KOJO NNAMDIYou're tuned in to The Kojo Nnamdi Show on WAMU 88.5, welcome. Later in the broadcast we'll examine the role this region played in undermining Prohibition as we mark the 100th anniversary of "The Great Experiment." But first the new strain of coronavirus known as the 2019 novel coronavirus has now infected nearly 6,000 people in China and caused more than 130 deaths. And despite attempts at quarantines and screenings at airports it has spread beyond China's borders with cases reported in more than a dozen countries including here in the United States.

KOJO NNAMDISo what is the coronavirus and what kind of public health risk does it really pose? Joining me to discuss this is Dr. Brian Garibaldi. He's the Medical Director of the Johns Hopkins Biocontainment Unit. Dr. Garibaldi, thank you for joining us.

BRIAN GARIBALDIThank you so much for having me.

NNAMDIAlso with us is Maureen Pao. She's a Reporter here at WAMU 88.5. Maureen, thank you for joining us.

MAUREEN PAOThank you.

NNAMDIBrian Garibaldi, let's start with the basics. What is coronavirus?

GARIBALDISo coronavirus is a group of viruses that can range anywhere in illnesses from the common cold, probably about 15 to 30 percent of what we consider to be the common cold is cause by a type of coronavirus. But as we've learned in the last 20 years there are other types of coronaviruses that can be more significant. And the two that I think everyone have known about before are SARS from 2002 and then the Middle Eastern Respiratory Syndrome, or MERS that we first discovered in 2012. And now we have this third virus that seems to be closely related to those two.

NNAMDIWhat do we know about this third, this new strain that has caused the outbreak in China, the 2019 novel coronavirus? What is it similar too?

GARIBALDISo we know that's part of the beta-coronavirus, which is the same general class as SARS and MERS. And it's probably about -- it's more closely related to SARS. It's about 80 percent similar to SARS. What we know so far is that it started in Wuhan City in China. The initial cases were reported in a wet food market in China, although, it's very likely that that was not necessarily the source of the outbreak, but an area where people had come together and there were just a lot of people gathering and virus spread through there. And right now we know that there have been person to person transmission in China, and we're starting to see cases in returning travelers from China. But we're not yet sure exactly how much this will spread person to person and how easily that transmission will continue now that it's outside of China.

NNAMDIWhat are the symptoms?

GARIBALDISo right now most people are presenting with non-specific symptoms that could be related to the flu such as fever, myalgias, but many patients are going on to develop either cough or shortness of breath several days into their course.

NNAMDIMaureen Pao, where is the epicenter of the outbreak. Dr. Garibaldi mentioned Wuhan. And why have the numbers being reported out of China jumped so quickly?

PAOYes. As Dr. Garibaldi said the first -- this virus was first detected in Wuhan, which is in central China. At this point the numbers are going up a lot, and I think there is a couple of different reasons. You know, the fact that -- one of the things that has recently come out is that right before Lunar New Year, which is the largest holiday in mainland China, more than five million people were allowed to leave. And that's just part of the annual migration to go back to see family for the holiday. I think that's probably contributing to the dissemination of the virus. I think also there has been some early research indicating that it's a very contagious virus and that might also be a reason for the rapidity with which it's spreading.

NNAMDIHow many cases have been confirmed here in the United States?

PAOSo here in the U.S. we only have -- we have five confirmed cases now. These are all people, who had been in the Wuhan area. So there is -- there are two people in California, one in Illinois, one in Arizona and one in Washington State.

NNAMDIBut it's my understanding that in some other countries there are people who have not been to the Wuhan area, which is an indication of the kind of person to person contagion we are experiencing.

PAOThat's exactly right. And Dr. Garibaldi did mention that that is something that researchers are starting to look at a lot. I mean, we have the couple of incidences. The one I just recently read about was a man in Japan who had been a bus driver for tourists from China. So that plus other -- again, also how quickly the numbers are rising in China itself also suggests person to person transmission, because not everyone is necessarily in that Wuhan area.

NNAMDISo far did all of the confirmed patients here in the United States recently traveled to China or have some type of connection to China?

PAOThat is correct. In fact, all of them have traveled recently to that part of China.

NNAMDIWhat about here locally in the Washington region? Has the virus reached us yet?

PAOSo as of now we have -- seven people have been investigated as -- after presenting symptoms that might correspond with the virus. As of now there are two people in the District of Columbia whose investigation is still underway. There is one person in Maryland and there is one person in Northern Virginia, which is a student at George Mason University. Right now what's happened is samples from these people have been sent to the CDC, the Centers for Disease ...

NNAMDIControl.

PAOControl and Prevention in Atlanta. It's the only place in the United States right now that's able to do the testing for this new strain of coronavirus, and so they're awaiting the test results for that.

NNAMDIIs that why it's taking so long to get the test results back? And what's the timeline for the tests on these local patients?

PAOSo that's a good question. I spoke to health officials in Virginia. They're expecting the Northern Virginia case test results to come back later this week. In D.C. and in Maryland, we're not entirely sure of that timeline. So if you just think about it all of the suspected cases in the United States, I believe there are currently 70 or so that are still pending, all of those tests have been sent to this one central location. And, you know, with staff limitations it's just going to take some time. The CDC is also trying to get the testing materials out to the localities, out to the states. And that should alleviate some of the backlog when that happens, but that's probably not going to happen for at least another couple weeks.

NNAMDIHere is Deborah in Washington D.C. Deborah, you're on the air. Go ahead, please.

DEBORAHYes. Good afternoon. My friend, and I can give his name if necessarily, was diagnosed with the coronavirus, I think at GW Hospital in November. He left my house in an ambulance. He had not been out of the country. It took them a while to figure out what it was, but it was confirmed that it was the coronavirus and he just kind of had to ride it out. And that was like I said, November around the 20th maybe.

NNAMDIAnd you're absolutely sure that it was the coronavirus that your friend was diagnosed with?

DEBORAHYou can check at -- I'm almost sure it was George Washington University Hospital.

NNAMDIHave you heard anything about this Dr. Brian Garibaldi?

GARIBALDIYes. So as we talked about earlier the coronavirus is a group of viruses and we do have the ability to test for several different strains of the coronavirus that we know about that usually cause mild symptoms that we would attribute to the common cold. But sometimes people can get sicker particularly if they have underlying other health issues related particularly to the heart and the lungs. So my sense is that your friend probably did have a coronavirus, but was not the coronavirus that we're talking about coming out of China right now, because we did not have the ability to test for that back in November.

NNAMDIWhat is the incubation period for the 2019 novel coronavirus?

GARIBALDISo information is still coming out. Right now we think it's probably on the order of 7 to 10 days, but perhaps up to 14 days. And so that's when we start talking about monitoring people for symptoms if they've potentially had an exposure or are returning from China. We're using 14 days as guiding us whether or not someone should be a person under investigation or at risk for that virus.

NNAMDIWould it be correct to say that we're only at the beginning of this outbreak?

GARIBALDII think that's fair to say. And I think at the very beginning of an outbreak like this the numbers are probably an underestimate obviously of how many people are infected, because what we're seeing is we're only getting a sense of the patients, who are coming to present to the health care system with symptoms. And so the denominator of how many people are actually infested, yes, it's continuing to rise as we identify more cases. But there probably are many more people who are either not symptomatic at all or have very mild illness and they have not reported to a health care location.

NNAMDISo we can be expecting the numbers to go up. Here is Barry in Baltimore, Maryland. Barry, you're on the air. Go ahead, please.

BARRYHi. I'm just curious about how many people actually have had the coronavirus and actually just gone through it as a normal virus versus just a normal seasonal viruses that people get. Is the mortality rate like one out of nine or, I mean, are there any numbers on it, yet?

NNAMDIIt would depend on the strain that we're talking about, but Dr. Garibaldi?

GARIBALDISo if we're talking about the novel coronavirus, the Wuhan coronavirus, the numbers are obviously changing as we get more information. Right now it looks to be about a quarter or 25 percent of patients are developing significant illness. And the mortality based on the numbers we're aware of right now is somewhere in the range of three to four percent. But again we're not quite sure what the denominator is. So hopefully that number will actually be lower as we learn more about what the spread of this disease has been.

NNAMDIWe're going to take a short break. When we come back we will continue this conversation on the coronavirus, the most recent strain of it, the 2019 novel coronavirus and its effects both in China and in other countries and here in the United States. I'm Kojo Nnamdi.

NNAMDIWelcome back. We're talking about the new strain of coronavirus called the 2019 novel coronavirus, which started in Wuhan in China and has been spreading around the world. We're talking with Maureen Pao. She's a Reporter at WAMU. Dr. Brian Garibaldi is the Medical Director of the Johns Hopkins Biocontainment Unit. And we're taking your calls at 800-433-8850. You can send us a tweet @kojoshow or email to kojo@wamu.org. You can go to our website kojoshow.org, join the conversation there.

NNAMDIMaureen, you've been talking to public health officials in Maryland and Virginia. Do they have a plan in place for dealing with the coronavirus if they suspect that cases are confirmed? And if so, what steps are they taking right now?

GARIBALDIRight. Well, so at this point we only have suspected cases here. And I think that the officials that I've spoken with have talked very much about how I think Dr. Garibaldi also mentioned this. You know, it's important during the flu season really to take all precautions in terms of respiratory diseases. They reiterate that at this point we've had no confirmed cases and even so in that instance like person to person transmission is still -- the risk is very low. And they also reiterate that the CDC is sort of saying as well that although it's a very fast changing situation. And everyone is taking it very seriously. But that the risk to most ordinary Americans if you have not had travel to China recently is very low. At this point they are liaising with all of their local health institutions.

PAOThey're fielding a larger number of calls. They are making sure that medical providers on the frontlines know what kind of symptoms to look for, know where to go once they detect someone, who may have a travel history and present with symptoms that might suggest this strain of coronavirus, that those frontline medical providers know where to go. They also both talked about -- especially in this area we've had in the past experience with and preparedness for things like H1N1 Influenza, SARS and MERS. And so having gone through these before has given them some experience on how to deal with these kinds of potential infectious diseases.

NNAMDIIs there a vaccine in the works?

PAOYeah. Currently there is no specific treatment for this strain of coronavirus. And there is no vaccine, but there are researchers, I know for sure at the NIH, that are working on that now. The director of the NIH recently said in an interview that he did not think that that would actually make it to market until maybe a year or so though.

NNAMDITravelers at 20 airports across the United States are being screened for symptoms of coronavirus in an effort to prevent the virus from spreading. What can you tell us about that?

PAOYeah, that was a decision that was recently -- I think at least a week ago the CDC had already implemented enhanced screening at five airports in the United States where there were direct flights from Wuhan to the U.S. They just expanded that to the 20 airports that have specific quarantine stations and that includes Dulles in our area. That means that passengers coming in from China will go through I believe they have a questionnaire that they need to fill out and they will be monitoring people's temperatures. Seeing if anyone presents with possibility of symptoms and then they'll take it from there to see if they need to isolate those people. So that's just that expanded list of airports just went into effect I believe yesterday.

NNAMDIDr. Garibaldi, how concerned should the average person listening to this conversation right now be? What kind of threat does coronavirus pose?

GARIBALDIWell, I think we're still learning more every day. And until we know a little bit more about how easily the virus is spread from person to person it's hard to know how big this -- or how wide this will spread in the U.S. I think right now we're still in the middle of flu season. And it's important to remember that the same precautions that we should all be taking for the flu, which includes, you know, good cough etiquette, sneeze etiquette, not coughing into your hands, washing your hands very very frequently, those are very likely to be the same things that will protect you from the novel coronavirus if there is sustained human to human spread in the United States.

GARIBALDIBut I think right now I'd be more worried about the flu. But we're obviously ramping up preparations to make sure that we're ready to provide care for any patients who might have the novel coronavirus.

NNAMDIMichael in Alexandria, Virginia, does that answer your question?

MICHAELI think for the most part it does answer my question. I just -- I want to make sure I wasn't, you know, I think it's a low risk right now like you said. I just want to make sure I'm taking all the precautions, you know, to make sure I'm protecting myself and my passengers.

NNAMDIAnd why? What do you do? Who are your passengers?

MICHAELOh, I'm a rideshare driver.

NNAMDIOkay. Well, that makes sense. Okay. Thank you very much for your call. Here now is Gloria in Centreville, Virginia. Gloria, your turn.

GLORIAHi. Thank you very much for taking my phone. I have a son in George Mason. And what can I tell him to protect him?

NNAMDIMaureen, one of the suspected cases here in our area is a student at George Mason, who just returned from a trip to China. University dorms and classrooms are very close quarters. They make the spread of viruses easy, and many of the universities in this area also have students studying abroad in China this semester. How would you answer Gloria's questions? And what are the universities doing to protect these students?

PAOYes. And I -- as a parent I too would be very concerned about these issues. I did speak with the Virginia State Epidemiologist and she did inform me how the people that have -- that are suspected of having this strain of coronavirus as they're awaiting the test results they are held in separate locations. They are under a kind of quarantine until they're able to rule that out specifically. I think in general as Dr. Garibaldi said the things that are most important really are to practice all of those hand washing things that we've learned as children. They really are the thing that we can do the most. If your child has not had any contact with China or anyone from China, the risk at this point should be quite low.

NNAMDIA number of local universities, American University being one are recalling students, who are studying in China. I should mention that American University hosts WAMU's broadcast license. But I think I've also been reading that George Washington University is doing the same thing, maybe the University of Maryland?

PAOThat's correct.

NNAMDIGeorgetown.

PAOThat is correct. So a number of these universities are recalling students that they currently have there. And then they are canceling or delaying study abroad programs and or university sponsored travel for faculty as well going forward.

NNAMDIHere is Lou in Annapolis, Maryland. Lou, you're on the air. Go ahead, please.

LOUThank you, Kojo. I guess my question is somewhat the reverse of the last one. And that is we are amongst many host families in the area that have just welcomed students back from China, who are attending school in the United States. And I wonder if there's been any research done on that group or any special precautions that the home state coordinators and the host families should be taking at this point?

NNAMDIDr. Garibaldi?

GARIBALDISo we don't, again, yet have enough information to know how many returning travelers are going to be at risk for this. Again, I think the best advice that I would give to you would be to be on the lookout for any symptoms that could be related to a respiratory virus. The vast majority of these cases will likely end up being seasonal flu. And I would also contact the program that you're working with to try to understand are there any programmatic plans that have put into place or, you know, if they're -- I'm sure those programs have begun to think about, you know, what do we need to do to make sure that we're ready and we keep our host families and our students safe? So that would be my advice to you just to reach out to your program today and just find out what they've been doing on their end.

NNAMDIThank you very much for your call, Lou. Dr. Garibaldi, what is the biocontainment unit that you run at Johns Hopkins Hospital?

GARIBALDIYeah, so the biocontainment unit was built back in 2014 in response to the West Africa Ebola outbreak. And the idea at that time was we wanted to have the capability to isolate patients to safely treat them while keeping our staff our hospital and our communities safe. And after we built our unit, the federal government actually had a special appropriations that funded the creation of 10 regional biocontainment units across the country, of which we are the region three biocontainment unit. And our initial charge was to be able to take care of patients with viral hemorrhagic fever.

GARIBALDIBut very quickly it became clear that we wanted to build the capability to take care of other pathogens that potentially were spread by airborne or droplet routes. And I think we are preparing to activate our biocontainment unit if we do get cases at Johns Hopkins or here to support the state and region, but I think it's also important to recognize that we're doing that out of an abundance of caution and more to contain potentially isolated travelers who might have the virus as opposed to saying that you only can take of these patients in biocontainment units.

GARIBALDIThe recommendations and the understanding right now is that this is likely spread by droplets, so sneezing, coughing, touching surfaces that might have respiratory secretions on them. And out of an abundance of caution we're taking care of patients across the country who might be suspected of this under airborne isolation. And every hospital has the ability to do that, because we're all prepared to take care of things like measles or tuberculosis.

NNAMDII was going to ask about that because it's my understanding that your unit is the only one of the 10 in the mid-Atlantic region. And if the outbreak does spread to the east coast, I was going to ask, can other hospitals treat patients? You say they can.

GARIBALDIYes. They absolutely can. And we've built a network through our state health department of hospitals that are able to identify, isolate and treat patients who might have scary things like Ebola or Lassa fever, that same network has branched out to train all of our frontline providers through a program that we've collaborated on at Johns Hopkins with the state health department to really focus on this. Identify, isolate, and inform piece and all of those facilities are able to put someone in respiratory isolation, appropriately do the screenings, send off the testing as right now to the CDC, but hopefully soon to local and state health departments and to begin treatment.

NNAMDIAn email our Louise asked, are there common characteristics, that is the elderly or preexisting conditions among those who have died? Do you know, Maureen Pao?

PAOI think that the reporting I've seen is that the more serious cases in China at least have involved people with underlying conditions or who are older. It has not as in I believe previous outbreaks of these kinds of respiratory illnesses hit children as hard. Dr. Garibaldi is that also you understanding?

GARIBALDISo in the reports that have come out so far, the median age of death has been in the early 70s. But the vast majority of patients are middle aged at this point in time.

NNAMDIHere is Charles in Silver Spring, Maryland. Charles, you're on the air. Go ahead, please.

CHARLESThank you, Kojo. British Airways just announced that they are suspending all flights to China. United has just announced that they are suspending several flights to China. In the aviation community there's some call for all flights to China to the U.S. to be suspended in order to stop the spread, but the question I want to ask the experts is would that even be effective stopping all flights to China?

GARIBALDISo you know, I think, again, we don't know. Certainly trying to -- I learned this during this current outbreak. On average there are about 22,000 travelers that come into the U.S. each day from China. So certainly that could potentially -- halting those flights could potentially reduce the number of people who are coming here who might have the infection. But I think it's still early to know. Again, we just need more epidemiologic data and understand how easily this is spread from person to person to really understand what the methods that need to be in place to prevent the spread.

GARIBALDII think the airport screenings are a great idea and they serve two purposes. One is to obviously identify anyone who might be unwell and need to be isolated. But also it reminds people who are returning that hey if you develop these symptoms that we're screening you for, right now, you need to let local health authorities and local health department know so that we can effectively isolate you, track contacts and provide any treatments that you might require.

NNAMDIHere is Anne in Herndon, Virginia. Anne, your turn.

ANNEHello. I have two children in the Fairfax County public school, high school. And we got an email from them yesterday acknowledging that members of the student body since it is a pretty international community had just come back from China. And that they were talking to the health department and on top of things. But I also keep hearing, we don't know yet, we don't know yet, we don't know yet. Meanwhile I'm sending my kids to a school with 3,000 other children that designed to hold 2700 where they can't wash their hands because they only have five minutes between classes and they're dashing to get there without being marked tardy. And so I guess I'd like to hear from the experts whether there's anything that you can say to reassure parents?

NNAMDIDr. Garibaldi?

GARIBALDISo I would say right now, you know, we have not seen sustained transmission in the United States. So at this point as we talked earlier, I think the risk of picking up this virus going to school right now is exceedingly low. And it's much more likely that if someone does become ill it's going to be a seasonal flu or another type of common cold virus that we see and that we always worry about in the winter when our small kids are at school. And so I think we just need to stay informed of the information as it becomes available. But right now I don't think there's any reason for you to be doing anything differently than sending your kids to school.

NNAMDIYour team has been practicing treating patients with contagious respiratory virus for the past week. What does that look like and why does this need to be practiced? Is it very different than treating other patients?

GARIBALDIWell, I think the difference is, you know, we're all comfortable wearing personal protective equipment of varying stages, but to do the normal care procedures that we do on a general medicine floor it is a little bit different if you're wearing a second pair of gloves or if you're wearing a special respirator. And being able to practice and not have it be the first time that you're doing a particular procedure or a process with a patient. You want to have practiced wearing that gear before you're actually in the room doing it for the first time.

NNAMDIAnd finally the Centers for Disease Control reported that so far this season there have been at least 15 million flu illnesses reported in the U.S. and at least 8200 deaths, including 54 children. The flu kills 650,000 people globally each year, but we don't spend a lot of time worrying about it. Should we be more concerned about more common viruses like the flu? Is the threat of coronavirus maybe being blown somewhat out of proportion?

GARIBALDIWell, let's sort of flip that on its head and say this is a great opportunity for us to begin to practice the same things that will protect us from the flu as would protect us from the coronavirus. You know, last year, you know, little over half of people, who were eligible to be vaccinated for the flu got vaccinated. So maybe this will be a reminder to people that for the common flu that there are things that we can do to reduce the severity of illness and prevent the likelihood of you getting sick from it.

NNAMDIDr. Brian Garibaldi is the Medical Director of the Johns Hopkins Biocontainment Unit. Thank you for joining us.

GARIBALDIAlways a pleasure. Thank you for having me.

NNAMDIMaureen Pao is a Reporter at WAMU. I know you had to come a long way to get here, but thank you for joining us in studio. You had to walk all the way across the hall.

PAOIt was my pleasure.

NNAMDIWe're going to take a short break. When we come back, we'll examine the role in that this region played in undermining Prohibition as we mark the 100th anniversary of what was known as "The Great Experiment." I'm Kojo Nnamdi.