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Dr. Alexander Salerno Discusses Lack of Equipment & Test Kits Despite Trump Saying All Who Need Testing Are Being Tested; NY Governor Cuomo Gives Update on Coronavirus Response. Aired 11:30a-12p ET

Aired March 26, 2020 - 11:30   ET



DR. ALEXANDER SALERNO, PRIMARY CARE PHYSICIAN: I think it could be as much as one in three walking around asymptomatic right now.

JOHN KING, CNN ANCHOR: One in three?

SALERNO: Yes. We have tested some patients that have had known exposure to COVID. They did not have a temperature. Their pulse aux was OK. They had very little symptoms, maybe just a headache you might call a sinus headache and they tested positive for COVID-19.


KING: So you need the tests --


SALERNO: Yes, we need the tests. We test people, we get a positive test, we risk-stratify them, we isolate them, and we separate them from the people who are not positive. So, yes, we could get people back to work safely.

And what about the worried well? You're right, mental health right now is being challenged and pushed to the brinks right now with anxiety about this.

KING: Dr. Salerno, I can't thank you enough for your insights -- I know you're busy as well -- for sharing your insights and your perspective from the ground. It's very helpful not only to people in New Jersey but around the country as we try to get our arms around this challenge. I very much appreciate it.

SALERNO: Thank you, Mr. King. Be safe.

KING: Thank you, sir. You be safe as well. Thank you for what you're doing.

Up next for us here, our views from the front lines on the coronavirus fight and the dramatic risks doctors are facing every hour.

(COMMERCIAL BREAK) GOV. ANDREW CUOMO, (D-NY): -- facts of the situation. And facts can be uplifting, they can be depressing at times, they can be confusing at times, but I think facts are empowering.

In a situation like this, not knowing the facts is worse because that's when you feel out of control, or when you feel you're getting selective facts or you're being deceived by the information you're getting, that is actually the worst situation.


So I say to my people in every situation, just give me the facts first and then let me understand what the situation and the reality is. And then we'll go from there. So that's what I try to do.

The facts on this situation are increasingly important on two levels. Public health, but also the economic facts. We've been focusing on the public health facts and the response of the public health system to the virus.

More and more we now have to deal on two fronts. We have to deal with the public health situation but we also have to deal with the economic situation. I'll get to that in a moment.

Public health, we have a two-pronged agenda which we've been pursuing aggressively. We still are. Flatten the curve. Reduce the flow into the hospital system. At the same time increase the hospital capacity.

What we're looking for is not a reduction in the number of cases. We're looking for a reduction in the rate of the increase in the number of cases, right? That's what comes first when you're starting to make progress. The rate of increase should reduce as opposed to the number of absolute cases. So that's what we're looking for.

The optimum is when they talk about the apex of the curve is not to have an apex, and that's what the flattening is, not to have that spike because that spike is when you overwhelm the hospital systems. We try to get down that rate of increase so you can actually handle it in the hospital system, right? And that's what they talk about by the flattening of the curve.

Just as an aside, Dr. Anthony Fauci has been so kind and helpful to me. I speak to health care professionals all across the globe, literally, but Dr. Fauci, I think, is just brilliant at this. And he has been so personally kind.

I call him late at night, I call him in the middle of the night, I call him in the morning, and he's been really a friend to me personally in the state of New York.

So this is all about getting that curve down and not overwhelming the hospital system.

Almost any scenario that is realistic will overwhelm the capacity of the current health care system. So a little reality. Keep the curve down as low as you can. But you cannot get the curve down low enough so that you don't overwhelm the hospital capacity. So any of these scenarios we have to increase the hospital capacity.

And that's why we're literally adding to the hospital capacity every way we can. That's what the Javits hospital is about. That's what the Stonybrook hospital is about. What's what the old Westbury additional site is. We're also scouting new sites now all across the downstate area of this state for possible sites.

Our goal is to have a 1,000-plus overflow facility in each of the boroughs downstate in the counties. Queens, Brooklyn, the New York City boroughs, Queens, Brooklyn, the Bronx, Staten Island, Nassau, Westchester and Rockland, so every county has a 1,000-plus-bed overflow facility. That's what we're working on at the same time.

As well as increasing the capacity of the existing hospital system. As we've said, the hospitals have a 53,000-bed capacity. We're trying to get to 140,000-bed capacity between the hospitals and the overflow facilities.

We've mandated that the hospitals increase their capacity by 50 percent. We've asked them to try to increase it 100 percent, but they have to increase it 50 percent.

We're also scouting dorms, scouting hotels for emergency beds, and that's going well.

Equipment and PPE is an ongoing issue. Right now, we do have enough PPE for the immediate future. The New York City hospital system confirmed that. So we have enough in stock now for the immediate need.


Ventilators, ventilators, ventilators. I didn't know what they were a few weeks ago besides the cursory knowledge. I know too much about ventilators now. We're still shopping for ventilators all across the country. We need more.

We have approved the technology that allows one ventilator to serve two patients, what they call splitting, which is where you add a second set of tubes to a ventilator to do two patients. It's not ideal, but we believe it's workable.

We're also converting anesthesia machines to ventilators. We have a couple thousand anesthesia machines in our hospitals, and we're converting them to work as ventilators.

Why is there such a demand on ventilators and where did this come from? It's a respiratory illness for a large number of people. So they all need ventilators.

Also, non-COVID patients are normally on ventilators for three to four days. COVID patients are on ventilators for 11 to 21 days. Think about that. So you don't have the same turnaround in the number of ventilators.

If somebody is a ventilator for three or four days, that's one level of ventilators you need. If someone is on for 11 to 21 days, that's a totally different equation. And that's what we're dealing with. The high number of COVID patients and the long period of time that they actually need a ventilator.

We're also working on equalizing and distributing the load of patients. Right now, the number of cases is highest in downstate New York, so we're working on a collaboration where we distribute the load between downstate hospitals and upstate hospitals and we're also working on increasing the capacity for upstate hospitals.

Shifting now to a totally different field. The economic consequences of what's going on, which have just really gelled after what the federal government has done, and we were waiting for the federal action to determine where we were from a point of revenues and economics.

What's happening to a state government, any state, what's happening to a city government is a double whammy. You have increased expenses because of the COVID virus. And you have a tremendous loss of revenue because all those businesses are closed, right, and all those people are out of work.

If people are out of work and not earning an income and they're not paying income tax. If businesses are closed, they're not making money, they're not paying business revenue. So we're spending more to take care of the COVID virus, and we're receiving less.

In the middle of all this, we have to balance a budget. So how do you do a budget when you have expenses going out and a loss of revenue? We estimate the loss of revenue as somewhere between $10 billion to $15 billion, which, you know, all these numbers are hard to give a context. That is a ton of money for the state of New York's budget.

We were waiting to see what the federal government did before we determined what we had to do, because water flows downstream, right? If the federal government had taken an action that helped state governments, city governments, et cetera, that would have put us in one situation.

We now know what they've done. They passed their $2 trillion stimulus bill. They say maybe they'll come back and there may be another bill. Maybe, maybe, maybe.

We know what they did do with the stimulus bill. The stimulus bill helped unemployment insurance, and that's a good thing. It helps more businesses, and that's a good thing. It did not help local governments or state governments. And it did not address the governmental loss. The federal officials, the ones who are being honest, will admit that.

New York State receives $5 billion from the stimulus. New York State government. And it's earmarked only for COVID virus expenses, which means it does absolutely nothing for us in terms of lost revenue to the state. The only thing it's doing is helping us on the COVID virus expenses, which is nice, but the bigger problem is on the lost revenue.

[11:45:20] The congressional action, in my opinion, simply failed to address the governmental need.

I've spoken to all the officials involved, I've spoken to our House delegation, I spoke to our Senators, and I believe what they did failed to meet the governmental need.

I'm disappointed. I said I was disappointed. I find it irresponsible. I find it reckless. Emotion is a luxury and we don't have the luxury at this time of being emotional about what they did.

When this is over, I promise you I'm going to give them a piece of my mind. But I would say to them today, this is an extraordinary time in this nation, and it's an extraordinary time for government. This was the time to put politics aside and partisanship aside.

This is the time for governmental leaders to stop making excuses and just do your job. Do your job. We're one nation. You know the places in this nation that have the most intense problems. Address the places that need the help.

This is not a time to point fingers. This is not a time to make excuses. This is not a time to blame everyone else. We've lived with that in Washington for years.

Now is a time to actually step up, do the right thing and do your job. They haven't, as far as I'm concerned, especially when it comes to the governmental need.

In any event, we have to do a budget, and the budget is due April 1. So the only responsible course for us is, number one, we have to address this revenue loss.

We know the revenues are down. We don't know how much. We don't know when the economy comes back. We don't know the rate at which the economy comes back. And we don't know what Washington may do to address this situation in the future, if anything. So you don't know, you don't know, you don't know, and you don't know.

But you have to do a budget with all of those unknowns. Address them realistically. And how do you address them realistically? First, we're going to adjust down our revenue projections for the initial budget.

And then what we're going to do, which is something we've never done before, is we're going to adjust the budget through the years to reflect the actual revenue.

Meaning, we'll say on day one, OK, we intended to give you $100. We don't have $100, so we're going to give you $95. But I can only give you $95 if I get $95. And I'll let you know quarterly or whatever the period of time is how much money I'm getting and how much I can give you of the $95, and therefore you can plan accordingly.

And that's, frankly, the only way that you can do this budget when you have so many unknowns. So adjust the initial number down and then have periods through the

course of the year where you say to school districts, local governments, et cetera, this is how much we actually received, this is what the federal government did, it's what the federal government didn't do. The economy is coming back faster, the economy is coming back slower, but these are the actual numbers so you can adjust your budget accordingly.

On the public health numbers, our testing numbers up again. We did 18,650 tests. This was just a massive mobilization operational undertaking. We had never done it before. You have to set up all these drive-thrus. You have to set up all these testing facilities.

And we're testing more than any other state in the country. We're testing more per capita than South Korea, more per capita than China. It really is amazing what we're doing.


And the testing is important. The testing is still helping you identify the positives and isolate the positives. The testing is not telling you how many people have the virus. And I think a lot of people conflate the two. And that's a mistake.

It's not even telling you the increase in the rate of infection. All it's telling you is you're increasing the numbers of tests. And the more tests you do, the more positives you will find. We are working very hard to increase the number of tests because we want to find the positives.

This is a really bad news. The number of deaths is increasing. It's bad news because people are dying. And that's the worst news you can have. It is not bad news in terms of it being unexpected.

What's happening is people, who were infected, who came into the health care system, have been on ventilators. The longer you are on a ventilator, the more probability of a bad outcome. We now have people who have been on ventilators for 20 days, 30 days. The longer you are on the ventilator, the more likely you are not going to come off the ventilator. That's what's happening.

Because we do have people who have been on for quite a long time. And those are the people we are losing. That's always been the way. The longer stay without recovery lead to a higher death rate. Right? And that's not just COVID. That's any medical situation we deal with.

That's the natural consequences when you have older and sicker patients staying on ventilators longer, they usually have the worse outcome, right? And I think people get that from their usual experience.

What we're seeing now is that is happening. We've had people on for a long time and they have not getting better and they are passing away.

The number of deaths at 385, up from 285. Since we still have a large number of people on ventilators for a long period of time, the experts expect that number to continue to increase, right?

We've said this from day one, you get the infection, 80 percent self- resolved and they don't go to the hospital. Some percentage go to the hospital and get treated and go home. Some percentage go to the hospital and need a ventilator and they never come off the ventilator. That situation where people deteriorate over time.

That's what we are seeing. That's the vulnerable population, the small percentage of 2 percent or 3 percent of the population, who we have always worried about. But that's what we're seeing.

And in the end, we expect it to increase because, as time goes on, by definition, we have more and more people on ventilators for longer periods of time.

The number of people tested 18,000. That's the break-down number of positive cases. Total of 37,000. New cases, 6400. The curves continue to go up. The spread across the state continues, which also what we expected just the way it is spread all across the country. We now have several counties that have don't have a single case.

The overall number, 3,700, tested positive, 5,000 current in the hospital. This is the point. And 37,000 tested positive, 5,000 hospitalized currently. And 1200 ICU patients, which is what we watch most carefully because those people who need ventilators. And 1500 patients discharged after being hospitalized. OK?

Not to be redundant. But people get sick, 80 percent of the people don't go to the hospital. They stay home. They don't even stay home. They just self-resolve. Some people get sick and stay home. Some people check into the hospital. You are talking about 15 percent or 20 percent. Of that, a percentage gets treated and leave.


Of that, the smallest percentage gets put on ventilators. That's the 1,290 ICU patients. Some of those people on a ventilator get better and come off the ventilator. Some people don't get better, stay on the ventilator. When you are on the ventilator for a prolonged period of time, the outcome is not positive.

But the percentage of people who wind up in that situation, it starts with the 1,290 ICU patients. Those are the people who are put on ventilators. And that's of the 37,000 that tested positive. We are talking about a small population. They're put on ventilators. Some recover and some don't.

Most impacted states, New York is still number one. Louisiana has a, quote, unquote, "hot spot." It has a cluster that's growing.

People in Louisiana and New Orleans are in our thoughts and prayers. We know what they are going through. We feel for them and we pray for them. We know the difficulty they are under because we are dealing with the same type of situation. So our best to them. Any way we can help them, we stand ready.

Again, total perspective is the Johns Hopkin's count that has gone from day one, 487,000, 21,000 deaths worldwide.

My personal opinion -- the facts, I give you the facts. My gratuitous two-cent, which is probably worth a penny and a half. This is a life moment. A moment in a life of this country. A moment in the life of the world. It is the moment in our family's lives. A moment for each of us. Each of us is dealing with it in our own way.

My observation has been that when the pressure is on is when you really see what people are made of. In a personal relationship, in a business relationship.

People can be great when everything is great. The question is: What does a person do when things are not great?. What does a person do when the pressure is on them?

That's where you can see a little crack in the foundation of a person. When the pressure is on, that little crack, that little crack can explode and that foundation can crumble. Or, you can see the exact opposite. You can see them get stronger.

But you get to see what they are really made of. You get the see the best and you get to see the worst. You get to see the beauty in people and you get to see the opposite.

The outpouring of support for the people of New York have been so inspiring, not just from New Yorkers. I am telling about from across the country and across the world.

You would be amazed at how many phone calls we get and how many offers of support and creative ideas, from everyone.

We've asked medical staff to volunteer, retired medical staff who are no longer practicing. And 40,000 had volunteered. We now have 12,000 more people in one day volunteering to help on the medical staff.

We asked mental health officials to come forward to volunteer to offer free mental health services for people who are dealing with the stress and the trauma of this situation. We had 6,000 people. We now have 8,600 people.

We have mental health professionals from other states calling up and saying they'll provide mental health services electronically via Skype or over the telephone.


It really is -- it gives me such strength and such inspiration.

But I don't want to sugar coat the situation. The situation is not easy. But, easy times don't forge characters. It is a tough time that forge characters. That's what we are looking at right now.

People say to me, people are getting tired of this situation.