Let's bring in our guest.

Dr.

Gregory Poland is professor of medicine and infectious diseases and the director of the vaccine research group at Mayo Clinic.

And Dr Scott Gottlieb is former FDA commissioner and now a CNBC contributor who is also a member of Visors board.

Dr.

Gottlieb, I want to start with you and just try to get the numbers on the ground.

You were with us last week and said, at that point it was probably too late to stop the spread in China.

But perhaps it was here.

What do you think about the increased numbers we've sends her?

Well, I think we need to change our posture here in the United States.

I think we need to have a posture.

We were going to try to detect outbreaks early, and that means broadening the screening criteria and brought in the capacity to do screening here in the United States.

Right now, the posture seems to be focused on preventing introduction of the virus into the United States.

That's helpful, but we have to assume authority here in circulating.

What we want to do is spot outbreaks early and step in to take measures to prevent small outbreaks from becoming large.

Roberts and an epidemic.

How do you do that?

I thought that the CDC were the only ones who could actually do the testing on this.

Well, that's just that the CDC should broaden that test of public health agencies and local labs, maybe even hospital Abbas a simple PCR based tests.

A lot of people could run it.

We also should change the criteria for screening anyone who presented with an atypical of bad pneumonia that has a negative screen on what we call the multiplex test for viral forms of pneumonia.

And it's a suspicious case.

They should probably get tested even they don't have been.

Even if they haven't been to China because it's what's gonna happen in a setting of an outbreak.

It's gonna be secondary spread.

It's not gonna be someone who visited China gets sick.

It's going to someone who you interact with someone who visited China, who was sick, maybe asymptomatic or had mild illness.

That's how we're going to spot an outbreak right now.

If you believe that about 10 to 20% of people develop pneumonia, so it's only a small fraction will end up in the hospital.

You might need dozens of cases in the city before you have enough suspicious cases showing up in any one institution to elicit testing.

So you want it.

You want to get that trigger earlier so you can spot small outbreaks prevent becoming big outbreaks.

Dr.

Poland.

What?

What are your concerns at this point?

And I guess what's the upside?

What do you think we're better at doing now than we were when stars came out?

Uh, first of all, absolutely agree with Scott and and his recommendations there.

We need to be clear.

We're basically at a pandemic now, and what we need to be doing in a situation like this is we need number one point of care diagnostics, which is what Scott was referring to.

We need to have a lower threshold for doing that.

And, you know, remember that SARS was controlled basically with very low tech but high efficacy measures like hand washing, social distancing, wearing mass etcetera.

So that's what we really need to be focused and concentrated on.

Now I think what we're trying.

What we should be trying to do here is buy time to get to the spring and summer, when the epidemiology of spread might change and hope that this summer's a backstop.

It might not be a backstop because this is so novel.

People don't have any close community might still transfer in the summertime, but we should hope that that's going to be a back in the summertime.

Just let's talk about the economic impact for a second.

If you're trying to wait till the summer, what else you gonna have to shut down between now and then?

Look, I think the next two weeks of pivotal if we don't start to see outbreaks in United States within the next two or three weeks, we might have dodged the bullet here.

I think we're going to start to see secondary spread the United States in the next two or three way, and then what?

And it's gonna be a difficult month.

I think people are gonna start to shut down, you know, certain activity to try to curtail the spread of this.

The good news is probably that people it sufficiently concerned, and I think we will be willing to take measures that will be necessary to stop this from becoming a bigger epidemic.

United States.

Can we talk about it?

It's early.

Had finish your thought.

Yeah, yeah, it's It's early.

But you know, we've had very limited second generation cases, as opposed to other areas like China.

Here, here in New York, for example, large, Ah, a lot of the Chinese immigrants moved to Flushing, Queens.

So if you take the seven line out there, there's a lot of people wearing masks.

Is that something that people in New York should consider doing?

Just generally or no masks have limited usefulness.

I mean, a simple surgical mask is gonna get moist in a small amount of time.

It's only useful for 10 15 20 minutes on and 95 mask.

But an N 95 100 mask is more useful for a longer period of time.

Most people aren't using that they're using nurses masks.

If you look at what they're wearing, I think the best value of a mass, frankly, is it prevents people from touching their face because this really transfers exactly through the country and tigers of people touching something in touching base.

If they have a mask on, the less likely it touch their face, they're doing some good.

Dr Poling, you point advantage.

Is the advantages behaviorally?

Exactly.

You point out that since SARS thehe mount of train travel in China is up tremendously the amount of air travel and you'd probably say the same thing around the globe.

We are seeing people travel much more frequently.

Well, that's that's really what makes this of concern Number one.

You've got a novel virus that can infect humans.

We don't really understand its reproductive number.

We don't really understand the case fatality yet.

The number of cases that you're hearing about over 17,000 today is absolutely an underestimate.

Those air, the more severe ones that we know about, what that real denominator is, we don't know.

And, as you point out, unprecedented in the history of mankind has been the level of travel in one week.

In China, there were about 2300 flights at the beginning of January, out from China to the rest of the world.

That's a lot of people moving around.

It's an excellent point.

I mean, we know the numerator, we don't even really know the numerator is trying is under testing right now from what I'm here.

But what?

We definitely don't know the denominator.

This probably tens, if not hundreds of thousands of cases in China.

So when you when you start the factor that every case fatality rate isn't 2% it might be more like 20.5%.

But even that would be devastating if that are not the transmissibility is 2 to 3 new cases for everyone.

Case, if you have something that has a case fatality rate of 30.5% the fluids but comparison 0.1% is gonna be devastated.

Smaller than that.

I mean, if you look at 15 million people who had influence or here in the United States you have 8000 people who died, I think it's closer to a point.

05%.

Remember, this could burn it in a word, population more efficiently.

We don't have any cross.

No vaccine, no backstop.

I'm sorry, Doctor.

Yeah.

No, that's right.

I was just going to say, you know, the updated numbers of influenza are an estimate of about 25 million that have been infected somewhere around 20,000 that have died this season in the U.

S.

And another 2 to 300,000 that have been hospitalized.

So, you know, you kind of compare the two what Scott was getting ready to say, and it is absolutely right is this is a novel virus for us there.

This is an absolutely virgin population.

We don't have any immunity to this, and that's why you tend to see somewhat more severe disease.