WEBVTT - Coronavirus update: How can we cope with COVID-19 anxiety?

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<v Speaker 1>Hi everyone, I'm Katie Current and welcome to Next Question.

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<v Speaker 1>It's a new day for us here at Next Question,

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<v Speaker 1>as I'm sure it is for all of you. The

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<v Speaker 1>rampant spread of the coronavirus across this country, let alone

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<v Speaker 1>the rest of the world, has forced most of us

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<v Speaker 1>indoors for an unknown period of time. The level of

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<v Speaker 1>restrictions on where you can go and what you can do,

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<v Speaker 1>the closure of schools, restaurants, nightlife, the canceling of sports

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<v Speaker 1>and entertainment is largely unprecedented, but it's necessary for the

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<v Speaker 1>health and safety of this country. So if you're not

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<v Speaker 1>social distancing yet, please do. But it's a lot to

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<v Speaker 1>deal with, and I know right now it's all consuming

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<v Speaker 1>for all of us. It's what we're reading about and

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<v Speaker 1>what we're worried about. But I'd really like to help

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<v Speaker 1>to settle into this new reality and perhaps understand what

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<v Speaker 1>all of this means for us, which is why we're

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<v Speaker 1>deaty kating the rest of this season of Next Question,

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<v Speaker 1>which means four more episodes every week and perhaps even

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<v Speaker 1>more to the coronavirus pandemic. For day to day news

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<v Speaker 1>on this ever changing story, I do recommend you continue

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<v Speaker 1>to turn to your local government, the CDC, and the

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<v Speaker 1>World Health Organization for the most up to date information.

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<v Speaker 1>I'm also providing updates on my Instagram feed. As for me, well,

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<v Speaker 1>I'm hold up in my house, which means I might

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<v Speaker 1>sound a little different to you. Social distancing means I'm

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<v Speaker 1>not going into our usual studio and speaking into a

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<v Speaker 1>fancy microphone. Right now, I'm sitting in my home office

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<v Speaker 1>and I'm recording myself on my phone, and instead of

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<v Speaker 1>speaking to my guests in person, we're connecting over our computers.

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<v Speaker 1>So bear with us, everyone, but please keep listening for

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<v Speaker 1>this critically important information. So today, my next question, how

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<v Speaker 1>do we manage this new normal and coronavirus anxiety. To

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<v Speaker 1>answer that, I called up my friend Laurie Gottlieb. Laurie

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<v Speaker 1>Hi by. Laurie Gottlieb is a psychotherapist with a private

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<v Speaker 1>practice in Los Angeles, but she's also a best selling author,

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<v Speaker 1>a journalist, and soon a podcaster too. But today we're

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<v Speaker 1>focused on the issue at hand, So um, let's talk

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<v Speaker 1>about why people are. You know, I think with good reason,

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<v Speaker 1>people are feeling a lot of anxiety. But I think

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<v Speaker 1>it's interesting that the unpredictability of all of this, Lorie,

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<v Speaker 1>is a perfect recipe for high anxiety. Can you explain that? Yeah,

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<v Speaker 1>you know, it makes sense that we have anxiety. And

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<v Speaker 1>I think there are two kinds of anxiety. There's productive

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<v Speaker 1>anxiety and there's unproductive anxiety. And productive anxiety is the

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<v Speaker 1>kind of anxiety that helps you to take action. So

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<v Speaker 1>that's why we're washing our hands all the time. That's

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<v Speaker 1>why we're social distancing. If we if we were in denial,

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<v Speaker 1>if we said, oh, this is no big deal, we

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<v Speaker 1>wouldn't be protecting ourselves and other people. So that's that's

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<v Speaker 1>good anxiety. The kind of anxiety that gets us into

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<v Speaker 1>trouble is unproductive anxiety, which is when we start just

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<v Speaker 1>ruminating and we start catastrophizing and futurizing, like you know,

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<v Speaker 1>those thoughts of oh my god, I'm going to get

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<v Speaker 1>this and I'm going to die, or someone I love

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<v Speaker 1>is going to get this and they're going to die,

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<v Speaker 1>and you know, just all the stories that were kind

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<v Speaker 1>of spinning in our heads, and and that doesn't help

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<v Speaker 1>us in any way. Well, what makes us go as

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<v Speaker 1>human beings too? That dark place? I know that in therapy,

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<v Speaker 1>you're you know, this better than I. But sometimes people

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<v Speaker 1>do say to patients, what's the worst that could happen,

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<v Speaker 1>as a way for them to help kind of conquer

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<v Speaker 1>their fears. But you believe in this case, that's not

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<v Speaker 1>super helpful. I don't think that that's helpful. I think

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<v Speaker 1>that one of the things that can really help ground

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<v Speaker 1>us is instead of thinking about what might up and

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<v Speaker 1>in the future because it hasn't happened yet, is to

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<v Speaker 1>stay grounded in the present. So one of the things

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<v Speaker 1>that I think happens is that when something extraordinary happens,

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<v Speaker 1>we long for the ordinary. We want we want our

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<v Speaker 1>routines back, We want all those things that we complained about,

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<v Speaker 1>you know, when when we didn't have something, we weren't

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<v Speaker 1>in a heightened state like this. Um, we want it back,

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<v Speaker 1>and yet it's still right in front of us. So UM.

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<v Speaker 1>I like to talk about the concept of both, and

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<v Speaker 1>which is, yes, something horrible is happening, and we can

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<v Speaker 1>also enjoy certain things like the ordinary. We can enjoy

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<v Speaker 1>the time that we're having connecting with people that we

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<v Speaker 1>normally don't really pay attention to in our daily lives.

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<v Speaker 1>We can enjoy cooking together. We can, you know, in

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<v Speaker 1>our own isolated family units, um, we can enjoy having

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<v Speaker 1>the time to read a book or to think our

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<v Speaker 1>own thoughts, or to um, you know, actually face time

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<v Speaker 1>with one and actually listen when you ask how are you?

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<v Speaker 1>I think one of the one of the kind of

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<v Speaker 1>nice things to come out of horrible experience like this

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<v Speaker 1>is that people are very kind. Kindness comes out. There's

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<v Speaker 1>sort of a resurgence of kindness in this world where

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<v Speaker 1>civility has been lost, and so I think that both

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<v Speaker 1>at both can exist, and if we can focus on,

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<v Speaker 1>you know, holding our fear and feeling our feelings, not

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<v Speaker 1>being in denial of our anxiety, and not being in

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<v Speaker 1>denial of what's going on around us, but also really

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<v Speaker 1>trying to stay present in what's happening in that moment.

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<v Speaker 1>We have so many questions. But before we get to

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<v Speaker 1>some questions from people who follow me or listen to

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<v Speaker 1>the podcast, Laurie, I'm a fairly normal person in that

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<v Speaker 1>I don't have huge anxiety, but I'm finding I'm feeling

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<v Speaker 1>a little neurotic about my health. If I have a

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<v Speaker 1>little bit of a sore throat when I wake up

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<v Speaker 1>in the morning, or if I cough, then I start thinking, oh,

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<v Speaker 1>my god, am I sick? And I'm sure I'm not

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<v Speaker 1>alone in that because it's part of catastrophizing. I'm sure,

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<v Speaker 1>what what is that about? How can we kind of

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<v Speaker 1>calm ourselves down? Well, I think the first step is

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<v Speaker 1>just realizing it that it's human nature to do that.

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<v Speaker 1>So I remember when I was in medical school, we

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<v Speaker 1>we talked about sort of medical school disease, which was

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<v Speaker 1>every disease that we were reading about. We all thought

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<v Speaker 1>we had all of a sudden we felt the symptoms

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<v Speaker 1>of it. You know, it's like, oh, my god, I

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<v Speaker 1>have this now because my my gland feels inflamed or whatever.

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<v Speaker 1>Um that now that we're reading all the time about

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<v Speaker 1>the symptoms of coronavirus, you know, it's almost like the

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<v Speaker 1>power of of uh implanting it into your suggestion. Right. So,

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<v Speaker 1>so I think just realized that the power of suggestion

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<v Speaker 1>is very powerful. And and so when you notice that,

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<v Speaker 1>of course be aware if you are having symptoms, but

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<v Speaker 1>also take a breath. Um. Part of part of the

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<v Speaker 1>problem is that we're reading about and I always tell

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<v Speaker 1>people that, yes, you need to get daily updates, but

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<v Speaker 1>you don't really need more than that. I think that

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<v Speaker 1>the more that we're just you know, kind of it's

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<v Speaker 1>kind of like we're binge, like binge watching a television show,

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<v Speaker 1>but it's kind of like binge eating junk food. That

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<v Speaker 1>the more you sit there and click from this article

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<v Speaker 1>to that article to the other article, it makes you sick.

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<v Speaker 1>It does not fill you up, It does not help you.

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<v Speaker 1>It actually makes you psychologically ill. How do you talk

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<v Speaker 1>to kids about this? I'm sure that a lot of parents,

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<v Speaker 1>you know, my children are older. Your son is in

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<v Speaker 1>high school now, right, he's in middle school, middle school,

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<v Speaker 1>so he's he's at home. Is he expressing concern? And

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<v Speaker 1>how do you suggest people talk to their kids about this?

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<v Speaker 1>I think that the way that we model our response

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<v Speaker 1>to this is going to impact the way that our

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<v Speaker 1>kids handle their anxiety around it. So it's kind of

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<v Speaker 1>like I think, you know, when when you're on an airplane,

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<v Speaker 1>they always say put on your oxygen mask first before

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<v Speaker 1>you put on your child. But I think it goes

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<v Speaker 1>beyond that. It's how does the pilot handle it when

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<v Speaker 1>there's a problem and the pilot doesn't say, oh my god,

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<v Speaker 1>we're all gonna die, you know, if there's something the

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<v Speaker 1>pilot says very calmly, Hey, we're gonna experience some turbulence

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<v Speaker 1>coming up. We want all of you to fasten your

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<v Speaker 1>seatbelts and please don't walk in the aisles right now.

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<v Speaker 1>And I think that's very calming. And I think that

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<v Speaker 1>for our kids, we need to say, yes, here are

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<v Speaker 1>the rules, here are the boundaries. You can't go and

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<v Speaker 1>play basketball. I say this to my kid, you can't

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<v Speaker 1>go play basketball with your friends right now because we're

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<v Speaker 1>social distancing, um, you know, and and we're gonna do

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<v Speaker 1>this instead. And and just to kind of, you know,

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<v Speaker 1>under help them understand. I think giving them a sense

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<v Speaker 1>of purpose to around this, which is we're not just

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<v Speaker 1>doing this for ourselves. We're doing this for our community.

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<v Speaker 1>We're doing this for our neighbors, for the elderly people

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<v Speaker 1>that we know. Um, we're doing this for people with

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<v Speaker 1>compromised immune systems. And I think that kids really engage

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<v Speaker 1>in that when they realize that it's bigger than them.

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<v Speaker 1>It's not just oh, this is a bummer. I'm stuck

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<v Speaker 1>here and I can't play with my friends, and I

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<v Speaker 1>can't do the normal things I like to do. Um.

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<v Speaker 1>There's there's something about being connected to the larger community

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<v Speaker 1>that really resonates with with tweens and teens. Well, let's

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<v Speaker 1>play dear therapist Lorie, because we've got so many questions

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<v Speaker 1>and I don't want to be sort of a pig

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<v Speaker 1>about just asking my own Rosanna says, how much information

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<v Speaker 1>should we deal with on an everyday basis, especially with

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<v Speaker 1>the situation changing by the hour or day. Do you

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<v Speaker 1>have any suggestions for what is a healthy media diet? Yeah?

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<v Speaker 1>I do. I think once a day is plenty. And

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<v Speaker 1>I think that's because we all know what we're supposed

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<v Speaker 1>to be doing, regardless of how many new cases are reported,

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<v Speaker 1>regardless of whether they're saying you can't go here, you

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<v Speaker 1>can't go that. We know we're supposed to be social isolating.

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<v Speaker 1>We know we're supposed to be washing our hands constantly. Um,

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<v Speaker 1>we know that we're supposed to be cleaning the the

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<v Speaker 1>all the handles and um, you know, door knobs and

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<v Speaker 1>things like that in our homes and all the sort

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<v Speaker 1>of high touch surfaces. We know what we're supposed to

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<v Speaker 1>be doing. Nothing is changing in that regard. So and

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<v Speaker 1>we also know if you're having symptoms what you're supposed

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<v Speaker 1>to do. So there's no information that's going to happen

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<v Speaker 1>during the day. That's going to change the basic facts

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<v Speaker 1>of what we need to do in our lives. And

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<v Speaker 1>we really need to protect our psychological immune systems as

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<v Speaker 1>much as we're protecting our physical immune systems, and that

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<v Speaker 1>means not overloading ourselves with information. Here's another question. What

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<v Speaker 1>are some tools new moms or expectant moms like me,

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<v Speaker 1>She said, uh, can use to get through this uncertain time.

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<v Speaker 1>Bringing a new baby home is tough enough, but limiting

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<v Speaker 1>the village from visiting and helping will put a strain

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<v Speaker 1>on many Thanks to you. Yeah, um, you know, I

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<v Speaker 1>think that it's really important for parents to kind of

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<v Speaker 1>trade off time so that they get a break. So

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<v Speaker 1>I think that when you've got a baby and you

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<v Speaker 1>don't have your village around you a lot of times, um,

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<v Speaker 1>you know, you need each other as adult as a couple.

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<v Speaker 1>But sometimes you're gonna have to say, you know what,

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<v Speaker 1>it's your turn, and I'm going to go take a

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<v Speaker 1>bath or I need to go just um, you know,

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<v Speaker 1>I need to go take a walk whatever it is,

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<v Speaker 1>and and hand off to the other parents. And you

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<v Speaker 1>really have to work as a team. So I think

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<v Speaker 1>that's really important, you know, if you're living in a

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<v Speaker 1>multigenerational household and you have, um, you know, other people

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<v Speaker 1>to help, that's great. I think it's also important that

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<v Speaker 1>you you connect again for your own mental health, that

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<v Speaker 1>you connect with your friends through technology and you take

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<v Speaker 1>some breaks and you laugh about how hard it is,

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<v Speaker 1>and you laugh about the dirty diapers, and you laugh

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<v Speaker 1>about the naps that are not being taken and all

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<v Speaker 1>of those things because you need someone to vent too. Yeah, definitely,

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<v Speaker 1>and laughter is really helpful. Here's a question, j P.

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<v Speaker 1>As I'm an addict in recovery, are twelve step groups

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<v Speaker 1>and meetings are shutting down. What is the best advice

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<v Speaker 1>to stay out of your monkey and stay connected even

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<v Speaker 1>at a time of much needed social distancing. So if

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<v Speaker 1>you have a sponsor that you can connect with virtually,

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<v Speaker 1>that would be really helpful. If you have other people

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<v Speaker 1>from that you know, from the group that you can

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<v Speaker 1>connect with, that would be helpful. There are also so

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<v Speaker 1>many online resources, um that you can listen to podcasts, um.

0:12:23.640 --> 0:12:26.920
<v Speaker 1>You know, uh M. I was gonna say, there's groups

0:12:26.960 --> 0:12:29.680
<v Speaker 1>online where you can you know, write in real time

0:12:29.720 --> 0:12:32.480
<v Speaker 1>and connect like that. So I would really search the internet.

0:12:32.520 --> 0:12:34.600
<v Speaker 1>I think the internet is our friend right now, not

0:12:34.640 --> 0:12:37.559
<v Speaker 1>in a sense of getting an overload of COVID information,

0:12:37.679 --> 0:12:39.520
<v Speaker 1>but in a sense of how we can get creative

0:12:39.520 --> 0:12:41.800
<v Speaker 1>around connecting with other people when we need it most.

0:12:42.840 --> 0:12:46.880
<v Speaker 1>Vivian says, how can I stop obsessing and stockpiling groceries?

0:12:46.920 --> 0:12:50.600
<v Speaker 1>I think that's such an interesting sort of primitive instinct.

0:12:50.720 --> 0:12:55.120
<v Speaker 1>People are going and kind of sometimes hoarding food. They're

0:12:55.160 --> 0:12:57.840
<v Speaker 1>so worried that the grocery stores are going to close

0:12:57.880 --> 0:13:00.400
<v Speaker 1>and that they're going to starve to death. You saw

0:13:00.440 --> 0:13:05.160
<v Speaker 1>that with the toilet paper shortage. It's fascinating thing to

0:13:05.280 --> 0:13:10.680
<v Speaker 1>observe just from a human behavior standpoint. Um, what advice

0:13:10.720 --> 0:13:13.080
<v Speaker 1>could you give Vivian and other people who are feeling

0:13:13.120 --> 0:13:18.760
<v Speaker 1>that way. There's a difference between being prepared and obsessing,

0:13:19.440 --> 0:13:23.360
<v Speaker 1>and that line is going to shift the more that

0:13:23.440 --> 0:13:26.000
<v Speaker 1>you kind of think about, oh, what's going to happen

0:13:26.000 --> 0:13:28.960
<v Speaker 1>in the future. I think being prepared means that, yeah,

0:13:29.040 --> 0:13:32.200
<v Speaker 1>you have some provisions in the house, and you you know,

0:13:32.280 --> 0:13:34.320
<v Speaker 1>you you have things that that you're going to need.

0:13:34.840 --> 0:13:37.559
<v Speaker 1>But you know, when you start getting to the point

0:13:37.559 --> 0:13:40.120
<v Speaker 1>where you've already gotten the provisions and you think, oh,

0:13:40.120 --> 0:13:42.000
<v Speaker 1>I need more, and then I need more and then

0:13:42.040 --> 0:13:44.880
<v Speaker 1>I need more. Um, that's when you need to step

0:13:44.880 --> 0:13:47.680
<v Speaker 1>back and say, you know what, I am prepared. I

0:13:47.720 --> 0:13:50.040
<v Speaker 1>will be able to get more later. But I have enough.

0:13:50.240 --> 0:13:53.280
<v Speaker 1>I've done my preparations and I've done what the recommendations are.

0:13:53.720 --> 0:13:55.600
<v Speaker 1>And then you really have to let go. And that's

0:13:55.600 --> 0:13:58.000
<v Speaker 1>again we're staying in the present. Helps where instead of

0:13:58.000 --> 0:14:01.200
<v Speaker 1>thinking about, um, you know, do I have enough, and

0:14:01.200 --> 0:14:03.960
<v Speaker 1>and you know, spending your emotional real estate on that,

0:14:04.600 --> 0:14:07.920
<v Speaker 1>do something else. And I know that sounds like I'm

0:14:07.960 --> 0:14:10.760
<v Speaker 1>trivializing this, but I'm not. Um, you know, go do

0:14:10.840 --> 0:14:13.520
<v Speaker 1>a puzzle, Go get those art those art supplies out,

0:14:13.520 --> 0:14:15.480
<v Speaker 1>Go read a book, Go take a walk, Go call

0:14:15.520 --> 0:14:18.280
<v Speaker 1>a friend. You have to take breaks, you have to

0:14:18.360 --> 0:14:21.840
<v Speaker 1>let go, and you have to stay active. I think,

0:14:21.920 --> 0:14:25.920
<v Speaker 1>even though you know the whole it seems anathetical with

0:14:25.960 --> 0:14:28.840
<v Speaker 1>the idea of staying home. There ways to stay active

0:14:28.920 --> 0:14:32.160
<v Speaker 1>at home. Clean out your closet, get rid of all

0:14:32.200 --> 0:14:34.600
<v Speaker 1>the clothes or put them aside that you can give

0:14:34.600 --> 0:14:37.920
<v Speaker 1>for dress to dress for success or to the goodwill.

0:14:38.080 --> 0:14:40.160
<v Speaker 1>You know, it is a good time to do some

0:14:40.280 --> 0:14:44.080
<v Speaker 1>serious spring cleaning, open the windows and and you know,

0:14:44.200 --> 0:14:47.640
<v Speaker 1>get the winter winter out of your house and out

0:14:47.640 --> 0:14:51.360
<v Speaker 1>of your things and maybe downsize a little bit. Andy asked,

0:14:51.400 --> 0:14:54.080
<v Speaker 1>I have a friend who suffers from anxiety. This is

0:14:54.120 --> 0:14:56.120
<v Speaker 1>kind of an obvious question, but it's a good one.

0:14:56.400 --> 0:14:59.440
<v Speaker 1>How can I best support them during this time? How

0:14:59.520 --> 0:15:03.080
<v Speaker 1>can you support people who you know? What can you

0:15:03.160 --> 0:15:06.520
<v Speaker 1>do for them? One of the things that happens with

0:15:06.560 --> 0:15:10.600
<v Speaker 1>anxiety is logic doesn't help. So you can't really talk

0:15:10.680 --> 0:15:13.400
<v Speaker 1>somebody out of their anxiety and try to tell them

0:15:13.400 --> 0:15:16.040
<v Speaker 1>that things are going to be okay. What you can

0:15:16.120 --> 0:15:18.640
<v Speaker 1>do is you can connect with them, and that's that

0:15:18.880 --> 0:15:22.400
<v Speaker 1>naturally sues people. So why don't you say, hey, let's

0:15:22.480 --> 0:15:26.400
<v Speaker 1>do let's have a virtual dinner together. Um, hey, let's

0:15:26.440 --> 0:15:30.160
<v Speaker 1>watch a movie together virtually? Um, you know what, whatever

0:15:30.200 --> 0:15:32.280
<v Speaker 1>it is that you can do. Um. You know some

0:15:32.320 --> 0:15:37.120
<v Speaker 1>people are exercising together and virtually, which is fun, so,

0:15:37.240 --> 0:15:39.440
<v Speaker 1>you know, and just moving your body helps so much

0:15:39.480 --> 0:15:42.480
<v Speaker 1>with anxiety. So if you can somehow get your friend to,

0:15:43.360 --> 0:15:46.040
<v Speaker 1>you know, move around, and you can do it with

0:15:46.080 --> 0:15:49.560
<v Speaker 1>that person virtually. You can support the person through actions,

0:15:49.600 --> 0:15:52.760
<v Speaker 1>as opposed to your words will not really help them,

0:15:52.800 --> 0:15:56.640
<v Speaker 1>but your actions will avas how to focus on work

0:15:56.680 --> 0:16:01.320
<v Speaker 1>while acknowledging that we're all scared. No, I think you

0:16:01.400 --> 0:16:05.560
<v Speaker 1>and I know that when you are worried or stressed out,

0:16:06.080 --> 0:16:09.800
<v Speaker 1>it's hard to concentrate. Actually, I know that from when

0:16:09.840 --> 0:16:13.280
<v Speaker 1>my husband was sick. I would read the same paragraph

0:16:13.440 --> 0:16:16.760
<v Speaker 1>over and over again in a book and I could not,

0:16:16.880 --> 0:16:20.120
<v Speaker 1>for the life of me, concentrate. So how can you

0:16:20.480 --> 0:16:23.480
<v Speaker 1>How can you fight that? Is there anything you can do?

0:16:23.720 --> 0:16:26.680
<v Speaker 1>I guess reducing the stress will help you concentrate more.

0:16:27.520 --> 0:16:29.720
<v Speaker 1>There's also something you can do with your body, which

0:16:29.760 --> 0:16:32.240
<v Speaker 1>is that sometimes when we kind of leave the present,

0:16:32.520 --> 0:16:35.200
<v Speaker 1>we need to physically ground ourselves. So what you do

0:16:35.280 --> 0:16:37.640
<v Speaker 1>is you close your eyes, and you start with your

0:16:37.640 --> 0:16:40.000
<v Speaker 1>feet and you say, I feel my feet on the floor,

0:16:40.560 --> 0:16:42.680
<v Speaker 1>and you feel them, and then you move up and

0:16:42.680 --> 0:16:45.320
<v Speaker 1>you say, okay, I feel put your knees together. I

0:16:45.360 --> 0:16:47.840
<v Speaker 1>feel my knees, and you move up and you just

0:16:47.960 --> 0:16:50.520
<v Speaker 1>keep and you feel your breath and you feel your diaphragm,

0:16:50.560 --> 0:16:52.400
<v Speaker 1>and you feel the different parts of your body and

0:16:52.440 --> 0:16:55.200
<v Speaker 1>it brings you back to the present moment and you

0:16:55.280 --> 0:16:57.720
<v Speaker 1>take some breaths, and then you move on with your work.

0:16:58.360 --> 0:17:00.240
<v Speaker 1>Kristen wants to know how do you cope with the

0:17:00.280 --> 0:17:03.520
<v Speaker 1>idea that we don't know how if when this is

0:17:03.560 --> 0:17:06.760
<v Speaker 1>going to end. I think that's in addition to the

0:17:06.840 --> 0:17:12.000
<v Speaker 1>unpredictability of this, This kind of not knowing when life

0:17:12.040 --> 0:17:16.920
<v Speaker 1>will resume, I think adds to people's stress levels. Right,

0:17:17.000 --> 0:17:19.080
<v Speaker 1>I mean not just am I going to get this

0:17:19.200 --> 0:17:21.879
<v Speaker 1>and what's going to happen? But how long is this

0:17:22.000 --> 0:17:24.399
<v Speaker 1>going to have to be the new normal? So how

0:17:24.480 --> 0:17:27.520
<v Speaker 1>do you cope with that? I think we have to

0:17:27.560 --> 0:17:31.800
<v Speaker 1>acknowledge that humans don't do well with uncertainty, and so

0:17:32.119 --> 0:17:35.400
<v Speaker 1>this is a good opportunity for us to build up

0:17:35.400 --> 0:17:39.439
<v Speaker 1>some resilience around uncertainty, which means that we just instead

0:17:39.440 --> 0:17:41.560
<v Speaker 1>of trying to figure it out. You know, this news

0:17:41.600 --> 0:17:45.000
<v Speaker 1>report says that, or this physician says that, to just

0:17:45.040 --> 0:17:48.000
<v Speaker 1>say we don't know, and to try to get comfortable

0:17:48.040 --> 0:17:49.840
<v Speaker 1>with that and say, what can I do in the

0:17:49.880 --> 0:17:54.280
<v Speaker 1>meantime to have as normal of a routine that I

0:17:54.320 --> 0:17:58.520
<v Speaker 1>can possibly have under these circumstances. You know, I don't

0:17:58.520 --> 0:18:01.200
<v Speaker 1>want to let you go before asking you if someone

0:18:01.359 --> 0:18:06.320
<v Speaker 1>is having real trouble, you know, if the anxiety reaches

0:18:06.400 --> 0:18:11.080
<v Speaker 1>a point where it's untenable or it's affecting someone's physical

0:18:11.080 --> 0:18:15.800
<v Speaker 1>health health, Um, you know, I I don't want to

0:18:15.840 --> 0:18:19.959
<v Speaker 1>trivialize the seriousness of this. So what can people do

0:18:20.040 --> 0:18:23.159
<v Speaker 1>if they really feel there at the breaking their breaking point, Laurie,

0:18:23.920 --> 0:18:27.639
<v Speaker 1>They should absolutely reach out to a therapist. And so

0:18:27.680 --> 0:18:33.720
<v Speaker 1>many therapists are doing online sessions specifically right now for this,

0:18:34.040 --> 0:18:36.040
<v Speaker 1>and they should reach out. And this is not a

0:18:36.040 --> 0:18:39.760
<v Speaker 1>time for shame or stigma or you know, oh my

0:18:39.840 --> 0:18:44.360
<v Speaker 1>problems aren't that bad minimizing our problems. Um, everybody else

0:18:44.440 --> 0:18:46.240
<v Speaker 1>is going through this, So why why why should I

0:18:46.280 --> 0:18:47.800
<v Speaker 1>get help? You know, all those things we say to

0:18:47.840 --> 0:18:50.280
<v Speaker 1>ourselves that prevent us from reaching out. This is a

0:18:50.359 --> 0:18:53.800
<v Speaker 1>time to say, I need to prioritize my emotional health

0:18:53.920 --> 0:18:57.400
<v Speaker 1>just as I'm prioritizing my physical health. And if you

0:18:57.560 --> 0:18:59.359
<v Speaker 1>need to talk to someone, you do not need to

0:18:59.359 --> 0:19:01.480
<v Speaker 1>be in a christ is. You can just be having

0:19:01.480 --> 0:19:05.960
<v Speaker 1>a moment. You can be feeling kind of free floating anxiety, depression,

0:19:06.000 --> 0:19:08.399
<v Speaker 1>whatever it is, or you just want to connect with

0:19:08.440 --> 0:19:11.639
<v Speaker 1>someone because you feel like preventively to kind of preserve

0:19:11.680 --> 0:19:15.160
<v Speaker 1>your emotional health. Please please please reach out. You can

0:19:15.160 --> 0:19:17.080
<v Speaker 1>find you can do a quick Google search and you

0:19:17.119 --> 0:19:22.919
<v Speaker 1>will find somebody who is available to do that for you. Well,

0:19:23.000 --> 0:19:26.879
<v Speaker 1>Lourie stays safe and call me and maybe we'll have

0:19:27.000 --> 0:19:30.000
<v Speaker 1>a virtual glass of wine together a cup of tea.

0:19:30.080 --> 0:19:32.520
<v Speaker 1>I don't want to encourage people to drink during this time,

0:19:32.560 --> 0:19:35.040
<v Speaker 1>but a glass of wine isn't going to hurt, right,

0:19:35.680 --> 0:19:39.600
<v Speaker 1>That's right, that's right. Thank you so much, Katie. Okay, bye, Laurie,

0:19:39.720 --> 0:19:45.240
<v Speaker 1>all right, take care or stay safe. Laurie gott Lee's

0:19:45.320 --> 0:19:47.919
<v Speaker 1>latest book is called Maybe You Should Talk to Someone.

0:19:48.240 --> 0:19:52.639
<v Speaker 1>She's also coming out with a podcast called Appropriately Dear Therapist,

0:19:53.040 --> 0:19:56.560
<v Speaker 1>co hosted Buy Another Therapist, Guy Wench. It's due to

0:19:56.600 --> 0:20:00.439
<v Speaker 1>come out from my Heart hopefully this summer. You know,

0:20:00.480 --> 0:20:03.320
<v Speaker 1>I really like what Laurie said earlier about how kindness

0:20:03.400 --> 0:20:06.920
<v Speaker 1>tends to emerge out of times of crisis. People are

0:20:07.080 --> 0:20:10.080
<v Speaker 1>kinder to one another, they want to help, And I'd

0:20:10.160 --> 0:20:13.200
<v Speaker 1>like to know the large or small ways you're seeing

0:20:13.280 --> 0:20:17.159
<v Speaker 1>kindness or promoting it in your own community. If you

0:20:17.160 --> 0:20:20.080
<v Speaker 1>want to share your story, please call and leave your

0:20:20.200 --> 0:20:23.240
<v Speaker 1>name and a detailed message for us at Next Question.

0:20:23.720 --> 0:20:27.520
<v Speaker 1>The number is eight four four four seven nine seven

0:20:27.640 --> 0:20:31.680
<v Speaker 1>eight eight three. That number once again is eight four

0:20:31.840 --> 0:20:36.760
<v Speaker 1>four four seven nine seven eight eight three. You can

0:20:36.800 --> 0:20:39.800
<v Speaker 1>also email me a voice memo or a written note

0:20:40.080 --> 0:20:44.040
<v Speaker 1>at info at Katie currect dot com. Just put next

0:20:44.119 --> 0:20:48.200
<v Speaker 1>question kindness in the subject line and you might hear

0:20:48.320 --> 0:20:52.520
<v Speaker 1>your story right here. On next question coming up, we're

0:20:52.560 --> 0:20:54.520
<v Speaker 1>going to be checking in with the doctor who's a

0:20:54.560 --> 0:20:57.040
<v Speaker 1>friend of mine and one of the smartest people I know,

0:20:57.520 --> 0:21:00.400
<v Speaker 1>to get a better sense of how the coronavis irs

0:21:00.760 --> 0:21:20.720
<v Speaker 1>affects our bodies and also our health care system. Dr

0:21:20.800 --> 0:21:24.480
<v Speaker 1>Peter Atilla is a Stanford and Johns Hopkins trained physician

0:21:24.840 --> 0:21:29.480
<v Speaker 1>living in San Diego. His clinical focus has been on longevity,

0:21:29.840 --> 0:21:33.160
<v Speaker 1>how to live better and longer, but since the outbreak

0:21:33.240 --> 0:21:38.280
<v Speaker 1>of coronavirus or COVID nineteen, he shifted gears, focusing his

0:21:38.400 --> 0:21:42.600
<v Speaker 1>research towards understanding the current situation, what we can do

0:21:42.680 --> 0:21:47.879
<v Speaker 1>to protect ourselves, and potentially the implication of what's to come.

0:21:48.600 --> 0:21:51.320
<v Speaker 1>And now he's here to share some of that with us.

0:21:52.480 --> 0:21:57.199
<v Speaker 1>So where are we now understanding? This story seems to

0:21:57.359 --> 0:22:01.360
<v Speaker 1>change on an hourly, if not minute I minute basis.

0:22:01.760 --> 0:22:04.679
<v Speaker 1>If you had to assess the situation right now for

0:22:04.760 --> 0:22:07.959
<v Speaker 1>our listeners, what would you say, Well, you know, I

0:22:08.000 --> 0:22:12.159
<v Speaker 1>think of these things through the lens of um. Is

0:22:12.200 --> 0:22:15.879
<v Speaker 1>the rate at which we are seeing infections growing or shrinking?

0:22:15.920 --> 0:22:17.960
<v Speaker 1>So you can think of being on one side or

0:22:17.960 --> 0:22:20.240
<v Speaker 1>another of that peak. So, for example, if we look

0:22:20.280 --> 0:22:23.919
<v Speaker 1>at mainland China, we know that they're now on the

0:22:23.960 --> 0:22:27.840
<v Speaker 1>tail end of this response. Again, there's always possibilities that

0:22:27.880 --> 0:22:31.119
<v Speaker 1>there's another outbreak as they go back to work and

0:22:31.160 --> 0:22:35.000
<v Speaker 1>begin to mobilize society again. But notwithstanding that, it's clear

0:22:35.080 --> 0:22:38.560
<v Speaker 1>that they're on the right side of that curve. Both um,

0:22:38.600 --> 0:22:41.879
<v Speaker 1>you know, right and correct um, we're still on the

0:22:41.960 --> 0:22:44.600
<v Speaker 1>left side of that curve, which means each and every

0:22:44.680 --> 0:22:47.480
<v Speaker 1>day it appears that we are seeing more and more

0:22:47.520 --> 0:22:50.680
<v Speaker 1>people get infected, or the rate at which the infections

0:22:50.720 --> 0:22:55.440
<v Speaker 1>are increasing is is still increasing. Now the million dollar

0:22:55.520 --> 0:22:57.800
<v Speaker 1>question for which a lot of people, you know, really

0:22:57.800 --> 0:23:00.719
<v Speaker 1>smart people, epidemiologists and such, are trying to project is

0:23:01.080 --> 0:23:05.000
<v Speaker 1>where is that peak? Because the peak is sort of

0:23:05.040 --> 0:23:08.040
<v Speaker 1>what gives us a sense of that maximum rate of

0:23:08.080 --> 0:23:11.520
<v Speaker 1>infection um, and that is, once you know what that

0:23:11.560 --> 0:23:13.359
<v Speaker 1>looks like, then you kind of have a sense of

0:23:13.400 --> 0:23:16.720
<v Speaker 1>what the overall number of infected people will be, and

0:23:16.760 --> 0:23:19.960
<v Speaker 1>then you can extrapolate, hopefully from the data we see

0:23:19.960 --> 0:23:21.919
<v Speaker 1>in other countries, what the impact is going to be

0:23:22.000 --> 0:23:24.440
<v Speaker 1>on the health care system. And of course the things

0:23:24.480 --> 0:23:26.800
<v Speaker 1>that really matter, like how many people are going to

0:23:26.840 --> 0:23:31.879
<v Speaker 1>potentially die or otherwise be debilitated by this. Why was

0:23:32.000 --> 0:23:36.600
<v Speaker 1>Italy so overrun with this virus? What was the perfect

0:23:36.680 --> 0:23:40.560
<v Speaker 1>storm that made it go through that country like wildfire?

0:23:41.000 --> 0:23:43.000
<v Speaker 1>So I think we can speculate on a couple of things.

0:23:43.800 --> 0:23:45.600
<v Speaker 1>First of all, I think part of it is bad luck.

0:23:45.760 --> 0:23:50.040
<v Speaker 1>I mean, it's it's important to understand that if um,

0:23:50.160 --> 0:23:52.080
<v Speaker 1>let's let's just make the math simple and say, let's

0:23:52.119 --> 0:23:55.240
<v Speaker 1>let's pretend there were a hundred infected people in China

0:23:56.040 --> 0:23:58.880
<v Speaker 1>as where the epicenter was, and that you know, ten

0:23:58.960 --> 0:24:00.840
<v Speaker 1>of them got on a plane aine and happen to

0:24:00.880 --> 0:24:04.399
<v Speaker 1>travel and go someplace. Well, the ten places that they

0:24:04.480 --> 0:24:07.480
<v Speaker 1>land are going to have a head start in terms

0:24:07.520 --> 0:24:10.600
<v Speaker 1>of where this virus is going to spread. And if

0:24:10.640 --> 0:24:12.880
<v Speaker 1>one of the places they landed was Italy and one

0:24:12.880 --> 0:24:15.280
<v Speaker 1>of the place that they landed was Iran, then those

0:24:15.280 --> 0:24:17.120
<v Speaker 1>places are going to have a bit of a head start.

0:24:17.200 --> 0:24:19.520
<v Speaker 1>So I think there's just a little bit of a

0:24:19.640 --> 0:24:23.320
<v Speaker 1>luck component, which is it probably got an early start

0:24:23.640 --> 0:24:26.639
<v Speaker 1>on the virus reaching there other factors that seem to

0:24:26.680 --> 0:24:29.400
<v Speaker 1>matter seem to be the age of the population. So

0:24:29.600 --> 0:24:34.440
<v Speaker 1>Italy has a relatively old population compared to other countries

0:24:34.480 --> 0:24:37.560
<v Speaker 1>in Europe and relative to the United States, meaning they

0:24:37.600 --> 0:24:40.560
<v Speaker 1>have more people who are in that high risk category

0:24:40.720 --> 0:24:44.200
<v Speaker 1>based on age alone. Furthermore, there seems to be a

0:24:44.240 --> 0:24:47.720
<v Speaker 1>slightly higher prevalence of smoking, and smoking is definitely one

0:24:47.760 --> 0:24:51.400
<v Speaker 1>of the major risk factors for people who, if they're infected,

0:24:51.440 --> 0:24:54.200
<v Speaker 1>are more likely to get ill. And then I think

0:24:54.240 --> 0:24:56.800
<v Speaker 1>the other component is, you know, some of the sort

0:24:56.800 --> 0:25:00.560
<v Speaker 1>of just societal things about the proximity that people are

0:25:00.680 --> 0:25:03.040
<v Speaker 1>to each other. So in other words, if you look

0:25:03.080 --> 0:25:06.160
<v Speaker 1>at the place like Wyoming, if someone had landed, if

0:25:06.160 --> 0:25:08.840
<v Speaker 1>one of the first people infected had landed in Wyoming,

0:25:09.119 --> 0:25:12.320
<v Speaker 1>it still would have likely spread slower than landing in

0:25:12.359 --> 0:25:16.120
<v Speaker 1>a place like Italy, northern Italy, where the population density

0:25:16.359 --> 0:25:19.480
<v Speaker 1>is such that there's more contact with an infected person

0:25:19.520 --> 0:25:21.760
<v Speaker 1>to another. And then I think, finally, just at the

0:25:21.760 --> 0:25:24.600
<v Speaker 1>policy level, they were probably a little bit later to

0:25:24.760 --> 0:25:28.439
<v Speaker 1>realize what was happening an institute the measures necessary to

0:25:28.520 --> 0:25:32.600
<v Speaker 1>slow the rate of spread. You have said it, Italy

0:25:32.720 --> 0:25:35.840
<v Speaker 1>taught us that it is the morbidity rate, not the

0:25:35.880 --> 0:25:40.160
<v Speaker 1>mortality rate of the disease that is grave for us.

0:25:40.520 --> 0:25:45.879
<v Speaker 1>Non doctors who may be listening, including myself. What is

0:25:45.920 --> 0:25:50.840
<v Speaker 1>the difference. So, mortality is kind of a binary variable.

0:25:50.920 --> 0:25:53.720
<v Speaker 1>It's to live or to die, and there's a lot

0:25:53.760 --> 0:25:58.040
<v Speaker 1>of attention that is appropriately being placed on the mortality rate.

0:25:58.480 --> 0:26:02.200
<v Speaker 1>It's often described through a case fatality rate, which is

0:26:02.200 --> 0:26:05.280
<v Speaker 1>another way of saying how many people die for a

0:26:05.320 --> 0:26:08.320
<v Speaker 1>given number of people who have this infection. And obviously

0:26:08.359 --> 0:26:14.520
<v Speaker 1>that's very important, but morbidity is more about the you know,

0:26:14.720 --> 0:26:17.840
<v Speaker 1>long term impact on quality of life, an illness that

0:26:17.920 --> 0:26:20.879
<v Speaker 1>has suffered that does not ultimately result in death. And

0:26:20.920 --> 0:26:24.400
<v Speaker 1>I was reading a paper this morning, UM that did

0:26:24.440 --> 0:26:28.439
<v Speaker 1>a ten year follow up on people who were infected

0:26:28.440 --> 0:26:31.399
<v Speaker 1>with the first STARS virus that we talked about stars

0:26:31.480 --> 0:26:34.760
<v Speaker 1>covie one. This was the two thousand three epidemic. This

0:26:34.840 --> 0:26:38.080
<v Speaker 1>was a pretty lethal virus, certainly appeared more lethal than

0:26:38.119 --> 0:26:41.399
<v Speaker 1>the current virus. About ten percent of people infected with

0:26:41.480 --> 0:26:45.399
<v Speaker 1>this virus died, so that's a staggering amount. But what

0:26:45.480 --> 0:26:47.760
<v Speaker 1>this paper followed up on was what were the long

0:26:47.880 --> 0:26:51.560
<v Speaker 1>term consequences of the people who were infected but survived.

0:26:52.040 --> 0:26:55.680
<v Speaker 1>And it was quite disheartening, frankly, that you saw much

0:26:55.760 --> 0:26:59.520
<v Speaker 1>higher incidence of cardiovascular disease in those people, much higher

0:26:59.560 --> 0:27:02.840
<v Speaker 1>incidents of lung disease in those people as the so

0:27:02.840 --> 0:27:04.639
<v Speaker 1>so if they didn't die from the disease, they were

0:27:04.680 --> 0:27:07.880
<v Speaker 1>still somewhat debilitated by it. And I think that that's

0:27:07.920 --> 0:27:10.240
<v Speaker 1>something that we're going to see a lot more of,

0:27:10.320 --> 0:27:13.800
<v Speaker 1>and I think the consequences of that, you know, economically,

0:27:13.840 --> 0:27:16.119
<v Speaker 1>will be significant. There are going to be people I

0:27:16.440 --> 0:27:18.320
<v Speaker 1>suspect who won't be able to go back to work

0:27:18.320 --> 0:27:20.879
<v Speaker 1>in the same capacity a year from now when all

0:27:21.000 --> 0:27:22.680
<v Speaker 1>is said and done, And the people who are most

0:27:22.720 --> 0:27:25.400
<v Speaker 1>susceptible to that are obviously the people who come in

0:27:25.840 --> 0:27:29.320
<v Speaker 1>with the greatest amount of pre existing medical conditions. So,

0:27:29.400 --> 0:27:33.440
<v Speaker 1>for example, diabetes. Why as diabetes a risk for this?

0:27:33.640 --> 0:27:35.720
<v Speaker 1>And I don't think we know entirely, but one thing

0:27:35.720 --> 0:27:38.560
<v Speaker 1>we know is that people with diabetes might already have

0:27:38.720 --> 0:27:43.359
<v Speaker 1>some underlying degree of insult to their kidneys, to their heart,

0:27:43.720 --> 0:27:46.119
<v Speaker 1>and it might be that they are less likely to

0:27:46.160 --> 0:27:48.760
<v Speaker 1>recover from this, even if they're fortunate enough to not

0:27:48.800 --> 0:27:52.560
<v Speaker 1>succumb to it. Yeah, I was interested in the diabetes

0:27:52.640 --> 0:27:57.680
<v Speaker 1>angle because I would understand smoking because correct me if

0:27:57.680 --> 0:28:02.640
<v Speaker 1>I'm wrong, Peter. But this virus does create some kind

0:28:02.680 --> 0:28:06.960
<v Speaker 1>of fibrosis and the lungs. Is that right? Eventually, Yes,

0:28:07.359 --> 0:28:09.520
<v Speaker 1>this is a virus that has a kind of unique

0:28:09.520 --> 0:28:13.240
<v Speaker 1>pathology relative to influenza, for example, which would be a

0:28:13.280 --> 0:28:18.080
<v Speaker 1>cousin of it um. The virus gets Every virus has

0:28:18.119 --> 0:28:20.800
<v Speaker 1>to replicate by getting into a cell within our body.

0:28:20.880 --> 0:28:22.520
<v Speaker 1>So it's you know, maybe we're taking a step back

0:28:22.560 --> 0:28:25.200
<v Speaker 1>to understand what the heck of virus is. A virus

0:28:25.400 --> 0:28:28.640
<v Speaker 1>is not quite like a bacteria. The bacteria is totally

0:28:28.680 --> 0:28:32.600
<v Speaker 1>self sufficient, meaning it has all of the equipment inside

0:28:32.640 --> 0:28:35.640
<v Speaker 1>of its cell to fully replicate on its own outside

0:28:35.640 --> 0:28:38.720
<v Speaker 1>of the body. That doesn't mean it won't in fact us,

0:28:38.760 --> 0:28:42.320
<v Speaker 1>but a virus is different. A virus doesn't actually have

0:28:42.600 --> 0:28:46.200
<v Speaker 1>much to it. It's a much much simpler piece of

0:28:46.280 --> 0:28:50.120
<v Speaker 1>you know, biologic you know entity. It has in this

0:28:50.160 --> 0:28:54.480
<v Speaker 1>case just some RNA and that's about it. And so

0:28:54.680 --> 0:28:58.240
<v Speaker 1>for it to replicate and survive, it must get inside

0:28:58.240 --> 0:29:00.440
<v Speaker 1>of a host, and in this case, you have now

0:29:00.520 --> 0:29:02.959
<v Speaker 1>become the host. Prior to this, of course, animals were

0:29:03.000 --> 0:29:08.920
<v Speaker 1>the host, and it uses our DNA replicating machinery to

0:29:09.040 --> 0:29:11.960
<v Speaker 1>replicate itself. So if you were going to think about

0:29:11.960 --> 0:29:15.160
<v Speaker 1>this sort of teleologically, the virus really has no intention

0:29:15.200 --> 0:29:18.160
<v Speaker 1>of hurting us. That's just an unintended consequence. What it

0:29:18.240 --> 0:29:21.800
<v Speaker 1>wants to do is replicate. From an evolutionary perspective, and

0:29:21.840 --> 0:29:24.560
<v Speaker 1>the most successful viruses, by the way, the ones that

0:29:24.600 --> 0:29:27.240
<v Speaker 1>can go on forever and ever, don't hurt their host

0:29:27.280 --> 0:29:31.200
<v Speaker 1>at all. It's the viruses that destroy their host that

0:29:31.320 --> 0:29:34.520
<v Speaker 1>don't really survive, much like ebola. Ebola didn't spread very

0:29:34.600 --> 0:29:37.680
<v Speaker 1>much because it was so devastating to its host. So

0:29:37.720 --> 0:29:40.320
<v Speaker 1>when this virus comes in, it has to pick a

0:29:40.400 --> 0:29:43.360
<v Speaker 1>cell that it targets, and that just happens to come

0:29:43.400 --> 0:29:45.720
<v Speaker 1>down to sort of the molecular biology of how this

0:29:45.800 --> 0:29:50.400
<v Speaker 1>virus works. And this cell it targets most commonly is

0:29:50.400 --> 0:29:53.720
<v Speaker 1>a cell in the lung called a pneuma site because

0:29:53.720 --> 0:29:56.280
<v Speaker 1>of a certain receptor that that cell has that allows

0:29:56.320 --> 0:29:59.400
<v Speaker 1>this virus to enter. When it gets into that cell,

0:30:00.040 --> 0:30:03.520
<v Speaker 1>it basically hijacks it. It takes over and uses the

0:30:03.640 --> 0:30:06.680
<v Speaker 1>cell's ability to replicate and says, hey, I'm going to

0:30:06.960 --> 0:30:10.200
<v Speaker 1>take this over for myself and replicate myself. And it

0:30:10.280 --> 0:30:13.560
<v Speaker 1>does that and it ends up destroying that cell. And

0:30:13.640 --> 0:30:15.880
<v Speaker 1>it turns out that in this case, that's a really

0:30:15.920 --> 0:30:19.640
<v Speaker 1>bad cell to lose because that cell, called a type

0:30:19.640 --> 0:30:24.520
<v Speaker 1>to numa. Site makes a chemical called surfactant, and you've

0:30:24.520 --> 0:30:27.440
<v Speaker 1>probably heard of surfact and it's like a detergent that

0:30:27.560 --> 0:30:31.720
<v Speaker 1>allows the air sacks in our lungs to not collapse

0:30:31.760 --> 0:30:35.200
<v Speaker 1>on themselves because of the surface tension. And so when

0:30:35.200 --> 0:30:38.840
<v Speaker 1>we lose enough of those, the lungs begin to collapse

0:30:39.320 --> 0:30:43.280
<v Speaker 1>and we aren't able to exchange air, and ultimately that

0:30:43.360 --> 0:30:47.160
<v Speaker 1>results in a type of pneumonia, or really something more

0:30:47.200 --> 0:30:51.520
<v Speaker 1>severe than a pneumonia called acute respiratory distress syndrome, where

0:30:51.560 --> 0:30:54.840
<v Speaker 1>a person can't exchange gas, and ultimately that will result

0:30:54.920 --> 0:30:58.800
<v Speaker 1>in potentially fibrosis of the lung. It turns out, by

0:30:58.800 --> 0:31:01.280
<v Speaker 1>the way that that cell um that that that the

0:31:01.360 --> 0:31:05.040
<v Speaker 1>virus can also gain access to um muscle cells of

0:31:05.080 --> 0:31:08.600
<v Speaker 1>the heart, and so we believe that we're going to

0:31:08.680 --> 0:31:11.920
<v Speaker 1>see sort of fibrosis of the heart going forward. In fact,

0:31:12.000 --> 0:31:15.880
<v Speaker 1>thirty or forty percent of patients on autopsy, people who

0:31:15.920 --> 0:31:18.400
<v Speaker 1>have already died from this virus are showing injury to

0:31:18.480 --> 0:31:23.960
<v Speaker 1>their heart. This sounds very, very bleak, but that's one

0:31:24.000 --> 0:31:29.920
<v Speaker 1>of the reasons smokers are particularly susceptible because they already

0:31:29.920 --> 0:31:32.960
<v Speaker 1>have some of the some damage to the cells that

0:31:33.040 --> 0:31:36.960
<v Speaker 1>you were discussing, yep, and they just have less what

0:31:37.000 --> 0:31:41.440
<v Speaker 1>we would call pulmonary reserve. They have less lung capacity

0:31:41.600 --> 0:31:44.360
<v Speaker 1>in excess. So you know, someone like you, Katie, who's

0:31:44.400 --> 0:31:47.600
<v Speaker 1>really healthy, you know you're not utilizing your full lung

0:31:47.640 --> 0:31:50.360
<v Speaker 1>capacity when you're sitting here at rest right now. You're

0:31:50.440 --> 0:31:52.920
<v Speaker 1>using a fraction of it. But let's say that you

0:31:52.960 --> 0:31:56.880
<v Speaker 1>know you're using of your lung capacity. Will imagine somebody

0:31:56.880 --> 0:31:59.080
<v Speaker 1>who has smoked for a long period of time. For

0:31:59.160 --> 0:32:01.840
<v Speaker 1>them sitting at as they might be relying on six

0:32:02.520 --> 0:32:04.800
<v Speaker 1>of their lung capacity, so they just have less of

0:32:04.840 --> 0:32:06.920
<v Speaker 1>a buffer. You know. You can think of it as

0:32:06.960 --> 0:32:09.720
<v Speaker 1>like how much does someone have in their savings account? Well,

0:32:09.760 --> 0:32:12.320
<v Speaker 1>the person who has less in their savings account is

0:32:12.360 --> 0:32:16.120
<v Speaker 1>going to be more likely to suffer the shock of not,

0:32:16.320 --> 0:32:20.160
<v Speaker 1>you know, having a job. Before we talk about being

0:32:20.240 --> 0:32:23.600
<v Speaker 1>better prepared, and I know that you watched the Bill

0:32:23.680 --> 0:32:27.440
<v Speaker 1>Gates Ted Talk, which I thought was eerily prescient in

0:32:27.600 --> 0:32:31.520
<v Speaker 1>its message. But let's talk just briefly, because I think

0:32:31.560 --> 0:32:34.440
<v Speaker 1>people are desperate for this kind of information to Peter,

0:32:34.560 --> 0:32:39.040
<v Speaker 1>and you have access to the latest, most accurate information

0:32:39.520 --> 0:32:44.280
<v Speaker 1>in terms of protecting yourself. Um, tell me what you're

0:32:44.320 --> 0:32:49.440
<v Speaker 1>doing in your home with your kids and your wife. Well,

0:32:49.840 --> 0:32:52.680
<v Speaker 1>we we sort of probably came across as a little

0:32:52.680 --> 0:32:57.120
<v Speaker 1>bit crazy at the outset. In mid February, I sort

0:32:57.120 --> 0:32:59.360
<v Speaker 1>of woke up to what was happening. I had been

0:32:59.480 --> 0:33:04.520
<v Speaker 1>largely and denial through January, and UM, I think had

0:33:04.640 --> 0:33:07.840
<v Speaker 1>naively assumed that this would be much more like the

0:33:07.920 --> 0:33:12.800
<v Speaker 1>First Stars outbreak, or like the Murs outbreak, except less

0:33:12.840 --> 0:33:15.959
<v Speaker 1>deadly and less likely to spread. In other words, I

0:33:16.000 --> 0:33:19.920
<v Speaker 1>hadn't fully dug into the properties of this virus that

0:33:20.040 --> 0:33:22.680
<v Speaker 1>make it a little more troublesome, which is namely its

0:33:22.720 --> 0:33:26.480
<v Speaker 1>capacity for spread. But in mid February, when I sort

0:33:26.520 --> 0:33:29.840
<v Speaker 1>of woke up to this, UM, I started to think about, well,

0:33:29.840 --> 0:33:32.240
<v Speaker 1>what what could we do if we wanted to buy

0:33:32.280 --> 0:33:35.680
<v Speaker 1>more time? And so that basically came down to much

0:33:35.680 --> 0:33:39.280
<v Speaker 1>greater social distancing, and UM that meant, you know, canceling

0:33:39.280 --> 0:33:43.200
<v Speaker 1>all travel plans. And then eventually it just you know,

0:33:43.280 --> 0:33:45.680
<v Speaker 1>came down to making a decision that was difficult to make,

0:33:45.720 --> 0:33:48.240
<v Speaker 1>and not a decision that everybody has the luxury of making,

0:33:48.280 --> 0:33:50.680
<v Speaker 1>because many people don't have the luxury of working from home.

0:33:51.040 --> 0:33:54.920
<v Speaker 1>But it was a decision to basically quarantine ourselves, UM,

0:33:54.960 --> 0:33:57.520
<v Speaker 1>and so that meant that, you know, we don't leave

0:33:57.560 --> 0:33:59.960
<v Speaker 1>the house and people don't come to us in the house.

0:34:00.120 --> 0:34:03.240
<v Speaker 1>And the thinking would be that after two to three

0:34:03.280 --> 0:34:05.800
<v Speaker 1>weeks of that period of a quarantine, absent having an

0:34:05.840 --> 0:34:09.359
<v Speaker 1>accurate test to measure UM, if you are infected, if

0:34:09.400 --> 0:34:12.279
<v Speaker 1>you're completely asymptomatic, you know, no temperature changes or anything

0:34:12.400 --> 0:34:15.040
<v Speaker 1>like that, the likelihood that you're infected is low. And

0:34:15.080 --> 0:34:17.000
<v Speaker 1>now at least you're in sort of a safe spot

0:34:17.000 --> 0:34:19.600
<v Speaker 1>while you wait for time to sort of play this out.

0:34:19.719 --> 0:34:21.880
<v Speaker 1>And time does a lot of things right. Time allows

0:34:21.960 --> 0:34:24.920
<v Speaker 1>us to potentially develop a vaccine. Although I think that's

0:34:24.960 --> 0:34:28.120
<v Speaker 1>a longer term strategy than most people think, it certainly

0:34:28.160 --> 0:34:31.279
<v Speaker 1>allows us to repurpose existing drugs and that's something I'm

0:34:31.320 --> 0:34:33.960
<v Speaker 1>really excited about. So if we're going to talk about optimism,

0:34:34.120 --> 0:34:36.560
<v Speaker 1>I actually am quite optimistic that there are a suite

0:34:36.600 --> 0:34:39.719
<v Speaker 1>of drugs that already exist that we're now learning how

0:34:39.760 --> 0:34:43.280
<v Speaker 1>can be repurposed for this And most importantly, it's giving

0:34:43.400 --> 0:34:46.480
<v Speaker 1>the hospital system and the health care system a chance

0:34:46.719 --> 0:34:51.080
<v Speaker 1>to slowly expand to meet the needs that are necessary.

0:34:51.120 --> 0:34:55.240
<v Speaker 1>Because again to your point about Italy, the real problem

0:34:55.280 --> 0:34:57.319
<v Speaker 1>in Italy is not the total number of people that

0:34:57.360 --> 0:35:00.960
<v Speaker 1>are infected, it's the speed at which those people needed

0:35:01.080 --> 0:35:04.000
<v Speaker 1>medical care. And so you can you've heard the term

0:35:04.040 --> 0:35:06.759
<v Speaker 1>flattening the curve. Why are people saying that. It's like

0:35:06.840 --> 0:35:10.640
<v Speaker 1>saying if a hundred thousand people are going to require hospitalization,

0:35:10.840 --> 0:35:13.600
<v Speaker 1>it's a big difference if they required in one month

0:35:14.000 --> 0:35:17.080
<v Speaker 1>or one year. And so it's not clear that we're

0:35:17.080 --> 0:35:19.280
<v Speaker 1>going to reduce the number of people that are ultimately

0:35:19.280 --> 0:35:21.200
<v Speaker 1>going to be infected, but we want to spread it

0:35:21.200 --> 0:35:24.120
<v Speaker 1>out as much as possible. So on a personal level,

0:35:24.200 --> 0:35:26.120
<v Speaker 1>my view is what can I do to make sure

0:35:26.160 --> 0:35:30.120
<v Speaker 1>I don't need healthcare resources anytime soon. I talked to

0:35:30.280 --> 0:35:35.520
<v Speaker 1>the director of an urgent care center, Peter, and he said,

0:35:35.680 --> 0:35:39.080
<v Speaker 1>do not go to the doctors, do not you know,

0:35:39.440 --> 0:35:43.120
<v Speaker 1>try to seek medical care unless it gets bad. But

0:35:43.200 --> 0:35:46.719
<v Speaker 1>I wondered, is there an inflection point, because I think

0:35:46.840 --> 0:35:50.680
<v Speaker 1>people are so paranoid. Every time I cough, I get

0:35:50.719 --> 0:35:55.920
<v Speaker 1>neurotic and uh and and when is that point where

0:35:56.000 --> 0:35:58.719
<v Speaker 1>you should seek medical care or at least talk to

0:35:58.760 --> 0:36:04.560
<v Speaker 1>a healthcare provide because we don't want to clog the system. Listeners,

0:36:04.600 --> 0:36:07.640
<v Speaker 1>I'm sure agree with this, but we also don't want

0:36:07.640 --> 0:36:11.479
<v Speaker 1>to ignore an illness that could worsen if we don't

0:36:11.480 --> 0:36:14.959
<v Speaker 1>get it, if we don't get the proper attention. Yeah,

0:36:15.000 --> 0:36:18.319
<v Speaker 1>I mean, that's such an important question, and truthfully, it's

0:36:18.360 --> 0:36:21.960
<v Speaker 1>one for which I think the answer is not entirely clear. Um,

0:36:22.120 --> 0:36:24.239
<v Speaker 1>we probably do need to think a little bit about

0:36:24.239 --> 0:36:26.960
<v Speaker 1>how to stratify. So I would agree with the advice

0:36:27.120 --> 0:36:31.080
<v Speaker 1>that your colleague and friend gave you, which is, we

0:36:31.280 --> 0:36:36.040
<v Speaker 1>certainly don't want everyone who, um, you know, thinks that

0:36:36.080 --> 0:36:38.040
<v Speaker 1>they have a little sniffle or a sneeze or a

0:36:38.080 --> 0:36:42.279
<v Speaker 1>sore throat to then expose themselves to an infection by

0:36:42.280 --> 0:36:46.799
<v Speaker 1>going out and seeking medical care, especially when we don't

0:36:46.840 --> 0:36:49.040
<v Speaker 1>have testing readily available yet. That's the important thing to

0:36:49.120 --> 0:36:51.920
<v Speaker 1>understand is what is it going to accomplish to go

0:36:52.000 --> 0:36:55.239
<v Speaker 1>and put yourself in harm's way If we don't even

0:36:55.239 --> 0:36:57.239
<v Speaker 1>have a test yet that's viable, are going to offer

0:36:57.280 --> 0:37:00.480
<v Speaker 1>as much. So I think we have to stratify patient. So,

0:37:00.719 --> 0:37:02.160
<v Speaker 1>you know, the way we are looking at it in

0:37:02.160 --> 0:37:04.839
<v Speaker 1>our practice is we're taking the patients who we think

0:37:04.840 --> 0:37:07.359
<v Speaker 1>are at highest risk. So these are people who are

0:37:07.760 --> 0:37:10.680
<v Speaker 1>you know, sort of in their sixties and older people

0:37:10.680 --> 0:37:14.400
<v Speaker 1>who have existing conditions like high blood pressure or heart disease,

0:37:14.440 --> 0:37:17.920
<v Speaker 1>atrial fibrillation, these sorts of things, and we're saying we're

0:37:17.920 --> 0:37:22.400
<v Speaker 1>going to have a lower threshold for getting them tested

0:37:22.640 --> 0:37:24.759
<v Speaker 1>or getting them in to see someone if we have

0:37:24.840 --> 0:37:27.520
<v Speaker 1>any concern. You know, my wife yesterday was called by

0:37:27.640 --> 0:37:31.120
<v Speaker 1>a friend of hers who lives in Colorado now, and

0:37:31.200 --> 0:37:34.080
<v Speaker 1>she has a lot of underlying medical conditions, and you know,

0:37:34.400 --> 0:37:36.520
<v Speaker 1>it was really difficult to spend the time on the

0:37:36.520 --> 0:37:39.120
<v Speaker 1>phone with here today and triage. What I couldn't fully

0:37:39.200 --> 0:37:42.840
<v Speaker 1>understand was either a panic attack or legitimately an illness,

0:37:43.360 --> 0:37:45.200
<v Speaker 1>and you know, we had to make a call, and

0:37:45.200 --> 0:37:47.680
<v Speaker 1>in the end we saw it. We decided after an

0:37:47.680 --> 0:37:50.040
<v Speaker 1>hour she probably did need to go into the emergency

0:37:50.120 --> 0:37:52.160
<v Speaker 1>room and get checked out because I just couldn't be

0:37:52.200 --> 0:37:55.360
<v Speaker 1>comfortable that this was just anxiety and I and she

0:37:55.440 --> 0:37:58.360
<v Speaker 1>has so many underlying medical conditions that I was actually

0:37:58.400 --> 0:38:01.040
<v Speaker 1>concerned that. You know, she's the type of person who,

0:38:01.080 --> 0:38:04.480
<v Speaker 1>if infected, could very precipitously, you know, fall off that

0:38:04.600 --> 0:38:09.560
<v Speaker 1>proverbial cliff. And what happened, Um, you know, she we

0:38:09.680 --> 0:38:12.759
<v Speaker 1>went there. I It's it's still unclear because of course,

0:38:12.800 --> 0:38:15.239
<v Speaker 1>the testing takes days to get back. So, but now

0:38:15.280 --> 0:38:18.239
<v Speaker 1>she is at least, you know, her blood pressure is normalized,

0:38:18.520 --> 0:38:22.279
<v Speaker 1>her oxygen levels are normalized. Um, the thing we are

0:38:22.440 --> 0:38:25.640
<v Speaker 1>most sensitive to is shortness of breath. That seems to

0:38:25.640 --> 0:38:29.280
<v Speaker 1>be the biggest single predictor of people who do versus

0:38:29.320 --> 0:38:32.319
<v Speaker 1>do not need medical attention. So people who do not

0:38:32.440 --> 0:38:36.040
<v Speaker 1>develop shortness of breath at any point in time are

0:38:36.080 --> 0:38:38.680
<v Speaker 1>generally going to recover in what we call a self

0:38:38.760 --> 0:38:42.600
<v Speaker 1>limited way. I hate to ask you this, doctor a

0:38:42.719 --> 0:38:45.920
<v Speaker 1>tea of a what is how do you know if

0:38:45.960 --> 0:38:48.560
<v Speaker 1>you have shortness of breath? I know that probably sounds

0:38:48.560 --> 0:38:51.319
<v Speaker 1>like a dumb question, but is there something you can

0:38:51.400 --> 0:38:55.879
<v Speaker 1>do to figure out? Is it walking upstairs? I mean

0:38:56.200 --> 0:38:58.960
<v Speaker 1>I get sometime shortness of breath if I try to

0:38:59.040 --> 0:39:01.879
<v Speaker 1>run a mile. I mean when when can you tell

0:39:01.960 --> 0:39:04.960
<v Speaker 1>you have that? Actually, Katie, that is not a stupid

0:39:05.040 --> 0:39:07.440
<v Speaker 1>question at all, and we've actually tried to explain that

0:39:07.520 --> 0:39:11.239
<v Speaker 1>exactly to our patients. So I'm glad you asked. Um.

0:39:11.400 --> 0:39:13.640
<v Speaker 1>We think one of the best litmus test is for

0:39:13.920 --> 0:39:18.279
<v Speaker 1>litmus tests for shortness of breath is air hunger while

0:39:18.320 --> 0:39:22.760
<v Speaker 1>speaking in long sentences. So when someone who could normally

0:39:22.920 --> 0:39:26.319
<v Speaker 1>rattle off, you know, three minutes of talking with just

0:39:26.360 --> 0:39:28.680
<v Speaker 1>the simple breath in between, all of a sudden has

0:39:28.719 --> 0:39:32.480
<v Speaker 1>to take longer pauses to take breaths in between speaking

0:39:32.920 --> 0:39:36.440
<v Speaker 1>to me, that's true shortness of breath. You use an

0:39:36.480 --> 0:39:38.560
<v Speaker 1>example of walking up a flight of stairs. I think,

0:39:38.600 --> 0:39:42.600
<v Speaker 1>if somebody knows what they're you know, normal exercise tolerance

0:39:42.719 --> 0:39:46.480
<v Speaker 1>is when that dramatically decreases. So if a person you

0:39:46.520 --> 0:39:48.400
<v Speaker 1>know lives in an apartment where they have to go

0:39:48.480 --> 0:39:50.560
<v Speaker 1>up and down a flight of stairs and normally that

0:39:50.880 --> 0:39:54.000
<v Speaker 1>poses no risk to them, and all of a sudden,

0:39:54.040 --> 0:39:57.400
<v Speaker 1>now they think, oh my god, like I'm really winded

0:39:57.400 --> 0:39:59.960
<v Speaker 1>walking up this flight of stairs, that that might all

0:40:00.040 --> 0:40:03.360
<v Speaker 1>so constitute shortness of breath. Um. The other thing to

0:40:03.400 --> 0:40:06.640
<v Speaker 1>keep in mind is shortness of breath by itself probably

0:40:06.680 --> 0:40:10.920
<v Speaker 1>doesn't show up without some other symptoms, such as, um,

0:40:10.960 --> 0:40:13.320
<v Speaker 1>you know, a fever, which is the single most common

0:40:13.360 --> 0:40:15.839
<v Speaker 1>symptom we see in people who are infected. But of

0:40:15.880 --> 0:40:19.000
<v Speaker 1>course it's important to understand people can develop fevers for

0:40:19.120 --> 0:40:21.400
<v Speaker 1>any sort of you know common you know, cold or

0:40:21.440 --> 0:40:25.520
<v Speaker 1>anything like that orl right, absolutely, and so all of

0:40:25.520 --> 0:40:27.680
<v Speaker 1>this I think points to something which is, you know,

0:40:28.120 --> 0:40:30.279
<v Speaker 1>do as much as you can buy phone right, call

0:40:30.360 --> 0:40:33.960
<v Speaker 1>your doctor, walk through all of these things and and

0:40:34.040 --> 0:40:36.839
<v Speaker 1>let you let your doctor help you decide if you

0:40:36.880 --> 0:40:40.640
<v Speaker 1>actually need to take the next step of getting tested,

0:40:40.680 --> 0:40:44.120
<v Speaker 1>which again we're currently in a testing environment that is

0:40:44.160 --> 0:40:48.520
<v Speaker 1>not adequate. So the CDC guidelines on testing are actually

0:40:48.600 --> 0:40:51.040
<v Speaker 1>quite stringent compared to what I think they should be

0:40:51.160 --> 0:40:55.719
<v Speaker 1>due to these limitations. So you know that that does

0:40:55.840 --> 0:40:59.200
<v Speaker 1>raise the question who should be tested and who shouldn't

0:40:59.280 --> 0:41:03.600
<v Speaker 1>and uh, sort of thinking about the common good and

0:41:03.680 --> 0:41:07.120
<v Speaker 1>not just yourself in these situations. But gosh, you know,

0:41:07.200 --> 0:41:10.399
<v Speaker 1>we're talking about in some cases life or death, peter

0:41:10.520 --> 0:41:14.200
<v Speaker 1>and so people I think, you know, they have this

0:41:14.280 --> 0:41:20.040
<v Speaker 1>primal survival instinct. So uh, in terms of testing, you

0:41:20.400 --> 0:41:23.680
<v Speaker 1>have to rely on your health care provider. But they're

0:41:23.719 --> 0:41:28.600
<v Speaker 1>making some tough decisions in Italy about who who gets

0:41:28.640 --> 0:41:34.080
<v Speaker 1>medical attention and who doesn't because of the crowded conditions

0:41:34.120 --> 0:41:38.160
<v Speaker 1>of hospitals, etcetera. I mean, it's it really feels like

0:41:38.280 --> 0:41:42.240
<v Speaker 1>the makings of a of a sci fi movie. Yeah,

0:41:42.320 --> 0:41:47.239
<v Speaker 1>they are making these decisions in Europe um already, and

0:41:48.400 --> 0:41:50.840
<v Speaker 1>it's not clear if we're not going to be in

0:41:50.840 --> 0:41:53.360
<v Speaker 1>the same position in the next two to three weeks.

0:41:54.080 --> 0:41:57.359
<v Speaker 1>UM as far as testing goes at the time, at

0:41:57.560 --> 0:42:01.520
<v Speaker 1>right this moment, Katie, the CDC sidelines are that testing

0:42:01.560 --> 0:42:05.840
<v Speaker 1>should be reserved for people who are symptomatic only. Now,

0:42:06.000 --> 0:42:09.040
<v Speaker 1>why do I think that that's insufficient? Um? I think it.

0:42:09.320 --> 0:42:11.840
<v Speaker 1>If you really want to control the rate of spread,

0:42:12.280 --> 0:42:15.399
<v Speaker 1>you should also be testing people with known exposure, even

0:42:15.440 --> 0:42:19.160
<v Speaker 1>if they are asymptomatic. Because this virus has such a

0:42:19.239 --> 0:42:23.560
<v Speaker 1>long latency period. Let's assume that you know, you are

0:42:23.600 --> 0:42:26.799
<v Speaker 1>around somebody who then went on to test positive or

0:42:26.840 --> 0:42:30.560
<v Speaker 1>frankly even went on to be symptomatic. In an ideal world,

0:42:30.719 --> 0:42:33.160
<v Speaker 1>if we had a sufficient number of tests and a

0:42:33.239 --> 0:42:36.480
<v Speaker 1>sufficient infrastructure for testing, it would actually be important to

0:42:36.520 --> 0:42:40.560
<v Speaker 1>know that you were negative before you know, we told you, hey,

0:42:40.600 --> 0:42:42.680
<v Speaker 1>it's you know. The fact that you're not symptomatic means

0:42:42.719 --> 0:42:46.000
<v Speaker 1>you're not at risk. In other words, the thing that

0:42:46.120 --> 0:42:50.960
<v Speaker 1>makes this virus so particularly troublesome is that people who

0:42:51.000 --> 0:42:54.799
<v Speaker 1>have no symptoms can spread the virus, and they can

0:42:54.800 --> 0:42:58.680
<v Speaker 1>do so for a long period of time, for fourteen days, right,

0:42:58.719 --> 0:43:01.040
<v Speaker 1>I mean, isn't that the inky bastion period and the

0:43:01.080 --> 0:43:05.120
<v Speaker 1>fact that some people can be vectors and yet never

0:43:05.600 --> 0:43:10.080
<v Speaker 1>symptomatic that makes it really freaky. Right, Yeah, that's the

0:43:10.320 --> 0:43:13.040
<v Speaker 1>that's the superpower of this virus. So if you were

0:43:13.080 --> 0:43:16.319
<v Speaker 1>gonna like create a you know, a list of all

0:43:16.320 --> 0:43:19.960
<v Speaker 1>the things that make this virus sort of troubling, that

0:43:19.960 --> 0:43:22.600
<v Speaker 1>that would be its superpower is that it has this

0:43:22.719 --> 0:43:27.919
<v Speaker 1>ability to very subtly get you know, get from one

0:43:27.960 --> 0:43:32.279
<v Speaker 1>person to another, usually without that person knowing it. And

0:43:32.640 --> 0:43:35.719
<v Speaker 1>again we'll use Ebola as a stark contrast. Right, why

0:43:35.840 --> 0:43:39.760
<v Speaker 1>was Ebola not really a big issue once it got

0:43:39.800 --> 0:43:45.000
<v Speaker 1>into um the United States? Because people were so sick

0:43:45.080 --> 0:43:48.160
<v Speaker 1>when they got it that there was no ambiguity about

0:43:48.200 --> 0:43:50.959
<v Speaker 1>whether that person had it and it was only during

0:43:51.000 --> 0:43:53.560
<v Speaker 1>that period of extreme sickness that they could go on

0:43:53.640 --> 0:43:58.839
<v Speaker 1>and shed the virus. If in fact, people are practicing

0:43:58.960 --> 0:44:03.839
<v Speaker 1>social distancing, now all these cities are closing down, I

0:44:03.880 --> 0:44:07.760
<v Speaker 1>guess you know San Francisco is a shelter in place

0:44:07.840 --> 0:44:12.320
<v Speaker 1>city other cities as well. Is that going to ameliorate

0:44:12.719 --> 0:44:17.640
<v Speaker 1>or mitigate some of the conditions that will be prime

0:44:17.760 --> 0:44:21.480
<v Speaker 1>for spreading this virus around or have we missed that

0:44:21.560 --> 0:44:26.080
<v Speaker 1>window of opportunity, Peter. It will absolutely have an impact.

0:44:26.120 --> 0:44:28.359
<v Speaker 1>I mean, in an ideal circumstance, if we had a

0:44:28.360 --> 0:44:30.480
<v Speaker 1>time machine. I think we would have done this, we

0:44:30.480 --> 0:44:33.600
<v Speaker 1>would have taken these precautions a month sooner. But I'm

0:44:33.600 --> 0:44:37.480
<v Speaker 1>actually still optimistic. And you know, we have a team

0:44:37.520 --> 0:44:42.080
<v Speaker 1>of analysts that are building forecast models, reviewing every piece

0:44:42.120 --> 0:44:46.080
<v Speaker 1>of data that's available and including data that aren't publicly

0:44:46.120 --> 0:44:49.560
<v Speaker 1>available by you know, you speaking with people on the

0:44:49.600 --> 0:44:53.600
<v Speaker 1>front lines to pressure test assumptions. I don't think that

0:44:53.760 --> 0:44:58.200
<v Speaker 1>it's a foregone conclusion how this ends. So um you know,

0:44:59.280 --> 0:45:01.800
<v Speaker 1>I can't even sit here and project how many people

0:45:01.800 --> 0:45:03.920
<v Speaker 1>are going to be infected in the United States, although

0:45:03.920 --> 0:45:06.160
<v Speaker 1>there are lots of estimates, and some of them are

0:45:06.239 --> 0:45:09.160
<v Speaker 1>quite scary. You know, Mark Lipsitch at the Harvard School

0:45:09.160 --> 0:45:13.040
<v Speaker 1>of Public Health projects that you know, more than the U.

0:45:13.160 --> 0:45:16.040
<v Speaker 1>S population will ultimately be infected by this, and that

0:45:16.200 --> 0:45:19.400
<v Speaker 1>the mortality rates we're seeing those are staggering numbers. That

0:45:19.440 --> 0:45:21.200
<v Speaker 1>that the implication of that, by the way to put

0:45:21.239 --> 0:45:24.600
<v Speaker 1>it in some numbers, is more people would die from

0:45:24.640 --> 0:45:27.480
<v Speaker 1>this virus in a year in the next year than

0:45:27.600 --> 0:45:31.479
<v Speaker 1>die of all other things combined. I mean that that's

0:45:31.520 --> 0:45:35.479
<v Speaker 1>a staggering statistic. Do I think that that is set

0:45:35.480 --> 0:45:37.600
<v Speaker 1>in stone yet, that that is our fate? I don't.

0:45:38.239 --> 0:45:41.319
<v Speaker 1>And I do think that the more aggressively we can

0:45:41.360 --> 0:45:45.760
<v Speaker 1>socially distance ourselves, the more aggressively we can implement testing

0:45:46.200 --> 0:45:51.360
<v Speaker 1>which will enable this stratification of distancing between people, and

0:45:51.400 --> 0:45:55.640
<v Speaker 1>the more readily available we can be pressure testing existing

0:45:55.719 --> 0:45:59.719
<v Speaker 1>drugs to then bring on treatments that can reduce the

0:46:00.120 --> 0:46:03.440
<v Speaker 1>mortality and morbidity. I think we still have a chance

0:46:03.480 --> 0:46:06.200
<v Speaker 1>to bend the curve of this thing. We're going to

0:46:06.320 --> 0:46:09.360
<v Speaker 1>take a break, but we'll be right back with more

0:46:09.400 --> 0:46:24.320
<v Speaker 1>critically important information from Dr Peter A Tilla. Hi, everyone,

0:46:24.360 --> 0:46:27.080
<v Speaker 1>I'm so happy we were able to get in touch

0:46:27.400 --> 0:46:30.440
<v Speaker 1>with Dr Peter Attia and he was able to spend

0:46:30.880 --> 0:46:34.879
<v Speaker 1>a good hour talking to us about this scary pandemic

0:46:35.360 --> 0:46:39.400
<v Speaker 1>because I think his knowledge, his experience, and his connections

0:46:39.400 --> 0:46:44.440
<v Speaker 1>are really unparalleled. So let's get back to that important conversation.

0:46:45.000 --> 0:46:48.479
<v Speaker 1>Let's say someone goes to the hospital, Peter, and they

0:46:48.520 --> 0:46:54.920
<v Speaker 1>have COVID nineteen. I know that ventilators and respirators to

0:46:55.040 --> 0:46:59.319
<v Speaker 1>help with lung capacity, but are there any medicines that

0:46:59.440 --> 0:47:02.400
<v Speaker 1>these people are keetting or are they just going to

0:47:02.480 --> 0:47:06.279
<v Speaker 1>the hospital? And uh, I mean, how are the how

0:47:06.280 --> 0:47:10.640
<v Speaker 1>are doctors fighting it right now? It's varying by hospital.

0:47:10.800 --> 0:47:15.040
<v Speaker 1>So myself and my team, we have enough friends in

0:47:15.160 --> 0:47:18.200
<v Speaker 1>hospitals that we're hearing, you know, we're finding out this

0:47:18.280 --> 0:47:21.319
<v Speaker 1>hospital in Boston is using this protocol, this hospital in

0:47:21.360 --> 0:47:24.600
<v Speaker 1>New York is doing this, etcetera. UM, So right now,

0:47:24.600 --> 0:47:28.200
<v Speaker 1>I would say, Katie, it's not standardized, but you're crazy.

0:47:29.040 --> 0:47:32.480
<v Speaker 1>I mean, that seems insane to me. That it's not

0:47:33.120 --> 0:47:36.840
<v Speaker 1>that it isn't standardized, that it's sort of kind of

0:47:36.880 --> 0:47:41.200
<v Speaker 1>a piecemeal approach. Well, the primary approach, as you said,

0:47:41.480 --> 0:47:44.400
<v Speaker 1>is supportive care. So the single most important thing for

0:47:44.440 --> 0:47:48.440
<v Speaker 1>a person once they're in the hospital is maintaining sufficient

0:47:48.520 --> 0:47:50.920
<v Speaker 1>respiration because that's the thing that's going to put a

0:47:50.960 --> 0:47:54.000
<v Speaker 1>person in the hospital. So the most common thing that

0:47:54.000 --> 0:47:57.279
<v Speaker 1>people are presenting with his respiratory failure as opposed to

0:47:57.280 --> 0:48:01.000
<v Speaker 1>say cardiac failure, renal failure, or other organ failure. So

0:48:01.320 --> 0:48:03.440
<v Speaker 1>you know, the first, second, and third line of defense

0:48:03.719 --> 0:48:08.280
<v Speaker 1>is through you know, oxygen and supplemental respiratory care, hopefully

0:48:08.280 --> 0:48:11.719
<v Speaker 1>not requiring mechanical ventilation, but obviously at some point that's

0:48:11.760 --> 0:48:15.640
<v Speaker 1>happening for enough people. That's that's the sort of supportive

0:48:15.680 --> 0:48:19.240
<v Speaker 1>side of things. UM. And I think we are seeing

0:48:19.239 --> 0:48:23.640
<v Speaker 1>more and more patients being treated with um chloroquin and then,

0:48:23.680 --> 0:48:26.800
<v Speaker 1>of course if the doctor's treating the patient have reason

0:48:26.880 --> 0:48:30.239
<v Speaker 1>to believe that they're now developing secondary infections, then things

0:48:30.280 --> 0:48:34.440
<v Speaker 1>like antibiotics are coming on board. And if it turns

0:48:34.440 --> 0:48:37.760
<v Speaker 1>into pneumonia exactly if it's a pneumonia that they believe

0:48:38.080 --> 0:48:42.000
<v Speaker 1>is an actual bacterial pneumonia versus sort of a viral

0:48:42.000 --> 0:48:45.759
<v Speaker 1>pneumonia for which the antibiotics wouldn't provide any benefit. There's

0:48:45.800 --> 0:48:50.080
<v Speaker 1>also HIV drugs. There's a drug that that is a

0:48:50.120 --> 0:48:55.879
<v Speaker 1>protease inhibitor that I think is sort of weakly um

0:48:55.920 --> 0:48:59.239
<v Speaker 1>potentially helpful. It's still too soon to say, but the

0:49:00.160 --> 0:49:03.000
<v Speaker 1>of using it seems relatively low, so it's it's also

0:49:03.120 --> 0:49:06.759
<v Speaker 1>being tested. UM one drug that I think to three

0:49:06.800 --> 0:49:09.600
<v Speaker 1>weeks ago we thought might be valuable that is looking

0:49:09.719 --> 0:49:13.799
<v Speaker 1>less valuable as the common anti flu drug called tama flu,

0:49:14.040 --> 0:49:18.720
<v Speaker 1>so I think most hospitals are moving away from that now.

0:49:18.760 --> 0:49:23.480
<v Speaker 1>But again UM it is unfortunately not a fully standardized

0:49:23.520 --> 0:49:26.480
<v Speaker 1>protocol because even though the CDC will have a recommendation,

0:49:27.040 --> 0:49:30.759
<v Speaker 1>ultimately the physicians are the ones at the bedside that

0:49:30.800 --> 0:49:34.319
<v Speaker 1>are going to be able to make the decisions. Can

0:49:34.360 --> 0:49:37.279
<v Speaker 1>you reverse this? So let's say someone goes to the

0:49:37.320 --> 0:49:43.040
<v Speaker 1>hospital they're having respiratory failure. Can those individuals with you know,

0:49:43.200 --> 0:49:47.719
<v Speaker 1>breathing assistance, with the ventilator a respirator, can they then,

0:49:48.239 --> 0:49:51.680
<v Speaker 1>um get the virus that, as you said, was sort

0:49:51.719 --> 0:49:55.839
<v Speaker 1>of taking over the cells and their lungs. Can they

0:49:55.880 --> 0:49:58.000
<v Speaker 1>how do they get that? How do they get it

0:49:58.120 --> 0:50:01.839
<v Speaker 1>out of their lungs? I know this ounds sort of elementary,

0:50:01.920 --> 0:50:05.239
<v Speaker 1>but I'm just trying to figure out, you know, is

0:50:05.239 --> 0:50:10.600
<v Speaker 1>that kind of support enough to eradicate this virus? Um. No,

0:50:10.680 --> 0:50:12.520
<v Speaker 1>it's actually not an elementary question at all. It's a

0:50:12.600 --> 0:50:15.839
<v Speaker 1>very important question. What's actually happening is there's a war

0:50:16.000 --> 0:50:20.480
<v Speaker 1>going on between the virus and the immune system, and

0:50:20.520 --> 0:50:24.080
<v Speaker 1>the whole purpose of supportive care such as ventilation is

0:50:24.120 --> 0:50:27.440
<v Speaker 1>to buy time for the immune system to win that fight.

0:50:28.360 --> 0:50:31.520
<v Speaker 1>Now it becomes a bit complicated because the immune system,

0:50:31.719 --> 0:50:34.280
<v Speaker 1>in its best effort to win that fight, can also

0:50:34.360 --> 0:50:37.480
<v Speaker 1>cause a lot of damage to the host. So you

0:50:37.520 --> 0:50:40.520
<v Speaker 1>think of it like a war going on in a country.

0:50:40.840 --> 0:50:42.560
<v Speaker 1>You have the good guys the bad guys. At the

0:50:42.640 --> 0:50:47.439
<v Speaker 1>risk of oversimplifying it, well, both of those entities when

0:50:47.480 --> 0:50:51.440
<v Speaker 1>engaging in war caused collateral damage, and so it's like

0:50:51.520 --> 0:50:55.680
<v Speaker 1>immunotherapy and cancer, it becomes too refed up and that

0:50:55.719 --> 0:50:59.880
<v Speaker 1>can create all kinds of autoimmune issues. Correct. Absolutely, So

0:51:00.120 --> 0:51:02.799
<v Speaker 1>the you know, the checkpoint inhibitors, which you know are

0:51:02.840 --> 0:51:05.480
<v Speaker 1>probably the most exciting thing in all of immuno oncology

0:51:05.640 --> 0:51:08.800
<v Speaker 1>right now, um, exactly have that as a side effect,

0:51:08.840 --> 0:51:11.520
<v Speaker 1>which is autoimmunity. The immune system goes a little too

0:51:11.560 --> 0:51:14.360
<v Speaker 1>far now in in this type of response to the

0:51:14.360 --> 0:51:17.120
<v Speaker 1>immune system. It's not so much autoimmunity that we're seeing

0:51:17.160 --> 0:51:19.719
<v Speaker 1>as the problem, but it's the sort of um, what's

0:51:19.760 --> 0:51:25.440
<v Speaker 1>called systemic inflammatory response syndrome or this cytokine storm that

0:51:25.600 --> 0:51:28.920
<v Speaker 1>is sort of you know, wreaking havoc both to kill

0:51:28.960 --> 0:51:31.880
<v Speaker 1>the viruses, but it's also the thing that can you know,

0:51:32.040 --> 0:51:35.120
<v Speaker 1>cause capillary leaking in the lungs that can lead to

0:51:35.480 --> 0:51:38.720
<v Speaker 1>other things like edema, and it can damage other parts

0:51:38.719 --> 0:51:41.840
<v Speaker 1>of the body. So basically what you're saying is that

0:51:42.080 --> 0:51:46.120
<v Speaker 1>it's a delicate balance between the immune system, which can

0:51:46.200 --> 0:51:50.799
<v Speaker 1>cause inflammation and damage if it's overly compensating for the

0:51:50.880 --> 0:51:56.120
<v Speaker 1>virus and sort of keeping the virus in check. YEP.

0:51:56.280 --> 0:52:00.320
<v Speaker 1>And we use supportive measures like ventilation to base sally

0:52:00.400 --> 0:52:03.960
<v Speaker 1>by time to augment what the lung needs to do

0:52:04.520 --> 0:52:07.320
<v Speaker 1>to to create that amount of time and space necessary

0:52:07.360 --> 0:52:09.600
<v Speaker 1>for the immune system to ultimately win that fight. But

0:52:09.680 --> 0:52:13.759
<v Speaker 1>winning the fight means that the virus has gone, you know,

0:52:13.800 --> 0:52:16.880
<v Speaker 1>winning the fight means that the number of actual copies

0:52:16.880 --> 0:52:21.640
<v Speaker 1>of that virus goes down to some insignificant level um

0:52:21.680 --> 0:52:24.360
<v Speaker 1>and you know, to you know, to contrast that with

0:52:24.400 --> 0:52:26.359
<v Speaker 1>other things, like when you look at the Spanish flu,

0:52:26.680 --> 0:52:30.400
<v Speaker 1>the one and one pandemic, that was kind of a

0:52:30.400 --> 0:52:32.920
<v Speaker 1>different animal. You know, that was an animal where so

0:52:33.000 --> 0:52:37.160
<v Speaker 1>much of the damage actually came from the hyperactive immune

0:52:37.200 --> 0:52:41.520
<v Speaker 1>response and then this immune paralysis that followed it that

0:52:41.640 --> 0:52:45.560
<v Speaker 1>led to these secondary infections. So you know, paradoxically, the

0:52:45.600 --> 0:52:48.640
<v Speaker 1>people that were most vulnerable to that flu were people

0:52:48.640 --> 0:52:51.400
<v Speaker 1>that had the most robust immune system and therefore the

0:52:51.480 --> 0:52:56.520
<v Speaker 1>strongest immune response. We're not seeing that here, which suggests

0:52:57.040 --> 0:53:00.760
<v Speaker 1>again it's just a suggestion that a hyper active immune

0:53:00.760 --> 0:53:04.600
<v Speaker 1>response is less of a problem than the actual damage

0:53:04.640 --> 0:53:10.760
<v Speaker 1>the virus is causing to the cells. That's fascinating. Um.

0:53:10.800 --> 0:53:16.160
<v Speaker 1>That raises a couple of questions about ventilators and respirators

0:53:16.160 --> 0:53:18.160
<v Speaker 1>and I don't even know the difference, and maybe you

0:53:18.200 --> 0:53:21.680
<v Speaker 1>can explain that. But uh, there's a real shortage of

0:53:21.760 --> 0:53:25.680
<v Speaker 1>medical equipment. How serious a problem will it be if

0:53:25.719 --> 0:53:28.799
<v Speaker 1>there is a lack of ventilators or respirators to buy

0:53:28.840 --> 0:53:32.000
<v Speaker 1>the time these patients need and what is being done

0:53:32.000 --> 0:53:34.840
<v Speaker 1>about that? So it's a huge problem. Let me answer

0:53:34.920 --> 0:53:40.719
<v Speaker 1>your first question. So, respirators are non invasive. So um

0:53:40.840 --> 0:53:43.719
<v Speaker 1>for example, you've probably visited somebody in the hospital and

0:53:43.760 --> 0:53:46.359
<v Speaker 1>you see like a little oxygen mask that they have on,

0:53:46.480 --> 0:53:48.800
<v Speaker 1>or even something called a nasal canyla where there's a

0:53:48.840 --> 0:53:51.360
<v Speaker 1>little device that goes under their nose that's just passively

0:53:51.400 --> 0:53:55.200
<v Speaker 1>blowing oxygen at them. So you know, you can you

0:53:55.239 --> 0:53:59.480
<v Speaker 1>can provide a person with supplemental oxygen in that sort

0:53:59.480 --> 0:54:04.960
<v Speaker 1>of passive manner. But when a person becomes really dependent

0:54:05.080 --> 0:54:09.640
<v Speaker 1>on oxygen, they require something called mechanical ventilation, and to

0:54:09.760 --> 0:54:13.520
<v Speaker 1>do that you have to undergo a procedure called intibation,

0:54:13.640 --> 0:54:16.040
<v Speaker 1>which anybody who has had surgery has has you know,

0:54:16.120 --> 0:54:18.399
<v Speaker 1>under general and aesthetic has had that. But that's where

0:54:18.400 --> 0:54:23.239
<v Speaker 1>a tube is actually placed into the main airway called

0:54:23.280 --> 0:54:26.319
<v Speaker 1>the trachea. So it's called an endotracheal tube. When a

0:54:26.360 --> 0:54:30.719
<v Speaker 1>person is intibated, they also have to be paralyzed and sedated.

0:54:30.880 --> 0:54:33.440
<v Speaker 1>It's not a comfortable thing. You You couldn't be wide

0:54:33.440 --> 0:54:36.960
<v Speaker 1>awake sitting there intibated um, so you have to be

0:54:37.080 --> 0:54:39.880
<v Speaker 1>sedating the patients and paralyzing them. And the reason you

0:54:39.920 --> 0:54:43.800
<v Speaker 1>have to do that is that their own voluntary muscular

0:54:43.840 --> 0:54:47.360
<v Speaker 1>movements can't fight the ventilator, so you actually have to

0:54:47.400 --> 0:54:50.400
<v Speaker 1>basically shut them down to let the machine do the breathing.

0:54:51.239 --> 0:54:54.359
<v Speaker 1>And you're absolutely right that these ventilators are very, very

0:54:54.400 --> 0:54:58.759
<v Speaker 1>specific and specialized pieces of medical equipment, and at some

0:54:58.840 --> 0:55:01.560
<v Speaker 1>point we will run out of them. In fact, was

0:55:01.640 --> 0:55:05.880
<v Speaker 1>just speaking to someone today at a small hospital outside

0:55:05.880 --> 0:55:08.160
<v Speaker 1>of New York City and they are now they have

0:55:08.280 --> 0:55:10.879
<v Speaker 1>just used their last ventilator, and they are now what's

0:55:10.920 --> 0:55:15.200
<v Speaker 1>called double venting patients, which means using one ventilator to

0:55:15.320 --> 0:55:19.200
<v Speaker 1>treat two patients, which you would normally never do because

0:55:19.239 --> 0:55:22.840
<v Speaker 1>of the contamination. Those two patients are now fully sharing

0:55:23.320 --> 0:55:27.160
<v Speaker 1>all their respiratory pathogens. But of course, you know, desperate

0:55:27.160 --> 0:55:29.719
<v Speaker 1>times call for desperate measures, and if these patients both

0:55:29.880 --> 0:55:32.839
<v Speaker 1>have the same virus and they are both suffering from

0:55:32.880 --> 0:55:35.799
<v Speaker 1>you know the COVID nineteen disease, then we we you know,

0:55:35.800 --> 0:55:37.680
<v Speaker 1>we'll do what we have to do. And then technically

0:55:37.719 --> 0:55:40.720
<v Speaker 1>a ventilator can probably be split up to four ways.

0:55:41.520 --> 0:55:44.399
<v Speaker 1>But at some point soon and it could be within

0:55:44.440 --> 0:55:47.720
<v Speaker 1>two to three weeks, this could become an enormous problem,

0:55:47.880 --> 0:55:51.839
<v Speaker 1>and so well can can can We are manufacturers kind

0:55:51.880 --> 0:55:56.719
<v Speaker 1>of speeding up the production of these pieces of equipment.

0:55:58.719 --> 0:56:02.160
<v Speaker 1>They are, but is still another bottleneck. And the one

0:56:02.200 --> 0:56:05.760
<v Speaker 1>thing that we can't make more of is doctors, nurses

0:56:05.800 --> 0:56:09.880
<v Speaker 1>and respiratory therapists, and so these pieces of equipment can't

0:56:09.880 --> 0:56:12.839
<v Speaker 1>work on their own. You know, a doctor is necessary

0:56:12.920 --> 0:56:16.040
<v Speaker 1>to put the end of tracheal tube in. Nurses and

0:56:16.080 --> 0:56:19.520
<v Speaker 1>respiratory therapists are necessary to actually run the ventilators and

0:56:19.600 --> 0:56:23.120
<v Speaker 1>manage the medications on a minute to minute basis. And

0:56:23.200 --> 0:56:29.920
<v Speaker 1>so it can't be overstated that a really fundamental break

0:56:30.040 --> 0:56:33.879
<v Speaker 1>point in this system could occur when the health care system,

0:56:33.880 --> 0:56:37.760
<v Speaker 1>through its workers, is so overwhelmed that we can't actually

0:56:37.760 --> 0:56:39.960
<v Speaker 1>have people on the front lines that are doing this work.

0:56:40.800 --> 0:56:46.160
<v Speaker 1>So how do they protect themselves because obviously we need

0:56:46.239 --> 0:56:49.640
<v Speaker 1>them desperately to be treating patients. We probably need to

0:56:49.960 --> 0:56:53.680
<v Speaker 1>and I know that a lot of retired medical professionals

0:56:53.719 --> 0:56:58.000
<v Speaker 1>are being called in UM. Are are they getting sick?

0:56:58.120 --> 0:57:01.439
<v Speaker 1>I know that some are, and should I mean, how

0:57:01.480 --> 0:57:05.280
<v Speaker 1>worried are you about that? I'm actually quite worried about

0:57:05.280 --> 0:57:08.400
<v Speaker 1>it because of some data that we're seeing from around

0:57:08.400 --> 0:57:11.919
<v Speaker 1>the world, including China and Italy, which is that when

0:57:11.960 --> 0:57:14.840
<v Speaker 1>healthcare workers get it, they seem to get a worse

0:57:15.080 --> 0:57:18.880
<v Speaker 1>version of it, suggesting at least preliminarily, that there might

0:57:18.920 --> 0:57:22.520
<v Speaker 1>be something about the amount of virus or the manner

0:57:22.520 --> 0:57:26.600
<v Speaker 1>in which they're exposed to it that is otherwise making

0:57:26.600 --> 0:57:29.919
<v Speaker 1>it worse than if they just acquired this virus out

0:57:29.920 --> 0:57:32.000
<v Speaker 1>in the community. So that's the first thing that has

0:57:32.080 --> 0:57:36.200
<v Speaker 1>me somewhat concerned. So how do you think they're getting it? UM?

0:57:36.240 --> 0:57:40.840
<v Speaker 1>Probably just through a greater concentration of respiratory droplets, given

0:57:40.880 --> 0:57:43.360
<v Speaker 1>the you know, the proximity that they have to people

0:57:43.400 --> 0:57:46.720
<v Speaker 1>who are sick. And obviously, if someone is sick and

0:57:46.760 --> 0:57:49.960
<v Speaker 1>they're in respiratory distress and you're intibating them, you're leaning

0:57:50.000 --> 0:57:53.320
<v Speaker 1>over a person, and you're just being exposed to a

0:57:53.480 --> 0:57:56.080
<v Speaker 1>much greater amount of virus than say, if you bumped

0:57:56.080 --> 0:57:59.080
<v Speaker 1>into somebody at the supermarket. The other thing that is

0:57:59.120 --> 0:58:04.360
<v Speaker 1>in short supply is ppe. It's the protective equipment that

0:58:04.520 --> 0:58:06.880
<v Speaker 1>the doctor's, nurses, respiray therapist, all the people in the

0:58:06.880 --> 0:58:11.919
<v Speaker 1>hospital need to protect themselves against this virus. And so

0:58:12.440 --> 0:58:14.920
<v Speaker 1>inasmuch as we need to be making more ventilators, we

0:58:14.960 --> 0:58:17.520
<v Speaker 1>also need to really be ramping up on the production

0:58:17.640 --> 0:58:20.520
<v Speaker 1>of all of the protective equipment. And the countries that

0:58:20.560 --> 0:58:23.120
<v Speaker 1>have done this well, I mean China did this very

0:58:23.160 --> 0:58:26.320
<v Speaker 1>well in the second wave. So in the second wave

0:58:26.440 --> 0:58:31.920
<v Speaker 1>after Wuhan, very few of the healthcare workers became infected.

0:58:31.960 --> 0:58:34.840
<v Speaker 1>So once they dialed in on how to protect their

0:58:34.840 --> 0:58:37.520
<v Speaker 1>healthcare workers, um, they were able to do this in

0:58:37.560 --> 0:58:39.919
<v Speaker 1>a much safer way. So you know, if I could

0:58:39.920 --> 0:58:42.919
<v Speaker 1>wave a magic wand we'd be making more ventilators, we'd

0:58:42.920 --> 0:58:45.880
<v Speaker 1>have more actual beds and spaces in the hospital, we'd

0:58:45.880 --> 0:58:49.560
<v Speaker 1>have more protective equipment for the healthcare workers, and obviously

0:58:49.600 --> 0:58:51.960
<v Speaker 1>we'd have more testing available so that we could more

0:58:52.040 --> 0:58:56.120
<v Speaker 1>quickly identify and stratify patients at risk. Speaking of that,

0:58:56.320 --> 0:58:59.520
<v Speaker 1>I know that a one thousand bed naval hospital ship

0:58:59.640 --> 0:59:03.120
<v Speaker 1>is being dispatch to New York Harbor. We may be

0:59:03.320 --> 0:59:06.800
<v Speaker 1>seen some of these medical ships that are often used

0:59:06.800 --> 0:59:12.360
<v Speaker 1>in times of war being deployed in specific ports all

0:59:12.400 --> 0:59:17.320
<v Speaker 1>around the country. Yeah, it's it's sort of hard to

0:59:17.440 --> 0:59:22.080
<v Speaker 1>believe how much has happened in one week. Um. And

0:59:22.280 --> 0:59:24.840
<v Speaker 1>and it's it speaks to the nature of non linear

0:59:24.920 --> 0:59:28.360
<v Speaker 1>exponential growth and and and again. You know, the irony

0:59:28.360 --> 0:59:30.800
<v Speaker 1>of it is that which we're talking about today, in

0:59:30.840 --> 0:59:34.320
<v Speaker 1>a week or two weeks will seem pedestrian in terms

0:59:34.400 --> 0:59:36.840
<v Speaker 1>of what we will know because of how quickly things

0:59:36.840 --> 0:59:39.920
<v Speaker 1>are changing, including you know, the rate at which you

0:59:39.920 --> 0:59:43.720
<v Speaker 1>know hospitals are running out of ventilators. We should uh

0:59:44.320 --> 0:59:48.640
<v Speaker 1>mention one thing, and that is a failure to comply

0:59:49.080 --> 0:59:53.640
<v Speaker 1>with CDC guidelines. I hope we're not seeing as many

0:59:53.760 --> 0:59:56.720
<v Speaker 1>kids in bars, and not just kids. You know. My

0:59:57.080 --> 0:59:59.880
<v Speaker 1>neighbor in New York City who lives on the Upper

1:00:00.080 --> 1:00:02.960
<v Speaker 1>Side said the bar was packed for St. Patrick's Day.

1:00:02.960 --> 1:00:06.360
<v Speaker 1>And it's so infuriating. But not only young people. I

1:00:06.440 --> 1:00:09.920
<v Speaker 1>read an article this morning about children of baby boomers

1:00:10.280 --> 1:00:14.280
<v Speaker 1>trying to get their parents in their seventies to not travel,

1:00:14.360 --> 1:00:18.840
<v Speaker 1>to not go to casinos. Um. It seems insane to

1:00:18.880 --> 1:00:22.960
<v Speaker 1>me that people are being uh so stupid and in

1:00:23.040 --> 1:00:27.200
<v Speaker 1>some cases so selfish about this or ignorant what is

1:00:27.240 --> 1:00:30.320
<v Speaker 1>that about? It's it's so interesting you say that because

1:00:30.480 --> 1:00:35.360
<v Speaker 1>I have noticed two extremes um and again these are anecdotes,

1:00:35.360 --> 1:00:37.400
<v Speaker 1>so I can't speak to this from sort of real

1:00:37.440 --> 1:00:40.800
<v Speaker 1>aggregated data. But you're absolutely right. I have noticed far

1:00:40.880 --> 1:00:45.920
<v Speaker 1>more concern from my patients about their parents than their kids.

1:00:46.160 --> 1:00:50.200
<v Speaker 1>First for starters, So the you know, I just I

1:00:50.200 --> 1:00:54.520
<v Speaker 1>could rattle off ten stories about, you know, people who

1:00:54.560 --> 1:00:57.200
<v Speaker 1>are in their seventies who have decided, Yep, we're gonna

1:00:57.400 --> 1:00:59.439
<v Speaker 1>we're gonna to the casino this weekend and we're gonna

1:00:59.480 --> 1:01:00.840
<v Speaker 1>go do this, and we're gonna go and do that,

1:01:00.920 --> 1:01:03.200
<v Speaker 1>and none of this stuff matters, and we're going out

1:01:03.240 --> 1:01:05.440
<v Speaker 1>and you know, doing all those things. And again I

1:01:05.680 --> 1:01:07.000
<v Speaker 1>have no idea what it is that. You know, I

1:01:07.040 --> 1:01:09.200
<v Speaker 1>could speculate and say, look, people at that age have

1:01:09.320 --> 1:01:11.560
<v Speaker 1>been through a lot and they've decided, hey, if it

1:01:11.600 --> 1:01:13.600
<v Speaker 1>hasn't got me, now it's not going to. And there's

1:01:13.640 --> 1:01:17.200
<v Speaker 1>sort of a false sense of confidence. Potentially, I think

1:01:17.440 --> 1:01:22.160
<v Speaker 1>they survives the stars outbreak and they've been there, done that. Yeah,

1:01:22.200 --> 1:01:24.720
<v Speaker 1>there's a little bit of that. Um, we certainly saw

1:01:24.760 --> 1:01:26.880
<v Speaker 1>a little bit of that Machismo in New York two

1:01:26.960 --> 1:01:29.640
<v Speaker 1>weeks ago, which I haven't seen. I've seen it damned

1:01:29.640 --> 1:01:31.760
<v Speaker 1>down a bit, which was, hey, look, we survived nine eleven.

1:01:31.840 --> 1:01:34.320
<v Speaker 1>This thing is not going to get us. Um. Obviously

1:01:34.360 --> 1:01:38.480
<v Speaker 1>that's apples and oranges. So it's sort of a nonsensical comparison. Um.

1:01:38.480 --> 1:01:40.720
<v Speaker 1>But I do share your concern with the number of

1:01:40.720 --> 1:01:44.800
<v Speaker 1>people who aren't respecting these quarantines. In fact, our nanny

1:01:44.880 --> 1:01:49.400
<v Speaker 1>who's in college, one of her classmates was an exchange

1:01:49.440 --> 1:01:52.560
<v Speaker 1>student in Italy, so he had to come back from Italy,

1:01:52.640 --> 1:01:55.720
<v Speaker 1>and he tested positive upon arrival, and so he was

1:01:55.840 --> 1:02:00.120
<v Speaker 1>placed in a quarantine, which he violated. So he was

1:02:00.160 --> 1:02:03.440
<v Speaker 1>seen out on social media three days after testing positive

1:02:03.560 --> 1:02:06.640
<v Speaker 1>and being forced into a quarantine, out at a party,

1:02:06.800 --> 1:02:10.040
<v Speaker 1>and so, you know, that kind of stuff is really upsetting,

1:02:10.080 --> 1:02:12.040
<v Speaker 1>and I think it is a bit of a communication

1:02:12.120 --> 1:02:15.720
<v Speaker 1>breakdown because I don't think that these people would really

1:02:15.760 --> 1:02:18.240
<v Speaker 1>be doing this if they understood the significance of what

1:02:18.280 --> 1:02:20.400
<v Speaker 1>they're doing. I just don't think people are that selfish

1:02:20.480 --> 1:02:24.160
<v Speaker 1>or that evil if they really understand the significance, which is, hey,

1:02:24.480 --> 1:02:27.360
<v Speaker 1>you can feel fine. You know, you college student who's

1:02:27.360 --> 1:02:30.400
<v Speaker 1>twenty years old, who tested positive who you know has

1:02:30.440 --> 1:02:33.200
<v Speaker 1>a little bit of a sore throat. It's not about

1:02:33.280 --> 1:02:36.280
<v Speaker 1>you getting worse. It's about what you could do to

1:02:36.440 --> 1:02:39.040
<v Speaker 1>somebody who could then go and do it to somebody else. Right,

1:02:39.120 --> 1:02:41.160
<v Speaker 1>It's like you infect another kid at that party, they

1:02:41.200 --> 1:02:43.800
<v Speaker 1>go home and infect their grandmother or something like that. So,

1:02:44.320 --> 1:02:46.680
<v Speaker 1>you know, my hope is that we're just going to

1:02:46.920 --> 1:02:49.760
<v Speaker 1>educate people a lot more about why the stakes are

1:02:49.840 --> 1:02:54.360
<v Speaker 1>high and how we all kind of have a responsibility

1:02:54.440 --> 1:02:57.640
<v Speaker 1>here to not just protect ourselves, but to then protect

1:02:57.720 --> 1:03:00.640
<v Speaker 1>others through that protection. I don't want to play the

1:03:00.760 --> 1:03:06.080
<v Speaker 1>blame game, but was critical time lost when this wasn't

1:03:06.160 --> 1:03:11.720
<v Speaker 1>taken seriously by the administration and frankly by some in

1:03:11.760 --> 1:03:18.600
<v Speaker 1>the news media. How how much damage was done by

1:03:18.720 --> 1:03:22.880
<v Speaker 1>that two or three week period where it just wasn't

1:03:22.960 --> 1:03:26.680
<v Speaker 1>treated as a serious threat to public health? Well you

1:03:26.720 --> 1:03:29.919
<v Speaker 1>alluded to the the Ted talk by Bill Gates, which

1:03:29.960 --> 1:03:34.320
<v Speaker 1>is now five years old, and he sort of predicted, uh,

1:03:34.720 --> 1:03:40.200
<v Speaker 1>in pretty frightening um, you know, reality, what was potentially

1:03:40.200 --> 1:03:43.280
<v Speaker 1>going to come if I were going to, you know,

1:03:43.880 --> 1:03:45.760
<v Speaker 1>really say, if if I could go back in time

1:03:45.760 --> 1:03:47.560
<v Speaker 1>and change one thing in the last three months, what

1:03:47.600 --> 1:03:54.480
<v Speaker 1>would it be. It's the following on January, the genome

1:03:54.680 --> 1:03:58.560
<v Speaker 1>of this novel, coronaviruns was sequenced and it was made

1:03:58.560 --> 1:04:03.600
<v Speaker 1>public another Chinese you got it. So the Chinese immediately

1:04:03.640 --> 1:04:07.280
<v Speaker 1>figured out what this was, immediately confirmed it was a novel,

1:04:07.600 --> 1:04:11.720
<v Speaker 1>brand new, never before seeing coronavirus, and put that information

1:04:11.800 --> 1:04:16.120
<v Speaker 1>out to the world, and some companies immediately ran and

1:04:16.160 --> 1:04:19.720
<v Speaker 1>developed pcr kits. And you know, one of those companies

1:04:19.720 --> 1:04:22.080
<v Speaker 1>in China has basically gone on to do over a

1:04:22.160 --> 1:04:27.160
<v Speaker 1>million tests already and have incredible data with specificity and sensitivity.

1:04:27.200 --> 1:04:29.640
<v Speaker 1>They can do a four hour turnaround. In fact, they've

1:04:29.680 --> 1:04:34.040
<v Speaker 1>already built fifty laboratories in China, each one capable of

1:04:34.080 --> 1:04:37.640
<v Speaker 1>doing fifty thousand to a hundred thousand tests per day.

1:04:38.400 --> 1:04:42.160
<v Speaker 1>What we did, in my opinion, was the biggest mistake,

1:04:42.240 --> 1:04:45.920
<v Speaker 1>which was basically ignoring that information, and then when push

1:04:46.000 --> 1:04:48.880
<v Speaker 1>came to shove sort of doing a botched job, the

1:04:48.960 --> 1:04:53.440
<v Speaker 1>CDC sort of put together its own um set of

1:04:53.480 --> 1:04:55.920
<v Speaker 1>primers that ended up not working very well. And then

1:04:55.960 --> 1:04:58.920
<v Speaker 1>eventually we got around to potentially doing something with a

1:04:58.960 --> 1:05:01.920
<v Speaker 1>company called Row. And where we are right now at

1:05:01.960 --> 1:05:04.800
<v Speaker 1>the time of this discussion is we still don't really

1:05:04.840 --> 1:05:08.520
<v Speaker 1>have any viable means of testing. We're probably just a

1:05:08.560 --> 1:05:11.040
<v Speaker 1>little bit over fifty thou people have been tested in

1:05:11.040 --> 1:05:14.120
<v Speaker 1>the United States, which is you know, two log orders

1:05:14.160 --> 1:05:16.840
<v Speaker 1>below where we need to be. So if you can

1:05:16.920 --> 1:05:19.240
<v Speaker 1>we just use the testing that's being used in other

1:05:19.280 --> 1:05:22.480
<v Speaker 1>places like South Korea, the one that was developed by

1:05:22.480 --> 1:05:26.080
<v Speaker 1>the w h O. Did the CDC simply think that

1:05:26.080 --> 1:05:30.560
<v Speaker 1>that test was inadequate? It seems to me that was insane.

1:05:30.840 --> 1:05:35.320
<v Speaker 1>At least use them while we develop a more specific test. Yeah,

1:05:35.360 --> 1:05:38.280
<v Speaker 1>that that is absolutely correct. So we are now in

1:05:38.320 --> 1:05:41.560
<v Speaker 1>a situation called emergency use authorization where I think the

1:05:41.640 --> 1:05:45.440
<v Speaker 1>CDC has finally realized that they're not going to be

1:05:45.480 --> 1:05:48.440
<v Speaker 1>the ones to solve this problem, and they're basically saying,

1:05:49.400 --> 1:05:52.080
<v Speaker 1>you know, so the Secretary of hss UM, the Secretary

1:05:52.080 --> 1:05:55.040
<v Speaker 1>of Health and Humans has has basically said, you know,

1:05:55.640 --> 1:05:58.200
<v Speaker 1>you can go and do this test on your own.

1:05:58.600 --> 1:06:00.760
<v Speaker 1>So I think right now what we're going to see

1:06:00.760 --> 1:06:04.000
<v Speaker 1>as states making their own decision on what to do,

1:06:04.120 --> 1:06:07.560
<v Speaker 1>and in fact, we're working with one state right now

1:06:07.880 --> 1:06:10.000
<v Speaker 1>to try to help them to actually just get that

1:06:10.040 --> 1:06:13.800
<v Speaker 1>test from China directly, because in my opinion, not does

1:06:13.840 --> 1:06:16.240
<v Speaker 1>that not seem insane to you. I mean, does that

1:06:16.320 --> 1:06:21.400
<v Speaker 1>not seem a massive failure of the federal government. Yeah.

1:06:21.480 --> 1:06:23.960
<v Speaker 1>And again I'm not the conspiracy guy, so I I

1:06:23.960 --> 1:06:27.720
<v Speaker 1>attribute these things more to just you know, negligence than

1:06:28.120 --> 1:06:32.720
<v Speaker 1>anything nefarious. And I've certainly heard people speculating that, you know,

1:06:32.760 --> 1:06:35.560
<v Speaker 1>there's sort of you know, an anti China bias and

1:06:35.600 --> 1:06:37.800
<v Speaker 1>all of these things. But but I have to be honest.

1:06:37.840 --> 1:06:40.360
<v Speaker 1>I think China has been very forthcoming here, and I

1:06:40.400 --> 1:06:44.800
<v Speaker 1>think this demonization of China UM, either either you know,

1:06:44.920 --> 1:06:48.120
<v Speaker 1>covert or you know or sort of explicit or implicit,

1:06:48.160 --> 1:06:51.040
<v Speaker 1>has really hurt us. UM. I think I think China

1:06:51.080 --> 1:06:54.280
<v Speaker 1>has been very forthcoming with their data, and for some reason,

1:06:54.400 --> 1:06:58.360
<v Speaker 1>our decision to not utilize exactly what they offered us

1:06:58.400 --> 1:07:01.000
<v Speaker 1>as far as testing has set us back, put us

1:07:01.040 --> 1:07:03.680
<v Speaker 1>on our heels. And my hope is that in the

1:07:03.760 --> 1:07:06.360
<v Speaker 1>next week the bell gets rung pretty loud on that

1:07:06.520 --> 1:07:09.160
<v Speaker 1>and we you know, we we take on these tests

1:07:09.200 --> 1:07:11.600
<v Speaker 1>because again, it's not an economic question. The United States

1:07:11.640 --> 1:07:15.080
<v Speaker 1>is very fortunate we can afford to do the testing. Um.

1:07:15.120 --> 1:07:18.120
<v Speaker 1>It's really a question of deployment and other things. You know,

1:07:18.200 --> 1:07:20.080
<v Speaker 1>you asked questions about running out of things, Well, we

1:07:20.080 --> 1:07:22.840
<v Speaker 1>don't even have enough swabs right now, so we're not

1:07:22.880 --> 1:07:25.040
<v Speaker 1>just having to buy the PCR test gets. We actually

1:07:25.040 --> 1:07:26.560
<v Speaker 1>have to make sure we have enough re agents to

1:07:26.600 --> 1:07:29.400
<v Speaker 1>use them, enough swabs to actually you know, test them

1:07:29.400 --> 1:07:31.960
<v Speaker 1>on the people. Um. And that's the stuff that really

1:07:32.520 --> 1:07:35.480
<v Speaker 1>we should be stockpiling that stuff, right and and and

1:07:35.520 --> 1:07:38.919
<v Speaker 1>we certainly in early January should have been preparing for

1:07:38.960 --> 1:07:43.680
<v Speaker 1>this to spread. And again, I I think Bill Gates

1:07:44.160 --> 1:07:46.560
<v Speaker 1>spoke to all of those things five years ago at

1:07:46.600 --> 1:07:49.600
<v Speaker 1>the tail end of the Ebola outbreak, when he said, look,

1:07:49.600 --> 1:07:52.080
<v Speaker 1>it's not a question of if, but when this happens again.

1:07:52.960 --> 1:07:57.320
<v Speaker 1>And yet the group responsible for a pandemic response, or

1:07:57.400 --> 1:08:02.919
<v Speaker 1>the Pandemic Response Team, was disbanded in two THO. Yeah,

1:08:02.920 --> 1:08:05.919
<v Speaker 1>I mean Michael Lewis's book The Fifth Risk, I think

1:08:06.000 --> 1:08:09.320
<v Speaker 1>does a great job of explaining all the non sexy

1:08:09.400 --> 1:08:13.000
<v Speaker 1>parts of government that we tend to forget about until

1:08:13.240 --> 1:08:16.559
<v Speaker 1>disaster hits um And it's funny I read that book

1:08:16.560 --> 1:08:18.519
<v Speaker 1>when it came out, so I don't even remember if

1:08:18.600 --> 1:08:22.040
<v Speaker 1>in the book Michael Lewis talked about this particular side

1:08:22.040 --> 1:08:25.160
<v Speaker 1>of the government. But you're absolutely right, this is this

1:08:25.240 --> 1:08:27.719
<v Speaker 1>is a part of government that when things are good,

1:08:27.760 --> 1:08:30.160
<v Speaker 1>it's easy to forget about It's easy to say, hey,

1:08:30.200 --> 1:08:32.559
<v Speaker 1>we can, we can, we can cut costs by getting

1:08:32.640 --> 1:08:35.639
<v Speaker 1>rid of them. Um. But but you know, you think

1:08:35.640 --> 1:08:37.720
<v Speaker 1>of this like you think of insurance, right, You don't

1:08:37.760 --> 1:08:40.120
<v Speaker 1>buy insurance for your home after it burns down. You

1:08:40.160 --> 1:08:45.040
<v Speaker 1>have the insurance in place before there's a fire. Before

1:08:45.080 --> 1:08:47.519
<v Speaker 1>we go on, one last question, even though I could

1:08:47.520 --> 1:08:51.520
<v Speaker 1>talk to you for hours, Peter um, and that is,

1:08:51.520 --> 1:08:55.120
<v Speaker 1>is there any evidence that once you get the this

1:08:55.439 --> 1:09:01.040
<v Speaker 1>pathogen or this virus, you build some immunity to getting

1:09:01.080 --> 1:09:04.280
<v Speaker 1>it a second time? Or is that just a complete unknown?

1:09:05.240 --> 1:09:07.680
<v Speaker 1>I think it's an unknown right now, Katie. There are

1:09:07.680 --> 1:09:11.080
<v Speaker 1>two issues at hand. The first is is this going

1:09:11.120 --> 1:09:14.400
<v Speaker 1>to be like influenza, where if you get it in

1:09:14.439 --> 1:09:17.280
<v Speaker 1>a given season, you're not likely to get it again,

1:09:17.560 --> 1:09:20.800
<v Speaker 1>but you'll always be susceptible to it in subsequent seasons

1:09:20.840 --> 1:09:25.280
<v Speaker 1>because it has enough genetic migration or drift year upon

1:09:25.360 --> 1:09:29.320
<v Speaker 1>year upon year. Or is it something like you know,

1:09:29.439 --> 1:09:32.960
<v Speaker 1>the measles or polio, where once you are vaccinated against it,

1:09:33.040 --> 1:09:35.840
<v Speaker 1>once you know it doesn't that the virus is not

1:09:35.960 --> 1:09:39.759
<v Speaker 1>moving around genetically very much. And you know, either getting

1:09:39.800 --> 1:09:42.519
<v Speaker 1>vaccinated against it, or in this case, if you acquire

1:09:42.600 --> 1:09:46.640
<v Speaker 1>the virus and recover, you're fine. We certainly think in

1:09:46.680 --> 1:09:49.519
<v Speaker 1>the short term there is immunity, and that's one of

1:09:49.520 --> 1:09:53.200
<v Speaker 1>the other really exciting potential therapies right now is something

1:09:53.240 --> 1:09:57.200
<v Speaker 1>called convalescent serum, where you actually take blood from a

1:09:57.240 --> 1:10:02.080
<v Speaker 1>person who has recovered, you ident deify the you know, uh,

1:10:02.120 --> 1:10:04.920
<v Speaker 1>the sort of the antigens and things that are in

1:10:04.960 --> 1:10:07.160
<v Speaker 1>the blood, and you can then infuse them into people

1:10:07.200 --> 1:10:09.920
<v Speaker 1>who are sick as a form of therapy at high

1:10:10.000 --> 1:10:13.640
<v Speaker 1>doses or at low doses to impart short term immunity

1:10:13.680 --> 1:10:18.160
<v Speaker 1>on people. So given that we're seeing um reasonable evidence

1:10:18.200 --> 1:10:20.800
<v Speaker 1>of the efficacy of convalescence serum, that tells us that

1:10:20.840 --> 1:10:25.000
<v Speaker 1>there must be at least some immunity that's acquired from this. Peter,

1:10:25.240 --> 1:10:27.720
<v Speaker 1>thank you very much for spending some time with us

1:10:27.800 --> 1:10:33.200
<v Speaker 1>talking about this very scary situation. Well, Katie, thank you

1:10:33.320 --> 1:10:35.640
<v Speaker 1>for what you're doing. Your podcasts on this topic have

1:10:35.760 --> 1:10:39.519
<v Speaker 1>been fantastic, So anything I can do to to help

1:10:39.560 --> 1:10:48.439
<v Speaker 1>you get this message out. It's an honor that was

1:10:48.560 --> 1:10:52.440
<v Speaker 1>Dr Peter Attia. You can follow more of his coronavirus

1:10:52.479 --> 1:10:56.720
<v Speaker 1>coverage on his Twitter at Peter Attia empty and on

1:10:56.800 --> 1:11:07.519
<v Speaker 1>his podcast which is called The Drive, and that does

1:11:07.520 --> 1:11:10.280
<v Speaker 1>it for this episode of Next Question. A reminder to

1:11:10.479 --> 1:11:14.479
<v Speaker 1>all of our listeners are reported episodes on topics like

1:11:14.560 --> 1:11:18.800
<v Speaker 1>maternal mortality and the environmental impact of meat are still

1:11:18.840 --> 1:11:22.000
<v Speaker 1>to come, but in the next season coming out this summer.

1:11:22.400 --> 1:11:25.759
<v Speaker 1>The rest of this season, as we mentioned, throughout March

1:11:25.840 --> 1:11:30.400
<v Speaker 1>and into April, will be dedicating to the coronavirus. You

1:11:30.439 --> 1:11:33.639
<v Speaker 1>can also follow us on Instagram and other social media

1:11:33.680 --> 1:11:38.200
<v Speaker 1>outlets for day to day coronavirus coverage. My morning newsletter

1:11:38.280 --> 1:11:41.200
<v Speaker 1>wake Up Call will also be dedicated to this topic

1:11:41.520 --> 1:11:44.479
<v Speaker 1>and you can subscribe to that by going to Katie

1:11:44.479 --> 1:11:47.519
<v Speaker 1>Couric dot com. And a quick reminder, if you want

1:11:47.560 --> 1:11:50.600
<v Speaker 1>to share a story of kindness you've experienced or witnessed

1:11:50.600 --> 1:11:54.120
<v Speaker 1>in this extraordinary time, tell me. You can leave your

1:11:54.160 --> 1:11:56.719
<v Speaker 1>name and a detailed voice message at the number eight

1:11:56.840 --> 1:12:01.320
<v Speaker 1>four four four seven nine seven eight eight three. That

1:12:01.520 --> 1:12:05.920
<v Speaker 1>number once again eight four four four seven nine seven

1:12:06.040 --> 1:12:09.400
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1:12:09.479 --> 1:12:13.200
<v Speaker 1>at Katie currect dot com. Just put next Question kindness

1:12:13.240 --> 1:12:17.640
<v Speaker 1>in the subject line. I know these are unprecedented and

1:12:17.880 --> 1:12:22.920
<v Speaker 1>very trying times. Stay safe, Stay indoors and we'll get

1:12:22.920 --> 1:12:26.000
<v Speaker 1>through this together. Thank you all so much for listening,

1:12:26.280 --> 1:12:30.080
<v Speaker 1>and until next time and my next Question, I'm Katie Couric.

1:12:37.880 --> 1:12:40.160
<v Speaker 1>Next Question with Katie Curic is a production of I

1:12:40.280 --> 1:12:43.720
<v Speaker 1>Heart Radio and Katie Curreic Media. The executive producers are

1:12:43.760 --> 1:12:47.519
<v Speaker 1>Katie Kurik, Courtney Litz, and Tyler Klang. The supervising producer

1:12:47.600 --> 1:12:52.200
<v Speaker 1>is Lauren Hansen. Our show producer is Bethan Macaluso. The

1:12:52.240 --> 1:12:56.400
<v Speaker 1>associate producers are Emily Pinto and Derek Clemens. Editing by

1:12:56.439 --> 1:13:01.479
<v Speaker 1>Derrek Clements, Dylan Fagin and Lowell Berlante, Mixing by Dylan Fagan.

1:13:02.040 --> 1:13:06.639
<v Speaker 1>Our researcher is Gabriel Loser. For more information on today's episode,

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<v Speaker 1>go to Katie Couric dot com and follow us on

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