constitutional republic work for generations, we will expire. there is no guarantee things are looking great but when things are looking great, it's time to shore up the foundations. >> watch april ryan and cal thomas sunday on booktv on c-span2. >> at our table jennifer nuzzo who senior scholar associate professor at the johns hopkins center for health security here to talk about the coronavirus and the response to it. let's begin with this virus. what exactly is it and how is it that it became something that went from an animal to humans? >> guest: so it's a respiratory virus. there are coronavirus is the sake of it among the population, frequent cause of the common cold but this is a new winter people don't have any immunity. seems to be producing more severe symptoms thanon a regular common coronavirus does.

we're fairly good evidence that originated in animals and at some point jump over to humans and then became capable of being transmitted between humans. we don't fully know when that occurred. the initial outbreak was detected at the end of december. it's likely started a month before then but possibly earlier. >> host: how does the jump from animal to human? >> guest: that mechanism is it now but it's likely a human came in contact with an animal that was infected and that virus mutated all of it so we could live in humans and then became more adapted to being in humans and then able to spread between humans, got thens right receptos to bind to the human lungs trim is it ingesting or just touching? >> guest: it's not larger to be spread by droplet transmission. somebody is symptomatic can expel virus and they can expel it directly on you or potential on the service you then touch and touch your face or nose turn with what about from animal to

human? is it that they touched this animal or they ate the meat? >> guest: it's unclear at this point. it might've been the ate the meat or they could been involved in the tray or some of the preparation but we don't yet know. >> host: is that were all viruses originate, from ingesting meat products? >> guest: we don't know it was ingested.ow i should say the evidence we have is this virus likely came initially from bats. most people think there was an intermediary virus possibly in a mammal of we figured out what that mammal is was so we don't fully know and we don't know how people were exposed to it. >> host: where do these viruses -- why do these originate from animals to humans? >> guest: it feels like the stories you read about new viruses emerging are increasing at its in fact, true. there are increased incidence. the vast majority of wildlife in

origin. partially they are new viruses are partially people encounter them and then if the virus changes in in a little way andt becomes -- cumin so that immunity and that they can transmitted that's received his outbreaks occur. >> host: why don't we have the immune system to combat this virus, or to some people have it and what makes them stronger than others? >> guest: this virus is new and not thought the people of existing immunity. we haven't really fully done tests to understand what level of population may have been infected already. it's quite different from the common coronavirus that circulates and so i don't think there's much thought it you're gotten a cold and had that fires that would protect you from this one. >> host: what happens when you get this disease? how do you know of what should you do if you think you might

have it? >> guest: first of all depends on where you are in terms of whether or not you're likely to be tested. it's a bit tricky because the virus starts off like many other respiratory virusesta do, maybea fever or sore throat, some kind of initial symptoms. the vast majority of the people who have been infected, over 80%, containing to have mild symptoms throughout the course of the illness, but there are some portion that go on to severe illness and some portion the going to critical illness, and then some portion that die. in terms of how you could be tested, in the united states if you want to be tested, you essentially have two have traveled to wuhan and have lower respiratory infection. that's when city in china where it's thought this global epidemic started. but if you've traveled abroad are china and you're sick and fb hospitalized it's possible to be tested but if you don't fold if of those categories, they are

not testing you. >> host: even with outbreaks in italy, iran, south korea? >> guest: that i think a been studyingave the situation are quite concerned about that, as this epidemic has evolved and there's an active debate whether or not we should be calling it a pandemic, regardless, we now know many countries have reported transmission. in fact, it was 34 countries yesterday. many of those countries are reporting active intense epidemics that are spreading locally. many of us have suggested that those very limited criteria for testing are probably no longer applicable and it would be really beneficial to expand testing beyond those very limited categories. >> host: what is the definition of a pandemic? >> guest: you will get a debate among individuals. i as an epidemiologist and most epidemiologists, we look at this as a description of the global

spread or geographic spread. so when you have in this case 34 countries and various different parts of the globe reporting case to us that satisfy the definition epidemic. the world health organization has p pushed back strong against that characterization and they believe the disease severity is a a factor. i don't believe that and that's not what we learn in epidemiology. i i think we can have mild pandemics and, unfortunately, we can also severe pandemics. >> host: how would you define what we are seeing? >> guest: i am believing this is a pandemic, that we are seeing countries across the globe reporting cases. we know surveillance the virus is quite limited in the ways of told you about certain countries like the u.s. are only testing people if they travel to china despite the fact factors active infections elsewhere. we areik likely to miss cases tt have resulted from other exposures. when you have a situation like that and you have virus that initially looks quite mild in a

lot of cases and people are able to put into a spread in the early phase when the symptoms are mild, that makes of it difficult to interrupt and it makes it very difficult to know where in the world the virus is. i think it's hate to say country that are not yet reporting may very well in fact, have cases. they just haven't found them yet and if they have i think there's a good chance they will because so far we have seen any of the aggressive actions the countries are taken like shutting down travel, ever stop the spread. >> host: what has the johns hopkins done and what will he play in tracking this disease? >> guest: we are research center of the johns hopkins school of public health and we are a faculty in the school of public health so we teach and mentor students but we also conduct independent research. our group focuses on policy around outbreak, epidemic and pandemic detection, response and what government and practitioners should do topi be ready for it. i also direct the project called

outbreak of server to, so we studied operational dimensions of outbreaks and outbreak response is basically understand what the challenges are and what resources are needed to combat these threats and to make sure we improve preparedness for future ones. >> host: what is your concern with over 100 cases in iran and the migration in and out of that country into the neighboring areas where they have had wars, fragile governments, and not a lot of transparency? >> guest: yeah, , so i think that's where our biggest worry is, at this virus will turn up in places that if we can for structure, particularly week healthcare infrastructure. directortu general of w.h.o. in deciding to declare this covid-19 epidemic at the time, a public health emergency of international concern. he actually cited concerns about

weak health systems is one of the reasons for making that declaration and wanted to make sure countries to get ready and to think about how they are going to manage potentially an influx of infected patients. certainly countries in the area are already reporting cases. as you mentioned there are a number that are undergoing many other challenges that could make it very d difficult to manage ts on top of the day-to-day civil conflict andnd other things. >> host: the iranian foreign minister held a public news codevelopment was made public yesterday that he has tested positive for the coronavirus. should he have been, , or should people be in public if they are feeling sick and there from these areas and they have tested positive? >> guest: i think if you tested positive for certain support to isolate at home so you won't spread to others. we now think it's possible to spread it relatively early in the course of illness. this feature makes this virus

quite different from the sars virus the calls the global epidemic in 2003. that was also caused by coronavirus. we were able to stop the spread of sars in part because we people became infected, they tend to did not transmit into there are quite ill and usually by that point it were not feeling up to be out and about. they were often already in the hospital. so by improving infection control practices at hospitals we were able to stop transmission of sars but this virus is quite different and so i think it's critically important that people who are sick should stay home. unfortunately in many places it's still difficult to test people for the virus but i think as a general rule anytime you're not feeling well, you have a fever, it's good for society, for you to try to stay home if you can. >> host: are you saying you could spread it before you start to feel it? >> guest: so there's an active kind of question as to whether people who never have symptoms are capable of spreading it.

certainly they found virus in people who haven't yet had symptoms. we don't know to what extent they may spread the virus because it's just simple easy to spread when you're symptomatic because you're more likely to expel the virus from your body when you're coughing and sneezing. but it seems possible people can spread early in their infection possible before they fully recognize how ill the article for a number of cases thought they had a cold or maybe for come down with something but not necessarily feell they were as severely ill as one might expect to be with this virus eventually tried what we want to take our viewers questions and comments aboutwa this. 202-748-8000 eastern/central. 202-748-8001 mountain/pacific. we can read some of your questions if you text us with your name comes the estate at 202-748-8003. we heard from healthcare healths in the, yesterday that said this could be bad.

how bad? what do you think when they say that? >> there are a few open questions about the virus. i think it is certainly a certainty that we will see cases here, additional cases in the united states.on one of the difficulties right now, as i said, we are notw, testing very many people, and so in the united states with tested fewer than 500 people. in places like south korea and singapore where they are experiencing large outbreaks, they have tested tens of thousands of people. so i think we have a very cool review of v whether or not there are cases already here. certainly we should expect to see more in the future. in terms of how bad it could be, one of the open questions about the virus is a what level of severity is produced by the virus. if you simply took the number of

deaths d reported and divided tt into the number of illnesses reported, it's about a 2% case theut taliban ratio. that probably sounds small to a lot of people just because 2% sounds like more often than not you are not going to experience it but that's on the order of what we saw with the 19th 18 influenza pandemic which is one of the deadliest events in modern history. that said, many people including myself don't fully believe that that 2% calculation is accurate because i think, i do think others hold this view, that there probably likely many more mild cases out there that we are not counting. if we were able to count it, our calculation of case the calibration would be possibly much lower. nonetheless, still potentially if it were 1% or .5% or

even .1%, when you later lay tn top of health systems that are struggling to deal do with the, it still quite a challenge to think about how they're going to manage those patients. >> host: your reaction to the supporting in the "wall street journal." so far american political systems have sought to contain the virus isolate the confirmed cases while monitoring close context of these patients for signs of infection. is that the way to handle this traffic i think isolation will be important and monitoring contact for as long as we can do it will be important but the will come a point cases are such a will not be able to that and we will have to expect that our approaches are going to shift whereby which is going to focus on treating the severely ill people trying to prevent those individuals who are most likely to become quite ill and die. that is for the most part elderly and people with underlying health conditions. if we get many more cases and i think you'll see efforts focusing on trying to mitigate the impact and helping the

vulnerable. >> host: would that be closing schools? what with that entail? >> guest: : i think it's an open-ended question that was mentioned yesterday at the cdc press conference that communities may have to consider these measures. i hope that states are considering what actions if any they will take. it's going to be important in thinking through those considerations that we not only examine their potential to produce -- not fully reduce, it's more likely it able sort of slow transmission but maybe not affect the total number of cases that we see. it's important as they consider taking those measures in an effort to potentially slow the spread of this virus but they also examine not only its potential public health benefit but its potential impact on society. although i thinkth a number of

people talking about school closures, that was something we did during the 2009 influenza pandemic. we did it for a short while before realize the virus possibly wasn't as severe as were initially feared it would, but he's a very disruptive measures.s. working parents, if at the stay home with her children, that possibly mean means they can'to work. it doesn't people are working at healthcare facilities or power plants or stocking the shelves at grocery stores, that could create a situation will be have possibly more harm to potentially the virus could pose. we have to makemo sure we now is those and have plans to mitigate those unintended consequences try but let's get to calls. nick, illinois. go ahead. >> caller: good morning, greta. thank you for taking the call. i'm not as concerned as everybody is about the coronavirus. it's bad. started in china. china has nearly 2 billion

people and they have lost almost 2000 people. we've got people like richard fowler on fox news last night with shannon blaming the trump administration and blamed the executive branch for this virus the start in another country from them either people rats, beavers, maybe we'll. >> the list goes on and on b tht is being fed to the chinese people. you can't have 1.5 billion people living on top of one another. we have lost 14,000 people in north america from the flu. >> host: let's take that point, nick. compare this to the deaths over the flu. >> guest: i am very worried about the flu. it is an important contribution to severe illness andbu death in the united states and frequent cause of hospitalizations, particularly in the season that we are in now. it is absolutely worth being concerned about and i very much encouraged anybody who hasn't

already got the vaccine to get the vaccine because your best chance of not having severe illness and death if you are vaccinated. it will also be helpful if we can reduce the number of flu cases, t that's less burn for te hospital staff to manage. that said, one of the reasons why this virus is getting the attention that it is, it's that because things like flu are not deadly but because they're still an open question as to whether this virus is more deadly than the flu. just based on the numbers reported to date, it is far more deadly than the flu. i've said i think those numbers are not quite accurate, but that uncertainty is still there and we have to prepare, given that uncertainty. the other challenge is that unlike the flu we don't have the same tools for the coronavirus. we are very limited ability to test people and diagnose someone with infection particularly in the u.s. we don't have a vaccine like we do for the flu. we don't have medicines we also give for the flu.

so the absence of those tools and the uncertainty make it i think essential we prepare for the i don't think making this political or placing blame is productive. but nonetheless it's important to facebook we need to do. >> host: when it comes to this disease or any disease, influenza, et cetera, are the things people can do beyond the flu shot or in addition to the flu shot tolu boost your immune system? >> guest: the bestt thing you can do best evidence we have is you should take measures that will reduce your likelihood of becoming infected in the first place. that's things like staying away from people who are sick possibly with respiratory symptoms. the best you can. washing hands is important because if some at a cost on a surface and you touch it and the new touches of, there's a possibility you could infect yourself. those are probably the i best measures at this point. it may become a time if there's a lot of cases out there where we will think about whether going into crowded public places is worth it.

there are still some planning that needs to be done around that and i think part of it is also involves peoples risk tolerance. someone who's elderly or his underlying medical conditions might be less inclined to take those risks than other people, pat, new jersey. [laughing] also having a hard time getting into a a panic over this. my question is, art the at-risk people, , the people with a higr risk of severe illness and if you can the same people at risk in every other epidemic, the elderly, the infirm, people with compromised immune systems? and for 95% of the people what are we supposed to do? how do i get worried over something that in many people is asymptomatic? how would i know the difference between the coronavirus and a cold? >> guest: i think that's a fair point. these risk groups i talked about, the elderly and people with underlying health conditions, those are risk groups we see for other diseases

like influenza. even the common cold coronavirus can cause severe illness and individuals. and like influenza, this novel coronavirus also has the ability to cause severe illness and death in prepa's a healthy individuals. while the elderly and people with underlying health conditions are most at risk of severe illness and death, they are not the only ones who have suffered severe outcomes like i described. but i think your point about why should i worry, i think i agree with you. i mean, what, we're looking for is just preparing the best we can and worry at this point is probably not productive. nonetheless, it doesn't mean we shouldn't appreciate the hard work that's going on in the country to prepare for it. i want to make sure we are doing as much as we can. >> host: lend in maryland

wants to know what is being done at the border and international airports to prevent someone from bringing the virus into the united states transit at the end of january the u.s. implement his travel restrictions, basically preventing certain people from come people come from china for getting visa to come to the united states also accompanying that implement in quarantine for americans who are returning from wuhan and broader china. this isn't something that a a number of countries have also done, but the best evidence suggests these measures are not likely to be effective in terms of keeping the virus out. first of all, as i said that are many countries that are now reporting ongoing epidemics of this virus. those are not on our list for travel restrictions and it would be difficult to just keep adding countries to the list because the resource requirements for screening people and implementing the quarantines

that event implement it to date have been extraordinarilyom burdensome. my great worried about this is that the health department officials who are now having to monitor and care for individuals under quarantine, it's the same people we would want to prepare communities to think about how we would reduce the impacts of a virus when it is circulated. much bandwidth. i have been deeply concerned it's diverted resources from the important community level work that needs to happen. i'll also point out that a number of the countries that are experiencing large epidemics like a bat e and south korea, ty implemented travel restrictions and canceled flights and suspended flights, and that didn't prevent the epidemics they are now experiencing. >> host: what mistakes did china make in theer beginning of this? and when they reacted later by shutting down wuhan province and restricting travel, did that

help? >> guest: i think there was an initial lack of understanding him grow the public. i often think that breaks like this and often see the country make mistakes in the beginning before they know what's happening. i never truly like to criticize orke site you should have done k what into because it just don't think it's productive. we should focus on going forward. there's always missteps in any event i ever looked at her been a part of, a practitioner. there were certainly i think mistakes. i think all countries are probably looking back at it and find things that they would do differently.

in terms of the restrictions and the lockdowns that china's implemented, i've been think dy worried about these measures. many are crediting them with potentially slowing the incidence of new cases, the number of new cases china is reporting seems to have slowed. i am a bit -- first of all,ca skeptical whether those trends are true. i think there's been some challenges with diagnostics in that country. even if you assume they have worked, it's likely those impacts are going to be temporary, and when they get back to work, frankly the world needs time to get back to work. it's an important producer of personal protective equipment at essential medicines and a lot of supplies the world will need in order to be able to manage this situation. it's important the country does get back to work, but when they do we would expect to see an

increase in the number of cases again. when we think about whether or not a conscious you do this, first of all we have to examine what are the benefits from a public health perspective? are those benefits sustainable? at what cost do they come in? i've been worried about whether the event additional harms impose on the people have been subjected to those restrictions. we know china has essentially in many places focus its effort and time on controlling the virus and that is meant people of the middle conditions like cancer patients and hiv have not been able to get the treatment they need. we have to balance the overall effect of these measures and then think about particularly if other countries are looking to china and thinking maybe this is something we should do. it's important to recognize china has incredible resources to be able to pull this off and

a certain government that may not be applicable in other places or accepted by the people that mayay be subjected to the. >> host: we will go to maryland, sue, good morning to you. >> caller: thank you for taking my call. my fathers sister died of the flu epidemic in 1918. she was two years old, and when. i i started think about this i took this very, very seriously and i think your guest is being a bit disingenuous with the public because thet communist party in china i don't think it's on the truth to the world. i don't think that the real truth, and another is because i someone at nih and very close to that is a molecular biologist and infectious diseases. when i first heard about this pandemic, i was listening to steve bannon podcast pandemic and he's having a lot of experts on your and there is still being

smuggled out of china with the crematoriums are running 24/7 50 comments party was time to keep this a secret because they didn't want the western world to know about it. i think not to tell the american public, i've gone out and bought 595 masks. i this is going to be much more serious than anyonele is letting on and i think your guest will talk but the fact there is no evidence coming forward that this virus started at the p4 lap 20 miles outside of wuhan and we have for dietrich in maryland that is a p4 lap. this virus is not what the media is saying. it's not a couple of people who have it in the united states. the task it is even the right test kit. they are using from nih saying, using a lot of the techniques for the sars virus to you have any clue what's really going on with this virus can where it

originated, how we're supposed to deal with it. to tell people to wash their hands and don't touch the faces is really -- >> host: maybe we can take the p4 labs trachea there's been a lot of chatter on in that method. i'm not a bra roses but all credible virologist i know people look at thecr genetic sequence and analyze the genetic tree, you know, the kind of virus, have the essentially ruled that out. they don't leave that's a credible hypothesis. no one i know who studies this issue seriously believes it originated anywhereio other than from someit animal. in terms of measures that we could take to protect oneself. i completely understand that when i sent wash her hands, that feels very underwhelming. i've got elderly relatives and it asked me the same thing. i want to be able to say more than that.

but but i can't, the art. in terms of stockpiling n95 mask and a something not recommended. first of all,, you need to be ft tested for a n95 mask to be sure that it is actually going to work for you. that's that was something that people can just do themselves generally. just to know you may think of protect the something is actually not going to protect you and that false sense of confidence you make it from it to put your more harm. the other wayit you could be moe harm by something that is if ever anybody goes out and gets its mass. there forho t healthcare workere going to be responsible for saving your life, that puts office at risk. i just want to point that out so we will be better served to make sure that the doctors and nurses and other health professionals are going to be putting their lives on the line to say people's lives. we need to make sure that the tools they need to be able to do that safely. >> host: gainesville texas.

>> caller: we have an epidemic going on right now in the united states and the assistant aptly nothing. we had 15 million who hd the influenza virus. i would like her to address that, that the u.s. has done absolutely nothing. as far as your referral to the coronavirus, you are saying it only happens in the elderly. that is 100% false. the first doctor who revealed the coronavirus in china died, he was 34 years old. i think it is very disingenuous to come on here and tell us to wash our hands when we should be isolating everybody who has this virus and we should corn time schools -- quarantine schools just like they did in china. i am a physician, by the way. also just wanted to say one more thing. host: let's have jennifer nuzzo

respond. guest: i agree with your concerns about influenza. it is a really important cause of death and illness in the united states each year. with your assessment that the united states is doing nothing. we have learned so much about influenza in the last 10 years because of enhanced surveillance. we also have diagnostic tools and health facilities, doctors offices and in hospitals. vaccine.it is not perfect, but it seems to be fairly good at preventing severe illness and death. i think we have a lot of tools. i wish we had a better one. i wish we had universal flu vaccine so you only had to be vaccinated once. i wish we did a better job of making sure people get vaccinated, particularly kids. there has been a high number of children that have died this

year. as a health professional and mother, i think that is a travesty. believe say i don't that this virus only affects the elderly and immunocompromised. 80,000 cases reported to date, and many of those individuals are young, healthy people. as she rightly pointed out, young and previously healthy people have died at this virus. that said, all of the data we have suggest that most of the people who are likely to die are those over the age of 80 with health conditions. i don't want to undersell that. that thinkinggree about washing your hands is probably one of the best ways to protect yourselves at this point is underwhelming, and i think that is one of the reasons communities will be talking about what measures we should be taking to protect those people most at risk. that largely includes the elderly and immunocompromised

people with underlying health conditions. it may include others. i think it is important for us to have the conversations about what measures are likely to work, and also understand what consequences these measures can cause. reaten't want to c a situation where you can't get to the hospital if you need to our health care workers can't show up to care for sick patients. we want to make sure we keep the lights on, water running and stores stocked with food because we don't want to create a situation where we implement measures that are worse for our communities than the virus itself. host: arlington, virginia. linda. caller: hi. i have two questions. one of which is regarding the innate immune system. i'm glad that you were talking about preventative measures because i all about prevention. i'm in my mid-70's, so i also realize that even though i have no underlying health conditions, i need to take special care.

washing hands, etc., and i have actually bought myself a mask, i am planning on getting things that would help boost my innate union system like vitamin c, garlic, turmeric, ginger, oranges, etc., etc.. i want your comments on that. host: let's let her respond. guest: i just want to re-emphasize what i said to the earlier caller about it depends on what mask you are using. it is possible they can give you a false sense of security and possibly put you more at risk. it is not recommended that people in the general public use masks. in particular, there is limited evidence -- we believe that a healthy person wearing a mask is not how mask can protect you. it is potentially better for people who are sick to wear a mask so they don't expel the virus. we don't want to create a

situation in which people go out and get masks and we don't have them for our health care workers. in terms of your suggestions for the other things, i don't think there is really strong evidence that they are going to help. i am a mom and i meant a lot of moms groups on the i was talk about garlic and elderberry. i just don't think there is great evidence that they are going to protect. host: did you have a follow-up? caller: i did. i did see one report, and i have no idea whether it is accurate or not. if it is, it gives me some scarce. -- scares. inre is at least one person china who recovered supposedly from this virus, and then later tested positive and came down with it again. thenat is indeed true, that tells me that your immune system did not learn and you are not immune to that same virus on a more.

if that is the case, then it tells me that there is a big question as to whether or not a vaccine can be developed. guest: i know about that report. i think it is hard to make sense. i think we are going to need more evidence before we understand what that means and whether that was a truly accurate observation or if there were testing issues. that will be an important consideration in the ongoing efforts to develop vaccines. i am heartened that governments and organizations have announced intentions to conduct clinical trials. those are going to be really important for providing the evidence that these measures protect and don't do more harm in the long run. nebraskave from omaha, texted us. is the human race a weaker species because of overuse of antibiotics? guest: i don't know that we are

a weaker species. i will say that overuse of anabiotic's is an important health threat and we have to be in concern about the rise we are seeing in antimicrobial resistance and want to make sure we are reserving antibiotics for appropriate uses so that we retain these tools in our fight against bacteria. host: bill in albany, georgia. if you are on antibiotics and you test for coronavirus and you show hardly any symptoms, are you more likely to be contagious for a longer period of time and spread it, able to go from place to place and still be able to go from different places and spread the virus? two, do you think that withholding these sanctions to these countries that need medical care, like drugs very badly, are they killing people and a lot of these places that

need these drugs that would help them to fight this? oxygen, withare on a respiratory virus, is the oxygen making it worse for you by being in an oxygen-rich environment? guest: i think a few points there, just to be clear, antibiotics don't have any. thatu are on antibiotics, should not affect your ability to get the virus or transmit it. he also had a question in there about sanctions. unfortunately, right now, we don't have specific medicines to treat this virus. there are clinical trials the role thatmine some existing drugs are used for other things may have in terms of treating people with the virus.

i think the general premise to your point about how we respond and politics in terms of different places, it is in the globe's best interest to respond to this collectively, share our resources as needed and as appropriate. countries have to protect their own, but it is also in our best interest to enable other countries that may have fewer resources to be able to respond to this such that they can reduce the impacts. as we see, something that starts in one part of the globe, i virus like this that spreads silently and rapidly, can be anywhere. it is also important for us to know what is going on in other countries so that we can understand this virus. ofhink there have been a lot question so far about china and what is happening in china. part of the challenge is that we don't have a really good window into what is going on there. we are relying on what others are saying and we don't have a direct line into seeing that. the extent to which we can

engage in a collaborative manner so we can understand what is happening and understand this virus and its impacts on whether or not they are changing over time, that will clearly be in our best interest. host: bonnie, montauk, new york. caller: i have a couple of questions. i was reading regarding the amount of ards in the initial cohort of 41 people that they looked at, specifically in wuhan, and that 29% of them annd up with ards, which is incredibly dangerous occurrence and a lot of people die from it. i wanted to find out because they said overall, it is about a 3% death rate. however, in this article, about 10% did die. i'm curious as to what is being looked at specifically regarding that, but also, i know you talked about the and 95 masks and they have to be fit.

they did a too, study supposedly about one of those labs. it is obviously a wet market. it is pretty understandable to understand how that got into the general public. but there is supposedly a lab that was studying specifically that type of that coronavirus, and there was an article that got yanked two weeks ago by the actual researchers. do you have any information about any of that? thank you very much advance. host: can you first explain ards? guest: that is acute respiratory distress syndrome. it is important for us to understand the pathology of this disease and what proportion developed this and what proportion are ultimately able to survive it. it is also important to understand a challenge in fully extrapolating from wuhan, is that that is where the start of

this situation was. there was some time before maybe it was fully appreciated that this could spread between people and fully appreciated what it was. as of the open questions is, knowledge has improved, and as our understanding of the need to clinically manage these cases, would we see better outcomes in patients who are hospitalized just as the system trains and learns about it? another question is whether resource constraints at all play a role in the proportion of people who develop severe illness and ultimately die. how early in the course of somebody's illness people see care can also play a role. we often talk about proportions of patients who develop severe illness or death as though it affects parameter of a disease pathogen.cular

these numbers aren't always fixed. for instance, when we talk about ebola and the places where we have seen epidemics of ebola, it is a fairly fatal disease with 60%-70% of people affected ultimately dying. when we see patients treated outside of settings where there are more medical resources available, many more people are able to survive their infections. it is really important when we think about these numbers to think about what medical resources are being brought to bear to help people come through their infection and survive. we probably know in some cases some of those patients who may have benefited from things like mechanical ventilation, may not have gotten it and so we need to understand what that role of those tools are. there was another question about the lab. again, talked about that earlier. i know they have done various

analyses to show that is the origin of the virus. that is not my area of expertise, but there are very thoughtful people who have given careful thought to this. we don't really, not only do we not have evidence, but i think there is very strong evidence to the contrary. i am wondering how trump can say we don't have a problem with the virus if we are not it, and how other countries like iran can test for it but we can't? guest: those are great questions. i think it is important for us to do enhanced testing so that we can understand whether it is here already and to what extent. if it is not here, so that we are ready to find it when it is. it sounds like there have been technical problems with the test the u.s. is using. don't fully understand where they are in terms of working that out. they have found it optimistic for a few weeks now.

i know state health laboratories fda requested from the permission to develop their own test because they very much want to do increased testing. that is somewhat of an extraordinary step, but i think it reflects the degree to which they want to lean in and be forward leaning on these issues. host: conrad, rockledge, pennsylvania. good morning. your question or comment? caller: hi. my comment is, i'm on my computer right now and i am looking at a front cover of a bestseller's book from back about 40 years ago by dean kootz. the topic is the eyes of darkness. it describes some kind of a bacterium smuggled out of the country, i guess and taken to china by a guy name lee chen.

i'm just -- and it went to whuan in -- wuhan in china. i'm wondering if anybody knows about this book. it is a bestseller. guest: i don't know about the book, but thank you for the recommendation. host: this is a question from stephen who wants to know why it doesn't seem like children have been greatly affected by the virus. guest: that is a reall >> guest: that's a really great question and it's one that people are wondering about we saw this during sars but it don't think we fully know. it's possible children to get infected but their illnesses are more mild and that perhaps we sit more in adult because their immune systems react more strongly to the virus but we don't know. but that said there have now been just in the data that reported of the cases, not many children and also there was a study looking at infants who were hospitalized in china and they didn't find much infection either. to me that's encouraging as a

mom in particular but also i think it's a point for us to think about when we talk about things like closing schools. one of the reasons why we talk about closing schools, it's something we did for influenza in the 2009 pandemic, and, and the theory behind that was thath one, children potentially could be at risk of having severe outcomes from the flu but, two, children are known to the important drivers of overall community transmission of influenza picks the kids get sick and they give it to the parents and grandparents, so the thought was if you could reduce the congregation of children and the ability of children to give the virus to each of you could reduce overall transmission. it's not clear where going to have the same benefits from school closures with this virus given so few children have been reported among cases. >> host: paul, charlestown west virginia. >> caller: hello. i'm a 70 year old er nurse who

is not working. i've been watching this morning, and i see us dancing around a disease that only has one or 2% fatality. i'm curious what you think would happen and how to proceed if we saw vectors of transmission and the tally rates that say occurred in 1348, 49, and 1350 in europe? >> guest: so i don't think we're worried about that at this point. i think the highest estimate of the kelly that, so far are from wuhan and that's around 4% of patients. as i i said, that's very high in the modern context.

in 1918 influenza pandemic pandemic which is an engine is one of o the deadliest disease events in modern history. that had about a 2% case the tally ratio. if you think about what even 2% means, if we think that many, many people on the planet could get this virus just because of the way it spreads and the lack of a pre-existing immunity and you up 2% to those numbers, those are very high numbers. as i said i don't believe that 2% is probably an accurate statistic. i think it potentially could be lower but we need more evidence and our understanding of the virus can change as we gather more evidence. another reason why i think the 2% might be wrong is often when we see these events, we tend to bias findings more severe cases because it's hard to find the mild cases. but nonetheless, i think we have

to prepare given the uncertainty. even if it were 1% or even on the order of the seasonal flu, blaring that on top of the kashmir as an er nurse you probably saw that firsthand how tough flu seasons are and this just think about additionally, additional patients coming in seeking care and potentially needing intensive care, that very challenging and so that's why this virus is getting the attention that it is. .. 9:30 a.m. eastern time, hh s secretary azar. turn your channel to c-span2. our website c-span.org or you can download the free c-span radio app.

testifying at 1:30 p.m. eastern time on the budget and coronavirus. that also is on c-span2 today along with our website and radio app. if you want to learn more about john hopkins center for health security, you can go online. senior scholar and associate professor, thank you for your time. >> we go live now to capitol hill where health secretary alex azar will testify about the administration's response to the coronavirus. he will take questions from the house subcommittee on health. this is a second hearing that secretary azar has testified at today. this is live coverage on c-span2 subcomtt