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With the coronavirus, ‘pay attention to the basics’

As the novel coronavirus continues to spread in the U.S., the National Institute of Health on Sunday advised vulnerable people, particularly the elderly with underlying health conditions, to avoid large crowds and trips. ProPublica reporter Caroline Chen, who has been reporting on the virus, joins Hari Sreenivasan to discuss what people need to understand about testing, infection rates and more.

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  • Hari Sreenivasan:

    Federal, state and local governments are in the midst of a complicated public health crisis, as the Coronavirus outbreak continues to grow in the U.S. and around the world. Joining me now is Caroline Chen, a reporter for ProPublica who is covering the COVID-19 response and what we need to know about the spread of the virus. You lived through SARS when you were a kid in Hong Kong. You have covered Zika and Ebola. So you've got a little bit of experience watching these things roll out. What is most concerning to you right now?

  • Caroline Chen:

    What's most concerning to me is how prepared the U.S. is. And we're in a critical junction right now because speed matters right now. We're still in early days in the U.S. But how prepared we are now and how we respond right now over these weeks are going to matter a lot. And the populations I'm most concerned about are the vulnerable. And for me, that means the elderly in particular with this disease and also the frontline workers. So that's health care workers and first responders because they are going to be on the front lines.

  • Hari Sreenivasan:

    Let's take a look at each of those populations. The elderly, that that was a devastating number of people that were affected in Seattle at that nursing care home. What should, kind of, anybody who has a relative in a nursing home be thinking right now? What kind of plans should those places have?

  • Caroline Chen:

    Yeah. So, nursing facilities, I hope that all of them really have a preparedness plan right now and are really stepping up their infection control in particular. And that is also the case for hospitals or any type of health care facility that are in states or in cities or in counties that have geriatric populations. But also, you know, even if you're not living in a nursing home, if someone is elderly, they might start thinking, you know, at some point in time, I might not want to be going out, you know, taking public transit and start stocking up a little bit. And I'm not talking about like panic buying, buying 16 bottles of Lysol, but start slowly and methodically, you know, buying a little bit more groceries every time you go for a grocery run. And also, I would encourage people to start thinking about their neighbors. So if you have an elderly neighbor, if you have an elderly grandparent, this is the time where we can really be helping our neighbors.

  • Hari Sreenivasan:

    Yeah. And then the other part of this equation, which I think is just as important here, is the health care workers. They're on the front lines. They're the ones who are actually going to be dealing with the patients. Well, we've already seen different cases around the country pop up where nurses who are getting sick were doctors who are getting sick are saying, 'Hey, I still don't get these tests. I just want to know if I can help people or if I would actually be a greater harm to people if I go out and touch them.'

  • Caroline Chen:

    Yeah. So I think there are two elements here. One is that we already know that there have been issues with testing and testing capacity in the U.S. And so that's urgent. Testing capacity really needs to ramp up in the US because if we don't know where the cases are and how many cases there are, that's going to put health care workers at risk. The second issue is supplies and supplies of what's called PPE, which is personal protective equipment. So that's masks, gowns and gloves. And we are already hearing that hospitals are being prepared for there to be scarcity there. And so that's an urgent issue. And part of my reporting is looking at that and whether there's gonna be enough. And that's something that governments, both on local levels and at the federal level are going to have to really be prepared for.

  • Hari Sreenivasan:

    So I kind of hear you saying two things here. On the one hand, speed up and be urgent if you're government, on the other hand, don't panic if you're a citizen.

  • Caroline Chen:

    Yes. So and I think that, you know, a lot of people I've heard saying, you know, should I go to a concert? You know, I want to know what I want to do. And I and I totally understand that you wanted to like, have the answer. But there isn't a blanket answer for, you know, I can't just say everybody, you know, here's the blanket answer. It really depends on who you are. You know, how old you are. What is your personal medical history look like, where you are in the country. And this is where I really urge people to listen to their public health officials. So those are the people who are trained and and know how to respond to epidemics and who are looking at the data in your area. And, and they are going to say, you know, now is the time when we want to stop mass gatherings in this particular area, for example. And so you have to make that judgment call for yourself and listen to those public health officials.

  • Hari Sreenivasan:

    So, speaking public health officials, yesterday, for example, a day before that, the FDA said, look, we're going to launch a million different test kits are gonna be available to nonpublic partners, maybe these labs that are around. Should I be comforted by the number 'a million tests'?

  • Caroline Chen:

    Yeah. So a lot of my reporting actually so far has been around testing. And one of the things that really has irked me is, is the numbers that have been putting out have been attached to the unit of test kits or testing. And I think what we care about as, is people. We want to know how many people can be tested and how many people have been tested. And I think what a lot of people don't realize is that there are limitations, because when you send out these kits, it actually takes a little while to setup. And the analogy I've been using, is they're a little bit like Blue Apron kits? You know, those? So when do you send out a kit to a lab, it takes them a little while to set them up. And then there's a manpower issue at a lot of these labs. So at the public health labs, what I've been told by the Association of Public Health Labs is that most of the labs on average can only run about 100 samples a day. Now, we're still not in the unit–

  • Hari Sreenivasan:

    Samples.

  • Caroline Chen:

    –That I care about. Right. Which is people. So 100 samples a day, you then have to divide that by two because you mostly run, the recommendation is to run two samples per patient, so you have a double check.

  • Hari Sreenivasan:

    To confirm.

  • Caroline Chen:

    To confirm. So now you got to divide that by two. So that's 50 patients a day at each lab. So I can tell you: a million tests. That sounds great. But if at your local lab, they can only run 50 patients a day. That's a limitation. So then the question is, how many labs are there in your area and how many patients a day can they run? So I was urging reporters to be asking the question and asking the question in the units of patients a day, to be saying, you know, how many labs are there in my area, for example. And asking them, 'what's your capacity in terms of patients per day?' And also asking, you know, officials when they say we ran, you know, X number of tests, you know, to say, 'how does that translate to patients? How many patients did you test?'

  • Hari Sreenivasan:

    Right. One of the things that has concerning people so much is that they've heard different rates of mortality, of how dangerous or how deadly this is. First we heard in China, it was, oh, somewhere around 2 percent. And the World Health Organization said, oh, might be 3 percent. And so there's this unknown. So how do we get to a better idea of this? Because it seems like you really can't get that unless you have more numbers to be able to divide by and say how many people have it? How many people got well? How many people didn't?

  • Caroline Chen:

    Yeah. So one of the really tricky things when there is an epidemic that is ongoing is pinning down the mortality rate. And I guess one thing I want people to know is that at this point in time, it is still an estimate. And so if you see a change from week to week where it was 2 percent and then it's 3 percent, it doesn't mean, like, it suddenly became more deadly. It means that the estimate is shifting. And how it's calculated is the number of deaths reported divided by the number of laboratory confirmed infections. And that's really important to understand that that's laboratory confirmed, which means that somebody had to be tested. And like normally I think when we think of mortality rate, you're really thinking like, if I got infected, would I die, right? So what we want to know is, you know, at the bottom is, how many people were infected. And right now, that's really, really hard to get an idea on because not everybody's being tested, right?

  • Hari Sreenivasan:

    Sure. So not everybody's reporting, not everything is inside the government data.

  • Caroline Chen:

    Yeah. So it is possible that there are people who, you know, got infected, but they they didn't even realize that they were infected or they had a milder illness. And so they didn't get a chance to go see a doctor. So that denominator is it's something that scientists are still trying to figure out at this point in time. So I think what's really important to know is that this is more deadly than the flu. And in particular, there is enough data right now to know that it is a really dangerous disease, particularly for the elderly. That's important to know. I think scientists are also confident enough to say that it is less deadly than a disease like SARS, where the fatality rate ended up being in the ballpark of nine to 10 percent.

  • Hari Sreenivasan:

    Right. So regardless, regardless of whether it's 2 or 3 percent, that doesn't mean stop washing your hands now, everything's fine because it's two, right?

  • Caroline Chen:

    Yeah. It's a dangerous disease and it needs to be taken seriously. But I think that freaking out over 2 percent versus 3 percent, like I think that's not very helpful right now. And I don't think it really makes a difference to the public. You know, whether, you know those two numbers, what's the difference? I don't think we have any actionable steps we can take between that sort of percentage change.

  • Hari Sreenivasan:

    Well, what about the notion of what is essential and what is nonessential travel and how different governments around the world are reacting to this? I mean, in a way, China had the sort of advantage, disadvantage of not being such a free society. But they can also just decide we're gonna close this down. We're not going to let X travel. We can quarantine X millions of people, right? Or even northern Italy last night. They decide, OK, this whole section. Compared to, I just don't see New Yorkers, for example, saying, yeah, you can't really go to the Bronx, but you got it. So it's a it's a hard thing to figure out. And then, you know, we have Anthony Fauci saying we probably won't see those kinds of restriction in the United States. Does that make these kind of things spread faster, the fact that we have access to be moving freely?

  • Caroline Chen:

    I mean, yes, in in a technical sense, I mean, if you just locked everyone up in their rooms at home.

  • Hari Sreenivasan:

    Yeah. Then it wouldn't spread.

  • Caroline Chen:

    It wouldn't spread. Right. And yes, I do think that in general, the U.S. tends to not impose that that type of thing. I'm not a politician. So, I can't forecast what the U.S. will or won't do. But I do think that this is where we do have to listen to our public health officials. Again, I say, and I hope that reporters in particular will, will listen more to the public health officials and to the scientists here over in terms of what they are recommending that we do for citizens. And again, I recommend that people really pay attention to the basics, like it really doesn't help to get super hung up on, you know, a plane versus a train if you don't wash your hands at all. Right?

  • Hari Sreenivasan:

    Right.

  • Caroline Chen:

    That sort of personal hygiene habit can make a huge difference. Yeah. And that's why, you know, the CDC and all the public health officials keep saying that over and over again, like learn how to wash your hands properly. Wash your hands often. Like those things make a very big difference. Don't go outside if you're sick. You know, right now we don't have a lot of testing capacity. That is a big problem. But you can help everyone by staying home if you are sick, whether it is the flu you have — which is still more likely, frankly — or the coronavirus. Because if you stay home, because you have the flu, you're also helping to decrease the burden on the health system as a whole. And that's helpful.

  • Hari Sreenivasan:

    One of the things that people get concerned about is how the math works out. And they see these numbers growing and they see these infections spreading. But as we were talking earlier, that there is actually a way to cut that math down, just through education. If we changed our behaviors, that math doesn't have to play out the same way.

  • Caroline Chen:

    Right. And this is what I was just talking about, which is everybody doing their part to have good personal hygiene habits. Stay home if you're sick. And we should probably talk about this, which is, you know, what are the symptoms of COVID-19? And the first presenting symptoms in most cases are fever and a cough, not a runny nose. I don't know how many people know that. And then what should you do if you do feel sick? We don't want everyone to rush to the E.R. That would overburden the health care system and probably increase spread. So the recommendation right now is to call. To make a call, call your doctor, call your provider. You know, if you're feeling really sick, you know, call 9-1-1 if you need to. But it's pick up the phone first, because that helps the health system to triage you and tell you what to do. And I was just on the phone this morning with the, with a emergency physician and asking him, hey, what are you doing in your area? And it's going to vary so much from system to system. They're all kind of working out their cases. And he was like, you know, if you were someone where, based on either your travel history or other circumstances, you know, where we thought that you were a likely candidate to have COVID-19, you know, we could do something like say, we want you to come to a designated location, but stay in your car. You know, don't walk right into the emergency room where you could infect other people. You stay in your car until we're ready to come get you. And we can have our people, you know, gown-up appropriately so we can reduce our risk of infection and then we can come get you when you're ready, you know? So that helps them have control.

  • Hari Sreenivasan:

    It's like those little buzzers at restaurants.

  • Caroline Chen:

    Yeah, exactly.

  • Hari Sreenivasan:

    Don't wait in line around people who are all coughing around you.

  • Caroline Chen:

    Yeah. So all these actions that we as citizens can take can also help lower the chances of transmission increasing.

  • Hari Sreenivasan:

    You've been focusing a lot on the reporting around hospitals and health care workers and how they're dealing with this. What do you need to sort of get to that next step?

  • Caroline Chen:

    Yeah. So we're really interested in hearing from people on the frontlines right now. So if you're a healthcare worker who's working on the front lines of the Coronavirus, please reach out to us and you can reach us at www.propublica.org/coronavirus.

  • Hari Sreenivasan:

    All right. Caroline Chen from ProPublica, thanks so much for joining us.

  • Caroline Chen:

    Thank you so much.

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