>> watch "the communicators" tonight at 8:00 eastern on c-span2. >> president trump and vice president pence are meeting with pharmaceutical executives later today at the white house to discuss the fight against the coronavirus. we'll have cameras in the room and will bring you coverage as soon as we're able. more now on the coronavirus with former f.d.a. commissioner dr. scott gottlieb. joining us k is dr. scott gottlieb, the former head of the food and drug --inistration commissioner in-service commissioner from 2018 to 2019. a resident fellow at the american enterprise institute here to talk about the response to the global coronavirus. good morning. guest: thanks for having me. host: can you start with you

gauging the response, what is working and what has done well. we made toefforts implement travel restrictions and limit travel from china clearly bought us some time. it slowed the rate of new cases coming into the country, i think the question becomes what we do with that time and we did some things well and some things not so well. i think we prepared the nation, we got the health care system prepared. we will educate providers. learn more about the virus and how it spread and how you can combat it. one thing we didn't do that we should have was had in place broader screening. we should event omitted screening weeks ago and really a month ago or even more. to try detect small outbreaks early. we had problems rolling out a diagnostic test, we took a very linear approach in my view and depended upon one test

promulgated by the centers for disease prevention rather than not -- it also working with academic labs together diagnostics. then we had to scramble and so we are now just getting in place the kind of screening capacity this country that we probably should've had weeks ago. what that means is there cases in the united states probably they came in some point in mid-january or maybe earlier than that from china probably that have been spreading. we probably have at this point certainly hundreds of cases that may be in the low thousands in certain regions. there will be certain hotspots in the country, this a pervasive spread. a country through had 30 million people, several thousand cases a soll of small number braided the risk is still low. but the challenge is now it spread in the country it will make it harder, not impossible,

but harder to contain those outbreaks and also mitigate the continued spread. host: does that factor to the two deaths in washington state, what does that suggest as far as concentration, possible concentration in the united states? caller: parts of -- guest: parts of washington state look like they could be a hotspot now. york,is a case in new given how much travel comes through new york city. i think you have cases where people are hospitalized, that suggests there a lot of people underneath those cases, but those are the ones that we will identify first, the patient they get tested first are the patients who have presented our right now in hospitals that are very sick with an undiagnosed form of pneumonia and now the doctors have the capacity of the

coronavirus they will test those. the initial cases that we identified in this country will be skewed heavily towards more severe patients. those anded back from start testing other people who might be mildly symptomatic, we will start to find more cases of more benign illness from coronavirus because we do know most people don't get very sick from coronavirus and a large percent, any meaningful symptoms at all is just a small percentage the development moan you in a small percentage that go on to have really severe illness and find themselves in intensive care. ourt: our guest -- host: guest here to answer your questions on coronavirus. if you have a question, 202-748-8000 for democrats, ,epublicans 202-748-8001

independents 202-748-8002. at can also text us 202-748-8003. i want to play the healthy human secretaries secretary. i want you to listen to what he has to say and then respond to it. [video clip] >> we promulgated it out in the country. there was a third element to the initial because we do believe in quality testing here in the united states, there was a third element of the test that was specific to all coronavirus is. some labs were unable to validate their own reporting on that. cdc never had trouble with that. had full throughput, no delays on testing there. authorizedsday we over 40 laps to use the test

results in the first two elements of that model of coronavirus. yesterday morning we authorized homebrew test by certified clinical labs around the country. that, what isg to your response to that? guest: i will look forward before a look back. looking forward by the end of this week we will have the capacity to test about 10,000 patients a day. test,unning about 100 some have more capacity than that. by the end of next week if we can get online the academic labs because they're not given regulatory flexibility. medical centers to promulgate their own tests. if we get most of those labs online we should have potentially another 10,000 patients a day testing capacity. in two weeks time we could have capacity of test upwards of 20,000 patients a day. that's a pretty healthy capacity.

that's assuming we can get the academic labs. others will be quick and be able to get on to what we call their automated system where they might be able to run hundreds of samples a day. it is the case that cdc has problems manufacturing a kit that could be used by other labs and public health labs. with the emergency use authorization and the laws put , saying as part of that cdc would go first. the first lap up and running would be cdc and they would thosep kits to advance two public health labs, state and local labs run by public health authorities and start testing for the pathogen as well. the reason we do that, one the reasons why we do that is because of access to samples. if you have a pathogen of significance like this virus or a pandemic flu strain, you want to handle that carefully.

cdc will be the first to have access to it and give samples to the lab. you want cdc in charge. that's what happened here. the challenge was the kit they manufactured, cdc is in the manufacturer. they run a high-capacity lab that they don't routinely make kits, thus the work of manufacturers. they are in the business of manufacturing kits. so when cdc went to manufacture that they didn't have a problem with will be caller reagent. one of the components of that kit, hindsight being 2020 we could have done and what we should probably think about doing in the circumstance is cdc should go first, but simultaneous to that we should also be working the manufactures to a developed approved kits and we should be working with a high complex a labs, let them make diagnostic inside

their lab. that's what fda did last week. they announce this on saturday. they a high complexity lab at the medical centers can now make their own tests subject to their own specification. dones what we could have three weeks ago, but that is hindsight. we need to learn from that going forward. the bottom line is we will have capacity but that also means there has been spread and we will start turning over that and start finding we have hundreds and the low thousands of cases in this country right now. to the contact trait and try to contain the spread where it can and mitigate it where it can. state, iwashington

state, ia think we are approaching mitigation steps to control the spread. host: the lines for the segment, 202-748-8000 for those in the eastern and central time zones and if you live in the mountains pacific sign zones, 202-748-8001 . dr. scott gottlieb joining us. harry is in woodbridge, virginia. you're on with our guest. caller: good morning. is should we be buying masks in the second question is i was online to buy a mask to protect myself because i'm the only one because as i the house. onlinewent to buy one but i saw the prices, a pack of 10 is costing over 100 to $200 on amazon or ebay. like that costing for five dollars before. should we be worried and what

should we do about these prices are what should the company's be doing about these prices. isst: hand sanitizer as well filling out online. prices have gone up. it's a board public officials tell people about what they can do to lower their individual risk. people are concerned, i think it's appropriate people are concerned. the risk of contracting coronavirus right now unless you're in one of those really specific regions where it might be spreading like certain counties in washington state or northern california, the risk is pretty low right now. that's going to increase. it's going to increase over time. i think it's important people understand to lower individual risk. putting on a mask probably won't help that much. the biggest benefit is that a propensity -- prevents you from touching your face. we have exchange with coronavirus causing the common

cold. it's from shaking hands, touching a dirty surface. handwashing really becomes important. it sounds a some thing so simple it can't possibly work. i've been fairly maniacal about using hand sanitizer, i impose that on my family as well. that can really reduce your risk. the coronavirus probably lives on surfaces like doorknobs for a couple of hours. on surfaces like cardboard it's lasting a bit longer bread touching, shaking someone's hand and then touching your face, those of the ways we are most likely to infect with this virus. it's not their droplet transmission prayed that is a risk, someone close to you talking very close, sneezes in your vicinity. it doesn't remain suspended in the air for a long amount of

time. the most likely route of transmission is probably going to be picking it up and touching your face. virginia, hampton, this is donna. donna from hampton, hello? caller: good morning. thank you for taking my call. i have a comment into question the doctor. least five family members spread across the united states that are in the medical field. saying the same thing you said. wash your hands, it's very important. is youam concerned with never hear anything in this virus that it is affecting small children, it is affecting adults is rather odd. thatone of these people believes mainstream media has made a bigger deal out of this.

if you look back at the records of the regular flu, more people die every year from the regular flu. this is another virus. basically the cold is a whole another virus. i think the panic has been caused by mainstream media. host: dr. gottlieb. guest: i don't think this is another virus, i respectfully disagree the caller. this isn't the flu. china didn't shut down their entire economy because they were having a particularly bad flu season. they did it because they were confronted with a string of the virus that could be very deadly. we don't fully understand this virus yet but we have a lot of data now and looks at the case fatality rate for the number of people who died and develop the disease and coronavirus might be around 1%. , but bys not sound high

proportion of other viruses it is extremely high. the flu by comparison is .1% or last. when a bad flu season, one person will succumb to the flu for every 1002 attracted. it may be that one person succumbs to the coronavirus per 100 who contracted. the number of new infections you get expect individuals also is very high. , it's on the 1.5 or 1.3 so for every person get the flu you will get on .5 or 1.3 who are infected prayed with coronavirus, we believe that that figure is at least two, most people agree it's at least two and it could be as high as six based on some of the analyses but it's probably higher than two. so it spreads efficiently and it can be very deadly. now the thing about this virus is there is not a typical spectrum of disease.

what i mean is with the flu, if you give 100 people the flu, they will all get pretty sick, there'll be some people with milder symptoms and some of more severe symptoms. but it will be sort of a smooth amount of illness. there'll be some mild, some severe and a bunch in the middle. with this it's a little bit more binary, there is people who develop very mild or moderate symptoms or are asymptomatic and there are some people who become really sick. about 80% of people have mild illness or maybe even virtually a symptomatic. will develop0% some form of pneumonia with this. and so you are seeing these sharp, there's not a lot of whole lot of in between. but the one white buildings are in ammonia from this, there developing it in pretty sick of get forms in ammonia in many cases. the people who are

immunocompromised or vulnerable for other reasons, maybe they are elderly or have diseases, that can be quite serious. host: the vice president will address the coronavirus and the u.s. response to it in 5:00 this afternoon. c-span3see that live on . the president is expected and reportedly expected to meet with drugmakers today. as a the coronavirus former head of the fda, what should these conversations entail? guest: i think with respect to trying to get a therapeutic vaccine, we have slowly need to be putting a robust effort behind a therapeutic vaccine. once ins knew when that a generation strain came along. maybe that's something we -- we knew when we came along to be our savior in

that setting and we will probably get the vaccine against this virus. that may be a year or two away. that could be focus on a therapeutic or something that can be used as a prophylactic to prevent people who are vulnerable getting the infection. repeatedly on it a monthly basis and you can use something like that for frontline health care workers are people are uniquely vulnerable. we have the potential to have a therapeutic by the fall. it's exceedingly unlikely we'll have it by the fall. need a short-term strategy and long-term strategy i think the long-term strategy will be the drug on the shelf or in antibody therapeutic. work withen some similar kinds of approaches. that's a thing we can have. what could happen here is march,

maybe april will be difficult months, we will see continued spread, the case numbers grow into the thousands in the united states. but then in july and august, section start to slow down. that's -- infection slows down. steps weart of the taking to mitigate spread and in part because coronavirus doesn't transfer as efficiently and summertime. typically they don't transfer at all. they have no immune system against the might spread it in the summer. but in september as the fall starts it may come back and we need to be ready for it to come back. the best way to be ready is with a therapeutic. if remember, the first edification that was in april 15th of 20 -- 2009 was the first case we identified. that spread an epidemic proportion well into june. it dissipated in the hottest month of the summer and then came back in the fall. but the difference then was we

vaccinefirst vaccine from one health care workers. by october we had licensed five vaccines in by december we had mass inoculated the population. delivering 100 million vaccines by december. and the vaccine effectively vanquished it. it still circulates and still hurts people but not to the proportion we once knew. host: two quick questions off of our social media feed. this one off of twitter saying the coronavirus has an inca bashan period of 14 days and more. could coronavirus becoming into product and food coming into the united states? guest: it has an incubation period about 14 days. you see that kind of variability in the reporting. that is typically much shorter than that. probably some the more i can do five to seven days. one of the unusual things here,

a lot of people aren't starting out very sick so the time to hospitalization some of the studies coming out of china is nine to 12 days. that means people got it, they had symptoms for weeks, they were not very sick and they became very sick and so the hospitalizations are occurring later in the course of the illness. as far as coming in from packaging, it's extremely unlikely and it wouldn't be concerned -- concerned about that. anything is possible but this shouldn't live on the services for extreme the long amounts of time. studies theome coronavirus can live on a surface for up to nine days under really optimal conditions so if you put it on an ideal surface at an ideal humidity in ideal temperature, it can live for an extended period of time. that is not typical. these things -- the other thing is even if it lives on the surface, you have a very rapid decline in the amount of virus on that surface and you

need a certain amount of virus to become infected. even if it is still on trace amounts on the surface, if they are sufficiently low it won't be some of the can actually affect -- infect you. host: you are next, go ahead. caller: i have a comment into question my comment is i would like to know why the federal government has not stopped our travel from any country to and from who had this virus and i , you'reke to know probably not found it out yet, but do we have carriers who have not developed the disease and maybe the people who have already had the disease may be can still spread this disease. i know another disease they found that they were carriers, they get a mild case in the become carriers and they don't

really -- realize about themselves and they spread to other people. have you considered this? host: we will let our guest respond. guest: we have people who were very sick from a virus and we know we have people who are very sick from the virus now and we had one fatality over the weekend. we have slowly have people who are not very sick with the virus and maybe a symptomatically spreading the virus. because we know there is a spectrum of disease but we will identify first is people who present to the health care system, those people are typically people who have worst -- worst diseases. there was a study two weeks ago that looked at the amount of virus in people's mouths and their nose and it looked at people across the spectrum of disease. mildpeople who had very diseases and some people who were very sick. what they found was the amount in some people had was

cases very equivalent whether they were very sick or they had mild disease and that is concerning because with that suggest is people who have very mild disease might have the same capacity as those who are very sick to actually spread the disease. in some other diseases what you will see is the amount of virus we have here and the amount of virus you can transfer comports with how sick you are in some cases. so people very sick would have more virus in their body and they would be able to spread more virus. youhis case it does appear have a lot of virus you'll be able to spread a lot without being very sick. as for the travel restrictions are concerned, they are going to have, they will very rapidly have diminishing utility because once this is spreading in the united states, stopping cases from being imported from other countries isn't going to really have an impact on the scope of

the outbreak in the potential epidemic here although i think we can avoid the epidemic here. there is certainly certain regions in the world that are hotspots right now were a lot of people have the virus where you probably should not travel to. and we should probably be more cautious but who is traveling from those regions because there will be much higher propensity of what comes out in parts of the world could be infected. hong kong, the travel restrictions are really going to decline in utility. pretty widespread transmission in france right now, germany, at some point all of europe will be blanketed. you have to ask yourself the question, what do you do when you have rapid transmission in california or washington state? do we been travel out of california washington state? we are not going to impose travel restrictions in this country and block people from different regions from

traveling. so the travel restrictions themselves are going to have much greater usefulness over time. initially they were useful. restricting travel from china casesevent additional from coming in and even though there were cases here there -- there were cases we were not contacting probably some additional ones that came after, we slowed the introduction of the virus into this country and that bought us some important time. host: dr. scott gottlieb former head of the food and drug administration under the trump administration resident fellow at american enterprise institute. a couple of weeks ago you wrote a piece for the wall street journal taking a look at preparing for coronavirus. one of the points you made was to develop a plan for deploying vaccines. i want you to talk about what that plan might look at especially as a viewer shows us off of twitter they say this when it comes to the possible vaccine, what about cost? is it reasonable to charge this type of vaccine and can you

factor those in as far as potential vaccine? guest: from a cost standpoint we need to be thinking about -- and i suspect people are, about how we can set aside money inside public health programs to make sure people who have challenges getting access to health care are not going to be challenged and getting access to a vaccine , developan do that now payment codes and set aside funding for vaccine. i think of a vaccine does come to fruition i believe it's a long way off. i don't believe vaccine will be what we have available to us in the fall. what he would likely do is probably vaccinate some portion of your most vulnerable people or most at risk people so your frontline health care workers initially. but that's going to depend upon how much confidence we have in the vaccine and what we know

about its potential risks and effectiveness. in the case of this winder the -- the swine flu into thousand nine we did vaccinate frontline health care workers first. we have a lot of experience manufacturing flu vaccines. that's why we were able to do that so quickly. h1n1 was not a very different challenges in developing a vaccine for the seasonal flu. we had to adapt tools against different passage -- a different pathogen. the vaccine we come up with may be a novel platform. some of the work is being done with rna-based vaccines. we've never used them before. on a wide scale to develop vaccines. probably likely to be more uncertainty and reluctance and appropriate reluctance to rollout experiment on people like frontline health care workers. if it does or not to be the case that the vaccine could 10 onlled -- there speculation why that could be the case with

the coronavirus why vaccines might behave differently in this kind of a setting against this kind of a pathogen versus other pathogens, you would not want to have all your frontline health care workers given a product that could increase risk so we are going to be more cautious. that also is going to slow the development of a vaccine here because we are dealing with a lot of novel ground. host: as far as currently available antiviral medicines, would they have some affect? guest: right now there are no currently available antiviral medications or any medications for that matter that has againstated effective the virus. products have shown activity, both in vitro and in the laboratory as well as in animals and humans. interesting most clinical trial is a drug by gilead pharmaceuticals, the

subject of two clinical trials that are ongoing now in china. one with mildly ill people, about 300 people with mild --ness and another trial host: we will continue with our conversation with dr. scott gottlieb reestablish the signal. he's going to be with us until 10:00 and if you want to ask questions it's the eastern and central time zones, (202) 748-8000 if you want to call in on that and the mountain and pacific time zones, (202) 748-8001. also tweet us at c-span wj. post on our facebook and you can also text us this morning your thoughts on the coronavirus and u.s. response. .hat number is (202) 748-8003 we will go to market in hawaii.

hello. you are on. we don't have the gas right with us but go ahead with her? comment. caller: i've got three issues the first has to do with our lieutenant governor out here dr. josh green, whose having all kinds of trouble with these test kits. sounds like he's incompetent because every days coming up with a new excuse. the second question has to do -- i why has the vaccine thousand cases of people who died from the vaccination if it's not a live virus? what is causing the death. happens. know why that i also would like to ask the -- 500,000 americans. without anybody holding them --

host:host: arthur in louisville kentucky, hello. caller:caller: my concerns and have alreadyey admitted they've known about this virus early before. what concerns me are the people -- for as a tatian, vacation, whatever, they come back and they have gotten sick and they weren't diagnosed at the time wereit and they interacting with family members and associates and everything now all of a sudden they find out they did have the virus and the spread of this virus is so do, evenat do you though you wash your hands and your diligent about cleaning and , what are your actual

,hances of not getting it -- host: just to reiterate, the potential of contracting it? hard to say. i think over time unless we can develop a vaccine or therapeutic care that can protect people and may be the case that at some point over the next coming years everyone will be at risk of contracting it. it's going to be like the common cold only more severe, coronavirus. it's hard to stop because it's very contagious. i do think that in time we will have a vaccine for this. it is a sinister virus that we will want to develop a vaccine and vaccinate the population against this virus in the same way we vaccinate people against the fluid might be a vaccine we need to get on a seasonal basis to continue to provide immunity. we might not get lasting immunity from a vaccine but be able to re-vaccinate it.

i think on this go around, the next year, the next six months, getting into next winter, i think we have the capacity to constrain this, to mitigate the spread of this virus and away that we can narrow the population that's going to ultimately contract virus and be at risk or it. they've been able to do that in singapore. very different country. they were able to take different measures. but we have a pretty good capacity in the u.s. through preventative tools and public-health tools to limit the impact of viruses like this. host: because of your time at the fda what does the situation tell us about the current dependence we have on suitable drugs manufactured outside the united states? guest: we have a high dependence on manufacturing capacity so the situation with china and the province where a lot of the infection was, with they manufacture there is not necessarily the drugs themselves

or what we call the active pharmaceutical ingredient, the actual material because in the drug, the chemical part, exactly the starting material, things like solvents and things that go into the manufacture of the pharmaceutical ingredients. china typically will ship back starting material to india. india will manufacture the rock drug ingredient and that will be shipped to other parts of the world for finishing, turning it into fills in many cases. a complex supply chain. a lot of those starting ingredients are sourced in china so china is a weak link in the entire supply chain for pharmaceuticals. so when we talk about drugs that are manufactured in china, it might be the case that only a small number of drugs are manufactured in china are manufactured exclusively in china or largely in china. we need to also worry about ingredients that go into drugs manufactured in china and we

don't have very good visibility into that because a lot of times as regulators, when i was at fda we did not know the entire supply chain. we knew where the drug came from and we might know where the active pharmaceutical ingredient came from but he would not necessarily know where all the starting material comes from. the obligation to oversee that is on the manufacturer. host: this is michele. good morning. caller:caller: thanks for taking my call. my husband is getting ready to travel to texas and you did answer this but should travel in the u.s. from state to state be avoided? my second question is, where the employees from human health services who initially met the evacuees from wuhan, where they properly protected with year when they met these people and could that be away the virus was transmitted?

guest: i don't know a lot about the situation with the employees. i saw the article in politico. but i don't have a lot of background on that. i did hear the secretary speak yesterday and say something to the effect that all the employees engaged in meeting those individuals off the plane who would been repatriated from wuhan are now outside the window of time for which if they were exposed they would now be infected. it does not appear anyone became infected from those interactions because of the amount of time that's passed and the fact we cap a close watch on those individuals. that's what i heard the secretary say. as far as travel inside the united states i don't think we are at the point where we need to on a broad base the concerned about travel, about reasonable gatherings. because i don't think this is widely spreading in the u.s. now. i think there are regions in the u.s. where we have spread. we might have quite a bit of spread but that's going to grow.

we are a little behind the curve identifying those pockets of spread and small outbreaks so they are going to grow larger before they get smaller. his no question about that until we can get on top of that they will continue to expand. it gets back to those simple things, they sound so simple, you ask yourself how could it possibly work but simple things do work. staying home when you're sick, practicing good hygiene, watching food handling of your business, watching food handlers closely. those things can have a big impact and we do them when everyone does them and they are a wide scale, they actually can have a big impact on slowing spread and lengthening the amount of time it takes for the number of people who have this virus to double. so if i was a business and i had a cafeteria might be thinking about what extra steps i can take to put in place good food handling practices to make sure you are not spreading the virus

in the workplace. what we've seen is that when this virus really explodes and takes off is when it gets inside and to touche and, in south korea it was the church, in italy, it was the nursing home. potentially nursing home in washington state. if you're running an institution with a lot of people in close quarters, you might want to think about what additional steps he could take for infection control. we have good procedures already but there is certainly more we could be doing. recently, cms put out additional guidance to nursing homes under the leadership to try to step up the level of vigilance they are taking. host: dr. gottlieb, give us your opinion on the choice of mike pence to head up the effort on this and the choices he's made so far. guest:guest: i don't have a lot of visibility into the choices

he's made because i'm not saying day today how that is working. i will say, having been there having high-level attention and leadership in the white house can be really helpful. having senior-level principles in the white house focused on your problem can help accelerate getting access to and implementing the kinds of policies need to address the public health challenge like this. that was the case after word rico -- after puerto rico. of all the manufacturing passively for pharmaceuticals off-line. having white house people who were focused on that problem in helping me get what i needed, that really improved our ability to respond to that. i don't think there's any -- there's one more senior person, but very little that you can do to get something or attention in the white house than having the vice president oversee it.

casual observation, i worked for the administration. my casual observation last couple of days, the vice president seems to be engaged and his staff seems to be engaged. this is not a figurehead appointment. the vice president seems to be engaged and seems to be consuming a lot of his time. i think this is a high priority for the nation. host: dno ambassador deborah birx? appointed as part of the team to lead this? guest: a little bit. she had a good reputation. i have not had the opportunity to work with her closely. i think that was a good appointment. host:host: there were reports you were supposedly in the running to head this thing up. is there truth to that? i'm not guest: going to comment on my conversations at the white house. as you probably expected me to say. i've been trying to provide my advice to folks in the white

house who can seeking it. where i can be helpful. host: does that include the vice president? guest:guest: i have not had a discussion with the vice president. host: let's go to north carolina. lewis and saulsberry. caller: top of the morning. i caught part of the conversation where he was talking about the vaccine. produced, myine is understanding, would it be cost to the public to receive that vaccine? another question is, a lot of other countries like china, iran , united states, people in those countries, some of them are affected but we don't hear anything that's coming out of sosia, north korea or israel could you respond on that a little? to get a handle on this thing because we've got blockades on certain countries i think we

need to blocking certain ones that are not holding back on the information. thank you guest: guest:. israel has reported cases. they does not appear to be local transmission but they have had pretty transparent reporting. iran, i don't believe the reporting is accurate but they are reporting a lot of cases. the spread seems to be far more pervasive than what is being recorded. they seem to have a widespread epidemic and have taken an unusual approach to this. they really have not implemented measures to contain the virus are medicaid the spread. in some ways they seem to be embracing it and letting it spread through the country. perhaps at a point where they don't feel they have capacity to stop the threat anymore. russia has not really reported, north korea certainly has not. a lot of variability in the reporting. we also have not seen reporting

out of malaysia, much out of malaysia, thailand, hard to believe those countries don't have cases. i think the challenge is they don't have the capacity and there have that in their health care system to identify cases. i'm worried about parts of west africa where this virus could be spreading. a lot of connections to china. hard to believe there were not imported cases into those regions. they also have limited capacity to detect the virus as well as treat people if they became ill. when you think about low in middle income countries, you start to be concerned about the impacts this virus could be. in a nation like ours where we have an excellent public health system and resources to deal a farhreats, we will have less severe experience with this in countries that lack those capabilities. host: this is lana off of twitter, should patients placed -- any additional

precautions to suggest? think the caller is asking about specific drugs. not knowing the biologic it's hard to formulate an opinion. host: she highlights it is for almost -- fall sort of colitis. inhibitor.ike a tnf is asking, and immunosuppressant that has qualities associated with it a connection is suppressed activity of the immune system. the answer is yes. people on drugs that affect the immune system could be more vulnerable to any virus including this one. i think they should be additionally vigilant about going into settings and engaging in practices that could increase their risk of transmission. the risk to any individual

american, unless you are in a specific part of the country right now are traveling into one of the hot zones outside the country is still low. people have a right to be concerned i think because there is arrest and that risk is going to increase and the other problem is we don't know the rest. we don't know where the virus is . i think that is also what is creating a lot of concern. of good news is, by the end this week and certainly by the end of the week after, i think we identify a lot of the pockets of rats. you will see the numbers go up rapidly. we may be looking at some point in mid-march to the end of march where we have 2000 cases in the country. that's not necessarily because we had 2000 cases that have been created in the next week or two, but because there are cases now that we start to identify. host: from ohio, we will hear from barbara. is, my my concern daughter waves in las vegas.

she has been sick since the beginning of january. tested.not been i guess she is getting better now. she is 27. i noticed nevada shows no cases. they have all that travel. people coming in from all over the place. -- her her husband husband is a police officer. they have both been sick since january with bad respiratory. another question is -- i'm in ohio and i noticed there's no cases reported. just passed onaw thursday, he died of pneumonia. clinic, up to cleveland brain hemorrhage. he will come three days later and that up getting pneumonia. hisad a host of doctors and

heart a fit of happened and the heart dr. -- i'm not sure if it's the same heart dr. but just past february for of influenza and cleveland clinic. he had a flu shot -- i don't know if that increases your case of getting it. he washes his hands and where's all the gowns and the mask. my thing is, i have kidney failure. i was up there visiting. i would wear a mask and i also was in a wheelchair. getting pushed because i can't now a long distance -- starting to wonder. i had two of my dogs puke this morning. can the dogs catch it? we host: will let our guest respond. guest: first of all i'm sorry to hear about your brother-in-law. a lot of respiratory illnesses circulate in the winter.

it's very unlikely that anyone right now who has pneumonia or had pneumonia have coronavirus. i'm going to say some because probably the case that some people who had bad pneumonia over the course of january and february or might be sick now could have coronavirus, small number. ut there's so much flu, mycoplasma circulating and we had a particularly bad flu season this year that by and large people who had respiratory disease or who have it right now really probably don't have coronavirus. they should get checked out for it and it's still not too late to get your flu vaccine. there's a study in china came out maybe a week or two ago that looked at a fever clinic in the u bay province -- in the hubei

province. they did checks of people who came in with fever and found a small fraction had coronavirus in a region where it was epidemic. so it is the case that there is a lot of human illness circulating at any one time and the risk of getting this particular pathogen is and will remain pretty low, but that does not mean people should not present to the doctor or call their doctor and try to get it checked out. i was recently in contact with someone who is concerned about respiratory illness and they had h1n1 which was the most likely cause of their symptoms. symptoms could have been consistent with coronavirus as well. it's important that if you are sick, call your doctor, seek medical care but also try to avoid other people and try to not spread it. host: mary is in north carolina. we are running short on time so jump in with you,.

-- with your question or comment. caller: are you concerned with the can on a virus mutating like the flu virus does? i know this year i had the flu shot and had the flu and my husband also had the flu and he was hospitalized and his lungs filled up. he was in intensive care for three days. -- yous just wondering always have to be worried. 2 -- there's a lot of reasons to worry. could the virus change in a way that makes it more dangerous? we don't see that happening with the coronavirus. we have multiple generations of strains that we look at the sequence of them. that could still happen. could the virus change in a way that makes it difficult to develop a vaccine against it and we believe there are targets against the virus, something

called the spike protein that the virus uses to infect its host, that is a target that should not undergo a lot of change if you develop a therapeutic against that target should work even if the virus drips. the flu is difficult because it rotates every season that makes it harder to develop a vaccine against. the components that undergo the change of the components we target with the vaccine that should not be the case with coronavirus it is possible. host:host: we have 30 seconds left. when do you start becoming concerned? guest: i was concerned six weeks ago. go back and look at my twitter feed i was concerned when we had a dozen cases that were initially reported as unusual respiratory illness. i think we should have been concerned. i think we should still be concerned. we are in the early innings of this but i think we know what

it's going to look like. i will be concerned if we don't have the capacity or the to docal or social will what's necessary to contain those outbreaks. the: dr. scott gottlieb is former head of the food and drug administration under the trump administration from 2017 to 2019 and a >> watch our super tuesday coverage of the presidential 14 aries and caucuses from states including alabama, arkansas, california, colorado, maine, massachusetts, minnesota,

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