"DIRECT CONNECTION" IS MADE BY MPT TO SERVE ALL OF OUR DIVERSE COMMUNITIES AND IS MADE POSSIBLE BY THE GENEROUS SUPPORT OF OUR MEMBERS.

THANK YOU.

LIVE FROM MARYLAND PUBLIC TELEVISION, THIS IS "DIRECT CONNECTION" WITH JEFF SALKIN.

>> Jeff: GOOD EVENING.

AND WELCOME TO YOUR "DIRECT CONNECTION."

COMING UP TONIGHT, DO YOU KNOW THE WARNING SIGNS OF HEAT STROKE?

THAT'S AHEAD.

WE BEGIN TONIGHT WITH THE LATEST ELECTION RETURNS AS THE COUNTING OF THE MAIL-IN BALLOTS CONTINUES.

WES MOORE LEADS THE DEMOCRATS RUNNING FOR GOVERNOR WITH ABOUT 33%.

THE LEAD HAS BEEN SHRINKING BUT IS PROJECTED TO HOLD UP.

AND MR. MOORE HAS BEEN DECLARED THE WINNER.

ON THE REPUBLICAN SIDE DELEGATE DAN COX HOLDS A LARGE LEAD OVER HOGAN ALLY KELLY SCHULZ AND JOINING US NOW TO ANSWER YOUR ELECTION QUESTIONS IS MILEAH KROMER, DIRECTOR OF SARAH T. HUGHES CENTER FOR POLITICS AT GOUCHER COLLEGE.

MILEAH, GREAT TO SEE YOU AGAIN.

YOUR TAKEAWAY FROM THE BIG HEADLINE, WHICH WAS A TOO CLOSE TO CALL RACE HEADING INTO ELECTION DAY, TURNING INTO A SIGNIFICANT VICTORY FOR WES MOORE.

>> Mileah Kromer: YEAH, THAT'S CERTAINLY WHAT OUR POLLING SUGGESTED, AND THAT WAS A COUPLE WEEKS BEFORE THE ELECTION, AND IT TURNED OUT SORT OF WHAT WE EXPECTED.

IT WAS A TIGHT THREE-WAY RACE AT ONE POINT BETWEEN PEREZ, MOORE AND FRANCHOT.

CLEARLY I THINK PEREZ AND MOORE HAD THAT MOMENTUM GOING INTO ELECTION DAY, AND MOORE, WHO REALLY DID A GREAT JOB GIVING KEY ENDORSEMENTS FROM LEGISLATORS LIKE SPEAKER JONES AND SENATE PRESIDENT BILL FERGUSON AND A LARGE SWATH OF DELEGATES AND STATE SENATORS ACROSS THE STATE, PLUS THE TEACHERS UNION, WAS REALLY ABLE TO BUILD ENOUGH MOMENTUM AND ENTHUSIASM TO PUT HIM ACROSS THE FINISH LINE.

PEREZ NARROWED THE GAP A LITTLE BIT ON THE MAIL-IN BALLOTS.

HE ALSO DID A GREAT JOB GETD ACROSS LEVEL SUPPORT FROM DEMOCRATS, BUT JUST NOT ENOUGH TO KEEP MOORE FROM WINNING.

>> Jeff: IT IS INTERESTING AS WE WATCHED THE MAIL-IN BALLOTS STILL BEING COUNTED TO SEE, AND I DON'T KNOW WHAT THE EXPLANATION IS AT THIS POINT, BUT IF YOU JUST LOOK AT THE ABSENTEE/MAIL-IN VOTE, IT'S TOM PEREZ BY 7 POINTS, BUT THE PEOPLE WHO VOTED ON ELECTION DAY AND WENT TO THE POLLS FOR EARLY VOTING FAVORED WES MOORE BY A SIMILAR MARGIN.

>> Mileah Kromer: RIGHT, AND I DON'T THINK WE'LL BE ABLE TO GLEAN A LOT FROM WHAT EXACTLY THAT MEANS AS WE TAKE A CLOSER LOOK AT THOSE BALLOTS AFTER EVERYTHING HAS BEEN COUNTED.

LOOK WHERE THOSE BALLOTS CAME AND THE DEMOGRAPHIC CEARVEGHTS PARTS OF THE STATE IN WHICH IT CAME FROM.

WHAT IF ANYTHING IT'S IMPORTANT FOR FUTURE CAMPAIGNS TO REALLY FOCUS ON THE IMPORTANCE OF MAIL-IN BALLOTS.

SO JUST LIKE MARYLAND EMBRACED EARLY VOTING WHEN IT WAS NEW, THE PANDEMIC CERTAINLY FORCED US OR FORCED MARYLAND TO ENTER INTO AN ERA WHERE MAIL-IN BALLOTS BECOME THE NEW NORMAL, AND YOU'RE GOING TO SEE A LOT OF CAMPAIGN ORGANIZATIONS FOCUSING ON THE BREAST WAY TO TURN OUT -- BEST WAY TO TURN OUT VOTERS WHO ARE ENTHUSIASTIC TO VOTE BY MAIL.

>> Jeff: IT IS REALLY, REALLY EASY.

I SPROATD THAT VOTE THAT WITH A WAY.

I'LL AN INDEPENDENT SO IT WAS A BIG EMPTY PIECE OF PAPER WITH A COUPLE OF SCHOOL BOARD CANDIDATES ON IT, BUT IT COULD NOT BE EASIER.

>> Mileah Kromer: THAT'S EXACTLY RIGHT.

I ALSO VOTED BY MAIL THIS TIME AROUND, AND MUCH LIKE A LOT OF FOLKS, I WAS ON SUMMER VACATION DURING THE ELECTION THAT GOT MOVED FROM THE JUNE, JUNE DATE, AND SO I THINK A LOT OF FOLKS CERTAINLY EMBRACED THAT AS A WAY TO BE ABLE TO PARTICIPATE WITHOUT ACTUALLY HAVING TO PHYSICALLY BE THERE AT ELECTION TIME.

>> Jeff: HOW ABOUT YOUR TAKE WAY FROM THE REPUBLICAN VICTORY OF DAN EXOKDZ FOR THE REPUBLICAN GUBERNATORIAL NOMINATION.

IT WAS A BIG SHOW OF STRENGTH FOR THE RECORD TRUMP WING OF THE MARYLAND PRPG PARTY.

>> Mileah Kromer: I COMPLETELY GREE.

IT WAS ACTUALLY A SHOW OF GRENTSDZ.

THE DAN COX IS A SINGLE DELEGATE COUNTY BEFORE THE TRUMP ENDORSEMENT AND PERHAPS SMCH PUSHBACK AGAINST HOGAN WITH COVID RESTRICTIONS.

YOU REALLY HADN'T HEARD MUCH ABOUT HIM STATEWIDE.

THE TRUMP ENDORSEMENT WAGS OBVIOUSLY THE BIG FACTOR THAT PUSHED HIM OVER THE EDGE HERE.

BUT THE BIG QUESTION IS WITH THIS PRIMARY AND WHAT IT LOOKS LIKE WHEN WE GET TO THE GENERAL ELECTION.

CERTAINLY HOGAN HAS GOTTEN HIS FAIR SHAFFER CRITICISM MIGHT BEING ABLE TO HAVE HIS ENDORSED CANDIDATE WIN THIS PRIMARY, BUT WHEN WE COME TO NOVEMBER, ALL OF THE PREVIOUS DATA, ALL OF THE ELECTION DATA WE KNOW PLUS OUR POLLING HAS REALLY SHOWN THAT A TRUMP-CENTERED REPUBLICAN CANDIDATE IS GOING TO HAVE A REALLY, REALLY DIFFICULT, ALMOST IMPOSSIBLE PATH TO VICTORY HERE IN MARYLAND.

>> Jeff: AND MR. COX HAS COMPLETELY TIED HIMSELF TO DRUMED WHO, TWO YEARS DFN DONALD& TRUMP WHO TWO YEARS AGO LOST MARYLAND BY A MILLION VOTES, 30 SOME PERCENTAGE POINTS.

>> Mileah Kromer: THAT IS THE WAY THAT MARYLAND WORKS.

SO MARYLAND IS -- IT MAY NOT BE A REALLY PROGRESSIVE STATE BUT IT'S CERTAINLY A DEMOCRATIC STATE.

DEMOCRATS OUTNUMBER REPUBLICANS BY TWO-TO-ONE AND DEMOCRATS WHO WE UPHOLD FOR YEARS DURING THE TRUMP ADMINISTRATION PREAL REALLY NEVER SUPPORTED DONALD TRUMP IN A MEANINGFUL WAY OFTENTIMES GIVING HIM A SINGLE DIGIT APPROVAL RATING.

MARYLAND IS AN INCREDIBLY DIVERSE STATE AND BLACK VOTERS WHO MAKE UP A HUGE PART OF MARYLAND'S ELECTORATE, AGAIN, NEVER GAVE DONALD TRUMP AN APPROVAL RATING OUTSIDE OF THE SINGLE DIGITS.

YOU PAWLT THOSE SORT OF FORCES TOGETHER AND YOU HAVE A CANDIDATE IN DAN COX WHO HAS REALLY LEANED INTO AMERICA FIRST SORT OF MAGA AGENDA WITH NO -- THAT HE IS INTERESTED IN -- DISPIEFERL DECIPHERABLE TO BETTER MEET THE POLICY PREFERENCES OF THE MARYLAND ELECTORATE, AND WES MOORE IS A STRONG CANDIDATE SO HE'S UP NOT ONLY IS HE SORT OF AN LOGICAL MISMATCH IN THE STATE BUT HE'S UP AGAINST SOMEBODY HOE HAS SHOWN THE ABILITY TO PUT TOGETHER A COALITION OF -- [INDECIPHERABLE] AND ABLE TO GET SIGNIFICANT CAMPAIGN FUNDS TO REALLY RUN I THINK A STRONG CAMPAIGN.

>> Jeff: LET ME REMIND OUR VIEWERS IF YOU HAVE A QUESTION FOR DR. KROMER, AN OBSERVATION TO SHARE, PERHAPS HOW SHE'S GETTING THE DOG TO NAP SO SOUNDLY DURING THIS INTERVIEW, GIVES A CALL AT THE NUMBER OAT SCREEN.

OR SEND US AN EMAIL.

MILEAH, HOW ABOUT THE DEMOCRAT PARTY'S VOTE?

DO YOU WANT TO GIVE US AN UPDATE ON THE PUP?

>> Mileah Kromer: SHE'S DOING GREAT.

IT'S THUNDERING A LITTLE BIT TODAY AND SHE'S A LITTLE BIT NERVOUS BUT RIGHT NOW -- I DON'T KNOW, WE DON'T WANT TO SPEAK TOO SOON.

>> Jeff: BOY, I MAY HAVE JINGDZ THAT.

I WAS GOING TO ASK YOU ABOUT THE 1 MILLION OR 2 MILLION OR WHATEVER IT TURN OUT TO BE THAT THE DEMOCRATIC PARTY SPENT TO BUILD UP DAN COX ON THEORY, I GUESS, THAT HE WOULD BE AN EASIER OPPONENT IN THE FALL.

BASED ON HIS MARGIN OF VICTORY, THEY MAY HAVE WASTED THE $2 MILLION.

BUT IN TERMS OF -- YOUR THOUGHTS ON THE THINGS OF THAT.

>> Mileah Kromer: SURE.

LISTEN, IT'S NOT JUST MARYLAND.

WE'VE SEEN THIS SORT OF INVESTMENT IN DIFFERENT RACES ACROSS THE STATE.

THE DJ IS GOING TO ARGUE AND OTHER PLACES AS WELL THAT IN MARYLAND THEY WERE JUST GETTING A HEAD START ATTACKING THE FRONTRUNNER, SO I'M NOT GOING TO SPEAK TO WHAT THE DJA'S INTERNAL DECISIONS ARE, BUT IT IS CERTAINLY, IF YOU LOOK ADAN COX AND YOU LOOK AT KELLY SCHULZ, ONE OFS THOUGH DONATES, COX MORE THAN SCHULZ, IS GOING TO BE A LOT EASIER TO BEAT THAT MARYLAND AND THAT'S JUST BECAUSE MARYLAND IS A HEAVY BLUE STATE, AND AGAIN TRUMP IS JUST NOT POPULAR AT ALL OUTSIDE OF THE GOP BASE.

>> Jeff: EMAIL QUESTION FROM A VIEWER ON THE SUBJECT OF MAIL-IN VOTING.

DO YOU HAPPEN TO KNOW IF THIS IS THE LARGEST MAIL-IN BALLOTING IN HISTORY?

AND THEN ASKING IF YOU BELIEVE THIS WILL BE WHERE MOST OF THE VOTES WILL BE CAST IN THE FUTURE.

AND DO YOU HAVE ANY WORRIES ABOUT IT?

I MEAN, SOME DAY THERE WILL BE AN INCIDENT WHERE A MAIL BOXED DISAPPEARS OR SOMETHING, BUT IN TERMS OF THE SECURITY OF IT, ANY WORRIES THERE?

AND AGAIN, YOUR THOUGHTS ON THE FUTURE OF ABSENTEE MAIL-IN VOTING, AND WE NEED A BETTER WORD, DON'T WE?

>> Mileah Kromer: RIGHT.

SO, NO, IT WOULDN'T BE THE HISTORIC HIGH WATER MARK JUST BECAUSE IN THE 2020 CYCLE THE IN MIDST OF THE PANDEMIC WE HAD EVERY SINGLE MARYLAND VOTER WAS SENT A MAIL-IN BALLOT DURING THE PRIMARY, AND THEN IN THE GENERAL ELECTION EVERYBODY WAS SENT THOSE -- THE APPLICATION FOR THE MAIL-IN BALLOTS.

BUT, YEAH, CERTAINLY, I THINK THAT IT REMAINS TO BE SEEN, I DO NOT KNOW OF ANY ELECTORAL SECURITYACIOUS AROUND STOLEN MAILBOXES.

I THINK IT'S DIFFICULT TO STEAL A MAIL BOXED.

BUT YOU MAIL-IN BARLTS JUST LIKE ANY OTHER BALLOTS AND I THINK THAT EASE OF ACCESS IS REALLY GREAT FOR A LOT OF MARYLANDERS PARTICULARLY.

ANYBODY WHO IS WORKING, WHO DOESN'T MAYBE HAVE THE TIME TO RUN BY THEIR LOCAL POLLING PLACE, CERTAINLY FOLKS WITH DISABILITIES, IT'S REALLY EASY TO VOTE FROM HOME, AND SO I DO THINK WE'RE GOING TO SEE A LOT OF FOLKS EMBRACE MAIL-IN BALLOTING AND A PUSH FROM THE DEMOCRATIC LEGISLATURE, LEGISLATORS INTO MAKING SURE WE CAN COUNT THOSE BALLOTS A LITTLE BIT EARLIER THAN WE WERE ABLE TO THIS TIME.

>> Jeff: YOUR THOUGHTS ON WES MOORE.

OBVIOUSLY EXTREMELY SUCCESSFUL IN A NUMBER OF FIELDS IN HIS LIFE, NOT INCLUDING POLITICS.

HE'S A FIRST-TIME CANDIDATE, APPLICABLE UNKNOWN ACROSS MARYLAND.

HIGHLY COMPETITIVE RACE AGAINST A NUMBER OF SKILLED, SUCCESSFUL POLITICIANS.

HE WINS.

HE'S ONLY GOING TO BE, ASSUMING HE WINS ON ELECTION DAY, THE THIRD AFRICAN AMERICAN ELECTED GOVERNOR OF ANY STATE EVER IN THE UNITED STATES.

SETS HIM UP IMMEDIATELY AS A NATIONAL FIGURE, DOESN'T IT?

>> Mileah Kromer: I THINK SO.

AND WHILE WES MOORE MIGHT BE A APPLICABLE NOVICE IN SENSE THAT HE HAD NOT RUN FOR ELECTED OFFICE BEFORE OR SERVED IN ELECTED OFFICE BEFORE, HE WAS CERTAINLY SOMEBODY IF YOU HAD PAID ATTENTION TO THE INSIDE BAIIVEL MARYLAND POLITICS ON BALTIMORE POLITICS SPECIFICALLY, THE I A NAME THAT HAS BEEN CIRCULATING AFTERNOON FOR THE LAST COUPLE OF YEARS OF COULD THIS REALLY DYNAMIC MIX GUY STEP IN AND RUN FOR EITHER MAYOR OF BALTIMORE WIEIVE HEARD THAT RUMOR BEFORE, OR NOW GOVERNOR, AND CERTAINLY WES MOORE IS A REALLY DYNAMIC PERSONALITY.

HE'S CAPTIVATING ON THE STUMP OF.

HE HAS A REALLY GREAT MIX OF MODERATE POLICY POSITIONS AND PROGRESSIVE POLICY POSITIONS THAT'S GOING TO APPEAL ACROSS THE IDEOLOGICAL SPECTRUM WHICH IS DIFFERENT THAN WHAT WE SAW IN 202018.

DEMOCRATIC BEN JEALOUS WAS STAUNCH PROGRESSIVE, AND TO HIS CREDIT HE STAYED TRUE TO THOSE PROGRESSIVE POLICY BELIEFS.

UNFORTUNATELY, SOME OF THAT WAS A LITTLE BIT OUTSIDE THE IDEOLOGICAL COMFORT ZONE OF SOME MARYLAND VOTERS BE WITH PARTICULARLY WHEN THEY HAD AN OPTION OF A RIGHT OF CENTER GOVERNOR THAT THEY WOULD HAVE -- I KNEW INCUMBENT GOVERNOR THAT THEY HAD DECIDED, AT LEAST A THIRD OF THE DEMOCRATS DECIDED TO DEFECT TO IN THE GENERAL ELECTION.

BUT WES MOORE HAD A CAMPAIGN APPARATUS AND AN INFRASTRUCTURE AROUND HIM THAT'S GOING TO ALLOW HIM TO RUN A WINNING CAMPAIGN.

>> Jeff: LET'S GET A PHONE CALL FROM KENT COUNTY.

THIS IS MARTHA.

MARTHA, THANK YOU FOR CALLING.

GO AHEAD.

>> Speaker: HI.

I'M INTERESTED IN YOUR TAKE ON THE POWER AND THE APPEALABILITY OF DAN COX GIVEN THE FACT THAT PEROUTKA, WHO IS ALSO A BIG TRUMPER, IS RUNNING FOR ATTORNEY GENERAL AND ANDY HARRIS, WHO IS LIKE MAJOR TRUMPER IN THE WHITE HOUSE BEFORE THE INSURRECTION, >> Jeff: THANK YOU VERY MUCH.

>> Mileah Kromer: SO THE DYNAMICS OBVIOUSLY OF THE 1st DISTRICT ARE FAR DIFFERENT THAN THE DINE 34EUBGS WE'RE GOING TO SEE STATEWIDE.

HEATHER MIZEUR, THE DEMOCRATIC NOMINEE, CERTAINLY HAS RAISED MORE MONEY AND HAS MUCH MORE NAME REC RECOGNITION THAN ANY OF THE CANDIDATES WE HAVE SEEN AGAINST ANDY HARRIS IN THE LAST FEW CYCLES.

THAT BEING SAID, THE HOPES OF THE DEMOCRATS THAT THAT PARTICULAR DISTRICT WILL BE DRAWN SLIGHTLY MORE FAVORABLE FOR A DEMOCRAT TO ACTUALLY BE COMPETITIVE, THOSE WERE CERTAINLY DASHED WHEN THIS THE FINAL MAPS CAME OUT.

IT'S GOING TO BE REALLY DIFFICULT FOR A DEMOCRATIC CANDIDATE TOWN SEAT ANDY HARRIS.

PEROUTKA AS ATTORNEY GENERAL AGAINST ANTHONY BROWN WHO IS ANOTHER SKILLED POLITICIAN, AGAIN, EIGHT YEAR LIEUTENANT GOVERNOR.

HE LOST THE GOVERNOR'S RACE BUT THEN QUICKLY TURNED AROUND AND SERVED IN CONGRESS WHERE HE WAS A MEMBER OF THE ARMED SERVICES COMMITTEE AND REALLY RAISED I THINK HIS NATIONAL PROFILE THERE.

ANTHONY BROWN IS GOING TO -- I THINK THAT HE CERTAINLY IS BY FAR AND AWAY THE FRONTRUNNER IN THAT RACE.

ONCE FOLKS TAKE A LONGER HARD LOOK AT SOME OF THE PREVIOUS STATEMENTS OF THE REPUBLICAN NOMINEE, IT'S GOING TO BE VERY DIFFICULT FOR HIM TO HAVE ANY SORT OF BROAD BASED APPEAL IN THE STATE.

>> Jeff: DID YOU SEE ANYTHING -- THINKING ABOUT THE DEMOCRATIC RACE FOR THEIR NOMINATION FOR GOVERNOR, YOU COULD ANSWER THIS ANYWHERE, WHERE SOMEBODY COULD HAVE DONE SOMETHING DIFFERENTLY?

I LOOK AT FROM AN KNOW AND PEREZ SPECIFICALLY AND THINK THEY LEFT IT WILL A ON THE FIELD, AS THEY SAY IN SPORTS, WORKED AS HARD AS YOU COULD AND JUST CAME UP SHORT, WHICH IS EASY FOR THOSE OF US ON THE SIDELINES, NOT IN THE ARENA, TO BE CRITICAL OF.

BUT I DON'T SEE ANY HUGE MIDST OPPORTUNITIES.

DO YOU?

>> Mileah Kromer: NO, AND IT'S ALSO, THIS ELECTION WAS NOT AS LOW TURNOUT AS I THINK MANY, MYSELF INCLUDED, HAD FEARED AS FAR AS IT WAS FROM 2018 BUT YOU HAVE A LOW TURNOUT ELECTION, PEOPLE WEREN'T PAYING ATTENTION UNTIL THOSE INWANG COUPLE WEEKS.

IT WAS IN THE MIDDLE OF JULY.

I THINK EACH THREE OF THOSE TOP TEAR CANDIDATES DID A GOOD JOB REACHING VOTERS BUT I WOULD CERTAINLY THINK THAT OBVIOUSLY MOORE BUT ALSO PEREZ HAD SOME SERIOUS MOMENTUM GOING INTO THOSE LAST COUPLE WEEKS.

BUT AGAIN, I THINK THE BIG DIFFERENCE THAT WE'RE GOING TO SEE FROM 2018 TO NOW IS EACH OF THE SUPPORTERS OF THOSE E. TOP TIER CANDIDATES AS WELL AS THE FOLKS WHO CAME IN FOURTH, FIFTH AND ON DOWN THE LINE -- >>> >> Jeff: MI E A, WE'RE GOING TO LEAVE IT THERE.

MILEAH KROMER, SARAH T. HUGHES POLITICS.

WE THANK YOU FOR YOUR TIME.

AND JOINING US NOW TALK ABOUT YOUR HEALTH IS DR. MICHAEL WINTERS WHO PRACTICES EMERGENCY MEDICINE AT THE UNIVERSITY OF MARYLAND MEDICAL CENTER AND A PROFESSOR OF EMERGENCY MARYLAND AT THE UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE.

THANK YOU FOR JOINING US.

IT HAS AI BEEN A CRAZY, HOT LAST COUPLE OF DAYS.

WONDERING WHAT YOU'VE BEEN SEEING IN THE EMERGENCY DEPARTMENT IN TERMS OF HEAT-RELATED CONDITIONS.

>> Michael Winters, MD: THANKS SO MUCH FOR THE OPPORTUNITY TO SPEAK WITH YOU THIS AFTERNOON.

YES, WE ABSOLUTELY HAVE SEEN AN INCREASE IN HEAT-RELATED ILLNESSES PRESENTING TO NOT ONLY OUR EMERGENCY DEPARTMENT AT THE MEDICAL CENTER BUT TO MANY OF OUR EMERGENCY DEPARTMENTS ACROSS THE UNIVERSITY OF MARYLAND MEDICAL SYSTEM.

>> Jeff: THE MOIST WORRISOME THING IS HEAT STROKE?

>> Michael Winters, MD: YES, THAT IS CORRECT.

SO HEAT-RELATED ILLNESSES REALLY EXIST ALONG A SPECTRUM, VERY MILD CAFNS HEAT-RELATED ILLNESS, AND THAT WOULD BE HEAT RASH, HEAT CRAMPS, REALLY THE MOST IMPORTANT TO REALLY KNOW ABOUT IS HEAT STROKE.

THAT IS A TRUE MEDICAL EMERGENCY WHERE TIME IS OF THE ESSENCE, AND COOLING PEOPLE WITH HEAT STROKE IS CRITICAL.

>> Jeff: I FORTUNATELY HAVE NEVER SEEN SOMEBODY IN THAT CONDITION.

EVERYBODY HAS SEEN ON THE NEWS IN THE LAST WEEK OR SO THERE WAS VIDEO OF A UPS DRIVER COLLAPSING.

A LOT OF SERIOUS CASES LIKE THAT.

WHEN DOES IT BECOME -- WHEN DOES IT GO FROM THAT TO THIS LIFE-THREATENING CONDITION CALLED HEAT STROKE?

WIRCHLTS HEAT STROKE.

WELL, HEAT STROKE IS DEFINED ABOUT A BODY TEMPERATURE ABOVE 104 DEGREES FARRON HIERGT 40 DEGREES SELLS EXPWRURKS THE DEFINING FEATURE OF HEAT STROKE IS WHEN THERE IS WHAT WE TERM NEUROLOGICAL DYSFUNCTION.

AND THAT CAN EVEN BE IRRITABILITY IN PATIENTS.

MORE OFTEN IT IS CONFUSION, AGITATION.

PATIENTS MAY ALSO PRESENT WITH A SEIZURE.

SO SEIZURE-LIKE ACTIVITY IN THE SETTING OF THAT TEMPERATURE ABOVE 104, AND IN EXTREME CASES PATIENTS CAN BECOME UNRESPONSIVE AND COMATOSE, AND THOSE ARE THE REALLY HALLMARK FEATURES OF HEAT STROKE.

>> Jeff: I'VE READ YOU STOP ACTUALLY SWEATING AT SOME POINT.

>> Michael Winters, MD: IN TERMS OF THE BODY'S RESPONSE AND TRYING TO DISSIPATE OR GET RID OF THAT INTERNAL HEAT, IT DOES REACH A TEMPERATURE WHERE YOUR BODY STOPS SWEATING AND RETAINS THAT HEAT, AND THAT'S REALLY GETTING TO AN EXTREME STATE AND MORE OF THE EMERGENT NEED FOR TREATMENT.

>> Jeff: HOPEFULLY IF THIS HAPPENS SOMEBODY IS NEARBY IN A POSITION TO HELP.

DO PEOPLE KNOW WHAT TO DO IN SITUATION?

AND OTHER THAN CALLING 911, WHAT'S THE FIRST THING YOU SHOULD DO?

>> Michael Winters, MD: WELL, YOU BROUGHT UP THE FIRST CRITICAL STEP IS ACTIVATING EMS, SO CALLING 911.

UPON THEIR -- OR WHILE WAITING FOR THEIR ARRIVAL, IT IS VERY IMPORTANT TO REMOVE THAT PERSON FROM ANY TYPE OF HEAT OR HEAT ENVIRONMENT, SO GET THEM INSIDE INTO A COOLER ENVIRONMENT, AN AIR-CONDITIONED ENVIRONMENT.

AND STEPS THAT CAN BE TAKEN WHILE AWAITING 911 ARRIVAL IS ACTUALLY TO REMOVE THE PERSON, MOST OF THE PERSON'S CLOTHING, AND THEN SPRAY THEM WITH WHAT WE WOULD TERM TEPID OR ALMOST LUKEWARM NORMAL TEMPERATURE WATER, AND DIRECT A FAN OVER THE TOP OF THEM.

SO IMPORTANTLY, REMOVE THEM FROM THE ENVIRONMENT.

REMOVE MOST OF THAT CLOTHING.

SPRAY THEM WITH THE WATER.

AND THEN RUN A FAN OVER THE TOP OF THEM WHILE THEY'RE WAITING FOR 911.

>> Jeff: IS THIS SITUATION OR ITS EMERGENCY TREATMENT DIFFERENT IF WE'RE TALKING ABOUT YOUNG CHILDREN OR THE ELDERLY?

>> Michael Winters, MD: THE TREATMENT WOULD STILL BE THE SAME IN THE PRE-HOSPITAL SOARGT UNTIL 911 POIMPS NOW, WHEN WE GET THEM TO AN EMERGENCY DEPARTMENT AND WE ASSESS THEM, THE TREATMENT WOULD BE SPECIFIC TO WHAT THAT PARTICULAR PATIENT, WHETHER IT IS AN YOUNG CHILD ARE AN OLDER INDIVIDUAL AND WHO WOULD ALSO BE DEPENDENT ON THEIR MEDICAL HISTORY, THEIR HEALTH PROBLEMS, ANY MEDICATIONS, BUT WHEN YOU'RE IN THE ENVIRONMENT AND YOU ARE RECOGNIZING THAT SOMEONE HAS A HEAT-LY RELATED EMERGENCY 1 THOSE STEPS THAT WE WENT OVER ARE CRITICAL TO APPLY REGARDLESS OF WHETHER YOU'RE AN OLDER VOIRD YOUNGER.

>> Jeff: YOU YOU KNOW, IF YOU STEP OUT THE FRONT DOOR OF YOUR EMERGENCY DEPARTMENT LATELY, IT'S BEEN 97, 98 DEGREES.

IN PARTS OF THE COUNTRY YOU GO OUT TO VEGAS OR THE DESERT, A GOOD 10 DEGREES HOTTER THAN THAT.

THEY ALWAYS SAY, BUT IT'S DRY HEAT.

DOES THAT REALLY MATTER?

I MEAN, IS THERE -- HOW DOES THE HUMIDITY AFFECT SOMEBODY'S ABILITY TO FUNCTION IN THAT KIND OF HEAT?

>> Michael Winters, MD: IT CAN MAKE IT MORE CHALLENGING, BUT WHEN WE TALK ABOUT DIFFERENT AREAS OF THE COUNTRY AND FOLKS THAT LIVE IN DIFFERENT AREAS, THERE IS AN OVERALL WHAT WE TERM A CLIMATIZATION, SO IN TERMS OF THOSE REGIONS, THOSE PEOPLE ARE ADAPTING TO HIGHER LEVELS OF AMBIENT TEMPERATURE.

IN OUR COMMUNITY WHEN WE ARE STEPPING OUTSIDE OF AND THERE IS A LOT OF THAT HUMIDITY AND TEMPERATURES ARE APPROACHING TRIPLE DIGITS, WE JUST SIMPLY AREN'T A DLIEMENTIZED TO THOSE HIGH -- CLIMATIZED TO THOSE HIGHER TEMPERATURES AND IT MAKES IT WILL MUCH HEARD WHEN THE TEMPERATURE RISES TO THIS DEGREE FOR US TO REALLY BE ABLE TO SWEAT AND GET RID OF THAT INTERNAL HEAT.

>> Jeff: HOW MANY PATIENTS WOULD YOU SAY THAT YOU SEE IN A TYPICAL SUMMER WITH HEAT-RELATED ILLNESSES?

AND HAVE YOU SEEN A CHANGE, A TREND IN RECENT YEARS?

>> Michael Winters, MD: IT'S A VERY INTERESTING QUESTION.

IN TERMS OF HEAT-RELATED ILLNESS, THE MOST COMMON TYPE OF HEAT OF RELATED ILLNESS THAT WE SEE IN OUR EDs IS WHAT WE TERM HEAT EXHAUSTION, SO PATIENTS COME IN AND REPORT AN ELEVATED HEART RATE, MAYBE A HEAD ACHE, NAUSEA OR VOMITING, AND THEY MAY IN SOME CASES EVEN PASS OUT.

NOW, THAT'S THE STAGE RIGHT BEFORE HEAT STROKE.

WHEN WE LOOK AT OUR NUMBERS ACROSS THE PAST SEVERAL SUMMERS, THEY HAVE REMAINED ACTUALLY FAIRLY STABLE, AND WE SEE ACROSS OUR UNIVERSITY OF MARYLAND MEDICAL SYSTEM ANYWHERE FROM ABOUT 90 TO 100 CASES OF HEAT-RELATED ILLNESS EACH YEAR.

>> Jeff: LET'S TALK ABOUT STAYING HYDRATED, AND WHAT YOU SHOULD DRINK.

ANYTHING YOU SHOULDN'T DRINK ON A SUPER HOT DAY?

I'M THINKING ABOUT ENERGY DRINKS.

I'M THINKING ABOUT HAVING A BEER.

>> Michael Winters, MD: SO A VERY IMPORTANT QUESTION IN TERMS OF HYDRATION, AND WE WOULD AVOID OR RECOMMEND AVOIDING ANY TYPE OF ALCOHOL IN EXTREME TEMPERATURES, AVOID ANY TYPE OF LIQUID THAT HAS CAFFEINE, AS WELL AS BEVERAGES OR DRINKS THAT ARE REALLY ARE HIGH IN SUGAR CONTENT.

WHY DO I SAY THAT?

BECAUSE ALL THREE OF THOSE TYPES OF HYDRATION WILL ACTUALLY RESULT IN DEHYDRATION.

SO IT WILL AGGRAVATE AND POTENTIALLY MAKE THINGS WORSE, SO YOU WANT TO AVOID ALCOHOL, AVOID CAFFEINE PRODUCTS AND PRODUCT THAT HAVE HIGH SUGAR CONTENT.

AND YOU MENTIONED ENERGY DRINKS, AND LOTS OF FOLKS CONSUME ENERGY DRINKS BUT KNOW THAT SO MANY OF THEM ARE VERY HIGH IN CAFFEINE CONCENTRATION, AND ONCE AGAIN THAT CAN AGGRAVATE OR WORSEN DEHYDRATION AND WORSEN OVERALL HEAT-RELATED ILLNESS.

>> Jeff: IF YOU WERE GEARING UP FOR A ABOUT A WHERE YOU WERE GOING TO HAVE TO BE OUTSIDE FOR WHATEVER THE SITUATION WAS, WHAT WOULD YOU TAKE?

WHAT WOULD BE LIKE IN YOUR THERMOS?

IF I HAD WATER, WOULD YOU WANT IT TO BE COLD OR DOES IT NOT MATTER?

YOUR THOUGHTS ABOUT THAT?

>> Michael Winters, MD: ONCE AGAIN, GREAT QUESTION.

I WOULD START ACTUALLY BY THE CLOTHING, THINKING SMARTLY ABOUT THE CLOTHING THAT YOU WEAR.

YOU WANT TO HAVE IT LOOSE FITTING, LIGHT COLORED SO IT'S NOT AB ABSORBING HEAT.

PERSONALLY I WOULD TAKE A COMBINATION OF WATER PRODUCTS, AND DEPENDING ON HOW LONG I PLANNED TO BE OUT IN THE HEAT ENVIRONMENT, I WOULD PROBABLY MIX THAT WITH SOME SORTS-RELATED DRINKS THAT HAVE TOM ELECTRO LIGHT CONCENTRATION OR ELECTRO LIGHT COMPLETION NAMELY SODIUM AND POTENTIALLY POTASSIUM.

>> Jeff: BEFORE WE GO A COUPLE OF COVID-RELATED QUESTIONS BECAUSE YOU'RE ON THE FRONTLINES IN THE EMERGENCY DEPARTMENT.

WHAT HAVE YOU SEEN COMING THROUGH THE DOOR?

WE KNOW, BASED ON STATE'S DATABASE, THE NUMBER OF PEOPLE HOSPITALIZED WITH COVID CONTINUES TO TREND UP A LITTLE BIT, NOT LIKE IT WAS IN THE WINTER, BUT TRENDING IN THE WRONG DIRECTION, THE TEST POSITIVITY TRENDING IN THE WRONG DIRECTION.

WHAT ARE YOU SEEING?

>> Michael Winters, MD: SO IN TERMS OF COVID, WE ARE SEEING A SLIGHT UPTICK IN PATIENTS, MORE PATIENTS PRESENTING TO OUR EMERGENCY DEPARTMENTS WITH SYMPTOMS AND CONFIRMED COVID-19.

AS YOU MENTIONED, IT IS NOT NEARLY THE WAY THAT WE SAW IN THE EARLY WINTER, HOLIDAY, THE JANUARY PERIOD OF TIME BUT OUR NUMBERS, AS OF SOD, REALLY WE HAVEN'T SEEN THAT DEGREE OF TESTING POSITIVITY ALONG WITH HOSPITALIZATIONS SINCE EARLY TO MID-FEBRUARY.

SO WE ARE SEEING MORE OF COVID AND HEIGHTENED OR JUST -- WE EMPHASIZE THE IMPORTANCE OF TAKING PRECAUTIONARY MEASURES WHEN YOU'RE IN HIGHER RISK SETTINGS OR SCENARIOS, AND THEN DEPENDING ON YOUR AGE AND HEALTH PROBLEMS, REALLY ENSURING APPROPRIATE VACCINATION AND BOOSTER STATUS.

>> Jeff: WE KNOW PRESIDENT BIDEN DIAGNOSED WITH COVID A NEW DAYS AGO.

HE IS ON PAXLOVID, THE ANTIVIRAL TREATMENT FOR IT.

IN YOUR SETTING WHO GETS THAT AND WHO DOESN'T AT THIS POINT?

>> Michael Winters, MD: WELL, THERE IS CERTAIN CRITERIA FOR PRESCRIBING PAKDZ LO INDIVIDUAL AND WITHOUT BEING TWO SPECIFIC IT IS USUALLY GOING TO BE OLDER PATIENTS THAT HAVE OTHER MEDICAL CONDITIONS THAT PUT THEM AT HIGH-RISK OR EITHER WORSE OUTCOME FROM COVID OR NEEDING HOSPITALIZATION.

NOW, IT'S IMPORTANT ALSO IN TERMS OF CONSIDERING PAKDZ LO INDIVIDUAL TO REVIEW SOMEONE'S NOT ONLY HEALTH HISTORY BUT ALSO TO REVIEW THEIR MEDICATIONS TO ENSURE THAT THAT'S A SAFE MEDICINE TO PRESCRIBE FOR THEM, YOU THE ABOUT IT IS CERTAINLY SOMETHING THAT WE ARE PRESCRIBING WITH INCREASED FREQUENCY OVER THE LAST SEVERAL WEEKS GIVEN THE INCREASE IN THE NUMBER OF CASES WE ARE SEEING.

>> Jeff: DR. MIKE WINTERS WITH UNIVERSITY OF MARYLAND MEDICAL SYSTEM.

THANK YOU SO MUCH FOR GIVING THE WINTERS' ADVICE ON THE SUMMER HEAT.

THANKS AGAIN.

>> Michael Winters, MD: THANKS AGAIN FOR THE OPPORTUNITY.

>> Jeff: AND THAT IS "DIRECT CONNECTION" FOR THIS WEEK.

WE'RE BACK FRIDAY WITH "STATE CIRCLE" AND THE LATEST ON MARYLAND POLITICS.

JOIN US FRIDAY EVENING AT 7:00.

NOW FOR ALL OF US A MPT, THANKS FOR WATCHING "DIRECT CONNECTION" AND HAVE A GOOD NIGHT.

CS:ZMPTCREDIT