KOJO NNAMDIYou're tuned in to The Kojo Nnamdi Show on WAMU 88.5. Welcome. Since the outbreak began in the Wuhan province of China, the novel coronavirus has infected more than 100,000 people worldwide and killed almost 4,000. In the United States there have been more than 750 cases and 25 deaths. In the Washington region 18 cases of COVID-19, the disease caused by the novel coronavirus have now been reported as local public health officials move to increase testing and contain the spread.

KOJO NNAMDISo what should we be doing to prepare for the pandemic and how do we protect those who are most vulnerable? Joining me in studio is Dr. Pascal Crosley, an Emergency Physician and Owner of Quality First Urgent Care in Burtonsville, Maryland. Pascal Crosley, thank you for joining us.

PASCAL CROSLEYThanks for having me.

NNAMDIAlso in studio with us is Dr. Christopher Rodriguez. He is Director of the District of Columbia Homeland Security and Emergency Management Agency. Christopher Rodriguez, thank you for joining us.

CHRISTOPHER RODRIGUEZThank you, Kojo.

NNAMDIJoining us from studios in Richmond, Virginia is Dr. Parham Jaberi, Chief Deputy Commissioner for the Virginia Department of Health. Parham Jaberi, thank you for joining us.

PARHAM JABERIThank you for having me.

NNAMDIAnd joining us from studios in Baltimore is Dr. Leana Wen, an Emergency Physician and Professor of Public Health at George Washington University. She formerly served as Baltimore's Health Commissioner. Leana Wen, thank you for joining us.

LEANA WENA pleasure to join you, Kojo.

NNAMDILet's start with the basics. Dr. Wen, what do we know so far about this novel coronavirus?

WENThanks, Kojo. And I'm glad you started that way with here's what we know, because this is a new virus, the new coronavirus. There's a lot that we know. There's also a lot that we do not yet know. What we know is that it is a respiratory virus. It is transmitted in a similar way to the cold or the flu via the respiratory route. The people who are affected most by this new coronavirus, COVID-19, are the elderly, those with chronic medical conditions. Everybody could get the virus, but those who have the most severe outcomes are those who fall into the category of being older with underlying medical problems.

WENWe also know that about 80 percent of people, who contract the virus will have mild symptoms that do not require inpatient hospital care. About 15 percent have more serious complications and about 5 percent may become critically ill. The death rate looks like it's somewhere between one to three percent globally. There is no vaccine. There are treatments and vaccines currently being tested, but it's going to take a while for those to come onboard. And this is why prevention through public health methods are the best way -- the best defense that we have to guarding against the virus and preventing its spread here in the U.S. and worldwide.

NNAMDIHow is COVID-19 different from SARS or MERS?

WENWell, it is a type of coronavirus just like SARS and MERS, but we also have to keep in mind that there are other coronaviruses, too. In fact, there are four coronaviruses all part of this class of viruses that cause the common cold. SARS and MERS have a much higher mortality rate. Of course, the coronaviruses that are part of the common cold have a much lower mortality rate.

WENI think it is important also to talk about what we don't yet know. We don't yet know how severe, how far, how wide this new coronavirus, COVID-19, is going to spread. It appears that certain containment efforts in China, for example, are working. But there is a lot that we do not yet know including we don't yet know what the impact of COVID-19 is going to be in the U.S. now that outbreaks have started here.

NNAMDIChristopher Rodriguez, before we get too deep into the details of the virus, I'd like to make sure we're getting the latest numbers from each of you. Let's start with you. What is status of coronavirus cases in the District of Columbia?

RODRIGUEZIn the District of Columbia, Mayor Bowser has directed us to post those numbers online. So anyone can go to coronavirus.dc.gov. We have four presumptive positives in the District of Columbia that have been reviewed by the D.C. Public Health lab, and one presumptive positive that has been reviewed by a lab in Maryland. So a total of five, Kojo.

NNAMDIAs the number of coronavirus cases grows, what is the bandwidth of your public health organizations to respond? How prepared are they?

RODRIGUEZThe public health lab in the District of Columbia does have what it needs to process the current tests that are coming in. What we would say is we need the federal government to step up. There are some materials that we still need that the public health labs are requesting from the federal government, and we'll continue to have that conversation.

NNAMDIAnd you say you'll continue to have that conversation. How urgent is the need? How quickly do you need this assistance?

RODRIGUEZWell, right now we have as I mentioned sufficient supplies to do all the testing that we need, but we do anticipate that we will need more and we have put in requests for that.

NNAMDII only ask that, because I think a couple of the members of Christ Church parishioners had said that the D.C. Health Department in their view had moved too slowly to respond to their reports of a first and second case in the church community.

RODRIGUEZWell, for the Christ Church example, as you know, we had a pastor at Christ Church in Georgetown, who self-identified as our first case. And what we mentioned to the parishioners and the congregants there--and the mayor talked about this, yesterday in her press conference--as a precaustionary measure anybody who attended services on either February 24th or between February 28 and March 3rd, we are asking them to self-quarantine for 14 days. And we have seen a lot of parishioners take that step.

NNAMDIParham Jaberi, what's the status in Virginia? What's the status of coronavirus cases in Virginia?

JABERISure. We have provided press releases on five cases. As you know, we announced our first case over the weekend. We do have others that are currently being worked up in the locality. So this number is likely going to change by the end of the day or by tomorrow, but currently we have five. And as was mentioned -- you know, and I'm really glad we have the speakers from the various areas as we do our continued investigations realizing that some of the people may live in Virginia and that's how we're counting the cases, but they may work in D.C. or they may be spending a lot of time in the community or their faith based organizations in another locality or in Maryland. So currently we have five individuals that live in Virginia that have been identified as cases.

NNAMDIPascal Crosley, how many cases have been reported so far in Maryland?

CROSLEYIn my understanding is that we're running around five now confirmed cases in the Maryland area. As with the other areas in Virginia and D.C. there are other cases that are patients that under investigation. And so the numbers are very fluid in the entire area between Washington, Virginia and Maryland.

NNAMDIIs that your understanding about Maryland too, Leana Wen?

WENI believe that there are six cases as of last count, but I do want to emphasize just how much this is a quickly evolving situation. Especially as there has been as the other guests have mentioned an issue with testing. I think we do need to acknowledge that on the federal level there has been some missteps in getting tests quickly out there to the localities to test. But as we do have more tests up and running we are going to see many more new cases in the coming days and weeks.

WENAnd I hope that that's something that we can talk about. We do expect for things to get much worse, because this disease is spreading within the U.S. Now that is not cause for panic. It is cause, though, for us to prepare including to prepare our own families and communities for what's ahead.

NNAMDILeana Wen, getting back to what we know and perhaps are still learning about the coronavirus, what are the symptoms and how do they differ from those of the cold of the flu?

WENIt's a wonderful question. And I think this is what people want to find out about the practical information. And so the symptoms of the new coronavirus, COVID-19, are similar to what one might find with the cold and the flu. Generally patients with COVID-19, present with fever, cough, difficulty breathing. Some people may have more cold like symptoms and be sniffing and sneezing. Some may have abdominal symptoms including nausea, vomiting, diarrhea, abdominal pain. Some patients present with very mild symptoms. We know that there are patients who have mild symptoms or even no symptoms who could transmit COVID-19 to others. Some as I mentioned before develop more severe symptoms and develop pneumonia that then require hospitalization even ventilation and higher levels of care.

WENNow it is tricky because these symptoms that I'm describing are non-specific. And they could also apply for the cold or the flu, and I do think that it's important to reassure listeners that for every day Americans, for any of us now if we start developing these symptoms of cough, fever, etcetera, chances are we do not have coronavirus, this new coronavirus. Chances are we have the flu. We have the common cold. We have some other viral illness, but given that COVID-19 is now present this is why there is heightened awareness and worry.

WENAnd I would caution for everyone, please do not go to the ER or the hospital first. Please call your doctor first. Our hospitals are already on the verge of being overburdened and over capacity especially if we have an influx of more patients, more cases coming in soon as we would expect. So do not go to the ER or the hospital first. Call your doctor first.

NNAMDIA few quick questions before we go to the phones. Do we need to be worried if someone sneezes in our vicinity?

WENWell, we should practice good hand and face hygiene. The same public health practices that help us to protect against the cold or the flu also help to protect against COVID-19. So anybody who is sick or feeling sick should stay at home. If they happen to be out and there's coughing and sneezing, please cough and sneeze into the crook of your arm or into a tissue and not into space. And for all of us, because there is no vaccine yet for COVID-19 the best thing that we can do is hand and face hygiene. Meaning wash your hands more, touch your face less. And if you have not gotten the flu shot, get the flu shot, because you can still protect yourself from getting the flu. And these are all kind of common sense precautions that we can be taking right now to protect ourselves and our families.

NNAMDIHow does this virus spread exactly, Dr. Wen?

WENIt is a respiratory virus that spreads through respiratory droplets similar to the cold or the flu. So imagine someone sneezes or coughs and those respiratory droplets land onto someone else who was standing within a few feet from you or you cough and sneeze into your hand and then you shake hands with someone else. That person doesn't wash their hands, and they put their hands to their face, and it then spreads into their mucus membranes, so similar route to the cold or the flu virus.

NNAMDIThere are, of course, skeptics. Here is Anise in Vienna, Virginia. Anise, you're on the air. Go ahead, please.

ANISEYes, sir. I just feel like everybody is panicking or the media is making a lot of hype out of this. I'm thinking when we compare the mortality rate between this pandemic and SARS or, you know, Swine Flu, then I guess the experts can explain that. It's not as bad -- I mean, it kind of reminds me of the situation this summer with the deaths in the Dominican Republican, where it was not anywhere near what it always is, but because of the media and all these events being highlighted in the media so much it kind of creates a panic. And maybe your experts can weigh in on this.

NNAMDIDr. Pascal Crosley, you think we're hyping this too much?

CROSLEYRespectfully I would disagree with the caller. Two things that I would say are a little bit different about this emerging pandemic. The first is it's a novel disease meaning folks in the community have not developed an antibody -- an immunological response to this new virus. It's never been seen. It's new. And so there's no previous immune system development that would protect people from this particular virus. That makes it -- the ability for it to be -- the transmission of the virus has been very significant.

CROSLEYSo therefore number one to have the exposure to the virus to be a new virus, which would make folks susceptible to the disease and the ability for it to be transmitted from person to person is very significant. And then if you factor in the mortality being one and three percent depending on who you're looking at or who you read, surely I think this is a virus and an emerging pandemic that should be fully respected and all resources should be behind the efforts to try to maintain and isolate it.

NNAMDIAnise, thank you very much for your call. You mentioned new virus, doctor. Here is Wile in McClain, Virginia questioning that. Wile, you're on the air. Go ahead, please.

WILEGood morning. And thanks for taking my call. And thank you for mentioning that it's a novel virus and that it's an outbreak. My question is if we tested people two years ago, if we had that testing capability that we have today and tested people who have symptoms two years ago, can anybody on the panel actually confirm with certainty that nobody would have tested positive for this virus if we had that testing capability, because I remember when I went to the doctor two years ago with a terrible cold I was told it's virus, get better. It's not the flu get better. Nobody was looking for it. So for that reason we don't know that it's viral -- that's it's actually novel. We don't know that it's novel, because we never looked for it. And we don't know that it's an outbreak either. So that's my point that I wanted to ask about.

NNAMDILeana Wen, care to respond?

WENI mean, I understand what you are referring to for the caller. As in much of the time when we diagnose people with viral illnesses we don't say, well, it's exactly this virus. We just say, you have the constellation of symptoms that make it a viral illness, because frankly in the winter there's so many different types of viruses that are circulating. This, though, is a novel virus. And here's how we know for certain, because when the outbreak first began in Wuhan City in Hubei province in China, this new virus, the cause of this new disease was sequenced. And the test was developed based on the sequencing of the gnome of this new virus. So we do know that this is a specific and new type of coronavirus.

NNAMDIGot to take a short break. Wile, thank you very much for your call. You too can join the conversation. Give us a call 800-433-8850. Have you canceled any travel plans or special events in response to the outbreak? How are you feeling right now, fearful, anxious, panics or perhaps just fine? 800-433-8850. Send us a Tweet @kojoshow or email to kojo@wamu.org. I'm Kojo Nnamdi.

NNAMDIWelcome back. We're talking about the incidents of coronavirus in this region. And before we started the broadcast there was 16, but since that time Prince George's County has announced two and Loudoun County has just announced one. So the count now stands at 19. Christopher Rodriguez, when we talk about this we're talking regionally even though we've got the District and Maryland and Virginia represented here. To what extent is the region cooperating?

RODRIGUEZWell, what this specific incident on COVID-19 is really reinforcing to a lot of people in the region is how interconnected and interrelated we really are. I know Homeland Security and Emergency Management Officials from across the region in the national capital region are communicating daily on new cases and sharing information. And that's not only happening in the emergency management space but also in the health space. And so the departments of health, the directors, are communication. And so there's a lot of close coordination with the state and with local jurisdictions.

NNAMDIPascal Crosley, who is most vulnerable to this disease?

CROSLEYYeah. The evidence coming back out of China is certainly the elderly, specifically over 80 years old. There's significant risk that we're seeing again out of the evidence coming back from China that the lethality and the mortality of the disease is going to be susceptible to the elderly. And as well as patients that have an underlying medical conditions, lung disease specifically, heart disease, cancers, any patients that have been immunosuppressed or under heavy treatments under immunosuppression should surely -- are surely at risk and should be surely cautious with their day to day exposures.

NNAMDIAnd Leana, we got a correspondence from Emily on Instagram who asks, "Any extra precautions pregnant women should be taking?"

WENSo great question. And I answer this as a pregnant woman myself. I am in my ninth month now of pregnancy, and so I definitely feel this on a very personal level. So it is interesting. There are a lot of comparisons for this new coronavirus with the flu understandably. And the one difference so far seems to be -- well, not the one difference, but one very prominent difference is who it affects.

WENThe seasonal flu and when we look at the swine flu in 2009 and H1N1 in 2009, the people, who were most affected not only included the elderly and those with chronic medical conditions, but also specifically included pregnant women and children. COVID-19 seems to not be that way. Those, who are the most affected as you heard from my colleagues, who are your guests are the elderly and those with chronic medical conditions, but not so much with children and not so much with pregnant women either.

WENNow with pregnant women specifically the number of people of affected is so small that it's hard to generalize and say, oh, well, that there are no effects. There might be certain effects and there might even be transmission between the mother and the fetus, although that has not yet been documented. So my advice for pregnant women is still to exercise caution, because being pregnant is still a state of being medically vulnerable.

NNAMDIParham Jaberi, we got a message on Facebook from Lesley asking, "I have heard that people who have the coronavirus are contagious even before they have symptoms. Is this true?"

JABERIYou know, we often find with infectious diseases that there may be a very short time before they actually become symptomatic where they can spread the virus. It all goes back to the very beginning. So when an individual is exposed to an infectious agent there's a period of what we call the incubation period. The germs enter their body. They have it, but they have yet to develop the symptoms that we know of, such as the fever, the dry cough, and others. As the individual mounts its immune response those symptoms become more evident.

JABERIIn many cases not just with this particular illness it has been found that an individual can be transmitting some time -- we use the word shedding a virus. So that may be possible, but usually with infectious diseases you're most transmissible when those symptoms are present and acute. So just before they start and just until after it ends.

NNAMDIHere now is Jessica in Washington D.C. Jessica, you are on the air. Go ahead, please.

JESSICAHi. Thank you for taking my call. The diagnosed patients of corona in D.C. had significant exposure to the public before they were isolated. We know that the virus spreads exponentially. So isn't it extremely likely the virus is currently spreading very rapidly throughout the D.C. area by community spread and why isn't D.C. taking emergency containment measures to prevent the spreading?

NNAMDIDr. Christopher Rodriguez.

RODRIGUEZWell, thank you for the question. There have been no instances so far in the District of community spread. But to the questioner's point, you will recall that our first patient, who self-identified at Christ Church at Georgetown, there was exposure from some of the congregants that attended that church. And so out of an abundance of caution, most of those congregants that were at the church on February 24th or between February 28th and March 3rd when the pastor was symptomatic have been self-quarantined for 14 days. So the community and the residents certainly are taking measures to ensure that there is no community spread. But to this point we do not have an instance of that here in the District of Columbia.

NNAMDINathan emails us, "Many churches are trying their best to love our congregation and community by being careful about our regular practices in light of the coronavirus. In particular, my congregation is changing up how we do communion and our coffee hour to start. I'm very concerned about our seniors and their well-being. Worship gatherings are an important part of their life that adds to their well-being and connection. What would you recommend to a pastor who cares about the health of all members of their congregation especially those who are most vulnerable, say to a regular attendee who does not want to miss church?" Leana Wen.

WENThis is so tricky. The guidance from the Centers for Disease Control and Prevention, the CDC, over this last weekend, again, this is very quickly evolving. But the CDC guidance from this past weekend, a couple of days ago is that older adults over 60 and especially if they have chronic medical conditions should avoid long haul flights, should not go on cruises, and specifically avoid large gatherings and places with crowds.

WENNow, I believe that everybody should weigh their own personal risk factors taking into account their own medical conditions as well as their risk tolerance, and how much different events mean to them. And it might be worth a conversation with your pastor and with your physician, but given this recent guidance from the CDC I would advise that these conversations occur sooner rather than later, because we do want to protect those who are the most vulnerable. Taking to account, though, what the pastor said as well that attending service for many people is also really important to approve overall mental well-being, emotional connectedness, as well.

NNAMDIWhat do we know about the death rate for people who contract coronavirus?

WENThe death rate appears to be somewhere between 1 and 3 percent. The World Health Organization's numbers are just above 3 percent, at 3.4 percent. Many public health experts, including myself, believe that the number is probably the ceiling of where it would be, given that those numbers reflect earlier on in the outbreak, when people who are first diagnosed, where people who are severely ill.

WENThe more recent numbers coming out in the modeling studies being done make it seem like the numbers are probably a bit lower, but not that much lower, so somewhere in the 1 to 3 percent category. Compare that to SARS and MERS, which are 10 percent and 30 to 40 percent, respectively. It's certainly lower, but it also is higher than the seasonal flu, which is -- the mortality rate is about .1 percent.

NNAMDIParham Jaberi, Holly just called in to say: I just left a physical with my doctor. She told me there are no test kits, and if you think you may have COVID-19, you have to go to the ER. That is a poor way to handle this. The state should have more kits available for people who are worried. What advice would you give to Holly?

JABERII certainly appreciate the concern that's been expressed, and we're obviously working on a state level closely with our federal partners to ensure that we get test kits to as many healthcare providers as possible. You know, this raises, again, a very legitimate concern, having to do with scarce resources.

JABERIAnd so what we do in public health is oftentimes use risk-based criteria in terms of who really should get the testing, so those who have been in close contact with an individual who's been diagnosed with COVID-19, a healthcare provider who's been taking care of such a person. Others would be those who've traveled from countries where we know that there's been wide spread of this illness. And then potentially other vulnerable populations.

JABERIWe've discussed -- appropriately so -- the specific risk on the elderly. So, if there's those individuals in a nursing home, where they are expressing, again, the signs and symptoms -- fever, dry cough, fatigue -- and have been tested for the flu and have a negative response on their respiratory pathogens and there's no other diagnosis, those would be other individuals that we would really want to test.

JABERISo, in a time of limited resources, it's important to be able to prioritize and be able to provide the testing for those individuals, but certainly appreciate the fact that there are many of those in the community that are concerned and would like to be tested.

JABERIAnd the good news -- as you've heard from our federal officials, and certainly the state -- is that those capabilities are being ramped up. So, I would expect to see multiple-fold increase just simply by next week for us to be able to do more testing in our primary care offices, away from EDs and urgent care, as Dr. Wen appropriately discussed, so we can protect the surge capacity. We can ensure that other patients that also need critical care -- whether it's trauma patients or your heart attack patients -- that those individuals are being appropriately seen and taken care of in those acute-care settings.

JABERIBut, again, I'll wrap up by saying that we know that those testing capabilities are going to be increasing by the day and should be much more available very soon.

NNAMDIDr. Crosley, Maryland Governor Larry Hogan declared a state of emergency last week, after the first cases of coronavirus were detected, in an effort to expedite the arrival of resources. Have those resources arrived, and what are they, exactly?

CROSLEYYeah, at the -- I have two settings that I currently see patients in. In the emergency department standpoint over at St. Agnes Hospital emergency department, we are currently working with the Maryland Department of Health for the testing capability.

CROSLEYSo, currently the hospitals do not have capabilities for testing. It is sent out for testing at this particular juncture. And, in an urgent care setting, with regards to sort of more the outpatient settings, some of the protections that we would be looking for regarding N95 masks, and certainly we don't have testing capabilities in urgent care settings.

CROSLEYThere is a little bit -- a paucity of those sort of protective paraphernalia. We have not received those, currently, but we are waiting on those.

NNAMDISix or now eight cases of coronavirus have been confirmed in Maryland, as of our airtime. What are the next steps, here?

CROSLEYWell, the next steps are to continue the monitoring process. If you are feeling -- you know, message to the community. Obviously, if you have traveled to an endemic area and if you're suffering from lung symptoms and have fevers and you feel well, we think that well folks that have moderate-to-mild symptoms should call their physicians and look for advice over the phone, and don't report to medical facilities.

CROSLEYBecause, generally, the process and treatment would be self-quarantine. Now, if you feel ill and you have some risk -- whether that be travel, fever and lung symptoms and you feel ill -- we think you should report to your medical facility with a call ahead, if you can, to prepare the facility for your arrival. The arrival of a patient that would be considered a patient under investigation requires some isolation, and specific protection for the facility to manage you.

NNAMDIDr. Wen, what do we know about the details of these coronavirus cases in Maryland?

WENWhat I understand, so far, of the initial six cases are that they are all cases that involve travel, as in the individuals had a known exposure somewhere else, and so that these are not cases of community transmission within Maryland. That said, I do want to caution that we will be seeing community transmission soon. And I don't just mean in Maryland, but all across the country, just because of the nature of the disease. This is not a reflection of the response of public health officials, whom, I have to emphasize, are doing extremely challenging work under extreme time pressure. People have to make hard decisions with very limited resources.

WENSo, it's not a reflection of the work being done. It's a reflection of the nature of this disease. And I think it's important for listeners to know, too, then, what we are anticipating and preparing for is we do not want for our healthcare systems to be overwhelmed, our hospitals to be overwhelmed by large numbers of patients coming in all at the same time, which is why we stress for the so-called "worried well," that people who do not otherwise need hospital care to stay home.

WENBut that's also why we are moving into the phase, as a country, of mitigation, meaning that we want to reduce the number of cases, of severe cases, so as to not overburden the healthcare system all at the same time.

NNAMDIDr. Rodriguez, Kasha emails us: How soon after testing are results from the coronavirus test available?

RODRIGUEZThe D.C. public health lab can have results, as soon as they get the samples -- and sometimes it requires more than one sample -- within a matter of hours.

NNAMDIAnd this question for you, Dr. Jaberi: Can you get the virus more than once, or is it like chicken pox?

JABERIYou know, I've heard multiple experts try and answer that question, including Dr. Fauci, on one of those press conferences. Generally, we believe when you are infected with an agent again -- not just coronavirus, but others -- that you have some immunity a short time thereafter. So, it's unlikely that you would be re-infected very closely thereafter.

JABERIBut whether, you know, we can track this and see whether the virus can potentially mutate, it may change. For example, we could potentially have a surge of cases now, it goes away in the warmer months, and then it comes back again next fall.

JABERISo, is it the same exact virus, is it slightly mutated? I think that possibility exists. But in terms of acute response, we generally think that once one person's been infected, their body develops a defense mechanism to ward off a continued infection or a subsequent infection very closely thereafter.

NNAMDIWe've got to take a short break. When we return, we'll continue this conversation on the coronavirus in this region. Taking your calls at 800-433-8850. What are you doing to prepare yourself for the daily disruptions, including the possibility of quarantine, that may be ahead?

NNAMDIHave you ever been quarantined? Tell us about your experience, 800-433-8850. Shoot us a tweet @KojoShow, or email to Kojo@WAMU.org. I'm Kojo Nnamdi.

NNAMDIWelcome back. We're talking about coronavirus in this region with Dr. Christopher Rodriguez. He's director of the District of Columbia Homeland Security and Emergency Management Agency. Dr. Pascal Crosley is an emergency physician and owner of Quality First Urgent Care in Burtonsville, Maryland.

NNAMDIDr. Parham Jaberi is chief deputy commissioner of the Virginia Department of Health, and Dr. Leana Wen is an emergency physician and professor of public health at George Washington University, who formerly served as Baltimore's health commissioner. Dr. Wen, has the coronavirus outbreak been classified as a pandemic, and what defines a pandemic, anyway?

WENThat's a great question, Kojo. The World Health Organization has yet to officially call the COVID-19, the new coronavirus, as a pandemic, although many public health experts believe that we are already in a pandemic situation.

WENJust yesterday, CNN has officially started referring to COVID-19 as a pandemic. I believe, too, that it is a pandemic, for the following reason, that it meets the definition. A pandemic is defined as a sustained, community, person-to-person transmission around the world of a virus, of a disease, that can cause serious illness or death.

WENAnd, by that definition, we are seeing sustained person-to-person transmission in multiple -- in various communities around the world. Now, COVID-19 is in over 100 countries, and still continuing to spread. Now, I understand why the World Health Organization is reluctant to apply this label.

WENThey're saying the reason is calling it a pandemic signals that the time for containment is over, and we have to move on to the next phase, the mitigation phase. And I understand what they're saying, that there is still a chance that we can contain this disease and stop the spread, slow the degree of the spread.

WENBut I also think that we need to call this disease for what it is, that words matter, and calling it a pandemic is not referring to the severity of the illness, it's referring to the spread of the disease. And we are at the point where it is widespread, where we have to take appropriate, aggressive actions. And calling it for what it is allows all of us to put in place our pandemic response plans and proceed accordingly.

NNAMDIWell, here is what the director of the World Health Organization, Tedros Adhanom, had to say during a press conference Monday.

TEDROS ADHANOMThe threat of a pandemic has become very real. But it would be the first pandemic in history that could be controlled. The bottom line is we're not at the mercy of the virus. The great advantage we have is that the decisions we all make as governments, businesses, communities, families and individuals can influence the trajectory of this epidemic.

TEDROS ADHANOMWe need to remember that with decisive, early action, we can slow down the virus and prevent infections. Among those who are infected, most will recover.

NNAMDIDr. Crosley, how worried should we be?

CROSLEYWell, I think there should be significant public health concern, understanding the transmission that was -- the infectivity that was happening in other countries. We can expect that to -- we can expect infected individuals to pick up and ramp up here in the United States, and, of course, in this area.

CROSLEYWe should listen to our news broadcasts, take specific precautions regarding recommendations coming out of the CDC, and I do urge your listeners to take this very seriously. This could potentially be a very serious disease that can last for a prolonged period of time -- up to years, is what epidemiologists are saying. And it should be taken very serious, in my opinion.

NNAMDIHere is Maget, in Virginia. Maget, you're on the air. Go ahead, please.

MAGETYes, I'm in an imam of a mosque in Virginia. I would like to ask when do you think would come a point to tell congregations not to attend religious services? Is any point the breaking point where you say (unintelligible) for everybody?

NNAMDIWell, allow me to add Barbara in Potomac, Maryland to that. Barbara, your turn.

BARBARAYes, thank you for doing this show, Kojo. I was wondering what criteria one should use, if you're a healthy person, to decide stopping to do certain leisure activities. Well, I don't know if you would call churchgoing a leisure activity, (laugh) but certainly, theater, movies, attending church/synagogue, swimming at the YMCA or other gyms, doing workout programs, ballroom dancing, where you're in close contact with people and you hold the hand of many different partners, and singing in a choir, where there's a lot of inhaling and exhaling.

NNAMDIThose are quite a few different types of activities. Dr. Rodriguez, what is the District of Columbia advising?

RODRIGUEZWell, what we're advising is to let the science guide our response, and to be guided by facts and not fear. So, we are not right now advising that residents or members of the public change their life routine or do anything that they wouldn't otherwise do from a day-to-day standpoint.

RODRIGUEZWe would refer back, of course, to the CDC's guidance on international travel, and particularly for those over a certain age and with underlying health conditions. But, at this point, we are not advising people to disrupt their daily routines.

JABERIKojo, if I may add, from Virginia Department of Health --

NNAMDIPlease do.

JABERI-- just to add this is a very tricky part of the process, so this is where the art and science of public health comes together, when we're talking about community mitigation strategies. That's how we're lumping it in in our multi-agency response here in the Virginia Department of Health.

JABERIWe realize, and we're not surprised, where we're seeing some of our initial cases in northern Virginia, where we generally have more international travel. And so what we may see in northern Virginia may be very different compared to other parts of more rural or southwest Virginia, and somebody from Maryland on the eastern shore or the western parts, is that communities are going to experience the spread of this illness at varying rates.

JABERISo, in terms of what those triggers need to be, that has multiple layers. One, for the northern Virginia residents, we look to our local health directors, so Dr. Goodfriend with Loudoun County, Dr. Gloria Addo-Ayensu in Fairfax, Dr. Steve Haering in Alexandria, Dr. Varghese in Arlington.

JABERIEach of these individuals have been there -- I started with BDH in 2010, they were all in their positions since then and prior. So, that significant experience working with local communities through Ebola, through Zika, and many of them with H1N1, and are looked to as the healthcare professional who can help with those public health decisions.

JABERISo, I want to emphasize the point that some of these community containment strategies are going to be driven locally, because there's going to be varying rates of infection across. However, we are getting some national guidance through the CDC when it comes to school closures and other efforts, and so we're going to be, hopefully, at the state level, taking in a federal guidance, the standard, clear guidance where possible, and tailoring that to the community response. But your listeners should not be surprise if in their local community something different is being done than potentially two counties away.

NNAMDIDr. Rodriguez, Dr. Jaberi just talked about school closings. Three D.C. schools were closed yesterday for, quote-unquote, "deep cleaning" over coronavirus concerns. And, today, Georgetown day school is closed. What's the protocol for closing schools and offices here?

RODRIGUEZWell, in those cases, for the school closures and particularly with School Without Walls, which the mayor closed yesterday for deep cleaning, we have seen instances in which a staff member or a student had direct and close contact with known cases.

RODRIGUEZSo, even though those individuals who had the contact did not exhibit symptoms, there was -- out of an abundance of caution -- a decision made to deep-clean the schools. And, fortunately, the district, under the mayor and our health director, Dr. LaQuandra Nesbitt, have been very proactive about setting up contracts to ensure that we can get folks in there, in these schools, if we do have to close them very quickly, to get our students back into schools.

NNAMDIFor the hundreds of parishioners of Christ Church, Georgetown, who have been asked to self-quarantine, how do you enforce that?

RODRIGUEZWell, at this time, we are not enforcing self-quarantine, merely asking that our residents do what's in the best interests of the community to prevent transmission and spread. And what we have seen is that a lot of our residents are taking the necessary precautions to self-quarantine.

NNAMDIHere is Janet in Baltimore County, Maryland. Janet, you're on the air, go ahead, please.

JANETHi, thank you. About hand sanitizers, we're told that the high alcohol content sanitizers are effective, but that's hard on your hands and clothing. How about hydrogen peroxide, and also benzalkonium chloride wipes? But they have disappeared. And I don't think that the facial wipes are antiseptic enough. Can you --

NNAMDIDr. Wen, can you help here?

WENI would encourage Janet and everybody else to go back to the basics. Soap and water are the most effective, much more so than the other agents that are mentioned. And there's no run on soap or water, as far as I'm aware of, that we have plenty of it.

WENWhenever possible, use soap and warm water, wash for at least 20 seconds. I know it sounds extremely basic. Remember, with COVID-19, in the absence of a vaccine, in the absence of treatment, while there are other viruses that are going around, too, the best thing that we can do is to follow good hand hygiene, especially when all these other products are actually being sold out. The one thing that we do have full access to, soap and water, is what we need to come back to.

NNAMDIDr. Crosley, Carol Lee from Silver Spring called in to say: I'm a medical provider, and I hear lots of individuals who have influenza A are being hospitalized. The flu shot hasn't covered that a lot, so how is influenza A different from COVID-19?

CROSLEYWell, influenza A is a type of obviously influenza, a type of virus. It is -- it doesn't have nearly -- the understanding is it doesn't have nearly the lethality of the coronavirus. The coronavirus, number one, is a new virus, what we call novel, that's new to be circulating in the community.

CROSLEYAs I mentioned before, there is no immunity inside of the community, and therefore, as compared to the influenza virus -- which has a significant amount of immunity inside of the community -- the coronavirus, again, because it's new, it's much more lethal. It's 10 times as lethal. And because of the lack of the immunology of the body inside of the community, it's much more susceptible to patients.

NNAMDIHere's Sinou in Chantilly, Virginia. Sinou, your turn.

SINOUHello, Kojo, thank you for taking my call. I have a couple of questions. So --

NNAMDIPlease make them brief, we're running out of time.

SINOUSure. Does it go away during the warmer months, number one. Number two, can this virus enter warmer or hot regions in the world?

NNAMDIDr. Jaberi?

JABERIYou know, we just don't know. This is a new virus, so its epidemiology is yet to be clearly delineated. We have seen, with other similar types of viruses, some waxing and waning with the warmer months. You know, that is very possible. But it's just certainly too soon to tell for sure.

NNAMDIOkay, thank you very much for your call. Here now is Linda in Bethesda, Maryland. Linda, your turn.

LINDAHi, Kojo. I'm 73 years old, and a few days ago, my husband got a really bad chest cold, which we knew was not the coronavirus. But we were already observing all of the --

NNAMDIBrouhaha?

LINDAAll the -- no, all the measures that we should be taking to protect us against the coronavirus. And yet I caught this heavy chest cold from him. So, it kind of shook my confidence in the measures that were being taken to protect ourselves from the coronavirus, and I wonder also if it's kind of inevitable that if one person in a household gets the coronavirus, will the other people in the household get it, too?

NNAMDIYou get this last question, Dr. Wen. You only have about 30 seconds.

WENIt's not inevitable, although certainly household contacts are at much greater risk. And so these are things that we can start preparing for right now. We can start preparing for what happens if our children have to stay home from school because of school closures, what happens if elderly relatives start getting sick, how can we make sure that we have supplies of chronic medications that people may be taking.

WENThese are all commonsense precautions that we need to be taking right now, because this issue is not going to go away, and, in fact, things are going to get worse before it gets better. But it's not cause to panic, it's cause for all of us to take this very seriously, and to prepare.

NNAMDIDr. Leana Wen, Dr. Parham Jaberi, Dr. Pascal Crosley and Dr. Christopher Rodriguez, thank you all for joining us. This conversation about the coronavirus in our region was produced by Julie Depenbrock. Coming up tomorrow, gun violence is on the rise in D.C., and among the dead are a heartbreaking number of young people. What are local police, lawmakers, and community leaders doing to help? That all starts tomorrow, at noon. Until then, thank you for listening. I'm Kojo Nnamdi.