Seeing isctors are that even among people who develop illness that is serious enough to bring them to the whoital, there are some fall off a cliff. There is a moment where they are doing pretty well. They dont feel well, but they are doing ok. Suddenly they need emergency icu care, possibly intubation, become gravely ill. The question on a lot of doctors minds is what is pushing people to that Tipping Point. It also sometimes happens in middleaged and young adults without these risk factors so i wanted to understand what exactly it was that was precipitating that fall. Be this cascade of immune system signals that go gets us arive and it little in the weeds in terms of the immunology. There are people looking into targets that could intentionally predict and hopefully stop that fall from happening. Host what are the doctors telling you about potentially of whats happening there . It starts to spread. It gets into cells. It starts replicating. Some peoples immune systems will pick that up pretty quickly. Inflammationome that creates symptoms that feel kind of like a flu and eventually eradicates the virus. In some people they are not picking it up quite as quickly and will stay asymptomatic for a longer period. At a certain point when the body starts to recognize, i am widely infected by this virus throughout my lungs, possibly involving other organs, sometimes there is this inflammatory response where signaling molecules are released into the blood and sound of fire alarm. They tell the body need to go into crisis mode right now and get this out so what felt like a mild illness suddenly very quickly becomes multiorgan distress. Espiratory fight made this prolonged or flight response where your body is trying to do everything at once to stay alive and that process is not sustainable for very long without life support and intensive care. Term you use in the piece is cytokine storm. Thats a term some doctors are using to describe this process. It isnt clear that every case involves it. Its a process that happens in lots of viral illnesses and nonviral illnesses. The body goes into panic mode and its a wellintentioned immune response but it becomes counterproductive. Earlyearly in the disease, docts are hoping, lets hope this persons immune system is able to find this virus and the person has a mild illness. At the later point, the fluid in heartbeat,abnormal drops in blood pressure. Things can be a result of the immune response itself so doctors are looking at targeting that immune response and tampa get down. The virus is all over the immune system. Tamp down the immune system. Host did the doctors tell you there are parallels to what you describe in other types of viral infections . Happen in lots of different viral illnesses. Its predictable to different degrees in different illnesses. We do have some evidence of ability to block certain cytokines. That youope heard the news today that there is some promise of a specific antiviral that will block coronavirus and it sounds promising, but that will still take time for us to be able to block this brand new virus. Our immune system doesnt have new tricks. We just need to know exactly which ones are happening when. The researchas that goes forward when looking , did they9 specifically cite research on how the body reacts to things . We are looking at a lot of different pathways. One of the promising areas is one of the cytokines that we can potentially block. With drugs that block that signaling molecule. Of quiet down the fire alarm so the body doesnt go into this state of immune overdrive. Other people are suggesting and trying, Clinical Trials using corticosteroids. The same things that people put. N their skin for a rash any kind of immune condition where the body is attacking itself and it needs to be tamped down. That is more of a widespread big ideally its always a real tension when you have a patient with an Infectious Disease and doctors are faced with with a should suppress the immune system really widely. Tryingeople feel safer test target to target this specific pathway in the immune system. Host you can ask questions at 202 7488000 eastern and central time zones. 202 7488001 mountain and pacific time zones. 202 7488002 all others. You can also tweet us at cspan wj. Yourself,al doctor reports of about 60,000 deaths. When you see the amount of doctor, whatedical is important to note in your mind . This virus is in a place that makes it so extremely dangerous because it manifests in so many different ways. You started to hear a report about asymptomatic cases and mild cases. I think that is whats confusing for a lot of people. There are some people who do fine and its not a big deal. Other people who become so that is sort of a worstcase scenario for any Infectious Disease outbreak modelers you have. Some people who are walking possiblyt very sick asymptomatic spreading the disease and it can cause fatal illness on the orders of magnitude that we are seeing here. Thats what makes public messaging difficult. Because some people think its not that bad because the people they know havent had bad cases. Thats what lets us put our guard down. Im also heartened by the social to try to mitigate the spread. We would be a lot higher than 60,000 right now if we hadnt taken such dramatic measures in some any places. Host is that social distancing measures or are there other fat . Other factors . You have seen heroic members by the Health Care System. Social distancing and shut down measures that you cant quantum by exactly the effect because theres no alternate universe in which we have the exact same country that didnt shut down. Thats our primary mode right i tryecisely because when to describe these immune system drugs, its very experimental and hard to definitively say how to best treat it. Its unfortunate and sad but we know it works. Youve heard the comparisons made by some about this virus compared to influenza not only in what it does to a body but the death tolls and the like. When you hear those comparisons, what goes through your mind . Portion of our population gets vaccinated against influenza. So you cant compare a brandnew virus to something that we are already very familiar with and have symptoms in place to track and test and vaccinate against. For our lack of immune system familiarity with this virus, our lack of infrastructure within the Health Care System and public Health Care System to and thend this virus simple fact of how dangerous this virus is, influenza is not a good comparison. You can see just from the raw that in less than three months we have lost or people just by official counts than a bad influenza season. T our first call froms comes from florida. You are on with our guest. Caller good morning. I have a quick question. What about once you feel the sore throat and some of the symptoms, what about if you that would something possibly kill the replication in the back of the throat at least. My understanding what ive read is it really replicates at the beginning of the infection. And if you could gargle with somehing that would kill of the replication, knock it down, make it less of an infection. Im just curious if that might help. Think thats an interesting idea sort of targeting right to the area where the virus is starting to take hold. I think most people are looking of drugsdministration of that would help viral replication. The most promising thing we have in terms of blocking viral seems to be its early phases right now. What they do seem to do is help people who are already in the phase of needing hospitalization. Might be able to target the immune side of things just by monitoring exactly when youre seeing this Tipping Point from mild disease into severe disease. Host jim talks about the site a keen storm. He asks is that one of the complications of covid19 but is the most important or controllable . It is the mechanism through which the complications happen. You might think of kidney failure, cardi arrhythmia, blood clotting and strokes. Things youthose could also try to target and treat individually. But the storm is this sort of sets off theat inflammatory process that can cause all of those things. You geting at how do that comment point comment point that is leading to all these different complications. That and howt to can we identify when its starting to happen early and help people know they need to get to the hospital and help doctors know how to identify that and target and treat it before we get into those late stages. Host jason is next in maryland. I believe i had covid19 for about two weeks. Couldnt taste, couldnt smell. I had a lowgrade fever. The only thing that gave me any kind of reprieve from the symptoms was actually line. I would eat lime zest, lemon zest and take Colloidal Silver and i would eat aloe and i found those things helped with my symptoms. The fact that they all have natural antivirals in them. Hello . Host we will let the doctor respond. Dont know ofi evidence that those things are actually killing viruses. But things that help with symptoms and arent known to make anything worse, i think im all for adding that to the evidencebased approaches that doctors recommend. So im glad that help to you feel better. Host the lack of smell and taste are things you bring up in the piece itself. Its another thing thats confusing to people. You are seeing a lot of young people with no other symptoms. They start to have a lack of smell and taste and the possibilities for that seem to be that you are having a viral infection thats actually attacking the nerve cells so they dont function appropriately or you are having an inflammatory response localized in that area that hasnt spread through your whole body and caused systemic severe an analogoushat is local voluntary response temporarily impairing the function of your own factory nerves and sense of smell. A differentirely sensation that a lot of us have felt with a bad cold. Sometimesre seeing it in the absence of congestion. Yet another open question but also the possibility for hope that we can better understand the process there may be usmonalities that could help modulate that which might seem like a trivial system compared to what other people are undergoing. When people are living in the fee that there mild disease could escalate at any moment that a symptom like that is proving very concerning to people because they dont know where this is going to go. Am i going to have to be in the icu or stay home and be just fine. Good morning. The normal body temperature is 98. 6. But if youre running a temperature of 95, what effect does that have on your immune system . Id be speculating. 95 is for most people dangerously low. I dont know. I havent heard of hypothermia being part of this disease. Dave in irvine, california. Caller i read this book the Coconut Oil Miracle. Hes come up with another book called the Coconut Oil Miracle for sedition. He says in that book that coconut oil, coldpressed, unrefined extra Virgin Coconut Oil kills all viruses. He also states, treats people with hepatitis c where you can buy a drug that costs like a thousand dollars per pill and he has cured all these people of hepatitis c and i was wondering have you ever read that book . He says in there that it cures all viruses. I would like you to comment on that and if you havent read the book, you should read it. Yeah. I think if there were a treatment like that, the people who are working real hard studying this and trying to cure people who are sick and dying would be all over it. So im open minded about anyones fears and welcome them to be tested and vetted clinically. Not forgo the best possible treatment in hopes that someone promising a literal miracle is in possession of some unique knowledge that has somehow evaded people who study viral diseases. Host for the way that you have reported about the way this attacks the body, what does that mean for the development of a vaccine . When you are making a vaccine you are trying to expose a person to just parts of a virus or an low enough dose that their body develops antibodies and immune memory but not so much that a person gets sick. Complexity ofthe treating this immune pathway will potentially inform the approaches we need to take to vaccines and what to look out for in terms of negative effects that we expect to see in early trials of vaccines. Suggestions that we are going to have to break truethe tried and mechanisms of Vaccine Development that we have been working on for decades. People are thinking out of the box for Vaccine Development, making a vaccine in a few years would be far quicker than we traditionally have and to do it in a year or two is unprecedented. Given the scale of the disease and the severity, thats why i think you are hearing people suggesting new methods of testing and expediting the process. Host such as what . I dont feel im not certain how seriously some of them are being proposed. Can tell you that normally when we develop a vaccine we air heavily towards safety. Especially given so many aboutns that people have vaccine safety in some parts of the country that have been growing lately. People will use animal models and then small groups of humans and then larger groups monitoring very closely and erring towards the side of giving a vaccine that might actually be ineffective. It wont hurt you because we wouldnt come close to giving you a dose of anything that would trigger a dangerous inflammatory response or infect you. Because we are trying to move quicker, people are suggesting giving, exposing the younger healthier people to the virus itself in ways that are more likely to actually host is that a reasonable length of time you think in this case . Area ofhis is not my expertise, but everyone i have spoken to says that is the best possible scenario. I think there are two elements to really consider. The technical aspects, at what point do we have something that scientists feel is viable, and at that point, people feel it. Ty confident in the variable right now is how do you get it from a sidedly viable that isto something actually administered to hundreds of millions of people in the u. S. Alone, billions worldwide . Terms of actually producing it and distributing it and making it affordable, we do not have the simple infrastructure to do that. Vaccines have not traditionally, for many years, been a big revenue generator for pharmaceutical companies, so you will not see pharmaceutical companies banging down the door of the government, saying, we really want to turn all of our production facilities into vaccine production facilities right now. Complexing to be a production and distribution process, and that is the second thing we should be talking about really seriously right now, to scale it up as soon as we have a safe and effective product. Dee, lets hear from fresno, california. Caller hello. Ave a question for the dr. I have lupus. All of this sounds like exactly what lupus does to your body. Why in all these years have you all known and i think you just answered my question on the last there is not a lot of money out there to give vaccines. So dont they hydrowhatever to ra and lupus 202 7488001 st hi dr. Corcoran hydroxychloroquine, there was a study in china that suggested it could inhibit viral replication in tissues in a petri dish, of the subsequent study did not show it had a good effect in this disease. You dont this immune process is not something to be taken lightly when someone is in a state of critical illness, we exactlybe careful about what parts of the process we are tamping down because the virus depresses the immune system too early or too dramatically, you could have worse viral spread. If you dont suppress it enough, you might have a person who dies , from organ failure that as a result of that immune process. I think people have been openminded in terms of using drugs that are targeted towards modulating the immune system, which are the same ones we use for lupus and Rheumatoid Arthritis and other drugs and people are trying different things. I mentioned even steroid, the most common thing we use really widely, we dont know the exact pathway. Host we heard dr. Fauci talking about remdesivir. What is about that drug that is particularly useful at this time . , we have thisvir first study, the result of which came out yesterday. It was stopped early because it seemed to show clear benefits and given the situation and urgency, a trial like that can be stopped if you think it would no longer be worth not giving the drug to a control group. You are withholding the drug from some people in a study like that, at one of the reasons you might stop it early. Promising, it is a drug that targets viral replication, and it seemed to decrease the length of stay in hospital. It is not a care, we will not have one drug it is not a cure, we will not have one drug that can do that, but if we have some drugs that inhibit viral replication or inhibit the way the virus is spreading and some drugs that help modulate, to strengthen our immune response to that virus or to slow down the part of the response that are dangerous to us, and it could be some cocktail of that and it would depend on your clinical situation, the severity of your disease, other conditions you have, what shape is your immune system, you might get at one po