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I mean a good man and I also just want to say I can't say enough about the team of people who are making this broadcast possible as everyone in this country right now yet now is dealing with this pandemic as people are around the world it takes a community and we have an amazing one here and I am ever thankful every single day seven weeks since the first case of the corona virus was reported in the United States we're spending the hour looking at how the trump administration not only has failed to account for what is clearly thousands of infections in this country because of ongoing problems with access to testing but we're talking about what needs to happen next this is the critical issue we're broadcasting from New York the mayor of New York just declared a state of emergency in the city he said while they're about a hundred people have tested positive just in New York City alone next week is expected to be a thousand just down the road in new Rochelle in Westchester is the epicenter of the corona virus and that came from one person who tested positive and very soon after his wife and two kids tested positive and now there's well over a hundred fifty people the National Guard are now in new Rochelle the schools are close they want to make sure kids get food because many kids all over this country get free lunch at school what happens when the schools are closed I so we're gonna be talking about a lot of issues still with us is doctor Stephen Goodman associate dean at Stanford medical school where is also a professor of epidemiology and population health and medicine I trained as a pediatrician he is also my brother my lifeline and issues like these he's joining us from Stanford University and joining us from Baltimore is Justin less slur associate professor at the Johns Hopkins Bloomberg school of public health senior author on a new study that suggests the median incubation period for the new corona viruses about five days so I just unlocked floor I want to start there what does that mean why is that significant that the incubation period is perhaps five days we've been hearing a lot about ten and fourteen and then I want to ask you about your work in China so the median incubation period is five days so that means fifty percent of people are going to develop symptoms within five days of being infected but it's important to remember that's not necessarily the number we're most concerned with if we're thinking about quarantine or active monitoring yourself isolation after potential exposure because we you know we don't want half the people who are infected to be out there in the community potentially spreading the virus before they know they have it so what we're more concerned with is is what we call the long tail of that and that's where we get to the fact that in our study we showed that about ninety eight percent of people develop symptoms by twelve days which suggests that the fourteen day period of quarantine or active monitoring suggested by almost every public health agency around the world is pretty good I mean some people will get free that but it was you know but it's pretty good is gonna cast sure the vast majority of people who develop symptoms will do so during that period so let me ask you about your work in China talk about the study you just completed comparing lu Han to a neighboring city tell us about the outbreak in Wuhan what happened how it was dealt with and how it was dealt with nearby so I just to be clear our study was looking at the epidemiology in sins in China we weren't directly comparing with Wuhan but Wuhan just to talk about it a bit had you know is the epicenter of the entire outbreak they clearly had things get out of control in the beginning and had to shut down the entire city and really a lot of the whole province of who may which you know they've not had to do in Italy as well so it's an example of both how bad things can get if we're not careful about staying on top of things and very proactive but it's also an example of the fact that you know massive direct action and can sort of squash the epidemic and stop the virus so where we did our work in shins and there has been a big outbreak and part of that I think is a proactive social distancing measures over the types of things are starting to see in the United States now get stopping mass events having people work from home and the like but they also had very intensive surveillance and very intensive contact tracing of cases that came in from bay province and elsewhere in China and that probably played a big role in why they didn't have an epidemic so can you talk about the fact that it looks like both in China it's hard to say were saying there's good news out of China right now because of this terrible pandemic but the actual good news that's coming out of China and South Korea as opposed to what we're seeing right now in Italy and now the United States were just beginning to understand the scope of the outbreak here yes Sir China clearly has been able to contain the disease at least temporarily I think there's a big question of what happens as they start to dial back all of the extreme measures they've taken in order to contain the disease and you know whether we see a resurgence or whether their skis me whether they're able to do that in a way that more gradually you know a more gradual dial dial back in a way that prevents the virus from resurging in in the country and you know it really is you know I think Italy is taking a similar course to China at world it remains to be seen how effective it is that you know it is in Italy it's a very different culturally population is different you know in US we're in a different part of the outbreak I think the hope is since we're early by doing things proactively cancelling the NBA canceling the NCAA tournament everybody working from home closing schools that we can get to a point where we're slowing the spread of this virus without having to have measures as extreme as were taken in China Dr Steve Goodman if you could talk about what's happened in Italy that horrific odd turn of events there where the entire country is on lockdown where the medical system is clearly overwhelmed and then talk about the United States and this whole issue of flattening the curve a term I think a lot of people are just beginning to hear right now but what do you understand took place in Italy well I haven't I don't have special expertise about exactly what's going on Italy but what is very very clear is that the the greed of spread and then present it has overwhelmed the medical care system that is very clear so part of what's happening there is an example of when and when an epidemic goes to its peak and is greater than the medical infrastructure can take care of it and as you may know there have been extremely poignant pieces both tweets and and other forms of communication by Italian doctors who literally have it with great distress talked about how they had to basically choose life and death for patients for whom they had to choose who to ventilate and who not to because they all they had a limited number of of ventilators so we don't want to get there and in this country so it again it shows that the case fatality rate which ultimately is one of the numbers that that produces the most fear is a is a function not only of how many cases are how many serious cases but how much can be absorbed and properly treated by the medical care system and so that gets right into your second question which is about flattening the curve the the goal of mitigation efforts now which is to obviously lower the number of cases and spread them out is to keep the number of cases to a level where the medical care system can adequately take care of each one where we have enough personnel where we have not found the waiters we have enough ICU beds we have enough beds in the hospital to take care of everybody optimally and the idea of flattening the curve is taking a and under certain number of cases that would occur in a certain period of time and spreading it out over time so the peak is less and so it occurs over a much longer period of time and hopefully obviously also reducing the number of cases but this match both regionally and nationally between the number of facilities personnel beds and go quick meant this has to be matched with a number of cases that are in that area it would be nice to hear from public health officials or national officials how they plan to shift resources if in fact the medical care capabilities in any particular region is outstripped by the number of cases but that's what flattening the curve is all about and that's what all of the measures that's described by yourself by Justin are attempting to do and this issue of respirators in the United States of ventilators of the access most people they do not want to go to the hospital even to their doctor's office most people actually will survive this and it's like a flu and for many people it's mild and for children I even less so that they can be carriers but this issue of overwhelming the number of respirators and ventilators and hospitals around the country can you explain that well obviously the numbers are limited I think we have something on the order of about a million beds and the actual number they're available on any one day is about a third of that the number of ICU beds is a fraction of that and I want to make it a particular point that this is not just about caring for cobit patients the eight the number of covered patients entering the system affects the care of other patients so the kinds of things that we take for granted and arms of care of any of us for any serious disease is affected by the demand on the medical care system for the care of covered patients so we are not geared up as a society for the start with the surge capacity to handle the number of potential covered patients that we would get if we didn't do anything so the kinds of things we're doing now are to keep the numbers below the search capacity the limited very limited search capacity that we have and again this is not just a national issue we can't just count that count up the number of national beds we have to look at this regionally the number of cases in New York City with the number of ICU beds in New York City and have disability to move those cases if in fact those numbers don't match up Dr Steve Goodman is associate dean at Stanford medical school Justin last letter is a professor at Johns Hopkins Bloomberg school of public health we're continuing with them after this break the record by radio head this is.

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