i didn't think it was good public health policy. though i didn't call it the great barrier declaration, i was one that needed to protect the vulnerable. we have lost public trust, no doubt about it. it really harms public health in a big way. we've lost trust in science. i think tony made a big mistake, he said when you criticize me, you criticize science. no, that's not what we're saying. we need to have honest, open discussions and debate and that's what science is about. i agree with my colleague here, we lost the ability to really have open, honest discussions. and we really have to try to make sure that doesn't happen again. >> senator johnson, should fauci appear before your committee again? roger: what are the big unanswered questions that still need to be death with and how do we built -- dealt with and how do we build from that and what reform needs to be investigated? sen. johnson: we need to restore confidence in science and scientific research. it's been corrupted. eisenhower warned us in his address. and he warned us abo

kennedy secretary will undermine our core public health institutions and undermine public belief in public health. people will die in this country and many, many more will die overseas if he is made secretary of health and human services. robert kennedy talks a big game on big pharma, big game on big pharma. there's no organizations that's more critical of big pharma than public citizen. so i wanted to clarify what i think is means when he is critical of big pharma. when we talk about big pharma monopolies, we mean that prices need to be lowered so people can get access to essential medicine. when we talk about big pharma having too much influence at the f.d.a., we mean standards need to be uplifted and pharma influence downgraded. when we talk about big pharma not pursuing a proper research agenda, we mean there are neglected diseases that don't turn a profit for big pharma and we need more r and d directed there. when robert kennedy says those things, when he says big pharma has got a monopoly, he means they're excluding, which they're not, but luckily our regulations do -- they're exclu

thanks, public health. because public health did its job, and we have not seen additional cases this year of malaria. but it is those kinds of things. no one is jumping up and down being like, did you hear? disney world is open. because it is invisible. public health worked. and so, we have to be but a storytellers. and so i hope those of you who clearly are following our work very closely help us tell good stories. we're trying to be better at that, there is still work to do, but we have to make that invisible, visible. dr. varmus: other hands. the gentleman behind barry, and then we will get barry. >> hi. i work for a mental health company for the elderly. first off, great to see a north carolinian. i want to assure you i did not go to duke. i still really like stephen. more importantly, last year the surgeon general said that loneliness was the public health epidemic of our time, of the year, something like that. i want to get your perspective on what is the future of loneliness. given advances in techno

attorney general said public health epidemic, i want your perspective. given advances in technology and data collection. >> three priorities this year, improving mental health and supporting young families. we know mental health has been strained. the important part is on data collection. we use the survey data to understand why it is being strained. so there is a lot to learn. what works to combat it. important part is continuing to ask the questions. >> professor? >> im barry kohler. i want to congratulate you, attuned to the pandemic, i was surprised to learn about variability in state obligations to report to the cdc. those things seem crucial, fascinated to hear about your access to emergency room, but where do things stand? we know during the pandemic some states defined covid death differently. it seems like a self inflicted wound and i just wonder where things stand? >> we do not have any new authority. i think what we are trying to do is use our authority and work to standardize data collection, support space in that work to make data exchange ea

toward public health science.ok, laurence, director of the o'neill institute at georgetown university. thanks for joining us here on "bbc news". >> thank you. caitriona: let's bring in our panel here on this. jim, i want to go to you first. as a supporter of president trump and robert f. kennedy jr. is obviously his pick, what do you make when you hear the concerns of someone, a health professional like we just have there? >> well, i think that we need to get away from this sense of misdirection. there's sort of a theme that's going along here that says that if you're in favor of vaccination, you must be against robert kennedy jr. i don't think that's a legitimate approach to the public policy and to the senatorial discussions and so i disagree with that. and by the way, nobel prizes in my view are not necessarily a symbol of legitimacy i might add. but i think that this is a misdirection. you have to listen to what kennedy is saying. you have to understand that he's vaccinated his own kids and here's my point. my

public health was not a part of that. the covid dollars that came from congress have allowed us to basically catch up with that investment that was made on the health delivery side. but you cannot put, what i think are very exciting tools in the ai space, unless you have the foundation right. we are still building the foundation. i want to do all of the very interesting and exciting -- and we all are. on large language models. when you see things happening on social media. why are people googling headaches in southern louisiana? we can pick up some of those trends and we are. we are using it for diseases, to look at different patterns. we are using it, but i want to make sure, those models are only as good as the models it is powered by. getting that infrastructure right, making sure the data has stated ways of it being liquid and interoperable are so critical to power what i think can be that data future. steve: the bigger picture that i think we are looking at, this is a very fragile moment where we are trying to preserv

public health was not part of that. so actually the covid dollars that came from congress have allowed us to catch up with that investment that we've made on the health delivery side. but i would say you can't -- you can't put any of these what i think are very exciting tools in the a.i. space unless you have the foundation right. and we are still building some of that foundation. so i want to do all of the very interesting and exciting and we are -- some large language models again to pick up trends when you start to see things happening, on social media why are people googling again headaches and southern louisiana. we can start to pick up some of those trends and we are -- we are using for legionella disease so to look at different patterns. so we are using it, but i want to make sure that those models are only as good as the data it is powered by. right, and so getting that infrastructure right making sure that the data has standard ways of it being liquid and inner operable are critical to power what i think can be

public health should public health agencies should and if we want be transparent, and if we want americans we . ~ ~ , ~~ transparency. i want to need transparency. i want to say something about what you assert, and when i frrstassenanawheni ' ”ty frrstassenanawheni ' my campaign it was launched my campaign it was about uniting americans, republicans and democrats, and there is no that should us more us more than the chronic unite us more than thechrunic epidemic, these are our health epidemic, these are our kids, 60-70% health epidemic, these are our kids, 60—70% of them are damaged and i know what a kid looks like because healthy kid looks like because i have some of them in my healthy kid looks like because i have: i me of them in my healthy kid looks like because i have: i did of them in my healthy kid looks like because i have: i did nothem in my healthy kid looks like because i have: i did not know1 my healthy kid looks like because i have: i did not know anybody family. i did not know anybody with a food allergy growing up, allergy, so why do a peanut allergy, so why do of my have fi

to communicate public health concerns is gravely concerned.eep using that terminology, but it is in fact, true. the danger that we see in the freezing of that funding at this point is that some public health programs could stop altogether. others could be significantly impacted negatively because of the ability to not have the sustained funding that they need in order to continue. it's a big problem. what we're seeing right now with, as i mentioned a moment ago, the spread of avian influenza, the inability of our federal government's public health agencies to communicate with laboratories, with hospitals and even with the public in terms of what they can and should be doing to protect themselves, what they should be concerned about, and what actions they should be taking along those lines, it stands to put us in real danger of not only this disease spreading, but seeing a lot more morbidity and mortality as a result. >> one last question. in regards to ai and climate, what are your concerns with forecasted electricity demand growth for ai data

he brought a remarkable body of public health and medical real-world experience to the white house forive years 2009 -- 2014. he ran the health department in west virginia he graduated direct the rest virginia bureau for public health 2015 to 2018 with a special focus on reducing overdose death from the opioid epidemic. this is a the death was soaring and becoming part of our national consciousness west virginia was at the epicenter of this. heat serves successfully under democratic and republican governors in west virginia. with the pleasure of posting him last summer to reflect on the impact of the first year of over-the-counter access, expanded access to the over dose reversal medication naloxone. one of the most recent bite of the important steps we'll from dr. gupta in the prevention of death overdose deaths. i want to single out for special thanks my colleagues who very carefully choreographed and organized today's event. supported by kayla, caitlin and rebecca. i want to offer special thanks whose integral to planning and thinking through this conversation. our remarkable produc

communications, soaked to not issue public healthc. how do you see that playing out?— playing out? so, that's dangerous. _ playing out? so, that's dangerous. i— playing out? so, that's dangerous. i mean, i playing out? so, that's| dangerous. i mean, the playing out? so, that's - dangerous. i mean, the us is in the mist — dangerous. i mean, the us is in the mist of— dangerous. i mean, the us is in the mist of an outbreak of avian_ the mist of an outbreak of avian influenza. that we are... audio loss to not have information on that undermines our ability to have an effective public response. do you — an effective public response. do you think, is there any situation where president trump could be persuaded to reverse some of this, particularly in relation to the world health organization? i relation to the world health organization?— relation to the world health organization? i am an optimist by nature. _ organization? i am an optimist by nature. but _ organization? i am an optimist by nature, but the _ organization? i am an optimist b

this would not pose a public health threat, but the public would be interested in this case and would want, you know, we would need to do coordinated messaging around that. number two is that the virus develops the ability to transmit from person to person, and then that so that increases the threat to the public. and so that would require a lot of different actions at that point. and then finally is more of like a close to a worst case scenario where it essentially sparks another pandemic or leads to high mortality. so the next slide, we're talking about planning steps. and so what we've completed is we have developed anticipated mitigation strategies by these three scenarios. subject matter experts have reviewed and built out plans for each strategy. and the public has been informed to avoid touching dead birds and to avoid drinking raw milk. currently, our plans are. plans are being reviewed and in the future we hope, perhaps by the end of this month, to have a tabletop exercise to test the plans and address any gaps that are identified. so finally, the next slide. in summary, the

gannon: ouldtill have to show a public health benefit. it wouldn't have to be the height and benefit in order to unter the heightened risk that fda had recognized -- justice gorsuch: but i thought your client took the position that there was no public health benefi. mr. gannon: we said they hadn't established that there was a higher public health benefit withespect to flavors in order sk that flavors posed.hi they are absolutely linked, and what i'm -- justice gorsuch: ok, how do you deal we chery problem, then? mr. gannon: the way i deal with the chenery problem answer i gave to the chief justice, the wayhrasthe first version of harmless error is the way the court said, you apply harmless error as you do in civil litigation. e asking yourself whether -- juste gorsuch: i know what that looks like. how do we reconcile that with chenery, which acknowledges there mangood explanations. we can conjure them, and do th work, and so we are going to remand it. mr. nnon: that's right when it gument, a different standardent where there may be some a

and we nonprofit that doa; tout public healthprofit that - public octors i we nonprofitthatn .. ublic , ., m nonprofitthatn .. ublic m made it clear. many of the senators _ made it clear. many of the senators today _ made it clear. many of the senators today quoted - made it clear. many of the senators today quoted his | made it clear. many of the - senators today quoted his own words back to him and how he founded the children's health defence organisation, a nonprofit that does tout anti—vaccine messages, and we heard public health doctors say heard public health doctors say he is not up to the job, why do you think he is most suited to this role of anybody else? you have to keep _ this role of anybody else? 7m, have to keep something in her mind about kennedy, he is up to and sense of term, you can't go into a courtroom and pull things out of thin air, he signs faced — science based and fact—based, and nobody owns it. the questions about the senator is is all fear, but they are not paid attention to the american people, that la

gannon: they would sti have to show a public health benefit. it wouldn't have to be the height and benefit in order to counter thhten risk that fda had recognized -- e gouch: but i thought th there was no public health benefit here. mr. nnon: we said they hadn't established that there was a higher public health benefit with reso flors in order to counterbalance the higher riskflavs posed. they are absolutely linked, and what i'm saying -- justice gorsuch: ok, how do you deal with the chenerlem, then? mr. gannon: the way i deal with the chenery problem is the answer i gave to the chief justice, the way you phrase th rst rsion of harmless error apy harmless error as you doou in civil litigation. you are askingelf ether -- justice h: inow what that looks like. how do we reconcile that with chenery, which acknowledges there may be many go explanations. we can conjure them, and do the work, and so we are going to remand it. mr. gannat's right when it would be a completely different argua dierent standard where there may be some alternative form of r

and look forward to watching what my colleagues will continue to address this really important public health issue. throughout my time in congress, the issue of clean drinking water, which in the richest country on the planet at the richest moment in its history, drinking water should be a right and not a privilege. but that challenge has defined much of my work. one of my really proudest accomplishments here in congress was working to provide real relief to flint families during that terrible flint water crisis, to replace those lead pipes, to expand the health care services, to establish the flint registry, which gives access to ongoing support for the long-term effect of that terrible crisis. what happened in my hometown wasn't an anomaly, it was a warning to the rest of the country that we got to be serious about commonsense regulations to protect public health. from the moment that manmade cyst is began, i knew we had to get to work. and throughout the crisis, i organized numerous delegations of members of congress to come to my hometown of flint. republicans and democrats. they met wit

skepticism about our public health institutions. some of this. >> i would say. >> is. >> warranted, but. >> it's now. created a pervasive lack of trust from the public that these institutions. >> are acting in. >> bad faith or failing. >> to act in. >> objective with objective. >> criteria. >> failing, in. >> short, to act. >> in the best. >> interests of the public. if confirmed. >> mr. kenney, how. >> will you work. >> to regain. >> the public's trust? i suspect. >> it will. >> take some time in these. >> important public. >> health institutions. >> i'm through radical transparency. i'm going to make these the reason people don't trust the public health agencies is because they haven't been trustworthy. and you, in the example of covid at the beginning of covid, everybody was rushing to get that vaccine. we had over 90% vaccination uptake. yes, sir. cdc s most recent recommendation is that americans take the eighth booster. only 23% of americans are complying. that means 77% of americans no longer trust cdc. and that is the problem

gannon: they would still have to show a public health benefit.it wouldn't have to be the height and benefit in order to counter the heightened risk that d regnized -- justice gorsuch: but i tho th there was no public health benefit here. mr. gannon: we sai ha't established that there was a higher public health benefit with respect to flavors in order to counterbalance the higher risk that s posed. stic gorsu: you are conceding they are linked. mr gannon: they are absolutely nkedand what i'm saying -- justice gorsuch: ok, how do you deal with the chenery problem, then? mr. gannon: the waal wh the chenery problem is the an gavto the chief justice, the way you phrase the first version of harmless error is the way the court said, apply harmless error as you do in civil litn. and so you are asking yourself whether -- justice gorsuch: i know what that looks like. how do we reconcile that with chenery, which acknowledges there may be many good explanat dinot do the work, and so wey are going to remand mr. gannon: that's right when it would be a complete

public health. prior to the presentation on the first budget there are things i want to under score about this budget process that are unusual. first, we note the severity of the budget the shacht deficit has not changed have you revenues not -- expend tours out pacing the revenues the shape and the distance in between are more significant than commissioners have seen in previous years. and also note the i think this budget process will be more dynamic will note the budget instructions we have were issued by then mayor breed. . in am december of the and while they have in the changed was the lurie registration coming on last week we expect that after our submission there will be additional back and forth in ways we have not seen in previous years. this is you know our first charter mandated step to make our budget submission by february 21 vnl i expect there will be continuing conversations beyond just these two months i will turn that over to mr. morale for presentation. >> good afternoon. commissi

rfk and. >> what she. >> knows about public health. >> as well. >> having served. >> and participatedefforts. >> around vaccination and. >> public health. you know, she she. >> not. >> only lists. >> some of his. >> challenges early. >> on in. >> his career. >> but says that he. >> is essentially, she calls him. >> a hypocrite for advocating. that families of sick children. >> not vaccinate. >> their children while his children are vaccinated. she also says that he. >> seeks to. >> enrich himself through propagating. >> some of. >> these anti-vaccine beliefs. >> such. >> as refusing. >> to recuse. >> himself from. >> a lawsuit that that he's. >> filed against the. >> hpv vaccine, citing a new york times report that the washington post has. not independently confirmed. but there are a list of things she goes. >> through in. >> this letter about why exactly she opposes the nomination. >> it might not. >> necessarily dissuade. any republicans. >> but. >> there were a few democrats who were on the fence that could could. >> really firm. >> up opposition. >> from them. >> she does point ou

recent years, particularly during the covid pandemic, there has been a lot of skepticism about our public health institutions. some of this i would say is warranted, but it's now created a pervasive lack of trust from the public that these institutions are acting in bad faith or failing to act objective -- with objective criteria, failing in short to act in the best interest of the public. if confirmed how will you work to regain the public's trust, i suspect it will take some time, in these important public health institutions? >> i believe in radical transparency. the reason people don't trust the public health agencies is because they haven't been trustworthy, and, the example of covid, at the beginning of covid, everybody was rushing to get that vaccine. we had an over 90% vaccination upstate. the cdc's recommendation is americans take the booster. only 23% of americans are complying. that means 77% of americans no longer trust the cdc and that is the problem. >> yes, sir. in the absence of full information, i think i agree with you, but i want your response, might it make sense to share tha

kennedy, but they seem to actually be concerned about public health. this is a you couldn't pick a worse choice. and caroline kennedy, i mean, this is his own cousin who's, by the way, a diplomat, a very serious, sober woman. and that letter is the most scathing and heartbreaking thing i think i've ever read. >> just one more question, scott, on kennedy before we move on, given the things he has said, he has said out loud about vaccines. if he goes back on them or tries to explain them away, is it just going to get memory, hold all these things? >> well, he'll be under oath and he'll have a chance to explain how he arrived at his views, and we'll have to see if that's persuasive. i don't know that it necessarily will be for everybody on that committee as as paul just mentioned, there are some really skeptical people on there. i will say this, you know, trust in the public health regime in this country is very low right now. people are very unhappy coming out of covid. and he is tapping into something with his views on that, plus his views on our overal

with department of public health. board request us turn off all electronics so they will not disturb the proceedings no eating or drinking in the hearing room. rules of presentation, appellates permit hold and department respondents begin 7 minutes to present and throw for rebuttal. people affiliated must include comment the periods. members of the public are not affiliated have up to throw minutes to address the board and no rebuttal. mr. long way will wurn 30 seconds before your time is up. since the board has a vacancy 3 votes are required to grant an appeal or modify. if you have questions about a rehearing the rules or schedules e mail staff. >> now public access and participation are of paramount importance. sfgovtv is broadcast and streaming live and we'll have the 8 to receive public comment for each item on the agenda. and providing closed captioning for the meeting to watch on tv go to cable channel 78. tell be rebroadcast on friday the for you p.m. on channel 26. a happening link to the live stream is on th

public health could be affected by these antiscience views? senator , -- >> senator, i have always been a pro-science person. i believe in evidence-based medicine and gold standard science. i have a sling is before you came in. 600 people out of work force of 91,000 is typical. last year alone, president biden replaced 3,000 people at hhs, and 700 at -- i want to say this. i said give infectious disease a break, because that has been the principal preoccupation. infectious disease, chronic disease is, accounts for 92% of deaths in this country, and almost nothing is studied at nah on the ideology of our chronic disease epidemic. it's going to infectious disease. >> it is an interesting point, but the problem is, we had to respond. it is actually the gates foundation and this cohorts that figured out what was wrong, and that we had an outbreak of covid that was going beyond the very first case, so we had to build a fast response. i take this to the university of washington that has conducted groundbreaking stem cell research on fetal tissue. to

and this is one example of critical public health information that doctors, public health researchers and the public rely on with real time data that is incredibly important for responding to and being aware of public health threats. there is also a concern with the scope of this directive. it's not just reports, but press releases. any meetings, guidances. regulations, everything is being held up until it is reviewed by a political appointee. i think, except for emergency alerts. so the slowdown is really preventing information that's critical to the public about threats to public health from being published. >> looking back at other and speaking to your colleagues to dahiyeh, can you think of any other examples that have been perhaps as shocking to you and your colleagues in previous administrations? or is this the first? >> i think that the scope in this administration so far is the most shocking. of course, there again, is always some level of transition, but we will see depending on how long this pause lasts and also the degree to which political appointees continue to be involve

your thoughts on the impact that has on public health leaders? and healthy debate is a good thing. but to withdraw protection from someone that has devoted his life to saving american lives, to advancing research, to taking data and making it into action, it sends a chilling effect. why would you step forward and be a champion for public health if this is how you were treated? i think we stand on the shoulders of giants in science and in health care. but to think of these kind of threats against them is really incomprehensible. and i think to your notion of how long is it going to take to recover from this? i really don't know how long it's going to take. >> yale daily news reports this will lose a generation of scientists. they go on to, say, 53% of grants received to fund research at the yale school of public health came from the nih, and the yale school of medicine is ranked fourth in the nation for total nih funding. quote, i'm just worried that this trend continues, that we'll lose a whole generation of scientists. eric, what is the what is t

public health? >> that public. >> health in and of itself could be affected by these kind of anti-science views? >> senator, i have always been a science person, a pro-science person. i believe in evidence based medicine and gold standard science. when i said, and i've explained this before, you came in at 600 people out of a population, out of a workforce of 91,000 is pretty typical. last year alone, president biden replaced 3000 people at hhs 700 at nih. i want to say this. i said, give infectious disease a break, because that's been the principal preoccupation infectious disease, a chronic disease is 92%, accounts for 92% of deaths in this country, and almost nothing is studied at nih about the etiology of our chronic disease epidemic. but right now, money is going to infectious disease. >> and i get. >> i get your point. >> it's an interesting point. >> the problem is we had to respond. >> and it's actually the gates foundation and a flu cove cohort. >> that figured out what. >> was wrong and th

but when taken together, the impact to public health is alarming and the public health concern isn'twill withdraw the united states from the world health organization, a move that experts warn will make it harder to fight the next pandemic. the un has now just confirmed that the us will in fact leave its informed them officially. and this is a step that donald trump has been working toward since the very first days of covid, when the world health organization questioned his approach. >> the w.h.o, that's world health organization, receives vast amounts of money from the united states, and we pay for a majority. a big portion of their money. and they actually criticized and disagreed with my travel ban. we're going to put a hold on money spent to the w.h.o. we're going to put a very powerful hold on it. >> joining me now is emanuel, former obama white house policy advisor, vice provost of global initiatives at the university of pennsylvania. zeke, good to see you again. thank you, my friend. between seeing you on the screen next to me and listening to donald trump talking, covid bring

can't have someone in that role that does not believe in the life saving potential of one of public health's greatest inventions. >> i want to ask you, are you famously survived ebola? this idea of cutting off all contact with the world health organization and ending pepfar, which has saved the lives of more than 20 million people infected with hiv, which does cause aids if untreated. what do you make of that? what would the impact of that be? >> let me be very clear. this is pure stupidity. as someone that has worked around the world battling disease outbreaks from ebola, hepatitis c, many others, i've seen the relationships, relationships that we've had. the cdc with the w.h.o., i've seen what where we benefit from having eyes on the ground and having those relationships. at this point, our cdc folks can't talk to w.h.o. folks about a marburg outbreak in tanzania, about a possible ebola outbreak in the dr. congo, about what's happening with mpox in countries around the world. we're not able to do that. getting rid of these programs, getting rid of those relationships, cutting things like p

so it needs to be law enforcement and public health working together, but we need solutions as big as the problem. >> okay, i guess that is where this number of 100 is coming from because that's an eye boggling number when it comes to people being arrested for simple drug use? >> and what i would say is to ask the people who would live in and around the sixth street corridor, when they see the scale of lawlessness that's playing out there. and the crisis, again, drug driven lawlessness is something it's a had not happening neighborhoods or our small businesses. but least of all, not anyone who is on the street addicted to drugs. and the reason that i asked for a role on the san francisco board of supervisors is because of my own journey and recovery from the drug addiction, so i do understand this is a real difficult thing to be captured by. we do need people to be making interventions in this that can be life saving. i'm not interested in doing something that is only punitive if we don't have the medically assisted treatment in the kind of detox and medication assisted options that a

let me close by saying i believe more strongly than ever and i have specialized in health care my time in public service that we are at a turning point with regard to health care in america. there is one word to describe american's feelings toward the health care system it is disillusioned. at every single turn, people feel like they are rolling loaded dice when they try to get health care. americans are justifiably angry and fed up and tired of a system that puts profits of a patients. instead of debating meaningful ways to improve american health care, now the committee is being forced to relitigate and settle science about vaccines and whether or not the federal government should help americans get affordable health care. i know where democrats on this finance committee stand when it comes to an agenda to lower costs and improve care. and i must say i cannot say the same about the nominee sitting in front of me, and let me acknowledge, finally mr. chairman, terry mills from portland, oregon who is here to represent nurses for america and i would like to enter a statement from her organization

former mayor london breed appointed colfax to sf public health director back in 2019. colfax did not say why he decided to leave the department, but his last day is february 7th. the deputy director will take over until mayor daniel lurie selects a new director. okay, here comes some big events. sfpd is outlining plans to protect two big public events that are happenining on e same weekend the nba all star game and the lunar new year parade. both are set for mid-february. on saturday, february 15th. thousands of fans will gather in chinatown for the lunar new year parade. then the next day, the nba's biggest and brightest stars will descend on chase center for the all-star festivities. sfpd's plan includes stepping up foot patrols in both areas. the police chief says the plan isn't just to ensure people are safe, but to make sure they feel safe. most people feel safer when they see officers, the officers that are engaged, that are present and that are taking care of issues when they see them. the police department is still about 500 officers short of its staffing goal,

we spoke with a doctor who is the assistant professor of medicine and public health at ucla.ter: thank you so much for joining us. you have lived on the west coast for a long time. how does this fire compared to others you have experienced and what kinds of symptoms are folks presenting in your clinical practice right now? >> it is been a very busy few days. lots of folks coming into the clinic feeling more chest tightness. in general just worse than their baseline. we have spent a lot of time trying to figure out how to optimize respiratory medications to compensate for that. and counseling on how to best keep themselves safe given these difficult circumstances we are experiencing right now. reporter: what kind of health issues tend to crop up when there are fires like this? >> we worry most about people with a lung disease. it can work its way down into the deepest parts of the loan. and transmit through the long. that can affect people without pre-existing lung disease. if people cannot get enough oxygen in their body. even if you are a seasoned athlete, this is not the ti