COVID-19 Update: Infectious Disease Expert Dr. William Schaffner | A Second Opinion Podcast | Rethinking American Health | Senator Bill Frist

COVID-19 Update: Infectious Disease Expert Dr. William Schaffner

You are about to hear a discussion I’m having on the COVID-19 pandemic with Dr. William Schaffner, an internationally renowned infectious disease specialist and public health expert with Vanderbilt University Medical Center; and Dr. Larry Van Horn, a healthcare economist, professor at the Vanderbilt Owen School of Management and advisor to the White House.    We are presenting virtually to our Nashville Health Care Council Fellows Class, a group of the brightest rising executives and leaders in the healthcare space. We are taping on Friday, March 27th.  This is a rapidly evolving crisis, changing day by day.  So, please continue to follow the latest recommendations by the CDC.

William Shatner:          If we don’t have the sufficient personal protective equipment so that we can manage these patients safely, then you’ll see some healthcare workers maybe not come into work if they are fearful for themselves and spreading the infection to their family, that could get very dicey.

Sen. Bill Frist:               Today on A Second Opinion, we bring you our latest special episode in our continuing series of providing the most up to date, real time coverage on the 2019 novel Coronavirus. You’re about to hear a discussion I’m having on the COVID-19 pandemic with Dr. William Shatner, an internationally renowned infectious disease specialist and public health expert with Vanderbilt University Medical Center. And Dr. Larry Van Horn, a healthcare economist, professor at the Vanderbilt Owen School of Management and advisor to the White House.

Sen. Bill Frist:               We are presenting virtually to our Nashville Healthcare Council fellows class, a group of the brightest rising executives and leaders in the healthcare space. We’re taping on Friday, March 27th. This is a rapidly evolving crisis changing day by day, so please continue to follow the latest recommendations by the CDC. I’m your host, Senator Bill Frist. Welcome to A Second Opinion.

Larry Van Horn:            You’ve gotten Dr. Shatner’s bio, of note he was the past President National Foundation for Infectious Disease and served on the executive board of the Infectious Disease Society. He has been an anchor for the formerly Community Preventive Medicine Department here that’s evolved into health policy. That’s where we, our paths cross occasionally.

Larry Van Horn:            And if you’re watching TV at all, you’re probably frequently seeing Dr. Shatner commenting both regionally and nationally on the COVID outbreak. And so, Bill, it looks like you’re probably over in your office somewhere over there in Vanderbilt and I’m hunkered down over in the center building here where we would have met. But this is going to be a great conversation on how we should be thinking about it, hopefully add some perspective and some context around the really challenging narrative that’s playing out in this country. And so Bill with that, appreciate you being here.

William Shatner:          Larry, it’s good to be here. And the other Bill asked me just to say a few words about where we are. I would assume that everybody, this is the advanced course. So we don’t need to talk about Coronavirus particularly, but where we are here in the United States, I think is at a critical inflection point. We’re a big country. We’re very diverse.

William Shatner:          We currently have some Coronavirus hotspots such as New York, Detroit, Chicago. We’ve got a bunch of warm spots and we have a lot of warming up spots such as our own community in Nashville. We’re seeing now a steady stream, not overwhelming yet, but a steady stream of Coronavirus patients being admitted to hospitals in the Middle Tennessee area.

William Shatner:          So, where are we nationally? There’s a lot of discussion. Many parts of the country are in some version of stay at home lock down. We certainly are in Nashville. And that whole concept is designed to reduce transmission of the virus, which of course is dominantly interpersonal, from person to person.

William Shatner:          We’re doing things such as we’re doing now, virtual teaching. Personally, everybody is trying to interpret what that means for themselves. People are staying home. I drive to work because I’m an exception. We’re actually running a surveillance system on behalf of the CDC, for patients who are hospitalized with laboratory confirmed Coronavirus. So we’re getting that underway on behalf of the CDC.

William Shatner:          But as I drive in, I just look around, and traffic must be around 5% of what it is normally. So I think our community, we’re the volunteer state, we’re volunteering to stay at home under direction from, among others, our mayor.

William Shatner:          So where are we going nationally with this? We’d love to know better, how widely and more precisely how widely distributed this virus is, how dense it is in some parts of our country, whereas I would suspect there are other parts of the country that are just beginning to see the Coronavirus. Perhaps some of the more rural parts of the United States haven’t been testing nearly as much as we would like. Testing is rolling out, that’s for sure. But it’s running into a number of stumbling blocks.

William Shatner:          Let me give you about, let me tell you about one here in Nashville. The National Metropolitan Davidson County Health Department has assessment sites out in the city. They’re ready to evaluate patients and make a selection about which patients ought to be tested. They have a good association with a laboratory that is ready to run the tests. But where’s the problem? The problem is, they’re in very short supply of the swabs of the appropriate type that are necessary in order to get the specimen.

William Shatner:          So if you can’t get the specimens, you can’t send them to the laboratory. Variations of this are going on around the country. There are other parts of the country. I heard about yesterday, where the swabs are in good supply, the assessment centers are working, they’re gathering the specimens and sending them to the laboratory, but that’s where the bottleneck is. It may take days, up to I’ve heard nine days, that must be extreme, but it’s really taking days for those laboratories working double, sometimes maybe even triple shifts to process those tests and get the information back to providers.

William Shatner:          So there’s a great disjunction between what people have heard nationally about the availability of testing and getting it done in the field. But I think my crystal ball, cloudy as it is, tells me that over the next three weeks, we’re going to see a surge in many parts of our nation, of patients coming into the healthcare system that are going to at the very least stress it. I hope it doesn’t overwhelm it. We may not all be New York and be in that circumstance, but I think we’ll have our work cut out for each other during these next upcoming weeks.

William Shatner:          I think I’ll pause there and invite my colleagues to make comments and then let’s feel some questions. Send them in. And we’ll have a pop quiz here.

Sen. Bill Frist:               Bill, I’ll open up on the testing issue, which one, as I look back over the last four weeks, our biggest failure and it’s collective, it’s not just our government, our biggest failure has been on the testing standpoint. Even today, we can’t get tested in Nashville. The big commercial labs here can’t get the reagents mainly. They can probably get the swabs but they can’t get the reagents themselves.

Sen. Bill Frist:               As we look ahead, as we test more there’s going to be a whole lot more infection, what can we do to prevent real panic? Because right now people are comfortable in Nashville because we don’t have very many cases. By that, I’m with you they’re going to increase the more we test, it’s going to skyrocket. What do we do in terms of just managing the panic around that?

William Shatner:          Bill, what I think will really raise people’s anxiety even more is if they get the sense that we in the medical care system will not be able to care for them if they need the care, if we really get overwhelmed, or if we don’t have the sufficient personal protective equipment, so that we can manage these patients safely. Then you’ll see some healthcare workers maybe not come into work, if they’re fearful for themselves and spreading the infection to their family. That could get very dicey.

Sen. Bill Frist:               Larry so this brings up we’ve got two different tracks going on. President Trump basically said it the other day, I think he went a little too far saying we’re going to open the country up and in two weeks, but way too far. But he did point out the fact that there is a huge economic cost that people are unemployed. We saw the unemployment figures yesterday, small businesses are closing down, restaurants margins are 2%. There’s no way they can stay closed for two months. So they just have to shut their doors.

Sen. Bill Frist:               People right now, as most people know, I’m helping the United Way locally. And the amount of requests now are higher than any time in the history of Nashville, Tennessee. It’s unprecedented. So we’re seeing this big economic cost, Larry, why don’t you take that and run with it.

Larry Van Horn:            Well, you and I had a conversation or two about this. And Bill Shatner you might know Kip Viscusi here at Vanderbilt. One of our other colleagues whose entire research career as an economist has been evaluating the relationship between economics and health and mortality and the statistical value of human life.

Larry Van Horn:            And his research and that’s been widely cited is that for every hundred million dollars you scrub out of the wealth of a country, it costs about one life. Now, if we’ve taken about $13 trillion out of the wealth of this country that’s over 100,000 lives, just in terms of the stress, the relationship between income and health, all of these other things. So there is this very difficult balance and conversation to have around how we respond from a policy perspective to constraint, contain the Coronavirus economic fallout and the health effects associated with the economic fallout is a very different balancing act. And it’s a tough narrative to add, to balance and it takes some real… It’s a very difficult conversation, Bill.

Sen. Bill Frist:               Bill Shatner comment on that, then I have another question.

William Shatner:          Well, it certainly sounds right. In fact, I’m surprised it’s not more. One of the things you mentioned, actually, is the impact on hospitals. There are a number of hospitals now that have already stopped admitting elective admissions, elective surgical procedures. And we all know that a hospital is a compilation of different medical care delivery systems. It’s not just all the same. And from a financial point of view, some things are expensive and a loss leaders like burn unit, and some things make money, elective surgery makes money.

William Shatner:          You start not doing elective surgery, and all of a sudden hospital balance sheets get a little bit shaky. It’s a very, I mean, these diseases and the responses to them, have all kinds of ramifications down the road that are not immediately apparent to the average person.

Larry Van Horn:            [crosstalk] Bill, Vanderbilt is relatively blessed, I think you’re probably sitting with 90 to 100 days cash on hand. You take many [crosstalk 00:12:30].

William Shatner:          Not me.

Larry Van Horn:            Many hospitals in this country do not have those days cash on hand. And they are going to face liquidity challenges here if this drags out a long time. And that’s going to generate a real practical problem. And there are hospitals today that are beginning to furlough employees at a time when we have this pandemic going on. And so there’s this juxtaposition of the economic consequences with the health consequences.

William Shatner:          Yeah, I was blown away when you said that previously hospitals furloughing employees, and they have an incipient surge of admissions? Whoa, talk about a paradox. I had not heard that before, Larry.

Larry Van Horn:            Yeah.

Sen. Bill Frist:               Bill for some level setting just whether we should use this statistics that when President Trump keeps comparing COVID-19 to the seasonal flu, which I think is really dangerous, really dangerous. But the difference is that when I’ve asked my infectious disease and epidemiology colleagues, they say that COVID-19 is at least 50% more infectious, requires hospitalization at least five times as often and results in death 10 times more often. Do you agree with those ballpark figures?

Sen. Bill Frist:               And I’m just trying to… So we all get asked, and the class is going to always get asked seasonal flu versus COVID-19? It’s still early, but are those figures rapidly, right COVID-19 50%, more infectious at least, requires hospitalization at least five times more often, and results in death 10 times more often.

William Shatner:          I mean, we can talk about the individual numbers, but the trends I think, are generally agreed to, by people in infectious diseases and public health epidemiologists, yeah.

Sen. Bill Frist:               Yeah. One second, then I’ll be quiet. But the flattening of the curve, let’s do some level setting with that. The whole idea of flattening the curve, number one is to prevent this surge of hospitalizations where we’re turning away people, where they’re dying in the hallways, they don’t make it to the door. This human capacity that we talked about as well. Tell us about flattening the curve, does that mean we’re really going to have the same number of cases eventually, incidence prevalence over time? We’re seeing the same number of cases, therefore the burden of disease is going to still be there, but we are eliminating the hospital surge.

William Shatner:          So let’s play with this a little bit. You notice my fingers are crossed, we’re going to venture into unknown territory here.

Sen. Bill Frist:               Yeah.

William Shatner:          I think in general, as we’ve talked about flattening the curve Bill, that’s exactly what was intended. So push the curve down, so the impact is spread out. What nobody has really talked about very much is whether the impact is going to remain ultimately the same. That is the same number of people just spread out over a longer period of time.

William Shatner:          Here’s a little bit of hope. Let me ask a question, is this new Coronavirus, the novel Coronavirus seasonal? Is it as seasonal as influenza? Because we know influenza that other really well known respiratory virus is dramatically seasonal.

William Shatner:          If we look at the human Corona viruses, the ones that cause us colds they are seasonal, not as dramatically seasonal as the influenza virus. But if they’re even… If this new one is even partially seasonal, maybe we can flatten the curve, spread it out, and indeed get some reduction when it does get warmer.

William Shatner:          So maybe there actually will be fewer patients. This go around. We can talk a little bit about what this Coronavirus is going to do down the road. But if that’s true, then we may get two benefits, Bill. We’ll get fewer people surging in a short period of time and maybe fewer people simply because the Coronavirus goes on a bit of a summer vacation. I have my fingers crossed.

Larry Van Horn:            Yeah. Why don’t we try to do this, Senator Bill. We’ve got a number of people who have posted questions in the chat or observations. I might like it rather than us fielding those, get people to engage directly here. And I think… And so I’m just going to start calling off some folks who put stuff in the chat. And if people want to actually ask a question, just raise your hand, and I’ll put you in the queue. Let’s go to Crystal Marie, let’s get your perspective.

Crystal Marie:               So I was curious in Dr. Shatner’s thoughts on how the COVID outbreak is exposing the need for shifts in the healthcare system.

Crystal Marie:               As you look at, there at least has been associations for the people that are dying, or having worse outcomes have some sort of chronic condition, usually, hypertension related, COPD, asthma, I saw a report about a young nurse who was in his early 30s and he had underlying asthma.

Crystal Marie:               So I hear what to me at least down here in Atlanta, there’s two worlds, you’ve got the concern about this new novel infection. So there’s that lane of work and getting people access to the new piece, but at the same time, you’ve got these people if the cases are very mild or mild, or for some, but if people can get their chronic care, aren’t we sometimes throwing out the baby with the bathwater? What are your thoughts on how to manage both systems at the same time?

William Shatner:          Yeah, well, that’s a very challenging question. The general approach today has been for everyone to shelter in place, right? Because that will protect transmission to those people who they’re not more likely to get the infection. But once they get it, they’re more likely to be on the severe end of the illness that they’ll acquire.

William Shatner:          So the whole approach has been, we all live so closely together, we can’t pick out who’s got hypertension, who’s got diabetes, and just ask them to stay at home. We all have to stay at home to reduce the risk of transmission. And then of course, when these people become ill, whether with Coronavirus, or issues related to their underlying illness, they still need access to medical care.

William Shatner:          And of course, one of the things that people have been concerned about is during the big surge period, if people do need medical care for underlying conditions that are part of the background, they may not be able to access it, because we’re all filled up with the Coronavirus patients.

Larry Van Horn:            Michelle, you’re up.

Michelle:                     Good afternoon. As we think about the staying in place, and if we want to look at it just from the Nashville perspective, one of the dialogues we’re having and that we’re advocating with the wrong group of people is around the risk that is being presented to healthcare workers.

Michelle:                     And so while we’re seeing people, I just heard now that there’s a whole group that’s trying to look at social distancing while playing golf. While that’s happening, seriously, but while that’s happening, I’m trying to figure out how to get a gown on a nurse to go into a room and I have so many PUI’s right now because I can’t get my tests for three days out. So that’s the real life of the, we’re calling them healthcare heroes, and people are starting to get around that, but not when it comes to staying at home and I just, I don’t get that.

William Shatner:          Well, a lot of us don’t get it, of course. And if you have a lot of patients under investigation or persons under investigation, you have to assume that they have Coronavirus, and you have to take the appropriate infection control precautions.

William Shatner:          At least in Nashville my sense is that we’re all okay at the moment, but certainly here at Vanderbilt we’re being very careful about how we use our current supply of personal protective equipment. You just can’t run in and grab a mask off the shelf and use it. You have to be very accountable for the circumstance in which you want to use the mask.

William Shatner:          And what we’re all concerned about is if the surge comes, how about that supply chain? Will we be able to refill the shelves and the drawers after we empty them? And that’s what has everybody nervous, because they’re already hearing stories here, there and everywhere. And people trying to do things like make their own homemade masks out of scarves and gosh, towels and gosh knows what else. So we’re in a dicey circumstance.

William Shatner:          Of course, one of the reasons that we’re there is that we as a society, as a medical care society, listen to all those people in the business schools have gone to a just in time delivery system, right? We don’t have warehouses anymore that are full of two months supply masks, and things like that. So we’re kind of a victim of our own fiscal efficiencies.

William Shatner:          [crosstalk] I guess another thing I would just say sorry, is that we’re a global industry. We’re a global people’s now. And some of these things are manufactured internationally. And we never gave that much of a thought, because we’re all together in this until things like this begin to separate us.

Larry Van Horn:            Yeah, I have a really burning question. And it goes a little bit to what you’re really thinking doctor. So if you could do this all over again a couple of weeks ago, how much of you would you have loved to create a greater sense of panic right up front, instead of managing people’s expectations slowly, just a little bit more scare tactics upfront, rather than this gradual warming up to social distancing?

William Shatner:          I am very, frankly, I am very wary of panic as being sustained motivator and an environment in which people really think coherently and learn well. So I don’t like panic. I think we need a clear after action report that’s done about this at all levels.

William Shatner:          Frankly, I’m president of the CDC fan club, I like to say, but the CDC doesn’t do those very well. And there were a number of missteps there. We focused so narrowly, both our testing and our epidemiologic concept. We had so much self confidence early on, that we were finding absolutely every single case. We were doing a good job with that and then all the contacts around them, we really, and along with the travel ban, we really thought we have this under control. This virus was much more subtle than that. It got right out from under us. And all of a sudden we were surprised, community spread what’s going on? And we were caught flat footed at that point.

Larry Van Horn:            Yeah, there’s something still about the communication aspect that I think is really interesting in terms of what is the balance? But we talked about the balance of health versus economics.

Larry Van Horn:            And it really feels that in an authoritarian regime like China, it was like, “Okay, yeah, we get this, let’s lock it down so that we recover really, really fast.” In a democracy where you’re trying to persuade people and you have all these other political considerations, it seems as though there must be a more effective way next time to do an early threat detection going, “Okay guys, social lockdown, Amber Alert.”

William Shatner:          I couldn’t agree with you more. And I think most public health people would say, if you have an incipient threat, such as this, of all the things you need to do, the most important is communication, clear, straight, fact based. The second is communication. Clear, fact based, consistent. The third is… You get my idea.

William Shatner:          And as you know, at the national level, the communication first about this was this disinterest, disdainful, dismissive, thought to be political as opposed to real. And it was very confusing, and, frankly, that continues to the present day. There are all kinds of conflicting messages, if I may say so, that come out of the daily press briefings of the President’s Task Force. That those lessons still haven’t been learned.

Sen. Bill Frist:               Let’s go back to the testing just a bit. From your standpoint, how important is it to get the testing? I just, unless we have some sort of denominator of how much virus is in a community, whether it’s a village, a county, a town, I don’t know how we’re going to judge, are we sheltering enough, or do we need to do more? And we don’t know really how transmissible it is without that denominator.

Sen. Bill Frist:               So it seems to me that we need a renewed emphasis on testing. A lot of people say we don’t, maybe most say it’s too late just forget it [crosstalk] but put that in perspective, because that’s something from a policy level that people have not stressed. President Trump has not stressed it enough, our leaders have not and in part because they don’t know what to do. They point back to the CDC messed up a few tests early on, they point their fingers there. But to me, there needs to be a renewed interest on and focus. Right now we have new ways of doing PCR, the traditional PCR takes six hours. State lab even seven days ago at most could do 100 a day.

Sen. Bill Frist:               We need to be doing thousands and the newer PCR equipment, which is out there, One Lab, the Path Group in Nashville, they have equipment they can do 6000 a day, but they can’t get the reagents. And the reagents come in part from San Diego and they come from Germany. And there’s just not enough testing. But put testing in perspective, and how important is it in terms of either knowing where to put resources now, or how we unwind when we do with base, we come back and reestablish our traditional norm.

William Shatner:          Bill, you and I are singing in harmony here. You’ve been talking about the public health need for testing. I have a couple of other reasons for it. But let me just reinforce first what you have said. From the point of view of national, and state, and local planning knowing where the virus is and how widely intensely it’s distributed in subpopulations of the states is just terribly important.

William Shatner:          We have to know, I mean, if you’re in the army, you have to know where the enemy is, right? If you’re not, you’re futzing around, and you’re ineffective, you have to know where this virus is, where it’s going, where it’s increasing, and maybe even where it’s decreasing. We need to know that.

William Shatner:          Number two, we need to know it clinically. We need to be able to diagnose patients, so that as a professor of mine once said, it’s always better to know when you’re taking care of sick people, and it helps also with protecting healthcare workers.

William Shatner:          And then I would have a third reason. You know, the public in the United States, the people here have been told by Washington, “You can go out and have a test, just go ahead. It’s going to be widely available.” And people have heard about asymptomatic infections, they know about mildly infected people who can transmit the virus. From their own sense of well being and the well being of their family and Uncle Charlie who’s got diabetes and grandmother Susie, who has chronic obstructive pulmonary disease because she smoked for 25 years. They want to know what to do in their own circumstances. And that’s perfectly reasonable, right? We need to test more broadly for all of those reasons.

Sen. Bill Frist:               Can you comment just on IGG, IGM, really to educate the class a little bit because we have the PCR, which is a polymerase chain reaction, we can do it in a short period of time on the new machines. Not everybody has the new machines, but these reagents were too short off. The LPCR take six hours, there’s a shortage of reagents there as well. And then you had the serologic test and you need to explain that, explain it to me, but to the class that are very, very different, but what role will they play once they come online?

William Shatner:          So we have two kinds of testing, one is for the virus. That’s the test that’s now widely available. It’s very good in many, many ways, has a few limitations. It can have false negatives early on after your infection, it may not yet be positive, because your body has not produced enough virus for the test to detect. So it tells you a moment in time. That’s one way of doing it.

William Shatner:          Another way of approaching diagnosis, current, and in the past is with a blood test, which could be as small as a prick in the finger. That can tell you with two kinds of antibody, those are the proteins the body makes in order to fight off the virus. Two kinds of antibody, have you been infected very recently, or more distantly in the past and are you now more likely to be protected? Doing those kinds of surveys can help one, with kind of more immediate detection and getting a sense also of how widely the virus has affected certain populations, children, older people, people with diabetes, people who are in rural areas, as opposed to urban areas, you could get a sense with some of these tests that are now going to be relatively inexpensive, easy to use, and very precise.

William Shatner:          Once again, where is this virus, and where has it been? What proportion of the population has already been infected and is likely protected? How much of a burnout of this epidemic might we be able to model if we had those data?

Sen. Bill Frist:               And those tests commercially available yet?

William Shatner:          Just coming online, and there are lots of people who are working on different ways to create those kinds of tests?

Larry Van Horn:            Carlos, you had your hand, my friend.

Carlos:                          Hi, guys. So I guess my question is following up on the testing theme. The first is around what we think is going to be necessary, particularly for those of us who are in sheltered place states to return to work? Is it going to be a positive antibody test that demonstrates you’ve been infected and recovered? Is it going to be a reduction in the number of cases, a reduction of the number of deaths? New York is still cresting, somewhat argue Italy is still cresting, they reported 1000 deaths yesterday. So it’s not like it’s going away soon in some places and maybe continuing to grow.

Carlos:                          And then the second question is around the resource allocation piece. Do we think that having testing that would predict who’s at highest risk of coming down with ARDS might be useful on the front end. We’re trying to get ahead of that at Stanford by beginning to sequence our positive cases and looking at potential biomarkers that may be in the blood 48 to 72 hours before patients come down with ARDS and just sort of thinking about that resource management piece. We’re lucky we’re not yet near being overwhelmed, but preparing in the event we need to get there. So would love some thoughts on both of those questions.

William Shatner:          Well, I certainly think that anything you can do to kind of predict potentially adverse outcomes and prepare for them is really an exciting idea. But I suspect you’re still in early days doing that.

William Shatner:          As to how it is, which metric we’re going to use in order to decide to begin to turn down, if not off. Some of our restrictions regarding movement and commercial activity, that’s not easy.

William Shatner:          Larry’s working on one with people in the Department of Health Policy. I would think the easiest thing, the one that’s the most obvious is how many people are coming into the hospital needing admission with serious disease. That’s easily available, easily understood, and if all of a sudden that starts to plateau, and even start to come down, uh huh, that’ll bring a smile to people’s faces.

Carlos:                          As a follow up, though, of course, the concern that if you raise restrictions at that point, that’s when it might catch like wildfire again, right?

William Shatner:          The rebound phenomenon. We’re all watching China very, very carefully, because Wuhan’s coming back to life, Hubei Province is coming back to life. Are they going to have a second wave? Most people out there think, yeah, they’re gonna have a second wave, but it’ll be much diminished. We’ll have to see. And of course, we have to trust their numbers.

Larry Van Horn:            Bill, do you have perspective on Vanderbilt available capacity? I heard that you have as many as 400 potential beds available to meet surge capacity. How are you guys planning and how are you thinking about this?

William Shatner:          Well, the pandemic preparedness plan is there in various stages. And in stage one, if people start packing up in the emergency room, everybody gets rounded every day and we try to get everybody out of the hospital one day earlier. You’re nurtured up more, and we go into stopping all elective admissions and turning surgical wards into wards where they take care of people with respiratory illnesses.

William Shatner:          By the way, that takes some retraining. Nurses that are excellent and have for five years worked with pre-op and post-op patients, they may need a little in service training to take care of a whole different kind of Cadbury of patients.

William Shatner:          So we’ve also built out some new beds that can be used as an intensive care unit for these pulmonary patients. And we’ve done it as fast as they did in China. I was blown away that we have this kind of capacity in the United States. So I think we’re ready to move. This is a pandemic preparedness plan that has been rehearsed. We have an incident command center that is in operation as we speak. And we’re ready to respond.

Larry Van Horn:            Bill as we wind down our time together. Can you make any forecasts about what the final case volume will be in Tennessee? Case fatality rate, anything? Because we have numbers here that are 70% of Tennesseeans are going to end up being infected and there’s going to be 100,000, 136,000 Tennesseeans who are going to die. Do those numbers seem sensible to you?

William Shatner:          Well, I actually would defer to specific numbers to my friends in health policy who are numbers crunchers and you work with them. I would say I would not be surprised if around the country, particularly in the more densely populated parts of the country, by the time this first surge of Coronavirus abates and I think it will do that, I think we’ll see somewhere around 60 plus percent of the population having been affected, infected, if we could do those serologic surveys that Bill was talking about.

Sen. Bill Frist:               Yeah, I would agree with that. I think we’re going to see probably, and that’s a guess. But I would think we’re going to have 60% infection, and I think we will have 100,000 people die. That’s a huge number of people. We have 20 to 30,000 people 20 to 25,000 people who die of the seasonal flu already. So thinking this is four to five times more fatal, those numbers could well be true.

Larry Van Horn:            All right, any closing comments, Senator?

Sen. Bill Frist:               No Bill, thank you. To the rest of the class, in times like this, we have science and science ultimately, and the numbers ultimately will drive a lot. But the reaction to something like this, which is a pandemic that none of us have seen, will have an economic impact that none of us have seen in a way that it affects everybody, everybody in some way.

Sen. Bill Frist:               But it takes to prevent panic and to handle the anxiety that’s out there, which has its own economic cost as well as mental cost. It takes great communicators. And Bill Shatner more than… Larry would substantiate this, more than anybody that we know in the healthcare, the clinical field, can articulate can be on the front line and talking to people in a realistic, scientifically accurate by the numbers, but does it in such a way that it takes care of that human element of anxiety, effect on emotions, effect on mental health. And Bill, I say that to really congratulate you and thank you because you’ve done it not just now, but you’ve done it in the other epidemics that we’ve had, you’ve done it explaining infectious disease.

Sen. Bill Frist:               When I helped start a heart transplant program at Vanderbilt, you were right there again explaining to the various stakeholders what all of that means. So thank you for both the time you spend with that public face, which does a lot to affect the mental health as well as the physical health of everybody who listens to you.

William Shatner:          You’re very, very kind. Those are terribly kind words, and I remember working together with you at the bedside.

Sen. Bill Frist:               That’s right.

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