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April 19, 2020 - The Ben Shapiro Show
59:39
Reopening the Country: Scott Gottlieb & Steve Forbes | The Ben Shapiro Show Sunday Special Ep 91
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This is going to be a constant challenge.
I don't think this goes away until we get to a vaccine.
I think there's always going to be cases.
I think you're going to see spikes in cases and flare-ups that are going to be on a regional basis.
Every part of the country is vulnerable to an outbreak.
And this is going to become a fact of life that we're just going to learn to live with.
Five weeks have passed since President Trump issued his stay-at-home recommendations in the fight against coronavirus.
We've all been a part of this global pandemic and have played a role in lowering the curve.
It's now time to look forward and reopen the country as quickly and safely as possible.
To do this, the President formed the Opening Our Country Council and invited thought leaders from different backgrounds and industries to come together to work out a solution to get everyone back to school and work.
We are joined today by two members of that council.
They're going to walk us through the policy and action behind the complex and urgent need to reopen the economy.
We will be talking about how to save businesses all over the country, How accurate our testing has been, how conservatives should be thinking about the stimulus packages, the number of asymptomatic coronavirus carriers, the deception from China, our consequences to expect from the lockdown, and a whole lot more.
Dr. Scott Gottlieb is the former commissioner of the Food and Drug Administration.
He's a resident fellow at the American Enterprise Institute, where he and colleagues wrote the report, National Coronavirus Response, a Roadmap to Reopening, which many state and federal government officials have looked to.
Dr. Gottlieb has been a leading voice on the coronavirus pandemic.
He serves on Maryland Governor Larry Hogan's coronavirus response team, and he's been an advisor to the White House during this time.
Now, before we get started, I just want to remind you and everybody that we will be asking Dr. Gottlieb a few bonus questions.
To hear those answers, head on over to dailywire.com.
Become a member.
You can hear the rest of our conversation over there.
Dr. Gottlieb, thanks so much for joining us.
You've been focusing a lot for months and months and months, going all the way back to January.
You were one of the first people who was actually calling for serious measures, and you really focused a lot On testing.
So I wanted to ask you, because I really have some questions about what testing can accomplish.
So for example, let's start with temperature tests.
There's been a lot of talk about people doing temperature tests when people walk into restaurants or into their place of business.
And since we now know that COVID is actually most transmissible when asymptomatic, are temperature tests even a useful gauge at this point?
Limited utility.
I mean, you make the right point.
There are limited utility.
You're going to catch some people, but by and large, people are infectious even when they're asymptomatic.
And there's been some research recently published this week showing that some people, or a lot of people, might be most infectious before they have symptoms.
So when they're asymptomatic before they develop symptoms or when they just develop symptoms.
And that's unusual for a virus.
Typically, you're most infectious after you develop symptoms.
So this virus has really designed itself to be maximally infectious.
So the temperature checks are going to be of limited value, but there's some value.
And if you're thinking of creating a framework where you have multiple layers of protection that are least intrusive as possible, the temperature checks are one element of that.
So there are two other types of tests I want to ask you about.
One, One is the antibody tests, the blood tests.
So those tests, testing for antibodies, presumably it takes a little while for the antibodies to actually develop.
It takes several days for antibodies to develop for the virus.
So do you have the same sort of problem with antibody tests that you would have for temperature tests?
Namely, that if we test for antibodies at a place of business, that while it may be good because it may tell us whether you now have a certain level of immunity, although we're not sure what level of immunity you have, It's going to be late on the game, meaning we test you, it comes up negative because you don't have the antibodies.
You're still asymptomatic, so you're still passing it around the workplace.
That's right.
I mean, the antibody tests typically tell you what's happened.
It doesn't tell you what's happening or what's going to happen.
So you're testing for two different kinds of antibodies, IgM and IgG.
The early antibodies that you get in response to an infection might take upwards of five days to develop them, sometimes longer, sometimes less.
But the antibody tests themselves aren't that sensitive, so you need to develop a certain level of antibodies to actually be detectable.
And the long-term antibodies, which is what really confers long-term immunity, those don't develop until well into the infection.
So by that time, you've probably cleared the infection.
And so if you were infectious and spread the infection around, that's already come and gone.
And so what the antibody tests are good for is to tell you from a public health standpoint how much infection there has been in the community.
So you can look at different communities, people from different work backgrounds, and tell how much of the infection has passed through those communities or those jobs.
And that can help inform public health decision making.
And we're going to find a lot of variability.
Some parts of the country where this has been epidemic, we're probably going to find that the exposure has been pretty high.
Parts of New York City, Staten Island, Queens.
But on the whole, probably the exposure to COVID-19 across the United States is relatively low.
Probably around 5%, and there was some data out today suggesting that's in fact the case.
And Dr. Gottlieb, the third type of test that's been used is a test.
Actually, I had my son tested for it because he came down with some some fairly high fever for about a week.
Thank God it turned up negative.
But that test is the kind of general test that people seem to be talking about.
There are a few different versions that have been talked about.
How fast are these tests in the turnaround time?
How accurate are the tests also?
Because early on, we were told that these things could be wrong 20 percent of the time.
So you could be testing negative and you're actually positive or you could test false positive and you're actually negative for it.
So how accurate are the tests?
And how fast is the turnaround time on the sort of tests we're talking about that are supposed to test for contemporaneous presence of COVID-19?
Right.
So these tests are real-time PCR.
And what you're doing with these tests is you're amplifying or making copies of the virus's RNA, its genetic material.
And then you're trying to detect that RNA and match it against probes that you have that are specific to the coronavirus, to this novel coronavirus.
These tests can be relatively fast.
Some of the machines that are point of care diagnostics that might sit in a doctor's office can return results within, let's say, 45 minutes.
Things like the Cephi GeneXpert platform.
Others might take longer where you have to run the tests overnight or it might take a few days.
And the reason is because to run these platforms, you do something called multiplex, which is you run multiple tests at the same time and you do that for efficiency.
And so you might, if you're a laboratory, you might need to get 100 or 200 samples in and run them all simultaneously.
So you need to wait for the samples to come in.
So that's why sometimes there's delays in getting back results.
And so oftentimes you have to wait overnight to get results.
The academic labs, which are adjacent to hospitals, the laboratories that the hospitals stand up, those oftentimes return results the same day.
And some of the big laboratories like Quest and LabCorp, when you put a rush on those tests, you can oftentimes get back results the same day if you need it for decision making in a healthcare setting.
OK, so I want to ask you a couple questions in a second about antibody testing.
First of all, I want to ask you what a testing regimen would actually look like across the country.
And second, whether a lot more people actually have COVID-19 than we have previously thought.
We'll get to all that in a second.
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You, me, my show's advertising partner.
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So, this leads to kind of two paths of questions that I wanted to ask you about.
One is, what can we actually expect from a testing regimen?
And the other is, looking at the prevalence of COVID-19 antibodies in the population.
And you referenced a study that came out today, the Santa Clara study, that talks about the prevalence of antibodies in Santa Clara, which is multiple times, as in 50 to 85 times, according to them, the number of cases present in Santa Clara that were actually identified.
What does that mean for public health?
So I want to start with the first question, which is what are the limitations of testing?
We've heard if we ramp up testing to 750,000 or a million tests a day, that this is going to lower the rate of transmission, allow us to identify hotspots.
How would that work in a country of 330 million people where presumably community infection is still going to take place, where this is asymptomatic?
Where we're not going to have 45 minute turnaround, presumably for most businesses.
Presumably for most businesses, you're going to see three, four day, five day turnaround at best.
Is it really realistic to suggest that we can ramp up testing to the extent that we could be able to lock this thing down in a seriously measurable way?
Well, we're never going to fully lock this down.
This is a highly infectious disease.
And as you said at the outset, a lot of the spread is from people who are asymptomatic or mildly symptomatic who may not present for testing.
You try to do the best you can.
I mean, you try to mitigate large outbreaks and certainly another epidemic.
And the most efficient way to do that is to have a broad testing regime where people can get tested very easily.
So if they have certainly signs and symptoms of coronavirus, they should present to a doctor to get tested for it.
But even if they have mild symptoms, if they have cold-like symptoms, you want to have testing really accessible so people can get swabbed all the time to make sure that they're not one of the people who has coronavirus but is mildly symptomatic so that if they are, they can self-isolate, they can avoid family members who might be vulnerable to the infection.
That's the way you cut down on the rate of transmission.
The reality is I don't think we need to scale up testing that much from where we are right now.
Our capacity right now is probably about a million tests a week.
I think if we got to 3 million tests a week capacity, that would probably be sufficient to do what we call sentinel surveillance.
Basically have enough testing being done on a regular basis that if there are outbreaks of any size, you know, if there's a couple of hundred cases within a city, you're probably going to be able to detect it.
And the reason I use the number 3 million is because there's about 3.8 million encounters with primary care doctors every week.
And so it's not unreasonable to say that, you know, for the foreseeable future, for the next six months, while we're worried about another epidemic, everyone who's presenting to a health care provider for routine primary care, regardless of what it's for, should probably get swabbed for coronavirus.
If you had that broad testing in place, now granted that's a selected population.
Some people are presenting because they're sick.
Some people are presenting for things like just routine health care or maybe because they sprained their ankle.
But if you're testing that broadly, it increases the odds that if there is an outbreak in a city, you're going to see it when there's Maybe hundreds of cases and before there's thousands of cases.
And when there's hundreds of cases, that's enough to be able to intervene.
That's a low enough number that you can actually intervene to try to contain the outbreak and not let it become epidemic.
So when you talk about containing the outbreak, would that involve locking down that specific area?
And how would contact tracing come into play when it comes to stuff like that?
So let's say that you've been able to identify an outbreak.
The outbreak presumably has taken a week to materialize fully because people have to infect each other a little bit.
Can you really backtrace contact tracing to a couple of hundred people in a city?
Is that really a possibility?
Or at that point are you looking at, you just lock down that area and you hope that it sort of peters out elsewhere?
Well, you don't want to lock down an area.
What you want to do is the contact tracing.
You want to do what we call case-based interventions, try to find people who are sick.
And, you know, if you have hundreds or even low thousands of cases, yet you can very efficiently do contact tracing.
We do it all the time for things like measles or multi-drug resistant tuberculosis.
So this is sort of the bread and butter of public health work.
In fact, we were doing it early on in the case of coronavirus as well.
It's just that the number of infections ended up exhausting our ability to do this.
And what it is in the simplest form is you wanna do two things.
The first is when people are infected, you wanna ask them to self-isolate for the duration of their illness.
So they should stay at homes because they're infectious.
I think if we're gonna ask people to self-isolate, we have to think about what we're gonna do to make sure that they're compensated so they don't lose wages and maybe even compensate them directly for some of the burden of self-isolating.
If we're asking to do that for societal good, What you don't want is a regime where you're asking people to self-isolate and they're losing wages, and so being diagnosed with coronavirus becomes something that's punitive.
So we need to think about that from a policy standpoint.
In terms of the contract tracing, when you do identify positive people, then you want to interview them and find out who they've been in touch with.
And you want to get in touch with those people and offer them the opportunity to get tested as well.
And that's how you can cut down a spread.
Nothing's going to be foolproof.
It gets back to what we started talking about with the temperature checks.
This is sort of everything's Swiss cheese.
But if you stack up enough layers of Swiss cheese, eventually you can get something that's impervious.
That's the goal here.
You're trying to get layers of protection in place that are the least intrusive measures possible so society can get back to normal life, but you can have some measure of protection.
You're not going to protect against outbreaks.
There's going to be isolated outbreaks.
This is a fact of life.
We always have outbreaks of infectious disease.
What you want to do is protect against large outbreaks and certainly epidemic spread on the proportion that we're having right now.
The other sort of avenue that I wanted to explore here was the antibody testing that's been done.
We've now had some antibody testing done in Iceland.
We've had it done in Germany.
There's a town in northern Italy where they did some antibody testing and now we have this antibody testing in Santa Clara.
And it tends to show, even in very small kind of ways, there's a study of pregnant women in New York City.
Showing that a multiple of people who are actually symptomatic have actually had this thing, and that it may in fact be a very high multiple, which of course is good news and it's bad news.
It's good news in the sense that it really does bring down the case fatality rate.
We're seeing case fatality rates that are maybe an order of magnitude.
If these studies are correct, at least an order of magnitude, maybe an order of magnitude times two, like 20 times or 30 times higher than the actual case fatality rate.
On the bad news, that means this thing is super duper transmissible, which means that if lots of people get it, lots of people die, even if the case fatality rate is low.
With that said, doesn't that just mean that what we really ought to be doing is looking at tranching the population?
A lot of the measures that seem to have been taken almost seem to treat populations as fluid, as though people who are elderly are getting this at the same rate as people who are younger, or that people, well, sorry, dying from it at the same rate as people who are younger, or that people who are younger are as vulnerable.
We keep hearing from public health officials Things like, yes, it's more dangerous for elderly people, but young people are dying of it, too.
And young people are dying of it, too.
That's true, but on a rate basis, it's extraordinarily different.
I mean, if you are 80 to 89, there's maybe a 20% chance that you die of it if you acquire it.
If you are below the age of 25, there's almost a 0% chance that you die of it if you acquire it.
Is it responsible?
Not separate out the populations every time public health officials and media experts and members of the government talk about this thing, because if we're talking about reintroducing people into the business workplace, isn't there a case to be made that we really should be pursuing in the long run what Sweden has done?
We just had to lock down first?
That basically if you're young and you're healthy, you put on a mask, you social distance and you go back to work?
Let me just touch on the first point that you opened up with about the antibody test and what the rate of infection is.
It's probably the case that we're diagnosing 1 in 10 or 1 in 20 infections.
So we're missing a lot of mild infections.
We're missing a lot of asymptomatic infections.
The number of people who are asymptomatic, there's been various studies that have looked at this and range from anywhere 20% of people on the Diamond Princess were asymptomatic.
Now, that's a selected population, older population, so they might be more likely to become symptomatic.
Some studies have shown as many as 50% of people are asymptomatic.
Most folks are going by the notion that there's probably 25% to 30% of people who are asymptomatic.
When you look at populations as a whole across the United States, it's probably going to be the case that the overall exposure to this has been relatively low, somewhere in the order of 2-5%.
In Santa Clara, where That was a hot spot.
I think the study that you referenced showed 2.5 to 4.6 percent positivity.
So the exposure on those antibody tests was 2.5 to 4.6 percent.
So relatively low.
Certainly not the kind of 50 to 60 percent exposure that you need to have herd immunity where it's not going to spread.
I suspect when we look at New York, we're going to find higher rates of exposure.
So if you look at the fatalities in New York right now, 11,477 as of yesterday.
If you assumed, we've only diagnosed, I think, over 100,000, but less than 200,000 cases in New York.
But if you assumed actually that a million people had coronavirus in New York, and we just didn't detect most of them, that still puts the case fatality rate at over 1%.
If you assumed 2 million New Yorkers had it, which I think would be high at this point, around 25% of the New York population.
We might get there, but I don't think we're there right now.
That would put the case fatality rate at 0.5%.
So significantly more than the flu.
Very high for something that's this That's this transmissible.
In terms of the issues around who's at risk, there's a lot of people at risk for this.
It's not just the older populations above 65.
There's a lot of hospitalizations for under 65.
There's a lot of people under 65 who are doing poorly or only surviving after prolonged hospitalizations.
But some of the risk factors beyond just age are things like diabetes, pulmonary disease, you know, chemotherapy if you're immunocompromised heart disease.
And so you start to scope in a broader section of the population.
10% of the population is diabetic.
Obesity seems to be a risk factor as well.
And so that doesn't just cut across the older populations, but younger as well.
And when you look at the fatality rates across the age spectrum, it's true that they spike up among the older cohorts.
But even for a 45-year-old, and I paid attention to this being around there myself, the case fatality rate's about 10 times flu.
So the case fatality rate for a 45-year-old is about 0.2, depending on what study you're looking at, sometimes a little bit higher than that.
The case fatality rate for flu in a 45-year-old is 0.02, maybe less, and so still 10 times the case fatality rate, the lethality of flu.
So, it is true that younger people are doing better than older people, but younger people are still at risk from this, and so I think the notion that, you know, if you just sort of let it loose in 40- and 50-year-olds, you're going to have a lot of morbidity there, too, and some mortality, but certainly a lot of morbidity.
So when you look at trenching populations back in, let's say that you're under 40 and you're healthy, and people are wearing masks and socially distancing.
What Sweden seems to have basically said, if you're older or you're vulnerable, it's your choice, but you really should stay at home.
And if you are younger, yes, you should engage in the social distancing to prevent exactly the sort of infection of people who may be vulnerable that we're talking about to prevent sort of widespread of this thing.
But if you're younger and you want to undergo that risk, then that's basically what you're going to have to do.
It seems like That is likely to happen with some level of testing just to identify epidemic hotspots.
Do we basically look like Sweden?
And was Sweden right, do you think, to not lock down at the beginning?
Or we're not going to be able to judge until a year has passed and we see what a second wave looks like?
Yeah, I think it's good.
I think being able to judge whether what we do is right and wrong is going to take time, because we don't yet fully understand the costs of what we've done.
I mean, beyond just the economic costs of what we've done to try to break this epidemic, and whether or not we're able to recover from that in a timely fashion, there's public health costs to what we've done.
So you're weighing the public health cost of the epidemic against the public health implications of what we've done.
If you look at data, vaccination prescriptions are down 80% since the pandemic started.
Now, those are some people who aren't going to get vaccinated.
Are we going to see outbreaks of measles because of that now?
People aren't presenting with heart attacks and strokes.
That's not because they're not having heart attacks and strokes, but they're staying home.
I saw data on people missing chemotherapy rounds.
And so there's going to be public health implications from that as well.
And it's going to take time to measure the full cost of that.
Now that said, this was a very broad epidemic in the United States that we were losing control of.
And so the only thing we had left were these population-based mitigation steps to try to break that epidemic.
I think now that we've done that and Now that we're going to be exiting the epidemic phase of COVID-19 in the United States, I think we're going to move to something more akin to what you're describing, where over the month of May, as we slowly return to work in a gated fashion, initially what's going to happen is people who are vulnerable to this virus because they're older or because they have one or more comorbidities
are going to be asked to stay at home initially for a week or two while everyone else goes back to work, and we make sure that we can do that safely without seeing a resurgence in the virus.
Because what we want to avoid most of all is what's happening now in Singapore and Hong Kong, where you're seeing a second wave.
I don't think we can afford to have a second wave in this country.
We can't go through what we've just gone through in terms of the economic costs of the stay-at-home orders and of this economic shutdown.
And so we need to make sure we get this right.
Speaking of the second wave in Hong Kong and Singapore, those are places that have fairly heavy testing as well as contact tracing.
I mean, it's one of the reasons they're able to lock down without completely locking down their economy in Singapore, for example.
And yet they're seeing a second wave anyway.
What do you think is the possibility that we actually avoid a fairly significant second wave?
I mean, really, I mean outside of New York City.
I can't imagine a situation in which there isn't some sort of second wave in New York City simply because Of the population and because of the what I mean just the population size, the density, the fact that everybody's using the subways, you know, it's it's it's hard to see how New York goes back to work anytime soon.
But the rest of the country is not New York, which which does suggest that maybe a federalist solution is the best solution here.
This is why I think the administration took the approach that it did where it gave a lot of discretion to local officials and governors because this isn't a one-size-fits-all epidemic and different parts of the country face different risks.
Different parts of the country have different resources than other parts of the country.
So if you're a more rural state, you're naturally socially distancing.
If you don't have the same density of population, but at the same time, you might not have a good health care infrastructure.
So you might be at more risk from that standpoint.
You might not be able to sustain an outbreak.
And so local officials and governors need to make those decisions.
And we've by and large done that.
And you've seen states take different approaches to how they've even implemented stay at home orders around the country.
And I think we're going to see that on the way out of this as well, where certain parts of the country, probably the tri-state area in New York, is going to be slower to go back to work and open things up versus other parts of the country where you didn't have epidemic spread.
The reality is any part of the country is at risk for this because it only takes a handful of index cases to turn into an epidemic.
Now, getting to the heart of your question, I think as we transition in May, we'll slowly transition back to work in May and June.
I think it's going to be a six-week to two-month effort to get people back to work.
I'm hopeful July and August, the depth of the summer, are going to be some kind of backstop against transmission.
There probably is some seasonal component to this coronavirus.
Most coronaviruses don't circulate in the summer.
Now that said, this one is likely to circulate in the summer because it's so novel.
We have no cross immunity.
But hopefully it doesn't circulate as readily as people are outdoors more so the epidemiology of spread changes and also droplet transmission becomes less efficient in the hot humid months.
So assuming we can get through this summer, we make a transition back to work, people are naturally skittish.
So they're not going back to all the activities they were doing.
And that's going to help break chains of transmission.
The fact that people are just going to be more cautious.
And then we get into July and August when things are slower anyway in the summertime.
I'm really worried about September.
I'm worried about what happens when we come back in the fall and you have residential college campuses back in session, schools back in session, people back in offices, and people are feeling more confident so maybe they're letting their guard down a little bit.
The mitigating factor there that I'm hopeful about is that we're going to have a different toolbox.
We'll have the testing in place, so we'll be doing that broad surveillance testing that we talked about at the outset.
And I'm hopeful that we'll have one or more therapeutics that can help rescue people, people who are vulnerable to the infection.
When they present to the hospital, they can get a dose of a drug, one or more drugs, that can help mitigate the infection and reduce the chances that they have a really bad outcome.
I'm hopeful we'll have that.
I think we'll have it.
We shouldn't be able to have it if we can pull through Thank you.
They're not going to be cures, they're not going to be home runs, but they don't need to be.
It's a very difficult time, I think, for a lot of Americans, not just because of the obvious, but also because it's a time when we have to listen to the experts, but the experts also don't know a lot about the virus.
I mean, the virus is a mystery.
And so one of the factors that's been sort of a problem is the criticism of the modeling.
So I've looked at, for example, the UW model, which changed over time in terms of the number of Because it was it was curve fitting.
I remember I asked you about this on Twitter because it was curve fitting.
The new data that was coming in was changing the number of hospitalizations that were suggested, the number of beds that were suggested, and all the rest.
People were obviously critical of that Imperial College model that originally had suggested 2.2 million deaths with no social distancing or anything at all.
And then as soon as the social distancing kicked in, they said, OK, well, this has changed the curve.
And so now it's only going to be 20,000 deaths.
Looking back on some of the models, as we get more information about the transmission rate and the fatality rate, do you think that the models could have been better?
Was it basically just people doing the best that they could?
Why do you think that the models were so off when it came to the number of ICU beds and ventilators that would be necessary in the UW model, for example?
Yeah, you know, people want to think that the models are dynamic and they're making all kinds of considerations about the impact of our policy decisions, and they're not really doing that.
As you said, they're fitting curves to lines and they're using some of the past experience to predict the future experience.
And it's not like forecasting the weather where you sort of make the prediction and you go away and see if it turns out to be correct.
You make the prediction and then you're starting to take policy steps based on what you're predicting and that's going to ultimately affect the outcome.
And that's what happened here.
You know, I think that there were a bunch of us who felt that the initial IHME model, and that's the University of Washington model you referenced, and that was the one that was being closely looked at by the White House, That the initial predictions around upwards of 250,000 deaths was high.
It felt very high relative to what you could sort of project on the back of an envelope in the United States if we were going to get this under control.
I think where it is now is probably more akin to where it's going to end up.
I think that the model right now is predicting around 60,000 deaths.
We might end up a little bit below that.
We probably have two more weeks of you know, more deaths associated with this illness at high rates because there's a delay in time to death here of three to six weeks.
And so you have a lot of people hospitalized now, a lot of people in the intensive care units, many of whom are going to succumb to the infection.
The rates of death once you're intubated is very high related to this infection.
But even if you impute those assumptions, you're probably going to get to something close to where the models are, maybe not quite there, maybe a little bit more.
But I think the models are more in line with where this epidemic is going to turn out.
The sort of uncertainties for me two weeks ago, and if you go back and look at my Twitter feed, what I was worried about was, With some of the states that were late to implement mitigation, but showed a rising number of cases, and they weren't testing that much, so you were worried you didn't have a great sense of what the overall background rate of infection were.
And those were states like Georgia and Texas, maybe Louisiana and Florida, Alabama.
I think that those states, Georgia and Texas in particular, we see declining infections.
Florida and Louisiana, we have a pretty good handle on the course of the epidemics there.
Louisiana turned out to be worse than what was being anticipated.
I think Florida is in line with what many people were anticipating, but Georgia and Texas in particular, you haven't seen an explosion number of cases and that's all hopeful.
I think we're really coming through this as a country and you're seeing declining rates of infection everywhere with the exception of a handful of hotspots where you're still seeing growth in cases, you know, selected counties in some selected parts of the country.
So looking at the possibility of a second wave, what would that look like?
Would it be as severe as the first wave?
We know with the Spanish flu, obviously, the second wave was a lot more severe than the first wave.
As people go back to work, if there is a second wave, and if, as you say, it sort of dies off a bit during the summer, people are outdoors more, And then everybody goes back to school in September, but grandma and grandpa are coming over and the social distancing has started to go by the wayside because you've got 100 kids in the school and you only have two rooms.
Then what exactly do you fear that a second wave will look like?
And over the course of a year until we hope a vaccine is developed, what do you think is a realistic number for Americans to have in mind?
Well, I'm really hopeful that we're going to have a much different set of tools and we can mitigate really large outbreaks or certainly epidemic spread again.
But there is a possibility that you're going to see sizable outbreaks within cities and you're going to have to adopt some element of social distancing within those cities.
You'll see maybe schools closed for a week or two.
You can see public transportation closed or reduced schedules in cities.
You can see orders for businesses to try to allow employees to telework, maybe closing indoor spaces that are for entertainment only, like bars and restaurants and movie theaters.
Those are all possibilities if you have a city that's having a sizable outbreak.
But I think we're going to be in a better position to both detect outbreaks while they're still small, try to contain outbreaks, and adopt some measures earlier in the course of an outbreak so you don't get to these really big outbreaks or epidemics spread again like we're experiencing right now.
So you don't have to go back to what we're doing now, which is basically a national shutdown simultaneously across the whole country.
I think we should be in a much better position to address this going forward.
But this is going to be a constant challenge.
I don't think this goes away until we get to a vaccine.
I think there's always going to be cases.
I think you're going to see spikes in cases and flare-ups that are going to be on a regional basis.
Every part of the country is vulnerable to an outbreak.
And this is going to become a fact of life that we're just going to learn to live with.
I think certain things that we do are going to change.
I think our habits are going to change.
How we practice hygiene.
I think masks are going to become more fashionable.
People are going to be more conscious of hand-washing.
I think a lot of businesses are going to advertise that they test their workers or that they clean shared spaces.
You're going to see airlines talking about what they do on hygiene related to travel.
Ubers maybe are going to do that.
So I think things are going to change.
Just like After 9-11 there were certain things that changed.
I don't mean to compare this to 9-11 at all, but after 9-11 we had certain security features that just didn't go away.
We never took our shoes off in airports.
We never handed in ID cards when we went into buildings.
There's going to be certain things that change around society that we never did before that we're going to do now going forward because of our heightened awareness of the risk of spread.
The good news, if there is any, is that we're going to get some benefits for that, not just in terms of reduced risk from coronavirus, but we'll probably have shortened flu seasons.
We'll probably have less death and disease from flu, because all the things that we're doing to cut down the risk of coronavirus are going to cut down the risk of transmission of flu.
And we're oddly complacent about flu.
We let flu infect far too many people each year.
And if we can cut down the rates of flu transmission, that's going to have some real economic benefits.
It's going to be captured in the form of significant productivity improvements that are going to be measurable.
So you sit on the reopening the country council for the president.
How has that been working?
How does that council actually operate?
Well, I think it's more of an advisory board, and I don't know how they're interfacing with other members on that council, but I've had discussions with various people in the White House about aspects of You know, both the public health response to the epidemic right now, as well as steps to try to reopen work and restart the economy.
And I published a number of papers.
A lot of the most of the private advice that I'm giving is the same as the public advice that I'm writing about.
And so I've published a number of papers that mirror the kind of private advice that I'm giving the administration on steps to, you know, effectively and efficiently, but also safely reopen the economy and do it in a staged fashion so we can mitigate the risk of, you know, So, looking at sort of how this has all been treated by the public and in the media, and how everything becomes very polarized very quickly, a lot of time has been spent looking retrospectively at what the administration could have done better.
I've looked at, obviously, the timeline here, and it seems to me that, aside from you, you were calling for pretty serious measures in late January, A lot of people were saying that coronavirus might be serious, but the kind of measures that they were actually proposing didn't start to get serious until early March.
By mid-March, the country was already looking at lockdown.
If you look at Europe, a lot of places were not issuing full lockdown orders until about the same time.
France and Germany.
Germany was early.
France was a little bit later.
France was like mid-February.
Sorry, mid-March.
Already, UK was about the same time as the United States.
How do you gauge the America's federal and state response, too, because there were a lot of state and local officials who also didn't get on the game until early March.
I remember being kind of bewildered as to why the mayor of Los Angeles was allowing the LA Marathon to go forward on March 8th, I believe it was, while at the same time everybody was starting to take this thing very seriously.
How would you gauge the United States' response retrospectively?
Well, the kinds of things that I was calling for in January and even into February was more diagnostic screening.
I had written a number of articles in January talking about the importance of getting the clinical labs and the academic labs in the game, starting to get them stood up to do testing.
And what I wanted to get into place at that time was what we would call a sentinel surveillance system.
And the idea would have been that For people who present with flu or flu-like symptoms and get tested for flu and are negative for flu, you'd want to be testing those samples for coronavirus.
And had you had that in place, my belief was at the time that you would have been able to detect outbreaks of coronavirus earlier while they were still small.
About of the people who present with flu-like symptoms and get tested for flu, only about 30% on any given week, and it varies over the course of the flu season, actually test positive for the flu.
So the question is, what do the rest have?
Oftentimes they have adenovirus or RSV, respiratory syncytial virus, or they might have another coronavirus.
But if you were actively testing for coronavirus at that time in January and February, my belief was you might have been able to detect Outbreaks.
And in fact, the first outbreak that we detected was in Seattle, and we detected it from some testing that was going on by a group of researchers of people who were presenting with flu-like symptoms and testing negative for flu.
They just started randomly testing those samples, and they discovered there was an outbreak there.
Which gets to the second part of your question, which is, how did we do?
The reality is, I think, when we look retrospectively, the cities and states were slow to implement mitigation steps here.
You know, New York, I think, has done an admirable job over the recent weeks and faced an outbreak of a proportion that nowhere else in the world, maybe even Italy, has faced the same proportion of infection that New York's faced.
But they were slow to implement mitigation steps in the city.
There's no question about that.
Slow to close the schools, slow to close the bars.
I think in particular, Seattle was very slow to implement mitigation steps.
And I was commenting on that at the time.
they had a sizable outbreak uh... and they weren't closing recreational indoor recreational venues like theaters and restaurants they they weren't closing their schools uh... well past the point that i think other cities ultimately made similar decisions to do those things seattle hadn't done that they were allowing cruise ships to leave from the port of seattle well after the point that we had multiple cruise ships with major outbreaks on those cruise ships and in fact there was a study out
this week that looked at cases of coronavirus in the state of Connecticut, where they sequenced those, and they found that, I think they sequenced seven or eight different strains of the virus from different people, and they found that they were related to clusters that were ultimately originated in Seattle in Washington state.
And so the upshot is that Seattle ended up seeding a lot of parts of the nation, and we're probably going to find that to be the case.
New York, it seems, was seeded by European travelers.
Seattle was probably seeded by travelers from China before the travel restrictions were put in place.
But other parts of the country were seeded by Americans.
They were seeded by New Yorkers and people from Seattle and Detroit and Chicago traveling to other parts of the nation, including the South.
So, final question for you.
As we look at reopening, you've mentioned mid-May to mid-June for the reopening.
Obviously, the President is pushing hard to do that faster in a wide variety of ways.
What do you think is the timeline for various states?
Because it is going to differ pretty widely by region.
What do you think a realistic timeline looks like by states and by industry, for example?
Right.
Well, look, I think some states are going to be much sooner than that.
I think, you know, the president talks about some states perhaps getting people back to work end of April, early May.
I think some states are going to be able to do that safely because they've had less spread.
Their health care system isn't exhausted.
They do have good testing in place.
Remember, this isn't sort of a binary switch.
It's not we all go back to work the same day.
Different states have had made different decisions about who isn't working.
So for example, my state, gardeners are working and some construction crews are working.
So people who work outdoors have continued to work.
But in other states, that isn't the case.
And so you could see some states making decisions to allow people who work outdoors to go back to work much sooner.
But then, you know, office workers go back a little later.
People can't naturally social distance on the job.
So it's going to be a gradual evolution of back to work over the course of the month.
I think some states that haven't had large outbreaks that have good capacity in place, probably going to make decisions early in May to start doing that, that gradual return to work.
I think states that have been hard hit, like the Northeast, are going to make decisions much later.
I think the New York tri-state area, probably not likely to see them start to send people back to work till mid-May.
I think that's a reasonable target.
And initially, that's going to look like, you know, staged fashion.
They're going to identify categories of work that can go back.
They're going to tell people who are older or have serious comorbidities that could make them more prone to a bad outcome to stay home for a little extra time, another week or two.
They're going to encourage businesses that can allow people to telework to continue.
They're going to put in place guidelines on how to create social distancing at work, things like, you know, you can't have meetings above a certain size.
You want to create physical separation, closed spaces where people congregate.
They're going to put in place guidelines for things like questionnaires when people return to work or fever checks, you know, because they, again to your original question at the outset of this, They're not foolproof, but they're additive.
They're another layer of protection.
So you're going to see all of those things factored in, and you're going to see a staged approach of sending people back to work, where you're going to send a group back to work, you're going to wait a week or two, measure to make sure there's no uptick in infections within that region, and then send another group back to work.
So I think this is going to be a gradual evolution that plays out over the course of May and June.
It's going to start in early May for some states, probably mid-May for other states.
But I think by mid-May, most states are going to be contemplating some back-to-work regime and doing it in hopefully as careful a fashion as possible so that we can mitigate the risk of a resurgence of this.
Dr. Gottlieb, thanks so much for being on the program.
Really appreciate the time, sir.
Thanks a lot.
You can hear me talk with Dr. Gottlieb about China and their faults in the outbreak.
If you want to go over to dailywire.com, if you want to hear that, just head on over to dailywire.com and click subscribe.
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helixsleep.com slash ben Steve Forbes is chairman and editor-in-chief of Forbes Media, a site synonymous with money.
He has been called on, along with Dr. Ghalib, to serve as a main thought leader on the Opening Our Country Council for President Trump.
He's the co-author of Reviving America, about how repealing Obamacare and replacing the tax code will restore hope and prosperity.
Steve's newest project is the podcast What's Ahead, where he engages top newsmakers, politicians, and pioneers in business and economics, and challenges traditional conventions.
Steve Forbes, thanks so much for joining the program.
Really appreciate it.
First of all, you're now on the President's Reopening Our Country Economic Council.
How is that council actually operating in practice?
What they're doing is just taking input from a number of people.
You read about the phone calls they did, marathon calls they did a couple of days ago for around the country.
I was part of those.
So you just provide input.
And what I like, though, is the way that this president, whether it's that activity or what he does at night with those pressers, is the way he always acknowledges the private sector and how critical that is.
I think that's the first presence of Ronald Reagan who's gone out of his way to say, this is how we make good things happen, especially in an emergency.
So, Steve, how exactly should we be weighing economic interests and public health interests here?
The president released his plan this week for reopening the country.
He mainly leaves it to governors, which is the appropriate response, because this is still a federalist country and localities do vary widely in terms of how they are going to treat this thing.
With that said, there's been this real push For lockdowns to be extraordinarily severe and last a really long time.
And even the White House plan suggests that widespread testing is going to need to take place.
I'm wondering realistically how that's going to ramp up and whether it's going to be effective, given the fact that there are now all sorts of studies suggesting really widespread prevalence of this thing in asymptomatic fashion.
Well, this is what happens when you just focus on one thing, and this was a terrible disease.
You don't want to get it.
It affects your lung, can affect your heart, your brain, everything else, not just a traditional virus.
And so a good response was needed.
However, we also have the fact that when you're cooped up, when you're confined, when your businesses are being destroyed, when you have 20 to 30 million people who are going to be out already, 22 million out of jobs, probably another eight or 10 million before this thing is over.
The psychological costs, the mental costs, what you're going to see in addiction, alcohol consumption, abuse at home.
The line question is, when does those lines cross?
And I think they have crossed other than certain hotspots like New York.
I live in New Jersey, which is probably the worst area right now at this particular time, but that's different from other parts of the country.
So a variated approach is absolutely appropriate.
And while we're not going to test everyone, I wish they would do much more on testing like they have with ventilators and other things.
So the people can go out and have some reassurance that, by golly, they don't have it, that they can in five minutes find out if they do have it.
And what we hope to have in the next few months, and this is where I wish they'd put really a real ramp up on it, to have a test on this COVID-19 be as routine as taking your blood pressure so that you can periodically see, do you have this thing?
And I think the great news today from Gilead that it looks like we might get a vaccine far sooner than we anticipated.
All this goes to show when you apply real brain power, this thing can be done quickly.
But what really annoys me is the way the federal government, and this is Congress especially, but also the Federal Reserve, has been laggard in getting real aid to small businesses.
We know that first fund just ran out.
Congress, Nancy Pelosi, we're not eating her $20 ice cream.
There's a blocking getting another $250 billion.
And the Federal Reserve has been dragging its feet on this so-called Main Street lending program, putting in crazy restrictions like high fees, high interest rates and the like.
You got to throw caution to the wind and just get the money out.
We can clean it up afterwards.
But when they talk about stimulus, you want to have an economy out there that you can re-stimulate.
And that's where I think, on the small business side, they're lagging.
So on an ideological level, there's been a lot of criticism of conservatives.
Suddenly, where all socialists goes the cry from people on the left.
My take on this has been that this is basically a governmental taking.
What we've seen here is the government coming in and destroying people's businesses, maybe for good reason, maybe in overblown fashion.
And that if you destroy somebody's business for a public purpose without just compensation, it's actually a violation of the Takings Clause of the Constitution.
That the government actually does have to compensate you for destroying your business forcibly the way they've destroyed Literally hundreds of thousands of businesses across the United States.
How do you think conservatives and libertarians should look at programs like the ones that are currently being espoused?
Well, this is insurance.
This is lifelines.
These are not permanent programs and should not be permanent programs.
And that's going to get to a real fight in this fall.
One of these key elections in American history.
We have them every 40 years.
The last big, big one was 1980.
What kind of country do we want to be?
Where do we want to go in the future?
I think things have happened in such a way.
The landscape is changing so much.
We're going to be able to do things if we push to make positive moves forward that we haven't before.
But in the meantime, anything you can do to hit people who are hurt by government action, not because of their mistakes or something like that, is absolutely fitting and proper.
One of the things I've been pushing with the president, as have others, is to suspend for a year the payroll tax, 15%.
That's a trillion dollars.
You don't know administrative costs.
You just don't collect the tax.
And what that means is working Americans get a $500 billion raise over the next 12 months.
We're making $40,000 a year.
That's a $3,000 raise.
Employers get a $500 billion reduction in labor costs.
So you keep people on longer, more willing to hire people.
That's instant.
And by golly, it has an enormous short-term impact.
So those are the kind of things we should be doing.
Massive programs to get the Fed just shoveling, have the bank shovel out money to small businesses.
Get this payroll tax suspension, and have a sensible way of reopening the economy.
My area may be a laggard, but other parts of the country can open up.
And we will recover.
We've seen already the pent-up energy in this country.
People wanting to get out there, do things, make things happen.
And it turns out, contrary to what Russia and China think, and Iran thinks, that we're a nation in decline, we're still a very strong nation with a good civil society out there, despite everything.
When it comes to rebuilding business and the sorts of loans that should be available and how we determine, you know, who should get a loan and who should not.
So the basic rule right now has been if you were damaged by government action, then you get a loan.
On the other side of that, there's a case to be made that there are going to be some fairly large systemic changes to the American economy, at least in the mid to in the short to mid term in the United States.
Travel industry is going to get absolutely decimated.
We know that the hotel industry has been decimated.
We know that that restaurants, for example, are being decimated.
They've been told that they can only go delivery only.
And for the foreseeable future, it is very likely that states across the country are going to be forcing social distancing at restaurants, which means that if you run a small bodega that only has four tables, you now only have one table, which means that you're in serious trouble.
With all of that said, it does mean that a lot of the businesses that are currently taking out loans, yes, we're filling them in for damage that's been done by the government.
But at the same time, they're very likely to fail after the economy comes back online if there are systemic changes in the way that the market itself is and the way that demand itself is structured.
How should we balance those risks?
Well, there's no question real damage is going to be done, and that's why the length of these loans should be long.
Instead of two years or four years, do ten years and try to make sure as many of these entities that can survive can survive.
And the criteria is very simple.
This is why the community banks have been playing such a key role.
One, they're getting the money out faster than the big ones.
But number two, they know which of their customers are solvent and which weren't solvent before the crisis.
And if the Federal Reserve backstops and says, keep those people going as long as you think it's prudent to do so, and we'll backstop you.
We won't gig you in terms of regulatory actions.
So yes, there'll be damage, but we can minimize the damage.
And in terms of social distancing and the like, this is where testing is very important.
We're doing about 130,000, 150,000 tests a day.
We should be doing a million, million and a half tests a day because people want to interact with other people.
And if you know, you don't have the virus or you know, you've got an immunity to the virus or finding out that there are various gradations of immunity.
I never knew that before.
We can test for that.
If people have some assurance that they can get a clean bill of health, and this is where hydroxychloroquine and other treatments are out there, that even if you get it, you can get a good treatment, effective treatment within three to six days.
So it's not perfect in the real world.
But as more than one doctor has said, when we pull out of this lockdown, there are going to be deaths.
And whether you do it or you don't.
And I think we're reaching the point where in much of the country, we've got to open up.
It's not going to be perfect.
Democrats are going to blame every COVID-19 death on Donald Trump.
He plotted in Trump Tower, you know, all that kind of nonsense, but it's going to be there.
But so be it.
Most of the American people know what, what happened.
And also too, in terms of people worrying about waste, Treasury's worried about, well, we're going to lose a lot of money in these loans.
So what?
When you're in a war and this is the equivalent of a war, There's going to be a lot of waste.
There's going to be a lot of mistakes made.
And afterwards, you can clean it up.
But first, you've got to deal with the crisis at hand.
And that should be the criteria.
Not trying to behave like a bureaucratic banker in normal times.
This is not normal times.
Not by a long shot.
When it comes to how we fix this when this is all done.
So let's say a lot of money is lost for this.
Presumably there are a lot of loans that will just be defaulted and the government will eat the loans.
Obviously the Federal Reserve is now injecting trillions of dollars into the system or they're supposed to be injecting trillions of dollars into the system.
Yeah, it's supposed to be.
One of the theories that's been bandied about by folks on the left, Elizabeth Warren famously was pushing this, was modern monetary theory, which is basically the idea that the dollar is a magical tree and that you can just continue to spend money and at no point will the bill actually come due.
Well, this has accelerated the sort of support for things like that because we are spending without limit and without apparent end.
We were before.
I mean, we were already spending enormous amounts of money we didn't have.
Now we are radically ramping that up.
And there are a lot of folks on the left who sort of want to make that Permanent and are saying, well, look, there's still appetite for American bonds.
There's still the American dollar remains strong.
There is an alternative to the American dollar.
What do you say to people who say, OK, well, listen, we're spending internally now.
Why can't we just spend eternally in the future and restructure our entire economy on this basis?
Yeah, tooth fairy monetary theory doesn't work.
Just look at Germany in the early 1920s or Venezuela today.
People still trust the dollar because they know there's still a very strong economy here in the United States.
And in terms of how we should be financing this stuff, yes, there is a very real danger of inflation down the road.
The Fed doesn't know much about inflation, even though it's in the business of trying to combat it.
It doesn't know how to combat it.
That's why one of the things that should be done is for the government to float 100-year bonds with, say, a 2% coupon.
That way you tap existing savings.
You don't print the money in effect.
You mobilize existing savings here and around the world.
to finance these temporary programs.
That's not inflationary.
It's a cost, but it's not inflationary.
And that's the real danger.
How do you finance all of these rescue programs?
There's a right way to do it and a wrong way.
I just get the feeling, you look at the gold price above $1,700 an ounce, it's sort of signaling, maybe the Fed doesn't know how to deal with it when this crisis is over and we have all of this liquidity out there, how to make sure we keep an economy going without a resurgence of inflation.
Now, when we look at the White House plan, one of the things that actually concerns me is that it might actually be too restrictive in some ways, meaning that in order for states to start to release lockdown, there's a suggestion there has to be a 14-day period of decline in the number of diagnosed cases, or at least in the number of cases as a percentage of the total number of tests that are being taken.
And I wonder if that's not too optimistic, specifically because one of the things that you could easily see happening is a 14-day decline.
Day one, we open up, and magically, because now people are out there infecting each other, the numbers go back up again.
Does that imply a renewed lockdown?
And then on a sort of general level, you've been looking at various governors and how they treat this thing.
There does seem to be a fairly wide differential between governors in how they are treating this sort of stuff.
Obviously, Gavin Newsom in California has been heavily restrictive.
Andrew Cuomo, I think a lot more understandably, because New York is the epicenter.
California really has not been hard hit.
But New York, obviously, is treating this thing very strictly.
Mike DeWine in Ohio is treating this thing very strictly.
And then you have in Florida, not as strict.
In Texas, not as strict.
What do you make of the various governors' responses?
And are you afraid that the White House guidelines may, in fact, lead to lockdowns that are actually too long rather than too short?
No, I think it gives a wide latitude.
And this was a great compromise, you might say, of the fight.
Who has the final authority?
OK, governors, it's up to you.
And you see the federal system at work.
You mentioned it.
Also, Michigan.
We have a person there who, if you go in and buy hand sanitizer and buy a pack of seeds, you can get fined $1,000.
And if you go out in a motorboat, you can go to jail.
But if you go around in a UV vehicle roaring through the woods, it's OK.
And you see these varied responses.
But the nice thing about it is we're going to see what works and what doesn't work.
For example, the governor of South Dakota got slammed because there was an outbreak.
She hasn't locked down the state formally.
Well, it turns out it's a meatpacking plant and she couldn't have closed it anyway because it's considered an absolutely essential thing.
Food, yes.
And the rest of the state's doing fine.
So I think you're going to see Governors, because they want to please their people, are going to take a varied approach.
And people, I think, understand That if you get a brief surge, it doesn't mean you have to lock down.
You don't have to smother the economy.
You can focus on specific areas.
And you look at the mortality tables.
I saw it in a paper the other day comparing South Korea, Spain and other countries.
Well, no surprise.
Yes, there are some young people who have been hit with this thing, but by golly, no surprise.
Those of us are above 60, 65.
Especially 80 to 89.
The mortality tables, if you get this disease, are absolutely frightening.
Whereas if you're younger, not.
So you're going to see a much more, I think, nuanced and sophisticated approach.
And this is where testing will be helpful.
Massive testing will be helpful.
You can find out whether you may be having the thing.
Like just taking your blood pressure from time to time.
I think that kind of ingenuity nuanced approach is the only way you can go and instead of this one size fits all so some of us are gonna be slower than others but.
Hey, we're a big country and we're not all the same.
Do you have any window into, practically speaking, how the testing would be rolled out?
So everybody keeps talking about testing and we're doing 150,000 tests a day.
You mentioned earlier you'd love to see it at 10 times that.
Realistically speaking, is that a thing that's going to happen in the near future?
The answer is yes.
Whoever would have thought that ventilators, that companies could make the switch and do ventilators.
Abbott came up with this five-minute, 15-minute test, who had heard about three or four weeks ago.
They're working on it, and apparently their other companies have similar kind of technology.
So if you focus on redirecting resources to a few specific areas during this emergency, you can get testing at a very high level.
And again, I think that creates a comfort level that you can go out there.
And I think when we get more data in, on the vaccine that the Gilead may have that looks like it's got real promise.
We know hydroxychloroquine, especially if you do it early in the thing, has had some very encouraging results in France and elsewhere.
You're going to have other things coming out.
70 tests are already underway for vaccines.
So I think people will start to get a comfort level, especially younger people.
Now, people in my age bracket may not be so free, but that's one of the perils of living longer.
Realistically speaking, what do you think the final date is going to be for various states?
I know that obviously you're ballparking this thing.
President Trump suggested that by May 1st, there may be some reopening.
Even Governor DeWine in Ohio is suggesting that there's going to be some reopening of businesses by May 1st.
By what point do you think that most people are going to be heading back to their I think by the end of the month, everyone's sort of geared mentally towards it, that there'll be, where it can be, a movement in that direction.
Now, I live in New Jersey.
We're probably the worst area right now in the country, so it's probably not going to be May 1st, but in other parts of the country, and we're going to see within states.
Texas is a big state.
Dallas was shut down more than other parts of the state, so you're going to see variations within states.
And so I think we will, I think May 1st, let's call it May Day, a positive May Day, where Americans are going to be liberated and in a positive way and start to rebuild.
And it's, again, not one size fits all.
We're just too big of a country for even entertaining that.
Well, Steve Forbes, really appreciate your time.
Thanks so much.
And stay healthy and safe.
You too.
Thank you.
Steve Forbes and I also discussed what level of risk Americans should be willing to undergo when they go back to work.
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Well, hope you have a wonderful Sunday, and we will see you all here tomorrow.
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