♪ >> c-span's washington journal, live every day with news and policy issues that impact you. saturday morning, will discuss the u.s. response to the coronavirus and potential impact on children with a children's national hospital doctor. a shortage of the central -- essential life-saving drugs in u.s. hospitals. that's with rosemary gibson. watch c-span's washington journal, live at 7:00 eastern saturday morning. join the discussion. ♪ onset, theus now national association of county and city health officials. she serves as the government and public affairs chief. tell us about your organization and its involvement at this time. association of county and city health officials. guest: the national association

of county and city health almostls represents the 3000 local health departments across the country. those are the folks on the front lines of the coronavirus response and so many of the other public health emergencies and crises that take place in communities across the country. guest: you heard the county executive talk about what is experienced. -- what arelarge the lessons that we could use in the united states at this time? guest: you get a great example of what it looks like in the ground on his community, and even those places that do not have confirmed cases are doing a lot of the same work. from the basic answering questions, there is a time of concern in the community -- ton of concern in the community, working with schools and others who are doing large gatherings. what should they be doing and what shouldn't they be doing. health care providers, what they are looking for and how to get people in line for testing.

they are also monitoring folks who may have symptoms while they are waiting for their test to there are cases, they are tracking them at people they are in contact with, making sure they are ok and if they need to be tested so they can get a good picture of what is going on in the community. host: what does the public health structure look like at this time and how prepared are they? guest: folks are prepared. public health professionals are incredibly dedicated to this work and they do spend time not just one -- waiting for crises to occur, but making sure they have the systems in place, they practice those exercises so that when something does happen and they are able to activate, they do that pretty quickly. at the same time, health departments are not well-funded and have really been hit hard in the 2008 recession and have not necessarily recovered from where they were at that time. there are fewer people and health departments that are able to be working on a broad range

of issues they are facing, but can be shifted to this response. they have smaller budgets, so there is not really, as the executive was saying, there is not a bunch of money sitting there, waiting for these types of crises. they are working with less, so we are really trying to support them. host: you heard the executive reference the $8 billion passed by congress, expected to be signed by the president. how do you expect that to be out? -- doled guest: we appreciate that both sides of the aisle came together and wanted to put an investment in this response. a lot of different numbers were thrown out there, so we not only appreciate that they did it though quickly, but that it was so robust. this is really important to go through state and local

localities for this response. when you do the schoolhouse rock thing, the money has to get out the door and that can take some time. we are hoping that specific money targeted to state and localities can get the door quicker. there is language that says, this have to go out in 30 days, which is an amazing things for folks that are waiting for these dollars. the way that funds trickle, they get to the state level and they need to get to the local health departments. we hope that people can move with all the speed to get these dollars out to the front lines, where people really need them. guest: are those -- host: are those dollars automatically spent, or does the state have to spend them and get reimbursed by the government? not clear about that. it looks like they are going to go out. there is also a law that says anything taken place from january 20 from today could be reimbursed. those are for current and future activities, the large part of money, but if you have been spending money until this point, we can reimburse you for that. host: you are here's visit way

to talk about the public response on a state and local level to coronavirus. if you want to ask our guest questions about it, you can do so on the phone lines. (202) 748-8000 for the eastern and central time zones. (202) 748-8001 for the mountain and pacific time zone. if you are a medical professional, call us at (202) 748-8002. you can also text us at (202) 748-8003. when it comes to those medical professionals, what does the staffing look like and are more staff brought in at this time? guest: it depends on your location. one of the issues, health departments have lost about a quarter of their workforce over the past -- since the 2008 recession. that is fewer bodies in the building that you can pull from, even if you are not working on infectious disease or preparedness projects. we know they have already tried to start hiring new people to work on this in some areas, and some places are calling in medical temps, for the lack of a better term, to work on the response.

they are activating their medical reserve corps, which is a group of lay people who sometimes have clinical backgrounds, sometimes don't, but can help in a public health response. even things like making sure your phone list is up-to-date, so you can make sure you are reaching out to the right people and liaison with the educational department and stuff like that. host: what does day-to-day activity look like with coronavirus? what is going on in these localities? day the story changes, and the story on the ground changes. early in the response, a lot of it was getting lists from the state or federal government, saying these were the people who came in from abroad that might need to be monitored, tracking those people down, making sure they are monitored and have a place to stay, food so they don't go out to the general public, and they are monitoring their symptoms and sending them into a nurse or public health professional checking in on them. in some areas, that is definitely still going on.

in some areas where they have cases, they are doing contact tracing. a lot of people were linked to testing as well as types of workingnformation and with other local departments like education, transportation, housing, etc. host: you said at the conference that secretary alex agar spoke about state and local health officials at this time. i want to what he said. [video clip] the state and local public health departments are the leaders in this country on any type of response like this. we get our information from them. they are experts. we provide background support, surge in to help them, provide a lot of infrastructure -- we provide about 50% of the funding for their work. they really are a trusted local source of authority in this space. we count on them, members of the house, the senate, and the public should count on our local and state public health leaders

also. i think he's right. these are folks on the front lines. these are also trusted members of your community. you might see your local health official at the grocery store or the school play. they know not only health and public health, but they know what is unique to where you live and what it means to be part of your community. they have this important lens to the work. you also mentioned the importance of federal support for local and state health departments, and that really is critical. andl budgets are tight health departments are just a order tohat, so in really -- we have so many tools in public health, but to deploy them in communities across the country on coronavirus or any public health issue, we really need the resources and support to do that. host: do you get a sense of the communication going on between the federal government and your state localities? where is that

information being exchanged? guest: it is important that everyone is speaking with the same voice. there are numerous calls a day with different sectors of public health, obviously there is a lot going on for knitting at the federal level, the federal response, and that is mirrored at the state and local level as they are working with parts of their organizations as well. there are always times when people want more communication or when people say oh, i have so many emails, just let me do my job, so it is hard to strike the right balance, but there is a role to play for the whole spectrum of local, state, and federal public health. host: we have some calls for you. we will start with south carolina. this is for our guest adriene casalotti. you are up first. caller: good morning, can you hear me all right. host: you're on. go ahead, we can hear you. caller: ok. i'm listening to this lady talk,

and it appears to me that she does not know what she is talking about. your local people are going to help you, whatever, when they don't even have testing kits. the federal government is telling you, if you get sick or think you are sick, call your doctor. what is your doctor going to do? he is going to refer you to somebody else and tell you to stay home. this is ridiculous. from what i understand, china is the only one that got any kind of antidote, and they are not giving it up. host: we will leave it there. the idea of testing kits. let's start on that track. guest: there has been a lot of tension around testing right now because you do not know what you do not know, and that is key for testing. the federal government has sent out testing kits, not to my knowledge -- this could have changed since yesterday -- not every state, six states are

still in progress, but every other state is able to test. there are some public health labs that can also test, and right now is really about volume. getting the kids out there, all she places getting the labs up and running, and private labs are developing their own tests, which are online soon. testing is critical. e we test, the more cases we will find, and we will get a better picture of where the outbreaks are. you have a locality and you do not have a doctor, you are sick and suspicious, where do you go? guest: i would think a phone call. how do you keep your social distancing, a term we use in public health, it has been used for many, many decades around hundreds of years around things like tuberculosis, keep yourself away from folks who are sick, you have less of the chance of getting sick. if you are sick, try not to make

other people sick. all your local health department and tell them your symptoms. they will tell you how you can get tested. , i have al and say bad stomach ache, they will say, that is not a symptom of the coronavirus. here is a place you can go. it is a great way to screen for what you need to do, depending on what your symptoms are. host: if finances are a problem for those in those localities, does the state or local level have something to offer? guest: local health department level, folks are doing the work, whether or not they have the money in the bank at this point because in public health, that is what you do. you respond. for testing, state and local public health lab testing is covered, that is free. different states have been putting in different orders to their insurance companies as well as just yesterday, the insurance company lobby said that their members are going to make testing free as well if you have private insurance.

those are all in progress, but i think there is a recognition, we need to make sure we do not put up any barriers to people getting tested if they may have coronavirus. host: let's hear from charles in illinois. caller: hello. my question is, i get a flu shot every year as recommended. i'm over 65. finally coronavirus is in a vaccine, will i be required to take two shots every year? a comment for c-span, there is an official name for coronavirus and i keep hearing it verbally, and it is published by the world health organization. would c-span please put that on the screen so we know how it is spelled? thank you. host: i will let you take that part. guest: so the first 1 -- i will take a second part first. i think it is covid-19 is what

he might be referring to. there are lots of different ways. the reason we have special names for them is that coronaviruses are a type of virus. this is a novel one, but there are others. going back to vaccines and shots -- so the flu and coronavirus, they are different. so important. they are critical -- not only can it prevent you from getting the flu, but it makes your symptoms a lot more mild. that is one of the problems we are having, with coronavirus hitting during flu season, we have similar symptoms. which do i have, if any, and just because they have similar symptoms does not mean they have similar vaccines. i do not know what the vaccine protocol is going to look like. if dr. fauci from nih, who is leading network, has said it could take a year to 18 months

before it is publicly available, they will hopefully learn as we are not only looking at the vaccine, but at the virus, that we are not only required, but recommended to get that vaccine to make it feel safe. host: from dallas, texas, chris. hello. caller: yes, the question i have are the local health departments , perhaps, ald do better job of communicating the ofal resources in the event a big covid-19 breakout? what left an indelible mark on me was the fact that in china, they build a hospital in 10 days because of all the patients. i say local resources, i'm talking about, how many beds are available in metropolitan areas? how many ventilators do they have? how many airborne isolation rooms do they have?

and what provisions can be set up quickly in order to accommodate patients in need? host: thanks, caller. guest: he makes some really great points. departments are always trying to communicate around these issues, and i think it is really important that they do so and do so in a way that gets into communities, so it is not just, you send out one notice. they are spending a lot of time and resources not only trying to do the public communication, but also translating it into different languages, making sure it was getting into different sectors. when it comes to public health communication, there is always

more we can be doing. that is an important point. you are at home, just stay home. resourceserve those for folks who really need that and n >> a great deal. c alming the people in the localities? guest: a lot. allulances and that stuff, and be like, what is

going to happen? i -- keepa mom, this is how we the kids safe, she is coming home singing happy birthday when and ishes her hands now, think she used to do it about four times, but being able to use those messages that are coming in through school. it is so important to help people understand what are your risks, how do you protect yourself, and in the grand scheme of things, a lot of what you can do are the same public health messages we are trying to get out there. people are more heightened in their attention right now, and we are not even seeing this in places where there are outbreaks. there are different messages being sent out there/. following what your local health officials are recommending is super important. host: our caller in huntington beach, good morning. caller: i have a question, because i have a grandmother and alsocopd stage four cancer. i had to take her to get a cat

scan yesterday. i went into the building and got her a mask, because i even took her in, but just to get chemotherapy. i'm concerned that she could get it, because she potentially is at high risk. i understand sometimes panic is than what is actually going to happen, but i do believe this will get way worse before it ever gets any better, so i'm just trying to help her as much as i can. when i leave the house, even i wear a mask because i believe it will get worse. is that the right way to take it, or what is the best way to help her get treated and not get the illness? guest: first of all, i think she is lucky to have you.

it is important that we take care of our family and our neighbors, and clearly this is really scary, especially when you are caring for someone that has so many underlying conditions that put them at risk. a couple of things in response to what you said. first of all, talking to her health care providers. i am not a physician, and so understanding what her risks are in the general public, when you are in chemo, that changes your immune system and what you are able to fight off at large, coronavirus or not, so really talking to them about what is helpful and necessary there. i will say, the cdc does not recommend masks for people who are healthy. nott of all, they are necessarily effective and they have a lot of information about that for people who are healthy saying an anything, arms length away from somebody,

no more hand shaking -- i do not know if you have seen this in basketball games, they are doing elbows -- granted, when they are doing elbows and hugs it is probably not helpful, but they are trying to make some changes. for your risks, they are not recommending masks for any person in the general populace who is not sick. marylandee cases in this morning, the governor declaring a state of emergency. do something happen on the public health level in the state of emergency is declared? guest: we hear about it from time to time, like a hurricane is coming in four days but we will call emergency services now. what it does for different services in states and localities, even when the federal government decides to call a state of emergency, that means, certain resources can be mobilized. other processes are stood up and put in place, so a lot of times it can kind of heightened panic because you are in a state of emergency, but what that is doing is allowing you to be more nimble in your response host:. host:this is -- response.

host: this is from north carolina, goldsboro. thank you for holding on. caller: i'm 80 years old. i lived through diphtheria. when i was 14 i had diphtheria, and there was an outbreak of diphtheria. i have not had a single person talk about fumigation. i have seen them fumigate homes where someone has this. understand that when this came around, you had to fumigate. host: thanks, mary. guest: thank you for your question, mary, and your comment. i have not heard anything in particular about fumigation. as we learn more about the disease, what people are saying is keep your distance, and that is the best way to keep yourself safe.

thatere is any guidance comes out of the cdc on that, they will certainly share it. host: this is from los angeles, california. david, hi there. caller: good morning. this is really a fascinating information and education opportunity as it relates to how we deal to pandemics -- with pandemics are national medical emergencies -- or national medical emergencies. if this does not support medicare for all or a national health care i do not know what does. as we have this patchwork solution to something isentially quite tragic, it only evidence that we need to start doing something on a national medicare for all basis. that is my comment. i think whatever your solutions are, our health-care

care system is messy. as we move from a public health response to more of a health care oriented response with more people having cases and having to deal with the private systems in that way, i think that messiness will manifest itself in this respect to. i do think it is important as we think about the health care to remember that public health can really help keep people out of that system. whatever changes we want to make on the health care side, when you look at health-care spending in the united states of every dollar, only three cents goes to public health. and peoplelth care when they are sick, but only 3% goes to keeping people from being sick in the first place. the balanceue that does not quite give us the opportunities to really protect people and communities the way that we could. president just signed that legislation, the $8.3

billion. made some comments about coronavirus. we will watch a little bit of it and get response. [video clip] $8.3 billion. i asked for 2.5 and they gave me a $.3 billion. i will take it. -- $8.3 billion. i will take it. ok? here we are, $8.3 billion. it is an unforeseen problem, what a problem. it came out of nowhere. but we are taking care of it. a lot of things are happening on this ship, people are being tested right now, and i just spoke to the governor of california, gavin newsom. we had a good conversation. we are working on the ship together. close to 5000 people on the ship.

we are doing testing on those people. away asything to take far as the federal government's response to this? guest: one thing that to take away is important, it coronavirus will spread across ie country, across the world, think we are approaching 100,000 cases globally. at the same time, in public health we know that these are possibilities. people have been preparing for whether it is pandemic flu or coronavirus or whatever that broad epidemic, pandemic might be for many years. yes, it is unforeseen what it is here. that is why we need the extra dollars for activation. at the same time, the planning has always been there, we just do not really talk about it that much. he also highlighted the difficulties in a response like this, whether it is the cruise ship or people coming in through air travel, we live in a global

and health issues and public health issues. infectious diseases do not care what your passport says. they are just going to spread. the more we can think of protects, how do we ourselves in a global context, is important for keeping people safe locally. host: from connecticut, hartford. diana, hello. caller: hello. i want to thank you for this. i do have a comment and a question also. connecticut and the gentleman that called in before that was really very upset, i just want to make a suggestion. perhaps if people listened to their local stations and get information about their state, it would tend to have the confusion lessened rather than

watching cable news. i do live in connecticut. our governor has come out, i am not a big fan of the governor but i commend him for bringing on an expert. about you are talking local areas -- i want to highlight a station that i listen to. connecticut foxnews, and they come on -- i started watching them when we had blizzards, because their idea, if we have facts not fear, and they had done this with the coronavirus, they would have experts come on. every day, they would have a section called facts, not fear. basic facts. views or whatever. today on the news, i noticed that they had an outline of the facts. no cases so far in connecticut. 18 people have been tested, 15 have been negative. we do have colleges that have brought back students, that told their kids to stay home until after march, so i like watching that. what ishey tell us

going on around the rest of new england, how many cases are in the rest of new england, where they came from. host: did you have something specific for our guests to address? the obama eran it was sixine flu, months before the president ever came on and talked about it, and 1000 deaths -- i do not even a member any discussion about the swine flu. withher comment had to do medicare for all, because i watched on this station a gentleman come on, and i think people with medicare for all have to realize that there will not be doctors available and hospitals will not have the resources -- ok, we will leave it there, only because that is diving into another part of the conversation. is there anything you want to take away? guest: you were talking about our local media statns when think the -- one thing we talk about, oh, your

budgets are tight, but everyone's budgets are tight. we think about the individuals doing the day-to-day work, but one thing that is so important our public information officers. the communications people of health departments and why are they important. it does not matter if you are doing this good work over here, if the public does not know or understand what it means for them and public health issues can become located -- be complicated, so to think about the resources and public health apartments to get you the information you need, it is a plug for public information officers. host: at these times, states and localities have certain budgets for these things, but where do they pull money from within the state if they need it? general funds is where they pull it from. coupleton state passed a

hundred million dollars to push out into response. other times they are trying to figure out, are there dollars that we can reprogram to work on this? sets arewhere skill really overlapping is disease investigation specialists, who ti's with things like s or tuberculosis or things they have for contact tracing. can we take you off of this to do this now instead? saidhe county executive the whole point is, we need to make sure that we do not have these pots of money that sit there waiting. we need to well resource our systems so they are not starting from a deficit when crisis strikes. our caller from ohio, a medical professional. pat, good morning. caller: good morning. my question to your expert this morning is, do we know at this point whether or not the person

that has the virus or the flu, so to speak, does have natural immunity after they have been through the process of the flu? guest: thank you for your question. the flu and coronavirus being separate strains, i do not know if i have seen anything about that in particular yet. i think we are learning a lot ,bout the coronavirus, covid-19 every single day. as we learn more, we have more information we can base our decisions on. i have not seen anything on that. the: you talk about spreading of information. how does social media help or hinder in these patterns? both. social media is great. you are able to get information out quickly without a lot of filters to whoever has signed up and if you are an individual in

connecticut or huntington beach or wherever, you can sign up for the twitter or facebook of your local health department. that is one way to get information very, very quickly. at the same time, we have seen public health misinformation spread very quickly on social media. things that cause people fear and panic spread very quickly on social media. it is so important to figure out what the sources are of your material. if you find a source and have never heard of that source before, look up the cdc website, for example, or the health department website. can you find it in five different reputable sources that you know of? the messages are going out quickly and going out far. ofng a good steward information is important, especially when this information is incentivized for what will make you can -- you panic. [video clip] >> i want to make it clear in terms of tests, we have provided

those to the state of washington and california that they asked for. the shipping of tests that we have talked about all week is completely on schedule. availablests that are are for up to 75,000 people. cdc has shifted to america's public health lab. to get toe contractor the private sector and hospitals has already shift enough tests -- shift enough tests -- shipped in of tests, and they are arriving at cdc for quality control it should get out this weekend. next week, we will keep ramping up production. willny as 4 million tests be driving forward. everything is on schedule for the testing. , [inaudible]ent >> [inaudible] >> we may go.

we thought there was a problem at cdc with somebody who had the virus. it turned up negative, so we are seeing if we can do it. afternoon, we were informed that there might have been a person with the virus. they now found out it was a negative test. they tested the person fully and it was a negative test. i may be going. we will see if they can turn it around. we may be going. host: that was the president from earlier today. ms. casalotti? guest: what we hear from the secretary and others, testing is critical. when we started getting testing online and public health labs, that is when you started to see these case numbers going up. it is not that the case numbers were not there before, we just know about them now. if you cannot measure it, you do not really know what the scope of the problem is. it is also important to recognize that a lot of these -- sending out a kit is one thing.

then the lab has to be able to validate the kids, get it up -- up and running. it is important to have those in states and communities because those cut down the time of how long until you get your results. public critical in health, we want our numbers and we want them now, but it is so important to an individual. you are asking someone to take off work for 14 days and they don't have paid sick leave or they might lose their job or do not have child care, whatever that is, you are putting them in a really tough position where you are asking them to prioritize our public health as opposed to their financial well-being. the more testing we can do and the shorter we can make those wait times, the better we are able to target that difficulty to people who need to be home to taken care of, as opposed other folks who are getting lost in the shuffle. host: let's hear from gabriel in north carolina. hi, pedro.

i want to preface this -- i am d/jd student at duke, so i have been around academic medicine for a long time, and i am a policy guy, so i am really into it. one thing i'd concerned about, seeing on the horizon, when an emergency takes place, whether there are restraints on the private sector walking away with the resources in a substantial way. what will traditionally end up happening, they will all fall underneath the guys of -- guise of, we need the testing, we need to have people approach their doctors outside of the emergency room setting, but it will get breezed over as opposed to what the cost is. what protects the united states government from further intrusion into that

revolving door of making the public-private just a blank check. ,uestion two is whether people in terms of the public health there is a major, major lack of public health. i could not agree with you more. there is not a lot of sound data to give to folks about where the [inaudible] , because the coronavirus it is in anin the tree area that is a little more alarming about where it sits. host: got you, gabriel. we will leave it there. thank you. guest: thank you for the shot out of the importance of public health. i am super passionate about it, our members are passionate about it, and all people should be passionate about it. been a lot of talk in congress around the cost of vaccines, the cost of treatment, the cost of diagnostics in relation to an emergency like this.

what you will see in the $8.3 billion package, there is a thatomise in there reiterates that the cost needs to be reasonable for the federal government in ensuring there is funding to help pay for these things for individuals. it is definitely a debate that continues to rage of you -- rage up here. is withriene casalotti the national association of county and city health. she is there government and public affairs chief. >> c-span's washington journal, live every day with news and policy issues that impact you. morning, we discussed the u.s. response to the coronavirus and potential impact on children with a children's national hospital doctor. a shortage of essential life-saving drugs in u.s. hospitals and its impact on

dealing with the coronavirus outbreak. watch c-span's washington journal, live at 7:00 eastern saturday morning. join the discussion. ♪ >> former vice president joe biden holds a community event saturday in st. louis ahead of missouri's democratic presidential primary. watch that live at noon eastern on c-span, online at c-span.org, or listen live on the free c-span radio app. on sunday, bernie sanders held a rally in grand rapids ahead of the state's democratic presidential primary. watch live at 12:30 p.m. eastern on c-span, online at c-span.org, or listen for free on the free c-span radio app. next, a book tv exclusive. our cities tour