WEBVTT
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Production funding for
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Behind the Headlines
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is made possible,
in part, by
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like you, thank you.
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- How Memphis is
fighting coronavirus,
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tonight, on
Behind the Headlines.
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[intense music]
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I'm Eric Barnes with
The Daily Memphian.
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Thanks for joining us.
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I am joined tonight
by two doctors
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from Le Bonheur
Children's Hospital,
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Jon McCullers,
Pediatrician-in-Chief
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at Le Bonheur,
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and a Senior Associate Dean
at the UT Medical School,
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thanks for being here again.
- Thanks for having us Eric.
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- And Nicholas Hysmith
is a doctor specializing
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in pediatric infectious disease,
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thank you for being here.
- Thanks.
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- Along with Bill Dries,
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reporter with
The Daily Memphian.
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I'm gonna start with
you Dr. McCullers,
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and we'll try to go
through, sort of,
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all kinds of things,
about social distancing,
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about the state of testing,
and about the symptoms,
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and what do you do if you
feel like you have symptoms,
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and so on, so try to
hit all those things in.
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And other issues, as we
go through this today,
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and try to stay as focused
as we can on Memphis
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and Shelby County,
but obviously
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this is a national
and global issue.
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For right now, the
social distancing,
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and we'll define that, it
seems to be the thing that
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in the last week and a half...
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You and I ran into each
other, in a restaurant,
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a week and a half
ago and chatted about
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where's this gonna go.
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I don't think that restaurant,
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I think they're
doing takeout now,
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I think most restaurants are
in the process of closing,
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people are working
from home, schools,
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I think every school,
public and private,
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and so on has closed.
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How far does this go, from
hey, let's stay apart,
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and let's not gather in places,
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to the end of the spectrum
where it's shelter in place,
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don't go out unless
it's an emergency
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or you need to get food.
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I mean, how far does this go?
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- So, we can think about it in
maybe three different phases,
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and one would be doing just
some simple social distancing,
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protecting those who are
immunosuppressed or at risk,
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and saying, "Hey, wash your
hands and stay, you know,
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a little bit distant
from each other."
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And let's just try
to not infect those
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who are at most risk.
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We're now in kind of a
phase we call mitigation.
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Which means we're
really doing many things
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that are designed to stop
the spread of disease.
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So, you know, not
gathering in large crowds,
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working from home when you can,
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staying away from, you
know, the grocery store,
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and you know, practicing that
six-foot social distancing.
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Cancelling many events that
we might otherwise have done.
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The third phase which,
you know, you refer to
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as shelter in place,
we call suppression,
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and that is really where,
you're just trying to do
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every single measure you can
to prevent social contact
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and to keep the virus
from moving at all.
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- And do you think,
from your point of view,
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we will or we need to
end up at suppression,
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shelter in place, that stage?
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- It's a very
interesting argument
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as to what is the degree
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to which suppression is better
at this than mitigation,
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and then what are the
costs of suppression?
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So, what are the
consequences on the economy,
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and on people's lives of
that sort of strategy?
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Versus one where, maybe
it doesn't work as well.
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You know, we really don't
know enough about this
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to say, I think, what
the best thing is.
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Which is why, many
municipalities are erring
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on the side of, well let's do
the maximal thing possible,
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for the good of the people.
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- Dr. Hysmith, bringing you in.
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Your sense, in terms
of, and we'll come back
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to some of these
social distancing,
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but I wanted to get you
in on, maybe on testing.
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And obviously, there's
a lot of frustration
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and confusion about
testing, that you know,
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the State got 500
tests, which seems...
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is obviously
wildly inadequate.
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What are you experiencing
within Le Bonheur,
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within the medical system,
in terms of your ability
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to get people tested?
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Can you get all
the people tested
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that you wanna
get tested?
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- So right now, the
answer is no to that.
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We cannot get everyone
at this time tested
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that we need to have tested.
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I think early on, when we
saw this happening in China,
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and we saw it happening
in Europe, we were all,
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the health departments around
the country were looking
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at ways that they could ramp
up their testing abilities.
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And when we had one or two
cases here, in our community,
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communities across
the United States,
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that was adequate, we could
test those individuals
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and then sort of trace who
they had been in contact with,
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and it wasn't using up a ton
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of our testing
resources at that point.
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Now that we have ongoing
community spread,
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in a lot of the communities
in the United States,
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and we will most certainly
have that here in Memphis.
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I think we definitely need to
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ramp up our testing
capabilities.
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We've seen some of the
commercial labs come online,
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however they are severely
backlogged right now
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with all the tests from
across the country as well.
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So, I think, working on
getting a test here in Memphis,
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in house, in some of our
facilities here in Memphis
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is gonna be critical
going forward.
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- Let me get Bill, we
have obviously have
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a lot more questions on that.
04:59.566 --> 05:04.137
- So Dr. Hysmith, for now,
it's not community spread
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with the cases
that we know about.
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So, there is tracing who people
have been in contact with,
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which seems to be a necessary,
but a tedious, process.
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Do people you contact about,
okay, tell me everyone
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that you came into contact with.
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I would imagine, they
can't remember that,
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in all cases.
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- Yes, that's true.
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That's a very tedious
process, and I can say that,
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as of this morning,
here in Shelby County,
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we have had cases that
have all been acquired
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somewhere other
than Shelby County,
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and they've come in here.
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So, when I say we haven't
had community spread,
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we haven't had community spread
here that's been documented.
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- And I should also
note, we're taping this
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Thursday morning, just cause
it is a fast moving thing.
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Back to you.
- Yes, true.
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I think that that will
change, and I think
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there has probably been
community spread already
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in Memphis that we
just haven't recognized
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cause we're not doing mass
testing waves at this point.
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- So, at that point, when
you have community spread,
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you don't trace, you simply
begin to treat and deal with
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what's gonna be a
locally spread virus?
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- So, yes to that question.
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There has been some,
that's sort of what they've
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started doing in some
other parts of the country.
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They have stopped the
contact tracing element,
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and they have simply
ramped up their testing.
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If you have symptoms,
you stay home.
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Don't go out into public,
practice social distancing,
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and in areas where they
have large amounts of tests
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that they're able to
perform, people can go to
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these testing stations
and be tested.
06:39.466 --> 06:41.835
- Let me go back to you,
Dr. McCullers, and talk...
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Have you administered a
test, yet, to someone?
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- Not during this outbreak.
- Not during this.
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But if you had,
let's take that from,
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there's a box or a swab,
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like walk through the
minutia of testing.
06:56.149 --> 06:59.986
- So, testing in this context,
you're trying to get a piece
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of the virus from out of
a person's mucus membrane.
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So, what we would do is,
the person would typically
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be in a setting where the
healthcare worker's protected,
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so either they're
going to the home
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and they're wearing all of this
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personal protective equipment,
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or now we're seeing
the drive-bys
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where people stay in their car,
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and the healthcare
worker's wearing
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their personal
protective equipment.
07:19.773 --> 07:21.608
You then would have
a little test tube,
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that would be full of what
we call viral transport medium,
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something the virus
stays alive in,
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and is stabilized in.
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You would take a swab,
and either swab their throat
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just like you're used
to with the strep test,
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or you would swab
through the nose
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and hit the back of the
throat with the swab.
07:37.190 --> 07:38.825
It then goes in the
transport media,
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you swish it a little bit,
break it in half, cap it.
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You send it to the
testing facility,
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where they're then gonna
run molecular tests
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which look for the genome of
the virus within that sample.
07:48.968 --> 07:51.037
- Right now, those
tests are being sent...
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There are two
commercial labs, I think,
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in Memphis, is what's been
reported that are doing it.
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A lot of them are
going to Nashville.
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I mean, in an ideal
situation, would they be done
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you know, at Methodist,
at Le Bonheur,
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at the hospital itself?
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Is that where
we're trying to get,
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in terms of the
speed of testing?
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- So, there's at least two,
right now, commercial labs.
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There's others that are coming
up in the very near future.
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And, to varying degrees,
they have to send 'em
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to other places in the
country because the model
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is of course
centralized testing,
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and then back out to
the different locales.
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So, some of these are actually
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going to California
to be tested.
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And you can see, with all the
travel issues we're having
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that that creates it's
own supply chain issues,
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and it takes five or six
days to get a test back.
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So, ideally, and this is
what we're hoping to do
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at UT within the next two weeks.
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We'd have a test here locally,
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the test only takes
about four hours,
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so if you're running it
a couple of times a day,
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you can get results
back in 12 to 24 hours
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that are actually
useful for somebody
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like Dr. Hysmith to use.
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- Who, in an ideal world,
who would be tested?
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Cause right now it's a
pretty high bar, right?
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I was talking to one
medical professional,
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who was saying, "Look, you've
gotta meet the CDC guidelines,
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having been in a
level three country,
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you have to have been
exposed, it's a very high bar.
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You might have some symptoms,
you might have a fever,
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but you're not gonna
get tested right now
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in Memphis, by and large.
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Ideally, who would be tested
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if the test were fast
and readily available?
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- So again, depends a little
bit on what the scale is,
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and how much new tests you have.
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Right now, we'd love for
doctors who are worried
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about a patient
having coronavirus,
09:16.923 --> 09:17.991
to be able to test 'em.
09:17.991 --> 09:19.626
So, that would be the
first line of that.
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- And not have to, you
know, hoard those tests
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for only the worst, most likely,
09:26.032 --> 09:27.467
- And you'd like it--
- Dangerous people.
09:27.467 --> 09:28.701
- To be easy to do,
you'd like it to be cheap
09:28.701 --> 09:30.870
or free to do is
another big case.
09:30.870 --> 09:32.672
And then secondly,
you'd like to be able
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to test contacts maybe.
09:34.274 --> 09:36.109
So, somebody's been in
contact with somebody,
09:36.109 --> 09:38.244
maybe they're a critical
healthcare worker,
09:38.244 --> 09:40.280
test 'em, say they
don't have the virus,
09:40.280 --> 09:41.614
they can go back to work, right?
09:41.614 --> 09:43.149
- Before I go to
Bill, your sense,
09:43.149 --> 09:45.385
and I didn't know this, but we
were chatting before the show,
09:45.385 --> 09:47.153
you've consulted with the CDC,
09:47.153 --> 09:49.722
you've trained other
people who've been,
09:49.722 --> 09:51.024
you know, flu specialists.
09:52.659 --> 09:55.495
You've seen this on a national,
global scale, and so on.
09:55.495 --> 09:58.498
Your sense of when we will
have tests at that scale.
09:58.498 --> 10:01.301
The amount of tests that
you all, as professionals, need.
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- I think within two weeks.
- Within two weeks?
10:03.403 --> 10:04.237
Within two weeks, okay.
10:04.237 --> 10:05.505
Let's go to Bill.
10:05.505 --> 10:09.209
- Dr. Hysmith, some people...
10:10.577 --> 10:15.048
are taking one view that
this is the end of the world,
10:15.048 --> 10:18.318
some people are taking the
view that, what's the big deal,
10:18.318 --> 10:21.421
this is just flu like we
experience all the time.
10:21.421 --> 10:25.625
This is not your
normal flu, is it?
10:25.625 --> 10:26.926
- No, yeah that's
a true statement.
10:26.926 --> 10:29.529
I think that we
have seen examples
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of this in Europe already,
10:31.164 --> 10:32.966
we've seen it in the
United States already,
10:32.966 --> 10:34.100
in some of the experiences
10:34.100 --> 10:36.102
some of the
communities are having.
10:36.102 --> 10:38.505
Simply, the amount of
healthcare resources
10:38.505 --> 10:42.108
that this is requiring is
10:42.108 --> 10:45.812
really not something that we
see normally, with influenza.
10:47.213 --> 10:50.984
The severity of the illness
in older individuals,
10:50.984 --> 10:52.352
or those with chronic diseases,
10:52.352 --> 10:54.954
has put a real strain
on the healthcare system
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in many parts of the country,
10:56.823 --> 10:59.726
so I think that we definitely
need to take this seriously.
10:59.726 --> 11:03.096
I think that young,
healthy individuals
11:03.096 --> 11:05.765
still need to practice
social distancing.
11:05.765 --> 11:08.201
We realize that we
have severe disease
11:08.201 --> 11:10.203
in those individuals as
well, but the big thing
11:10.203 --> 11:13.506
is transmitting that to
someone that is elderly
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or has an immune
compromising condition.
11:16.576 --> 11:19.012
- Dr. McCullers, what
about a vaccine?
11:19.012 --> 11:22.916
And does the development
of a vaccine suggest
11:22.916 --> 11:26.753
that COVID-19 is
11:26.753 --> 11:29.689
not going to vanish
when this is all over?
11:29.689 --> 11:32.258
- So, we know the
virus isn't going away.
11:32.258 --> 11:34.460
It's spread enough
around the world
11:34.460 --> 11:37.730
that it's gonna be here
for some time with us.
11:37.730 --> 11:40.366
Vaccines are really,
really difficult to make.
11:40.366 --> 11:41.868
Let me just say that.
11:41.868 --> 11:44.237
We've been working on SARS
vaccines in the United States
11:44.237 --> 11:47.473
and worldwide for 17 years,
we don't have a vaccine.
11:47.473 --> 11:49.309
We've been working
on a vaccine for RSV,
11:49.309 --> 11:52.412
which infects babies, for 50
years, we don't have a vaccine.
11:52.412 --> 11:56.449
So, I think there's hope
that we can develop a vaccine
11:56.449 --> 11:58.184
to this, but it's not assured.
11:58.184 --> 12:00.386
Now, the good thing about
the SARS experience,
12:00.386 --> 12:02.155
is we do have some
vaccines that are coming
12:02.155 --> 12:04.424
into very early, you
know, human trials.
12:04.424 --> 12:06.426
So some candidate vaccines.
12:06.426 --> 12:08.261
We're able to
rapidly adapt those
12:08.261 --> 12:10.296
because the viruses
are so similar,
12:10.296 --> 12:13.199
and get coronavirus vaccine
trials for the new strain
12:13.199 --> 12:15.902
into trials very, very quickly.
12:15.902 --> 12:18.504
It still is an 18-month
to two-year process,
12:18.504 --> 12:20.139
even if it works,
and we're not assured
12:20.139 --> 12:21.407
that it's gonna work.
12:21.407 --> 12:25.011
- So Dr. Hysmith, your
thoughts on a vaccine,
12:25.011 --> 12:29.315
and also, a bit about
hearing the word vaccine,
12:29.315 --> 12:30.984
and kind of looking at that as,
12:30.984 --> 12:34.387
oh, okay, well
that's on the way.
12:34.387 --> 12:36.589
So, we don't have
to change behavior.
12:36.589 --> 12:40.460
Quite obviously, we are
having to change behavior.
12:40.460 --> 12:42.795
- Right, yeah, I think that
definitely in this point
12:42.795 --> 12:44.897
we have to change
our behavior, if not,
12:44.897 --> 12:47.433
we're gonna overwhelm
our healthcare system
12:47.433 --> 12:51.104
with the illnesses
that the elderly
12:51.104 --> 12:53.306
and those with chronic
medical conditions will have.
12:53.306 --> 12:55.408
I think the vaccine is
great, and that's something
12:55.408 --> 12:57.644
that we can look forward
to in the future.
12:57.644 --> 12:58.845
But right now,
we have to deal with
12:58.845 --> 13:00.413
what's going on currently.
13:00.413 --> 13:02.348
And if we don't
practice these measures
13:02.348 --> 13:05.618
that the CDC has
recommended, we're going to
13:05.618 --> 13:07.453
overwhelm our healthcare system.
13:07.453 --> 13:10.323
- Do you think this changes
our healthcare system?
13:11.858 --> 13:15.595
Aside from the virus,
aside from the medicine,
13:15.595 --> 13:18.598
is the structure of our
healthcare system changing,
13:18.598 --> 13:21.067
or should it change
as a result of this?
13:21.067 --> 13:22.268
- That's an
interesting question.
13:22.268 --> 13:23.903
I think I would like
to see it change
13:23.903 --> 13:25.405
as a result of
this going forward.
13:25.405 --> 13:28.307
I think there definitely
can be opportunities
13:28.307 --> 13:31.244
for more collaboration,
around the community,
13:31.244 --> 13:33.212
amongst all of our
healthcare facilities,
13:33.212 --> 13:35.448
and amongst our
healthcare enterprise
13:35.448 --> 13:37.450
as a whole in the city.
13:37.450 --> 13:39.952
I think that for a
long time we discussed
13:39.952 --> 13:41.554
the healthcare system
in the United States,
13:41.554 --> 13:44.357
and I think this is
the perfect opportunity
13:44.357 --> 13:46.259
for that to change,
going forward.
13:46.259 --> 13:47.760
I can't say how it would,
13:47.760 --> 13:50.730
but I think that this is the
perfect opportunity for that.
13:50.730 --> 13:53.700
- Mhm, Dr. McCullers,
your thoughts on that?
13:53.700 --> 13:56.903
- So, I think this is an
opportunity for us as a country
13:56.903 --> 13:58.871
to kinda revisit how
we do healthcare.
13:58.871 --> 14:03.342
We have been divesting in the
public health infrastructure
14:03.342 --> 14:05.878
and in primary care
since the 1940s
14:05.878 --> 14:08.414
when we really rallied
around tuberculosis
14:08.414 --> 14:10.483
and preventing
transmission of that,
14:10.483 --> 14:12.752
as well as
mosquito-bourne illnesses.
14:12.752 --> 14:15.555
And, particularly in the
last 5 to 10 years,
14:15.555 --> 14:19.425
we've seen a divestiture
and really a lack of respect
14:19.425 --> 14:22.562
for, and acknowledgement, of
the public health officials
14:22.562 --> 14:25.131
and the experts that
really would help us
14:25.131 --> 14:26.599
prepare for this sort of thing.
14:26.599 --> 14:30.002
So, 15 to 20 years ago, I
worked with the US Congress,
14:30.002 --> 14:33.039
with WHO, to work out
pandemic preparedness plans,
14:33.039 --> 14:35.007
our strategic
national stockpile.
14:35.007 --> 14:37.143
Since that time, there's
just been a degradation
14:37.143 --> 14:38.778
of our ability to respond.
14:38.778 --> 14:40.313
So I think this
is a call to say,
14:40.313 --> 14:42.682
after we get through
this, we really need
14:42.682 --> 14:45.251
to build that back up and
make that our primary focus
14:45.251 --> 14:48.221
to prevent this sort of thing,
and prevent just the normal
14:48.221 --> 14:50.656
chronic diseases
that we see everyday
14:50.656 --> 14:52.625
that are preventable if
we put the resources in
14:52.625 --> 14:55.061
up front, instead of
waiting till they're present
14:55.061 --> 14:57.563
and trying to treat
the results of them.
14:57.563 --> 14:58.798
- I was thinking about this
14:58.798 --> 15:00.333
as we were getting
ready for the show.
15:00.333 --> 15:03.503
It has felt, over the
last, I don't know, weeks.
15:03.503 --> 15:05.872
It's like a slow motion Katrina.
15:05.872 --> 15:08.474
Where you kind see
the storm coming,
15:08.474 --> 15:10.309
it's like, oh yeah, we
get storms all the time.
15:10.309 --> 15:11.611
We get flu outbreaks
all the time,
15:11.611 --> 15:12.879
we always live through those.
15:12.879 --> 15:15.181
And then people, as
it's getting closer,
15:15.181 --> 15:17.717
start saying this is a
different kind of storm.
15:17.717 --> 15:19.185
And then it hits.
15:19.185 --> 15:21.120
And suddenly, and you know,
I remember with Katrina,
15:21.120 --> 15:23.556
there was this sense
that everyone was waiting
15:23.556 --> 15:24.991
for the federal
government to come in,
15:24.991 --> 15:27.794
for some days, and then
suddenly the locals realized,
15:27.794 --> 15:28.861
they're not coming.
15:28.861 --> 15:30.830
We gotta do it ourselves.
15:30.830 --> 15:33.332
Is that where we are,
where you feel like we are,
15:33.332 --> 15:35.134
in Memphis,
in Shelby County,
15:35.134 --> 15:35.935
as a state,
15:35.935 --> 15:37.904
that it's really up to
Memphis and Shelby County
15:37.904 --> 15:40.506
to make the good
decisions, and get help
15:40.506 --> 15:42.308
from the state and federal
government where it comes.
15:42.308 --> 15:44.510
Whereas I think, people
seem to have expected
15:44.510 --> 15:46.212
the federal government
was gonna lead on this,
15:46.212 --> 15:47.980
and you all would
follow their lead.
15:47.980 --> 15:49.782
- So I think there's
some elements of that.
15:49.782 --> 15:51.684
Certainly, we were
supposed to have
15:51.684 --> 15:54.854
a strategic national
stockpile that had, you know,
15:54.854 --> 15:57.824
95 million and 95
masks for instance,
15:57.824 --> 15:59.258
and it did at one time.
15:59.258 --> 16:01.127
It now has 12 million,
because Congress
16:01.127 --> 16:02.995
has not appropriated
to fill that up.
16:02.995 --> 16:05.164
We don't have enough ventilators
at the federal level.
16:05.164 --> 16:06.899
We've had a very
poor federal response
16:06.899 --> 16:07.834
the last three months.
16:07.834 --> 16:10.002
Those are all very, very true.
16:10.002 --> 16:12.038
And we're having to do many
of those things now locally.
16:12.038 --> 16:13.940
In terms of, setting
up our own testing.
16:13.940 --> 16:15.741
Okay, so you would have
thought the federal government,
16:15.741 --> 16:17.543
through the health
departments would have
16:17.543 --> 16:19.145
been able to manage that,
well they've not been able
16:19.145 --> 16:21.347
to manage that, we're
having to do it ourselves.
16:21.347 --> 16:23.916
At the same time, you
don't want every town
16:23.916 --> 16:26.185
and municipality
making their own rules
16:26.185 --> 16:28.654
and doing their own thing,
because we are a country
16:28.654 --> 16:31.424
and a population that has
so much interconnection
16:31.424 --> 16:33.426
that if my neighbor is
doing something crazy,
16:33.426 --> 16:34.861
it's going to impact me.
16:34.861 --> 16:37.029
And again, we should be
having the federal government
16:37.029 --> 16:39.832
help us make those decision
and set some of those rules.
16:39.832 --> 16:42.969
- To that end, well
let's talk about
16:42.969 --> 16:44.503
Le Bonheur for a second.
16:44.503 --> 16:45.905
Le Bonheur, they announced,
like maybe it was yesterday,
16:45.905 --> 16:49.909
sometime this week,
that their visitations
16:49.909 --> 16:51.444
for people who are in
there for whatever,
16:51.444 --> 16:53.646
a broken leg, or whatever
they've got going on.
16:53.646 --> 16:55.615
Only two healthy
adults and caregivers,
16:55.615 --> 16:57.550
y'all are gonna screen
them before they come in
16:57.550 --> 16:59.685
to make sure their
temperature and so on.
16:59.685 --> 17:02.655
The volunteer program at
Le Bonheur is shut down.
17:02.655 --> 17:04.323
Postponing elective surgery.
17:04.323 --> 17:05.725
I thought that was interesting,
17:05.725 --> 17:07.793
you've heard that nationally,
why is that important,
17:07.793 --> 17:09.562
postponing elective surgery?
17:09.562 --> 17:11.130
Go ahead.
- There's been a bit of debate
17:11.130 --> 17:13.065
about postponing
elective surgeries
17:13.065 --> 17:15.268
and how far you go with
that, and what really is
17:15.268 --> 17:16.702
an elective surgery, right?
17:16.702 --> 17:20.339
So, if we don't do an
elective surgery right now,
17:20.339 --> 17:22.909
does that person then
develop a bad outcome
17:22.909 --> 17:25.578
because of the timing of
the surgery is disrupted?
17:25.578 --> 17:27.346
Does it become an
emergent surgery,
17:27.346 --> 17:29.715
where it's much more
difficult to deal with it.
17:29.715 --> 17:33.319
So, there's urgent, versus
non-urgent surgeries.
17:33.319 --> 17:35.621
There's unnecessary,
or nice surgery,
17:35.621 --> 17:37.657
like cosmetic
surgery for instance.
17:37.657 --> 17:38.791
That you maybe
don't need to do.
17:38.791 --> 17:40.760
But then really,
where's that gray area,
17:40.760 --> 17:42.828
where you need to do it, but
do you need to do it now,
17:42.828 --> 17:44.564
and do you have worse outcomes
if you don't do it now?
17:44.564 --> 17:47.433
- And I ask that in
part, not that I know
17:47.433 --> 17:49.669
where that bar should be,
but back to this notion
17:49.669 --> 17:50.903
of a coordinated response.
17:50.903 --> 17:53.806
That's Le Bonheur's
rules, but I mean,
17:53.806 --> 17:56.042
are those the same
rules for Methodist,
17:56.042 --> 17:57.310
even though y'all
are under Methodist.
17:57.310 --> 17:58.577
Is that the same
for Regional One,
17:58.577 --> 18:00.246
is that the same for
Baptist, and so on.
18:00.246 --> 18:02.448
I mean, are different hospitals
having different rules,
18:02.448 --> 18:04.083
and is that problematic?
18:04.083 --> 18:06.652
- I think most of the
hospitals are following
18:06.652 --> 18:09.388
the idea that you're gonna
cancel elective surgeries,
18:09.388 --> 18:11.190
but they're leaving it
up to their experts,
18:11.190 --> 18:13.259
which are the surgeons
themself to say
18:13.259 --> 18:15.294
which of those are essential
versus non-essential.
18:15.294 --> 18:17.697
Which do we cancel,
which do we not cancel.
18:17.697 --> 18:19.765
I think that's pretty
much uniform doing that.
18:19.765 --> 18:21.667
The one little
difference is, you know,
18:21.667 --> 18:24.904
hospital based surgery
versus outpatient center.
18:24.904 --> 18:27.173
Do we wanna keep some of the
outpatient center surgeries
18:27.173 --> 18:30.042
going so you don't have those
get into the hospital later
18:30.042 --> 18:31.711
and fill up beds, that's
one of the debates
18:31.711 --> 18:33.145
we're having right now.
18:33.145 --> 18:34.447
- Okay, about seven minutes
left, go back to Bill.
18:34.447 --> 18:37.717
- All right, I wanna
go back to one of
18:37.717 --> 18:40.386
the more basic
points about testing.
18:40.386 --> 18:44.724
Does everyone need
to be tested in this?
18:44.724 --> 18:48.160
In other words, should
an employer send
18:48.160 --> 18:51.564
all of their employees in,
once there are enough tests,
18:51.564 --> 18:54.333
or as we get more tests.
18:54.333 --> 18:56.602
To have everyone tested
to make sure the workforce
18:56.602 --> 18:58.971
is safe, because I would
imagine that's no guarantee
18:58.971 --> 19:01.807
that someone's not gonna
get this in the future.
19:01.807 --> 19:03.776
- Right, true, and
I think this is
19:03.776 --> 19:07.013
a highly debated issue about
who all should be tested.
19:07.013 --> 19:09.248
I think you raise a great point
with the healthcare workers.
19:09.248 --> 19:12.318
One thing we're looking at
pretty intently right now,
19:12.318 --> 19:14.654
intensely right now,
is when we have,
19:14.654 --> 19:17.223
so we will be screening at
all our Methodist facilities,
19:17.223 --> 19:19.625
we'll be screening
all the visitors
19:19.625 --> 19:21.293
and all the associates
that come in.
19:21.293 --> 19:23.462
So, if we have an
associate that is
19:23.462 --> 19:25.297
screened positive
for an illness,
19:25.297 --> 19:27.600
we need to be able
to rapidly determine
19:27.600 --> 19:31.137
that that associate does
or does not have COVID-19.
19:31.137 --> 19:33.305
So that's gonna be one
key piece of the testing,
19:33.305 --> 19:37.143
and I would say that all
associates that have symptoms
19:37.143 --> 19:38.944
should be tested, that
way we can get them back
19:38.944 --> 19:41.047
into the workforce
as soon as possible.
19:41.047 --> 19:43.616
With regards to our community,
19:43.616 --> 19:45.284
I think that is a debated issue.
19:45.284 --> 19:47.186
I think that there are
some communities that are
19:47.186 --> 19:49.488
looking at, sort of,
you have symptoms,
19:49.488 --> 19:51.490
stay home, unless
they're severe.
19:51.490 --> 19:52.992
But, I think there
are other communities
19:52.992 --> 19:55.094
that are looking at
everyone with symptoms
19:55.094 --> 19:56.829
should be tested, that
way they can sort of
19:56.829 --> 19:59.832
stay away from, you know,
grandma and grandpa,
19:59.832 --> 20:01.734
and young children
and things like that.
20:01.734 --> 20:05.337
And I think that that's
probably the way we're headed,
20:05.337 --> 20:08.007
is testing the majority of
individuals that have symptoms.
20:08.007 --> 20:09.475
And I think that that's one way
20:09.475 --> 20:12.611
to sort of, better get
the spread under control.
20:12.611 --> 20:13.879
- Hmm.
20:13.879 --> 20:18.417
Strategically, should
we deal with COVID-19,
20:18.417 --> 20:21.921
the novel coronavirus,
outside of the hospitals
20:21.921 --> 20:25.491
to ensure that the hospitals
are not overwhelmed?
20:25.491 --> 20:28.494
- I think to the
best ability we can,
20:28.494 --> 20:30.463
we should try to manage it
outside of the hospital.
20:30.463 --> 20:32.798
Obviously, if you have
a severe enough illness
20:32.798 --> 20:35.267
that you need to come
into the emergency room,
20:35.267 --> 20:37.403
you're having trouble
breathing, that sort of thing.
20:37.403 --> 20:40.306
Then, obviously, that
follows a different criteria
20:40.306 --> 20:42.942
and you will have hospital
care at that point.
20:42.942 --> 20:45.377
But I think, for the
most part, this should
20:45.377 --> 20:47.346
be something
that we can manage
20:47.346 --> 20:49.115
on the outside of the hospital.
20:49.115 --> 20:51.117
- And by outside, is that
sort of screening tents,
20:51.117 --> 20:52.351
and screening locations?
20:52.351 --> 20:54.620
I mean, what is outside,
if it's not inside,
20:54.620 --> 20:55.454
what is outside?
20:56.922 --> 20:59.191
- Let me clarify that, I was
thinking of your question
20:59.191 --> 21:00.793
as being should all
of these individuals
21:00.793 --> 21:02.428
come to the emergency
department, that sort of thing.
21:02.428 --> 21:04.830
And that is definitely
not the model
21:04.830 --> 21:06.265
that we are proposing.
21:06.265 --> 21:08.234
It would be more of these
outpatient screening-type
21:08.234 --> 21:11.237
centers, where we're
not directing these
21:11.237 --> 21:14.507
people to come to the emergency
department for screening.
21:14.507 --> 21:15.741
- Five minutes here.
21:15.741 --> 21:18.611
Let me walk through
just some basic stuff.
21:18.611 --> 21:21.213
And people have read this,
but I think it's helpful
21:21.213 --> 21:22.748
that somebody who is
maybe their neighbor,
21:22.748 --> 21:24.416
and from a local
hospital to go through.
21:24.416 --> 21:26.886
Just, so...symptoms.
21:26.886 --> 21:28.888
What are those
symptoms that should
21:28.888 --> 21:30.923
concern someone, or
not concern someone?
21:30.923 --> 21:32.625
- So one of the important
things to realize,
21:32.625 --> 21:34.226
the symptoms are
fairly distinct.
21:34.226 --> 21:37.096
It's fever, cough, and
then lower respiratory
21:37.096 --> 21:39.431
difficulty breathing,
or chest pain.
21:39.431 --> 21:40.666
Really lower respiratory.
21:40.666 --> 21:42.902
This virus doesn't have
a lot of the typical
21:42.902 --> 21:45.371
runny nose and congestion,
things that we see
21:45.371 --> 21:47.740
with flu and some
other cold viruses.
21:47.740 --> 21:49.241
- All right, as we
tape this on what,
21:49.241 --> 21:53.245
March 19th, I think here,
if you feel those symptoms,
21:53.245 --> 21:54.513
what should you do?
21:54.513 --> 21:56.048
- You should call
your physician,
21:56.048 --> 21:58.984
or you should call into
somebody that you trust.
21:58.984 --> 22:02.254
And if it's mild, you're
gonna be told stay home,
22:02.254 --> 22:03.923
manage yourself at
home, don't come
22:03.923 --> 22:05.891
to the doctors office,
don't go to the ED
22:05.891 --> 22:08.194
If it's serious,
you can't breathe,
22:08.194 --> 22:10.529
you're having trouble with
your breathing, you're worried,
22:10.529 --> 22:12.531
then you go to
the ED, but call ahead
22:12.531 --> 22:14.300
to the ED to tell
them you're coming.
22:14.300 --> 22:16.068
- Difficulty breathing,
just to clarify,
22:16.068 --> 22:17.536
is different than a cough?
22:17.536 --> 22:19.738
Just, for a layman, layperson,
22:19.738 --> 22:22.308
the difference between a
cough, even a bad cough,
22:22.308 --> 22:24.977
and the lower respiratory
that you're talking about?
22:24.977 --> 22:26.445
- All right, so a lot of
us are coughing right now
22:26.445 --> 22:28.347
because allergy
season is coming in,
22:28.347 --> 22:30.649
we got some nasal drip
and things like that.
22:30.649 --> 22:31.884
So you're gonna have a cough.
22:31.884 --> 22:33.919
Difficulty breathing is
typically chest pain,
22:33.919 --> 22:36.021
difficulty getting your air out,
22:36.021 --> 22:37.790
fast breathing,
labored breathing,
22:37.790 --> 22:39.091
is what we're talking about.
22:39.091 --> 22:40.726
- If you don't have a
doctor that you can call,
22:40.726 --> 22:42.228
who do you call?
22:42.228 --> 22:44.330
- Well, I would normally
say the Health Department,
22:44.330 --> 22:45.898
but the Health Department's
being overwhelmed
22:45.898 --> 22:47.099
with calls right now.
22:47.099 --> 22:50.469
So this is again, is
one of our gaps in care
22:50.469 --> 22:52.972
we have right now, that
we have so many uninsured
22:52.972 --> 22:54.173
and who don't have a physician,
22:54.173 --> 22:55.741
they don't have
somebody they can call.
22:55.741 --> 22:58.777
- Are the organizations,
and I'm not endorsing here,
22:58.777 --> 23:01.580
but like Christ Community,
like Church Health Center,
23:01.580 --> 23:03.115
some of those, are
those places that people
23:03.115 --> 23:05.351
without insurance, or
without a regular doctor,
23:05.351 --> 23:07.152
should turn to?
- They're really stepping up
23:07.152 --> 23:08.887
right now, so I do
think, you know,
23:08.887 --> 23:10.256
what we call our
federally qualified
23:10.256 --> 23:12.925
healthcare organizations
like Christ Community,
23:12.925 --> 23:14.960
and others, are great
places to think about.
23:14.960 --> 23:16.262
- Is there a list
of those that you
23:16.262 --> 23:17.529
could send people
to, do you go to
23:17.529 --> 23:18.764
the Shelby County
Health Department,
23:18.764 --> 23:20.266
they have a list of
other alternatives
23:20.266 --> 23:22.668
for people to go, again, if
they don't have a doctor?
23:22.668 --> 23:24.503
- I don't know that there's
a comprehensive list.
23:24.503 --> 23:26.639
I have one myself,
so I will put it up
23:26.639 --> 23:28.674
on our UTHSC
coronavirus website.
23:28.674 --> 23:31.610
- Okay, and let me,
if you were exposed
23:31.610 --> 23:35.481
to someone, if it turns out
your child, your mother,
23:35.481 --> 23:37.950
your girlfriend, your
husband, whatever it is,
23:37.950 --> 23:40.352
has it, you are exposed,
what should you do?
23:40.352 --> 23:42.021
- Well first of all,
I wouldn't panic.
23:42.021 --> 23:44.123
All right, so, we know
for most people
23:44.123 --> 23:47.126
under the age of 60 this
is fairly mild disease.
23:47.126 --> 23:49.395
If you're over 60,
maybe there's a risk
23:49.395 --> 23:50.863
for a more severe disease.
23:50.863 --> 23:53.299
So, I would not panic, I would
keep doing the same things
23:53.299 --> 23:55.000
we're doing with the
social distancing,
23:55.000 --> 23:56.669
and with you know, trying
to take care of yourself
23:56.669 --> 23:58.871
and wash your hands, and
then if you get sick,
23:58.871 --> 24:01.573
make sure your healthcare
provider knows you were exposed.
24:01.573 --> 24:04.109
- If you get it, and
people in Memphis have,
24:04.109 --> 24:05.711
and more probably than
even know have it, right?
24:05.711 --> 24:07.813
That's part of the mystery
24:07.813 --> 24:08.647
and the murkiness
of where we are.
24:08.647 --> 24:09.715
What are...
24:11.083 --> 24:13.319
It runs it's course, I'm
acting like I'm a doctor here,
24:13.319 --> 24:14.553
but it runs it's course.
24:14.553 --> 24:16.322
What are the long term
consequences for people?
24:16.322 --> 24:17.823
I mean, I've had the flu before,
24:17.823 --> 24:19.892
I've had the flu multiple
times, is it like that?
24:19.892 --> 24:21.393
That it's a really
miserable period of time,
24:21.393 --> 24:23.128
and then you just
go about your life?
24:23.128 --> 24:24.496
Or is it long term damage?
24:24.496 --> 24:26.031
- Well, we think for most people
24:26.031 --> 24:28.233
it would be like the flu,
and you're gonna be okay.
24:28.233 --> 24:29.735
There are some cases
we're seeing now,
24:29.735 --> 24:31.704
including in young healthy
adults who have it,
24:31.704 --> 24:33.839
where they're
suffering lung damage
24:33.839 --> 24:36.408
that probably will be a
chronic, respiratory issue
24:36.408 --> 24:37.643
for the rest of their lives.
24:37.643 --> 24:39.745
So, again, we're not
seeing a lot of deaths
24:39.745 --> 24:42.047
in young adults, but we
are seeing infections,
24:42.047 --> 24:43.282
we are seeing severe infections,
24:43.282 --> 24:44.650
we are seeing some
of this damage.
24:44.650 --> 24:46.385
- Okay, just a
minute left, Bill.
24:46.385 --> 24:47.219
- All right.
24:50.656 --> 24:55.060
Nobody alive now in our
city has any memory...
24:56.695 --> 24:57.930
firsthand memory of what
24:57.930 --> 24:59.798
the Yellow Fever
epidemics were like.
25:00.966 --> 25:05.037
From what you've
both read about this,
25:05.037 --> 25:07.740
is this similar to that?
25:07.740 --> 25:10.275
- It's similar in that
we're having to do
25:10.275 --> 25:11.944
the kind of social distancing.
25:11.944 --> 25:14.179
During Yellow Fever, everybody
moved out to the country,
25:14.179 --> 25:16.548
for instance, and got
out of the downtown.
25:16.548 --> 25:18.550
It's a little different
in that we do have experts
25:18.550 --> 25:19.785
who can talk about it.
25:19.785 --> 25:20.986
Back then, nobody
knew it was carried
25:20.986 --> 25:22.154
by mosquitoes,
they worried about
25:22.154 --> 25:24.022
the miasma from the sewers
25:24.022 --> 25:25.891
and things like that
being responsible.
25:25.891 --> 25:28.494
And so I think there was a
lot more fear of the unknown.
25:28.494 --> 25:30.195
We still have that
here, but I think
25:30.195 --> 25:31.864
we're hopefully able to
mitigate that somewhat
25:31.864 --> 25:34.767
by going on TV and talking
about it with the experts.
25:34.767 --> 25:37.069
- Dr. Hysmith, your
thoughts on that?
25:37.069 --> 25:38.303
I mean, it's the
first thing that
25:38.303 --> 25:40.406
comes to mind for
many Memphians.
25:41.807 --> 25:44.910
- No, I think that
Dr. McCullers says it spot on.
25:44.910 --> 25:48.580
I think that we just need to
let our healthcare providers
25:48.580 --> 25:50.315
and our professionals
in the community
25:50.315 --> 25:51.884
sort of guide the
response to this,
25:51.884 --> 25:53.652
and know that there
are people out there
25:53.652 --> 25:56.021
who are working
on this very hard
25:56.021 --> 25:57.556
for the public's behalf.
25:57.556 --> 25:59.291
- All right, that is all
the time we have this week.
25:59.291 --> 26:00.826
Thank you both for being here,
26:00.826 --> 26:02.561
particularly in this busy
time, we really appreciate it.
26:02.561 --> 26:03.796
Thank you for joining us,
26:03.796 --> 26:05.264
that's all the time
we have this week.
26:05.264 --> 26:06.765
Remember, you can get
past episodes of the show
26:06.765 --> 26:09.668
at wkno.org, you can also
get the podcast of the show
26:09.668 --> 26:12.037
on The Daily Memphian
site, iTunes, Spotify,
26:12.037 --> 26:13.806
or wherever you
get your podcasts.
26:13.806 --> 26:14.706
See you next week.
26:15.541 --> 26:18.277
[intense music]
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[acoustic guitar chords]