The Pacific Research institute who makes the argument against medicare for all. Watch tv tonight starting at 8 00 p. M. Eastern on cspan2. Joining us from nashville, tennessee is doctor william shatner, a professor of Preventive Medicine and Infectious Diseases and at Vanderbilt University medical center. Doctor, thank you for your time this morning. Sure, good to be with you. Doctor, the United States has surpassed china in a number of cases at 82000. What do you make of that and what are your concerns with that number . Guest my concern, of course, is that it will grow. You know, we have not yet completely define how widespread this virus is in the united instates and how intensely it is just a beaded in different parts of the country. We need to do more testing but the next several weeks, i think, will see a surge of cases coming into hospitals. It may not get as bad as new yorkd everywhere but we are already seeing patients coming ain in a rather steady weight here in nashville and we expect more over the next several weeks. Host describe what it is like in hospitals when you see or when you see these patients . How are they suffering . Guest obviously, people are very, very ill. If you get a respiratory infection that involves the lungs and that means you have difficulty breathing. That is an extraordinarily uncomfortable illness because it makes you extremely anxious and of course, and makes everyone around you, your family members anxious. If it gets bad enough you have to be sedated and you get intubated and you were put on a ventilator to help you breathe and recover hopefully, this is while your body fight off the virus. Host why w are we seeing people die of cardiac arrest . E guest well, when the longrt gets bad and particularly older people who have underlying illnesses who may already have an underlying heart disease, the two can work together. The virus can affect any number of organs in the body and so cardio pulmonary arrest is what we often, im afraid, the final exodus. Host why are ventilators being shared in new york and what concerns do you have with that . Guest well, ventilators are being shared, i anticipate not having been there, because that some people can use them for part of the time and be taken off and other patients can be put on them. Obviously, that is usually being done when you have a shortage of ventilators but it is not the usual procedure. Now, it can be done safely because obviously, ventilators are used from one patient after another but you have to be meticulous in all your Infection Control precautions. If you switch the ventilator from one person, one patient to another. He host doctor, theres a headline in the paper this morning and i believe it was the Washington Post that some. Octors are writing their wills guest o, my. That is serious. Isnt it . Thats ominous. Workers and their safety. Everyone has been trained in the appropriate Infection Control precautions. We need the personal protective equipment and we have to be meticulous in their use. All of that together, nonetheless, is the risk that Health Care Workers can acquire these infections and once the virus or bodies, our bodies are just like everyone elses, we may get a less severe infection and those of us who are a little older and may have underlying illnesses, we may be at hazard of getting more severe infections also. Its the anytime the headline, doctors are writing their wills. What are nurses and doctors needing in their personal protective equipment that theyre not getting, describe the shortage. The shortages range and it varies in different parts of the country. The thing that weve heard the most about of course are the masks. Both the simple surgical type masks and the socalled more rigorous n95 respirators. People are reusing them, resterilizing them. And being meticulous about who uses them. We dont need to have them used casually now because they are in general short supply across the country. Were doing all right here but we have monitored their use very, very carefully, so its not wasteful but were a little anxious but a the supply chain. Should things heat up here and we get more patients, were concerned about whether the supply will be steady over time. All the more reason among many others to dampen, to flatten the socalled epidemic curve, stretch out the patients over time, that will make it better and easier for us to take care of patients appropriately and safely over a longer period of time. Wed like to flatten out that epidemic curve and stretch things out. Host would at your facility are folks getting tet evidence if they have symptoms and how quickly are they getting result senate we have a multifalls setted Testing Program in nashville. The state health attend has its own testing facility and is running tests at double shift so theyre working the maximum. My own institution has a series of assessments centers out here. We dont have them in the emergency room. We dont want people who are ill to come to our emergency room and spread their infection elsewhere. They will be assessed very carefully, temperatures taken and i theyve have a fever and some symptom related to the lower respiratory tract such as a cough or difficulty breathing, they will be eligible for a test, a specimen will be taken and sent to our laboratories. Our own institutional laboratory is also up to here, working fulltime, and then our metropolitan government also has Assessment Centers scattered throughout the city so patients can good there also but i must tell you, were have something difficulty in our Health DepartmentAssessment Centers because i just learn this morning, they have a Good Relationship with the laboratory that will do the tests but they dont have sufficient supply of swabs in order to take the specimen. And i know my colleagues in the Health Department are scrambling now trying to get sufficient supplies to actually take the specimen. Once the specimens get to the laboratory, the turnaround is pretty good. We usually get information within a matter of hours or certainly 24 hours. Back to the patient and the provider. So, were okay at the moment. Wed like to test much more widely. Host if somebody tests positive, then what do Health Officials in your state do to try to trace and contain the infection coming from that person . Guest yes. So, were at a transition between containment, where Case Investigation is very important and getting all the contacts, and kind of mediation or moderating the disease just trying to lower the impact, where you have so many cases that you cant possibly trace each some every one. Depends on the county in which youre operating, and the resources of the Health Department. Were still trying to do Case Investigation, get contacts as much as possible at the very least informed, and many of them also, depending upon their symptoms, tested. So were doing a bit of both in our state. Host let me fifth the phone number for viewer, Eastern Central part of the country, 202 7488000. Mountain and pacific, 202 7488001. Medical professional wades want to hear from you, 202 7488002. Start dialing in now so we ick take your questions and comments for dr. William schaffner. Doctor, i want to shower you and our viewer he dr. Anthony fauci at the White House Task force briefing talk us about vaccination, development and trials and have you respond to it. One of the most important things is one that i mentioned several times from the podium and that is to clarify a bit about the timeline of veeps and would that have vaccines and would that have impublicity o the rebound or the cycling in the season. Certainly for sure a vaccine wont help us now, next month, the month after but is a mentioned to you, went went to a phase 2001 trial and i keep referring to one vaccine. Theres more than one. Theres a couple of handfuls of vaccines at different stages of development. But theyre all following the same course. The course is, you first good in to a phase one trial to see if its safe and very few people, 45 people in a certain age group, all healthy, none at really any great risk of getting infected. The reason you do that, because you want make sure its safe. That tikes the months easily, maybe more. That brians us into the dipping or middle of the summer. Then phase two trial or what we say, twothree, which means well put a lot of people in there we hope that the arent a lot of people getting infected but it is likely there will be somewhere in the world where thats going on. So its likely we will get what is call an efficacy signal and well know whether or not it actually works. If in fact it does we hope to rush it to be able to have some impact on a recycling in the next season. And like i said that could be a year to a year and a half. Im not changing any date i mentioned. One thing we are going to do that you need to understand that has been a stumbling block for Previous Development of vaccines, and that is even before you know something works, at risk you have to start producing it because onceup now it works, you cant say, great, it works, now give me another civics months six months to produce so it were working with a variety of companies to take that risk. We didnt take it with zika. Same we sars so thats one of the things were going to push on. Is to be able too have itself ready if in fact it works. Host doctor schaffner, your thoughts after listening to dr. Fauci . He did Vaccine Development 101 and theres a lot of confusion, let me unpack some of that and explain what tony was talking about. The first thing in development of a vaccine and lets make sure we know what a vehicle is, its november for treatment. Its for prevention. So we would like to prevent this disease. Like we prevent measles, by giving a vaccine so you dont get the disease aft all. So the first thing you have to do is work in the laboratory to create a candidate vaccine. Then this is what dr. Fauci was talking about. Why does it take so long then after youve got this candidate vaccine in the laboratory to develop it before its ready to be licenses for use. Two things are very important. You have to make sure that the vaccine is safe, that it doesnt make you ill in and of itself. There have been vaccine candidates in the past that have done that. So we dont want to do that. We dont want to harm the American People. Of course, the other thing is, you have to be sure it works. To h and ill walk you through that. Youve get a small number of volunteers, people who are recruited themselves. Usually young adults who are otherwise healthy. About 40 or 50 of them. Theyve get the vaccine. You check to make sure that nothing adverse other than a sore arm guess on and you draw glad periodically to test whether the vaccine has worked in the body. If all of that goes well and he says by the time you recruit all those people, give them the injections, follow them up, that can take three months, surprisingly long. Then you open it up and get a much larger group of people who volunteer. Some of them will got the vaccine, some of them will gate placebo, a salt solution, for example. Nobody knows who has gotten what and then in the context of an ongoing outbreak, some people will get sick, others wont, and you will be able to discover whether the vaccine actually prevents the disease and having given it to a larger number of people, you also have a better assessment of how safe the vaccine is. Once you know exactly how well it works, how effective it is, and its safe, then you can good to license it. The other thing tony said was, as you are working through this process, what the government will do is not wait until the whole process is finished. That it will make the government will make an initial investment, probably a Publicprivate Partnership working with manufacturers. If dr. Fauci and others think the vaccine will work theyll actually tart making the vaccine in large amounts before the final results are in, such that when the results do come in, bang, you can start vaccinating the person people right away. Host dr. Schaffnerthe relying on one vaccine. No no. Dr. Fauci said there are any number of scientists that are trying to develop a variety of vaccine candidates, so we will have a number of these trials going on simultaneously. We may wind up with one or maybe four different vaccines. The more the merrier. Host hell go to connie in fort meiers, floridaor, question or comment for the doctor. Good more. Id like to ask the doctor what the success ray is of people who have been intubated and on reps raters . We dont know that what the outcome and is how long do they have to stay on that respirator . Are we rearranging the chairs on the titanic . Thats my first question. Host go ahead, doctor. Connie, those data are not available but you take care of sick people when they come into the hospital and if they get even sicker, theyre admitted to the intensive care unit and put on a respirator and then just as with any person with any illness for whom we are giving intensive care we watch that person very, very care any, hoping that they respond. Some those patients, these the most severely ill patients will die. Others will recover and we can gradually, gradually wean them off the respirator and some of those people will leave the intensive care unit and go back to life and recover. So, our capacity to provide intensive care is so much better today than it was 20 years ago. We would expect some of those gravely ill people to actually turn the corner and come back in effect to life and go back into the community. Host bill next in new jersey. A medical professional. Bill, what do you do . Caller im a retired rn. And i volunteer as a emt on my local ems unit, and we are taking precautions as far as masks. We dont have any masks of course, but we do take precautions, and we take a patient to the hospital, the stretcher is thoroughly sanitized. The vehicle is thoroughly sanitize it. When we get back to our base, the unit is sanitized again. And then the unit is left outside with the air conditioning on and vents on for approximately an hour. Now, we have the option to do that because were not really a busy outfit. We run 1500 calls a year. So, these other units that are out this which are doing runs after runs after runs, things have to be thoroughly sanitized and i wonder how theyre doing that. Guest well, bill, first of all, thanks for your service. Im glad youre doing that with need all he help we can get. I love you. I think everybody is doing absolutely the best they can, and simple sanitation will those wipes actually works very, very well. Kills the virus very, very rapidly so i think theres usually time to wipe down a ambulance very carefully and thoroughly between patients. We ought to be a able to do that. Host next from priscilla, West Virginia. Youre a medical professional as well. What do you do. Caller im a registeredders in. Host your question. Caller at a Critical Care hospital. We use n95 masks with dont have a shortage yet but were all issued one mask and use it until the eless strike wears out and then put a face shield over it and then just clean the face shield. And thats pretty much just what we have been doing but the as far as my bigger issue i think is just prevention, if people come into the hospital, and were trying tone courage people that arent sick enough to be there to stay home but thats fruiting when the president says things like, he wants all the businesses to open up by easter, or recently said something empty right to figure out maybe which counties are at less risk than others, but as we know West Virginia has the highest risk population by most peoples estimation but be wave not seen a large quantity yet of cases we know of. So, i guess first of all i think how do you feel but the method i described of freezing or mask and re using the mask andsen tieing the face kohl if theres no best way to sanitize the mask but minimizing any potential connell tact by wearing a face shield. Priscilla, thank you for being out there for us. Yes, you can reuse n359 respirators. Do it with care. Between patients you can actually put them in a paper bag so they dont get damaged and we have long known that unless the n95 repsator has gotten so i would or distorted, it can be used more than once. And youre getting double protection because in addition to the respirator youre putting on a face shield in front of that so you have double protection and you can sanitize that face scheel readily with a wipe. So good for you, ons leak youre doing a good thing, and hang tight because i suspect youll be seeing more cases in the next two or three weeks. Host well go a angela in virginia. Caller yes, good morning. I want to say that the way that this doctor and the way the cspan and the way that so many others are the newspapers and all, the way you are reporting this it seems you just want the American People to be afraid, because i notice that you will report how many people contracted and you report how many people die, but you wont report how many people have tested negative, you wont report how many people have recovered. Is tom hank on the respirator in ever . Did he die . Youre not giving us a fall picture and seems seems to me tu dont want to give us a full picture because the majority of everything that you have been talking about is hype, and it is a shame to me that you socalled leader would too this to the American People. Now, if its not hype, give us the full picture thank you. Host okay. Doctor. Guest angela im are so if ive given youve the wrong impression. There isnt any doubt that were going to get many infections and this virus causes a spectrum of infections from people who get infect who have no stomachs to people who have very might symptoms weapon see this every day in nashville, that people have mild milder symptoms and dont get serious involvement of lungs. There is that notable serious component. It is thought that about 70 to 80 of people will have milder symptoms, not need hospitalizations. But still, if you have about, lets say 5 , 20 of people who have symptoms sev