Johns Hopkins University Experts Discuss Novel Coronavirus

  [MUSIC PLAYING]  JOSH SHARFSTEIN: Welcometo this special broadcast from Johns Hopkins University. Thank you for joining us. I'm Joshua Sharfstein, ViceDean of Public Health Practice and Community Engagement at theJohns Hopkins Bloomberg School of Public Health, and formerSecretary of Maryland's Department of Health. We're here to talk aboutthe outbreak of 2019 novel coronavirus, known as COVID19, with three Johns Hopkins experts who have been at theforefront of response efforts. First, we will hearfrom a scientist who developed the InternationalIndex of Preparedness cited by President Trump. I'm going to ask her why thisindex was developed, what criteria wereconsidered, and how well is the United States preparedfor the novel coronavirus. Second, we'll talk to anexpert studying misinformation and fraud about how youcan protect yourself from coronavirus scams. Third, we'll talk to threeexperts about the breaking news from the west coastof the United States about the community spreadof the novel coronavirus. We'll hear what to expectin the days and weeks ahead. Our goal today is to bringtheir knowledge directly to you. If you have questions, you cansubmit them via the webcast Q&A Module, and we'll havea chance to answer a few of those questions today. And we'll also have more chancesto talk about coronavirus. We plan to do moreof these webcasts. And we're launchinga new podcast series called Public Health onCall with regular episodes on the coronavirus. You can get all of this contentvia the Bloomberg School website and YouTube channel. In the next few days,we expect this podcast to be available where youregularly get your podcasts. And with that, let meintroduce our great panel. First, Jennifer Nuzzo. She is a senior scholar atthe Johns Hopkins Center for Health Security here atthe Johns Hopkins Bloomberg School of Public Health. Next, Dr. Tara Kirk Sell,also a senior scholar at the Johns HopkinsCenter for Health Security. And then assistantprofessor Lauren Sauer is Director of Operationsat the Johns Hopkins Office of CriticalEvent Preparedness and Response at the JohnsHopkins University School of Medicine. I'm going to startwith you, Dr. Nuzzo. Recently, President Trumpcited a Johns Hopkins study of internationalpreparedness called the GlobalHealth Security Index. I think this here wasactually the study that the President cited. His exact words were, JohnsHopkins, highly respected, they did a study, comprehensive,the countries best and worst prepared for an epidemic,and the United States, we rank number one. So Dr. Nuzzo, what was yourrole in creating this index? JENNIFER NUZZO: Thanks. Well, the GlobalHealth Security Index was the partnership ofthree organizations. The Johns Hopkins Center forHealth Security, where I am, and The NuclearThreat Initiative, an organizationin Washington, DC, And the EconomistIntelligence Unit, which is the research armof The Economist magazine. Our three organizationswork together. In terms of my role, Iled the Hopkins team that worked on developing the index. We helped define thequestions that went into it, oversaw the data collection,analyzed the data, and really extractedfrom it what the findings and recommendations are thatwe published in the report that you held up. JOSH SHARFSTEIN: How longdid it take to collect all that information? JENNIFER NUZZO: Well, itwas a three year project. Data collection was ashorter component of that. And we couldn't have doneit without the Economist Intelligence Unit, whichhas analysts in essentially every country in the world. It's capable of collectingdata in native languages and pull thatinformation together in a culturally vettedway to make sure we're getting the right information. JOSH SHARFSTEIN: So take usinside this index a little bit. What does it measure? JENNIFER NUZZO: So we measurethe health security capacities and readiness of 195 countries. We measure their readinessin six categories. I can actually show for youwhat those six categories are. The first three islooking at their abilities to prevent, detect, and respondto infectious disease threats. These are commonlymeasured areas that are part of otherinternational benchmarking tools. But we added to those effortsthree additional categories. Specifically, welooked at the strength of countries' health systems. We looked at the degreeto which countries comply with internationalnorms and their commitment to transparency. And then we looked at what theiroverall risk environment is. And these are the kindof national factors that can influence, firstof all, whether diseases are likely to spreadwithin countries, and also the degreeto which countries are going and being able tomarshal the resources that they have on paper. JOSH SHARFSTEIN:So each country got assessed according to howmany different dimensions within these six categories? JENNIFER NUZZO: Yeah,there are 140 questions that we looked at. And these questions werecrafted in such a way that when any analystgoes out to collect data, two analysts in differentparts of the world looking for the exact same-- the answer to theexact same question will get the exact same answer. So that took a lot ofeffort to make sure that we phrased thequestions properly. JOSH SHARFSTEIN: Got it. So let's see what you found. JENNIFER NUZZO: Yeah. So the fundamental findingof The Global Health Security Index is that no country isfully prepared for epidemic or pandemic threats. In fact, the scores, onaverage, were quite low. The average score among allcountries was about a 40.2 out of 100, whichmeans that there is a lot of work to be done. The President was right. The United Statesdoes score highest. But even the United Statesis not fully prepared, and there are anumber of areas where additional work is needed. JOSH SHARFSTEIN: So I want tofirst start outside the United States, and I want to ask yousome questions about the United States. We know that the virus,now, is on six continents. And it's in a numberof the countries that are not in the toptier on your ranking. And what are your concerns? What's, generally speaking,lacking in those countries, and what are the biggestissues for the global spread of this disease? JENNIFER NUZZO:My biggest concern is actually a concernfor all countries, which is the readiness oftheir health systems. There've been a lot ofwork in recent years trying to improve countries'public health capacities, strengtheninglaboratories, trying to strengthen surveillance. And I think there are a numberof countries that you possibly wouldn't expect scorehigher on the list, just because they have madenational commitments to do that. That said, very few countrieshave really given the attention to the health systemthat they need. Making sure they have enoughdoctors and nurses, making sure these doctors andnurses can see patients in a way that'ssafe, that they have the right personalprotective equipment. And so across the board,we were really worried. Category four, that lookedat the health system, was the lowest performing amongall countries in the index. JOSH SHARFSTEIN: Andas a result of that, if there are a lot of patientswho are quite sick, then you can see really seriousstrains in many countries around the world. JENNIFER NUZZO: Yeah. We have seen timeand time again, in outbreaks and situations,that health systems that are unprepared oftenserve as points that amplify transmissionto the larger community. So it's not just important thatwe have the doctors and nurses there to save patients' lives. That's, of course,extraordinarily important. But we want tomake sure that when patients do show up atthese health facilities, that what happens there issafe, such that we don't inadvertently spread to thepatients and the clinicians, but also the broader community. JOSH SHARFSTEIN: So let'stalk about the United States, the strengths andweaknesses that you found when you did this surveyand index for our country. JENNIFER NUZZO: There weresome interesting places where the United States seemsto have some work to do. I think probablythe biggest worry of ours in looking at itsscores was in terms of access to health care. We wanted to make sure that,in an infectious disease emergency, it's absolutelyimportant that people, one, are able to physically get to andlive near health facilities so that they canget there in time, so that they canbe treated early. But then an addeddimension to this is if fear of thecost of health care is a deterrent, then that couldcreate a bad situation where people either remainat home, potentially, or in their communities,potentially, affecting others. Also, they may not seek careuntil late, where they're potentially puttingothers at risk who are going to carefor them, because now it requires a lot of resources. So making surepeople's fear of cost is not a barrier toseeking care when it's needed in an emergency. JOSH SHARFSTEIN: So our sort ofdisjointed health care system could have consequences forour response to this crisis? JENNIFER NUZZO: Absolutely. JOSH SHARFSTEIN: What canbe done in the short term? I know that the purposeof the Global Health Index was to generate, in part,long term investments for some of these veryserious underlying challenges. But now that we'rewhere we are, what can be done in the short term? How much in thesegaps can be made up? JENNIFER NUZZO: Well,one of the things that we're seeingthe index being used for, it's very difficultto say from the index that, you know, acountry that scores two points higherthan another one will be that much better in theresponse to the coronavirus. That said, in benchmarking wherecountries may have weaknesses and gaps, we think that's reallyimportant for organizations and governments to think about,trying to make improvements now and to prioritize what actionsthey take so that they don't keep putting money into areasthat may be stronger they think of redirecting. But also, I think interms of, let's just take the broader health system. I think that's a place wheregovernments and communities need to put theirgreatest focus now, making sure thathealth facilities have the personal protectiveequipment they're going to need, that the health workershave the training, that they have plans for how to dealwith a surge of potentially critically ill patientsso that an unready health facility doesn't put the restof the community at risk. JOSH SHARFSTEIN:And where can people go to find out moreabout this index? JENNIFER NUZZO:We have a website. It's called the GHSIndex.org. JOSH SHARFSTEIN: Can wepull up the slide there? JENNIFER NUZZO: Thereport is there. yes. JOSH SHARFSTEIN: I thinkthat one mentions it. JENNIFER NUZZO: Thefull report is there. You can download not only thereport, but the data model that has all of our data sources. And we encourageother researchers to think about using thesedata for other projects. JOSH SHARFSTEIN: And, youknow, your transparency is actually matched by one ofyour question survey, right? Like, the part of preparednessfor, I understand, for the team, is assessingwhether countries are being forthright about epidemics. JENNIFER NUZZO: Yeah. Many of the questions askedabout the availability of public informationregarding certain capacities or capabilities,we thought it was really important to do that. Because if you'reliving in a country and you don't knowthat a plan exists, it's questionable whetherthat plan is going to work. And also, we need to be ableto-- this is a great example, COVID 19 is a great exampleof an international crisis. When an internationalcrisis happens, countries around the worldneed to be able to understand, when cases arereported somewhere, what strengths that countryhas to be able to continue to report cases and to respondso that they can calibrate their responseplans appropriately. JOSH SHARFSTEIN: Well,it seems like this is going to be a great resourceduring this difficult time that we're in now. Thank you. I want to turn next to Dr. Sell. Dr. Sell, you have studiedmisinformation and scams for a while. Can you tell us a littlebit about your background on that topic? TARA KIRK SELL: Yes. So the researchthat I recently did was on Ebola, the misinformationduring the Ebola outbreak, and what was happening onTwitter and in social media. And so we did astudy where we looked at all theseEbola-related tweets, and we found that 10% ofthem had misinformation or half true information. We also saw that there wasa really strong relationship between misinformationand politics, or discord-inducing tweets. And we also-- anotherthing we also saw was that there are reallystrong rumor trends. And so we saw a lot of rumorsabout government conspiracies in our data set. JOSH SHARFSTEIN: And now,on the novel coronavirus, there's some rumors aboutgovernment conspiracies. Can you talk aboutwhat you're seeing as you're looking outat the current landscape of information? TARA KIRK SELL: Right. So yeah, we have here-- you know, we have anexample of that coronavirus might have originatedin a lab linked to China's biowarfare program. That's misinformation. The interesting thingabout this misinformation is that if you go toa different country, it blames a different country. So this is a coordinated effortto sow discord and division when we need it themost, when we need to have cooperation the most. JOSH SHARFSTEIN: And whatelse, when you look out on the variousdifferent websites, social media channels, whatdo you see that is concerning? TARA KIRK SELL: Yes. So we also see anumber of fake cures when we look at misinformationabout coronavirus. There's fake cures,and then there are also different efforts toblame different populations. Here we have someexamples of some cures out there thataren't going to work. We also see an effort for peopleto try to buy and stockpile masks, which aren't effectiveto protect yourself. JOSH SHARFSTEIN:And so, you know, if somebody is sellingsomething online that isn't going to work, youknow, what's the harm in that? What kind ofproblems can you see? TARA KIRK SELL: Well, thereare a number of things that can be harmful about that. People can go wastetheir money, and people can think they're protectedwhen they're not protected, and take risky actions thatthey shouldn't be taking. And sometimes, these actual-- so cures actually willharm people themselves. JOSH SHARFSTEIN:And, to date, there's no approved treatment forthat novel coronavirus? TARA KIRK SELL: Right. So anything you see that saysit cures coronavirus is false. JOSH SHARFSTEIN: Got it. Now, how, in this seaof misinformation, do good sourcesof truth get out? TARA KIRK SELL:Yeah, so people are working on trying to promotedifferent sort of true sources of information and also pushback against misinformation. We see on Facebook,they're trying to push people to gotowards official sources, the same with YouTube. The WHO is promoting orproviding some myth busting. Other public health authoritiesare trying to do the same. We see that the FDA haspushed back against a rumor that there's a risk ofCOVID 19 from taking drugs that are made in China. So I think thereare a lot of efforts out there to combatthis misinformation. But I think the thingthat is most important is that people need to bethoughtful about what they're reading on the internet,and consider, is this true or not and not justtake it as automatic. JOSH SHARFSTEIN: I want tozoom in on one issue, which is masks. Because the Surgeon Generalhad to jump on Twitter and dispel somemyths and say like, please don't stockpilemasks at home. They're really needed forhealth care professionals. And yet you showed asite which is saying, this will protectyou from coronavirus. You know, what shouldpeople know about masks? TARA KIRK SELL: So masksare not effective on-- if it's a surgicalmask, it's not going to be protectiveagainst coronavirus, right? Because the air canget in from the side. So buying a lot of masksand stockpiling them just prevents professionalsfrom being able to have access tothem when they need them for other things. Or if you're trying tostockpile an N95 mask, these are resources thatwe need at hospitals for people who are actuallydealing with coronavirus cases. And so it's not good to takethem out of the marketplace so that no one elsehas access to them. JOSH SHARFSTEIN: Hopefullyhis message will get across. Great. Now I understand that if peoplewant to hear more from you, you're going to be onCapitol Hill later this week? TARA KIRK SELL: Right. So I have some congressionaltestimony about this issue, about misinformationon Thursday at 9:00. JOSH SHARFSTEIN: Great, andgood luck with that testimony. TARA KIRK SELL: Thank you. JOSH SHARFSTEIN: OK, nowlet's go to our third topic, the news of the day. Community transmission ofCOVID 19, the novel coronavirus on the west coast, including acouple of deaths now reported. Let's bring into the discussionAssistant Professor Lauren Sauer. I want to start witha basic question. Until now, the approach hasbeen, if there is a case, we're going to aimfor containment. The person may be isolated. Other people whoare exposed may be asked to sort ofself quarantine, stay away from otherpeople until they know they haven't gotten it. Go home, if it's ahealth care provider, you know, if you'vetaken care of a patient, wait at home for 14 days. But as there becomes morecommunity transmission, can that be sustained,and what has to change? LAUREN SAUER: Yeah,it's a great question. I think that, as we move fromjust thinking about containment to thinking moreabout our mitigation strategies and our healthsystem preparedness strategies, knowing that we will seecommunities transmission and we will see cases, a modelthat we've used previously and continues to work hereis this identify, isolate, and inform. So even if you're movingbeyond the idea of containment, you still want toidentify these people, whether it's in the communityor the health system, isolate them so thatthere's no further spread to impact thecommunity even further, and to protect healthcare workers and the rest of the people in the hospital,and then inform your infection prevention groups, yourpublic health workers. Use the reporting mechanismsthat have been set in place. And that's really helpful forreducing the burden of disease in a community and protectingvulnerable populations during the time where we knowwe're seeing communities spread anyway, and we're not goingto stop every single case that we come across. JOSH SHARFSTEIN: And thank youfor that great explanation. And that's relatedto your day job. Maybe could youexplain what you do? LAUREN SAUER: Sure. I'm the Director of Operationsfor the Johns Hopkins Office of Critical EventPreparedness and Response. And it's a preparedness andresponse entity at Hopkins that looks to really streamlinethe approach to preparedness and response across allJohns Hopkins Communities. So ensuring that thehealth system is protected and responding, ensuringthe university is protected and responding,protecting our faculty, our staff, ourstudents, and our entire broader communityat Johns Hopkins. We are a globalcommunity, and so it's all the more important to havea consistent and collaborative message aroundpreparedness and response. JOSH SHARFSTEIN: And partly whatyour message here is, is that, even when containment strategy,that starts to fade away, the substitution forthat is not panic. LAUREN SAUER: Absolutely. The substitution is never panic. JOSH SHARFSTEIN: Yeah. The substitution for thatis isolate and inform. LAUREN SAUER: Yeah. Identify, isolate, andinform is a model that we use in the health system,but works in the community, works in communityhealth centers, it works in longterm care facilities, and really can help protectvulnerable populations within our community. JOSH SHARFSTEIN: I'mgoing to follow up with a question aboutlong term care facilities, because in Washingtonstate, that's where they're seeing an outbreak. And it's obviously a veryvulnerable population. What should be going on atlong term care facilities, and how should thiscurrent situation change their practice? LAUREN SAUER: Yeah. One of the challenges withlong term care facilities is that you have a populationthat is somewhat unhealthy and is potentially morevulnerable to diseases like COVID 19. So what you want to seehappening in long term care facilities is postingsigns at entrances, encouraging handhygiene, encouraging that visitors stay home anddon't visit when they're ill, isolating the patients in thefacilities who may be ill, even if they're mildly ill. These things that work sowell for us during flu season, or that we encouragepeople to do in flu season, will also help inthis situation. And one key thing, I think,that all long term care facilities can do, andactually that any of our health facilities in generalshould be doing, is encouraging theirhealth care workers to stay home when they areill or use a mask whenever they develop any sortof symptoms, which is another reason whyprotecting the masks supply is so important. JOSH SHARFSTEIN: Great. I'm going to go backto you, Dr. Nuzzo, and ask you about socialdistancing measures, which are what is sort of the officialname for things like closing schools, telling peoplenot to go to the movies, canceling concerts,things like that. There's a little bit of anunderstanding that like, when there's communitytransmission, now it's time to flip awhole bunch of switches. How do you think aboutthose sorts of measures? Do they work? Is it time to start? You know, as you think aboutwhere we are right now. JENNIFER NUZZO: Right. So this is somethingI think we're going to be hearing a lot moreabout, particularly as states continue to report casesand we continue to find, as we are rampingup our surveillance. And that's clearlywhat's happening now, is that we're expandingsurveillance for this virus. So we're testing morepeople than we did before, which means that we'regoing to see more cases, and that we believethat we're now gaining a window into whatmay have been happening in the communities. So as we discover the presenceof the virus and evidence that there's beenlocal transmission, we need to thinkabout how we may try to reduce the impact ofthe virus on our communities. And one of the approachesis, in absense-- since we don't have vaccines ordrugs targeted at this virus, to think abouttrying to increase the distance between people. It stands to reasonthat, if you're sick and you reduce thenumber of people you come in contact with,that there's less of a chance that you can transmitit to others. So many of themeasures considered, like closing schoolsand possibly closing public gatherings,those are all things that are trying to increasedistance between people. The evidence for thesemeasures are not as strong as we would like it to be. They have been used in thepast largely around influenza. This disease hassome similarities, but it's not fullysimilar to flu. And so I think as states,in particular here in the US and other countries,are thinking about using thesemeasures, it's critical that they examine the evidencethat the measures will work. And, in thinkingabout using them, also consider what thepotential risks are. JOSH SHARFSTEIN: What doyou mean by potential risks? JENNIFER NUZZO: Andthere are risks, right? So while a measure maysound great on paper in terms of reducingtransmission, say you close schools for anextended period of time, maybe that makes people morelikely to stay at home. Maybe it doesn't. If people, then, recongregate elsewhere, we need to thinkabout whether we're going to achieve thebenefits that we'd hope. But critically, ifwe implement measures that make it harderfor people to say, get to work, make it harderfor the health care worker to show up, becausenow schools are closed and they no longer havechild care to depend on, then we could findourselves in a situation where the measuresthemselves may cause more harm than the virus itself. JOSH SHARFSTEIN: So itsounds like this is not going to be a one size fits all. JENNIFER NUZZO: Absolutely not. JOSH SHARFSTEIN: And it'llbe a dynamic situation depending on the nature of theoutbreak in different parts of the country. JENNIFER NUZZO: Absolutely. And you'll probably hear acontinual revision of planning and an reassessmentof the information. So I think that's animportant point for the public to consider. They may think, as soonas they hear about cases, we should close schools. We should close everything. But we really need to take avery thoughtful and nuanced approach to this, because wedon't want to make it such that the people whokeep the lights on and the water flowing andthe grocery stores stocked can't get to jobs and keepour societies functioning. JOSH SHARFSTEIN: Andsimilarly, if you start in one place and you trysomething different, that doesn't necessarily mean-- JENNIFER NUZZO: Absolutely. JOSH SHARFSTEIN: --that peopledon't know what they're doing. They're just working theirway through a set of options to see what's going tohave the biggest impact. JENNIFER NUZZO: Absolutely. This is an uncertainsituation, and it's important to collectinformation the best we have and use new informationas it becomes available and continually reassessand revise approaches as new information surfaces. JOSH SHARFSTEIN: Great. Now, Dr. Sell, you have showna few slides about things that people shouldn't do. Go running out andspend all this money on cures thataren't cures at all. What are a few things thatpeople should be doing? TARA KIRK SELL: Right. Well, the first thing thatpeople really need to do is think about doing a betterjob washing their hands, having respiratory etiquette,coughing into your elbow. Think through,hey, how am I going to practice making sure thatI do this in my everyday life. And then also think, OK,if one of my family members is mildly ill,hospitals are taking care of the most sick patients,how do I care for a loved one at home? How do I make sure that Ihave the time and availability in my work to do that? And then finally,think about some things that you may need tohave ahead of time. You might want tothink about making sure you have enough of yourprescription medications so that, if it's inconvenientto go to the store or if you don't want tostand in line with people who might be sick, you haveyour prescription medications. But overall, I think the mostimportant thing that people need to do is think abouthow we can work together through this and not panic. JOSH SHARFSTEIN: Great. So we have timefor a few questions from our audience,which I'll look at. One here is about testing. The question is, isthere enough testing? And how should wethink about testing? I think that that's beena big issue, since there was some trouble withthe initial tests, and now we're kindof catching up. Who should get tested,and for what purpose? Dr. Nuzzo? JENNIFER NUZZO: Right. So we are catchingup, and testing is going to be greatly expandedover the coming weeks, which is welcome news. Because I think it'simportant for us to gain an insight into what'shappening in our communities. My guess is that thepriority will be first for hospitalizedpatients, trying to understand what they maybe infected with, particularly for those patientswho are severely ill and don't have influenza orother respiratory viruses. It will be importantso that clinicians can know how totreat that patient, and also so that they don'tput themselves in harm's way. But I think oncewe get to the point where we have a little bitmore capacity in the system, it will be important to possiblydo broader testing so that we can understand betterwhere the virus is, and to include in our testingefforts, mildly ill patients so that we canunderstand how much virus is in the community, howlong has it been here, how quickly is it moving. There are a lot offundamental questions that we need toanswer, for which additional diagnostictesting would be helpful. TARA KIRK SELL: But,you know, one thing that's really importantabout the testing that people need to understandis that, as testing expands, we will see anumber of new cases, and that those newcases may expand sort of very quickly as ourtesting capacity expands. JOSH SHARFSTEIN: Theywere always there. TARA KIRK SELL: Butthey were always there. It's not that we're havingthis explosion in our country. It's that we're findingthe cases that are there. JENNIFER NUZZO: AndI think on a point another that we should stress,because we've seen this in, let's say, the 2009 pandemic,is that as people hear about testingbecoming available, they may just be concerned,do I have the virus, even though they're not ill. I think we would be ina very bad situation if people went to an ER, forinstance, an emergency room, to get tested whenthey're not ill. Right. JOSH SHARFSTEIN:Just to get tested, they could wind up getting sick. JENNIFER NUZZO: They couldwind up getting sick. That reduces the resourcesthat are available in the ER to treat people who are sick. And, you know, wedon't routinely test people who don'thave any symptoms. So that would bean important thing that they shouldn't just tryto go out and get the tests out of curiosity. JOSH SHARFSTEIN:Well, thank you. And I certainlyappreciate the fact that you all are now 24/7on the novel coronavirus. And I guess a questionthat has come in is, how does the work thatJohns Hopkins University does, and you all do, different fromthe work of the public health department or CDC? TARA KIRK SELL: Laurenwould be [INAUDIBLE].. LAUREN SAUER: So Ithink it is in support of the work of publichealth departments and CDC. We are a universityand an entity that seeks to build evidence toimprove public health practice. I mean, I think, even thoughwe're all academicians, we are also publichealth practitioners. And it is so important touse that evidence space to inform whatplaces like the CDC and state and localhealth departments do. When we make policyand procedures at Johns Hopkins that arebased on the work of the CDC or the work of state andlocal health departments, it is focused aroundsupporting our community. So it may be nuanced. It may be slightly differentthan the language that's used in CDC or healthdepartment guidelines, but is always taking intoconsideration the work that they havedone, and are doing, and continue to do to supportthe broader community, and then focusingon Johns Hopkins. JOSH SHARFSTEIN: And Iknow from my own experience as a public healthofficial, the team here was just an incredible sourceof support and expertise for all kinds of uniqueand different questions. And I think what'sgreat now is that we'll be able to share some of thatknowledge with the public. So thank you to a greatpanel for a candid discussion of the COVID 19 outbreak. As I noted at thetop of the broadcast, this webcast is just one ofthe many ways Johns Hopkins University experts aresharing their knowledge on this global publichealth challenge. Please be sure to follow JohnsHopkins and Bloomberg School channels to get all ofyour latest information and stay up to date with theexpert knowledge you need. If you have questions to addressin the future on programs like this or on ournew podcast, please emailpublichealthquestion@ghu.edu, publichealthquestion@ghu.edu. Thank you very muchfor joining us. [MUSIC PLAYING]