of money and some do need to work or do basic jobs that have to sort of come back to work and the rate of recovery, some estimate is about 60/70%, so the economy is [Inaudible 14:40] come back. 

And the government to help that in the sense that they are pumping a lot of money into the system, into the banking system or give money to the state owned big companies; as a result because at this stage, the money is not needed in manufacturing because the money's not the key problem, the key problem is that people want to work here. So to park the money into the stock market and elsewhere, so we see that the stock market is well, even though the economy is contracting, so this is what we see as strange things happening.

Thom Canalichio:  If anyone else has any questions for Zhaohul, please chat them to us. I wanted to ask you also what you can tell us about what we've seen this week, obviously with a lot of stock market volatility and energy markets, in particular being predicted may be affected as there was some controversy with OPEC and oil pricing as part of this, obviously China a big energy consumer with their economy slowing down temporarily at least their demand for energy was lower. How do you see that whole picture shaping up? And what that might mean for the US economy and the global trade overall? 

Dr. Chen:  Sure, okay. So the breakdown of negotiation between Saudi and Russia, so this is what happened on Monday and that sort of wreaked havoc to their stock markets and capital markets in general. So the reason, in my view, is really sort of short term and is motivated by factors other than economics or business factors. So in my view, I think Putin has no incentive to give up at this juncture, because he is seeking to change the constitution. He wants to be the President until at least 2030. So on the other hand, The Crown Prince of Saudi Arabia also has its own political problems because he wants to be the next successor. At this point, he really needs to appear strong and firm as a super strong leader. So both of those leaders have all the incentive in the world to appear strong and cannot compromise because they don't want to appear weakened and cannot change the landscape of politics.  As a result the head bursts completely, so this is over, they don't want to compromise.  In the past Russia and OPEC almost always, you know, in this situation, try to negotiate and compromise, and in the past, mostly they'll work well, but at this particular juncture they cannot, okay? Because they cannot afford to compromise, they have to appear strong. So the topic down on economic habit have sort of spilt over, but it's okay in the sense that both Countries can afford at least the short term to have this sort of chaotic, okay, they can have some deficit and they can take some hit in the oil revenues. In particular, Russia, Russia has been sanctioned by th west for a long while so they can sort of weather the storm a little bit. So I think it's going on a little bit but will not have a long term impact, because I think eventually they'll come back to the negotiating table again and solve this issue.

Thom Canalichio:  So, Zhaohul, we have from Mark Manier: “A key part of leadership in a health crisis would be projecting confidence and relaying accurate information and reasonable policies, the Trump administration record has been mixed on this front. Could you comment on last night's speech by the President if you followed that closely enough that you feel like you can; and for example, blocking travel from Europe, was this adequate, too little or too late?” And I'd love, Zhaohul, for you to answer that. I'd love to also have Dr. Reyna answer that.

Dr. Chen:  So, all I can comment here is the reaction of the stock market today, as we know that the European and American economy are close, very intertwined. So the stop of the travel is going to be a big blow to the economy. Today we have, at least in the early morning; at least, we have like, almost close to 10% decrease in stock market. Now it's about...it's down a little bit more than 2%, so it recovered a little bit. The investors worry about, that the policy, this sort of stop [Inaudible 20:48] may cause more harm to the economy than, actually, the disease itself. So, people really worry about the uncertainty in terms of the government policy because, okay let's just make just a crude and cold sort of a calculation. So the death rate, let's see, assume it's 2% and most of the concentrates are older people. So those are like retired people and are maybe less productive.  As a result, in fact, to the GDP growth or the whole economy, it's not as even though with that play out, as it is, so mostly the stock market does come from the uncertainty in government response.

Thom Canalichio:  I want to go next to Dr. Valerie Reyna of Cornell University. Dr. Reyna, I think, with your background, talking about risk perception and a lot of other topics related to that, I think it'd be very interesting for you to weigh in as well on your assessment of President Trump's address last night. Dr. Reyna is from Cornell University where she's in psychology. Tell us your views on that in response to Mark's question.

Dr. Reyna:  I'm in the Human Neuroscience Institute and direct the center on behavioral economics and decision making and thank you so much for doing this and getting the word out, obviously, information is so important. It's difficult for me to comment on the President's address, but I can certainly comment on as a scientist of the psychological components here.  I was struck in all of the comments of the experts so far, how contingent everything they've said is on human behavior. Human Behavior really is the linchpin here, whether we're talking about the reactions of the market, which seemed to be very psychological or we talk about non business causes and non-pharmaceutical factors. We're talking really about Psychological Science and Human Behavior. So with any virus, whether we're talking about HIV, or HPV, the Human Papilloma Virus or the Corona virus, human behavior is key and there's a science of that, that's extremely instructive. So people are getting lots of information from many places. They're getting it from social media and that spreads enormously quickly. They're getting it from family and friends. They're getting it from new sources like this one and this is really, really important. I can't say, I can't tell you, I can't overestimate how important it is to get the news out to people and to continue to repeat it but people are awash in information and a lot of it is misinformation. So they're struggling and what the psychological literature says they're struggling to figure out what is the gist of the information? What does all of this boil down to, our own models of risk communication really relied on the computer as a metaphor for human thinking but people do not think like computers, they don't just take in a whole bunch of facts and fill up with facts and then retrieve the facts, they interpret the facts, so it's extremely important, and this is the foundation for our emotional reactions to the facts as well. When we interpret the facts, it's called cognitive appraisal. We decide whether Is this a threat, should I feel fearful? Or should I feel relief? And you have certain paradoxes right now in the information that's coming at people.  People are in a quandary over whether they're in a low risk situation, or they're a high risk situation and it's confusing, and it's confusing in a way that is true many public health threats. On the one hand, if you look at the absolute number of deaths so far, and people talked about the denominator out of these large populations, many people will say; ' That's low risk, because there's a few people who've died out of large populations'. On the other hand, we know that this is changing rapidly and so if we think about prevention and mitigation of this pandemic, this is going to rise rapidly. So the actions we're taking now are because we perceive high risk, but we're not perceiving, it's not necessarily at the present moment, it's what's going to happen very soon. So the experts are sort of saying two different things to people and naturally, people are confused but the bottom line is, this is going to change, these cases are going to increase, from a few today to many tomorrow, as Dr. Falchi said yesterday, and that's really the gist that we have to stress that even though the number of known cases at the moment around you may be small, the nature of epidemics is that there's a cumulative probability mounts up really fast and it mounts up much faster than people can apprehend.

Thom Canalichio:  We have a question from Freelancer Kathy Kowalski asking about the impacts of social distancing? And what are some of maybe the barriers to people implementing those things in their lives, especially where it might involve family with members who are older and have these immuno-compromised types of situations? What are, in your view, the complications to people taking action on the right steps that they should take in their personal lives, so that they could protect their family members, especially in a case for example, where they might be compelled to travel, to visit family who maybe don't live in the area or things like that, how does that break down and people take the gist of the risk and then start changing their own behavior?

Dr. Reyna:  Well, you said it, I mean, the people have to make decisions and this is where the science of risky decision making is so fundamental. They have to absorb all this information and make decisions as an individual and that will then determine how they process that information, will determine their actions and their emotions. So, and there's some really predictable things that are difficult to understand. For example, young people may be vectors of this, meaning that they're infected, and they're spreading it to lots of people, so they themselves may not show symptoms as severely or as soon as older people. So you have people who, and this is true, by the way in the ordinary flu season as well, people spreading the disease and then people vulnerable to the disease. So you have to think about, again, two different things that almost seem contradictory and in making people's decisions, they need that information.

Thom Canalichio:  Thank you Dr. Reyna for some historical perspective, I want to go now to Dr. Tom Ewing of Virginia Tech, and ask him to tell us a little bit about some historical examples, for example, Dr. Ewing, compare the COVID-19 outbreak to the 1918, Spanish Flu or even something a little bit, maybe less well known the Russian Flu in the late 19th century, and how the actions that officials took in those situations can give us a template for how we can maybe make better decisions today.

Dr. Ewing:  Sure, thank you and I am going to echo my colleagues in thanking you for arranging this forum and giving us the chance to participate but also more broadly to be able to disseminate information that is useful more and more widely. There are many, many parallels to the 1918 influenza epidemic, particularly around the question of social distancing, non-pharmaceutical interventions, many of the things that we're experiencing right now, closing schools, banning public meetings, trying to limit travel, taking steps to ease congestion in public spaces. Most of those were implemented in the United States strictly in the cities in the fall of 1918, and so I think we can look at those examples in a couple of different ways. One is to say, what was the point in the epidemic at which they were implemented? Was it just the right time? Was it too late? Was it too early? How effectively were they announced, enacted? Were they were they completely implemented or were they partially implemented? And then to go back to this question of psychology, how do people respond to these kinds of measures and you can see a real spectrum of responses in the 1918 influenza epidemic in the United States. Things like the decision to close schools which a lot of school systems are dealing with right now, was pretty widely adopted in 1918 across the United States. In some cases, this was done early enough so that the children were kept home and they did not spread the disease as widely as might have happened, and in other cases, it was probably done too late, the disease was already in the community, it was already spreading and at that point closing the schools doesn't really do any good at all. In fact, it could make the situation worse by dispersing children back into their, into their families and out into the community and other ways, but it's interesting in 1918, there were some schools and very large school systems that actually chose not to close the schools. New York City and Chicago are two of them, with the argument that you also hear now, which is the schools themselves may be a safer place for children. There you could practice pathogenic practice activities there. You can screen children and see if they're sick and in some ways you can provide social services and so I think the historical example of the 1918 influenza epidemic gives us a kind of range of ways to think about the current one, we can look at situations in which correct decisions were made that were implemented that may have made a difference in terms of slowing the spread of the disease and lessening its impact, but there are plenty of counter examples, you know, situations where social distancing practices were not implemented, and there was the disease spread much more quickly and became more deadly as a result, or where they were implemented too late or very partially, and one example, you can actually hear less about it now than you did a couple weeks ago, was a whole question of wearing masks, there are cities in United States, San Francisco, in particular that made it mandatory to wear a mask out in public, those measures probably didn't help at all, the masks were not effective in containing the spread of disease, and what they actually did was to provoke people into a kind of resistance, they didn't want to wear the mask, and so they didn't, and so I think that we have to be very aware, as we implement public health measures, to think about the timing, to think about how they're being enforced, how widely and how are people going to react to them.

Thom Canalichio:  Thank you, I'd like to start back again to Dr. Dong as well as Dr. Khan to ask about the announcement made last night from the Trump administration regarding the 30 day travel ban from Europe. This was part of Mark Mainers question about responses to Trump's National Address last night.  Dr. Dong would a measure like this, in your view, first of all, be the right step at the right time and ultimately be effective and do you think maybe we should be doing this with wider regions of international travel?

Dr. Dong:  That's a good question comments Thom, it's really difficult to decipher and the one reason is that is because there's a community spread as Valerie said that there are many vectors, people who are fairly asymptomatic who already traveled across the globe and so it's really not clear shutting the border or limiting travel can achieve the same benefits, as I think that one may hope for, but I think the better question is really how do we empower patients and families and community to adopt those hygiene practices and to really change your behavior that we have so used to for years and I think the last three months really forced us to think about how do we need to act differently? How do we behave differently in our day to day lives to minimize the spread? I think the core the responsibility, as much as the government and the systems can play a role really resides to each one of us and how we spread this news and what's the right thing to do for our peers and families.

Thom Canalichio:  Dr. Khan, what's your view about the announced travel ban from Europe and where else should we be considering to ban travel and what ultimately might be the effect of this?

Dr. Khan:  So thanks, Thom, as you know travel bans are a political lightning rod. So I'll stay away from the political lightning rod and stick with the science for now, so a travel ban associated with a clear strategy around containment is the model that we see from China. So China had a clear strategy that they want to contain and as they liked, I think, as President Xi likes to say; 'Gonna beat back that devil virus into the wild'. So they've gone from 5000 cases to 20 to 40 cases a day and now what they're doing is in Beijing specifically, international visitors to Beijing must undergo a 14 day quarantine, if you're coming into Beijing. This is sort of variably enforced throughout the country at this point may eventually go countrywide. So China has decided it's not called a travel ban, but it's essentially the same thing, right, which is, they've gotten rid of disease within their country, or they almost have gotten rid of it and they're not anxious to import any back end at this point from somebody else.

Thom Canalichio:  Thank you, Dr. Khan.  Dr. Reyna, what is your impression of the acceptance more widely around the US or around the world of things like these travel bans? As people categorize their perception of the risk, right? Are they potentially becoming more inclined to either voluntarily limit their movement around or accept if it's imposed by the government? What are your thoughts on that?

Dr. Reyna:  Well, again, it's all hinges on people's understanding of why the travel ban might or may not be effective, what exactly is it trying to do? and again, this distinction between containment at the initial stages versus spread at later stages is very important. So these policies have to be explained to people. The other issue is that any risk is perceived as more dreadful if you can't control it personally. So control and personal control of your risk feeling that you're out of control is been a long standing classic dimension of risk perception, risk communication and reaction to risk. People need to feel that they can take the protection, their actions they can take, and when you control people's behavior and tell them they can't do things and you see this for example, in the vaccination controversies, which is going to be an issue obviously when we develop a vaccine for the Corona virus, some people feel if the government is telling you that you must take a vaccine that gets people's back up. So, we have to explain to people, at the end of the day, we have certain policy tools, we can quarantine we can, the government can do certain things, but it helps enormously when you're talking about millions of people, that they understand why government is taking certain action and that they feel personally empowered.

Thom Canalichio:  And what would you say about for example, in an academic community or university campus and the decision to halt classes, or hold all classes online, but no classes in person, as I believe a number of universities are announcing each day as this progresses. One of the questions from our attendees, it touched on concern about anxiety and social distancing among college students, as a precursor to mental health concerns as well as other things. What's your take on how we can better communicate to university communities, for example, to mitigate those issues, as even though their lives are getting disrupted?

Dr. Reyna:  Yes, I think it's very predictable that people are going to feel more socially isolated when they're more socially distanced that just goes with the territory and a lot of research has shown that that connection to other people is so important for health, mental health and physical health. So however, we live in a wonderful age of technology, and for all the problems that social media and the other technologies create, they also create opportunities to connect to other people, to other human beings and we're now trying to take advantage of that and so people do not feel isolated. I also think people in their local communities need to reach out to people that there are older people living alone and so and think about your neighbors. So it is very predictable as these social cues mount, that there's something wrong when you cancel classes and people have to go home, when sporting events are canceled, that is going to provoke anxiety and when you have people more socially distanced they're going to feel more isolated and that's one of the coping mechanisms, there's other people who are dealing with fear and anxiety. So we have to think about that and be proactive and think of ways to connect electronically in other ways that can reassure people.

Thom Canalichio:  Thank you.  For Dr. Dong I would like to ask whether or not you think that social distancing at this stage, is it too late, are more drastic measures needed. This is from one of our reporters attending.

Dr. Dong:  I'm sorry; I delivered some hearing, would you mind repeating the question?

Thom Canalichio:  Yes, absolutely, absolutely. Is it already too late for voluntary social distancing to be effective in the United States? And how long would those kinds of measures such as working from home and kids staying off campus how long would that be needed to be in place for it to be effective if it was going to work?

Dr. Dong:  Sure, Thom, I don't think it's too late. I do think that especially looking at the trajectories of the viral spread that seems to be still going up. I mean, I think the potential mode and when that happens, I think the social distance does play a role, but I do want to acknowledge what Valerie said earlier about the unintended consequences of social distancing, especially for older adults, in the way that we know social isolation leads to premature death and all sorts of other mental health outcomes, that we ought to leverage other ways to be able to support the families and vulnerable populations. In terms of  when do we decide to help that or reduce that I think all the factors that I talked about earlier are not [Inaudible 40:35] or are zero, essentially looking at the speed of the spread of the virus from one person to another and there are variant estimates of what that number is going to be, but I think until the numbers become really stable a bit, then I think there's a social distance does play a role and I think some of that does speak to the fear factor that Valerie talked about as well the unknown, right, unknown how that will impact me, my family people around me but it's not to say that we should just do a social distancing myself without acknowledging the unintended consequences.

Thom Canalichio:  Thank you to Dr. Khan again, one of the questions from our reporters touches on a study being done in Germany currently of COVID-19and the results indicate that the virus may be still traceable in the patient in the form of the RNA, whether or not they're still contagious is not known. Are you familiar with this study? What would you say to exploring that question itself to try to determine the contagious period and other questions?

Dr. Khan:  Glad to provide a little insight into that. So the data suggests that people are actually quite infectious very early, when they start demonstrating symptoms and that maintains true for about five days or so before the virus decreases and then for most people, it's gone in about eight days and this is in their nose and in their mouth and so the upper respiratory part of their body. Now independent of that we do know that you can find virus fragments and blood stool, urine, but they don't seem to be able to pick those up on virus isolation. So that's a little bit different than finding the live virus than finding pieces of the virus. So all of this is encouraging, some of it is discouraging news, which means that when you're mildly are just sick, that you putting out a whole lot of virus, which explains why we're seeing such efficient transmission within our communities but the fact that it rapidly declines means that after about 10 days or so you're unlikely to be infecting other people. There are also additional studies that suggest that if you have very mild or asymptomatic infection, you also likely are not shedding as much virus and are less likely to infect other people. So some pieces of good news in that, I remember the initial concern that the PCR was positive and stool and others and the urine and stuff like that but just to remind people that just because you have a fragment of a virus in a fecal sample does not mean that it's live, and also does not mean that this is a source of transmission. We know that people most likely are getting infected, as you heard from Dr. Dong earlier, from coughs and sneezes and stuff like that at short distances.

Thom Canalichio:  Thank you. I want to ask Dr. Chen, again, about impact to markets and the economy. We're seeing the Dow continuing to drop. I just loaded it on a browser here and it's down almost 2000 points at the moment. There have been continuing announcements about cancellations and major events being postponed, for example, we The NCAA Tournament coming up, I just noticed that UVA, my Alma Mater, our basketball game against Notre Dame is canceled. How would you predict? How would you analyze the impact of these kinds of things to the economy in the United States and Globally? With travel bans, travel restrictions and major events being canceled, universities halting all events? How do you see that taking shape over the coming weeks?

Dr. Chen:  Okay, so first of all, I have a live stream here. So it's actually most of them don't come back, right now it's only down about less than 2%. Okay, so that's good news, because in the morning, it was down 10%. So I'm glad mostly.

Thom Canalichio:  So my numbers are delayed, because I'm just looking at it on Google and you're looking at instant right?

Dr. Chen:  Yes.

Thom Canalichio:  Gotcha. 

Dr. Chen:  Yeah, I track it too. I mean, since it's so fluid, so it's good for me to. 

Thom Canalichio: So that's a huge swing then to be down almost 2000 and then and then back to only down 2%, big change.

Dr. Chen: Exactly, so the volatility has gone way off, the up and downs since Monday as just tremendous, okay. So in terms of people's activity, and clearly you can tell it has really bad consequences on the economy, because we slow down our business activity, we're not creating as much value as well as from work this side, okay, from consumer side, we don't consume as much anymore. We don't go to restaurants, okay, we don't buy cars anymore, because at this juncture, you cannot even go out why do you need a car? So all the sort of imposing terms of supply in terms of going to work be productive, as well as a consumer to consume to spend to create value, both of this channel was sort of effective. So if China is any sort of example we can tell that actually, you know, the economies is go way down. So in this sort of lockdown period of time, generally it's just gone way down. So I don't think we're there yet but you can see that it's good to have some consequences and also because of the government activity as I said earlier, okay. So we also have huge uncertainty about what the government will do, in particular Trump will do. That uncertainty, you don't know what's the next activity is going to take uncertainty is going to hurt investors’ confidence too.

Thom Canalichio:  In looking at the global economy, and International Trade, if we were to see prolonged impacts on the US economy that resulted in lower demand for manufactured goods, for example, coming from China, if those sorts of things were to really be in place for some time, are there other major long lasting impacts that you'd see in terms of changes to what all of our intertwined economies around the globe are doing in terms of supply and demand for goods and manufacturing?

Dr. Chen:  Okay, so right now, sort of the epicenter of this disease is moved out of China, moving to Europe here, so as a result, I think what you just described in terms of demand for Chinese exports, sort of [Inaudible 47:58] it already happened. So what happened in China, so as a response to this sort of lower demand, what happened is that the government [Inaudible 48:11] so they try to stimulate its consumption and spend within China to fill the gap of this demand deduction. So, as a result, they have all kinds of a big construction plan, which is going to play out in the open next [Inaudible 48:33]. So the government spending has gone really crazy and people are expecting other things to [Inaudible 48:42]. 

So in terms of long term view, I think the healthy development in China right now, I mean, not necessarily in terms of the consumption going up, is going to be good to the economy because eventually what happens is that it will spill over to other countries as in the US. So maybe the demand for US goods and also we should not forget the Trade War Treaty, okay because just conclude with one, China's agreed to buy around 200 billion goods. I think at this juncture it's perhaps a good thing for the US economy. For example, the energy goods okay. So right now the demand for US energy good is so low because oil prices so low, so but because of agreement, so that would help [Inaudible 49:40] a little bit.

Thom Canalichio:  Thank you and to Dr. Ewing. How do you view through the lens of history in these past outbreaks that you've studied, changes to the global economy as well as what other major steps that we should be taking now? And where do you see us in the course of the next maybe two to three months? On the basis of those previous models?

Dr. Ewing:  Yeah, no, and I appreciate the question and also, listening to the comments from the panelists, reminds me of a conversation I've had half a dozen times today, which is, how is this what we're going through right now, similar to what we've experienced before and I don't think there was a close analogy to this recently, we had some disruption after the September 11 attacks, there was the H1N1 concerns in the spring of 2009, there was the economic crisis of 2008, but none of those, as far as I can tell, had the same kind of not only pervasive effect on society, but the mobilization of governments at every level to implement these kinds of really drastic measures. So I think we're in a new territory right now and I think we need to recognize that, appreciate that.  History can still be useful; I have to say that because it's just my profession, if you look at the situation in the 1918 influenza epidemic, it comes to the United States in the middle of a war. United States had been at war. The European powers are in their fourth year of the war and in some sense, the disease is overshadowed by that situation and its part of the reason there's less attention to the disease, in some cases in newspapers, the government is preoccupied. The United States government makes a decision, it's endorsed by President Wilson, to continue sending American troops across the Atlantic on these very tightly packed ship transports, where very, very large numbers of men got sick and many of them died. They were fully aware of the risks of that, but they decided the war effort was more significant it was more important to get man across the across the ocean to fight the war than it was to even recognizing the cost and so I think this reinforces the point that you've heard several times, which is, we have to deal with this disease, but we also have to recognize we're not dealing with it in isolation, we have all the contemporary global economic issues that we just talked about, their questions about how we're handling decisions at the federal government level at the state government level and in some sense, I agree with the sentiment that we need to put politics aside and just deal with the disease and absolutely endorse the idea of listening to the experts from the CDC and IAD and the WHO, but at the same time, we have to recognize that we don't choose the context in which we deal with these diseases and it has to be a factor in our consideration. So I think as I said earlier history gives us some guides that can help us identify things that work and avoid things that don't work but we also have to recognize this is an unprecedented situation that we're in. It's unprecedented in terms of the disease, but also our relationship with the media and our in the economic situation.

Thom Canalichio: Dr. Reyna, you have studied a lot about the aftermath of 911 something Dr. Ewing mentioned as a possible analogue to kind of a monumental, transformative moment in our nation's history. I'm sure everyone recalls the sort of theme of that period being that everything changed. Does this measure up to a potential similar level of not only disruption to our daily lives, but looking forward and how people negotiate with these kinds of crises nationally and internationally? What are your thoughts on that?

Dr. Reyna: Well, I was in Washington, DC working at a research agency and met with a lot of people and was part of many Task Forces involving risk communication after 911 and how the government was communicating with people and I think there are many lessons to draw from that situation to now.  Many of the scientific principles that some of our great scientists have developed, were implemented then and they apply now and that's the beauty of theoretical scientific principles. They have broad implications for different situations in different contexts. I would say, we really have to think about also, we really need to value our competent can do people, our scientists and our innovators. We need to think about if we're going to invest, for example, from the government, we can think about investing in things that will have long term payoffs, about infrastructure and so on, that will ultimately help the economy and humanity, so on later. So if we think very wisely about innovation and reinvestment and think in the long term, I think we'll be able to weather this better. We've got to think about our public health infrastructure and the comments on volatility are very instructive. We think about, well, the average use of the average emergency room, we may be equipped in many communities for that, but what about the variability? Can we handle these events that are going to stress the system? We have to think about that and plan ahead and I would say also, I want to underline that I think and please, the clinicians and epidemiologists correct me if I don't have this correct, social isolation and social distance, well, social distancing at this point has the capacity to flatten the curve and what that means is there will be community spread of the disease, but it will happen at a slower rate and that's very, very important because it means we won't necessarily exceed our capacity in hospitals and other things. So, notice, by the way, it's that categorical just above the capacity below the capacity. That's the key thing here. If we're able to keep it within the capacity of the health system to respond and meet people's needs, that means when people do get sick, they'll get care, and they're more likely to have good outcomes. So again, I think the social distancing is something we can do that will have multiple positive effects.

Thom Canalichio:  Thank you, Dr. Reyna, I want to build on that response there with Dr. Dong and talk a little bit of what that capacity looks like and we've heard in some recent days of the situation in Italy, and with some of the communities that are being most hard hit, Doctors and hospitals are getting to the point of exceeding that capacity and having to make trade off decisions for those who have the best outcome of potential survival, versus those who may not.  One of the questions from one of our attendees, my mother is 88 and lives in an apartment, would she be safer if I brought her to live with me for a short time during the situation? As a geriatrician what are your thoughts about how families and communities can support those who are at risk? And obviously, if we were to make sure that the social distancing strategy was effective, if they do need to then be admitted to an ICU, there's a bed for them. What are your thoughts about how someone can handle that? I'm sure there are a lot of people out there in the public asking the same question.

Dr. Dong:  Sure, Thom, very reasonable, I think in general, that that type of support is needed, especially during this period of time, as a lot of psychological distress that's associated with this. It really depends on the risk level exposure for the family members. If older adults really could benefit from the support and minimize social isolation and the family is a fairly low risk, and I would say that that is very reasonable to have the elderly looked after but the at the same time if the family member is, for example have high risk exposures or who are in contact with sick patients who have potential higher risk, that that may or may not be in the best interest of older adults to have that family member moving with them, and really depends on what we call in geriatric medicine. What are the predisposing risk factors? What are the precipitating risk factors?  And thinking about what is the risk factor of the older [Inaudible 58:46] that may put them at a low medium, high level risk? And what are the [Inaudible 58:51] things that are outside of the control when you mix that together, really in geriatric medicine that is the combination that leads to our decision making on how to care and treat older adults if someone's really functional, and is happy living his or her apartment, and looking after them through social media through FaceTime, providing that support may be sufficient, as opposed to others who have more impairment in day to day activity daily living.  In terms of infrastructure support, and I think as Dr. Khan said earlier, as we iterated, if you don't feel well, if you're potentially sick, don't just go to the clinic or the emergency room without contacting your physician first.  Don't put yourself and others at unnecessary risk. Hospitals are very much stressed, in this way, there's only limited to the intensive care unit beds or the step down units, or the hospital beds in general and it's really important to be pre-emptive to think about not only how with the support the healthcare system with all necessary the missions, but rather from the family perspective, support older adults in different ways as well.

Thom Canalichio:  Thank you, Doctor. If anyone else participating has questions for any of our experts, please do chat them to us and we will ask them. We're getting to about the hour mark and I want to move toward wrapping up shortly unless of course we have more questions from media. While we're waiting to see if anyone chats any more questions, I do want to give every one of our experts an opportunity to ask answer this one question if you can, briefly. What is the key piece of misinformation that you've encountered during this that you would like to make sure is debunked unequivocally Dr. Dong?

Dr. Dong:  Facemask, washing hands.

Thom Canalichio: That's the face mask is not effective, but washing hands is more effective?

Dr. Dong:  Face masks are really not effective in terms of prevention for people who really have the disease and symptoms. Having face masks, the right kind of face mask is really important as well, but washing hands, how long to wash hand, is something which is often misunderstood as my earlier comment about singing Happy Birthday twice.

Thom Canalichio:  Sing Happy Birthday twice. Yes, with the face mask by the way, just a follow up question to that if you may be sick, wearing a face mask, does that help you to reduce your risk of transmitting it to others?

Dr. Dong:  It's not really the face mask; it's really how often we touch our face and nostrils area. That's really the part that people don't understand. If you wear the face mask that will potentially make things worse, because you use the same one the bacteria virus may accumulate and that may actually potentially make you worse off than if you did not wear the face masks.

Thom Canalichio:  Okay, noted and I'm sure a lot of people looking at buying face masks on Craigslist for $100 that maybe would like to know that. So thank you for that comment, sir.  Dr. Khan is there a piece of misinformation that you've encountered recently that you'd like to make sure is unequivocally knocked down?

Dr. Khan:  There's lots of pieces of misinformation and disinformation that I've encountered but let's just tell people to step away from the toilet paper and make sure that they actually buy food. So, let's make sure that everybody in our communities is ready. If they need to self-isolate for two weeks. That means, do they have sufficient food? Do they have sufficient water available to them? If they have the ability to their insurance company? Do they have their meds available to them, so they wouldn't need to go to a hospital to get their meds refilled? Do they make sure that they have good social contacts of who to contact and phone numbers to check up on them? So I think everybody should be putting together their preparedness plan and making sure that they're ready if they're really asked to quarantine because of potential exposure.

Thom Canalichio:  Thank you, Dr. Chen, any myths, conspiracy theories or other misinformation you've encountered in your area that you'd like to address?

Dr. Chen:  Well, I think I have alluded to before so in terms of the market and economic panic, we have experience, so I just want people just look at history. So we have weather, as have talked about wet weather, almost all kinds since 911. We have weathered H1N1 and SARS in the long term stock market seems to be okay. Don't panic over the short term volatility.

Thom Canalichio:  Don't panic over short term volatility. Thank you. Dr. Reyna, what about you? What's a key piece of misinformation that you'd like to comment on?

Dr. Reyna:  Well, the key one is that the problem, the risk is low because there are so few people who've died at the moment and that is probably the single most dangerous piece of,  it's not really a misconception because it's true, but it doesn't take into account as many misconceptions, it's kind of part of the truth, but it doesn't take into account this change and the fact that the probability is going to increase very rapidly and we have to think about risk it's about the future and not about right now at this moment. Another misconception and misinformation that I think is very important to address is the whole issue of foreigners being the source of the disease, and that it's a hoax and things like that those kinds of ideas, along with distrust of the media are really kind of toxic soup for these kinds of crises and these are, again, short term issues, but also long term issues that we have to address.

Thom Canalichio:  Thank you, Dr. Ewing, any thoughts about any misinformation, conspiracy theories or anything that you've seen that you'd like to raise as something that we should negate?

Dr. Ewing:  Yeah, I think I would agree with many of the examples you've already heard. I think the one I would add goes back to something I was talking about earlier, and which many of us are dealing with right now. Which is the timing? The social distancing measures, I think it's a misconception to say we're going to wait to start to close schools or to shut down events or cancel sporting events until someone is sick by then it's probably too late for all the reasons we've just talked about in terms of how the disease is actually spread and I learned this from Twitter over the last few days social distancing is not for you. It's for everybody else. It's to keep you from infecting others and I think that's a that's a change in mentality that we all need to embrace.

Thom Canalichio:  Very good. Dr. Dong, you had mentioned to me that you wanted to address concerns about prejudice, discrimination, microaggressions toward Asians and the Asian American community as a result of this. We've seen this playing out in some news and social media. What do you have to say about that, and this might be one two that I'd like to open up to others on the team as we have obviously a diverse group but experts, what are your thoughts about that Dr. Dong?

Dr. Dong:  Sure, we have seen quite a bit of xenophobia, xenophobia against Chinese and other groups in the US and around the world as well. When you look at Chinese history, the United States or one of the oldest immigrant groups who are one of the largest, and yet when you look at the history of Chinese Exclusion Act of 1882, the Anti-massage Nation Act during the Gold Rush period of time, and to what we face today and we've done our own research from the Pine study looking at discrimination. It's associated with all sorts of mental health outcomes as well as increasing risk for pre-mature death as well as increased risk for suicide. So I think it is something that we need to be very cognizant of is the issue of how we collectively as a community as social media, how we portray the stories, it's very human nature to think about this is something exotic and is coming to us as defined however we define that but it is something as a collective community we [Inaudible 1:06:59] to understand linguistic cultural appropriateness and dealing with those kind of issues.

Thom Canalichio:  Thank you and Dr. Reyna, we've touched on this a little bit when we were speaking before the event. Is there anything about these kinds of issues discrimination, microaggressions, prejudice, against Asians?

Dr. Reyna:  Yeah, I want to echo the prior remarks and we know from the scientific literature, that as this, this feeling of dread is going to increase and it will, because the cases are going to increase exponentially. It is a psychological truism that people are going to look around for scapegoats. So, this will play into the narratives that we have currently going on, that people have with this distrust and beliefs about the other and we really have to, again, we have to think about this long term to.  These are trading on long term fears of the other that are currently being activated but during a period of anxiety like this, we can expect them to increase and we gotta think proactively about communicating with people about these things.

Thom Canalichio:  Thank you Dr. Reyna with that I think we will move to a conclusion. I'd love to tag my wonderful colleague Jessica Johnson to ask if she has any closing thoughts before we conclude.

Jessica Johnson:  I want to thank everyone. This is a great panel. Thank you all for contributing and participating and yes, and for reporters and CIOs, and the audience, please feel free to contact us if you have any questions or other specific questions or other experts and sources. We are going to try to continue to have these events throughout the week. So we look forward to seeing you in the future.

Thom Canalichio:  Thank you, Jessica. To all of our experts participating we appreciate you so much for helping to shed some further light on all these issues for spending the time with us as I'm sure you're very busy with not only your day jobs, but also getting media requests and other kinds of inquiries about all of this, so we hope that this has been a good experience for all of you and we'd like to make sure that we're able to make the media aware of how to contact you for further follow up. So, for the media and attendance, we're going to, if you registered, we're going to follow up with you later today to make sure that you have contact information for the communicators at each of these wonderful experts universities, so that you can follow up with them if you have further questions and we also do have another second part of this expert panel series scheduled for Monday, where we have currently I think we have confirmed six other experts who are going to join us to answer similar questions but obviously a couple of other unique perspectives involved in that, including experts on the airline industry, on Wall Street, lab testing for example, as well. So for those who have registered, we'll send you a reminder about joining that meeting, which will be at the same time 2pm, eastern on Monday. We'll let you know and send you a calendar invite for that and if anyone else has any other questions or needs assistance, connecting with the PIOs to contact our experts, please do feel free to shoot us an email. You can send an email to info@Newswise.com you can reach me personally at Thom with an h, T H O M @Newswise.com and I'd be happy to help you to connect with any of these experts today. Thank you again, Dr. Dong, Dr. Chen, Dr. Khan, Dr. Reyna and Dr. Ewing.  Have a great day everyone. 

 

The following is a transcript of the Newswise Live Expert Panel on Monday, March 16, including the following experts:

  • Carmen Wiley, PhD, President, American Association for Clinical Chemistry
  • Dean Headley, PhD Wichita State
  • Jennifer Horney, PhD, University of Delaware
  • Dawn Bowdish PhD, McMaster University
  • Daniel McKeever, PhD, Binghamton University
  • Dr. Jennie Kuckertz, Ph.D, from McLean Hospital
  • W. Graham Carlos, MD, Indiana University 

Thom Canalichio: Welcome to Newswise Live, this is an expert panel with seven different experts from various universities and other associations answering questions about various topics related to the coronavirus outbreak and COVID-19. I’m going to start off with Dr. Carmen Wiley, president of the American Association for Clinical Chemistry. Dr. Wiley, tell us where else you are working as a professor and PhD. 

Dr. Wiley: Right, so, I’m the president of AACC but I’m also the Chief Medical Officer of a start-up company called VERAVAS, which is based out of Oakdale, Minnesota. But, I do live in Washington State. 

Thom Canalichio:  Great, thank you Dr. Wiley. I hope that you can tell us with your background obviously from AACC and in biotech, what is the status of the testing and all of these labs that are needing to process tests to confirm COVID-19 cases. What is the picture there? What have we seen happen, and what can we expect? 

Dr. Wiley:  First, let me start with addressing why there has been a delay in testing. I think there’s a lot of misunderstanding around that. So, first, I’d just like to say that the CDC and the FDA really wanted to control the quality of what was going on, but that really doesn’t work well under an emerging disease state like this. So, they put a lot of restrictions in place, but once some of those restrictions were loosened, it allowed labs to do what labs do best, which is design laboratory, develop tests to perform testing in local communities. Additionally they worked with the large manufacturers to produce testing kits which are now available by two diagnostic companies which is Roche Diagnostics and Thermo Fisher, and our for-profit large reference labs here in the US being Quest and LabCorp, are also now able to offer this testing. So, as of this week, we’re seeing a real uptick in the available of testing. 

Thom Canalichio:  Sorry about that interruption, Dr. Wiley, please continue, or were you finished with your answer? 

Dr. Wiley:  I just paused because I heard some background ground. 

Thom Canalichio:  Yeah, please continue, sorry about that. 

Dr. Wiley:  No problem. So, I do think that what we’re going to see now and what’s being covered everywhere is that there is greater availability in testing and it is due to a combination of lab experts doing what they do best, diagnostic companies really rising to the challenge, and our for-profit laboratories working really hard to address the need. 

Thom Canalichio:  And what would you recommend patients ought to know about getting tested? One of the things that has been covered in the news at some places where outbreaks have been extremely bad, and maybe you have some knowledge of this in Washington state, setting drive-thru testing or setting up testing outside of clinics, and some concerns about people who may be carrying and infectious, they maybe shouldn’t come directly into the waiting room. What are some of the things that patients ought to know about the whole situation of going on about getting tested? 

Dr. Wiley:  Right, so I think, first I’d like to highlight, even though we have an increase in availability of testing, really, we need to be good citizens and we need to allow the most vulnerable patients to receive testing and those who are experiencing symptoms of the disease and have likely exposure. So, I’d like to lay that out there first. But, now let’s talk about these drive-thru testing places and places to get testing. So, first of all, whenever we’re going to a separate location, whether it’s a drive-thru location or a community center, or something like that, we’re collecting the samples, I’d like to emphasize what they’re doing there is collecting the samples and gathering the information they need, and then that testing does get sent to laboratories. And the reason that we’re asking people to not go into the healthcare centers, is because we want to reduce exposure to our vulnerable patients who are needing to be seen in those clinics. The other thing I really want to make people aware of is that, for instance, if you go to your community hospital that may have the ability to do 200 tests per day, they’re going to prioritize the most vulnerable patients to do that testing locally, even if they’re collecting thousands of samples in other locations. Then they will triage which ones should be done locally, and then the other samples, they will most likely send to a large reference laboratory. So, patients should understand that if their test is done locally, they may get their answer sooner than someone else who literally went to the same location, but their sample may have gone somewhere else. So, they do need to understand that there can be a difference in receiving their answers, but I think the most important thing to know is that it’s going to be a high quality answer regardless of where it goes. But I do think there can be some anxiety when people there is a timing difference. 

Thom Canalichio:  Okay, thank you Dr. Wiley. I want to move on next to Dr. Dawn Bowdish from McMaster University. Dr. Bowdish, please, if you could in just a moment, sum up a little bit about what your work is in this area, in particular, immunology. 

Dr. Bowdish: I’m a research scientist who studies aging immune system and why we become more vulnerable to infections like pneumonia as we get older. So my research interest is in both what are the factors that keep older adults healthy with regard to their immune system, and also the factors that make them predisposed to getting infections like COVID-19. 

Thom Canalichio:  So, could you explain a little bit the incubation of this particular virus and also the period in which those infected can be infectious to others before they even start showing symptoms? I think this has really been a major, major part of why this disease is such an issue, and I’m hoping you can shed some more light on that and explain it for people. 

Dr. Bowdish:  Absolutely. So, for most acute respiratory infections, we can think of influenza, we can think of SARS, we can think of MERS, which are more closely related, there really is a very short period before you become asymptomatic and this infection has been particularly hard to contain because it has a long period of being asymptomatic. So, let me just explain why we are asymptomatic. When we’re originally infected with the virus, there is very few of them, it could be literally tens or maybe hundreds, and that isn’t enough to give us any symptoms. When we start to feel symptoms, it’s because we are feeling our immune response dealing with that virus. And so most very serious infections start in the upper respiratory tract and it takes two or three days to get the viral load high enough that we really start to feel sick. And people who have had SARS or MERS or severe influenza really describe having a rapid onset of symptoms, know they’re sick right away and feeling very unwell. The problem with this particular virus, and I can’t tell you why yet, because it just hasn’t been around enough for us to understand, is that there is a slow and steady increase in symptoms. So people often describe maybe feeling slightly headhachey one day, but maybe they don’t get that high fever that sends them to the doctor until 3 to 5 days in. That’s a problem, because of course, when people don’t feel, working people, parents, most of us, if we’re feeling just ever so slightly off, we still go to work, we still do all the things we do in our daily life. And so one of the issues with spread of this virus has been that really slow period of incubation. In general, it looks like most people display symptoms 5 to 7 days after they’ve been infected. But the reason we had these longer quarantine periods than normal, 14 days, is because there’s some evidence that it takes much longer for some people. So, if there’s any question that you might be infected, you will be asked to self-quarantine for 14 days. 

Thom Canalichio:  Okay, excellent, that’s so helpful to understand some more detail about that. And based on the difference with COVID-19 to influenza, for example, with the period of being contagious while still not having symptoms, what does that mean and what should people know about protecting vulnerable populations, the elderly, people with other chronic conditions, and why is the social distancing and these kinds of quarantines going on so important in that regard? 

Dr. Bowdish:  So, I’m Canadian, full disclosure, and my country has just instituted really vast social distancing measures, because we’re in the very early stages of our epidemic. The reason we’re trying to do this right away is so that we can block those people who have little to no symptoms and are walking around making other people sick. Similarly, in places where there is massive outbreaks of infection, the social distancing measures are designed to stop that spread. So, what I would advise people to do, if there is any chance you have been in contact with somebody who even might have these symptoms, you should really minimize your social contacts, if you are able to stay home, that’s great, if you’re not able, then we need to have you being adamant about handwashing and keeping away from people, we want you 2 meters away from people, covering your mouth when you sneeze, that sort of thing. 

Thom Canalichio:  Thank you, Dr. Bowdish, and just a reminder to all the media in attendance, if you have any questions for our experts as we go through, please do chat those, you can either chat directly to me or to everyone in the room, that’s certainly fine, either way. I have also now Dr. Jennifer Horney from the University of Delaware, thank you for joining us, doctor. I want to ask you a couple questions about the epidemiology of this whole situation and ask what’s your analysis of the outbreak currently, compared to other disease epidemics? What’s different about this one? And are we taking the right steps right now? 

Dr. Horney: Hi, so, Jennifer Horney at the University of Delaware, and I want to build on some of the things that have previously been said. I think what has made COVID-19 different than a seasonal influenza or another sort of coronavirus that we’ve seen in the past, like SARS or MERS, is that it seems to be causing more severe disease, at least in among a subset of the population. And at this time since it’s a novel virus, we don’t have any vaccines or therapy that’s available. And so I think that is both anxiety-inducing to the general public who feels that they may be at risk, as well as the scientists who are working as hard as possible to get things done quickly as possible. And so I think if we think about this from the perspective of seasonal influenza, that we don’t try to contain seasonal influenza or do contact tracing on cases. At a certain point in the season we usually even stop testing and just start presumptively treating people with antivirals if we believe they have the flu. And so we just don’t have the public health resources available to do contact tracing for something like seasonal influenza. But in this case, because we have a more severe disease and no vaccine, so we have to turn to these nonpharmaceutical interventions like the social distancing to address this.  

Thom Canalichio:  And what does the declaration of this being a pandemic and other state of emergency declarations from governors, or the President just announcing a national state of emergency for this, how does that help for healthcare providers and hospitals prepare for this, and what are the steps that are being taken to flatten the curve, so to speak, as that has been described? What does that look like? 

Dr. Horney: Yes, so every epidemiologist I know is happy about one thing, which is we will never be asked if we study the skin, again, that’s a frequent question. But I think it’s important to know about the public health declarations and the use of the Stafford Act by the President to declare an emergency is that those are really administrative declarations that allow public health agencies to increase their capacity to respond. So, by issuing a declaration, we’re able to do things like speed the approval of test kits to the market, we’re able to do things like order people to be isolated and quarantined, although we do depend on the public to voluntarily follow the orders for the most part. Public health agencies are able to receive additional funding, for example, or move funding around from different pots of money which they may not be able to do otherwise. And so those declarations enable to administratively respond by maybe hiring surge capacity staff or accepting additional funding for the resources that are going to be coming down from the federal government. So, while they’re important, they aren’t necessarily a reflection of an intensification of the public health concern, they’re more something that allows public health agencies to build their administrative capacity to respond. 

Thom Canalichio:  Thank you, Dr. Horney. I want to go next to Dr. Graham Carlos at Indiana University. Dr. Carlos is a pulmonologist and I want to ask some questions about these kinds of cases and what sort of symptoms patients are presenting with when they get admitted to the ICU, what kind of care is currently being done, and what else you hope to be able to do, as we understand more about this disease. 

Dr. Carlos:  Thank you for the question. We’re learning a lot about the virus and how it presents both from China, from Seattle, and discovering that the virus, while it commonly presents with fever, cough, shortness of breath, we have been hearing cases that you might have some atypical presentations. For example, a cough without a fever. So, just because those are the three most associated symptoms right now, it doesn’t mean that we can really hang our hat with 100% certainty that if you don’t have those symptoms, then you don’t have the virus. This because, like we talked about earlier with Dr. Bowdish, you may be affected by the virus, but either you don’t have symptoms and your immune system is just kind of wiping it out, so social distancing becomes important, particularly with our children who may not get a really profound immune response, but who may be transmitting the virus between themselves, giving it to their loved ones, et cetera. So, cough, fever, shortness of breath are the big three, but don’t necessarily hang your hat on the fact that if you don’t have those, that you couldn’t spread it to others. 

Thom Canalichio:  Thank you for that, Dr. Carlos. And that leads me really perfectly to my next question for you which is about one of these pieces of misinformation that’s floating around. There is a very popular, I guess popular is not really and appropriate word for it, but there is a very prevalent, let’s say, chain email going around, and one of the first things that this chain email says is that if you can do a little self check by holding your breath for 10 seconds without any discomfort or coughing, then that means you don’t have the coronavirus because your lungs must be clear of any fibroids or any other issue. What’s your take on that. 

Dr. Carlos:  I join Dr. Bowdish and Dean Headley, and others on Zoom here, in shaking my head, no. We don’t have evidence that there is truth behind that. This deep breath technique as you’re describing to me, while it might seem like that’s a good test to detect if you have the virus or have inflammation, that’s not even a test we’re using in hospitals and emergency departments and clinics. So, I would like to say that that seems to be more of a myth at this point in time, to me. 

Thom Canalichio:  A couple of other points from that chain email, one was the coronavirus doesn’t cause a runny nose, so if you have a runny nose, you must have a regular cold and you don’t have the coronavirus. True or false? 

Dr. Carlos:  Well, any time you have an immune system response, you can increase inflammatory mediators in the upper respiratory system including the nasal passages. So I would not say that presence or absence of a runny nose rules in or rules out being affected with the coronavirus. I think it’s time you need to delete that email, Thom. 

Thom Canalichio:  I completely agree, Dr. Carlos, thank you. One other question for Dr. Carlos, one of our viewers mentioned that they’re from the Midwest area, Indiana specifically, Emma Atkinson, and she would like to know more about testing. Do you know anything about the availability of testing in the region, private testing, hospitals, healthcare providers, any updates or knowledge about that in your state or region, Dr. Carlos? 

Dr. Carlos:  Thanks for the question, Emma. I’ll refer to what Dr. Wiley said earlier, that we have learned that private companies have become empowered to start making their own tests, and I am hopeful that as they develop these tests, they will be able to do them in big batches. So I envision big pans with a thousand samples that can be run at one time, for example. Right now, we like most states that I’m aware of in the country have a limited supply of tests. So, we have to be very judicious, as already had been mentioned, with who we’re going to test. We’re reserving those tests for patients that we believe have a high risk of having the disease and those that are very critically ill. So, for right now, we hear hope is on the way. We’re setting up drive-thru clinics as already had been mentioned, to be ready for those tests when they get here. But for right now, for today, March 16th, we’re still in a wait and see type of setting here in Indiana. 

Thom Canalichio:  Thank you, Dr. Carlos. I want to go next to Dan McKeever from Binghamton University. Dan is an expert on Wall Street and the economy. Dan, I’d like to ask, can you explain the current stock market volatility and especially in the context of is this a reaction to the reality of goods and services and money moving around, or is this in anticipation of some future expected uncertainty? 

Dan McKeever: Yeah, it’s almost entirely expectation of future behavior. So, when we look at a stock market index, which is sort of the main way that the media tends to report on changing economic conditions in response to some shock, which is what we have now, what you’re looking at are the prices of a representative basket of companies and the idea is that if this price is decreasing, what stock traders are saying is that they expect that these companies’ profits are going to be reduced by some amount going forward. So, it’s almost entirely anticipation of what’s to come, rather than reacting to actual disruptions that have been realized so far. The cause and effect here is sort of a double whammy as far as what’s driving this route in stock prices right now. So, the S&P for frame of reference is down more than 20% in the last month, it’s down about 13% in the last week. Those are really, really large numbers in context. These types of drops don’t happen this quickly very often. We are down officially into bear territory for the one year return. The way to interpret this is to say, number one, there are significant ripple effects that result from disruptions to supply chains and disruptions to consuming behavior as a result of this virus. So much of our global economy depends on trade and things crossing borders. That has been effectively eliminated in large part because of this virus. It also depends on people leaving their house and buying things. You spend money, that money goes to the merchant, that merchant goes and spends it at the grocery store, and so on, and so forth. So, this social distancing, while it’s entirely necessary to flatten that curve rate of infection and keep hospitals below their critical capacity to the extent possible. You see what it does, there’s a direct first order effect to the expectations that investors have for the stock market. The second part of this double whammy is what we call supply shock in the market for crude oil. And what that means is that last week we saw the Kingdom of Saudi Arabia and Russia who are the number one and number two oil exporters in the world, engage in a price war. And that means that each of them continues to one-up the other in terms of the amount of oil that they’re willing to flood the market with. The reasoning is that if the market is shrinking on the consumer side, it sort of becomes a winner takes all for the lowest price of oil. And so these large producers have engaged in this price war with no real signs of pulling out of it. That adds up to a massive decreased in the price of everything. That’s why the expert consensus now seems to be that we are headed for recession if we’re not already in one. The question going forward, sort of the pertinent question for investors and for people that just participate in the overall economy is how deep is this recession going to be and how long is it going to last. And that’s one that I think hinges more on the response to the virus than any other factor. And so that’s one that I can’t say anybody knows with a great degree of certainty. 

Thom Canalichio:  Great, thank you so much, and one additional question for you about all that is, a lot of this can be described as unprecedented in a lot of ways, and especially recent moves by the federal government and the Treasury, with announcing of a reduction of interest rates, if I’m hearing that correctly, bringing them down to practically zero, are these kinds of things expected to be effective and is the market responding to them? What can you tell us about that?

Dan McKeever: Yeah, so, as you mentioned rates, the Fed has slashed rates yet again, to be basically at zero, and the issue with this strategy is that you can only repeat it so many times before you run out of runway, which is what we just saw. There is nowhere to go below zero. So, these sort of temporary reprieves have had temporary effects on the market after each one of these cuts was announced, after the A package passed through Congress, you would see temporary upticks in the over Index level, and then you would see them plummet after another news item would break about the disease spreading further or growing faster than we thought. One thing to consider is that for about the last two years there has been a general understanding between market observers and market practitioners that we were in a bit of an asset bubble. There is sort of a conventional saying, or a saying of conventional wisdom, that you can’t really know what a bubble is while you’re in it, but that’s not exactly true. You can know what a bubble is, you can know when asset prices are overheated. The difficulty is knowing when it’s going to burst. So, for the last two years or so, we’ve had stock prices that were inflated above what’s sort of their long-term steady state level, and everybody understood that eventually they were going to have to come back down to be in lines with earnings. The difficulty is that nobody who is holding those stocks and managing money for a client wants to get off the ride while it’s still on the way up, right? As a quick example, at the end of 2018 the market lost about 15% over the last quarter of the year. You had a couple of the major indicators start tilting toward recession and there were a couple people the subscribed to the idea of now is the time to sell, it’s time to get off the ride. Anybody that got off the ride at that point missed out on a nearly two-year period of unbroken gains after that. Timing the market, entry and exit, is very, very difficult. You asked about the misinformation that’s being spread. So, there is not only misinformation about the virus, like the email that you mentioned, there is misinformation about how you should manage your money in response to it. One common trope that you hear whenever there is a downswing in the market, has the acronym BTFD, so, BT and D are Buy The Dip, I’ll let you figure out the other letter. The difficulty with that strategy is knowing when you’re at the bottom of the dip. I had people a couple weeks ago saying oh, I can’t wait to buy, I’m looking at stocks to buy. Anybody that did that just got routed for another 13%. So, the best thing that you can do with respect to managing your investment portfolio, provided that you’re investing for the long term and that you’re not within a few years of retirement, is to stay calm, don’t panic, and basically keep some social distancing from clicking on your mutual fund account, because looking at it is only going to make you panic. 

Thom Canalichio:  Great advice, Dan, thank you. I’d like to go next to Dr. Jenny Kuckertz at McLean Hospital which is affiliated with Harvard University. Dr. Kuckertz, as a clinical psychologist, what can you tell us about the impact of this disease outbreak, of strategies like social distancing, and what that means for people and their mental health?

Dr. Kuckertz: Yeah, so I think there has been a lot of uncertainty for all of us, and uncertainty is one of the hardest for people to deal with. I’m sure the former presenter was just talking about it in terms of effects on the market, but it’s also very hard for us in terms of mental health and it’s one of the biggest drivers of anxiety. And so I think when we become really anxious, and there’s a lot of uncertainty, we feel desperate to do things that make us feel more in control, and that can often times lead us to feel kind of perhaps helpless, so I think that’s something that we want to be mindful of. But it can also lead us to dismiss threats entirely because it’s kind of uncomfortable to acknowledge the presence of these threats that we can’t control. And obviously both of those I think has a negative effect. So, I think it’s helpful to actually start by acknowledging that yes, there is uncertainty and it’s anxiety provoking and if you feel anxious, that’s actually a good thing, because anxiety is kind of this biological preprogrammed system that we have to alert us to when there are potential threats, and to motivate us to change our  behavior and take action, which is what we need to be doing right now. Doing things like staying away from crowds, washing our hands, letting our friends and relatives know that we’re thinking about them, and getting our prescriptions refilled. I think we do want to stay up on the news and that’s helpful for letting us know what behaviors we want to change. But at the same time I think we do want to set a media diet so that we’re not constantly glued with our faces in front of the news, and I think the more we do, the more uncertainty is going to increase, because we’re getting a lot of different conflicting kind of confusing sources of information and that can lead us to make bad decisions. So, I think that’s something we all want to be mindful of. 

Thom Canalichio:  I have a question for Dr. Kuckertz from Anna Ashbrenner at USA Today. Would you have any insight into this anxiety changing people’s voting habits? Would they maybe be willing to change their interest in one candidate in favor of another because of the circumstances of this outbreak, and that might affect their decision making? 

Dr. Kuckertz: Yeah, it’s a really interesting question. I haven’t seen any data on that. I think that you can certainly speculate that would be the case. People may react in a variety of ways. I don’t know that there is a particular pattern that you would necessarily tend to see. I think on the one hand when there is a lot of uncertainty sometimes people kind of look for comfort in what they already know and don’t necessarily want a lot of change, and I think that other people may panic and really become upset and very angry, and really want something drastically different. So I think that yes, it certainly could affect voting patterns, and I guess we just have to wait to see the data in terms of where exactly that tilts. 

Thom Canalichio:  So, from a mental health and anxiety perspective, how would you assess some of these behaviors that we’re seeing with a lot of panic buying that’s going on? What does that tell you about what people maybe need to know about some healthier strategies to deal with this uncertainty? 

Dr. Kuckertz: Yeah, so I think there’s a couple of things to think about in terms of panic buying. Is it smart to make sure that you have some supply of some type of food and basic selfcare products for a couple weeks? Absolutely. But when we talk about panic buying, we’re seeing people buying many, many, many more times the amount of supplies that they need, and I think that has consequences, not only from a societal perspective, but also individually at a personal level. So, I think a lot has already been said in the media in terms of societal consequences. There are a lot of people out there who are on a budget and don’t have the ability to stock up on supplies. There are seniors and people with disabilities who are only able to get out to the grocery store at certain times when people take them, and there is healthcare organizations and kind of small residential programs that really rely on being able to get these supplies when they need, and they’re shopping at a lot of the same places as us. So, that’s the societal level. But I think from a more personal perspective, there are reasons why we might want to put a little bit of a break on that. So, first of all, waiting in long lines in crowded stores is not consistent with social distancing, so I think that’s an immediate consequence. But if we act like it’s the end of the world, we’re going to feel like it’s the end of the world, and that’s going to make it a lot harder to cope. So really, when we’re buying these months and months, we’re sending a really strong signal to ourselves that these are not normal times and it’s kind of apocalyptic, and I think that can be particularly hard if you have kids and you have all of these supplies piled up all over the living room, that can be very scary, so it’s something that we want to think about and I think it makes it harder for us to cope, doing things like making normal meals, doing our remote work, keeping your kids on schedule, reaching out to friends and family. So, I think that there is a number of things we want to think about, in terms of the recommendation that we kind of focus on what we need a bit beyond that. 

Thom Canalichio:  Great, thank you Dr. Kuckertz. I want to next to Dean Headley at Wichita State University. Professor Headley is an expert on the airline industry, he’s half of the team behind the annual airline quality rating report. Professor, could you tell us what, to your knowledge, airports and airlines are doing for screening measures and security, and how they’re partnering with regulators in order to try to reduce the risks here? What can you tell us about all that. 

Dean Headley: Well, they certainly have all the meetings that you would expect they would have. Most airlines, all that I’ve heard of anyhow, have basically said we’re going everything they can. They obviously clean airplanes and they deep clean airplanes, they’ve worked with terminal staff to make sure the terminal experience, as best they can, is good. At the same time, the airlines obviously are taking it on the chin. If you tell people to say home, then they’re certainly not going to get in an airplane, well, most won’t, some still will, we found that out. You look at the issues in the international sector, people trying to get home from another country to the United States, that’s a disaster as far as what we know we should be doing to social distance ourselves. They’re standing in line for 6, 7, 8 hours to get through the security and health checks, and all that. But in the domestic system, the airlines have done as good a job as they can without having tests run on the airplane, they’ve done as good a job as they can of making sure that if the person is bound and determined to travel, that they can keep them as safe as possible. Now, there are two or three things happening there. Number one, the air in the cabin, most airlines have HIPPA filters or something similar to that, that keeps the air circulating and clean. If you get on an airplane right now, you’re not going to be sitting next to anybody, most likely. It’s a fairly thin crowd out there, that’s probably good. So, if you must get on an airplane, you may have some options to do the social distancing. My recommendation would be do not get on the airplane in the first place. That doesn’t sit well with the air system that we have. The only way that you can rally compare this and the impact that it’s going to have is really go back to 9/11. At the time of 9/11, we had a very sudden and dramatic event that put a different kind of fear in a lot of people, and they said I’m not getting on an airplane, I mean, that’s the weapon of choice, evidently, it seemed at the time it was the weapon of choice, was an airplane, to do harm to the public. Now, we have an unseen foe, we don’t really know where it’s at, who has got it, you can’t do anything really to protect yourself except stay away from other people. And that means you’re not going to get on an airplane. In 9/11, they immediately took about 20% of the capacity of the domestic system out of service and kept it out, and the travelers did not come back for about 2 or 3 years to full force. Now we’re looking at them taking more than 20%, sometimes there are airlines that are parking up to 300 airplanes, they’re parking them, they’re just not flying these airplanes. They’re looking at over 20, probably up to 30 or 40% of the capacity on domestic systems not flying at all. Well, that’s good to a point, certainly not good for the airlines, but good, because they are responding as best they can to the public. 

Thom Canalichio:  Building on those last points, if that were to persist long term, as did with post 9/11, it was more than a year before things started to pick up again, airlines and airports employ a lot of people, are you predicting the possibility of layoffs, price wars, reduction in service of some routes around the nation? What are those long-term impacts that you would envision if this situation were to persist? 

Dean Headley: The short answer, yes, to all that. You really would, you would have layoffs,  obviously they’re not necessarily going to pay people that aren’t in the system and working. Price reductions, classically when you see a reduction in the demand, with way the airlines get that demand to rekindle itself is to lower the price on the travel experience. That’s good for the consumer, we don’t know when that’s going to happen. We’ve heard some economic news, we’ve heard from folks about the psychology of this event. This is a different fear and it’s going to take a while for everybody to reengage in a different way than we have in the past. We really have to kind of look at this and say yeah, the airline industry is going to have some trouble, they’re certainly taking a big financial hit right now, and how long that will last depends on how quickly the American psyche, we’re a nation of wanderers, we travel, we go around, you can’t hardly keep people from doing that. It’s really eerie small to go out right now and see the lack of traffic and lack of people running around, that’s unusual, you look at Times Square and places like that, it’s just unbelievable, but it’s happening, and that’s a good thing, we have to do that. But, how long is it going to take for that “I want to go again” mentality to kick in after somebody says, well, we’re on the downward side of this curve, or we’ve seen the worst of it, which hopefully someone will come along in 6, 8, 10 weeks and say well, maybe we’re past the worst of this now. I hope it doesn’t take much longer than that, it might. But we are wanderers and we will get back to the system, it’s just a matter of how quickly we adjust our mental attitude and say I’m ready to go again. 

Thom Canalichio:  Okay, thank you very much. I want to return again to Dr. Wiley from AACC and ask if you can tell us if there has been any misinformation that you’ve seen out in the media, maybe in particular to the testing, but any other factors, too, that you would be interested in commenting about and debunking any misinformation. 

Dr. Wiley:  There’s two things I’d like to really clarify. The first one is I’ve seen some things on social media that would lead people to believe that laboratory developed tests are something brand-new and that it’s something that labs are doing just because of failure to adequately deliver testing. It’s really important for people to understand that we in the lab community, we’ve been doing these tests for a really long time. A concrete example is we were really there on the forefront for HIV testing and so we did laboratory developed tests for HIV testing and were also responsible in reporting to our state and local agencies and our national agencies, and reporting the prevalence of this disease. So I want people to know that we’re experts and we’re doing the best we can. The second thing that I really want to make sure people know is that they should not be buying at home collection tests and then putting them in the mail to get tested for COVID-19. To the best of my knowledge there is no at home testing right now, so please don’t waste your money on that. 

Thom Canalichio:  Very good, thank you for that little PSA. I didn’t know that that was an issue. It certainly would be a shame for people to get scammed with something like that. I have a question from the chat from Tina Say at Science News, she directs it to Dr. Bowdish, I think maybe Dr. Carlos, as well, could be a good one to answer this. What should people who may have been exposed do at home to prevent spreading the disease to family members, and at what point should they decide to get tested? So, Dr. Bowdish, tell us about what you think and then I want to see what Dr. Carlos has to say, too. 

Dr. Bowdish:  So, we’re moving to the stage now where because of the limitations in testing, there will be increased importance of not getting people tested who can manage their symptoms at home. So, if symptoms, most public health agencies are recommending that if symptoms are relatively mild, the person is okay, they can treat with Tylenol and you can keep yourself hydrated, as long as you don’t have that shortness of breath or really severe symptoms, then you may not need to get tested at all. You may be able to just keep yourself in your home and try not to spread it to your family. So, that’s the first thing to remember. As testing facilities get more overwhelmed, we’re less able to do those sorts of tests. So, if your symptoms are mild and you can stay at home, that is probably what you need to do. Now, what can you do to not spread it to your family? This we have some fairly good science on. You will have heard in the news that you shouldn’t be wearing masks through the streets, because those are designed to actually protect people from you. But in your home, if you do have symptoms and you want to keep your family safe, it is perfectly acceptable to wear a mask, just remember, they’re disposable, they’re one use, you don’t wear them for three days on end. If it’s possible and you can stay in one room, and even better, if you can have one room and one bathroom for yourself, that’s helpful. You need not to be touching surfaces that the rest of your family would touch, or that the outside public should touch. So, for example, your front doorknob, your mailbox, if your postal service is going to put mail in there, don’t touch those things, or if you do, clean them afterwards, because that’s a way you could be transmitting germs. Handwashing, 20 seconds between fingers, fingernails, back of the hands, thumbs, all the places that people miss are very helpful. Making sure you have one garbage bag where you throw all your Kleenex and anything you’re using in there and you tie them up and you don’t let other people handle them. Essentially, if you want to keep the rest of your family safe, you need to not touch the things anyone else might touch, and you need to stay away from them. 

Thom Canalichio:  Thank you, Dr. Bowdish. Dr. Carlos, anything that you would like to add to that? And I have another question for you, as well. 

Dr. Carlos:  That answer was so comprehensive and well done, Dr. Bowdish, I think there is no reason to sprinkle anything on top of it, I’ll take the next question. 

Thom Canalichio:  Very good, I wanted to ask you then, what we should be aware of if hospitals begin to reach their capacity, if hospitals are admitting so many COVID-19 patients that all the ICU beds are taken, we start seeing those numbers get to that level, what does the public really need to know about that level of situation? 

Dr. Carlos:  Well, one thing that’s been nice is that hospitals have had some time to prepare, and so we are still preparing with plans in a tiered approach. So if you have one patient, what does that mean? Five patients? What does that mean? Ten patients etc. and so with each tier, you enact different measures. One of the earliest things we want to do is cohort patients. So once we have tests that are coming back quickly, we'll be able to rapidly identify which patients can be grouped in a similar area because they have the virus versus patients that don't have the virus that we're trying to protect from getting the virus as hospitals and you're seeing this on the news are cancelling elective surgeries and cancelling various outpatient tests and procedures that as you might expect, frees up more room and more space, and so now we can think strategically about; 'Okay, now that we have this space available, how can we convert that into patient care areas if need be'. There are also certain things going on with the government to free up hospitals to be able to triage patients, let's say for example, in a tent outside the hospital, to avoid bringing them in, so we don't crowd out the ED's. Many measures are being taken to expand capacity as much as possible, in the event that we start to see a situation where our standard amount of ICU rooms, the standard amount of patient care rooms aren't enough to take care of all the patients that are coming in.

Thom Canalichio:  It's good to know that so many of those plans and procedures are in place. We just hope we don't get there. Thank you, doctor. I want to go next to Dr. Horney again from the University of Delaware and ask you a little bit more about the epidemiology behind this and in particular, how does herd immunity apply to this disease as a new novel emerging virus? We don't have herd immunity to it, obviously, because it hasn't been circulating long enough, is herd immunity ultimately, a goal, that if enough people get exposed to it over a long enough period of time slowly, does that benefit us? How could you explain that kind of issue here?

Dr. Horney:  So I don't think we really know enough to talk about that just yet, because we don't really understand people's length of infection and ability to be infected more than one time. So we've got cases of people who are still testing positive even a long time after having symptoms. To go back again to the earlier question about how is this comparable to flu? We ask people to get a seasonal influenza vaccine every year, even though we know that it's not a perfect vaccine, it's usually somewhere between 30% and 60% effective depending on how good the matches to the circulating stream, between the effectiveness of the vaccine and the number of people that get vaccinated, we can effectively get that herd immunity from that, so I think in Covid, it's really too early to start thinking about herd immunity at this point.

Thom Canalichio:  Okay, understood. Thank you very much, back to Dr. Carlos for a moment. How can we differentiate between Covid 19, classic pneumonia, SARS and other respiratory illnesses? This is coming from Yasmin Recevi, one of our media attendees.

Dr. Carlos:    Hi, Yasmin, thank you for your question and I typed a response to the group as well. The only way we're going to be able to tell if somebody has Covid 19 is by having an accurate test. This is because viruses and viral pneumonias, they can show the same symptoms and signs, as it's common to viruses, cough, fever, sometimes shortness of breath, and you also need to remember that different patients and populations be it younger, older, diabetic, non-diabetic, various other medical conditions such as asthma, this could present a lot different depending on the patient who's being affected.

Thom Canalichio:  Thank you, Doctor. I want to go next to Dr. Kuckertz and ask, how can we talk to kids about this? How can families talk about this amongst themselves? Especially, if they have elderly family members.  I mean, this is very common that people have a senior family member who may have dealt with some other chronic disease and could be especially vulnerable. How do you recommend they address this with their families?

Dr. Kuckertz:   Yeah, there are so many families, I think, that are really wrestling with these questions and in terms of kids, I think the number one thing for parents to remember is that they are their kids biggest role model and their filter through which they interpret all the information in the world. So it's really important to talk to your kids, answer their questions and remind them that all the adults in their life are working to keep them safe and I think it's important to answer their questions realistically, but not to exaggerate the threat either, so parents can teach their kids good hand washing practices and explain that they're staying home to say extra safe, but remember that kids are really, they're really sensitive to how adults in their life are reacting and they often tend to have imaginations and so even kind of little pieces of information on you know, kids can really kind of blow up and have a whole story about it and it can be really scary. So if you're constantly watching the news, and talking about how bad things are, or how things are being mismanaged, kids are going to feel more unsafe and I think it's fine and it's completely understandable that adults will need to vent and let some of that out but I would try to do that out of earshot of your kids, to the extent is possible and remember to keep as many normal things possible that you can, so what you're eating, when you're eating, when your kids are waking up, the school may be cancelled, but they still may have remote learning and so try to keep that during the school day and have a schedule for when you're taking breaks, when you're going to do fun things with your kids and when you're going to eat lunch. In terms of visiting the seniors in our family, grandma and grandpa, I think it's important to amongst ourselves as adults, but also with kids, let them know that this is temporary. We're kind of talking to grandma and grandpa over the phone and maybe sending them cards because it's not a very safe time to see them right now, but we're looking forward to seeing them soon and I think that's also the message we want to convey when we're talking to them and that we have not forgotten about them.

Thom Canalichio:  Thank you Dr. Kuckertz. I want to ask a question from the chat to Dr. Bowdish, are spot spices effective for immunity compared to supplements sold at drugstores. Is it possible that other drugs as well for other diseases such as HIV, or malaria could be effective, treating the Covid 19 virus?

Dr. Bowdish:  This is the question I get most often, we are so desperate to want to do something to protect us, but I'm about to tell you some bad news. So there were over 200 clinical trials done in China of different treatments to try to ameliorate the disease. All of them failed. As of right now, there is some discussion that using repurposing specific drug sometimes used for malaria Black widow in Italy may have shown promise but in truth, we haven't seen the data from that. I don't hold out a lot of hope. So, what can the average person do to be used to boost your immune system? The answer is nothing. There is no spice there is no magic and in fact, what people are dying of are hyper inflammatory responses, they're having too much of an immune response. So there really is nothing you can take no zinc, no oil breaking or nothing. Having said that, though, there is sufficient good-quality data to say that vitamin D supplementation and people who live in the Northern Hemisphere like us who tend to be a little bit vitamin D deficient, protects against other acute respiratory illnesses, that's the only scientifically credible source, it does not necessarily apply to this and in fact, it may not apply. It may not protect us at all from Covid 19 but if you want to do something, and the best data's for vitamin D, there isn't a lot of data for everything else. We're watching clinical trials happening in Italy. Now we're watching the results to see what happens. We're also seeing if maybe some of those trials that failed in China, maybe a person is too sick at that point, but maybe if we protected people are at high risk like their husbands, wives, children who live in the same house maybe we could prevent them getting sick. We won't know the answer to that right now but I have to say that results are not very promising.

Thom Canalichio:  Thank you, Dr. Bowdish. I want to turn to our business experts once again about a couple questions especially with the travel ban from Europe and now including Ireland and some other countries, for Dan McKeever, Ireland has become a prominent outsource location for the tech industry and pharmaceuticals for example. Do you see any potential major impact of this travel ban on the economy on Wall Street due to any issues there?

Dan McKeever:  A few things such [No Audio - 51:19] as outsourcing activity to countries that have very low corporate tax rates, like Ireland is essentially tax sheltering, but am I still muted or no, I'm good. It's essentially tax sheltering, so there are relatively few human beings that are actually travelling back and forth. I would imagine that the effect of that would be relatively second order compared to the effect on manufacturing industries on the travel industry, especially as one of the other experts weighed in on and then also on, this is going to hit my expectation that this is going to hit Main Street businesses a whole lot harder than Wall Street, so two reasons for that. Number one, the government has more tools at its disposal that it's ready, willing and able to use to support, for example, financial institutions in times like this, we saw that the Fed freed up an extra one and a half trillion in liquidity, so basically what it does in that action this past week, is pumping big infusions of cash onto banks’ balance sheets to keep them solvent and the idea there is that as the economy contracts, you're going to have borrowers defaulting on debts. So that maybe corporate borrowers who have a line of credit with a bank to fund a project, that maybe people that have their mortgages with a bank who are suddenly out of work and can't make their payments, so on and so forth, but the bank stocks tend to be a little bit of the canary in the coal mine or the bellwether for how broad the ripple effect is going to be from something like this and so one of the worst days that the market took a beating last week, each bank stock you know, for the major commercial banks in the United States was down about 9% to 10% in a single day. My expectation is that bank stocks will eventually recover; they will probably recover faster than most of the other assets that we might be looking at, in part because, as we talked about before, the Fed has more tools at its disposal to prop those businesses up. What I would be more concerned about are Main Street businesses. So small businesses, mom and pop shops, local restaurants and things like that, that are going to be immediately affected by the loss of customer demand. These not only affect the viability of the ongoing business, they affect workers’ paychecks. The aid package that went through Congress is by no means comprehensive. I think there's relatively bipartisan consensus that it is not going to cover everybody or anywhere close to it. We also live in an economy that's been transformed by gig work, which means that traditional unemployment insurance and unemployment benefits are right now better calibrated toward people with traditional employment. So for example, if you're applying for food stamps or support for paying your heat and light bills, you may have to produce verification of your last three months income. If you are a gig worker, somebody that's taking jobs off of Task Rabbit or driving for Uber, it may be more difficult to prove that you meet the criteria and so my concern as far as economic ripple effects would not be so much with the prices of stocks on Wall Street. My concern would be more with how this is going to affect local economies and smaller businesses that are less easily able to be protected through federal intervention or at least the type of federal intervention that we've seen the government willing to exercise so far.

Thom Canalichio:  Okay, thank you so much and Professor Headley, your take on rooted in the same question with the travel ban from Europe and from Ireland? How much do they account for travel to the US and tourism in that sector, for example, and what do you see the impact even with the short 30-day ban, and of course, if this has to increase and be expanded to include other parts of the world?

Dean Headley:  A little perspective on the volume of that we see, on a given year, domestic travel inside the United States runs somewhere around 700 million passengers. That's a lot. That's 2 to 2 and a half million a day goes somewhere. On an annual basis, there are around 250 to maybe 300 million that come into this country from some other country. So we have 700 million or so flying around here domestically, but we have another third of that coming from somewhere else. So it's a big deal. In most of the travel industry right now, if you look at a lot of the expansion before this virus impact, you look at a lot of the expansion that the airlines were doing. A good majority of that was International; they were expanding their routes to international places. A lot of it was South America. We haven't heard much about that in the virus incident that we're dealing with right now. It's probably going to be there but other countries, Europe and Pacific Rim countries, definitely a big part of the travel that comes to this country and certainly as we're finding out, look at the lines of the people trying to get out of those countries to come back home. So it's a big deal and it is a financial loss and certainly impacts at that point but as I said before, it will come back, we are wanderers, we like to go so it just takes some time, like anything else that it will come back.

Thom Canalichio:  Okay, thank you. I want to go again to Dr. Kuckertz; we have a lot of college students who are being told not to come back from spring break. We have a lot of states that are closing public schools, elementary schools, high schools and of course, the isolation from elderly family members to protect them from getting the disease. How should people deal with the loneliness and isolation that this whole situation could bring about?

Dr. Kuckertz:   Yeah, I think that the thing to think about is that even though physical distancing is recommended, that doesn't mean that all social connectedness is banned and so I think if you're a college student, it can be really hard to suddenly find yourself back at home, not with your friends, not with your community and on top of that, I think for most college students being sent home, their exams, their lectures, their assignments are continuing, but without that support and that structure that they have come to so depend. So I think if you're a college student still Facetiming group, chatting with members in your group, talking about the homework problems and assignments, talking about how life is at home staying connected in those ways too, with maybe your friends from home if you're going back to where you went to high school and I think for people in general, I would give the same recommendation. So a lot of us, you know, may miss our colleagues and the structure that work provides and so reaching out to our friends, yes, but also staying in touch with our colleagues and checking in on how they're doing, even talking about the projects and staying engaged in our work, I think makes us all feel more connected in this time, where our lives are so abnormal and our team is so often people really need that.

Thom Canalichio:  Thank you, Dr. Kuckertz. It's good advice. We have a question from the chat that isn't addressed to anyone in particular; I think it might be a good one for Dr. Carlos from Betty Kaplan, who's a medical writer. She saw something in the literature about a possible role for angiotensin receptor blockers such as Iosartan or losartan I'm not sure how to pronounce that to treat Covid 19, any knowledge about that Dr. Carlos or anyone else?

Dr. Carlos:   Yeah, and Dr. Bowdish might be good on this one too. So there was initially some concern about the role of angiotensin receptor blockers. 

Thom Canalichio:  Could you explain first and foremost what an angiotensin receptor blocker is and does?

Dr. Carlos:  Sure, yeah, so we control blood pressure through angiotensin and some patients who have high blood pressure are placed on medications to suppress this effect and these are angiotensin inhibitors or ACE inhibitors, or angiotensin receptor blockers, Aces and ARBs as they're called in the medical communities, they're very commonly prescribed and there was initially some concern that these medications may have an effect that would cause the virus to have a higher proclivity to cause disease in patients that caught the Coronavirus. That's initial thought has been fading a little bit. In particular, we're learning that people who are affected by the Coronavirus need to have good control of their blood pressure and their hearts need to be kept safe so that they can fight the disease. We don't want to necessarily make recommendations right now, for or against the use of Aces and ARBs. What we do want to do is get more data and more literature so that we can provide a consensus statement. So I'd encourage everybody on the call to do is keep your eyes out for a big consensus organization like the American College of Physicians, or American College of Cardiology when you see big groups like that make strong recommendations, that's when you want to lean in. When you see one-off studies and blogs and opinions, that's when you want to employ a healthy dose of skepticism.

Thom Canalichio:  A follow up to that is possible that the assumption that ARB's and Aces maybe had something to do with the presenting symptoms, the fact that the Coronavirus also does infect the heart. I believe I've read something about this in the last week or so that in some cases people are getting cardiomyopathy in addition to the pneumonia and respiratory symptoms. Can you explain that as well?

Dr. Carlos:   Yeah, so we are seeing some associations of inflammation in the heart just like we have inflammation in the lungs, and in the heart, it can cause myositis or inflammation of the heart muscle and left to progress, it could lead to cardiomyopathy where the heart muscle does not squeeze as strong. So the ejection of blood out of the heart is not as good. This can lead to heart failure and troubles with blood pressure and circulation. We are not seeing that all patients with the coronavirus develop these symptoms or this myocarditis, in fact, it's a very, very, very, very small proportion of patients, particularly patients that end up let's say, in intensive care units, like I work every day, we are hoping that as we get more data from Italy, from Seattle and other places that are affected, we'll be able to have a bigger end.  Medicine and end mean the number of people that are affected so that we can make better predictive guesses at who might be at risk for this myocarditis, what types of patients we might avoid certain medications on if that's the case and what other therapies such as steroids may help to quell the inflammation. So more to come, it's just the virus is so new, and we're still trying to put all the pieces of the puzzle together. It's hard to make strong recommendations.

Thom Canalichio:  Great, thank you so much for that and one final question for Dr. Bowdish, I do want to move toward wrapping this up soon as we're just at about an hour and five minutes but we do have a couple of other questions from the chat and one of them Dr. Bowdish, I see wrote some of that but I want you to give you an opportunity to say so on camera as well. Are there any over the counter remedies that may cause worsening of symptoms or any concerns there?

Dr. Bowdish:   So in truth, we just don't know. I mean, we have no idea because the disease is so new and because it's gone to different geographies, you know, we are watching the lessons from China and Italy, and quickly trying to piece together all the observations to apply here and of course, people take different things in different parts of the world. So I would say there's no evidence for that right now, no strong evidence, but as Dr. Carlos was referring to, in the initial days, there's a lot of confusion because people with hypertension seem to be dying at a higher rate than people without so we didn't know was it the medications or was the disease itself, we now think it was the disease, not the medications. So as of right now, there's not a lot of over the counter things that can make it worse. There is a little bit of a discussion about if people should use non-steroidal anti-inflammatory diseases like drugs like ibuprofen, or if they should use drugs like paracetamol Tylenol we are waiting to see how that works out, but as of right now, there's no good data to provide any strong advice about that.

Thom Canalichio: Okay, for one final question for the experts, I want to ask if there's any other misinformation or fake news that you're seeing out there or as you're watching the coverage, something that you feel is just missing entirely that you want to make sure it gets out there, Dr. Bowdish, anything that strikes you on those two questions?

Dr. Bowdish:   Well, I think there's been a shift in the past week about it's just the flu and I don't need to worry to people being genuinely concerned and I will say that although, and for young people, the symptoms are generally not too severe, and most people would be okay. There are a significant proportion of people who are young, who still need major, major intensive care to get through this time and so even if, in general, younger people are okay, there will be some young people who will need major medical intervention to get through this and just because you're young, doesn't mean you're not passing it on. The second consequence of that is in a bad influenza year, all-cause mortality goes up, so deaths from all-causes increase and that's because our healthcare workers have to be dealing with influenza and in this case Covid 19 and because of the gowning and protective gear that they have to wear that can slow things down in intensive care, seconds or hours. So there will be increases in deaths not just to this infection, but to all the other things that we might end up in the hospital for. So that's why it's so important to do these protective steps early, the social distancing, the handwashing, to save us from other causes of death as well.

Thom Canalichio: Okay, thank you. I want to go next to Dr. Horney for the same question, any misinformation that you'd like to address or anything that you see absent from the news coverage that you feel people should know?

Dr. Horney:   Yeah, so I would just like to point out that public health does this interview keen basis, now, this is a novel infection but this is a similar function that serves when investigating outbreaks of mumps or pertussis or other things in the community and so I think there's been a lot of conflation of the terms like isolation and quarantine and orders, and self-quarantine and things like that. So I think it's important for people to understand that isolation is for ill people, people who are sick, and quarantine are for people who may have had contact with those sick people. So we're asking people to self-quarantine because we don't really know yet what is going on but as we see more cases, more people are going to be contacted by the health department and by other officials who are trying to trace their contexts and better understand how this works. So public health when it works really well, we don't hear anything about it. So just encourage people to know that this is a task that public health does on a regular basis and to cooperate with them to the fullest extent that they are able.

Thom Canalichio:  Okay, thank you, Dr. and same question to Dr. Kuckertz, what would you say about any misinformation that you're aware of or anything you see not getting talked about that you feel should be out there?

Dr. Kuckertz:   Yeah, so I want to echo and expand upon something Dr. Bowdish mentioned and I've seen a lot of really extreme reactions on both sides, about how panicked people should be and we know from decades of psychological science, that there's an optimum level of anxiety for almost any situation and the same applies here. So, for example, if you think about any tests that you've ever taken, saying; 'Oh, whatever, I'll be fine, I'm sure it'll be easy', means you're probably not likely to take it seriously and you're probably not going to do very well but on the other hand, if you completely panic, it's going to be really hard to study effectively, you'll procrastinate and maybe you won't even try at all but having a medium level of anxiety is probably going to motivate you to study, it will sharpen your attention and you're going to get the best grade and I think the same is true here. So I see a lot of people on social media and earlier on in the more mainstream media comparing this to the common flu as Dr. Bowdish mentioned, and kind of dismissing the threat, and those people probably aren't taking effective measures to protect themselves, and they're more likely to infect themselves than others but on the other hand, I think talking about how this virus is going to decimate the planet and how it's already too late, is probably going to paralyze us. In other words, if it's too late, why even try? So I think that everybody should be anxious to some degree, but also recognize that we have a lot of control over the spread of this disease, and our safety and the safety of the people that we love and at some point, life will go back to our regular routine.

Thom Canalichio:  Thank you. Dr. Kuckertz.  Professor Headley, what would you say is any misinformation or something that you feel is missing from the coverage of about the impact on the industry that you study?

Dean Headley:  As I said, before the industry will come back, airline travel will come back, we will get to go to Ireland again and we'll get to go to [Inaudible 01:09:12] and that's not going to disappear but I do think at this point in time, it is extremely prudent to do your own quarantine if you want to call it that isolation, take steps. It's everybody's part, just like before, all the experts that said that we all have a role to play. The airline industry has a role to play in a good economy. They have a role to play in this economy. Let's face it, airlines will still fly. How do you think some of the medicines and things that we're going to need are coming from other countries, it's not coming by boat, we don't get it that quick. So they're still going to fly. It just may not be with as many people, so do what you can to take care of yourself and prevent whatever spread or escalation of this circumstance that we find ourselves in, and things will get better. They may get a little worse first, but the airlines are doing what they can and travel will be an option in the near future for anybody that wants to feel comfortable in doing it again.

Thom Canalichio:  Thank you and Professor McKeever, any misinformation you're seeing talking about Wall Street and financial markets, or any other topics that are not being discussed, that you think people should be aware of?

Dan McKeever:   Mostly what I think is a gap in the media coverage so far, and it's an understandable one is a short term focus, sort of at the exclusion of thinking what this means long term. So with financial markets, what we're typically trying to do is come up with a number that reflects some future set of circumstances. So we're forecasting how profitable is a given country or industry going to be based on what we expect to happen. So if x happens, how does it affect the value of y and so on and so forth. It's a tremendously complicated undertaking, and it's necessarily sort of an emotional one. What I see missing from the coverage is not what happens with the Coronavirus as first and second-order effects. What I see missing from the coverage is what happens with the next Coronavirus and the next Coronavirus after that, right. So I think it's reasonable to expect that just like this isn't the first major outbreak of an infectious disease that we've seen, it probably won't be the last and so the relevant question for me is not necessarily how quickly do things get back to equilibrium after this virus eventually gets contained or burns itself out or whatever happens? My question is, can we or do we observe the necessary improvements to the systems that we need in order to prevent this type of large scale catastrophe from happening the next time, so there has been tremendous variation in how effective different countries responses have been to this virus right. South Korea has sort of set the gold standard in flattening the curve through its aggressive testing methods and social distancing requirements. Whereas Italy and now the United States have sort of been at the opposite end of the spectrum, Iran is another one that's been at the opposite end of the spectrum. I think it's worth considering and worth studying, and maybe with sort of a cross-disciplinary focus, why is it that some countries perform exceptionally well in these cases? And why is it that others fall completely flat in terms of handling this challenge? What do we need in order to shore up our healthcare systems? So that the next time this happens, and the time after that our response has demonstrated some lessons learned from this time? Now, for obvious reasons, that can't be the focus of the ongoing media coverage? Right, there's a crisis to deal with but I think it's at least worth asking ourselves, how did we get here and what does it mean for where are we going?

Thom Canalichio:  Thank you very good points. Next, I want to ask Dr. Wiley, you already told us a little bit about some of the misinformation and some advice for patients I just want to kick it to you for any other final thoughts, predictions or other points that you feel like the public in the media ought to know. 

Dr. Wiley:  I think it's really important for everyone to know that the limited availability of testing around Covid 19 is not a failure of science. It's not a failure of our scientists or our healthcare. We've all been working really hard. It was really a failure of our government and regulatory agencies to recognize how quickly this was going to escalate. So I just really need to commend everybody on this panel and everyone else that's working on this that science and medicine is doing a great job.

Thom Canalichio:  Thank you, Dr. Wiley. Last but not least here Dr. Carlos, any other misinformation apart from things like the chain email that we talked about, that you feel like people ought to know and debunk or any other topics that you're not seeing getting adequate coverage?

Dr. Carlos:   Well, I understand the term social distancing, and I'm all for flattening the curve, but I don't love the term. I join Dr. Kuckertz when I say I would prefer physical distance because I think socially is a time need to come together, for example, this Newswise it's all these smiling faces, we're coming together socially, to work together on a common problem. The other thing that I don't think is being talked about as much on the news that I've seen is the impact of full hospitals. If the Coronavirus fills up a hospital and you come in with another condition needing medical care, it's possible that you might not get the same level of care that you would have had in the past. While you might not die of the Coronavirus, you certainly are going to be impacted and you might die from whatever disease you had that [Interference - 01:14:39] so I think that as we look at the numbers and the figures, you're going to hear a number of people that died from Coronavirus, pay attention to the fact that if you see rises in mortality rates at the same time, those might be indirectly also caused by the pandemic.

Thom Canalichio:  Understood, thank you so much for your thoughts on that, Dr. Carlos and as you put so well, this event has been an attempt from our perspective at connecting these different experts from all over the country, in fact, internationally with our participant from Canada and that's definitely a big goal of what Newswise hopes to do with this kind of thing and we're talking about plans for more of these in the future as we continue to monitor the news. Our staff based here in Charlottesville, Virginia, we are also distancing, working from home rather than at our main office and as I'm sure a lot of the universities and others are doing as well. So we really appreciate everybody making the time to participate, especially to our media who had questions. A few final thoughts here as we wrap up. We're going to offer a recording of this session as well as the contact information for the PIO's if you want to get in touch with any of our experts that participated today and we'll be sending that around to the media who registered with us to attend today. So you'll be seeing that follow up information available shortly and like I said, we'll keep you posted about the possibility of doing more of these events in the future. I want to call on my colleague, Jessica Johnson for any other final thoughts that she wants to share before we wrap it up, Jessica?

Jessica Johnson: No, that was great. It was very helpful to hear everyone's perspective and to continue learning from all of your points that there are many things that aren't covered in the news. So I really appreciate that additional information and thank you all to all of the experts that joined us and to all the participants and visitors today.

Thom Canalichio:  Thank you, Jessica. Again, for any of the media if you have questions or need help getting in touch with any of our experts or getting access to the video once we have that processed and posted online please feel free to drop us a line. You can email me directly it's Thom with an H, T H O M@newswise.com, if you're already registered for this, we know who you are and we'll send you that update but if you're uncertain about that, feel free to just shoot us an email. You can also contact us at info@newswise.com with that we will go ahead and close. Thank you so much to all of our experts, you're all wonderful and gave so many important insights that I think our media and the public ought to know and we really appreciate you making time for doing this. Have a great day everyone, stay healthy, stay safe and good luck.