COVID Voices: Dr. Jeff Bland and Dr. Sara Gottfried

So here we are with Dr. Sarah Gottfried, and we decided that because of all that's going on in COVID 19, it would be wonderful as we released this podcast that she and I did some time ago, that we brought an update into it to make it a little more current. And there's no one I could think of better that I'd like to have a discussion with as it relates to COVID 19 than Dr. Gottfried. So, Sarah, thanks so much for joining us for this little additional vignette that we're going to attach to our previously recorded podcast. So maybe you can just give us some glimpse as to what your world is like being the center of information for so many of your followers in the world and how you see this thing unfolding.

Sure. Well, thank you, Jeff, for having me. I'm super happy to be with you and with our listeners today. You know, I was just talking to Kara Fitzgerald about COVID stress. And I think for many of us, we wake up in the morning and we want to get current. We want to see sort of the latest risks, the latest mortality, the latest case data. But there's also, there's the latest tragedy. And I think that's weighing heavily for all of us. We're also searching through the literature, the things that are on preprint for where's the hope? When are we going to turn this around? Are we flattening the curve? So I would say that that's kind of the high level view of what's happening for me. And as I try to translate the information that we have for my followers, that's really what I'm focused on. And as a gynecologist, I don't have, you know, tremendous expertise in immunology. I can certainly talk about it as it relates to pregnancy. But one of the things we're seeing with COVID 19 or SARS 2 is that there seems to be some sex differences. And that always gets my attention. Not because I think we need to pay attention to women versus men, but more that it teaches us more about the biology when we understand some of these fundamental differences that exist between men and women. So what about you, Jeff? I want to hear also what you're paying attention to and translating.

Yeah, thank you. I think you've hit upon the emotional component that we're all dealing with because each one of these people that we lose prematurely to this infection, we recognize that these things are totally preventable in the abstract. In the theory, every one of these illnesses is preventable because if you're not exposed to the Virus, you don't get it. It doesn't happen like a chronic degenerative disease that just kind of works on you over time. This comes as a consequence of exposure and then your body's response to exposure. And so theoretically, all of these are preventable. So it's almost like when you hear these deaths, it's like we didn't really need to have that person die. That's the tragedy. But I also recognize in the reality of the world that we're working this complex society where we're crowded together, we have all sorts of variables that we have to deal with that we're not going to change tomorrow because we have lots of billions of people on the planet and many things are not optimal. So we, as a species that's not completely invulnerable to all sorts of things, is dealing with our own imperfections and. And not the perfect immune system that immediately recognizes every harm and neutralizes it before it has an adverse effect on our body. So I wrote a short piece which I called what I've learned from COVID 19, which I'm sure I'll learn more, but I thought I'd put something down because I grew up in 1981 and two on sabbatical at the Pauling Institute in Palo Alto, which we had a seminar by Dr. Olverding, who was the first person to observe in San Francisco this infectious disease in young men that we later called hiv, aids. And he came and gave a presentation to us that changed for me my whole view of viral infections irreversibly. And, you know, the history after that, everybody knows very, very well. And then I think about, okay, that was a. Was a socially contracted viral infection. It happened to be another reverse transcriptase, reverse RNA type virus. It had a very high infectivity with certain routes of transmission, but it's more important and horrible portion of it was very, very lethal. And, you know, more than 80% of people that got contracted with it early on died. And many, many good. Well, I mean, I would have. Not many. Probably everybody that died was a good person. But, you know, it took a lot of health care workers with it who tried to do their best to be heroic and was transmitted through blood and biological fluids. So this was a pretty tragic time to learn something about these highly infective viruses that have high pathogenicity. And during that time, there was all sorts of exploited, exploitive things that were said and done with people trying to sell all sorts of stuff to treat it based on false hope or on misinformation. I Mean, there were all others that really were trying their best to give hope and were not necessarily exploited, but just didn't know the answer. So they were saying things that later proved out not to be correct. And so we had a mismatch, a kind of a mash up of all sorts of confusion, paranoia, misinformation and panic. And out of that then arose a mobilized effort, which was really pretty remarkable, to change the fda. It changed the way we think about viral infections, how we respond to them. It mobilized a reaction group across a combination of citizens and pharmaceutical investigators in the Food and Drug Administration and hhs, and. And that led into ultimately what I believe was at least a learning curve about how we would deal with these types of infections, these pandemics, and then to see it kind of dissembled and disassembled over the course of the last few years at a time that we recognize that infection is going to become more prevalent in this world of crowding and changing in global climate and all sorts of things, and transportation, with more and more people traveling for transmission to then disassemble a group of individuals that were put together across many different disciplines that were designed actually to be able to handle these types of emergencies. It seems almost incomprehensible to me as to how this happened.

And you're referring to the government disassembling. Yes, these entities that we have to help us for future pandemics and had.

Many different people from different backgrounds who had some experience and some learnings that could work collaboratively across different platforms to respond as quick responders. So then it takes a while to get things up and going. And it's time is the essence. As we know, if you're going to keep an environmentally transmitted disease in check, you've got. You don't have a lot of time until the logarithmic curve starts to catch up with you. So I think the good news is, I believe certain places got the message quicker than others, and we started to implement the right kind of strategy. Because it is a lifestyle disease. Yes, we really think about it. It's a lifestyle disease. And therefore people started implementing the proper kinds of implementation that I think will. Well, we'll flatten the curve in the meantime, I think the most important thing that we can transmit to individuals are not only the standard things of washing your hands and, you know, staying away from other people and being patient as we allow this thing to sweep through as virus infections do, but also there are certain things that we can do to help our bodies to be as strong as possible and that our immune system is very responsive to how we treat it, how we are sleeping, how we're thinking, how we're acting, what you're eating, how much fluid we're taking, how much exercise we're getting. Our immune system is not static. It's very dynamic. And I think this is a time to relearn that lesson. And I know that's your message. That's the message that we're trying to take out through the Institute for Functional Medicine. And try not to be like goody two shoes about this, but try to say here are other things to consider as you're sitting there in quarantine and you've got some time on your hands. Here are ways that you can really start taking charge and develop self efficacy because your immune system is waiting for you to tell her the message. So that's kind of how I see it.

Well, thank you for sharing that. I agree with you. I think it's a network medicine approach. It's a pleiotropic approach to this pandemic that we're facing. It's not, you know, that these older medications are going to save us, although maybe they'll help. We still don't know from trial data. But I totally agree with you that we have to be thinking of these foundational issues. Like how much deep sleep did you get last night? Are you getting the restorative sleep that you need? Are you able to manage that high perceived stress that is so ambient right now for so many of us? Are you getting nutrient dense foods even if it's harder to shop and get the five colors of the rainbow each day? Are you getting the nutraceutical support that you might need? I totally agree with you. I think it's important to look at it in this much broader context and not necessarily to race off and get Plaquenil or a Z Pak as your only approach to dealing with this pandemic?

Yeah, and I think it goes back to me and what you were talking about earlier, the difference in gender frequency between women and men. You know, I'm always been a believer and I think it's even more reinforced recently that women, maybe because of biological necessity, whatever the reason, have generally been the tenders of health of their families and are more sensitive to health issues than men. Men, you know, kind of just push it off as like, well, you know, I'm immune to those kind of things and I'll deal if I'm broken. I'll get someone to fix me when I'm broken and that Kind of logic in these times where you're not really putting into the bank account a lot of reserves and you're pulling from reserves, then when your body is under the need to go to those reserves and to mobilize them, that's the organ reserve in your immune system. If you've been working on the bank account by doing withdrawals for a long time now, it comes back to roost. And I can't help to think that maybe some of this gender difference is not just hormonal differences between men and women, but it's the way we have actually thought genders have thought about their health and taking care of themselves. And there are lots of studies showing that women generally have better health habits than men. So I can't help but feel maybe this is a test of the reserves that we're seeing here.

Well, I agree, certainly we don't know when it comes to SARS 2 or COVID 19. I would agree with you that I would hypothesize, I would speculate that there are some sex differences perhaps related to estradiol as a signaling modulator of the immune system. And then there's gender differences, such as what you just described with health practices. You know, maybe women wash their hands more. Who knows? I've certainly seen with my. The men in my world that they're very concerned about the stock market. That is a primary concern. And not to generalize or to put all men into this category, but, you know, women are much more concerned about how are people coping, how can I be especially kind to the folks that are delivering groceries, how can I take care of my children? How can I help with the educational gap that they might have? Yes, there's these gender differences, there's these sex differences, and it's showing up in the data. We know that from the New England Journal of Medicine just March 26, that the folks, if you look at the Chinese data, somewhere around 39 to 40% of those who test positive are female. So much. A higher proportion are men. And if you look at mortality, a higher proportion are men. And we don't have. I don't have data that I've seen published from Italy, but we know that about 60% of those that have tested positive in Italy are female. Sorry, are male. And about 70% of the mortality in Italy is male. So it's definitely, you know, we're seeing it in terms of the epidemiology. Trying to understand it more on a basic science level, I think is still evolving.

Thank you. I think that was really well Said, I'm interested. What's going to happen now with both homemakers being home, both the woman and the man being home with their children, because most people are not taking their kids to daycare, obviously. So now you've got these families in very controlled environments. How is this going to influence the socialization of the family and how will the man in that? I know that there is in younger age groups of couples now that the men are playing a much more participatory role in raising their children and engaging the family than maybe in my generation. But there will be some social lessons to be learned out of this whole phenomenon, and maybe certain value system priorities will change as a consequence. You know, people say, well, we're going to go back to normal. Well, it will never be the normal it was. It'll be a new norm. The old normal is gone. Just forget it. I don't know what the new normal is going to look like, but it will not be the old normal. So I, I hope there's some advancing opportunities for cultural evolution through this transition. Maybe that would be a positive outcome.

Well, I think that's certainly one of the potential gifts of this crisis that we're facing. I think there's a lot of gifts I would love for our value system to be disrupted. We're in a very disruptive time. And you, you started the conversation with the HIV AIDS epidemic and how that really changed social mores. And it got, I would say, mainstream medicine and science to pay attention to the crisis in a way that they hadn't before. And it really, it disrupted social mores. So I look forward to this disruption. I think we also have, along with the pandemic, we have this outpouring of kindness that we're seeing in Italy, that we're seeing in Spain, we're seeing in the US and all around the country. That just warms my heart. I love to see that. I think it's an important co variable along with all the other variables that we're tracking right now.

Yeah, I really thank you for bringing that up because I think that is the warmth, blanket of comfort that I put around myself as I listen to what's happening there. There is so much tragedy and personal stories that are, they're very sad. But I believe on the other side, it does remind us that we are an animal who is a social animal. We need other people, we need to be connected, we need to reach out. We need to be part of something bigger than ourselves and that the value system upon which that's built is not Just related to our gross national product. It actually comes right down to the individual connections we have with others, many of whom we may not have met before. We meet them in times of crisis and we find a place to be able to support one another. And I think in our local community here I live outside of Seattle. We're seeing that in our local community. Seattle is pretty much like a ghost town now. You know, Amazonia, which I call downtown Seattle because so many of the young professionals that have started to live in the city are part of the Amazon workforce. They're now all in their apartments or condos or in their inner city places they're living and they're having developed all sorts of new connections and new thoughts. And it's a little bit like the United nations because Amazon has hired people from all around the world, young professionals to work there. And many languages are being spoken now and in that area. And I'm thinking, well, this is a kind of, it's kind of a test case in Seattle about how we're going to deal with some of these more global issues of connectedness. So that's the positive stuff on the other side of the many sad stories that we're dealing with.

Yes. And you're on Bainbridge Island. So what's it like on Bainbridge?

Well, you know, Bainbridge is an interesting community. It's a 30 minute ferry ride from downtown Seattle, but it's really a tree hugger community. You know, we have a lot of woods here and it's very kind of seemingly rural, although it's fairly gentrified. But here, because of the nature of why people live here and are willing to get on the ferry and go to work every day, community is really, really important. And the school, schools are really important. The kids are really important. Not that they aren't elsewhere, but it's a very folksy community. And what I found is a tremendous amount of outpouring of health. If you look at the local blog, sphere, Internet for the local community, people are really doing all sorts of things to assist one another. So it's very affirming that there's goodness in people, which in the face of all this other stuff is awfully nice to see. So we're lucky. We're living in a very good place and we have our infection here, but the way people are responding to it is very positive.

I believe that's great to hear.

And how about you and your neighborhood?

Well, I live in the San Francisco Bay area and the cluster that we've had here was not quite as dramatic as what you had in the Seattle area. And it's certainly not as dramatic as what we're seeing in the state of New York and New Jersey, New Orleans, Chicago and so forth, and now Los Angeles. But similar, you know, I would say here in the Bay Area. I think we've. We've had great leadership from our governor, Gavin Newsom. I think his call in the San Francisco area to shelter in place was right on. I'm hoping that that helps at least flatten the curve as we have sort of this rolling apex through the United States. And yeah, there's a sentiment of tenderness that I think you're describing in Bainbridge island that I feel here too. Just trying to help each other as much as we can while self quarantining and, you know, happy hour by Skype, you know, physically distancing, but not socially distancing. So physically distancing, but staying socially connected while we stay safe is essential.

That's a really powerful message. I think that's a great way for us to kind of bring this to close. You know, we, in the state of Washington, we have a governor that's also been very proactive and, you know, we're sheltering in place here as well. And ironically, we've just seen the conversion of our football stadium into a new hospital to take people out of our major hospital centers in Seattle and put them into this to free up beds for COVID patients. I think it's kind of ironic to think of the football stadium being turned into a hospital. You know, this is kind of the battleground. But our governor has equally been very, very proactive, and I think it is making a very positive impact. We seem to be seeing the curve flattened. Although he's raised the ire of our president, as you probably know, and he's been called out on Twitter quite a bit. But we all are cheering him on. He's doing a very good job for us. And he's a Bainbridge resident too. He's a neighbor.

Oh, well, he's doing the right thing. I'm behind him 100%.

Yes, we are as well. So I want to thank you. This has been a real special moment to share these thoughts with you. And we'll of course have this as an addendum to the podcast that we had the privilege of doing, or I had the privilege of doing with you some time ago. But I wish you well. Let's continue our vigilance and our advocacy and we'll turn this thing around.

That sounds great, Jeff. Thank you so much. And thanks to all of our listeners.

Likewise. Be well.

You too.

Bye. Bye.