American enterprise institute. Can i start with the headline in the washington post, sevenday averages for new virus cases hit fresh highs in over a dozen states. Why do you think we are in this situation that we are in right now . Well, thanks for having me this morning. I think were going to have a rotating series of regional epidemics in this country. What were seeing happen is as soon as a region starts to cool down and get control over the epidemic, a new region heats up. I think were in this position because we have a lot of infection all around the country. We reopened not just early but aggressively. And so that instigated more spread. And now you have a situation where theres just so much infection that its going to get into other parts of the country. We never fully crushed the virus in any part of this country. The sunbelt is showing signs of improvement. Thats the epicenter of the u. S. Epidemic right now, states like, arizona, texas, florida, southern california. There are signs of a slowing of cases when you look at the data. Its less clear in florida and southern california. Were seeing infections pick up. You look at kentucky, indiana, illinois, georgia, ohio, alabama, South Carolina have looked bad for a period of time. And so the gains that were making in the states that look like theyre starting to peak are going to be offset by the other state that is look like theyre accelerating. Why are they showing down in the sunbelt states and picking up in the states that you mentioned . Its unclear what exactly the ingredient was that caused the epidemic to start to slow in the sunbelt states. Policy action was slow to be implemented but the governors in those states did eventually take actions, for example, to try to encourage the use of masks or mandate masks. They took actions to cut close certain congregate venues like bars and reduce head count and restaurants, close movie theaters, particularly in arizona. So the distincticombination of action, consumers drawing back a little bit, more compliance with masks and targeted policy actions to take mitigation steps may have been enough to start to bend the epidemic without Strict Lockdowns like we had to do in the northeast because the epidemics there were more severe and denser and more we had less certainty about which way things were going to head. And so it is important, i think, to look at whats going on in the south, notwithstanding the fact that i think the Political Leadership was slow to take action there, if they are successful in taking these sort of targeted mitigation steps combined with implementing mask mandates and consumers just becoming more aware of the risks and starting to be more prudent on what they do on a daily basis, that might be a middle ground if you will between Strict Lockdowns which dont really seem to be acceptable doesnt seem like were going to go that direction again and get Popular Support for it and hapless spread. Some kind of happy medium between Something Like a Strict Lockdown and letting the virus course its way through the population which is not acceptable. So these kind of targeted steps where you implement mask mandates and take targeted mitigation steps may be the middle ground that we have to reach for in other states. Whats the role of the mask in stopping the spread . It appears to be more and more effective. All of the data that weve gotten around the use of masks in the setting of covid seems to suggest that they are effective at stopping the spread of covid19. This is a respiratory illness. And masks should be pretty effect at reducing transmission through that route, certainly reducing the risk that someone is infected is going to transmit and affording protection for the people who wear the masks. A procedure mask which looks a lot like the masks that a Dentist Office might wear or a surgeon might wear in a surgical procedure, that affords about 60 to 90 protection. A cloth mask, depending on the quality of the cloth mask is going to forward less protection in that level three procedure mask. Still some protection, but less. So i think the more consumers can get their hands on Higher Quality masks, the more protection that theyre going to afford themselves. Wearing any kind of mask is going to help protect other people from you if you happen to be an asymptomatic carrier of the infection. The final point, when you wear a mask, the presumption was youre protecting other people from you, youre also protecting yourself. And regardless of the quality of the mask, the higher of the quality of the mask, the more protection youre going to afford yourself. You write in todays wall street journal, covid shows the need for a diagnostic stockpile. What are you arguing for here . Were arguing that you should build excess capacity in this country so that if you have surge demand for diagnostics testing its always there. What happened right now is that the big commercial labs, which are handling the bulk of the testing, labcorp, quest, those labs operate in a highly efficient fashion. They use their capital equipment, their big platforms that they use to do the pcrbased testing that were doing to detect covid at 70 to 80 capacity. Theyre running at about 80 capacity. What im argue ing is that the government should subsidize these companies to use more capacity. Run them all at 70 or 60 or 50 capacity. You have extra capacity built in and running all the machines just a little bit less. Therefore, you have Surge Capacity if you have suddenly a big spike in demand for testing because you have a pandemic spreading or some kind of new pathogen. Right now we dont have that excess capacity. Theres other settings where the government pays companies to build reserve capacity. A new drug that is used to reconstitute white blood cells. Its a drug that you would want to have an excess supply of in the unlikely of a radiological attack because the radiation would impact the bone marrow and you would need that drug to reconstitute white blood cells. So the government wants to make sure theres going to be an unimpeded supply of that drug. So they built into the amount of money they reimburse into supplying that drug for stock piles, extra margins basically in manufacturing facilities of how the drug gets manufactured. It manufactures distributed sites around the country and those sites are very hardened. They can continue operations even in the setting of certain calamities. This became apparent during the hurricane that devastated puerto rico. Its extremely hardened that has a lot of rezid yall and redundant capacity. Thats an example where the government has paid to make sure theres an unimpeded supply of drug. You can pay to ensure theres capacity as well. You recently predicted 300,000 deaths from coronavirus by year end if these Current Trends continue. Do you stand by that . Well, i hope not. What i said was that if we dont get this under better control if you just look at the trajectory were on right now, you would reach Something Like 300,000 deaths by the end of the year. We were having last week about a thousand deaths a day. It dipped down over the weekend. It usually does because theres less reporting on the weekend. If we continue on the current trend line youre going to see average of 1,000 deaths a day, maybe more, as more people succumb to the infection. You do the math on the number of days left in the year, and you get to scary numbers. I think youll start to see hospitalizations decline in the south. Death is a lagging indicator, so theres going to be more deaths even as hospitalizations and new cases decline. Deaths may even go up but it takes time for people who are going to succumb to the infection to ultimately sa couc to it. Around the country you see outbreak states in the south that are currently the epicenter of the epidemic spread in this country, but youre seeing rises in other states. If all we do is have a rotating series of regional epidemics and any gains we make in one state are off set by increases in other states, this is going to be a very hard fall and winter and were going to see a lot of excess death and disease. Lets get to calls. If you live in the eastern part of the country, 202748, 8000. Mountain pacific, 8001. James in north carolina. Good morning to you. Caller good morning, good morning doctor. Im disappointed in the medical and Research Community allowing this virus to get so politicized. I mean, its almost as if no one is standing up and saying, hey, weve got to stop this. I mean, i knew at the time they opened up the government it was obvious you couldnt open up. People were still dying and the risks were still going up and people opened up the government and they opened up the bars and everything. It was almost common sense. And yet still the medical community, the scientists, they didnt stand up and say no, this should not be done. I remember a time when cdc was the pearl of the world. I mean, they told the world how to stop these type of things. And cdc is so politicized. People dont walk we just had a we just were talking about people going back to work. Theyre telling people to go back to work now and people are saying, they need to go back to work as if this virus is not out there. And these older people who are at home or some of these rich people who are at home and these younger people and people who have these lowend jobs, they have to go paback to work out here. And none of the scientific or the medical or the socalled movers and shakers are saying we need to stop this mess. Okay, james, heard your point. Dr. Gottlieb. Look, i think on the second point, i think theres a lot of people who have to work and feel very uncertain about the environment. And thats very concerning to all of us, i think, engaged in Public Health. Theres a lot of essential employees, a lot of people in jobs being put at risk, not just First Responders, but people thatnes. They have the to work and continue to earn money and theyre doing it in an environment where they put themselves at risk. We have to get infection under control first andif you think bd april and may, different parts of the country had Different Levels of spread, and so it is reasonable that, you know, parts of the country that were heavily engulfed took more time to start reopening venues versus part of the country where there really was not as much infection. But it is not just the timing of the reopening, it is what they reopened and sort the pace of the reopening. I think with hindsight, we should have done ang down the rf the mostat werent created a lot of risk. And the most obviousif example bars. If we really wanted to preserve the ability to open schools and wanted to keep the epidemic at bay and wanted to be prudent and cautious and take our time to see how this was going to evolve, you probably would have wanted to keep closed longer certain congregate settings, indoor congregate settings whert you know the virus is are n lik spread that are purely try t entertainment, that arent an essential feature of the economy. Try to get people back to work f first and foremost. Try to make sure youre in a e e position tor, open schools and open those venues last if you secured the safety of the public by opening those other more important sites. I own recognize that theres ba owners and restaurant own rs who probably hear this and say my accomplishment is very important it is. As to but on the hole, if you look at things from a population level and try to maximize gains to the site as a whole, you would haveo gaiclosings longer. Ich in and i think now that weve had a surge in infections, those are e going to be kept closed for a longer period of time. Rich in marion, ohio. Caller great discussions. I 1000 appreciate your suggest have probably saved 100,000 or more lives. One i thought about was just pointing out things that work on handshakes has been significantf one thing comes to my mind is if we could get information on quic people that and we do have y it that can get the tests oud back quicker like one day or it less, it could save on ppp. It could save hospitals having to have extra rooms set aside. Se the other thing i thought about is how much, if we have real vs test if we think about how much heat of to 90 viruses, heat the ram above 90 degrees, to have h realen data on that like the company thats really good at getting into these problems. S. Theyre studying Library Books e right now for how many days it saves on where you have real data to do that. Do it seems like we have to have k all the good ideasee coming together. And i think when we do it, m bew class and keep it, maybe we cant do it, but we know where its at, and share between hospitals, you just can see thel winning plays coming one after another. And i think thats what brought our deskquesti down. Ill hang up and listen to your answer. Thanks a lot for the question. I think with respect to talkingu about different k waysno to disinfect classrooms, there are different chemicals that are being used to sort of fog venues, being used on airplanes, being thoughtwi to be used con indoors. It doesd appear that less of th spread here is through contact with contaminated surfaces, what we call fomites in medicine. Someone whos infected coughs into their hand and touches a surface and you go and touch the surface and touch your face. It appears some of the spread, but probably less so. I think whats important for the schools, and many of them are k loog at doing this, is retrofitting their air handlingt systems with different kinds of filters to make sure they dont become vehicles for nditio transmission. It doesav appeare that in certa settings the addition of air se conditioning may have been a contributing factor for the spread. It may have been because of the way it blew around the virus in, certain settings. I think thats part of what in happened in the southto sum is t was very hot in phoenix and texas and miami, so people conge rather thanga going outside as g got into the summer were going inside for the benefit of air re conditioning into congregateop settings and that was causing hd spread. If you look attma israel, was r reopened schools may 17th. So th about ten days later they had major outbreaks. They had a heat wave and allowed students to take off their masks and closed the windows and turned on the air conditioning. People talk about the virus is i aerosolff transmission or airborne excuse me, droplet transmission or airborne. The difference is droplet transmission is wet, moist droplets. You have to be close to someone tomean transmit something throu droplet transmission because ets your droplets have to land on them. E aerosol transmissionvacu meansa virus can get into small roplet droplets, those droplets can evaporate the virus can stay suspended in air for a long period of time. The classic infection thats. Spread through aerosol transmission thats airborne is measles. Covid probably isnt airborne ir that sense, but its probably mostly droplet transmission. But its not a binary thing t either. Viruses that are sort of spread through droplet transmission under the optimal circumstances can start to spread through a condition that approximates airg aerosol zags. If you put it in just the ar perfect environment in terms of temperature, cool environment, airen canning on blowing thingsk around, people grouped together, you start to get a pattern of spread thatat we ar looks more r aerosolization. I think its going to be importantab to retrofit the hva systems. Youre absolutely right, we need to be turning around tests faster. A test that results takes six, days to get the result back really isnt that helpful clinically anymore, and especially if were going to be reopening schools and trying to use testing as a tool to to identify and mitigate outbreaks in the local community. You want to be able to get that result back within 24 or 48 hours. Part of that meansfferen gettin testing supplylythat into the m. Part of that means getting different kinds of testing in n thehe market. Things that are going to be don, at home is important in facilitating. Emething you can ship them a, test kit the same day, get the test kit, swab themselves, get it back in the same day or the h next day ande get a result witn 24 or 48 hours. R those kindsresu of innovations the market are going to be very important for building out the h ability to gete quicker result to patients that are actionable. Dr. Gottlieb, i want to go ga back to the classroom. If you are in that optimal condition as you laid out where the air conditioning is running in a school, if those children teachers are wearing a mask in those conditions, are they mostly protected . D . Bo ittt certainly helps. So, i dont want to say theyre 100 protecteded because the bottom line is we dont know. We dont have good data on this. Certainly wearing the mask is going to help. Most kids are going to be hould wearing cloth masks. I think teachers should think about wearing better protective equipment and we should get than kind of equipment to teachers. Remember, if all the children are Wearing Masks, theyre not aerosolizing the droplets as ch. Much. Their masks are getting moist but most of the droplets greting caught by the mask. Thats the benefit of the mask in that kind of setting. Its going to afford some form of protection to the children themselves in terms of what theyre breathing in. We have seen many settings now, its sort of anecdotal, settingo where there has been virus that otherwise should have spread bue it didnt because people were s Wearing Masks. Had to and the h classic case study th the cdc cited was the case in o. Where you had two hair stylists that, you know, performed services on more than 100 people. They they both were infected. They wore masks. Th the people they were servicing i wore masks, different kinds of masks, different quality masks and nobody got infected. Thats pretty instructive because you didnt see any llero infections. You have to believe that the ng action manies we er inwere having an effect and. Effect. Profound caller good morning. Im a Grocery Store cashier and im in a higher volume setting. U one of thestom things about mass weve been mandated as employees to wear them far a while but mandated customers wear them as well. Customers will strip them off when they come in and by the ug time they get to ush or at the cashier stand most of them arent wearing them anymore. Ey wearing eople that are them, if they have to cough or sneeze, theyre taking them off. Theyll take them offpeople so dont get them dirty which e defeats the purpose. Nd w thehe other thing we deal is people are are just so angry. You know, theyre angry about the choice and whether they sho