On Plugged In… A new COVID milestone … in the United States: 200-thousand deaths … ((Dr. Tom Frieden)) “We're going to have to continue wearing masks, testing, tracing, stopping outbreaks protecting those most vulnerable, adjusting some of the things indoors, well through 2021.” The outlook … from a former director … of the America’s … Centers for Disease Control. A COVID survivor… recounts her personal struggle… with the deadly virus… ((Diana Berrent)) "I was actually just diagnosed a couple of weeks ago with COVID onset glaucoma." What happens now … if you must go … to the hospital … for COVID? ((Dr. Mizuho Morrison)) “Today if you were to come in, we would do quite a lot different.” And the different plans … To handle the crisis ... From both candidates … for U.S. president. On Plugged In… COVID-19: Fighting a Pandemic. (Greta Va Susteren) Hello and welcome to Plugged In. I’m Greta Van Susteren reporting from Washington. It has been nine months since a virus most of us had never heard of turned the world upside down. Now, coronavirus cases has topped 31 million worldwide. More than 960-thousand people have died. At the top of the list is the United States with more than six-and-a-half million confirmed cases. And the U.S. death toll has passed 200 thousand. India has around five and a half million confirmed cases and nearly 90-thousand deaths. Brazil has almost a million fewer cases than India but a higher death toll approaching 140 thousand dead. Those three countries the US, India and Brazil account for more than half of the world’s confirmed cases. President Donald Trump’s handling of the coronavirus pandemic is among the biggest issues for voters in the U.S. election. He and his challenger former Vice President Joe Biden outlined how they would direct vaccine distribution once one is ready for use. VOA Senior White House Correspondent Patsy Widakuswara has the story. (COVID-19 Vaccine Distribution) A coronavirus vaccine will be available in limited supply sometime between November and December, the director of the U.S. Centers for Disease Control and Prevention told lawmakers. But he said it won’t be widely available for the American public, until much later. ((Robert Redfield, U.S. Centers for Disease Control and Prevention)) “I think we're probably looking at late second quarter, third quarter 2021." ((NARRATOR)) Just hours later, President Donald Trump contradicted his own expert. ((President Donald Trump)) “I think he made a mistake when he said that, it's just incorrect information. And I called him, and he didn't tell me that and I think he got the message, may be confused, maybe it was stated incorrectly. We’re ready to go immediately as the vaccine is announced and it could be announced in October.” ((NARRATOR)) America’s response to COVID-19 is a key issue in the November presidential contest, and Trump has said a vaccine could be ready by Election Day. Trump also contradicted the CDC director’s statement that masks are proven effective and may provide more protection than a vaccine. In a town hall anchored by ABC News' George Stephanopoulos, Trump said the coronavirus would disappear without a vaccine, claiming the nation would eventually develop herd immunity. Herd immunity occurs when a sufficient percentage of a population has become immune, reducing the likelihood of infection for individuals who lack immunity. ((William Schaffner, Vanderbilt University Medical Center)) “The only way you achieve herd immunity without a vaccine is that the virus does it all by itself, then the virus has to infect many, many people and make many, many people sick, put them in the hospital, and we would have many deaths of people of all ages, children, young adults, and of course, many older people and people with chronic illnesses. No, we wouldn't want that.” ((NARRATOR)) Seeking to draw a contrast with Trump’s approach to combating the pandemic, Democratic presidential nominee Joe Biden laid out his plans to develop and distribute a vaccine if elected. ((Joe Biden, Democratic Presidential Nominee)) “They include a detailed timetable for when people will get the vaccine, clear delineation of priority of populations to get the vaccine, a specific means and mechanism for shipping and storing vaccine in appropriate temperatures. Two of those vaccines if they come forward, they have to be stored and shipped at 70 degrees below zero. The division of responsibility at every level of government has to be clear. And I will provide the leadership necessary to carry out that plan.” ((NARRATOR)) As some Americans begin mailing in their ballots ahead of the November election, a recent ABC News – Ipsos poll showed 65 percent of Americans disapprove of Trump’s handling of the pandemic. Patsy Widakuswara, VOA News. (Greta) The Centers for Disease Control is the leading U.S. agency responsible for the health and safety of Americans. Its sterling reputation has been tested by the coronavirus pandemic. Dr. Tom Frieden was the CDC Director during the Obama Administration. We talked about the CDC’s response to the pandemic, the outlook for vaccines and treatments. ((Dr. Tom Friedman Interview)) GVS: What has the CDC response been of recent how do you how do you look at them, are they doing a good job in informing the public? TF: Well what's been deeply troubling is that the administration has been meddling with CDC. It's been spending more time, frankly, or a lot of time fighting the science instead of fighting the virus. And what we see is the admission today that officials from Washington who don't have a public health background wrote things and put them on the CDC website. That's frankly an outrage. To me that's equivalent to someone vandalizing a national monument with graffiti, you know the monument doesn't really look the same afterwards, and many of us had assumed that was the case because some of the things that have popped up on the CDC website are just not scientifically justifiable. And that's really damaging because it undermines trust in what has been one of the most trusted institutions of the country. And that kind of behavior is a reflection of the disregard for science that has led to tens of thousands of preventable deaths and millions of jobs that didn't have to be lost in this country. GVS: Doctor, where are we on vaccines? TF: Well on the one hand, we're encouraged that we can be guardedly optimistic that there may be a safe and effective vaccine. On the other hand, we're seeing this become something of a political football. We need to focus on fighting the virus, and for a vaccine to work, it's got to be not only safe and effective but also trusted. Two of the drug companies released their protocols. That's important that many people myself included, have been calling for them to do that, now we need to look at those closely and see what they imply for what and when we might learn. Even if and when we have a safe and effective vaccination against COVID, it's going to still be here, immunity is not just around the corner, we're going to have to adapt we're going to have to continue wearing masks, testing, tracing, stopping outbreaks, protecting those most vulnerable, adjusting some of the things indoors, well through 2021. GVS: I have done a little research and I see that Russia has claims to have one that is almost at the gate ready to go. Do you have any information, reason to trust that one? Do you know the protocols they use should we be suspicious of those and likewise with some of the vaccines coming out of China? TF: Russia and China apparently have vaccines in advanced stages. The Russian one, there was a publication about it but it really lacked a lot of data. So I think we don't have any objective information about how safe and effective that vaccine is. We also have only seen preliminary information from some of the vaccines made in China, but we can't think that we're going to be safe just in the US. We need to think about the world getting vaccinated. We won't otherwise get our economy back or travel back, we won't be able to recover fully until the world is safer. GVS: Where are we on treatments? TF: We've learned a few things. One of them is that late in the course of disease - if someone's still very sick, steroids appear to help, things like dexamethasone. Remdesivir appears to help somewhat if given early in the course of disease. Convalescent plasma, a lot of controversy on it. My read of the data is no evidence, it works. Maybe it works, somewhat for some people, probably would have to be given early and really it's a very blunt weapon because we don't know which plasma is better what dose to use. So these are the kind of things that need to be rigorously studied and it's now quite clear that for treatment Hydroxychloroquine has no benefit and some risk. GVS: Do you see masks as being something that that's probably just going to remain with us in some form, maybe not as rigorously, but some. TF: I hope so. I think there will be long term changes in our, the way we structure things having handshakes without for a while masks are in for a while, more telework than previously. And I hope there'll be a recognition that we really are all connected and helping to protect and promote health, anywhere, helps all of us reach our full potential, both economically and socially. (Greta) Recent spikes in U.S. coronavirus cases is being blamed on re-opening schools and colleges.    But how did the U.S. get to nearly seven million infections and 200-thousand deaths in just nine months?  January 9th: The World Health Organization announces China’s discovery of a novel coronavirus, discovered in a patient in Wuhan, China who was reported to have died two days later. Less than two weeks later, on January 21st, the U.S. confirms its first case of the novel coronavirus. The patient had returned from Wuhan six days earlier. While cases and deaths in Europe and Asia grew, it took until February 29th for the first American coronavirus death to be recognized. As major U.S. sports leagues started shutting down – on March 13th President Trump declared a national emergency. By the end of that weekend, Americans were advised to avoid groups of more than 10 people. On March 26, the U.S. passed 1,000 coronavirus deaths and doubled within two days. President Trump signed legislation to provide two-trillion dollars in economic relief as more states tell people to stay at home. A week later, April 3rd, the U.S. Centers for Disease Control recommends all Americans wear face coverings. By the end of April, more than a million Americans contracted COVID-19 and more than 55 thousand died from it. By the end of May, amid mass protests for racial justice, America’s COVID death toll doubled, passing 100 thousand. 1.8 million in the U.S. had been infected. Since June 1st, Instead of seeing the virus diminish in the summer heat, the number of infected Americans more than tripled. In the same time, the American death nearly doubled, past the 200-thousand mark. (Greta) With flu season approaching doctors are facing an unprecedented challenge of treating seasonal influenza alongside cases of COVID-19. Dr. Mizuho Morrison is an emergency room doctor in Southern California. She became infected with COVID while treating a patient in March. Dr. Morrison has since recovered and we talked about the evolution of treating COVID-19 over the last six months. (Dr Mizuho Morrison Interview) MM: Today if you were to come in, we would do quite a lot different. First of all I'd give you almost no I.V. fluids. We've learned that keeping patients drier and preventing their lungs from overflowing with fluid is much more helpful. We've learned that proning patients, so positioning you forward -and having had COVID, I get this - I would be sitting on the couch just watching television, trying to get through my day with COVID, and when I leaned back, I would feel more short of breath. When you lean forward, I think just the removing, you know the pressure of your chest weight and your heart and whatnot, the physics of it, leaning forward tends to expand the lungs better. And so now we literally call it the chicken rotisserie. We have patients every 15 minutes rotating and changing their position to help hyper expand their lungs. So we're doing proning position change. We're decreasing I.V. fluids. They're getting vitamin C. They're getting zinc. How effective are those? You know, the data is mixed to be honest. But the risks of them is so low. That it‘s why not at least help boost their immune system. And then we've added steroids and, you know, depending on which steroid you want to choose, Decadron or Dexmethasone is often used mostly because it's a longer acting steroid. And that makes sense. It's an inflammatory process that COVID causes. And so decreasing that inflammation in any way is helpful. GVS: And this virus is so much more contagious, at least seemingly so, than the flu virus. MM: Well, that's sort of a nuanced question. Yes and no. So, yes, in that for those of us who are, you know, when we're intubating patients, obviously it's really close contact, we’re in their face and intubating them. But it depends - the community spread is certainly much more contagious. But what's fascinating is that compared to flu - and I love doing this comparison-- influenza is spread far more amongst children. Like children are-- vector is the word that we use for --like they're the vehicle that transfers and transmits the infection. So children are the vector for influenza, far more than COVID, interestingly. And so it really depends on the patient population you're sort of talking about. GVS: What's an explanation for that though? Because I take it if a child has COVID and an adult has COVID if they both sneeze, they're both sneezing the same virus. So you know why would a child be less contagious than an adult? Because I hear so often children are less contagious. MM: The truth is I don't think we're going to know until we look back in 5-10 years and sort of look at the public health spread in the data. But what we do know, particularly with the upcoming flu season that all of us front liners are concerned about, is that flu is highly spread amongst children. and they are also much more susceptible. So kids under the age of five in particular are the highest risk patient population to suffer complications. We're talking things like a secondary pneumonia, high fevers which can lead to febrile seizures and particularly in the infant age group, babies under the age of six months can't get the vaccine. So we're dependent on all the other caregivers, parents and babysitters and teachers and adults alike around those kids to get vaccinated so that we're not spreading the infection to the highest risk population which is young children. And then of course the same elderly and immune compromised patients. GVS: Is there a way when you sort of look back now, with 20/20 hindsight, recognizing all of the sort of difficulties and challenges that we've had and the surprise factor, how did, how would you grade us and sort of our nation's response to this? MM: I think the reason there was only one case in January or, you know minimal cases and then suddenly now today there's so many is it comes down to testing. I mean, will tell you, March, April we were seeing these patients in the ER daily and we knew it was likely COVID, but we didn't have enough tests to confirm. So those patients aren't being counted right into that initial early phase. So testing and I mean, I'll be I'll be frank, I think that this pandemic has highlighted sort of the weakness and the holes within our health care system at large. You know for us to not have enough PPE to provide in a first world country is ludicrous. So I think there are certainly weak spots and failures that we've clearly had. I think that some things were done appropriate. You know it’s a tough one. I'm very sensitive to not play Monday morning quarterback. Just like we have made mistakes in the E.R. as well, you know we're all learning. And I think that's really the whole point of all of this is that as things change, as data comes in, as we learn new things, we have to be able to mobilize and change the plan, so that we can effectively shut down this virus. (Greta) Some patients recovering from COVID-19 have reported symptoms lingering for months even after tests show no active presence of the virus. Diana Berrent is the founder of “Survivor Corps” a grassroots organization that provides support and promotes research on the long-term impacts of COVID-19. We spoke earlier about the group’s efforts to help researchers develop a coronavirus vaccine. (Diana Berrent Interview)GVS: You started something called Survivor Corps. What is that? DB: So I started Survivor Corps as an open Facebook group from my bedroom on March 24th as a way of mobilizing an army of survivor volunteers to donate plasma and support science in every way possible to participate in every academic, medical and scientific study for which they qualify. So not only are we now a Facebook group with over well over 100,000 members, we also have a website survivor corps.com and it is a one stop shop on how you can give back how where you can donate plasma, studies that you can sign up for. And more recently, we have become a patient advocacy group. GVS: In terms of tracking it, have you made it? I mean, it seemed to me there like three main groups, there's the mild symptoms, the severe symptoms, and then what we now called the long haulers those who seem to it's just doesn't go away. Are you able in your universe of people that you have come in contact with submitted information, how many fall into each category? DB: It's hard to say exactly, because there's actually a tremendous overlap between the mild cases and the long haulers. The people who are experiencing long COVID which is right now sort of loosely defined it by the CDC as anybody who has not recovered in about three weeks from infection. And they are saying that one third of people are not recovering. And those are not, those are generally not people, the same people who are hospitalized. These are not necessarily the people who are on vents. These are people who had what I call the Gatorade and Tylenol variety of COVID like I did, GVS: If you so called recover, you know, if you’re in that mild case, and you turn out to be a long hauler, are you still showing, are people being tested to determine whether they actually got rid of the infection or not? DB: Yes, some people are showing up positive for many months. They are unusual, but it really we are pretty, I think the science is pretty clear at this point that between the 14 and 21 day mark, post infection, whatever viral content that the PCR tests at the diagnostic test is picking up are dead virus viral particles. So even if you are experiencing these long-term symptoms, that doesn't, that doesn't mean you're contagious anymore. On the contagion, you know, whether or not you're contagious is the same, whether or not you are continuing to experience symptoms. But what we've realized is because we now know that it's a vascular disease and not a respiratory disease, is that it is impacting every single organ system. So we have people experiencing severe neurological symptoms, cardiac issues, on post, post COVID, onset diabetes, post COVID onset lupus. I was actually just diagnosed a couple of weeks ago with COVID onset glaucoma. GVS: I assume that It would be quite helpful if people got on the page survivorcorps, even from around the world, because you know, we have different experience in different demographics, different food, different everything, perhaps that would be helpful in trying to get a grip on what this is. DB: Absolutely. And it's already an international community. We have about 20% international community. And we welcome that, because it's really, really important in the same way that vaccine research needs to be done globally, to make sure that we're not looking at different strains that we're not, you know, overlooking any disparate situations and demographics that could impact the effectiveness of that vaccine. We need to work we need to look at this collaboratively as a global issue, and come together as a global community. And so we welcome members from all over the world. And on it is a tremendous way to be able to reach out for help to share your experiences with others, and really work to fight for change and acknowledgement of this condition and towards the solution. (Greta) The coronavirus pandemic is touching people in many ways. Travel restrictions forced VOA Kenya – based reporter Ruud Elmendorp to spend nearly six months in neighboring Tanzania. Now reunited with his girlfriend he is finding coronavirus is changing much in Kenya. (Reporter’s Notebook – Ruud Elmendorp) “I am in the National Public Health Laboratory in Dar es Salaam for a COVID-19 test, and filming is not allowed. The lady at the counter just handed me the certificate with the result and it is negative. I asked her what happens if one tests positive. “You tested negative, so you don’t have to know what happens if you test positive,” she said.” There are many people wanting to travel now that the skies have reopened. At the counter there is a photograph of President John Magufuli looming over the test applicants. In June, he announced that Tanzania had become the first country in the world to vanquish the coronavirus.” On the way back from the testing center I wondered how I could have avoided becoming infected in the nightclubs we went. Could Tanzania really be free of the virus? Feeling sad to leave yet happy to go, we threw a goodbye party on the beach. The next day I checked in at the airport after having registered on a self-quarantine app established by Kenya’s Ministry of Health. The flight was smooth, and I quickly found a taxi driver to bring me home. But as soon as we cleared the gate of the airport, I realised there was no other traffic on the roads. The driver told me that’s because of the curfew and that we were exempted because of coming from the airport. Roaming though a dark and deserted Nairobi, I started wondering where I had ended up. The reunification with my girlfriend was wonderful and we were so happy, having missed each other for so long. The wake-up call came the next morning with an SMS alert from the Ministry of Health saying that it was time to file my health details in the self-quarantine app.   Kenya seemed to be serious, a realisation that was driven home when I went out shopping. My familiar shopping mall has been converted into one big hand-washing zone with soap dispensers every 20 meters. The floor is speckled with footstep stickers indicating social distancing space. The tables in my usual coffee shop are sprayed before patrons sit down. The menus have disappeared to prevent infection; instead there are stickers with QR codes for downloading the menu onto my phone.   Then there is the curfew, and the closure of bars and restaurants. Now I realize how isolated from COVID-19 I had been in Tanzania. We are happy to be together now in a country where at least the virus is acknowledged and we are reminded to stay vigilant.   What really happened in Tanzania we will hopefully find out after the pandemic is over. But I miss my friends on the beach. The alerts for my health check will continue for 14 days. Ruud Elmendorp for VOA News in Nairobi. (Greta) Before we go, the tributes are still coming after the death of U.S. Supreme Court Justice Ruth Bader Ginsburg. She was the second woman to serve the nation’s highest court. VOA’s Julie Taboh remembers the life of a remarkable American woman. (Death of a Legal Pioneer) "I, Ruth Bader Ginsburg, do solemnly swear…" ((NARRATOR)) On August 10, 1993, Ruth Bader Ginsburg became the second woman in U.S. history to become a Justice of the United States Supreme Court. Ginsburg knew she wanted to be a lawyer by her third year in college. She was motivated by the "red scare" that gripped the nation in the 1950s, when Americans were afraid of the perceived threat posed by the Soviet Union. Led by Senator Joseph McCarthy, thousands of people were publicly accused of being Communists. ((RUTH BADER GINSBURG, SUPREME COURT JUSTICE)) "There were brave lawyers who were standing up for those people, and reminding our Senate, look at the Constitution, look at the very first Amendment, what does it say? If lawyers can be helping us get back in touch with our most basic values, that's what I want to be." ((NARRATOR))             Ginsburg's parents discouraged her from studying law, fearful that she would not be able to find a job in the male-dominated profession. But Ginsburg was determined. And after graduating from Cornell University in 1954, she was accepted to Harvard Law School, just five years after they started admitting women. ((RUTH BADER GINSBURG, SUPREME COURT JUSTICE)) ((18:25:00)) "When I entered law school, the class numbered over 500, nine of us were women." ((NARRATOR))             Two years later, Ginsburg's husband - Martin Ginsburg, a renowned tax attorney and law professor - took a job in New York City, and Ginsburg transferred to Columbia Law School where she received her degree in 1959 and, as her parents had predicted, she found breaking into a man's world, challenging. ((RUTH BADER GINSBURG, SUPREME COURT JUSTICE)) ((18:26:38)) "There wasn't a single firm in the entire city of New York that was willing to take a chance on me." ((NARRATOR)) But with the help of a sympathetic professor, she got a clerkship. Soon after, she started teaching at Rutgers University School of Law and Columbia Law School. In 1972, Ginsburg founded the Women's Rights Project, to work for equality for women and girls, in all spheres of life. ((LENORA LAPIDUS, DIRECTOR, WOMEN'S RIGHTS PROJECT, ACLU)) "At that time there were many, many laws on the books that gave preference to men simply based on their being men." ((NARRATOR)) Lenora Lapidus is director of the Project, an initiative of the American Civil Liberties Union. ((LENORA LAPIDUS, DIRECTOR, WOMEN'S RIGHTS PROJECT, ACLU)) "Throughout the 1970s, as she led the Women's Rights Project, she brought case after case to the Supreme Court in order to establish that the Constitution prohibited sex discrimination." ((NARRATOR)) Two decades later, Ruth Bader Ginsburg was a member of that Court, appointed in 1993, by President Bill Clinton. During her time on the Supreme Court, she was an articulate voice for the liberal wing of the bench. Ginsburg believed that gender barriers facing women in the workplace today have all but disappeared in the United States. What remains, she said, is something a court cannot mandate; for American society to be open to the idea that women, and men, need a balance between work and family. Ginsburg balanced her own life as a working mother of two children, with the love and support of her husband Martin, who passed away in 2010. ((RUTH BADER GINSBURG, SUPREME COURT JUSTICE)) "Well the most important thing by far, was that I had a life partner, my husband, who thought my work was at least as important as his, and who wanted very much to be part of his children's growing up years." ((NARRATOR)) Supreme Court Justice Ruth Bader Ginsburg said she always tried to do what she believes is right. ((RUTH BADER GINSBURG, SUPREME COURT JUSTICE)) "I hope that I will be remembered as someone who loves the law, loves her country, loves humanity, prizes the dignity of every individual, and works as hard as she can with whatever talent she has, to make the world a little better than it was when I entered it." Julie Taboh, VOA News, Washington. (Greta) After tributes at the Supreme Court and U.S. Capitol, Ruth Bader Ginsberg will be buried at Arlington National Cemetery next to her husband. Thank you for watching and thank you to my guests: Dr. Frieden, Dr. Morrison and Diana Berrent. For the latest news go to our website VOANews.com.        And don’t forget to follow me on Twitter @Greta.         Thank you for being Plugged In.    #####