Dr. Michael saag. It is the at the university of alabama Birmingham School of medicine. Thank you for being here doctor period. Dr. Michael saag thank you for having me. Host is look at the reopening that is happening in many states across the country. What are you looking for as possible potential early indications of the spikes and states reopen, as that summer in singles and fall begins. Dr. Michael saag will he think that we are all concerned about, is this expansion of cases that happens over time. If we opened up too soon, then it will be an increase in cases that we will see and they will engage with us in a way that is going to choke spikes in cases. What im expecting to see over the next couple of weeks and months, is that wepl are going o have a slow climb. I dont think we will see a spike. But like in alabama, what we have seen since weve reopen at the beginning, we had say may 1st, we had about hundred and 80 cases a day. On average. As of june 1st, we had 520 new cases a day. So you can see the reopening, probably was associated with an increase of cases but, we were also testing a lot more. So you could ask the question, was just more testing for new cases. I think it was both. Host then was there internet yavailability of about the risig of cases no matter when the reopening happened . Dr. Michael saag in my opinion, yes. It makes sense to me. We have a virus that nobody have seen before. That means the majority of the population is susceptible that they get exposed or will be infected and dont have any natural immunity. They will get infected and a lot of them will get sick. So if we do the mitigation like we have withio a stay at home orders and the shut down at home sheltering at home, then people arent intermingling. When you relax that, people start coming back together again,ll you will see some case. The question that still remains. One, doesnt summertime lead to a reduction ofto cases on its o. That is been seen with other coronavirus is, is been seen rick seasonal flu. Ive that happen. Well perhaps because people are spread out more, they are outside more and not in indoor locations very much. I dont think the virus has changed but maybe the way that we interacth with each other. But in this case because we are sheltering at home, we release and we go back to interacting, i think were not going to see a decrease in cases necessarily or we might see a leveling off. Or maybe like a slow prize that will happen over the next several months. Then the question is what happens in the fall. I think what we are all concerned about his that is when we might see a spike in cases again. Host just for appointive reference of where things stand. Numbers from john hopkins university, total numbers of cases in the u. S. , nearly 1. 9 million, the deaths in the u. S. , 108,211. Worldwide cases, are over 6 billion. Youre the director of Infectious Disease division thereof uap medical. What is your division focusing on particularly with covid19. Dr. Michael saag g small correction. Ivm a member of the division am a former director. We are addressing the epidemic not only here in birmingham, but engaging with our state Health Department and working statewide. We would like to do, have widespread testing throughout our state, there are hotspots like in most states run around the country where there seem to be more cases than in other areas. By identifying those hotspots, we can go and do some case contactt tracing which basically means you find the person who is infected, you put them under quarantine and then you test the people they been in close contact with over the last several days. Because what we do know, and this is important. The peak time ofrt transmission from one person toim another, is in that 24 hour time before symptoms develop. That is a very important. So the person is fine, they said restaurant or at a sporting event or their out of the beach. For the summer. And they are around other people, they could be spreading the virus to other people even though they are not sick. They might get sick the next day. So having case Contact Tracing atvi the point where these hotspots are, we are hoping we will start to mitigate the epidemic in our local environment throughout our state. Host because were such a mobile society, is a t way Contact Tracing can be done, but just in a state like alabama but especially in the summers people travel, grantedan less this sumr but people still will be traveling. Dr. Michael saag its a really good question. The oldfashioned sort of then to working out case Contact Tracing as you interview the person and say, who have you been around and try to find this folks. There are some technologies can help us in todays world. There is a debate that we can get into if you like where you use a cell a phone. And with permission, the cell phone can have a program or an app that will identify anyone who is within a 6foot radius roughly when that individual, over the last two three days and can identify those individuals even if they have as you suggested, traveled and they can bey tested. It is a little bit new. People are concerned about the privacy issues but if it is left to be and often, i am concerned about this. Imco okay and with people monitoring my phone. If others like was a real going to that thatt can be an importat tool to help us with case Contact Tracing. Host university of alabama, Birmingham Medical School professor there as well, dr. Michael saag. We welcome you to our conversation. 2024 and 2000. And your medical profession 2,027,488,002. We will get to your calls momentarily. The chief testified before a House Committee yesterday. The headline that she fears message about the virus. Does it not resonating with the public. Dr. Michael saag i want to play you some of the comments that doctor renfield made. I think those individuals, that have partaken in these peaceful protests or have been out protesting, and in metropolitan areas have not really control thehe outbreak, minneapolis happens to be one still having significant transmission in dc is another one british we really want those individuals to highly considered being evaluated and getva teste. And obviously go from there. Because do think there is a potential unfortunately for this to be a seating event. In the way to minimize that is have each individual to recognize that is to the advantage of them to protect their loved ones. Say hey, i need to go get tested. In three or five or seven days. And make sure that i am not infected. Host doctor renfield, is thinking about the proximity of the protesters. What do you think you might see in the weeks ahead. Dr. Michael saag i think the concern is very real that some of thee protesters who are in close proximity of one another, marching especially if they were not wearing a mask. They could well have picked up the virus in the activity. But is not restricted simply to the protesters. It is about the relaxation ofre all of the stay at home and a lot of the locations. Cento going to a restaurant by definition, you cannot beat with a mask on. Sue going to be an enclosed area, often times indoors. You will be talking and laughing and that type of thing. That is what is going to lead it to transmission. So doctor read field is correct. Therern is a concern about the protesters coming together. But we sure that concern not just for protesters but for everyone. I think that is the message that is getting muddled over time. Were not hearing unfortunately a consistent message about what people shouldd do. Everyone sees the impact on the economy. Its profound. We have since that but we may not be seeing in our neighborhood, someoneno who has covid19. Wait a little while, that will change us because weng are now relaxing and getting back. The main pause for a minute. You hear about mask lot. And then i think that is a key point. Masks, what we have learned about them over the last couple of months is the following. I mentioned earlier that people transmitting the virus 24 hours before the involved systems. With the mask does as it protects the people around to you. You have the infection, youre wearing a mask that mask is goingg to block to a large degre the amount ofru virus that is coming out into the environment around you. So the lessme likelihood of your friends and neighbors, families picking it up if you happen to be infected. In the image that i like to use this going back toag the peanuts cartoon again, the character of the clutter on him all the time. Thats what its like was a buddy has the infection. In the spreading it. The mask helps protect that. So the punchlinene here is durig a mask, which are communicating is i care about you. I care about the people around me because im going to wear a mask and protect you from getting infected in case i have this. Host we have calls waiting for dr. Michael saag. Barbara. Morning to guest good morning doctor. A couple of weeks ago, the raised the possibility of adding a prophylactic to knock down the in the back of the throat. By doing deep throat gargling and he did not suggest any particular thing he used but i went on to the internet and found a fascinating study. If your team could write this down cspan, june 8, 2018 issue of the journal Infectious Diseases and therapy pages 249 259. As a group of german scientists who studied the use of the mouthwash called pdi, i for iodine. To 7 percent mouthwash. It was an in vitro study. In in vitro, killed the virus at the level of 99. 99 percent. I really would appreciate it if you would look into this because what is really fascinating was that these german scientists present in this work in a japanese conference. With this kind of mouth wash, iodine containingg mouthwash, is apparently use on a regular basis. Host have you heard of this dr. Michaelav saag. Dr. Michael saag lets deconstruct this just a little bit. This is an antiseptic. It could be iodine, but it could be any one of the number things including mouthwash is that half safe 70 percent alcohol. I could going to the lab and show roughly the same impact in vitro, so it is a meeting. In the test tube innocence tpretty not inside of a human, not inside of an animal. And you can show that you can disable the virus, kill the virus in essence in that setting. And theres lots of solvents. Lots of things that we come into contact with everyday. Just plain old everyday mouthwash might work. But lets take a pot of hot. Does that mean it will work. In my opinion no unfortunately barbara. But that would be doing is perhaps misuse the world sterilizing the back of the throatat or wherever this mouthwash can go. The receptors to pick up this virus are throughout the entire respiratory tract, not just the back of the throat. So then enclose the nose in the back of the nose and trust me, im not advising anyone to take any kind of solvent and put it in your. That would be dangerous. But then there is also have the deep airways. These receptors are called a cd to. So they say to receptors over the virus bind us. So you might sterilize the back of the throat with mouthwash, than the air that youre breathing in and again going back to pigpen, if you breathe in the air, some of it might get disinfected on the way down or something but its going to make it into the lungs and thus are persons going to get infected. I encourage all of us to do this type of research in the labs and what not. But i caution against using any kind of solvent or material is a gargle with the hopes or the mission that youre going to prevent the infection. Im sorry do you be the bad news but i dont think its going to work. Host good morning. Guest a couple of questions for you. You just said, you talked about the masks. It was all over the internet that the who said masks do not help. So why are people still promoting it and governors still pushing it. It is ridiculous to me. I am 80 years old. I live through the h1 and one. And i dont remember any issues after the wind sock, 600,000 young people were there. Shoulder to shoulder for days and days. Did we ever hear of anything after that. Nope. Absolutely not. There were no illnesses, no masks a brace. So to me, this is going on now long enough and i think a lot of it is bogus. That the governors are telling you you have to do thi this is e of a control virus than anything in my aspect. Dr. Michael saag thank you for your question i think the feelings thank you just expresses a lot of people in the country are killing exactly right now. People are tired of this. They been bombarded with the information. It is just exhaustion at some point. Here is the problem though pretty just for the numbers from John Johns Hopkins at the top of the show. Theyre about about a thousand people dying every day. Of this virus. Were now up to about 109,000 almost, people in our country who have died of this prettiness much more than seasonal flu and much more than h1 and one that you referenced. Stopping. We have to do something to medicate this in my opinion. So lets go back to the mask. I think what the who was saying in a have to look at the exact references where you mask myself, does not necessarily protect you. From bringing in a virus. But the realng purpose of wearig a mask is to prevent transmission from a person who has the virus to somebody else. So when you are a mask, what youre saying to your friends, neighbors and family, i care about you. Because if i had this virus, a much is likely to spread it to you and if i was not wearing a mask. So think about it this way. When a surgeon goes into an operating room, they were mask. Do they wearve a mask from keepg the patient to give something to them. No. Its migh it works. The same concept is true here. Money opinion is, if we are for masks when were out in public, we will protect our friends and neighbors from getting this and that will bring down the number of new cases along with keeping social distance, six eight peter part as well as washing our hands frequently. Host i want him of the retraction about two studies on covid19. And to reset for our viewers and listeners the reporting the newr york times to major covid19 studies. Retracted from faulty data. In the alter the course of research into this coronavirus pandemic were attracted thursday by renowned at scientific journal becauseow the authors dd not verify the data on which the results depended. One study undercuts residents trumps claim that certain anti malariaa drugs, illness caused y the virus, including the medications and facts were dangerous to patients. The other than the some Blood Pressure drugs did not increase the risk of covid19 and might even be protective. The studies were led by a professor at harvard and most depended on Huge National databases of patient rent medical recordsse that few expes heard of it. They may breathe new life into the antimalarial drugs. Relentlessly promoted by mr. Trump as a remedy. Despite a lack of evidence. On wednesday after the two journals, the new england journal of medicine and the lancet noted that concerns about the studies, the World Health Organization announced that it would resume trials of the medications. When you think all of this happened it with those studies in the retraction of the studies. Dr. Michael saag really glad u. S. Questions because one of the Silver Linings of this horrible cloud of coronavirus is that the public isti getting to learn, looking to the scores a little bit about how science happens because it is happening so fast. When this giant time of discovery which is unreliable exciting and another level. Confusing. These two studies, electronic records, very valuable i can get information quickly. When another potential benefit is that you can collect data. He can pull it off of the information on individual patients, strip the identity away of that person and just use the outcome. Heres the problem. Those data are often times an error. And you said yourself, how the world could ad patients medicl record fbn error. Maybe sometimes a data is entered wrong or diagnoses put down what isi a roulette meetig the person or the doctor think they may have that but its ultimately proven to be incorrect. And it failed to take that diagnostic off of the problem list. As was the date it gets transferred to the sergeant centers as indicates of these two studies, and people analyze them. And were talking about tens of thousands of asian experiences, up to 96000. Anything health could that be wrong. And with the overall numbers overwhelm any errors that might be there. The problem is no. Larger numbers of data that are not pristine, not wellpr validated,s give you a bigger answer that happens to be wrong. So in the case of the hydroxy study, what it showed was comparing one group of people that got it based the analysis of these medical record data, versus those who did not that actually the people who didnt not get it, did better. And so i think the problems are twofold. One as i mentioned, and having the data may not be accurate. I think that is why they were attracted but the second thing t is something called selection bias. The doctor saw the patient, mightve thought this patients a little sicker than the other enng going to give them the intervention. But the person who did not get it, do not look as sick. And so that is why sometimes these observational studies show that one intervention doesnt work as well is no intervention at all because of that selection bias. The final point, thats what we need randomized studies and take everybody in this randomly assignment of hydroxy or placebo in this case, we have not had those types of trials yet. At least not ince large numbers. Host lets get wayne in georgia. Guest good morning. Question regarding vitamin c. Forty. They may actually help the immune system. From getting the coronavirus in an extreme case. Typically among africanamericans, the tend toam lead to severe cases. Some wondering just vitamin d, is it significant. In terms ofic suppressing severe cases. Dr. Michael saag thank you. I think that vitamin d is an important vitamin. It is that we all need. And there are a lot of people who have vitamin dha deficiencis however, there has been a lot of studies of trying to do replacement vitamin d. Get the levels back up somewhat but its kind of hard to get those levels up. I dont think the vitamin d alone is going to be sufficient to improve an immune system response either to this fires or others. One of the things we have to be careful of is to make this caution out there for folks is that if you think your vitamin d levels are low, just go to the store and buy a bunch of vitamin d and start taking it, theres downside to be a that in terms of calcium read and calcium levels can cope very high if youou overdo the vitamid thing. So when you do, go to your provider have them check the levels. If it is very low, then they can do replacement and monitor you. Host good morning. This is dean ohio. Guest the problem that i have with a