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CDC Warns of Possible Second Wave of COVID-19 in Winter; New Study on Hydroxychloroquine Indicates Negative Effects of Drug Treatment; President Trump Suspends Green Cards for 60 Days Due to Coronavirus Pandemic; Georgia Governor Faces Resistance Over Move to Reopen. Aired 8-8:30a ET

Aired April 22, 2020 - 08:00   ET



ALISYN CAMEROTA, CNN ANCHOR: They are now the earliest known casualties of this pandemic here in the U.S. There's also a dire warning from the director of the CDC that a second wave of the virus could be coming this winter and could be even worse than what we're battling now. So this morning, we will look into how it could be worse.

Also, this morning, more southern states are looking to reopen despite pushback from some of the mayors, business leaders, and residents who are wary of the danger.

JOHN BERMAN, CNN ANCHOR: We have news this morning about one of the treatments that President Trump has been touting, oddly and notably, above all others for coronavirus, hydroxychloroquine, his aide, Peter Navarro, did memorably right here on this show. A new study found that those who took hydroxychloroquine had higher death rates than those who did not. This is a very small study, it is not peer reviewed, but it is information you should know along with the studies that the president has been touting.

It is notable this morning that the National Institutes of Health is recommending against using hydroxychloroquine in combination with another drug the president has been talking about.

Also of note, the Senate passed a $480 billion relief package for small businesses, hospitals, and testing. The House is expected to vote on the measure tomorrow.

We want to start with this news out of California that shifts the timeline of the pandemic in the United States. CNN's Dan Simon live in San Francisco with the details. Dan?

DAN SIMON, CNN CORRESPONDENT: Hi, John. Experts have been speculating for some time that the virus had been in the country much longer than anybody previously thought. Now, this adds to the growing body of evidence that this was the case. Now, what Santa Clara County officials are saying is that somebody who died in their home on February 6th had the coronavirus. Keep in mind, the first reported death in the country was actually on February 29th in the Seattle area. And Santa Clara also linking two additional cases, one on February 17th and one on March 9th.

What does this tell us? What it tells us is that this represents many more infections that were likely in the country, according to Santa Clara County officials. Now, at that time, to have gotten tested for the coronavirus, you would have had to have traveled over to China and had certain specific symptoms. In these particular cases, from what we understand, they did not travel to China. So we're talking about community spread here. So what does this information tell us? The speculation now is that this had been in the country for weeks earlier than anybody previously thought, and now the question is how many more cases out there could be just like this? John and Alisyn, we'll send it back to you.

CAMEROTA: Thank you very much, Dan. We really appreciate the reporting.

Joining us now is CNN chief medical correspondent Dr. Sanjay Gupta, and Dr. N. Stuart Harris. He's an emergency physician at Massachusetts General Hospital. We look really forward to talking to you.

But Dr. Gupta, we want to start with you, because here's what we now know from this reporting this morning. This was not -- these casualties were not in Washington state, so we had originally thought the first deaths were in Washington state. These were not cruise ship passengers. We knew about the outbreak on cruise ships there off of California. These were not travelers who had just returned from China. They, in fact, had no known travel history.

And, Sanjay, I brought this up before, I remember that morning when we were all on the air, and I think it was February 26th when we first heard the term, at least John and I, community spread. You, of course, knew it, but this is community spread, then, weeks earlier than we knew it existed.

SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: Yes, Alisyn. I think this is very significant, and perhaps not surprising, to your point. I think for some time, as Dan said, Dan Simon, that we suspected that there may be earlier cases. Did we really think that we happened to catch the very first patient in the United States or were there patients that we were missing even before January 21st when that first patient was diagnosed in Washington state. I think we've long suspected that there were probably earlier cases.

I think the fact that these patients not only had contracted the virus, but they had died sadly, February 6th. So what does that mean if you start to back up the timetable? First community spread, because they hadn't travelled to China, as we know, but also that their exposure was likely several weeks earlier, maybe middle or even early January now. So you really significantly start to back up the timetable in terms of when people were likely being exposed to this.

So how long was this virus in the United States, and how long was it already spreading before we knew about it? Keep in mind, in between those two dates that you had on the timeline there, February 6th and February 17th, the CDC tried to put out a test to try and do point of care testing, that was February 12th, and that test was flawed. So even at that point we still didn't have a test. So this is a very significant, somewhat stunning finding, but also not that surprising. It just gives an idea of just how much this was spreading much earlier than realized.


BERMAN: As we said, it does shift the parameters here and puts other dates into perspective as well. The travel ban to Chinese nationals coming to the United States, January 31st, it seems clear now that the virus was already here and spreading person to person weeks before that ever happened. And Sanjay, I also wonder if this means that there were people dying in the United States of COVID-19 before we knew.

GUPTA: I think so, John. And you and I had conversations about this over time. There is a lot of people, obviously at that time you're in the middle of flu season as well, there are people who have respiratory symptoms, who may not have conclusively been diagnosed with a particular virus who were thought to just have had just had flu. I shouldn't say just to have flu, but to have had flu, and the flu actually had led to their deaths. But now in retrospect, as they did here in Santa Clara, was they went back and looked. They said we didn't have the testing then, we have testing now, maybe does it make sense to go back and see what did these patients actually die of?

Maybe it doesn't change much. We still know the strategy that we need to adopt going forward. I don't know that it changes much. But it does really put into a brighter light exactly what was happening and when. And maybe it was even earlier than that. We are basing some of this on what the information that we had out of China. But we know that the initial evidence that came out of China suggested that these were patients all from exposure to an animal market. That wasn't true. We heard the middle of December was the first patients diagnosed. That wasn't true. So there is all these things that are starting to back up the timeline here in the United States, but also on the other side of the world.

INGRAHAM: We have new information also this morning, Sanjay, about hydroxychloroquine, the drug that we've heard so much about as to whether or not it is some sort of treatment for coronavirus. So there was a study out of V.A. hospitals, 368 patients were studied, and the results are not promising. They're the opposite, actually. So the death rate was higher for the people who took the hydroxychloroquine. Those who didn't had a death rate of about 11 percent. Those who did take the drug had a death rate of about 28 percent. Both of these groups had the same amount of ventilation needed. So that didn't help either.

So, look, we keep -- it is not peer reviewed. You always caution us about these kinds of studies, they're too small, they're not done right, they haven't been peer -- they're not done adequately to draw conclusions. But do we know anything else about this? Were these patients who died older? Were they further along in the course of their disease, anything else we can glean?

GUPTA: There was a little bit of evidence in that study that the patients who received hydroxychloroquine may have had more severe disease. But I think exactly the way you framed it, Alisyn. We just don't know. This was not a randomized study. It's a small study. So you've got to be careful to read into these studies right now. We wouldn't even be talking about it on your program were it not for these unusual circumstances that we're all in right now.

But there has been a drumbeat of very dismal evidence on hydroxychloroquine out of Brazil, out of Sweden, where the guidelines are the hospitals should not administer it outside of a trial anymore, out of France where they showed toxicity of this medication at high doses, and now this study out of the V.A. So these are small studies. There are larger studies that are under way, some data has already been given to the FDA. We're trying to get a hold of that data because, remember, some 10,000 doses as a result of this went to New York to be used under the auspices of a clinical trial. That doesn't mean 10,000 patients, but 10,000 doses. We still need to see that data.

But I'm not that enthusiastic about this medication based on what we're seeing. The NIH has not been enthusiastic, and you have just got to make sure we don't take our eyes off the ball on other potentially more promising therapeutics, because we all want that, we all want something that works. That will change the dire statistics we're talking about. But this doesn't look like it so far.

GUPTA: Dr. Harris, we lost you for a second there. It's good to have you back. I do want to ask you about another bit of information we received over the last 24 hours, and this was a statement from Dr. Redfield at the CDC who said that he thinks that a second wave of COVID-19, of coronavirus, could be worse than the one we're going through right now. Now, you're on the front lines, you're working in the emergency department at Mass General Hospital, MGH, treating patients every day in Boston. What does this news mean to you?


DR. N. STUART HARRIS, EMERGENCY PHYSICIAN, MASSACHUSETTS GENERAL HOSPITAL: John, I think just the continued need for prudence is wise. This is a brand-new disease. We don't know how the disease works. We're learning that as physicians on a daily basis. We're learning how our population interacts with it. And so I suspect there's going to be some -- just prudent, and since we know influenza is a deadly killer to expect that if these two things happen simultaneously, it is something we want to be thoughtful about.

CAMEROTA: Dr. Harris, I know our viewers appreciate that we have technical difficulties during this time of remote reporting, and they're being patient with us. Doctors continue to learn stuff every day about this virus, and doctors in emergency rooms, we hear, continue to try desperately different things to keep their patients alive. And so what is happening in your emergency room, and are you trying new things?

HARRIS: Yes, of course -- difficult time. We're trying some --

CAMEROTA: Sorry, Dr. Harris, hold that thought for a minute because the technical gods are not with us at the moment. Sanjay, do you know about some of the new things, the new treatments that are being tried, particularly for the respiratory symptoms?

GUPTA: Yes, some of the things, I'm sure Dr. Harris was about to mention, some of them are sometimes extraordinarily simple things. One of the things that I think has come out recently is this idea of what they call proning patients, basically instead of having patients on their back, trying to be able to roll them on to their stomach to open up the amount of lung capacity they might have. Sounds like a very simple strategy, but when they started to do this for patients, they noticed that they started to improve.

They realized that patients are coming in sometimes almost acting, again, an area that Dr. Harris has a lot of expertise, almost acting like they had altitude sickness, where they had low oxygenation, and yet they weren't gasping for air, like somebody would when their oxygenation really starts to drop. So why would that be? And a lot of times that happens with altitude sickness because the pressure of oxygen in the air around you is just lower, so you're just not able to get as much oxygen into the body. So things like that.

And we're all learning as we go along. There is some evidence that maybe, look, this is a respiratory disease, but it is not just affecting the lungs. Is it affecting the blood in some way, actually robbing the blood of its ability to transport oxygen and there affecting many organs. We talked about the central nervous system, the kidneys, why are all these various organ systems being affected, and early, in the course of this disease? Why would someone lose their sense of smell as an initial symptom of a respiratory virus? What does that mean? What do we have to learn from that? There is a lot to still discover here, and hopefully that might lead us to better treatments.

BERMAN: It is interesting. Dr. Harris is involved in a study now with nitric oxide, which is something that newborn babies, premature babies are often given to help open their airwaves and help them to breathe. It is something their trying there, just like many things are being tried, and he's involved in a study on that.

Our thanks to you, Sanjay. Our thanks to Dr. Harris. We apologize for the technical glitches. Everyone can understand the challenges we're facing now.

So this morning, President Trump says his executive order to suspend immigration into the United States only applies to green cards and only for 60 days. It will not affect workers entering the country on a temporary basis.

Joining us now, CNN White House correspondent John Harwood. John, you told us so, basically, yesterday, when we had you on talking about this. As a policy move, less than meets the eye, which begs the question, how much is this just about politics? And where does it fit in with some of the other messaging and challenges the president faces this morning?

JOHN HARWOOD, CNN WHITE HOUSE CORRESPONDENT: John, this is pretty much entirely a political song and dance by the president. When you're talking about suspending green cards for 60 days, you're talking about in the name of protecting the jobs of American workers who lost their employment over the last month or so, you're talking about 75,000 people in a two-month period based on the rates in 2019 who would be getting green cards, 75,000 as compared to 22 million people who have lost their jobs. It doesn't even -- it is barely a rounding error in those estimates.

So no, that's not the reason. It is about politics. It is about trying to give his base something to feel good about. He made an exception for all of the larger numbers of people who come in to do agricultural work in the United States because business leaned on him not to cut off those people. So this is the president in his role as cheerleader, positive or negative, trying to rouse a base at a time when we're having catastrophic events in the United States. Positive side of that was you just talked about it a few minutes ago with Sanjay, and the doctor from Massachusetts, is hydroxychloroquine.


He had something in the moment he thought would sound good, and that he wanted to give people hope on.

It turned out, at least there is way insufficient evidence and some evidence for caution that's come out, people who have lupus are having more trouble getting their drugs.

On immigration, he's telling people, well, I'm going to address this problem of foreigners coming in to the country and sort of suggest that that is linked to the difficulties they're going through on coronavirus. They're not. But that's how the president operates.

The good news is that there's a whole lot of people within the federal government who are not engaged in politics, who are trying to move us ahead on testing and therapeutics and vaccine development and all the other stuff, but the president as the front man is focused on politics right now.

JOHN BERMAN, CNN ANCHOR: John, just one bit of news coming from the president and his Twitter feed. He just made an announcement that he's instructed the United States Navy to shoot down and destroy any and all Iranian gunboats if they harass U.S. ships at sea. This is something that did happen I believe not far off the Straits of Hormuz a few days ago.

I'm not sure whether this actually changes any of the rules of engagement, but he is making the public announcement that he's told U.S. Navy ships to take action.

HARWOOD: Well, yes, and, obviously, if United States plane or ships are under threat from Iran or other foreign powers, clearly, they need to defend themselves. I'm not sure how proximate or serious that threat is.

And I should note that the president has said that he is going to send assistance to Iran, which has been struggling with its own coronavirus outbreak. So, not clear the import of this, other than some more message sending.

BERMAN: John Harwood, we appreciate you being with us, rolling with the news this morning. Thanks so much.

HARWOOD: You bet.

BERMAN: People in Georgia can get a haircut or go bowling by the end of this week, despite concerns from health officials, some mayors, even business owners. The head of state's largest business organization joins us next.




GOV. BRIAN KEMP (R), GEORGIA: We took measured steps to get to the shelter in place. And now we're taking measured steps to come out of that. This is not a giant leap forward.


ALISYN CAMEROTA, CNN ANCHOR: That's Georgia's Governor Brian Kemp defending his decision to reopen barbershops, nail and hair salons, bowling alleys, gyms and massage parlors this Friday. Restaurants and theaters can reopen there on Monday.

So, joining us now is Chris Clark. He's the president and CEO of the Georgia Chamber of Commerce.

Mr. Clark, we're really happy to have you here.

And I know that you support the governor's decision. But just explain to me, why now? I mean, just in the past 48 hours, Georgia has seen another spike in cases. You all haven't hit your peak of cases yet.

So why not push this reopening for a few more weeks?

CHRIS CLARK, PRESIDENT & CEO, GEORGIA CHAMBER OF COMMERCE: Well, Alisyn, thank you for having me on this morning. We appreciate the coverage.

I think you have to understand how Georgia businesses have been operating for the last six weeks. We've really had three different categories of businesses.

You've had your essential businesses like our UPS, our healthcare systems, our utilities. They've been operating with a dimmer switch and basically following the CDC guidelines.

And you've had 13 business sectors, some of which you mentioned, barbershops and others, that have been completely shut down. That's about 20,000 businesses.

And then you've had the rest of Georgia businesses that have been able to continue minimum operations if we follow 20 guidelines. And that's worked extremely well with the shelter in place.

And so, this order is in my mind a baby step at a marathon, to allow 20,000 businesses to at least start planning.

But make no mistake: since April 11th, according to our director of Health and Human Services in Georgia, we have seen a decrease in cases, and our shelter in place is in effect until the end of the month.


CAMEROTA: Yes. Well, I just want to -- I just want to jump in there for a second --

CLARK: Yes, sure.

CAMEROTA: -- because that's different than what Johns Hopkins is looking at. So, Johns Hopkins looks at your state and they count the cases, and they also count the suspected cases of people who showed all the symptoms but weren't able to get a test.

And what they show is that two days ago, so on Monday, you had a big spike in cases of more than a thousand cases that day. Just yesterday, 767 cases. And those are going in the wrong direction.

So I know that on the website of the Georgia Public Health, the numbers are different. But this looks troubling enough to just rethink it.

But let me just move on to this, because I want to hit something else that you said, which is, these businesses that you're talking about, these are high touch businesses -- hair salons and nail salons, massages.

How on earth can you abide by the guidelines of staying six feet away from people when getting a haircut?

CLARK: Sure. And our department of cosme -- our Cosmetology Board in Georgia, they've been meeting all night to put together rules and regulations.

Listen, this is not a mandate. Not every business has to open. Some won't.

But I think you have to understand who those 20,000 businesses are. You know, those are small mom-and-pop, most of them have run out of capital 14 days ago. Many of them are minority and immigrant-owned businesses and most of them are sole proprietors who were not able to (AUDIO GAP) for the PPP until the day before the money (AUDIO GAP). And so, they're struggling.

So, what you're basically saying is you can come back if you follow these guidelines, maybe what you can do is see one customer, if you wear a face shield, you put on gloves, maybe you can cut hair.

The company right beside you in the shopping mall has been able to have a customer on their floor for the last six weeks but you haven't. So, some company is going to take advantage of this, some won't. But many that I talked to are going to use this as an opportunity to plan. You know, these aren't just businesses we're talking about. These are

families. And they employ other families. They've struggled through this. It's a -- it's a -- again, it's a baby step in this process.


CAMEROTA: Yes. And I certainly understand the economic devastation that families are feeling, I mean, all around the country.

CLARK: That's right.

CAMEROTA: For sure, people are desperate to get back to work.

But what happens, Mr. Clark, if cases go up? If cases spike after --

CLARK: Sure.

CAMEROTA: -- let's say people go back to work this Friday and then over the next three to four weeks, in Georgia, you see cases spike? What's the plan then?

CLARK: So, the governor has been very clear that this is a dimmer switch. He can turn it back up if we need to. He's going to extend regulations and protocol and orders.

But I also think that businesses around this country have to think long-term. We're never going to go back to a normal for at least the next 18 to 24 months.

And so, I think it's incumbent upon every business in this country to make sure that they're taking care of the safety and well-being of their employees and customers because quite frankly if the public doesn't feel comfortable going to get their haircut or flying on a plane, or going into a shop, then the free market is going to take those companies out in the short-term.

And so, I really do think we are not just planning for a spike in the next few weeks, we're having to plan for what a spike might look like, as your earlier guest said, maybe this winter. And I think that's part of what we have to do is to preen (ph) our process and to take that responsibility to care for our customers and our employees.

CAMEROTA: Yes. Well, we're all watching to see what happens over the next few weeks in Georgia.

Mr. Chris Clark, president, Georgia Chamber of Commerce -- we really appreciate all the information.

CLARK: Thank you, Alisyn.

One of baseball's biggest stars is talking about when he thinks it will be safe to play ball again. World Series champion Ryan Zimmerman joins us next.