Is it safe to Walk my Dog? Why is the Fatality Rate so High? Coronavirus Q&A 3-18-2020

by birtanpublished on August 15, 2020

Welcome to a very special episode of healthcare triage we're gonna dedicate at least this show if not a few shows to answering your questions about coronavirus Tiffany is going to be asking our questions she's sitting right over there

But not near me cuz we are actually acknowledging social distancing at this point so she's got to be what twelve feet 15 feet away from me I think so we think that's a safe distance so she's answering your question she's asking

Your questions I should say I'm answering your questions here we go okay so let's start with one of the most asked questions what is the deal with NSAIDs should we avoid things like ibuprofen for now just to be safe so a

Lot of the concern about NSAIDs and ibuprofen has to do with some studies that looked only at viruses in the respiratory tract in general no none specifically with kovat and some of those studies did show perhaps some

Associations that there might be some you know getting a little bit worse or having some side effects if you had a respiratory virus and check out the profile the best study I've seen though is a randomized controlled trial that

Gave people basically see them in a fin or ibuprofen or something like you know an end-state or nothing or some combination and it found incredibly minimal differences tiny really tiny and so I don't even know how much of this is

There this is old news I mean these studies are like a couple years old it's not new it is not Kovac specific and so everyone's concerned about this just seems a little more than we need right now

Okay so what's being said on Twitter is that ICU physicians are saying that they've noticed a trend that people are worse off when they have been on NSAIDs so again I don't know that these are actually informal studies and that we

Actually know you're gonna hear anecdotal reports but of course if the anecdotal reports that are gonna make the most noise I have not yet seen any conclusive data to push us in that direction so the rest of the questions

I've just tried to group so this first group is gonna be questions about social distancing and quarantine so this first one can you do things outside in suburban areas like walk your dog basketball with your family as long as

You stay away from other people and then what about playing on an outdoor golf course if there aren't a lot of people and you're away from others first of all going outside great there's no reason to stay in the house this is not like

Floating around in the air but want to follow the same rules with other people that you would follow in the house like walking with a neighborhood friend who's staying more than 6 feet away is fine like you know don't get in

The zone where they could coffin sneeze on you then you should be fine playing basketball with the same people like your family that you are otherwise in the house house with otherwise likely

Fine now playing basketball with people that are not part of your like social isolation group is not okay really because then that's just like hanging out with them that's what we're trying to avoid so being outside if you're

Following the social distancing rules are just great being outside and close with people you are otherwise close to is great but don't be outside with people you otherwise wouldn't be close to cuz that's just as dangerous being

Inside with them so I think that also answers the question people wanted to know if kids could play together outside so if they are your kids from the same house yes with neighbors probably not you know it's easy to say nobody should

Ever see anybody that's very difficult to hold down so there's a couple ways you could theoretically go about doing this one is if you have a couple families and you guys commit that like these are the families that are only

Seeing each other while you've socially isolated yourself and just a slightly larger group and if they truly commit to that that's pretty much okay secondly if you can agree to the same rules that I just said it's fine so we've told our

Youngest daughter she can have like one friend that she's designated over but they have to you know play by the same rules more than six feet away washing of hands no sharing of anything you know they can play together like a video game

Or something but no making tik-tok videos and falling around you got to respect those distances if kids can do that on playdates and they're old enough great if you're talking about small kids then again if you set up with like one

Or two families and say like d'art kids are just gonna socialize with each other and nobody else and the families are not doing anything else and you keep the group contained then that's probably okay so I feel like that also addresses

This question on should you refrain from having people over to your house same rules I'd say would apply if you like can identify one flaky we have sort of two families that we would consider perhaps let's say we do let's say two

Families that are best friends so it's just three families that if we say we're only doing our three families and nobody else okay the same way I also said like I have a neighbor he lives across the

Street is a friend of mine I imagine you know if he came over and wanted to sit and chat and sat over there and I said over here and we you know follow the same rules and good hand-washing there's really minimal risk there so you have to

Be smart about it but you want to keep it to a minimum I mean you really do though part of this is trying to keep social distance and of course if we go to serious quarantine in lockdown you should probably stop even

That but we're not there quite yet okay and still keep all of this to groups what less than ten there's oh well I mean the president of CDC said no group should be getting together larger than ten I think that that's still too large

I mean it's just I would say like you know if you're getting together in a group of ten people unless you're all committing to sit six feet apart it's a pretty large room and so I don't know how we're actually pulling that off now

With our family we're reading around the kitchen table but that's because we're agreeing that's our social circle and if you live in a family of ten five you know keep the ten people in the house nobody's saying break up the household

But you probably shouldn't be inviting a random ten people over to your house at any time that's not serving the purposes it's very unlikely you're following the rules and keeping at least six feet apart from anybody else how do you

Practice appropriate social distancing in places like grocery stores and pharmacies that you sometimes really need to go to so clearly of course you know all the usual rules apply hand-washing hand-washing hand washing

Don't touch your face coughing your elbow don't go if you're sick stay away from sick people it's also better to go on off hours when if your people aren't going to be there it's better to avoid it when there's huge lines as much as

Possible keep your distance from other people you know it's know we could stand in line stand in line like six feet apart you know making sure we're not sneezing or coughing on each other I'm certainly the second chore done wash

Your hands you know again and again and again when you unload the groceries wash your hands you know just constantly constantly constantly get used to making you sure you are clean and you've taken whatever might have gotten on your hands

Off certainly before you touch your face certainly before you eat is it okay to volunteer at places like food banks if you have no symptoms and use a mask this is where I would talk to the food bank and find out their policy but again

They're gonna want to restrict it to as few people as possible the whole goals we don't want like lots and lots of people coming in to con each other so if they said we have a core of volunteers and these people are

Agreeing only to go up and back to the food bank and not to anything else that would be ideal should we cancel all non-critical doctor appointments in March maybe in April this person said it feels like I should but I don't want to

Leave issues unresolved for potentially months I'm laughing at this question because I get asked this question about should I cancel X by friends family and acquaintances all the time and every single time my response is it's gonna

Get cancelled anyway I think it's very unlikely that a lot of these optional appointments over the next few weeks certainly are going to stay in place be it a dental visit a non emergent doctor visit a nail visit

A haircut yeah we're petting towards probably much more strict isolation in which case they're going to get cancelled but the truth of the matter is yeah we probably should cancel them because because they're just exposing us

In ways that we probably don't need to next question should student health care workers coming back from Spring Break be allowed to continue work on clinical rotations many are even after having travelled I mean our medical school just

Shut down all third year rotations for medical school and we're waiting to hear what they're doing on fourth year rotations I think that's gonna stop no matter what because again I think we're headed towards you know really only

Essential personnel should be exposed and so I think you know this is one of those theoretical questions that people are asking now that I think in a week will be moot how can families of health care workers support their family

Working in health care well still helping contain the virus so how do they keep their kids neighbors etc safe when someone in the home is a doctor nurse paramedic getting lots of exposure I'm rolling I'm like I've seen extremes on

Twitter where where doctors who know they're being exposed are like moving into the garage to protect their family which is just I can't believe this is where we are but you know we I think we're living in a world where I mean

Look as much as you can in a house practice good hygiene wash your hands stay away from people don't share stuff my kids are all in high school you know my oldest is in his room most of the time so it's like it's

Not as hard for us to do social isolation if you have if you have small children it's much more difficult almost impossible let's go on it's almost impossible but but doctors who are seriously being exposed

To take as much care as possible to keep their families safe but it's gonna be very hard should we bring parents home from care facilities assuming no one in the home is sick and then related to that should I get my elderly parents to

My house from another state before things get worse if you're committing to true isolation like you're not gonna leave your house and you can drive and get your parents so that you know they're not going to an airport

I guess it's theoretically possible that you could safely get them to you and then all commit to not leaving the house but you would almost have to have the same rules that were advising the elderly at that point like it would be

Dangerous for you to go to the supermarket and then come home and be near your elderly parents you'd almost have to go shutdown so that's very hard to do if they're in a nursing home or long-term care facility I'd talk to the

Nursing home I don't know what's safer to be honest whether to bring them home or not sometimes it's impossible you just can't provide the care that they need which is why they work in a facility to begin with and of course

Once they're exposed I'm not sure how much good it does to bring them out so these are the kinds of incredibly hard no good answer questions that people are going to ask that are worth discussing but I would do that you your doctor or

Your parents doctor and the health care facility where they are is it safer to have your food delivered or to order food for pickup great question so I I suppose it depends on how the pickup goes so here's the thing there's there's

Not as there's really not really much evidence for transferring food as long as people are taking usual precautions and of course if you get delivery they could put the package down walk away you could open the door never be exposed to

Human being take your food unpacked and wash your hands you're good to go no exposure that's possible with pickup but it's also possible you walk into pickup and there's six other people waiting to pick up at the exact same moment and

Those are the kinds of exposures we're trying to avoid okay and I feel like it might be important to mention here that we should tip the people oh well I guess you only ask me a safety issue we should is generous to everyone as humanly

Possible right now we have canceled the people that helped us clean the house we are still paying them and I say that not to brag and not do it but it's like as much as you can help all the people that you can yes because they are utterly

Dependent on a lot of the income is coming in to completely cut it off will leave the most vulnerable vulnerable of us at risk so yeah tip as generously as you can like I'm all for ordering food I think you know helping

Restaurants helping the delivery as much as we can let's keep the economy going as long as it's safe and food delivery is one of the few areas was like we've got to keep that kind of stuff going and so but of course you know as much as you

Can't be as generous as possible that should go without question yeah okay next group of questions is about testing first one why so many different tests for example why didn't the CDC just use the w-h-o test so I mean I've seen a lot

In the media recently where there there's questions now about whether the w-h-o test was really refused or really was being reserved for countries that were more in need but the bottom line is we should have been developing tests you

Know you know for allowing universities is you so getting companies we are way behind the game when it comes to testing why are there so many because everybody's trying to develop them as rapidly as possible and there's no like

One test that everybody knows to use usually it's like you're trying to do some kind of PCR and look for you know something that matches the virus itself so they're gonna see a lot of tests but hopefully I want to see hopefully

They're ramping up now but we keep hearing that news and we're not seeing it yet so we really need that as soon as possible do we know or should we be worried about rates of false negatives on tests so having people testing

Negative they actually have it and then go spread it I think PCR in general is a pretty low false negative rate just because of the nature of the test of course we just don't have the sensitivity specific is

No other tests and of course to get those kind of test characteristics you'd have to run the test in a controlled environment on people you knew had the disease and you knew did not have the disease and of course we have no gold

Standard because we have no test so all of these things are great questions we are just not going to know but it but at least what we've seen in the field and knowing PCR in general the concerns of false negatives are low on our number of

Concerns right at this moment and tests are only going to show if you currently have it right not if you had it and have since recovered without knowing well there's when we say have it we got to be very specific because of course

There's infected and they're sick and those are two separate things lots of people can be infected and not show symptoms they still have it people who are sick have it people who who have been sick or now feel better but it's

Still shedding virus have it the point is the test will be positive until you stop shedding virus I just saw a piece in Pediatrics recently that said really little kids can actually continue to shed virus fecal-oral route for some

Time which of course is a nightmare scenario for daycares where if they're changing diapers and moving between kids the game is up so it's until you're not shedding virus any more tests will be positive so how

Then can we track people who did get it got better all without knowing never never sought out treatment because isn't that important to know for the final numbers so some point we do that with probably

Some kind of antibody antibody titer test but that is again low and the list of priorities at the moment we need to know where I know just a test of do you have it that's that's priority number one at some point in the future should

Be great to know those to have those kinds of tests and oh that data as well someone asked some places are not testing asymptomatic patients who have maybe other risk factors like they've come in contact with someone

Etc because test supplies are low isn't that dangerous it's dangerous in terms of infectivity but since we're giving people the advice assume you have it and go home that's the treatment remember there's no

Therapy for this and especially if you're mild enough not to require hospitalization the therapy is go home and wait it out so whether you are sick with another virus or whether you were sick with this that's the advice we have

So the danger is just infectivity not a danger to that patient what we're more concerned about at the moment is how do we isolate people and keep them apart and what do we do and what kind of course can we expect in the hospital

Which is why you're seeing I think that the testing when there's such limited numbers directed at really sick people now all 58 members of the Utah Jazz got tested they were not at risk I don't know how that actually happened but

Clearly we're not applying these kind of rules and priorities across the board and we should be but we'd like to get to a point where everyone who has symptoms are as concerned can get tested we're nowhere near there yet if I have

Symptoms what should I do go straight to an ER no no my god no no no no no call your health care provider talk to them they're probably going to say if you are not seriously affected you should stay at home because

Going out will put you at risk of infecting other people there's nothing we're going to do at the moment and since we're not even testing those people there's really nothing to do if you're sick enough to require evaluation

By a physician hopefully they'll direct you to somewhere that has been set up to take care of patients in this specific need so that you're not infecting patients who are there for various other reasons

And if you're sick enough and they want to run a test and they've got one that is what they will do but no do not immediately just get up and go to the ER unless you true and with less you really truly feel sick in which case you need

To call 9-1-1 but call call your health care provider that's the first thing you do next set of questions are about spread and likelihood of infection so first one can be spread through the air and here I think we should talk about

Spreading through the air as in it like as an aerosol versus spread through air because you are standing too close to someone so you hear anecdotes and stories of people though we've got concerns so we talk about is something

Airborne what we are often talking about is destroy with measles measles I can walk into a room I could cough I could leave the room and like two hours later somebody could come into the room and get measles that's forever that's why

It's you know you know what is it a are not of like 14 or whatever it is because it's so infectious this disease appears to be attaching itself toward the virus that should say is an airborne droplets meaning I can sneeze it on you and it

Will be attached to those droplets and go through the air which is why we have the six feet ROK's that's about how far I can COFF maybe but I can get it to you I can COFF it to you through the air but it is not like off and then it's

Hovering in the air no that's not we don't believe that's what it's doing it's that I can cough and whatever it will go through the air and then landed table and it can live on services for a period of time we don't know exactly how

Long but we're talking usually hours to maybe a day I think it's like the high end of course watch surface assured you're concerned about you know have common sense but it is not we do not believe that it is airborne in the sense

That that it's hovering and flying through the air and can go great distances if it were we would expect it to be far more infectious than it is and it's pretty infectious already so you answer the next question on how long it

Stays on objects but they also want to know does it change for different surfaces so is it gonna stay longer on stainless steel versus plastic we're not doing studies so I cannot definitively answer I would say that probably the

Difference is not between say stainless steel and plastic it's probably between soft and hard in other words if it gets absorbed versus it's there just to be on the safe side you know wash stuff you know clean it off certainly clean your

Phone clean stuff you're touching all the time and again all of this is prevented by hand-washing there could be virus on here and I go boom boom boom but if I wash my hands I'm gonna be okay

Wash your hands wash your hands wash your hands okay at this point do we know how likely a symptomatic transmission is it seems likely I mean I think the studies again that we're referencing that pediatric

Study I talked about earlier most of the kids the vast majority of interaction which is double it's a majority of the kids who were infected were asymptomatic or very mild illness so it is yes very possible that there are asymptomatic

People transmitting this for people who are so mildly affected that there for all intents and purposes a symptomatically transmitting this and of course if people if kids don't know to report incredibly mild symptoms they are

By definition you know a symptomatically transferring this so the short answer is yes but we don't know how much do we know how long someone sheds virus / at what point are they no longer infectious no well we know we know in the sense by

An individual we can keep testing them until they are no longer doing it but we don't have a set time yet and so the only way really to know is to keep testing until you're done some they will presumptively just give you an

Appearance I mean just be like yeah two weeks no going anywhere no door anything after symptoms have resolved that's just because we're assuming that after two weeks it's pretty much gone and most people after they've recovered and I

Think we have indirectly answered this one but someone did ask they no pets can't get it but could you pick it up by someone petting an animal who had who was contagious and then you pet that same animal I suppose but again wash

Your hands like it's like you know this is all fixed by if you pet an animal wash your hands before you touch your face or anything else because you just can't magically get absorbed through through your hands if you pet the animal

Wash your hands what do we know about if infection confers immunity for how long or is reinfection pretty likely we don't know we're assuming immunity just cuz we haven't really seen reinfection yet I mean I think people are panicked about

It you know we may at some point because some immunocompromised people might not develop the antibiotics just like with some viruses which we know confer immunity some people do get reinfected but they're usually incredibly small

Numbers and that is what we're seeing so far so we believe that eventually we'll build up immunity to this but you should be careful just a few questions about risk now so first I know kids are less affected but what about kids that have

Underlying health conditions like asthma or yeah their risks certainly absolutely and younger kids and babies are more at risk too probably at least according to the data were seeing still less than the elderly but anyone who is at risk

Immunocompromised or as chronic condition is going to be at higher risk and no one should treat this incredibly lately like nobody should be running out to get this just because they believe they're safe yes I'd like to underscore

That point I feel like a lot of people are thinking that because they're not at risk I was like I've seen people say oh I'm not in the high-risk group why does it matter because even like in the low-risk group if it's like if you let's

Say it's a point oh one percent chance of death why you know that means you know if a point oh one percent I don't want to do them now I'm gonna do the math of my head so add one percent to be a hundred at point one percent to be a

Thousand point out means one at every 10,000 people that gets it it's gonna die you don't want to do that I wouldn't want to do that and also please care about the people that you could spread it to yes yes I mean that goes without

Saying but even if you think you're at no risk and want to infect yourself to just and then you're gonna sit inside and not give it to anyone else you're only putting yourself a risk but why why why

What is the level of concern for people taking immunosuppressants for autoimmune disorders so that you're not like as immune suppressed as someone who is going through chemo or getting an organ transplant but you're still taking

Something that yeah these are great questions that will be hit who we would if we had well-designed studies and more time we'd have answers too and we don't so we have to go off of what we know just by viral infections in general and

Other similar type illnesses and I don't think we can grade or rank those so we're just saying if your immunosuppressed or I have a chronic condition we just know you're at higher risk and we've seen it then we're just

Lumping them together at one point so just take it seriously if you fall into any of those categories what's the process for getting a vaccine to the market the same as it would normally be they got to do phase 1 phase 2 and phase

3 testing first they got to develop something and think that it actually works and then go through all the steps we haven't even gotten to step one you know you get your safety efficacy trying it all that those things where we're

Just getting started which is why most people are saying it's probably like a year away at least alright these next few questions are just about the virus itself so what are the odds of it becoming a recurrent issue like a

Recurrent disease you know like seasonal like the flu I think they mean oh why I mean at this point that's what it looks like is going to happen and so if but it if it follows what happens with flu if it follows what happens with the 19 you

Know 17 flu pandemic we will see a peak now and then it will probably drop there in the summer and then in the fall I'll help could break loose because it'll come back with a vengeance and it won't start in like February or January as it

Did this time it'll start like in September and so by the winter it could be a nightmare that's what happened with with the pandemic in 1970 1918 it was really bad and then it looked good in summer and everybody fell good and in

The fall it killed like 50 million people so we have to be super careful now we will eventually get to hurt immunity could take two three I think with the that pandemic it took like three three seasons to get through it

Eventually we get to sort of some level theoretically of herd immunity but that's that's a nightmare scenario because again if if we're accounting to get her immunity somewhere between 40 and 70 percent of the population to get

It and let's say let's say it's just 0.1 percent mortality which is way less than most estimates that's a horrific a large number of people that is not what we'd like to do so the goal would be to keep it at bay as long as possible and

Hopefully get to a vaccine but but we don't know this is all uncharted territory okay so can we just a lot of people are asking about HIV and similarities so can we just address that for everyone I just I wouldn't even

Bring this up in the same breath almost as HIV which is a completely different kind of virus which can take a long time even for a test to show positive once you've actually gotten it and then can still take a long time before it comes

And then is there forever you know coronaviruses are like colds remember is that like you know we're showing symptoms in a couple days you're sick for a short period of time and then you get better

Unfortunately this one's worse then coronavirus than other coronaviruses but but that's that is the track and that is how it works it's really bears no resemblance to HIV at all someone else wants to know what are the chances that

We would see multiple strains of this virus we don't know I mean viruses can mutate and it's possible this could I don't think we're seeing major mutations yet that have everyone concerned but we don't we don't know and why is the

Fatality rate higher for this virus than some other criminal viruses well that's what's freaking us all out we haven't had a virus with this level of infectivity and this level of serious disease since like the 1917-18 flu

Pandemic where we have no treatment no vaccine no nothing we've seen other pandemics but we've had vaccines which we could potentially use or they have not been as infectious and we've seen more serious corona viruses like SARS

And murders but they were not as infectious and so they just weren't we were able to contain them this is this is different this is why I think a lot of experts are freaked out because we haven't had sort of this level of you

Know seriousness and infectivity and lack of any therapy or vaccine since like you know almost basically a hundred years ago someone wants to know why the fatality rate seems to be higher in Italy so I can

Give you a guesses well we don't really know for sure one Italy has a older population so more old people more smokers it's possible that they are clustered or living in a different way but soon the older people are going to

Be the ones that are most affected and if you have a higher percentage of population is old and certainly that's how it's going to show up but you know if you look at the the course of number of cases and I know I tweeted this Kevin

Drums done a great job of of tracking this every day with a chart we're following sort of the rate of infectivity almost to almost exactly that Italy was which is why we're all concerned because that's how many cases

And how quickly it's spreading that that is concerning we just we just don't know how it's gonna play out which country will most resemble so that actually goes right into the next question someone wanted to know as it stands are we more

Likely to be Italy or South Korea it sounds like we're more likely to be Italy at this I mean I think we're more likely be Italy because we're we're reacting more like Italy did you know South Korea again testing like crazy

Much more locked down doing drive-through testing taking you know suppression measures we're doing much more mitigation measures that is more like what Italy was doing our health care system more closely resembles Italy

Our reaction to this more closely resembles Italy and not necessarily you know what what they did in China and South Korea and Singapore and some other Asian countries and so it's probably a fair guess that we will more closely

Resemble what's going on there but we don't want to and that's why hopefully we're taking action a little bit faster but but I wish we were taking action even faster than we are yeah someone actually did ask and I

Don't know that we can answer this but they said why aren't we mobilizing more resources to handle this I don't know I'd like them to but I'd also like people to take this more seriously I mean I saw you know a tweet from I love

Walt Disney World but I saw a tweet from Disney World I'm like the 15th the night before they closed and there could not have been more people packed in front of you know Cinderella's castle would watch the fireworks what a nightmare

I mean there not gonna get on planes and go home across to all 50 states and and in Florida still people are packing the beaches at st. Patrick's Day to that but tons of people gonna be packing bars so

All of us all of us could be doing a better job okay and then someone asked a question about h1n1 they said they don't remember there being this much mobilization for that and so they're wondering if that is true and if so why

The difference so some of it is the timing of the flu and when the pandemic truly came we did take it seriously we saw an uptick in deaths I think we reacted differently partially because that was also killing the young and that

Is panic inducing in ways that that often it is not when we're seeing deaths in a population that we normally expect deaths but we also had we know how to make flu vaccines and so you know even if like this spring was bad when it came

Back in the fall we were better prepared and so we were in a better situation I think to get a handle on it and unfortunately we are for coronavirus and that's that is you know it's different we we can handle flus a little bit

Better than we can something that's completely different for which we have no therapy and really no vaccine okay we're down to the last couple questions here so someone wants to know is it responsible to make claims the X number

Of people could die when we know that testing is inadequate and we have no idea what the real infection numbers are in the US without knowing about people with mild symptoms who never seek treatment aren't we just making wildly

Inaccurate claims no the alternative is to make no claims we can continue to update our data and our priors based upon what we're seeing but we can only model off what we're seeing in countries like I said we we can say well we

Resemble Italy in this way and this is what China had and this is what see what we can make guesses we have it's not that we have no data we don't have good data so we have to go off the data we can the alternative is to put our heads

In the sand and pretend there's no data so I don't know what else we could be doing if we're taking what we see and saying with absolute authority we know what's up that'd be a mistake but again originally we thought it was you know

There might be a mortality rate if any point for maybe it's one if it's point one this could be a catastrophe so it's it's you know there's there's overreacting and then there like pretending there's no problem at

All we can't do the latter this is this is a problem do you have any tips or resources for people caregiving for the sick at home um you know certainly stay in close contact with health care providers but um again supportive care

Is the best the body the body's gonna fight this off as best it can if people get truly sick they need to go to hospitals they need to get care but otherwise you would care for this as you would if if anyone had you know any

Virus with you know treat the fever treat symptoms keep them hydrated eat while you can rest you know and love what else you gonna do yeah and lots of hand-washing course of course of course we're not saying that should be playing

On a loop behind me yes okay last question can you just talk for a second about how important investment in public health infrastructure is in the long term not only you know just just for life but also then to deal with things

Like this in the future the reason we're comparing ourselves more to Europe and not to Asia and this is because Asia has been through this before with respect to things like SARS so when SARS happened it was a nightmare

And they learned so a lot of the facilities being used in China right now and in other Asian countries we're built during the SARS epidemic because they realize this is what we need to do in order to care for these viruses and so

We need to be careful because our response is likely not going to be as good as theirs because they invested and they have the stuff that they need to get this done they know what they're doing we do not we we skated by in the

Last few pandemics you know MERS didn't really affect us SARS didn't really affect us an h1n1 did but it was a flu and so we just haven't built the infrastructure and got it going to be ready for these kinds of things we need

To do that so we need then again we've done whole episodes on public health and how we're under investing in the infrastructure but this is you know it's just the cautionary tale we need to learn as other countries did from past

Pandemics what to do in these kinds of situations and how to do it better next time look I know I'm never trying to tell people to panic that's not the goal panic will serve no good but I hope you

See in here concern and I think I've built up enough credibility over the last what six seven years of making healthcare triage that I spend a lot of these episodes telling you that the danger is not as big as you

Think this is not that time the danger is real and I'm very concerned if you've been following me on Twitter or if you've read my articles or even watch some of these videos this is real and even if the estimates are not as bad as

The worst case and I don't think they're gonna be as bad as the worst case scenario there's significant danger not only in overwhelming the health care system but to people in general we need to act we need to follow the rules of

Social distancing and physical distancing and we need to do what experts say we need to do we need to get through the next few months and the summer things may look a bit better but then we really gotta prepare for the

Fall when this could come raging back so you know take care of each other stay away from each other but still stay in contact cuz that's super important but physically we need to prevent the spread of this virus please please please

Follow the rules wherever you are and let's do the best we can all together we hope you got something out of this we encourage you to share it so that other people do as well we're gonna link right here to other videos we've made

Answering questions about Ferno virus or talking to you about corona virus so that you can be informed as to what's going on it's very unlikely we will generate any ad revenue from any of these videos which is perfectly fine but

If you're inclined you can go to care chairs where you can help support the show you can help us to be able to make good videos like this which hopefully do some good

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