"washington journal" program, or through our social media feeds. c-span, created by private industries. rated as a public service and brought to you today by your television provider. a doctor joins us live from zoom. line from "the hill" newspaper noting scientists are learning about coronavirus at an unprecedented speed. at a time where medical journals are hardly keeping up with a number of submissions that come in daily, what has been the most important development in the past week or two? guest: it is hard to choose one. i would say the most impactful one from the standpoint, not science, but the

implications from public health and opening things up as a study from china that was published in nature a few days ago, that studied 100 people, and looked at the virus over time, both before they became symptomatic, and then afterward, and they quantify the amount of the virus , and the most important implication of that study was that about 40% of the transmission that they think occurred in that group happened before people developed symptoms. and that is what we are calling now the presymptomatic phase. we used to call it the asymptomatic phase, but i did not think -- but i don't think it emphasized enough that people could develop symptoms. if 40% of the transmission is occurring in the presymptomatic phase, then you have to think differently as we have been forced to do about how to prevent transmissions of

vulnerable people. host: what does that mean? more importance of testing everyone in the population? we used to focus more on when this first started, checking peoples' temperatures, and now,, it sounds like there are a lot of ways where temperatures may not be the thing that shows. guest: temperatures are not the same. the evolution of even widespread practice in trying to keep people safe has been stunning. even six to eight weeks ago, we received pictures of the sensors in wuhan, and even our airports in the united states. it turns out temperature is a very insensitive index of infection. by insensitive, we mean, it will not be there most of the time, and that is because elevated temperature and favors one of the symptoms that tends to develop after that presymptomatic period. and so, really looking for fever

can help you identify those people who are well on their way, but they are probably four or five days into their infectious period. so really, what it means is we have to do more identification of people who are infectious before they get their symptoms. how does that work? the whole concept becomes looking for testing and tracing than isolating, and we can talk about that if you want to go there, but that is really what we are thinking about. host: dr. jean is here with us for this hour on "washington journal." phone lines are split up regionally. eastern (202) 748-8000, mountain (202) 748-8001, and a special line for medical professionals at (202) 748-8002. symptoms andve

weakens only come back to it, but what do you know about the loss of sense of taste and smell being a symptom, and also studies and reports his vehicle swelling with the tips of one's toes being effected? guest: right. this virus is really interesting. if you can separate yourself on the horrible trauma that it has caused from an academic standpoint, which we can't. , wespectrum of symptoms have seen was some respiratory viruses and other viruses in a sermon, general area, but it is unusual to see a betrayed virus like this because so many interesting manifestations. what we have seen includes this full neurologic spectrum, and that includes some of our atnial nerves, the nerves are feet, sense of smell and taste. , something specific in

this context is loss of smell. a lot of patients have told us that among the first symptoms they had was a very surprising and interesting sense of smell. you know, when we get a cold, we often lose our sense of smell, but that is associated with being stuffed up and having a runny nose and not being able to breathe and all that sort of stuff. this is different. ofis a really profound sense loss of smell that indicates there is nerve involvement. their other neurologic modifications. there were reports of brain inflammation or encephalitis. this says that virus can get into the nervous system and do things that we have seen other viruses do. there restraint. -- doeses that offer that offer other avenues for treatment? guest: that is a great question.

i don't think it does yet because trading viruses i get into the central nervous system is notoriously challenging. you need to have medications that penetrate across the blood/brain barrier, which is a very robust barrier between exactly what it sounds like, our bloodstream and the brain because we are trying to protect our brain. probably ait is not principal target right now because these symptoms, or at least the most serious ones, like brain information -- rain inflammation seem to be rare. host: you mentioned the story about how quickly scientists are learning about coronavirus mentioned the new england journal of medicine saying since the beginning of february, the journal has received at least 20 coronavirus-related submissions every day. in recent weeks, the number has grown to 150 a day, and on

monday of this week, they received 174 submissions. you are there at the university of alabama-birmingham. what advice do you get to the doctors there about how to keep up with all of this information, and how to sort through all the different treatments that are being tested or studied or written about? guest: it is a gigantic challenge. we, like many centers, who are treating these patients, have a group of physicians, about six to eight, and across disciplines, so long doctors, infectious disease doctors, icu doctors, rheumatology -inflammation doctors who get together every week, and review the relevant literature, and revise our recommendations. that is, i think, a good place to do it, but it is really challenging if you are not apart of a group like ours to figure out, not only what is going on, but what is reliable and what is not. there are some sources that i really recommend.

there are some great people to follow on twitter and some fantastic science journalists. i have to say that this -- i have to say that the coverage of this pandemic has shown a light on how dramatically good science coverage can really get complex ideas out of people. not just health professionals, but the general public. what i have told people is to a core group of information providers who you know are reliable and can trust, and are not going to be susceptible to some of the hype. some of the hype has been really concerning. the other challenge is when the journals are getting that many submissions, what do they rely on to decide what to publish? they rely on something called which means to provide rapid feedback and give a recommendation on who to publish them. who usually does that? the people who are busy right

now taking care of all of these patients, right? so getting things turned around for a journal, like one i got 174 submissions in a day, is really a big challenge when you are relying on people on the front lines to look at these papers. really, you have to interpret these things with caution and try to find some reliable folks to help digest it for you. host: could you give viewers recommendation of at least a place to start where people are trying to find reliable sources? guest: sure. one very reliable organization is the infectious disease society of america. i am actually a board member. it is a group of professional infectious disease physicians that have been very involved in working with the cdc for decades on exactly this sort of issue, and the thing -- and all disciplines have them, everything from kidney doctors

to long doctors. the infectious disease group is important because it has had a very close relationship with the nih as well as the cdc, so dr. fauci and many cdc folks have come to our meetings and given us overviews and their perspectives. the website and its accompanying materials have very good information, particularly for professionals, but really good news overviews as well as advocacy information, so people working hardeally to keep our funding going. and to keep the public safe. i think that is one good place to start. another place i would recommend a cdc's website. cdc.gov has an excellent bifurcation, one for the public, and non-health professionals, and one for health professionals, and they have done an amazing job trying to keep up with all of the current

of knowledge that we have been talking about. i think those are two fantastic sources. if you are on twitter, there are some very good people to follow. ,hat news site is excellent "the washington post" is excellent, "the wall street journal" is good. host: let me throw one twitter handle out there. m. jean she is with us this morning to answer your questions to talk about the latest on the covid-19 front, taking your thoughts on the phone lines. set up originally. -- set up regionally. county,out of fairfax virginia. good morning, jack. caller: good morning. i would like to ask the doctor, there are 670,000 cases roughly

in the united states. which i thinkths, it works out to just about 4% or 5%. records of the 4% of 5% who don't make it, how many of them had pre-existing conditions? why 95% ofring people go through it successfully, and the other 5% don't. what the percentage of the deaths may be hooked up with some kind of pre-existing condition? caller: jack, that is the billion dollar question. so a very insightful question. i want to address two issues with your question because it really opens up the pandora's box. what is the true mortality rate? if you look at many databases, starting with wuhan, china, and going to italy, then spain, then

germany, norway, and then the u.s., and individual counties in the u.s., you will see mortality than that range from less one per 100 people in the population, which is how we like to measure it to 270 or so. if you look in china, it is less than one. if you go to some of the parishes outside of new orleans, or parts of new jersey, it is above 50. what does that really mean and how does that translate to the percentages you are talking about? pardon it has to do with understanding the denominator. this has been a perpetual problem throughout this entire pandemic. we don't really understand how many people are really infected. that is why we can't get a handle on what the true prevalence of infections without any symptoms really is. so, when we look at mortality rate, we have to sort of really think carefully about what the

denominator is part of these people who come to the hospital? these people out in the community who happened to die at home, and we won't -- and we don't know what the circumstances were? the best estimates related to your question of core morbidities comes from the database out of italy, in particular, or western europe, and some extent china, but i think the western european countries have really started to track this as well. if you look at the database from wasy, some of which published last week, where they looked at people who were admitted to intensive care units, a lot of the people who were most profoundly affected and died had cardiovascular diseases, like hypertension. the mortality rate and those people were often times twice as high. so how do we extrapolate that to a country as complicated as the united states?

we are seeing when we look at the deaths in places like, even alabama, which is not yet as affected as in cases like detroit and chicago, that demographic factors predict mortality because we know the black race is unfortunately very much a characteristic of people who have died of this virus. is that because that is linked to a higher prevalence of hypertension, diabetes, of other cardiovascular diseases? we don't know, but there are very strong signals that any of those comorbidities devlin increases peoples' risk of mortality, and i think we need a better sense of what those estimates really are. host: to jeffrey osborne, new york. good morning. caller: good morning. before i get to my question, could you have someone on dealing with the fairness doctrine? host: in terms of media coverage? caller: yes. the president's ongoing

ramblings, and we need a democratic response. ok. here is my question. we just went through easter and passover, and i am really concerned about your previous guest. dusty johnson, smithfield farms, and there has also been an outbreak at carmel food processing and tyson's. i am really buried about the jump -- i am really worried about the job. i am a cook by profession, so i am worried about food safety. but human to hog and back to human mutation of the virus, and also human to bird and back to covid-19.tion of this i am really worried about a new and improved strain, either a bird or a swine flu. host: thank you for the call. jeffrey, are you working right now in auburn, new york as a cook?

i think jeffrey jumped off the line, but go ahead? guest: jeffrey brings up two incredibly important points. first of all, this concept of animal to human to animal transmission. kansas was on tv last night talking about meatpacking plants and the potential for outbreaks. that is a separate issue from an animal to animal transmission, and when we look back at how coronaviruses and even influenza, actually mutate and get into places where they should not be, this animal to human transmission issue is really the heart of the matter. so, we think that many of these viruses --iable core variable coronaviruses could -- in the wild. thatirus can mutate out of

into other hosts and there has been speculation that with his trade ine wildlife wuhan in the chinese wet markets could have been the originator of this process because it really facilitated that close quarter transmission of the virus from the host to another host and then to humans. influenza virus classically has involved the pig loop with the bird and then humans. 1918, the pandemic influenza was thought to perhaps have originated in kansas with the pig farms and with the chickens. i think it is a great question, and it is something we absolutely need to be very, very concerned about. the other question about food safety and your job as a cook is huge. i have been talking to a few people in birmingham who own

restaurants, and they have actually used the term that they are really terrified of when the restrictions are lifted. what does that mean for them and their staff and their customers? because you can't really wear a mask when you go to a restaurant. the point is to go and enjoy your food. i think that we have to be very cognizant, not only enhance hand hygiene in those settings, but also physical distancing, so we have been talking in some areas about letting people go back to eating establishments with an appropriate social distance more physical distance of at least six feet if not more between tables. that still doesn't get you over concerns around and hygiene because you still are people preparing food, handling food from all that sort of stuff we worry about with hand hygiene in the restaurant industry anyway, but that is now magnified several fold. it is doable, but we have to be

very supportive and listen carefully to our restaurant --viders and state gainers providers and sustainers as we work through this. this,as we work through we talked about the president opening up america's plan. you are part of the efforts at the university of alabama-birmingham to study how to reopen the university. what you think of the president's plan of what factors are you taking into account before reopening the university? guest: great question. again, another billion dollar question, maybe a trillion dollar thing given the economic impact. i think that the plan we heard about last night has a ton of common sense in it. what we have been talking about, many of us in public health have been talking about, really three things they need to happen. -- things that need to happen before we feel comfortable in

talking about this. the first thing is that you really want to have probably declining rates of new infection andke hospitalizations deaths. over the course of two weeks, and i think that is reasonable. if you are competent you were on that downslope -- if you are confident you are on that downslope of the curve. this is more the flattening. this is sustaining a downward turn, which is really critical. if you feel like you are there, that is an incredibly positive sign, and you can start to talk about how you can reintroduce these kinds of physical interactions in society. i think that is great. the caveat to that though is the testing issue we have been talking about. if you don't test you will not find, and you will be seeing a very nice decline in the curve, right?

so, we don't want to get a false sense of assurance and security by not knowing exactly what is out there. so, it comes back to the second issue that i think we really need to have before we get comfortable with this concept of opening things up, and that is adequate, diagnostic testing. at the press conference yesterday at the white house, i believe it was dr. fauci or dr. birx who emphasized, we are thinking about two buckets of diagnostic testing. we need to have access to the kinds of tests that can diagnose acutely infected people. so, the nose swab, right? we may be using throat swabs. maybe soon we will be using saliva would will be very useful. these are tests that can tell you whether or not you have the virus and you are infectious. those are very helpful because were all the reasons we talked about, we want to get those people out of circulation and

try get them to stay-at-home, or if they need to get care, get them into care. again, thert -- rates coming down, having a way to measure that in real time, as you look at reintroducing things. the other product the diagnostic toolkit is antibody testing, and be have been talking about this a lot. antibody testing allows you to see who has been infected and we think who is immune to reinfection. versus who has not been infected and is still vulnerable. that will be important, particularly when we think about mobilizing health-care workers because you can imagine, we would like to have health-care workers who have been infected and have some immunity in settings where they may be caring for people with this virus. that would provide some measure of safety for those interactions. those are some of the things we

are talking about. the third thing that i think needs to happen before we get out and say we are all good, we need to be sure we do not want to be faced with dealing with recurrent and searching outbreaks and health care workers not be protective. we have already had devastating stories of health coworkers dying and needing to be taken out. those are the three things that need to be in place in order to develop and field comfortable to open things up.

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