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Economists: 4 to 8 Million Unemployment Claims Last Week; Study: People May Be Most Infectious Before Showing Symptoms; South Korea: 141 Recovered Patients Test Positive Again. Aired 6-6:30a ET

Aired April 16, 2020 - 06:00   ET



UNIDENTIFIED MALE: It's difficult to imagine us getting together in the thousands any time soon.


KAITLAN COLLINS, CNN WHITE HOUSE CORRESPONDENT: They are going to unveil these new guidelines. The president has been hinting that he believes there are some states that can reopen.

DONALD TRUMP (R), PRESIDENT OF THE UNITED STATES: We want the states to administer these tests. And if we're not happy, we'll take very strong action against a state.

GOV. ANDREW CUOMO (D-NY): Why doesn't the president want to go near testing? Because testing is a quagmire. No one can bring it up to scale quickly.

UNIDENTIFIED FEMALE: Checks are starting to be cut by the Treasury Department. We have almost 17 million Americans who are out of work.

UNIDENTIFIED MALE: So much of a transition occurs from asymptomatic people. Perhaps the way to really put this fire out is to start testing asymptomatic people.


ANNOUNCER: This is NEW DAY with Alisyn Camerota and John Berman.

ALISYN CAMEROTA, CNN ANCHOR: We want to welcome our viewers in the United States and all around the world. This is NEW DAY. It is Thursday, April 16, 6 a.m. here in New York.

And we begin with the devastating economic impact of the coronavirus pandemic. And the debate over when and how to get Americans back to work. President Trump will announce new federal guidelines today, but governors and even major business leaders are warning that they are nowhere near being able to reopen.

Dr. Deborah Birx on the White House task force says they have identified nine states with fewer than 1,000 confirmed cases. She didn't spell out at the time exactly which states those are. But they could open sooner than others.

But business leaders are warning that testing is still inadequate and needs to be dramatically ramped up before people can go back to work. The U.S. is still testing at a far lower rate than many other countries, John.

JOHN BERMAN, CNN ANCHOR: Yes, and Alisyn, that's really the news this morning. There are not two stories, the economic and medical one. They are the same story.

The economy needs testing to get going at a whole different level than right now. Workers need to feel comfortable that the person in the next cubicle is not infectious.

A brand-new study indicates that people might be most infectious before showing symptoms. So you need to test people who don't seem sick to guarantee a safe workplace. The economy needs testing.

Later this morning, weekly unemployment claims will be released. A projected 4 to 8 million more jobs lost. The report is expected to show that the U.S. economy has erased all of the jobs created since the Great Recession.

So that's why we want to begin with CNN's Julia Chatterley. Julia, 16 million jobs lost in three weeks. We're about to learn week four, and the projections are devastating.

JULIA CHATTERLEY, CNN INTERNATIONAL ANCHOR ANCHOR: They are. What we're witnessing here, John, is economic catastrophe in terms of scale and in terms of speed.

At worst, as you said there, we could see a further eight million people asking for help, filing first-time benefits. We're talking about an unemployment rate, in that case, of 17 percent in the United States. It dwarves anything we saw in the financial crisis.

And to your point, too, what we could be approaching the point where we have completely erased all the job gains that we saw over the last ten years in the space of four weeks.

You were just showing the range there, and I do think that's very important. We have no clue. That's the truth about what this number is going to look like. It could be as low, and it's not, as 3.8 people. It could be as high as 8 million people. There's still the uncertainty to do with this tsunami of people trying to get access to these benefits.

The gig economy workers. We're talking up to 23 million people who, in certain states, like Massachusetts and Pennsylvania, were being told, please wait until the end of the month, because we simply can't deal with you. We need to build new systems here.

What we've seen in the space of -- of four weeks is millions of people here in the United States uncertain, losing their jobs, furloughed, losing access to benefits. These are households and families that are dealing with two crises here, to your point. Health crisis and economic crisis. And we can't separate them.

CAMEROTA: Julia, thank you very much. We'll check back in with you as we get these new numbers throughout the morning.

Joining us now is Dr. Suraj Saggar. He's the chief infectious disease doctor at Holy Name Medical Center; and Dr. Manisha Juthani, associate professor of medicine and epidemiology at Yale School of Medicine.

OK, guys, I want to start with the connection between the devastating economic news and the devastating medical news. And that is people are desperate to get back to work, Dr. Juthani, as we know. But they can't, because we don't have widespread testing.

For months, we've heard about the need for testing, but now, this morning, there's a new wrinkle. So this nature of medicine study finds that people are highly infectious before they ever begin showing symptoms.

Explain how -- if people aren't coughing and sneezing, how is it possible that they're highly infectious?

DR. MANISHA JUTHANI, ASSOCIATE PROFESSOR OF MEDICINE AND EPIDEMIOLOGY, YALE SCHOOL OF MEDICINE: So this nature medicine paper is a very interesting paper that I also read over the last couple of days. And I think the thing that's most provocative about it -- there are two things that are very interesting about it.

No. 1, it shows that, after you get infected, it takes about five days to show symptoms. But the virus is taking hold both in your nasopharynx, in your throat, and sort of in that upper respiratory tract. And that is where the virus starts replicating.

So it's around day three that we believe that people are starting to become infectious, but they don't have symptoms until day five. So this is exactly the quagmire that you pointed out. That there's about two days when people seem to be highly infectious, and yet, don't have any symptoms. And this is one of the biggest challenges with controlling this disease, and that is different than maybe the first SARS epidemic that we saw. And that's one of the real challenges in terms of transmission.


BERMAN: So Dr. Saggar, what does that mean in terms of testing and reopening office spaces? If we have 30 people who come into this office here, and they all seem healthy, does that really mean we have to figure out ways to test as many of them as we can, even if they're not coughing?

DR. SURAJ SAGGAR, CHIEF INFECTIOUS DISEASE DOCTOR, HOLY NAME MEDICAL CENTER: No. That's a good point. Actually, this is a departure of what we initially thought, which was the sicker you are, the more you're sneezing, the more you're coughing, the higher your temperature, that you're actually more infectious at that point. What this paper points out is that the virus is actually concentrating

in the oropharynx, as my colleague mentioned early on. And actually, when people become more sick, when they progress to lung symptoms, pulmonary symptoms, pneumonia, the virus actually migrates to the lower part of the lungs.

So what we do know about this virus is the majority of people are either asymptomatic or have very mild disease.

What's interesting now is those patients, actually, are the ones that may be spreading the virus more readily in the community, as opposed to there are those that are more sick and maybe staying at home.

And what we need to know is, one, can we test those patients? Do those patients then subsequently have antibodies that are protective? Are the levels of the protections of those antibodies the same as someone who recovers from more severe disease? There's a lot of questions out there in terms of what the results of the tests actually mean.

We know we need more testing, but we also need these tests to be vetted by the FDA. And we need to know more in terms of what the results mean, what the antibodies mean, how long they may last, how strong and what kind of efficacy, what kind of durability they might provide before we can really feel confident opening up and saying, well, someone in the next cubicle over may be asymptomatic and may still be positive. And what is the chance they can, A, be protected; and what's the chance they can spread to myself, working next to them?

CAMEROTA: This is why it's so worrisome, obviously, Dr. Juthani, to go back out. Because if you can't visibly tell that somebody is sick, then how can you protect yourself, unless you're always going to wear a face mask, which now, you know, four states are saying you will have to starting, I think, today or tomorrow. And unless you're social distancing. And that doesn't work, obviously, for getting back to businesses and getting back to work, et cetera.

And it's so counterintuitive to think that somebody who looks completely healthy is actually a super spreader. But we do know from some of these events that started all of this that everybody at a party or everybody at a, you know, biogen conference looked healthy, and then so many dozens of people got sick.

JUTHANI: Absolutely. And I think you brought up the exact point, Alisyn, that wearing a mask is really the only way around that.

Because one of the problems with testing is that, if you test too early, you might not catch the virus. If you test once somebody starts having symptoms, that's pretty obvious. You're trying to catch this window when they don't have symptoms.

And so how else can you get around that, other than wearing a mask when in public settings? I think that's why testing and mask wearing is going to be the combination to get back to any sort of normal life until we have therapeutics, vaccines, things of that nature that are going to be able to help protect a community or have enough herd immunity, as well. Not really instead of, but with. Is that, is there are enough people in a community that also are already immune, that can help. But this is going to be one of the real challenges in the months to come.

BERMAN: And look, and that's why you now have Los Angeles saying that masks are going to be required for people outside. New York state saying masks are going to be required for people outside. New York City, the metro system, you can't ride the subway now or going forward without a mask. It's because of where we are with this virus.

And Dr. Sutter, I want to know how much testing? I acknowledge there are many different kinds of testing. There's the antibody testing, which is a separate thing.

But in terms of determining who has it, how much testing are we talking about? Because I think there have been, what, 3 million tests conducted. Say I'm off. Say it's 4 million now. That's still only right around 1 percent of the population. How much more do you need than that?

SAGGAR: Well, we need, certainly, to ramp up dramatically. We're doing a good job. We need to continue. Our turnaround time on the front line has gone from many days, a week, to a few days now. We're doing it in- house in most institutions so we can have it back the same day.

But we have to rapidly improve our ability to test. The PCR test, which is looking for someone who actually has the disease. And the antibody test will be very important for us to know, eventually, retrospectively, looking back, in terms of exactly the denominator. How many people actually had the disease so we can determine exactly how infectious it was and also to determine what the case fatality rate.


But the reality is that we need to ramp up our testing, both the PCR testing to diagnose the test and the antibody testing. But I would caution there's many antibody tests out there. And we really need to be -- make sure that they're vetted by the FDA so that we know their sensitivity and specificity. That is, the chance they'll be positive in disease, the chance they'll be negative in the absence of disease. Because we don't want compounded issues where we have false negatives and false positives, which can be a very real issue when we're talking about testing like this.

CAMEROTA: Dr. Juthani, there's a new CNN poll conducted last week that shows people's comfort level with all of this. So you know, leaders can say, yes, we're open for business. Everybody get out of there. But 60 percent of respondents say that, if social distancing were to end, they would not be comfortable right now, you know, on May 1 going back.

And you know, Dr. Birx of the White House task force yesterday said that there are nine states -- we might have a map -- that have less than 1,000 cases. And so basically, it would stand to reason that those states could maybe lead the way, or those states could try to get back to normal.

But then, there are other states that didn't seem to have any -- you know, many cases -- Iowa, Nebraska and South Dakota -- that are now seeing spikes.

So what do you think about those nine states?

JUTHANI: I think it's important to see what the trajectory of cases has been. So when we say 1,000 cases, is the curve that everybody is familiar with seeing just continuing to go up? Or have they seen a peak and are they coming down? That might give us some sense of if the virus seems to have made it through that community or not.

I do think there are going to be different solutions for different communities, and we have to be aware of that. But the only way we can really make that type of determination is with some real data.

And without testing more people to be able to know who might have had disease and who might not have -- I mean, I know that just as a member of my community, I'm certainly wearing my hat as a physician and an infectious disease physician. But even just as a mom and, you know, having friends and colleagues telling me about their kids who had, you know, fevers and cough in January and February and tested negative for flu and negative for strep, and could they have had it? The answer is, we don't know.

And you know, we need to start testing in the highest risk areas like hospitals and people who are working there themselves. And you know, for example, I was able to participate in an antibody test that's happening in -- at Yale for healthcare workers. And so, you know, I'll be able to get a sense of do I have immunity or not? This is a research study. But I think that that's -- we don't know that for so much of the population.

CAMEROTA: Doctors, stick around, if you would, because there is another big story on this front that we need to ask you about.

So there's potentially this major development out of South Korea. More than 100 recovered patients who no longer are showing any symptoms, they've come through coronavirus, they've tested positive again. What does that mean? We ask our doctors, next.



BERMAN: So developing this morning. South Korea has just announced that 141 patients who had recovered from coronavirus, they had it and got better. They have now tested positive again.

Back with us, Dr. Suraj Saggar and Dr. Manisha Juthani.

And Dr. Saggar, what exactly does this mean? And I know there are some questions. Even in South Korea, they have some questions about the reliability, the testing before and after. But if people who had it and recovered can get it again, that alters the whole equation here, doesn't it?

SAGGAR: Well, I think there's some important caveats we should discuss with this. They didn't necessarily say they're people who recovered, were sick and tested positive. They said that when they tested, probably, their stool and/or their urine, they found results or reports of evidence of virus still present. We don't know if that means it's infectious.

We know that patients, once they recover, can shed. That means shed. It means the virus can still be found in the stool, as well as in the feces. It doesn't necessarily mean that they are longer infectious. So we don't necessarily know the correlation or the significance of testing positive.

When you say test positive, it really means that they found evidence of the virus in other parts of the body.

We at least expect the patients that recover for some time -- of course, the million-dollar question is how long -- will have some degree of immunity. In terms of how long that lasts, what that will mean for the fall, the winter for 2021 is unclear.

But we do know for at least a short period of time, people should be protected.

So again, finding the virus and testing positive, quote-unquote, really means find the virus in the stool and the feces, but we need to -- and the urine. But it doesn't necessarily mean that they are sick, that they got sick again after recovery.

CAMEROTA: OK. Then I'm going to exhale for the first time in an hour. Because that is different than -- I mean, having a trace, Dr. Juthani, of the virus still makes sense, as opposed to somehow them having to go through that whole ordeal again, because they were re-infected. So it is -- you interpret it the same way?

JUTHANI: Absolutely. I completely agree.

So what we understand is that they were able to identify the RNA. So it's basically the genetic signature of the virus. That does not mean that they were able to grow the virus. And what I understand is that they're in the process of trying to do that. To see if they are able to grow the virus, which would then tell us, this is infectious.

In fact, that same "Nature Medicine" paper that we talked about showed that somewhere around day seven to 10, that you may still detect virus for days longer, maybe up to three, four weeks, but that it's no longer infectious. That's a pretty small study, small sample of patients. But I think that that's an important point.


And we need more papers like that, more data to be able to take a deep breath again and again and be able to feel comfortable that patients are not necessarily infectious. We may be finding that genetic signature, but that they're not necessarily going to infect other people.

BERMAN: This just goes to show how much more we still need to learn about coronavirus and how early we are in all the stages of this.

And Dr. Juthani, both of you, but Dr. Juthani first, you as you have been watching this and helping treat it over time, have noticed two distinct stages of the sickness. Explain what they are.

JUTHANI: Yes. So this is something a lot of infectious disease doctors, you know, we're all new to this, too. But we've become experts very quickly in learning about this disease. And there are sort of diagrams out there of other researchers and people taking care of patients who have seen the same thing that all of us, I think, are seeing, which is that the illness seems to have a phase that is predominated by the virus in the beginning. This is generally about the first seven days, roughly.

And patients may have a fever, body aches, cough, things like that. And it's all related to sort of the virus replicating. And that starts to wane.

And in the second phase of the disease is when we seem to have more of the body's immunologic response. Now, some people don't have that vigorous of a response. Some people sort of get better. You know, I know that there are people that have dwindling symptoms for days, sometimes weeks after that initial phase.

But some people, sometime around day seven to 10, is sort of a window, I think, we're seeing where some people seem to get worse. And this is where people start having maybe worse respiratory symptoms, need oxygen, need to come to the hospital, because they feel like they can't breathe, worsening shortness of breath. This is a lot of the time when people get admitted to the hospital.

Some people are able to get better. Some people are getting worse and needing to go on ventilators. This is when we're really able to try the different medications or enroll patients in clinical trials to be able to see if they can actually benefit from some of the different therapeutics that we've been trying.

CAMEROTA: Dr. Saggar, I know that you have the case of a patient that still haunts you from last month. A man who came in with mild symptoms and what happened?

SAGGAR: Yes. You know, so this is really reflective, as my colleague mentioned, how we're learning in real time so much about this disease.

Early on, we thought this virus has a predilection for the lungs. So we were looking for cough, shortness of breath and fever. We learned later in real-time that patients present other manifestations. They present with gastrointestinal symptoms.

And I had a patient who came in who really had kind of a nausea, vomiting, diarrhea. Very mild gastrointestinal symptoms. I did a CAT scan of his belly, and I noticed that he had some findings in his lungs. That was basically early, middle March. So at that time, I just under extra precaution, decided to isolate him and test him for coronavirus. And this is back when it took up to a week to get results back.

And I remember very vividly telling him that I didn't really think he had it, but I was just being overly cautious. And sure enough, not only did he become positive, but ultimately developed very severe lung disease and, unfortunately, ultimately succumbed to this disease.

As my colleague mentioned, this is really a very tricky virus. It can have a lot of different manifestations. Not just lungs and pulmonary manifestations, as you mentioned in the news. But you can have gastrointestinal symptoms. You can have cardiac symptoms. And we're learning more and more of how it really affects the entire body, what we call systemic disease.

BERMAN: What are the implications, then, Dr. Saggar, on treatment or vaccines, given these two distinct phases?

SAGGAR: Well, I mean, the treatment is really looked, as my colleague mentioned, there's two distinct phases. So the anti-viral, the treatments that are looking at stopping the virus from integrating, that is entering and hijacking the human body and replicating within the body, is probably most effective in the first week.

We know in the ones, the patients that we're most concerned about, the ones that are progressing and more than a week into symptoms, that's where the body is developing what we so called cytokine storm, where we're throwing everything and the kitchen sink, so to speak, at this virus. And actually, that immune response, the very robust immune response, especially in certain patients, oftentimes males, that causes significant disease and significant damage to the lungs.

So if we can understand those two different phases to this virus, we can then subsequently tailor our treatment approach. Early on, look at drugs that attack the virus itself. Later on in the disease, look at medications that can blunt or block the immune response, like steroids, like certain types of anti-monocle (ph) antibodies. These are things looking at stopping the cytokine storm, quote unquote, that has been mentioned in the news so often.

So as we understand the pathophysiology, as we call it in the infectious disease world, we're better able to develop and time our modalities of treatments.


BERMAN: This has been so helpful, doctors. I appreciate both your time and helping us understand all the new medicine and public health implications over the last 24 hours. Really appreciate it.

JUTHANI: Thank you.

SAGGAR: Thanks for having us.

BERMAN: Be sure to join Anderson Cooper and Dr. Sanjay Gupta for a new CNN coronavirus town hall tonight at 8 p.m. Joe Biden is joining them, as well as Facebook founder and CEO Mark Zuckerberg and Dr. Priscilla Chan on how Facebook and the Chan Zuckerberg Initiative are working to fight the coronavirus.

Nearly a dozen African-American pastors demanding equal access to testing and treatment, as African-American continue to die at disproportionate rates in this country. That story next.


BERMAN: As of this morning, nearly 31,000 -- 31,000 -- Americans have died with coronavirus. And there have now been nearly 640,000 confirmed cases in the U.S. We have reporters across the country bringing you the latest developments.