Live Q&A June 12, 2020

Schedule. I was supposed to be at a conference in Atlanta, Georgia and totally forgot that the conference got canceled. So this past Thursday, saw my Friday schedule was empty and I decided to take off today because I felt like I needed a day off. I haven't had a day off since Christmas because we working straight through. So it was kind of nice to have a day just outside in the garden, weeding it, getting a little sun. So hopefully you all having a little time off as well. It was actually nice to have a slow day, so hopefully have more as the future comes around. So we're just waiting for both technologies to pop up here. So if you're as you're coming on, this is a Q and A session. If you have questions, save them. You can put them out there. We have a list that people have already submitted that will be going through and if you have additional questions, we can answer those as time permits. There will also be some articles they'll be posting related to the questions that will be available on social media. Looking for those and some references as well to Facebook and other things we're posting out there. So just kind of stay abreast. All those things will keep you in the loop with everything we're doing. And as soon as everything's going, I get the nod, we'll go on and start answering questions. Can people on Facebook hear? Is the audio on Facebook? Okay?

It's gonna be a delay.

Just remember. Okay. And the questions. My director of Internet affairs, Rebecca, will be asking the questions. So that's the voice I'll be. You'll be hearing in the background. Everybody needs a title, so we created one. Can Facebook.

I think we got some thumbs up.

So I think we got thumbs up on Facebook. Okay.

And it's just now 8:31 probably. Okay to get started? All right, I'm looking.

So.

Okay. Yeah, I think we're all right.

All right. All right. Looks like everything's connected on social media. Looks like we've got by attached. So again, this is gonna be a question answer session based on questions people been putting on social media. When you put questions, please just ask questions. When we get three paragraphs with the question hidden there, it's kind of hard to find those and answer them. So if you are putting questions out there on social media, just try to make them brief and to the point. We did get some clinical vignettes and it makes it kind of hard. And once we have everything ready, we will go ahead and start.

I think we're all set.

Okay, great. So anyway, just a summary we're gonna. This is a question answer session. Rebecca will be answering, asking the questions in the background. That'll be the voice, the young lady that will be asking the questions. And then I'll be answering them to the best of my ability. This is not medical advice. This is my opinion as a physician, clinical researcher, functional medicine practitioner, integrative, holistic, board certified physician, etc, etc, but this is not to be construed as the opinion of any international. Science and literature. As a practicing clinician with about 20 years of clinical experience. So I just got to put that, that caveat out there.

So also just really quickly, can you go over that? It's on Facebook, YouTube, Instagram. Facebook and YouTube are the same.

Okay.

And people have an Instagram, they can.

Okay.

And vice versa.

Gotcha guys. This right now is on Facebook, Instagram and YouTube. So if one of these stops, wherever you're at, you can always just switch to the other media. They'll be reposted later as a recording. But if for some reason it cuts out, just switch either to YouTube or Instagram or Facebook.

Okay, let's go. Okay. Little League sports are starting back next week. What are your thoughts on the safety of this?

So we've been getting a lot of questions in regards to children's activities in the summertime. So I think whether it's little League sports, whether it's swimming pool, whether it's camps, I think the underlying idea, the kids are at a very, very low risk. This is less dangerous in kids than a typical flu. So I guess the question would be, would you not send your kids to Little League if flu was going around? And that's my basic answer to that. Kids are the young, healthy ones, they're the low risk individuals. You know, camps, same kind of thing, the high risk people. It appears that highest risk issues are going to be vitamin D deficiency, obesity, diabetes are like some of the major issues, as well as high blood pressure. Kids tend not to have these issues. So in general, Little league sports are actually okay. You want your kids to be active, this thing is killed outside. Being outside is probably the safest place to be. The UV radiation from the sun kills it, the heat kills it. You know, hot objects over 133 degrees, which is any metal object in the sun. So I think outdoors are pretty, pretty safe.

So you kind of covered. The other question was pool openings and are they safe. The actual people know the water is safe, but how do you social distance in the water?

I mean, I think the social distancing is a pragmatic perspective. As a father who has a nine year old social distance extrovert son who has no strangers, how do you tell kids to social distance that. How do you tell them to wear masks? That's outside my expertise as a physician and relies on parents and parenting issues. I just don't know how that would work with my kids. Chlorine sodium hypochlorite, which is in chlorine pools is one of the major killers of this virus. So pools are pretty safe place. And social distancing, the major utility of social distancing is actually indoors where you don't have fluid air movement, we don't have laminar flow of air. So you literally have aerosolized particles sitting in the air. That does not happen outside where you have even a basic breeze is moving large volumes of air. So you know, again, pools are fairly safe. And you have to realize there's also a lot more humidity in the air. Things are going to drop out of the air quicker in a pool environment because of the increased humidity. As the summertime comes along and the humidity goes up, you're also going to have a lot more the particles in there falling out quicker because they're weighted down with water in the air. So overall, pretty safe place to be basically if you're outdoors, I mean and you're. That's pretty safe. It's really interesting. There's this article that was probably posted on social media and it was interesting. Ford actually is taking on police cars and actually putting a chip in it that when the police officers stop the car and close it down, the car cuts back on, turns the heat on up to 133 degrees for 15 minutes and cuts off and literally 95 to 99% of all the virus is killed in the car during that 15 minute time frame. So in the summertime my car is probably closer to 150 to 160 point. Being heat kills this thing fairly effectively.

So I have a question about COVID 19 and autoimmune disease. Has there been much research on autoimmune disease and what effect Covid has on people with those diseases, especially with regard to triggering an autoimmune flare up autoimmune diseases.

About 1 in 12Americans have an autoimmune disease. So this is a very, very common question. Autoimmune diseases as a whole, if you put them together, are the second or third most common cause of chronic disease in our country, which is a pretty profound statistic to think about. The thing about autoimmune diseases is they are not ubiquitous, they're different. If you're an asthmatic, which is a Th2 dominant autoimmune disease, that's different than lupus, which is a TH1 dominant autoimmune disease. It also depends on whether you're actively inflamed or not. What we understand from COVID 19 is a lot of the morbidity mortality is from the second phase of the viral infection where people's immune system mainly they're innate system actually goes out of whack and they create lots of cytokines which are part of your mainly part of your innate immune system, not your adaptive immune system which is the th1, th2 part. We do know that inflammation increases the issues morbidity risks with this, particularly things that revolve around metabolic syndrome. So that's probably a bigger umbrella. That's your high blood pressure, diabesity, high triglycerides, elevated sugars. There's some interesting data coming out with newly diagnosed diabetic increased risk for this disease. Yes, autoimmune diseases are inflammatory diseases. Yes. I would assume that you're going to be at high risk because you have an autoimmune disease. We just don't haven't seen anything published in that yet. It's mainly inflammatory diseases that revolve around metabolic syndrome type things including sleep apnea, gout, kidney stones. These are all kind of fall into the metabolic disease realm. Most literature is with obesity, diabetes, some stuff with sleep apnea, hypertension. Again, if you're not actively autoimmune, I would do all the. Now I would not say you're at an increased risk more than someone else with a different chronic disease.

A quick related question just came in. Would prediabetes be treated the same with regards to Covid as diabetes?

Prediabetes is just diabetes before someone else decides to call it diabetes. So if your sugar is over 5.5 you have an increased risk endothelial dysfunction, you already have inflammatory markers. So we don't have pre diabetic leach literature on this because no one's looking at prediabetes in general in our country, even though 35% of our country is pre diabetic. However, you do see this similar inflammatory markers with prediabetes that you see with full blown diabetes. It's just an earlier state. It takes about anywhere from eight to 12 to 15 years from going from insulin resistance to full blown diabetic. And it's just a continuum of increased inflammation, increased insulin resistance. You know it's interesting, the HSCRP which is something we see in diabetics that's elevated. There's a correlate to the interleukins 1 and 6, which are things we see elevated in severe COVID 19. Those are markers we see people elevated in people with metabolic diseases, particularly diabetes. So the risk is there. It's just not going to be as great. The literature we're seeing about diabetics is that the higher the sugars are, the more controlled it is, the higher risk you are. So if you're pre diabetic, now is a great time to be proactive to cut out carbs and grains under control to make sure vitamin D level is appropriate. If you're pre diabetic, I'm 99% sure your vitamin D level is low. Your C is kind of borderline, you probably have some B vitamin deficiencies. So I'd focus on all these things to help lower your risk for inflammation. That there is literature that doing these things may limit or decrease the disease severity of this entity. I will throw on a side note here. I actually learned an interesting fact from talking with. I'm a local restaurateur who's Indian who has like a ton of friends in India that are physicians and I've read some things about firsthand that in India, if you pay attention to some of the literature, India, yeah, it's a huge country of a billion people, but they're not having a massive uptake in mortality to date that we'd expect for a country as big as like, like we did in China. I mean literally, literally right by China. Interesting enough, in India they, when you get admitted to the hospital, they give people curcumin or turmeric tea, ginger tea and EGCG or green tea throughout the hospital stays as anti inflammatories. That really is intriguing to me because the Institute for Functional Medicine put out this provider practitioner guide 6 weeks ago looking at modulars, inflammation and the inflammatory stages. And all these substances were actually anti inflammatory agents they recommended. So you know, inflammation is a big key, a big player in this and there's many things you can do to diminish inflammation. I actually did a, a blog post on inflammation on our website that actually talks more in depth about lowering inflammation. So if you want. Has some pretty good recommendations there for you.

Okay. And a follow up to the autoimmune discussion. Would you recommend that people with autoimmune conditions wear an N95 mask when they go out and then maybe comment on where you've heard people finding them?

Okay.

And if not do you recommend the three layer cloth masks the WHO recommends.

If you have an autoimmune issue. I mean it's an inflammatory condition per se, it's an immune modulatory condition. I think the best thing to do is wear it. I mean you want to minimize your, you know, you want to do all the things we've talked about in the past on multiple other sites and as well on the blogs, etc. But you want, you do want to minimize your risk. You know, you want to decrease it and then 95 is better. It removes 95% of the particulates, which is huge. You know, if you can't get a hold of. Personally, actually I had a patient, she's great, awesome patient. She might be watching right now. Who Basically I think she went. She'll probably, if she's watching, she'll probably note it. Correct me if I'm wrong, but I think she said she went to Home Depot Lowe's and she got 95 masks for myself and my staff maybe four weeks ago. And they're available. So I mean you're going to pay a little more now than you would have paid, you know, months ago. But they're out there. If you can't find them at a local Home Depot Lowe's, a small local hardware store, then you can use the three layer masks. The best thing, the idea behind those is you can actually make your own masks. From the WHO about two weeks ago, which is just old information being recycled all over again. We know that anything in front of your face is going to slow air velocity. It's going to decrease water droplet spread. One thing that people. Where this stuff is aerosolized everywhere with nebulizers, you are much more likely to have severe disease than if you get exposed to a random particle in the air somewhere walking through a building. So the face masks diminish that viral load exposure that we think probably plays into their protection, protective effect. So there's something is better than nothing. N95 is best. You know, I have a few people using N100 masks, but they're kind of hard to. You might feel claustrophobic in those.

I hear what you're saying about mortality for under age 25 being less than the flu, but is this more easily transmitted than the flu? Would we expect to see more deaths than the typical flu just due to high numbers of cases? Thinking about the fall?

Yeah. The thing is when you talk about this in the flu, the typical flu, only about 25%. Kind of exposed. Only about 25% of the people. The difference with this is that it's novel. No one has immunity. So if you need 60 to 70% of people to get this automatically, 75 for number's sake, that's three times more people that might get this so automatically. If this mortality was the exact same as the flu, you'd still expect three times more people to die from it. Simply because it's novel. Really depends on how many people have already been exposed. I mean we have no idea. You know, New York City, 25% plus have already been exposed as of four weeks ago. So they might hit herd immunity by the end of the summer. You know, other places, some areas in California, 5% from some testing. There was a homeless place in Boston that 50% of the people they tested, this homeless center were positive. The reality is for our country, we just don't know how many people already have that. And that's the big question mark. If the more people that get this during the summertime, the less likely we'll get an uptick. So which is one, which would be one reason that we want our kids playing, going to camps and going out there. We want the people that are not that are the low risk people to get this so that in the fall they can become the roadblocks for rapid spread for this. We want this, when it comes back in the fall to be spread over the whole winter season, not to be crammed into a short period of time. And I would assume, to be honest with you, that typically you see influenza outbreaks and the local environment usually is about a six week time frame. Yes. Flu seasons from November to, you know, April, May, depending on where you're at in the country. But typically in the local environment it's about six weeks when it goes crazy. And that tends to correspond with low, with nadirs and vitamin D levels, with cold air, with humidity, with how the lack of access to outside. So a lot of different factors play into that. So. But I'd expect this to be similar to other respiratory tract infections where it should be hopefully be spread throughout the winter. It won't be, you know, all crammed into one short time frame. You know, this thing kind of popped up during a typical to have the intense numbers, even though we know that was actually here in the United States in late December, maybe even earlier. So anyway, that's a long winded answer I know to that question. But yeah, it's gonna probably pick back up when kids go back to school, because kids will be back in school.

Someone asked a question about what is the Best test for Covid And I just want to mention, or you can mention the last video right before this one is basically a whole video covering that. So just in case anybody hasn't seen the last one, it's, it's like on the reliability of COVID 19 testing or something, it's titled, something like that. It's literally the last video before this one. So on Instagram you'll see just the title. On Facebook, if you go into our videos, it will be the one right before this.

So as far as the question today about the most reliable test depends on if you're acutely in disease versus if you think you had three, four to six weeks ago, if you think you're sick. Now, the best test is going to be the viral PCR test, which is either nasal swab or LabCorp is doing an oral swab. They actually ran out of the nasal swabs and switched over a couple weeks ago. But it depends on when you're sick. You know, the test is most accurate in the first three days of illness. You know, greater than 90% accuracy. At day six to seven, accuracy drops down to 80%. And if it's 10 plus days, the viral PCR swab drops, sensitivity actually drops to less than 60%. So if acutely, that's what you want. As far as if you think you were sick, then that's just when you're doing IgG, doing the serum testing, which I talk in depth about that in a video and my opinions about that and some experiments. I did actually my own clinic with patients. We've been seeing patients with this and testing. We've been testing for this since March. And I've had a fair amount of experience testing people, tracking their families, retesting with different, with different tests. I actually talk about that in detail in that video. So.

Does O positive blood have anything to do with COVID.

This is something that popped up. It came out. There's a lot of things that are kind of wash and repeat things in the media where it pops up, it goes, you know, the mask thing. Right. The bad, the good, the bad, the good. You know, this is something that popped up maybe two months ago. I think the big, the big thing is people do have different types of antigens on their blood. They can be related to some in small degrees, just different inflammatory diseases. But in general, for this, it's a small, small, small blip. Not enough to make a big deal about it. I'd be more concerned about your vitamin D status, about your nutrient status. If your thiamine pyridoxine, your B vimin staph is low. Those are bigger markers than if you're a type O or AB positive or whatnot. So. And plus you can't change your blood type, but you can Vitamin D status, for example. There was a great article I did talk about that came out with the Lancet and Lancet did a. It was, it's basically the best review article you're going to get Maest doing an actual randomized trial on this, which is not. No one's going to do a $25 million trial on, you know, a $2 supplement. But it went, it reviewed all the European literature and they showed direct correlations with vitamin D levels, severity of disease, risk for ICU admission as well as risk for death in the ICU based on your vitamin D status.

That one is a picture of a beach if you are looking for it in our feed.

Yeah.

So, okay, I'm worried about a loved one who is a smoker. Have you had anyone who is a smoker recover from COVID 19?

So I'm saying they are smokers, so I assume that means they're currently a smoker. Yes, I have, I've had previous smokers recover as well in my clinic, to be honest with you. I've had a lot of patients have COVID 19, You know, so I've had experiences like that. One of my patients, actually her son was admitted in the ICU for almost two months and everybody, her family got sick. He survived, you know, so I have stories like that. I personally don't have any story of anybody dying yet in my clinic, which I know there are people that are dying from it. So I don't want to minimize that. If you're smoking, you know, it's a risk factor. It causes lung inflammation. I mean there's literature now out there that if you're in a city with, you have a risk for increased severity of COVID 19. If you are exposed to more combusted smoke particles, you have an increased risk for severity of COVID 19. And I'm putting, or either put those out there in social media, those are going to be put out over the next couple weeks. Not sure where we're at in the cycle with that it's concern. There are some things you can do, however, like vitamin C. You know, if someone smokes that you need 10 times more vitamin C consumption to mitigate the inflammatory response of smoking than a non smoker. NAC inosylcysteine was something back in the 1980s actually that physicians were using to treat COPD before some of the newer fancy drugs came out. And that's a supplement. You can get Vitamin D stats. Pretty much all my smokers are vitamin D deficient. Get those levels up. But ultimately they need to quit smoking. You know, that's the biggest thing. Okay.

Could you. Okay, I just messed up everything.

Technical difficulties with the iPad, with the questions on them. So.

Could you talk a little bit about the WHO statements about asymptomatic spread and the fact that their position keeps changing?

Yeah, that's. That's more of a political question, I guess. You know, whenever we talk about WHO statements, CDC statements, you have to realize these are. These are governmental organizations. They have political influences. There's a lot going on. It's not simply the best and brightest minds getting together and making a statement. There's this whole filtering process and any, you know, it's by committee. It's just not the kind of. The best kind of mess. And making a recommendation that applies, the CDC, that applies to over 7 million people from thousands of different ethnic groups that have thousands of different languages from different ages. It's like, how do you make a recommendation like that to apply to everybody? I mean, I don't know if I could. That's pretty profound. I make recommendations to individuals. My field of expertise is talking to people, evaluating their risk factors and then giving them recommendations. Not looking at a map of the world and saying, everybody in the universe should do this. So that's part of the reason why you see inconsistency, you know, also because of the political bent of some of these things. You'll see a recommendation come out, and then things change really quickly. You know, the hydroxychloroquine is a great example that I did put out something. Social media Lancet just retracted their. And this is not political. This is just me stating what Lancet said. So don't take this the wrong way, social media world, please. So. But literally, Lancet just retracted that article that said that hydroxychloroquine didn't work because the data collection, the company collecting the data, when questioned, because someone wanted to look at the data. Because typically in published studies, I should be able to request the data and look at. They could not reproduce the data. So the Lancet pulled that back because they're like, wait a second, we published an article that now people are questioning the lit. The data and we can't produce it. So this stuff happened. Three months ago. So people. So someone will say, well, I picked a viral particle up, a speck of dust in the air. So therefore the mask doesn't work. It's like, well, a speck of virus in the air doesn't mean the mask doesn't work. It just means there's a speck of virus in there. And that's where a lot of things are being conflated, you know. You know, a mask is not 100% perfect, you know, but it works really, really daggone good. And if you minimize the viral exposure, you have less risk. And that's where you have these, these things come out. You know, the media questions that someone else has a report, they get retracted, new literature comes out, puts back out. And that's what, just as hard for the average person to know how to interpret this because it's confusing and it's frustrating on my end because like we get the same questions over and over again. It's like masks. You know, surgeons wear masks when they do surgery. They've been doing that for decades. You know, we've used masks for infectious disease prevention for decades, if not almost close to a century maybe. So they work. We use them for a reason. You know, I don't understand why it's such a difficult question and why major organizations that they're supposed to give us pretty reliable, dependable recommendations can't stick with it. But I think that's where, you know, medicine by committee is not probably what most people want. So again, one of the mantras I've said is find reliable sources, good sources of information, stick with those. And if you see something that doesn't quite make sense, don't necessarily let it rock your world because it'll change in a week. You know, the idea, truth, perspective, facts are interpreted and people are reinterpreting facts all the time. Truth is different, it's consistent, doesn't change. And that's where truth and masks work. They work. It's just how do you interpret the facts behind that? I'm sorry, that was a little long winded.

Inflammatory syndrome in children MIS C and I'm seeing a lot of people who are scared using that as an excuse not to start school.

School backup, okay. I think school backup and multiple system inflammatory disease are two, are two different questions. I'll talk about the inflammatory disease first. I looked at this the other day and as of mid May, the cases of this in the country. Okay, to put that in spectrum, as of Today there's over 2 million cases of COVID 19 in the country. So that's a pretty daggone low risk for getting that 102 out of 2 million. Is it terrible? Absolutely. It's gonna be devastating. You know, the risk for it's pretty, pretty low. And there's things called Kawasaki's disease, which is something I learned about in medical school, which is another. This thing seems very similar to Kawasaki's disease, which Kawasaki's we assume is virally induced. This post viral inflammatory process where kids get aneurysms and red eyes and tongues, and it's really pretty nasty thing. There are other post infectious inflammatory conditions, Guillain Barre is one, where you get demyelination of your nerves. It happens about one in a million with flu shots, for example. These things are out there, they're super rare. But we shouldn't necessarily make school policy, school reentry policies based on the exception rather than the rule. You know, ultimately kids are low risk. I mean, every year when kids go back to school, what happens? Kid, you know, about three to four weeks in, you can predict it. I start seeing lots of people in my office. Kids are getting sick. Everybody's getting runny noses and coughs and sinus issues. That happens every year. They go back home for Christmas. They come back, happens, you know, two, three weeks after they come back from Christmas. This happens all the time. And we should kind of expect that. My wife did the math on the multiple systemic inflammatory disease, and it came out at 0.005% of the total cases of that in the country end up getting this disease. So pretty low risk.

Are there any updates on the actual mortality rate? I hear so many doctors agree that this is not as deadly as we thought. So why is the government still acting like this is a serious threat?

That's another political kind of sort of question. I think the first part is the update. I wish I could give you an update on America, but America is basically 50 countries that are kind of stuck together, you know, from. From England. There was an update a couple weeks ago and I think we're gonna put that article out there, if it's not already out there at the end of the.

I have to go find it.

We have to go find. It'll be attached here somewhere. Just look for it. The comment. There we go. But. But England, it's 0.5% mortality and that's the overall mortality. So if you look at, you know, again, less than 25 to 30, it's less than the flu. If you're over 85, it's like a 15% mortality, but it's also 85% surviving is another way to look at it. We haven't really seen that number budge a whole lot. We're learning more about nuances about obesity versus diabetes for the risk. I think that's where right now, that's where we're refining our numbers right now. 0.5%, it might go down a little bit, but it's not going to be like the 12.6, 12.4% from the China to the, you know, the Italy numbers were at 1 point time 14% or the 5.4% from Wuhan or it's not going to be anything like that kind of big a change. It might be 0.5 to 0.4 or whatever. It's still worse than the regular flu. But we're now defining now is like certain populations, like if you're obese, if you have diabetes, if your sugars are high, we're actually redefining certain populations like vitamin D stats. There's a lot of great literature coming out of Europe with vitamin D status and the risk. I mean, for example, I mentioned this on social media a couple weeks ago that if you're in Indonesia and you're in the icu, so kind of sick already and your vitamin D Status less than 15, which is, which is really low, that you have a 10.14 fold increased risk for dying, you know, so we're redefining the risk numbers more on those lines. You know, smoking, air pollution. If you live in an area that has a lot of air pollution, you have a fourfold increased risk for complications. For example, with COVID 19. So maybe that explains the New York phenomena and the northern Italy phenomenon and the Wuhan phenomena and the London phenomena. These are all areas that have a lot of. Those are the kind of things we're kind of fine tuning right now. Understanding of what individual factors in the population and increase your risk more. Not so much the overall because at this stage, the 0.5%, what does that mean if you're 12? It means nothing because it's like super, super low. And if you're an obese diabetic male who is over 80. So that's, that's where we're kind of fine tuning it right now.

Should the number of COVID cases be the only determination for opening back up or should it be based more on hospitalizations and deaths as compared to overall cases?

That's a great point. It's a great question. We don't really know how many people have this disease yet in Virginia or in the United States because we're not actually doing at least in Virginia statewide or nationwide surveillance stuff to see how many people have this. So we don't actually. We're still guessing 10 times more people have it than we think we are. Problem with the testing is we're only testing people who request, at least in Virginia, where I'm at, we're only testing people who request it or hospitalized. We're not actually testing the general population. So we're testing a subset of the population that self selects, which makes our guesstimates on some our surveillance data skewed. So we don't really know how many people in our country have it. That'd be great to know because then we could say, hey, maybe it's 20 times more than one thing versus 10. You know, there's a ton of asymptomatic spreaders. You know, maybe it's closer to 80%, which is one article suggested, versus 50% from the Icelandic data. You know, one thing suggests as low as 5%. So if something ranges between 80 and 5%, that just tells me we have no idea, you know, so that's where it's hard. The better data is who's getting hospitalized because those are your sick people and who's dying. Those are the most important numbers. And I looked at the numbers this past week from the Worldometer in both Hopkins site, and you see them overall in our country. In my state, in most states, you see them going down, you don't see them going up. So people getting infections going up. Sure, more people are going to get this, but I think we're seeing a phenomenon, more younger people going out. You know, with a lot of social unrest right now, it's mainly younger people. It's not, you know, typically grandparents that are diabetic that, you know, have multiple health issues, even though there are some out there that, you know, are going out and things are happening to them. But it's mostly young people. So yeah, I expect to see the numbers go up just like we did after spring break when everybody was in Miami or after Mardi Gras in New Orleans. Right. We saw things pick up. So we're going to see that it's to be expected. We've talking about that things will go back up once people go to school. The bigger question is, are the numbers of deaths going up in more proportion than we expect the numbers to go up? And if it is, that's a different story. But you know, if the numbers bump up 10% more people get, then I expect to see 10% more deaths. And that's actually not what we're seeing right now.

Can you speak to just the idea that like this is.

This is not going anywhere. And that's something that people have to realize, they have to have to get. This is this is not going anywhere until we've all been, until we get to herd immunity. Whether herd immunity comes from vaccination where you know, we all get vaccinated or you know the population is vaccinated. So the question is what's a good public policy that will keep us keep our society together, that'll keep our kids educated, that'll keep most of us employed, you know, for the next two to three years. And that's kind of what we need to keep our mind on. If a vaccine pops up in September, which would be the fastest vaccine production in the history of the world that I've ever heard of, it still takes six months to get deployed. So we're still looking at getting deployed late winter. So what makes sense to do what they did in Sweden and other countries, even some states in the United States have done this where they just didn't close and they told the sick of people to having a kid sneak in the thing right now you need to go Cleo.

Fear a second wave and shut everything back down. If our, If our odds are similar to a seasonal flu like the mortality.

Rate, I mean that's kind of a self answering. That's a self answering question. We don't do this for the flu typically. So it's real is interesting the, the Hong Kong flu of 1968. The population of our country at that point in time was about 200 million and 100,000 people died. About 100,000 people dying from this. So and we didn't shut down any major. It just kind of went through. So you know, shutting everything down again when we did it the first time and we didn't. The question is how much of what's going on in our country right now. Social unrest from all these other things going on is our secondary epiphenomena from having the whole country quarantined and shut down. Can we go through another around that as a country and society? That's maybe that's a better way to ask the question. Ultimately that's a political question. Up to our leaders to decide.

Could you touch on herd immunity and any benefits from getting Covid naturally versus through a vaccine should one become available. And then there's a couple more parts to that question, but I'll stop there.

Natural immunity is always better than vaccination. The regular flu vaccine, I mean at best is 70% effective. Sometimes it's effective. There's some years that literally we do it and it's like, oops, we picked the wrong virus. And literally it's not really hardly effective at all. So we're assuming that this virus is not going to mutate as much by the time the vaccine comes out. But the natural way is always better than the vaccination. But vaccines work and vaccines can get herd immunity. It's kind of how we polio, it's how we eradicated hep B in our country. Basically. Pediatric meningitis is mostly non existent due to the Hib and prepnar vaccines. So they work. You know, they work.

Are the risks of this virus great enough that we need to live in a bubble until a vaccine is made, if ever?

That's an interesting question. You know, I think the answer's no. I think I've kind of answered that already. Do we have any FDA approved drugs? The answer is no. That's what phase four trials are. So, you know, phase one trial is a safety trial. You pick, you know, a small group of people, you expose them to the drug and you see if it's safe. Your phase two is your dosing trials. How much do you need to get a certain physiological effect? And your phase three trials, which is mostly what I do in my research company, where you take the drug at the dose, you think and you say, hey, do we actually get enough. Study population data where it goes out and gets deployed? We've had vaccines before, like the Lyme vaccine or the swine flu vaccine that didn't work out that great. So you never know how safe any vaccine is until it's actually deployed. You never know how safe any drug is until it's deployed. That's one of the reasons why I personally tend not to be the first person to jump on board or the last person unless the intervention is so disease altering that you have to jump on it as soon as it comes out. And there are things like that do come out. Ultimately this vaccine we just got to see, you know, see what comes out. We don't know yet. There's over 100 different trials going on right now. And so we don't know which ones are actually going to make it. And then we won't know until they actually make it through approval and have to look at the literature and the data and say, hey, how effective is this based on data? Is it only antibody response? Because a lot of vaccines are solely antibody response to studies, not actual clinical studies. And then you know what the safety information is. You know, great question. That's. I have to figure that one out.

I'm not sure when we discussed autoimmune disease if we fully explored your thoughts on whether it could cause a flare. Did I. Did you already come up?

You didn't ask that question.

Okay, so as far as like.

Yeah, the underlying question is the specific question is can infection with COVID 19, by definition, you have to have one of four things to have an autoimmune disease. And this is According to Dr. Yehudis Schoenfeld, who's one of the top immunologists in the world. He's at the University of Tel Aviv. And one of the four things you have to have is an infection of some sort. You know, we are studying autoimmune diseases as actually there's an infectious process, whether that's a low grade GI tract infection, sibo, sifo, Whether it's an Epstein Barr virus infection. There's data with Hashimoto's as well as multiple sclerosis and certain cancers. Actually Burkett's lymphoma, certain leukemia is being triggered by a low grade Epstein Barr virus infections. So for an autoimmune disease you have to have an infection of some sort to kind of trigger your immune. So could COVID 19 cause. That's true for flu. That's true for any infection. I have some of my patients with autoimmune issues get the seasonal. And they should be better than a week. And they're rheumatoid flares. You know, it's actually a great example. There is the model there for infections causing flares of autoimmune diseases. We don't know specifically for COVID 19 any particular autoimmune disease as of yet. We do have this inflammatory syndrome, but obviously any infectious disease could cause a flare in your underlying autoimmune process. Based on what we know about them.

Could you share just some of what is coming up in the next couple weeks on our social channels?

Sure. So we're working on just some general information to help everybody kind of get through stuff with things you can do revolving on certain nutrients supplements, putting some little information about resilience. It's something. It's an idea I'm kind of playing against. How can you build resilience not just to COVID 19 and not to just stress and social unrest, but just life in general. These are some ideas I've been kind of mulling the last four to five months. And it seems like resilience in my mind is a big issue right now. So we're going to start throwing out some basic information about that. We may actually turn it into blog series or some kind of podcast or something. It's just, you know, if we have time for that. But we are working at those things and putting that out there in social media. We have, we have rebooted a little bit with social media and so we'll be changing things a little bit and just kind of putting some general information for health improvement, resilience building and then as things pop up with new, new things. With COVID 19, one thing I'd like to put something out there, some interesting literature I'm looking at and mainly from the UK and Europe on certain actually modifiable. I think the key is modifiable factors that may be the major cause for the ethnic disparities we're seeing in different ethnic groups in Europe and the UK with COVID 19. So I think that's kind of exciting because some of those factors, certain gene factors, but as well as some things like vitamin D status, you can almost track the disparity between males and females and the severity of COVID 19 with the vitamin D status as well as some of the UK data. And it's mainly in London. London's a very diverse city and they have a ton of different ethnic groups there and the disparities they're seeing correlate correlations, not causation, but with vitamin D status. So this is the kind of stuff we're going to be throwing out there over the next several weeks and month and as things go forward, I liked.

The thing that you said the other day about that you like, in order to like fight for what you believe in, you have to like in order to.

The things you believe in. Whatever you're fighting again, there's a lot of stuff going right now in our world, whether it's just keeping your family safe, that's a big issue with a lot of people right now, is just personal and family safety. If you don't have your health, you can't really fulfill your dreams. You can't stand up for anything worth standing up for. You can't fight injustice if you literally don't have the strength to get out of bed in the morning or if you're so scared to go outside because you think you might get sick. From COVID 19 your health is huge. And so if nothing my part, I feel like I can play in this. As a 47 year old father of three kids, what I have to offer is my expertise in building resiliency. All our Kids we adopted from pretty bad situations. Some came to us with asthma and bad lung issues, different exposures to chemicals that kids aren't supposed to be exposed to, different traumas. And they've all developed. One of them has had an antibiotic. Since we've had them.

Yeah, maybe since we've had them.

Yeah, since we've had them, one has had an antibiotic, which is pretty profound from a. It's kind of what, you know, you can't stand up for what you believe believe in. If you don't have your health, if you don't have the energy, you don't have the mental acuity to think things through clearly. If you're, if you're in fight or flight mode and so stressed, you can't. Like us, hit the little bell or whatever things that people on social media tell you to hit because that's how this stuff gets spread around, you know. You know, we're a small, small get up. We don't have, you know, name, but I feel like we have useful information. I've heard over the. Multiple times from patients in the office. This is helping them kind of get through stuff, helping them stay, giving them usable information. So if you feel that way, please share it because that's how this information gets out there.