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Speaker 1: Welcome to Prognosis. I'm Francesco Levi. Laura Carlson is out.

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Speaker 1: It's day one hundred nine since coronavirus was declared a

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Speaker 1: global pandemic. Today's main story. The virus still plagues many countries,

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Speaker 1: but in the six months or so since it first

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Speaker 1: emerged in humans, we have learned a lot about how

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Speaker 1: to treat it. That knowledge may help us save many

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Speaker 1: more lives than in the early days of the pandemic.

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Speaker 1: But first, here's what happened in virus news today. US

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Speaker 1: President Donald Trump is amping up pressure to send kids

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Speaker 1: back to school, regardless of the safety risks. Today he

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Speaker 1: blasted the Centers for Disease Control and Prevention atter they

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Speaker 1: set guidelines for reopening schools. In a tweet, Trump called

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Speaker 1: the guidelines quote very tough and expensive, and said he

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Speaker 1: would meet with the CDC earlier. Trump said he may

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Speaker 1: cut funding if schools do not open before the November election,

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Speaker 1: saying keeping them closed benefits the Democrats. The country's largest

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Speaker 1: public school system, New York City, announced today that students

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Speaker 1: would probably return to physical schools part time this fall.

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Speaker 1: Mayor build A Blasio said he anticipates a blended learning

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Speaker 1: program with students in class two to three days a week.

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Speaker 1: New York State Governor Andrew Cuomo said a decision on

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Speaker 1: schools would be announced the first week of August. Melbourne,

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Speaker 1: Australia's second largest city, goes into lockdown today for the

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Speaker 1: second time in four months. The country's missteps in handling

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Speaker 1: travelers returning from overseas and the complacency of a few

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Speaker 1: neighborhoods tipped the city back into the danger zone. Melbourne

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Speaker 1: is now responsible for the vast majority of Australia's new

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Speaker 1: COVID nineteen cases in the past month. Even as life

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Speaker 1: in most of the nation returns to normal, Melbourne's five

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Speaker 1: million people will be back under stay at home orders

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Speaker 1: that were first imposed in March, and finally, Brooks Brothers

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Speaker 1: filed for bankruptcy. The company was the latest victim of

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Speaker 1: the pandemics hit to clothing sales. Neiman Marcus Group, Jay

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Speaker 1: Crew Group and John Varvados Enterprises have all filed for

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Speaker 1: bankruptcy since the virus took hold. And now for today's

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Speaker 1: main story. Almost two hundred days after the first coronavirus

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Speaker 1: cases were reported in Central China, health workers and researchers

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Speaker 1: have raced to learn more about the brand new pathogen.

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Speaker 1: As many as one thousand COVID related research papers are

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Speaker 1: being released daily. Bloomberg Senior editor Jason Gale reports that

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Speaker 1: that research and the experience of frontline healthcare workers is

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Speaker 1: informing better ways to diagnose, prevent, and treat the disease,

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Speaker 1: and it's helping to save more lives. On April six,

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Speaker 1: in New York, for a personal experience, I think that

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Speaker 1: was the worst day hospital wise. That's Associate Professor Sonya Yellow,

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Speaker 1: an eighteen year veteran critical care doctor currently working at

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Speaker 1: the Columbia University of a Medical Center. We were really,

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Speaker 1: really very busy, and the hospital was full of patients

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Speaker 1: with with COVID, and I was working in the intermediate

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Speaker 1: care unit or step down unit, which normally has eight

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Speaker 1: to tend patients, and that day we had a more

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Speaker 1: than sixty patient. At some point we had sixty eight patients,

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Speaker 1: so that's approximately eightfold increased. Many patients struggled to breathe.

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Speaker 1: The most critical we transferred to a pop up intensive

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Speaker 1: care unit, but others also required more invasive respiratory support.

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Speaker 1: Despite all our efforts, we were stuck with the several

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Speaker 1: patients who needed to be incubated, but there was no

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Speaker 1: way Sonia and a colleagues could incubate all of them

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Speaker 1: at once. She had to buy time, so she made

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Speaker 1: the decision to do something unorthodox, something for which there

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Speaker 1: are no guidelines or protocols. We've been hearing about this

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Speaker 1: technique in the beginning of April from friends and some

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Speaker 1: colleagues about this prawning, which means putting people to lay

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Speaker 1: on their stomach among patients who are not intubated, that

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Speaker 1: means they are not on a respiration or not on

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Speaker 1: a mechanical ventilation, and that's an unconventional treatment. There are

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Speaker 1: no guidelines on such therapy and non intubrated patients. Feeling

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Speaker 1: she had nothing to lose, Sunny went ahead anyway. Laying

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Speaker 1: on the stomach improves blood circulation in the upper portion

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Speaker 1: of the lung, increasing the volume of oxygen and carbon

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Speaker 1: dioxide that can be exchanged. It also decreases pressure around

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Speaker 1: the lung and can help clear secretions from the airways.

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Speaker 1: So we tried that and the first few patients I

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Speaker 1: remember first three patients really had a dramatic improvement in

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Speaker 1: their oxygen nation, which is measured from a finger by

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Speaker 1: pulse of symmetry. That's a small clip like device that

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Speaker 1: attaches to the patient finger. But we were very encouraged

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Speaker 1: by that and also the clinical stuff. Nurses and nurse

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Speaker 1: practitioners as well as hospital is they really surprised how

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Speaker 1: well this works. So we said, okay, let's just see

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Speaker 1: who else is needing the most oxygen. So we decided

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Speaker 1: to do this promposition only in those most severe cases

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Speaker 1: who would otherwise be integrated. Immediately, Sonya got approval to

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Speaker 1: attract these patients and report what happened to them in

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Speaker 1: a study. Her paper was published last month and the

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Speaker 1: Journal of the American Medical Association. She and a colleagues

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Speaker 1: founded if they were able to get patients blood oxygen

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Speaker 1: levels back into the acceptable or normal range, then there

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Speaker 1: was a forty six percent reduction in the probability of

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Speaker 1: them being intubated. We were hoping that this would be

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Speaker 1: helpful to other health care providers dread and COVID patients.

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Speaker 1: The approach hasn't yet been tested in a large randomized

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Speaker 1: control old trial, but it's a reminder that necessity is

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Speaker 1: the mother of invention in the absence of a cure.

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Speaker 1: Doctors like Sonia are left relying in part on trial

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Speaker 1: and error, but months into the most destructive pandemic in

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Speaker 1: a century, their collective experience is starting to build a

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Speaker 1: framework of how best to cope with coronavirus patients. In April,

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Speaker 1: Gilead's anti viral Rhamdavia, now approved with the brand name Vecklery,

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Speaker 1: were shown to speed recovery time and COVID patients. Last month,

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Speaker 1: the inexpensive corticosteroid decks of methad zone was found to

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Speaker 1: reduce debts by a third among patients receiving mechanical ventilation.

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Speaker 1: Doctors are also routinely administering heprin, another anti coagulants to

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Speaker 1: prevent dangerous blood clots from forming in the veins of

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Speaker 1: the critically ill or. COVID nineteen is a respiratory disease.

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Speaker 1: We now know that it has the capacity to cause

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Speaker 1: diverse manifestations um but little by legion, we discovered the

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Speaker 1: new sign new symptoms of the disease. This is Dr

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Speaker 1: Sylvie Bryant, the World Health Organization's Director for Global Infectious

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Speaker 1: Hazard Preparedness. Now we know that there is really a lot,

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Speaker 1: a lot of possibilities for these barns to attact the

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Speaker 1: human body. The quest is to create a toolbox that

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Speaker 1: will enable doctors to provide better care for the full

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Speaker 1: range of COVID patients aill we says. The w h

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Speaker 1: O is collating data from countries to identify the crucial

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Speaker 1: elements that reduce the proportion of COVID patients who die

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Speaker 1: from their illness. These include how health systems triage COVID patients,

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Speaker 1: how they protect those vulnerable to more serious complications, and

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Speaker 1: the speed with which they provide intensive care. It's not

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Speaker 1: only what you do. Sometimes at this level there is

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Speaker 1: a little different, but it's really how you do it.

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Speaker 1: What is the particular point that that makes the difference.

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Speaker 1: We are in the midst of our surge now, we

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Speaker 1: are are we have exponential growth in Arizona. The daily

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Speaker 1: case rates are going up, our hospital admissions are going up,

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Speaker 1: So we are in the midst of it right now.

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Speaker 1: The more COVID patients Dr. Jared Mosey A sees in

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Speaker 1: his hospital's intensive Kegan in Tucson, the more he says

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Speaker 1: he's convinced that saving lives comes down to protecting the

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Speaker 1: lungs of those with acute respiratory distress. Syndrome. It's an

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Speaker 1: inflammatory condition doctors refer to simply as a RDS. Most

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Speaker 1: patients need breathing support, but too little or too much

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Speaker 1: air pressure and volume can damage the lungs further. And

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Speaker 1: so I look at all of those things and tinker

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Speaker 1: with the ventilator for a good while every day to

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Speaker 1: try to find that balance, and to me, that is

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Speaker 1: the thing that will save the most lives in in

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Speaker 1: this disease is just excellent critical care management of a

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Speaker 1: r d S. Jared is also an associate professor of

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Speaker 1: emergency medicine at the University of Arizona. When I spoke

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Speaker 1: with him in late June, his hospital had just expanded

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Speaker 1: in intensive care facility to one beds, with plans for

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Speaker 1: more if needed. He says he's laid hands on more

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Speaker 1: than one hundred COVID patients over the past four months

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Speaker 1: or so. I asked him if he thought better treatments

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Speaker 1: we're leading to better survival. How do I hope? So?

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Speaker 1: I think I think that's the case, but it's very

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Speaker 1: hard to answer that question when you're in the thick

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Speaker 1: of it. I hope. So some days I think we're

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Speaker 1: actually getting pretty good at this and other days. I

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Speaker 1: think this is demoralizing. That's the humbling thing about the pandemic.

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Speaker 1: The more we know, the more we understand that there's

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Speaker 1: so much more we don't yet know well, such as

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Speaker 1: doctors and health authorities are racing to come up with

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Speaker 1: a better waste to find COVID nineteen in the absence

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Speaker 1: of an effected vaccine. The best way to find the

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Speaker 1: pandemic remains avoiding catching the coronavirus in the first place.

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Speaker 1: That was Jason Gale in Melbourne. And that's it for

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Speaker 1: our show. For coverage of the outbreak from one bureaus

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Speaker 1: around the world, visit bloomberg dot com slash coronavirus and

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Speaker 1: if you like the show, please leave us a review

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Speaker 1: and rating on Apple Podcasts or Spotify or wherever you listen.

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Speaker 1: It's the best way to help more listeners find our

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Speaker 1: global reporting. The Prognosis Daily edition is produced by Topor

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Speaker 1: foreheads Jordan Gospore, Magnus Hendrickson, and Laura Carlson. Today's main

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Speaker 1: story was reported by Jason Gale. Original all music by

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Speaker 1: Leo Sidran. Our editors are Rick Shine and me Francesco Levi,

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Speaker 1: Bloomberg's head of podcast is me,