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Brian Lehrer: Brian Lehrer on WNYC. With me now is Aaron Carroll, professor of pediatrics at the Indiana University School of Medicine and a regular contributor to the New York Times. He's had a series of Times coronavirus articles already. Dr. Carroll, thanks so much for some time today, welcome.

Dr. Aaron Carroll: Thank you very much.

Brian: You tweeted this morning a quote from an LA Times article, "The easiest way to speed Medicaid waivers is a declaration from the president of a national emergency." Why were you tweeting about Medicaid waivers and asking for a national emergency declaration?

Dr. Carroll: Well, one of the few ways that states can try to sign more people up for Medicaid easily or get more people to have coverage that they might need to go get healthcare is for a declaration of a national emergency. It's not just a series of words, it actually has political and legal weight. Until the national emergency is declared, a lot of states cannot make the changes that they need to, to try to adapt and provide more healthcare. It is a little bit baffling at this point about what it would take for this to become a national emergency if it's not one already.

Brian: It seems like the president and Speaker Pelosi are close to a bipartisan bill to address the crisis, including some public health measures and also a relief for the financially hard hit. You're a doctor, not a political analyst, but is there anything you're seeing or would like to see?

Dr. Carroll: I'm seeing reports of that, but I'll tell you, I always am somewhat skeptical of reports of being close to an agreement. We've seen a lot of agreements before they get really close to the line and then blow up. There's no question that action is needed, not just from the health perspective but also from an economic perspective to help individuals make the decisions we need them to make to put us all at lower risk for this disease to be transmitted.

Brian: I see that, as a pediatrician, your position on closing schools other than colleges is, you said, "Closing schools, other than colleges, is a harder decision." What's your thinking on that because many systems have closed but New York City is the big example right now of taking it on a case-by-case basis and there are others?

Dr. Carroll: Yes. We've seen it-- I mean, just here, my children's school is going to be closing on Monday. They declared it yesterday. Today is the day they're preparing and they're closing Monday, but one of the things I was pleased to see my school district do was that they announced that they were going to be immediately working with families who depend on schools for meals, breakfast and lunches, to arrange for either food pickup or delivery. That's an essential part of what schools provide for so many children. They depend on schools for food. It's often where many children get the only good meal that they may be getting, so we can't just shut down the schools and turn away.

Another problem is that, unless we make it easy for parents to stay home and care for their children when schools are closed, often what might happen is that they might hand their children off to other people to watch their kids, maybe even grandparents who are, of course, at highest risk for illness. We don't want that. That'd be a worst-case scenario, where instead of making things safer by keeping kids at home, we're actually putting the elderly at higher risk by handing the kids off to them.

It's a good idea from a standpoint of preventing transmission amongst kids and letting them become a reservoir for the virus to shut down schools, to really improve social distancing, but we've got to be careful about it and also make sure that we're protecting them and keeping them fed and also not putting other populations at risk.

Brian: Listeners, as we've been doing nearly every day, we have a medical professional here, in this case, pediatrician and New York Times contributor, Aaron Carroll, and we can continue to take your coronavirus questions for him today at 212-433-WNYC, 212-433-9692. Your latest Times article, I see, is about the possibly biggest thing to worry about, that the number of hospital beds and ventilators will not meet the potential need. We know they're experiencing that in Italy. What are you warning of?

Dr. Carroll: The big concern that many epidemiologists have is not how many people will get the disease or what the numbers might look over the long-term because, of course, that's what people are talking about when they throw around the flu, what's concerning is how many people get hit at the same time. We don't have as much surge capacity or the ability to take on an influx of very, very sick people.

We don't have the big capacity that many people imagine we do. Hospitals run pretty close to full all the time, especially during flu season, which is going on right now. If a lot of people get sick at the same time, then, they can easily overwhelm our ability to provide intensive care in intensive care units, and also, to provide respiratory support through ventilators or the devices that help them to breathe. If we do that, then, we can't even provide the care that many of the very sick will need, and then, they have to start making decisions about which patients get care and which patients don't. In a sense, they have to decide who's going to die. That's a horrific situation.

It's, unfortunately, going on in Italy right now, where they're actually putting out guidance on how to triage patients and decide who gets the care and who does not. We don't want to see that in America, and that's what people are freaking out about. When we talk about flattening the curve, we are doing that. We're trying to prevent too many people from getting sick at the same time, very quickly. That's what we're trying to do with social distancing.

Brian: I cringe at even asking, but what guidance are they putting out about that in Italy?

Dr. Carroll: I mean, it's still influx, but I think, generally, what they're saying is that they're going to preferentially treat younger people, people who are not already ill, who don't have a ton of other conditions because they're more likely to recover and then lead a longer lives. I hate even saying those words out loud because no one wants to endorse that idea, no one wants to think that that's acceptable, but they're facing a real problem of there's not enough resources to devote to the number of people who are sick.

This is an excellent healthcare system. This is not a developing nation. This is not like-- This is comparable if not better, arguably, in some ways, to what we've got off and going on in the United States. Northern Italy is already overwhelmed, Southern Italy maybe soon, and what we're seeing there could easily happen in American cities if we don't slow down the way at which this virus is moving from one person to another.

Brian: What can be done about that in this country to prevent that horrific scenario, both to slow everyone getting exposed at the same time so there isn't the biggest surge? I think that's what everyone's been talking about mostly with all of this social distancing and closing things, but also ramping up supply.

Dr. Carroll: In an ideal world, we would be moving to the past and we would have acted sooner with better testing because if we could identify who has contracted the virus, we can much more target, in a targeted way, isolate those people, and keep this from spreading. We failed to do that. We failed miserably. Without testing, we don't have a sense of where it is, how it's moving, who's infected, and there are probably many people out there who are ill and don't know it or don't realize it, and who are now transmitting it to other people.

Since we are now in that standpoint, the only thing we can do is just isolate everybody. That's what you're seeing with this social distancing, canceling huge events with lots of people will get together, preventing gatherings of large groups, shutting down religious institutions so that we don't have people coming to mass or going to synagogue, large groups, or just not being gathered. That's why the schools are shutting down, that's why colleges are shutting down, and we're trying to get people as much as possible to stay away from other people so that we don't keep transmitting it. We have to do that for everyone because we really don't know who has this or who doesn't.

Brian: Can we ramp up the supply of respirators?

Dr. Carroll: Not very quickly. I suppose companies could turn around, but it's not as if we can create thousands of these overnight. I imagine we could create tens or hundreds, but it's not easy to do it as quickly as we would want. It would cost money. It's not clear where that money is coming from. Some of them are mobile. The CDC has a small cache, I believe, where they could send them to an area that is hit hard, but if a couple of areas get hit really hard, we can't do anything about that.

Say, we have 160,000 respirators in the United States. Those are not spread out in a thoughtful manner of where the disease is going to show up. They're spread out where the hospitals are. It's very easy to overwhelm any one area, especially a metropolitan area, where a ton of people could become sick at the same time. On top of the ventilators, it's important to remember we only have a limited number of physicians, of nurses, of respiratory therapists, and if they start becoming ill in caring for all of these patients too, we could run out of those resources as well, which is happening in Italy.

Brian: Obviously, even if there were enough ventilators, prevention is better, testing to aid with prevention is better. What's your understanding of why we don't have the testing capacity we need that other countries have had? How much is it Trump? How much is it the CDC bureaucracy or anything else?

Dr. Carroll: I think it's probably all of the above, in some sense. We probably had a window to adopt WHO tests that we did not. We probably had a window to recognize we weren't really meeting capacity. I don't think we've been taking this as seriously as we probably should as a whole public health infrastructure, and that doesn't mean the individual workers, but I don't think the message from on high has been, "This is a real emergency. Everyone's got to get their act together and do something." I think part of why you're seeing a lot institutions taking action right now, sporting events, Broadway, schools, is because there isn't a clear direction from the federal government of, "We all need to act together and do this."

Often, I think you get people contradicting each other and making it not to be, "That this is not as big a deal, that the flu is much worse, that we're going to be fine, that people are overreacting." I don't think we're overreacting at the moment. There's no reason to panic. Most people, it is true, are not individually at risk, but we don't do these things just to prevent ourselves from having risk. We have to do things to prevent those who cannot protect themselves, which includes immunocompromised, it includes sick people, it includes the elderly, and unless we take the actions that I think people are taking, this could easily get out of control and easily overwhelm the healthcare system.

Brian: Let me follow up on one of the things you just mentioned as a reason we don't have enough tests. Was there an offer of tests for the US by the World Health Organization that the US actually turned down?

Dr. Carroll: That's what I've read in reports. I will be-- I'm not an investigative journalist nor was I part of any of those decisions, but many of the reports I've been seeing said that there was probably a window where we could have either adapted the test or, at least, been much more thoughtful in truly ramping up the number of tests that we could create. You have to remember, at some level, we're a very wealthy country, very well-resourced. We can truly do almost anything when we set our minds to it.

Countries with far less than we do are testing tens of thousands of people. Korea, at this point, I believe they're testing like 15,000 people a day. I don't believe we've tested close to that number total since this whole thing started. We are woefully behind, and it's hard to argue that another country is smarter, better resourced, or richer than we are. Something must have gone wrong, in the sense, that we're not only not doing it, but not appearing to catch up in any quick way.

Brian: Let's take a phone call. Here is Mark in Hudson, New York. You're on WNYC with professor of pediatrics and New York Times contributor, Dr. Aaron Carroll. Hi, Mark.

Mark: Yes, hi, thanks for taking my call. Longtime listener, Brian, thank you so much for your service. I'm going to try to be quick here. I think that piggybacking on what the mayor was saying before that this is something we have to zoom out, and we need to all contribute and think about the bigger picture. I'm curious to hear what the professor's opinion would be on-- I, myself, my wife is an Italian citizen. Our 90-year-old grandmother is in Milan, at the moment. We're very familiar with what's happening there.

Additionally, I'm raising three kids, I'm commuting from Brooklyn to Hudson, I'm a gig worker, I'm a producer. I'm just wondering if it's time for creative solutions such as putting people like myself and some of the stagehands and people that are out of work that are, by nature, MacGyvers giving us some sort of rapid training so that we can put our native skills to work, to help be more prepared for when the hospital beds had filled up, for when-- Presuming that we could get the medical equipment needed, isn't it time to start thinking outside of the box?

Dr. Carroll: I think it's possible that in some locations it could get there. The problem is, we don't even know where that would be or where to do it. We have a pretty good sense at this point that Seattle is in bad shape, that they likely have community transmission.

Mark: [crosstalk] starting right here in New York City, start the training. I've worked in production in New York City for 25 years. I mean, that skill set really lends itself to crisis. Before this even happened, I haven't had a paycheck since the fall, and that's just the nature of where the economy's at. I can think of a crew of 25 people that are in my phone book and Rolodex right now that I employ on a regular basis. That would be amazing. Working with elderly, working to help keep people spirits up learning how to use certain devices. It just feels like we need to start now and get in front of it.

Brian: Mark, I'm going to get one more response from you, and then, I'm going to go to some other callers, but thank you for raising all of that.

Mark: It's great. First of all, I totally endorse where your heart is at, and I think that it's something that probably could go-- I think part of the problem is that there's no resources available for training at the moment. It's important to remember that, really, what we need to focus on at the moment is distancing, so bringing people together to do that kind of work, it's just hard to wrap our heads around that when right now, the best thing we can probably do is keep people apart. Certainly, if things move forward, I would absolutely pick up the phone and see if volunteering can make a difference.

Brian: Jean in Manhattan, you're on WNYC with Dr. Aaron Carroll. Hi, Jean.

Jean: Hi, there. I am very concerned about not being able to get tested. I'm a 74-year-old woman, who got off a cruise ship on Sunday, as crazy as that may sound. I have bronchial issues, and I have, gradually, in the last five days, the symptoms have increased. I don't really have a-- My normal temperature is 96.8. I'm up to 98.8, and that's not anything I'm concerned about, but the coughing and the congestion is something that I am concerned about. I watched the mayor yesterday on TV, I called 311. They were all very nice, and the first person forwarded me to the Mental Hygiene and Health Office. I talked to them, and they forward me to a doctor and I was cut off. After that, I called three more times, and by that time, the office was closed.

Brian: Jean, let me ask you to put the question that you would have liked to ask 311 to Dr. Carroll. What advice do you need?

Jean: I see that everyone-- I see people on television-- I see people talking about the testing. I don't have a clue of anyone who has been tested. My primary care physician said he didn't have a clue of how you got tested, to call the health department. I have been calling people constantly just to find out how I can get tested. It seems to be a huge runaround. I can't believe-- I know you're talking about it, but I don't know anybody who has been tested.

Brian: It is another testing horror story, and here you are in the position of giving medical advice over the radio to somebody you haven't met, but what can Jean do?

Dr. Carroll: Here's the thing, I'm not surprised by this. Look, there aren't enough tests, I'll say it, there just aren't. People are not getting tested who want to be tested. Because of that, we have to act like you have it. Meaning, you need to isolate yourself, you need to stay home, you need to take care of yourself, and if symptoms really worsen, then, you need to call 911, or you need to call your physician, and then, take care of yourself.

Even if you were tested today and you found that you had it, that would still be the advice. There is no medicine for this at the moment. The treatment is all supported if you truly get ill and require oxygen or ventilation or things like that. There's not much else anyone-- The horrible/good news is that the testing wouldn't do. You're not symptomatic enough to go to the hospital or require care, which is great. Take care of yourself, isolate yourself, act as if you have been exposed, and are sick, and then, do the best that you can. It sounds terrible. I hate the words coming out of my mouth, but that's where we are. We just have to assume it's likely you might have it.

Brian: The horrible thing here is that maybe she doesn't have it, maybe she just has bronchitis, but now, you're telling her that she's in a position where she has to quarantine herself.

Dr. Carroll: Right. It's terrible in the sense that you're going to have to quarantine yourself worse than you would, but given your age, given the fact that you're feeling ill, even if this wasn't coronavirus, my advice would almost be exactly the same, stay at home, take care of yourself, avoid other people because, of course, people who are sick and already have other problems are even more susceptible to being worse off if they were exposed or got it. My advice would be the same whether you have it or you don't have it. You'd really need to self-quarantine, really need to stay away from other people, and you need to take care of yourself.

Brian: Jean, I hope that helps. Thank you for your call. This is WNYC-FM HD and AM New York, WNJT-FM 88.1 Trenton, WNJP-FM 88.5 Sussex. You know what, let's do one more thing for Jean. If she's still there on hold-- I think she is. I'm going to volunteer something that the mayor usually says, but I want to do it for Jean in this case even without the mayor inviting it. Let's take Jean's contact information and put her in touch with city hall, put city hall in touch with her because she was trying to get through to somebody for an answer on 311 she said, with repeated calls and couldn't get an answer from 311. That's the city's responsibility.

Let's take Jean, and I see she's still there. Mary, thank you very much for taking her contact information, and let's get her a response from city hall. Jean, I hope we can help you. This is WNYC. Now, I'm going to go back to the legal ID as usual. This is WNYC-FM HD and AM New York, WNJT-FM 88.1 Trenton, WNJP 88.5 Sussex, WNJY 89.3 Netcong, and WNJO 90.3 Toms River. We are New York and New Jersey Public Radio. We have a few more minutes with pediatrician from the Indiana University School of Medicine and New York Times contributor, maybe you've been seeing his articles, Dr. Aaron Carroll.

I'm going to take a call for you that was really intended for Mayor de Blasio when he was our previous guest, but because we had to triage information with so much that needed to be said about so many things, we didn't get to this. I think it's an important question. We're going to take Russ in Manhattan, you're on WNYC with Dr. Aaron Carroll. Hello, Russ.

Russ: Good morning. On the show, Mayor de Blasio stated that there was no airborne transmission of the COVID-19 virus. This was contradicted by Dr. Osterholm of the University of Minnesota, who very much said that droplets and moisture were not the only vectors for the virus. Since the airborne transmission question is very critical to keeping the kids in school, I wondered how our physician guest feels about that.

Brian: Did you hear him say that? Not on the show today, right? He said it on All Things Considered.

Russ: No, he said it on the show today.

Brian: Did he say it again?

Russ: "There was no airborne transmission of the virus. It was by droplets," the direct quotation of Mayor de Blasio on this show.

Brian: Doctor.

Dr. Carroll: I think that most of the evidence shows that and, of course, whenever you talk about airborne transmission, if I sneeze and I'm expelling the virus in droplets and it goes through the air and it lands on something, that has also gone through the air. In other words, you don't need to have direct human contact. I can propel or get the virus out of me onto surfaces or even, I suppose, onto you, and then, you could get it. The question is, does-- Everybody worries about more is, if I sneeze, does it hang around in the air? Does it move around in the air so that later, someone can come in the room and can get it? Measles can do that. That's why we panic so much about measles and that's why we have a vaccine against it.

It doesn't appear, as far as I know, the coronavirus does that. Most of the time, it is-- Granted, yes, we can expel it in a sneeze through the air, but it is then contact with our hands or something like that, and then, to our mouth, and that is how we get the disease. That's why the CDC and other experts are saying over and over and over again, "Hand wash, hand wash, hand wash," best thing you could do, soap and water, 20 seconds. Don't touch your face because once you've washed it, that's how it gets to you. Cough into your elbow so that we don't spread it around like that. Stay away from sick people, and if you're sick, stay away from them. That will prevent the vast, vast, vast, vast, vast majority of transmissions, regardless of the vectors or the minutiae of how it's moving from one person to another.

Brian: This is a very important distinction that you're making. Maybe the mayor was being too general or too sloppy in his language if he said it this morning. To be perfectly frank, I missed it with all the many words that are going by, and sometimes, I miss a few. I know he also said the same thing on the station on All Things Considered the other day. The mayor is going out there saying there's no airborne transmission and maybe he's not using that term precisely enough.

Dr. Carroll: I think some people use it to mean that it's not transmitting like, in other words, that I sneezed and it goes further than the distance. Usually, they're saying we should be 6 to 10 feet away from other people because that's the distance almost, I believe, of a sneeze. In other words, it's not hovering and floating around. That's what a lot of people refer to as airborne transmission, and in that, I believe he is correct. It is not as if you're in the back of the plane and someone's in the front of the plane, that you're likely to get it. The problem is if you're close enough that someone could theoretically sneeze on you or transmit it or cough on you. That's the concern.

Brian: Before you go, I want to touch on one other topic that you've written about because you also wrote an article for the Times called Coronavirus Highlights the Pitfalls of Healthcare Deductibles. As I read the article, you also get into the other ways that insured patients, and I mean insured patients, pay like co-pays and co-insurance. I think you see a somewhat good motivation to have patients have skin in the game, but the results are perverse and especially in this case.

Dr. Carroll: Again, we're talking more about policy now. There are good reasons or thoughtful reasons, at least, we could have cost-sharing. If it drives patients towards more cost in use of care and it avoids overuse of care, both of those things are good. The problem is that the ways that we do cost-sharing are not accomplishing any goals nor can anyone really explain what we're trying to do. We just think it's going to lower spending. It does. It gets people to consume less healthcare. The problem is that they wind up consuming less necessary healthcare, along with less unnecessary healthcare.

Another way we do it is that we make it restart in January. Everyone in the United States right now is probably facing a deductible, and deductibles are blunt, crude instruments that just gets you to spend less. When it's flu season and, yes, when it's coronavirus season, we don't want any barriers towards people that need care, getting the care that they need, and the ways that we implement cost-sharing wind up putting those barriers in place. It's not thoughtful. It's not good. We could do a better job.

Brian: Are you a Medicare-for-All person and be done with all that?

Dr. Carroll: This is the thing, if Medicare-for-All as Medicare exists right now, Medicare has plenty of cost-sharing. The plan put forward by Senator Sanders would abolish all cost-sharing, and that has pros and cons, in the sense that, that would remove a lot of these barriers, but there can be thoughtful cost-sharing it can be used and is used by many, many, many countries in a much more thoughtful manner. I think Medicare-for-All is a reasonable way to get to universal healthcare in the United States but it's certainly not the only way we could get to universal healthcare in the United States. There are lots of other healthcare systems in the world that do far better than us or Canada that don't use anything close to a single-payer system.

Brian: How about Medicare-for-All who have coronavirus? Could Washington do something like that for this emergency?

Dr. Carroll: It's interesting because, of course, I think what we're trying to get to is we want to remove all the barriers for people getting care with coronavirus. We could absolutely do that, but that's necessary and yet not sufficient because, as I said before, until we remove the many other barriers of getting care like missed work, the ability to stay home, to have food. All of those things are tied up in things that people still need to do every day that are very, very, very bad with respect to this pandemic. Health insurance is necessary but not sufficient to take care of all of that.

Brian: Dr. Aaron Carroll, professor of pediatrics at the Indiana University School of Medicine and a regular contributor to the New York Times. Dr. Carroll, thank you so much.

Dr. Carroll: Thank you.

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