170: Dr. MJC on What to Know and Do Next

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What's next? This is a question we're all having to ask and answer more frequently. I'm Jenny Blake, your host of the Pivot podcast and author of Pivot. The only move that matters is your next one.

For show notes from this episode, visit pivotmethod.com podcast. If change is the only constant, then let's get better at it. Here we go.

Hi everybody. I am back with Dr. Michael J. Consuelos. We have been podcasting together since the pandemic really hit the States. And I am just so grateful for Michael who stepped up and said, hey, I have experience in pandemic response and coordinating the health system and he has been on the front lines. He was even in the army for six years doing emergency preparedness and all kinds of things. He now runs his own consulting and advisory business, MJC Solutions. And so he's been a great co pilot during this time. And you know, we said to each other when the first conversation went well and we said, let's just keep in touch, let's see how things unfold. The last time we spoke was six days ago. I cannot even believe it, but so much has changed since then. We texted on Friday and said, what do you think? Is there enough here for another conversation? And by the time we are here Today on Tuesday, March 24, holy cow. It is a whole new world. Michael, welcome to the show.

Thanks, Jenny. Looking forward to it.

Once again, you encouraged me before we even hit record. First we both arrived at this zoom meeting and we took a big exhale.

Okay.

It's like we came scared getting into the, you know, from the week, from the last six days, seven since you and I did an episode solo and then the next day was with Lindsay in the greater Seattle area. And yeah, wow. It's like we just started with this big exhale and then you encouraged us to also do a check in which you've been doing in all your business meetings of how the heck are you?

I am, you know, I would say busy, yet really energized. It sounds kind of strange at this moment but.

Just the hours go by so fast, Jenny, with all of the ingestion of new information and then turning it around and trying to make it. Make it somewhat purposeful for others that I'm working with. So there is that sort of digestion of information and how can it be useful and then pushing it back out. So that's really, really busy on the family front, which I think is important to mention. I think one of the calls or podcasts we had, I mentioned that I went and rescued my daughter from University of Michigan. And she's now actually, as we speak, she's in a class remotely. So she's doing well in adjusting to the new environment and has done a great job in my mind, making sure she stays on schedule. And she actually, in our kitchen, has a piece of paper right in the middle of the kitchen that shows Maddie's schedule every day and the day, you know, the hour by hour when she's in class, so we know we don't disturb her. Not as fancy as your door hangers that you've mentioned before, but it's helping everybody keep on schedule. And then tonight, I'm doing what I'm calling Operation Escape from New York. I'm going to go get my son, who works for ESPN and his girlfriend, who works for a large financial firm whereby she can work now remotely. For a period of time, he's been working remotely. So we are getting them out of New York. And then you can talk about your experience because New York has really become the epicenter for the United States for COVID 19. So I think our worry factor, our family worry factor, is going to go way down once we have them in our warm embrace, at the same time using social distancing because they are coming from a hotspot. So luckily we have enough room to keep them kind of separate for a period of time. But, yeah, so busy. But now my level of tension is going to go down once my son is home and his girlfriend's here. Her parents are in another state. They've traveled out of the New York City area to do the same thing. So we are trying to shelter in place. I think we'll talk about that, why that's important and limit social gatherings. And so, yeah, that's me today. How are you doing?

Well, I love your Operation Escape from New York. If you want, you could just throw me, Michael and the dog in the backseat. But I don't even know. We're probably contagious by this point. I mean, hate to say it, but yeah, it's a Real reality here in New York when you see how fast the cases are growing and there are people who live very close to us that we know have it. And we're at the dog park, we're touching the dog, the fence to get in and out of the dog park. I mean, it's tough. Like it's. It's even someone, another person who has a dog. We have a lot of fun. Central park allows you to go off leash, humans and dogs, before 9am and he gave us a ride because it takes a little while to get there. And I just purposely didn't touch anything in his car. His daughter has asthma, so I didn't want to touch the seatbelt and the door handle. And there's so much conscious awareness. And then the closest grocery store to us is Whole Foods. So I went for the first time since all this has been going down. And one just the awareness of everything we touch, every package, every product. There's a moment of uncertainty and for me, my experience. I've shared these on a couple conversations and one yet to be released that I did with Sarah on being an empath and highly sensitive person during this time.

I've had waves of sadness the last few days. I don't know if it's my own personal sadness, if it's the collective sadness.

Seeing a place, a city like New York, and even the Whole Foods where we are in Harlem and the streets that are normally so busy and so crowded and just seeing how vacant it all is and knowing that a lot of good can come from this. But I think for me too, how am I doing? Last week was just like all hands on deck. I mean, as the business owner and having clients and having the momentum launch, I just went all in to keep everything afloat. And so by the time the weekend hit, I was exhausted. I think I texted you as much. I was just dead, so tired, so wiped out. And so I am noticing now in this week, it is all about energy management and it is going to be having to be really conscious about what I say yes to resting twice as much as I think I need probably four times as much and just kind of clearing my calendar a little bit and not letting my. What do they say? Not letting your mind write a check your body can't cash. So I do think that that's really important right now.

Yeah. Wow. I guess self disclosure here. There was a couple days this past week that I've been sad too. So I have family in Italy who right now is doing well. Luckily, most of them are in Southern Italy. But I've spent part of my childhood in Italy. My mother's Italian.

My son was there for a semester studying. And.

It saddens me to the core. I know that we're here in the United States and we are battling this, but I shared with my wife the other day, she looked at me and she sort of said, what's going on? It's like just really sad.

I mean, I'm trying not to choke up here, but it's, you know, perspective. Yeah, I mean perspective is that the past couple days in Italy, it's like, like two jumbo jetliners crashing every day. I think the numbers were numb to the numbers, the overall numbers at some point. But I think if you put them in the perspective of what it means to humanity to be a relatively small country and like every day a jumbo jetliner or two or maybe three are crashing out of the sky.

I think it's going to have long term effects. And these are so Italy's social system is so tied in with personal connection and the family and sort of this more senior elderly folks in the family really are the. In many ways there's a kind of a matriarchy, patriarchy, kind of not in a bad sense, but really the grandparents are really the hubs, the family wheel, the spokes, you know, coming back and all those people are going to be gone.

So yeah, so there is a sadness, but I think that.

This too will wash over us. I think it's also at some level confirming in my mind why we need to do the things that we're doing today. I think that there's a lot of people who are questioning still and they're putting the economy versus human life. And I think if we don't do. There's a lot of great evidence from the scientific community and we can talk a little bit about that. If we don't do the things we're doing right now, the impact is going to be unimaginable, completely making the world wars look like a walk in the park. So I want to get off the sadness piece I'm trying to shift here, but I think it's okay to be sad. I think it's absolutely.

And you must experience a layer of that as well, being so intricately tied into the healthcare system and the medical response. And I feel like you are getting information a little earlier than let's say somebody living in the middle of the country. So not only are you on the east coast, you even had family in New York and Italy and you're part of the medical community and connected into many of the frontline responders. So one, of course you're sad and feeling it. And there's such a. There's such an adrenaline rush of what can I do? How can I help? And then I feel that it's equally matched by the waves of reality and sadness when you realize the magnitude of it all. I'm curious if you could share with us actually, what are you seeing hearing on the front lines? I think at this point, many of us do know the basics. You know, wash your hands, social distancing. There was a guy, kind of reminded me what you just said. There was a guy on the daily Today, the New York Times, the daily podcast. He was angry. He was just saying, we are bungling this response. We are screwing this up. We must do better. And I wonder what your thoughts are from your vantage point.

Well, I think there's uneven application of scientific.

Public health measures. And I can see where I do get angry also. So amongst that sadness, there is anger. That and what you said earlier, Jenny, is that it's that driving the purpose of taking that and what can I do? So I'm on almost daily calls with hospitals, large organizations, federal officials, and just for the New Jersey New York City metro area, the infection rates are four to five times higher at this point than the rest of the country, which at some level makes sense because of mass transportation and large corporations and just the way people live in that area.

But that's basically what Italy and other countries were facing too. And the current instruction by Governor Cuomo and Mayor de Blasio.

Using one lens, is this because the. For some reason people are not believing this to be a true threat. Seems like a huge inconvenient and economic.

Issue. Whereas the rest of us in the medical community are saying, yes, please do more of that. I'm concerned for. And I communicate regularly with friends and family who are in the healthcare business and trying to be supportive of where I can to let them know that people are behind them. So that's. So I guess answering your question a little bit there. So four things I guess I just want to clarify. Just maybe if I spend a few minutes talking about why the social distancing and shelter in place is an important piece. Can I do that just for a couple minutes?

Please do.

Yeah. So the science behind that. So I'm gonna get a little techie here. So as you look at how viruses and other infections work replicate and you'll see this, this R number reproduction rate number bandied around, people throw it out there in papers, it's really is how many, it's, what's important is how many people will get infected by, by one case. So if I have COVID 19, what are the factors for me or what is the potential for me to spread it to other people, if that makes sense. Right. So as you look at different types of infections, the most infectious thing that we know is the measles virus. And it is, its r factor is 12 to 18. That means that one person, because basically it's airborne and the particles are so small that they float around in the room and land on things and you could infect some. And that's why we have seen these cases of measles pop up in areas where vaccine rates are so low. And you go, wow, how could one person infect a couple hundred people? Well, because the R factor is almost 20 for that. It's 12 to 18 depending on the study. Right. So then you look at polio, right? So polio, which has been eradicated for basically across most of the globe.

Its R factor is five to seven. And there's a bunch of other things that we have basically through important vaccinations have dropped. That's how we do things like what's infectious, it causes harm. With COVID 19, it is not that high, thankfully, but it's somewhere in the 2 to 3 range. That means every person. So one person can infect at least two or three other people on average. So maybe there's some super infectors out there that have higher levels and some people who are lower. But anyway, the math behind that is basically take one person, multiply that by two, and then those two people then infect two more people, then you start doing that. It's sort of like this exponential growth starts to happen. So one person in a month that is not self quarantined or that infected other people is actually responsible for two to 300 other people being infected.

Let me just let that sink in, right? So one person who didn't wash their hands, who had the illness, who didn't do what they're supposed to do.

Could eventually infect hundreds of people.

Then there's another factor which is if one of those people who they infect then also does what they're supposed to do, they break that chain of infection and that number starts to drop. If you infect two people, but one of them did a good job and has been washing their hands and is doing social isolation and social distancing, you break that sort of chain, that branching pattern that starts to appear from that one person. That's why what we're doing is so important because we don't have a treatment. I could talk about that in a couple of minutes. We don't have a vaccine. So all those other things, fees, polio, mumps, pertussis, we all have vaccines for those. So we break that chain of transmission very easily in the population. If there's an outbreak, we just vaccinate people. In this case there is no vaccination so it's allowed to run rampant across the population as it did in Italy, who didn't do enough early enough. They hadn't seen this early enough. And that's why we have all those deaths in Italy. Other countries such as China, Singapore have done great in our eyes may look like draconian measures. Jenny, they stopped that reproduction rate. They dropped it. Right. Because they were able to not only.

Stop people from contacting each other, but also they had enough tests so that when they found the case they could do some tracing and contact those people and say hey, you've been potentially infected, you need to self quarantine or you need to take these appropriate measures. So the contact tracing is also piece that's very important. That's why the medical community has been really talking a lot about the testing and that's why testing is important not just to cohort patients and hospitals allow the medical community to know who has it and who doesn't. But if you're able to do some contact tracing through the community, you can potentially stop that branching. Pound or that that multiplication effect.

Okay.

Anyway, that's a mouthful of stuff.

No, it's good. I have three follow up questions that you can address in any order, please.

No, no, go ahead.

There's. I'd love to hear what you're hearing around vaccines and progress or not there. Contact tracing. I saw that South Korea was very successful by tracking people's cell phone data and then backtracking and then mass texting to anyone they were in the region. But then that brings up some surveillance capitalism concerns. And then number three, you had just mentioned, what was the last thing you said? I have calling it like coronavirus brain. Oh, testing. Should everyone get tested? I saw, I forget the name of the kit but a new kit released today that it was like you to see like direct to consumer testing kit. A little over $100. Do you think everyone should take that? Any order on those three things?

Okay, I already forgot about. I already forgot the first question.

Vaccine, contact tracing and yeah, yeah, great.

Yeah. Folks, this is why I enjoy Having conversations with Jenny Blake. She keeps my brain in order here. So. All right, so vaccines. Okay, so this is an RNA virus, and I don't need to go into details why that's important, other than the fact that it is a difficult vaccine to make for RNA viruses. And so for a previous episode, we talked about the SARS and the MERS respiratory viruses that are also. They're basically cousins of COVID 19. Both of those vaccines stopped in phase one trials.

And what phase one trials is. So vaccines are made like, I'm gonna. Sorry, folks. It's important for me to explain this. So as you develop a vaccine, you have to figure out. Take parts of whatever the organism is, the virus or bacteria, and then you basically. There's a couple ways of doing this, but you're basically trying to form antibodies or something that will elicit an antibody response in a human body. You start off with things in little tubes, and you start then induce a little bit of some animal testing to make sure that obviously you don't want to kill people. This right away. I'm sorry, folks who don't believe in animal testing, but that's the safest way for us humans to do this. And then you move to phase one, which is you give it to 40 or 50 people at one time. So right now, as I understand it, we are in phase one testing. There's 40 some people who have the current vaccine for COVID 19. And what they do is you, first of all, number one, safety. You don't want to give someone who gives them potentially a worse problem than you're trying to cure. Secondly, you want to see if the body makes an appropriate response to the vaccine. There's ways of testing the antibodies that. Yep, you saw COVID 19 in this vaccine, and your body is appropriately responding to it, not just in a safe manner, but also in a manner which you're producing the correct antibodies that will give you some sort of immunity. Great, That's.

And is it true that the malaria vaccine is related to this somehow?

I don't know that. That's a good question. I don't know. There is the malaria treatment, which is chloroquine.

Oh, maybe that's what I was hearing. Something about malaria.

Yeah, that's the chloroquine, which we can talk about, but so put a pin in it. I hate going into this deep detail, but, you know, hey, people are learning, right? So if they're still here, they're in.

The JBNC podcast club.

Exactly right.

This is how it's going to go.

Right now, we're going to give them a certificate. Right?

I like it.

Yeah.

Great.

So we are in phase. So people, we are in phase one, which is early, lots of vaccines, including the MERS and the SARS vaccines. Again, these are coronaviruses we didn't get past for a couple different reasons. We didn't get past phase one. Okay, so if we get through phase one, then what you do is you go to phase two and phase two is hundreds of people. You're doing the same thing and now you're spreading it out across age groups, demographics. You're just basically expanding the number of people that you can make sure this is working. That's phase two. Then there's phase three, which, where you're there in the thousands of people, and then there's other phases, phase four, and then you start doing studies to make sure that actually it works at scale again, because many times there may be a vaccine, that there may be unintended consequences. So we may fast track this through all those phases. I've moved right to implementation. But we probably need to go through at least phase one, phase two, if not phase three, to make sure this, number one, safety reasons. And two, there is a vaccine that works. Because what you don't want to do is you don't want to provide a vaccine thinking that you are now immune and you go out and not do the things we're doing currently, and then you get infected. Right. That's not the right way. So there's another way. There's an old, old way of making vaccines. So this is back in the, in the cowpox, smallpo. You can actually infect people with the vaccine and then you can draw up their serum and basically concentrate it. And what you're doing is you're actually giving the antibodies from the people who already had the disease. I'm giving a shortcut here. But then you can use it as a treatment for people or give people as a vaccination to other people. That's sort of a long. I'm kind of blurring that line a bit. So there's also the testing around that and you may be hearing about that, but that's a different process and it can't be done at scale because you're literally drawing people's blood and separating the serum and you're separating the antibodies and then giving it to people. So that's a different process and really shouldn't be able to use at scale. So that's a vaccine. So, folks, we are early in this, I think If. And there is the possibility, because, again, it's an RNA strain, which is difficult, and it mutates. That's the other thing I need to mention, is that the other reason to stop the spread across populations, large populations, is RNA viruses are easily mutated. So every time you mutate a virus, it's possible that whatever vaccine or treatment you have come up with won't work. And that's why influenza vaccine, which is not an RNA virus, it's a DNA virus. Every year we have to give you a new type of vaccine, because as it goes around the world, it replicates so much that there's natural drifts and shifts in the DNA. And so you end up with a different vaccine, I'm sorry, different influenza virus every year. So that's reason number like 45. But a very important reason not to have large populations get infected with COVID is that there's. You're increasing the possibility of a mutated strain, that whatever vaccine or treatment you have developed, it won't be effective for the people who are infected with that strain.

So is there a possibility that we could have a different coronavirus strain? I mean, I know that's why we're calling it COVID 19, because this is the unique strain, but is it possible that this thing replicates like crazy.

It's doing and mutates. It's doing it now. It's happening as we speak. It's not something that people talk a lot about, and I don't want to be an alarmist by any stretch of imagination, but there is in the scientific community. This is the conversations you asked me about what is being talked about in the medical community. This is one of the concerns not just to. We've talked about flattening the curve.

But this is one of the other concerns about not flattening the curve is that you aren't able to. That you're putting at whatever vaccine you're developing at some risk. It may not be high, but there is some risk that a different, more virulent COVID 19, Covid 20, whatever the number is, pops up. So there are different strains. So the other question you had for.

Me, there was contact tracing as a method to flatten the curve.

Yeah.

Why haven't we done a podcast? It should just be called flatten the curve. Everyone makes fun of the phrase now.

But contact tracing and then self testing, if that's worth people doing. Even if, you know, I sneezed yesterday. Should I self test? I had a sniffling. My. My throat is a little sore. Should I Self test, you know what I mean? So what do you recommend on that front?

Yeah, the contact tracing is a, literally, I think it's a 200 year old process to track diseases across countries. So this is not anything new. So this is what people in public health are in that they are using.

Cell phone data now.

Exactly. Right. Yeah.

Location tracking, crazy amounts of data.

Right, right, exactly. So countries who can do that are obviously have done that and we've seen the effects. Right. So I don't think my opinion is that here in the United States we're not going to get to that point, but we do contact tracing for other diseases. So. All right, kids, close your ears. So for sexually transmitted diseases, there's actually these are, there's a group of reportable diseases. So we do that. So actually if someone contracts a sexually transmitted disease that is reported to the state and then what the physicians in most cases will do is contact that person and ask who else they've been in contact with. And then you do contact tracing because you want to stamp out sexually transmitted diseases and HIV and AIDS and those things. That's a little bit different. There's a lot more security and inpatient protection around that piece. But for a lot of things like measles outbreaks, when you heard measles being, I think it was Disney World or Disneyland, there was an outbreak, they did contact tracing and basically they figured out who they stayed with, who they went, where they traveled and they started alerting people.

I think right now we're kind of beyond that for COVID 19. So I think that is still something that can be done at some levels and I think it is being done in certain cases. The, the problem is that at some point it's going to become what we call endemic, which is part of the natural viral load out there in the community, which is it doesn't work anymore because either everybody has had it or is going to get it. So contact tracing doesn't really help because everyone's at risk.

The testing question is a great question. At this point in time, we do not have enough tests to test everybody in the United States. Just got off a call with federal folks where they were again trying to instruct people to limit the testing to patients who are in hospitals. As you can imagine, that's important for that patient to know that they have COVID 19. It's important.

For the healthcare providers to know the patient has it and also for the use of ppe, the famous personal protective equipment. So if a patient does not have COVID 19, let's say has another illness or another type of pneumonia, we can save on PPE because we need to use it for other patients. So that is the choke point right now for us is that in the inpatient areas, will there be a time we can start testing more people? I think there probably will be, but this point in time, because of so few tests and the turnaround time is also an issue. So if it takes you two or three days to be tested, if Jenny Blake tests herself, test herself and we say, okay, don't go out in public until we give you a result. Right now it's taking two, three days minimum and there's in some cases five to seven days to get that result because we are prioritizing the inpatient.

Tests. What are you going to do? You're going to stay inside forever? So it's not practical at this point in time, unfortunately. But I think as we start having more and more tests produced and you mentioned the self administered nasal swab. So that's not the one that you do a, a deep swab in your sinuses, but rather one or nasal passages, but one just at the tip of your nose, that there's some good data that that's going to be helpful. And I think that will probably be released most likely to outpatient areas and screening centers and maybe not to the general public at this point in time. So the answer is not yet.

Yeah, because it's interesting, I saw Everlywell is the name of the company. I saw where they were saying, okay, as of Monday you can buy a kit. And now I see updated 322 because of course everything changes one day to the next. It says update with recent briefings from the White House. Everything you just said, Michael, that we need to prioritize health care companies and workers on the front lines. So. Because I was thinking, yeah, that is crazy that already we'd be able to have consumers basically just requesting kits. But even they have pivoted and are saying no, we need to get it to the people who need it most. And can you foresee a time where. Because it also doesn't seem safe to go in to any facility to get tested if you think you have it. And yet at some point there would be value in knowing. It's just so crazy that you could be a carrier for two weeks with no symptoms. Yeah, I saw one thing that said if you can't smell your coffee, that could be an early marker.

Like if you can't smell certain things, there's growing data. Thank you for bringing that up there's growing information, call it data yet information that you get. Anosmia, I know that you like new words. So anosmia is basically the inability to smell. So yeah, there's some evidence that that may be happening. I wouldn't use that as your marker, but you brought up a good point about keeping people away from hospitals and healthcare areas and reducing risk. So maybe we could pivot a little bit around what's happening in telemedicine or telehealth.

Yeah, I'd actually telehealth would be great. And at some point MJC we're going to have to address what do you do if you think you have it? And I'm asking that because I'm in New York and I watch that bubble grow every day. But do you obviously you stay home, do you contact people? Do you, what do you, do you telemedical? Do you call a phone number?

Yeah, yeah. So those are all great questions. So I think number one, if you think you have it, you need to do the social isolation, self quarantine, hand washing and washing of surfaces that you touch, doorknobs, tabletops, whatever. So if you're living with someone it probably is advisable again to continue that six foot kind of radius and not have close contact. Little things like put away your own dishes, clean on your own dishes, clean your own bathroom. If you have more than one bathroom to use, try to really limit that contact. You think you have it.

That is important.

Contacting your medical provider at this point in time, what they are doing is going to help you with that decision of whether or not you have it. A lot of hospitals, physicians there is screening questions that they'll answer and then they'll give you some opinion at some level. Actually I think I just got an email, I think from Apple the other day that now you can like tell Siri to ask you questions for screening for Covid. I think Google, I think a lot of online.

Folks are putting these screening questions. So use those. The CDC has those questions also online. So I think asking you those questions and then there's a lot of them will then follow up with some sort of. This is what you should be doing in case you have it. If you're basically having a cold, if you think you have it, you've been exposed, you think, and you think you basically have a cold. You don't need to go see anyone if you are a person of high risk. So let's say age over at this point in time, 50 and under, it looks like you're probably going to do okay, but not 100%, 50% and over. Definitely people in their 70s and 80s are at high, high risk. Those folks probably. Even though I'm saying if you feel okay, you probably should contact your medical provider because you're at high risk. If you have medical conditions, you probably should contact your medical provider. As a medical provider myself, I would rather know that you think you have it. We may not do anything again, we'll use telehealth to have an interaction, but I would rather know in advance and give you some instructions of reasons to contact the medical facility as opposed to you wandering into your local hospital trying to seek help. It's easier for us to help you navigate the system if it's possible. But I think that we haven't talked about New York yet really specifically because I've been on a long discussion. But as you know they're putting up temporary hospital at the convention center there in New York City. I think there are organizations who are prepared for large waves of patients but whatever you can do not to overwhelm the medical system would be greatly appreciated.

So in that case, it seems that if someone were to get symptoms you could call. It's so crazy, I just switched health insurance. I don't even have a doctor like a designated person let's say, but that there's people doing telemedicine. Ostensibly there's someone you could call. She coughs as she virtually waves across the screen. But then.

At what point do you just see if it passes versus oh maybe I need to get treated or I do need to wanna. Anna, I'm curious to hear your take on pop up hospitals like convention centers and even cruise ships.

Oh, okay, well so the pop up hospital. Luckily what you're having going on in New York City is a well coordinated fema. So the Federal Emergency Management Agency coordinating with the city and the state. So a federal, state, local government, completely coordinated event. That's great. So there's pallets of medical equipment as I understand it, they're standing up a 1,000 bed hospital and they're smartly in my opinion dividing up into four. So it's actually 250 independent within one roof. That's just easier from operations to manage smaller populations of flow of supplies and people and that kind of stuff. And it's being staffed by.

Folks in the medical community, not directly in New York City. So you're bringing workforce, you're bringing supplies and luckily you're doing what we call a hardened structure so it can weather the weather it's not just a tent, it's not a pop up in the sense of a pop up that you put in your backyard. And so it has a lot of great element that's coordinated. And individual organizations all over the country are doing some version of that at the local or regional level, which is great. So those things that I just described are important for coordination of care, tracking, contacts, all the things we've discussed and those, I have great confidence that those will go as well as they possibly could. Is it the same as your local hospital? Well, it's not because it's not a local hospital, but at least the organization is ready for you. So I have confidence about that. The cruise ship thing I think is an interesting idea and I think it's great for us to flex expansion of alternate sites of care. My understanding is those would be for people who don't have COVID 19 is what I'm understanding. So what do you do with patients who don't have COVID 19 that still need care? They're dehydrated and they may have pneumonia.

Or delivering a baby.

They're having a baby, right? Like you don't want them in the hospital.

The one issue I have with that, not an issue, I shouldn't say issue, but I have questions about that and I've shared it with other people is where's the workforce coming from to stand those up? So the military.

And there is a whole volunteer emergency medical system that is being activated on a regular basis. I'm part of that. I get a daily email for the Pennsylvania portion of that to see if I'm available. That's being coordinated that way. I don't know if there's going to be enough people around to number one, staff those. So that's a concern. I'm not saying it's not a bad idea. Just I don't know how that plan is being rolled out. Then there's the personal protection equipment, the PPE. If it's going to all these focused areas of COVID 19, it doesn't mean that you don't need PPE for those other patients. There's other diseases. There still is the flu, there still is people with tuberculosis. Those diseases have not gone away because they've decided take a vacation. COVID 19 has taken over the world. They still exist. Like you said, giving birth to babies. I'm not sure that'll happen on ships. But you're right, there's other things that need to be happening and then there's supply, other supply things that concern me. Even more, which is, for example, how do you deliver oxygen tanks to a large ship and was there enough supply out there? So I'm not saying that that's not a good idea. I think the logistics of that is still needs to be drawn up. I do know that federal authorities and state authorities and the folks at the assistant Secretary for Preparedness are working all through that. So I have confidence that that's all being worked out. I just think it's premature to say that's going to be the saving grace for our country today.

If we have other maybe levers to pull.

There's one more thing about the curve that we have not talked about publicly in the medical or I'm sorry, in the lay press, but I think maybe it's important for your listeners.

Please.

Doctor to know about. So flattening the curve is not just about COVID 19, ladies and gentlemen, it's about other diseases. When you overwhelm the medical System and your ICU is your intensive care unit is filled with COVID 19 patients and your emergency department is filled with COVID 19 patients. And unfortunately, someone in your community has, let's say a heart attack, which is still happening.

When it used to take five or 10 minutes to get that ambulance out to that person and bring them in to the emergency department and have them go through a cardiac procedure to stent open to open up their arteries around their heart. It's a life saving procedure that clearly minutes matter in that scenario. What happens in this scenario when the ambulances are overwhelmed, the emergency departments are filled and everyone's all hands on deck for COVID 19. So there is part of the reason to flatten that curve is not just to help the medical system take care of COVID 19, it's to take care of everyone else who's going to be sick. There are still people who need cancer care, who are going to have heart attacks, who are going to have babies. Not all of it has to be bad news. And we want to make sure that they get their care appropriately and efficiently and effectively in a way that's safe to them. So I know it's an inconvenience to be living at home and working from home and not be able to do the things we all enjoy but to stay. And again, the other question that you mentioned earlier is do I seek medical care? That's another reason the less we impact medical care day to day, you're making room and capacity for the health system to absorb not just COVID 19, but the people who actually need care today. And they're in the midst of the COVID 19 pandemic, unfortunately, so I don't.

So thank you for sharing.

I'm doing too much talking.

Hey, you're my guest expert, you know, that's the point.

Yeah.

That's why we're paying you the big bucks.

Oh, yes.

That's $0 for the Fitbit podcast.

And I got the hint of who the doctor is that you're going to call when you need, so I got that.

Right, right?

I guess, yeah. That's great. Great.

No, don't worry. I will overwhelm your telemedicine line.

Yeah, you know, you can tell me, so. Yeah. So.

Well, this is really helpful. I so appreciate your perspective, and you've been a touchstone for at least me and maybe a certain percentage of Pivot podcast listeners. Some of the news and even some medical practitioners are so aggressive, it's hard to listen to. You have a really rational, gentle sort of approach to conveying this important information. And I also think it's interesting that you happen to, at the moment, be straddling the medical community and business and leadership. And I've seen you, you've been doing a lot of webinars, putting a lot of content out there, given your unique vantage point on all this. I know you mentioned the role of scenario planning for the next three to six months. Some of us have been saying, oh, yeah, weeks could be three months. Wow. Where everything is stopped and we don't leave the house at this point. Do you think it could be longer? A, and then B, what are you recommending to businesses for scenario planning?

Yeah, scenario planning is not. So I'll answer that. So I don't think we're going to be. I think if we do the right thing, Jenny, and I'm really hoping that the federal, state and local officials continue the social isolation shelter in place, because that will give us time to get a potential vaccine. It'll give us time to get to work out whether or not certain medications are truly effective against COVID 19. It buys us time. One of the analogies that I've heard is we're going into battle. And do you want to go into battle with what you have at hand now, or would you like time to repair? And what flattening that curve does, it allows us to prepare more and more. Eventually, we're going to have to figure out the treatment and vaccination issue around COVID 19.

That wraps up part one of the latest installment with my Pandemic podcast co host. As weird as that is to say, Dr. Michael J. Consuelos make sure you're subscribed to the Pivot Podcast so that you get the next part of this conversation where we shift to talk about business impact and contingency planning as well as journaling, even from a business perspective, and what we've both learned personally and professionally, even just in the last seven days.

For those of you who are following this pandemic series and even might want to go to these episodes directly or share them with a friend, which I would be so grateful if you were to do, you can go to pivotmethod.com podcastarchive.

Stay tuned for part two of my conversation with Michael coming up. Thank you all so much for being here and for listening.

Thanks so much for listening to this episode of the Pivot Podcast. Make sure you don't miss an episode or my insider tips templates by signing up for Pivot List, a curated twice monthly newsletter where I share the inside scoop on what I'm reading, watching, listening to, and the latest tools I'm geeking out on. Sign up@pivotmethod.com pivotlist get show notes from this episode@pivotmethod.com podcast and connect with me on Twitter ennyblake.

Remember, build first, then your courage will follow. Hasn't it always.