coronavirus pandemic. our guests are -- dr. roy of new york university. some of the more severe, nonpulmonary effects that u.s. virus is having on patients. and a doctor of massachusetts talks about tal work on self-assembling vaccines eing developed to combat the virus. join the conversation tonight at 8:00 p.m. eastern on c-span. wi initiative and served as senior director for global health security and biodefense national security council during the final year of the obama white house. let me begin with the path forward with covid-19. what's next for our country, for our citizens, and for our economy? >> thanks for having me on this morning. it's the best question exarktly hat should happen now.

and i've been thinking about this opening and closing as less of an open/closed society and more like we're a rubber band and we need to start stretching to put people back in contact but we have to do it carefully and with a planned strategy or we're going to end up where it's going to snap back on all of us and we're going to be back where we are now social distancing from one another in a more extreme way. i think what needs to happen over the next several weeks and months is that states should be opening slowly and considerably with very consistent metrics. i think that we have to have the kind of testing that everyone's thinking about and the ability to train and isolate those positive in all states before we begin opening up and certainly before we begin having any very large crowded events. so the thing that's really keeping me up right now is sort

of the lack of a unified strategy the way that's happening in a slightly more piecemeal way across the country. so i think first is that we need to have that unified plan for reopening with a little bit more specificity than with a we've seen coming out of the white house plan. and there are many states that are starting to put pen to paper on this in really positive ways. i'm sitting on an advisory task for with the mayor of seattle for example so i've got insight into what the government and governor's office in washington state has been doing and there they've been looking at very specific metrics for what kinds of testing should be in place, what kinds of contact tracing should be in place before putting more people in touch with one another. but i do -- in contact with one another. but i do think it's important to really tell americans and to be really clear about it that the summer is going to be very different than other summers if we want to avoid a spike or a second wave of this virus. and if we want to avoid ending up where we are now.

and i think that means really being honest with people that crowding at beaches, some of the larger events that we would like to be doing this summer, going to concerts, going to games, those things are going to be very different and may not be able to happen at all in order for us to come through this year and get into a position where we have a safe and effective vaccine ideally next year and can really restart those kinds of activities. so i guess i say that's the short term. over the long term it's clear that we need to treat pandemic preparedness the way that we treat our national defense and that means a much more significant investment. i heard bill gates on anderson cooper saying that are for 5% of the department's defense budget we could be in the $30 billion range i think by my last calculation, we would be in a much more significantly prepared position in the united states. and by the way it's not just us.

we really need to invest in working with partners around the world to get prepared. we know that there are huge preparedness gaps everywhere. so i do think that we need to put this issue of pandemic preparedness much more at the top of the leader's agenda. host: i'm sure you've seen the demonstrations in state capitals around the country these are just some of the photographs as the demonstrations took place in lansing, michigan. i mention this because people do have pent-up frustration and anger saying they want to get back to work, back to their lives. my question and we've heard this from the administration, how do you make certain that the cure is not worse than the disease? guest: it's an excellent question. i think first and foremost this is -- we're all feeling frustrated. it's normal to feel frustrated. i think some of the demonstrations have shutdown that. some i think have been a little more than that and have really used some hateful speech and have been an opportunity again uncovering some of the divides in our country and some of the

challenges that people have when they are feeling frustrated and looking to take that frustration out on segments of our society and unveil prejudices that exist. so i think we do need to address those underlying tensions in our country. but i do think that for all americans that are feeling frustrateded and the vast majority of which are absolutely paying attention to and adhering to social distancing, the fear should not be worse than the disease. instead what we should be doing is recognizing that public health and our economy right now are inextricably linked. so everything that we do for our public health ultimately is better for the economy. i think what's missing is how to make that real for individual people and individual families. i think some interesting research that i had the opportunity to look at last week european scientists are

starting to look at different types of jobs and industry sectors and think about what's the long-term plan for subsidies for making sure that businesses that cannot function without putting people back out into positions where they would be contacting a lot of people, that those are really the segments of the society targeted tw long-term financial subsidies and more funding, whereas others i think should really be subsidizing people to stay home. so there's a lot in our country in terms of our social safety net that i think is being uncovered here. and i know that's not a perfect answer but right now i guess what i would say is my number one answer to your question is that if we all go back into society the way that we were in march and february and interact in the same ways that we were then, we know from looking at the case counts that we will see a spike in the disease. and without the ability to test and isolate people, we're going to be right back where we are

now. and to quote, from an interview the other day, the only thing worse than a first wave is a second wave. so we really need to get ahead of it and hold on for a little bit longer to get those tests and contact out there. >> you literally wrote the playbook on the pandemic back in 2016. what did you write three or four years ago and how has that played out today? guest: the pandemic playbook first it was a huge team effort that was at the request of the national and homeland security advisers, and i had the honor of overseeing that effort. but it was a huge u.s. government effort. and the reason i mention that is because it's important for people to know that playbook was in no way a political piece of paper. it was the sum total of u.s. government expert knowledge, the vast majority of which and the people that put inputs were civil servants like myself who

were trying to pass on the best information that they had about how to deal with the pandemic. so what the playbook actually is is an informational decisionmaking ruberic. what i mean by that -- that's kind of wonky. what i mean by that is that we wanted to leave behind for the white house a decisionmaking tool that sort of said look if the situation looks like this, it's green. and if it looks like this it's yellow. and if it looks like this it's red. you really need to be thinking about putting additional measures in place. and so the playbook walks through many different scenarios in the lifespan of a disease threat. for example, looking at the covid-19, the coronavirus outbreak, what it would have done is would have identified human clusters of a disease that had the potential to be a pandemic. and then it would have -- so that would have started flashing maybe yellow. and then red certainly would have been when there were large

clusters in china with the potential to be sustainably transmitted between people and so on. and then it asks specific questions that the white house is supposed to be asking of its government experts across all departments and agencies. for example, what is the availability of diagnostic testing for this disease? when should we be thinking about deploying if it was a disease that had a large presence in a politically unstable place or a disaster area? when do we deploy a disaster assistance response team like we did during the ebola epidemic? when should we start looking at our strategic national stockpile? so spent a lot of time looking at the playbook and questions over the last several weeks and i think it does hold up. but it's important to know that it was supposed to be used to guide the questions that would be asked. the answers still have to come from the experts in the context of the disease threat that they're currently facing, and

it was meant to make sure that the white house was asking really hard questions as early as possible, because we learned in ebola that you need to anticipate and think about the thing that is will become your points of failure. and i think in this outbreak obviously the lack of our ability to field quickly a diagnostic test did become a single point of failure but we had a backup plan we might have been in better shape. >> beth cameron, earning her doctorate from johns hopkins university. how has all of this changed our nation? >> i think our nation really is going to be forever changed in many ways. and i hope that we're changed in how we prioritize this particular set of threats. threats caused by epidemics and pandemics. but i do think that the social fabric of our country will also change. tony fauci has been quoted saying the hand handshake might be a thing of the past and

instead we might be using the less intrusive nams stay that they use in india. i think those are small ways our society might change that might have good benefits for influenza season when we all don't like to get the flu and still costs thousands of lives here and around the world over year. but i also think it may have some significant changes in how we view international travel, ow we look at big mass gatherings. and also i hope how we treat one another. because one of the only silver linings in this terrible pandemic that we're undergoing is i think the incredible solidarity that we've had amongst people in communities. i hope that also translates to solidarity in how we work with our partners around the world, because this disease is going to be here for a really long period of time even after we have the vaccine it has to be equitabley distributed and

people have to be vaccinated all over the planet. and i think that's going to be something we need to spend a lot of time preparing for and really working with our partners in africa, asia, latin america, all over the world to do that now. host: a look at the numbers courtesy of johns hopkins university. 3.4 million confirmed cases, 3.2 million around the world have recovered. the death toll in 187 countries just over 244,000 with the u.s. leading the list of cases and the death toll. guest: how's it going? i love scientists. it's amazing, thee guys in there with guns and all this other stuff. you can't shoot a virus. one fire craker would have gone off and probably everybody would have gone shot. the reason they're out there is because of economics. you can send everybody in america, what 360 million people a million dollars and you would save $1 trillion and they could stay at home.

and then please every time you hear disinformation like the virus came out of here or there, whatever, you won't have chinese running from these other guys trying to blame them for doing this. somebody flew to europe landing i guess in kennedy and then there we go. ok. so scientists please stand up. when you hear stuff like chinese did this or that, say something. thank you. host: thank you. beth do you want to respond? guest: absolutely. i think one of the great things that you just highlighted is how interconnected our world is. and you're right, we do know that the cases on the east coast and in new york city came from europe and that the cases on the west coast by and large came from wuhan from china. i think what that shows us is when you have a deeze like this one that breaks out and becomes

capable of infecting people and sustainably transmitting between them you really don't have a lot of time to respond. and you do need to share information extremely quickly and you do need to anticipate that our interconnected flights are going to be moving everywhere. so the second you learn about a disease threat like this one you pretty much need to assume that it's going to be in your country and that you're going to have cases. and so that's definitely a lesson that many of us have been thinking about for a while, but certainly it's been demonstrated here. i think you're also getting tat question of blame, whether or not it's right or appropriate to place plame on particular countries. and what i would say to that is we all need to learn some lessons from this including the united states. and i think one of the lessons that's been levied at china is the need to share information as quickly as possible about the disease, and certainly there have been reports that

that wasn't done in that case. but, look, disease threats start anywhere and we know, for example, that the 1918 influenza -- or not actually sure exactly where it started we know it likely was not spain even though it's been called the spanish influenza. but the first case really identified there was here in the united states. obviously the h1n1 influenza pandemic started in mexico. so we need to be prepared that every country could be -- a virus is going to pop out anywhere and it doesn't respect borders, it doesn't carry a passport. so that means we need to come together with our partners including china, including is the who, including all of our partners to find better ways to prevent, detect, and respond to these threats as early as possible. so thanks for your question. host: during the transition between the obama and the trump white house, were you part of any table top discussions or war games -- when i say war

games really just mapping out different sken airs i don't see, in which this was discussed? >> i was part of the transition exercise that took place at tepid of the obama administration. and i was one of the people who worked with our homeland security adviser lisa monaco who really headed up that effort and our national security adviser susan ry. that was mandated by legislation so the bush administration did this between bush and obama, the obama administration did this between obama and trump. and what this is is an opportunity for the white house and for the cabinet officials from the administration that's leaving to pass on their concerns about some of the top threats that they either face to the homeland of the united states or top threats that they're worried that the next administration will certainly face and where they think there needs to be a lot of emphasis. so within that exercise that happened which brought together the cabinets from the obama administration and then the

presumptive nominees from the trump administration, there were several that actually a relatively small number -- i shouldn't say several, there are three specific areas that were emphasized and one of them was pandemics. in that scenario we actuary looked at a pandemic influence flunesa and had our experts really brief that group including the outgoing c.d.c. director, including the outgoing assistant secretary for preparedness and response. and they talked about the areas where they really felt that we needed to be prepared for a coming pandemic. one of the things that made that really poignant at that moment in time is that the h 7 n 9 influenza virus which occurred first in humans in 2013, there was a large number of cases in humans that year in 2017 as the administrations were transitioning. and so there was a concern a real live virus that people

were track wrg it had a high degree of mortality but has not and still has not yet gained the ability to transmit efficiently between people. so there was a concern and we wanted to pass that on. i've stayed into the new plrks and worked for the homeland security adviser that took over the helm from lisa. ost: back to your phone calls. san diego, good morning. caller: question and comment. question would be could you please ask her to explain to the audience who are listening the difference between mortality and the more bidty rate which i think -- moibmoishtty rate which i think the public doesn't understand. i'm an independent. however, it is very unfortunate that the protesters showing up that are being displayed up on

the cnn, ms nbc showing up to these rallies with weapons totally, totally disgusted at that. whether you're a trump supporter or not. that it really sends out a message of violence instead of having to figure this thing out of the virulence of this pandemic that's going on. what i've been hearing a lot from the bureaucrats is that we are looking into this and looking into that. what i'm afraid of and what i've been tracking is that the country itself is being taken over by the tech knocksy any more it's no longer a democracy. and as far as ms. cameron that just explained that we'll no longer be shaking hands and we're going to be going by the way of india and other countries, i think is absolutely appalling that someone should suggest that

coming up on 68 years old and i've fought in two wars and i'll be damned if i'll be changing my life of a virus that's going to have to be changing. people live and people die. and that's just the fact of life. and people will have to learn to accept that. unfortunately, america itself, the country that i fought for and grew up in was asleep at the -- host: we'll leave it there and get a response. guest: well, thanks first and foremost thanks for your service. i really appreciate that what you've done for our country. and i think you're certainly expressing frustration with this public health emergency that many people have. first i want to say to your question about morbidty and mortality your first question that yes mortality is the number of people or the case rate of people that die from the disease relative to those who are infected. a the infection rate is not

case rate so there are more infected than who will die. what more bidty means is the people who are affected not necessarily the number including the people who die but also the people who recover. so there are going to be way more people as steve mentioned with the statistics earlier about the numb of cases versus the number of deaths. i do think that the number of deaths from this disease is quite high and it would have been much, much higher in this country if we had not instituted the social distancing measures. and that's one of the big challenges in public health is that you have to really react and overreact, really, in order to be able to prevent the worst-scace scenario from happening. and then when it doesn't it looks like you did too much and i think that's what we just have to be prepared for with public health. i do think that we need to be looking at public health in an

interconnected way working with partners around the world, including india, including china, and including europe and including canada, all partners. these disease threats are not political and thai don't respect our socio economic and geopolitical boundries, and we know that a disease threat anywhere in the world is a threat here. and so i do think that we need to be working closely together with those partners. the last thing that i would say is that i think you're right that it is unfortunate certainly people have the right to protest in this country and that's one of the things that makes this country great. but i definitely am very concerned about the public health risks for the people who have to actually make sure that those protests are safe and making sure that they the police officials and first responders who have to be there are well protected from

potential transmission of this viret. and i really want to see people take more care to not bring weapons and turn these types of protests into political rallies or statements about that could turn into violence. i'm quite worried about that, and that really underscores the need for a unified federal response that explains clearly and crisply to everyone in america what the gates are for reopening the number of test that is we need to be able to get back to more people in contact with each other. and then finally just really clear communication that we are going to be essential services are already reopening, people are going to be teleworking, they need to continue to telework. and mass gatsdzergs really aren't going to be happening and shouldn't be happening, safely, for a long period of time, frankly potentially through the summer. i think if we were more clear about that and explained what people will and won't be able to do, it might be helpful with some of that frustration.

host: we mentioned these numbers in the first hour but covid-19 numbers from the labor department and the c.d.c. the number one killer in april with just over 58,000 deaths, followed by heart disease, cancer, respiratory disease, accidents, strokes and anyou'risms and alzheimer's'. the numbers from the c.d.c. official count published this morning in the "washington post." good morning from virginia. caller: good morning. hope you will help me with my dilemma. the amount of deaths in africa with the exception of south africa is very low compared to the rest of the world. the other day c-span guest stated that the reason behind that is because of the lack of testing. however, the death rates are very, very low in africa.

so my question is what exactly is going on? thank you. host: thank you, sir. guest: that is an excellent question. it's actually one i wish i had a perfect answer for you. i don't. i'm actually speaking next week with the head of africa c.d.c., an excellent colleague who is working on the continent on fighting covid-19 across all countries, and with the african union he's lo. in order to ask him some of these questions myself. so what i've learned so far is very similar to what you said, which is there's a couple of problems that are occurring. one -- and john just wrote a piece that i commend to you. i i think it was in nature but i can double check. that looked at the access of the african continent to tests. and it's really a huge challenge that they are not able to access test kits in a

way consistent with being able to test enough people. so there is definitely underreporting of covid-19. so that's first. second, it is possible that some of the underreporting for death rate is simply a function of lack of reporting capability in general and just not being able to know what people are dying of and there being so many confounding other factors and disease threats in many countries on the continent. and so the answer is it is one of the big con understood rums that the global health and global community are facing and i think the most important thing from a global health security professional perspective is that we get ahead of this as much as we can in africa that we shouldn't count on there not being as many cases in the future on that continue nenlt and that we shouldn't count on the fact that there aren't already a large number of undiagnosed cases now. so i would really like to see the united states partnering closely with our partners in

africa and the african union to get more diagnostic test kits not only here but there so that we have a better sense of what's going on. and then of course in order to save lives all around the world. so very important question. one that i wish there was a more clear answer to and one that i believe should be a huge focus for our own government to solve. host: paul lein, thank you for waiting. caller: first time i'm calling. good morning. i have a question about the malaria drug that donald trump pushed quite heavily to use. was there any success with that at all? i didn't really hear any. and another thing, was that made by a french company? and if so i also heard that donald trump had a financial interest in the company. host: thanks for the question. beth are you aware of any of these points? guest: the one thing that i would say is that there have been studies of hired clorne

and my understanding and please take this for what it's worth i have not heavily researched the clinical trials that have been ongoing with hired quinn the drug you're speaking about is that it has not shutdown substantial benefit. i'm not aware of the different companies that produce it nor of any interest financially that the president might have in those companies. and i would just say that it's really important to look at the science and also to understand that medication is used for a wide array of other things including malaria, including lupus. and so there were a lot of concerns about the run on that drug. but i am not aware of a financial interest this that company. host: what about remdesivir and what do you know about it? how significant is that as a treatment for covid-19? guest: the rem disvir studies do look promising. and you've seen probably the news and many of your callers

have probably seen the news that it has been effective enough that they have now given it to the people who are otherwise on the plass blow in those clinical trials. so that does look promising. there's still work to do before the -- we know how effective it is in all different types of patients. but i am encouraged by that. and i do think that therapeutics hopefully will become one way that we're able to help the most at-risk patients for covid-19 to be able to see a significant morbidty. their i have been reading through some of the o information last week there was a lack of clarity if i'm reading correctly that rem disvir is not -- they're not completely sure that it does cut down the whole number of deaths, but it does help people who have been infected with recovery and makes it rate more quick.

but in terms of whether it will ultimately cut down the number of ultimate deaths i think there's still some information that they need to gather on that. host: beth cameron, vice president for programs at the nuclear threat initiative, also served as part of the national security council during the final year of the obama white house and trump transition joining us via zoom. chris, maryland. good morning. caller: good morning. just very quickly. he hughes of hydroxychloroquine -- the use might be why the low numbers. but my two points are that china silenced the doctors and failed to inform the world thing. ter the devoss my second point is this. and in march 25, pick a number

out of the air, there were only 675 deaths now there's 67,000. march 25 mitt published an article that based on autopsies that showed people are dying because their capillaries are clogging up. you can see that in the covid toes looks almost like frostbite. so we've known since march 25 that the reason people are dying they're getting organ failure because wherever it's expressed you're getting coagulation. so it seems like -- i know in previous research tissue activated has been used to block clots, it's used in strokes and heart attacks but for some reason the protocols say you can only use it after you find a blood clot in the brain or an embolism stuff like that. it seems we could have saved many, many deaths if we had

changed the protocols. i know mt. sinai used hospital used tpa but found they had to use heparin to continue the blood thinning effects. host: i'll leave it there. but would that have made a difference? guest: it's a great question and here i'll self-disclose i'm not a medical doctor so i'm not comfortable providing information. i think we're learning a lot about this virus day by day. i think that the information that's been coming out about blood clotting is extremely interesting. i'm following it but i'm actually not sure. the only thing that i did want to respond to that i do have information about with respect to the caller's question is that we did have the sequence of the virus released by the chinese scientists in january. now, look, definitely there should have been information coming out as soon as these clusters occurred with the potentially pandemic novel coronavirus but i'm fairly certain that the sequence was

released before the vavose event and that allowed every country to look at making diagnostic tests. host: hampton, virginia. good morning. caller: good morning. i've got a couple of questions. so hold on a minute. i was just on this morning to get statistics before i called. the regular flu from c.d.c. says 62,000 deaths already this year. and we are at 58 thoirks i believe it is for the covid-19. am i right? host: it's actually 66,000 for covid-19. caller: ok we already have and we don't know actually if the 62,000 is correct because i have five family members that are in the medical field and yes they're from seattle to alabama to florida to virginia. doctors are, whether it's a heart attack or not, saying put

down covid if they are in the hospital. and that's not giving you a very good statistic on the actual death count for covid or for the flu. and i am 79 years old. i was around for the mcelhinney which was -- h1n1 which was horrendous but we didn't shut the country down. they closed some schools but they did not shut the country down. so to me in all reality this is not a covid-19. it's a political virus and it's going to continue to be that way until the election because the democrats are so desperate they will do anything use anything project anything to try and ruin the election. me that's what's really got upset more than anything. host: thanks for the call. we will get a response.

beth cameron. guest: so i think that it's unfortunate if social distancing is being perceived as a political move. there are a number of prominent republicans who worked in multiple administrations including significantly the george w. bush administration where there actually a lot of the work that was done to determine how social distancing could be put in place the way that we're doing it now was actually pioneers by experts in that administration. and has been absolutely supported by officials who served in that administration and also in the trump administration. so i don't think that this is political. i think instead this virus has some significant differences from h1n1 and from influenza in that each person can transmit it to more people. it has a higher mortality rate, the ability to cause death especially in people who are older or have underlying medical conditions. and so i think when we look at

the numbers of zetsdzes, first it's been the leading cause of death as steve said earlier for the last several days. it's been also i think one really important detail is that the number of deaths that we're seeing is what we're seeing with social distancing in place. if social distancing has not been put in place and that was really the concern was that the hospital system would become overwhelmed and we see more deaths not only from covid-19 but from everything else. i do though want to say that one issue that you raised on the call, which i think is really important for people to pay attention to, is that the number of deaths from any infectious disease threat, from flu, from covid-19, from anything that requires a large surge in cases or a large surge in hospital capacity, is that the death toll is not just the number of people that die from the disease. it's the number of people who die from everything else because they're not able to actually access medical care.

and so there are a few different ways that people actually die as a result of a pandemic threat. so the reason that we're undergoing social distancing is first to decrease the number of cases of covid-19, but most importantly the reason that we're doing it is to make sure our hospital system can stay open for everyone, for everyone that needs to be in the hospital for heart attacks for strokes and for covid-19. so i don't think that social distancing was a political move and i think that it's unfortunate if it's politicized in that way. host: and this map from the c.d.c. look at where the pandemic is, the so-called hot spots. hey include california, texas, illinois, michigan, florida, pennsylvania, new york, new jersey, and massachusetts. pat from nebraska. good morning. caller: hi, guys. i have a question about the numbers here. the united states has about

4.25% of the world's population and -- this is what i need from the expert. shouldn't we have about 4 difficulty 25% of the deaths and the cases in the world? and yet we have 25% of the world's deaths in the world and to me that's a massive fail that nobody's talking about. am i right? am i wrong? i find that really disturbing. thank you for your expertise. i appreciate it. guest: thanks so much for your question. so i think you can look at the population rate and try to determine who might be most impacted. but with a disease threat what really matters is where the disease spreads, who has the first -- where the a first cases come from. so we see lots and lots of cases in wuhan and china. then we see cases all over the world connected by air to the first places where the first cases arrive. and so where the disease begins to spread is a function not

only as a population and the density in the country where it arrives but also how connect it had country is to the place where the disease started. more importantly, though, what the number of cases in the united states and the large number of case that is we're seeing i think is mostly a function is the fact that we had community transmission of this disease and we're unable to contain it early on. there are other countries that were able to contain it more quickly using rapid testing, contact tracing to find out everyone in contact with those people, and then to be able to quarantine those people, test them, and isolate those, and wash rinse and repeat that cycle until the virus was contained. so it's not a function of how many people are actually in the count rifment it's a function of how the virus is spreading, where it's spreading and how quickly and well you're actually able to contain it. so i think the reasons that we have the large numbers of cases here are because we had large scale spread and were unable to

stop it early. host: and again this region by region map courtesy of johns hopkins university. the darker the coloring the greater density of covid-19 cases in those stoys or regions. gary from indiana. aller: good morning. i'm going to allude to a phrase from the 80s initially to start off on this. it ain't over until it's over. and a lot of people seem to be passing this off casually like it's just going to be a come and go thing, no big deal. like for one example the n.f.l., they're not doing any planning on postponing anything. it's going to be, the schedule is going to go on. let me tell you what there's numbers as far as the deaths and the cases are still on the rise, there's no vaccine, come on. this is more of a driving force

than we -- some of us seem to real combries. and everything -- realize. and everything that needs to be done to flatten the curve just needs to be done. plain and simple. you can have false hope never got anybody anywhere. plain bottom line fact. so we need to deal with this the right way. and if we don't have enough facts we need to get the facts down. that's all i'm going to say. host: thank you. beth cameron. guest: thanks. i really agree with you. i think that having the facts is absolutely the most important and being straight with the american people that right now we're not yet in a position to be able to contain the disease if we relax social distancing measures. and we know that we're not because when you look at that map and you look at other map that are on line and available that show where those particular places with hot spots are -- what you want to see is you want to see the case

counts declining and you also want to see the percent positive tests in a really low range. the who says 10%, my cletion at jorget say 3%. that a -- georgetown say 3%. that means all tested, all health care workers have access to test. essential service providers can be tested. hat and we want to see the results low. that tells you it's circulating but each person is not infecting one other person. you want each person to be infecting less than one other person and that's how the case count actually go down. so i think we're not there yet and i think we need to be honest with people about that and we're not going to be seeing -- we shouldn't be seeing people gathering on the beaches or in stadiums until each location is in the country is able to do that. also importantly we're

connected by air, by interstate transport, and so we really need to start dealing with how that is going to be managed as some states begin to relax those measures in different ways than other states. so i'm actually really nervous about that patchwork reopening that we're seeing right now. and to your point about what we're seeing with the virus already and what could have been, many experts who i trust around the world were predicting at the beginning of this without any measures in place that we could be seeing as many as 50 million people dead around the world. that's essentially the same number we saw with the 1918 influenza. if you do the straight math looking at this disease's infection the way that it's transmibble and its mortality rate as an average, you would get to those numbers. so the measures we're putting in place are having an impact for sure and the numbers being what they are are terrible in our country but they would be much, much higher if we weren't

doing what we're doing now. and that's a hard thing to explain to people when they're not seeing that impact because they are doing what they should be doing, which is staying home and not contacting others. host: before we get to our next call you are with the nuclear threat initiative. what is it? guest: an international security organization. we work to reduce biological and nuclear catastrophic risks working with partners around the world. host: joe eff in new york. good morning. caller: good morning. thank you. my question has to do with the transition from the obama administration to the trump administration, specifically michael lewis' book the fifth risk. were you involved in that transition? and what he said in that book is that accurately portrayed and is that what you experienced when you did

transition? much. thanks very so i was involved in the transition between the obama and the trump administration. rather than commenting on what the book said and how i experienced -- what the book -- sorry. rather than commenting on what the book said i'll tell you what i experienced because i think it's really important for callers and listeners to know exactly how a transition happens. and you can compare it to what's said in the book as well, which i've also seen. so i was a civil servant in the transition between administrations. and my emphasis was on making sure that our work, the u.s. government's work here not specific to any administration, on biological risks and threats was accurately transitioned from the obama administration to the trump administration. and so i briefed the incoming homeland security adviser, the incoming national security

adviser, and then h.r. mcmaster when he took over that role several weeks later. and i sent memos to them and those -- that information i believe was also likely relayed to the president although i did not preef him myself in person. my experience with the transition was that it was an extraordinary transition. i don't say that politically. the obama administration wanted to beat the mark that the bush administration left. the bush administration left a super high bar. they had a fantastic transition where they provided excellent information to the obama administration. that was widely reported in the obama white house. and we wanted to meet that mark or beat it and have a successful transition and this wasn't political and we're all pat rts. on our end we performed a very successful transition from my perspective. on the receiving end i had a lot of support for the issues

that i worked on. in particular the homeland security advisor who has been quite vocal, no longer in the trump administration, has been quite vocal about the preparedness of pandemic preparedness. he worked in the bush administration during sars and hile we were worried about h 5 n 1 so he did quite a lot of work on pandemic preparedness and was very interested in what i had to say and maintaining the office and direct rat that i ran. so from my perspective the transition was very smooth and i was in my op ed pretty surprised when our office was dissolved and changed approximately a year later. so my experience was good. i will say that there were a lot of questions about how the transition was going to run. for my issues it ran smoothly. i definitely did see from my colleagues' perspective some of the other challenges with that transition in terms of not having a lot of briefing time

with incoming officials. and that was also true for me. most of my briefing time happened after the officials took their roles. host: brian from washington state. caller: good morning. i'm so glad i got to talk to you. i called our state governor's office last week and i requested that they make public notice that if we go out in our shutdown mode and make a purchase in our grocery store or go to the pharmacy or whatever essential purchases we need to make, that we keep our receipt so that we have the time and date and the cash yirs identification number. so if i am testing positive later or i hear that the business i dealt with has a positive test, i can make a reference to the time and date and that person that checked me out in the store with their cash shirs number.

and i made a request that we go with the public notice that people have a zip lock bagie and they keep all their receipts while we're in hutdown mode if we have a test and we are positive and then we have to go back and trace our contacts, that receipt seems like it would be very vital for us people that don't rely on our phones, that don't have smartphones, that are snail mailers and landliners. host: thanks for the call. we'll get a response. guest: i think that's an excellent idea. and i think that what it does is it really highlights what people should be and can be empowered to do themselves. so people aren't power lines in this pandemic. -- powerless in this pandemic. we can trace our contacts to the best of our ability. what we're doing on social distancing is protecting each other, our health care workers and those that are at risk including the elderly,

including people with medical conditions that would be more likely to die if they contracted this disease. so your idea is an excellent one and it's one that i hadn't heard. it's simple, it's something that everybody can do. and i definitely commend it. in addition to those of us that are using smartphone technology to track our locations and to be able to know where we've been i think that's a simple wonderful suggestion that all americans could take to heart. with et me conclude where we begin. what the summer is going to look like. from your perspective how do you answer that? guest: first of all, we don't know exactly what's going to happen with the heat of the summer. there's been a lot of speculation about it and i think honestly i haven't seen in evidence to suggest that the disease is going to go away. if you think about it as thousands of tiny embers out there who still have the disease, if you look at the map

that you showed earlier. we know there's still a lot of embers, people infected with covid-19. so if we were to open up and to think about social distancing relaxing as an open/shut endeavor and we were to open quickly and all go to the beaches and go back to our concerts and ball games, those embers have an opportunity to spread and spread quickly and to turn into raging forest fires. and we know from watching what happens with this disease that's likely to happen. i don't think there's any evidence to suggest that won't happen just because it's summer and it's warmer in most parts of america. so i think what the summer is going to look like if we don't want that to happen, if we don't want it to end up in a situation with many more cases in august moving into september when we start to see increases in the flu what the summer should look like is that people who can telework should continue to telework. essential services providers

should all continue their work and be able to be tested. there will probably be some great experiments run by businesses around the country about how to safely reopen parts of their employees' -- of their businesses with social distancing measures in place. but i actually think that for a large number of americans if we want to avoid that inferno that we're all trying to keep from happening before a vaccine is available, the summer is going to look a lot like it looks now. and people are going to get more comfortable wearing masks when they go out in public, more comfortable with wiping things down when they're delivered at the door, and more comfortable socially distancing at every opportunity. so that's what i think. and i'm not -- host: i've got to jump in because we have to leave it at that but thank you for joining us from here in washington, d.c. a

>> following an extended recess because of the coronavirus pandemic, the senate is back today at 3:00 p.m. eastern per legislative work. they will debate the nuclear regulatory commission nominee for secretary general and the vote is scheduled for 5:30 p.m. we could see work later this week on executive nominations and fisa reauthorization. coverage a live senate on c-span two. congress returns today, at least half of it, returning for legislative work this afternoon. we are joined by alex bolton. alex bolton, why the senate and not the house? the house was supposed to return today. guest: that is right, but speaker nancy pelosi and the house majority leader changed their minds after getting advice from the attending physician, who