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Number of Coronavirus Cases in U.S. Continues to Increase; Senate Economic Stimulus Bill Stalls; President Trump Tweets about Effect of Coronavirus on U.S. Economy; Hospitals Warn Of Shortages And Closures Without Emergency Aid; Interview With Mayor Bill de Blasio (D-NY). Aired 8-8:30a ET

Aired March 23, 2020 - 08:00   ET



DR. JEROME ADAMS, U.S. SURGEON GENERAL: People out on beaches. We see here in D.C. that the district set up a cam for people to watch the cherry blossoms. You look on the cam, you see more people walking around then you see cherry blossoms. And this is how the spread is occurring.

Everyone needs to be taking the right steps right now, and that means stay at home.


JOHN BERMAN, CNN ANCHOR: It's going to get bad this week, says the surgeon general. There are now more than 34,000 coronavirus cases in the United States, more than 400 Americans have died. New York at this moment is the epicenter of the outbreak in this country, with roughly five percent of the world's total cases.

President Trump is activating the National Guard in three of the hardest hit states, New York, California, and Washington state. The federal government is also sending medical supplies and directing FEMA to set up medical stations to increase the number of available beds. More than 100 million Americans are waking up this morning under stay at home orders.

And overnight there was this remarkable interview with the nation's top infectious disease doctor, Dr. Anthony Fauci, who expressed frustration, it seemed, with the president's grasp of facts. He told "Science" magazine, quote, "I can't jump in front of a microphone and push him down."

ERICA HILL, CNN ANCHOR: Also overnight, the U.S. Senate failing to reach an agreement on a historic $1.8 trillion stimulus bill. Democrats arguing the Republican measure puts corporate interests above the needs of the American workers.

A vote is now expected around 1:00 after Democrats blocked Senate Majority Leader McConnell's effort to force a vote this morning, which McConnell wanted to hold just minutes after the opening bell on Wall Street. We can tell you, that Republican effort has also been hampered by the absence of five GOP senators who are now quarantined, including Senator Rand Paul, who has tested positive for coronavirus.

The Senate dysfunction comes at a time when millions are waiting anxiously for help. They have rents, they have mortgages, they have bills to pay. They may have already lost their job or had their paychecks cut. Just a few hours ago the president putting out a statement that raised new questions whether he may be losing his patience with the mandated social distancing. We just heard from the surgeon general how important it is, the president tweeting overnight, "We cannot let the cure be worse than the problem."

We begin this hour with CNN's Chief Medical Correspondent, Dr. Sanjay Gupta. And Sanjay, first, I just want to get your take on what we heard from the surgeon general moments ago, this week is going to get bad. How do you read that?

SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Well, look, you can sort of predict this trajectory for some time based on what we've seen in other countries, based on the testing. Keep in mind that there are a lot of people who may have been exposed over the last couple of weeks who just now this week and the days following are going to start having symptoms.

And that's going to sound alarming, but that's sort of the incubation period of this virus. So a lot of people I think have become complacent saying, hey, look, we've been hearing about this for some time. I feel fine. No problem. And hopefully it stays that way.

But again, keep in mind that there is a lag time here between the time of exposure to the time of symptoms. We're hearing -- I was just looking at some of the studies late last night, up to nine days typically between the time someone is exposed to the time they go to the hospital, if they need to go to the hospital. Most people won't need to go to the hospital, but for about the 10 percent to 20 percent of people who do end up going to the hospital or so, this is going to be the time.

And I think it's going to be quite jarring, not just in terms of the numbers but in terms of what we then see at the hospitals. Are they capable of actually taking care of these patients? Look, you're hearing out of New York, you're hearing out of California, Washington, and other places around the country, it's not entirely clear what it's going to look like this week.

BERMAN: Sanjay, we've really been trying to focus on this show, on what will save lives, and keep it out of politics as much as we can. The president over the last few minutes on Twitter has been putting out these statements, retweeting these statements. And I don't want to you respond to the politics of it, but I want you to respond to the medical implications.

He now seems to be indicating that he's got some belief that social distancing may be going too far. He retweeted someone who said flatten the curve, not the economy. He retweeted someone who said 15 days, then we isolate the high-risk groups and the rest of us get back to work before it's all over for everyone. Another one he says, so we're all basically on house arrest but they're letting prisoners out. Sounds like a brilliant idea.

Again, politics aside, the idea that soon we could loosen some of the social distance regulations in terms of the medical and public health implications of that, what would it be?

GUPTA: Well, look, this isn't going to last forever, just to be clear, but it's not ready to be over yet either. And there's data on this from around the world, there's data on this from throughout history.


Here is the point, is that if you sort of think about being able to do this for a period of time diligently, thoroughly now, it's going to really save the amount of pain that people suffer later on from this. So if you do the social distancing mechanisms now, and they are best done if they're done early, they're going to have a much bigger impact. If we don't do that, then it's likely we're going to be dealing with this for a much longer time.

I get it. Flattening the curve probably does mean flattening the economy for a period of time, but it's a question of how quickly both can recover. And both can recover more quickly if you're more diligent about it now. And that's not me just saying this.

This is the data from public health officials that are looking at things right now, but also, we've shown many times, 1918 and other pandemics what it has looked like when you've been able to actually practice diligent social distancing. It makes a huge difference.

HILL: Sanjay, can you put it in perspective for us. So as John said, and I find it such a jarring statistic that New York now has essentially five percent of the world's cases. Are there so many cases in New York, specifically in New York City, because we are simply doing more testing and we know more? Is it because it is such a dense area? Or is it perhaps all of the above, but we don't have a final answer yet?

GUPTA: I think it's definitely all the above, and I would say that I think there is going to be other communities around the country, because they haven't tested as much, that are going to start to see a lot more evidence of community spread in the areas. In fact, look, I think the entire country probably now has evidence of community spread. This virus has been circulating around the United States for some time. Perhaps cities that are more densely populated, have international airports, are more likely to have the virus come to those communities first, but it's here, clearly.

And one point I want to make about testing, Erica, and I think it's important. We're going to see a strategic shift in testing, I think over the next week or so, and the strategic shift is going to be away from testing. Part of it is that we've just never had enough tests. We've been talking about this for weeks and weeks and weeks, and we still haven't clearly had enough tests around the country.

The other point is that what is the purpose of the test? The purpose of the test for the public health community at large is to say, is the virus here? Is it spreading? I think the answer to that question is yes. For any given individual, if they get a test, a doctor administers a test, the question they're really trying to say is, OK, now that we have got this test and we get this conclusion, are we going to do anything different based on it?

And the answer is no, because there is no specific anti-viral. You're going to treat the symptoms as you otherwise would, people should stay home if the symptoms aren't that severe. The point is that tests really don't mean that much to any given individual.

What they mean something to really is the public health at large to establish that the virus is here, and frankly, that's been established. So I think the testing has become the metric to success. We have got to move on. We have got to move on to actually dealing with the issues that you've been interviewing other doctors about, making sure these hospitals are ready.

BERMAN: And Sanjay, you say New York and Los Angeles have already announced that shift in strategy, where in some cases they're only going to test it if it will change the outcome for a specific patient?

GUPTA: That's right. So they in part, to be clear, it's been driven by the fact that there's a frustration still with having inadequate testing, people coming and saying I've got to be tested, and doctors saying, why? How is that going to change anything for you personally? You should already be staying at home. If you have symptoms, you should be isolating yourself regardless of whether it's coronavirus or something else.

That was the guidance even before this outbreak. Now from a public health standpoint, certainly in New York and Los Angeles, they know the virus is there. The virus is spreading. So simply testing every single individual isn't going to stop that process at this point. The efforts, the energy, the resources need to be really focused on how to care for the sickest patients of all.

GUPTA: All right, Sanjay, stand by. We have a lot more questions for you coming up.

In the meantime, Washington in a little bit of a standstill. The Senate is going to try in a few hours to vote again on a roughly $2 trillion stimulus bill. Democrats blocked it. Why? Well, they say that the Republican plan fails to adequately protect the American workers or impose enough restrictions or controls on bailed out businesses. CNN's Joe Johns live at the White House with much more on this. Joe?

JOE JOHNS, CNN SENIOR WASHINGTON CORRESPONDENT: Good morning, John. We are told from sources here and up on Capitol Hill that Steven Mnuchin, the treasury secretary, along with the president's legislative director, Eric Ueland are expected to meet with Senate Democratic Leader Charles Schumer about an hour from now, 9:00 eastern time, to pick up on discussions that left off last night that was after that procedural vote in the United States.

[08:10:05] The procedural vote failing to move forward on the Bill 4747 that needs 60 votes in order to do so. The fault lines are quite obvious. There is a lot of anger up here on Capitol Hill and at the White House over this issue, $1.8 trillion, which would be the biggest stimulus in the history of the American government. Democrats arguing that there's not enough in the bill for families and workers.

They're concerned about accountability, they say, in the bill. Republicans saying if there is more money in the bill for companies, that, of course, will help American workers. There is still optimism, even from the president himself, that this bill is going to get done, not just for the people who are hurting, but also to calm the markets on Wall Street. John?

BERMAN: Joe Johns for us at the White House. Joe, please keep us posted on this. Erica?

HILL: Emergency room doctors are being forced to improvise as the number of patients increase and supplies run short. Just ahead, we'll speak with two of the doctors on the front lines. That's next.


HILL: Front line healthcare workers, doctors, nurses, and so many others in some of the hardest hit areas are pleading for more masks and other protective equipment as their supplies run low.

Dr. Sanjay Gupta is back with us.


And also joining us now, Dr. Josh Lerner, an emergency physician in Massachusetts and Dr. J. Randall Curtis, Director of the Cambia Palliative Care Center at Harborview Medical Center in Seattle. It's good to have all of you with us.

I do want to touch just off the top on the supplies because some of the numbers that we're hearing specifically, what we were given in terms of guidance here in New York City on Friday, the Department of Health coming out and saying, listen, you have to be really careful with how you're using these supplies, especially if healthcare workers or first responders are asymptomatic even if they've come into contact with people.

And then you have the Chief of Surgery at New York Presbyterian Columbia here in New York City who said on Friday, each employee will get one N-95 mask and they are responsible for making sure that it stays clean, and that it is always available.

When we hear something like that, Dr. Curtis, I have to say my first thought was, how often can you reuse that mask and is that safe?

DR. J. RANDALL CURTIS, DIRECTOR OF THE CAMBIA PALLIATIVE CARE CENTER, HARBORVIEW MEDICAL CENTER: Yes, well, I would say is that my experience here in Seattle, having just finished a week in the COVID- 19 ICU is that we do have enough supplies and I was able to use a different mask each time I went into a patient room.

But I think we're reasonably worried that that's not going to stay that way if this pandemic really goes the direction we think it could go.

HILL: Dr. Lerner, you put up this impassioned Facebook post and I know it's got a ton of reaction. Part of what you were discussing, though were the C.D.C. guidelines that we all talked a lot about at the end of last week that if you don't have enough masks, try a bandana or a scarf.

And you wrote, "Make no mistake, the C.D.C. is loosening these guidelines because our country is not prepared. Sending healthcare workers to the frontline asking them to cover their face with a bandana is akin to sending a soldier to the front line in a t-shirt and flip-flops." Has anything changed since you posted that?

DR. JOSH LERNER, EMERGENCY PHYSICIAN: What's changed I think is the outpouring of support that my hospital has gotten from the community.

We've had people showing up donating masks, offering just these masks. It's been very touching. You know, I would say if the military had a shortage of helmets, would we say it's acceptable to wear baseball caps? Or do we get to work making more helmets?

And I think that's what we need to do in this country, is we need to start making more N-95 masks.

HILL: We hear so much, Sanjay, about the N-95 masks and we also hear about the personal protective equipment. Is it your sense that the message is getting out there, not just to the folks who are making these products, you know, and when we're hearing about governors basically bidding against each other to try to get what available supply there is.

But do you think as a whole, the population in the U.S. has a sense of what doctors on the front lines, like all of you are facing on a daily basis?

GUPTA: I don't think so. I don't think most people have a sense of that. You know, and I'll be at the hospital later on. And I know that in order to just see my patients who are not COVID patients, coronavirus patients, I will still need to wear personal protective equipment.

But you know, Erica, there have been there has been models sort of predicting how much of these this sort of equipment and supplies would be necessary, and if you look at some of these models, they predicted that in the midst of a moderate pandemic, that you would need some three -- up to three billion or so masks.

You know -- and the reason for that is because as the virus is circulating, you don't know who has it, who doesn't have it. So you have to really put on your personal protective equipment for every patient. This was known -- the lay public may not know it, and they may not

know what healthcare providers are sort of going through, but I think it's a little frustrating for people who are the planners, organizers in big medical structures to know that look, it was known that we might need up to three billion masks in this sort of scenario. We had weeks to sort of think about this. We're trying to play catch up now.

There are the numbers there on the screen. We do make a lot of masks, 1.5 billion annually. But we knew -- there it is -- 3.5 billion could be necessary in this sort of scenario and there's the shortfall.

That's a problem. It's a problem that maybe we could have addressed. I don't want to look in the rearview mirror anymore. It's not helpful. But I think that that's the part that's a little bit frustrating.

HILL: There are lessons to be learned and specifically as we look at how this has spread, how it has been handled in other countries, and even at this point in other cities, Dr. Lerner, I know you believe that in Massachusetts, it maybe days or weeks behind New York City.

What kinds of lessons are you taking from areas like Seattle, like New York as you prepare?

LERNER: Yes, I think we are days, maybe a week or so behind my colleagues on the West Coast and in New York. We are starting to try to conserve N-95 masks particularly as much as possible.

I think the N-95 mask is probably the most important piece of PPE, but it also includes gowns and gloves. I just wanted to reiterate something that had just been said, you know, any -- for any one patient encounter, you have multiple healthcare workers at the bedside -- doctors, nurses, respiratory therapists and they all need the PPE.


LERNER: So it's not just one mask for one patient. We may be talking five or six masks for one patient in the ER at one time. And so that really I think speaks to the volume of PPE that we need.

In Massachusetts, we are starting to conserve. We've been asked to reuse our masks. We use a mask for about four hours during a shift in the ER and we are trying to do that, we are trying to be cognizant of our supplies.

HILL: As you're doing that, Dr. Curtis, you said you've actually seen a little bit of a flattening at your hospital there at Harborview Medical Center in Seattle. What do you attribute that to?

CURTIS: I hope so. I think it's early to say for sure, but what I would say is over the last two weeks, the numbers of new patients particularly seriously or critically ill patients has been relatively stable.

And I'm hopeful, it's early, yet, I'm hopeful that the reason we're seeing that stability is because of the social distancing, the canceling travel, that the public health measures that have been taken are perhaps making a difference.

I think -- I don't want to be overly optimistic. I think we have to worry that it's not having the effect that we want and need it to have. But at least right now, it looks to us like things have been relatively stable.

HILL: Well, we'll take that obviously, with a degree of caution. Sanjay, as we look at -- as we look at overall what we're seeing across this country, there are also these interesting new studies. I know you were tweeting about some of them over the weekend. We talked about some of them earlier this morning.

But studies also looking at -- you were pointing out what we're seeing as some of the symptoms that may not have been initially things that people would associate in their mind with coronavirus.

What are some of those? What should we perhaps be paying closer attention to this morning?

GUPTA: Yes, I mean, I think we're getting a little bit more insight into the types of symptoms that patients might have, and some of the symptoms that patients might initially have as well.

A study out of China, where they looked at some of the earliest patients, some 200 patients, and they found that digestive or stomach, you know, GI symptoms, were actually there in about half the patients.

I mean, initially, this was thought to be almost solely respiratory and I think fever and cough and shortness of breath are still the prevailing symptoms, it sounds like, if you look at these studies, but there were patients who also had diarrhea, who have loss of appetite, who had abdominal pain, even vomiting.

The loss of appetite was actually quite common in people who had any digestive systems, about 80 percent of them had some loss of appetite.

Now that can be vague, it can be hard to sort of pin down, but it's just a sense to give people an idea, is there something different in the symptoms that they're having?

I don't want everyone to start thinking that every single GI symptom is now coronavirus by any means. But it gives clinicians and doctors and nurses a better chance.

One other thing that -- I just want to amplify what Dr. Curtis was saying, everyone obviously hopes that these measures are sort of flattening the curve.

One thing to just keep in mind again, though, is that whatever we're seeing now, it's kind of like seeing the light from a star, right? You know, the light from a star actually emanated a long time ago. The picture that we're seeing right now is sort of behind the curve.

It typically takes several days between the time of exposure, the time someone gets sick, and then if they do get tested, it takes a few days after that. So we really could be you know, 10 to 14 days behind. So I think these next two weeks, I think, again to Dr. Curtis's point

are going to be really critical to see if the numbers sort of stay flat or not.

HILL: And of course we also have -- this is on the heels of the Surgeon General this morning saying, this is the week that it's really going to get bad.

Doctors Gupta, Lerner and Curtis, thank you all for being here answering our questions this morning. And again, thank you for everything that you are doing out there on the frontlines. Stay safe -- John.

BERMAN: So New York City is now really the epicenter of this pandemic in the United States and hospitals here in dire need of critical medical supplies. The city's mayor joins us next.



BERMAN: All right, new this morning, the U.S. Surgeon General not mincing words about what we're about to face with the coronavirus pandemic.


DR. JEROME ADAMS, U.S. SURGEON GENERAL: I want America to understand this week, it's going to get bad. This is how the spread is occurring. And so we really, really need everyone to stay at home.

UNIDENTIFIED FEMALE: You don't think people are taking it seriously?

ADAMS: I think that there are a lot of people who are doing the right things. But I think that unfortunately, we're finding out a lot of people think this can't happen to them.


BERMAN: This week is going to get bad, says Dr. Jerome Adams. Right now New York City is really the epicenter of the outbreak in the United States and five percent of all the cases worldwide.

Joining us now is New York City Mayor Bill de Blasio. Mr. Mayor, thank you so much for being with us this morning. You heard the Surgeon General say this week, it's about to get bad.

Last count from the city, about 16,000 cases, 114 deaths. I know at a certain point, it's hard to keep track of the numbers. But what's the current situation in the city?

MAYOR BILL DE BLASIO (D-NY): John, the Surgeon General is right. It's going to be bad this week. It is going to be worse the following week. I mean, we have to be honest about this. This is just the beginning.

I don't mean that, you know, to be anything but blunt and honest with New Yorkers and all Americans. It's the beginning of something that will get worse throughout April and into May.

And we've got to brace ourselves and we've got to change our lives and we absolutely need help from Washington. There's no way not only this city, the greatest and largest city in the country. We're struggling and we need help.

But imagine, John, as this spreads, all of the cities, all of the towns, all of the counties around this country that are going to be overwhelmed, the only way they can make it through is with Federal help and right now that's hanging --