By Adem Lewis / in , , , , , , , , , /


Welcome to this special briefing from
the Johns Hopkins University of Medicine. Thank you all so much for joining us. I’m
Lauren Sauer, the director of operations for the Johns Hopkins Office of Ccritical
Event Preparedness and Response. Ttoday we’re here to talk about the outbreak of
2019 novel coronavirus, known as COVID-19 with five Johns Hopkins experts who have
been at the forefront of the response. First we’ll hear from an infectious
disease expert who is internationally recognized in the field of public health,
preparedness, pandemic and emerging infectious disease, and prevention of and response to biological threats. Second we’ll hear
from a researcher who created the outbreak map being used by officials
worldwide to track the virus. Third we’ll talk to an expert of basic virology and
influenza and other emerging and zoonotic infections. Fourth we’ll hear
from a health systems epidemiologist and infection control expert. And finally
we’ll talk to a nurse epidemiologist whose research seeks to streamline care
approaches that optimize navigation, linkage, engagement, and retention in care
for persons with infectious diseases. As the COVID-19 outbreak evolves, we’ll hear
from the distinguished panel of experts from across Johns Hopkins University and
Medicine who will shed light on the understanding of the virus, its
progression, and our response efforts. Our goal today is to bring their knowledge
directly to you. After short presentations from each of our panelists,
the audience will have an opportunity to ask questions directly to our experts
and will have more opportunity to learn about the virus. As Johns Hopkins experts
have been at the forefront of the response to COVID-19, we recently
launched the Johns Hopkins Coronavirus Resource Center. This website is a
resource to help advance the understanding of the virus, to inform the
public, and brief policymakers in order to guide a response, improve care, and
most importantly save lives. You’ll find links to subscribe to a daily update on
COVID-19 from the Johns Hopkins Center for Health Security, webinars, and a new
daily podcast from the Johns Hopkins Bloomberg School of Public Health. We
encourage you to check it out at coronavirus.jhu.edu. Before going
further I would like to take the opportunity to thank
Congress for its swift and decisive action on passing HR 6074,
the Coronavirus Preparedness and Response Supplemental Appropriations Act. This 8.3 billion dollar package will fund a robust response to
coronavirus, including vaccine development, support for state and local
governments, and assistance for affected small businesses. And with that, I’ll
introduce our panel. First, Dr. Tom Inglesby.
He’s the director of the Johns Hopkins Center for Health security the Johns
Hopkins Bloomberg School of Public Health. Then Dr. Lauren Gardner,
co-director of the Johns Hopkins Center for Systems Science and Engineering. Dr.
Andy Pekosz, who is the co-director of the Johns Hopkins Center of Excellence
and Influenza Research and Surveillance. And Dr. Lisa Maragakis, senior director of
infection prevention the Johns Hopkins Health System and hospital
epidemiologists at the Johns Hopkins Hospital. And finally, Dr. Jason Farley,
professor of nursing, a nurse epidemiologist, and a nurse practitioner
in the division of infectious diseases in the Johns Hopkins University Schools
of Nursing and Medicine. I also wanted to let you know that C-SPAN is here, and to
take an efficient approach to our question and answer and assure that we
answer as many of your questions as possible, we’ll be passing out cards for
the Q&A. And so if you do have a question, please write it on a card and pass it
along, and we will be sure to get it back to our panelists. So we’ll start with a
few brief words from each of our panelists. Dr. Inglesby.
Thank you, Lauren.
I was asked to say a bit about COVID-19’s spread in the world and the disease, and
a few points about U.S. priorities at this point. COVID-19 was first recognized in
Wuhan China at the start of December and in the following two months had grown
from one case to more than 70,000 cases and had spread to all 31 provinces across
China As of March 5th, the disease has been diagnosed in more than a hundred
thousand people—we’ll hear more about that from Lauren Gardner in a moment—and
has killed more than 3,300. Outside of China, leading countries
include South Korea, Iran, Italy, France Germany, and the U.S. The U.S. is about
seventh in terms of total cases of disease in the world. And as of March 5th,
actually as of this morning, there have been approximately 215 cases in the U.S.,
with 14 deaths, and most importantly, 78 of those cases have no known link to
known coronavirus cases. Those cases then we would consider something called
community transmission, which is transmission that’s occurring without an
obvious link to some other case. Patients who become sick with COVID-19
have coughing and fever, and in the more severe cases, can develop viral pneumonia.
In the worst cases patients, develop a syndrome called ARDS, which is a severe
pulmonary syndrome which mirrors the disease that was caused by SARS back in
2002/2003. Some patients’ initial symptoms can be GI symptoms: nausea, vomiting, or
diarrhea. In China, approximately 80% of those with illness developed mild
symptoms not requiring hospitalization, with people recovering without any
medical intervention. About 15% of cases required hospitalization of some kind
and 5% of cases required critical care. Most of those would require
ventilation in the United States. It’s not clear exactly how many of those
patients in China did receive mechanical ventilation. The overall mortality if
this disease is difficult to calculate because of the different ways we are
diagnosing the disease around the world. We believe that there is a over
diagnosis or a over-representation of people who are the most severely ill. We
find severe cases first because they’re the most obvious and they’re in the
hospital, so that is going to skew case fatality rates or mortality rates upward
and the more that we do diagnosis, the more that we diagnose mild cases, the
more that will drive down the overall case fatality rate. But it’s too soon to
say how far that will go. We do know that in Hebei Province, the
province where Wuhan City is, about 4.3 percent of recognized cases there have
died. Again, that’s not a case fatality rate, that’s just a crude calculation of
the number of cases of that have been identified and the number of deaths. In
Italy that number is about 3.2 percent of cases have died. In the Republic of
Korea, only about 0.6 percent. I don’t mean to minimize that, but lower number, 0.6% of
those cases have died, and we think that that represents a much more ambitious
testing strategy in Republic of Korea. More than 140,000 people have been
tested over a short period of time, which does, we think, increase the number of
mild cases that will be identified and decrease the the mortality rate. The
mortality rate of those who’ve been identified over age 70 and over 80 is
especially worrisome and is substantially higher than those who are
younger adults. We have not seen serious mortality in children, although we are
seeing cases. As opposed to what we initially thought, there are substantial
numbers of cases, pediatric cases, in the 0 to 10 and 10 to 20 age group. The
virus has a 1- to 14-day incubation period, with an average incubation of
about five days. It’s spread primarily via respiratory droplet, which means close
contact, usually within six feet. And in China, we’ve seen in some
studies that as many as 20% of cases have no symptoms, which makes containing
this disease and slowing it down particularly challenging. Major
interventions have been put in place in countries which are experiencing serious
outbreaks or epidemics of COVID-19 and I’m sure you all have seen in China
they took maximum measures to try and contain it, including lockdown of cities,
closure of travel routes, closure of schools, closure of business. As many as
760 million people or more were at one point confined to homes. And in Italy in
Iran they’ve also taken fairly substantial
containment efforts, including cancellation of mass gatherings, closures
of schools, and as of last night there were more than 300 million kids around
the world that were out of school because of this virus. And then finally,
closing with priorities that I believe are important for the U.S. at this point.
I think we need to continue to substantially expand diagnostic testing.
That has really changed over the course of this week, now 45 states out of 50 are
reported to have the ability to do testing and many hospitals will be
coming online as well as they develop their own tests and get them validated.
We also heard today news that Quest is moving to develop its own test, which is
a promising sign because they have such large volumes of clinical
testing around the world—rather around the United States. And so it’s the, I
think the goal is to get to a point where any patient who has
symptoms consistent with coronavirus can be tested quickly. We are not at that
point now, we don’t have the bandwidth to do that now but that is the goal. I know
that’s the the administration’s goal and state health labs I think are moving in
that direction. We do need to do substantial work to get our health care
system prepared for this virus there are many hospitals that have done that work,
but others I think have much more to do. In Italy and South Korea and Japan and
China, we have seen that there’s been major pressure already on the health care
systems there and we know that in the United States if we see similar numbers
of cases, which we will understand better in the coming weeks, that there could be
substantial pressure on intensive care units to be able to take care of larger
numbers than usual of critically ill patients. We also need to make sure our
outpatient clinics remain available to patients. In China we saw that cancer
clinics and dialysis clinics have closed in an attempt to try and manage the
virus, and that would be a really unfortunate secondary consequence of
this disease in this country, which we need to avoid. And we also need
to take very special care of our long-term care facilities. We’ve already
seen in Washington State how terrible this virus can be within a long-term
care facility for people who are most vulnerable. We need to support our public
health agencies, they are now already working 24/7 to try to isolate cases,
diagnose them, to quarantine people who need to be quarantined.
If cases significantly rise in this countr,y it may no longer be possible to
pursue the strategy that’s underway now around identification of every case and
quarantine of all contacts. It may become too large and scale for our health
agencies to be able to do that, and at that point we would need to shift to
focusing on understanding the overall burden in the population, making
recommendations to the public regarding isolation and testing, and possibly
measures which we would call collectively social distancing measures,
which might include closure of businesses or telecommuting, might
include cancellation of large gatherings and could include in some places
closures of schools. Those decisions will probably need to be taken and be taken
by local health officials with local political leaders and business and
school leaders. And finally a last word about medicines and vaccines. Vaccine
development is likely to be 12 to 18 months away if all goes well. We’ve heard
that consistently from the countries and internationally from vaccine scientists
around the world. We should be developing plans for mass manufacture of vaccine
when this vaccine is developed Similarly antivirals and monoclonal
antibodies are being developed by a number of companies. Those could be
developed far sooner in terms of the process of developing and approving
those medications and we will also need plans for mass manufacture of those
medicines and hopefully in multiple places in the world as well. If the
United States itself gets a new product there will be enormous pressure from
around the world to be able to access that product, so even though it’s not
usually done this way, we do need to think about making medicines and
vaccines in multiple places in the world at the same time. It’s great to see this
kind of attention and attendance in this kind of meeting on the Hill and I think
the response has been very swift in terms of developing the emergency
appropriations bill, and we’re very excited that that is being aimed at
hospital preparedness, public health agencies, the agencies of government that
work with industry to make these important products. So I’ll stop there
and look forward to questions. Is this on? Yeah. My name is Lauren
Gardner, I’m a associate professor at the Civil and Systems Engineering department
at Johns Hopkins University I’m leading the efforts behind the COVID dashboard
that most of you are probably aware of. So I just am here to talk through a
little bit about how this dashboard works, the features of it, and a bit about
the data collection process behind it, and some of the user stats as well. So
let’s if this works. Set the screen extension again, I can
grab it here. You can do it? I can do it from here. I
can’t see your screen though. Sorry, this worked earlier. We want the dashboard up. So, I can start
talking about it. There we go. I have the technical
capability to build this dashboard but not actually open a PowerPoint
presentation, that’s comforting. So what we’re doing is clearly we’re tracking
total cumulative confirmed cases of COVID all around the world, and we have
here in this now global view, the red circles represent the total number of
reported confirmed cases to date by region. And the region, the spatial
resolution of the regions that were reporting on, differs depending on
where we are in the world. So for instance, in China we’re reporting at the
province level, at the U.S. at the county level, Australia and Canada, the city
level, and the rest of the world at the country level for right now. Over here on
the left is a list of all the countries, and on the right is the deaths and
recovered which is we’re also reportin,g and you can see the actual numbers by
region. You can click on a location and it zooms into it on the map, and
you also here can highlight the specific stats for
that region. And then you can switch tabs here and you can see at the finer
spatial resolution for that location. Another thing that we’re highlighting is
in addition to the total confirmed cases is the number of active cases at any
point in time, and so this is the total number of cumulative confirmed cases, minus
the recovered, minus the deaths, and so this is really important because it kind of
represents the more– or, better reflects the risk at any point, in time
and I think what we’ll see over the next few months is a shift of these, kind of,
active cases from east to west. On the bottom right we have a little timeline
of the kind of temporal nature of this outbreak, and so here we’re tracking the
total cases over time, the total recovered over time, and the cases are
broken down into cases within China and– within mainland
China and outside of China. You can switch tabs over here and see it
at the logarithmic scale so we can kind of capture the exponential nature of the
outbreak that we see at early stages. And then also we can track it at a daily
scale in terms of the number of new cases or newly recovered cases reported
on a daily basis. And you can kind of turn these off and on so you can see
just one series. And what we’re looking to do soon is disaggregate this red bar
chart and split it between new daily cases in mainland China and
outside mainland China, because we’ve recently passed the point at which case
we’re now have more cases outside China than inside China on a daily basis, which
I think is a pretty critical shift in this situation. And then on the
bottom here is a text box with a whole bunch of really important stuff that I
think nobody reads, and it includes a link to Lancet Infectious Disease
article that– or letter that we wrote, which details the data collection
protocol behind this and what the data sources are. There’s a link to a mobile
app and the link here to our blog, which details background about both the
outbreak, the mapping efforts, and also some other modeling efforts that we’re
doing behind the scenes. And then a bit more about the data sources and some of
the details about the map. So that’s it for this, I think I should be able to get
back to my slides now. Can you make these fullscreen over there? Oh wait, I can do it from there, leave it,
thanks. Okay. And so as I said ,this is all actually
hosted out of the Whiting School of Engineering at Johns Hopkins, and so one
thing about where this data is coming from. In two minutes I cannot explain the
details of the process behind this data collection but what I can say is that it
spans the entire scope of pure manual data input to purely automated data
input, depending on the source, and also some combination of both. And so for
example China data is completely automated and has been since February
1st and is pulled from a particular website and updated every 15 minutes. At
the moment the U.S. data entry is completely manual, and then the rest of
the world is some combination between these two. Where the data is coming from
is a variety of sources, and in general it’s based on daily– it starts with the
daily reports from WHO and the National Health Commission of the
People’s Republic of China, but those only come out every 24 hours,
so we use those kind of as a baseline and then throughout the day we
supplement with local level, city level reporting and reputable news and media
outlets and local health departments as new cases come available, because
obviously these are coming out at the city level first, so they’re not able to
be incorporated into these national level reporting reports that only come
out on a daily basis or less frequent. And so to kind of instill confidence
and validate this data, what we’re doing behind the scenes is we’re consistently
comparing our data on the dashboard with the data provided by those WHO reports,
and so that’s what’s shown in these two maps on the left. And so what we can see
is that at any given point in time, we’re always presenting more cases as you
would expect, because we have the cases that have at least always been reported
previously by WHO, plus whatever the new cases are at the time, But what you
can also see is that they follow the same trend, and so we are consistently reporting the reliable and, I think,
accurate data. There are a few discrepancies ,for instance on the bottom
when Hubei Province changed their reporting criteria and started reporting
clinically diagnosed cases there was a huge jump of about 15,000 cases reported
that day. We captured it at the time, WHO captured it a few days later. And
then on the right on the bottom is something that I think is really
important and critical about this dashboard, is it shows its ability to let
the public know when a new region becomes affected and it does this in a
really timely matter.aAd so what that shows is on the bottom is the countries
that are reported in the WHO situation reports and the date that reported on. On
the top is when we include the countries in our dashboard; blue means we did it
before the WHO report came out and red means we missed it. And you can see that
we almost always report countries on the dashboard before they’re formally
reported in the WHO reports, with only a couple exceptions and those exceptions
happened in the first week of the dashboard when everything was done
manually, and one of them was early Saturday morning when my PhD student was
sleeping, I think. So we’re doing a really good job I think of keeping tabs of when
new important events are happening and then we can see that the data that we
are presenting is accurate and aligned with the official reports that are
coming out, even though we’re providing and collecting it in an independent
manner. And this is all provided in the Lancet Infectious Disease Letter. And
then a little bit about the user statistics, this has been really a bit of
a shock. This is a curve of the daily requests. So this is not necessarily
eyeballs, it’s interactions with the dashboard on a daily basis. And we can
see that it’s been pretty popular for a while, and at the moment we’re getting
well over a billion requests per day, or interactions with this dashboard on a
daily basis. A couple peaks happen, for instance, around late January when Italy
first reported its first case, then there was another peak around
the time that there was a lot of spread within the EU and around the Middle East,
and then more recently with the U.S. local transmission. And so what this is
is this is showing where this usage is coming from geographically and it lists
the top ten countries using the dashboard, with the U.S. being the
one with the highest usage, and then the green is the rest of the countries
aggregated together. So in terms of who is using this dashboard as far as I can
tell it’s it’s pretty much everybody. It’s everyone in terms of general
public has really been the predominant users of this, and it’s gone viral on
almost every social media channel that exists, all the way up to our local, state,
and federal governments, public health entities, and pretty much everything in
between. And so I think that this really speaks to this huge demand for reliable,
trustworthy, objective information, especially around situations like these,
and so I think it’s really important to kind of acknowledge this gap and support
these kind of data procurement and data visualization tools moving forward that
are to be made publicly available because this is clearly something that
was missing and needs to exist moving forward. And so lastly this is definitely
not something that I have done or could do or would ever do on my own, and all the
other people that are part of this team really deserve all the credit for the
work that’s being done, especially the two guys on the right. This is Frank and
Hongru, who are two of my PhD students, and Frank has really been the
pioneer behind this and led the efforts behind the actual building out of this
dashboard, and these two have worked tirelessly to keep this running and
we also have some other really great support out of the Center for Systems
Science and Engineering, which is my center and
where this whole effort is being led out of. And then we’ve had wonderful support
from Johns Hopkins University Applied Physics Lab and also Esri, who’s the
technology that we’re actually using to build this dashboard, and this whole
thing has been internally supported through Johns Hopkins University as well.
Thank you, Lauren. Next we’ll go to Dr. Andy Pekosz, and
I’ll just take a moment to remind you that the cards that are being passed
around or for you to write questions on. If you write one just give it a quick
wave and someone will come grab it for you so that we have them ready to go
during the session. Hi, I’m Andy Pekosz, I’m a professor of molecular
microbiology and immunology at Johns Hopkins Bloomberg School of Public
Health, and I’m here to focus my discussion on issues related to the
virus and the immune response to infection. As I’m sure you all know, Dr.
Anthony Fauci from the National Institutes of Allergy and Infectious
Diseases has provided important leadership in the public health response
to contain the COVID-19 outbreak, as well as in driving forward vaccine
development efforts. In January he also called together a myriad of laboratories
who were involved in research on influenza and other respiratory viruses
and charges to bring resources and expertise to bear on the COVID-19
outbreak. I’d like to summarize some of the work that has been initiated and
continues to go on through these efforts and other efforts. The coronavirus
family includes viruses that are responsible for a wide spectrum of
disease in humans, ranging from the common cold to the quite severe disease
caused by SARS, MERS, and of course now COVID-19. Understanding the differences
between the original SARS virus and COVID-19 viruses, viruses that are
similar genetically yet have very different disease penetration and
perhaps transmission patterns is critical in understanding how the COVID-19 virus has been able to spread to so many parts of the globe while the SARS
virus was eventually contained and then eliminated from the human population. We
need to understand virus shedding in much greater depth, and that involves
looking for infectious virus levels in respiratory secretions and not only
virus levels quantified by the current PCR tests. This will give us a better
understanding of the true window of time in which a
person can be infectious and will better inform our public health responses to
the epidemic. The area of virus sequencing and genomic analysis has
provided us with a powerful tool that allows us to follow chains of
transmission by tracking unique mutations that have occurred in the
virus genome during its replication. However these same mutations may help
the virus to adapt to its new human host and that might be associated with better
virus transmission or altered disease potential, so understanding and
monitoring changes in disease severity and how they track with changes in the
virus genome is a high priority going forward. We’re also planning work to
understand the immune responses to infection. Some basic questions such as:
What kind of immune response is induced by infection? How long did those immune
responses last? And does infection protect you from a second exposure to
COVID-19? These are all critical questions that inform public health
responses and will help guide the vaccine projects that are currently
moving forward at a rapid pace and into clinical trials. The factors that drive
disease severity need to be identified. As Tom mentioned, epidemiological data
shows that age, gender, and pre-existing medical conditions are associated with
severe disease, but we need to understand why that’s occurring. Understanding how
disease in these populations compares to the milder disease seen in other age
groups may help inform better treatment regimens for those high-risk populations.
COVID-19 is sometimes compared to seasonal influenza and I think it’s
important to remind everyone that influenza is responsible for upwards of
18,000 deaths in the United States this year alone, and that’s with vaccines,
antivirals, and having a portion of the population that’s immune from severe
disease because of previous exposures to influenza. We have none of those
things at our disposal to battle COVID-19. A deeper understanding about what the
virus is doing in humans will drive more informed and effective
interventions and treatments that are essential and
controlling the outbreak and minimizing the virus’s impact on human health.
Again, thank you for the opportunity to speak. I’ll turn it over it’s Lisa. Thank you very much. So my name is Lisa
Maragakis, I am an associate professor of medicine and infectious diseases at
Johns Hopkins University School of Medicine, and I’m the senior director for
infection prevention for our Hospital and Health System. And what I wanted to
talk with you today, what I wanted to talk with you about today, is our
healthcare infrastructure and the preparedness activities that are
happening across the nation in facilities and healthcare systems like
Johns Hopkins Medicine to prepare and make sure that we are as ready as we can
be to safely care for patients who become infected with this
novel coronavirus. At the beginning I would like to just remind you
that we have faced a number of infectious disease threats over the the
past several years, and the good news about that is that we learn more every
time, we become more and more prepared. And I I would like to point to the
importance of the periods in between infectious disease threats and how
building infrastructure and preparedness is critical for our ability as a health
care system across the nation to respond to this kind of a novel pathogen,
particularly pandemic respiratory virus. In particular there has been a large
investment in emergency preparedness infrastructure in this country that
began with the Ebola crisis in 2014 and 15 in West Africa, and the assistant
secretary for preparedness and response regional approach to making sure that we
have treatment centers for patients with highly infectious diseases, and a whole
network of regional treatment centers and assessment hospitals and frontline
care facilities. So really the emphasis is that all parts of our health
care system maintain readiness and an all-hazards approach. That funding was
really directed at viral hemorrhagic fever, but the great news is that it has
allowed infrastructure to grow, partnerships to develop between the
healthcare infrastructure on the front lines and public health authorities,
and all aspects of emergency management and preparedness, and I think that that
level of preparedness has really allowed us to pivot more rapidly to be prepared
to meet this threat. That doesn’t mean, however, that we don’t have a lot of work
remaining to be done because certainly we do. I will say that every institution
has some manner of pandemic respiratory virus planning. We need to take those out
and hopefully everyone has already done that. Certainly at Johns Hopkins Medicine
we have. Dust off those plans and think about really the nitty-gritty of
what it will take to operationalize and implement those plans. Inevitably one
finds that there are novel aspects of the pathogen that must be addressed in
in applying those preparedness plans to the specific situation and also moving
forward and making sure that all of the myriad details are in place that might
not be contained in such a plan. So we have heard from some of the other
speakers about mode of transmission, which is a major piece that plays into
preparedness, and so I would say that most of the pandemic respiratory virus
planning in this country and probably around the world has centered on the
assumption that such a virus would be spread by the droplet route, by really
larger droplets that are expelled when a patient infected with a virus coughs and
sneezes. Those particles tend to go about 6 feet in front of that person and then
fall because they’re relatively heavy and they land on surfaces and the
floor, and that’s why it’s so important to use environmental disinfection
of high touch surfaces as one of our strategies. However there’s another
category called airborne transmission, whereby smaller viral particles or
“droplet nuclei” they’re called, really remain aloft for a
longer period of time so that they can float around in the air and be inhaled
by someone who comes along a bit later, even after the patient may have left the
room. So that’s a different kind of threat that we’re used to handling in
healthcare environments with tuberculosis and varicella and other
kinds of pathogens, so there is a notion that this virus, although most of the
data suggests that it’s spread by the droplet route, that it is possible that
the airborne route may also play a role, especially in certain circumstances
where procedures are being performed in the healthcare settings, like intubation
of a patient who needs mechanical ventilation, for instance, that may cause
those aerosols to be present. So out of an abundance of caution, the current
guidance from the Centers for Disease Control and Prevention is to use
airborne precautions for this virus, and so part of the work that is being done
in healthcare facilities across the nation and around the world is to try to
figure out how best to take that pandemic respiratory virus planning and
adapt it for airborne pathogens. That means several things. It means that we
need to look and we all are looking at our facilities and the air handling in
those facilities to determine critical planning for patient placement, and then
staffing to go with the patient placement so that we can provide the
safest care possible in our facilities. We all have airborne isolation rooms as
they are called that have special air handling for treating patients who have
tuberculosis, varicella, measles, etc., but what we don’t have is a large number of
the rooms. And so many facilities—and Johns
Hopkins Medicine is certainly leading this effort—to look at air handling
modifications that can be made to turn entire medical units in acute care
hospitals into a respiratory isolation unit. We are also working really
around-the-clock about how to ready ourselves to handle an influx of
patients, and a surge—we call that surge capacity planning. Many of our hospitals
across the nation operate in a very lean sort of way,
meaning that much of our healthcare delivery has been moved into the
outpatient or ambulatory setting. So looking at the remaining inpatient acute
care facilities that have really been streamlined for cost control—which is
entirely appropriate—now we need to ask ourselves how we can ensure that we have
the staffing and the readiness in case a large number of patients do need
inpatient care all at the same time, particularly if they need critical care
services and mechanical ventilation, etc. So that’s a lot of the work that’s going
on, and even when we find the places for patients to be housed in the right
air handling conditions, then staffing is another major concern, and we are working
with our Human Resources colleagues and with our planners to make sure that we
have the providers, the nurses, the respiratory therapists, and really
every member of the healthcare delivery team ready, so that we can ensure that we
can provide care to all who need it. I wanted to take a minute and kind of
walk through a couple of aspects of really how a patient might move through
the healthcare setting, because it has implications really across the health
care spectrum. As Dr. Inglesby alluded to, patients will have a wide
spectrum of symptoms. They may be asymptomatic, they may have very mild
disease indistinguishable from a common cold, or shortness of breath that doesn’t
really progress. One of our tasks right now is to make sure that we get the
right care to the right patient at the right time, and that means keeping the
worried well and the mildly ill out of our emergency departments and our
clinics, where they might not need to be, and they might cause exposures to other
people who are there for other medical reasons, and also kind of clog the system.
And so we have services that provide in-home care, home care colleagues, we
also have opportunities to use strategies like telemedicine and phone
triage to support patients who are recovering at home and really encourage
patients who are worried that they may have the virus but have very mild or no
symptoms to recover at home. Turning then to those who present for care, testing is
an enormous concern on our mind right now. As has been mentioned already, we
need the need we need the ability to test rapidly, we need that to be at scale
so that we can do widespread testing. I think you’ve heard today some reasons
why we need that, to understand the epidemiology of what’s happening in this
country, but also for any given patient to decide on appropriate therapies and
and to get them immediately into appropriate isolation precautions, so
that is a major amount of work that’s going on. A word about supply chain: this
is of concern across the healthcare system and something that our supply
chain colleagues are helping us tackle to make sure that we have all kinds of
options on the table about personal protective equipment, which is of course
top of mind to keep our healthcare workers safe. But in addition
to personal protective equipment, having a large amount of manufacturing
in China that has in many cases been disrupted has led to allocation or
suggested caps, or enforced caps, on over 400 items across all kinds of categories
that we use in healthcare. So I think we have some strategies to deal with this,
but this is one of the challenges that we are tackling. And I’ll mention just a
couple more things and turn it on to my colleagues, but partnership with federal
and state health authorities is critical, and the more we can all work together,
the stronger we will be able to respond to the the needs that may come our way.
And what would this look like? It might look like regional strategies for
patient placement and staffing and a lot of the things I’ve described, so that
it’s not health systems like ours planning on our own, but really
partnering with other health systems and federal and state and local public
health authorities. I think we need to be mindful of accessibility issues and
affordability issues that will be very important for patients, especially those
who live far and have affordability challenge.sAand then finally I just want
to mention that we are also preparing to participate in clinical trials. You’ve
already heard here today we don’t have a vaccine, we don’t have therapies, but we
do have some candidate therapies and it will be important to learn more about
that and to make sure that we are offering the very best care at any given
time, and meanwhile collecting data so that we can learn how better to
handle this disease. Thank you, Dr. Maragakis. I’ll hand it over now to Jason Farley. Dr. Farley, good afternoon. I’m Jason Farley, professor at Johns
Hopkins University School of Nursing. I would like to begin by thanking our
frontline health care workers who are on the forefront of COVID-19 response. I
thank you for what you’re doing and the work that you’ve done and continue to do on
a daily basis, as well as our public health officials for keeping us all
informed and up-to-date as this outbreak occurs. I’d also like to thank each of
you who were here today and supporting the members and the tireless effort that
you have for the work that you do for our nation. As my colleagues have already
detailed throughout our discussion today, this is a quickly changing outbreak, one
that is causing alarm across the nation and the globe. The WHO has dubbed the
situation of COVID-19 as much an outbreak as it is an outbreak of
misinformation, an info-demic is the word they used, As the only nurse on the
panel I believe is my duty to speak to you first and foremost about the
frontline health care workers who are at the forefront of the response and I
really think it is they’re following their duty and stepping to the forefront
to care for patients with kovat 19 as many of you have seen there are growing
concerns across the health care workforce related to the their personal
safety as well as access to personal protective equipment as well as timely
testing that has been mentioned it is important that we arm everyone with
accurate information as well as personal protective equipment throughout the work
health care workforce in a survey conducted recently by the National
Nurses United a union representing approximately 150,000 nurses which is
granted a small sample in comparison to the four million registered nurses
across the United States but nonetheless it is the most accurate and up-to-date
information that we have and the best I’ve seen thus far at about 6,500
nursing respondents to this survey who participated with about 29 percent
reporting that their hospitals had they knew about a plan that was in place at
their facility for coronavirus patients 44 percent of these registered nurses
said they perceived that they had received guidance from their health care
system another 30 percent in that same sample didn’t really know exactly what
was happening at on the ground at their spa site which is the most alarming fact
that means the communication in the individual healthcare system has fallen
short in some way but this is a mere glimpse of what’s happening at the
frontline of the epidemic this is just a mere snapshot but it has led to
activities such as the New York Times report and others reporting significant
anxiety among the healthcare workforce and I think that’s contributing to
community level anxiety as well so the CDC put out interim new guidelines which
they’re doing quite frequently and quite rapidly again approximately two days ago
and they recommended that health care workers who have potentially been
exposed or in settings where there’s community ongoing community transmission
report every day to work and report whether or not they have symptoms and/or
fever they also noted that implementation of both contact and as
dr. Marcus mentioned airborne precautions in the healthcare facility
would be implemented and recommended despite the fact that we do believe the
virus is most likely transmitted via droplet again that six foot high sneeze
coughed that spray that everyone sees in those pictures that you’ve probably all
seen across the internet but but with that droplet transmission close contact
is generally required and the CDC has a clear definition of what we believe
close contact is Coast contact is defined by the CDC is that six feet
parameter right or contact for a prolonged period of time with someone
with known coronavirus symptoms or known to have corona virus now importantly
that can be both with personal protective equipment depending on the
circumstances and without and the CDC has given us a pretty clear roadmap for
the type of exposure a health care worker might face in those circumstances
what’s considered high moderate and low-risk has been clearly outlined in
those CDC guidance so I invite you to take a look at that it will provide you
a pretty clear picture also you will see across the media I think what is a
somewhat of a misrepresentation often of an Ebola like personal protective
equipment response posted on multiple media outlets and I really wanted to
call our attention to what the CDC actually recommends
for protection right we’re thinking airborne precautions right we have an in
95 health care workers are fit-tested meaning they’ve been specially tested
and their face has been shaped right perfectly for that mask
they’ve been evaluate or determine whether or not it works for them or not
which is why yet again we’re not recommending the general public go out
and seek that type of respiratory support or protection also there are
personal air purifying respirators or poppers which kind of look like a
spacesuit kind of comes down covers your entire face again really adds an extra
layer of protection because it covers all the mucous membranes
alright that’s another layer of protection that many healthcare workers
have access to I know at Johns Hopkins we are all trained on the use of what we
call as poppers but that must be can used in conjunction with contact
precautions so barrier precautions as appropriate as well as standard
precautions as the case may be in addition to appropriate health care
worker and health environment don’t cleaning so our frontline staff our
cleaning staff our housekeeping staff are as equally as important in stopping
the spread of this outbreak both within facilities as well as in ambulatory care
settings as our our collisions are providing the care hand hygiene works
absolutely you don’t need a nurse to tell you though to wash your hands
but Purell whether it’s alcohol-based santé hand sanitizers or or water-based
and soap water and soap it’s really both equally effective so use what you’ve got
at home it’s equally effective I think that’s important high touch areas and
high surface area so you’re thinking about you know the metro that you all
wrote in on this morning right those are high traffic hand environments keeping a
bottle of Purell in your pocket it’s a simple activity that you can do a little
alcohol sand hand sanitizer keeping frequent hand hygiene is really really
critical it’s probably your most important protection when we think about
current studies suggesting how long coronavirus will live on those hard
surfaces it the answer is it depends environmental conditions and also the
type of media that was coughed or sprayed out how quickly that dries but
estimates range from anywhere from a couple of hours to up to several days
I’ve seen estimates as high as nine days after
exposure to an environment but we must also keep in mind that the CDC interim
guidelines provides us that clear exposure table for health care workers
and has given us clear guidance which I’ll go into now for the community one
final thing before I leave the healthcare workforce recommendations it
is we are still in the middle of influenza season and so we also must
think about other respiratory viruses that could be causing. I was in clinic
last week and diagnosed a patient who came in with influenza B so we are still
seeing a record number of influenza cases that are quite common in our
environments as we move to the general public infection control precautions and
things you could do I think first and foremost is we’ve heard lots about
staying at home if you’re feeling ill or sick and all of us again who took that
Metro in this morning have heard the coughing sneezing sniffling and stuffy
head you know nyquil commercial kind of symptoms on that Metro and I think it’s
really critical that we are taking heed of it sure if you’re not feeling well
stay at home but also from a patient and human centered response know that there
are millions of health workers throughout this country who do not have
the option of staying at home because if they do not report to work they do not
get paid so there is a balance that we need to achieve with that recommendation
finally we know about general cough hygiene coughing into your elbow lots of
elbow bump since as opposed to hand shaking there’s some basic principles
and practices that one can employ there and as I mentioned in 95s those special
types of masks that healthcare workers use are in very short supply I was in a
conference call in some of the work I do in tuberculosis in South Africa and the
cost of an individual in 95 masks for healthcare workers in TB wards in South
Africa have more than quadrupled in the last month and so we’re seeing a global
shortage of in 95 both for in the United States for our health care workers and
some sites reporting that they are having challenges with achieving enough
in 95 but in global settings as well and in the world’s leading infectious
disease killer tuberculosis we are having challenges with healthcare
workers so again pay very close attention to those options if you are
SiC a simple paper mask one of those slight blue masks could help not prevent
you from getting ill but prevent you from infecting others by stopping that
droplet transmission right that coffin that sneeze still if you are concerned
and living in the in the community and there’s community transmission we’ve
talked about social distancing meaning staying at home telecommuting possibly
watching your Sunday services or Saturday services or whichever day you
worship those services online or through some other means and supposed to
congregating in those settings also limiting travel we’ve seen lots of
limitations that have occurred and recommendations on limitations with
travel and then really thinking about as dr. mariga’s pointed out we do not have
the capacity for a large influx of worried well meaning if you’re you
simply have a cold you’re feeling fine certainly talk to your primary care
clinician seek advice but over owning the health care system at this point is
actually the opposite of what needs to do what needs to happen and then finally
just on public health messaging and communication a clear consistent trusted
messaging is extremely important we need again a people centered approach meaning
we must raise awareness without raising panic and fear and so that’s a delicate
balance that needs to be struck also we really have to avoid and I think the
data that’s being presented by dr. Gardner is very important because it
helps us to realize that the over generalization of any region of the
world and any population within the world is is clearly we’ve gone beyond
that and so there were some initial points of reports of stigma and
discrimination that we’re occurring for people from certain parts of the world
and that is not something that any of us would like to see happen and I think
that we should use an evidence-based approach and look at this data to know
that stigma discrimination of any kind particularly as it comes to a co vyd 19
is not something that should be supported by any evidence that we have
available to us thank you thank you so much I’m gonna go ahead and
start the Q&A session I would say about a third of these are focused around
testing capacity so maybe I’ll start with one for dr. Mary Gatos and dr.
Inglesby do you think the testing capacities Act is adequate in the US and
do hospitals with labs have access to everything they need to either package
up and send or perform the tests thank you for that question
I think the short answer is no it testing capacity is not currently
adequate and we need more we need this as soon as we can have it and I think
there are a variety of efforts underway to provide access to that testing one of
them is that test kits have been distributed again from the CDC to the
State Health labs and many state labs are now coming online to provide testing
for their areas in addition microbiology labs like the one at the johns hopkins
hospital have taken a number of steps to develop their own testing and and we
hope that ours will come online in a matter of days if all of the validations
step goes well so I think all of those individual efforts are to be commended
because we desperately need the testing and then finally we also know that
commercial laboratories and companies who develop diagnostic tests are also
working on this issue so that hopefully we will have and I think this is
probably in a matter of weeks hopefully not months but hopefully weeks that we
would have access to more rapid forms of diagnostic testing that we’re not so
labor-intensive as the tests that we have now – that is just to say that this
is the process that occurs when a new emerging infectious disease is
discovered and the country needs to test for it in that CDC
is the developer of the initial test and then they move that out to state health
laboratories around the country but neither CDC or health labs are intended
or designed to handle very high clinical volumes around the country and for that
to occur we need to have our major clinical Diagnostics companies fully
involved and it seems that they are at this point and I think the only question
is when will they be able to get their tests online I think they’re working
quickly to do that and hopefully in the next week or few we’ll be able to see
much more scale at clinical sites around the country great thank you
um the next questions for dr. Farley as we start to see more people infected and
more cases rise so as the testing capacity increases and we see the cases
that may or may not be already there what’s the best way to keep people calm
and informed and message what those those increased numbers mean this is
this is a setting in which having more appropriate testing will ultimately lead
to greater public call because I think the data dr. Inglesby reported to us
from South Korea and the actual case fatality rate data you know in a setting
in which we know that testing was rolled out quickly and adequately and to a
large number of people we saw numbers of total cases that were having severe
disease and/or subsequent death declined significantly and I think that really
will help us to message correctly right now because of the focus on testing for
those most ill we’ve got a really large case fatality rate I mean and larger
than we would we hope to expect it will ultimately play out to be so I think
that’s the first thing the second thing is messaging around that needs to be one
of the public health experts providing that knowledge and expertise and I think
we’ve seen some great data coming out of dr. fell with dr. Falchi and ambassador
birx as well as dr. Redfield from the CDC providing that clear and consistent
and calm message to the public and a follow-up question to that possibly for
you and dr. Marcus what should we be doing to better protect
these vulnerable populations such as people with disabilities seniors and and
the populations that are going to be most affected by this disease so or
thank you it’s an important point that we are not all we are all susceptible as
far as we know to this virus because no one has immunity since it’s a novel
virus however we are not equally susceptible to the severe consequences
of this infection so our data suggests so far that 80 to 85% of people who
become infected will have very mild to no symptoms and it will be a
self-limited disease and so really what I think you’re alluding to is the very
vulnerable populations which at this time seem to be older individuals
individuals who have suppressed immune systems or underlying medical conditions
and and this is very familiar to us this happens every year with influenza
as well some of the same populations that when infected with respiratory
virus like this can exacerbate the underlying medical conditions and and
lead to severe consequences so measures that we can take I think first of all is
knowing that and taking we’ve heard a variety of strategies here today so I
won’t list them again but taking extreme caution with those who are more
vulnerable one spot of bright news I think for this virus is that the
youngest children don’t seem to be as vulnerable and and that’s a blessing in
this case we’re not sure exactly why that that seems to be the case but a
difference for this virus great thank you and I follow up to question to
something that dr. Marcus and dr. Farley touched on maybe for Andy peckish um how
long can the kovat 19 survive on surfaces and and how our science is
starting to look into this question of analyzing that a very important question
and has it been mentioned here before you know the how long a virus survives
on a surface is dependent upon a lot of different parameters how large
the droplet was that was deposited what was in that drop let there’s some
interesting studies that suggest that sometimes your mucus that’s present
there can actually stabilize these viruses and maybe extend the amount of
time that they’re there so some of these studies are ongoing right now
and we can’t give you a firm answer but I think it’s also very clear that the
all the disinfectants that we can use against standard viruses work very very
well against this kovat 19 virus so almost irrespective of how long the
virus can survive on a surface is the fact that if you simply do a good job of
trying to clean these common areas these these areas that people are touching on
a regular basis you will be reducing your risk to getting infected so good
cleaning technique good disinfection techniques being aware of your
environment and the and the weak links that would people have like the doorknob
or the door that will be pressing as we’re leaving here is a common area that
what what are worried about a hundred of us are going to be touching so
understanding those kind of services you know and and intervening there is
probably the best strategy to try to minimize transmission and perhaps
washing your hand as soon as you leave the room dr. Inglesby we have a question
about the emergency authorities that are available to the president and governors
and other political leaders when we have a public health emergency like this what
circumstances would you think that activating these authorities may be
necessary are we there yet do we have more to go in the US public
health authorities are mostly devolved to the States and in most states there
is law that allows governor’s to do what they think is right in public and in the
interest of public health and protecting public health so if necessary governor’s
around the country will likely have the power to to cancel gatherings to
quarantine individuals that they believe need quarantine in perhaps to use
facilities that are would be used for isolating cases or
quarantine cases I think local decision-makers will make those choices
hopefully in ways that are the most wise for their communities and I think we’ve
seen that governors who have cases have already invoked emergency authorities to
allow them to do these kinds of things so I think they’re in place I don’t
think it’s so it’s not a large barrier for them to use them and I think they’ll
use them in the ways that they feel like are most important for their communities
great things um a question maybe for the whole panel but particularly dr. Mayer
Gatiss hand sanitizer is very hard to get these days how many stores or many
stores are sold out and so when you go to his store has sold out what are the
alternatives a great question I actually took a
picture last weekend of my local stores empty shelves there was no Purell no
store brand no kind of any alcohol-based hand sanitizer the good news is that it
was surrounded by shelves of soap and so I think we heard here today that good
old-fashioned hand washing soap and water will work and so far I don’t think
there’s any shortage of soap so I think we shouldn’t panic by those empty shells
and and just wash our hands get back to the to the sinks and the soap and and
and the other good news I think is that alcohol-based hand sanitizer and perhaps
the companies will be unhappy with me for saying so but you know we can make
it there is a key ingredient there that is the the alcohol so you know I’m not
too worried about this great thank you dr. Farley could you talk a little bit
about first responders and how they can prepare for the outbreak and and things
that they can do to protect themselves um and how we can support them sure well
obviously you know when we think about the sharp end of the spear our first
responders are that sharp end of the sphere and really a critical component
in the chain of survival for so many of our patients our first responders EMS
and others are very well equipped with personal protective
equipment in ambulance vehicles and others where it is probably less clear
at this moment is what one needs to do as the spread occurs more generally in
the community in terms of how they would respond to each individual call because
remember our first responders walk into scenarios where they really have no
background information other than 911 called right
and so each jurisdiction and each area will need to make that own EMS related
decisions as to what level of PPE as you know depending on the spread within a
given community the first responders would would actually use it may get to a
point if there’s long going community transmission that it would make sense
for a slightly elevated level of personal protective equipment for first
responders but that would be on a community by community ems by ems basis
great thank you dr. Gardner and also for dr. Farley as well you both sort of
touched on this but there is a lot of misinformation out there and there’s a
lot of false data out there how do you combat both misinformation and also
analyze whether the data you’re seeing are real and accurate and trustworthy so
I’ll start with this one because it’s obviously relevant to the dashboard it
is really tricky there is a lot of misinformation we aren’t focusing so
much on that as much as spending all of our efforts really finding the sources
that are reliable and so like I said the dashboard is built on data collection
that spans everything from fully automated to fully manual entry the
manual entry is because especially at the moment for example all the us entry
and the Canada and Australia entry is done manually because we’re actually
checking each case as it’s reported and looking into what is the source that was
reporting it and making sure that it is a valid source coming out of some kind
of Public Health Department and a real confirmed case the automated data that
we’re including we include only after we have vetted it
and observed it for a period of time and so that we’re confident in the data that
is being basically provided on these sources that were scraping and
automatically updating into the website and so and then the other thing like I
said is we do put a lot of energy into what the data is that we do include in
the dashboard and then as kind of a second double check we continually
compare the data that we’re presenting with w-h-o data which is the completely
independent source and make sure that our data aligns with that data and again
I mentioned the only discrepancy is based on at a given point in time we
want to expect it to be the exact same we would expect ours to be higher
because it’s built in real time but we can see that at least over time the
trends align and so I think that really one of the huge motivations behind this
and clearly why it is so popular is because there is just such a need for
having trustworthy reliable objective information today given all of the noise
that is out there and so that’s we just basically do the best we can to provide
that as one single source wanted to mention one thing that you know there
there there have been a number of rumors that have been started in a number of
perhaps preliminary perhaps incorrect sort of scientific papers that have been
put out there in this quest for rapid dissemination of information and and I
do think that there is a small cadre of scientists that are actively out there
on social media that are you know really patrolling for these things and not just
responding in terms of oh this isn’t true but actually using fact and
evidence and logic to actually argue against some of these things and well in
some cases one can say well if someone says something truly incorrect that’s
very inflammatory perhaps the genie is out of the bottle but at the end of the
day having responses that scientists have put together that really
my point discredit or disprove or cast doubt on other people’s conclusions is
something that is really important out there in terms of for most people having
some level of confidence that that the right information is getting out there
and that there’s a level of policing of the information so that not everything
is getting out there and being freely disseminated actually I will add to that
one of the best things about having billion eyeballs on our dashboard is
that essentially in some ways this is crowd-sourced information and there are
so many people watching it and so as soon as where you become behind on cases
people send us that information which my email inbox is not happy about and
usually the source with it and so we’re actually guided right to the correct
information if we are missing it and if we ever over report we will be corrected
on that too and so we’re actually kind of cross-checked by the public on this
because of the way it’s designed I would just add that each of particularly that
those of you in the room that are staffers with members you you have in
your in your possession a digital influencer someone who has the social
media capacity to influence fact accurate information and to prevent
misinformation from moving forward we also has a personal responsibility to
that vet and validate things that we share on social media so if you are
sharing things that you personally don’t know the source of that information or
don’t necessarily know that you would trust it for your own health why share
that particular piece of information on social media and then finally I want to
applaud both CDC and whu-oh for working with our social media giants in helping
to dissuade misinformation the propagation of misinformation on various
platforms there have been a lot the buy-in of many of the platforms to take
down unfactual and misinformation on their platforms and I want to just say
that that is an exact type of response that we need from it them at this time
great thank you I’ll hand this one over to dr. Inglesby
as we heard from dr. Marcus Hopkins has an impressive you know presentation of
medical capabilities for this and and even we are working overtime to prepare
to and respond to this outbreak what would you say the state of readiness of
US hospitals you know broad scale across the country
looks like and what can we do to improve it we we don’t really have a completely
systematic way of answering that question it’s not we don’t have systems
that can pulse every Hospital and understand it’s complete state of
readiness hospitals have been involved in receiving support through a federal
program called the hospital preparedness program which is administered by a spur
and they work with their state health agencies on that in the end that’s even
though it’s a substantial grant program there are many hospitals in the
countries so the overall support for any one Hospital is still relatively modest
so I think at a high level I think we have to say that the readiness level
across the country is it’s quite varied and in big institutions that have large
teams I think we can expect that readiness is higher I think if we think
about health care institutions that are smaller or away from cities I have more
concerned that they have less surge capacity less training around infection
control less access to information that some of our best hospitals and our
biggest cities might have so in our planning at a federal and state level I
think we need special attention to some of the smaller institutions with less
resource and with less access to some of the top leaders or protective equipment
or other kinds of strategies that we’ve used for the big institutions great
thank you I’m gonna combine two questions for the
whole panel so anybody who wants to take this on Ken particularly thinking of our
population that cannot tell a work or you know telecommute or work from home
how can the public especially if they do have to go out during this outbreak
protect themselves while taking public transportation going to schools working
if they can’t work from home etc go just yeah sure hand hygiene hand hygiene hand
hygiene number one if you’re sick stay at home and those are your two most
important features please note the statistic of eighty to eighty-five
percent of people who are known to be infected with corona virus are doing
very very well and so most of us that are out in that
workforce particularly you know young healthy able-bodied people are are very
low risk of clinical complications from this virus and that’s an extremely
important message so hand hygiene you know if you’re concerned about touching
surfaces or else will fall over if you’re not holding onto the rail in the
metro you know it takes a little small package of Clorox wipes or some other
thing and wipe it down before you grab it it’s all it’s all just basic kind of
general personal hygiene techniques and practices great thank you
um so if viral particles can remain airborne and for a certain amount of
time or create these this disease excuse me disease can create droplets can you
talk a little bit about the the advice that is out there on not wearing masks
and why that’s important for general public maybe I’ll hand it off to dr.
mayor Gatos and then dr. pet gosh sure this is another area that I think we
need a lot of messaging to the general public because we do see a lot of images
of people around the world wearing masks in public settings the current guidance
is to that that is not necessary and in fact may not even really add to to
protection I think the things that we just heard about washing our hands even
though it sounds so basic it’s just that’s the critical link we touch
surfaces we touch doorknobs we touch our face and that’s how viruses get access
to our to our mucous membranes so if we wash our hands that
that is the the very best way to prevent infection and yes I’ll also emphasize
that you know a mask me sometimes give you a false sense of security as was
mentioned here we get trained on how to put these masks on and they’re verified
in terms of how well they’re they’re they’re they’re fitting they’re they’re
working just before I came here my biosafety officer actually walked by and
jokingly gave me a razor because I’m gonna have to shave to be refitted
tested for an n95 because having facial hair it precludes me from using an n95
effectively and it’s these kind of things that I think the general public
doesn’t really understand and anytime you know something that like a face mask
that has the potential to help you if it’s not used correctly again as a south
false sense of security and may actually help facilitate behaviors and exposures
so I think the training behind those masks is something that needs to be
emphasized to the general public it’s not just having a mask it’s knowing how
to use it effectively and safely I can just add one more thing and that is that
I think we’ve already talked about some of the supply chain challenges so I’m
just really trying to get the supplies that we do have to the people who need
it most and where we know it is effective um so we have a couple of
questions on the illness itself so I’ll just combine them all and then anyone
who wants to chime in can um how long after contracting the corona virus will
some what will it take for someone to test positive and are false negatives
possible and if so what does that mean for spread and then if you recover from
Kovan 19 can you get it again and if yes what does that mean for vaccine research
and development so anybody who wants to grab one of those go for it
a couple of those so we know that the incubation period has a wide range so
from the time that you’re exposed the time that you are sick can be anywhere
from a day to 14 days the first patient that came back from China and was
diagnosed with corona virus had very mild symptoms at the start
and eventually self-identified brought himself to the hospital and over a
period of time developed cough and fever and then at some point mild shortness of
breath but it can take some time for those symptoms to accrue for people who
get really sick it can be five days six days from the time that you start with
symptoms to the point where you feel really ill and need hospital care so
it’s important even in people who have initial mild symptoms just to be aware
that your condition might change over time and might need hospitalization at
some point again most people will not need that but there are the cases that
do have some progression of illness over time Oh
testing testing is it possible to have a false negative test yes it is people are
tested multiple times and the course that our illness when that’s possible
it’s possible we’ve we’ve heard reports of people testing positive then testing
negative and then testing positive again most scientists don’t believe that
that’s person being reinfected but that’s just the that’s just the nature
of the test it’s not a perfect test you might test negative but still again a
better test or a subsequent test is positive so in most cases it repeated
tests negative are required before someone is discharged from care you know
the question about reinfection is a really important one I think we’ve only
now gotten to the stage where we’ve had people who have been infected recovered
and and recovered long enough for us to actually start asking those questions
but that also is going to require the development of new types of tests tests
that are based on antibodies that tell you not that you still have the virus
but what what your history of exposure to that virus was and our best guess is
that antibody levels are going to be predictive of whether you’re protected
from infection so these antibody based tests that people are now developing and
will soon be hearing a lot about are going to give us a lot of information
about how strong your immune response is how long it lasts and how well that’s
going to correlate with protection so I think the answer is we’ll know more over
the next couple weeks as a case with a lot of questions about
this this outbreak great thank you I’m going to ask dr. Mara Gatos this one
because we just had a conversation about it we’ve been seeing a lot of people
bumping elbows instead of shaking hands but germs can but can germs be
transmitted this way because people are also being told to sneeze our coffee
into their elbows instead of it to their hands what a great question so you know
I go back to to the earlier comment about hand-washing I shook hands with
someone two days ago and they they looked at me astonished and said you’re
still shaking hands so you know I do think that anytime something like this
happens we have to look at our cultural practices in in this country handshakes
are almost second nature I know our European colleagues are also looking at
the kissing each other on the cheek and you know in other other opportunities
that we have so and that falls into the category of social distancing so yes
bumping elbows you know is one one way there are other ways so probably I would
say we need to you know come up with a different kind of accepted cultural
greeting that everyone can can utilize because you know this is the the threat
that’s with us today and we know that respiratory viruses sweep through every
every season so that would be a good habit to get into
as far as sneezing into your elbow yeah it’s a good point I hadn’t really
thought about I’m going to ask one last question since we’re short on time and
so anyone who has thoughts on this one I’m sure there are a lot of people in
here who would love to hear it and we do have spring break coming up and people
are making decisions I’m canceling plans and changing travel arrangements maybe
we could just go down the panel and give us some thoughts on on what it means to
cancel plans or if you should be thinking about cancelling plans they’re
very difficult set of questions because at this point just thinking about
domestic travel for Spring Break we are going to learn a lot about
the extent of disease in the coming week or two as State Health labs and
hospitals begin to test more I think what we’re gonna see is that there’s
disease in most places in the country and whether your risk is higher when
there’s 20 cases in a state versus 50 cases in a state I don’t think we have
that kind of perfect knowledge so it’s not clear yet that going to special
places in the country is likely to increase your risk and and federal
health authorities have advised that they don’t think there is any need yet
for any kind of domestic travel restrictions from studies on airplane
with airplanes with other viruses we think it’s just using airplanes as one
mode of travel that there is risk if you’re sitting very close to someone
with corona virus or with another respirator disease which rewards been
studied before or in a row or two in either direction but typically the whole
plane isn’t considered to be at risk it’s really do you have the bad luck of
sitting next to someone with a particular disease or in a row in front
or behind so to some extent these are gonna be decisions that people need to
make on their own there probably isn’t going to be guidance that is clear for
everyone in every condition I think a lot is going to depend on what your
destination is whether it’s national or international and just understanding
again appropriate things that we can do in our own control to reduce risk around
hand hygiene or trying to avoid people who are actively sick in your presence
and I think these decisions will be changing over time but at this point
there isn’t any national guidance around travel restrictions domestically and
there’s pretty clear guidance around where the US government believes people
should not go or should only go for essential work reasons you will I’ll
tell you what we’re dealing with I don’t have an answer to this either but what
we were dealing with too is is the question of scientific conferences so
the past president of the American Society for virology
has an association over 2000 virologist that annually gets together
to discuss wide-ranging issues on viruses our meetings in the middle of
June in Colorado State and we’re having very significant discussions as to
whether that meeting should go forward people are coming from all sorts of
areas of the country areas that have exposures that have transmission areas
that don’t and I think even more importantly there’s the financial
considerations for individuals where you know perhaps we’d like to wait and make
a decision but at some point in time airlines may not refund tickets hotels
may not refund British hotel costs and so there are all those other factors
that are also coming into our decision-making factor outside of just
the question of whether or not this is this thing that we should be doing at
this point in time regarding epidemic control and kovat spread so it’s a very
very complicated question that I think a lot of societies are also
dealing with as well as individuals great thank you
well we are out of time and this concludes our briefing I want to thank
you all so much for being here I think judging by the number of people in this
room we can tell that this is an issue that’s on everyone’s minds I will
encourage you to visit the johns hopkins coronavirus resource center online at
coronavirus JHU edu where you can find all the johns hopkins resources to help
advance the understanding of the virus to inform the public and brief policy
makers in order to guide a response improve care and most importantly save
lives at johns hopkins were guided by the principle of creating knowledge for
the world my colleagues at the johns hopkins office of federal strategy stand
ready to assist you with any policy or research support you may need ANCOVA 19
and countless other issues thank you so much for attending and for tuning in and
I’ll remind you to wash your hands after you leave the room have a good afternoon
everyone thank you you


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