The university of Birmingham University of alabama at birmingham. About looking at the reopening that is happening in many states across the country. What are you looking for as possible early indications of spikes as States Reopen and the summer ensues, and fall begins . What we are all concerned about is the expansion of cases that happens over time. If we open up too soon, then it casese an increase in that we will see, and they will engage with us in a way that is in cases. Spikes what i am expecting to see over the next couple of weeks and months is that we are going to have a slow climb. I do not think we will see a spike. In alabama we have seen since we reopened at the beginning, we had about 180 cases a day, on average. 520 newne 1, we had cases a day. You can see that reopening probably was associated with an increase in cases, but we were also testing a lot more, so you can ask the question was it more testing or new cases . I think it was both. Host was there an inevitability about the rise in cases no matter when the reopening happened . Guest in my opinion, yes. It makes sense to me. What do we have . Hasave a virus that nobody seen before, and that means the majority of the population is susceptible. If they get exposed, they will get infected and they will not have natural immunity. Mitigation, the like we had with the stayathome orders and the shutdown at home, sheltering at home, then people are not intermingling and there is not much transmission. You relax that and people start coming back together and you will see cases. The question that still remains, one, does the summer time lead to a reduction of cases on its own, which has been seen with other corona viruses. It has been seen with seasonal flow. Why would that happen . Perhaps because people are spread out and are outside more and not in indoor locations much. I do not think the virus has changed, but maybe the way we interact with each other. Because we were sheltering at home, we release and go back to interacting, i think we will not see a decrease necessarily, but we might see a leveling off for a slow rise that will happen over the next several months. Then, the question is what happens in the fall . What we are all concerned about is that is when we might see a spike in cases. Host just a point of reference to our viewers and listeners for where things stand. Number ofs, total cases, nearly 1. 9 million. The deaths, 108,211. The worldwide cases are over 6 million. You are the director of Infectious Disease division at uab medical, what is your division focusing on in particular with covid19 . Guest just a small correction, i am a member of the division, a former director. What we are focused on is addressing the epidemic, not only here in birmingham, but engaging with our state Health Department and working statewide. What we would like to do is have widespread testing throughout our state. There are hotspots, like in most states where there seem to be more cases than in other areas. Weidentifying those hotspots can go in and do Contact Tracing, which means you find the person who is infected and put them under quarantine, and then you test the people they have been in close contact with over the last several days. What they do know, and this is important, the peak time of transmission from one person to another is in the 24 hour period before symptoms develop, that is very important, so the person feels fine, they are in a restaurant or at a sporting event, or out on the beach or somewhere, and they are around other people and they could be spreading the virus to other people even though they are not sick. They might get sick the next day. Having Contact Tracing at the point where these hotspots are, we are hoping that we will start to mitigate the epidemic in our local environment. Is there a way that case Contact Tracing can be done, not in a state like alabama, but broadly, as people travel, granted they will travel less. The people still will be traveling. Guest that is a good question. Gumshoe, workned, it out a case Contact Tracing as you interview the person and how you find those folks, there are technologies that can help us. There is some debate, that we can get into, where you use a cell phone, and with permission, the cell phone could have a program or app that identifies anyone within a six foot radius of that individual over the last two to three days and can identify those individuals, even if they have traveled. And then they could be tested. It is a little bit new and people are concerned about the privacy issues, in my opinion, if it is an opt in so you can say, i am concerned about this and i am ok with people monitoring my phone if others around me are likewise agreeing to that, then that could be eight an important tool. That could be an important tool. Sagg, we michael welcome you to the conversation. Forlines are 2027488000 the eastern and central time zones. Mountain and pacific, 2027488001. And, if you are a medical professional, 2027488002. We will get to calls momentarily. The cdc chief testified before a House Committee yesterday. Chief years, cdc message about the virus not resonating with the public. I want to play you some of the comments and get your thoughts. Here he is. [video clip] i think the first thing i would like to see is those individuals that partake in these peaceful protests, or have been out protesting, particularly if they are in metropolitan areas that have not controlled the outbreak to the extent we want, minneapolis happens to be one with significant transmission and d. C. Is another one. We want those individuals to consider being evaluated and getting tested, and obviously, going from there. Because i think there is a potential, unfortunately, for this to be a seeding event. The way to minimize that is to have each individual recognize the advantage to protect their loved ones and to say i need to go get tested. And, in 3, 5, or seven days get tested. [end video clip] raising concerns about the recent protests and the proximity of the protesters. What do you think we might see after these protests . Concern isink the very real that some of the protesters who are in close proximity with one another, marching, especially if they were not wearing a mask, could well have picked up the virus in that activity, but it is not restricted simply to the protesters. It is about the relaxation of all of the stayathome, and a lot of those locations. Going to a restaurant, and by definition you cannot eat with a mask on. Youre going to be in a closed area, oftentimes indoors, and talking, laughing, that type of thing. That is what is going to lead to transmission. Dr. Redfield is correct, there is a concern about the protesters coming together, i think we share that concern not for protesters, but for everyone. I think that is the message getting modeled. ,e are not hearing unfortunately, a consistent message about what people should do. Everyone sees the impact on the economy, it is profound. We may not be but seeing in our neighborhood someone who has covid. Wait a little while, and that will change because we are relaxing and getting back. Let me pause for a minute, you hear about masks a lot. And that, i think, is a key point. What we have learned about masks over the last couple of months is the following, i mentioned earlier that people are transmitting the virus 24 hours before they develop symptoms. What the mask does is it protects the people around you. If you have the infection, and you are wearing a mask, it will thek to a large degree amount of virus that is coming out into the environment around you, so that there is less likelihood of your friends, neighbors, and family picking it up if you happen to be infected. The image i like to use is going back to the peanuts cartoon, pigpen, the character with the cloud around him. If that is what it is like when someone has the infection and they are spreading it, the mask helps protect that. The punchline is, if you are wearing a mask, what you are communicating is i care about you, the people around me, because i will wear a mask and protect you from getting infected in case i have this. Host we have calls waiting. Let us go first to massachusetts and say good morning to barbara. Caller hello, good morning. A couple of weeks ago, a caller to this program raise the possibility of adding a prophylactic to knock down the virus in the back of the throat by doing deep throat gargling, and he did not suggest any particular thing to use, but i went onto the internet and i found a fascinating study, and if your team could write this down, it is the june 8, 2018 issue of Infectious Diseases throughapy pages 249 259. It was a group of german scientists who study the use of zpi, a 7 h called p gargle mouthwash, and it was an in in vitro, but it killed the virus at the level of 99. 99 . It i really would appreciate if you would look into this, because what was really fascinating was that these german scientists presented this conferenceapanese where this kind of mouthwash, iodine containing mouthwash, is apparently used as on a regular basis. Host im in a let you go, and have you heard about this . This i have not heard of specifically, but let us deconstruct this. What this is is an antiseptic. It could be iodine, but it could be any number of things including mouthwash is that have 70 alcohol. I could go into the lab and show roughly the same impact in vitro, so what does it mean . It means in the test tomb, not inside of a human or animal. And you can show that you can disable the virus and kill the virus in that setting. Thingsere are lots of that we come into contact with every day, just plain old every day mouthwash will work. Let us take a pause, does that mean it will not it will work , in my opinion, no. What that would be doing is perhaps sterilizing the back of the throat, or wherever this mouthwash can go. Heres the problem. The receptors that pick up this virus are throughout the entire respiratory tract, not just the back of the throat including the nose, the back of the nose, and trust me, i am not advising anyone to take any kind of solvent or put it in your nose. That would be dangerous. There is also down in the deep airways. They are called ace 2. They are where the virus bins. Binds. You might sterilize the back of the throat, but then the air that you are breathing in, and going back to pigpen, if you breathe in the air, some of it might get disinfected on the way down, but it will make it into the lungs and that is where a person will be infected. I encourage all of us to do this type of research in the labs and whatnot, that i caution against using any kind of solvent or material as a gargle with the hopes and vision that you will prevent the infection. I am sorry to give you the bad news, but i do not think it will work. Host donna in hampton, virginia. Good morning. Caller a couple of questions for you. You just talked about the masks, and it was all over the internet that the who said that masks do not help, so why are people still promoting it and governor still pushing it . It is ridiculous to me. I am 80 years old. I lived through the h1n1, and i after remember any issues the woodstock 600,000 young people were there. Shoulder to shoulder for days and days, did we ever hear of anything after that . No. Absolutely not. There were no illnesses, no mass outbreaks. On longhis has gone enough, and i think a lot of it is bogus. That the governors are telling you, you have to do this and that. It is more of a controlled virus than anything, and my aspect. For yourank you question, and i think the feelings that you just expressed is what a lot of people in the country are feeling right now. People are tired of this, they have been bombarded with information, and it is exhaustion at some point. And, heres the problem. As we just heard the numbers from Johns Hopkins at the top of the show, there is about 1000 people dying a day every day of this virus. We are now up to 108 or 109,000 people in our country who have died of this, and that is more than sleaze and seasonal flu and much more than h1n1, and it is not stopping. We have to do something to mitigate this, in my opinion. Let us go back to masks. What the who was saying that i have to look at the exact reference is that wearing a mask by itself does not exactly protect you. It might help some, but the real purpose of wearing a mask is to prevent transmission from a person who has the virus to somebody else. So, as i said earlier, when you wear a mask, what you are saying to your friends, neighbors, and family, i care about you, because if i have this virus, i am much less likely to spread it to you than if i was not wearing the mask. Thanks about it this way, when a surgeon goes into the operating room, they wear a mask. Do they do it to prevent the patient from transmitting something to them . No. They are wearing a mask to prevent themselves from infecting the patient with bacteria or whatever might be in their mouth or coming out of their breathing. It works. The same concept is true here. My opinion is that if we wore masks when we 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 to eight feet apart and washing her hands frequently. Host i want to ask you about the retraction of two major reports on studies on covid19, and just to reset for our viewers, the reporting in the new york times, two major studies are retracted for faulty data. They produced astounding results and altered the course of research into the pandemic were retracted by renowned scientific journals because the authors could not verify the data on with on which the results depended. One study under clot undercut the claim that certain malarial drugs care covid19 including concluding that the medications were dangerous to patients. The other found that some blood trip pleasure drugs pressure drugs did not increase the risk. The studies were led by a professor of harvard and depended on Huge International databases of patient medical records birds experts that few had heard of. Life into thehe antimalarial drugs despite a lack of evidence. On wednesday, after the two aboutls noted concerns the studies, the World Health Organization announced that it would resume trials of the medications. Why do you think all of this happened with the studies and the retraction . Yout i am really glad asked that question, because one of the Silver Linings of this horrible cloud of coronavirus is that the public is getting to learn and look under the skirts a little bit of how science happens, because it is happening so fast and we are in this giant time of discovery, which is on one level exciting and another level confusing. This is what those two studies were about. We have Electronic Health records and are valuable for me, because i can get information quickly. Another potential benefit is that you can pull data and information on individual patients, strip the identity away, and just use the outcome. Heres the problem, those data are often times in error, and you say how could a patients medical record be an error. Maybe sometimes a data is entered wrong. Sometimes i diagnosis is put down but it is a rule out, meaning that the doctor thinks that they may have that, but it is ultimately proven incorrect and they failed to take diagnosis off of the problem list. So as the data gets transferred to these large centers, as in the case of these two studies, and people analyze them, and we are talking about tens of thousands of patient experiences, up to 96,000 in one of the studies. You think how could that be wrong, and wouldnt the numbers overwhelm any errors that might be there . And the problem is no. Larger numbers of data that are not pristine or well validated just give you a bigger answer that happens to be wrong. So, in the case of the hydroxychloroquine study is complete wearing comparing one peers one group of people who got it versus those who did not, and the people who did not get it did better. So, i think the problems are two fold. Data may having the not be accurate, i think that is why they retracted. The second thing is something called selection bias. What does that mean . The doctor saw the patient and thought this one is a little sicker than the other so i will give them the intervention. But the person who did not get it did not look as sick. , these why sometimes observational studies show that one intervention does not work as well as no intervention at all because of selection bias. The final point, that is why we need randomized studies that take everybody and randomly hydroxy or a to random placebo. Host we will go back to our collars. Rs. Georgia colle good morning. Regarding question is vitamin d. There have been some studies that show that vitamin d may help the immune system from getting coronavirus in extreme cases, severe cases. Of, i have seen low levels vitamin d among africanamericans tend to lead to severe cases. I am wondering, is vitamin d significant in terms of suppressing severe cases or not . Guest well, thank you. I think vitamin d is an important vitamin. It is what we all need, and there are a lot of people who have vitamin d deficiencies. However, there have been a lot of studies of trying to do replacement of vitamin d again to get the levels back up, it is hard to get the levels up, and i do not think vitamin d alone is going to be sufficient to improve an immune system response to either this virus or any other situation. One of the things we have to be careful of, and i want to put this caution out there, if you think your vitamin d levels are low, just to go to the store and buy a bunch of vitamin d intake it, there could be a downside in terms of calcium, and your calcium levels can go high if you overdo the vitamin d. So what do you do . Go to the provider and have them check your level. If it is low they can do replacement and monitor you. Holland, ohio. Good morning. The problem i have with all of this, and i just think we had the disease as last time, the swine, ebola, and i think there was another one when mr. Obama was in, no one shut crazy. D went out and i think people accept things when you and the people give it to them what can happen and what you should do to take care of yourself. And then it went with everybody should wear a mask. It is not true. Wearing a mask can be harmful to some people, and i feel it is a nasty thing to put on and breathed in, and touch it and do everything. A lot of people do not know how to carefully work with match. With masks. Most of them have it down trying to breathe anyway. That is not the real way, and another thing, as a constitutional people have choices. If you want to wear a mask, you wear one, it will protect you. If another person tries chooses not to do it, when god is set a number, we will leave, but we should be careful. That does not