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Speaker 1: Hi everyone, I'm Katie Current and welcome to Next Question.

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Speaker 1: It's a new day for us here at Next Question,

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Speaker 1: as I'm sure it is for all of you. The

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Speaker 1: rampant spread of the coronavirus across this country, let alone

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Speaker 1: the rest of the world, has forced most of us

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Speaker 1: indoors for an unknown period of time. The level of

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Speaker 1: restrictions on where you can go and what you can do,

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Speaker 1: the closure of schools, restaurants, nightlife, the canceling of sports

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Speaker 1: and entertainment is largely unprecedented, but it's necessary for the

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Speaker 1: health and safety of this country. So if you're not

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Speaker 1: social distancing yet, please do. But it's a lot to

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Speaker 1: deal with, and I know right now it's all consuming

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Speaker 1: for all of us. It's what we're reading about and

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Speaker 1: what we're worried about. But I'd really like to help

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Speaker 1: to settle into this new reality and perhaps understand what

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Speaker 1: all of this means for us, which is why we're

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Speaker 1: deaty kating the rest of this season of Next Question,

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Speaker 1: which means four more episodes every week and perhaps even

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Speaker 1: more to the coronavirus pandemic. For day to day news

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Speaker 1: on this ever changing story, I do recommend you continue

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Speaker 1: to turn to your local government, the CDC, and the

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Speaker 1: World Health Organization for the most up to date information.

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Speaker 1: I'm also providing updates on my Instagram feed. As for me, well,

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Speaker 1: I'm hold up in my house, which means I might

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Speaker 1: sound a little different to you. Social distancing means I'm

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Speaker 1: not going into our usual studio and speaking into a

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Speaker 1: fancy microphone. Right now, I'm sitting in my home office

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Speaker 1: and I'm recording myself on my phone, and instead of

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Speaker 1: speaking to my guests in person, we're connecting over our computers.

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Speaker 1: So bear with us, everyone, but please keep listening for

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Speaker 1: this critically important information. So today, my next question, how

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Speaker 1: do we manage this new normal and coronavirus anxiety. To

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Speaker 1: answer that, I called up my friend Laurie Gottlieb. Laurie

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Speaker 1: Hi by. Laurie Gottlieb is a psychotherapist with a private

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Speaker 1: practice in Los Angeles, but she's also a best selling author,

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Speaker 1: a journalist, and soon a podcaster too. But today we're

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Speaker 1: focused on the issue at hand, So um, let's talk

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Speaker 1: about why people are. You know, I think with good reason,

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Speaker 1: people are feeling a lot of anxiety. But I think

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Speaker 1: it's interesting that the unpredictability of all of this, Lorie,

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Speaker 1: is a perfect recipe for high anxiety. Can you explain that? Yeah,

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Speaker 1: you know, it makes sense that we have anxiety. And

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Speaker 1: I think there are two kinds of anxiety. There's productive

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Speaker 1: anxiety and there's unproductive anxiety. And productive anxiety is the

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Speaker 1: kind of anxiety that helps you to take action. So

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Speaker 1: that's why we're washing our hands all the time. That's

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Speaker 1: why we're social distancing. If we if we were in denial,

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Speaker 1: if we said, oh, this is no big deal, we

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Speaker 1: wouldn't be protecting ourselves and other people. So that's that's

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Speaker 1: good anxiety. The kind of anxiety that gets us into

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Speaker 1: trouble is unproductive anxiety, which is when we start just

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Speaker 1: ruminating and we start catastrophizing and futurizing, like you know,

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Speaker 1: those thoughts of oh my god, I'm going to get

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Speaker 1: this and I'm going to die, or someone I love

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Speaker 1: is going to get this and they're going to die,

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Speaker 1: and you know, just all the stories that were kind

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Speaker 1: of spinning in our heads, and and that doesn't help

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Speaker 1: us in any way. Well, what makes us go as

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Speaker 1: human beings too? That dark place? I know that in therapy,

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Speaker 1: you're you know, this better than I. But sometimes people

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Speaker 1: do say to patients, what's the worst that could happen,

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Speaker 1: as a way for them to help kind of conquer

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Speaker 1: their fears. But you believe in this case, that's not

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Speaker 1: super helpful. I don't think that that's helpful. I think

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Speaker 1: that one of the things that can really help ground

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Speaker 1: us is instead of thinking about what might up and

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Speaker 1: in the future because it hasn't happened yet, is to

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Speaker 1: stay grounded in the present. So one of the things

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Speaker 1: that I think happens is that when something extraordinary happens,

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Speaker 1: we long for the ordinary. We want we want our

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Speaker 1: routines back, We want all those things that we complained about,

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Speaker 1: you know, when when we didn't have something, we weren't

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Speaker 1: in a heightened state like this. Um, we want it back,

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Speaker 1: and yet it's still right in front of us. So UM.

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Speaker 1: I like to talk about the concept of both, and

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Speaker 1: which is, yes, something horrible is happening, and we can

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Speaker 1: also enjoy certain things like the ordinary. We can enjoy

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Speaker 1: the time that we're having connecting with people that we

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Speaker 1: normally don't really pay attention to in our daily lives.

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Speaker 1: We can enjoy cooking together. We can, you know, in

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Speaker 1: our own isolated family units, um, we can enjoy having

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Speaker 1: the time to read a book or to think our

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Speaker 1: own thoughts, or to um, you know, actually face time

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Speaker 1: with one and actually listen when you ask how are you?

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Speaker 1: I think one of the one of the kind of

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Speaker 1: nice things to come out of horrible experience like this

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Speaker 1: is that people are very kind. Kindness comes out. There's

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Speaker 1: sort of a resurgence of kindness in this world where

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Speaker 1: civility has been lost, and so I think that both

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Speaker 1: at both can exist, and if we can focus on,

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Speaker 1: you know, holding our fear and feeling our feelings, not

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Speaker 1: being in denial of our anxiety, and not being in

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Speaker 1: denial of what's going on around us, but also really

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Speaker 1: trying to stay present in what's happening in that moment.

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Speaker 1: We have so many questions. But before we get to

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Speaker 1: some questions from people who follow me or listen to

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Speaker 1: the podcast, Laurie, I'm a fairly normal person in that

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Speaker 1: I don't have huge anxiety, but I'm finding I'm feeling

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Speaker 1: a little neurotic about my health. If I have a

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Speaker 1: little bit of a sore throat when I wake up

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Speaker 1: in the morning, or if I cough, then I start thinking, oh,

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Speaker 1: my god, am I sick? And I'm sure I'm not

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Speaker 1: alone in that because it's part of catastrophizing. I'm sure,

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Speaker 1: what what is that about? How can we kind of

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Speaker 1: calm ourselves down? Well, I think the first step is

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Speaker 1: just realizing it that it's human nature to do that.

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Speaker 1: So I remember when I was in medical school, we

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Speaker 1: we talked about sort of medical school disease, which was

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Speaker 1: every disease that we were reading about. We all thought

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Speaker 1: we had all of a sudden we felt the symptoms

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Speaker 1: of it. You know, it's like, oh, my god, I

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Speaker 1: have this now because my my gland feels inflamed or whatever.

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Speaker 1: Um that now that we're reading all the time about

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Speaker 1: the symptoms of coronavirus, you know, it's almost like the

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Speaker 1: power of of uh implanting it into your suggestion. Right. So,

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Speaker 1: so I think just realized that the power of suggestion

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Speaker 1: is very powerful. And and so when you notice that,

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Speaker 1: of course be aware if you are having symptoms, but

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Speaker 1: also take a breath. Um. Part of part of the

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Speaker 1: problem is that we're reading about and I always tell

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Speaker 1: people that, yes, you need to get daily updates, but

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Speaker 1: you don't really need more than that. I think that

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Speaker 1: the more that we're just you know, kind of it's

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Speaker 1: kind of like we're binge, like binge watching a television show,

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Speaker 1: but it's kind of like binge eating junk food. That

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Speaker 1: the more you sit there and click from this article

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Speaker 1: to that article to the other article, it makes you sick.

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Speaker 1: It does not fill you up, It does not help you.

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Speaker 1: It actually makes you psychologically ill. How do you talk

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Speaker 1: to kids about this? I'm sure that a lot of parents,

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Speaker 1: you know, my children are older. Your son is in

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Speaker 1: high school now, right, he's in middle school, middle school,

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Speaker 1: so he's he's at home. Is he expressing concern? And

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Speaker 1: how do you suggest people talk to their kids about this?

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Speaker 1: I think that the way that we model our response

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Speaker 1: to this is going to impact the way that our

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Speaker 1: kids handle their anxiety around it. So it's kind of

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Speaker 1: like I think, you know, when when you're on an airplane,

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Speaker 1: they always say put on your oxygen mask first before

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Speaker 1: you put on your child. But I think it goes

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Speaker 1: beyond that. It's how does the pilot handle it when

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Speaker 1: there's a problem and the pilot doesn't say, oh my god,

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Speaker 1: we're all gonna die, you know, if there's something the

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Speaker 1: pilot says very calmly, Hey, we're gonna experience some turbulence

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Speaker 1: coming up. We want all of you to fasten your

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Speaker 1: seatbelts and please don't walk in the aisles right now.

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Speaker 1: And I think that's very calming. And I think that

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Speaker 1: for our kids, we need to say, yes, here are

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Speaker 1: the rules, here are the boundaries. You can't go and

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Speaker 1: play basketball. I say this to my kid, you can't

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Speaker 1: go play basketball with your friends right now because we're

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Speaker 1: social distancing, um, you know, and and we're gonna do

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Speaker 1: this instead. And and just to kind of, you know,

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Speaker 1: under help them understand. I think giving them a sense

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Speaker 1: of purpose to around this, which is we're not just

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Speaker 1: doing this for ourselves. We're doing this for our community.

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Speaker 1: We're doing this for our neighbors, for the elderly people

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Speaker 1: that we know. Um, we're doing this for people with

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Speaker 1: compromised immune systems. And I think that kids really engage

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Speaker 1: in that when they realize that it's bigger than them.

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Speaker 1: It's not just oh, this is a bummer. I'm stuck

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Speaker 1: here and I can't play with my friends, and I

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Speaker 1: can't do the normal things I like to do. Um.

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Speaker 1: There's there's something about being connected to the larger community

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Speaker 1: that really resonates with with tweens and teens. Well, let's

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Speaker 1: play dear therapist Lorie, because we've got so many questions

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Speaker 1: and I don't want to be sort of a pig

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Speaker 1: about just asking my own Rosanna says, how much information

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Speaker 1: should we deal with on an everyday basis, especially with

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Speaker 1: the situation changing by the hour or day. Do you

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Speaker 1: have any suggestions for what is a healthy media diet? Yeah?

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Speaker 1: I do. I think once a day is plenty. And

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Speaker 1: I think that's because we all know what we're supposed

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Speaker 1: to be doing, regardless of how many new cases are reported,

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Speaker 1: regardless of whether they're saying you can't go here, you

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Speaker 1: can't go that. We know we're supposed to be social isolating.

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Speaker 1: We know we're supposed to be washing our hands constantly. Um,

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Speaker 1: we know that we're supposed to be cleaning the the

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Speaker 1: all the handles and um, you know, door knobs and

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Speaker 1: things like that in our homes and all the sort

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Speaker 1: of high touch surfaces. We know what we're supposed to

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Speaker 1: be doing. Nothing is changing in that regard. So and

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Speaker 1: we also know if you're having symptoms what you're supposed

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Speaker 1: to do. So there's no information that's going to happen

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Speaker 1: during the day. That's going to change the basic facts

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Speaker 1: of what we need to do in our lives. And

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Speaker 1: we really need to protect our psychological immune systems as

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Speaker 1: much as we're protecting our physical immune systems, and that

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Speaker 1: means not overloading ourselves with information. Here's another question. What

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Speaker 1: are some tools new moms or expectant moms like me,

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Speaker 1: She said, uh, can use to get through this uncertain time.

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Speaker 1: Bringing a new baby home is tough enough, but limiting

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Speaker 1: the village from visiting and helping will put a strain

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Speaker 1: on many Thanks to you. Yeah, um, you know, I

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Speaker 1: think that it's really important for parents to kind of

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Speaker 1: trade off time so that they get a break. So

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Speaker 1: I think that when you've got a baby and you

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Speaker 1: don't have your village around you a lot of times, um,

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Speaker 1: you know, you need each other as adult as a couple.

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Speaker 1: But sometimes you're gonna have to say, you know what,

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Speaker 1: it's your turn, and I'm going to go take a

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Speaker 1: bath or I need to go just um, you know,

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Speaker 1: I need to go take a walk whatever it is,

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Speaker 1: and and hand off to the other parents. And you

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Speaker 1: really have to work as a team. So I think

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Speaker 1: that's really important, you know, if you're living in a

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Speaker 1: multigenerational household and you have, um, you know, other people

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Speaker 1: to help, that's great. I think it's also important that

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Speaker 1: you you connect again for your own mental health, that

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Speaker 1: you connect with your friends through technology and you take

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Speaker 1: some breaks and you laugh about how hard it is,

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Speaker 1: and you laugh about the dirty diapers, and you laugh

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Speaker 1: about the naps that are not being taken and all

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Speaker 1: of those things because you need someone to vent too. Yeah, definitely,

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Speaker 1: and laughter is really helpful. Here's a question, j P.

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Speaker 1: As I'm an addict in recovery, are twelve step groups

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Speaker 1: and meetings are shutting down. What is the best advice

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Speaker 1: to stay out of your monkey and stay connected even

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Speaker 1: at a time of much needed social distancing. So if

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Speaker 1: you have a sponsor that you can connect with virtually,

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Speaker 1: that would be really helpful. If you have other people

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Speaker 1: from that you know, from the group that you can

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Speaker 1: connect with, that would be helpful. There are also so

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Speaker 1: many online resources, um that you can listen to podcasts, um.

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Speaker 1: You know, uh M. I was gonna say, there's groups

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Speaker 1: online where you can you know, write in real time

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Speaker 1: and connect like that. So I would really search the internet.

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Speaker 1: I think the internet is our friend right now, not

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Speaker 1: in a sense of getting an overload of COVID information,

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Speaker 1: but in a sense of how we can get creative

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Speaker 1: around connecting with other people when we need it most.

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Speaker 1: Vivian says, how can I stop obsessing and stockpiling groceries?

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Speaker 1: I think that's such an interesting sort of primitive instinct.

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Speaker 1: People are going and kind of sometimes hoarding food. They're

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Speaker 1: so worried that the grocery stores are going to close

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Speaker 1: and that they're going to starve to death. You saw

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Speaker 1: that with the toilet paper shortage. It's fascinating thing to

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Speaker 1: observe just from a human behavior standpoint. Um, what advice

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Speaker 1: could you give Vivian and other people who are feeling

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Speaker 1: that way. There's a difference between being prepared and obsessing,

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Speaker 1: and that line is going to shift the more that

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Speaker 1: you kind of think about, oh, what's going to happen

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Speaker 1: in the future. I think being prepared means that, yeah,

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Speaker 1: you have some provisions in the house, and you you know,

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Speaker 1: you you have things that that you're going to need.

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Speaker 1: But you know, when you start getting to the point

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Speaker 1: where you've already gotten the provisions and you think, oh,

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Speaker 1: I need more, and then I need more and then

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Speaker 1: I need more. Um, that's when you need to step

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Speaker 1: back and say, you know what, I am prepared. I

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Speaker 1: will be able to get more later. But I have enough.

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Speaker 1: I've done my preparations and I've done what the recommendations are.

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Speaker 1: And then you really have to let go. And that's

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Speaker 1: again we're staying in the present. Helps where instead of

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Speaker 1: thinking about, um, you know, do I have enough, and

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Speaker 1: and you know, spending your emotional real estate on that,

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Speaker 1: do something else. And I know that sounds like I'm

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Speaker 1: trivializing this, but I'm not. Um, you know, go do

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Speaker 1: a puzzle, Go get those art those art supplies out,

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Speaker 1: Go read a book, Go take a walk, Go call

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Speaker 1: a friend. You have to take breaks, you have to

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Speaker 1: let go, and you have to stay active. I think,

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Speaker 1: even though you know the whole it seems anathetical with

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Speaker 1: the idea of staying home. There ways to stay active

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Speaker 1: at home. Clean out your closet, get rid of all

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Speaker 1: the clothes or put them aside that you can give

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Speaker 1: for dress to dress for success or to the goodwill.

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Speaker 1: You know, it is a good time to do some

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Speaker 1: serious spring cleaning, open the windows and and you know,

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Speaker 1: get the winter winter out of your house and out

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Speaker 1: of your things and maybe downsize a little bit. Andy asked,

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Speaker 1: I have a friend who suffers from anxiety. This is

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Speaker 1: kind of an obvious question, but it's a good one.

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Speaker 1: How can I best support them during this time? How

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Speaker 1: can you support people who you know? What can you

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Speaker 1: do for them? One of the things that happens with

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Speaker 1: anxiety is logic doesn't help. So you can't really talk

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Speaker 1: somebody out of their anxiety and try to tell them

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Speaker 1: that things are going to be okay. What you can

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Speaker 1: do is you can connect with them, and that's that

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Speaker 1: naturally sues people. So why don't you say, hey, let's

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Speaker 1: do let's have a virtual dinner together. Um, hey, let's

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Speaker 1: watch a movie together virtually? Um, you know what, whatever

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Speaker 1: it is that you can do. Um. You know some

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Speaker 1: people are exercising together and virtually, which is fun, so,

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Speaker 1: you know, and just moving your body helps so much

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Speaker 1: with anxiety. So if you can somehow get your friend to,

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Speaker 1: you know, move around, and you can do it with

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Speaker 1: that person virtually. You can support the person through actions,

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Speaker 1: as opposed to your words will not really help them,

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Speaker 1: but your actions will avas how to focus on work

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Speaker 1: while acknowledging that we're all scared. No, I think you

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Speaker 1: and I know that when you are worried or stressed out,

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Speaker 1: it's hard to concentrate. Actually, I know that from when

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Speaker 1: my husband was sick. I would read the same paragraph

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Speaker 1: over and over again in a book and I could not,

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Speaker 1: for the life of me, concentrate. So how can you

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Speaker 1: How can you fight that? Is there anything you can do?

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Speaker 1: I guess reducing the stress will help you concentrate more.

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Speaker 1: There's also something you can do with your body, which

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Speaker 1: is that sometimes when we kind of leave the present,

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Speaker 1: we need to physically ground ourselves. So what you do

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Speaker 1: is you close your eyes, and you start with your

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Speaker 1: feet and you say, I feel my feet on the floor,

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Speaker 1: and you feel them, and then you move up and

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Speaker 1: you say, okay, I feel put your knees together. I

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Speaker 1: feel my knees, and you move up and you just

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Speaker 1: keep and you feel your breath and you feel your diaphragm,

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Speaker 1: and you feel the different parts of your body and

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Speaker 1: it brings you back to the present moment and you

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Speaker 1: take some breaths, and then you move on with your work.

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Speaker 1: Kristen wants to know how do you cope with the

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Speaker 1: idea that we don't know how if when this is

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Speaker 1: going to end. I think that's in addition to the

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Speaker 1: unpredictability of this, This kind of not knowing when life

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Speaker 1: will resume, I think adds to people's stress levels. Right,

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Speaker 1: I mean not just am I going to get this

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Speaker 1: and what's going to happen? But how long is this

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Speaker 1: going to have to be the new normal? So how

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Speaker 1: do you cope with that? I think we have to

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Speaker 1: acknowledge that humans don't do well with uncertainty, and so

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Speaker 1: this is a good opportunity for us to build up

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Speaker 1: some resilience around uncertainty, which means that we just instead

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Speaker 1: of trying to figure it out. You know, this news

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Speaker 1: report says that, or this physician says that, to just

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Speaker 1: say we don't know, and to try to get comfortable

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Speaker 1: with that and say, what can I do in the

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Speaker 1: meantime to have as normal of a routine that I

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Speaker 1: can possibly have under these circumstances. You know, I don't

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Speaker 1: want to let you go before asking you if someone

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Speaker 1: is having real trouble, you know, if the anxiety reaches

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Speaker 1: a point where it's untenable or it's affecting someone's physical

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Speaker 1: health health, Um, you know, I I don't want to

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Speaker 1: trivialize the seriousness of this. So what can people do

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Speaker 1: if they really feel there at the breaking their breaking point, Laurie,

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Speaker 1: They should absolutely reach out to a therapist. And so

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Speaker 1: many therapists are doing online sessions specifically right now for this,

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Speaker 1: and they should reach out. And this is not a

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Speaker 1: time for shame or stigma or you know, oh my

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Speaker 1: problems aren't that bad minimizing our problems. Um, everybody else

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Speaker 1: is going through this, So why why why should I

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Speaker 1: get help? You know, all those things we say to

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Speaker 1: ourselves that prevent us from reaching out. This is a

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Speaker 1: time to say, I need to prioritize my emotional health

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Speaker 1: just as I'm prioritizing my physical health. And if you

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Speaker 1: need to talk to someone, you do not need to

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Speaker 1: be in a christ is. You can just be having

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Speaker 1: a moment. You can be feeling kind of free floating anxiety, depression,

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Speaker 1: whatever it is, or you just want to connect with

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Speaker 1: someone because you feel like preventively to kind of preserve

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Speaker 1: your emotional health. Please please please reach out. You can

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Speaker 1: find you can do a quick Google search and you

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Speaker 1: will find somebody who is available to do that for you. Well,

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Speaker 1: Lourie stays safe and call me and maybe we'll have

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Speaker 1: a virtual glass of wine together a cup of tea.

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Speaker 1: I don't want to encourage people to drink during this time,

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Speaker 1: but a glass of wine isn't going to hurt, right,

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Speaker 1: That's right, that's right. Thank you so much, Katie. Okay, bye, Laurie,

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Speaker 1: all right, take care or stay safe. Laurie gott Lee's

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Speaker 1: latest book is called Maybe You Should Talk to Someone.

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Speaker 1: She's also coming out with a podcast called Appropriately Dear Therapist,

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Speaker 1: co hosted Buy Another Therapist, Guy Wench. It's due to

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Speaker 1: come out from my Heart hopefully this summer. You know,

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Speaker 1: I really like what Laurie said earlier about how kindness

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Speaker 1: tends to emerge out of times of crisis. People are

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Speaker 1: kinder to one another, they want to help, And I'd

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Speaker 1: like to know the large or small ways you're seeing

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Speaker 1: kindness or promoting it in your own community. If you

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Speaker 1: want to share your story, please call and leave your

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Speaker 1: name and a detailed message for us at Next Question.

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Speaker 1: The number is eight four four four seven nine seven

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Speaker 1: eight eight three. That number once again is eight four

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Speaker 1: four four seven nine seven eight eight three. You can

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Speaker 1: also email me a voice memo or a written note

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Speaker 1: at info at Katie currect dot com. Just put next

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Speaker 1: question kindness in the subject line and you might hear

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Speaker 1: your story right here. On next question coming up, we're

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Speaker 1: going to be checking in with the doctor who's a

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Speaker 1: friend of mine and one of the smartest people I know,

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Speaker 1: to get a better sense of how the coronavis irs

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Speaker 1: affects our bodies and also our health care system. Dr

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Speaker 1: Peter Atilla is a Stanford and Johns Hopkins trained physician

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Speaker 1: living in San Diego. His clinical focus has been on longevity,

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Speaker 1: how to live better and longer, but since the outbreak

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Speaker 1: of coronavirus or COVID nineteen, he shifted gears, focusing his

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Speaker 1: research towards understanding the current situation, what we can do

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Speaker 1: to protect ourselves, and potentially the implication of what's to come.

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Speaker 1: And now he's here to share some of that with us.

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Speaker 1: So where are we now understanding? This story seems to

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Speaker 1: change on an hourly, if not minute I minute basis.

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Speaker 1: If you had to assess the situation right now for

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Speaker 1: our listeners, what would you say, Well, you know, I

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Speaker 1: think of these things through the lens of um. Is

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Speaker 1: the rate at which we are seeing infections growing or shrinking?

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Speaker 1: So you can think of being on one side or

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Speaker 1: another of that peak. So, for example, if we look

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Speaker 1: at mainland China, we know that they're now on the

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Speaker 1: tail end of this response. Again, there's always possibilities that

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Speaker 1: there's another outbreak as they go back to work and

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Speaker 1: begin to mobilize society again. But notwithstanding that, it's clear

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Speaker 1: that they're on the right side of that curve. Both um,

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Speaker 1: you know, right and correct um, we're still on the

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Speaker 1: left side of that curve, which means each and every

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Speaker 1: day it appears that we are seeing more and more

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Speaker 1: people get infected, or the rate at which the infections

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Speaker 1: are increasing is is still increasing. Now the million dollar

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Speaker 1: question for which a lot of people, you know, really

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Speaker 1: smart people, epidemiologists and such, are trying to project is

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Speaker 1: where is that peak? Because the peak is sort of

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Speaker 1: what gives us a sense of that maximum rate of

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Speaker 1: infection um, and that is, once you know what that

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Speaker 1: looks like, then you kind of have a sense of

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Speaker 1: what the overall number of infected people will be, and

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Speaker 1: then you can extrapolate, hopefully from the data we see

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Speaker 1: in other countries, what the impact is going to be

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Speaker 1: on the health care system. And of course the things

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Speaker 1: that really matter, like how many people are going to

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Speaker 1: potentially die or otherwise be debilitated by this. Why was

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Speaker 1: Italy so overrun with this virus? What was the perfect

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Speaker 1: storm that made it go through that country like wildfire?

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Speaker 1: So I think we can speculate on a couple of things.

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Speaker 1: First of all, I think part of it is bad luck.

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Speaker 1: I mean, it's it's important to understand that if um,

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Speaker 1: let's let's just make the math simple and say, let's

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Speaker 1: let's pretend there were a hundred infected people in China

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Speaker 1: as where the epicenter was, and that you know, ten

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Speaker 1: of them got on a plane aine and happen to

428
00:24:00,880 --> 00:24:04,399
Speaker 1: travel and go someplace. Well, the ten places that they

429
00:24:04,480 --> 00:24:07,480
Speaker 1: land are going to have a head start in terms

430
00:24:07,520 --> 00:24:10,600
Speaker 1: of where this virus is going to spread. And if

431
00:24:10,640 --> 00:24:12,880
Speaker 1: one of the places they landed was Italy and one

432
00:24:12,880 --> 00:24:15,280
Speaker 1: of the place that they landed was Iran, then those

433
00:24:15,280 --> 00:24:17,120
Speaker 1: places are going to have a bit of a head start.

434
00:24:17,200 --> 00:24:19,520
Speaker 1: So I think there's just a little bit of a

435
00:24:19,640 --> 00:24:23,320
Speaker 1: luck component, which is it probably got an early start

436
00:24:23,640 --> 00:24:26,639
Speaker 1: on the virus reaching there other factors that seem to

437
00:24:26,680 --> 00:24:29,400
Speaker 1: matter seem to be the age of the population. So

438
00:24:29,600 --> 00:24:34,440
Speaker 1: Italy has a relatively old population compared to other countries

439
00:24:34,480 --> 00:24:37,560
Speaker 1: in Europe and relative to the United States, meaning they

440
00:24:37,600 --> 00:24:40,560
Speaker 1: have more people who are in that high risk category

441
00:24:40,720 --> 00:24:44,200
Speaker 1: based on age alone. Furthermore, there seems to be a

442
00:24:44,240 --> 00:24:47,720
Speaker 1: slightly higher prevalence of smoking, and smoking is definitely one

443
00:24:47,760 --> 00:24:51,400
Speaker 1: of the major risk factors for people who, if they're infected,

444
00:24:51,440 --> 00:24:54,200
Speaker 1: are more likely to get ill. And then I think

445
00:24:54,240 --> 00:24:56,800
Speaker 1: the other component is, you know, some of the sort

446
00:24:56,800 --> 00:25:00,560
Speaker 1: of just societal things about the proximity that people are

447
00:25:00,680 --> 00:25:03,040
Speaker 1: to each other. So in other words, if you look

448
00:25:03,080 --> 00:25:06,160
Speaker 1: at the place like Wyoming, if someone had landed, if

449
00:25:06,160 --> 00:25:08,840
Speaker 1: one of the first people infected had landed in Wyoming,

450
00:25:09,119 --> 00:25:12,320
Speaker 1: it still would have likely spread slower than landing in

451
00:25:12,359 --> 00:25:16,120
Speaker 1: a place like Italy, northern Italy, where the population density

452
00:25:16,359 --> 00:25:19,480
Speaker 1: is such that there's more contact with an infected person

453
00:25:19,520 --> 00:25:21,760
Speaker 1: to another. And then I think, finally, just at the

454
00:25:21,760 --> 00:25:24,600
Speaker 1: policy level, they were probably a little bit later to

455
00:25:24,760 --> 00:25:28,439
Speaker 1: realize what was happening an institute the measures necessary to

456
00:25:28,520 --> 00:25:32,600
Speaker 1: slow the rate of spread. You have said it, Italy

457
00:25:32,720 --> 00:25:35,840
Speaker 1: taught us that it is the morbidity rate, not the

458
00:25:35,880 --> 00:25:40,160
Speaker 1: mortality rate of the disease that is grave for us.

459
00:25:40,520 --> 00:25:45,879
Speaker 1: Non doctors who may be listening, including myself. What is

460
00:25:45,920 --> 00:25:50,840
Speaker 1: the difference. So, mortality is kind of a binary variable.

461
00:25:50,920 --> 00:25:53,720
Speaker 1: It's to live or to die, and there's a lot

462
00:25:53,760 --> 00:25:58,040
Speaker 1: of attention that is appropriately being placed on the mortality rate.

463
00:25:58,480 --> 00:26:02,200
Speaker 1: It's often described through a case fatality rate, which is

464
00:26:02,200 --> 00:26:05,280
Speaker 1: another way of saying how many people die for a

465
00:26:05,320 --> 00:26:08,320
Speaker 1: given number of people who have this infection. And obviously

466
00:26:08,359 --> 00:26:14,520
Speaker 1: that's very important, but morbidity is more about the you know,

467
00:26:14,720 --> 00:26:17,840
Speaker 1: long term impact on quality of life, an illness that

468
00:26:17,920 --> 00:26:20,879
Speaker 1: has suffered that does not ultimately result in death. And

469
00:26:20,920 --> 00:26:24,400
Speaker 1: I was reading a paper this morning, UM that did

470
00:26:24,440 --> 00:26:28,439
Speaker 1: a ten year follow up on people who were infected

471
00:26:28,440 --> 00:26:31,399
Speaker 1: with the first STARS virus that we talked about stars

472
00:26:31,480 --> 00:26:34,760
Speaker 1: covie one. This was the two thousand three epidemic. This

473
00:26:34,840 --> 00:26:38,080
Speaker 1: was a pretty lethal virus, certainly appeared more lethal than

474
00:26:38,119 --> 00:26:41,399
Speaker 1: the current virus. About ten percent of people infected with

475
00:26:41,480 --> 00:26:45,399
Speaker 1: this virus died, so that's a staggering amount. But what

476
00:26:45,480 --> 00:26:47,760
Speaker 1: this paper followed up on was what were the long

477
00:26:47,880 --> 00:26:51,560
Speaker 1: term consequences of the people who were infected but survived.

478
00:26:52,040 --> 00:26:55,680
Speaker 1: And it was quite disheartening, frankly, that you saw much

479
00:26:55,760 --> 00:26:59,520
Speaker 1: higher incidence of cardiovascular disease in those people, much higher

480
00:26:59,560 --> 00:27:02,840
Speaker 1: incidents of lung disease in those people as the so

481
00:27:02,840 --> 00:27:04,639
Speaker 1: so if they didn't die from the disease, they were

482
00:27:04,680 --> 00:27:07,880
Speaker 1: still somewhat debilitated by it. And I think that that's

483
00:27:07,920 --> 00:27:10,240
Speaker 1: something that we're going to see a lot more of,

484
00:27:10,320 --> 00:27:13,800
Speaker 1: and I think the consequences of that, you know, economically,

485
00:27:13,840 --> 00:27:16,119
Speaker 1: will be significant. There are going to be people I

486
00:27:16,440 --> 00:27:18,320
Speaker 1: suspect who won't be able to go back to work

487
00:27:18,320 --> 00:27:20,879
Speaker 1: in the same capacity a year from now when all

488
00:27:21,000 --> 00:27:22,680
Speaker 1: is said and done, And the people who are most

489
00:27:22,720 --> 00:27:25,400
Speaker 1: susceptible to that are obviously the people who come in

490
00:27:25,840 --> 00:27:29,320
Speaker 1: with the greatest amount of pre existing medical conditions. So,

491
00:27:29,400 --> 00:27:33,440
Speaker 1: for example, diabetes. Why as diabetes a risk for this?

492
00:27:33,640 --> 00:27:35,720
Speaker 1: And I don't think we know entirely, but one thing

493
00:27:35,720 --> 00:27:38,560
Speaker 1: we know is that people with diabetes might already have

494
00:27:38,720 --> 00:27:43,359
Speaker 1: some underlying degree of insult to their kidneys, to their heart,

495
00:27:43,720 --> 00:27:46,119
Speaker 1: and it might be that they are less likely to

496
00:27:46,160 --> 00:27:48,760
Speaker 1: recover from this, even if they're fortunate enough to not

497
00:27:48,800 --> 00:27:52,560
Speaker 1: succumb to it. Yeah, I was interested in the diabetes

498
00:27:52,640 --> 00:27:57,680
Speaker 1: angle because I would understand smoking because correct me if

499
00:27:57,680 --> 00:28:02,640
Speaker 1: I'm wrong, Peter. But this virus does create some kind

500
00:28:02,680 --> 00:28:06,960
Speaker 1: of fibrosis and the lungs. Is that right? Eventually, Yes,

501
00:28:07,359 --> 00:28:09,520
Speaker 1: this is a virus that has a kind of unique

502
00:28:09,520 --> 00:28:13,240
Speaker 1: pathology relative to influenza, for example, which would be a

503
00:28:13,280 --> 00:28:18,080
Speaker 1: cousin of it um. The virus gets Every virus has

504
00:28:18,119 --> 00:28:20,800
Speaker 1: to replicate by getting into a cell within our body.

505
00:28:20,880 --> 00:28:22,520
Speaker 1: So it's you know, maybe we're taking a step back

506
00:28:22,560 --> 00:28:25,200
Speaker 1: to understand what the heck of virus is. A virus

507
00:28:25,400 --> 00:28:28,640
Speaker 1: is not quite like a bacteria. The bacteria is totally

508
00:28:28,680 --> 00:28:32,600
Speaker 1: self sufficient, meaning it has all of the equipment inside

509
00:28:32,640 --> 00:28:35,640
Speaker 1: of its cell to fully replicate on its own outside

510
00:28:35,640 --> 00:28:38,720
Speaker 1: of the body. That doesn't mean it won't in fact us,

511
00:28:38,760 --> 00:28:42,320
Speaker 1: but a virus is different. A virus doesn't actually have

512
00:28:42,600 --> 00:28:46,200
Speaker 1: much to it. It's a much much simpler piece of

513
00:28:46,280 --> 00:28:50,120
Speaker 1: you know, biologic you know entity. It has in this

514
00:28:50,160 --> 00:28:54,480
Speaker 1: case just some RNA and that's about it. And so

515
00:28:54,680 --> 00:28:58,240
Speaker 1: for it to replicate and survive, it must get inside

516
00:28:58,240 --> 00:29:00,440
Speaker 1: of a host, and in this case, you have now

517
00:29:00,520 --> 00:29:02,959
Speaker 1: become the host. Prior to this, of course, animals were

518
00:29:03,000 --> 00:29:08,920
Speaker 1: the host, and it uses our DNA replicating machinery to

519
00:29:09,040 --> 00:29:11,960
Speaker 1: replicate itself. So if you were going to think about

520
00:29:11,960 --> 00:29:15,160
Speaker 1: this sort of teleologically, the virus really has no intention

521
00:29:15,200 --> 00:29:18,160
Speaker 1: of hurting us. That's just an unintended consequence. What it

522
00:29:18,240 --> 00:29:21,800
Speaker 1: wants to do is replicate. From an evolutionary perspective, and

523
00:29:21,840 --> 00:29:24,560
Speaker 1: the most successful viruses, by the way, the ones that

524
00:29:24,600 --> 00:29:27,240
Speaker 1: can go on forever and ever, don't hurt their host

525
00:29:27,280 --> 00:29:31,200
Speaker 1: at all. It's the viruses that destroy their host that

526
00:29:31,320 --> 00:29:34,520
Speaker 1: don't really survive, much like ebola. Ebola didn't spread very

527
00:29:34,600 --> 00:29:37,680
Speaker 1: much because it was so devastating to its host. So

528
00:29:37,720 --> 00:29:40,320
Speaker 1: when this virus comes in, it has to pick a

529
00:29:40,400 --> 00:29:43,360
Speaker 1: cell that it targets, and that just happens to come

530
00:29:43,400 --> 00:29:45,720
Speaker 1: down to sort of the molecular biology of how this

531
00:29:45,800 --> 00:29:50,400
Speaker 1: virus works. And this cell it targets most commonly is

532
00:29:50,400 --> 00:29:53,720
Speaker 1: a cell in the lung called a pneuma site because

533
00:29:53,720 --> 00:29:56,280
Speaker 1: of a certain receptor that that cell has that allows

534
00:29:56,320 --> 00:29:59,400
Speaker 1: this virus to enter. When it gets into that cell,

535
00:30:00,040 --> 00:30:03,520
Speaker 1: it basically hijacks it. It takes over and uses the

536
00:30:03,640 --> 00:30:06,680
Speaker 1: cell's ability to replicate and says, hey, I'm going to

537
00:30:06,960 --> 00:30:10,200
Speaker 1: take this over for myself and replicate myself. And it

538
00:30:10,280 --> 00:30:13,560
Speaker 1: does that and it ends up destroying that cell. And

539
00:30:13,640 --> 00:30:15,880
Speaker 1: it turns out that in this case, that's a really

540
00:30:15,920 --> 00:30:19,640
Speaker 1: bad cell to lose because that cell, called a type

541
00:30:19,640 --> 00:30:24,520
Speaker 1: to numa. Site makes a chemical called surfactant, and you've

542
00:30:24,520 --> 00:30:27,440
Speaker 1: probably heard of surfact and it's like a detergent that

543
00:30:27,560 --> 00:30:31,720
Speaker 1: allows the air sacks in our lungs to not collapse

544
00:30:31,760 --> 00:30:35,200
Speaker 1: on themselves because of the surface tension. And so when

545
00:30:35,200 --> 00:30:38,840
Speaker 1: we lose enough of those, the lungs begin to collapse

546
00:30:39,320 --> 00:30:43,280
Speaker 1: and we aren't able to exchange air, and ultimately that

547
00:30:43,360 --> 00:30:47,160
Speaker 1: results in a type of pneumonia, or really something more

548
00:30:47,200 --> 00:30:51,520
Speaker 1: severe than a pneumonia called acute respiratory distress syndrome, where

549
00:30:51,560 --> 00:30:54,840
Speaker 1: a person can't exchange gas, and ultimately that will result

550
00:30:54,920 --> 00:30:58,800
Speaker 1: in potentially fibrosis of the lung. It turns out, by

551
00:30:58,800 --> 00:31:01,280
Speaker 1: the way that that cell um that that that the

552
00:31:01,360 --> 00:31:05,040
Speaker 1: virus can also gain access to um muscle cells of

553
00:31:05,080 --> 00:31:08,600
Speaker 1: the heart, and so we believe that we're going to

554
00:31:08,680 --> 00:31:11,920
Speaker 1: see sort of fibrosis of the heart going forward. In fact,

555
00:31:12,000 --> 00:31:15,880
Speaker 1: thirty or forty percent of patients on autopsy, people who

556
00:31:15,920 --> 00:31:18,400
Speaker 1: have already died from this virus are showing injury to

557
00:31:18,480 --> 00:31:23,960
Speaker 1: their heart. This sounds very, very bleak, but that's one

558
00:31:24,000 --> 00:31:29,920
Speaker 1: of the reasons smokers are particularly susceptible because they already

559
00:31:29,920 --> 00:31:32,960
Speaker 1: have some of the some damage to the cells that

560
00:31:33,040 --> 00:31:36,960
Speaker 1: you were discussing, yep, and they just have less what

561
00:31:37,000 --> 00:31:41,440
Speaker 1: we would call pulmonary reserve. They have less lung capacity

562
00:31:41,600 --> 00:31:44,360
Speaker 1: in excess. So you know, someone like you, Katie, who's

563
00:31:44,400 --> 00:31:47,600
Speaker 1: really healthy, you know you're not utilizing your full lung

564
00:31:47,640 --> 00:31:50,360
Speaker 1: capacity when you're sitting here at rest right now. You're

565
00:31:50,440 --> 00:31:52,920
Speaker 1: using a fraction of it. But let's say that you

566
00:31:52,960 --> 00:31:56,880
Speaker 1: know you're using of your lung capacity. Will imagine somebody

567
00:31:56,880 --> 00:31:59,080
Speaker 1: who has smoked for a long period of time. For

568
00:31:59,160 --> 00:32:01,840
Speaker 1: them sitting at as they might be relying on six

569
00:32:02,520 --> 00:32:04,800
Speaker 1: of their lung capacity, so they just have less of

570
00:32:04,840 --> 00:32:06,920
Speaker 1: a buffer. You know. You can think of it as

571
00:32:06,960 --> 00:32:09,720
Speaker 1: like how much does someone have in their savings account? Well,

572
00:32:09,760 --> 00:32:12,320
Speaker 1: the person who has less in their savings account is

573
00:32:12,360 --> 00:32:16,120
Speaker 1: going to be more likely to suffer the shock of not,

574
00:32:16,320 --> 00:32:20,160
Speaker 1: you know, having a job. Before we talk about being

575
00:32:20,240 --> 00:32:23,600
Speaker 1: better prepared, and I know that you watched the Bill

576
00:32:23,680 --> 00:32:27,440
Speaker 1: Gates Ted Talk, which I thought was eerily prescient in

577
00:32:27,600 --> 00:32:31,520
Speaker 1: its message. But let's talk just briefly, because I think

578
00:32:31,560 --> 00:32:34,440
Speaker 1: people are desperate for this kind of information to Peter,

579
00:32:34,560 --> 00:32:39,040
Speaker 1: and you have access to the latest, most accurate information

580
00:32:39,520 --> 00:32:44,280
Speaker 1: in terms of protecting yourself. Um, tell me what you're

581
00:32:44,320 --> 00:32:49,440
Speaker 1: doing in your home with your kids and your wife. Well,

582
00:32:49,840 --> 00:32:52,680
Speaker 1: we we sort of probably came across as a little

583
00:32:52,680 --> 00:32:57,120
Speaker 1: bit crazy at the outset. In mid February, I sort

584
00:32:57,120 --> 00:32:59,360
Speaker 1: of woke up to what was happening. I had been

585
00:32:59,480 --> 00:33:04,520
Speaker 1: largely and denial through January, and UM, I think had

586
00:33:04,640 --> 00:33:07,840
Speaker 1: naively assumed that this would be much more like the

587
00:33:07,920 --> 00:33:12,800
Speaker 1: First Stars outbreak, or like the Murs outbreak, except less

588
00:33:12,840 --> 00:33:15,959
Speaker 1: deadly and less likely to spread. In other words, I

589
00:33:16,000 --> 00:33:19,920
Speaker 1: hadn't fully dug into the properties of this virus that

590
00:33:20,040 --> 00:33:22,680
Speaker 1: make it a little more troublesome, which is namely its

591
00:33:22,720 --> 00:33:26,480
Speaker 1: capacity for spread. But in mid February, when I sort

592
00:33:26,520 --> 00:33:29,840
Speaker 1: of woke up to this, UM, I started to think about, well,

593
00:33:29,840 --> 00:33:32,240
Speaker 1: what what could we do if we wanted to buy

594
00:33:32,280 --> 00:33:35,680
Speaker 1: more time? And so that basically came down to much

595
00:33:35,680 --> 00:33:39,280
Speaker 1: greater social distancing, and UM that meant, you know, canceling

596
00:33:39,280 --> 00:33:43,200
Speaker 1: all travel plans. And then eventually it just you know,

597
00:33:43,280 --> 00:33:45,680
Speaker 1: came down to making a decision that was difficult to make,

598
00:33:45,720 --> 00:33:48,240
Speaker 1: and not a decision that everybody has the luxury of making,

599
00:33:48,280 --> 00:33:50,680
Speaker 1: because many people don't have the luxury of working from home.

600
00:33:51,040 --> 00:33:54,920
Speaker 1: But it was a decision to basically quarantine ourselves, UM,

601
00:33:54,960 --> 00:33:57,520
Speaker 1: and so that meant that, you know, we don't leave

602
00:33:57,560 --> 00:33:59,960
Speaker 1: the house and people don't come to us in the house.

603
00:34:00,120 --> 00:34:03,240
Speaker 1: And the thinking would be that after two to three

604
00:34:03,280 --> 00:34:05,800
Speaker 1: weeks of that period of a quarantine, absent having an

605
00:34:05,840 --> 00:34:09,359
Speaker 1: accurate test to measure UM, if you are infected, if

606
00:34:09,400 --> 00:34:12,279
Speaker 1: you're completely asymptomatic, you know, no temperature changes or anything

607
00:34:12,400 --> 00:34:15,040
Speaker 1: like that, the likelihood that you're infected is low. And

608
00:34:15,080 --> 00:34:17,000
Speaker 1: now at least you're in sort of a safe spot

609
00:34:17,000 --> 00:34:19,600
Speaker 1: while you wait for time to sort of play this out.

610
00:34:19,719 --> 00:34:21,880
Speaker 1: And time does a lot of things right. Time allows

611
00:34:21,960 --> 00:34:24,920
Speaker 1: us to potentially develop a vaccine. Although I think that's

612
00:34:24,960 --> 00:34:28,120
Speaker 1: a longer term strategy than most people think, it certainly

613
00:34:28,160 --> 00:34:31,279
Speaker 1: allows us to repurpose existing drugs and that's something I'm

614
00:34:31,320 --> 00:34:33,960
Speaker 1: really excited about. So if we're going to talk about optimism,

615
00:34:34,120 --> 00:34:36,560
Speaker 1: I actually am quite optimistic that there are a suite

616
00:34:36,600 --> 00:34:39,719
Speaker 1: of drugs that already exist that we're now learning how

617
00:34:39,760 --> 00:34:43,280
Speaker 1: can be repurposed for this And most importantly, it's giving

618
00:34:43,400 --> 00:34:46,480
Speaker 1: the hospital system and the health care system a chance

619
00:34:46,719 --> 00:34:51,080
Speaker 1: to slowly expand to meet the needs that are necessary.

620
00:34:51,120 --> 00:34:55,240
Speaker 1: Because again to your point about Italy, the real problem

621
00:34:55,280 --> 00:34:57,319
Speaker 1: in Italy is not the total number of people that

622
00:34:57,360 --> 00:35:00,960
Speaker 1: are infected, it's the speed at which those people needed

623
00:35:01,080 --> 00:35:04,000
Speaker 1: medical care. And so you can you've heard the term

624
00:35:04,040 --> 00:35:06,759
Speaker 1: flattening the curve. Why are people saying that. It's like

625
00:35:06,840 --> 00:35:10,640
Speaker 1: saying if a hundred thousand people are going to require hospitalization,

626
00:35:10,840 --> 00:35:13,600
Speaker 1: it's a big difference if they required in one month

627
00:35:14,000 --> 00:35:17,080
Speaker 1: or one year. And so it's not clear that we're

628
00:35:17,080 --> 00:35:19,280
Speaker 1: going to reduce the number of people that are ultimately

629
00:35:19,280 --> 00:35:21,200
Speaker 1: going to be infected, but we want to spread it

630
00:35:21,200 --> 00:35:24,120
Speaker 1: out as much as possible. So on a personal level,

631
00:35:24,200 --> 00:35:26,120
Speaker 1: my view is what can I do to make sure

632
00:35:26,160 --> 00:35:30,120
Speaker 1: I don't need healthcare resources anytime soon. I talked to

633
00:35:30,280 --> 00:35:35,520
Speaker 1: the director of an urgent care center, Peter, and he said,

634
00:35:35,680 --> 00:35:39,080
Speaker 1: do not go to the doctors, do not you know,

635
00:35:39,440 --> 00:35:43,120
Speaker 1: try to seek medical care unless it gets bad. But

636
00:35:43,200 --> 00:35:46,719
Speaker 1: I wondered, is there an inflection point, because I think

637
00:35:46,840 --> 00:35:50,680
Speaker 1: people are so paranoid. Every time I cough, I get

638
00:35:50,719 --> 00:35:55,920
Speaker 1: neurotic and uh and and when is that point where

639
00:35:56,000 --> 00:35:58,719
Speaker 1: you should seek medical care or at least talk to

640
00:35:58,760 --> 00:36:04,560
Speaker 1: a healthcare provide because we don't want to clog the system. Listeners,

641
00:36:04,600 --> 00:36:07,640
Speaker 1: I'm sure agree with this, but we also don't want

642
00:36:07,640 --> 00:36:11,479
Speaker 1: to ignore an illness that could worsen if we don't

643
00:36:11,480 --> 00:36:14,959
Speaker 1: get it, if we don't get the proper attention. Yeah,

644
00:36:15,000 --> 00:36:18,319
Speaker 1: I mean, that's such an important question, and truthfully, it's

645
00:36:18,360 --> 00:36:21,960
Speaker 1: one for which I think the answer is not entirely clear. Um,

646
00:36:22,120 --> 00:36:24,239
Speaker 1: we probably do need to think a little bit about

647
00:36:24,239 --> 00:36:26,960
Speaker 1: how to stratify. So I would agree with the advice

648
00:36:27,120 --> 00:36:31,080
Speaker 1: that your colleague and friend gave you, which is, we

649
00:36:31,280 --> 00:36:36,040
Speaker 1: certainly don't want everyone who, um, you know, thinks that

650
00:36:36,080 --> 00:36:38,040
Speaker 1: they have a little sniffle or a sneeze or a

651
00:36:38,080 --> 00:36:42,279
Speaker 1: sore throat to then expose themselves to an infection by

652
00:36:42,280 --> 00:36:46,799
Speaker 1: going out and seeking medical care, especially when we don't

653
00:36:46,840 --> 00:36:49,040
Speaker 1: have testing readily available yet. That's the important thing to

654
00:36:49,120 --> 00:36:51,920
Speaker 1: understand is what is it going to accomplish to go

655
00:36:52,000 --> 00:36:55,239
Speaker 1: and put yourself in harm's way If we don't even

656
00:36:55,239 --> 00:36:57,239
Speaker 1: have a test yet that's viable, are going to offer

657
00:36:57,280 --> 00:37:00,480
Speaker 1: as much. So I think we have to stratify patient. So,

658
00:37:00,719 --> 00:37:02,160
Speaker 1: you know, the way we are looking at it in

659
00:37:02,160 --> 00:37:04,839
Speaker 1: our practice is we're taking the patients who we think

660
00:37:04,840 --> 00:37:07,359
Speaker 1: are at highest risk. So these are people who are

661
00:37:07,760 --> 00:37:10,680
Speaker 1: you know, sort of in their sixties and older people

662
00:37:10,680 --> 00:37:14,400
Speaker 1: who have existing conditions like high blood pressure or heart disease,

663
00:37:14,440 --> 00:37:17,920
Speaker 1: atrial fibrillation, these sorts of things, and we're saying we're

664
00:37:17,920 --> 00:37:22,400
Speaker 1: going to have a lower threshold for getting them tested

665
00:37:22,640 --> 00:37:24,759
Speaker 1: or getting them in to see someone if we have

666
00:37:24,840 --> 00:37:27,520
Speaker 1: any concern. You know, my wife yesterday was called by

667
00:37:27,640 --> 00:37:31,120
Speaker 1: a friend of hers who lives in Colorado now, and

668
00:37:31,200 --> 00:37:34,080
Speaker 1: she has a lot of underlying medical conditions, and you know,

669
00:37:34,400 --> 00:37:36,520
Speaker 1: it was really difficult to spend the time on the

670
00:37:36,520 --> 00:37:39,120
Speaker 1: phone with here today and triage. What I couldn't fully

671
00:37:39,200 --> 00:37:42,840
Speaker 1: understand was either a panic attack or legitimately an illness,

672
00:37:43,360 --> 00:37:45,200
Speaker 1: and you know, we had to make a call, and

673
00:37:45,200 --> 00:37:47,680
Speaker 1: in the end we saw it. We decided after an

674
00:37:47,680 --> 00:37:50,040
Speaker 1: hour she probably did need to go into the emergency

675
00:37:50,120 --> 00:37:52,160
Speaker 1: room and get checked out because I just couldn't be

676
00:37:52,200 --> 00:37:55,360
Speaker 1: comfortable that this was just anxiety and I and she

677
00:37:55,440 --> 00:37:58,360
Speaker 1: has so many underlying medical conditions that I was actually

678
00:37:58,400 --> 00:38:01,040
Speaker 1: concerned that. You know, she's the type of person who,

679
00:38:01,080 --> 00:38:04,480
Speaker 1: if infected, could very precipitously, you know, fall off that

680
00:38:04,600 --> 00:38:09,560
Speaker 1: proverbial cliff. And what happened, Um, you know, she we

681
00:38:09,680 --> 00:38:12,759
Speaker 1: went there. I It's it's still unclear because of course,

682
00:38:12,800 --> 00:38:15,239
Speaker 1: the testing takes days to get back. So, but now

683
00:38:15,280 --> 00:38:18,239
Speaker 1: she is at least, you know, her blood pressure is normalized,

684
00:38:18,520 --> 00:38:22,279
Speaker 1: her oxygen levels are normalized. Um, the thing we are

685
00:38:22,440 --> 00:38:25,640
Speaker 1: most sensitive to is shortness of breath. That seems to

686
00:38:25,640 --> 00:38:29,280
Speaker 1: be the biggest single predictor of people who do versus

687
00:38:29,320 --> 00:38:32,319
Speaker 1: do not need medical attention. So people who do not

688
00:38:32,440 --> 00:38:36,040
Speaker 1: develop shortness of breath at any point in time are

689
00:38:36,080 --> 00:38:38,680
Speaker 1: generally going to recover in what we call a self

690
00:38:38,760 --> 00:38:42,600
Speaker 1: limited way. I hate to ask you this, doctor a

691
00:38:42,719 --> 00:38:45,920
Speaker 1: tea of a what is how do you know if

692
00:38:45,960 --> 00:38:48,560
Speaker 1: you have shortness of breath? I know that probably sounds

693
00:38:48,560 --> 00:38:51,319
Speaker 1: like a dumb question, but is there something you can

694
00:38:51,400 --> 00:38:55,879
Speaker 1: do to figure out? Is it walking upstairs? I mean

695
00:38:56,200 --> 00:38:58,960
Speaker 1: I get sometime shortness of breath if I try to

696
00:38:59,040 --> 00:39:01,879
Speaker 1: run a mile. I mean when when can you tell

697
00:39:01,960 --> 00:39:04,960
Speaker 1: you have that? Actually, Katie, that is not a stupid

698
00:39:05,040 --> 00:39:07,440
Speaker 1: question at all, and we've actually tried to explain that

699
00:39:07,520 --> 00:39:11,239
Speaker 1: exactly to our patients. So I'm glad you asked. Um.

700
00:39:11,400 --> 00:39:13,640
Speaker 1: We think one of the best litmus test is for

701
00:39:13,920 --> 00:39:18,279
Speaker 1: litmus tests for shortness of breath is air hunger while

702
00:39:18,320 --> 00:39:22,760
Speaker 1: speaking in long sentences. So when someone who could normally

703
00:39:22,920 --> 00:39:26,319
Speaker 1: rattle off, you know, three minutes of talking with just

704
00:39:26,360 --> 00:39:28,680
Speaker 1: the simple breath in between, all of a sudden has

705
00:39:28,719 --> 00:39:32,480
Speaker 1: to take longer pauses to take breaths in between speaking

706
00:39:32,920 --> 00:39:36,440
Speaker 1: to me, that's true shortness of breath. You use an

707
00:39:36,480 --> 00:39:38,560
Speaker 1: example of walking up a flight of stairs. I think,

708
00:39:38,600 --> 00:39:42,600
Speaker 1: if somebody knows what they're you know, normal exercise tolerance

709
00:39:42,719 --> 00:39:46,480
Speaker 1: is when that dramatically decreases. So if a person you

710
00:39:46,520 --> 00:39:48,400
Speaker 1: know lives in an apartment where they have to go

711
00:39:48,480 --> 00:39:50,560
Speaker 1: up and down a flight of stairs and normally that

712
00:39:50,880 --> 00:39:54,000
Speaker 1: poses no risk to them, and all of a sudden,

713
00:39:54,040 --> 00:39:57,400
Speaker 1: now they think, oh my god, like I'm really winded

714
00:39:57,400 --> 00:39:59,960
Speaker 1: walking up this flight of stairs, that that might all

715
00:40:00,040 --> 00:40:03,360
Speaker 1: so constitute shortness of breath. Um. The other thing to

716
00:40:03,400 --> 00:40:06,640
Speaker 1: keep in mind is shortness of breath by itself probably

717
00:40:06,680 --> 00:40:10,920
Speaker 1: doesn't show up without some other symptoms, such as, um,

718
00:40:10,960 --> 00:40:13,320
Speaker 1: you know, a fever, which is the single most common

719
00:40:13,360 --> 00:40:15,839
Speaker 1: symptom we see in people who are infected. But of

720
00:40:15,880 --> 00:40:19,000
Speaker 1: course it's important to understand people can develop fevers for

721
00:40:19,120 --> 00:40:21,400
Speaker 1: any sort of you know common you know, cold or

722
00:40:21,440 --> 00:40:25,520
Speaker 1: anything like that orl right, absolutely, and so all of

723
00:40:25,520 --> 00:40:27,680
Speaker 1: this I think points to something which is, you know,

724
00:40:28,120 --> 00:40:30,279
Speaker 1: do as much as you can buy phone right, call

725
00:40:30,360 --> 00:40:33,960
Speaker 1: your doctor, walk through all of these things and and

726
00:40:34,040 --> 00:40:36,839
Speaker 1: let you let your doctor help you decide if you

727
00:40:36,880 --> 00:40:40,640
Speaker 1: actually need to take the next step of getting tested,

728
00:40:40,680 --> 00:40:44,120
Speaker 1: which again we're currently in a testing environment that is

729
00:40:44,160 --> 00:40:48,520
Speaker 1: not adequate. So the CDC guidelines on testing are actually

730
00:40:48,600 --> 00:40:51,040
Speaker 1: quite stringent compared to what I think they should be

731
00:40:51,160 --> 00:40:55,719
Speaker 1: due to these limitations. So you know that that does

732
00:40:55,840 --> 00:40:59,200
Speaker 1: raise the question who should be tested and who shouldn't

733
00:40:59,280 --> 00:41:03,600
Speaker 1: and uh, sort of thinking about the common good and

734
00:41:03,680 --> 00:41:07,120
Speaker 1: not just yourself in these situations. But gosh, you know,

735
00:41:07,200 --> 00:41:10,399
Speaker 1: we're talking about in some cases life or death, peter

736
00:41:10,520 --> 00:41:14,200
Speaker 1: and so people I think, you know, they have this

737
00:41:14,280 --> 00:41:20,040
Speaker 1: primal survival instinct. So uh, in terms of testing, you

738
00:41:20,400 --> 00:41:23,680
Speaker 1: have to rely on your health care provider. But they're

739
00:41:23,719 --> 00:41:28,600
Speaker 1: making some tough decisions in Italy about who who gets

740
00:41:28,640 --> 00:41:34,080
Speaker 1: medical attention and who doesn't because of the crowded conditions

741
00:41:34,120 --> 00:41:38,160
Speaker 1: of hospitals, etcetera. I mean, it's it really feels like

742
00:41:38,280 --> 00:41:42,240
Speaker 1: the makings of a of a sci fi movie. Yeah,

743
00:41:42,320 --> 00:41:47,239
Speaker 1: they are making these decisions in Europe um already, and

744
00:41:48,400 --> 00:41:50,840
Speaker 1: it's not clear if we're not going to be in

745
00:41:50,840 --> 00:41:53,360
Speaker 1: the same position in the next two to three weeks.

746
00:41:54,080 --> 00:41:57,359
Speaker 1: UM as far as testing goes at the time, at

747
00:41:57,560 --> 00:42:01,520
Speaker 1: right this moment, Katie, the CDC sidelines are that testing

748
00:42:01,560 --> 00:42:05,840
Speaker 1: should be reserved for people who are symptomatic only. Now,

749
00:42:06,000 --> 00:42:09,040
Speaker 1: why do I think that that's insufficient? Um? I think it.

750
00:42:09,320 --> 00:42:11,840
Speaker 1: If you really want to control the rate of spread,

751
00:42:12,280 --> 00:42:15,399
Speaker 1: you should also be testing people with known exposure, even

752
00:42:15,440 --> 00:42:19,160
Speaker 1: if they are asymptomatic. Because this virus has such a

753
00:42:19,239 --> 00:42:23,560
Speaker 1: long latency period. Let's assume that you know, you are

754
00:42:23,600 --> 00:42:26,799
Speaker 1: around somebody who then went on to test positive or

755
00:42:26,840 --> 00:42:30,560
Speaker 1: frankly even went on to be symptomatic. In an ideal world,

756
00:42:30,719 --> 00:42:33,160
Speaker 1: if we had a sufficient number of tests and a

757
00:42:33,239 --> 00:42:36,480
Speaker 1: sufficient infrastructure for testing, it would actually be important to

758
00:42:36,520 --> 00:42:40,560
Speaker 1: know that you were negative before you know, we told you, hey,

759
00:42:40,600 --> 00:42:42,680
Speaker 1: it's you know. The fact that you're not symptomatic means

760
00:42:42,719 --> 00:42:46,000
Speaker 1: you're not at risk. In other words, the thing that

761
00:42:46,120 --> 00:42:50,960
Speaker 1: makes this virus so particularly troublesome is that people who

762
00:42:51,000 --> 00:42:54,799
Speaker 1: have no symptoms can spread the virus, and they can

763
00:42:54,800 --> 00:42:58,680
Speaker 1: do so for a long period of time, for fourteen days, right,

764
00:42:58,719 --> 00:43:01,040
Speaker 1: I mean, isn't that the inky bastion period and the

765
00:43:01,080 --> 00:43:05,120
Speaker 1: fact that some people can be vectors and yet never

766
00:43:05,600 --> 00:43:10,080
Speaker 1: symptomatic that makes it really freaky. Right, Yeah, that's the

767
00:43:10,320 --> 00:43:13,040
Speaker 1: that's the superpower of this virus. So if you were

768
00:43:13,080 --> 00:43:16,319
Speaker 1: gonna like create a you know, a list of all

769
00:43:16,320 --> 00:43:19,960
Speaker 1: the things that make this virus sort of troubling, that

770
00:43:19,960 --> 00:43:22,600
Speaker 1: that would be its superpower is that it has this

771
00:43:22,719 --> 00:43:27,919
Speaker 1: ability to very subtly get you know, get from one

772
00:43:27,960 --> 00:43:32,279
Speaker 1: person to another, usually without that person knowing it. And

773
00:43:32,640 --> 00:43:35,719
Speaker 1: again we'll use Ebola as a stark contrast. Right, why

774
00:43:35,840 --> 00:43:39,760
Speaker 1: was Ebola not really a big issue once it got

775
00:43:39,800 --> 00:43:45,000
Speaker 1: into um the United States? Because people were so sick

776
00:43:45,080 --> 00:43:48,160
Speaker 1: when they got it that there was no ambiguity about

777
00:43:48,200 --> 00:43:50,959
Speaker 1: whether that person had it and it was only during

778
00:43:51,000 --> 00:43:53,560
Speaker 1: that period of extreme sickness that they could go on

779
00:43:53,640 --> 00:43:58,839
Speaker 1: and shed the virus. If in fact, people are practicing

780
00:43:58,960 --> 00:44:03,839
Speaker 1: social distancing, now all these cities are closing down, I

781
00:44:03,880 --> 00:44:07,760
Speaker 1: guess you know San Francisco is a shelter in place

782
00:44:07,840 --> 00:44:12,320
Speaker 1: city other cities as well. Is that going to ameliorate

783
00:44:12,719 --> 00:44:17,640
Speaker 1: or mitigate some of the conditions that will be prime

784
00:44:17,760 --> 00:44:21,480
Speaker 1: for spreading this virus around or have we missed that

785
00:44:21,560 --> 00:44:26,080
Speaker 1: window of opportunity, Peter. It will absolutely have an impact.

786
00:44:26,120 --> 00:44:28,359
Speaker 1: I mean, in an ideal circumstance, if we had a

787
00:44:28,360 --> 00:44:30,480
Speaker 1: time machine. I think we would have done this, we

788
00:44:30,480 --> 00:44:33,600
Speaker 1: would have taken these precautions a month sooner. But I'm

789
00:44:33,600 --> 00:44:37,480
Speaker 1: actually still optimistic. And you know, we have a team

790
00:44:37,520 --> 00:44:42,080
Speaker 1: of analysts that are building forecast models, reviewing every piece

791
00:44:42,120 --> 00:44:46,080
Speaker 1: of data that's available and including data that aren't publicly

792
00:44:46,120 --> 00:44:49,560
Speaker 1: available by you know, you speaking with people on the

793
00:44:49,600 --> 00:44:53,600
Speaker 1: front lines to pressure test assumptions. I don't think that

794
00:44:53,760 --> 00:44:58,200
Speaker 1: it's a foregone conclusion how this ends. So um you know,

795
00:44:59,280 --> 00:45:01,800
Speaker 1: I can't even sit here and project how many people

796
00:45:01,800 --> 00:45:03,920
Speaker 1: are going to be infected in the United States, although

797
00:45:03,920 --> 00:45:06,160
Speaker 1: there are lots of estimates, and some of them are

798
00:45:06,239 --> 00:45:09,160
Speaker 1: quite scary. You know, Mark Lipsitch at the Harvard School

799
00:45:09,160 --> 00:45:13,040
Speaker 1: of Public Health projects that you know, more than the U.

800
00:45:13,160 --> 00:45:16,040
Speaker 1: S population will ultimately be infected by this, and that

801
00:45:16,200 --> 00:45:19,400
Speaker 1: the mortality rates we're seeing those are staggering numbers. That

802
00:45:19,440 --> 00:45:21,200
Speaker 1: that the implication of that, by the way to put

803
00:45:21,239 --> 00:45:24,600
Speaker 1: it in some numbers, is more people would die from

804
00:45:24,640 --> 00:45:27,480
Speaker 1: this virus in a year in the next year than

805
00:45:27,600 --> 00:45:31,479
Speaker 1: die of all other things combined. I mean that that's

806
00:45:31,520 --> 00:45:35,479
Speaker 1: a staggering statistic. Do I think that that is set

807
00:45:35,480 --> 00:45:37,600
Speaker 1: in stone yet, that that is our fate? I don't.

808
00:45:38,239 --> 00:45:41,319
Speaker 1: And I do think that the more aggressively we can

809
00:45:41,360 --> 00:45:45,760
Speaker 1: socially distance ourselves, the more aggressively we can implement testing

810
00:45:46,200 --> 00:45:51,360
Speaker 1: which will enable this stratification of distancing between people, and

811
00:45:51,400 --> 00:45:55,640
Speaker 1: the more readily available we can be pressure testing existing

812
00:45:55,719 --> 00:45:59,719
Speaker 1: drugs to then bring on treatments that can reduce the

813
00:46:00,120 --> 00:46:03,440
Speaker 1: mortality and morbidity. I think we still have a chance

814
00:46:03,480 --> 00:46:06,200
Speaker 1: to bend the curve of this thing. We're going to

815
00:46:06,320 --> 00:46:09,360
Speaker 1: take a break, but we'll be right back with more

816
00:46:09,400 --> 00:46:24,320
Speaker 1: critically important information from Dr Peter A Tilla. Hi, everyone,

817
00:46:24,360 --> 00:46:27,080
Speaker 1: I'm so happy we were able to get in touch

818
00:46:27,400 --> 00:46:30,440
Speaker 1: with Dr Peter Attia and he was able to spend

819
00:46:30,880 --> 00:46:34,879
Speaker 1: a good hour talking to us about this scary pandemic

820
00:46:35,360 --> 00:46:39,400
Speaker 1: because I think his knowledge, his experience, and his connections

821
00:46:39,400 --> 00:46:44,440
Speaker 1: are really unparalleled. So let's get back to that important conversation.

822
00:46:45,000 --> 00:46:48,479
Speaker 1: Let's say someone goes to the hospital, Peter, and they

823
00:46:48,520 --> 00:46:54,920
Speaker 1: have COVID nineteen. I know that ventilators and respirators to

824
00:46:55,040 --> 00:46:59,319
Speaker 1: help with lung capacity, but are there any medicines that

825
00:46:59,440 --> 00:47:02,400
Speaker 1: these people are keetting or are they just going to

826
00:47:02,480 --> 00:47:06,279
Speaker 1: the hospital? And uh, I mean, how are the how

827
00:47:06,280 --> 00:47:10,640
Speaker 1: are doctors fighting it right now? It's varying by hospital.

828
00:47:10,800 --> 00:47:15,040
Speaker 1: So myself and my team, we have enough friends in

829
00:47:15,160 --> 00:47:18,200
Speaker 1: hospitals that we're hearing, you know, we're finding out this

830
00:47:18,280 --> 00:47:21,319
Speaker 1: hospital in Boston is using this protocol, this hospital in

831
00:47:21,360 --> 00:47:24,600
Speaker 1: New York is doing this, etcetera. UM, So right now,

832
00:47:24,600 --> 00:47:28,200
Speaker 1: I would say, Katie, it's not standardized, but you're crazy.

833
00:47:29,040 --> 00:47:32,480
Speaker 1: I mean, that seems insane to me. That it's not

834
00:47:33,120 --> 00:47:36,840
Speaker 1: that it isn't standardized, that it's sort of kind of

835
00:47:36,880 --> 00:47:41,200
Speaker 1: a piecemeal approach. Well, the primary approach, as you said,

836
00:47:41,480 --> 00:47:44,400
Speaker 1: is supportive care. So the single most important thing for

837
00:47:44,440 --> 00:47:48,440
Speaker 1: a person once they're in the hospital is maintaining sufficient

838
00:47:48,520 --> 00:47:50,920
Speaker 1: respiration because that's the thing that's going to put a

839
00:47:50,960 --> 00:47:54,000
Speaker 1: person in the hospital. So the most common thing that

840
00:47:54,000 --> 00:47:57,279
Speaker 1: people are presenting with his respiratory failure as opposed to

841
00:47:57,280 --> 00:48:01,000
Speaker 1: say cardiac failure, renal failure, or other organ failure. So

842
00:48:01,320 --> 00:48:03,440
Speaker 1: you know, the first, second, and third line of defense

843
00:48:03,719 --> 00:48:08,280
Speaker 1: is through you know, oxygen and supplemental respiratory care, hopefully

844
00:48:08,280 --> 00:48:11,719
Speaker 1: not requiring mechanical ventilation, but obviously at some point that's

845
00:48:11,760 --> 00:48:15,640
Speaker 1: happening for enough people. That's that's the sort of supportive

846
00:48:15,680 --> 00:48:19,240
Speaker 1: side of things. UM. And I think we are seeing

847
00:48:19,239 --> 00:48:23,640
Speaker 1: more and more patients being treated with um chloroquin and then,

848
00:48:23,680 --> 00:48:26,800
Speaker 1: of course if the doctor's treating the patient have reason

849
00:48:26,880 --> 00:48:30,239
Speaker 1: to believe that they're now developing secondary infections, then things

850
00:48:30,280 --> 00:48:34,440
Speaker 1: like antibiotics are coming on board. And if it turns

851
00:48:34,440 --> 00:48:37,760
Speaker 1: into pneumonia exactly if it's a pneumonia that they believe

852
00:48:38,080 --> 00:48:42,000
Speaker 1: is an actual bacterial pneumonia versus sort of a viral

853
00:48:42,000 --> 00:48:45,759
Speaker 1: pneumonia for which the antibiotics wouldn't provide any benefit. There's

854
00:48:45,800 --> 00:48:50,080
Speaker 1: also HIV drugs. There's a drug that that is a

855
00:48:50,120 --> 00:48:55,879
Speaker 1: protease inhibitor that I think is sort of weakly um

856
00:48:55,920 --> 00:48:59,239
Speaker 1: potentially helpful. It's still too soon to say, but the

857
00:49:00,160 --> 00:49:03,000
Speaker 1: of using it seems relatively low, so it's it's also

858
00:49:03,120 --> 00:49:06,759
Speaker 1: being tested. UM one drug that I think to three

859
00:49:06,800 --> 00:49:09,600
Speaker 1: weeks ago we thought might be valuable that is looking

860
00:49:09,719 --> 00:49:13,799
Speaker 1: less valuable as the common anti flu drug called tama flu,

861
00:49:14,040 --> 00:49:18,720
Speaker 1: so I think most hospitals are moving away from that now.

862
00:49:18,760 --> 00:49:23,480
Speaker 1: But again UM it is unfortunately not a fully standardized

863
00:49:23,520 --> 00:49:26,480
Speaker 1: protocol because even though the CDC will have a recommendation,

864
00:49:27,040 --> 00:49:30,759
Speaker 1: ultimately the physicians are the ones at the bedside that

865
00:49:30,800 --> 00:49:34,319
Speaker 1: are going to be able to make the decisions. Can

866
00:49:34,360 --> 00:49:37,279
Speaker 1: you reverse this? So let's say someone goes to the

867
00:49:37,320 --> 00:49:43,040
Speaker 1: hospital they're having respiratory failure. Can those individuals with you know,

868
00:49:43,200 --> 00:49:47,719
Speaker 1: breathing assistance, with the ventilator a respirator, can they then,

869
00:49:48,239 --> 00:49:51,680
Speaker 1: um get the virus that, as you said, was sort

870
00:49:51,719 --> 00:49:55,839
Speaker 1: of taking over the cells and their lungs. Can they

871
00:49:55,880 --> 00:49:58,000
Speaker 1: how do they get that? How do they get it

872
00:49:58,120 --> 00:50:01,839
Speaker 1: out of their lungs? I know this ounds sort of elementary,

873
00:50:01,920 --> 00:50:05,239
Speaker 1: but I'm just trying to figure out, you know, is

874
00:50:05,239 --> 00:50:10,600
Speaker 1: that kind of support enough to eradicate this virus? Um. No,

875
00:50:10,680 --> 00:50:12,520
Speaker 1: it's actually not an elementary question at all. It's a

876
00:50:12,600 --> 00:50:15,839
Speaker 1: very important question. What's actually happening is there's a war

877
00:50:16,000 --> 00:50:20,480
Speaker 1: going on between the virus and the immune system, and

878
00:50:20,520 --> 00:50:24,080
Speaker 1: the whole purpose of supportive care such as ventilation is

879
00:50:24,120 --> 00:50:27,440
Speaker 1: to buy time for the immune system to win that fight.

880
00:50:28,360 --> 00:50:31,520
Speaker 1: Now it becomes a bit complicated because the immune system,

881
00:50:31,719 --> 00:50:34,280
Speaker 1: in its best effort to win that fight, can also

882
00:50:34,360 --> 00:50:37,480
Speaker 1: cause a lot of damage to the host. So you

883
00:50:37,520 --> 00:50:40,520
Speaker 1: think of it like a war going on in a country.

884
00:50:40,840 --> 00:50:42,560
Speaker 1: You have the good guys the bad guys. At the

885
00:50:42,640 --> 00:50:47,439
Speaker 1: risk of oversimplifying it, well, both of those entities when

886
00:50:47,480 --> 00:50:51,440
Speaker 1: engaging in war caused collateral damage, and so it's like

887
00:50:51,520 --> 00:50:55,680
Speaker 1: immunotherapy and cancer, it becomes too refed up and that

888
00:50:55,719 --> 00:50:59,880
Speaker 1: can create all kinds of autoimmune issues. Correct. Absolutely, So

889
00:51:00,120 --> 00:51:02,799
Speaker 1: the you know, the checkpoint inhibitors, which you know are

890
00:51:02,840 --> 00:51:05,480
Speaker 1: probably the most exciting thing in all of immuno oncology

891
00:51:05,640 --> 00:51:08,800
Speaker 1: right now, um, exactly have that as a side effect,

892
00:51:08,840 --> 00:51:11,520
Speaker 1: which is autoimmunity. The immune system goes a little too

893
00:51:11,560 --> 00:51:14,360
Speaker 1: far now in in this type of response to the

894
00:51:14,360 --> 00:51:17,120
Speaker 1: immune system. It's not so much autoimmunity that we're seeing

895
00:51:17,160 --> 00:51:19,719
Speaker 1: as the problem, but it's the sort of um, what's

896
00:51:19,760 --> 00:51:25,440
Speaker 1: called systemic inflammatory response syndrome or this cytokine storm that

897
00:51:25,600 --> 00:51:28,920
Speaker 1: is sort of you know, wreaking havoc both to kill

898
00:51:28,960 --> 00:51:31,880
Speaker 1: the viruses, but it's also the thing that can you know,

899
00:51:32,040 --> 00:51:35,120
Speaker 1: cause capillary leaking in the lungs that can lead to

900
00:51:35,480 --> 00:51:38,720
Speaker 1: other things like edema, and it can damage other parts

901
00:51:38,719 --> 00:51:41,840
Speaker 1: of the body. So basically what you're saying is that

902
00:51:42,080 --> 00:51:46,120
Speaker 1: it's a delicate balance between the immune system, which can

903
00:51:46,200 --> 00:51:50,799
Speaker 1: cause inflammation and damage if it's overly compensating for the

904
00:51:50,880 --> 00:51:56,120
Speaker 1: virus and sort of keeping the virus in check. YEP.

905
00:51:56,280 --> 00:52:00,320
Speaker 1: And we use supportive measures like ventilation to base sally

906
00:52:00,400 --> 00:52:03,960
Speaker 1: by time to augment what the lung needs to do

907
00:52:04,520 --> 00:52:07,320
Speaker 1: to to create that amount of time and space necessary

908
00:52:07,360 --> 00:52:09,600
Speaker 1: for the immune system to ultimately win that fight. But

909
00:52:09,680 --> 00:52:13,759
Speaker 1: winning the fight means that the virus has gone, you know,

910
00:52:13,800 --> 00:52:16,880
Speaker 1: winning the fight means that the number of actual copies

911
00:52:16,880 --> 00:52:21,640
Speaker 1: of that virus goes down to some insignificant level um

912
00:52:21,680 --> 00:52:24,360
Speaker 1: and you know, to you know, to contrast that with

913
00:52:24,400 --> 00:52:26,359
Speaker 1: other things, like when you look at the Spanish flu,

914
00:52:26,680 --> 00:52:30,400
Speaker 1: the one and one pandemic, that was kind of a

915
00:52:30,400 --> 00:52:32,920
Speaker 1: different animal. You know, that was an animal where so

916
00:52:33,000 --> 00:52:37,160
Speaker 1: much of the damage actually came from the hyperactive immune

917
00:52:37,200 --> 00:52:41,520
Speaker 1: response and then this immune paralysis that followed it that

918
00:52:41,640 --> 00:52:45,560
Speaker 1: led to these secondary infections. So you know, paradoxically, the

919
00:52:45,600 --> 00:52:48,640
Speaker 1: people that were most vulnerable to that flu were people

920
00:52:48,640 --> 00:52:51,400
Speaker 1: that had the most robust immune system and therefore the

921
00:52:51,480 --> 00:52:56,520
Speaker 1: strongest immune response. We're not seeing that here, which suggests

922
00:52:57,040 --> 00:53:00,760
Speaker 1: again it's just a suggestion that a hyper active immune

923
00:53:00,760 --> 00:53:04,600
Speaker 1: response is less of a problem than the actual damage

924
00:53:04,640 --> 00:53:10,760
Speaker 1: the virus is causing to the cells. That's fascinating. Um.

925
00:53:10,800 --> 00:53:16,160
Speaker 1: That raises a couple of questions about ventilators and respirators

926
00:53:16,160 --> 00:53:18,160
Speaker 1: and I don't even know the difference, and maybe you

927
00:53:18,200 --> 00:53:21,680
Speaker 1: can explain that. But uh, there's a real shortage of

928
00:53:21,760 --> 00:53:25,680
Speaker 1: medical equipment. How serious a problem will it be if

929
00:53:25,719 --> 00:53:28,799
Speaker 1: there is a lack of ventilators or respirators to buy

930
00:53:28,840 --> 00:53:32,000
Speaker 1: the time these patients need and what is being done

931
00:53:32,000 --> 00:53:34,840
Speaker 1: about that? So it's a huge problem. Let me answer

932
00:53:34,920 --> 00:53:40,719
Speaker 1: your first question. So, respirators are non invasive. So um

933
00:53:40,840 --> 00:53:43,719
Speaker 1: for example, you've probably visited somebody in the hospital and

934
00:53:43,760 --> 00:53:46,359
Speaker 1: you see like a little oxygen mask that they have on,

935
00:53:46,480 --> 00:53:48,800
Speaker 1: or even something called a nasal canyla where there's a

936
00:53:48,840 --> 00:53:51,360
Speaker 1: little device that goes under their nose that's just passively

937
00:53:51,400 --> 00:53:55,200
Speaker 1: blowing oxygen at them. So you know, you can you

938
00:53:55,239 --> 00:53:59,480
Speaker 1: can provide a person with supplemental oxygen in that sort

939
00:53:59,480 --> 00:54:04,960
Speaker 1: of passive manner. But when a person becomes really dependent

940
00:54:05,080 --> 00:54:09,640
Speaker 1: on oxygen, they require something called mechanical ventilation, and to

941
00:54:09,760 --> 00:54:13,520
Speaker 1: do that you have to undergo a procedure called intibation,

942
00:54:13,640 --> 00:54:16,040
Speaker 1: which anybody who has had surgery has has you know,

943
00:54:16,120 --> 00:54:18,399
Speaker 1: under general and aesthetic has had that. But that's where

944
00:54:18,400 --> 00:54:23,239
Speaker 1: a tube is actually placed into the main airway called

945
00:54:23,280 --> 00:54:26,319
Speaker 1: the trachea. So it's called an endotracheal tube. When a

946
00:54:26,360 --> 00:54:30,719
Speaker 1: person is intibated, they also have to be paralyzed and sedated.

947
00:54:30,880 --> 00:54:33,440
Speaker 1: It's not a comfortable thing. You You couldn't be wide

948
00:54:33,440 --> 00:54:36,960
Speaker 1: awake sitting there intibated um, so you have to be

949
00:54:37,080 --> 00:54:39,880
Speaker 1: sedating the patients and paralyzing them. And the reason you

950
00:54:39,920 --> 00:54:43,800
Speaker 1: have to do that is that their own voluntary muscular

951
00:54:43,840 --> 00:54:47,360
Speaker 1: movements can't fight the ventilator, so you actually have to

952
00:54:47,400 --> 00:54:50,400
Speaker 1: basically shut them down to let the machine do the breathing.

953
00:54:51,239 --> 00:54:54,359
Speaker 1: And you're absolutely right that these ventilators are very, very

954
00:54:54,400 --> 00:54:58,759
Speaker 1: specific and specialized pieces of medical equipment, and at some

955
00:54:58,840 --> 00:55:01,560
Speaker 1: point we will run out of them. In fact, was

956
00:55:01,640 --> 00:55:05,880
Speaker 1: just speaking to someone today at a small hospital outside

957
00:55:05,880 --> 00:55:08,160
Speaker 1: of New York City and they are now they have

958
00:55:08,280 --> 00:55:10,879
Speaker 1: just used their last ventilator, and they are now what's

959
00:55:10,920 --> 00:55:15,200
Speaker 1: called double venting patients, which means using one ventilator to

960
00:55:15,320 --> 00:55:19,200
Speaker 1: treat two patients, which you would normally never do because

961
00:55:19,239 --> 00:55:22,840
Speaker 1: of the contamination. Those two patients are now fully sharing

962
00:55:23,320 --> 00:55:27,160
Speaker 1: all their respiratory pathogens. But of course, you know, desperate

963
00:55:27,160 --> 00:55:29,719
Speaker 1: times call for desperate measures, and if these patients both

964
00:55:29,880 --> 00:55:32,839
Speaker 1: have the same virus and they are both suffering from

965
00:55:32,880 --> 00:55:35,799
Speaker 1: you know the COVID nineteen disease, then we we you know,

966
00:55:35,800 --> 00:55:37,680
Speaker 1: we'll do what we have to do. And then technically

967
00:55:37,719 --> 00:55:40,720
Speaker 1: a ventilator can probably be split up to four ways.

968
00:55:41,520 --> 00:55:44,399
Speaker 1: But at some point soon and it could be within

969
00:55:44,440 --> 00:55:47,720
Speaker 1: two to three weeks, this could become an enormous problem,

970
00:55:47,880 --> 00:55:51,839
Speaker 1: and so well can can can We are manufacturers kind

971
00:55:51,880 --> 00:55:56,719
Speaker 1: of speeding up the production of these pieces of equipment.

972
00:55:58,719 --> 00:56:02,160
Speaker 1: They are, but is still another bottleneck. And the one

973
00:56:02,200 --> 00:56:05,760
Speaker 1: thing that we can't make more of is doctors, nurses

974
00:56:05,800 --> 00:56:09,880
Speaker 1: and respiratory therapists, and so these pieces of equipment can't

975
00:56:09,880 --> 00:56:12,839
Speaker 1: work on their own. You know, a doctor is necessary

976
00:56:12,920 --> 00:56:16,040
Speaker 1: to put the end of tracheal tube in. Nurses and

977
00:56:16,080 --> 00:56:19,520
Speaker 1: respiratory therapists are necessary to actually run the ventilators and

978
00:56:19,600 --> 00:56:23,120
Speaker 1: manage the medications on a minute to minute basis. And

979
00:56:23,200 --> 00:56:29,920
Speaker 1: so it can't be overstated that a really fundamental break

980
00:56:30,040 --> 00:56:33,879
Speaker 1: point in this system could occur when the health care system,

981
00:56:33,880 --> 00:56:37,760
Speaker 1: through its workers, is so overwhelmed that we can't actually

982
00:56:37,760 --> 00:56:39,960
Speaker 1: have people on the front lines that are doing this work.

983
00:56:40,800 --> 00:56:46,160
Speaker 1: So how do they protect themselves because obviously we need

984
00:56:46,239 --> 00:56:49,640
Speaker 1: them desperately to be treating patients. We probably need to

985
00:56:49,960 --> 00:56:53,680
Speaker 1: and I know that a lot of retired medical professionals

986
00:56:53,719 --> 00:56:58,000
Speaker 1: are being called in UM. Are are they getting sick?

987
00:56:58,120 --> 00:57:01,439
Speaker 1: I know that some are, and should I mean, how

988
00:57:01,480 --> 00:57:05,280
Speaker 1: worried are you about that? I'm actually quite worried about

989
00:57:05,280 --> 00:57:08,400
Speaker 1: it because of some data that we're seeing from around

990
00:57:08,400 --> 00:57:11,919
Speaker 1: the world, including China and Italy, which is that when

991
00:57:11,960 --> 00:57:14,840
Speaker 1: healthcare workers get it, they seem to get a worse

992
00:57:15,080 --> 00:57:18,880
Speaker 1: version of it, suggesting at least preliminarily, that there might

993
00:57:18,920 --> 00:57:22,520
Speaker 1: be something about the amount of virus or the manner

994
00:57:22,520 --> 00:57:26,600
Speaker 1: in which they're exposed to it that is otherwise making

995
00:57:26,600 --> 00:57:29,919
Speaker 1: it worse than if they just acquired this virus out

996
00:57:29,920 --> 00:57:32,000
Speaker 1: in the community. So that's the first thing that has

997
00:57:32,080 --> 00:57:36,200
Speaker 1: me somewhat concerned. So how do you think they're getting it? UM?

998
00:57:36,240 --> 00:57:40,840
Speaker 1: Probably just through a greater concentration of respiratory droplets, given

999
00:57:40,880 --> 00:57:43,360
Speaker 1: the you know, the proximity that they have to people

1000
00:57:43,400 --> 00:57:46,720
Speaker 1: who are sick. And obviously, if someone is sick and

1001
00:57:46,760 --> 00:57:49,960
Speaker 1: they're in respiratory distress and you're intibating them, you're leaning

1002
00:57:50,000 --> 00:57:53,320
Speaker 1: over a person, and you're just being exposed to a

1003
00:57:53,480 --> 00:57:56,080
Speaker 1: much greater amount of virus than say, if you bumped

1004
00:57:56,080 --> 00:57:59,080
Speaker 1: into somebody at the supermarket. The other thing that is

1005
00:57:59,120 --> 00:58:04,360
Speaker 1: in short supply is ppe. It's the protective equipment that

1006
00:58:04,520 --> 00:58:06,880
Speaker 1: the doctor's, nurses, respiray therapist, all the people in the

1007
00:58:06,880 --> 00:58:11,919
Speaker 1: hospital need to protect themselves against this virus. And so

1008
00:58:12,440 --> 00:58:14,920
Speaker 1: inasmuch as we need to be making more ventilators, we

1009
00:58:14,960 --> 00:58:17,520
Speaker 1: also need to really be ramping up on the production

1010
00:58:17,640 --> 00:58:20,520
Speaker 1: of all of the protective equipment. And the countries that

1011
00:58:20,560 --> 00:58:23,120
Speaker 1: have done this well, I mean China did this very

1012
00:58:23,160 --> 00:58:26,320
Speaker 1: well in the second wave. So in the second wave

1013
00:58:26,440 --> 00:58:31,920
Speaker 1: after Wuhan, very few of the healthcare workers became infected.

1014
00:58:31,960 --> 00:58:34,840
Speaker 1: So once they dialed in on how to protect their

1015
00:58:34,840 --> 00:58:37,520
Speaker 1: healthcare workers, um, they were able to do this in

1016
00:58:37,560 --> 00:58:39,919
Speaker 1: a much safer way. So you know, if I could

1017
00:58:39,920 --> 00:58:42,919
Speaker 1: wave a magic wand we'd be making more ventilators, we'd

1018
00:58:42,920 --> 00:58:45,880
Speaker 1: have more actual beds and spaces in the hospital, we'd

1019
00:58:45,880 --> 00:58:49,560
Speaker 1: have more protective equipment for the healthcare workers, and obviously

1020
00:58:49,600 --> 00:58:51,960
Speaker 1: we'd have more testing available so that we could more

1021
00:58:52,040 --> 00:58:56,120
Speaker 1: quickly identify and stratify patients at risk. Speaking of that,

1022
00:58:56,320 --> 00:58:59,520
Speaker 1: I know that a one thousand bed naval hospital ship

1023
00:58:59,640 --> 00:59:03,120
Speaker 1: is being dispatch to New York Harbor. We may be

1024
00:59:03,320 --> 00:59:06,800
Speaker 1: seen some of these medical ships that are often used

1025
00:59:06,800 --> 00:59:12,360
Speaker 1: in times of war being deployed in specific ports all

1026
00:59:12,400 --> 00:59:17,320
Speaker 1: around the country. Yeah, it's it's sort of hard to

1027
00:59:17,440 --> 00:59:22,080
Speaker 1: believe how much has happened in one week. Um. And

1028
00:59:22,280 --> 00:59:24,840
Speaker 1: and it's it speaks to the nature of non linear

1029
00:59:24,920 --> 00:59:28,360
Speaker 1: exponential growth and and and again. You know, the irony

1030
00:59:28,360 --> 00:59:30,800
Speaker 1: of it is that which we're talking about today, in

1031
00:59:30,840 --> 00:59:34,320
Speaker 1: a week or two weeks will seem pedestrian in terms

1032
00:59:34,400 --> 00:59:36,840
Speaker 1: of what we will know because of how quickly things

1033
00:59:36,840 --> 00:59:39,920
Speaker 1: are changing, including you know, the rate at which you

1034
00:59:39,920 --> 00:59:43,720
Speaker 1: know hospitals are running out of ventilators. We should uh

1035
00:59:44,320 --> 00:59:48,640
Speaker 1: mention one thing, and that is a failure to comply

1036
00:59:49,080 --> 00:59:53,640
Speaker 1: with CDC guidelines. I hope we're not seeing as many

1037
00:59:53,760 --> 00:59:56,720
Speaker 1: kids in bars, and not just kids. You know. My

1038
00:59:57,080 --> 00:59:59,880
Speaker 1: neighbor in New York City who lives on the Upper

1039
01:00:00,080 --> 01:00:02,960
Speaker 1: Side said the bar was packed for St. Patrick's Day.

1040
01:00:02,960 --> 01:00:06,360
Speaker 1: And it's so infuriating. But not only young people. I

1041
01:00:06,440 --> 01:00:09,920
Speaker 1: read an article this morning about children of baby boomers

1042
01:00:10,280 --> 01:00:14,280
Speaker 1: trying to get their parents in their seventies to not travel,

1043
01:00:14,360 --> 01:00:18,840
Speaker 1: to not go to casinos. Um. It seems insane to

1044
01:00:18,880 --> 01:00:22,960
Speaker 1: me that people are being uh so stupid and in

1045
01:00:23,040 --> 01:00:27,200
Speaker 1: some cases so selfish about this or ignorant what is

1046
01:00:27,240 --> 01:00:30,320
Speaker 1: that about? It's it's so interesting you say that because

1047
01:00:30,480 --> 01:00:35,360
Speaker 1: I have noticed two extremes um and again these are anecdotes,

1048
01:00:35,360 --> 01:00:37,400
Speaker 1: so I can't speak to this from sort of real

1049
01:00:37,440 --> 01:00:40,800
Speaker 1: aggregated data. But you're absolutely right. I have noticed far

1050
01:00:40,880 --> 01:00:45,920
Speaker 1: more concern from my patients about their parents than their kids.

1051
01:00:46,160 --> 01:00:50,200
Speaker 1: First for starters, So the you know, I just I

1052
01:00:50,200 --> 01:00:54,520
Speaker 1: could rattle off ten stories about, you know, people who

1053
01:00:54,560 --> 01:00:57,200
Speaker 1: are in their seventies who have decided, Yep, we're gonna

1054
01:00:57,400 --> 01:00:59,439
Speaker 1: we're gonna to the casino this weekend and we're gonna

1055
01:00:59,480 --> 01:01:00,840
Speaker 1: go do this, and we're gonna go and do that,

1056
01:01:00,920 --> 01:01:03,200
Speaker 1: and none of this stuff matters, and we're going out

1057
01:01:03,240 --> 01:01:05,440
Speaker 1: and you know, doing all those things. And again I

1058
01:01:05,680 --> 01:01:07,000
Speaker 1: have no idea what it is that. You know, I

1059
01:01:07,040 --> 01:01:09,200
Speaker 1: could speculate and say, look, people at that age have

1060
01:01:09,320 --> 01:01:11,560
Speaker 1: been through a lot and they've decided, hey, if it

1061
01:01:11,600 --> 01:01:13,600
Speaker 1: hasn't got me, now it's not going to. And there's

1062
01:01:13,640 --> 01:01:17,200
Speaker 1: sort of a false sense of confidence. Potentially, I think

1063
01:01:17,440 --> 01:01:22,160
Speaker 1: they survives the stars outbreak and they've been there, done that. Yeah,

1064
01:01:22,200 --> 01:01:24,720
Speaker 1: there's a little bit of that. Um, we certainly saw

1065
01:01:24,760 --> 01:01:26,880
Speaker 1: a little bit of that Machismo in New York two

1066
01:01:26,960 --> 01:01:29,640
Speaker 1: weeks ago, which I haven't seen. I've seen it damned

1067
01:01:29,640 --> 01:01:31,760
Speaker 1: down a bit, which was, hey, look, we survived nine eleven.

1068
01:01:31,840 --> 01:01:34,320
Speaker 1: This thing is not going to get us. Um. Obviously

1069
01:01:34,360 --> 01:01:38,480
Speaker 1: that's apples and oranges. So it's sort of a nonsensical comparison. Um.

1070
01:01:38,480 --> 01:01:40,720
Speaker 1: But I do share your concern with the number of

1071
01:01:40,720 --> 01:01:44,800
Speaker 1: people who aren't respecting these quarantines. In fact, our nanny

1072
01:01:44,880 --> 01:01:49,400
Speaker 1: who's in college, one of her classmates was an exchange

1073
01:01:49,440 --> 01:01:52,560
Speaker 1: student in Italy, so he had to come back from Italy,

1074
01:01:52,640 --> 01:01:55,720
Speaker 1: and he tested positive upon arrival, and so he was

1075
01:01:55,840 --> 01:02:00,120
Speaker 1: placed in a quarantine, which he violated. So he was

1076
01:02:00,160 --> 01:02:03,440
Speaker 1: seen out on social media three days after testing positive

1077
01:02:03,560 --> 01:02:06,640
Speaker 1: and being forced into a quarantine, out at a party,

1078
01:02:06,800 --> 01:02:10,040
Speaker 1: and so, you know, that kind of stuff is really upsetting,

1079
01:02:10,080 --> 01:02:12,040
Speaker 1: and I think it is a bit of a communication

1080
01:02:12,120 --> 01:02:15,720
Speaker 1: breakdown because I don't think that these people would really

1081
01:02:15,760 --> 01:02:18,240
Speaker 1: be doing this if they understood the significance of what

1082
01:02:18,280 --> 01:02:20,400
Speaker 1: they're doing. I just don't think people are that selfish

1083
01:02:20,480 --> 01:02:24,160
Speaker 1: or that evil if they really understand the significance, which is, hey,

1084
01:02:24,480 --> 01:02:27,360
Speaker 1: you can feel fine. You know, you college student who's

1085
01:02:27,360 --> 01:02:30,400
Speaker 1: twenty years old, who tested positive who you know has

1086
01:02:30,440 --> 01:02:33,200
Speaker 1: a little bit of a sore throat. It's not about

1087
01:02:33,280 --> 01:02:36,280
Speaker 1: you getting worse. It's about what you could do to

1088
01:02:36,440 --> 01:02:39,040
Speaker 1: somebody who could then go and do it to somebody else. Right,

1089
01:02:39,120 --> 01:02:41,160
Speaker 1: It's like you infect another kid at that party, they

1090
01:02:41,200 --> 01:02:43,800
Speaker 1: go home and infect their grandmother or something like that. So,

1091
01:02:44,320 --> 01:02:46,680
Speaker 1: you know, my hope is that we're just going to

1092
01:02:46,920 --> 01:02:49,760
Speaker 1: educate people a lot more about why the stakes are

1093
01:02:49,840 --> 01:02:54,360
Speaker 1: high and how we all kind of have a responsibility

1094
01:02:54,440 --> 01:02:57,640
Speaker 1: here to not just protect ourselves, but to then protect

1095
01:02:57,720 --> 01:03:00,640
Speaker 1: others through that protection. I don't want to play the

1096
01:03:00,760 --> 01:03:06,080
Speaker 1: blame game, but was critical time lost when this wasn't

1097
01:03:06,160 --> 01:03:11,720
Speaker 1: taken seriously by the administration and frankly by some in

1098
01:03:11,760 --> 01:03:18,600
Speaker 1: the news media. How how much damage was done by

1099
01:03:18,720 --> 01:03:22,880
Speaker 1: that two or three week period where it just wasn't

1100
01:03:22,960 --> 01:03:26,680
Speaker 1: treated as a serious threat to public health? Well you

1101
01:03:26,720 --> 01:03:29,919
Speaker 1: alluded to the the Ted talk by Bill Gates, which

1102
01:03:29,960 --> 01:03:34,320
Speaker 1: is now five years old, and he sort of predicted, uh,

1103
01:03:34,720 --> 01:03:40,200
Speaker 1: in pretty frightening um, you know, reality, what was potentially

1104
01:03:40,200 --> 01:03:43,280
Speaker 1: going to come if I were going to, you know,

1105
01:03:43,880 --> 01:03:45,760
Speaker 1: really say, if if I could go back in time

1106
01:03:45,760 --> 01:03:47,560
Speaker 1: and change one thing in the last three months, what

1107
01:03:47,600 --> 01:03:54,480
Speaker 1: would it be. It's the following on January, the genome

1108
01:03:54,680 --> 01:03:58,560
Speaker 1: of this novel, coronaviruns was sequenced and it was made

1109
01:03:58,560 --> 01:04:03,600
Speaker 1: public another Chinese you got it. So the Chinese immediately

1110
01:04:03,640 --> 01:04:07,280
Speaker 1: figured out what this was, immediately confirmed it was a novel,

1111
01:04:07,600 --> 01:04:11,720
Speaker 1: brand new, never before seeing coronavirus, and put that information

1112
01:04:11,800 --> 01:04:16,120
Speaker 1: out to the world, and some companies immediately ran and

1113
01:04:16,160 --> 01:04:19,720
Speaker 1: developed pcr kits. And you know, one of those companies

1114
01:04:19,720 --> 01:04:22,080
Speaker 1: in China has basically gone on to do over a

1115
01:04:22,160 --> 01:04:27,160
Speaker 1: million tests already and have incredible data with specificity and sensitivity.

1116
01:04:27,200 --> 01:04:29,640
Speaker 1: They can do a four hour turnaround. In fact, they've

1117
01:04:29,680 --> 01:04:34,040
Speaker 1: already built fifty laboratories in China, each one capable of

1118
01:04:34,080 --> 01:04:37,640
Speaker 1: doing fifty thousand to a hundred thousand tests per day.

1119
01:04:38,400 --> 01:04:42,160
Speaker 1: What we did, in my opinion, was the biggest mistake,

1120
01:04:42,240 --> 01:04:45,920
Speaker 1: which was basically ignoring that information, and then when push

1121
01:04:46,000 --> 01:04:48,880
Speaker 1: came to shove sort of doing a botched job, the

1122
01:04:48,960 --> 01:04:53,440
Speaker 1: CDC sort of put together its own um set of

1123
01:04:53,480 --> 01:04:55,920
Speaker 1: primers that ended up not working very well. And then

1124
01:04:55,960 --> 01:04:58,920
Speaker 1: eventually we got around to potentially doing something with a

1125
01:04:58,960 --> 01:05:01,920
Speaker 1: company called Row. And where we are right now at

1126
01:05:01,960 --> 01:05:04,800
Speaker 1: the time of this discussion is we still don't really

1127
01:05:04,840 --> 01:05:08,520
Speaker 1: have any viable means of testing. We're probably just a

1128
01:05:08,560 --> 01:05:11,040
Speaker 1: little bit over fifty thou people have been tested in

1129
01:05:11,040 --> 01:05:14,120
Speaker 1: the United States, which is you know, two log orders

1130
01:05:14,160 --> 01:05:16,840
Speaker 1: below where we need to be. So if you can

1131
01:05:16,920 --> 01:05:19,240
Speaker 1: we just use the testing that's being used in other

1132
01:05:19,280 --> 01:05:22,480
Speaker 1: places like South Korea, the one that was developed by

1133
01:05:22,480 --> 01:05:26,080
Speaker 1: the w h O. Did the CDC simply think that

1134
01:05:26,080 --> 01:05:30,560
Speaker 1: that test was inadequate? It seems to me that was insane.

1135
01:05:30,840 --> 01:05:35,320
Speaker 1: At least use them while we develop a more specific test. Yeah,

1136
01:05:35,360 --> 01:05:38,280
Speaker 1: that that is absolutely correct. So we are now in

1137
01:05:38,320 --> 01:05:41,560
Speaker 1: a situation called emergency use authorization where I think the

1138
01:05:41,640 --> 01:05:45,440
Speaker 1: CDC has finally realized that they're not going to be

1139
01:05:45,480 --> 01:05:48,440
Speaker 1: the ones to solve this problem, and they're basically saying,

1140
01:05:49,400 --> 01:05:52,080
Speaker 1: you know, so the Secretary of hss UM, the Secretary

1141
01:05:52,080 --> 01:05:55,040
Speaker 1: of Health and Humans has has basically said, you know,

1142
01:05:55,640 --> 01:05:58,200
Speaker 1: you can go and do this test on your own.

1143
01:05:58,600 --> 01:06:00,760
Speaker 1: So I think right now what we're going to see

1144
01:06:00,760 --> 01:06:04,000
Speaker 1: as states making their own decision on what to do,

1145
01:06:04,120 --> 01:06:07,560
Speaker 1: and in fact, we're working with one state right now

1146
01:06:07,880 --> 01:06:10,000
Speaker 1: to try to help them to actually just get that

1147
01:06:10,040 --> 01:06:13,800
Speaker 1: test from China directly, because in my opinion, not does

1148
01:06:13,840 --> 01:06:16,240
Speaker 1: that not seem insane to you. I mean, does that

1149
01:06:16,320 --> 01:06:21,400
Speaker 1: not seem a massive failure of the federal government. Yeah.

1150
01:06:21,480 --> 01:06:23,960
Speaker 1: And again I'm not the conspiracy guy, so I I

1151
01:06:23,960 --> 01:06:27,720
Speaker 1: attribute these things more to just you know, negligence than

1152
01:06:28,120 --> 01:06:32,720
Speaker 1: anything nefarious. And I've certainly heard people speculating that, you know,

1153
01:06:32,760 --> 01:06:35,560
Speaker 1: there's sort of you know, an anti China bias and

1154
01:06:35,600 --> 01:06:37,800
Speaker 1: all of these things. But but I have to be honest.

1155
01:06:37,840 --> 01:06:40,360
Speaker 1: I think China has been very forthcoming here, and I

1156
01:06:40,400 --> 01:06:44,800
Speaker 1: think this demonization of China UM, either either you know,

1157
01:06:44,920 --> 01:06:48,120
Speaker 1: covert or you know or sort of explicit or implicit,

1158
01:06:48,160 --> 01:06:51,040
Speaker 1: has really hurt us. UM. I think I think China

1159
01:06:51,080 --> 01:06:54,280
Speaker 1: has been very forthcoming with their data, and for some reason,

1160
01:06:54,400 --> 01:06:58,360
Speaker 1: our decision to not utilize exactly what they offered us

1161
01:06:58,400 --> 01:07:01,000
Speaker 1: as far as testing has set us back, put us

1162
01:07:01,040 --> 01:07:03,680
Speaker 1: on our heels. And my hope is that in the

1163
01:07:03,760 --> 01:07:06,360
Speaker 1: next week the bell gets rung pretty loud on that

1164
01:07:06,520 --> 01:07:09,160
Speaker 1: and we you know, we we take on these tests

1165
01:07:09,200 --> 01:07:11,600
Speaker 1: because again, it's not an economic question. The United States

1166
01:07:11,640 --> 01:07:15,080
Speaker 1: is very fortunate we can afford to do the testing. Um.

1167
01:07:15,120 --> 01:07:18,120
Speaker 1: It's really a question of deployment and other things. You know,

1168
01:07:18,200 --> 01:07:20,080
Speaker 1: you asked questions about running out of things, Well, we

1169
01:07:20,080 --> 01:07:22,840
Speaker 1: don't even have enough swabs right now, so we're not

1170
01:07:22,880 --> 01:07:25,040
Speaker 1: just having to buy the PCR test gets. We actually

1171
01:07:25,040 --> 01:07:26,560
Speaker 1: have to make sure we have enough re agents to

1172
01:07:26,600 --> 01:07:29,400
Speaker 1: use them, enough swabs to actually you know, test them

1173
01:07:29,400 --> 01:07:31,960
Speaker 1: on the people. Um. And that's the stuff that really

1174
01:07:32,520 --> 01:07:35,480
Speaker 1: we should be stockpiling that stuff, right and and and

1175
01:07:35,520 --> 01:07:38,919
Speaker 1: we certainly in early January should have been preparing for

1176
01:07:38,960 --> 01:07:43,680
Speaker 1: this to spread. And again, I I think Bill Gates

1177
01:07:44,160 --> 01:07:46,560
Speaker 1: spoke to all of those things five years ago at

1178
01:07:46,600 --> 01:07:49,600
Speaker 1: the tail end of the Ebola outbreak, when he said, look,

1179
01:07:49,600 --> 01:07:52,080
Speaker 1: it's not a question of if, but when this happens again.

1180
01:07:52,960 --> 01:07:57,320
Speaker 1: And yet the group responsible for a pandemic response, or

1181
01:07:57,400 --> 01:08:02,919
Speaker 1: the Pandemic Response Team, was disbanded in two THO. Yeah,

1182
01:08:02,920 --> 01:08:05,919
Speaker 1: I mean Michael Lewis's book The Fifth Risk, I think

1183
01:08:06,000 --> 01:08:09,320
Speaker 1: does a great job of explaining all the non sexy

1184
01:08:09,400 --> 01:08:13,000
Speaker 1: parts of government that we tend to forget about until

1185
01:08:13,240 --> 01:08:16,559
Speaker 1: disaster hits um And it's funny I read that book

1186
01:08:16,560 --> 01:08:18,519
Speaker 1: when it came out, so I don't even remember if

1187
01:08:18,600 --> 01:08:22,040
Speaker 1: in the book Michael Lewis talked about this particular side

1188
01:08:22,040 --> 01:08:25,160
Speaker 1: of the government. But you're absolutely right, this is this

1189
01:08:25,240 --> 01:08:27,719
Speaker 1: is a part of government that when things are good,

1190
01:08:27,760 --> 01:08:30,160
Speaker 1: it's easy to forget about It's easy to say, hey,

1191
01:08:30,200 --> 01:08:32,559
Speaker 1: we can, we can, we can cut costs by getting

1192
01:08:32,640 --> 01:08:35,639
Speaker 1: rid of them. Um. But but you know, you think

1193
01:08:35,640 --> 01:08:37,720
Speaker 1: of this like you think of insurance, right, You don't

1194
01:08:37,760 --> 01:08:40,120
Speaker 1: buy insurance for your home after it burns down. You

1195
01:08:40,160 --> 01:08:45,040
Speaker 1: have the insurance in place before there's a fire. Before

1196
01:08:45,080 --> 01:08:47,519
Speaker 1: we go on, one last question, even though I could

1197
01:08:47,520 --> 01:08:51,520
Speaker 1: talk to you for hours, Peter um, and that is,

1198
01:08:51,520 --> 01:08:55,120
Speaker 1: is there any evidence that once you get the this

1199
01:08:55,439 --> 01:09:01,040
Speaker 1: pathogen or this virus, you build some immunity to getting

1200
01:09:01,080 --> 01:09:04,280
Speaker 1: it a second time? Or is that just a complete unknown?

1201
01:09:05,240 --> 01:09:07,680
Speaker 1: I think it's an unknown right now, Katie. There are

1202
01:09:07,680 --> 01:09:11,080
Speaker 1: two issues at hand. The first is is this going

1203
01:09:11,120 --> 01:09:14,400
Speaker 1: to be like influenza, where if you get it in

1204
01:09:14,439 --> 01:09:17,280
Speaker 1: a given season, you're not likely to get it again,

1205
01:09:17,560 --> 01:09:20,800
Speaker 1: but you'll always be susceptible to it in subsequent seasons

1206
01:09:20,840 --> 01:09:25,280
Speaker 1: because it has enough genetic migration or drift year upon

1207
01:09:25,360 --> 01:09:29,320
Speaker 1: year upon year. Or is it something like you know,

1208
01:09:29,439 --> 01:09:32,960
Speaker 1: the measles or polio, where once you are vaccinated against it,

1209
01:09:33,040 --> 01:09:35,840
Speaker 1: once you know it doesn't that the virus is not

1210
01:09:35,960 --> 01:09:39,759
Speaker 1: moving around genetically very much. And you know, either getting

1211
01:09:39,800 --> 01:09:42,519
Speaker 1: vaccinated against it, or in this case, if you acquire

1212
01:09:42,600 --> 01:09:46,640
Speaker 1: the virus and recover, you're fine. We certainly think in

1213
01:09:46,680 --> 01:09:49,519
Speaker 1: the short term there is immunity, and that's one of

1214
01:09:49,520 --> 01:09:53,200
Speaker 1: the other really exciting potential therapies right now is something

1215
01:09:53,240 --> 01:09:57,200
Speaker 1: called convalescent serum, where you actually take blood from a

1216
01:09:57,240 --> 01:10:02,080
Speaker 1: person who has recovered, you ident deify the you know, uh,

1217
01:10:02,120 --> 01:10:04,920
Speaker 1: the sort of the antigens and things that are in

1218
01:10:04,960 --> 01:10:07,160
Speaker 1: the blood, and you can then infuse them into people

1219
01:10:07,200 --> 01:10:09,920
Speaker 1: who are sick as a form of therapy at high

1220
01:10:10,000 --> 01:10:13,640
Speaker 1: doses or at low doses to impart short term immunity

1221
01:10:13,680 --> 01:10:18,160
Speaker 1: on people. So given that we're seeing um reasonable evidence

1222
01:10:18,200 --> 01:10:20,800
Speaker 1: of the efficacy of convalescence serum, that tells us that

1223
01:10:20,840 --> 01:10:25,000
Speaker 1: there must be at least some immunity that's acquired from this. Peter,

1224
01:10:25,240 --> 01:10:27,720
Speaker 1: thank you very much for spending some time with us

1225
01:10:27,800 --> 01:10:33,200
Speaker 1: talking about this very scary situation. Well, Katie, thank you

1226
01:10:33,320 --> 01:10:35,640
Speaker 1: for what you're doing. Your podcasts on this topic have

1227
01:10:35,760 --> 01:10:39,519
Speaker 1: been fantastic, So anything I can do to to help

1228
01:10:39,560 --> 01:10:48,439
Speaker 1: you get this message out. It's an honor that was

1229
01:10:48,560 --> 01:10:52,440
Speaker 1: Dr Peter Attia. You can follow more of his coronavirus

1230
01:10:52,479 --> 01:10:56,720
Speaker 1: coverage on his Twitter at Peter Attia empty and on

1231
01:10:56,800 --> 01:11:07,519
Speaker 1: his podcast which is called The Drive, and that does

1232
01:11:07,520 --> 01:11:10,280
Speaker 1: it for this episode of Next Question. A reminder to

1233
01:11:10,479 --> 01:11:14,479
Speaker 1: all of our listeners are reported episodes on topics like

1234
01:11:14,560 --> 01:11:18,800
Speaker 1: maternal mortality and the environmental impact of meat are still

1235
01:11:18,840 --> 01:11:22,000
Speaker 1: to come, but in the next season coming out this summer.

1236
01:11:22,400 --> 01:11:25,759
Speaker 1: The rest of this season, as we mentioned, throughout March

1237
01:11:25,840 --> 01:11:30,400
Speaker 1: and into April, will be dedicating to the coronavirus. You

1238
01:11:30,439 --> 01:11:33,639
Speaker 1: can also follow us on Instagram and other social media

1239
01:11:33,680 --> 01:11:38,200
Speaker 1: outlets for day to day coronavirus coverage. My morning newsletter

1240
01:11:38,280 --> 01:11:41,200
Speaker 1: wake Up Call will also be dedicated to this topic

1241
01:11:41,520 --> 01:11:44,479
Speaker 1: and you can subscribe to that by going to Katie

1242
01:11:44,479 --> 01:11:47,519
Speaker 1: Couric dot com. And a quick reminder, if you want

1243
01:11:47,560 --> 01:11:50,600
Speaker 1: to share a story of kindness you've experienced or witnessed

1244
01:11:50,600 --> 01:11:54,120
Speaker 1: in this extraordinary time, tell me. You can leave your

1245
01:11:54,160 --> 01:11:56,719
Speaker 1: name and a detailed voice message at the number eight

1246
01:11:56,840 --> 01:12:01,320
Speaker 1: four four four seven nine seven eight eight three. That

1247
01:12:01,520 --> 01:12:05,920
Speaker 1: number once again eight four four four seven nine seven

1248
01:12:06,040 --> 01:12:09,400
Speaker 1: eight eight three. You can also email me at info

1249
01:12:09,479 --> 01:12:13,200
Speaker 1: at Katie currect dot com. Just put next Question kindness

1250
01:12:13,240 --> 01:12:17,640
Speaker 1: in the subject line. I know these are unprecedented and

1251
01:12:17,880 --> 01:12:22,920
Speaker 1: very trying times. Stay safe, Stay indoors and we'll get

1252
01:12:22,920 --> 01:12:26,000
Speaker 1: through this together. Thank you all so much for listening,

1253
01:12:26,280 --> 01:12:30,080
Speaker 1: and until next time and my next Question, I'm Katie Couric.

1254
01:12:37,880 --> 01:12:40,160
Speaker 1: Next Question with Katie Curic is a production of I

1255
01:12:40,280 --> 01:12:43,720
Speaker 1: Heart Radio and Katie Curreic Media. The executive producers are

1256
01:12:43,760 --> 01:12:47,519
Speaker 1: Katie Kurik, Courtney Litz, and Tyler Klang. The supervising producer

1257
01:12:47,600 --> 01:12:52,200
Speaker 1: is Lauren Hansen. Our show producer is Bethan Macaluso. The

1258
01:12:52,240 --> 01:12:56,400
Speaker 1: associate producers are Emily Pinto and Derek Clemens. Editing by

1259
01:12:56,439 --> 01:13:01,479
Speaker 1: Derrek Clements, Dylan Fagin and Lowell Berlante, Mixing by Dylan Fagan.

1260
01:13:02,040 --> 01:13:06,639
Speaker 1: Our researcher is Gabriel Loser. For more information on today's episode,

1261
01:13:06,760 --> 01:13:09,280
Speaker 1: go to Katie Couric dot com and follow us on

1262
01:13:09,320 --> 01:13:17,200
Speaker 1: Twitter and Instagram at Katie currec. For more podcasts for

1263
01:13:17,280 --> 01:13:20,400
Speaker 1: My Heart Radio, visit the I Heart Radio app, Apple podcast,

1264
01:13:20,560 --> 01:13:22,599
Speaker 1: or wherever you listen to your favorite shows.