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>>BOB ZALTSBERG: Welcome to Noon Edition on WFIU. I'm your host, Bob Zaltsberg. I'm being joined today by co-host and news bureau chief Sara Wittmeyer. There's been so much going on in the news lately, we are covering a couple of topics today. First, we'll talk about Supreme Court Justice nominee Amy Coney Barrett and her Indiana ties, and then we'll close out the hour with IU Health's Dr. Dan Handel talking about reopening the state and COVID-19. We have two guests for the first part of the program with us. We have Beth Cate, an O'Neill School of Public and Environmental Affairs clinical professor - a clinical associate professor. Sorry, Beth. She's been a frequent guest on our show when issues involving Supreme Court arise. She also is an attorney. And Alan Achkar is the editor - executive editor of the South Bend Tribune. His newspaper has done quite a bit of reporting on Judge Barrett, who is a Notre Dame faculty member. You can join us on Twitter. You can follow us at @noonedition. And you can also send us questions there. And you can send us questions for the show and news at Indianapublicmedia.org. Well, thank you, Beth and Alan, for being with us today. I want to start with Alan. You have been aware of of Amy Coney Barrett for quite some time up there in South Bend. So can you sort of give us an overview of her connections to your community? 

>>ALAN ACHKAR: Yes. Can you hear me OK, Bob? 

>>BOB ZALTSBERG: Yes, sir. 

>>ALAN ACHKAR: OK, yes. So Amy Coney Barrett actually is from New Orleans. She grew up in New Orleans area. But she did go to - her introduction to South Bend came in the late 1990s, when she attended Notre Dame's law school. And she graduated top of her class, so she was an outstanding student. After graduating, she worked in both some private practice, but also clerked for some justices and then came back to Notre Dame to be a - to join the faculty in 2002. And she has lived in South Bend and been a Notre Dame professor in that time. And also in those last 18 years, she and her husband, Jesse, have had seven children that they have raised here in South Bend. Two were adopted from Haiti. She has talked publicly about - as she and her husband were preparing to get married, they were very influenced by friends they knew or acquaintances who had adopted from overseas and felt that that was something they wanted to do at some point in their lives. And again, they have done that twice from Haiti. And really, she - her public profile went big in 2017, when she was appointed to a circuit court - circuit appeals court judgeship by President Trump. And then, shortly thereafter, not even a year later, she was a finalist for the Supreme Court. Brett Kavanaugh got that pick, but Amy Coney Barrett by all accounts was one of the top three or four finalists for that position. And sure enough, she was the pick this time when the seat came open again. So that is a very quick introduction to her and her ties to South Bend. 

>>BOB ZALTSBERG: All right. Well, we'll be back to you in a few minutes to talk more about, you know, her public profile up there. But, Beth Cate, what do you see as, you know, the importance? And, you know, there have been lots and lots of things that have been talked about on the news. But how do you see her nomination shaping the court? 

>>BETH CATE: Sure. So thanks, first of all, for having me. Can you hear me OK? 

>>BOB ZALTSBERG: Yes. Yes, we can. 

>>BETH CATE: OK, great. So, you know, there was a lot of discussion before Justice Ginsburg's death in kind of the post-mortem on this Supreme Court term about this really being John Roberts' court and that he was kind of aggressively trying to build coalitions to issue rulings that would preserve the integrity of the court and the perceived integrity of the court because he cared so much about the institutional reputation of the court and so on. And to some extent, a - you know, losing Justice Ginsburg and replacing her with a conservative justice is going to - whether it's Amy Coney Barrett or someone else - now, obviously, she's the nominee - challenges Chief Justice Roberts' power, if you will, to some extent to achieve some of the, you know, 5-4 rulings where he was voting with what are typically called the liberal justices to - you know, to just kind of have an outcome that is going to be perceived as - you know, or he thought would be perceived as less politicized. And so, you know, it's just - it - you end up with potentially a very solid conservative bloc of six justices. And Roberts himself is a conservative justice if you look at his voting history. So I think that, you know, in that sense, that the big question in people's minds - and no one really knows until, you know, she's on the court and we start to see cases - is, what is this going to look like? And how much would his desire to try to steer the court in a direction that will preserve in people's mind the notion that this is not just politicians in robes - it is, you know, people doing law - how much that will influence her in how she approaches cases. I mean, if you compare to Kavanaugh, for example, Justice Kavanaugh came on, he's actually voted really quite a bit in lockstep with Chief Justice Roberts since he's gotten on the court. She will, you know, also face, I think, a fairly aggressive hearing process. Not in quite the same way as Justice Kavanaugh, but, you know, I think for him, it sort of scarred him enough that when he came on the court, he's been sort of actively trying to steer a mild course. And with Amy Coney Barrett, I - really, I don't know. I don't see quite the same factors necessarily limiting her. But it's so hard to say. You know, she's been on the appeals court only three years. She has some decisions on the appeals court. But when you get on the Supreme Court, you don't have the same restrictions that you do when you're an appeals court judge. At the same time, you know, you're joining a very small group. And I think there are just some dynamics on the court that could shape anyone when they go on there and they try to figure out how bold and aggressive to be in pursuing what they think is the appropriate judicial path versus hanging back for a little while and getting your footing. So... 

>>BOB ZALTSBERG: Yeah, if I could follow up about Justice Roberts, I mean, I think it was believed pretty strongly when he was named to the court that he would be a strong conservative voice on the court. And that hasn't necessarily turned out to be the case. 

>>BETH CATE: Yeah. I mean, sort of yes and no. You know, people point to some of the decisions where he's, if you will, crossed the aisle. And obviously, with another challenge to Obamacare coming up this term, people are pointing back to his decisions in earlier challenges to Obamacare - as one example, the recent vote on the June medical case involving abortion rights - as another, the Title VII cases and so on. And I think it's fair to say that he has really - his institutionalist side has caused him to try to really look for coalitions and build some coalitions where the court will move incrementally. It will not take bold steps in certain areas that are highly controversial or would make the court look in particular politicized. I think his votes and his writing - he's actually, you know, taken - when he's in the majority, he gets to decide who writes the decisions. And a lot of times, that's been him. And then he gets to sort of steer that path even more. And so in cases like the census case and in the DACA case, where he was, I think, making a strong statement about, we have some baseline minimum expectations when public servants issue regulations, or they take certain actions in the administration. They're going to be honest and above-board in describing why they're doing what they're doing and have that be reasonable and take into account the effects of that. All of that, yes, sounds like - you know, people point to this and say that John Roberts is not a - you know, a sort of conservative in the way people might have expected. At the same time, he has cast plenty of conservative votes as well - on the First Amendment with respect to religious freedom, for example, a topic that has come before the court a lot in recent years. So, you know, it's a mixed bag with him, I think. 

>>BOB ZALTSBERG: All right. Well, I'm going to ask you this question, but I want to get Alan Achkar's take on it first. I mean, a lot of the critics of Judge Barrett have talked about her being sort of - being very conservative to the point of, you know, very religious conservative. And, you know, I guess people on the liberal side have not been very kind to her and think that she's going to be a radical who's going to overthrow all sorts of liberal ideas. And I want to ask you, Alan, first, I know she's very popular in Notre Dame - at Notre Dame. And are people in South Bend and at Notre Dame talking about her as - I mean, did they see this side of her? Or do they think that she will be a very measured and very smart jurist? 

>>ALAN ACHKAR: So that's actually a complicated question, and I think it goes to her personal life as well and aspects of that. So let me unpack that. On the Notre Dame campus, she has three times been voted professor of the year, so that attests to how popular she is among students who say she is big on mentoring. She thinks it's a very important role for a professor. And they praise her for her smarts, her teaching and her mentoring. When she was nominated for the appeals court in 2017, every single member of the Notre Dame law faculty signed a letter to the president supporting her nomination. So that was a unanimous essential vote by her colleagues. So - and Father Jenkins, the president of Notre Dame, has said repeatedly he thinks she's a terrific choice for the Supreme Court. So, yes, on the Notre Dame campus, as a teacher, as a lecturer, as a legal mind, she's very well respected, universal praise about how intelligent she is and well thought-out. Where the controversy has come largely is within her personal life. She is a devout Catholic and makes no qualms about that. It's her association with a group called People of Praise that has raised eyebrows. Let me give you a quick background on that group. It is a Christian group. It is not affiliated with any church. It is primarily Catholic, but there are some other Christian denominations who are involved in that group. Formed in the 1970s, early 1970s, in South Bend around the Notre Dame campus. It grew out of the Pentecostal movement, and so it shares many of the elements that you would traditionally think of with the Christian Pentecostal movement. It's not a very large group. They've got about 2,000 members now worldwide. A few hundred - I'd say 300 to 400 of those are in South Bend. The reason it's drawn attention is there have been accusations from former members that the group is dominated by men, that it can be very controlling, that key decisions are heavy-handedly imposed on members, and that if you disagree with the views or tried to leave, you are shunned. The other thing that's gotten a lot of attention - the group believes in heads or mentors to sort of coach other members. They used to be called handmaids. The women were called handmaids at one time. It is a phrase that the group no longer uses. They've distanced themselves from that phrase because of the negative connotation that handmaids has come to have. The group denies most of these accusations. They say, we're not heavy-handed. While men are in leadership positions, this is not a sexist organization, and that they do not interfere in a heavy-handed way in people's personal lives. They - as a community, they come together to worship, to advise each other. But this is strictly a community group. And there's - the term cult has been thrown around, which they bristle at. They say they absolutely are not that. And certainly, in their members professional lives, they insist they take no role. And they say they have said - back in 2018, they said, look, if she becomes a judge, we're not going to be affecting her rulings. She is her own person. So it has attracted a lot of attention because, I think, it's a small group. It's not in the mainstream. And there are former members who have expressed a lot of reservations and criticisms of the organization. It's pretty clear that Amy Coney Barrett was a member of People of Praise for many years. But recently, the group has taken moves to sort of wipe that out. So, for example, in the last few days on their website, they've tried to remove all references to her. They said they've done that to - because they like to protect the privacy of their members. She has not spoken publicly about it. So it's unclear if she is still a member, even though she has been for years and her parents have been leaders in the organization. But it's unclear if today she is still a member. I suspect this is going to come out in the hearings. And then, of course, there's been a lot of focus on her views on abortion, which I don't want to go into that now, but we can certainly talk about that as well. 

>>BOB ZALTSBERG: OK. Yeah, just briefly, I mean, what are her views? And I think we all - probably, if we've been paying attention, we know - but if you could just expand on that a little bit. 

>>ALAN ACHKAR: So one key piece that's been - again, she's a devout Catholic, and so she, you know believes - so that would lead one to assume that personally she would be pro-life. That's not a difficult conclusion to reach. People of Praise, the group I mentioned, is on record saying they are also pro-life, so, again, not a huge leap of assumption to make. But there are two pieces that sort of lend credence to that. She was in 2015, at least, part of a group at Notre Dame called Faculty for Life. She did sign a letter. She was one of one of the faculty members who signed a letter to the Catholic bishops affirming the teachings of the Catholic Church, including the sanctity of life. And then the news that broke this week that drew national attention yesterday, the local St. Joseph County Right to Life, which is a local pro-life group here in our county, every year takes out an ad in my newspaper, the South Bend Tribune, in which hundreds of people in the community sign a - it's an ad, and hundreds of people attach their names to it, affirming the sort of pro-life, anti-abortion views and saying, we oppose abortion, and we choose life. And in 2006, Amy Coney Barrett and her husband signed that ad. Their name was included in the ad. In other words, they threw their support behind this pro-life declaration. So that would indicate - as if people didn't already assume they did - that she is personally, at least, very much pro-life. That has Roe v Wade proponents nervous. But Amy has said repeatedly in public that she doesn't believe a judge's personal views should affect their rulings and that she always separates her personal beliefs from her rulings. So that's the shortened version on the abortion Roe v. Wade issue. 

>>BOB ZALTSBERG: OK, Sarah. 

>>SARA WITTMEYER: Beth, I want to ask you, we've - in talking about Amy Coney Barrett, we've talked a lot about Roe v. Wade and even the Affordable Care Act. But how likely is it that one of those issues will be among the first to come up? I mean, what are some of the first cases that maybe she'll be a part of? 

>>BETH CATE: Well, there's a case in the Supreme Court term - this coming term, in fact, that's coming up in early November on Obamacare. And so back in the first challenge to Obamacare, one of the challenges was whether the individual mandate was constitutional. And five justices said, well, it's unconstitutional as a regulation of interstate commerce. But John Roberts, who is - you know, who said, yes, no commerce clause power to do this. But he said it's a tax. I see it as a tax. And the court, generally, the Supreme Court and courts are under an obligation to try to find legislation constitutional if they can. And he said, given that obligation, I think it's reasonable to read the penalty that you pay if you don't get health insurance under this individual mandate as a tax and upheld it in that way. Fast-forward to 2017 and the Trump administration, and Congress signed into law a Tax Cuts and Jobs Act, which zeroed out the penalty that you pay if you don't get insurance. And that then led to another challenge to the individual mandate, saying, hey, there's no more tax here, and therefore now there's no constitutional justification for this piece of Obamacare and then took the next step and said, and if this goes, the whole statute has to go. The whole law goes, including protection for people with preexisting conditions to get access to health care, for example. And so that's what's being fought about this fall. And so if she is confirmed in time for that oral argument, she'd participate in the oral argument in the decision on the case. She could participate, even if she's not confirmed in time for the oral argument or doesn't participate in the oral argument, but that's more rare. So that's coming up. And then, in terms of abortion, I think it's fair to say that states are passing and have continued to pass in recent years many, many regulations of access to abortion and procedures and so on, and so including in Indiana. And so the court is bombarded all the time with petitions to take up issues of abortion. And I don't think that's likely to change. So then the question will be, is she going to be a vote to not just take one of those cases, but to take it and overturn the basic right identified in Roe v. Wade? On the one hand, she has said in speeches as a professor that she's given that she doesn't think the Supreme Court will overturn Roe so much as continue to uphold various state regulations that continue to restrict or regulate access to abortion. On the other hand, she has also written in articles, again as a professor, about stare decisis, you know, and that people talk about Roe v. Wade as a super-precedent and that the principle of stare decisis - let it stand if it's been decided - should protect Roe. And she has suggested in those writings - not with respect to abortion, per se, but more generally - that stare decisis shouldn't overly restrict courts, that it may pose even due process problems if it's too constricting and doesn't allow courts to revisit earlier precedents that might have been wrongly decided. But, you know, again, you just - really, you don't know whether, you know, she's going to go in for overturning the basic premise of Roe as an originalist. She bills herself as an originalist. I think she emerges that way in some of the cases I've seen of - from her on the 7th Circuit. And, you know, versus just saying, OK, I'm going to do what the court's been doing, which is, assuming the right exists, will they uphold various regulations of abortion? So stay tuned. 

>>BOB ZALTSBERG: All right. We will. We're talking about Supreme Court Justice nominee Amy Coney Barrett today on the first - well, two-thirds or so of our program. We have Beth Cate, an O'Neill School of Public and Environmental Affairs clinical professor - clinical associate professor at - she's with SPEA. 

(LAUGHTER) 

>>BOB ZALTSBERG: And Alan Achkar, South Bend Tribune executive editor. So if you have questions for us, you can get to us through Twitter at @noonedition. You can also send us your questions to news@indianapublicmedia.org. So, Beth, do you see her as an automatic vote on the right? 

>>BETH CATE: Well, I mean, it's a good question. I suspect that she - you know, she's an originalist. She is a textualist. And I think that she will approach and continue to approach cases in that way. I think there is a tendency to equate the concept of a conservative or a liberal justice with policy outcomes, the political or policy outcomes. And I think that's a little unfortunate. I do think that she's likely to be a conservative justice in how she approaches interpreting the Constitution, interpreting statutes. But I wonder if she will end up being a little bit like Gorsuch. You know, Gorsuch came out, and he wrote the three cases this past term which held that the federal nondiscrimination law in employment banned discrimination against people for being gay or transgender and did that on strict textualist grounds. You know, so he's a bit of a, look, I'm going to approach jurisprudence in this way, and let the chips fall where they may in terms of the, you know, policy outcomes and whether they match up with what the right from a policy or politics sense wants. So she may end up being a little bit more like that, actually. 

>>BOB ZALTSBERG: Well, Alan and I are mere journalists. But, Alan, I think you sort of alluded to this. You said that, you know, she says that she won't let her personal views get into how she interprets the law. She will base her decisions based on the law. And, Beth, you know, I've always sort of held out the hope that people who are nominated and then seated on the Supreme Court or any court are going to try to follow the law and interpret the law in their - the best way that they can. So I guess my question for - Beth in particular, but Alan, you certainly can join in here - is... 

>>BETH CATE: (Laughter). 

>>BOB ZALTSBERG: You know, how - you know, these fights over the Supreme Court have become so political in recent years. And maybe they always have been. But the notion that, you know, the Supreme Court is sort of looked at - people on either side will say, well, these activist judges want to do this, want to do that. I mean, this term... 

>>BETH CATE: Right. 

>>BOB ZALTSBERG: ...Activist judges - how fair is that? 

>>BETH CATE: You know, I mean, you can find activism on both sides of the received spectrum, I think, if you're talking about how the justices approach the interpretation of very broadly-worded constitutional language. Even - you know, Amy Coney Barrett clerked for Justice Scalia, and - who is a sort of famous originalist, and he spoke of, you know, it's judicial restraint to take an originalist approach because what you're saying is, we are bound in how we read this language by history and by what we can see in the historical record people in the 18th century who wrote this language thought that it meant. But, you know, justices are not trained historians. And so you can also see great amounts of debate over what the historical record even is. And so people make choices in that. And, you know, is that activism, too? So, you know, I think that people will sort of see this. But I will say you can take some comfort, I think, from the fact that justices and judges have to publish their decisions. For the most part, they do publish their decisions, and they write out their reasoning. And it has to make sense, or else you can spot where it doesn't or where you think that this is being driven by other considerations. And so that itself helps to try to keep judges and justices honest and try to anchor what they do in the law. And, you know, I think - I haven't read everything that she's written, but in the opinions that I've read, she seems to be writing in a very careful way. And she certainly as a - you know, a Seventh Circuit judge, she has to hew to precedent from the Supreme Court. But when she's a justice on the Supreme Court, assuming she gets there - and I think there's every reason to assume that right now - you know, she will have more flexibility to revisit precedents that she might have thought were wrongly decided based on her approach. So, you know, I - yeah (laughter), activism - it's everywhere if you're looking for it. I sometimes think that people overstate what they think are the politics driving justices and they under-appreciate the drive to try to understand this as applying law? Even if - you know, reasonable people disagree about the interpretation of the meaning of law. If these cases were easy, we wouldn't all be fighting about them all the time. So it suggests that there are competing yet reasonable interpretations. 

>>ALAN ACHKAR: You know, Bob, we... 

>>BOB ZALTSBERG: Oh, go ahead, Alan. 

>>ALAN ACHKAR: You know, there's this dance that unfolds every time someone is nominated by either party. So, you know, the potential justice insists that their personal views will not influence their judgments. The opposite party accuses them of being an activist judge... 

>>BOB ZALTSBERG: (Laughter). 

>>ALAN ACHKAR: ...And then pours over every microcosm of their past, everything they did from first grade onto their more recent career to find evidence of how evil they are. And then the party that likes them will insist they're the most brilliant, experienced legal mind in the history of the law. So we play this dance, you know, and it's playing out now with Amy Coney Barrett as well as we're seeing this. You know, the only clue - and it's been hit on - she clerked for Justice Scalia. She has said many times she is a big devotee of his originalist philosophy of judging. And so that gives you, I guess, the best clue of how she would rule on certain cases. So, you know, it's - we see this pattern playing out again. She's the greatest thing on one side, and the other side is saying she's scary, and she's going to do this, and she's going to dismantle this, this and this. At the end of the day, I don't think we're really going to know until she's seated. I think the one issue that's also really interesting here - it's hard to separate politics on this one in that the Republicans want her seated before the election because if the election or an aspect of the election gets contested and goes to the Supreme Court, they want that, you know, potential extra conservative voice to rule on it. And this is, I think as a result, a confirmation vote that's got an extra political bent to it because everyone's got an eye on that election. And I think that's why you're seeing an extra dose of politics this time. 

>>BETH CATE: I agree with that for sure. 

>>BOB ZALTSBERG: Sarah. 

>>BETH CATE: And calls for her recusal, for example, if there is that kind of challenge. 

>>SARA WITTMEYER: Yeah, just keeping that in mind, I'm just wondering about just sort of the long-term effects here and if it's possible there's any kind of court reform if she's confirmed. 

>>BETH CATE: I mean, you know, Democrats are already talking about the prospect of if they are able to keep the House, take the Senate, take the White House to try to get some court reform in place. There is a bill that was supposed to be proposed - I think this week, but I haven't seen it yet - to limit terms of Supreme Court justices and to do that by legislation, which it's unclear you could actually do that by legislation as opposed to requiring a constitutional amendment. But there have been proposals to just broaden the number of justices on the court so - and to try to, if you will, then give, you know, the next president, a Democrat, many more slots to fill, presumably with justices that would reflect that president's ideological bent toward constitutional interpretation and so on. One of the more interesting proposals I've seen out of Professor Ruckers is, why don't we just treat the court like we do the circuit courts? Meaning, let's not just go up to 11 or 15 justices or whatever it will take to now get a liberal majority, but let's go up to 27 and do panels that are randomly picked, and so try to dial down the intensity and the politics surrounding having only nine people and really only needing five for a majority vote. So yeah, there's talk of reform in the wind. Whether it will come about is anyone's guess. I'm not holding out a huge amount of hope for that. 

>>BOB ZALTSBERG: Only got a couple of minutes to go on this segment of the program. Beth, I wanted you to - if you could look back in history, I mean, the - what Mitch McConnell and the Republican Senate did in not allowing a vote on Merrick Garland for 10 months and then rushing this one through - you know, it looks like - to the naked eye, it looks like hypocrisy in the greatest sense. But then McConnell says, well, you know, we - the voters voted for us, so we can do what we want now. What kind of precedent is there for that? 

>>BETH CATE: Well, I mean, filling an empty seat in an election year is actually not unusual, although this is very close to the mark. I don't know that we've had anyone confirmed after July, I think, was what the data that we're looking at - I was looking at before. But I - but yeah, I mean, to my eye, it seems a little hypocritical, too, particularly because the statements about the clear mandate that the Senate got in 2018, the Republicans got in the Senate in 2018 - it's a little overstated, I think. It's - you know, their majority didn't go up a huge amount. They lost the House. And it wasn't all about judges necessarily, although the Supreme Court's always in people's minds. But we've had a number of empty seats filled in election years. This is extremely close. The fact that we had empty seats filled in election years is what made it so really outrageous not to give Merrick Garland a hearing when there was, I think, 270 days there before the election, and now we are literally counting down the last 30-plus days. So, you know, there's precedent for justices to get confirmed. This is bringing it much closer to the mark. And in a year where this is a hotly contested election - and the other thing I'll say about the mandate - sorry, I know we're close on time - is, you know, claims about, well, they voted us in - well, look at the electoral map back in 2018. I mean, Republicans were in very safe positions then. That is not the case here. It's exactly the flip of that. And so there's maybe a stronger argument to say, hey, leave it for the voters. And recent polling shows a majority of Americans wanting the next president to pick this justice, so... 

>>BOB ZALTSBERG: All right, thank you very much, Beth Cate and Alan Achkar. Alan's from the South Bend Tribune. Beth is with the O'Neill School of Public and Environmental Affairs. Thanks for joining us to talk about Amy Coney Barrett. We're going to be back in just a second with Dan Handel from IU Health. Thank you. 

>>BETH CATE: Thanks very much. 

>>ALAN ACHKAR: Thanks. 

>>BOB ZALTSBERG: All right. Now we're going to switch over very quickly. Dr. Handel, you're here with us now. And I guess we want to switch and talk about coronavirus and COVID and about the recent decision by the governor to move Indiana to stage five. And I should say... 

>>DAN HANDEL: Right. 

>>BOB ZALTSBERG: I should give Dr. Handel a little bit better introduction than that. He's the chief medical officer for the IU Health South Central Region. So were you surprised to hear that Indiana would be moving to stage five? 

>>DAN HANDEL: Well, first of all, it's good to talk with you again, Bob. 

>>BOB ZALTSBERG: Thank you. 

>>DAN HANDEL: I think, you know, that the biggest challenge is that it's important to really localize the restrictions based on the community. I understand from the governor's perspective, the overall numbers are trending in the right direction. I mean, if you check out the State Department of Health, you know, we're in the 4% positive range, which is usually below the 5% threshold that most states are using to ease restrictions. Obviously, Monroe County has taken a more restrictive bent, which makes sense when you have a highly mobile college community where it's not only their mobility within Bloomington and Monroe County but throughout the state, as they come from all over the state. So I definitely appreciate why we still maintain more restrictive guidelines in Monroe County compared to the rest of the state. 

>>BOB ZALTSBERG: So as the state does reopen, I mean, I think it's worth going over what that means and how people can protect themselves. I mean, maybe eventually Monroe County will reopen as well. But, you know, you certainly serve people who are well outside of Monroe County. So, you know, what do you recommend to people if they're going to now be able to go into a place that has 100% capacity? 

>>DAN HANDEL: I think it's - it gets back to the basics. I remember when you and I first talked in March, it's social distancing. It's wearing the mask. It's handwashing. I mean, none of those strategies have changed throughout the course of 2020. And I think people just have to be mindful of the environment they're in. And if you can maintain the six feet, great, do that. If not, you have to wear - you know, it's - you have to wear a mask. And that's still in stage five. You know, obviously, the weather's getting a little cooler now, and so doing outdoor dining, which has been a nice change, is going to get a little harder logistically. But I think people just have to be mindful of that. And I know this has been going on a long time, but it's - we just have to remain diligent because we're not through this yet. Actually, if you look at the R value, which is the reproductive number for the state of Indiana, we're fourth-highest in the country right now. So we are definitely not at a point where we're trending down. So we just have to remain vigilant. 

>>BOB ZALTSBERG: Yeah, can you explain that a little bit more? I'm not sure that I understand R value. 

>>DAN HANDEL: Sure. So the R numbers is the effective reproduction number. So basically, it's, are we spreading to more people for every person who gets infected? So one is for every person who gets infected, they spread it to one other person. If it's less than one, that's better. This means less people are getting - catching the virus from others. And you want that number to be less than one. Right now, as of September 29, Indiana's at 1.18. The only states that are higher than us right now are Montana, Massachusetts and Wyoming at the highest of 1.27. So as long as you have a number greater than one, that means we're heading in the wrong direction in terms of containing the virus. 

>>BOB ZALTSBERG: So how is IU Health doing? I mean, can you talk to us in terms of capacity? And are you, you know, still prepared if a surge comes? And what have you learned since we first talked in March? 

>>DAN HANDEL: Well, I - thankfully, we're doing well in this region. Different parts of the state are busier than others. Our colleagues up in the Muncie area are quite busy right now. I mean, I think I want to give credit to President McRobbie and Provost Robel for doing a nice job of being very strict with the guidelines for students as they came on to campus. So most of the people who are turning positive in Monroe County are younger ages, which is translating to lower hospitalization rates. So we only have a handful of people in the hospital who are COVID-positive at this time. The - we are busy. We have a lot of people who unfortunately delayed care during the pandemic, so we're trying to get caught up and making sure that they get caught up and get their health care needs met. Unfortunately, chronic diseases do not take a break during a pandemic, so we're really trying to make sure they get caught up, they get into the clinics to get seen, if they have surgeries that they've delayed, that we're getting the surgeries completed for them. And we've taken a lot of steps to be very intentional in keeping people safe when they do come into our hospitals, when they do come into our clinics - with social distancing, with barriers, with allowing people to wait in their cars until it's time for them to come in, with screening of people to make sure if they're having symptoms that we're keeping them and the people taking care of them safe. 

>>BOB ZALTSBERG: So we're talking with Dr. Dan Handel, the chief medical officer for IU Health, South Central Region. If you have a question, you can send it to us at news@indianapublicmedia.org. You can also follow us on Twitter at @noonedition. I mean, this is - this topic - you know, it comes in and out of consciousness. There's so much news going on. But, of course, today, we have the news that President Trump and First Lady Melania Trump have both tested positive. So I think this is probably on more people's minds today that maybe it was yesterday. So it's a moving target, this virus. So winter is approaching. And I know we've talked before, and we've talked with other health experts before about the need to get a flu shot to be able to protect yourself from influenza as well. Could you walk us through that - why protecting yourself from influenza is important in trying to keep COVID under control? 

>>DAN HANDEL: I think this year more than ever, it's important for people to get their flu shots early. We're now entering the window where it's the right time to get the flu shot. And it's just - getting vaccinated for the flu means it's one less virus you have to worry about. There's nothing that says that you can't get both flu and COVID. And since the only vaccine we have right now is for the flu, that's what we're encouraging people to get. That's one less thing that they're at risk for. The Monroe County Health Department's done a great job - and we partner closely with them - about setting up opportunities for people to get vaccinated all throughout the county. IU Health has a lot more flu vaccines available this year than years past, and our goal is to make sure that we use every single one of them to make sure that as many people as we can get vaccinated. 

>>SARA WITTMEYER: I've got a question from Sara, and she's asking about immunity from COVID. So if you get COVID, do you have any idea, Dr. Handel, about how long immunity lasts after recovery? 

>>DAN HANDEL: I think the jury's still out on a definitive answer. The best numbers I've seen so far is about three months. So - and the thing we don't know yet is, is this virus mutating in any way, so are there different strains, so that you may get one and another? And I think that's what they're trying to figure out. So I don't think people think if they've had it, they can stop doing the masking, the distance thing, the handwashing. It's - as far as we know from the science we've seen, it's a very transient phenomenon. 

>>BOB ZALTSBERG: How successful do you think the masking mandate throughout the state and also, of course, locally has been? 

>>DAN HANDEL: I think it's only as good as we enforce it. I can tell you, I think Bloomington, to its credit, has been better than some other communities around us about enforcing it. And it's hard. I get it. People are tired of doing the masking, of staying away from their friends and family. But it's just something - we've got to keep going until it's clear that we're out of the woods. 

>>BOB ZALTSBERG: So what are you - when I - I think I asked earlier, you know, what have you learned since March? I mean, I know when we have Dr. Tom Rismalazan, he said that the - physicians have found better ways of treatment. So, you know, is it as scary to you now as it was back then? 

>>DAN HANDEL: I think as we learn more, I think we get more comfortable about what we need to do to protect patients and ourselves where we're taking care of patients. I mean, I can tell you, I'm a practicing emergency physician in our region, and I know there's a routine I go through now where in terms of wearing mask, when do I have to put a face shield, goggles? What I do in terms of, at the end of the shift, how do I basically decontaminate myself to protect my family? So I think it's - we're getting better with it because the more we know, I think the more comfortable we are with knowing what we need to do. I still think there's a lot that still needs to be done. And if you think about it, the pace of change and knowledge that we're gaining compared to past infections is way faster. I mean, if you think about how many years we spent studying the HIV virus in the early '80s compared to what we're learning by week by week as we do this, I think that the knowledge is gaining. But at the same time, we just have to be cautious that any knowledge - any data or studies we're looking at that are validated, so we're not reacting to less-than-optimal studies. You know, and I think, you know, that kind of came out early on with the hydroxychloroquine, where some preliminary studies which hadn't been fully vetted were suggesting it's beneficial, but when you really looked deeper at the data, that didn't pan out. But I think that the medications we're using now throughout IU Health have sustained - there's evidence and there's support over the past couple weeks and months. So - but we're constantly looking at the data again. We have - Dr. Rismalazan's part of a larger system infection prevention team that meets twice weekly, and they look at the latest data and say, OK, what are the studies showing us now? Do we need to change anything in our treatment algorithms throughout IU Health across the state? What do we keep? What do we get rid of? So it's a constant reflection of, what do we need to do to improve how we take care of patients? 

>>SARA WITTMEYER: We've gotten a couple of questions about MCC returning to school and also, of course, IU and then spreading the virus to the community. Can you talk a little bit about how, even if it is young people, as it is here in Monroe County, that make up the majority of the cases, how the virus affects them and if that is different than how it affects older adults? 

>>DAN HANDEL: Yeah. No, I think MCC has done a great job in terms of being very deliberate about their green, yellow and red targets in terms of percent positivity and trending up, trending down. Thankfully, kids who do get sick, it's very rare where they have a severe inflammatory response. As far as I know, we have not seen any children with those severe symptoms in Monroe County. But it's something we're being mindful of. And Dr. Jim Laughlin, who is one of our physician leaders through our medical group here in Bloomington, has been working closely with the county, along with Dr. Scott Moore, another one of our pediatricians, about really looking at the evidence so that the asymptomatic spread, the studies have shown, is a lot less in children than it is in adults. So, I mean, we've had a handful, as the news outlets have reported, of positive cases of students. But those been relatively well-contained. So I think it's - you know, you're trying to you're trying to inherently balance the need for children to have in-person education and the social benefits above and beyond what they're learning in school that's needed with that - while also maintaining the safety of the students, the safety of the teachers who are working with them and the community at large. So, you know, I think it makes sense that the counties or the school corporation's doing a month-by-month assessment of what needs to be done. And it's just looking at trajectories of the cases in Monroe County. 

>>SARA WITTMEYER: I got a question about how IU Health is preparing for 2021 given the latest reports that there might not be a vaccine until late 2021. 

>>BOB ZALTSBERG: We are preparing for the worst, hoping for the best. We are planning as if there won't be a vaccine in terms of making sure we have stockpiled enough PPE throughout the year for 2021, making sure that we have the resources we need if there is another significant spike that leads to a lot of hospitalizations. Hopefully the vaccine becomes available before the end of '21, and then if so, great. We've been prepared. But we're taking a very conservative approach just to make sure we can meet the needs of our communities. 

>>BOB ZALTSBERG: If I could follow up on that, when a lot of people are seeing the vaccine as a silver bullet - that everybody can get back to their normal lives once the vaccine is available - can you sort of walk us through what happens when a new vaccine is here? I mean, are we going - is it going to be 100% effective, 50% effective? I know you probably don't know the answer to that totally. But how does a new vaccine actually - how's it measured, and how do we know it works? 

>>DAN HANDEL: You know, the challenge for the vaccine studies is that they require time in terms of the stage trials to really see how effective they are. And part of that is you get a - you're in the trial group, you get a shot, and then you see, OK, a month from now, two months from now, six months from now, who got infected versus not? No vaccine has been 100% effective. You know, if you remember, with the flu shots, some years have worked better than others in terms of really doing that - the same thing with the vaccines that we've gotten over the years. So I think even when we start getting to a critical mass of people being vaccinated, it will get us much further down the road of really knocking this down into a manageable infection rate - that R number we talked about. But I think there's still going to be masking, social distancing for a while after we get to a critical mass of people who get vaccinated. 

>>BOB ZALTSBERG: I'm going to revisit this. We've talked about this before, and I just want to ask this question again, since we're, you know, six months down the road. But a lot of people early on tried to equate the COVID-19 with influenza. And what's the data really been showing us? 

>>DAN HANDEL: I think that particularly in our older populations, that we found that COVID is a much more virulent virus than the typical flu. I mean, yes, we do have a number of people who die every year from the flu. But because our bodies have never really seen this virus before, we have seen people who are fine and then get sick very rapidly and die, which is not something we've seen with flu, at least in my lifetime. So I think it still does not bear out that it can be compared as something as minor as the flu, just based on how sick some people have gotten so quickly. 

>>BOB ZALTSBERG: OK, so last thing - we only have about a minute to go. So if everybody out there listening were your patient, what would you tell them to do to keep themselves safe? 

>>DAN HANDEL: No. 1, keep on wearing a mask. Keep the patience in keeping this up. No. 2, get your flu shot. 

>>BOB ZALTSBERG: All right. Well, we are out of time. I want to thank you very much for being with us, Dr. Handel. It's always a pleasure. 

>>DAN HANDEL: My pleasure - good talking to you. 

>>BOB ZALTSBERG: All right. Thanks. So I also want to thank Beth Cate and Alan Achkar for the first half of the program. And I want to thank our co-host, Sarah Wittmeyer, producers Bente Bouthier and John Bailey, engineers Matt Stonecipher and Mike Paskash. I'm Bob Zaltsberg. Thanks for listening to Noon Edition. 

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