>>UNIDENTIFIED PERSON #1: Production support for Noon Edition comes from Smithville - fiber internet, streaming TV, home security and automation in southern Indiana. More information at smithville.com. And from the Bloomington Health Foundation - partnering with local organizations and citizens to invest in programs that address our community's health needs. Bloomington Health foundation - improving health and well-being takes a community. More at bloomhf.org.
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>>BOB ZALTSBERG: From the Milton Metz studio in IU's Radio TV building, this is Noon Edition on WFIU. I'm Bob Zaltsberg from the WFIU WTIU news team and I'm co-hosting today with Sara Wittmeyer, the WFIU WTIU news director. This week, we're doing an update on the coronavirus. It's a topic that's on everybody's mind, and we're going to be talking about it and how it will affect Hoosiers. We have three guests with us in the studio. Kosali Simon is a professor in the IU O'Neill School of Public and Environmental Affairs and she's a health policy expert. Ana Bento is a professor in IU's School of Public Health and Biology Department. And Dr. Dan Handel is chief medical officer for the IU Health South Central region. You can join us for the show by calling 8128550811 in Bloomington or toll-free at 18772859348. You can also send us questions for the show at email@example.com. And today we're on Facebook Live, so you can catch us there as well. And you can follow us on Twitter at @noonedition. So thank you all for being here. It's a huge topic. It's one that everybody is talking about - everybody's concerned about. And I wanted to turn to Dr. Dan Handel first and say, you know, we've - there's been a lot on social media and a lot of different places - we're getting a lot of e-mails saying that there has been a confirmed case in Monroe County. Is that true?
>>DAN HANDEL: Well, I think the big thing is really looking for - what are reliable sources of information? What we use and who we coordinate closely with is the Indiana State Department of Health. So according to the Indiana State Department of Health and by our resources, as of this morning, there are no confirmed cases in Monroe County.
>>BOB ZALTSBERG: OK. That - so, yeah, that - your point about about making sure that the information you get is correct and accurate is a really good one.
>>DAN HANDEL: Yeah. So, I mean, if - I think one of the big takeaways I can give to our listeners today is really look at - for reliable sources of information. In addition to the State Department, iuhealth.org has a good link for people to check, and also the Centers for Disease Control.
>>BOB ZALTSBERG: OK. So there are lots of different things we are going to want to talk about today. And, you know, one of them is that - you know, the way that this disease is spreading and what people can do to try to protect themselves. So - Ana Bento, do you want to take that first? And what - yeah, so let's just start there.
>>ANA BENTO: Yeah. Sure. Absolutely. So the first thing that we need to discuss is, because it's a novel virus - some - a virus that emerged, we now think, at the beginning - mid to - of November in China. It's a virus that, even though it's very close - closely related to other coronaviruses that been have been described previously, there is no actually specific treatment for this COVID-19 and also there's not been a vaccine developed for - specifically for COVID-19 - in fact, for none of these specific coronavirus in general. So the only measures that we are able to apply in an event of a coronavirus, for which all of the population, initially, is susceptible - and what I mean by that is because we've never encountered such a virus, we're all somewhat likely to become infected at, of course, different levels of susceptibility. So things like general rules of social distancing, self-quarantining if you are feeling sick. If you are sneezing and coughing and there are people around you, you should cover your face and sneeze into your elbow so you don't touch areas. Also, you should avoid touching your face and, you know, touching surfaces in general. And of course, the most basic of all things is washing your hands. So basic rules of hygiene apply here and actually are one of the most efficient things to try and avoid onward transmission.
>>BOB ZALTSBERG: OK. So Kosali Simon, you're - you've studied health policy for the U.S. - around the world - what are some of the sort of implications about just - you know, from - this has been determined to be a pandemic now. So what does that - what should that mean to all of us?
>>KOSALI SIMON: One thing it should mean to us is that we think about the capacity of the health care system and also payment sources, incentives for innovation, and supply of the things needed - both people and equipment and medications. So one thing to keep in mind is that, when we think about capacity, there's a timing issue. We usually think of the regular flu in terms of how many people were affected in a year, but we have to keep in mind they were not all at the same time. So in this case, what we are worried about is what are going to be the peak needs at a given time and how does that relate to hospital capacity and how other types of capacity - respiratory equipment availability. So the U.S. does have, compared to some of the other nations that have been hard hit right now, fewer hospital beds per person. So that's already - you know, that's known that we've, over time, actually had a reduction in the number of hospital beds as more things have shifted outpatient and as the cost has been high. If it's not needed at the time, it's very expensive for a hospital to have all this excess capacity. But it really matters at times when everyone's likely to need it in a short period of time.
>>SARA WITTMEYER: So could you talk a little bit about the hospital's plans to deal with an increasing number of cases?
>>DAN HANDEL: Yeah. So what we've been doing, actually, over a week now is we've set up at - not only at a local and regional level, but at a system level - an incident command center throughout IU Health throughout the state. So we're really thinking about - OK, these are the needs of our communities and our patients today. If we need to surge up - whether it's, to Kosali's point about more ventilators more beds - this is how we're going to do it. We also look, on a regular basis and a continuous basis in terms of our supply. So making sure we have enough masks, enough gowns to last us 30 days - 45 days, and so forth, and really being intentional about that. And as with all hospitals and all acute care facilities, you know, we have surge capacity plans in place that we repeatedly drill on and make sure that we're ready for for situations such as this.
>>SARA WITTMEYER: So what is the capacity when we're talking about - because I've heard a lot of reporting from from other countries and talking about how there's not enough ventilators, there's not enough beds, the ICU in particular... Well, I mean - so Bloomington Hospital in itself is over 300 licensed beds. I mean, I can't tell you off the top of my head exactly how many ventilators we have. But, you know, there's the ability to pull from different locations and different settings ventilators, if needed. So, for example, if people are going to places where they otherwise would get elective surgeries - and obviously, elective surgeries would not be happening - we could pull those ventilators to locations where they're needed the most.
>>SARA WITTMEYER: So what should happen - what should someone do right now if they think they have symptoms? I'm assuming showing up at the hospital is not what people should be doing.
>>DAN HANDEL: Yeah. I think one of the many benefits of today's current technology is we have abilities for people to connect without having to be in person. So the big thing we're pushing from an IU Health perspective is our app. So there's a virtual health hub. We rolled this out over the past weekend and it's been immensely successful. And actually, even prior to the COVID concerns, as we are in the peak of flu season as well, people have been using it. And it's a great way for people to engage with us free of charge 24/7 to connect with one of our licensed clinicians about whether or not they need further screening or not. And that's - for people who have the ability from a technological standpoint, that's what we're advocating for as a first step.
>>BOB ZALTSBERG: So we've had a lot of questions come to us through our city limits page, and I'm just going to go through a few and Sara will jump in and we can have a conversation about all this. Oh, go ahead.
>>ANA BENTO: Before we jump in...
>>BOB ZALTSBERG: Yeah, sure.
>>ANA BENTO: ...I just wanted to address something that I think is very important. So the definition of pandemic versus an epidemic - I think it's a very important one and I think our listeners might be interested in understanding. So an epidemic is declared when a specific disease kind of spreads quickly through a specific geographic area and a number of individuals become ill. So the definition between epidemic and pandemic - it's mainly a logistic one where it's just the bigger geographic spreads of a disease, right? So declaration is more of a logistic one. So in fact, the things we should do as an individual - all of the cares that I just explained earlier should remain exactly the same whether it's still an epidemic or a pandemic is declared. The difference between epidemic and pandemic has actually effects more on what was described in terms of response of hospitals because, of course, as soon as a pandemic is declared, then it has a bigger burden in terms of seeking help - seeking medical help, and then how hospitals will be able to respond. But also an economic one as Kosali was explaining because then people are more likely to have reactions and enhanced panic because sometimes an unexplained definition of what the difference is between an epidemic and pandemic actually can have repercussions in terms of seeking of hospitals and actually understanding how you actually spread and, as an individual, what you might do. I think - I just thought it was important to understand.
>>BOB ZALTSBERG: No. Thank you. No, I appreciate that. We talked - we were talking a little bit before the show about children. We have a question that's really, I think, relevant to this. This says, "do I, as a healthy 62-year-old, need to self-isolate from my young grandchildren if they are still going out in the community?" So how does that relate in the whole issue of children?
>>ANA BENTO: So that's that's an interesting question. So I think we're all aware, in social media, of the hashtag flatten the curve. Flatten the curve means how individuals can actually break the chains of transmission, right? So any sort of mitigation strategies such as self-quarantining and social distancing and all the regular hygiene measures will help flattening the curve - closing schools because it decreases the contact between any individuals that might be infected and the susceptible ones will actually, again, flatten that curve, right? And what I mean by that is that the increase of number of infected and how quickly that spreads, right? So our listener that was asking that - yes, they should self-quarantine, but not because it's an elderly individual and the 16-year-old. It's basically the same rule of - we should apply social distancing when it's possible, right? I think Kosali will explore this idea that it's not always possible depending of your social status or certain subpopulations that you might belong to - that you might not be privileged enough to be able to distance socially or self-quarantine. But yes, our listening should definitely also inform their granddaughter that perhaps she should take the basic cares of social distancing as well. So don't shake people's hands. You know, it's a time where perhaps a little social awkwardness might be the thing we should strive for.
>>SARA WITTMEYER: I think that gets to something that, Kosali, we were talking about before the show - this idea that, yes, we are telling people they can work from home, but then what do you do with the kids all day? So maybe they're going to a grandparent - and is that a risk that we should be avoiding in particular because of the age? But also those folks who have to work still.
>>KOSALI SIMON: Yes, I think it - a lot of these things come down to weighing costs and benefits. And when there's uncertainty involved, it's really unclear to people - how should I make this decision? I don't know exactly what risk I'm averting by not going on this trip or by not going to work today. We are risk-averse. There is a great - the seriousness of what could happen - that is - it's so large that we take extra precautions and we weigh the costs as, perhaps, larger than if we just thought, oh, based on the statistics today, doesn't seem like the numbers are that high, right? But we're operating under the assumption that there's an underlying threat we're not quite aware of yet. So then you think, what are the things where postponing something is not that great a cost? Whenever possible, you think that we act in these prudent ways. But it gets to a question of who has the flexibility and what are the consequences if you do not go to work in an area - in a setting where you cannot telecommute? So in looking - I was looking at some surveys from the Bureau of Labor Statistics before coming here about what fraction of people report that they're able to do some of their work remotely. And depending on the source - there are different surveys that have been done - it's between a quarter and about a half - say at least some can be done, but this is also something that can be changed when needed. So I think this is a time when people wonder, even if we didn't have this ability, what can we do now to allow more telework? Because otherwise there is going to be a lot of consequences of sudden drops in income, of course, and with figuring out work settings with child care and family care.
>>BOB ZALTSBERG: We have a lot of questions here that we're going to get to, but if you have a question and want to give us a call - 8128550811 in Bloomington or 18772859348. You can also send questions to firstname.lastname@example.org. I wanted to ask this question which came from a reader. Is COVID-19 testing available in Indiana? Let's get into that testing issue.
>>DAN HANDEL: Yeah, that's the biggest question we're getting across IU Health. As of this morning - and obviously, this is a constantly-changing process - testing for COVID is only available at the state level. So if someone presents to any of our IU Health facilities and wants to be tested, we are following the guidelines of the state Department of Health in terms of whether or not they qualify for testing. And I definitely appreciate people's frustration when we say, "according these guidelines, you don't meet the criteria as of today for testing." You know, the big question is what's going to happen in the near future when testing becomes widely available? And really, we're going to have to think through who gets tested, who doesn't get tested based on what was mentioned before - because there's going to be certain things we can do for people to support and certain people where it's going to be - the recommendations are the same - you need to go home, you need to self-quarantine yourself, you know, and then supportive therapy like you would do for any other virus or any other cold. So, as I said, the take-home messages as of this moment - the state is really dictating who does and doesn't get tested.
>>BOB ZALTSBERG: OK.
>>SARA WITTMEYER: Do you have any sense of how many tests are even in Indiana?
>>DAN HANDEL: I - not off hand, no. I mean, I - if you go to the State Department of Health website, they can tell you how many people they tested.
>>SARA WITTMEYER: Right. I think it's at 73.
>>DAN HANDEL: Yeah, I think that's what I saw this morning.
>>SARA WITTMEYER: 73 and 12 positive cases. But that's - I mean, that's a really low number.
>>DAN HANDEL: Right. Yeah, I don't know off hand. I think - I mean, that's a question for the state.
>>SARA WITTMEYER: Yeah.
>>BOB ZALTSBERG: We can knock off this other question - I think you sort of did. Are there any plans in the works for COVID-19 testing to expand to residents?
>>DAN HANDEL: Yeah, so most facilities - most health systems, including ours, are looking at the ability to expand that. You know, and once we have that capability, the question will be - OK, we have - to your point - X number of tests, how do we appropriately deploy them and what are the criteria we're going to use for people who are and aren't tested at that time?
>>SARA WITTMEYER: We've got a couple questions here from Facebook asking - what is the patient to nurse ratio for a patient who is expressing symptoms? And then will they be caring for other patients as well? I think there's an underlying concern about infecting other folks.
>>DAN HANDEL: So, I mean, I think it depends on the severity of the patient. So obviously, if you're in an intensive care unit setting, like any other patient, there are fewer patients per nurse. But the other thing too is we're very intentional in terms of how we protect patients - how we protect our team members from the spread of the virus in a health care setting. The most recent guidelines have been something called airborne precautions. Those are actually - which means that N95 masks, negative pressure rooms - but those are actually being eased based on more recent evidence by the CDC to what we call a droplet and contact precaution, which is not the N95, it's a regular surgical mask, it's a gown, it's a face shield. The - and this is actually more in line with the precautions we use if someone has the regular flu. And the good news about that is that expands our supplies and our ability to prevent the transmission with sufficient protection so it doesn't go from one patient to another.
>>BOB ZALTSBERG: You mentioned the regular flu, and we have this question which, you know, people are asking all the time or - and there - I think there's misinformation about it out there too. Right now, the numbers of people who die from the flu is many times more than the COVID-19 virus. What makes it more dangerous? Who wants to handle that one?
>>ANA BENTO: So I can address it from an ecological point of view, right? So we have to realize several things. As I mentioned earlier, COVID-19 is a novel virus for which we still don't know if there's some sort of, like - perhaps some people might have a cross-protection if they've had contact with other coronaviruses. We don't know yet if there's cross-protection between different types of coronavirus. So the assumption is that all of the population is susceptible to begin with. And what I mean by that is that most - all the population, until they become infected, are likely to become infected when they encounter a novel pathogen. Also the fact that we still don't have an understanding yet whether this will become seasonal or not - we actually don't know. And I want to address one more thing that is a myth - that as weather will warm, that we should expect this virus to subside. We don't know yet. But the main thing is that, for a flu, we have some medications that have been proven to be effective, such as Tamiflu - and I'm not trying to make an advertisement, but generics of that, right? Also we have a vaccine that most people do not use, but they should still use. And we have this evidence of a somewhat cross-protectiveness between earlier viruses from previous seasons. So that means that we have very specific parts of the population that are definitely more susceptible or more prone to very significant consequences of having the flu. So why we should be more concerned about COVID is because there are many things we still don't know, right? So if we don't understand exactly things like we described previously - who is more infectious and who is more susceptible - because we are still discovering these types of things. Are children really a group of concerned or not? Should we only focus on the elderly because these are the population that has been most significantly been hit by it? So it's almost like, at the risk of sounding a little patronizing, comparing apples and pears. In fact, we should be worried about both, but because we know very little about this novel pathogen that is definitely, you know, circulating globally, we should, of course, be more concerned because there are many more things we still don't know. And, of course, we do not have a vaccine, so we can only protect it in, you know, the good old fashioned way of creating these distances and basic hygiene rules.
>>BOB ZALTSBERG: Our time's going very fast, but I think I'm going to take the - our break just a minute or so early, and then we've got a lot more questions we're going to get to after the break. And if you have a question, you can call us at 8128550811 or toll-free at 18772859348. You can send questions to email@example.com and you can follow us on Twitter at @noonedition. We're talking about coronavirus today. We'll be right back.
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>>UNIDENTIFIED PERSON #1: From the Milton Metz studio at IU's radio TV building, this is Noon Edition on WFIU. WFIU News covers South Central Indiana and the state throughout the day at wfiunews.org and on Twitter at @wfiunews. You can watch unfiltered video of breaking stories on Facebook Live. And you can get a digest of all the day's top stories delivered to your inbox each afternoon. It's a free and easy way to stay on top of the headlines, plus the in-depth audio, video and print news stories you can't get anywhere else. Subscribe now at wfiunews.org.
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>>BOB ZALTSBERG: Welcome back to Noon Edition. I'm Bob Zaltsberg along with Sara Wittmeyer and we're talking with three experts today about coronavirus. We have some great guests in the studio with us Kosali Simon - professor in the IU O'Neil School of Public and Environmental Affairs. Ana Bento, professor in IU's School of Public Health and the biology department. And Dr. Dan Handel, chief medical officer for the - for IU Health South Central region. You can join us on the show by calling 8128550811 in Bloomington or toll-free at 18772859348. You can send questions at firstname.lastname@example.org. You can catch us on Twitter at @noonedition. And we're on Facebook Live today, so you can find us all sorts of places.
>>SARA WITTMEYER: Yeah. Several feet people are asking how long it takes to get test results back. Dr. Handel, can you address that?
>>DAN HANDEL: I don't know if I have a precise answer. I mean, I think it depends also - I mean, if you think about it, a sample's collected wherever you are in the state, it gets sent to Indianapolis to the State Department of Health, and they need to run it. As we have not had that instance here in - what we can guess is about a day or so for the test to come back, and I think it also depends on the demands on the state at that time in terms of how quickly they can process those tests. And it's a day-to-day and it - there's suddenly some fluidity with it.
>>BOB ZALTSBERG: I did talk to a person who has all the symptoms of the disease. She went to her own physician in Indianapolis after the state. She was not having much luck with the state. Her physician swabbed her, sent it off to a national lab. They said it would be four days before she got the results back.
>>DAN HANDEL: Yeah. So I think that's - and there's going to be probably three layers of testing that occurs when it becomes available beyond the state level. There's going to be still the state level, there'll be local facilities, and then there will be national labs. And depending on how it gets sent - the batching of it, I think the turnaround times will definitely vary.
>>BOB ZALTSBERG: Right.
>>SARA WITTMEYER: Someone wrote in - wants to know - they say, "I have a scheduled knee replacement on April 1st. Should I be talking about postponing that until later this year?"
>>DAN HANDEL: I think it's a day-to-day, you know? I mean, I - you know, I can tell you, from an IU Health perspective, we are at normal operations. I mean, I think one of the things - because we - actually, as of yesterday, we've implemented increased screening criteria. So we want to make sure that, if people are having symptoms but they're otherwise mild symptoms, that they're staying home. And it's not only to protect them, it's - but - to protect people who are coming to the hospital for other reasons. So it kind of gets back to that social distancing. So I think - it's - there's not a clear black and white answer to that, but I think people need to kind of see how they're feeling, where they're going for the surgery and so forth and kind of make a judgment decision at that time.
>>SARA WITTMEYER: OK.
>>ANA BENTO: With their medical provider.
>>DAN HANDEL: Absolutely. Absolutely. That's a really good point.
>>ANA BENTO: So these are - unfortunately, I don't think these are questions we can have a blanket...
>>DAN HANDEL: Right.
>>ANA BENTO: ...Answer, right?
>>SARA WITTMEYER: A frustration I've seen online is this idea of - if it's especially hitting older people harder, and telling them to try to get more prescriptions in advance, and then saying that might not be possible because of their insurance. Kosali, can you can you talk about that and what they can do in those situations?
>>KOSALI SIMON: Well, that's a good question, which is - are there going to be things outside of the normal routine that will happen now with insurers? Because this is a bigger issue than just - so in a typical way, if you went to try and fill your prescriptions for longer, your insurance would say, well, we - you know, it's too soon to fill the next prescription. There are - insurers, we know, are putting into place, unvoluntarily, some different rules, for example, for testing. The question would be, if this was a normal situation, then you would fall under the deductible and you'd have to probably pay for it. There are insurers - so it's not - there's no national policy. There's no state policy. Insurers are voluntarily deciding. They're going to do different things, again, because our area hasn't had this question yet, we don't know what it will be like. But insurers could decide that they're going to change it, but currently...
>>SARA WITTMEYER: That's for testing of it.
>>KOSALI SIMON: ...For testing or if, for some reason, in order to support social distancing, longer prescriptions are going to be allowed. So I think the advice is just to ask your particular...
>>SARA WITTMEYER: Insurer.
>>KOSALI SIMON: ...Insurer what, at that time, is the process.
>>SARA WITTMEYER: So if you are diabetic and require insulin, right now you can't get a longer prescription unless you...
>>KOSALI SIMON: It's whatever the - yeah.
>>SARA WITTMEYER: ...The insurer says.
>>KOSALI SIMON: Unless your insurer has instituted something special already.
>>BOB ZALTSBERG: Have we learned anything about policies that have been put into place from other nations that are a week - two weeks - three weeks ahead of us on this?
>>ANA BENTO: Yes.
>>BOB ZALTSBERG: What kind of things have we learned?
>>ANA BENTO: We learned that quarantining works. We learned that social distancing works. So we've seen that particularly in China. So we've seen that - of course, we are aware that, in the U.S., we cannot apply the same type of state-imposed quarantining situations, but that is a natural experiment that we can learn from, right? We understand that, in a situation where a state can impose a quarantine - we saw - again, I go back to my #flat - flattening of the curve, right? There's - of course, given the specific traits of this pathogen, it takes a few days or a few weeks for that effect to be seen because there are individuals that get sick but they don't have symptoms immediately. So it's not an immediate effect. But we do see quarantining working. We also see that social distancing works. We also saw that in Italy - which is that intermediate case between China and the U.S., right? In terms of how free individuals are to make a choice given an imposition or an advice from the government. So those are things, from the epidemiological and ecological point of view that we know that definitely work. From a public policy...
>>BOB ZALTSBERG: Yeah, so anything from a public policy point of view?
>>ANA BENTO: Well, there is the - South Korea and mass availability of testing.
>>ANA BENTO: ...Oh, yeah, that's a good point.
>>KOSALI SIMON: That's a health care system policy...
>>ANA BENTO: Yeah.
>>KOSALI SIMON: ...Decision. There's also the - in terms of policy, just how quickly we move to say the - that there's going to be closures or cancellations or these messages. We know those are - voluntarily, people are making those decisions, again, on a cost-benefit decision basis. But when we think about the reason why this may be a public policy decision, the spillovers are really vast, right? So it's not just - when I consider my individual costs and benefits, they're different from what should be for society. I might say, oh, why should I postpone my travel? Because I'm going to end up getting exposed to other people who have traveled. That's an individual-level thinking.
>>ANA BENTO: Yes.
>>KOSALI SIMON: Public policy level should be thinking, the more people think like that, the more there will be of community transmission.
>>SARA WITTMEYER: A couple more questions. Wendy is - she wants to know, is it safer to speak outside with people than inside? And second question to that, are you OK to go shopping as long as you practice good hygiene?
>>ANA BENTO: So that's an interesting question, right? So that goes back to some of the myths of - is the climate or weather - temperature - humidity affecting any sort of, you know, degree of - risk of infectiousness? We still don't know, right? So us talking in the studio might have exactly the same risk as us talking outside at this exactly same distance. We don't know yet. So the common practice is, unless you really need to go to the shopping mall or to the supermarket or to the pharmacy or to the hospital, you should refrain from doing so simply because it, again, applies this idea of self-care and self-quarantining and social distancing, but especially going back with - to what Kosali said which is our own risks versus the population risks. By removing an individual from an environment we're, in effect, removing a possible link in the transmission chain. So the fewer people there are in a space, the - reduces the likelihood of a transmission event to occur. So we don't really know whether, you know, being indoors or outdoors changes something. From, for instance, the flu point of view, there's been certain discussions that, you know, we tend to have more cases in the wintertime because people spend more time indoors. But that's just one factor of why we do see increased cases of flu or seasonal colds in the winter. It's kind of like - it's a more complex system in the sense that we have many different factors. So I would say, if you can, postpone the shopping unless it's absolutely important. And if you go, try to avoid people as much as possible.
>>BOB ZALTSBERG: We had a question about restaurants too, but it was a little bit of a twist to this one. It says why are obviously sick people being served in restaurants? Right now, we need to empower restauranteurs to refuse service or ask them to leave. Is that some policy that could be put into place?
>>KOSALI SIMON: That's a really good question that raises these issues of - how much are we going to be considering individual rights and difficulty of discerning who is and who is not a risk? And that leads also to difficult issues of trying to say, OK, statistically speaking are you a bigger risk? And we know there's lots of ethical problems with that. So those are the kinds of things, as Ana was talking about, that our societies are going to be very hard-pressed to come up with - with these sorts of rules that we've seen, perhaps in other countries, have been imposed.
>>SARA WITTMEYER: Dr. Handel, I think this - I think you've kind of answered this, but another question wondering - I'm sorry, saying academic medical centers around the country have announced some degree of in-house testing capability. Is IU Health and IU School of Medicine working on this to help supplement the state lab and hopefully, eventually, private labs?
>>DAN HANDEL: Yeah. The short answer is yes. You know, as I said, I can't give a definitive timeline when IU Health will have that testing capability, but like most academic medical centers around the country that - our labs are actively working on a test that we can do in-house.
>>SARA WITTMEYER: OK.
>>BOB ZALTSBERG: So this is a very sort of basic question, but I think it's worth going over. Somebody asks about symptoms of COVID-19. Are there specific symptoms that might differentiate it from the - from influenza or a common cold?
>>ANA BENTO: Absolutely not. They are as generic as they can come. Do you want to give a description?
>>DAN HANDEL: That's congestion, cough, fever - which sounds like people who have the common cold, who have the flu. And I think that's - I think a lot of the anxiety that people are experiencing right now is we're still in peak flu season. So it's, do I have a cold? Do I have the flu? Do I have coronavirus? And so it's - unfortunately, because the symptoms are very non-specific, it's really hard for us, as individuals, to differentiate between all the things that are prevalent this time of year.
>>BOB ZALTSBERG: So there are some people - I mean, a lot of people, like me, get a flu shot every year. There are some people who don't get flu shots every year. We know the flu shot doesn't work on coronavirus, but why should people still get a flu shot and how would this help the situation with coronavirus?
>>ANA BENTO: I can...
>>DAN HANDEL: Yeah. I mean, as it was mentioned, it's not clear what the cross-reactivity - but, you know, it's one less thing. You know, the more we can build up our immune systems the better. So I think it's one less thing to worry about. So there's zero downsides for people getting a flu shot every year. So the more we can encourage people to do that on a yearly basis on a timely basis, as we approach the traditional peak flu season, I think the better we are from a population standpoint.
>>SARA WITTMEYER: I think this is a follow up to your previous answer - somebody wanting to know, why is it that it can escalate so quickly, then, if - yeah...
>>DAN HANDEL: You mean the coronavirus?
>>SARA WITTMEYER: ...Yeah.
>>DAN HANDEL: Yeah, I mean, I think as was mentioned, it's a virus that we've never seen in our population before. So whereas from one year to the next, we build up certain kind of immunity to the influenza viruses, this is something that's new. And so we don't have the natural immunity to it like we do for other viruses out there.
>>SARA WITTMEYER: And how does - like, what is it doing when it escalates? What are - I've heard about folks in ICUs on ventilators. That seems different than the flu.
>>ANA BENTO: So I want to address two things before we get to that. So the question of the flu vaccine - so there's an individual decision of getting the vaccination to protect yourself - and we know it's not a perfect vaccine. So the advantage here is, even though we know it's not a perfect vaccine, likely is that, if you contract the flu in that same season, that you will still have symptoms - so you can still get infected, but it - normally, the result is that, because there's some cross-reactivity and cross-immunity, your symptoms will be milder. So there's an individual advantage. But most importantly, it's a population-level advantage. So in epidemiology and disease ecology, we have this concept of herd immunity, which is basically a bubble of protection we create around our population, right? So the more individuals there are that have protection - that are vaccinated, the less chances we are - we have of actually having more cases because there's always individuals in the population that, for some reason, are not able to get a vaccine. So we're not only protecting ourselves, but we're also protecting individuals that are unable to have the vaccine. In response to escalation - so if I understand correctly the question, we're thinking about how quickly we go from one case to cases to 10,000 cases, right? I think it's what the listener is probably concerned about. And that goes back to the things we've been discussing, right? This idea of a novel virus. But I also want to alert the fact that only a subset of the population in all countries is developing extreme symptoms and only a very small - even though it's - any death is important and we should care about, but we should also tell people that, depending on the country, case fatality rate, which is the number of individuals that die given a specific infection, is actually low. And, of course, some case - some countries will have a case fatality rate higher than others, but that's dependent on almost - I can say the make up - the demographic make up of a country. So if we think about Italy, it hit an area of Italy that is composed mostly from individuals that are later in their life - so 50 year olds and higher. So that population, by default, as we know, is at a higher risk. So we actually see a higher case fatality rate. And we also see more cases that are what we call visible in the sense that we see more symptoms. But in terms of that take off, we have to realize as well that there are cases that are asymptomatic and there are cases that reveal very mild symptoms for which we are naturally unable to discern if it's the common cold the flu or seasonal allergies until we have the ability of testing. So - but that takeoff goes from several things like novel pathogen. The more we test, the more we find, right? So in South Korea - in China, we saw a very large jump after a few weeks that the virus was detected in specific countries. We see that it went from 1,000 cases to 20,000 cases, right? That big jump. And that's not necessarily because, all of a sudden, the pathogen evolved and became more infectious. It's more of the case of this diagnostic artifact that tells us, OK, we're looking more for something, therefore we find, right? So...
>>SARA WITTMEYER: We got a couple questions just about the length of it, saying how long can we keep kids out of school? How long can I not work? I still have rent to pay. So I guess I'm looking for a reaction on that. What are people supposed to do? Just not work indefinitely?
>>KOSALI SIMON: So currently, it's figuring out what are arrangements - what are private arrangements that can be done in the sense - what are employers doing? What are individuals finding in a community? We're still waiting to see what will change at a federal level? What will happen, perhaps as has happened in Ireland, to paid sick leave? What will happen to extensions to unemployment benefits? There are a variety of options that are on the table for public policy responses. Thinking about - where would the change have the greatest effect? Thinking of - what are the kinds of activities right now that are encouraging work-seeking - so to continue having unemployment benefits, you have to show that you are actively seeking work. Well, that's something we want to discourage now from social distancing. So what will change in policy that will maybe extend and make those things - similarly, with the ability to have sick leave pay. That's...
>>DAN HANDEL: And I think the quarantine guidelines, as of today - you know, and we may be having a very different conversation a week from now - is anywhere between 14 and 21 days. But I think the more we learn about the virus and its incubation period and so forth - so for example, the range they're seeing of people from exposure to symptoms is anywhere between two and nine days. So they're saying the median at this point is about five days. So I think the more information we get - I think that the recommendations along those lines will become more precise.
>>SARA WITTMEYER: And people are recovering after that time too.
>>ANA BENTO: Most people are recovering.
>>SARA WITTMEYER: Right.
>>DAN HANDEL: Vast majority.
>>ANA BENTO: Yes. So that's something very important to say, right? So most people recover. It - the disease as a natural course, like the flu - like the common cold. And then depending on the traits of the specific pathogen, those lengths differ, right? So in this case we have, on average, taking two weeks to recover. But also that's very important to refer that it's on average, meaning some people recover sooner, some people take longer to recover. That's a very important concept as well to take...
>>SARA WITTMEYER: Get it - oh, sorry. We have a lot of - if you get it once, can you get it again? If you...
>>ANA BENTO: So that's - for me, as a disease ecologist, that's one of the most interesting things that I've been thinking about. And from a perverse sort of sense, it's something that it - that actually makes me incredibly excited to try to understand because that has repercussions in - not only in lifting quarantines in China, for instance. Do we expect these people that already have the disease to have it again once, you know, social life comes back to normal? But we don't know yet, right? So we actually have no clue, and that goes back to that idea of cross-immunity or the ability of having something again. We actually do not know. There were some kind of examples that were kind of described, but not in a scientific sense. So there are people that have said that they believe that they have had twice, but we don't know yet. So those are, again, one of the many unknowns that we're still trying to discover.
>>BOB ZALTSBERG: The questions I wanted to ask are about transportation, and one of them of is is flying within the U.S. a safe thing to do? Would you all hop on an airplane today?
>>DAN HANDEL: Go ahead.
>>ANA BENTO: That goes back, again, to the shopping center question, right? At the moment, I think we should exercise caution. So unless there's an absolute - an event that you cannot miss, you should strive to not go somewhere because, in an airplane, the air is kind of, like, circulating. We don't know if that increases your probability of becoming sick or not. We don't know who's in the airplane. It doesn't mean that they know they are sick and they're traveling, but they can be unsymptomatic or they're still too soon for them to have symptoms. So we can do only things to minimize our risk, right? But it's a case-by-case decision. If you absolutely must travel today from Indianapolis to Atlanta or wherever, right? Or to China - then you have to. So it's a question of - goes back to what Kosali was saying. We are naturally risk-averse. There are individuals that are not. We should exercise that caution of - do we really need to do this? Do we have the freedom to choose not to do it?
>>BOB ZALTSBERG: And that brings up - that goes to the other question. A caller called in to say what's guidance on public transit? You know, some people have to take the bus to work or have to - you know, their - local transportation is sometimes sort of a necessity for people in living their lives. Kosali?
>>KOSALI SIMON: I think this, again, goes back to the same issue of - we are not sure where transmission could occur. We're not sure where there's asymptomatic individuals - where the risk is. And so the general advice would be social distancing, self-quarantining to the extent possible, breaking the modes of transmission. And sometimes the costs of that are really high and it's a question of are - we're not all in the same capabilities of avoiding those costs or being able to weather those costs. So they're just hard decisions individuals are having to make, and hopefully we'll have resources that will make that easier.
>>SARA WITTMEYER: This is - I hope probably Dr. Handel and Kosali, you can respond to this, but folks really just looking for assurance that the health care system is going to be able to handle a significant increase. And is there any plan to collaborate with other hospitals? And what about urgent care centers?
>>DAN HANDEL: So the answer is yes. I mean, the short answer. And we already are collaborating at the state level. You know, I think one of - obviously, IU Health has a system - is a very large system, but we work closely with our partners throughout the state. You know, and the state Department of Health has actually had plans like this in place for years. If you look back, there was a concern for pandemic influenza in 2014. You know, back to the H1N1. I mean, we've had these public health concerns pop up every couple of years or so. So the upside of that is it's given us multiple opportunities to prepare and rehearse for situations like this. So, you know, if we get to a point where the volumes are high enough, that becomes a coordination at the state level and - and we work through our State Hospital Association - through the state Department of Health to coordinate to make sure that we're meeting the needs of the state.
>>KOSALI SIMON: There's something we should keep in mind about health insurance, and that is even if - health insurance is not designed, necessarily, to pay for everything, right? We know that there's a lot of cost-sharing included. And depending on the type of insurance - Medicaid has less of that than other types of insurance. But we have many more people insured now than had this been 2013. In 2013, there were about 45 million people uninsured. More recently, it's about 30 million uninsured. So we have about close to 15 million more people, for a variety of reasons. Primarily, policy has expanded health insurance through Medicaid marketplaces. So that is something to be aware of - that it - had this been earlier years, we'd be thinking even harder about how are we going to pay for treatment.
>>SARA WITTMEYER: A question we've gotten a couple times is wondering about boxes, packages, things delivered to their door. Can it be transmitted that way? And I think before - one question we got before was specifically asking about China, but I think this is more asking about grocery deliveries, things like that.
>>DAN HANDEL: No. I mean, the short answer is no. I mean, it's - you know, obviously, people should wash down things they get. But, I mean, I don't think there's been any documented transmissions through mail or otherwise. So - I mean, particularly you think about the distances that these - a lot of these packages travel - whether it's across the country or across the world. So I don't think that's a significant concern at this time.
>>BOB ZALTSBERG: So we only have a couple months to go and I'm going to throw out kind of a big question. You know, last week, at this time, we hadn't shut down all major sports, people are not going to big events. Where are we in terms of, like, the timeline of this? Can anybody predict - like, if the - you know, if Major League Baseball, who said we're going to be out for two weeks and then we may start the season - is there really any chance of that? Are we going to know?
>>ANA BENTO: So school closures and this kind of, like, cancellation of major events will always have a huge impact in decreasing - let's go back again to that epidemic curve, right? So the longer we stay within those ranges of behaviors, the more we decrease the number of infected and we decrease those chains of transmission - those opportunities for transmission. At some point, we will have to go back to normal life, like China is now trying to transition. Because we still don't understand if this virus has a seasonality to it, there is, of course, a risk of - as we go back to normal life, that we will see, again, an increase in cases. But however long we stay in this quarantine event will help decrease the sustained infection that we have now. So even when we go back, even though we might see a number of infected cases, it will still be much lower than had we maintained life as usual. But how long we are going to do that for - it's not so much a question of epidemiology or public health, it's a question of public policy. It's a question of economic consequences. So this virus, like any other novel virus that might pop up some other time, is no longer a very contained question of public health. It's a question of many consequences at all levels of society. So yeah, it's hard to look on.
>>BOB ZALTSBERG: We're out of time. We could talk about this for several more hours, but I want to thank our three guests today. Kosali Simon, Ana Bento, and Dr. Dan Handel. For Sara Wittmeyer, Benthe Bouthier - who's our producer - and engineer Mike Paskash, I'm Bob Zaltsberg, thanks for listening.
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