With the senate back in session today, we will talk to a leading vaccine expert from newton, massachusetts. Later, we will examine some of the new side effects from this virus. We hope you join in on the conversation. Our phone lines are open. If you live in the eastern or central time zone. 202 7488000. For those out west, 202 7488001. If you are a medical professional, we would love to hear from you. 202 7488002. Good monday evening. Thank you for being with us. We begin as we always do, look at the numbers from Johns Hopkins university. Now around the world, the number of coronavirus cases approaching 3. 6 million in 187 countries and regions. The death toll has exceeded 251,000 around the globe. Joining us from massachusetts is dr. Mark poznansky, director of the vaccine and Immunotherapy Center at mass general hospital. I want to begin with the headline today from the new york times. As states moved to reopen, at least one model predicting the u. S. Death rate could double. As you see that headline and follow the story today, what is your reaction . Dr. Poznansky well, its a tragic inevitability of the fact we are facing a pandemic virus infection where there is no native immunity. No ones naturally protected against this virus. Therefore, the most vulnerable in the population the elderly, those with preexisting conditions are at the mercy of that virus. With all the best will in the world to social distance and contain the virus, there is still the tragic lossoflife because of the severity of the illness by those severely affected by it. Steve with the death toll that could top 3000 a day from a report inside the trump white house. Dr. Poznansky yes. It goes with the territory of a pandemic that spreads in this way. As states open little by little, it increases the risks that people will be in contact with each other. The virus will spread to some controlled degree, but those people who are vulnerable to the infection will become infected and the most serious cases will end up being hospitalized with the infection. I think the only thing i can say is working in the hospital is that the Health Care Workers are getting more and more experienced in dealing with this new disease. There are new developments emerging in terms of treatment. New ideas about handling cases in the intensive care unit. The issues of having patients lie flat to improve oxidization of their lungs. This has happened in real time as we have seen the severity of this infection in hospitals. There is the sort of battle in terms of numbers, but the actual active battle going on in hospitals to continuously improve care. I think the Biggest Issue as these numbers increase is that they shouldnt, as best as we can do with social distancing and the controls at which we are doing, overwhelm the healthcare services. Under those circumstances, there is a tragic needless deaths of people waiting to come to hospitals. The in adequate numbers of ventilators. Keeping the numbers of infected under some sort of control by social distancing advances the goal to avoid overwhelming healthcare services, as we saw in new york city which is now resting back control. Or as we see in boston, we do have experience, a sustained level of control over the pandemic through social distancing here in the city. Steve our guest is also associate professor at harvard medical school. Tomorrow, dr. George daley, the dean, will be joining us tuesday evening at 8 00 eastern time. I want to get your reaction to what the president said last night in a fox news town hall meeting on where we stand for the vaccine. Pres. Trump we are very confident we will have a vaccine by the end of the year. By the end of this year . Pres. Trump we think we are going to have a vaccine by the end of the year. We dont even have the final vaccine. Johnson johnson, if you look at Johnson Johnson is doing it. We have Many Companies are, i think, close. I meet with the heads of them and i find it a very interesting subject because it is so important. I think we will have a vaccine by the end of the year. Steve as you hear that from the president , is he on target . Dr. Poznansky people who know me know im an optimist. The optimistic things are the more than 70 vaccines at play in the moment. We have his great advantage of multiple shots on goal which gives us a chance to find a way through here with an effective vaccine. The issue here is time to develop a safe and effective vaccine. Two elements of time of that which is related to the mechanics of making a vaccine and the biology itself. On the mechanics, it takes time to actually assemble a vaccine, test it, make sure it is safe, make sure it is actually effective. Make sure there are not uncaused effects of the vaccine. That takes time. Dr. Fauci has talked about 12 to 18 months. Secondly, there is one part of this that is the fundamental biology of the virus. We dont yet completely understand what consists of socalled protective immunity. What is the immune system doing and people get infected with this virus actually protect them . That biology remains unknown at this time. In some ways, were laying the track for a vaccine while building the train that is moving along that track at the same time. There remains unknown answers to very significant questions that make prediction of shortterm Vaccine Development really, really tough to make. There are a number of known unknowns, as they are called, which we have to know in order to develop an effective vaccine and those remain unknown at this time. Steve which is what you outline in a recent piece at thehill. Com, entitled changing america. You said we are still many months away from final testing of the vaccine. From your standpoint, what is your biggest unknown . Your biggest question . Dr. Poznansky my biggest question is truly this question i raised about what constitutes protective immunity . In other words, if you are infected with the virus, you recover, what are the elements in your body that are defending you effectively against a subsequent infection . Because that detail of the immune system that a vaccine absent that infection will have to bring about in your body. That question, once that is answered, will speak on the development of vaccines. We will actually know what the target is. Like i am optimistic about 70 or more vaccine platforms targeting covid19 at the moment is simply because by chance, whether it is the oxford team for the Johnson Johnson team or our team at mass general, there is a chance we are able to invoke the immune response that will protect people against infection with the covid19 virus. At the moment, that question remains to be unanswered and consequently, we are moving on vaccines forward as we are laying the tracks towards that understanding. Steve you are working on what is being described as a selfassembling vaccine. What is that . Dr. Poznansky it is the sort of interesting biological construct which consists of one component which is a protein that activates your immune system generally to get ready to fight a virus. And then the second part is one that actually targets that response to the specific virus. This is actually funded by darpa, the department of defense over eight or nine years ago as part of a Pandemic Preparedness Program that they launched. The selfassembling piece you attach one part of the belco molecule to one part of that vaccine, and the other piece of velcro so the other part of the molecule. They come together straightforwardly to make the whole vaccine. It is an extremely stable construct. That velcro component are naturally occurring proteins that can be added to both sections of the vaccine. Then, they come together when you mix those in a test to. It is stable, it is longlasting and suitable for distribution in large quantities, manufacturing, stockpiling large quantities which was the stipulations of a pandemic preparedness type of approach in making a vaccine. Steve our guest is dr. Poznansky from mass general. Our phone lines are open. We have a line set aside for medical professionals at 202 7488002. If you are a doctor, nurse, emt, we were left to hear from you. Pat is on the phone from new jersey. Caller even if by some miracle we got a vaccine by the end of this year, wont this virus still be existing in the population for years to come . How long is it going to take to vaccinate every Single Person in the world . Thank you. Dr. Poznansky that is another enormously important question, which is once you have made a vaccine, how do you then deploy it across the globe to eradicate a virus . We have some models of this in history, the eradication of polio, the eradication of smallpox. Absolutely right. It takes a long time. That does not mean we cannot make significant strides to get this effective vaccine. We would vaccinate those at most risk. The frontline workers. The individuals who have high risk of severe disease. The elderly. Those with coexisting medical complaints like diabetes and Chronic Airways disease and so forth. We can make a very Significant Impact on the severity of the disease in the population as one of the first metrics. But pats right, this is a major global undertaking as it was with smallpox, as it was with polio. To go after the global population, deploy effective vaccines and get to everybody effectively on the planet to protect them against this disease, because the alternative is that the virus starts hanging around on the globe, infecting pockets of patients and individuals even when there is an effective vaccine for it. Steve you mentioned vaccines in development. Some confirmed, some not confirmed. When you get to phase one of a vaccine, what does that mean . Dr. Poznansky phase one is the principal test you are doing is safety. That is that you dont see adverse reaction to the actual vaccine itself. We are talking about serious adverse reactions, including skin rashes, upset symptoms that are related to the vaccine itself. It first at phase one. You can at that stage have a readout of efficacy as well as a second refinding based on the fact of the context of the vaccine that those people you are testing within the trial might themselves be challenged with the virus, just hanging around on the planet, being exposed to it. You cant see whether in phase one, if there is some indication of efficacy, you can in more developed settings work out with generating those who got the trial vaccine are generating an immune response to the virus that looks like it should, at least in theory, challenge the virus. Steve lets go to stephen joining us from brooklyn, new york. Caller thank you, doctor, for everything you have been doing during this crazy pandemic. What are some risks and challenges you have been facing during this development of the vaccine . Im wondering when the next update for dr. Poznansky the things we face challenging the first one delivered us on a plate. Our vaccine platform, six month before the pandemic, was actually licensed to a company that was interested in it initially as a cancer vaccine platform. But once the pandemic arose, they realized it could turn on a dime and be ineffective pandemic virus an effective pandemic virus vaccine which it was initially designed for. Why they said it was a hurdle that was almost instantaneously overcome is as we develop vaccines, especially in academia, we must have partners in industry who will take this on and drive them into being a product. This thing of academic universities dont make medical products, Companies Make products, that kind of partnering early on is incredibly important component of what we do. Those challenges we would have otherwise faced melted away in conjunction with therapeutics that came together to provide the expertise to take on a new Covid Vaccine further towards full development and testing and provided the Financial Support to make that possible. That all happened in the space of two or three weeks. Certainly in the history of academia, that is a very short period of time, i can tell you. Steve james is next from shreveport, louisiana. Good evening. James, go ahead. I will ask you to turn the volume down on your set, otherwise we have to move on. James, are you with us . Let me go back to that development of remdesivir which is a new treatment for covid19 patients. How significant is that in terms of the timeline and in terms of what its potential means . Dr. Poznansky the key thing as one of the first barriers to this awful virus is a drug that will change severe disease into moderate disease, moderate disease into mild disease. Tamiflu equivalent. That we have the flu, but the tamiflu equivalent of covid19. We saw the first glimmers. Again, im an optimistic person. It is an intravenous drug that can be given to severe patients which shortens the duration of their symptoms. It is important to note it did not release the preliminary reporting on the Clinical Trials significantly impact the instance of mortality or death as a result of covid19 infection which is disappointing to doctors like myself because we like to have it all and see it succeed in every possible way at this time. It is certainly significantly reduced the duration and severity of the disease which is a major advance for us. And could have a potential impact in the icu to reduce the length of the state in icu. The quicker the patients get out of the icu into the general ward, the better. The only caveat i would say im a pragmatist is that the positions of the scientists, we await the full report of the trial so we can understand the details of how it was executed and what the devils of the detail were about the trial itself. That is imminent and we are obviously all excited to see that. There may be more positive data to be yielded through scrutiny of that data. Steve dr. Poznansky joining us from his home in newton, massachusetts. He is the director of the vaccine and Immunotherapy Center at massachusetts general hospital. Raju is joining us from houston, texas. A medical student. Could evening. What are you studying . Caller im actually planning to go to medical school in the next few years. Im currently a biotechnology student. Ive taken classes related to virology and things like that. In regards to covid, a lot of the talk has been about in terms of side effects or other types of viruses that have the ability to mutate, because if you try a vaccine, the virus will heal itself and things like that. Has there been any trouble with regards to vaccine trials, the virus mutating or shielding or things like that . Or is it more in regards to the side effects and the clinical endpoint you guys are trying to reach . Steve thank you for the question. Dr. Poznansky i encourage you to go into medicine. We need all the help we can possibly get. With regard to the mutation rate of the virus, it has been low, but there have been sequences of the virus that have different versions genetically. The vaccinologists are very aware of this. We have a platform that can newly change the targeting vehicle of the vaccine to adapt to the specific changes in the virus. A vaccine for covid19 to a vaccine for covid19a, for example, if we need to. The other important point to stay about viruses changing it can change genetically but it may not have a major consequence in terms of either their immunology or biology. It is an area very close monitoring, like with a lot of viruses, how they are changing genetically. But there are vaccines out there which are watching that and ready to move and adapt according to the way the virus changes. Steve gary, you are next. Good evening. Caller evening. Interested in knowing whether there have been any reported cases of influenza in covid19. If not, what are your thoughts about that occurring . Steve what is your background . Caller im a family physician. Dr. Poznansky that is a deep medical question. I have not personally seen cases of combined infection with flu and covid19. I have seen patients who had flu and thought they had covid19. Also, as one of the areas of Infectious Diseases specialty, i work in an area where we are treating patients who are immunocompromised. We certainly see coinfections or two or three different infections affecting the same individual when their immune system is impaired by medications like steroids and agents like in cancer, patients of cancer. Conceptually, it is certainly possible that a patient with an immune defect could actually be coinfected with both viruses. It is just i have not personally read about it or seen it for myself. Steve lansing, michigan. You are on the air. Caller i have a question. How is it possible somebody gets the disease and recovers and not be immune . It seems to be contradictory that if you develop immunity by injection or given an injection of sort to create the immunity from scratch. Steve thank you for the question. Dr. Poznansky another great question. It does relate to what i said earlier about not knowing exactly what protective immunity means in the context of covid19. So, until there is more understanding of that, we wont know what constitutes it. Again, in the hospital so far, i havent personally seen patients who have had recurrent covid19 infection. I think as dr. Fauci said, it is much more likely that once you have been exposed to this virus, just like other viruses, you end up being immune to that virus. The thing thats holding us up is understanding what immune to that virus actually means. That takes time and science to work out. That point is exactly what i gave the analogy of laying the tracks while moving the train along it. That we are heading into Vaccine Development without a clear idea of that, but we have enough shots on goal and enough experience with the science of Vaccine Development to make certain assumptions we are moving that train along to an effective vaccine, that we will get to effective immunity based on the number of different vaccine platforms being tested. Steve how do you make sure that train reaches the destination . In other words, how do you test the vaccine to know it is working and what are some of the stumbling blocks along the way . Dr. Poznansky the key stumbling blocks actually, the biggest tumbling block is the industrial interest in taking the vaccine all the way to the end. We know the financial component of Vaccine Development where the product, each unit has to be under one dollar and cost and it is going to be a global product. Theres going to be all sorts of economic ramifications. Companies will have to swallow that to drive this forward. The second one is simply that vaccines have moved along the Railroad Track towards phase ii and phase three have ultimately failed on safety. That issue of safety actually magnifies if you move along the path. The reason why is as these trials move from phase one to phase two to phase three, you get to see the effect of the vaccine on more and more patients. From hundreds of patients to literally thousands of patients. The view about safety for vaccines is they have to have very high levels of safety and ultimately, you are giving those vaccines to entirely healthy people. The idea of inducing any health into those patients as a result of the vaccine is counterintuitive. That hurdle of safety gets magnified as you get down the track to phase three trials. Everything you can do, we are doing that in our Vaccine Development that you can mitigate against the safety affects of your vaccine that might impact the safety of the product, you have to do. I know other companies are doing that as much as we do from therapeutics and other therapies. Steve let me conclude with this question. You find a vaccine, you tested it, it works. You want to manufacture it and distribute it to 300 million americans. What is the timeline for that . Dr. Poznansky youve got to find im not the sort of person in the room anyway and not the smartest person in the room to answer that question. There are experts, absolute experts in this field who really focus on the other second half of Vaccine Development, which is vaccine deployment, that would be best to answer the question. That is a whole subject in its own right. Deploying that vaccine worldwide effectively and definitively as the next few hurdle beyond addressing safety and efficacy. Steve dr. Mark poznansky is with mass general hospital, head of the vaccine and mnu therapy center. Hes also an associate professor at harvard medical school. Professor and doctor, thank you for being with us. Dr. Poznansky thank you. Steve i want to turn our attention to washington, d. C. And this headline from roll call. The senate back in session as members of the u. S. Senate, including the republican leader Mitch Mcconnell, wearing face masks. Joining us on the phone is a reporter who covers congress for cq roll call. Thank you for having me. Steve it seemed to be a day with new norms for physical and social distancing. The mandatory headgear for members of congress as well as reporters covering congress. Katherine yes, its definitely a whole new world in capitol hill. It is important to note that the masks, while recommended by the attending physician and started an arms on capitol hill, masks are not a requirement. There is no one enforcing mask wearing up year. There were some senators today who opted not to, including senator roy blunt, chairman of the rules committee in the senate. So it is definitely not a rule. Some Capitol Police also opted out of the masks. Steve when the Senate Republican leader Mitch Mcconnell walked into the senate chamber, he was wearing a mask. The photograph from the story you posted earlier. The question some democrats were asking is the need to come back today. What were the priorities and what can we expect this week . Katherine well, Mitch Mcconnell has made clear his nominees are the nominees from the administration are priorities. Today, the senate voted on a Nuclear RegulatoryCommission Position to be Inspector General of the Nuclear Regulatory commission. What democrats have raised the issue of is the senate has been brought back. They flew back, drove back from all across the country despite the coronavirus. Yet, there is not coronavirus legislation scheduled for the floor this week. So, they have drawn that contrast to the priority of coronavirus, why is coronavirus legislation not on the floor . Republicans contend that doing regular business for the nations descendents job and when coronavirus legislation is ready, the senate will act quickly and they will be here to do that. Steve the white house offering testing equipment for members of the house and the senate in what is really a rare moment of bipartisanship. Speaker pelosi and leader mcconnell saying thanks but no thanks. Why . Katherine that was surprising to a lot of people, myself included, to see a statement from mcconnell and pelosi unite on that issue. Senators are saying that while they would love to be tested and no whether they have this disease or not, they are much more concerned about areas of the country and communities that have a much higher risk and much higher need. Places where regular citizens are having trouble getting tested. There is not much acknowledgment among lawmakers that there is something unique about the capitol hill workplace and they, by being elected to congress, arent in a very special category that i think could have allowed them to be tested. I think the optics of all of congress being tested while regular people languish waiting to be tested is something they were not prepared to contend with and they did not want to face backlash from that. I did talk to lawmakers today about that decision. Most of them were in line with leadership about rejecting those tests, but others did say it would be really nice to know whether they are bringing this illness home when they go home on the weekends to their family. Many of them have at risk family members. Steve what about the house . Because Speaker Pelosi has been on the Cable Network programs over the last couple of weeks. Any indication on when they will return . Katherine i dont yet have a timeline for that. She has said that when there is more coronavirus legislation ready to move, that would certainly bring the house back today. There was a modification notification to all house members that while the house will not be back this week, almost certainly as soon as there is coronavirus legislation ready to move, they will be called back and as seen in previous weeks, they will be given a certain number of hours notice to get themselves back to the capital to vote. That has also garnered some criticism on both sides of the aisle in the house because it is very glaring that the only people involved in crafting this coronavirus legislation our leadership. There is very little input, it seems, from rankandfile members. Maybe some Committee Chairman are involved. But those lowerlevel, more junior lawmakers feel cut out of the process. Steve katherine tullymcmanus joining us live on the phone. Her work available on rollcall. Com. Thank you for joining us. Katherine thank you. Steve our phone lines are open. If you live in the eastern half of the country. For those in the mountain or specific time zones, 202 7488001. If you are a medical professional, 202 7488002. We turn our attention to the Clinical Care for covid19. This is a headline from forbes magazine. The viral brain attack, neurological manifestations of covid19. Dr. Lipi roy writes early on, we were warned about three cardinal symptoms associated with covid19 fever, cough and shortness of breath. Symptoms commonly connected to most respiratory viral illnesses, but no longer. As each day goes on, we learn more and more about how this pathogen attacks the human body. Neurological signs and symptoms are among a growing list of manifestations associated with coronavirus. Dr. Roy is joining us from new york. Lets elaborate on exactly what you have learned and thanks for being with us. Dr. Roy it is good to be with you. How are you . Steve good, thank you. Dr. Roy yes, we are learning something new every day about this novel coronavirus. At first, we knew it was a respiratory virus causing respiratory symptoms such as cough and shortness of breath. But, we are learning about all these different multisystem, multiorgan manifestations. We knew about the heart. Now we are learning about neurological manifestations, ranging from headaches and dizziness, two of the more common symptoms, to seizures and strokes and altered consciousness. Its been fascinating, but it also means clinically when patients present with these other atypical symptoms such as neurologic symptoms, doctors and clinicians should have their antenna raised and suspect covid19. Steve we are also learning about new symptoms for children. I wonder if you could elaborate on what you have learned and how that potentially could Impact School district around the country as they consider whether to reopen this september. Dr. Roy as i said before, it is actually kind of surprising that multiple clinical taste cases the vast majority has been an adult. It is kind of a good thing. Children are not really affected. That said, i think we are at eight death toll of 68,000 in the united states. A very small number have been children. But as we are seeing, children are not completely immune. This really does impact the opening of schools because as i am sure you know and all of your listeners know, children cannot it is impossible for them to socially distance. The nature of their context as children. I think the younger, Elementary School but middle school and high school, definitely they can influence more social distancing. We need to find an effective way to protect children. Steve why this evolution of symptoms with covid19 . What is behind the virus . Dr. Roy those are great questions. As i said before, we are really learning something new about this virus every day and as you know, this is a novel virus. It is not new to nature but it is new to human beings. It is new to us in terms of really how it clinically manifests. We also dont know about seasonality. We dont know how it is going to react in the summer months. We expect and maybe hope based on the behavior of all the other coronavirus is that it will be less active in the summer months, but we just dont know. I dont think it is safe to assume anything about this virus. From a research and scientific standpoint, it is fascinating but it is also quite challenging and devastating as well because it is affecting so many people in so many ways. Steve you are seeing this that nyu as you make your rounds, as you see the patients. Can you give our viewers a sense of what exactly you are seeing and what troubles you the most . Dr. Roy right now, i have an adjunct teaching position at nyu, but i am speaking to my medical colleagues all over the country. New york city is the epicenter. But in speaking to my medical colleagues on the front lines every single day, if not every hour, it has really been a recurring theme early on. Today, we are seeing a lack of ppe. In new york city, we are ok for the most part but it depends which hospital, which community hospital, academic hospital. The bigger issue is more clinical in terms of direct patient care. The interactions of very sick patients and the overwhelming things burdened with this large number of patients who are really sick. The ones who are really in late stages, who are on the ventilator, really critically ill who eventually succumb to the virus and died as you know, because this is such an infectious pathogen, these patients are not allowed to be with their family members. That is just really emotionally devastating. Doctors and nurses and these frontline workers, respiratory therapists, they are playing the role of not only Health Care Professionals would also surrogate family members. Communicating messages. Talking to family members on ipads. All of it is really far from ideal. Steve we are talking with dr. Lipi roy joining us from new york. She earned her md at masters in Public Health at tulane university. She also taught at harvard medical and worked at mass general. First up is peter joining us from provincetown, rhode island. Good evening. Peter, go ahead. Caller hi. Steve go ahead. Caller yes, thank you for taking my call. Two quick questions for the doctor. One is, i understand there is a team in japan that is investigating the application of the pancreatitis drug. Im wondering why that would be going on in relation to the pandemic. The second question i have is, i often see patients lying on their stomachs rather than their backs as they are being treated. Im curious as to what is going on there. Dr. Roy let me address the first question. Its a great one because one of the exciting things right now is there is research, robust medical research happening globally to find a treatment and a vaccine. Theres actually over 250 different potential treatments that are being researched and investigated. About 95 vaccines. Those treatments could be from all types of origins. Right now, remdesivir is a treatment that is being investigated and looking promising as an antiviral medication. That is not too far removed from an antiviral medication. There is a lot of research happening and i dont know the origins of that pancreatic drug but i am all for anything that can be clinically effective. As for the second question, yeah, there is some study showing that when a patient lies in the prone position, it can help sometimes with ventilation and oxygen exchange. That really depends on the patient and how critically ill they are. I think that is what hes referring to. Steve dr. Roy serves as a clinical assistant professor at population health. I want to ask you about the longterm implications of this. The respiratory implications of covid19. What are you seeing . Dr. Roy yes. Again, we dont have that much years and years, decades of data like we do with influenza and other viruses. But, we now have at least months out data from people who are now in recovery from china, italy. I think what some of the studies i have read have shown is some of the stations have respiratory issues. Lung scarring or fibrosis. A lot of the respiratory issues we are seeing are from people who have been ventilated, intubated for prolonged periods. That is not the virus itself causing those clinical manifestations. The virus itself has been shown to cause other longform respiratory symptoms. We need a lot more data. Thousands of patients are in recovery peter we will get that as time moves on. Steve frank in richmond, virginia. Caller hello. Steve go ahead. Steve frank in richmond, virginia. Caller hello. Steve go ahead. Caller dr. Roy and cspan, thank you for your time. Ive been following this pandemic and one question no one seems to address i understand that children are less affected than most of us and i cannot tell whether they are asymptomatic, they get infected and simply flush the virus immediately. Or the virus never get situated. But, then there is the question of why children . Is it because they have all been vaccinated . Is it because they are cute . Maybe the virus likes little kids. [laughter] dr. Roy i can tell you with confidence that i dont think it has anything to do with cuteness. That is something we were talking about earlier. We really dont know why this virus is preferentially not attacking children. I think that is a good thing. Time will tell. Lets be clear, there have been children who have gotten sick and sadly, some who have died. Young children, babies and some adolescents. We dont really know. We need time to figure this out. In many ways, children have more robust immune systems than the other end of the spectrum, holder adults, particularly people with chronic conditions. In that regard, children dont have the slew of chronic conditions older people do. If they have any illness at all, it might be childhood asthma or they might have one or two other things. I think you have adults in almost every adult i have has had anywhere from three to five chronic conditions. That can be one explanation. Then again, kids got the flu and other viruses. We just dont really know. Steve you treat adults more than children, but as parents nothing about summer camps signing up for the summer, what is your recommendation based on what you know now . Dr. Roy yeah, thats tough. Honestly, we dont know how this virus will behave in the summer. It could dip, it could miraculously go away. I dont think thats going to happen. Again, in the fall with flu season and covid19. For summer and summer camp, i would not feel comfortable sending my child to be with another large group of children along with counselors who are adults. Unless they can guarantee physical distancing, children for the most part can get the disease. I would caution against summer camps. Kids can still be outside in the summer and a more controlled manner. You cannot really get that in a camp setting. Steve lets go to dr. Nicholas joining us from kansas city, missouri. Caller good evening. I have a quick question. One of the major differences between the adult elderly person and a child is the level of vitamin d. Have any correlations been run to determine whether the adults who are dying have an unusually low vitamin d deficiency, and whether the children on the others have a higher, more proper level of vitamin d . Steve what is your background . Caller hospital administrator. Steve how are you dealing with all of this . Caller we are all doing very fine. My wife is being very cautious. Steve good luck to you. Thank you for phoning in. Caller thank you. Dr. Roy yes, such a poignant insight with vitamin d, which i think most people think of vitamin d for their own health but it plays a significant role in the immune system. Yes, adults, not all but many tend to have lower vitamin d levels. We suspect they are not outdoors as much as kids are. I know when i was a resident, we would do 80 to 100 hours inside a hospital. Most residents are vitamin d deficient. The short answer is i dont know if there is a role there between vitamin d and the activity of the virus. Im sure id surprised if that was not already an area of research right now. Steve when you teach medical students, what is their level of apprehension after having gone through this the last three months and knowing the road ahead . Dr. Roy you know, its interesting. I think right now, it is such an unprecedented time in so many ways because now some of them are being fast tracked as far as graduation and being thrown in early. There is such an acute need on the front line. To be honest, i think medical students have a pretty strong understanding. Lets be honest, who doesnt have a pretty fair level of understanding of what this virus is doing, particular todays medical students are just so much more tech savvy. They are always digesting information. They are very social media savvy. I think they are going to be playing such a Critical Role from a medical standpoint and a Public Health standpoint as far as really addressing all the different medical and social aspects of really what health means, especially in a pandemic. Steve dr. Lipi roy with nyu. Jim is on the phone from louisville, kentucky. Good evening. Caller thank you for cspan. Im a retired pathologist. I would like to know if this thrombotic phenomenon we are seeing, causing the strokes, is dic. I have never seen anybody mentioned that or seen it written in any of the studies. Steve explain d. I. C. Caller it is a clotting phenomenon. Steve thank you. Dr. Roy . Dr. Roy excellent question. I talked a little bit about coagulation in my article about neurologic manifestations because we suspect the stroke phenomenon is happening because of a clot formation induced by the virus. The clot traveling up to the brain and blocking brain vessels resulting in a stroke. The American Society of hematology has written on their website the phenomenon called covid19 associated coagulopathy. A fancy way of saying the virus is impairing the bodies ability to destroy clots. The actual physiology of that, we just dont know. What we do know clinically is a lot of my colleagues are already weeks, if not months have been seeing clots in iv tubing. They have been seeing clots when trying to draw blood or give medication by iv. They have seen clots in legs that have resulted in amputation. They are seeing clots in the lungs and, of course, strokes. The reason for this, we just dont know. To answer the doctors question about d. I. C. , which is what we see usually in people with severe illness sepsis d. I. C. Is a very common phenomenon in severe illness. That can happen from various causes. I think that is actually different from whats happening with this covid associated, but we need a lot more research and data to understand. Steve more details at forbes. Com. The piece you wrote last week, this is what it looks like. As we talked to vicki in austin, texas. Caller thank you for taking my call. You may have touched on the answer to my question just now, but there is such a variety of different organs or systems that are being affected. More neurologic, but also cardiac, various organs are affected. How much do we know about whether these are due to the direct effects of the virus versus more indirect effects through the inflammatory response in along those lines . How much of a role does treating the inflammatory response play in the overall treatment . Thank you. Steve thank you. Dr. Roy yeah, so thats a great question by vicki. They have been talking about this surge. All these other inflammatory molecules are involved in the bodys immune system, identifying foreign objects. Whether that is the bacteria, virus. Again, the short answer is we dont know the actual physiology but there are researchers quite literally working on this as we speak all over the world trying to get a better understanding of this novel coronavirus. We have some existing information because we have had other coronavirus is. Sars is similar to this particular virus but again, this virus is really it is affecting various organs since systems in our body from the neurologic to the cardiac to the clotting mechanisms. There has been some skin manifestations. We think it is a direct response to the virus but it could also be as a result of an inflammatory response. We need a lot more data. I sound like a broken record player but it is the safer answer than saying something that is not true. We need a lot more data. Steve when you study the neurological impacts, what are you looking for . Dr. Roy there was a dutch study. My article was based on a dutch study and looked at a little over 200 patients. About 20 percent to 30 of them had neurologic manifestations. There was another study from wuhan, china that also showed amongst icu patients, the dutch study was looking at icu patients, but the wuhan study looked at i cannot recall the number but about 25 . These are all case studies, case reports. They are not randomized controlled trials but it is enough to show that clearly people with covid19 infection are exhibiting the nervous system signs. We just dont know why yet. Steve c. J. , you are next. Thanks for waiting. Caller im wondering what the implications are for the type of research that has been done for the coronavirus. Do you think in the future, scientists can come together, thousands of scientists from around the world can come together to cure the different types of cancers all at one time, similar to whats going on now . Everybody is working together to make progress. It seems like it should have some implications in future research to cure cancers and different types of diseases. I was just wondering what your thoughts are on that. Steve thank you. Dr. Roy yeah, thank you for that question. Ive been thinking about this for a long time. I think there are many, many lessons we need to be learning from this particular pandemic and one of them is i think we need far more funding in health and Public Health. That is for certain. Funding for Public Health and different Public Health departments at local and state levels has been egregiously underfunded and cut over the years. The other one is that yes, we are noticing people from all over the world, researchers are coming together and sharing knowledge. There are people that are cancer researchers, neurological researchers, lupus researchers all over the world that are doing this work. Maybe not necessarily communicating as much but the media is really focusing on that as much. Yeah, i fully agree that i hope we learn many lessons in terms of the scientific camaraderie. Also, where the media plays a bigger role in communicating. Getting the doctors and researchers more attention, because the public clearly is interested and fascinated in this work. Steve we are grateful for your time and expertise tonight. Don is joining us from solana beach. Caller thank you, cspan and dr. Roy. Im in my 90s, and therefore, i have had the opportunity over the years to catch most everything. Ive been treated for some of it, and some of it was the flu several times, very seriously involved. Im just wondering now, for the past 10 years, i have not had any flu shots and barely had a cold. Is there any residual effect from those multiple flu shots for different types of flu that might be a benefit . Finally, wouldnt aspirin therapy help a bit on that clotting . Steve you say you are in your 90s. Can i ask how old . Caller 91. Steve sound great. Thanks for the call. Caller thank you. Dr. Roy congratulations on hitting the 90s. I aspire to do that as well. Let me address the vaccine question. I have no explanation. Maybe don is very lucky to have had the flu in the last 10 years, but he said hes had multiple times in the past. Im a strong advocate for getting the flu vaccine. Sadly, only 40 of the vaccine actually gets a flu vaccine. The reason thats going to be really important, especially come september when we get flu season again, is that while it wont directly affect, wont have any effect directly on covid19, it will reduce the number of people who get sick from influenza and it will reduce the burden on Health Care Workers. I have no explanation. I think don was maybe lucky. He has said he has had it multiple times in the past. I am a strong advocate for getting the flu vaccine. Only 40 of the population gets the flu vaccine. The reason that is going to be important come september when we are going to get flu season again as that it will directly affect or have any effect prickly on covid19. It will reduce the number of people who get sick from influenza and it will reduce the burden on Health Care Workers. It will also reduce the risk of severe complications from the flu such as severe pneumonia and acute respiratory disease syndrome. Those are things we as healthcare workers are worried about. I strongly encourage everyone to get the flu vaccine. I would recommend getting every possible vaccine you can get. I am a big proponent of it. Steve i want to conclude. We are going to show some numbers from Johns Hopkins university that will show the u. S. Is still leading the world in the number of new cases in covid19. Why is that . Dr. Roy you know, it is sad. It is disappointing. If we can Just Transition from the macroscopic to the microscopic, i know we have been talking over a million cases in the united states. Over 68,000 deaths. We are talking about men and women, some children. This could be your relatives. This could be my loved ones. Could be you, it could be me. Anybody and everybody is potentially vulnerable to this virus. It is a fatal pathogen. It really is. Frankly, i think the reason we are not seeing a decline is because this is such a patchwork in how the cities and counties are responding. There is not a unified method from federal leadership or from states. Different counties and states are opening up. The argument is it is not really affecting our state. We need the business. I understand that. Steve your advice to the mayors or governors . Dr. Roy it is just that. It is two things. Widespread testing of all the people as best as you can. I would prioritize people in nursing homes, homeless shelters, prisons, jails. Places where we know people are congregating. Widespread testing combined with contact tracing. These are triedandtrue Public Health measures and emphasize the physical distancing, the stayathome. We need that before you can do widespread opening up of the economy. Steve dr. Lipi roy joining us from new york. Thank you for being with us. Hope you will come back again. Dr. Roy thank you, steve. Have a good evening. Steve here are the numbers from Johns Hopkins university. Worldwide infections in the last 60 minutes. Nearly 2000. Worldwide deaths in the last 60 minutes, 306. 231 in the united states. We are back tomorrow evening at 8 00 eastern time with a primetime addition of the washington journal. Joining us will be the dean of harvard medical center. George daley will be joining us. And the assistant professor of epidemiology at Johns Hopkins. This available at our website at cspan. Org coronavirus. Thank you for joining us on this monday. Stay healthy, keep well. We are back tomorrow morning at 7 00 a. M. Eastern time. [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap. Org] [captions Copyright National cable satellite corp. 2019] cspans washington journal live every day. News and policy issues that impact you. Coming up tuesday morning, we will discuss the Airlines Response to the coronavirus pandemic. With the International President of the association of flight attendants. Then, i discussion of the pandemics impact on assisted living facilities with the American Health care associations david gifford. And, the antilockdown protests and the overall federal response to the virus. Watch cspans washington journal live at 7 00 eastern tuesday morning. Join the discussion. Be sure to watch washington journal saturday at 8 00 a. M. Eastern. We are taking calls and questions from high scores across the country preparing to take the advanced placement u. S. History exam. Here is a look at live coverage tuesday. For the second day in a row, the Supreme Court hears oral argument by teleconference on a case concerning freespeech and federal restrictions on aids and hiv funding for u. S. Groups. 10 00. Live at the u. S. National Constitution Center reviews the case with legal scholars. In the afternoon, the Senate Banking committee pulled a confirmation hearing for pending nominations including the treasury departments special Inspector General for pandemic recovery. There is also a confirmation hearing on cspan2 at 9 30 a. M. Eastern for texas representative John Ratcliffe who has been picked to serve as the next writer of national intelligence. At 11 00 a. M. , the senate is back to consider the nomination of the National Head of intelligence and security center. Use the congressional directory for Contact Information for members of congress, governors, and federal agencies. Order your copy online today