COVID-19 Live with Q&A 04.08.2020

We'll give it a shot.

Okay. If you can't hear us, it's Facebook issue this time. Facebook issue this time. So this the purpose of tonight's really.

Far and I can't what's on me.

Shoot.

I haven't worn makeup in like two weeks.

Yeah, three weeks. Usually Wednesdays are date night and so we're a little discombobulated because we're, we're pausing date night for a live thing. So if we're a little discombobulated, that's the reason why. Bad excuse. I know, but we'll have to go with it. We'll start now. So the purpose of tonight's live is to basically help answer some questions and dispel some anxieties related to some of the information that's going on that's passing around there. There's been two major articles or groupings of information I've been passing around social media. One has to do with the lack of the epidemic and how empty ers, etc. Are. Another one has to do with some of the questions about what is this even dealing with. It's not acute respiratory distress syndrome. So what is it? Are ventilators actually hurting people? So I want to try to help with those two areas, but I want to step back really quick and just talk about how evidence works and how things like this can cause a lot of anxiety. Even the best data that's randomized, double blind, placebo controlled, that goes to the most stringent testing categories, that's published in the most prestigious journal. Fold. Literally we're taking information anecdotally and magnifying it multiple times. So anecdotal, I don't really like that term per se because. You. With this changing environment, it's patients dealing with it, it's administrators who are trying to create protocols for care, patients who are non medical individuals. And the whole world is basically seeing this unfold in real time. And it's cause. Those as time permits. The first one has to do with this, a feed that went viral looking at an inside reporter going into local emergency rooms, hospitals and showing how dead they were. And the point of it was, hey look, the coronavirus is actually not real, it's overblown. Etc, Etc. I did a video a couple, a couple times ago talking about models and how models work. And part of a model, it's like a tsunami. And what you do is you try to prepare for a tsunami, an earthquake, a hurricane, as best you can. And so what has happened is, is with the modeling at one point in time, we're thinking the death. Yesterday was 84,000 deaths. With our current modeling this, the issue with modeling, it's only as good as the information you put in. And it's always changing. So our expectation was, hey, there's gonna be a lot of potential deaths. We made a move and the purpose of the move was to maximize hospital's ability to take care of people when this wave comes. So the tsunami, if it's coming, you know, it's really interesting how tsunamis work because actually as the tsunami approaches, the water on the beach actually goes away. It dissipates, it goes back. And so if you don't know what the, the phenomena you're looking at, you're like, wait a second, the water's going away, what's going. And you have to, if you are a local, like what happened in the Indonesian tsunami, the locals saw the abnormal activity of the birds. They saw what was going on with the water and they went on versus those who did not know what they're observing were like, hey, let's take pictures, let's go up and see what's going on. And when the tsunami hit, it was too late. And so that's exactly what we're trying to do. We're trying to prepare for this. And so what we've seen in New York is actually some of the projections were that by the 14th to 15th, New York would be overrun, People would not have access. And as of this morning, the governor, the mayor of New York City is saying, look, we have plenty of ventilators. No one is going without care. The people that are dying are not dying because of lack of care. And I think that's because of the so much misinformation out there and so much stuff being passed around by that's non vetted. It's just causing a lot of anxiety, a lot of stress. And people ultimately don't know what information to rely on and depend on. And that's something I've been talking about for the last month or two. Just finding a reliable, dependable source of information that you can trust and sticking with a few of those. Now we did a video on anxiety yesterday and put that up there. And one of the things that I mentioned in that is that just looking at this literature that just looking at news feeds makes you anxious. So just the more news feeds you look at, the more of these videos you watch, the more whatever you look at, that by itself drives anxiety. Throw the unknown in there, throw a black swan event that no one expected. And it's just causing a lot of anxiety. So if you're someone who is being driven by the need to know, just find a few sources you can rely on if you're someone. And some people just need to pull away, some people just need to pull back and not watch this stuff because it's just going to cause a lot of anxiety and angst. And so I did send that one video that went viral that people ask me about to one of my colleagues who's in the ER here in Richmond. And his response, he couldn't actually watch the whole thing because he got so mad. Because Even though the ERs are not as busy as usual, the same day surgery centers are closed down in preparation for what may happen here in Virginia. All the patients they're seeing are really sick. They're intubating multiple patients a day. They're doing four to five codes a shift. They're really busy with really sick people. And so it's just if I go to where, where the events are not happening, I report the non events, then yes, it looks like a non event. And that's where we have to just kind of realize what's kind of going on. The second thing is going on around some information about us trying to understand what this acute respiratory distress syndrome, this, this pulmonary event with COVID 19 actually is. And so there's been some interesting. I was actually, my family member sent me an article they might be watching right now a couple days ago with this initial information written by a blogger, someone who was non medical. And they had some terse language and basically they cursed in it. And so my initial response was this is just not good information why this being brought to my attention. And so I just paid a little more attention to exam open into learning things and come to find out some of the issues that have been going on with these patients are being intubated is they're not acting like typical acute respiratory distress syndrome patients. Typically in acute respiratory distress syndrome, what happens is as your lungs fill full of fluid, it gets harder. It's like a balloon that gets really, really tight, so it's harder to breathe. And what happens is the lungs, the diaphragm and the muscles of breathing ultimately fail and people lose the ability to breathe. And you intubate them. What's happening in this, this entity is what's happening. And one of the protocols that occurs is when your oxygen's, you know, 80%, you get intubated. And what's happening with these patients is that if they're intubated to too High of levels, they can actually get lung damage. Intubation is not one of the things with the media. The media has made intubation sound like, hey, if we have enough, we have enough ventilators. That's the problem in our country. We don't have enough ventilators. The ventilator is the latch ditch effect. That's literally one. It's like a transplant. It's like dialysis. It's like ecmo. Something outside your body breathes for you, works for your heart for you. If you're that sick. Yeah, it makes sense that 50 to potentially up to 90% of people who get intubated with this entity. I will be doing a video tomorrow or the next day. I get days mixed up talking about some new information from England, the United Kingdom about their ventilator survival rates. And they're seeing it more closer to 50%, which is an improvement from some of the Chinese data we had initially. Point being is that if you, if you're sick enough to get intubated, you're pretty sick. However it appears with this entity, maybe we should be more gentle, not intubate as quickly. Maybe we should watch these people and do oxygen first. There's a lot of question about the physiology of this process. And we're actually still, again, we didn't know what this thing was even four months ago. So we're still learning about the physiology of it. There's some questions about whether the way the way hemoglobin works, if that creates an oxidative stress, causing more lung damage, maybe that's the way the vitamin C, one of the ways vitamin C works as an antioxidant, maybe that's one of the ways curcumin works, maybe that's one of the ways quercetin works. These are all things that modulate the inflammasome, which are small cells that modulate inflammation in your lungs. The problem is this is so much information, not even physicians are having access to it. And that just causing lots of anxiety in people in general. And so that's what I'm feeling from questions we're getting is just the general sense of angst and unrest and not knowing. Find good resources of information, you know, hopefully have a good practitioner that you can work with that can help help you through this time and just realize that 80% of us are going to get this. The vast majority of us who get this will be fine. About 20% of people who get it will need some kind of intervention with the hospital. And about 5% of people will go to the intensive care unit. The ones who make it to the ICU are the ones that you really have to worry about because those are the ones that are more likely to have complications. I'll be talking about that either today or tomorrow when our next video is put out. So. But ultimately there's just so much misinformation going around out there and it's just causing a lot of anxiety. Whether it's, this is not, this is a non event, this is all created by the government or it's created by whatever or we don't understand what's going with the lungs. And if you get intubated it kills you. This is a thing in emotion. It's one interesting. There are some ER physicians in New York that are actually talking about some of their experience. And we're learning from Italy, we're learning from England, we're learning from New York. And so you all are literally watching that learning process that occurs every day in the practice of medicine, occurs every month in the practice of medicine. And so that's what we do. We learn as we go. That's the practice. It's just now you're part of what it is to the unknown unknowns. You see someone in front of you, you know they're sick, you don't know what's going on and you do the best you can. And so it's just now you're all part of our business, our life of seeing people on a daily basis. And of course it causes anxiety in you because people expect us to have all the answers and the reality is we don't. That's the beauty of the practice of medicine, that's the Achilles heel. And that is that every half of what I know will be obsolete in five years. That's a pretty crazy statistic. I think half of what I know now is going to be obsolete in five years. Every 18 months scientific information doubles. So basically whatever humanity knows now is double in 18 months. And half what I know is obsolete in five years. So what that's going to do is you have to be okay with uncertainty and a certain amount of unrest to practice this. And now patients and individuals are being brought into this and it makes a lot of people uneasy. So my recommendations are if this is making you anxious, maybe pull away from social media, pull away from these things. That might be the best for a lot of people. Others maybe find two or three key sources that what I'm doing right now is I have a few physicians around the world, people I'm talking with And I'm using their information, their research and then I'm looking at news articles and just running through that on a daily basis and kind of trying to pick out what I feel are the salient things that are changing, that are valid and that people are worried about. And I can't keep up with it. I've got a full time job. I'm spending another two hours a day with this stuff and it's too much. So I just can imagine how much anxiety this causes for individuals who. This is not their field of expertise. Just find reliable resources if you can't pull back. But ultimately stress is a bad thing. The more you stress, it does actually increase cortisol and suppress your immune system. So I'm not trying to make you stress about stressing, but don't stress. Okay. I actually have a podcast about that coming out hopefully soon. I've been saying it for the last week, but obviously we have a lot of other things going on and sometimes date night gets in the way as well. So anyway, if there are questions, additional questions, I actually answered a couple of them that I recently asked. If there's any other questions out there to do my best to answer those with my limited knowledge that I have.

You want to talk about the survival guide?

I was reminded by my executive producer that the survival guide. I did put a survival guide out this morning actually it's on our website, richmondfunctionalmedicine.com you can just download it. We sent out about 10,000 emails today as well, just inviting all of our people on our email list to download it. It's like what I feel the most pertinent data points information as well as links to PubMed if you're into articles. I've tried to compile it into a basic one basic place. So hopefully if you're interested in that you wanted something to share with people or look at that's out there for you functional. And download it for free.

So okay, apparently there's an issue with.

The.

The link to go sign up for the to get the guide.

So if there's an issue with the link you can all just go to our practice website as well and download it. Which is. Which is. Yeah. Which is richmond functional medicine.com if you've had if for some reason the email LinkedIn do technology. That's my chief operator. Oh, okay. It's giving us an error. Okay then just go to the website.

Excuse me.

Any other questions. And as well, if you all feel like this is helpful, you know it is helpful for us if you either give us a five star rating or like it or follow us because that actually boosts, that gives us feedback that people are actually watching this as well. It makes it more available to other people. So if you feel like this is helpful, just kind of, you know, click the little things to say you think it's helpful, leave a comment. That's always nice as well. If you have things you want us to address, which is happening all the time, feel free to leave those comments there as well.

There was a question about how like, is there a way to kind of like know if your immune system is like up to par? Like if it's. If you're prepared that's weather this well?

I mean if that's a technical question, the question was how do you know if your immune system is prepared for this, to weather this well, that's a hard question to answer because it requires unless you, if you're someone who has health issues, then you kind of already know. But if you're someone who's healthy, as far as you know, that has no known medical issues, the only way to really know is through lab testing to check immune markers, to check inflammatory markers, cholesterol markers that are a part of your innate immune system. So without actual lab testing you'd be basically just based on your medical history, exposure. That's something that you could be answered if you saw a functional practitioner who did a. Usually a two hour intake for me to see people to figure out kind of stuff. But without data, if you have no symptoms, you need lab testing. I routinely see people who are pretty healthy and I do lab tests and I find their stuff is off and then we address it.

Thank you for giving some of your date night for this. I appreciate all of the info you've been, been putting out there. See or think that this is peaking and we should be going into a.

Downward trend based on the most of the, the most of the. The forecasting is based on University of Washington. There's a United, there's a UK model and then University of Washington model. I'm kind of using the University of Washington model because it's an American model and it does show that basically that New York City is going to peak in about a week. You can look at that actually and it shows different areas of the country peaking at different times. Virginia, I believe last time I looked at is supposed to be peaking in two to three weeks. The problem with these models is they're only good to them. And so literally overnight you saw the number of deaths in our country drop dramatically from three days ago to today, 84,000 predicted deaths. Which, to put that in perspective, one of our worst flu seasons on record, 2017 and 2018, we had 80,000 deaths with that flu season. The thing that these models are not talking about, which concerns me, is they go out to August 1st. So you've probably heard about the second wave. You know, what happens when kids go back to school in the fall? You know what happens about that? And these. These models are not taking that into account. So my question is, okay, you know, we flatten the curve. Great. We actually are flattening the curve. We're doing that. Okay. But if people go back into society and culture, if kids go back in school in the fall, we're not actually going to diminish the number of people who are exposed. We're just gonna make it take longer. So my question is, what's our end game as our public health professionals? What's the end game with this? If we're waiting for the vaccine, that's something people don't talk about. Yes. There's 12 to 18 months before we might see a vaccine if going to take about six months to get this vaccine into 330 million arms. So even if you get the vaccine, you have to actually deploy it. So you're looking at, you know, maybe 18 months or more. And so the question becomes, what do we do as a culture once we start seeing each other again? Do we everybody. Does everybody start wearing masks? Do we do like some of the Scandinavian countries have done and just release the kids and keep the older people that are sick back so we can develop this herd immunity? Our health officials are not really addressing that at all right now. And for me, that's my question. What's our end game? And locking down for three months is not a very good end game. And we are seeing things peak. So what do we. One of the nutrients. Everybody's talking about hydroxychloroquine. But the South Korean research was using hydroxychloroquine and comparing it with egcg, which is a green tea extract, and then some stuff with quercetin, which is a extract from apples and onions. So there are natural products you can take that get the zinc in your cells, similar to hydroxychloroquine. So why can't we just start taking that stuff? And that in my. The survival guide talks about that kind of stuff. But that makes sense. These are takes. It can take up to five years to get a study done, to get something approved. And we just don't have that kind of time. So whatever intervention I'm recommending as outside the hospital, I want to be a safe intervention. And if someone's got this and they have a high risk and they're over 60 and they've got high blood pressure, then hydroxychloroquine and azithromycin, as long as your EKG is okay, is actually a relatively safe thing as well, even though it's experimental. And on a side note, did you ever find the source? Because remember I wrote an article from one of the reliable sources that told me basically that the CDC was pulling back their recommendation for hydroxychloroquine. And then when I actually went to the CDC site, I could not find that information. And so that for me is even more frustrating because I feel like I'm up on this stuff and when I'm hearing reliable news sources telling me the CDC is reversing their decision. But I'll go to the CDC site and my chief operation officer as well goes to the CDC site and who is more tech savvy than I and cannot find it. It makes me question the static out there. I know it was a long winded answer to your question, but we are peaking basically is the short answer the next question there is what is what next really? And that's what no one. That's what our health professionals are not addressing. And that's my concern. What next?

I'm skipping a couple questions down, but don't worry, I've seen the other ones. I just want to that this one might take a couple minutes to address. How long do we think it will be before antibody testing is offered?

Antibody testing, That's a great question. Antibody testing. Okay. So you hear on the news, you know the testing will be available next week and then it doesn't show up. So that's a problem is that people in administrations hyperson this is coming. The reality is for testing locally. For example, I can get from LabCorp tests for COVID 19. Our office has 10 practitioners. I can get five tests a week. I can't deploy that in my office. I can't tell people I have that test unless I can get enough for hundreds of patients a week. So my question is when am I going to have a test in my office that I can email people and say, look, check you. Cleveland Heart Labs actually is launching an antibody test the end of this week, the beginning of next week. And so I'm seeing if we can get that in our office Again. I'm not quite sure Seeing in different places in the country next week. The Mayo Clinic actually has an antibody testing there available already. But the question is, wherever you're calling from or you're questioning from in your local, if it's the Richmond environment, don't know. I'm hoping to have antibody testing. We are working with another lab that's actually going to be giving us a rapid test, hopefully in the next two to three weeks. But they're choosing urgent care centers first. So the short answer is hopefully next week. I think that's going to be. I'm looking forward to that because that's my. If I was to make a plan. If I was to make a plan about how we'd reenter, I would say the people that are high risk get tested with antibodies, and if their antibodies are positive, then they don't have to worry as much. The younger people that are low risk might not worry about as much, but that way we can at least risk stratify people based on their risk for gayness and dying, which we know that data, and then if they've been exposed or not. And so hopefully that will have that by next week. The biggest question is when will be deployable? Not just when can one person get the test, but when can one office like ours give it to hundreds of patients a week? So I'm hoping that will happen in the next week or two.

Okay, this is a little complicated, but should a nurse be like an RN be wearing an N95 mask in contact with a known positive or only with aerosolized treatments?

I'm going to talk actually about how this gets aerosolized in a video. I just did two today, and my chief operating techie has to put these things out there. So. And we're trying to homeschool and do all kinds of fun things. So it makes it a little difficult. So look at that when it comes out. Absolutely, yes. The problem is, is when you. When I sneeze, I can spread fine particulates up to 28ft away from me, which means my whole room can be actually spread with that. And the only way to prevent you from getting that is an N95 mask. So if you're a nurse anywhere in the system, you should definitely be wearing an N95 mask, period. That is the best way to keep from getting exposed to this. Ideally, the patients would be wearing surgical masks so that when they cough and sneeze, they do not create the velocity that makes this massively aerosolized. But absolutely, you should be wearing an N95 mask without doubt I actually will talk about this article I'll be putting out again. Just look for that. That actually goes a little more in detail to particle size, how to filter it. Coughing vs. Sneezing vs. When I talk, just me talking is spreading particles. That's where social distancing comes from. It's just talking. Okay, what if I sneeze? Okay, well, now we've more than tripled that distance.

This might be too specifically medical, but does florinef acetate lower your immune response?

That's a very specific question. Florinef is actually a mineralocorticoid. That's. That's an interesting drug to use for a lot of POTS and dysautonomia patients. It does not specifically. It's a mineralocorticoid, not a glucocorticoid. It does have some mild glucocorticoid activity. And the person asking that question is probably referring to the steroids like prednisone and their association with increasing the risk of complications. If you're on that, though, it's not really something you'd stop. If you're taking it for pots of dysautonomia or maintain your blood pressure, some people, if you have adrenal issues, might take it as well. And those people are all macularly high risk because of their adrenal issues. So probably you'll be higher risk because of your other medical problems. The drug itself has low glucocorticoid activity, so you would have not have a huge, but a mild immune modulation from them.

Do we know if there are lifelong impacts after recovering from COVID 19 or is it too early to tell?

We didn't know what this was in December. Some will say it's too early to tell. However, COVID 19 is a coronavirus. In a typical head and a typical flu season, 5 to 10% of upper respiratory tract infections are a coronavirus of some sort. And during the flu epidemic season in your local environment, up to 3, 30% of all infections are a coronavirus of some sort. It's not going to be like others as far as you get exposed, you get immunity, you move on. It's just that no one has ever seen this one ever before in the history of humanity. And so it's just having a much more robust effect on people. So my expectation would be it's eventually going to be the normal thing in the season and three to four years out from now, it'll just be like the H1N1 was. It's just the normal thing floating Around.

I'm going to adapt this question, Kim. Hopefully you don't mind too much. But for people who are maybe have lost other work hours in another category, you know, and have started working in a grocery store, delivering groceries or those types of things, are their chances of catching COVID 19 increased? Should family members be concerned or take extra precautions?

Okay, I think that question will probably be. You'll understand a little bit if you watch the video about coughing and how this is spread. Basically right now, if you're following social distancing, where this is continually to be spread is in grocery stores. There's a reason why there's been a recommendation in New York that everybody wears facial covering in public. There's a reason why Los Angeles is recommending the same thing. It's because you go in public, you cough, you sneeze, you talk. You know, if you're a, you know, bagger, cash, a cashier at a grocery store, are you within six feet of people? That's the distance for just talking how much water droplets are spread and talking. If you're coughing or sneezing, if you cough, it's like 16, 18ft. If you sneeze, it can be up to 29ft. That's a big distance to project these things. So if you're in public that you're. You, you have risk, you know, and so, you know, if you're in public and you're concerned because you have family members at home, I'd recommend you wearing a. At least a surgical mask of some sort. Mainly, you know, ideally a N95 mask if you can get a hold of one, which I know is controversial still because they're hard to get a hold of.

Well, people reporting them?

Yeah, lots. There's a lot of other issues there.

I'm trying to see. I think, I think we got all the questions. Questions.

Okay.

Yeah, I think, I think we got them all.

Yeah. But as far as if you're at get. We got all the questions, so we'll stop there. But the grocery store question, I would just say wear a mask. Wear. Wear gloves. What I do, what I do. Okay. I'm a physician. I'm in public right now. What do I do? I have my scrubs, I wear to work, I wear long sleeve shirt. So the only thing exposed to coughing, just my face and my hands. I wash my hands between every patient, which means they're really dry right now. And I have my nightfly mask on. When I come home from the end of the day, typically someone opens the back door for me. To come through. I take my. I wash my hair every day. I don't usually wash my hair every day. I'm doing it now and you can see it's a little suboptimal and it's getting long. I need a haircut. So anyway, but the point is, like, I do that before I introduce myself to my family because if I have something on my clothing, it can live on cardboard for 24 hours. So maybe on other non cellular materials as well. My hair can have some issues as well. So I just do that before I reintroduce myself to my family after I've been gone for the day. And so if you're out, I'd probably recommend something similar as long as, you know, especially if you have anybody in your house with any kind of respiratory tract issues, asthma, etc. So with that, we're going to call it a night, hopefully. Again, hope this is helpful. If you've, if you enjoyed this, obviously you're watching just like us, follow us, all that kind of stuff. It makes this information more available. My hope is that this is actual useful information. I was actually listening. I mentioned this before. Maybe I don't. I kind of forget what I say to who these days because I'm talking a bunch and you know, but for those of you know who El Elyron is from Allianz, he's really, really big, runs a bunch of important funds, really well known in the investment world. And he was talking about the, the financial effects of what's going on right now. And when he was just talking about his personal experience. And he comes home and he's talking with his daughters and they're really stressed and anxious. And he found, just talking about data, information, telling what's going on. Just the fact of knowing that in the sea of chaos there is some, there are some things we know that actually helped ease their anxiety and help them feel like they're in a little more. And so my hope is, you know, there's way more that I don't know, that I do know. But my hope is that this is a source for y' all just to help keep your feet more than ground grounded while everything else is moving. We're gonna get through this. 80% of us are gonna be exposed. Most of us will be fine. And even, you know, even if you're over 85, you know, if you're over 85 and you get this, 85% of those people will survive this. So the good news is most people are going to do fine. It's just we're doing all this to protect the vulnerable. This is what, this is what Americans do. This is what we do. This is what humans do. We try to protect. And that's what this is all basic about is protecting those who, if they get exposed, are going to do really poorly. The vast majority will be fine. It's just we're doing this for that few that at risk minority who we don't know who they are. We might not even meet them. That's who we're doing this for. If you keep that in mind, then hopefully you'll be a little more at ease. Hope you have a great night. Take care and we will see you next time. Have a great night.