Transcript
This isn't your average business podcast, and he's not your average host. This is The James Altiger Show. Today on The James Altiger Show. We need to increase awareness out there because people don't realize this the the notion that it is somehow contained is a notion that we have to abandon. This is everywhere. We had a major testing blunder. I applaud the CDC in admitting it and moving on. They have recognized that was a massive misstep. So what what my concern is, James, is that the cable news outlets and everybody is saying, oh, we have, you know, 2,000 cases in the United States. We don't have 2,000 cases. We have probably 25 to 50 cases for every one that is confirmed on our Johns Hopkins map. We've been tracking around the world how many cases there are in every place, but those are just confirmed cases. Hospital executives and doctors are telling me, hey, Marty. In Philadelphia, we had a couple deaths. We didn't test them for COVID 19, but we're pretty sure they were COVID 19. Unfortunately, the tests have not been available, so there's this misunderstanding that we've had, say, 59 deaths, which is, a recent number, a total tally in the US. It's probably when we reported 59 deaths, this past week, it was probably 500 deaths, but we're just under testing. It would be good to know if that works, if containment works. I mean, the the the data from South Korea and Singapore sort of suggests that containment works, and even from China. Once they started containing, it seemed like, deaths went down and infection infected cases went down. Very pleased to have on the podcast today for this, special coronavirus podcast, which is, the the 4th podcast now I've done on this virus, and I plan to do one every Monday. But, so anyway, on the podcast today is doctor Marty Makary. He's been on the podcast before. He wrote the book, The Price We Pay about, problems in the health care system. He's been a regular voice on on CNBC and other networks about the coronavirus. He's, writes for The Wall Street Journal, USA Today. He's a practicing surgeon at Johns Hopkins and is a professor of health policy and management at the Johns Hopkins School of Public Health. He's published more than 250 scientific articles, including articles on vulnerable populations and best practices in health care. He's, he's actually, if you if you, read the book checklist by Atul Gawande, another prominent surgeon and writer, who Marty has worked with, he also is the lead author on the original publications describing using a surgical checklist. He's been elected to the National Academy of Medicine, and, he also is the author of, New York Times bestselling book, Unaccountable, which was turned into the hit TV series, The Resident. So in any case, let's go to the interview I'll go to interview in a second, but I do wanna say, couple of things. One is, it's good and I see a lot of people who are are skeptical of the data, skeptical of the politics on both sides. But I really wanna stress that even if you're skeptical of the data here, it's important to look at what a worst case scenario can be. It's important to understand who is at risk in the population. And just because elderly people seem to be more at risk, it doesn't mean you should do nothing. Particularly if you're a young person, you need you need to avoid not you need to avoid this disease, this virus, so that you don't transmit it to the elderly. So I tell my own kids that when you do what's called social distancing and you stay home from school and you stay home from large events and so on, you're actually saving lives. And if you don't do this, there's a great risk you could be killing people as well. And this is not said in any kind of hysteria. I I do think and and you'll hear in the discussion with Marty that, you know, these these actions that we're taking now as a society, could very much help people and is very probably help people in other countries. We'll we'll soon learn if it's helped people in Italy, for instance. But we need to take it very seriously, this social distancing. It's not this virus is not going to last forever, and we've got some estimates from from upcoming with with Marty about that. It's not gonna last forever, but we need to do what we can individually and as a society to actually make sure the percentages are as low as possible. And second, I think we should take action figuring out how to help the people who need it. Are there elderly that you know or that anybody knows that they could use deliveries or they can use some sort of, help from you or a visit or a phone call or food or whatever? We need to all kind of start taking action. In any case, here's doctor Marty McCarrie who's been a prominent expert throughout this virus. And I also wanna add, I will do an outro after the interview with Marty, kind of summarizing my thoughts on what he said. Let's go to the interview. Thanks very much. Alright. So doctor McCarrie, thanks once again for for coming on The James Altice Show. Again, you you came on, you came on earlier a few months ago for The Price We Pay, which is your latest book, which I just mentioned in the intro, which Steve Forbes himself described as a must read for every American. And, hopefully, it doesn't become more of a must read now in terms of the price we pay, in terms of how we're dealing with this, pandemic. But, thanks again for for coming on the show, Marty. Great to be with you, James. And, so just tell me a little bit. We haven't yet spoken about the coronavirus. What's I've read some articles. You I read one article you've read. I've seen some of your appearances on CNBC. What's what's your latest thoughts as of today? And then, of course, I'm gonna hit you with thousands of questions. Well, bring them on. You know, James, I'm very concerned that we are about to witness a storm hit this country 10 times worse than Katrina, and we've got 40% of the population right now, according to a survey just released, that thinks actually the worst is behind us. It's not. I mean, look, I'd love to be wrong, James. I would love for this hurricane to take a different course, but all the projections from our own group at Johns Hopkins, from the Harvard epidemiology study, to all the infectious diseases specialists that there is an 80 to 90 percent chance we are going to get hit so hard. It will be the greatest epidemic of our generation since polio. And, I just don't think people are awake. I think part of it is is the echo chambers of cable news where you go on these, you know, cable news programs and all you see are these political opinions. You know, we don't need any more political opinions. We need medical opinions. And unfortunately, you know, we live in an era where Twitter and social media promotes everybody blurting something out without knowing any information. I think it's time to get prepared. I'm telling people to, take extra caution for those at high risk. I mean, our parents right now, we've gotta watch out and take care of each other, so I'm very concerned. Well, okay. So so let me start off asking a couple questions about the worst case scenario, because I I I I am curious about some of the data, particularly from South Korea and China, which suggests that the kind of containment we're doing right now might produce a a better than worst case scenario. But what is the worst case scenario? Well, the Harvard study suggests that 40 to 70 percent of the US population will have this virus. And now we know from history, pandemics last about 3 months. That's how long the Spanish flu lasted in 1918. It went from September to January. That's how long SARS lasted. That's how long MERS lasted. We can anticipate we will be in the clear in the summertime. Now that's one piece of good news. The other piece of good news is that it it is hard for this virus to hurt somebody who is young and healthy. But beyond that, the numbers are not pretty. Our health care system's about to get overwhelmed. Can I just run a number by you here? Yeah. So let's say we've got 350,000,000 Americans. Let's take the low end of the Harvard estimate, which says 40 to 70 percent of Americans will be infected. Let's say 40%. That's a 140,000,000 Americans. Now about 20% from the reports get hospitalized. Let's just assume, to be really conservative, that half of folks don't have symptoms or they have mild symptoms, they blow off, they don't really think they have it. So let's just say instead of 20% get hospitalized, half of that 10%. That is 14,000,000 people coming to our hospitals. And if a quarter of them need an ICU bed or a critical care bed, which is roughly what we're seeing in other countries, That's 3,500,000 Americans needing respiratory support or critical care level beds. We only have a 100000 beds, critical care beds in the United States. We only have 400 some thousand overall. Now how how, quick is it and these are just naive questions. How quick is it to take a not ICU bed, let's say the next level of support, and turn it into an ICU bed? So I was, working in the hospital during 9:11, and I witnessed INOVA, Fairfax Hospital, and some others, empty out 70% of their patients within hours to get ready for the, what it was anticipated to be the 9 11, you know, influx of patients. So let's assume they can convert in an emergency, you know, the other 70% of their beds into critical care beds. Let's just assume. That only increases our capacity by 2 to 3 fold. Let's say we get to 200,000 bed ICU bed capacity or 300,000. We're looking at a possible 3,500,000 patients. Now look, let's say let's say the number of estimates off and we get half of that. We're still talking about overwhelming the health care system. And, James, what concerns me is that these are not really opinions. What we are watching in Italy right now is a preview of what we should expect. And that movie What are we seeing in Italy right now? Well, first of all, China has not been transparent with their data. Iran has not been transparent with their data. But the next biggest country to get this, early on, Italy has been extremely transparent. And they they had, on Saturday, 250 roughly Friday Saturday averaged about 250 deaths on each of those days. Sunday, it was 386 deaths on that one day. Now This is the end of last Sunday a week ago. Yeah. This is this past Sunday. Now, Italy, northern Italy, those hospitals are overrun. We we're talking to doctors there who are now rationing ventilators. Italy is not a poor country. Italy has first rate hospitals and first rate doctors and, you know, informed citizens, and we're watching a disaster unfold there. That is a movie that is about to play in the United States, and, unfortunately, this idea of American exceptionalism is crossing over into arrogance that somehow our immune systems are stronger. This is the best predictor of what we should expect. Now those let's say this past Sunday, 386 deaths. Italy is 1 fifth of our size. Adjusted for population and age differences, that is about 2,000 deaths per day in the United States at this stage of the pandemic, at their stage of the pandemic, which is 3 to 4 weeks before its peak. Are we ready for to see over a 1000 Americans die each day? Well, so so, Marty, let me ask you some questions on on Italy's data, and then also I wanna ask about South Korea. And then the one kind of, sort of closed case study we have, even though it's much smaller, is this the data from this cruise ship where where, everybody was perhaps exposed to the the virus. But in Italy, since last Sunday and since they've done total lockdown, has there been less, cases of infection? Well, first of all, it's a great point. One difference between Italy and the US is they've had a total lockdown. Right? They've got martial law. We're not even close to that. So that's something to factor in. People say, oh, well, the Italians kiss more, and they're more intimate. Well, they're also doing a total lockdown, which we're not doing. South Korea and Singapore have had model responses to this thing, and they have tested people early, traced them, isolated. It has been a model response. We have we had a major testing blunder. I applaud the CDC in admitting it and moving on. They have recognized that was a massive misstep. So what what my concern is, James, is that the cable news outlets and everybody is saying, oh, we have, you know, 2,000 cases in the United States. We don't have 2,000 cases. We have probably 25 to 50 cases for every one that is confirmed on our Johns Hopkins map. And all you do is Google Johns Hopkins map, and you'll see we've been tracking around the world how many cases there are in every place, but those are just confirmed cases. Hospital executives and doctors are telling me, hey, Marty. In Philadelphia, we had a couple deaths. We didn't test them for COVID 19, but we're pretty sure they were COVID 19 because the testing situation was such a nightmare to get that done. You know, it doesn't change our management as a doctor. I'm a physician. When somebody comes in with this COVID 19 thing, you treat them the same if it's influenza or COVID 19. You manage them with respiratory support. You provide, critical access. So why would we be testing people except to for public health information and to isolate and trace who they've been around? So, unfortunately, the tests have not been available. So there's this misunderstanding that we've had, say, 59 deaths, which is, a recent number, a total tally in the US. It's probably when we reported 59 deaths, this past week, it was probably 500 deaths, but we're just under testing. So so you're saying 500 deaths because maybe there are people who died for reasons that maybe at the time we thought were pneumonia or some other respiratory disease, and we miscategorized it? Well, to be honest with you, the doctors have a suspicion that it's COVID 19. Oftentimes, they're confident, but they're just they can't go through the bureaucracy of getting the test. So we refer to those as ILI, patients, influenza like illness patients. And ILI deaths are surging right now. And say, for example, New York City, you can look it up and I'll I'll tweet this out, but you can see a surge in influenza like illness deaths. Now is influenza spiking? No. Influenza has been on the decline for weeks. We know, we can conclude, we can deduce that these are COVID 19 cases. We just couldn't get the test for them. So actually, I'm gonna look that up. So the CDC keeps track of The CDC's numbers have been outdated for a while. It's embarrassing, to be honest with you. There is another site, and I'll pull it up here as we're talking, but there's another site where you can track actually cases in New York state. New York's done a pretty good job tracking, but, let's be honest, a lot of times the doctors say, hey, this patient's got COVID 19. It's gonna be a nightmare to test the patient. We're busy. We're busy here in the hospital. We're overloaded. Let's just treat the patient presumptively for COVID 19. So all that to say, we need to increase awareness out there because people don't realize this the the notion that it is somehow contained is a notion that we have to abandon. This is everywhere. So I'm looking at, the New York state site, and it's hard to actually understand what's happening here on this site. There's, like, 2 different charts. 1 is spiking up. Oh, no. That's in in November. Yeah. There's there's one that I'm looking at right now. Positive influenza. Oh, okay. So that's that's actual influenza results. I don't know where the ILI ones are. But, anyway, I'll I'll check that out later. But okay. I but I'm curious. So in in Lombardi, Italy, since the lockdown, do we have any data? Lombardi, yes. We do have some data. By the way, I'm seeing that website as weinberglab.shinyapps dot I o backslash nyc underscore syndromic. Anyway, Weinberg Lab, I think, is one of the, places here that I'm seeing those numbers. A spike in the last couple days in what we call influenza like illness. Lombardi, you know, we we are hearing that they are now moving beyond what we call the testing phase. And the irony, James, that we have been, you know, so focused on testing, which we needed to be and we need to be right now, but at a certain point, once we hit a certain threshold, the value of testing goes way down. What do we do when 1 in 2 Americans test positive? I mean, is the test really that helpful? So ironically, we may have gotten so far behind the 8 ball with the testing, that we need to move you know, folks start focusing on capacity building and not as much on increasing the availability of the test. So, Lombardi has already moved to that point. Lombardi province in Northern Italy is now only testing serious illnesses where they're, where they think testing can really help identify a pocket or an isolated cluster, or, they just wanna confirm what it is. So so but we don't know the effects yet of their containment. Because because, I mean, it seems like it's still relevant to test if given that they've changed strategy, they've gotten this into essentially this martial law situation. It would be good to know if that works, if containment works. I mean, the the the data from South Korea and Singapore sort of suggest that containment works. And even from China, once they started containing, it seemed like, deaths went down and infect infected cases went down. Well, certainly. Well, China, I I have a lot of opinions on China, but, basically, China is parading around strength, like this entire time. China likes to project strength, right? So they have reported about 3,000 deaths when the doctors there have told me and my team that they're not even counting body bags. They may be, you know, there's rumors that they may be, disposing of bodies in ways that are not typical there, because no one has been counting. And China claims that they are beyond this, but they have been shut down. The whole country has been shut down. And actually, just a couple days ago, they started to let people out of their places in Beijing. Now they're all wearing masks. People are very cautious. They're worried about a second wave. But somehow the idea that China has beat this or that the virus has moved on past China is just not true. It's still a very real threat, and the country has been mostly shut down. We don't have, to answer your question, James, a randomized controlled trial of 2 countries, one like Italy that's quarantined and one that has not. Although the United States may be an example. Uh-oh. Well, also has not. Also England, which is doing a strategy of of herd immunity right now. Yeah. It'll be interesting. I mean, this is uncharted territory. But if if Italy had 368 deaths on one day, just a couple on Sunday, and they have a massive lockdown. What are we expecting here since we're 5 times their size? That's my concern. Yeah. So so, but we don't know we we don't know yet if their if Italy's infection rate has gone up or down since the lockdown. We do know in South Korea, as soon as they started doing, kind of containment and quarantining, that it seemed like infected cases went down. And that data seems to be pretty reliable. Well, Italy is definitely reporting more new cases each day. That is that's definitely true. So the number of cases is going up each day. But I just I just warn people against interpreting number of cases when those are really confirmed cases. I love our Johns Hopkins team. I love our Johns Hopkins map. It's become the standard now worldwide for tracking cases. But at the same time, people have to remember that map is not accurate because it only represents confirmed cases, and it's a function of testing more so than a function of the actual number of cases out there. Okay. So so, I mean, one thing about Italy is if they just did their started their lockdown a week ago, we're still seeing since people are asymptomatic for for 1 to 2 weeks, we're still seeing the results of people who might have gotten the virus 2 weeks ago, for instance. And now they're kind of in serious shape. So now they're a reported case from up from an asymptomatic case. Yeah. Way up. So so we don't we won't necessarily see the results of the lockdown for another week from Italy. Yeah. I mean, I'm look. If you really wanna track this pandemic and you really wanna know what to expect in the United States, there's two numbers to track. And I tell this to, like, the Wall Street traders who are, you know, how big you need to get information about what's gonna happen. Track the number of deaths on a day for each day in Italy. And the second number is the number of beds they have available for the number of beds they need. Now just recently here they reported 368 deaths in one day and 3,590 cases on that same day, new cases. Right. So the new deaths, almost 400, new cases, almost 36100 in one day. But but you would you agree that these cases don't yet reflect the results of the lockdown? Yeah. It's it's just hard to know the results of the lockdown, and the reality is when there's a bell curve, imagine a bell curve, what you do when you reduce transmission is you squash that curve down. You you you prolong it or expand it, and you reduce the surge in cases at at one point in time. And we talk about so called flattening the curve to reduce the demand on on the health care system because that big spike in the middle of the bell curve is something no country can handle. Now just to give you a sense as to as to how under prepared we are, we talked about the number of ICU beds in the US. We have 2.8 beds of any kind for every 1,000 patients. By comparison, Japan has 13 beds for every 1 person, of every 1,000 people. We probably rank 32nd in the developed world for number of beds per person in a in a community, And that's because our hospitals run like well run businesses, and they don't anticipate, you know, a need for this massive fluidity. We don't have a strategic national reserve like we do for oil for health care. And that's one that's one great concern. So so so, I agree with this that in the worst case scenario, and and we'll talk about what happens potentially, you know, in a worst case scenario. But I'm trying to I'm trying to just understand, I guess, you know, viewing it as a, a bell curve. We're just trying to understand the probabilities of the worst case scenario. So for instance, we've now put in place these travel bans. A lot of people are self quarantining. A lot of events and large gatherings have been shut down in many states. It's been mandatory that a lot of large events have been shut down. And it does seem like there's been some evidence from South Korea and depending on how you view the data in China, which I agree is unreliable. At least from South Korea, there does seem to be some evidence that these sort of policies have flattened the curve a little bit, that less, cases of infections have been the result of these kinds of policies that are happening now in the US. No doubt. Look. If if you can and as an individual, James, and for me as an individual, if we can reduce our our transmission rate in half, that is we can wash our hands better, be more careful, not touch doorknobs, use a use a barrier, avoid public areas. If we can change our behaviors to reduce our personal transmission rate in half, we've reduced the societal transmission rate in half, and that that could have a big impact. Now we know South Korea has been a model, and you're right. They have been so on top of this, they may have stabilized it or even, you know, had a victory over the peak already. You know, they're very careful. But China, let's not be fooled. It wasn't like they were shut down just in Wuhan and then reopened. That entire country is on edge. Most people are still not working. The schools are still shut down. People were just allowed this weekend to get out and walk in this outdoors in Beijing. So we're not gonna go down the the road of martial law, and I just worry that we're underprepared. Right. And and and I agree. And and and we'll talk about that in a second. I'm just trying to still understand, some of the data that we've seen. So for instance, you mentioned, or or maybe I brought up the the cruise ship where, it was quarantined, 37100 people were or you mentioned, I think, in your article, your recent article on MedPage, 37100 people were on the cruise ship. 700, people caught the disease. 300, I think, had to be had to have some sort of medical treatment. And there were 6 6 deaths. So so I'm wondering, first off, if all 37100, were exposed probably all 37100 people were exposed to the virus. 700 so 20% got it as opposed to that 40 to 70% number that the Harvard study suggests. And of the 700, there was less than 1% deaths, albeit 6 deaths. It's not statistically significant. But I'm just I'm wondering what you think of that data. Yeah. I think, you know, we have been unfortunately very distracted by arguments about what is the true case fatality rate. Early on, the WHO was saying 3.4 percent of those people who get it die. The US was arguing, we think it's closer to 1%. And unfortunately, this was a a major a major hang up why people wouldn't take this virus seriously. They were saying, oh, you can't believe that stuff. Well, anywhere in that range is really bad. Okay? And the case the Diamond Princess cruise ship was the perfect case study. Like you said, 705 people tested positive confirmed. So about that's that's about, like, 18, 17% of the number of people on the cruise ship. Again, which is different than the Harvard study, which suggests up to 70% of people could be infected in the US. It seems like given our awareness and given that the actual percentage on this cruise ship, an isolated, case, seemed to be about 16 or 17 percent of people exposed gotten disease. Do you think that percentage could be reflected, in the overall US? I I don't. My personal opinion is no because they had a total quarantine early on. The second point is that in a bad flu season, we might get 20, 30, 40 percent of the population getting the flu. So that's not unheard of. It's just the problem is this is more dangerous. And so if 20% of the the people on the cruise ship got it, about 705, and as you said, 6 people died, and since one more person got it, so that's 7, that's a 1% case fatality rate. Now granted that's a slightly older population, and the good news is it is hard for this virus to hurt somebody who's young and healthy, but the the data is skewed heavily towards older folks. China said if you were over age 80, your risk of of dying from it was 14% if you had the infection. So it really does spike when you get up there in years. Right. Although China's probably not counting the asymptomatic cases, when they say 14%. Obviously obviously, 14% is a lot, and there might not be many. We just don't know how many asymptomatic cases are of people over age 80. You're right. And that's why it it's hard to interpret anything from China. It's hard to interpret anything based only on confirmed and tested cases, and that's why I think the the Diamond Princess is a useful example. And and the the other thing the other thing I'm curious, you say the Diamond Princess was on total quarantine. But what do you think the odds are that the entire population of was was exposed to the infect to the virus? Hard to say. Hard to say, James. I mean, let's assume a third of the folks were exposed to it, you know, had some sort of common, interaction or you know, most people in these cruise ships don't know each other. So they might talk, but you don't see people all over the place hugging and, you know, it tend it it would it was noted in clusters of people, people in shared rooms and people who were who were in the same, groups. I see. So that suggests that some people who weren't in these clusters weren't even exposed. Yeah. And on the flip side, maybe if they were Italian, they were all hugging and and greeting each other with a kiss. Who who knows? But it's hard to really, decipher. Okay. So so right now, you know, we've got these kind of we got this travel ban. Essentially, borders are more or less closed. Large events are all canceled. Many schools have been closed down. Like, all of my kids' schools have been shut down. Do you think this is gonna flatten the curve a little bit? Like, we we've kind of talked about this a little bit. What's your final guess on this? And I know, this doesn't really address hospital preparedness, but it does address whether we're gonna hit a a a horrible worst case scenario. It helps. Look. All of that helps. My my concern is that people get very strong opinions when you talk about shutting down everything. And I think what we the reality is what we need to do is realize that we need to break down society into 2 constructs, essential and nonessential workers, and high risk and low risk individuals. Now I would consider essential workers people in credit markets, some parts of the financial services industry, supply chain, pharmacy, food delivery, some restaurants, that are delivering food, grocery stores, and health care workers. That's what I consider to be essential services. You could you could add utilities. You could add certain things. I mean, we need to keep people with broadband access. That is our lifeline. But nonessential services. Okay. Work from home or give your employees FMLA or come up with an arrangement or pull a Mark Cuban and just take tell your folks you're gonna take care of them for 3 months. We will get through this. This will be over sometime in the summer. The high risk individuals, James, should not be out there. Okay? I mean, they can go for a walk in the park, but they should not be having human contact or interaction in any way where they could get this. Anyone who's high risk, which is folks over 70, if you've had an organ transplant, weakened immune system, on chemo, seizure disorders, severe disability, non ambulatory, do not interact with anybody. Okay? Hunker down. Get enough food to get through this. And those people are very high risk, and those folks are sometimes relatives and loved ones. Yeah. I mean, obviously, this is this is gonna be horrible no matter what. And I'm just trying to like like, it you know, take other pandemics that killed up to a mil you know, a 1000000 or more people around the world. So you have in 1968, for instance, there was the the Hong Kong flu killed between 1 and a half and 3,000,000 people around the world. Would you say and then again, it's still early in this. But, you know, you know, what what's the difference just in terms of the numbers and the exponential activity of this? What's the difference between this and something like the Hong Kong flu or H1N1 in 2009 or Asian flu in 1957? I'm just wondering, like, what other pandemics you can compare this to. Well, this could be roughly 5 to 10 times worse than any of those. This would, using the low end of the Harvard estimate, affect, kill 14,000,000 people. Now let's let's Worldwide, you're saying? No. In the United States, 40% infection rate, that's a 140,000,000 people, and then 1% case fatality rate, that's 14,000,000. Now I hope I hope that is half or a quarter or 0. I mean, let's be optimistic. But the reality is, what is the risk of over preparing and then say, oh, you know, Harvard the Harvard estimate ended up being a little high. That's my concern right now is when we see 386 deaths in one day in Italy, 3 to 4 weeks before its peak, that is 2,000 deaths a day in the United States, 3 weeks before our peak in the future. And that's why I think we've gotta be super protective of our most vulnerable. Right. So, okay, let's let's talk about protection. So, you know, if I peek outside, it's weird how the streets in New York City are still kind of crowded, which is unusual to me given the state of panic in, you know, kind of the policy right now. Why do you think people are ignoring I see people, like, in the playground just just playing. You know? And I people in in Zabar is one block away. It's, like, filled with old people right now. Well, first of all, real quick, I think I gave you the wrong number. I think I gave you 14,000,000 people could die when, in fact, that was the hospitalization number. 1 percent of 140,000,000 is 1,400,000 deaths. Yeah. That that is the number of that that would fit the 40% estimate from Harvard. But but also also, we don't that that New York's I always question the data because that New York Times, or that Harvard report is referring to total cases when and that includes asymptomatic when, as far as we know, the the the fatality rate numbers that are being thrown around in most cases just have to do with people who are, being hospitalized. So, like, 1 or 2 1 to 2 percent of hospitalized. K. That's a good point. Let's stop to take a quick break. We'll be right back. Think of the regular flu season. The regular flu kills maybe 30,000 to 80,000 people a year. I think last year it was about 38000 people a year die. Now do you know of anyone who died of the regular flu last year? I don't. Right? So this is so disproportionate to the vulnerable and towards the elderly that we're gonna see probably that same distribution if this thing ends up claiming a 1% case fatality rate. So that 1,400,000, once again just interpolating the numbers from Harvard, would be heavily skewed towards that, group. And that's my fear. Right? As we go to the playground and we go to a kid's soccer match and we look around, we see people who are like ourselves, who are young and healthy, and we say, there's no carnage here. I don't know what the big deal is. You know? This this thing's not a real threat. And that is my concern. Right? Because we are community transmitters, sometimes silent without even knowing that we're carriers. We are transmitters to those who are vulnerable. When we go to visit our parents, when we interact with somebody at work who is, you know, 80 years old, those are the very dangerous scenarios that people need to be aware of. Right. So so what I'm wondering though is the is the, 1 to 2% that the Harvard report is reporting, as potential like this 1,400,000, or is it 1% of the number of potential hospitalized, the 14,000,000? So that would be up around a 140,000 deaths in the US when this is over. Well, Harvard, doctor Lipsitch simply reported that 40 to 70 percent of the population, could get this. Now the 1% case fatality rate is extrapolated from the diamond princess, from other countries, from reporting from other countries. So most countries that report are are landing with a case fatality rate of generally 1 to 4%. Now because we know they're not testing a lot of asymptomatic people, we sort of mentally cut that in half, assuming half of people never get tested because they don't even know they have it or they blow off their symptoms. So the 1% case fatality rate is kind of the number I use to eyeball the potential of what this can do. Okay. And then and then in terms of what we should do, so, obviously, there's the stay in your home, wash your hands. There's, you know, do you know, there's need versus want. So you said, like, keep essential workers because we need them, but, you know, we don't need to have random you know, if you have some job that's not essential to the functioning of society, take a take some time off. And I'm wondering, is there anything, like, have you seen any kind of not a cure, but any sort of remedies that could at least help with symptoms or alleviate some of the, trauma from this? You know, there are symptom medications, but they don't really, slow down the virus. And I'm I'm amused, James, when I watch the financial networks on TV talk about how this pharma company is on the brink of a new drug or on the run on the brink of a vaccine or who can get to a vaccine quicker. James, we have been working on a medication for the common cold, which is just another type of coronavirus, for 50 years with a big jackpot of money for anyone who can invent something, and we have nothing. Why do we think we're gonna come up with something in 4 weeks? Yeah. It's kinda funny because, everybody it's a it's a common saying. There's no cure for the common cold. And and is this in any way in terms of treatment, is this in any way different from the common cold, or do we have to suffer through this the way we suffer through the common cold? And and just to be clear, the common cold is a kind of coronavirus. It is a kind of coronavirus. So I mean, look, I love the, you know, the bold, optimistic language of our political leaders and our drug companies. But let's put things in perspective here. Any vaccine takes about a year. And if we look at our response to other things, did we come up with a medication for SARS or MERS? I mean, look how long it took for us to come up with a medication for HIV. So the idea that somehow the American ingenuity and innovation, like I heard one commentator say, we're gonna beat this thing with American innovation and ingenuity. Good luck. We have about 4 weeks until our peak, and we've been working on this coronavirus for 50 years in the form of the common cold, and we don't have squat for it. Let's do what we know. Let's use a treatment that is 100% effective in stopping the transmission and its spread. Let's wash our hands with soap and water. And and the staying indoors. Yeah. I mean, I I don't it's not necessarily indoors. It's reducing contact or modes of transmission. So as the weather starts to get nice, it's good for people to go on walks. It it's probably safe to go out and play tennis as long as you're not, you know, opening the door handle with your hands or you wash your hands before and afterwards. You know, golf, as long as you're not interacting and stay as long as you're social distancing. I think it's good for people to stay active and go for runs and walk, but they just don't want to interact or come close to others or share common surfaces. So gyms are a bad idea. You know? Yeah. And so so so, like, the gyms are full in New York City right now or not full. There are people in the gyms. Like, I understand. Are people not reading the news? Or what's what's going through people's heads? Because they're all there's I assume they're all somewhat intelligent people. Are they not scared? I think they're probably intelligent and misinformed or intelligent and have a sense of resiliency, like we see in teenagers when we tell them not to use drugs or smoke. Right? This sense of being indestructible. And my greatest fear, James, is that people think, well, this can't hurt me. And the reality is it is hard for it to hurt someone young and healthy. So they say, I'm not really at high risk, which may be true if you're, say, 33 and healthy. And then they go around and be silent carriers and transmit it through community transmission and promote the public dissemination of this thing. That is, a a big concern right now. And I think also, if you look at the survey, 40% of Americans think that they don't think the worst is is ahead of us. They're basically living, you know, in denial, or they know the information and they don't believe it. I mean, unfortunately, we got some bad information on cable news. We hear politicians. You know, I I can't believe when I watch cable news and they'll say, with us to discuss the coronavirus is Democrat strategist so and so or Republican strategist. How about we listen to doctor opinions instead of political opinions? And the only doctor we've had out there was Anthony Fauci. Now it it I probably shouldn't say this, but can I say something about Anthony Fauci? Yes. Look, Anthony Fauci is a darling. He's a darling of the media, highly respected among doctors, great scientist, incredible virologist, and he calmed the country through Ebola, through the AIDS epidemic, through SARS, through MERS. He is a great man, but he has been muted. For 3 months. We have seen this thing about to happen in all of us in public health. Well, most of us have been like, why doesn't he say something? He's going on all these networks for the last 2 months. You can go back and watch anything he's done. All his interviews, they're vague, generalities. He's not saying anything. He's saying, you know, we we just don't know. He kept saying, you know, we don't know. Then he would say some people are at higher risk than others. And then last weekend, he basically said, if you're high risk and you're older, don't go on a cruise. That's it? That's all you have to say? How about let's shut down South by Southwest like many of us lobbied mayor Adler to do? How about let's, you know, change the NCAA schedule? How about let's postpone the NBA? How about let's make contingency plans for schools? How about we have all non essential workers stay at home and work from home or get paid to stay at home through some assistance? Where are where have those big messages been? And I've been very disappointed with Anthony Fauci. It was just this past weekend where for the first time, he said, we're gonna need to ask ask some people to hunker down. That's the first time he's ever said anything like that. So I think when when we have a love affair with one doctor in the in the United States and all everyone falls, you know, jumps on the bandwagon and falls in line, What we, you know, have, not heard is that, this dire sense of preparing. We've not heard it from Fauci, and he's just starting to change his tune. I love the man. Great guy. I feel bad. He's 79 years old. He's had an incredibly distinguished career. It hurts me to say this because he's had so many great contributions to medicine, but he he has not said anything specific and and preparatory until very recently. And, you know, the government leaders look to him. He he is the head of infectious diseases for the government. So so so now, though, like, all those things you just suggested, like major events, major sports events, schools closing, all of this now has happened. And in and in most states, I think maybe every state, you know, there's a limit on the size of gatherings. So that's effectively shut down, you know, movies, shows, and, you know, other sports events that maybe weren't, initially stopped. But so all of this is happening now. And and, again, there is some suggestion both from the data and and from what you said that this could reduce the overall infection rate. You know, this could this could make the peak virus either happen sooner or or perhaps just just lower the number of people who need, intense hospital care. You know, so fortunately, we we've done it. I'm wondering if you think it will avoid, you know, the hospitals being overflooded. It sounds like you don't think it'll still it'll avoid the hospitals being overrun still. No. Well, it everything helps. So what we're trying to do by flattening imagine this bell curve with a big peak in the center. We're squashing it down and spreading it out more over time. So the peak is later, and the burden is more manageable over time. Because I really worry, James, about our country's nurses and our first responders and our physicians and respiratory therapists. They are getting hammered. Do you know health care professionals have the highest risk of getting this infection? And when we saw it two and a half weeks ago, we saw UC Davis quarantine a 120 health care workers. That's now a bigger quarantine and more national throughout the country. Lots of places are doing it. There's a doctor at Hopkins. There's public information now. This is not, inside information. Who is quarantined? And there's gonna be many more, and there's probably many more for every one that we hear about. Who's gonna staff the hospital for these massive influxes? So I'm worried. So what do you think so what do you think will actually happen? How will this play out? Well, I think, unfortunately, James, there's going to be some massive triggers in society that may unfortunately create hysteria and mass panic. And I think it could be a very high profile person, getting sick. Imagine on the evening news, Joe Biden is in the hospital right now on a ventilator. What's that gonna do to markets? Imagine Lester Holt on the evening news says more than 1,000 Americans died today from the coronavirus. I mean, there's going to be some trigger. It might be a beloved figure in Hollywood who is not alive. It may be half of Congress is quarantined. There's going to be some trigger, right? It could be an athlete that people are going to say, oh my gosh, no one is immune. I'm like that person, and I need to go finally and get some food and get prepared and make contingency plans and think about childcare and that kind of stuff. Okay. So let's say let's say that happens. What's what happens next? I'm worried about the shelves on the grocery stores. Now, if you look at some of the grocery stores in the United States, the ones in Texas right now are just getting hammered. Right? People are coming in there, and, unfortunately, we get these hoarders. You know? And I've stopped telling people, as I was from 3 months ago up until 3 weeks ago, to go out and get 3 months of food because the supply chain right now can't handle it. We need to rely on delivery and curbside pickup and delivery services. So right now in some parts of the country, the shelves are empty. And I'm concerned if you look at what happened in China with the long quarantine. People were, like, on long fasts. People were not eating. People were, you know, begging for food. Now people are out there. Now there's some, you know, more delivery services. But, you worry about what society looks like, not for you and me, James. God you know, life's been good to us. God's been good to us. But imagine you're someone who lives paycheck to paycheck, and each month you have to decide how much food you can buy based on how much money you have. Half of America has less than $400 of cash on hand, and they don't have a 3 month supply of food. They don't may not even have a 3 week supply of food. So as we talked about when we talked about the book, the price we pay, when people get hit with these high costs, they get clobbered, and it's it's crushing. And right now, I I do worry about those people. Now I don't want you to be depressed about this stuff. I want you to think about who do you know that's vulnerable that could use a drop off delivery of some food that you might have around, some extra food. Think about your parents and what they're doing and how you can encourage them to stay put or not go to the bingo night or avoid their trip that they're planning to take unless it's to an isolated location to hunker down. There's a lot we can do to take care of each other, and that's who we are as Americans. Right? We take care of each other. And I think you've seen it already with Mark Cuban saying he's gonna take care of all the concession workers that work his NBA games for those for the duration of this absence. You see that CEO of Delta Airlines say he's gonna forego his salary for a year to make sure everybody's whole. That is the great American spirit. And I think more than ever we need to do that. I wish there were sites, and maybe there are, I wish there are websites around where, we can see how to, let's say, deliver to the elderly. Like, maybe there are some people who are staying in their apartments, don't really have access to the outside world other than through the Internet, maybe don't have much of a family, but can sign up for a site. Hey. I need delivery or some help. I I don't know of any sites out there that I can refer people to to to help people. I don't know of any either, James. It's a great question. You know, I've encouraged people to try to think of folks they know, check-in with them by phone. And I think historically when we have natural disasters or hurricanes, that stuff all pops up after the peak, after the, you know, the main damage has been done. I hope to God that this hurricane is gonna steer away and shift from the United States. Right now, we are on a direct collision course, and my fear is that people are undergoing their routines, without any preparation. It's better to be overprepared and to look back and say, you know, I overdid it. I agree. It's better to be overprepared, like, but I am wondering if if we're looking too pessimistically at at the data that's out there. And I'm not saying people shouldn't stay in. People shouldn't do everything they can to avoid either contracting it or spreading it. But I wonder if if when we start looking at numbers, like 70% of the US are gonna get infected, if if that's really realistic. It hasn't happened in any country at all, and, you know, we just we just don't know. It seems like that's something we don't know yet. Yeah. I I agree with you. I don't think we're gonna be closer to that 70% number from the initial Harvard study. It was a range. I I do think we could be within some margin of error of the 40% number. Let's just assume we get 20%, which is which is probably what we get in the flu season. Right? 20 plus to 30% of people might get the regular seasonal flu. So let's say we get 20%, that may be consistent with what we saw in the Wuhan province of China, where they have about 10,000,000 people, probably about a1000000 of them got the infection, and probably 100,000 people died. That is roughly, what happened over there. So who knows? I mean, look, I hope we can do some social distancing, hygiene, and hunker down practices, and take care of our seniors so that we can cut the rates in half and cut those rates in half and and make this as least painful as possible. But we have a lot of examples right now, and I think we will look back just like we did in Katrina and say, can you believe the problem with the levies was known for a long time? Or the Space Shuttle Challenger, where we looked back and said, can you believe the o ring problem was well known to many for a long time, and people recommended do acting on it, and those recommendations were blown off. My concern is right now we've got so much data from overseas. We have so much information from Wuhan, from Italy. It is this will not spare the American immune system. Right? Our immune systems are not stronger than that of the Chinese or Italians. And so I think what we're seeing in Italy is the best preview of what we can expect. Again, the good news is hard for this to hurt healthy people, and it will be over by summer. That's the historical pattern. And and, you know, I think possibly good news is that you can flatten the curve with social distancing, which does seem to be the unofficial policy of the US now. Even though I still see a lot of people outside, at least legally, a lot of things are shut down right now. Yeah. And that yeah. I'm I'm very happy to see a lot of people getting on board. You know, when I started talking about this and David Klassen, infectious diseases doctor in Utah and Mark Lipsitch from Harvard, we started telling folks and going on different media outlets, hey. What we're hearing about in Wuhan from talking to the doctors there, this has a very high transmissibility quotient in what appears to be a very high case fatality rate, and we need to get ready. This is out the cat's out of the bag. We need to get ready. I get so much nasty emails. You know? I was alarmist and all this stuff. And each sequential day, those criticisms go down and down and down. And people are realizing, hey. This is this is something I pay attention to. And I guess, also, like you say, it'll be done in the summer. And and, of course, between now and then, horrific things can can happen. But if you look at other pandemics, there does seem to be at least one revival a few months later. And I shouldn't say that. I'm I'm thinking specifically of the Asian flu in 1957. It was a flu based, not coronavirus based, but that came back in November. It it was sort of like from February to some summer, and then, came back in in November. So so there is still like, what are people gonna should what should people do in the summer? Should they go out and play and then just go back into their homes, in the fall? Well, you know, another good thing, is that people are learning great personal hygiene. I've never seen people take so many good precautions that, by the way, we will probably benefit from this change in behavior and education for the next several flu seasons, right, because we should be doing this stuff all the time. And our society is not like Asian societies where if you get a cough I mean, tell me, have have you ever done this in your life? I have never. You get a cough, and you just automatically put on a mask, and you wear it every single public place you go. That's what they have done in Asia for a long time. I mean, the few people in the US who wear masks out there in public are Asian Americans or Asians visiting. It's a cultural trait. And if nothing else, we have learned incredible, personal hygiene and distancing and best practices. And so that is helping. And that is helping. You know, can I ask you a question that I would never I'm only asking because you're an expert, and you would I would never just ask social media the this question? But, you know, of course, like everybody, I'm using doctor Google to understand this more and more. And there does seem after the SARS in 2002, 2003, there does seem to be some published reports by doctors and scientists that ant antimalaria, drugs might have some preventative ability, at least for SARS back then, like Chloroquine. I don't know if you I don't even know if I'm saying it right. I'm just reading this. Yeah. Chloroquine. Yeah. I you know, there may be something to it. To be very honest with you, I'm I'm not a laboratory scientist or a virologist. I'm a I'm a public health professor, and so I don't know. But it's certainly as a physician, I could see that the certain properties of not only the medications you mentioned, but the other antivirals out there, like in China they're using a lot of HIV medications, I could see how that might conceivably reduce some of the viral load or burden or disease. But let's be honest, if you look at something like, you know, canker sores in the United States or anywhere in the world, the medication, valetrex, only reduces the symptoms from it but does not actually, you know, reduce its transmissibility or the or the period of the viral infection. So these these different meds could help a little bit, but let's put it in perspective. You know, I I doubt they're, they do a lot, and I think it's worth the research. And Spain and Nebraska, University of Nebraska are doing a lot with this stuff to see if other stuff out there works, stuff that's already on the shelves. But I do not think we're gonna medicate ourselves out of this, problem. We're gonna have to change our behavior and lifestyle. And you're right about this sort of what I call after quakes. That is after the pandemic, there's another small surge. They are relatively rare. Most times community immunity works. But in the 1918 Spanish flu pandemic, which killed 25 to 30,000,000 people, there was a sort of second reinfection phenomena that happened later that killed about 200,000 people, so it is something. That's why in China they're very cautious about getting out there worried about a second wave. And do you think there's, you know, the common cold doesn't have much immunity. Like, if you get the common cold, you're probably immune for a tiny bit afterwards, and and and but then you can get it again. I don't I don't know for sure if that's true, but that's what it it seems like to me. Do you think there's do you think there's some immunity with this? Or or if you if you get it now, you can get it again? The only reason I think that there probably is immunity with this is that we're seeing sort of the the down, the the de escalation side of the curve now of infections. And so I'm hoping that is the sort of community immunity. Now let's let's hope 2 other. What do you mean we're seeing the de escalation? Where where are we where are we seeing it? Like in South Korea or In Wuhan. In Wuhan. So, things are slowly starting to, you know, get back to a semblance of normal. There's 2 other really rare things that could happen that could make us very lucky. One is the virus just mutates into a less virulent or damaging form. And the other phenomena is that we discovered that there's some heat sensitivity at some very high temperatures. Although early evidence suggests that the virus works perfectly fine in temperatures from 55 degrees Fahrenheit to 80 degrees Fahrenheit. And as I followed the data in Buenos Aires, where it's been in the eighties, it's following the same playbook that it's following elsewhere. Right. So, not not really what what other good things can happen? Is there any best case scenario? Oh, there there there was some there was some speculation about 2 weeks ago that it had mutated into a less virulent strain, but I think that research has been debunked. Well, I think I did see that. I think it it did mutate, and we often do see mutations at some point, but I there was just no evidence to suggest that that mutated strain was any less severe. That's what I saw on it. Okay. Yeah. And so so, I guess, you know, we gotta just strap ourselves in. Like, when you say, you know, usually viruses or pandemics run for 3 months, when do you put the start date of this one in the US? I would say probably early March. If you look at the Spanish flu of 1918, it started in September and ended in January. Now interestingly, during that pandemic, James, all the leaders, all the government officials, and authoritative figures said, don't worry. It's not that bad. We're we're pretty much done with it. And they constantly spoke optimistically and were in denial of the reality. All the governors back then were talking about how this is not a problem and it's not really going to hurt a lot of people. Don't worry. We're going to get through it. It's an amazing book called The Great Influenza, and I think there's some real lessons from history there. I'm most inspired by seeing people come together. You know, we saw this, after 9:11. We saw this at other points in our history, even, the hurricane in Houston, Texas. It's a time for us to take care of each other, forget about these political artificial boundaries, and, you know, see the best in people. And so so, I agree. And I I I I think that's that's been happening. And and it seems like things are different now as opposed to the Spanish influenza, because, you know, even though they delayed it for quite some time, world leaders are all do seem to be responding to this now. So, again, in America, essentially, everything is canceled for business. Like, all all events are canceled, and a lot of people are, even though I just said earlier, a lot of people are outside, a lot of people I know are self quarantining and and so on. So it seems like there is a slightly different response than than in the Spanish flu. I hope so. You know, it's variable by region. So there are parts of the country, and trust me, I get enough hate mail. Twitter is a nasty place. Right? How dare you suggest that this is gonna be a big problem? You know, we need to live our lives. I mean, prominent physicians too sometimes in on cable news. We need to be out there and talking, you know, all political nostalgia, and the American spirit will overcome this. And, you know, we've this virus knows no boundaries for political parties. And this is a hurricane. It is coming. Let's hope to God he it shifts away. But this is all about preparation right now, and I do hear people like yourself talk about all the precautions you've personally taken, but I do hear people who say this is, you know, not gonna happen. It's not real. We're proceeding with these events. You know, I speak around the country frequently, and I've called all the events I have in the next 3 months, and I said, just in preparation for the flu season, we wanna or for the coronavirus, pandemic, we wanna just go over what you know, what your plans are. Some of them are like, oh, yeah. Of course. We're canceling. And others are like, no. What are you talking about? No. Oh, why would we cancel? Oh, well, because there's this pandemic. Oh, no. No. That's and I'm like, how could there be this much variation? And I think right now the message and the reason I'm, gonna go on TV a lot here in the next couple weeks is that we need to speak truth without these political lines, without being worried what people are gonna think about us, and get people on the overprepared side instead of underprepared side and not rely on government leaders. Look. Some of them are doing a great job, but let's just be honest. During Ebola, there's constant, you know, shifts in who was in charge, and there was a delayed response. And finally, hospitals, about 6 months after the Ebola scare was gone, after Ebola, they started asking everybody who walked into the hospital, have you been to Africa? Okay. Well, that's about a year too late. Okay? That could have been done on day 1. I mean, you've probably been there. You've probably been to a doctor, and they've said, well, you yeah. I know you don't go to a doctor. But Yeah. I I probably people have accused me of being a hypochondriac because I never go to a doctor. And so I'm probably afraid of what I'll find. I thought I was healthy, but everyone says, no. No. You're You're probably just a hypochondriac, which now I believe. But and and and which is why I've been obsessively interested in this. I'm not a germaphobe, but I I, a, have been telling my kids I I do think the way to get kids to do social distancing is to tell them that right now, they're they're, like, licensed killers. And you you need to avoid killing people now, and that's how you stay that's how you why you stay in. And that's what I've been telling my kids, and, hopefully, other people are are telling their kids something similar. But I I I also and I know I've taken up a lot of your time. I I I really appreciate this. I do wanna I do wanna suggest that that we don't real I I don't like the numbers. And and it's not that I don't like them. It's that I don't quite believe the numbers in this Harvard study either. Even though I'm personally taking all the precautions as if they are true, it just seems like we haven't seen an example of 40 percent 40 percent of people getting infected. We haven't seen we don't really know the, exposure versus infected rate, you know, exposure over infected rate. We don't really know the infected versus fatalities rate or or hospitalized rate because we don't know how many asymptomatic people there are. And so I'm just wondering, like, even in the numbers you suggested, like, let's say, you know, a 140,000,000 people are infected, but we don't know the exposure rate. We we just might know, how many are the number amount hospitalized might might be much smaller and that the fatality rate might only be a small percentage of those hospitalized. That kind of shrinks. And then now we have this social distancing. Each one of these factors shrinks the overall percentages of of both hospitalized and and fatalities. Well, it's a great point. But I think two things. 1, before the financial collapse, financial advisers were telling families there's that that that's just too extreme. We just would not see a massive downturn in the market. I just can't imagine it. Right? I've never seen it before in my lifetime. It's unfathomable. So remember, this is the infection of our generation. The second point is that I think you're right. I think our social distancing and early techniques to, try to contain and address this are working. They are lowering the percent infected from the Harvard estimate numbers. But Italy, remember, went into quarantine early, and they are seeing the US equivalent of 2,000 deaths per day 3 weeks before. But that's because, arguably and I'm not I'm not trying to question your understanding of the numbers. But I would say we haven't seen the result because there's, like, a 2 week incubation 1 to 2 week incubation period, and the real full martial law lockdown only happened about a week ago in Italy, we haven't seen the full we haven't seen any effect yet from their lockdown on and and we shouldn't have seen it yet. We'll see it probably in the next week or so if numbers start to dive in in Lombardi. That's a great point. But remember, we have not done a lockdown either. So let's assume that 386 deaths in one day is without a lockdown. You're right. The lockdown might help, and we might see the benefit down the road, But that's the trajectory that we are on. Now let's I would love to be wrong. But in terms of planning, and you're asking all the right questions, and you're as smarter than people even say you are. You know, people say you're a super smart guy. And I love it, and I love your podcast, and I love your show. But right now, the trajectory that we are on is Italy is about 10 days ahead of us, and we are in a trajectory. So in 10 days, we will have over a 1000 people die a day. I would love to be wrong. That's what the data is telling us. Let's hope it's less. And and and that thousand could continue to go up if we're not at the you're saying when you say pandemics are usually over at 3 months, when is usually the peak time? Is that in the middle of the 3 months? Right in the middle. Right in the middle. So so peak could be, let's say, mid mid April. Yeah. And then we'll start to see number of infected cases go down a week or so after that, and and a number of fatalities go down after that. Roughly, yeah. Somewhere in that range. Yes. And and, hopefully, as you say, these percentages get better, because of what things we've done. But this is just a reminder that we need to to do these things and more. And if you're listening to this, do whatever you can to avoid the spread of this, to to avoid getting infected, to help other people understand, and to maybe see also how you can help those in greater need right now. And it's I agree. It's definitely, the I would say 3 things have scared me in my lifetime. The first was 911, the second was the financial crisis, and this is now certainly the third. And this this is this is arguably the scariest. Well, I think you're taking this seriously. I admire that. I tell people over and over again, don't panic. Prepare. We don't wanna create hysteria. There's a lot you can do individually, and this is one of the only things in health care ever where what you do affects the rest of the country. That is somebody you've never met living in a nursing home or out there who's at risk. What you do will affect the community transmission that'll impact somebody else's health care outcome. Well, doctor Marty Makary, I really appreciate your your time. Where where can people find you if they are you on Twitter anymore, or do you get too much, hate tweets? I'm on Twitter, and I welcome any friendly person to follow me on Twitter. And I'm on LinkedIn and, martymd.com, and I'm on all social media. So, yeah, feel free to engage, get in touch. A lot of folks have since we had our last conversation about medical bills. And so, keep up the great work, James. I just love what you're doing. And and you as well, Marty. And, again, I I mentioned this in the intro, but you're the author of The Price We Pay, which is how, you know, business leaders and families can lower their health care costs and what's going on in in the in the health care industry right now. And, hopefully, you'll even do a revision a revised version of that book after this that's has some positive stuff in it, but we'll see. So thanks again, Marty. And, I hope to talk to you again soon if there's, you know or feel free to give me a call if you wanna update people on anything or if you find out anything new, but I really appreciate this. Okay. Have a good one, James. Good talking with you. Thanks, Marty. Bye. Yep. So again, that was, doctor Marty McCarrie, and I just wanna summarize real quickly, what we heard. First thing is take this very seriously for yourself. Social distancing is important. Doesn't mean you're going to get it if you don't do social distancing. It doesn't mean you should panic. It doesn't mean we should get hysterical, but there does seem to be some evidence that, you know, staying away from people, not going to things that you don't need to go to, only go to things that you absolutely need to, or if if you don't have an essential job in society, then maybe try to work remotely, try to work from home. Kids should stay home from school. Doesn't mean you don't go outdoors, but stay, you know, within 6 to 10 feet of others. And I don't say this in hysteria, but I say this in terms of the data does seem to suggest that this is helping, and any little bit you help yourself means you help severely the populations that are most at risk, I e, the elderly. Even if you're not even if you get it and you know you're gonna be okay, like if you're a kid, it looks like you're gonna be okay, doesn't mean you can just go around and, you know, risk getting infected. So I'm probably as I mentioned in the podcast, I'm probably a little bit more optimistic on the data we've seen, and and Marty is playing the role he should play, which is take this very seriously, and I agree with him. In terms of the worst case scenario, I don't believe that's gonna happen, but that doesn't mean the only reason the worst case scenario is not going to happen is because we are starting to take this seriously as a society. And the data is not in yet on what the results of that will be, but there's every reason to be optimistic that if we all take this very seriously, this could be over, you know, with much fewer fatalities than are being predicted, and hopefully, it'll be over more quickly. So take things seriously, prepare for the worst, but I think we have every reason to hope for, not necessarily the best, but hope for at least a much better outcome than the worst case scenario if we take the worst case scenario seriously. Thanks again for listening. Subscribe to my podcast if there's, you know, I may have midweek updates. I'll have updates on this whenever there's an opportunity. My goal here is I just wanna say I don't money on this podcast. There's ads where that goes to, paying for the infrastructure I have, And I really wanna use this platform as a way to share reliable information from reliable people, hopefully share slightly more calm, maybe even optimistic information when when opportunity affords that. And, you know, I did it with Iran. I did it a little bit, you know, over the past month with or I did it quite a bit with this coronavirus, and I plan on always doing that with any disaster. Although this is a particularly important disaster to stay updated with reliable information. I also wanna mention, there was some optimistic mention from Marty on antiviral, medications. There's no conclusive results on this. I'm just telling you, what I'm doing, but I don't recommend it in any way. I'm not trying to spread false information. There is some, results about, you know, the effects of antimalarial drugs on the SARS virus, which in China has suggested it might be also good for this virus. There are over the counter alternatives to to these, antimalarial drugs. I encourage people to do their own research. And, again, take any precautions. Be careful. Don't take anything without a doctor saying that's okay for you. And, look, stay tuned for for the next update, and take care of yourself. Thanks very much.
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