麻豆传媒

News — The following is a transcript of the 麻豆传媒 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 麻豆传媒 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 麻豆传媒, 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 麻豆传媒 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 麻豆传媒 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 [email protected], 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 [email protected] 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.