How Did America Screw Up COVID So Bad?

– What’s going on Z-Pac, it’s Dr. Z. Welcome to COVID cluster F rounds live. It’s Friday, May 15th, it’s the Ides of May. And I figure let’s just dive into this. So what I wanted to do tonight, and I’ve been thinking about this quite a bit this week because we spoke with Dr. Marty Makary. There’s another Dr. Todd Strumwasser, whose show is coming out probably tomorrow, that we talked to, who runs a series of hospitals in California. And we talked with Jud Brewer who’s a psychiatrist managing sort of the kind of burnout and stress that’s going on during COVID, and after and before.

And kind of integrating all this stuff thinking about how the heck we got where we are in this COVID disaster. And why is it the greatest country on Earth, us, America, right? We have American exceptionalism. We’re fantastic, we invented all kinds of stuff. We have medical innovation. We have all kinds of awesomeness. How did we end up with the number one death toll in the world from COVID-19 when we saw it coming from miles away? And talking to Marty Makary about this really kind of brought some of this home. So let’s go back to the beginning, and kind of talk about what exactly was going on early on. So November, December, sometime like that, this thing emerges in China.

Now whether it was… Now we don’t think it was bio-engineered, but there is also the theory that was it an accidental release from something that was being studied in a lab? Who knows? Was it from a zoonotic from an animal in those wet markets in Wuhan? Whatever it is big screw up, number one, is first of all just that China exists at all in a state where this is allowed to happen. So when SARS happened in 2003 it was a disaster in Asia, and they learned a lot.

Pretty much every Asian country learned, oh, my gosh, when this happens again we’re gonna do X, Y, and Z. We’re gonna do aggressive testing, contact tracing, isolation, quarantine, screening, all those things, to make sure that we don’t get SARS two the sequel. Well, the Chinese also had this idea, but, unfortunately, it appears that were early sort of signs that party members didn’t want to rock the boat. It wasn’t really clearly, and transparently discussed early on, but one of the things that was happening is doctors on the frontlines were putting out signals. You remember Dr. Li, rest in peace, was basically raising the alarm. Hey, this is SARS 2, the sequel, we need to do something.

And how much of that was hushed up by the Chinese government? Like Marty Makary said on the show you cannot trust the Chinese Communist party as far as you can spit, but you can believe people on the ground. And there were plenty of people on the ground saying what was happening. So in that sense now you have a perfect storm already from the beginning where you have Wuhan, which is 10 million people, it’s a travel hub. You’re pushing up on the eve of one of the great migrations in humanity, annually, which is Chinese New Year, people leaving everywhere. So before really anything could have been locked down properly this thing was already spreading all around the globe.

“The New York Times,” actually, had a great online piece where it was an animation showing exactly the motion of what has been deduced patients were doing. And they were going out of Wuhan all over Asia, Bangkok, New York, California, basically, all around. And so this thing was already getting out. Now, at this point, the Koreans, Hong Kongers, the Taiwanese are getting wise to this. WHO was saying a bunch of stuff. They quickly sequenced the genome, released it publicly, so people could start developing tests. WHO had a pretty robust test. And so the Asian countries like Singapore, South Korea, Taiwan were testing aggressively, were doing something called contact tracing, which is if someone tests positive, or has symptoms, or is presenting with a case of this they would figure out through a pretty aggressive mechanism using technology, which even at the time

I remember saying, hey, what these guys are doing the U.S. would never. You would have privacy advocates screaming bloody murder if we tried to do this in the U.S., and yet they did it, and they did it successfully. So they were able to say, okay, this person exposed this many people, and quickly find those people. Have them isolated at home for 14 days, and very quickly, actually, were able to control the outbreak even though they had proximity to China, even though all those other things. Now then what was happening here early on is CDC, WHO, our government officials were saying, okay, we got our eye on this thing. We think that it’s gonna be controlled maybe in a similar way to SARS because the reason SARS was controlled so well is that you weren’t contagious until you had pretty rip-roaring symptoms.

In fact, a little after you had pretty rip-roaring symptoms. So screening for SARS was pretty easy. You could actually look at temperature, so if they had a fever it’s already a concern, and any other symptoms. And at point you could quarantine and test those people, which was done so well that were only 8,000 cases, or something worldwide because they were able to very quickly quarantine, isolate, screen, and that was an international effort. So airports were screening, et cetera. And same thing with MERS, the Middle Eastern respiratory syndrome. So because of the nature of SARS, SARS one, the original, still a classic in my mind. The disease actually was stamped out for all intents and purposes by taking that reproductive number, the R naught, R with a little zero, and squeezing it down so low that the disease actually petered out of existence. And so people who were working on vaccines at the time, Peter Hotez whose been on our show found their vaccines being shelved because nobody was urgent about SARS anymore. Now what happened with SARS two, the sequel, coronavirus, this current coronavirus.

Remember SARS two was a coronavirus as well, okay? So this is SARS COVID two. In this case, initially, it wasn’t clear. And in fact, the Chinese government was denying person-to-person transmission. They were denying community transmission, they were saying the only cases are potentially from animal to human, but what was happening on the ground was very different. And so for whatever reason the Asian countries acted very quickly, but Americans were still kind of watching, and waiting, and seeing, and saying, well, we’re not gonna have community transmission here. We’re far away, they’re screening, et cetera. Little did they know that the way this sequel presented, the current COVID-19 disease, is that people could be asymptomatic, have no symptoms, and still be replicating virus, and still be shedding and transmitting virus. And as a result all your screening protocols that don’t involve direct testing are going to fail because people who already have symptoms it’s already out of the bag.

They could have been transmitting disease for days prior to developing symptoms. And early data from the Diamond Princess, and other situations showed that it’s asymptomatic people of large proportion maybe never developed symptoms. Some have symptoms that are very little delayed until later, and they’ve been transmitting the whole time. And, actually, looking in retrospect at a good example of this, a single asymptomatic patient in Washington State as part of a choir, a group of people in a large sort of church where they were doing social distancing, but they weren’t wearing masks, and they weren’t doing aggressive hand hygiene, and they were still like stacking chairs together, and exchanging snacks and things like that.

This one person infected 53 people that night over a two hour period where they were doing their choir rehearsal. And that asymptomatic person ultimately led to two people dying in that cohort of 53 infections. Now it’s interesting, too, because if you look at the average median age in that group it was 69, so that was a much older group, and two lives were lost out of 53, right? Which is what, a roughly 4% mortality in an elderly population is kind of interesting, but the idea then that this super-spreader could actually infect so many people without ever knowing it, and part of the reason they were super-spreading is another thing that wasn’t understood about this virus early on, or wasn’t really communicated well which is that whether you’re symptomatic or asymptomatic you can project this thing into the air by aggressive breathing. So in the course of singing that is a projection from the lower respiratory tract into the air.

We don’t know the distance, but the truth is when you’re thinking about infection you need a particular dose of virus to get you infected. So it has to reach a certain threshold, and in order to hit that threshold it needs to get in your eyes, or your nose, or your mouth, or on your hands and then in your eyes, nose, or mouth, and that takes some time. So the majority of cases were not transient experiences where you were briefly exposed to someone. They were close contacts, family members, people living in the same house indoors, which is another thing we learned about this virus, which is it does not like the outdoors as much. Sunlight, UV, high temperatures don’t do well for this virus, but indoors is a perfect environment. So here you have this church, and a super-spreader who has now got a captive audience around them.

They’re putting the virus into the air. It’s either getting on stuff, and people are touching stuff and touching their eyes, or they’re just exposed there for a long time breathing that same confined air space. And that’s how this thing spreads, right? So in the setting of that then it’s a great illustration of how this thing got way out of hand. Now this was happening at a time when I think it was like the day of, or a day prior to, when Washington decided to do a shelter-in-place, or a lockdown. So what happened to these 53 people? And this is, again, this is now we’re translating into the American experience. They actually went home. Some of them started developing symptoms. They talked amongst themselves. They started to self-isolate. One of their representatives then reached out to the public health department, and said, hey, we think something’s going on. They then got tested, et cetera, but by this automatic process of doing the right thing, having symptoms and self-isolating, talking to public health, they were able to avert possibly hundreds of thousands, if more, infections. So let’s think about that.

There was no real direct government intervention. They just decided to do the right thing because they were good, conscientious citizens. And that makes you wonder, too, about, again, if you look at the Swedish experience versus the American experience, the Swedish experience where people are just asked mostly to do the right thing, and large gatherings are banned versus other experiences where you’ve really had to tell from above, hey, don’t do anything. So this being said at this point, there has been travel to Italy. Italy which is one of the oldest populations on the planet, smokers, et cetera, high migrant Chinese worker population, did not shut the country down to travel early ends up with a massive infection rate. They’re not known for their DNR/DNI code status, so everyone’s on ventilators. The health care system gets overwhelmed. People are dying left and right, but the same time people are traveling back and forth to New York which is a major travel hub, and the rest of Europe is getting infected.

At this point the Europeans are already getting wise to this, and are doing aggressive lockdowns, spinning up testing, using either their own test or WHO’s test. So what happened in the U.S.? At this point early on CDC says, well, hmm, this is a thing. And they’re asked to decide what. And there was a great “Rolling Stone,” rolling stone of all things, “Rolling Stone” article about this whole process of cluster F’ery, right? I’m trying not to curse so you guys will share this. And I’m so tired of people yelling at me for cursing. If you have to go out of your way to send me an email chiding me for cursing you can F off. And, again, I would say the full word, but I want you guys actually to share this today. Normally, I don’t give an F. All right, that all being said, the CDC had to make a decision. Do we make our own test, or do we rely on WHO’s, or another outside test? Now this is where our great American exceptionalism comes in. CDC is acknowledged as one of the great public health bodies in the world.

They said why would we need another outside test when we can just make our own? And they started doing that. Unfortunately, a perfect storm occurred where there was a mistake in part of the test reagents. It had problems, and they had to recall it leading to huge delays. And then on top of this, right? We have this wonderful perfect storm where it’s clear that health care systems are being overwhelmed elsewhere, so how do we spin up enough personal protective equipment, masks, et cetera, for frontline health care providers including the swabs to do the testing when a lot of that ish is made in China, and China’s on lockdown, or sending it locally, or to local partners. Well, this was one of the huge disasters that happened early on. So combine the lack of testing, which was a CDC screw up, and by the way, again, we’re not assigning blame. We’re saying what happened?

Discoordination at all levels of government on both parties, but if you look at CDC, you’ve got it run by a guy named Redfield, who actually doesn’t have public health experience, was known in the ’80s for being an abstinence guy for HIV. We know how well that works. It actually works quite well, but in reality on the ground it doesn’t work, right? So this guy is running CDC. He’s known to be an obsequious butt-kisser just trying to smooth things over. So you have this perfect storm of crappy leadership, bad coordination, right?

And a government actually that has not really been on the side of science as much as we would like combined with pre-existing structural problems where we’re getting all our PPE from China. And at this point we have the perfect storm of crappy testing, and no PPE. Well guess what? Those two feed on each other because if you have good testing you can determine which patients don’t have the disease, and you don’t have to burn through your personal protective equipment using it on patients that don’t have the disease. Instead of needing to wear PPE for every patient who walks in ’cause you have no idea whose an asymptomatic carrier of this disease. The tests aren’t perfect, but they’re way better than nothing, which is what we have.

Do you guys remember what a disaster it was? People were coming with symptoms and couldn’t be tested. I had colleagues here in the Bay Area telling me I have a patient I know has COVID-19, and CDC is saying he doesn’t meet criteria to be tested because you had to send the sample to the CDC in Atlanta because they didn’t have the tests out in the community because of that screw up. So this was one of the major derailings that led the United States to becoming this exceptional force for health care, which actually it isn’t, by the way FYI. I’ve talked about that. To being as of today we have 90,000 deaths from COVID-19, and you could say that a lot of those were preventable if we had done the right thing early on. Now at this point there’s crappy testing.

We’re seeing community spread, which is actually underestimating what’s been happening because of asymptomatic carriers. Looking at antibody studies which aren’t great. We’ve talked about this in other shows. The prevalence of this disease is like two to three to five to 15% depending on where you are. Every location is handling it differently. So San Francisco handled it actually pretty well. Clamped down quickly and aggressively, and actually slowed, bent the curve pretty rapidly, but sacrificed quite a bit of what people would consider individual liberties because I have to wear a mask on an outdoor trail system, right? New York was a little slower, and it’s a much more difficult thing to handle ’cause it’s so dense, so much travel, and the cat had already been out of the bag at that point. So massive rates of infection. Health care system coming very close to overwhelm if not, frankly, overwhelmed.

And health care professionals on the frontlines dying because they don’t have enough PPE because of that other screw up that we’re talking about. So at this point it’s a complete cluster F, right? Now the Chinese who figured out pretty quick how to handle this shut everything down, universal masking. And we’re not talking about cloth masks. So let’s talk about masking, and where this went crazy. So early on CDC, Surgeon General Jerome is saying don’t do masks. I was saying if you wear a mask in public you’re a dick, and the reason I said that is that the masks that people were wearing were surgical masks that they were basically taking from the short supply of frontline health care workers who need it.

Remembering that the big screw up is we didn’t have enough PPE, right? For the people who were at most risk, which are close quarters, prolonged exposure, which means people who are already sick, and their family members, and frontline health care workers who get this thing at very high rates, which was shown to us by China already, but they figured it out really quick, and dropped their nosocomial, their health care worker rates very, very low. The South Koreans did the same thing, which we did a show with Gloria Hwong about how they did this. So at this point, we are way behind the places that are doing this well. They are already in cultures where universal masking is just that’s no problem, right? You just do it. They’re using mostly surgical grade masks. They’re not using cloth diapers on their face.

At this point CDC changes its tune and says, well, all right, let’s try a way what’s going on. Instead, okay, if we say everyone should wear a mask then they’re gonna go out and buy surgical masks, so we’re gonna say it’s okay to wear cloth masks. Save the surgical masks for doctors, which, of course, doesn’t work because people are gonna go buy surgical masks wherever they can, but then let’s use cloth masks. Now the problem with cloth masks is, okay, maybe they reduce the aerosolization of large droplets better than nothing, right? And that’s the problem. It’s not so much about protecting you it’s about protecting other people from the droplets. If you have asymptomatic carriers, but they’re wearing something on their face the chances of them spraying the area with infectious material, people touching it, touching their eyes, or breathing it in directly much, much lower. They said, yeah, go ahead and wear these cloth masks. And, of course, people don’t really know how to use them.

They’re still touching their face. They’re putting their cell phone to their face. They’re wearing gloves and touching stuff, and touching, I mean, so, again, an education issue, which I ranted about saying I think the cloth masks are dumb because people are going to misuse them. Now where has my thinking evolved, and where should we be going with this because right now I think masking is becoming more accepted. You can already start to watch the stigma decrease about masking in the U.S. in areas where there’s dense urban environments.

So in the Bay Area I’m now seeing pretty much everybody’s wearing a mask. It took a while, it took a few weeks, right? Just like in Asia. And if you look at the countries that handled it well there’s correlation not causation. There’s correlation with universal masking, and lower transmission rates for the reason of common sense, and scientific extrapolation, but not direct data. And that’s another problem with cloth masks. We don’t have good data in the wild that these things actually are reducing transmission because we don’t know what the transmission rate is out in the wild. We know that probably the majority of transmission is occurring indoors with people in close contact for long periods of time. So, yes, grocery stores it makes sense. Subway it makes sense. Does it make sense on an outdoor trail system? That’s nonsense, right? Just working from first principles. Again, whose gonna study it right now? We need the actual data to show us. We know that, okay, hand washing reduces transmission from many other diseases, and most of our data we’re extrapolating from influenza studies, which may behave slightly differently. All right, so now you have different levels of lockdown across the country because this country isn’t one country. It’s a series of federated states, basically, that each have their own thing going on.

So Gavin Newsom in California is one extreme, and then you have whoever else saying just smoke ’em if you got ’em, right? So it’s gonna be very different, but, of course, that may well be appropriate in America because the rates of infection and our risks are different. Now let’s get back to why American exceptionalism actually harmed us here. We are an exceptional country. We’re exceptionally fat. We have exceptionally poor diet. We have exceptionally high rates of chronic disease. We have an exceptionally high gap between racial groups in terms of social determinants of health. So if you’re African American, if you’re Hispanic, you’re more likely to be poor, live in a congested area, in a smaller space, and have to take public transit.

Those are all risks for getting coronavirus infection, and you’re more likely to have hypertension, diabetes, diseases of poverty, obesity. Well, those are more likely to kill you when you get coronavirus. So America is, again, an exceptional target for this disease in terms of mortality because we’re so sick. And when you look at the demographics of whose getting sick, originally everyone was saying it’s just old people. Well, in America, actually, a lot of young people were getting sick. Some of who had not a lot of diagnosis, but, again, that’s still a small component. We remember it because we go, oh, that could be any of us then, but a lot of people have either undiagnosed, or diagnosed diabetes, hypertension, things that put them at risk. And the show we did with Ronesh Sinha, Dr. Ron Sinha, talked about why those diseases can actually put you at risk. So theorizing why you would be more likely to suffer an inflammatory cascade cytokine storm, and other things like that that can kill you with COVID. So, again, I’m referencing these conversations we’ve had over time. So at this point America is disorganized. They don’t have the testing. They don’t have the universal masking culture. So what do we have to do? Very draconian measures that shut the economy down in a way that causes economic turmoil and disaster, and huge unemployment which leads to more suicide, more mental illness, more domestic abuse, more pediatric abuse, less people come into the hospital because they’re afraid of getting COVID, so they’re not getting their regular vaccinations, which what’s gonna happen when you combine a COVID epidemic with a measles epidemic with a flu epidemic ’cause no one’s getting vaccinated. So you have a complete screw up. Everything kind of all Swiss cheese holes aligned to have this bullet come right through and hit us. So that’s why we are where we are today. It’s a series of unfortunate events, right? So here’s the question. Where do we go from here to make this better?

And this is where I’m actually quite encouraged because I think we’re actually gonna do, we’re gonna come out of this better than we went in on many levels, right? We’re gonna be doing more telehealth. We’re gonna shake up administrations, how physicians and other health care professionals are paid. We’re gonna change ideas around personal hygiene, and working from home, and commuting. We’re gonna reduce traffic and congestion. We’re changing the face of our economy to be one that’s much more work from home, stay with family. We’re changing how we educate our children. They’re using tools like Zoom. It’s not perfect, but it’s a different way of doing things, and then as far as the virus goes I do think, and Marty Makary and I agree on this, that the warming climate in the summer is gonna kick this thing in the aah, our butt for a while until the second resurgence in the fall, so we have time to prepare. Yes, they’re working on vaccines. Now the problem is, here’s another thing that’s uniquely American.

One of our big strengths as a country is that we have open free speech. We have a robust social media apparatus. Well, combine those two, and what you do is you start to weaponize disinformation, and we’re seeing this already with COVID-19. So you have people out there protesting lockdowns, not wearing masks because they believe conspiracy theories that are crazy. Now if you’re out there protesting lockdowns because you believe that the economic consequences of a lockdown outweigh the known scientific consequences of COVID that’s a decision you’ve made based on what your values are. That’s fine, I’m gonna repeat that, that’s perfectly reasonable. People of good intention can disagree as to the best way that we want to fight this. I think it’s perfectly reasonable for a person to say, I’m not saying I’m saying this. It’s reasonable for a person to say we should have just let this rip through the community, and kill who it’s gonna kill and get it over with, and develop herd immunity, and develop a more resilient economy, and a better way to fight pandemics in the future. I don’t take that stance. I think it’s not compassionate. I think the care versus harm principle applies, and you’re killing people who could have been saved including health care workers because they don’t have PPE, but somebody who says that is making a balance saying he or she believes that more people would die from the economic turmoil, and the prolonged nature of flattening the curve instead of the curve hitting us all at once, and wrecking everything.

The same number of people get infected over a longer period of time that’s no good. Now why would someone believe that because vaccines are not easy. Anyone who tells you that a vaccine’s coming in like 12 months is trying to sell you something that is not safe. And our interview with Dr. Paul Offit, who has made and invented vaccines, and has every incentive to push a vaccine was very circumspect and cautious about this. And I think we should be, too. We should be working on it with everything we have as well as antiretrovirals, antivirals, and all that, actual treatments, but at the same time we need to understand that that’s not coming right away. Now back to disinformation. The people that you cannot forgive are people who are latching onto these conspiracy theories, and denying the actual scientific facts, which are pretty clear now.

It’s taken us a minute to really get them settled, but it’s pretty clear. In elderly people this is way more fatal than flu. In lower risk people maybe not so much, but in elderly people this is a killer, and people with chronic disease this is a killer. We’ve had plenty of guests on the show. Scott Weingart is one of them talking about how this disease is so different clinically from flu in how it’s killing people. And this is the evolution of understanding this disease. We’re seeing blood clots in patients who have no business clotting. We’re seeing inflammatory cascades in multisystem organ failure. We’re seeing heart pathology because of presumably ACE-2 receptor mediated damage from the virus. And, again, we’ve talked about this in other shows our medical updates, and this is remarkable in that people who are recovering can suddenly die of a cardiac arrest. And now we’re starting to see, where as before, we thought children were not affected really at all, we’re seeing a rare, but still very concerning pattern in children of this multisystem inflammatory syndrome of children, MIS-C, which looks like Kawasaki’s disease, which is an autoimmune disease in children that affects blood vessels in the heart, larger blood vessels in the heart. We’re seeing a slightly different syndrome that resembles it somewhat in children now. And the cases are popping up in a way that’s way more than random probability, and they’re often associated with a positive COVID test, or an exposure to the coronavirus that causes COVID-19 disease. So as this disease evolves our understanding of it evolves.

Originally everybody was getting intubated early. Even I said, hey, the standard of care from what we’re seeing in Washington State is intubate early if you think people are looking like they have low oxygen levels. Now we’re realizing there are people called happy hypoxemics who can actually tolerate low oxygen levels quite well. And so avoiding the cascade that happens when you put a breathing tube in someone, and force air into their lungs under pressure that creates its own set of problems. And we talked to Dr. Wes Ely on the show about that set of problems that you create. How do you balance that? We’re getting better at that. One of the advantages of flattening the curve, by the way, is that you buy yourself some time to learn how to manage the disease.

I would much rather get sick with COVID-19 later when we have a better understanding than early on, right? And so this being said, right now we have to understand what we don’t know is still a butt ton. What we know is actually growing by the minute. The way we’re gonna manage this moving on is we’re gonna take advantage of what’s gonna happen in the summer, which is gonna be a slowing of infections. Take advantage of the time we’ve bought through our lockdowns. Start to open up where appropriate doing it thoughtfully. Absolutely we need to do that because the economic damage, and the damage to our way of life costs lives, period. So we have to do that, but we need to watch carefully. And at that point we do need to consider if we can get PPE spun up, ditching these stupid cloth masks, and getting everyone surgical masks. Why isn’t the government spending that $3.2 trillion stimulus package on rapidly building factory capacity to manufacture surgical masks for the public. In addition to sending someone a stimulus check send them five surgical grade masks, which we know from the South Korean experience, and the Singaporean experience actually work quite well, right? So then people aren’t wearing flimsy bandanas that give them a false sense of security. And I think we could actually do a lot better, change the culture and the stigma around masking, right? And there is one, there is one. So that being said, you do that. Then the question is in America are we ever gonna be able to spin up a quote, unquote, army of contact tracers? This is where I have a lot of reservation because Americans just hate that stuff, right? They have to be shown death and despair at their doorstep to give up their privacy, or to give up the freedom not to wear a mask, something like that.

And in places where that is happening like New York, they’re willing to do it. In places that haven’t seen enough COVID they’re willing to deny it even exists as a thing. They think it’s a government conspiracy. And there’s no way they’re gonna let contact tracers violate their privacy. So we have to start to think about what that means. And the question is are we ever gonna have enough capacity to do the testing and the contact tracing that would lead us to a Singapore like outcome, or are we gonna be stuck with this is gonna burn through our population at a rate that is slowed by some of the auto distancing practices. Now back to this, Sweden. There’s all kinds of press on Sweden. And how you read that press depends on your politics. If you’re right of center, and you’re a right of center press outlet you’re gonna spin that as, aye, look, these guys didn’t have draconian shutdowns, and they’re doing just fine. If you’re left of center your press is gonna spin it as look at the excess number of deaths in Sweden relative to other countries that did more aggressive lockdowns.

Here’s where I think the truth is, and as usual some of are in the middle. Most of their deaths are in the elderly in nursing home populations, which they did not manage correctly early on. They self-admitted this, but the rest of the population is doing what that choir in Washington State did. They’re doing what a grownup responsible person would do. If they had symptoms they self-isolate. They’re doing basic rational self-isolation. Now they’re different because the majority of their households are single person households. Social distancing is built-in. In America that’s not how it is. In Louisiana there’s multiple multigenerations living in a single house. And a lot of the infections happen in those homes in close quarters with sustained contact because it’s area under the curve of how many virus particles are you exposed to over time?

So it’s a very different experience, but the autoregulation of people just saying, you know what, oh, I see a lot of people are getting sick. I’m gonna be a little bit more careful about going out. If I have symptoms I’m gonna wear a mask no matter what, this kind of thing, that can help a lot. And that means actually relying on our fellow citizens to do the right thing so that we don’t have to necessarily shut down the economy, right? Grocery stores have actually done a pretty good job. Even in you have places where the curve has been bent a lot grocery stories are open, people are wearing masks, right? Checkout clerks aren’t getting massively sick. So something’s working, and we should learn from the bright spots of what is actually working, which we’ve talked about on the show the different brights spots where things actually work.

So that all being said, let’s see if we have some comments here that we can read. Is it possible that COVID is an autoimmune virus that affects lungs and other systems? Says Gail Keitel. We know that the immune system is a huge part of how COVID-19 causes its havoc. Part of the reason is it’s the immune response to the virus. So the virus itself can cause havoc by actually killing, and causing what they call direct viral cytopathogenic effect, harming cells it directly affects. And those can include lung cells, the cells lining the blood vessels, which is one theory as to why there’s so many blood clots in patients with COVID infections because you’re damaging the endothelial cells, and allowing the clotting cascade to occur because you’re exposing compounds underneath those cells that cause blood clotting because the blood thinks, the blood thinks that… I love to personify blood cells.

The blood thinks that there’s been a cut, and it needs to clot because it’s seeing blood vessel wall that it normally doesn’t see. That’s actually kind of what happens in a heart attack, too, when you look at myocardial infarction. So that being said, there’s direct cytopathic effect of the virus, but then there’s also the response of the body’s immune system to the virus that can be overwhelming, and can cause infiltration of organs with inflammatory cells that are parts of the immune system as well as cascades causing low blood pressure, and organ failure that come from an aggressive response. Think about anaphylaxis from a peanut allergy. That’s your own immune system killing you, right? So, yes, it has a huge immune component. And one of the theories why it affects older people more than young is that older people have been more exposed to coronaviruses over time. They have a stronger immune system that can actually partially have some memory of previous coronavirus, and mounts this huge, but ineffectual attack on the virus that then causes more harm to the host. So that’s one theory. Now let’s read some other comments actually. When is it safe to see our families? Says Dana Zentgraf.

So this is where Americans have a very… All of us have a very bad grasp of risk, risk and benefit. So a lot of people ask me this question. When is it safe? I’m a grandmother when can I see my grandkids? My own parents asked me this question. When can we see our grandkids? Well, you have to weigh a few things. What’s the risk of the activity you’re undertaking? And what are the benefits to you, and those around you? If the benefits outweigh the risk than you take that action. If the risks outweigh the benefits than you wait. So let’s say you’re a grandparent, and you want to see your grandkids. Well, we know that children and adults can be asymptomatic carriers. We know that older people are at higher risk of dying of COVID-19. We also know that older people are at risk of dying from loneliness related disorders. We also know that if you were to die of something else because you’re not going to the hospital because of COVID, and you don’t see your grandchildren that can leave longstanding scars on the family. There’s all kinds of considerations. So how do you mitigate the risk, which is dying of COVID, and maximize the benefit, which is hang out with your kids? Well, one way might be going and seeing them from a distance on a front lawn outside where it’s sunny. Well, UV rays, it’s warmer, maybe you’re wearing masks so that if somebody coughs, or projects something you’re safe. That’s one way to mitigate risk, or you may say I’m okay with getting infected, and I’m willing to see my grandchildren because I know I’m not gonna make them so sick that they’re likely to die that’s very unlikely. So you could weigh the risk that way. This is the same thing as we open up how much risk are you willing to take? Do you want to go to a restaurant and not wear a mask, and have a waiter who is wearing a mask?

Thinking the risk is not that high if there’s good ventilation, especially, if there’s outdoor seating. And I think we ought to weigh risks as a society. What are the risks of hiking on a trail that isn’t crowded like Central Park say? They’re pretty damn low. So maybe we shouldn’t force people to wear masks outside like that because first of all it creates this weird culture of fear in outside environments, when we ought to be encouraging people to go outside and exercise because that’s gonna be one way to prevent, and lower your risk of dying of COVID, which we talked about with Ron Sinha on the show. Let’s see, let’s see, let’s see. Boy, these comments move so fast. Let me try to grab a few others here. Yeah, Debbie sees some really dumb stuff as a retired infection nurse. How do you know for sure the virus will go down in the summer? Says Okeisha, I can’t read, oh, it already went away. These comments scroll too fast you guys. Stop leaving comments, um, wait.

Oleshka G., how do you know it will go down in the summer, and even if it doesn’t how to you know… It’s just already it’s just spinning, and even if I try to hold it doesn’t stay. All right, I’ll try to understand this. We don’t know, but we have inferences from what we see in states that are warmer and countries that are warmer. They have lower infection rates. Other coronaviruses don’t do well in warm climates, and influenza doesn’t do well. Even that’s a little controversial, but doesn’t do well in warm. That’s why we see it predominantly in the winter, although, it’s also because schools are open in the winter, and influenza travels quite quickly through children, right? So this all being said, I think we may have hit… Let me see if there’s any other comments that I can see here. Do you believe there will be a rebound? Theresa Gates, I don’t know it’s not a matter of belief. This is a simple mathematical fact. Unless you extinguish the virus like you did with SARS all it takes is another individual to be a super-spreader, and you have a new cluster if people aren’t vigilant, if we aren’t doing contact tracing, and extensive testing and screening. So it’s a foregone conclusion they’ll be a second wave, but the question is, again, it’s a bad disease. Nobody wants to get it. It may just be inevitable that we have to go through this. Do the most harm reduction we can knowing that there will be people who die, and get sick, and have long-term consequences. It’s the other thing we don’t talk about.

We don’t talk about the PTSD in health care workers, and in people who’ve gotten sick, and are tortured in the ICU, paralyzed and sedated, or sedated and not getting sedation holidays, and not getting spontaneous awakening trials, and spontaneous breathing trials that Wes Ely talked about on the show. And they’re suffering prolonged cognitive deficits. We’re not really talking about those things, but those are things we have to consider when we talk about the impact of this disease. So it’s a bad disease, but it may be one of those things that’s just inevitable because of all the screw ups and everything that happened we got to get through it, we will, and we’ll get back to some semblance of what’s a new normal. And my opinion is the new normal will be better, actually, than the old normal which was complacent.

And I suspect that the habits we learn with between social distancing, hand hygiene, masking when you’re sick, or when you’re not sick, might actually find that we reduce influenza, and other respiratory diseases particularly among elderly, and those that are vulnerable in a way that’s permanent, which would be fantastic. So I’m actually quite encouraged that American exceptionalism will actually find a lot of good silver lining. I think we’re gonna totally revamp the health care system. And I’ve been talking to a lot of leaders in health care, actually, who are working on thinking about how we’re gonna do this because it’s all about how we’re paid. If we can change how we’re paid. One of the great things that could happen is COVID-19 could tear through our politician leadership, and just sideline them and we get new leaders. That would be great, but that’s wishful thinking, and, also, a little mean and not compassionate, but still I’m just saying greater good, greater good, people. And I think our medical understanding of viruses, and our immune system is gonna be better including vaccines which will be great. So now back to disinformation, forgot to tie that up. The disinformation campaigns that are Facebook speciality, YouTube specialty they’re trying, but they can’t control it.

The anti-vaxxers are back, people, and they’re back with a vengeance. And they think they know what’s up, and the problem is now more than ever they are gonna cost lives with disinformation. So the way we fight back is we block those guys. We deprive them of having a voice on our own platform, right? And we fight that with information, and rational dialogue, and, also, accepting that the anti-vaxxers, and the conspiracy people have a point. There’s hell-no you shouldn’t trust the government, or big corporations to keep you well and healthy. You have to think for yourself, but that means using critical thinking. And, unfortunately, that’s were anti-vaxxers, and conspiracy people fall flat. Their critical thinking is stunted. So maybe we ought to focus on teaching critical thinking. And I’ll be doing a podcast on Sunday with somebody whose kind of a famous podcaster talking about how we can get better at our own critical thinking. All right, so that’s the main thing I wanted to say at 45 minutes. The other thing I wanted to say is I want to thank all the supporters of the show who subscribe for 4.99 a month on Facebook, or 4.99 and up, whatever they choose on YouTube, or send support through PayPal at paypal.me/zdoggmd because in this time this is the way we support the team, and our show, and our broadcast, so it means a lot to us, but the way you can really support us if you can’t do that, or don’t, ’cause people are going through hard times, guys. That’s why I appreciate it so much that you’re able to do this, and I support my ongoing team for that reason. Leave a comment, share the video, tell us what you think. That is spreading information and critical thinking. So I love you guys. I will see you the next time we do a show. And we are out, peace.