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U.S. Death Toll Due To COVID-19 Nearly Doubles In One Week; Experts Indicate Testing Must Increase In U.S. For Economy To Reopen; New Nasal Swabs May Be Used To Test For COVID-19; Key Model Forecasts Dates That States Could Ease Restrictions. Aired 8-8:30a ET.

Aired April 20, 2020 - 08:00   ET



UNIDENTIFIED MALE: We've been fighting for testing.

DONALD TRUMP, (R) PRESIDENT OF THE UNITED STATES: The governors what to have us, the federal government, do the testing. The testing is local. You can't have it both ways.

UNIDENTIFIED MALE: Everything associated with testing ultimately has to be approved by the CDC and the FDA, as it should be. The states shouldn't be making their own decisions on that stuff.

UNIDENTIFIED MALE: He does not, in my view, understand this disease in the beginning. We are not going to be able to get back on our feet and restart if we don't get help from Washington.


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

ALISYN CAMEROTA, CNN ANCHOR: Good morning, and welcome to our viewers in the United States and all around the world. This is your NEW DAY.

The death toll in the United States is now nearly 41,000 people. When NEW DAY came on the air last Monday morning, that number was 21,000. In other words, in the space of just a week, the casualty number has almost doubled to 41,000 people. That's a number that just a few months ago would have been unthinkable.

On a positive note, several hot spots, including New York, Connecticut, Rhode Island, Detroit, and New Orleans, appear to be stabilizing. Governors there say they are seeing progress in stopping the spread. Over the weekend the hospitalization rates in Connecticut and New York dropped after weeks of a steady climb.

So which places are next to be hardest hit? Well, Chicago, Boston, and Philadelphia are being closely monitored as areas of concern. So are we on track to reopen parts of the country soon? That's hard to answer because of the continuing problems with testing. Over the weekend, we saw tension between the White House and a group of governors over how to get testing done. JOHN BERMAN, CNN ANCHOR: Yes, many of the nation's governors, Alisyn,

from both parties say there just aren't enough tests, things like swabs needed for the tests are in short supply. This morning, researchers from Harvard estimate that testing rates must triple before the United States can safely reopen. The president disagrees. But he does now claim that he'll use the defense production act to manufacture swabs.

A new "Wall Street Journal"/NBC News poll shows nearly 60 percent of Americans are concerned about reopening too quickly, nearly 60 percent. Now keep that in mind when you see pictures of these small pockets of protests around the country, calling for an end to the stay-at-home orders.

A little bit of key economic news this morning. Word from Washington that a deal on an additional small business aid package could come as early as today.

Joining us now, CNN chief medical correspondent Dr. Sanjay Gupta and Dr. Jeanne Marrazzo, she is the director of infectious disease at the University of Alabama in Birmingham. Sanjay, I want to start with you. Testing this morning is still the primary issue. It seems to be a political issue but very much a public health issue. We're going to speak to someone who is involved with this Harvard School of Public Health Study saying the number of tests needs to triple. Why? What do you see this morning?

SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Yes, well, if you look at the overall numbers that we're doing in terms of testing, its' probably around 150,000 tests per day. We hear that it needs to triple, go to 450,000, 500,000, in order to just test the people who are of most concern, people who have symptoms, health care workers, frontline workers. In order to do real surveillance ultimately, it would probably need to be maybe 10 times higher, closer to 1 million or so tests per day, that's when you're really starting to get an idea of the surveillance out there.

It's an interesting study, John, you may have seen just at the end of last week a study out of Stanford showed that in this one town about 1,000 people who had confirmed to be infected, when they started doing surveillance and using things like antibody testing, their prediction is the number is close to 50 to 80 times higher than that. Again, so 1,000 people confirmed. They think there may, in fact, be 50,000 to 80,000 people who had at one time been exposed to the virus. So that gives you also an idea of why we need to do the surveillance testing.

CAMEROTA: That's what's so confounding, Dr. Marrazzo, honestly, the numbers, they're just so all over the place. Are there a ton of asymptomatic people or are there not? From what we know from the testing that Sanjay was just referred to, something like 20 percent of the people who have been tested are positive. Is that a high number? Is that a low number? I understand that we need it to be lower, three to 12, but if you have symptoms, I would have thought that it would have been higher. So what do you see in these numbers?

DR. JEANNE MARRAZZO, DIRECTOR OF INFECTIOUS DISEASES, UNIVERSITY OF ALABAMA AT BIRMINGHAM: Well, Alisyn, it's really hard to say, because the devil is in the details of how the numbers were actually arrived at. So when people talk about antibody testing, there is a huge complexity to that seemingly simple term. It turns out that in the last couple of weeks, many antibody tests have received the emergency use authorization at the FDA.


Many of those we really don't have adequate performance data to feel confident in some of the estimates that we're seeing. So some of them have a specificity that sounds good, like 95 percent, but when you apply that to a population whose true prevalence of disease you don't really know, that can be way too low and tell you a lot of false information. So again, we really need to back up and figure out what are the tools we need, and how do we accurately deploy them.

BERMAN: The antibody testing has been an area of major concern.

Sanjay, I want to shift, if I can, there's been so much focus on the respiratory issues surrounding COVID-19, but you've been looking at some of the cardiac, some of the heart issues surrounding it as well.

GUPTA: Yes, and just about every organ system in the body, now, John, that we're start starting to see affected about, it's quite interesting when you talk to my colleagues who are taking care of these patients, you think a respiratory virus, so you focus on the lungs, understandably, but then so many of these patients are also requiring dialysis.

There's been impacts on the liver, and perhaps most concerningly, as you mentioned, John, the heart. The idea that people are having signs, blood tests that are consistent with the patient having had heart damage, you would think maybe that was because there wasn't enough oxygenated blood going to the heart that led to the heart damage.

But it seems like maybe there's something else happening here, maybe a more systemic sort of inflammation when it comes to this particular disease, or something that's affecting the blood in some way. So not just the lungs. Blood clot, you could see the list there -- blood clotting, low blood oxygen, people going into shock, whatever it might be.

And 70 percent to 80 percent of patients who go on these ventilators, according to some of these studies, aren't coming off the ventilators. They're not being successfully weaned off the ventilators. What's going on here? There's got to be something else here that I think is impacting the body in ways that we need to better appreciate.

CAMEROTA: Dr. Mazzarro, obviously you pointed out there's so much that we don't know. We heard last week about the neurological effects of this virus, and how everything from seizures to hallucinations to loss of smell and taste.

And another thing that we know less about, and you alluded to this in your last answer, and Dr. Birx talked about this at the White House this weekend, is the antibody testing themselves. We don't -- well, OK, not the testing. The antibodies, how long they last, how long immunity, once you get this virus, how long are you covered with immunity. Here's what Dr. Birx explained.


DR. DEBORAH BIRX, WHITE HOUSE CORONAVIRUS RESPONSE COORDINATOR: In most infectious diseases, except for HIV, we know that when you get sick and you recover, and you develop antibody, that that antibody is often confers immunity. We just don't know if it's immunity for a month, immunity for six months, immunity for six years.


CAMEROTA: We need to know that. How are we going to figure out if it's a month or six years?

MARRAZZO: Well, again, fantastic question. I wish immunity was as simple as Dr. Birx made it sound, but it's probably one of the most complex human systems we've evolved. Just imagine your body faced with tons and tons of foreign material, foreign pathogens. It's a very complex system.

The challenge with this coronavirus and with many viruses is, remember the way the surface looks, why it's called a coronavirus with all those spikes. That surface is very complicated and has many little components, and our body's immune systems are sophisticated enough to know to make antibodies to all the different parts of that capsule or that surface of the virus.

We don't even know yet which one of those antibodies to which one of those capsular or surface proteins actually confers infection, let alone how long it lasts, when it peaks, and whether it will sustain immunity over time. So these are the kinds of studies that people are working feverishly to try to figure out.

BERMAN: That's so interesting, because my reading, albeit as a lay person of some of the articles about the antibody testing, Sanjay, some of these tests are testing for different antibody or antibodies that appear in different stages of coronavirus. And that can be problematic if we're going to get results.

GUPTA: Right, you're getting different results, and as the doctor just pointed out, sometimes you get inaccurate results as well, false positive results.

One thing I want to also point out, if you get an antibody test, the question you may be trying to answer is how long and how strong you may have immunity, which is obviously a very important question. But there's also potentially other benefits if you get a good test. I spoke to some folks who are running one of the largest labs in the country around this.

First of all, a lot people may think to themselves, hey, look, I had these weird symptoms several weeks ago. Was that the coronavirus infection? I don't know.


If you do an antibody test, it comes back positive, it's an accurate test, that at least gives you some idea that that probably was the coronavirus infection, not 100 percent, but at least now you know. Second of all, this idea that you've not battled the infection and gotten through it. Again, we don't know how much immunity you have, but you've done this now once before. Your body actually got through this infection, that might offer some peace of mind.

And also, if I had the infection, let's say I came back and had positive antibodies, I knew I had had the infection at some point, I might want to monitor my close contacts now as well knowing that at one point or another I had the coronavirus. So there's other benefits, I'm saying, beyond the immunity. We have to figure out the immunity part, as Dr. Marrazzo was mentioning, but there are other benefits which people may have more in the peace of mind category.

CAMEROTA: Sanjay I have now said the words "nasal swab" more in the past two hours than I have ever said in my life, and certainly than I ever thought I would say during breakfast time across America.


CAMEROTA: But I think that you have brought a show-and-tell, a hand show-and-tell, so that we can know what we're talking about.

GUPTA: Yes, I'm right with you on this, Alisyn. I never thought I'd be talking about nasal swabs as much. But there's a couple things. So this is flocked nasal swab, which you're going to hear this term a lot now, just not nasal swab but flocked nasal swab. I think it's the one of the far right there. Basically, it's really interesting, there is this one small company, Puritan, that makes these swabs. There's only two companies really in the world that make these swabs.

Puritan is one of them here in the states, another one is in Italy. The one on the right, the flocked swab, it has the fibers, these filaments of different lengths so all these different length filaments, when you use that as a swab is going to be a better, superior specimen collection sort of tool, and you might not have to put it as far back into the nose, because if anyone you know has had the test, they'll tell you right away it's uncomfortable. This could be something that could be done more superficially because of the varying lengths of the filaments here.

But it's so interesting, these companies, Puritan, small company relatively in a small town, I think the town has about a 1,500 population in Maine, and all of a sudden we are very dependent on that company really ramping up their production. Maybe other companies will jump in, but this is part of -- this becomes a linchpin in some ways of the testing process. There are other deficits as well, but this is a big one.

BERMAN: Swab styles, I have to say, the flocked swab has always one of my personal favorites. Dr. Sanjay Gupta, Dr. Jeanne Marrazzo, we lost your IFB there for a second, Jeanne. Thank you so much for being with us, Dr. Marrazzo, I really appreciate it. MARRAZZO: My pleasure, thank you. Stay well.

BERMAN: So the key model in the United States now projects when some states could safely reopen. A key researcher who is part of that modeling joins us next.



CAMEROTA: The key model that the White House has been using predicts a slightly lower final death toll for coronavirus in the United States, and for the first time, it is projecting dates when certain states could perhaps ease those stay-at-home restrictions.

So, joining us is Professor Ali Mokdad from the University of Washington's Institute for Health Metrics and Evaluation. Professor, Mokdad, great to see you here.

Let's talk about those states. You've identified four states that could, you think, open first, even by May 4th. I believe those are Hawaii, Montana, Vermont and West Virginia.

So, how do you know that those states could be safe enough to reopen without seeing a spike in cases?

ALI MOKDAD FROM THE UNIVERSITY OF WASHINGTON'S INSTITUTE FOR HEALTH METRICS AND EVALUATION: Good morning. Now, that reporting is a level that a state can comfortably move to a containment stage where we predict that will be one case per million, and we assume they have the capacity and workforce from public health to trace that case, who came in contact with it.

So, for a state like my state, about eight million would expect like a level when they have eight cases every day coming up. They can investigate them. They have enough power to do so. That's what we're telling people, be ready to move to a containment stage. Still, you have to test, and you have to be vigilant and you have to be very careful.

CAMEROTA: Do you think that states have that testing capacity to prove that they have one case per million a day?

MOKDAD: So that's a very good question, and I want to distinguish the two questions that people are debating right now in the media and what we are talking.

What we are talking is once you have a workforce that you release that workforce. You have the capacity first to test it, and then you send them to the workforce.

Now, you are monitoring that. That is a kind of surveillance going on -- public health surveillance and then you can detect a case, and then if you detect that case, you have the manpower to go and follow up on that case, and this is what we're proposing one per million, we feel like it's a comfortable number. It would be able to contain at that level.

CAMEROTA: Yes, but I mean, I guess I'm just trying to figure out what the reality is. Do Montana, Hawaii, Vermont and West Virginia have that testing capacity right now to make those determinations?

MOKDAD: Yes, based on their workforce, the available number of workforce, that's the estimation we feel they can do it. So, we looked at this from a data source available workforce, public health workforce in every state, and there is an association called National Association for County Commissioner who has looked and they have a number -- an estimated number of the workforce and that's what we have used that we feel states are ready at that level to be able to do it.

But, again, Alisyn, this is a different debate than how many tests -- we have to test the workforce to go back to work. These two are different issues.

CAMEROTA: You know, some researchers have taken issue with your model. I'm talking about the University of Texas at Austin. They say your predictions could fall far short of the reality.

I'll just read a little portion of this from "The New York Times" this weekend, they say, "The IHME's model" your model, " ... masks some significant concerns. The institute's projection runs through August 4th describing only the first wave of the epidemic. Without a vaccine, the virus is expected to circulate for years and the death tally will rise over time."

"The gains to date were achieved only by shutting down the country, a situation that cannot continue indefinitely." So what about their concerns that August 4th doesn't -- isn't long enough and the death toll could be much higher?


MOKDAD: So, that's a very good concern. Listen, we are -- we have a model that now is pulling the mortality data and we see it almost every state is coming down in terms of their epidemic. Some of them are a little bit late.

But we see the level coming down and we're following the model until August 4th. Will, our model accounts for a second wave after August 4th? No.

We don't have the data right now if there is a second wave. We don't have the data out for you, but yes, we have to keep monitoring on a daily basis and I don't think our models are going to go away in June or July if we don't see any more cases, we have to be vigilant and still do the surveillance and then we have to beef up our capacity and prepare for a second wave.

Alisyn, people have different models and you know, an academic like me will come and say my model is better than everybody else. That's not the debate here.

We're not pitting models against each other. The issue here, all models says that this is a dangerous epidemic. We're all susceptible for it and we have to be very careful.

But at the same time, what we are proposing at the I.H.M.E. is when can we safely open the businesses because the capacity at hand and the workforce at hand in the states to do the testing and the proper surveillance that the C.D.C. does on a regular basis.

CAMEROTA: Yes, yes. I understand that there's always academic competition. I'm just trying to set our expectations, and set our viewers' expectations. So, is it your model that suggests that the peak of deaths for the country has passed, because the University of Texas model believes that the peak of deaths in this country will be May 7th? Do you believe it has already passed?

MOKDAD: Yes. Now, according to our model, it has and so far the data that we have been following, we have been following it exactly extremely well. Our models have been following the deaths accurately.

The other thing, Alisyn that we need to be careful and let the audience be aware of, right now there's a change in looking at the numbers of cases of COVID-19 where presumptive cases are being added right now.

So, you'll see an increased number of reporting but for a curve for an epidemic it is going to remain the same and the worse it behind.

CAMEROTA: Okay. Professor Ali Mokdad, we appreciate you explaining your modeling system to us. Thank you very much.

MOKDAD: Thank you. Thank you.

CAMEROTA: New research suggests the coronavirus testing needs to more than triple in order to safely reopen the country. So one of the doctors behind that research is going to join us to explain, next.



BERMAN: This morning, there are heightened calls to vastly increase coronavirus testing across the United States.

Currently, there are about 150,000 tests carried out each day, but a group of Harvard researchers says that number needs to more than triple to at least 500,000 per day in order for the economy to open and remain open.

Joining me now is one of the researchers, Dr. Thomas Tsai. He is from the Harvard School of Public Health and a surgeon at Brigham and Women's Hospital in Boston. Dr. Tsai, thank you for joining us right now.

I want to break this down in to different pieces. Right now, there are 20 percent positives in all the tests taking place. You guys say in your study that we need to test so much that the number of positive cases ends up being around 10 percent. Why is that important? DR. THOMAS TSAI, HEALTH POLICY RESEARCHER, HARVARD SCHOOL OF PUBLIC

HEALTH: I think the best thing to suggest, John, is that the range that the W.H.O. is recommending for countries that are testing adequately, a range from three percent to 12 percent.

One example is in South Korea where the test positive rate has been three percent and that is a clear example of a successful effort to contain the infection there.

In Germany, they're testing between six percent to eight percent positive, but we can all agree on is that testing around 19 percent to 20 percent positive like we are in the United States is clearly way too high, which is strong evidence that we should be ramping up our testing effort over the next several days and weeks.

BERMAN: Why is it too high, though? Can you explain that?

TSAI: Right, so I think because of the shortage of testing, we have been focusing primarily on symptomatic patients over the last month. In fact, patients or individuals who have mild symptoms have been told to stay home and self-quarantine, instead of coming in for testing.

So, what's that left is a situation where we have imperfect information on what the true magnitude of the number of infected individuals both asymptomatic, as well as symptomatic are, and we need that information in order to guide our policies about when we can reopen the economy and return to life as normal.

BERMAN: Who should be tested? Just symptomatic people? Light symptoms? What are your recommendations there?

TSAI: I think we need to broaden our indications for testing. I think beyond just the number of tests, John, we have to think about the strategy that's guiding those numbers and I think about it in sort of three phases.

Right now, we are in the phase where we need to catch up on the number of individuals who need to be tested because of the backlog of testing and we need to test anybody with symptoms, any of their contacts in order to get the information that we need to know that where each state or each city, each county is in the transmission curve for COVID-19.

As we move into the second phase, we really need to test to be able to test symptomatic individuals and test their contacts, so really practice strategy of testing, tracing and isolating and that requires more tests.

BERMAN: I was looking at the contact tracing and that means going back and testing people that everyone who tests positive has come in contact with and you look at a number of saying, at least 10, at least 10 contacts, you can just test at least 10 people that every positive case has been with over the last several days.

Just so people understand the math there -- that would mean that as of now there would have been what -- 7.6 million tests completed. We are well short of that now. So we're vastly under testing just on the contacts.

TSAI: That's right. And I think, you know, the range in terms of the contact varies in terms of prior pandemics that range from six to over 20.

We chose 10 as the middle of the range estimate. We're finding in Massachusetts right now is that the contacts may be as few as six.