Speaker 1: Hi everyone, I'm Katie Current and welcome to Next Question.
Speaker 1: It's a new day for us here at Next Question,
Speaker 1: as I'm sure it is for all of you. The
Speaker 1: rampant spread of the coronavirus across this country, let alone
Speaker 1: the rest of the world, has forced most of us
Speaker 1: indoors for an unknown period of time. The level of
Speaker 1: restrictions on where you can go and what you can do,
Speaker 1: the closure of schools, restaurants, nightlife, the canceling of sports
Speaker 1: and entertainment is largely unprecedented, but it's necessary for the
Speaker 1: health and safety of this country. So if you're not
Speaker 1: social distancing yet, please do. But it's a lot to
Speaker 1: deal with, and I know right now it's all consuming
Speaker 1: for all of us. It's what we're reading about and
Speaker 1: what we're worried about. But I'd really like to help
Speaker 1: to settle into this new reality and perhaps understand what
Speaker 1: all of this means for us, which is why we're
Speaker 1: deaty kating the rest of this season of Next Question,
Speaker 1: which means four more episodes every week and perhaps even
Speaker 1: more to the coronavirus pandemic. For day to day news
Speaker 1: on this ever changing story, I do recommend you continue
Speaker 1: to turn to your local government, the CDC, and the
Speaker 1: World Health Organization for the most up to date information.
Speaker 1: I'm also providing updates on my Instagram feed. As for me, well,
Speaker 1: I'm hold up in my house, which means I might
Speaker 1: sound a little different to you. Social distancing means I'm
Speaker 1: not going into our usual studio and speaking into a
Speaker 1: fancy microphone. Right now, I'm sitting in my home office
Speaker 1: and I'm recording myself on my phone, and instead of
Speaker 1: speaking to my guests in person, we're connecting over our computers.
Speaker 1: So bear with us, everyone, but please keep listening for
Speaker 1: this critically important information. So today, my next question, how
Speaker 1: do we manage this new normal and coronavirus anxiety. To
Speaker 1: answer that, I called up my friend Laurie Gottlieb. Laurie
Speaker 1: Hi by. Laurie Gottlieb is a psychotherapist with a private
Speaker 1: practice in Los Angeles, but she's also a best selling author,
Speaker 1: a journalist, and soon a podcaster too. But today we're
Speaker 1: focused on the issue at hand, So um, let's talk
Speaker 1: about why people are. You know, I think with good reason,
Speaker 1: people are feeling a lot of anxiety. But I think
Speaker 1: it's interesting that the unpredictability of all of this, Lorie,
Speaker 1: is a perfect recipe for high anxiety. Can you explain that? Yeah,
Speaker 1: you know, it makes sense that we have anxiety. And
Speaker 1: I think there are two kinds of anxiety. There's productive
Speaker 1: anxiety and there's unproductive anxiety. And productive anxiety is the
Speaker 1: kind of anxiety that helps you to take action. So
Speaker 1: that's why we're washing our hands all the time. That's
Speaker 1: why we're social distancing. If we if we were in denial,
Speaker 1: if we said, oh, this is no big deal, we
Speaker 1: wouldn't be protecting ourselves and other people. So that's that's
Speaker 1: good anxiety. The kind of anxiety that gets us into
Speaker 1: trouble is unproductive anxiety, which is when we start just
Speaker 1: ruminating and we start catastrophizing and futurizing, like you know,
Speaker 1: those thoughts of oh my god, I'm going to get
Speaker 1: this and I'm going to die, or someone I love
Speaker 1: is going to get this and they're going to die,
Speaker 1: and you know, just all the stories that were kind
Speaker 1: of spinning in our heads, and and that doesn't help
Speaker 1: us in any way. Well, what makes us go as
Speaker 1: human beings too? That dark place? I know that in therapy,
Speaker 1: you're you know, this better than I. But sometimes people
Speaker 1: do say to patients, what's the worst that could happen,
Speaker 1: as a way for them to help kind of conquer
Speaker 1: their fears. But you believe in this case, that's not
Speaker 1: super helpful. I don't think that that's helpful. I think
Speaker 1: that one of the things that can really help ground
Speaker 1: us is instead of thinking about what might up and
Speaker 1: in the future because it hasn't happened yet, is to
Speaker 1: stay grounded in the present. So one of the things
Speaker 1: that I think happens is that when something extraordinary happens,
Speaker 1: we long for the ordinary. We want we want our
Speaker 1: routines back, We want all those things that we complained about,
Speaker 1: you know, when when we didn't have something, we weren't
Speaker 1: in a heightened state like this. Um, we want it back,
Speaker 1: and yet it's still right in front of us. So UM.
Speaker 1: I like to talk about the concept of both, and
Speaker 1: which is, yes, something horrible is happening, and we can
Speaker 1: also enjoy certain things like the ordinary. We can enjoy
Speaker 1: the time that we're having connecting with people that we
Speaker 1: normally don't really pay attention to in our daily lives.
Speaker 1: We can enjoy cooking together. We can, you know, in
Speaker 1: our own isolated family units, um, we can enjoy having
Speaker 1: the time to read a book or to think our
Speaker 1: own thoughts, or to um, you know, actually face time
Speaker 1: with one and actually listen when you ask how are you?
Speaker 1: I think one of the one of the kind of
Speaker 1: nice things to come out of horrible experience like this
Speaker 1: is that people are very kind. Kindness comes out. There's
Speaker 1: sort of a resurgence of kindness in this world where
Speaker 1: civility has been lost, and so I think that both
Speaker 1: at both can exist, and if we can focus on,
Speaker 1: you know, holding our fear and feeling our feelings, not
Speaker 1: being in denial of our anxiety, and not being in
Speaker 1: denial of what's going on around us, but also really
Speaker 1: trying to stay present in what's happening in that moment.
Speaker 1: We have so many questions. But before we get to
Speaker 1: some questions from people who follow me or listen to
Speaker 1: the podcast, Laurie, I'm a fairly normal person in that
Speaker 1: I don't have huge anxiety, but I'm finding I'm feeling
Speaker 1: a little neurotic about my health. If I have a
Speaker 1: little bit of a sore throat when I wake up
Speaker 1: in the morning, or if I cough, then I start thinking, oh,
Speaker 1: my god, am I sick? And I'm sure I'm not
Speaker 1: alone in that because it's part of catastrophizing. I'm sure,
Speaker 1: what what is that about? How can we kind of
Speaker 1: calm ourselves down? Well, I think the first step is
Speaker 1: just realizing it that it's human nature to do that.
Speaker 1: So I remember when I was in medical school, we
Speaker 1: we talked about sort of medical school disease, which was
Speaker 1: every disease that we were reading about. We all thought
Speaker 1: we had all of a sudden we felt the symptoms
Speaker 1: of it. You know, it's like, oh, my god, I
Speaker 1: have this now because my my gland feels inflamed or whatever.
Speaker 1: Um that now that we're reading all the time about
Speaker 1: the symptoms of coronavirus, you know, it's almost like the
Speaker 1: power of of uh implanting it into your suggestion. Right. So,
Speaker 1: so I think just realized that the power of suggestion
Speaker 1: is very powerful. And and so when you notice that,
Speaker 1: of course be aware if you are having symptoms, but
Speaker 1: also take a breath. Um. Part of part of the
Speaker 1: problem is that we're reading about and I always tell
Speaker 1: people that, yes, you need to get daily updates, but
Speaker 1: you don't really need more than that. I think that
Speaker 1: the more that we're just you know, kind of it's
Speaker 1: kind of like we're binge, like binge watching a television show,
Speaker 1: but it's kind of like binge eating junk food. That
Speaker 1: the more you sit there and click from this article
Speaker 1: to that article to the other article, it makes you sick.
Speaker 1: It does not fill you up, It does not help you.
Speaker 1: It actually makes you psychologically ill. How do you talk
Speaker 1: to kids about this? I'm sure that a lot of parents,
Speaker 1: you know, my children are older. Your son is in
Speaker 1: high school now, right, he's in middle school, middle school,
Speaker 1: so he's he's at home. Is he expressing concern? And
Speaker 1: how do you suggest people talk to their kids about this?
Speaker 1: I think that the way that we model our response
Speaker 1: to this is going to impact the way that our
Speaker 1: kids handle their anxiety around it. So it's kind of
Speaker 1: like I think, you know, when when you're on an airplane,
Speaker 1: they always say put on your oxygen mask first before
Speaker 1: you put on your child. But I think it goes
Speaker 1: beyond that. It's how does the pilot handle it when
Speaker 1: there's a problem and the pilot doesn't say, oh my god,
Speaker 1: we're all gonna die, you know, if there's something the
Speaker 1: pilot says very calmly, Hey, we're gonna experience some turbulence
Speaker 1: coming up. We want all of you to fasten your
Speaker 1: seatbelts and please don't walk in the aisles right now.
Speaker 1: And I think that's very calming. And I think that
Speaker 1: for our kids, we need to say, yes, here are
Speaker 1: the rules, here are the boundaries. You can't go and
Speaker 1: play basketball. I say this to my kid, you can't
Speaker 1: go play basketball with your friends right now because we're
Speaker 1: social distancing, um, you know, and and we're gonna do
Speaker 1: this instead. And and just to kind of, you know,
Speaker 1: under help them understand. I think giving them a sense
Speaker 1: of purpose to around this, which is we're not just
Speaker 1: doing this for ourselves. We're doing this for our community.
Speaker 1: We're doing this for our neighbors, for the elderly people
Speaker 1: that we know. Um, we're doing this for people with
Speaker 1: compromised immune systems. And I think that kids really engage
Speaker 1: in that when they realize that it's bigger than them.
Speaker 1: It's not just oh, this is a bummer. I'm stuck
Speaker 1: here and I can't play with my friends, and I
Speaker 1: can't do the normal things I like to do. Um.
Speaker 1: There's there's something about being connected to the larger community
Speaker 1: that really resonates with with tweens and teens. Well, let's
Speaker 1: play dear therapist Lorie, because we've got so many questions
Speaker 1: and I don't want to be sort of a pig
Speaker 1: about just asking my own Rosanna says, how much information
Speaker 1: should we deal with on an everyday basis, especially with
Speaker 1: the situation changing by the hour or day. Do you
Speaker 1: have any suggestions for what is a healthy media diet? Yeah?
Speaker 1: I do. I think once a day is plenty. And
Speaker 1: I think that's because we all know what we're supposed
Speaker 1: to be doing, regardless of how many new cases are reported,
Speaker 1: regardless of whether they're saying you can't go here, you
Speaker 1: can't go that. We know we're supposed to be social isolating.
Speaker 1: We know we're supposed to be washing our hands constantly. Um,
Speaker 1: we know that we're supposed to be cleaning the the
Speaker 1: all the handles and um, you know, door knobs and
Speaker 1: things like that in our homes and all the sort
Speaker 1: of high touch surfaces. We know what we're supposed to
Speaker 1: be doing. Nothing is changing in that regard. So and
Speaker 1: we also know if you're having symptoms what you're supposed
Speaker 1: to do. So there's no information that's going to happen
Speaker 1: during the day. That's going to change the basic facts
Speaker 1: of what we need to do in our lives. And
Speaker 1: we really need to protect our psychological immune systems as
Speaker 1: much as we're protecting our physical immune systems, and that
Speaker 1: means not overloading ourselves with information. Here's another question. What
Speaker 1: are some tools new moms or expectant moms like me,
Speaker 1: She said, uh, can use to get through this uncertain time.
Speaker 1: Bringing a new baby home is tough enough, but limiting
Speaker 1: the village from visiting and helping will put a strain
Speaker 1: on many Thanks to you. Yeah, um, you know, I
Speaker 1: think that it's really important for parents to kind of
Speaker 1: trade off time so that they get a break. So
Speaker 1: I think that when you've got a baby and you
Speaker 1: don't have your village around you a lot of times, um,
Speaker 1: you know, you need each other as adult as a couple.
Speaker 1: But sometimes you're gonna have to say, you know what,
Speaker 1: it's your turn, and I'm going to go take a
Speaker 1: bath or I need to go just um, you know,
Speaker 1: I need to go take a walk whatever it is,
Speaker 1: and and hand off to the other parents. And you
Speaker 1: really have to work as a team. So I think
Speaker 1: that's really important, you know, if you're living in a
Speaker 1: multigenerational household and you have, um, you know, other people
Speaker 1: to help, that's great. I think it's also important that
Speaker 1: you you connect again for your own mental health, that
Speaker 1: you connect with your friends through technology and you take
Speaker 1: some breaks and you laugh about how hard it is,
Speaker 1: and you laugh about the dirty diapers, and you laugh
Speaker 1: about the naps that are not being taken and all
Speaker 1: of those things because you need someone to vent too. Yeah, definitely,
Speaker 1: and laughter is really helpful. Here's a question, j P.
Speaker 1: As I'm an addict in recovery, are twelve step groups
Speaker 1: and meetings are shutting down. What is the best advice
Speaker 1: to stay out of your monkey and stay connected even
Speaker 1: at a time of much needed social distancing. So if
Speaker 1: you have a sponsor that you can connect with virtually,
Speaker 1: that would be really helpful. If you have other people
Speaker 1: from that you know, from the group that you can
Speaker 1: connect with, that would be helpful. There are also so
Speaker 1: many online resources, um that you can listen to podcasts, um.
Speaker 1: You know, uh M. I was gonna say, there's groups
Speaker 1: online where you can you know, write in real time
Speaker 1: and connect like that. So I would really search the internet.
Speaker 1: I think the internet is our friend right now, not
Speaker 1: in a sense of getting an overload of COVID information,
Speaker 1: but in a sense of how we can get creative
Speaker 1: around connecting with other people when we need it most.
Speaker 1: Vivian says, how can I stop obsessing and stockpiling groceries?
Speaker 1: I think that's such an interesting sort of primitive instinct.
Speaker 1: People are going and kind of sometimes hoarding food. They're
Speaker 1: so worried that the grocery stores are going to close
Speaker 1: and that they're going to starve to death. You saw
Speaker 1: that with the toilet paper shortage. It's fascinating thing to
Speaker 1: observe just from a human behavior standpoint. Um, what advice
Speaker 1: could you give Vivian and other people who are feeling
Speaker 1: that way. There's a difference between being prepared and obsessing,
Speaker 1: and that line is going to shift the more that
Speaker 1: you kind of think about, oh, what's going to happen
Speaker 1: in the future. I think being prepared means that, yeah,
Speaker 1: you have some provisions in the house, and you you know,
Speaker 1: you you have things that that you're going to need.
Speaker 1: But you know, when you start getting to the point
Speaker 1: where you've already gotten the provisions and you think, oh,
Speaker 1: I need more, and then I need more and then
Speaker 1: I need more. Um, that's when you need to step
Speaker 1: back and say, you know what, I am prepared. I
Speaker 1: will be able to get more later. But I have enough.
Speaker 1: I've done my preparations and I've done what the recommendations are.
Speaker 1: And then you really have to let go. And that's
Speaker 1: again we're staying in the present. Helps where instead of
Speaker 1: thinking about, um, you know, do I have enough, and
Speaker 1: and you know, spending your emotional real estate on that,
Speaker 1: do something else. And I know that sounds like I'm
Speaker 1: trivializing this, but I'm not. Um, you know, go do
Speaker 1: a puzzle, Go get those art those art supplies out,
Speaker 1: Go read a book, Go take a walk, Go call
Speaker 1: a friend. You have to take breaks, you have to
Speaker 1: let go, and you have to stay active. I think,
Speaker 1: even though you know the whole it seems anathetical with
Speaker 1: the idea of staying home. There ways to stay active
Speaker 1: at home. Clean out your closet, get rid of all
Speaker 1: the clothes or put them aside that you can give
Speaker 1: for dress to dress for success or to the goodwill.
Speaker 1: You know, it is a good time to do some
Speaker 1: serious spring cleaning, open the windows and and you know,
Speaker 1: get the winter winter out of your house and out
Speaker 1: of your things and maybe downsize a little bit. Andy asked,
Speaker 1: I have a friend who suffers from anxiety. This is
Speaker 1: kind of an obvious question, but it's a good one.
Speaker 1: How can I best support them during this time? How
Speaker 1: can you support people who you know? What can you
Speaker 1: do for them? One of the things that happens with
Speaker 1: anxiety is logic doesn't help. So you can't really talk
Speaker 1: somebody out of their anxiety and try to tell them
Speaker 1: that things are going to be okay. What you can
Speaker 1: do is you can connect with them, and that's that
Speaker 1: naturally sues people. So why don't you say, hey, let's
Speaker 1: do let's have a virtual dinner together. Um, hey, let's
Speaker 1: watch a movie together virtually? Um, you know what, whatever
Speaker 1: it is that you can do. Um. You know some
Speaker 1: people are exercising together and virtually, which is fun, so,
Speaker 1: you know, and just moving your body helps so much
Speaker 1: with anxiety. So if you can somehow get your friend to,
Speaker 1: you know, move around, and you can do it with
Speaker 1: that person virtually. You can support the person through actions,
Speaker 1: as opposed to your words will not really help them,
Speaker 1: but your actions will avas how to focus on work
Speaker 1: while acknowledging that we're all scared. No, I think you
Speaker 1: and I know that when you are worried or stressed out,
Speaker 1: it's hard to concentrate. Actually, I know that from when
Speaker 1: my husband was sick. I would read the same paragraph
Speaker 1: over and over again in a book and I could not,
Speaker 1: for the life of me, concentrate. So how can you
Speaker 1: How can you fight that? Is there anything you can do?
Speaker 1: I guess reducing the stress will help you concentrate more.
Speaker 1: There's also something you can do with your body, which
Speaker 1: is that sometimes when we kind of leave the present,
Speaker 1: we need to physically ground ourselves. So what you do
Speaker 1: is you close your eyes, and you start with your
Speaker 1: feet and you say, I feel my feet on the floor,
Speaker 1: and you feel them, and then you move up and
Speaker 1: you say, okay, I feel put your knees together. I
Speaker 1: feel my knees, and you move up and you just
Speaker 1: keep and you feel your breath and you feel your diaphragm,
Speaker 1: and you feel the different parts of your body and
Speaker 1: it brings you back to the present moment and you
Speaker 1: take some breaths, and then you move on with your work.
Speaker 1: Kristen wants to know how do you cope with the
Speaker 1: idea that we don't know how if when this is
Speaker 1: going to end. I think that's in addition to the
Speaker 1: unpredictability of this, This kind of not knowing when life
Speaker 1: will resume, I think adds to people's stress levels. Right,
Speaker 1: I mean not just am I going to get this
Speaker 1: and what's going to happen? But how long is this
Speaker 1: going to have to be the new normal? So how
Speaker 1: do you cope with that? I think we have to
Speaker 1: acknowledge that humans don't do well with uncertainty, and so
Speaker 1: this is a good opportunity for us to build up
Speaker 1: some resilience around uncertainty, which means that we just instead
Speaker 1: of trying to figure it out. You know, this news
Speaker 1: report says that, or this physician says that, to just
Speaker 1: say we don't know, and to try to get comfortable
Speaker 1: with that and say, what can I do in the
Speaker 1: meantime to have as normal of a routine that I
Speaker 1: can possibly have under these circumstances. You know, I don't
Speaker 1: want to let you go before asking you if someone
Speaker 1: is having real trouble, you know, if the anxiety reaches
Speaker 1: a point where it's untenable or it's affecting someone's physical
Speaker 1: health health, Um, you know, I I don't want to
Speaker 1: trivialize the seriousness of this. So what can people do
Speaker 1: if they really feel there at the breaking their breaking point, Laurie,
Speaker 1: They should absolutely reach out to a therapist. And so
Speaker 1: many therapists are doing online sessions specifically right now for this,
Speaker 1: and they should reach out. And this is not a
Speaker 1: time for shame or stigma or you know, oh my
Speaker 1: problems aren't that bad minimizing our problems. Um, everybody else
Speaker 1: is going through this, So why why why should I
Speaker 1: get help? You know, all those things we say to
Speaker 1: ourselves that prevent us from reaching out. This is a
Speaker 1: time to say, I need to prioritize my emotional health
Speaker 1: just as I'm prioritizing my physical health. And if you
Speaker 1: need to talk to someone, you do not need to
Speaker 1: be in a christ is. You can just be having
Speaker 1: a moment. You can be feeling kind of free floating anxiety, depression,
Speaker 1: whatever it is, or you just want to connect with
Speaker 1: someone because you feel like preventively to kind of preserve
Speaker 1: your emotional health. Please please please reach out. You can
Speaker 1: find you can do a quick Google search and you
Speaker 1: will find somebody who is available to do that for you. Well,
Speaker 1: Lourie stays safe and call me and maybe we'll have
Speaker 1: a virtual glass of wine together a cup of tea.
Speaker 1: I don't want to encourage people to drink during this time,
Speaker 1: but a glass of wine isn't going to hurt, right,
Speaker 1: That's right, that's right. Thank you so much, Katie. Okay, bye, Laurie,
Speaker 1: all right, take care or stay safe. Laurie gott Lee's
Speaker 1: latest book is called Maybe You Should Talk to Someone.
Speaker 1: She's also coming out with a podcast called Appropriately Dear Therapist,
Speaker 1: co hosted Buy Another Therapist, Guy Wench. It's due to
Speaker 1: come out from my Heart hopefully this summer. You know,
Speaker 1: I really like what Laurie said earlier about how kindness
Speaker 1: tends to emerge out of times of crisis. People are
Speaker 1: kinder to one another, they want to help, And I'd
Speaker 1: like to know the large or small ways you're seeing
Speaker 1: kindness or promoting it in your own community. If you
Speaker 1: want to share your story, please call and leave your
Speaker 1: name and a detailed message for us at Next Question.
Speaker 1: The number is eight four four four seven nine seven
Speaker 1: eight eight three. That number once again is eight four
Speaker 1: four four seven nine seven eight eight three. You can
Speaker 1: also email me a voice memo or a written note
Speaker 1: at info at Katie currect dot com. Just put next
Speaker 1: question kindness in the subject line and you might hear
Speaker 1: your story right here. On next question coming up, we're
Speaker 1: going to be checking in with the doctor who's a
Speaker 1: friend of mine and one of the smartest people I know,
Speaker 1: to get a better sense of how the coronavis irs
Speaker 1: affects our bodies and also our health care system. Dr
Speaker 1: Peter Atilla is a Stanford and Johns Hopkins trained physician
Speaker 1: living in San Diego. His clinical focus has been on longevity,
Speaker 1: how to live better and longer, but since the outbreak
Speaker 1: of coronavirus or COVID nineteen, he shifted gears, focusing his
Speaker 1: research towards understanding the current situation, what we can do
Speaker 1: to protect ourselves, and potentially the implication of what's to come.
Speaker 1: And now he's here to share some of that with us.
Speaker 1: So where are we now understanding? This story seems to
Speaker 1: change on an hourly, if not minute I minute basis.
Speaker 1: If you had to assess the situation right now for
Speaker 1: our listeners, what would you say, Well, you know, I
Speaker 1: think of these things through the lens of um. Is
Speaker 1: the rate at which we are seeing infections growing or shrinking?
Speaker 1: So you can think of being on one side or
Speaker 1: another of that peak. So, for example, if we look
Speaker 1: at mainland China, we know that they're now on the
Speaker 1: tail end of this response. Again, there's always possibilities that
Speaker 1: there's another outbreak as they go back to work and
Speaker 1: begin to mobilize society again. But notwithstanding that, it's clear
Speaker 1: that they're on the right side of that curve. Both um,
Speaker 1: you know, right and correct um, we're still on the
Speaker 1: left side of that curve, which means each and every
Speaker 1: day it appears that we are seeing more and more
Speaker 1: people get infected, or the rate at which the infections
Speaker 1: are increasing is is still increasing. Now the million dollar
Speaker 1: question for which a lot of people, you know, really
Speaker 1: smart people, epidemiologists and such, are trying to project is
Speaker 1: where is that peak? Because the peak is sort of
Speaker 1: what gives us a sense of that maximum rate of
Speaker 1: infection um, and that is, once you know what that
Speaker 1: looks like, then you kind of have a sense of
Speaker 1: what the overall number of infected people will be, and
Speaker 1: then you can extrapolate, hopefully from the data we see
Speaker 1: in other countries, what the impact is going to be
Speaker 1: on the health care system. And of course the things
Speaker 1: that really matter, like how many people are going to
Speaker 1: potentially die or otherwise be debilitated by this. Why was
Speaker 1: Italy so overrun with this virus? What was the perfect
Speaker 1: storm that made it go through that country like wildfire?
Speaker 1: So I think we can speculate on a couple of things.
Speaker 1: First of all, I think part of it is bad luck.
Speaker 1: I mean, it's it's important to understand that if um,
Speaker 1: let's let's just make the math simple and say, let's
Speaker 1: let's pretend there were a hundred infected people in China
Speaker 1: as where the epicenter was, and that you know, ten
Speaker 1: of them got on a plane aine and happen to
Speaker 1: travel and go someplace. Well, the ten places that they
Speaker 1: land are going to have a head start in terms
Speaker 1: of where this virus is going to spread. And if
Speaker 1: one of the places they landed was Italy and one
Speaker 1: of the place that they landed was Iran, then those
Speaker 1: places are going to have a bit of a head start.
Speaker 1: So I think there's just a little bit of a
Speaker 1: luck component, which is it probably got an early start
Speaker 1: on the virus reaching there other factors that seem to
Speaker 1: matter seem to be the age of the population. So
Speaker 1: Italy has a relatively old population compared to other countries
Speaker 1: in Europe and relative to the United States, meaning they
Speaker 1: have more people who are in that high risk category
Speaker 1: based on age alone. Furthermore, there seems to be a
Speaker 1: slightly higher prevalence of smoking, and smoking is definitely one
Speaker 1: of the major risk factors for people who, if they're infected,
Speaker 1: are more likely to get ill. And then I think
Speaker 1: the other component is, you know, some of the sort
Speaker 1: of just societal things about the proximity that people are
Speaker 1: to each other. So in other words, if you look
Speaker 1: at the place like Wyoming, if someone had landed, if
Speaker 1: one of the first people infected had landed in Wyoming,
Speaker 1: it still would have likely spread slower than landing in
Speaker 1: a place like Italy, northern Italy, where the population density
Speaker 1: is such that there's more contact with an infected person
Speaker 1: to another. And then I think, finally, just at the
Speaker 1: policy level, they were probably a little bit later to
Speaker 1: realize what was happening an institute the measures necessary to
Speaker 1: slow the rate of spread. You have said it, Italy
Speaker 1: taught us that it is the morbidity rate, not the
Speaker 1: mortality rate of the disease that is grave for us.
Speaker 1: Non doctors who may be listening, including myself. What is
Speaker 1: the difference. So, mortality is kind of a binary variable.
Speaker 1: It's to live or to die, and there's a lot
Speaker 1: of attention that is appropriately being placed on the mortality rate.
Speaker 1: It's often described through a case fatality rate, which is
Speaker 1: another way of saying how many people die for a
Speaker 1: given number of people who have this infection. And obviously
Speaker 1: that's very important, but morbidity is more about the you know,
Speaker 1: long term impact on quality of life, an illness that
Speaker 1: has suffered that does not ultimately result in death. And
Speaker 1: I was reading a paper this morning, UM that did
Speaker 1: a ten year follow up on people who were infected
Speaker 1: with the first STARS virus that we talked about stars
Speaker 1: covie one. This was the two thousand three epidemic. This
Speaker 1: was a pretty lethal virus, certainly appeared more lethal than
Speaker 1: the current virus. About ten percent of people infected with
Speaker 1: this virus died, so that's a staggering amount. But what
Speaker 1: this paper followed up on was what were the long
Speaker 1: term consequences of the people who were infected but survived.
Speaker 1: And it was quite disheartening, frankly, that you saw much
Speaker 1: higher incidence of cardiovascular disease in those people, much higher
Speaker 1: incidents of lung disease in those people as the so
Speaker 1: so if they didn't die from the disease, they were
Speaker 1: still somewhat debilitated by it. And I think that that's
Speaker 1: something that we're going to see a lot more of,
Speaker 1: and I think the consequences of that, you know, economically,
Speaker 1: will be significant. There are going to be people I
Speaker 1: suspect who won't be able to go back to work
Speaker 1: in the same capacity a year from now when all
Speaker 1: is said and done, And the people who are most
Speaker 1: susceptible to that are obviously the people who come in
Speaker 1: with the greatest amount of pre existing medical conditions. So,
Speaker 1: for example, diabetes. Why as diabetes a risk for this?
Speaker 1: And I don't think we know entirely, but one thing
Speaker 1: we know is that people with diabetes might already have
Speaker 1: some underlying degree of insult to their kidneys, to their heart,
Speaker 1: and it might be that they are less likely to
Speaker 1: recover from this, even if they're fortunate enough to not
Speaker 1: succumb to it. Yeah, I was interested in the diabetes
Speaker 1: angle because I would understand smoking because correct me if
Speaker 1: I'm wrong, Peter. But this virus does create some kind
Speaker 1: of fibrosis and the lungs. Is that right? Eventually, Yes,
Speaker 1: this is a virus that has a kind of unique
Speaker 1: pathology relative to influenza, for example, which would be a
Speaker 1: cousin of it um. The virus gets Every virus has
Speaker 1: to replicate by getting into a cell within our body.
Speaker 1: So it's you know, maybe we're taking a step back
Speaker 1: to understand what the heck of virus is. A virus
Speaker 1: is not quite like a bacteria. The bacteria is totally
Speaker 1: self sufficient, meaning it has all of the equipment inside
Speaker 1: of its cell to fully replicate on its own outside
Speaker 1: of the body. That doesn't mean it won't in fact us,
Speaker 1: but a virus is different. A virus doesn't actually have
Speaker 1: much to it. It's a much much simpler piece of
Speaker 1: you know, biologic you know entity. It has in this
Speaker 1: case just some RNA and that's about it. And so
Speaker 1: for it to replicate and survive, it must get inside
Speaker 1: of a host, and in this case, you have now
Speaker 1: become the host. Prior to this, of course, animals were
Speaker 1: the host, and it uses our DNA replicating machinery to
Speaker 1: replicate itself. So if you were going to think about
Speaker 1: this sort of teleologically, the virus really has no intention
Speaker 1: of hurting us. That's just an unintended consequence. What it
Speaker 1: wants to do is replicate. From an evolutionary perspective, and
Speaker 1: the most successful viruses, by the way, the ones that
Speaker 1: can go on forever and ever, don't hurt their host
Speaker 1: at all. It's the viruses that destroy their host that
Speaker 1: don't really survive, much like ebola. Ebola didn't spread very
Speaker 1: much because it was so devastating to its host. So
Speaker 1: when this virus comes in, it has to pick a
Speaker 1: cell that it targets, and that just happens to come
Speaker 1: down to sort of the molecular biology of how this
Speaker 1: virus works. And this cell it targets most commonly is
Speaker 1: a cell in the lung called a pneuma site because
Speaker 1: of a certain receptor that that cell has that allows
Speaker 1: this virus to enter. When it gets into that cell,
Speaker 1: it basically hijacks it. It takes over and uses the
Speaker 1: cell's ability to replicate and says, hey, I'm going to
Speaker 1: take this over for myself and replicate myself. And it
Speaker 1: does that and it ends up destroying that cell. And
Speaker 1: it turns out that in this case, that's a really
Speaker 1: bad cell to lose because that cell, called a type
Speaker 1: to numa. Site makes a chemical called surfactant, and you've
Speaker 1: probably heard of surfact and it's like a detergent that
Speaker 1: allows the air sacks in our lungs to not collapse
Speaker 1: on themselves because of the surface tension. And so when
Speaker 1: we lose enough of those, the lungs begin to collapse
Speaker 1: and we aren't able to exchange air, and ultimately that
Speaker 1: results in a type of pneumonia, or really something more
Speaker 1: severe than a pneumonia called acute respiratory distress syndrome, where
Speaker 1: a person can't exchange gas, and ultimately that will result
Speaker 1: in potentially fibrosis of the lung. It turns out, by
Speaker 1: the way that that cell um that that that the
Speaker 1: virus can also gain access to um muscle cells of
Speaker 1: the heart, and so we believe that we're going to
Speaker 1: see sort of fibrosis of the heart going forward. In fact,
Speaker 1: thirty or forty percent of patients on autopsy, people who
Speaker 1: have already died from this virus are showing injury to
Speaker 1: their heart. This sounds very, very bleak, but that's one
Speaker 1: of the reasons smokers are particularly susceptible because they already
Speaker 1: have some of the some damage to the cells that
Speaker 1: you were discussing, yep, and they just have less what
Speaker 1: we would call pulmonary reserve. They have less lung capacity
Speaker 1: in excess. So you know, someone like you, Katie, who's
Speaker 1: really healthy, you know you're not utilizing your full lung
Speaker 1: capacity when you're sitting here at rest right now. You're
Speaker 1: using a fraction of it. But let's say that you
Speaker 1: know you're using of your lung capacity. Will imagine somebody
Speaker 1: who has smoked for a long period of time. For
Speaker 1: them sitting at as they might be relying on six
Speaker 1: of their lung capacity, so they just have less of
Speaker 1: a buffer. You know. You can think of it as
Speaker 1: like how much does someone have in their savings account? Well,
Speaker 1: the person who has less in their savings account is
Speaker 1: going to be more likely to suffer the shock of not,
Speaker 1: you know, having a job. Before we talk about being
Speaker 1: better prepared, and I know that you watched the Bill
Speaker 1: Gates Ted Talk, which I thought was eerily prescient in
Speaker 1: its message. But let's talk just briefly, because I think
Speaker 1: people are desperate for this kind of information to Peter,
Speaker 1: and you have access to the latest, most accurate information
Speaker 1: in terms of protecting yourself. Um, tell me what you're
Speaker 1: doing in your home with your kids and your wife. Well,
Speaker 1: we we sort of probably came across as a little
Speaker 1: bit crazy at the outset. In mid February, I sort
Speaker 1: of woke up to what was happening. I had been
Speaker 1: largely and denial through January, and UM, I think had
Speaker 1: naively assumed that this would be much more like the
Speaker 1: First Stars outbreak, or like the Murs outbreak, except less
Speaker 1: deadly and less likely to spread. In other words, I
Speaker 1: hadn't fully dug into the properties of this virus that
Speaker 1: make it a little more troublesome, which is namely its
Speaker 1: capacity for spread. But in mid February, when I sort
Speaker 1: of woke up to this, UM, I started to think about, well,
Speaker 1: what what could we do if we wanted to buy
Speaker 1: more time? And so that basically came down to much
Speaker 1: greater social distancing, and UM that meant, you know, canceling
Speaker 1: all travel plans. And then eventually it just you know,
Speaker 1: came down to making a decision that was difficult to make,
Speaker 1: and not a decision that everybody has the luxury of making,
Speaker 1: because many people don't have the luxury of working from home.
Speaker 1: But it was a decision to basically quarantine ourselves, UM,
Speaker 1: and so that meant that, you know, we don't leave
Speaker 1: the house and people don't come to us in the house.
Speaker 1: And the thinking would be that after two to three
Speaker 1: weeks of that period of a quarantine, absent having an
Speaker 1: accurate test to measure UM, if you are infected, if
Speaker 1: you're completely asymptomatic, you know, no temperature changes or anything
Speaker 1: like that, the likelihood that you're infected is low. And
Speaker 1: now at least you're in sort of a safe spot
Speaker 1: while you wait for time to sort of play this out.
Speaker 1: And time does a lot of things right. Time allows
Speaker 1: us to potentially develop a vaccine. Although I think that's
Speaker 1: a longer term strategy than most people think, it certainly
Speaker 1: allows us to repurpose existing drugs and that's something I'm
Speaker 1: really excited about. So if we're going to talk about optimism,
Speaker 1: I actually am quite optimistic that there are a suite
Speaker 1: of drugs that already exist that we're now learning how
Speaker 1: can be repurposed for this And most importantly, it's giving
Speaker 1: the hospital system and the health care system a chance
Speaker 1: to slowly expand to meet the needs that are necessary.
Speaker 1: Because again to your point about Italy, the real problem
Speaker 1: in Italy is not the total number of people that
Speaker 1: are infected, it's the speed at which those people needed
Speaker 1: medical care. And so you can you've heard the term
Speaker 1: flattening the curve. Why are people saying that. It's like
Speaker 1: saying if a hundred thousand people are going to require hospitalization,
Speaker 1: it's a big difference if they required in one month
Speaker 1: or one year. And so it's not clear that we're
Speaker 1: going to reduce the number of people that are ultimately
Speaker 1: going to be infected, but we want to spread it
Speaker 1: out as much as possible. So on a personal level,
Speaker 1: my view is what can I do to make sure
Speaker 1: I don't need healthcare resources anytime soon. I talked to
Speaker 1: the director of an urgent care center, Peter, and he said,
Speaker 1: do not go to the doctors, do not you know,
Speaker 1: try to seek medical care unless it gets bad. But
Speaker 1: I wondered, is there an inflection point, because I think
Speaker 1: people are so paranoid. Every time I cough, I get
Speaker 1: neurotic and uh and and when is that point where
Speaker 1: you should seek medical care or at least talk to
Speaker 1: a healthcare provide because we don't want to clog the system. Listeners,
Speaker 1: I'm sure agree with this, but we also don't want
Speaker 1: to ignore an illness that could worsen if we don't
Speaker 1: get it, if we don't get the proper attention. Yeah,
Speaker 1: I mean, that's such an important question, and truthfully, it's
Speaker 1: one for which I think the answer is not entirely clear. Um,
Speaker 1: we probably do need to think a little bit about
Speaker 1: how to stratify. So I would agree with the advice
Speaker 1: that your colleague and friend gave you, which is, we
Speaker 1: certainly don't want everyone who, um, you know, thinks that
Speaker 1: they have a little sniffle or a sneeze or a
Speaker 1: sore throat to then expose themselves to an infection by
Speaker 1: going out and seeking medical care, especially when we don't
Speaker 1: have testing readily available yet. That's the important thing to
Speaker 1: understand is what is it going to accomplish to go
Speaker 1: and put yourself in harm's way If we don't even
Speaker 1: have a test yet that's viable, are going to offer
Speaker 1: as much. So I think we have to stratify patient. So,
Speaker 1: you know, the way we are looking at it in
Speaker 1: our practice is we're taking the patients who we think
Speaker 1: are at highest risk. So these are people who are
Speaker 1: you know, sort of in their sixties and older people
Speaker 1: who have existing conditions like high blood pressure or heart disease,
Speaker 1: atrial fibrillation, these sorts of things, and we're saying we're
Speaker 1: going to have a lower threshold for getting them tested
Speaker 1: or getting them in to see someone if we have
Speaker 1: any concern. You know, my wife yesterday was called by
Speaker 1: a friend of hers who lives in Colorado now, and
Speaker 1: she has a lot of underlying medical conditions, and you know,
Speaker 1: it was really difficult to spend the time on the
Speaker 1: phone with here today and triage. What I couldn't fully
Speaker 1: understand was either a panic attack or legitimately an illness,
Speaker 1: and you know, we had to make a call, and
Speaker 1: in the end we saw it. We decided after an
Speaker 1: hour she probably did need to go into the emergency
Speaker 1: room and get checked out because I just couldn't be
Speaker 1: comfortable that this was just anxiety and I and she
Speaker 1: has so many underlying medical conditions that I was actually
Speaker 1: concerned that. You know, she's the type of person who,
Speaker 1: if infected, could very precipitously, you know, fall off that
Speaker 1: proverbial cliff. And what happened, Um, you know, she we
Speaker 1: went there. I It's it's still unclear because of course,
Speaker 1: the testing takes days to get back. So, but now
Speaker 1: she is at least, you know, her blood pressure is normalized,
Speaker 1: her oxygen levels are normalized. Um, the thing we are
Speaker 1: most sensitive to is shortness of breath. That seems to
Speaker 1: be the biggest single predictor of people who do versus
Speaker 1: do not need medical attention. So people who do not
Speaker 1: develop shortness of breath at any point in time are
Speaker 1: generally going to recover in what we call a self
Speaker 1: limited way. I hate to ask you this, doctor a
Speaker 1: tea of a what is how do you know if
Speaker 1: you have shortness of breath? I know that probably sounds
Speaker 1: like a dumb question, but is there something you can
Speaker 1: do to figure out? Is it walking upstairs? I mean
Speaker 1: I get sometime shortness of breath if I try to
Speaker 1: run a mile. I mean when when can you tell
Speaker 1: you have that? Actually, Katie, that is not a stupid
Speaker 1: question at all, and we've actually tried to explain that
Speaker 1: exactly to our patients. So I'm glad you asked. Um.
Speaker 1: We think one of the best litmus test is for
Speaker 1: litmus tests for shortness of breath is air hunger while
Speaker 1: speaking in long sentences. So when someone who could normally
Speaker 1: rattle off, you know, three minutes of talking with just
Speaker 1: the simple breath in between, all of a sudden has
Speaker 1: to take longer pauses to take breaths in between speaking
Speaker 1: to me, that's true shortness of breath. You use an
Speaker 1: example of walking up a flight of stairs. I think,
Speaker 1: if somebody knows what they're you know, normal exercise tolerance
Speaker 1: is when that dramatically decreases. So if a person you
Speaker 1: know lives in an apartment where they have to go
Speaker 1: up and down a flight of stairs and normally that
Speaker 1: poses no risk to them, and all of a sudden,
Speaker 1: now they think, oh my god, like I'm really winded
Speaker 1: walking up this flight of stairs, that that might all
Speaker 1: so constitute shortness of breath. Um. The other thing to
Speaker 1: keep in mind is shortness of breath by itself probably
Speaker 1: doesn't show up without some other symptoms, such as, um,
Speaker 1: you know, a fever, which is the single most common
Speaker 1: symptom we see in people who are infected. But of
Speaker 1: course it's important to understand people can develop fevers for
Speaker 1: any sort of you know common you know, cold or
Speaker 1: anything like that orl right, absolutely, and so all of
Speaker 1: this I think points to something which is, you know,
Speaker 1: do as much as you can buy phone right, call
Speaker 1: your doctor, walk through all of these things and and
Speaker 1: let you let your doctor help you decide if you
Speaker 1: actually need to take the next step of getting tested,
Speaker 1: which again we're currently in a testing environment that is
Speaker 1: not adequate. So the CDC guidelines on testing are actually
Speaker 1: quite stringent compared to what I think they should be
Speaker 1: due to these limitations. So you know that that does
Speaker 1: raise the question who should be tested and who shouldn't
Speaker 1: and uh, sort of thinking about the common good and
Speaker 1: not just yourself in these situations. But gosh, you know,
Speaker 1: we're talking about in some cases life or death, peter
Speaker 1: and so people I think, you know, they have this
Speaker 1: primal survival instinct. So uh, in terms of testing, you
Speaker 1: have to rely on your health care provider. But they're
Speaker 1: making some tough decisions in Italy about who who gets
Speaker 1: medical attention and who doesn't because of the crowded conditions
Speaker 1: of hospitals, etcetera. I mean, it's it really feels like
Speaker 1: the makings of a of a sci fi movie. Yeah,
Speaker 1: they are making these decisions in Europe um already, and
Speaker 1: it's not clear if we're not going to be in
Speaker 1: the same position in the next two to three weeks.
Speaker 1: UM as far as testing goes at the time, at
Speaker 1: right this moment, Katie, the CDC sidelines are that testing
Speaker 1: should be reserved for people who are symptomatic only. Now,
Speaker 1: why do I think that that's insufficient? Um? I think it.
Speaker 1: If you really want to control the rate of spread,
Speaker 1: you should also be testing people with known exposure, even
Speaker 1: if they are asymptomatic. Because this virus has such a
Speaker 1: long latency period. Let's assume that you know, you are
Speaker 1: around somebody who then went on to test positive or
Speaker 1: frankly even went on to be symptomatic. In an ideal world,
Speaker 1: if we had a sufficient number of tests and a
Speaker 1: sufficient infrastructure for testing, it would actually be important to
Speaker 1: know that you were negative before you know, we told you, hey,
Speaker 1: it's you know. The fact that you're not symptomatic means
Speaker 1: you're not at risk. In other words, the thing that
Speaker 1: makes this virus so particularly troublesome is that people who
Speaker 1: have no symptoms can spread the virus, and they can
Speaker 1: do so for a long period of time, for fourteen days, right,
Speaker 1: I mean, isn't that the inky bastion period and the
Speaker 1: fact that some people can be vectors and yet never
Speaker 1: symptomatic that makes it really freaky. Right, Yeah, that's the
Speaker 1: that's the superpower of this virus. So if you were
Speaker 1: gonna like create a you know, a list of all
Speaker 1: the things that make this virus sort of troubling, that
Speaker 1: that would be its superpower is that it has this
Speaker 1: ability to very subtly get you know, get from one
Speaker 1: person to another, usually without that person knowing it. And
Speaker 1: again we'll use Ebola as a stark contrast. Right, why
Speaker 1: was Ebola not really a big issue once it got
Speaker 1: into um the United States? Because people were so sick
Speaker 1: when they got it that there was no ambiguity about
Speaker 1: whether that person had it and it was only during
Speaker 1: that period of extreme sickness that they could go on
Speaker 1: and shed the virus. If in fact, people are practicing
Speaker 1: social distancing, now all these cities are closing down, I
Speaker 1: guess you know San Francisco is a shelter in place
Speaker 1: city other cities as well. Is that going to ameliorate
Speaker 1: or mitigate some of the conditions that will be prime
Speaker 1: for spreading this virus around or have we missed that
Speaker 1: window of opportunity, Peter. It will absolutely have an impact.
Speaker 1: I mean, in an ideal circumstance, if we had a
Speaker 1: time machine. I think we would have done this, we
Speaker 1: would have taken these precautions a month sooner. But I'm
Speaker 1: actually still optimistic. And you know, we have a team
Speaker 1: of analysts that are building forecast models, reviewing every piece
Speaker 1: of data that's available and including data that aren't publicly
Speaker 1: available by you know, you speaking with people on the
Speaker 1: front lines to pressure test assumptions. I don't think that
Speaker 1: it's a foregone conclusion how this ends. So um you know,
Speaker 1: I can't even sit here and project how many people
Speaker 1: are going to be infected in the United States, although
Speaker 1: there are lots of estimates, and some of them are
Speaker 1: quite scary. You know, Mark Lipsitch at the Harvard School
Speaker 1: of Public Health projects that you know, more than the U.
Speaker 1: S population will ultimately be infected by this, and that
Speaker 1: the mortality rates we're seeing those are staggering numbers. That
Speaker 1: that the implication of that, by the way to put
Speaker 1: it in some numbers, is more people would die from
Speaker 1: this virus in a year in the next year than
Speaker 1: die of all other things combined. I mean that that's
Speaker 1: a staggering statistic. Do I think that that is set
Speaker 1: in stone yet, that that is our fate? I don't.
Speaker 1: And I do think that the more aggressively we can
Speaker 1: socially distance ourselves, the more aggressively we can implement testing
Speaker 1: which will enable this stratification of distancing between people, and
Speaker 1: the more readily available we can be pressure testing existing
Speaker 1: drugs to then bring on treatments that can reduce the
Speaker 1: mortality and morbidity. I think we still have a chance
Speaker 1: to bend the curve of this thing. We're going to
Speaker 1: take a break, but we'll be right back with more
Speaker 1: critically important information from Dr Peter A Tilla. Hi, everyone,
Speaker 1: I'm so happy we were able to get in touch
Speaker 1: with Dr Peter Attia and he was able to spend
Speaker 1: a good hour talking to us about this scary pandemic
Speaker 1: because I think his knowledge, his experience, and his connections
Speaker 1: are really unparalleled. So let's get back to that important conversation.
Speaker 1: Let's say someone goes to the hospital, Peter, and they
Speaker 1: have COVID nineteen. I know that ventilators and respirators to
Speaker 1: help with lung capacity, but are there any medicines that
Speaker 1: these people are keetting or are they just going to
Speaker 1: the hospital? And uh, I mean, how are the how
Speaker 1: are doctors fighting it right now? It's varying by hospital.
Speaker 1: So myself and my team, we have enough friends in
Speaker 1: hospitals that we're hearing, you know, we're finding out this
Speaker 1: hospital in Boston is using this protocol, this hospital in
Speaker 1: New York is doing this, etcetera. UM, So right now,
Speaker 1: I would say, Katie, it's not standardized, but you're crazy.
Speaker 1: I mean, that seems insane to me. That it's not
Speaker 1: that it isn't standardized, that it's sort of kind of
Speaker 1: a piecemeal approach. Well, the primary approach, as you said,
Speaker 1: is supportive care. So the single most important thing for
Speaker 1: a person once they're in the hospital is maintaining sufficient
Speaker 1: respiration because that's the thing that's going to put a
Speaker 1: person in the hospital. So the most common thing that
Speaker 1: people are presenting with his respiratory failure as opposed to
Speaker 1: say cardiac failure, renal failure, or other organ failure. So
Speaker 1: you know, the first, second, and third line of defense
Speaker 1: is through you know, oxygen and supplemental respiratory care, hopefully
Speaker 1: not requiring mechanical ventilation, but obviously at some point that's
Speaker 1: happening for enough people. That's that's the sort of supportive
Speaker 1: side of things. UM. And I think we are seeing
Speaker 1: more and more patients being treated with um chloroquin and then,
Speaker 1: of course if the doctor's treating the patient have reason
Speaker 1: to believe that they're now developing secondary infections, then things
Speaker 1: like antibiotics are coming on board. And if it turns
Speaker 1: into pneumonia exactly if it's a pneumonia that they believe
Speaker 1: is an actual bacterial pneumonia versus sort of a viral
Speaker 1: pneumonia for which the antibiotics wouldn't provide any benefit. There's
Speaker 1: also HIV drugs. There's a drug that that is a
Speaker 1: protease inhibitor that I think is sort of weakly um
Speaker 1: potentially helpful. It's still too soon to say, but the
Speaker 1: of using it seems relatively low, so it's it's also
Speaker 1: being tested. UM one drug that I think to three
Speaker 1: weeks ago we thought might be valuable that is looking
Speaker 1: less valuable as the common anti flu drug called tama flu,
Speaker 1: so I think most hospitals are moving away from that now.
Speaker 1: But again UM it is unfortunately not a fully standardized
Speaker 1: protocol because even though the CDC will have a recommendation,
Speaker 1: ultimately the physicians are the ones at the bedside that
Speaker 1: are going to be able to make the decisions. Can
Speaker 1: you reverse this? So let's say someone goes to the
Speaker 1: hospital they're having respiratory failure. Can those individuals with you know,
Speaker 1: breathing assistance, with the ventilator a respirator, can they then,
Speaker 1: um get the virus that, as you said, was sort
Speaker 1: of taking over the cells and their lungs. Can they
Speaker 1: how do they get that? How do they get it
Speaker 1: out of their lungs? I know this ounds sort of elementary,
Speaker 1: but I'm just trying to figure out, you know, is
Speaker 1: that kind of support enough to eradicate this virus? Um. No,
Speaker 1: it's actually not an elementary question at all. It's a
Speaker 1: very important question. What's actually happening is there's a war
Speaker 1: going on between the virus and the immune system, and
Speaker 1: the whole purpose of supportive care such as ventilation is
Speaker 1: to buy time for the immune system to win that fight.
Speaker 1: Now it becomes a bit complicated because the immune system,
Speaker 1: in its best effort to win that fight, can also
Speaker 1: cause a lot of damage to the host. So you
Speaker 1: think of it like a war going on in a country.
Speaker 1: You have the good guys the bad guys. At the
Speaker 1: risk of oversimplifying it, well, both of those entities when
Speaker 1: engaging in war caused collateral damage, and so it's like
Speaker 1: immunotherapy and cancer, it becomes too refed up and that
Speaker 1: can create all kinds of autoimmune issues. Correct. Absolutely, So
Speaker 1: the you know, the checkpoint inhibitors, which you know are
Speaker 1: probably the most exciting thing in all of immuno oncology
Speaker 1: right now, um, exactly have that as a side effect,
Speaker 1: which is autoimmunity. The immune system goes a little too
Speaker 1: far now in in this type of response to the
Speaker 1: immune system. It's not so much autoimmunity that we're seeing
Speaker 1: as the problem, but it's the sort of um, what's
Speaker 1: called systemic inflammatory response syndrome or this cytokine storm that
Speaker 1: is sort of you know, wreaking havoc both to kill
Speaker 1: the viruses, but it's also the thing that can you know,
Speaker 1: cause capillary leaking in the lungs that can lead to
Speaker 1: other things like edema, and it can damage other parts
Speaker 1: of the body. So basically what you're saying is that
Speaker 1: it's a delicate balance between the immune system, which can
Speaker 1: cause inflammation and damage if it's overly compensating for the
Speaker 1: virus and sort of keeping the virus in check. YEP.
Speaker 1: And we use supportive measures like ventilation to base sally
Speaker 1: by time to augment what the lung needs to do
Speaker 1: to to create that amount of time and space necessary
Speaker 1: for the immune system to ultimately win that fight. But
Speaker 1: winning the fight means that the virus has gone, you know,
Speaker 1: winning the fight means that the number of actual copies
Speaker 1: of that virus goes down to some insignificant level um
Speaker 1: and you know, to you know, to contrast that with
Speaker 1: other things, like when you look at the Spanish flu,
Speaker 1: the one and one pandemic, that was kind of a
Speaker 1: different animal. You know, that was an animal where so
Speaker 1: much of the damage actually came from the hyperactive immune
Speaker 1: response and then this immune paralysis that followed it that
Speaker 1: led to these secondary infections. So you know, paradoxically, the
Speaker 1: people that were most vulnerable to that flu were people
Speaker 1: that had the most robust immune system and therefore the
Speaker 1: strongest immune response. We're not seeing that here, which suggests
Speaker 1: again it's just a suggestion that a hyper active immune
Speaker 1: response is less of a problem than the actual damage
Speaker 1: the virus is causing to the cells. That's fascinating. Um.
Speaker 1: That raises a couple of questions about ventilators and respirators
Speaker 1: and I don't even know the difference, and maybe you
Speaker 1: can explain that. But uh, there's a real shortage of
Speaker 1: medical equipment. How serious a problem will it be if
Speaker 1: there is a lack of ventilators or respirators to buy
Speaker 1: the time these patients need and what is being done
Speaker 1: about that? So it's a huge problem. Let me answer
Speaker 1: your first question. So, respirators are non invasive. So um
Speaker 1: for example, you've probably visited somebody in the hospital and
Speaker 1: you see like a little oxygen mask that they have on,
Speaker 1: or even something called a nasal canyla where there's a
Speaker 1: little device that goes under their nose that's just passively
Speaker 1: blowing oxygen at them. So you know, you can you
Speaker 1: can provide a person with supplemental oxygen in that sort
Speaker 1: of passive manner. But when a person becomes really dependent
Speaker 1: on oxygen, they require something called mechanical ventilation, and to
Speaker 1: do that you have to undergo a procedure called intibation,
Speaker 1: which anybody who has had surgery has has you know,
Speaker 1: under general and aesthetic has had that. But that's where
Speaker 1: a tube is actually placed into the main airway called
Speaker 1: the trachea. So it's called an endotracheal tube. When a
Speaker 1: person is intibated, they also have to be paralyzed and sedated.
Speaker 1: It's not a comfortable thing. You You couldn't be wide
Speaker 1: awake sitting there intibated um, so you have to be
Speaker 1: sedating the patients and paralyzing them. And the reason you
Speaker 1: have to do that is that their own voluntary muscular
Speaker 1: movements can't fight the ventilator, so you actually have to
Speaker 1: basically shut them down to let the machine do the breathing.
Speaker 1: And you're absolutely right that these ventilators are very, very
Speaker 1: specific and specialized pieces of medical equipment, and at some
Speaker 1: point we will run out of them. In fact, was
Speaker 1: just speaking to someone today at a small hospital outside
Speaker 1: of New York City and they are now they have
Speaker 1: just used their last ventilator, and they are now what's
Speaker 1: called double venting patients, which means using one ventilator to
Speaker 1: treat two patients, which you would normally never do because
Speaker 1: of the contamination. Those two patients are now fully sharing
Speaker 1: all their respiratory pathogens. But of course, you know, desperate
Speaker 1: times call for desperate measures, and if these patients both
Speaker 1: have the same virus and they are both suffering from
Speaker 1: you know the COVID nineteen disease, then we we you know,
Speaker 1: we'll do what we have to do. And then technically
Speaker 1: a ventilator can probably be split up to four ways.
Speaker 1: But at some point soon and it could be within
Speaker 1: two to three weeks, this could become an enormous problem,
Speaker 1: and so well can can can We are manufacturers kind
Speaker 1: of speeding up the production of these pieces of equipment.
Speaker 1: They are, but is still another bottleneck. And the one
Speaker 1: thing that we can't make more of is doctors, nurses
Speaker 1: and respiratory therapists, and so these pieces of equipment can't
Speaker 1: work on their own. You know, a doctor is necessary
Speaker 1: to put the end of tracheal tube in. Nurses and
Speaker 1: respiratory therapists are necessary to actually run the ventilators and
Speaker 1: manage the medications on a minute to minute basis. And
Speaker 1: so it can't be overstated that a really fundamental break
Speaker 1: point in this system could occur when the health care system,
Speaker 1: through its workers, is so overwhelmed that we can't actually
Speaker 1: have people on the front lines that are doing this work.
Speaker 1: So how do they protect themselves because obviously we need
Speaker 1: them desperately to be treating patients. We probably need to
Speaker 1: and I know that a lot of retired medical professionals
Speaker 1: are being called in UM. Are are they getting sick?
Speaker 1: I know that some are, and should I mean, how
Speaker 1: worried are you about that? I'm actually quite worried about
Speaker 1: it because of some data that we're seeing from around
Speaker 1: the world, including China and Italy, which is that when
Speaker 1: healthcare workers get it, they seem to get a worse
Speaker 1: version of it, suggesting at least preliminarily, that there might
Speaker 1: be something about the amount of virus or the manner
Speaker 1: in which they're exposed to it that is otherwise making
Speaker 1: it worse than if they just acquired this virus out
Speaker 1: in the community. So that's the first thing that has
Speaker 1: me somewhat concerned. So how do you think they're getting it? UM?
Speaker 1: Probably just through a greater concentration of respiratory droplets, given
Speaker 1: the you know, the proximity that they have to people
Speaker 1: who are sick. And obviously, if someone is sick and
Speaker 1: they're in respiratory distress and you're intibating them, you're leaning
Speaker 1: over a person, and you're just being exposed to a
Speaker 1: much greater amount of virus than say, if you bumped
Speaker 1: into somebody at the supermarket. The other thing that is
Speaker 1: in short supply is ppe. It's the protective equipment that
Speaker 1: the doctor's, nurses, respiray therapist, all the people in the
Speaker 1: hospital need to protect themselves against this virus. And so
Speaker 1: inasmuch as we need to be making more ventilators, we
Speaker 1: also need to really be ramping up on the production
Speaker 1: of all of the protective equipment. And the countries that
Speaker 1: have done this well, I mean China did this very
Speaker 1: well in the second wave. So in the second wave
Speaker 1: after Wuhan, very few of the healthcare workers became infected.
Speaker 1: So once they dialed in on how to protect their
Speaker 1: healthcare workers, um, they were able to do this in
Speaker 1: a much safer way. So you know, if I could
Speaker 1: wave a magic wand we'd be making more ventilators, we'd
Speaker 1: have more actual beds and spaces in the hospital, we'd
Speaker 1: have more protective equipment for the healthcare workers, and obviously
Speaker 1: we'd have more testing available so that we could more
Speaker 1: quickly identify and stratify patients at risk. Speaking of that,
Speaker 1: I know that a one thousand bed naval hospital ship
Speaker 1: is being dispatch to New York Harbor. We may be
Speaker 1: seen some of these medical ships that are often used
Speaker 1: in times of war being deployed in specific ports all
Speaker 1: around the country. Yeah, it's it's sort of hard to
Speaker 1: believe how much has happened in one week. Um. And
Speaker 1: and it's it speaks to the nature of non linear
Speaker 1: exponential growth and and and again. You know, the irony
Speaker 1: of it is that which we're talking about today, in
Speaker 1: a week or two weeks will seem pedestrian in terms
Speaker 1: of what we will know because of how quickly things
Speaker 1: are changing, including you know, the rate at which you
Speaker 1: know hospitals are running out of ventilators. We should uh
Speaker 1: mention one thing, and that is a failure to comply
Speaker 1: with CDC guidelines. I hope we're not seeing as many
Speaker 1: kids in bars, and not just kids. You know. My
Speaker 1: neighbor in New York City who lives on the Upper
Speaker 1: Side said the bar was packed for St. Patrick's Day.
Speaker 1: And it's so infuriating. But not only young people. I
Speaker 1: read an article this morning about children of baby boomers
Speaker 1: trying to get their parents in their seventies to not travel,
Speaker 1: to not go to casinos. Um. It seems insane to
Speaker 1: me that people are being uh so stupid and in
Speaker 1: some cases so selfish about this or ignorant what is
Speaker 1: that about? It's it's so interesting you say that because
Speaker 1: I have noticed two extremes um and again these are anecdotes,
Speaker 1: so I can't speak to this from sort of real
Speaker 1: aggregated data. But you're absolutely right. I have noticed far
Speaker 1: more concern from my patients about their parents than their kids.
Speaker 1: First for starters, So the you know, I just I
Speaker 1: could rattle off ten stories about, you know, people who
Speaker 1: are in their seventies who have decided, Yep, we're gonna
Speaker 1: we're gonna to the casino this weekend and we're gonna
Speaker 1: go do this, and we're gonna go and do that,
Speaker 1: and none of this stuff matters, and we're going out
Speaker 1: and you know, doing all those things. And again I
Speaker 1: have no idea what it is that. You know, I
Speaker 1: could speculate and say, look, people at that age have
Speaker 1: been through a lot and they've decided, hey, if it
Speaker 1: hasn't got me, now it's not going to. And there's
Speaker 1: sort of a false sense of confidence. Potentially, I think
Speaker 1: they survives the stars outbreak and they've been there, done that. Yeah,
Speaker 1: there's a little bit of that. Um, we certainly saw
Speaker 1: a little bit of that Machismo in New York two
Speaker 1: weeks ago, which I haven't seen. I've seen it damned
Speaker 1: down a bit, which was, hey, look, we survived nine eleven.
Speaker 1: This thing is not going to get us. Um. Obviously
Speaker 1: that's apples and oranges. So it's sort of a nonsensical comparison. Um.
Speaker 1: But I do share your concern with the number of
Speaker 1: people who aren't respecting these quarantines. In fact, our nanny
Speaker 1: who's in college, one of her classmates was an exchange
Speaker 1: student in Italy, so he had to come back from Italy,
Speaker 1: and he tested positive upon arrival, and so he was
Speaker 1: placed in a quarantine, which he violated. So he was
Speaker 1: seen out on social media three days after testing positive
Speaker 1: and being forced into a quarantine, out at a party,
Speaker 1: and so, you know, that kind of stuff is really upsetting,
Speaker 1: and I think it is a bit of a communication
Speaker 1: breakdown because I don't think that these people would really
Speaker 1: be doing this if they understood the significance of what
Speaker 1: they're doing. I just don't think people are that selfish
Speaker 1: or that evil if they really understand the significance, which is, hey,
Speaker 1: you can feel fine. You know, you college student who's
Speaker 1: twenty years old, who tested positive who you know has
Speaker 1: a little bit of a sore throat. It's not about
Speaker 1: you getting worse. It's about what you could do to
Speaker 1: somebody who could then go and do it to somebody else. Right,
Speaker 1: It's like you infect another kid at that party, they
Speaker 1: go home and infect their grandmother or something like that. So,
Speaker 1: you know, my hope is that we're just going to
Speaker 1: educate people a lot more about why the stakes are
Speaker 1: high and how we all kind of have a responsibility
Speaker 1: here to not just protect ourselves, but to then protect
Speaker 1: others through that protection. I don't want to play the
Speaker 1: blame game, but was critical time lost when this wasn't
Speaker 1: taken seriously by the administration and frankly by some in
Speaker 1: the news media. How how much damage was done by
Speaker 1: that two or three week period where it just wasn't
Speaker 1: treated as a serious threat to public health? Well you
Speaker 1: alluded to the the Ted talk by Bill Gates, which
Speaker 1: is now five years old, and he sort of predicted, uh,
Speaker 1: in pretty frightening um, you know, reality, what was potentially
Speaker 1: going to come if I were going to, you know,
Speaker 1: really say, if if I could go back in time
Speaker 1: and change one thing in the last three months, what
Speaker 1: would it be. It's the following on January, the genome
Speaker 1: of this novel, coronaviruns was sequenced and it was made
Speaker 1: public another Chinese you got it. So the Chinese immediately
Speaker 1: figured out what this was, immediately confirmed it was a novel,
Speaker 1: brand new, never before seeing coronavirus, and put that information
Speaker 1: out to the world, and some companies immediately ran and
Speaker 1: developed pcr kits. And you know, one of those companies
Speaker 1: in China has basically gone on to do over a
Speaker 1: million tests already and have incredible data with specificity and sensitivity.
Speaker 1: They can do a four hour turnaround. In fact, they've
Speaker 1: already built fifty laboratories in China, each one capable of
Speaker 1: doing fifty thousand to a hundred thousand tests per day.
Speaker 1: What we did, in my opinion, was the biggest mistake,
Speaker 1: which was basically ignoring that information, and then when push
Speaker 1: came to shove sort of doing a botched job, the
Speaker 1: CDC sort of put together its own um set of
Speaker 1: primers that ended up not working very well. And then
Speaker 1: eventually we got around to potentially doing something with a
Speaker 1: company called Row. And where we are right now at
Speaker 1: the time of this discussion is we still don't really
Speaker 1: have any viable means of testing. We're probably just a
Speaker 1: little bit over fifty thou people have been tested in
Speaker 1: the United States, which is you know, two log orders
Speaker 1: below where we need to be. So if you can
Speaker 1: we just use the testing that's being used in other
Speaker 1: places like South Korea, the one that was developed by
Speaker 1: the w h O. Did the CDC simply think that
Speaker 1: that test was inadequate? It seems to me that was insane.
Speaker 1: At least use them while we develop a more specific test. Yeah,
Speaker 1: that that is absolutely correct. So we are now in
Speaker 1: a situation called emergency use authorization where I think the
Speaker 1: CDC has finally realized that they're not going to be
Speaker 1: the ones to solve this problem, and they're basically saying,
Speaker 1: you know, so the Secretary of hss UM, the Secretary
Speaker 1: of Health and Humans has has basically said, you know,
Speaker 1: you can go and do this test on your own.
Speaker 1: So I think right now what we're going to see
Speaker 1: as states making their own decision on what to do,
Speaker 1: and in fact, we're working with one state right now
Speaker 1: to try to help them to actually just get that
Speaker 1: test from China directly, because in my opinion, not does
Speaker 1: that not seem insane to you. I mean, does that
Speaker 1: not seem a massive failure of the federal government. Yeah.
Speaker 1: And again I'm not the conspiracy guy, so I I
Speaker 1: attribute these things more to just you know, negligence than
Speaker 1: anything nefarious. And I've certainly heard people speculating that, you know,
Speaker 1: there's sort of you know, an anti China bias and
Speaker 1: all of these things. But but I have to be honest.
Speaker 1: I think China has been very forthcoming here, and I
Speaker 1: think this demonization of China UM, either either you know,
Speaker 1: covert or you know or sort of explicit or implicit,
Speaker 1: has really hurt us. UM. I think I think China
Speaker 1: has been very forthcoming with their data, and for some reason,
Speaker 1: our decision to not utilize exactly what they offered us
Speaker 1: as far as testing has set us back, put us
Speaker 1: on our heels. And my hope is that in the
Speaker 1: next week the bell gets rung pretty loud on that
Speaker 1: and we you know, we we take on these tests
Speaker 1: because again, it's not an economic question. The United States
Speaker 1: is very fortunate we can afford to do the testing. Um.
Speaker 1: It's really a question of deployment and other things. You know,
Speaker 1: you asked questions about running out of things, Well, we
Speaker 1: don't even have enough swabs right now, so we're not
Speaker 1: just having to buy the PCR test gets. We actually
Speaker 1: have to make sure we have enough re agents to
Speaker 1: use them, enough swabs to actually you know, test them
Speaker 1: on the people. Um. And that's the stuff that really
Speaker 1: we should be stockpiling that stuff, right and and and
Speaker 1: we certainly in early January should have been preparing for
Speaker 1: this to spread. And again, I I think Bill Gates
Speaker 1: spoke to all of those things five years ago at
Speaker 1: the tail end of the Ebola outbreak, when he said, look,
Speaker 1: it's not a question of if, but when this happens again.
Speaker 1: And yet the group responsible for a pandemic response, or
Speaker 1: the Pandemic Response Team, was disbanded in two THO. Yeah,
Speaker 1: I mean Michael Lewis's book The Fifth Risk, I think
Speaker 1: does a great job of explaining all the non sexy
Speaker 1: parts of government that we tend to forget about until
Speaker 1: disaster hits um And it's funny I read that book
Speaker 1: when it came out, so I don't even remember if
Speaker 1: in the book Michael Lewis talked about this particular side
Speaker 1: of the government. But you're absolutely right, this is this
Speaker 1: is a part of government that when things are good,
Speaker 1: it's easy to forget about It's easy to say, hey,
Speaker 1: we can, we can, we can cut costs by getting
Speaker 1: rid of them. Um. But but you know, you think
Speaker 1: of this like you think of insurance, right, You don't
Speaker 1: buy insurance for your home after it burns down. You
Speaker 1: have the insurance in place before there's a fire. Before
Speaker 1: we go on, one last question, even though I could
Speaker 1: talk to you for hours, Peter um, and that is,
Speaker 1: is there any evidence that once you get the this
Speaker 1: pathogen or this virus, you build some immunity to getting
Speaker 1: it a second time? Or is that just a complete unknown?
Speaker 1: I think it's an unknown right now, Katie. There are
Speaker 1: two issues at hand. The first is is this going
Speaker 1: to be like influenza, where if you get it in
Speaker 1: a given season, you're not likely to get it again,
Speaker 1: but you'll always be susceptible to it in subsequent seasons
Speaker 1: because it has enough genetic migration or drift year upon
Speaker 1: year upon year. Or is it something like you know,
Speaker 1: the measles or polio, where once you are vaccinated against it,
Speaker 1: once you know it doesn't that the virus is not
Speaker 1: moving around genetically very much. And you know, either getting
Speaker 1: vaccinated against it, or in this case, if you acquire
Speaker 1: the virus and recover, you're fine. We certainly think in
Speaker 1: the short term there is immunity, and that's one of
Speaker 1: the other really exciting potential therapies right now is something
Speaker 1: called convalescent serum, where you actually take blood from a
Speaker 1: person who has recovered, you ident deify the you know, uh,
Speaker 1: the sort of the antigens and things that are in
Speaker 1: the blood, and you can then infuse them into people
Speaker 1: who are sick as a form of therapy at high
Speaker 1: doses or at low doses to impart short term immunity
Speaker 1: on people. So given that we're seeing um reasonable evidence
Speaker 1: of the efficacy of convalescence serum, that tells us that
Speaker 1: there must be at least some immunity that's acquired from this. Peter,
Speaker 1: thank you very much for spending some time with us
Speaker 1: talking about this very scary situation. Well, Katie, thank you
Speaker 1: for what you're doing. Your podcasts on this topic have
Speaker 1: been fantastic, So anything I can do to to help
Speaker 1: you get this message out. It's an honor that was
Speaker 1: Dr Peter Attia. You can follow more of his coronavirus
Speaker 1: coverage on his Twitter at Peter Attia empty and on
Speaker 1: his podcast which is called The Drive, and that does
Speaker 1: it for this episode of Next Question. A reminder to
Speaker 1: all of our listeners are reported episodes on topics like
Speaker 1: maternal mortality and the environmental impact of meat are still
Speaker 1: to come, but in the next season coming out this summer.
Speaker 1: The rest of this season, as we mentioned, throughout March
Speaker 1: and into April, will be dedicating to the coronavirus. You
Speaker 1: can also follow us on Instagram and other social media
Speaker 1: outlets for day to day coronavirus coverage. My morning newsletter
Speaker 1: wake Up Call will also be dedicated to this topic
Speaker 1: and you can subscribe to that by going to Katie
Speaker 1: Couric dot com. And a quick reminder, if you want
Speaker 1: to share a story of kindness you've experienced or witnessed
Speaker 1: in this extraordinary time, tell me. You can leave your
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Speaker 1: very trying times. Stay safe, Stay indoors and we'll get
Speaker 1: through this together. Thank you all so much for listening,
Speaker 1: and until next time and my next Question, I'm Katie Couric.
Speaker 1: Next Question with Katie Curic is a production of I
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