Speaker 1: Oh hey, it's that sticky quarter hiding under your floor mat,
Speaker 1: just waiting for you to get desperate enough to use
Speaker 1: it at a parking meter. Ali ward back with a
Speaker 1: coronasde This is the third installment of coronavirus episodes. The
Speaker 1: first one was with virologist doctor Shannon Bennett from cal Academy,
Speaker 1: and then we had an isolation era March thirty. First
Speaker 1: episode called All Washed, Hands on Deck with doctor Michael
Speaker 1: Wells about testing resources, what we can all do to help,
Speaker 1: and also how to practice self care during a really
Speaker 1: tough time. So it's been two months and things are
Speaker 1: starting to slowly reopen in the US and we all
Speaker 1: have a lot of questions. So I hopped on the
Speaker 1: horn with past guests doctor Mike Natter. He is a
Speaker 1: physician in New York City who you know from the
Speaker 1: Diabetology episodes. He has been on the front lines in
Speaker 1: emergency and ICU units and gives us an account of
Speaker 1: the disease prognoses what to expect next. I also chatted
Speaker 1: with doctor Shannon be a virologist extraordinaire, to talk about
Speaker 1: how the virus behaves and how we should behave because
Speaker 1: that's a big part of it. But before we get
Speaker 1: to them quickly, just a few thanks to everyone on
Speaker 1: patreon dot com slash ologies for submitting questions for this
Speaker 1: episode this is all your questions, and for supporting for
Speaker 1: as little as a buck a month. Thank you to
Speaker 1: everyone sending these episodes around via word of mouth and
Speaker 1: social media and subscribing and rating and of course reviewing.
Speaker 1: Your reviews have kept me company during a lonely time,
Speaker 1: and as proof, I read a fresh one that someone
Speaker 1: left each week. This one is from history Kid, who
Speaker 1: says that this podcast makes learning about topics I've never
Speaker 1: even heard of so interesting and enjoyable. I have to
Speaker 1: confess her intro and the shows the music always make
Speaker 1: this fifty five year old man cry with joyful anticipation.
Speaker 1: Thank you History Kid for letting me creep your weeps,
Speaker 1: and everyone who left reviews this week for serious Okay,
Speaker 1: let's get to the interviews with doctors Natter and Bennett.
Speaker 1: You'll learn about her immunity and vaccine progress, what it's
Speaker 1: been like on the front line, if the virus will mutate,
Speaker 1: if it's seasonal, what ppe we should be wearing, if
Speaker 1: picnics in the park are a good idea and when
Speaker 1: you can hug people again, are handshakes canceled? You will
Speaker 1: find out it starts off tough, explaining the importance of
Speaker 1: having flattened the curve, and by the end you will
Speaker 1: have a clearer picture of the future. So get comfy
Speaker 1: and listen up and then bang on a saucepan and
Speaker 1: applaud into the dusk were physician doctor Mike Natter and
Speaker 1: virologist doctor Shannon Bennett.
Speaker 2: Okay, my goal is to not cry in the thirty
Speaker 2: minute chat that we have.
Speaker 1: Please don't feel like you have to stick to that.
Speaker 2: Can I tell you I've been ugly crying like I
Speaker 2: feel like what I imagine a very very pregnant woman
Speaker 2: with like lots of hormones flowing through.
Speaker 1: So you heard doctor Macnatter in the Diabetology episode, and
Speaker 1: you may recall that he is a super sweet, super
Speaker 1: empathetic dude, and he works in a family of three
Speaker 1: hospitals in Manhattan, and he has seen things not on
Speaker 1: the news, not explained via press conference, but firsthand, so
Speaker 1: he knows the real shit. Can you explain to me
Speaker 1: a little bit of what it's been like since early March. Yeah,
Speaker 1: mid late March.
Speaker 2: It was a lot. There's a lot of volume. We
Speaker 2: had to basically kind of just to give you some scale,
Speaker 2: just to like, and it's always tough because like when
Speaker 2: you're in the hospital, like you see the trees, you
Speaker 2: don't see the forests, so you don't necessarily know what
Speaker 2: everyone else's experience is. So I can really only speak
Speaker 2: to that I was seeing a lot of trees, a
Speaker 2: lot more trees than is typical for this patch of forest,
Speaker 2: So just to give you some scale. The hospital and
Speaker 2: internal medicine works like this. If you come to the
Speaker 2: emergency room, they try and gets you better so that
Speaker 2: you don't have to be admitted if you are sick
Speaker 2: enough to need admission, which unfortunately many of the folks
Speaker 2: that have like really bad COVID do need because their
Speaker 2: oxygenation is so low. If they are sick but not
Speaker 2: too sick, they go to what's called the general floor.
Speaker 2: We call it the floor, or like some people call
Speaker 2: it the ward, the wards. The general medicine floor is
Speaker 2: kind of like you're sick enough to be admitted, but
Speaker 2: you're not on death's door by any means. And then
Speaker 2: if you get sicker, then you go to what we
Speaker 2: call the unit, which is short for the ICU. There's
Speaker 2: different flavors of ICU, but in general they're just all
Speaker 2: acute critical care. On average, there will be in one
Speaker 2: ice you let's say there's maybe thirty forty beds, there
Speaker 2: will be maybe on my particular team, ten to twenty patients,
Speaker 2: of which maybe five to seven of them are intubated
Speaker 2: and very very very sick. The entire ICU, plus a
Speaker 2: million other floors that we had to kind of make
Speaker 2: shift into ICUs, were being overrun with the patients. There
Speaker 2: was hundreds, literally at the peak at this particular hospital,
Speaker 2: I think close to two hundred intubated ventilated ventilator you know,
Speaker 2: necessitating patients. And it was really, really really bad. So
Speaker 2: that was bad, And that was at one particular hospital,
Speaker 2: and then I went to I rotate between another one,
Speaker 2: and the other hospital up the street, which has a
Speaker 2: lot more resources, was even more overrun than that hospital.
Speaker 2: But we had people from surgery, from plastic surgery, from pediatrics,
Speaker 2: from psychiatry, from neurology who we just needed to kind
Speaker 2: of help us essentially with the volume, and so it
Speaker 2: was like an on flought of volume patients.
Speaker 1: What was life like in New York at that time.
Speaker 1: Because you're born in New York, you've lived most of
Speaker 1: your life in New York. What's it like going from
Speaker 1: the hospital is back home every day knowing that that's
Speaker 1: kind of an epicenter in America.
Speaker 2: It's scary. I mean, I think, you know, New Yorkers
Speaker 2: are pretty rough and pretty and nothing really affects anyone
Speaker 2: and everyone kind of no matter what's going on in
Speaker 2: the world, everyone seems to kind of be able to
Speaker 2: do their thing no matter what, and there was this
Speaker 2: clear sense of kind of unity and camaraderie. You know.
Speaker 2: The only other time that I've lived through that felt
Speaker 2: even remotely close, but for very different reasons, I think
Speaker 2: was nine to eleven, and to some degree a little
Speaker 2: bit post Superstorm Sandy. But it just was different, Like
Speaker 2: it's a very different vibe. It's so eerie and very
Speaker 2: uncomfortable and jarring for me to see the streets as
Speaker 2: empty as they are, because that's something that's like a
Speaker 2: constant of New York. The lights are on, people are
Speaker 2: moving around, things are going on, no matter how crazy
Speaker 2: the world gets, and the fact that that's not the
Speaker 2: case was also i think extremely noticeable and jarring. MM hmm.
Speaker 1: How are doctors looking at the curve for New York?
Speaker 1: Where is it at Now we're in that beginning of May.
Speaker 2: It's looking a lot better. I mean, it's all. What
Speaker 2: I would say is thanks to you good leadership from
Speaker 2: Cuomo and some degree to Blasio, because it's the idea
Speaker 2: of shutting things down to limit the spread, and we
Speaker 2: are seeing a massive flattening of the curve for that reason.
Speaker 2: Hospital of mission rates are significantly down. Death rates are
Speaker 2: coming down each day. There still are packed ICUs and
Speaker 2: there's still lots and lots of very, very sick, sick patients,
Speaker 2: but we're able to manage them because the volumes have
Speaker 2: started to settle down. It's almost indefinitely thanks to the
Speaker 2: social distancing and the lockdown and the kind of shelter
Speaker 2: and place orders that have been issued by the governor.
Speaker 1: So a few patrons had questions about symptoms of COVID
Speaker 1: NINETEENVID nineteen is the disease caused by SARS COVID two,
Speaker 1: which is a new type of coronavirus. Coronaviruses are a
Speaker 1: type of virus named for the crown or corona of
Speaker 1: structures on its cell surface that help it bust into ourselves.
Speaker 1: So A recent Center for Evidence Based Medicine article stated
Speaker 1: that between five and eighty percent of people testing positive
Speaker 1: for COVID nineteen may be asymptomatic. Between five and eighty percent. What,
Speaker 1: that's a big range, so we don't totally know how
Speaker 1: many people have it, but experts pretty much settled on
Speaker 1: fifty percent are a symptomatic. Patron Lisa Moore asked about
Speaker 1: neurological symptoms, and in one small Chinese study of two
Speaker 1: hundred and fourteen people hospitalized with COVID nineteen, more than
Speaker 1: a third of them had neurological symptoms like headaches and
Speaker 1: changes in smell and taste, nerve pain tingling in the
Speaker 1: extremities and kind of wooziness and dizziness, and other observed
Speaker 1: neurological effects of COVID nineteen are short term memory loss,
Speaker 1: difficulty concentrating, so it can affect you neurologically. Patron Toby
Speaker 1: Chrisnik asked if there's going to be a second wave,
Speaker 1: will there be new and unknown symptoms? They say, I'm
Speaker 1: already hearing about corona tose, so yes. Other observed symptoms
Speaker 1: of this coronavirus have been coronatose, which are lesions on
Speaker 1: the toes, diarrhea, and perhaps even something called Kawasaki disease,
Speaker 1: which has been seen in some children. It presents a
Speaker 1: little like toxic shock syndrome, with a high fever lasting
Speaker 1: several days, and abdominal pain, vomiting, a bright red or
Speaker 1: what's called a strawberry tongue, and peeling rashes on the
Speaker 1: feet and hands and groin. Other complications of COVID nineteen
Speaker 1: we did not necessarily know much about a few months
Speaker 1: ago are blood clots and stroke, inflamed heart tissue, lung scarring,
Speaker 1: and even issues with male fertility. I know you're like,
Speaker 1: what the fuck are all these symptoms? Why are you
Speaker 1: bumming me out? Dad? Well, there's a chance that you
Speaker 1: or someone you love might have symptoms without realizing it
Speaker 1: is the RONA, So I'm here to tell you now.
Speaker 1: The tough part is that this is a novel virus.
Speaker 1: We've only known about our a few months, so every
Speaker 1: day we get more information. So every day yesterday's information
Speaker 1: might be a little more wrong. But the good news
Speaker 1: is that people are working around the clock on it.
Speaker 1: Doctor Natter explains, that's a good question.
Speaker 2: I mean, I think I think, just speaking generally, a
Speaker 2: lot of the fear around this is that we don't
Speaker 2: know things. Yeah, we don't understand why some people who
Speaker 2: get coronavirus have a sniffle and then they get better,
Speaker 2: or they have a few fevers and they get better,
Speaker 2: and then the same individual with whose I mean, I
Speaker 2: saw very young patients with no cool morbid or past
Speaker 2: medical history who have died, and many others who are
Speaker 2: on dialysis and ECMO machines and emodialysis and ventilators and
Speaker 2: all these things. That doesn't make sense, and so that
Speaker 2: fear is felt really amongst the pop general population, but
Speaker 2: amongst healthcare workers. I think we like to intellectualize as
Speaker 2: a defense mechanism, but you can't intellectualize when you don't
Speaker 2: know and when you see what you're seeing.
Speaker 1: So worldwide, as of this recording, two hundred and eighty
Speaker 1: five thousand, nine hundred and seventy one people are reported
Speaker 1: casualties of the virus, over eighty thousand in the US alone.
Speaker 1: So how is it still spreading any surprises? Myrologist at
Speaker 1: the California Academy of Sciences, doctor Shannon Bennett, explains, Well.
Speaker 3: It's really fascinating. I would say that it's definitely by
Speaker 3: and large behaving as we would have expected the kind
Speaker 3: of the way, which was this sort of steep exponential
Speaker 3: growth rate early on that then flattening and leveling off.
Speaker 3: And I'm talking about leveling off in terms of the
Speaker 3: number of daily new cases and the number of daily
Speaker 3: new deaths. In both cases. The one the death's legs
Speaker 3: behind the new cases. But they start to ramp up,
Speaker 3: then they level off such that the number of daily
Speaker 3: new cases is almost the same day over day, maybe
Speaker 3: over a sliding two week a two week window, and
Speaker 3: then it starts to drop down the other side of
Speaker 3: the waves. So here in California we're a big surfing culture.
Speaker 3: So it's just like surfing a wave, you know, you
Speaker 3: go up, flatten, and then down the other side. And
Speaker 3: I do apologize making light of this. This is very serious,
Speaker 3: but it is an effective analogy I think to indicate
Speaker 3: that that, just like an energetic wave in water, then
Speaker 3: the number of cases out there, because any individual case
Speaker 3: is infecting a certain number of other individual cases, and
Speaker 3: that numbers can be pretty high. At the beginning of
Speaker 3: the epidemic, the doubling time was on the order of
Speaker 3: a few days, and then it sort of spread out
Speaker 3: as we flatten the curve, and so that metric represents
Speaker 3: the energy of the virus to push out and push
Speaker 3: through a population, just the way that the energy in
Speaker 3: a wave that we surf behaves. And so the energy
Speaker 3: of that course of infection is becoming dampened as the
Speaker 3: number of daily new cases starts to level off, and
Speaker 3: then that gets reflected in the reduction in the number
Speaker 3: of daily new cases day over day until it's close
Speaker 3: to zero. And that's the bleeding out of the energy
Speaker 3: of that wave as well as that force of infection.
Speaker 3: And so that's the way it's rolled in most countries,
Speaker 3: including our country here in the US. At state by state,
Speaker 3: maybe the intensity, the height of the peak of the
Speaker 3: wave might be a little different. It was certainly the
Speaker 3: highest in New York. And the timing of that wave
Speaker 3: is jittered, so some states hit their exponential growth sooner,
Speaker 3: others have hit it later and to a much lesser extent.
Speaker 3: And what's interesting to me is looking at different states
Speaker 3: or even different countries. Although the form of the wave
Speaker 3: largely plays out the same with some exceptions, we can
Speaker 3: really see how country and states have implemented different policies
Speaker 3: and that kind of plays out on the epidemiologic landscape.
Speaker 3: Like you can really see the difference. You can see
Speaker 3: how different states, for example, really managed to keep that
Speaker 3: curve very low, very flat and delayed start and in
Speaker 3: very quick time have seen it decrease.
Speaker 1: So you're seeing policies have like a direct mathematical effect
Speaker 1: on that curve. Yes, most definitely. Patron Joanna Gebhard asked,
Speaker 1: do we know what the mortality rate is yet? And
Speaker 1: I awkwardly ask doctor Datter how much higher were the
Speaker 1: mortality rates of your patients than you're used to dealing
Speaker 1: with and how.
Speaker 2: Did you passively massively.
Speaker 1: How did you deal with that?
Speaker 2: Not? Well, yeah, yeah, well it's hard. It's really hard.
Speaker 2: While in the hospital. Surprisingly, I think you have like
Speaker 2: a purpose and you have tasks and you're able to,
Speaker 2: you know, kind of get your head down and do
Speaker 2: your work and feel like you're doing something of substance,
Speaker 2: But then coming home is very difficult.
Speaker 1: Do healthcare workers, is there anything any plans in the
Speaker 1: works for how to deal with that emotionally psychologically for
Speaker 1: healthcare workers.
Speaker 2: I think there's a lot of talk. I think it's
Speaker 2: very well understood and known that there's a lot of
Speaker 2: his traumas being kind of dealt with. And I think
Speaker 2: we know that, and I think a lot of our
Speaker 2: colleagues in psychiatry have been really great and they've been
Speaker 2: helping us out, and they're offering us a lot of
Speaker 2: like WebEx therapy sessions and debriefings and having like kind
Speaker 2: of group meetings and stuff, which is great, I think
Speaker 2: for me at least, and I think for most of
Speaker 2: my colleagues, like right now, we're okay. I think it's
Speaker 2: more what's going to happen kind of days, weeks, months,
Speaker 2: and likely years from now that's going to be interesting.
Speaker 2: And I also, like I worry a lot about it,
Speaker 2: Like I have colleagues who've graduated a few months early
Speaker 2: from medical school so they could come join the ranks
Speaker 2: with us. And I think it's so traumatic to be
Speaker 2: an intern to begin with, when you start, you know,
Speaker 2: when you're your first days as a doctor, it's very
Speaker 2: stressful and difficult. And then having to deal with this
Speaker 2: whole pandemic as your first kind of soare into medicine,
Speaker 2: I think is you know, could potentially sow some seeds
Speaker 2: of trauma.
Speaker 1: Yeah, how about how about actual PPE? How how well
Speaker 1: protected are you all? Now?
Speaker 2: We're good. I feel as though I don't think I've
Speaker 2: ever been without, you know, having actual PP. My institution
Speaker 2: has been pretty good. There's three hospitals in my institution,
Speaker 2: and one is a public hospital of New York, which
Speaker 2: is obviously like less fund than others, but the amount
Speaker 2: of donations and people coming out has been just like phenomenal,
Speaker 2: the people pouring in either actual money to get PP
Speaker 2: or actual PP, and then obviously food. There's like signs
Speaker 2: and chalk on the street, there's everything you can imagine,
Speaker 2: free scrubs and all this stuff. So we're being very
Speaker 2: much showered and pampered, which is great, and it feels
Speaker 2: kind of I feel kind of shitty in that, like
Speaker 2: there is such a need for food, like in the country,
Speaker 2: and there's like a lot of food banks that are
Speaker 2: going dry, and we literally are just in an dated
Speaker 2: with food, like really really good food. And I always
Speaker 2: feel so bad when I'm like, you know, there's some
Speaker 2: of this food really needs to be diverted to some
Speaker 2: of these these other places that need it.
Speaker 1: At Doctor Natter's Behest, we made a donation to Food
Speaker 1: Bank for New York City in his name. So that's
Speaker 1: twenty five hundred more meals will be made possible in
Speaker 1: the New York area by him mentioning that to us.
Speaker 1: Thanks for the heads up, doctor Natter. Now, if up
Speaker 1: to eighty percent of folks with it are asymptomatic, how
Speaker 1: many people have or have been infected with SARS kobe too?
Speaker 1: Doctor Bennett says, what we see is probably the tip
Speaker 1: of an infection iceberg. Do doctors have any idea because
Speaker 1: testing is just so like rare testing in the general population,
Speaker 1: do we have any idea what the mortality rate of
Speaker 1: this is.
Speaker 2: We have a sense, but I think, like you you
Speaker 2: you tapped onto the way we you know, calculate rates
Speaker 2: is that you need to have a numerator and a
Speaker 2: denominator to figure out all of this, and right, the
Speaker 2: denominator is based on if you've tested someone. I think
Speaker 2: we've caught up a little bit in terms of testing.
Speaker 2: There's a lot of miscommunication and kind of guidelines that
Speaker 2: were shifting in terms of who should get tested, when
Speaker 2: they should get tested. Oftentimes to not overload the er,
Speaker 2: we would tell people if you have symptoms, but you're
Speaker 2: not short of breath or you're not becoming hypoxic to
Speaker 2: really not come in, because we have people that would
Speaker 2: overrun the ED to get tested when they weren't sick
Speaker 2: enough to necessarily need to be admitted, and then they
Speaker 2: were basically either exposing themselves in the ED or creating
Speaker 2: more volume for the emergency UMAN physicians that they couldn't handle.
Speaker 1: This week, the President of the United States, and I'm
Speaker 1: just going to quote this in a very neutral informational way,
Speaker 1: said quote, by doing all of this testing, we make
Speaker 1: ourselves look bad because the case numbers go up. Oh wow,
Speaker 1: So there is that information now. I checked in with
Speaker 1: doctor Michael Wells, who we spoke with for the All Washed,
Speaker 1: Hands on Deck episode in late March, and I got
Speaker 1: an update from him just today on his database of
Speaker 1: scientists willing to help with the testing, and he said, quote,
Speaker 1: the database has now exceeded ninety three hundred scientists from
Speaker 1: all fifty states side note, yes, Wyoming, you did it,
Speaker 1: also DC, Guam and Puerto Rico. And he now has
Speaker 1: a large team of coordinators, many of whom found out
Speaker 1: about the database through ologies, which is awesome to hear.
Speaker 1: A way to go, y'all, He says, scientists from our
Speaker 1: database are helping process tests in Los Angeles, DC and Michigan.
Speaker 1: We even had a few visit SpaceX in Los Angeles
Speaker 1: to help with some of their COVID nineteen efforts, and
Speaker 1: we are spending a majority of our time actively seeking
Speaker 1: additional volunteer opportunities across the country. They have a new
Speaker 1: website so people can keep updated on their activities, and
Speaker 1: I will put a link to those in the show notes.
Speaker 1: Many of you patrons asked about testing, such as Rachel
Speaker 1: Weiss and Ira Gray and Sophia Dill asked what is
Speaker 1: happening with testing and when will we have testing widely available? Sophia,
Speaker 1: I appreciate your triple and Tara bang on that question.
Speaker 3: We really need to broaden the testing and the kind
Speaker 3: of testing that's happening, you know, it's really we're we're
Speaker 3: starting to test here in San Francisco. Anybody with symptoms
Speaker 3: associated with somebody with any symptoms can get a free test.
Speaker 3: This is a PCR based test, so it's a test
Speaker 3: that looks for the direct presence of the virus. So
Speaker 3: it's no point, you know, running off to get tested
Speaker 3: if you have the virus or you thought you had
Speaker 3: the virus three weeks ago. It's really just measuring the
Speaker 3: direct presence of virus at the moment that the test
Speaker 3: that the sample is drawn, so it has a very
Speaker 3: short applicability.
Speaker 1: Megan McLean asked about the depth that they plumb into
Speaker 1: your nasshole, asking quote, why does the test swab have
Speaker 1: to go so far up into your noggin to get results?
Speaker 1: And that six inch splunking. I looked it up. It's
Speaker 1: hitting the back of the naso pharynx, which is where
Speaker 1: your sinuses meet the back of your throat, kind of
Speaker 1: like a taint. But for your mouth knows will you
Speaker 1: have to do this twice? If this thing you take
Speaker 1: Many of you, including Eric Astairs, Russa Holtzmann, Anna Okrazinski, Maddox,
Speaker 1: Cameron Stewart, Stephanie enkl, Anna Thompson, Don Swart, and Kevin
Speaker 1: Lay wanted to know about strains and mutations now. A
Speaker 1: paper came out just in late April by the Los
Speaker 1: Alamos National Lab that noted the G strain of the
Speaker 1: virus is more prevalent in Europe and on the East
Speaker 1: coast of the US, and speculated that it's a more
Speaker 1: of uralin form, but that paper has not yet been
Speaker 1: peer reviewed, and many other scientists say there's pretty much
Speaker 1: only one strain. Coronaviruses apparently mutate at one tenth of
Speaker 1: the rate as influenza, and that G strain may have
Speaker 1: just by chance become more prevalent. It might just be
Speaker 1: a lucky virus with good odds and not necessarily more
Speaker 1: dangerous or more infectious. So jury is still very much
Speaker 1: out on that. Now, if you've had COVID nineteen, are
Speaker 1: you immune if it mutates?
Speaker 2: Even if you do have immunity, when does it start
Speaker 2: to wane? So are you going to be immune for
Speaker 2: a couple of weeks, a couple of months, a couple
Speaker 2: of years forever, We don't know. And then is this
Speaker 2: virus possibly able to mutate? And if it mutates, then
Speaker 2: maybe your immunity is not going to be useful. And
Speaker 2: the best example of that is the flu. So the
Speaker 2: flu is a virus, and you have to get a
Speaker 2: flu vaccine every year because there's something called antigenic drift
Speaker 2: and antigenic shift, and what that means is that their
Speaker 2: DNA is very susceptible to mutation, and so you get
Speaker 2: these tiny little mutations and that's just enough for it
Speaker 2: to basically kind of evade the antibodies from the previous season.
Speaker 2: That's not a coronavirus, So maybe it's not the same mechanism.
Speaker 2: I don't know, but no one knows. Now. That being said,
Speaker 2: if you have antibodies and you get tested positive for
Speaker 2: these antibodies, that should not mean that you're less vigilant
Speaker 2: about how you go about your life. It might give
Speaker 2: you a little bit of mental solace, which is good.
Speaker 2: But you should still wear your mask, you should still
Speaker 2: be careful, you should still wash your hands. It's just
Speaker 2: still socially distant when you can all of those things
Speaker 2: still apply. The other thing I want to say is
Speaker 2: that the antibody tests, and this is actually very interesting.
Speaker 2: So we were so behind on the diagnostic PCR test
Speaker 2: that basically do you have COVID or do you not
Speaker 2: have COVID tests? And that was in part because the
Speaker 2: FDA was so heavily regulating how those tests got rolled out,
Speaker 2: which is what their job is. But in this pandemic
Speaker 2: they really kind of put lay the book down and
Speaker 2: said like, no, you can't you you know, Medical Academic
Speaker 2: Center X can't make your own diagnostic test, even though
Speaker 2: you have a lab and you have their utilities to
Speaker 2: do so, because we need to regulate it. And that
Speaker 2: was part of the reason why it took so long
Speaker 2: to get a wider diagnostic test out there. They went
Speaker 2: so far on the other end of the spectrum with
Speaker 2: the antibody test, and they went to the free markets
Speaker 2: that have at it. Do it as much as quickly
Speaker 2: and as many as you can. And what that spawned
Speaker 2: was a very large spectrum of reliable antibody tests. And
Speaker 2: so the same antibody tests from a different manufacturer made
Speaker 2: not give you the same reliable tests, meaning you can
Speaker 2: get false positives, false negatives, and you can imagine what
Speaker 2: that would mean if you get a false positive saying
Speaker 2: yes you have antibodies, yeah, and people that maybe get
Speaker 2: a little less vigilant, and then you're gonna have a
Speaker 2: lot of problems.
Speaker 1: So a bunch of patrons like Crystal Mendoza, Oda, Helene Chatz,
Speaker 1: Michelle Neir, Gwen, Kelly Mariese, the Holsman, and first time
Speaker 1: question asker John C. Faludi wanted to know about antibody
Speaker 1: tests and errors in testing.
Speaker 3: Antibody tests have to be validated to show that they're
Speaker 3: sensitive enough to pick it up and specific enough to
Speaker 3: distinguish between this stars Cove two virus versus other related viruses,
Speaker 3: and a lot of those validation tests are still ongoing.
Speaker 3: It's very very very much a work in progress, and
Speaker 3: in many cases, if those tests are being done by
Speaker 3: commercial labs, there's not always full transparency into the rates
Speaker 3: of false positive or false negative results. Know, there's no
Speaker 3: point getting a blood sample drawn for a PCR test
Speaker 3: because it turns out that the virus is mostly in
Speaker 3: your your mucus membranes, in your nasofringial passage and lungs.
Speaker 3: But an antibody test is actually going to want to
Speaker 3: look for the antibodies in your blood stream because it's
Speaker 3: not you don't build up a lot of antibodies in
Speaker 3: your nasofringial and by the way, that you don't build
Speaker 3: up antibodies until at least ten maybe fifteen days when
Speaker 3: you start after the virus is cleared, so it's really
Speaker 3: challenging or in some cases after the symptoms start. So
Speaker 3: it's a when you take the sample and what kind
Speaker 3: of test and from which tissue type it's taken from,
Speaker 3: and how how much virus you had in your system
Speaker 3: are all important variables that can change the outcome of
Speaker 3: the test in an artifactual way.
Speaker 1: So can you get it twice? Now? A study out
Speaker 1: of South Korea thought maybe yes, and then they realized
Speaker 1: that their tests were so good, so sensitive that they
Speaker 1: were just detecting old fragments of the first infection. So
Speaker 1: that is good news now. Patrons Jen Anathys, Jessica Jansen,
Speaker 1: Carolyn Wolfram, Patti Bergman, Jenny Hoover, Ellen Skelton, Mike Munakowski,
Speaker 1: and Zoe Buckley wanted to know, can we get it
Speaker 1: like a double whammy.
Speaker 3: If you had it in January and now you're exposed again.
Speaker 3: We don't think so. Almost all evidence indicates that you
Speaker 3: cannot get it again, because you do develop immunity, some
Speaker 3: degree of protective immunity. What we don't know is how
Speaker 3: long that protective immunity lasts. So you know, it might
Speaker 3: be that either the virus evolves away from what your
Speaker 3: immune system has trained on, or it might be that
Speaker 3: your own immune response is maybe not that effective. When
Speaker 3: you get a virus deep into your lungs, there's a
Speaker 3: really amazing blood viral interactions so that you can develop
Speaker 3: a really strong immune response to viruses that infect you
Speaker 3: at that sort of intimate level. But the viruses we
Speaker 3: get in our nasophryngial passages, the common colds, we never
Speaker 3: really develop anything but very transient immunity because we don't
Speaker 3: there's no opportunity to really have that nice viral blood
Speaker 3: bath interaction to really develop the strong immune.
Speaker 2: Response let the blood that begin.
Speaker 3: So with common colds, we only ever get transient immunity,
Speaker 3: and then the next season, next year, we can get
Speaker 3: the same cold, and so it goes over and over again,
Speaker 3: year over year. So the big question is will we
Speaker 3: develop protective immunity to severe disease to viral pneumonia, but
Speaker 3: will this virus then sort of kick up a new
Speaker 3: quasi existence as sort of a common cold like virus
Speaker 3: where we never really develop a protective immunity to, but
Speaker 3: only transient immunity to more upper respiratory type virus.
Speaker 1: I asked doctor Natter about that too.
Speaker 2: So it's a very good question. The truth is, we
Speaker 2: don't know the answer yet, but we think that if
Speaker 2: you look at just like what we know in science
Speaker 2: medical science typically speaking, when your immune system gets introduced
Speaker 2: to an antigen or a foreign invader like a virus
Speaker 2: or a bacterium or something along those lines. Your immune system.
Speaker 2: One path of your immune system is to make antibodies
Speaker 2: in order to fight that off. Your body then has
Speaker 2: things called memory cells or plasma cells that then essentially
Speaker 2: turn into these factories of that specific antibody, and they
Speaker 2: just crank them out, and that's how you develop an immunity.
Speaker 1: Marisa Holsman and Emma Fury wanted to know about herd immunity,
Speaker 1: and in patron Wayne Hovey's words, how does this herd
Speaker 1: immunity thing work? So, as long as I had a
Speaker 1: smart virologist on the line, I asked this stupid question
Speaker 1: for all of us.
Speaker 2: No such thing.
Speaker 1: Okay, I don't quite understand. And we all come out
Speaker 1: of isolation. How are we not going to just keep
Speaker 1: spreading it?
Speaker 2: Again?
Speaker 1: From an epidemiological standpoint, what is going to happen in
Speaker 1: a couple of months when we're all out and about
Speaker 1: like we used to be?
Speaker 3: Yeah, I mean this is this is a really important concept.
Speaker 3: It relates back to this concept of herd immunity, and
Speaker 3: it's it's recognizing that there's a certain proportion of people
Speaker 3: that we may interact with in our in our populations
Speaker 3: that might have had the virus and be immune, so
Speaker 3: they're no longer susceptible. So what we assume is that
Speaker 3: that you know, when the epidemic wave starts to drop,
Speaker 3: two things are happening. For whatever reason, policy wise or
Speaker 3: or not. The energy in the wave has bled out
Speaker 3: because you know, there aren't as many infected spreading the
Speaker 3: virus to as many susceptibles, and so we can we
Speaker 3: can impact that wave by reducing the number of infected,
Speaker 3: which you know, we isolate people and their opportunity to
Speaker 3: impact susceptibles, to interact with susceptibles. So we're reducing those buckets.
Speaker 3: But when we all go back out and we've seen
Speaker 3: this in China, you know, why didn't the virus flare
Speaker 3: back up to pre peak of the wave levels? And
Speaker 3: so it's you know, we presume that the virus is
Speaker 3: basically run out of susceptibles that a certain number of
Speaker 3: infecteds might run into. So there's like, you know, how
Speaker 3: many infecteds are circulating, how many susceptibles might they run into?
Speaker 3: So are there hotspots of transmission? For example, are there
Speaker 3: these sort of key sectors in the public domain where
Speaker 3: people would more likely exchange virus. And that's why people
Speaker 3: are thinking about different scenarios when we all go back
Speaker 3: out there, you know, maybe we'll be we'll be getting
Speaker 3: back up there slowly where we may try to put
Speaker 3: in place some social distancing mechanisms or you know, trickle
Speaker 3: back in so that we can keep that contact right
Speaker 3: between infecteds and susceptibles lo all the while we try
Speaker 3: to understand the base herd immunity, like how many people
Speaker 3: truly were impacted and might be immune, So those susceptibles
Speaker 3: would be sort of taken out of the equation because
Speaker 3: they're not susceptible, they're immune. So, you know, we're looking
Speaker 3: empirically at kind of the way things are rolling in
Speaker 3: other countries that have seen the end of the wave
Speaker 3: and have opened back up. They haven't experienced a resurgence,
Speaker 3: but they're doing a.
Speaker 1: Lot of things.
Speaker 3: They had a wave, they definitely have some herd immunity,
Speaker 3: but they're also coupling that with social distancing measures.
Speaker 1: What if you have had it and want to put
Speaker 1: your body fluids to good use. Well, according to the
Speaker 1: Red Cross, people who have fully recovered from COVID nineteen
Speaker 1: have antibodies in their plasma that can attack the virus,
Speaker 1: and this convalescent plasma is being evaluated as a treatment
Speaker 1: for patients with serious or immediately life threatening COVID infections,
Speaker 1: so it's called convalescent plasma. Patrons Gwen Kelly, Anakin, Jeniak,
Speaker 1: and Marissa Holsman wanted to know about it. Is there
Speaker 1: a way to donate like plasma if you do have antibodies?
Speaker 1: Does that even work?
Speaker 2: So it's a good question. Yes, there's plenty of ways
Speaker 2: you can do that. I think you have to reach
Speaker 2: out to your local kind of hospital, your local academic
Speaker 2: hospital to find out how they're doing it and where
Speaker 2: to go. I know that in New York for sure,
Speaker 2: Mount Sinai and NY you are doing that. But the
Speaker 2: way that works is actually very interesting. So it's not
Speaker 2: a blood donation as much as it is a plasma donation,
Speaker 2: or rather transfusion. And the difference between blood and plasma.
Speaker 2: Plasma makes up part of the blood. So the blood
Speaker 2: is a bunch of cells, it's got white cells and
Speaker 2: red cells and a bunch of other stuff, but also
Speaker 2: has plasma. Plasma's kind of like gatorade portion if you
Speaker 2: took out all the rest of the stuff. You get
Speaker 2: this kind of like yellowee fluid. It's kind of all
Speaker 2: the electrolytes and all the good stuff. But in addition
Speaker 2: to having all that, it has your antibodies. So if
Speaker 2: you had coronavirus, you got better, you got tested for antibodies,
Speaker 2: and you're positive and you're healthy and you're able to
Speaker 2: donate blood, then you might be someone that could donate
Speaker 2: your plasma. They then they do what's called the centrifu,
Speaker 2: so they kind of spin it really fast to separate
Speaker 2: the plasma from the blood, and they take that plasma
Speaker 2: and they can then give it to someone who's very,
Speaker 2: very sick who has COVID at that time, theoretically giving
Speaker 2: them the actual antibodies, so that the body hasn't made
Speaker 2: the antibodies yet you're giving it to them, they get better.
Speaker 2: We think this might help. Back in the day, they
Speaker 2: would do this and there was some evidence for it.
Speaker 2: We're still testing it, so we still don't have the
Speaker 2: hard evidence, the hard data to say it will. The
Speaker 2: science suggests that it should. Same idea with if you
Speaker 2: have tested positive for antibodies, then the science says you
Speaker 2: should have some immunity. We think but until we have
Speaker 2: the numbers and the objective data, you can't say for sure.
Speaker 1: And what about the effects on our hearts and by hearts,
Speaker 1: I mean brains. I just think that there's more of
Speaker 1: a psychological impact that we maybe won't understand until you know,
Speaker 1: you touched on PTSD. But yeah, I think that there
Speaker 1: is a certain kind of psychological trauma of being scared
Speaker 1: of this invisible thing that could kill you, or if
Speaker 1: you go into the store to go buy soup, that
Speaker 1: you could end up killing seven people by doing it.
Speaker 1: You know, you would never I would never handle a
Speaker 1: live firearm, much less just start shooting into an open crowd.
Speaker 1: So it's kind of like, you know, that level of
Speaker 1: fear I think is probably pretty exhausting for people.
Speaker 2: But yeah, and I think for better for words, I
Speaker 2: think people are like becoming less vigilant and anxious, and
Speaker 2: so that's good in some ways, I think for mentality,
Speaker 2: but I think it's also dangerous because as people are
Speaker 2: letting up, obviously there's going to be a lot more
Speaker 2: you know, potential for outbreaks and so on.
Speaker 1: So, as we mentioned in the first Virology episode, one
Speaker 1: of the reasons COVID nineteen spreads so effectively. Is that
Speaker 1: unlike SARS one, it's transmissible even when you don't have symptoms,
Speaker 1: and a lot of people don't have symptoms. Now, a
Speaker 1: bunch of patrons like Katya Nizzick, Gwen Kelly and A Thompson,
Speaker 1: Jennifer Lowe, Yano Wiznuski, Gillian Klug and Atalie, Jamie Pickles
Speaker 1: and Marissa Laws wanted to know what we've learned about
Speaker 1: how it's transmitted, like how far can our juicy, infectious
Speaker 1: droplets travel and why is it important to wear masks?
Speaker 1: And why is social distancing so important?
Speaker 3: You know, Originally we you know, we were kind of assuming,
Speaker 3: or a lot of people were assuming. You know this,
Speaker 3: the pathology of this virus is viral pneumonia. So we
Speaker 3: recognized that it was binding to cells in the respiratory
Speaker 3: tract at a large scale in the lower respiratory tract,
Speaker 3: and then you know, transmitting through viral pneumonia like symptoms
Speaker 3: causing disease like viral p amumonia. And those symptoms were
Speaker 3: like these explosive coughs and sneezes, and so that's bringing
Speaker 3: droplets from deep into deep, you know, deep within your
Speaker 3: lungs up and out and spreading the virus. So what
Speaker 3: we've learned since is that this virus also pretty efficiently
Speaker 3: infects the upper nasopharyngeal passages and tissues. So you know,
Speaker 3: it is infecting those mucous membranes in your nasal passages,
Speaker 3: for example, even before it gets into your lungs and
Speaker 3: can potentially infect your lung tissue. And that means that, wow,
Speaker 3: that that possibly suggests that you know, maybe the virus
Speaker 3: could pretty efficiently transmit through the products from our upper
Speaker 3: nato feryngial passage, like you know, maybe if you clear
Speaker 3: your throat, or you just have a tickle like a
Speaker 3: light cough, or maybe you're breathing very heavily from exercising.
Speaker 3: And so you'll notice there was a change in policy.
Speaker 3: Like two sources of information came together. One that from
Speaker 3: the population level perspective, all the estimates of how transmissible
Speaker 3: this virus was was pretty high, suggesting that you know,
Speaker 3: it's maybe not just people with severe disease products that
Speaker 3: are you know, spreading the virus, but rather than maybe
Speaker 3: more people could spread it asymptomatically through breath or light
Speaker 3: coughs or tickles. And then there was also some laboratory
Speaker 3: data that showed, especially in hospital settings, when we use
Speaker 3: equipment like ventilators, we can nebulize the virus into tiny
Speaker 3: the tiniest tiniest droplets, and these are like a millionth
Speaker 3: of a meter so point point one microns. Uh, they
Speaker 3: can the virus can float in the air for up
Speaker 3: to three hours through the tiniest of droplets. Now, when
Speaker 3: we cough or sneeze, there's a very very small fraction
Speaker 3: of droplets that are that tiny, so most of the
Speaker 3: droplets will fall down. They're bigger, they fall out of
Speaker 3: the air at that six foot level. But because there
Speaker 3: could be a very very small fraction of the tiniest
Speaker 3: of Chinese particles that could have the virus, that's really
Speaker 3: why we started. Why you could see policy changed to
Speaker 3: have masks, even cloth homemade mask be worn as a
Speaker 3: general protective measure.
Speaker 1: A lot of you asked about masks, like Casey Wright says, masks,
Speaker 1: what's the real scoop on them? Jessica krag Yvon Bustos,
Speaker 1: Don Swartz, Edgar, Velita Ellen Silva, Syracule, Debra n and
Speaker 1: Kathleen Ma wanted to know what masks are the best
Speaker 1: to be wearing Now, Doctor Bennett told me she wears
Speaker 1: a homemade triple layer, high quality, high thread count cotton
Speaker 1: fabric mask. It's fitted around her nose with bendable wires
Speaker 1: and it's two layers of that high thread count cotton
Speaker 1: with a layer of pantyhose. And now searchers think a
Speaker 1: strip of pantyhose nylon stocking can also be tied over
Speaker 1: a fabric mask to help seal the gaps between your
Speaker 1: face and the mask. Mind the gaps. Let's say you're
Speaker 1: just using a flappy cowboy bandana, it's better to at
Speaker 1: least tuck it into your shirt. Now, Doctor Natter wears
Speaker 1: a respirator used for spray painting, and that filters out
Speaker 1: he says, about ninety nine percent of particulates, and it
Speaker 1: has changeable filters. What about if you're going running or biking,
Speaker 1: wear a mask.
Speaker 3: So a mask is protecting both you from shedding virus.
Speaker 3: And remember up to you know, there's a huge variability
Speaker 3: in asymptomatic rates people that are undetected symptoms. Right, so
Speaker 3: it ranges from I think thirty to eighty five percent,
Speaker 3: with an average of fifty percent, So you might be infected.
Speaker 3: So a mask protects you from shedding virus, not completely,
Speaker 3: but it blocks big droplets, for example, and it also
Speaker 3: may protect you from sucking in a virus infected droplets.
Speaker 3: So if you're working out, you're going to be breathing
Speaker 3: more heavily, You're going to be breathing out more heavily and.
Speaker 1: In more heavily.
Speaker 3: But but you know, it's actually really hard to wear
Speaker 3: a triple or mask and work out. So I am
Speaker 3: trying whenever I can to wear a mask. But then
Speaker 3: as I'm beating along on my hike to the words
Speaker 3: at the top of the hill, I might have to
Speaker 3: like whip it off and take a big deep breath
Speaker 3: and try to get air, and then I try to
Speaker 3: put it back on. But you know, the places I'm
Speaker 3: sheltering in place and I'm staying local, and I'm walking
Speaker 3: up the trails in my neighborhood, and there are a
Speaker 3: lot of people out there. So unless I wait until
Speaker 3: very late in the evening, which I'm now doing to
Speaker 3: sort of not run into people, I hesitate to exercise
Speaker 3: without a mask because I just there's so many people
Speaker 3: you can pass, and you can try to socially distance
Speaker 3: yourself by moving across the street that it it's really.
Speaker 1: Challenging, So that makes sense.
Speaker 3: I would recommend wearing a mask all the time.
Speaker 1: Listener Caitlin Mills wanted to know if this will go
Speaker 1: away in the summer, how cyclical will COVID nineteen be.
Speaker 3: So in a lot of seasonal viruses, you know they're
Speaker 3: seasonal because humans in the temperate zone are gathering together
Speaker 3: in classrooms or in inside spaces where the air is
Speaker 3: recirculated and it's you know, cool and dry, and they're
Speaker 3: crowded up. And so it's probably in many cases host
Speaker 3: behavior that's driving seasonality in many viral pathogens. But this
Speaker 3: is a big question that remains to be seen whether
Speaker 3: this virus needs that seasonality boost of a clustered up
Speaker 3: humans to kick it back into circulation in the fall.
Speaker 3: The biggest risk is when you have touched something that
Speaker 3: has virus on it and then you touch it to
Speaker 3: your mouth or nose. You might imagine like let's say
Speaker 3: you get you buy a box of cheerios and you
Speaker 3: bring it in the house. If you put it away,
Speaker 3: and let's say, maybe it has we call them viral
Speaker 3: full mtes. When you know somebody deposited a virus particle
Speaker 3: on the surface of something. It's called a full mte.
Speaker 3: So let's say there might have been a couple of
Speaker 3: full mites on the box and you put it in
Speaker 3: the cupboard. So long as you wash your hands before
Speaker 3: you prepare food, and you wash your hands before you eat,
Speaker 3: you're going to put in a barrier in between you
Speaker 3: and those foemtes and your your mouth or nose. That
Speaker 3: said there, there definitely you want to reduce the You
Speaker 3: want to put barriers up at every opportunity, right and
Speaker 3: and there have been some studies. There was a lab
Speaker 3: study that you know, this is new new information. We
Speaker 3: didn't know this at the beginning. We were just inferring
Speaker 3: how long viruses last on surfaces from what we knew
Speaker 3: about other viruses. And we know this viruses it's encapsulated
Speaker 3: in an envelope, a lipid layer, two membrane layer of lipids,
Speaker 3: and so it's actually a delicate virus because soap can
Speaker 3: break that outer layer up and make that virus basically dissolve.
Speaker 3: And so that's why people are saying, wash your hands
Speaker 3: with soap. You can wash surfaces with soap, like you know,
Speaker 3: I'm washing my fruits and my vegetables very well, maybe
Speaker 3: well soap okay. So then there was a study that
Speaker 3: showed that asked the question, if you don't wash with
Speaker 3: soap or sanol or isopropanol or some disinfectant, how long
Speaker 3: would the virus last on a surface.
Speaker 1: Doctor Bennett cited a recent study that seeded SARS COB
Speaker 1: two on different materials including cardboard and stainless steel, copper, plastic,
Speaker 1: and researchers found that on plastic and stainless steel it
Speaker 1: could live up to seventy two hours. Now, some types
Speaker 1: of coronavirus leave only a few minutes on cardboard and paper,
Speaker 1: while others can live for days. We're just not sure.
Speaker 3: So in some cases I'm just like getting hum throwing
Speaker 3: my mail in a bin. I'm not gonna check it
Speaker 3: in three days. I'm not in a big rush, right. So,
Speaker 3: in theory, the virus doesn't stick around that long on
Speaker 3: surfaces because it's kind of delicate, up to so many
Speaker 3: two hours, and it can be killed by a lot
Speaker 3: of different kinds of surface disinfectants, including something as simple
Speaker 3: as just soap and water. And furthermore, if you don't
Speaker 3: want to be bothered washing every piece of groceries. Just
Speaker 3: make sure you wash your hands before you prepare food
Speaker 3: and before you eat, and don't touch your eyes, nose,
Speaker 3: the mouth before washing your hands.
Speaker 1: Yeah, what about when you're in the grocery store? Devra
Speaker 1: Lats has a great question. If I'm wearing a mask
Speaker 1: and gloves, for instance, in the grocery store, is it
Speaker 1: safe to be less than six feet away from other
Speaker 1: people who are also wearing masks and gloves or should
Speaker 1: I wait until the aisle is empty and then grab
Speaker 1: the butter.
Speaker 2: Yeah? No, it's a good question. So you know, in
Speaker 2: a perfect world you remain six feet away from everyone,
Speaker 2: But okay, your risk is much more mitigated when you
Speaker 2: take the precautions of you know where a mask and
Speaker 2: the other person wearing a mask. But you shouldn't feel
Speaker 2: like you have your invisible cloak of you know, immunity
Speaker 2: on that you can kind of walk up it to
Speaker 2: anyone when you have a mask on. And I would
Speaker 2: like to make a point about gloves. It's impossible, like
Speaker 2: in your everyday life, like it's impossible to properly wear
Speaker 2: masks and gloves. And I will say this also, these
Speaker 2: masks and gloves medically are designed to be single use,
Speaker 2: so like you're meant to wear them into a patient room,
Speaker 2: have your patient contact, and then what we call doff
Speaker 2: the ppe and like take off the gloves and the
Speaker 2: mask and they shouldn't be used ever again because they're contaminated.
Speaker 2: But in terms of gloves, my point about gloves is
Speaker 2: that people wearing gloves like the same kind of risk
Speaker 2: is there even if you're not wearing gloves, Meaning if
Speaker 2: you take the gloves and touch your face, then you've
Speaker 2: done nothing. The gloves have done nothing for you, and
Speaker 2: any surface that that glove were to touch, if that
Speaker 2: you know, were contaminated, then the gloves are contaminating. And
Speaker 2: so what I always say, especially to my parents who
Speaker 2: wear the gloves, is pretend wear the gloves, but pretend
Speaker 2: that the gloves are not on, and wash your hands
Speaker 2: the same as you would, meaning you can put purel
Speaker 2: on the gloves. And so I try to kind of
Speaker 2: indoctrinate them to wash their hands even if they have
Speaker 2: gloves on. Kind of thing.
Speaker 1: Okay. Patron Greg Wallach chimed in and said, amen, on
Speaker 1: the glove question. Do people even understand how gloves actually work?
Speaker 1: He says, I saw a woman eating a donut with
Speaker 1: her gloved hand. She's keeping herself from getting sticky fingers.
Speaker 1: I guess, and researchers do report that one percent of
Speaker 1: those eating donuts get sticky fingers afterward. I am researchers. Actually,
Speaker 1: what are scientists busy studying right now? Let's get into it. So,
Speaker 1: both doctor Natter and doctor Bennett mentioned that the cytokine
Speaker 1: storms that cause organ shut down, those tend to be
Speaker 1: less severe in younger patients than older patients, and comorbidities
Speaker 1: like lung disease, obesity, and heart disease can contribute to
Speaker 1: less optimistic prognosis, and those are less common in kits. Now,
Speaker 1: hospitals are starting to prone patients. This is a practice
Speaker 1: that doctor Natter's colleagues affectionately refer to as Tommy, because
Speaker 1: laying on your stomach with an oxygen mask gives the
Speaker 1: lungs more space and has been shown to be a
Speaker 1: promising option over intubation. Now, other research is being done
Speaker 1: with medication.
Speaker 2: The amount of studies that are currently ongoing, the amount
Speaker 2: of publications that are coming out. A lot of my
Speaker 2: colleagues at my institution are like brilliant, and there's a
Speaker 2: lot of interesting theories. A lot of stuff that's going on,
Speaker 2: and I think we are going to have nailed down
Speaker 2: very soon good kind of guidelines and treatments for one
Speaker 2: to do what you know, none of this, we don't
Speaker 2: have treatments like the remdesivir now.
Speaker 1: Remdesivir side note, is an anti viral drug that, according
Speaker 1: to a paper published April twenty ninth in the journal Lancet,
Speaker 1: has been shown to reduce hospital stays by about four days,
Speaker 1: but it hasn't been shown to reduce the risk of death. Still,
Speaker 1: it's in huge demand and some hospitals can't even get
Speaker 1: their hands on it. Doctor Natter explains.
Speaker 2: There's a lot of talk about remdesivir, which is a
Speaker 2: great drug, but it's not a cure and it's not
Speaker 2: going to necessarily reverse course as much as we hope. Unfortunately,
Speaker 2: the other drugs that we're getting a lot of hype
Speaker 2: as well that I've seen anecdotally or doing nothing, the
Speaker 2: hydroxy corequin and the zithromycin and zinc. But I will
Speaker 2: say I am curious to know if those drugs were
Speaker 2: started very early on in the course before someone was hospitalized,
Speaker 2: if that would have any effect, because I think once
Speaker 2: someone gets hospitalized, what we're seeing is less of the
Speaker 2: vireemia and more of the immune destruction and like a
Speaker 2: cytokind storm. And I think that's part of why a
Speaker 2: lot of these antiviral treatments, if they're not started upfront,
Speaker 2: are not going to have as much of an impact.
Speaker 2: That's totally my guess, my theory. I don't know if
Speaker 2: it's true.
Speaker 1: I mean it's I was talking to the virologists right
Speaker 1: before this, and she was talking about all of the
Speaker 1: different publications you can look at and what people are
Speaker 1: working on, and how inspiring that is that there's a
Speaker 1: lot of people kind of behind the scenes just working
Speaker 1: on it. It's very diligently.
Speaker 2: Oh, it's amazing. It's amazing. And not only behind the scenes,
Speaker 2: Like there are a lot of physician physician scientists who
Speaker 2: will literally like work with me on you know, like
Speaker 2: one of my tennings will be there and we'll be there,
Speaker 2: you know, on our twelve hours or whatever, and then
Speaker 2: they'll go home and they'll like basically like type up
Speaker 2: all this stuff and do all this research and like
Speaker 2: publish and you know, the next day it's like in
Speaker 2: jama and I'm like Jesus like, do you not sleep
Speaker 2: like any doing?
Speaker 1: This is what doctor Bennett had said.
Speaker 3: One thing I do for Jolly's is I go on
Speaker 3: to the WHO website. They actually have a registry of
Speaker 3: all clinical trials worldwide. You have to register a clinical
Speaker 3: trial for any of these things, whether it's an anti
Speaker 3: viral or a vaccine, or a test or even an
Speaker 3: epidemiologic toolkit that you want to develop. You take it
Speaker 3: into these clinical trials and you have to register them
Speaker 3: with WHOW and then the NIH that's our own US
Speaker 3: National Institutes of Health also has a Registry of Clinical
Speaker 3: Trial and you would be amazed at how many clinical
Speaker 3: trials are in progress. And for me, it gives me
Speaker 3: a great deal of hope. There are hundreds and hundreds
Speaker 3: of antibody tests, vaccines and therapies that are currently being
Speaker 3: tested and examined, and at a minimum, many of these
Speaker 3: can be used for emergency use, at least the anti
Speaker 3: the therapies.
Speaker 1: Speaking of vaccines, in Amanda Mueller's words, what is causing
Speaker 1: the hold up? Kathleen Carlson, Eileen Prince, will Plia Law,
Speaker 1: Caitlin Mills, don Ewaald, Betsy Shephard, Adam Drake, Gwen Kelly,
Speaker 1: and Sultan Sazi all echoed our universal impatience. And then
Speaker 1: what about vaccines? Are they taking doctors design to be like, hey,
Speaker 1: it's going to be to September or are they like, hey,
Speaker 1: it's going to be never.
Speaker 2: I've heard nothing that the general public has heard hasn't
Speaker 2: heard about vaccines. I do think we are going to
Speaker 2: see a vaccine significantly faster than we would normally. Normally
Speaker 2: a vaccine takes about four years. Ou ou Yeah, I
Speaker 2: think we're going to see a vaccine way sooner than that.
Speaker 2: And that's partially for a couple of reasons. For one,
Speaker 2: everyone is in the world is affected by this virus,
Speaker 2: and so there is a huge impetus to get this done.
Speaker 2: But the other thing is a lot of folks have
Speaker 2: been working on vaccines for similar things, like mers, like ebola,
Speaker 2: like other viruses, and so some folks had a headstart.
Speaker 2: I think, particularly in England, they seem like they're doing
Speaker 2: really well. The other thing is, even if you're able
Speaker 2: to get the right concoction for a vaccine, you obviously
Speaker 2: need to test efficacy, but you need to test safety first.
Speaker 2: But then outside of that, you have to manufacture it.
Speaker 2: So on average, like a normal vaccine, the infrastructure is
Speaker 2: set up to maybe make I don't know, five ten
Speaker 2: million doses you know, we need on the order of
Speaker 2: three hundred million in the United States. If it's a
Speaker 2: single dose vaccine, it might be a double dose in
Speaker 2: six hundred million doses of this. So the infrastructure, you know,
Speaker 2: and I think doctor Fauci already started saying this, but
Speaker 2: like you need to start working on that now before
Speaker 2: you have the vaccine, and you need to kind of
Speaker 2: convert different factories that could potentially, you know, manufacture the
Speaker 2: vaccine before the vaccine's even ready to be manufactured.
Speaker 1: So a vaccine side note is a weakened form of
Speaker 1: the virus injected into the bloodstream so that your immune
Speaker 1: system can sus it out and make a good defense
Speaker 1: army against it. For more on this, you can listen
Speaker 1: to the Epidemiology episode with guests the doctor's erin of
Speaker 1: this podcast will kill You Now. In terms of a
Speaker 1: SARS covy two vaccine, doctor Bennett.
Speaker 3: Says, and in fact, some of the vaccine candidates that
Speaker 3: are being explored are the stars one of vaccine candidates
Speaker 3: that were just kind of left and never developed and
Speaker 3: so it's gotten us a head start. We have a
Speaker 3: a good head start on vaccine candidates borrowed from other
Speaker 3: similar related viruses. There are clinical trials happening right now
Speaker 3: with many vaccine candidates, and that definitely means that it's
Speaker 3: much going to be much shorter than four years out
Speaker 3: and I would definitely put it definitely on the twelve
Speaker 3: to eighteen month track.
Speaker 1: So that's great. So we'll get back to your questions
Speaker 1: in just a second, but quick note on donations for
Speaker 1: this episode. They were made to the Food Bank for
Speaker 1: New York City in doctor mac natter's name. We also
Speaker 1: made a donation to the California Academy of Sciences in
Speaker 1: honor of doctor Shannon Bennett, who does such amazing work there.
Speaker 1: Also this episode, we are shouting out another great podcast
Speaker 1: with tons of coronavirus info science versus with the wonderful
Speaker 1: Wendy Zuckerman. So take a listen to that for some
Speaker 1: great coverage. Okay, back to your questions. So many people
Speaker 1: want to know Kendall Burnell, Emily Dilger, Madeline Duncle, Tamara Oliver,
Speaker 1: first time question asker, Kate Strelhow and Michelle Harvey Jamie
Speaker 1: Thornlan and in Dave Miller's words, are we absolutely nuts
Speaker 1: to have even partial reopening? Are we opening up too soon?
Speaker 2: Oh? Man, this is crazy. I imagine what it's like
Speaker 2: to be like like a governor Cuomo or like some
Speaker 2: of these folks like that, like no one knows, No
Speaker 2: one knows. I am worried because I do think that
Speaker 2: opening up inevitably will create more potential infection. I think
Speaker 2: if you just look at the like, the reason that
Speaker 2: the infection rates are down isn't because we've conquered this
Speaker 2: illness and COVID somehow like went away, Like it's still
Speaker 2: very much there. So if you, you know, allow you know,
Speaker 2: a city of six million to densely populate the subways
Speaker 2: all over again, like I don't care how many gloves
Speaker 2: and maths you have on like, there's going to be
Speaker 2: more transmission of this disease. But it's it's this balance
Speaker 2: of you know, how much longer can you keep people
Speaker 2: all locked down? And I think it might be this
Speaker 2: slow dance where you take a few steps out slowly
Speaker 2: and you you know, you track how many infections are,
Speaker 2: you track the admission rate, you track the I few
Speaker 2: admissions you track the death rate. The death rate will
Speaker 2: obviously lag behind by a couple of weeks, but you
Speaker 2: track everything you can, and you test as much as
Speaker 2: you can, and then you may have to kind of
Speaker 2: go a couple steps back and wait a little bit,
Speaker 2: and you know, as to not overwhelm the healthcare system
Speaker 2: and as to keep infections as low as possible. I
Speaker 2: don't think it's wrong to try, but I think it
Speaker 2: has to be done very responsibly and very very slowly,
Speaker 2: and with a lot a lot of vigilance and testing
Speaker 2: and everyone buying in in terms of trying to keep
Speaker 2: their distance, in terms of trying to you know, not
Speaker 2: spit anyone else's face.
Speaker 1: Right, avoid that for now.
Speaker 2: It's not recommended.
Speaker 1: Let's get philosophical and ethical about it.
Speaker 2: But I think, you know, guvnor Cuomo, I think says
Speaker 2: it really well, and he's like you're at you're essentially
Speaker 2: asking when you when you have to open things back up,
Speaker 2: you know, how much is a human life worth? Is
Speaker 2: the way he sees it. And you know, to him,
Speaker 2: when you open up, you're going to people are gonna die.
Speaker 2: And so he, I think is doing a good job
Speaker 2: and trying to find resources for people to not have
Speaker 2: to go back to work, you know, you know, give
Speaker 2: you know, something to these individuals so that they can
Speaker 2: have food and they can you know, not worry about
Speaker 2: getting evicted and all these things. And there's only so
Speaker 2: much that can be done. Yeah, but don I don't
Speaker 2: know who knows, who knows.
Speaker 1: How do you feel when you see people in Central
Speaker 1: Park just picnicking?
Speaker 2: Yeah? I mean listen, if you can be six feet
Speaker 2: away from everyone else, great, are you actually six ft
Speaker 2: away from Probably not? And I think this past weekend
Speaker 2: I was talking to my friends about it, and it's it.
Speaker 2: It worries me a little bit. I think it's a
Speaker 2: harbinger for the inevitable second wave that's going to come
Speaker 2: after things start opening up, because I think as things
Speaker 2: start open up, they are going to get less and
Speaker 2: less vigilant really and more and more kind of flagrant about,
Speaker 2: you know, giving up this whole social distancing and stuff.
Speaker 2: I am worried and I do, unfortunately, think that there
Speaker 2: will be another wave, and I just hope that it's
Speaker 2: nowhere near as bad as what it was.
Speaker 1: Right. This next question is from patron Anti Se who
Speaker 1: tapped into our collective consciousness and inquired, simply, so, how
Speaker 1: fucked are we? I asked doctor Bennett, what we can
Speaker 1: expect next?
Speaker 3: Spring is in the air. We're all getting a little excited,
Speaker 3: and we miss each other physically, obsensual, everybody's observing that
Speaker 3: the curves are flattening. I would definitely say that it's
Speaker 3: definitely too soon to bunch up and we need to
Speaker 3: stay the course. And so I do cringe when I
Speaker 3: see people that are clearly not in family groups sort
Speaker 3: of throwing caution to the wind and bunching up. I
Speaker 3: understand it, but it definitely is too soon and we
Speaker 3: need to not do it. We're not ready. We will
Speaker 3: be ready. There is light at the end of the tunnel,
Speaker 3: but we shouldn't sort of be racing for the end
Speaker 3: of the tunnel just yet.
Speaker 1: Speaking of missing each other physically, Star and Shannon Patterson
Speaker 1: wonders know when they can see their parents and their
Speaker 1: family again. Marissa Laws asked should we cancel handshakes forever?
Speaker 1: And Tracy Michael wondered will we ever be able to
Speaker 1: hug freely again? I really miss hugs, they say.
Speaker 3: I would trade out a handshake any day for a hug,
Speaker 3: Like I don't think we need handshakees. But I miss
Speaker 3: hugs too, And my mom lives in Canada and I
Speaker 3: you know, she was supposed to come down and visit
Speaker 3: for my daughter's birthday and we couldn't make it happen
Speaker 3: and we miss our family. I myself struggle with this
Speaker 3: question is when is it okay to hug? It's about risk, right,
Speaker 3: It's about thinking about the risk of the person you're
Speaker 3: hugging to getting a virus from you. And so if
Speaker 3: that is an older person or an older that's not
Speaker 3: in your immediate family circle, then you may be bringing
Speaker 3: a virus to a vulnerable person. So that that's one
Speaker 3: thing for sure, But you know, everybody needs to be
Speaker 3: empowered to sort of assess their own risk, right, So
Speaker 3: it might be that you know, if the loved ones
Speaker 3: that you that are in your family are themselves isolated
Speaker 3: and they have a very very tiny contact sphere, and
Speaker 3: you yourself has you know, have been really strict about
Speaker 3: containing your contact sphere, then you know, at some point,
Speaker 3: as we lift shelter in place and we can start
Speaker 3: to interact physically with each other or move to each other,
Speaker 3: then there's there's probably going to be a way for
Speaker 3: you to mitigate risk to your older loved ones that
Speaker 3: you can share hugs. But maybe the proper and official
Speaker 3: answer because that's kind of my metric as a person,
Speaker 3: But but the official answer really is that unless and
Speaker 3: until we know what you know, how many people are immune,
Speaker 3: and what the true size of the iceberg of this
Speaker 3: coronavirus population really is, because right now we just see
Speaker 3: the tip of the iceberg through the limited testing. But
Speaker 3: once we really understand how you know, how widespread it
Speaker 3: is and how many people are immune, and then once
Speaker 3: we build up our toolkit for responding to the infections
Speaker 3: by like really really strategic contact tracing and social distancing,
Speaker 3: and then we also have our toolkit to have therapeutics
Speaker 3: and vaccines. I mean all of those things sort of
Speaker 3: would we would want to come bring them all together
Speaker 3: to make risk zero, right or near zero for a hug,
Speaker 3: But many of us live with a little bit of
Speaker 3: risk every day.
Speaker 2: Yeah.
Speaker 1: Doctor Natter mentions the mental health effects as well.
Speaker 2: This is a really really stressful time. It's very emotional.
Speaker 2: People are losing their jobs. People don't have the same
Speaker 2: kind of outlets, they don't have the same social you know,
Speaker 2: support because physically they can't it's hard, it's very scary,
Speaker 2: and so I think it's important to recognize what your
Speaker 2: triggers are. It's important to find things that are safe
Speaker 2: to do during this time. But doing them. It seems
Speaker 2: like people are really liking the baking of bread right now,
Speaker 2: But you know, finding something that's going to kind of
Speaker 2: center you and keep you saying and recognizing that, like,
Speaker 2: this is a really scary, really shitty situation, but I'm
Speaker 2: seeing a lot of amazing generosity and charity and just
Speaker 2: like humanity through all this, which is one of the
Speaker 2: more beautiful things. And like the appreciation that we're seeing
Speaker 2: and feeling from you know, us the healthcare workers is
Speaker 2: like tremendous. And I was thinking about how said I'm
Speaker 2: going to be because right now, every night at seven pm,
Speaker 2: everyone comes out collapse and the firefighters come over. And
Speaker 2: I was thinking, I'm going to be so sad when
Speaker 2: this ends, because it hasn't ended. It's been going on
Speaker 2: for months now, and I was like, the day this stops,
Speaker 2: I'm gonna be really bummed out. And I'm like, maybe
Speaker 2: like something like this, I not necessarily like having everyone
Speaker 2: come out and cheer for us, but something along the
Speaker 2: lines of appreciating each other hopefully gets you know, salvaged
Speaker 2: and stays with us. I think it will, at least
Speaker 2: on some level. I think it will, and I'm I'm
Speaker 2: hopeful that this is all going to come to an
Speaker 2: end at some point. I don't think it's going to
Speaker 2: go back to the same normal that we had. I
Speaker 2: think there's going to be a new normal, unfortunately. And
Speaker 2: I think it's kind of like, you know, living through
Speaker 2: nine to eleven. I never had to, you know, take
Speaker 2: my shoes off before getting an airplane, and now that's
Speaker 2: kind of routine, you know. So I think there will
Speaker 2: be things that are different but that we will very
Speaker 2: much adapt to, and that will be, you know, in
Speaker 2: everyone's best interest in terms of public health.
Speaker 1: Yeah, I'm glad that the banging on pots of pants
Speaker 1: doesn't annoy you as a healthcare worker.
Speaker 2: Oh my god, I love it. Why wouldn't you annoy me?
Speaker 1: I don't know. Maybe you're trying to sleep. And I
Speaker 1: think I wonder if there's a nurse out there who's like,
Speaker 1: shuit the fuck.
Speaker 2: That would actually make a great comic. I should do.
Speaker 2: My mom, who's like the most adorable woman ever. My
Speaker 2: dad took a video of her on her terrors, like
Speaker 2: with her little pot and pan.
Speaker 1: I look this up and his mom Ellen Natter is
Speaker 1: an adorable, diminutive blonde woman with stylish horn room glasses.
Speaker 1: She's hipper than me. She's on her midtown Manhattan balcony
Speaker 1: smacking a saucepan toward the sky. An appreciation of healthcare
Speaker 1: workers and hospital staff who every day are putting their
Speaker 1: lives on the line, like her son, I don't know
Speaker 1: how you guys do it. You're amazing. Is there anything
Speaker 1: any anything you would want people to do or take
Speaker 1: away from this or continue doing or not do anything
Speaker 1: that the rest of us who are just sitting around
Speaker 1: making sour dough can do it for y'all.
Speaker 2: No, keep making sour dough. I think it's you know.
Speaker 2: I think we feel it, like the healthcare workers, at
Speaker 2: least I can speak for myself and my college. We
Speaker 2: feel the love, we feel the appreciation, and we really
Speaker 2: appreciate it. I think, please just follow. I mean, I
Speaker 2: imagine the majority of your listenership are people that are
Speaker 2: very socially conscious, so they're probably already doing this anyway,
Speaker 2: but just follow the guidelines that are given. I recognize
Speaker 2: and get frustrated myself when they seem to change minute
Speaker 2: to minute and they seem to sometimes not make any sense.
Speaker 2: But if we don't do it all together, then a
Speaker 2: lot of it's not going to work. And so socially
Speaker 2: distancing I think is very key. Wearing masks if you
Speaker 2: know your local government tells you too, I think is
Speaker 2: very helpful. But just being kind to each other and
Speaker 2: just making sure that you know, we get through this together.
Speaker 2: I should also say, I think it's important to recognize
Speaker 2: that your neighbors may be elderly and alone, it might
Speaker 2: need some help, and you know, picking up some groceries
Speaker 2: for them, and just just kind of being a good human.
Speaker 2: I think now more than ever, is really.
Speaker 1: Important check in on each other and such. Yeah, yeah,
Speaker 1: that's good. Doctor Bennett says that in person relationships are
Speaker 1: important and maybe we're all realizing that a little more.
Speaker 2: Now.
Speaker 3: What do we mean to each other all of a sudden,
Speaker 3: I think we mean a lot more to each other
Speaker 3: than we thought.
Speaker 1: So let's not take our friend for granted. Check in
Speaker 1: with each other, even if it's just to send a
Speaker 1: picture of a flower or an apricot that looks like
Speaker 1: a butt. We need those moments.
Speaker 3: Yeah, and how much we all need other people, whether
Speaker 3: we're in the US, or whether we're a Republican or
Speaker 3: a Democrat, or whether or you know, we're a Muslim
Speaker 3: or Jewish or living in China. I mean, we all
Speaker 3: need other people.
Speaker 1: So call up old friends or new ones and ask
Speaker 1: them stupid questions, because no question is stupid, and we'll
Speaker 1: get through this together.
Speaker 2: No.
Speaker 1: You can follow doctor Shannon Bennett and doctor Mike Natter
Speaker 1: at the links in the show notes, and I'll also
Speaker 1: put a link there to aliward dot com slash ologies
Speaker 1: slash virology too, so you can get more links to
Speaker 1: the study sided and the Science Versus podcast. We mentioned
Speaker 1: the organizations receiving donations, database for scientists and more. We
Speaker 1: are at ologies on Twitter and Facebook. I'm at ali
Speaker 1: word with one L on both. Thank you Shannon Feltis
Speaker 1: and Bonnie Dutch of the comedy podcast Do You Are That?
Speaker 1: For handling merch. Thank you Aaron Talbert for admitting the
Speaker 1: Facebook group, Caleb Patten for Bleeping episodes, and Emily White
Speaker 1: for handling the ology's transcription efforts. Thank you to everyone
Speaker 1: who works on those transcribing them. The Bleeped episodes and
Speaker 1: the full transcripts are available for free on my site
Speaker 1: at alliwar dot com slash Ology Stash extras link in
Speaker 1: the show notes. Thank you to Noel Dilworth for helping
Speaker 1: me with scheduling and getting all these interviews all lined up.
Speaker 1: Thank you to Jared Sleeper of mind Jam Media for
Speaker 1: assistant editing, and of course the Jewel in our Corona,
Speaker 1: Steven Ray Morris of the podcast that per Cast and
Speaker 1: See Jurassic Rite for editing these altogether and making sure
Speaker 1: that they go up on time. Nick Thorburn wrote and
Speaker 1: performed the theme music. And if you make it through
Speaker 1: the credits without bailing, I tell you a secret. And today,
Speaker 1: like an hour ago, I made a caesadilla with some
Speaker 1: corn tortillas that I noticed how to sell by date
Speaker 1: of April second, it's over a month ago. But they
Speaker 1: weren't moldy, and I was like, I'm gonna eat them anyway.
Speaker 1: And then I went to get some cheese and we
Speaker 1: had some jalapeno cheddar and it was moldy, but I
Speaker 1: just cut the mold off and I ate the good
Speaker 1: parts with the expired tortillas. Now it's been an hour,
Speaker 1: I'm still alive. I'm just at the part of quarantine
Speaker 1: where I eat garbage like a raccoon. Also, I made
Speaker 1: a Caesadia for Jarrett too, but I didn't tell him
Speaker 1: about the mold. I cut off the cheese or the tortillas.
Speaker 1: And since he helps me edit, he saw this in
Speaker 1: my notes, has my secret and I was like, are
Speaker 1: you mad? He was like, no, just cut the mold
Speaker 1: off the cheese, eat it anyway, so everyone does. I
Speaker 1: was like, okay, bye bye. Pacodermatology, hobbiology, hydo zoology, lithology, technology, meteorology, pedatology, nathology, zereology, elology,