Portugal Doctors Tout Steroid For COVID-19 Patients
GORANI: Ten U.S. states have seen a record number of new corona virus cases this week. Johns Hopkins University is reporting that nationwide more than 2.1 million people have been infected since the pandemic began, and in America over 118,000 people have died. On Thursday the U.S. Vice President Pence said, he was proud to announce that we slowed the spread of COVID-19 in his words. But CNN's latest projections show cases, in fact, increasing in at least 23 states. Obviously that's almost half the country. So where is the disconnect between this administration and the facts? Here with more is CNN's Chief Medical Correspondent, Dr. Sanjay Gupta. And Sanjay, I want to start with Florida, which is seeing a very sharp uptick in cases this week, and there are new projections that suggest it could become the new epicenter. And we were speaking with Rosa Flores in Miami who was saying that some hospital ICU beds are filling up very fast.</s>DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: yes, that's the big concern. We know that Florida is one of these states that shut down later than other states they opened earlier than other states, so we've been keeping an eye on Florida for some time. It's obviously a place where a lot of people travel to as well here, as for vacations and things like that, so it's been a concern. There's no mandatory mask policy, just basic public health, things like that, there is no mandatory policies across the state so it's been a concern and you can never say for sure when you're going to start seeing these spikes. But I think it was pretty clear to public health experts we would see spikes in Florida, which we are. Two points to make, Hala. First of all, while there is increased testing across the country, Florida's testing overall has been a little bit higher but mostly flat, so you can't say the more testing is sort of accounting for this increase in cases. The second thing, and Rosa mentioned this, is that, when it comes to potentially being particularly problematic, who are the people that are living in this state? They tend to be elderly. A lot of people who are retired move down there. They tend to have more preexisting conditions as a result, so not only do they have more people getting infected but more people who are likely to get sick as well. Remember, Hala, most people who get this infection, 80 percent are going to have minimal or no symptoms. But elderly people, people with preexisting conditions, are more likely to get sick. So Florida is a real concern right now in the United States.</s>GORANI: And there are other states as well, Texas, Arizona, the Carolinas all seeing a record high 7-day average of new cases, and we've been told that we needed to flatten the curve. But this doesn't look like these curves are flattening.</s>GUPTA: Well, you know, I sort of regret in some ways that flattening the curve became the sole metric of success. Flattening the curve, if you had to put that in medical terms, is sort of like we need to stop the bleeding, right? But it was never supposed to be about really reducing case numbers as we've seen in other places around the world into the teens or hundreds like we've seen in places like Italy. We have remained around 20 to 25,000 cases a day. And at that point we're reopening, which means the case numbers are going to go up without question. So it's almost like we stopped the bleeding for a period of time, but we're then going to let bleeding occur and then hopefully try and stop it again. It's really no way to take care of a patient, or in this case, no way to take care of a country. So, it's concerning. Flatten the curve was just a situation to not overrun hospitals. But if you truly wanted to try and bring this virus down into submission, you needed to actually do that, and we haven't done that in this country.</s>GORANI: And President Trump is still holding his rally tomorrow in Tulsa, even though the city just reported its highest number of new cases to date. In fact, even the President said some attendees may catch the virus, adding, it's a very small percentage. He's made people attending sign a form promising they won't sue if they get sick.</s>GUPTA: Yes. It's pretty remarkable, right, to think that you would attend a rally; you have to sign a form about this. But one thing I found interesting, Hala, it's hard to convey risk. What is the risk? Okay, we know it's riskier if you're indoors. We know it's riskier if you can't physically distance, we know it's riskier if you're not wearing a mask. I think people generally get that. But still how risky is it? I sat down with one of my analyst yesterday to try and put that into some context. What we learn is that, even before the rally even starts, there's probably in a gathering of 20,000 people in Tulsa, about 100 people who are likely to show up, who are already carrying the infection. They may not know it, they may not have any symptoms, but they're carrying the infection. Now in a situation like this, what we find is because of the crowding without masks and stuff like that, 20 of them are likely to be the biggest shedders of the virus. So 20 out of the 100. And they're likely to spread it to 40 or 50 more people. I know this is a lot of numbers here, but pay attention to these numbers because they make a difference. So, 20 people, 20 percent are likely to really significantly spread it to 40 or 50 people. So, what does that mean? That means 800 to 1,000 new infections now out of those 20,000 people. That's significant. Those people then go home to their communities they go to their families and potentially spread it even more. That is the anatomy of a potential outbreak. That's how these outbreaks, these clusters, occur, and that's exactly why public health officials are so nervous. You can't even predict who those 20 people are likely to spread it. You're not going to know that they're spreading it to their community or family until weeks after the fact. And then if people do get sick, it may be another few weeks after that. So, it's very challenging to control it, which is why people advocate not having large indoor unmasked gatherings where you can't physically distance in situations like this.</s>GORANI: Right, absolutely. And as you say, Dr. Sanjay, they'll go back to their communities all over the U.S., presumably.</s>GUPTA: That's right.</s>GORANI: It's not just a local thing. Thank you very much, Sanjay Gupta, as always. The World Health Organization calls it a potential breakthrough, a new study showing that steroids may give a fighting chance to hospitalized COVID patients who are very sick. Doctors in Portugal say one particular steroid contributed to their very low death toll, their relatively low death toll there. Fred Pleitgen is live in Lisbon. Fred?</s>FREDERIK PLEITGEN, CNN SENIOR INTERNATIONAL CORRESPONDENT: hi there, Hala, and all those says, many people predicted that the pandemic would hit Portugal extremely hard. Just to put this in perspective when the pandemic started Germany was the country that had the most ICU beds per 100,000 people in the European Union with about 29.2. Portugal only had 4.2. So, there certainly seem to be a really bad shape. But they did a lot of measures to try and clamp down on the pandemic, they shut down very early, they did mass testing. But they're also very early on using these Corticosteroids especially on people who are on ventilators in the ICU. And they say that two things happen.</s>PLEITGEN: On the one hand, they kept people alive. But they also got them often latest and out of the ICU quicker. Here's what we're finding out. Francisco Francesca is doing some heavy lifting. Building his new beach bar. A miracle he believes since he only recently recovered from corona virus including 7 days on a ventilator in a medically-induced coma.</s>FRANCISCO FONSECA, COVID-19 SURVIVOR: It was really painful, not the breathing itself, but the skin. And I knew it was not the skin itself, it was like the lungs.</s>PLEITGEN: Portugal seems to set up to be devastated by COVID-19 with among the fewest intensive care beds per capita in the entire European Union. But so far, the opposite is true. Portugal seems to have been very successful in dealing with the corona virus pandemic. And they say, key points of their strategy were, they closed down very, very early, and then they also did mass testing to try to mitigate the pressure on their medical system. One possible reason doctors in corona virus wards, like here at Lisbon's Central University Hospital, have for months been treating patients with steroids to combat inflammation in the lungs, the head of the ICU, Dr. Nuno Germano who tells me.</s>DR. NUNO GERMANO, HEAD OF ICU, LISBON CENTRAL UNIV. HOSPITAL CENTER: What we've seen with critical therapy is that, we're been able to reduce the inflammation and greatly improve their respiratory function of the patients.</s>PLEITGEN: About 60 percent of ventilated patients here are treated with steroids, including the 63 year old woman who was able to leave the ICU just one day after we filmed. A new Oxford study has now found this type of treatment can reduce the risk of death for hospitalized patients. And the World Health Organization calls it's a potential breakthrough. Dr. Germano says, it's an effective tool that help, keep the death toll for ICU patients at around 16 percent, but that's not all they're doing.</s>GERMANO: We have a team that does outreach that goes out of the ICU and observes patients. And what we do is we do early incubation and ventilation to the patients. So any patient which has signs of difficulty breathing and criteria that needs ventilation, we don't delay the intervention and ventilation of the patient. And we admit them early to the ICU.</s>PLEITGEN: While some other experts around the world say patients should only be placed on ventilators as a last resort, the medical professionals here say early ventilation in certain circumstances has been working. And it certainly worked for Francisco Francesca. He hopes that now that his health has come back, tourists will come back to Portugal as well and help him jump-start his business. So, it's obviously not only important for that gentleman that we had in that report, but for this country as a whole. And one of the things of course Hala that Portugal's is doing is it's actively saying, look, we managed to keep this pandemic under control, we still have it under control. And therefore tourists can now come back with confidence as the European Union is opening up many of the borders. However, the authorities here now also of course continuing to take a look at the situation. You have seen a bit of an uptick in new corona virus infections, especially here in the Lisbon area. And so, certainly, while the authorities here have managed to keep the virus under control, keep the situation under control, they do still have to look very, very carefully as they open up the country to make sure that there is not a new spike in infections, Hala.</s>GORANI: Fred Pleitgen in Lisbon. Coming up, black voters are promising to show up at the polls in November to vote against Donald Trump. Their motivation is the renewal of these anti-racist protests. And the U.S. President fights himself at odds with the social media giants. What they say he did that violated their policies.</s>DONALD TRUMP, PRESIDENT, UNITED STATES OF AMERICA: We've been really for many years, I would say.