Coronavirus update: How can we cope with COVID-19 anxiety?

On this episode of Next Question with Katie Couric, Katie continues with special coverage of the coronavirus pandemic. First, Katie tackles coronavirus anxiety and how to balance our mental health with concern over our physical health. Katie talks with psychotherapist and best-selling author Lori Gottlieb who shares ways to cope during this uncertain time and answers questions from Katie’s listeners and followers. Then,San Diego physician Dr. Peter Attia hares what he has learned in his research of the pandemic, from the mysterious biological mechanisms behind COVID-19 and the looming challenges it poses for our healthcare system. So take a deep breath, everyone, and - as always - go to CDC.gov and WHO.int for the most updated information. You can also sign up for Katie's morning newsletter Wake-up Call, at KatieCouric.com, for dedicated coronavirus coverage.

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Episode Transcript

Speaker 1 (00:00):
Hi everyone, I'm Katie Current and welcome to Next Question.
It's a new day for us here at Next Question,
as I'm sure it is for all of you. The
rampant spread of the coronavirus across this country, let alone
the rest of the world, has forced most of us
indoors for an unknown period of time. The level of

(00:22):
restrictions on where you can go and what you can do,
the closure of schools, restaurants, nightlife, the canceling of sports
and entertainment is largely unprecedented, but it's necessary for the
health and safety of this country. So if you're not
social distancing yet, please do. But it's a lot to

(00:43):
deal with, and I know right now it's all consuming
for all of us. It's what we're reading about and
what we're worried about. But I'd really like to help
to settle into this new reality and perhaps understand what
all of this means for us, which is why we're
deaty kating the rest of this season of Next Question,
which means four more episodes every week and perhaps even

(01:06):
more to the coronavirus pandemic. For day to day news
on this ever changing story, I do recommend you continue
to turn to your local government, the CDC, and the
World Health Organization for the most up to date information.
I'm also providing updates on my Instagram feed. As for me, well,

(01:28):
I'm hold up in my house, which means I might
sound a little different to you. Social distancing means I'm
not going into our usual studio and speaking into a
fancy microphone. Right now, I'm sitting in my home office
and I'm recording myself on my phone, and instead of
speaking to my guests in person, we're connecting over our computers.

(01:50):
So bear with us, everyone, but please keep listening for
this critically important information. So today, my next question, how
do we manage this new normal and coronavirus anxiety. To
answer that, I called up my friend Laurie Gottlieb. Laurie
Hi by. Laurie Gottlieb is a psychotherapist with a private

(02:15):
practice in Los Angeles, but she's also a best selling author,
a journalist, and soon a podcaster too. But today we're
focused on the issue at hand, So um, let's talk
about why people are. You know, I think with good reason,
people are feeling a lot of anxiety. But I think
it's interesting that the unpredictability of all of this, Lorie,

(02:38):
is a perfect recipe for high anxiety. Can you explain that? Yeah,
you know, it makes sense that we have anxiety. And
I think there are two kinds of anxiety. There's productive
anxiety and there's unproductive anxiety. And productive anxiety is the
kind of anxiety that helps you to take action. So
that's why we're washing our hands all the time. That's

(02:59):
why we're social distancing. If we if we were in denial,
if we said, oh, this is no big deal, we
wouldn't be protecting ourselves and other people. So that's that's
good anxiety. The kind of anxiety that gets us into
trouble is unproductive anxiety, which is when we start just
ruminating and we start catastrophizing and futurizing, like you know,
those thoughts of oh my god, I'm going to get

(03:20):
this and I'm going to die, or someone I love
is going to get this and they're going to die,
and you know, just all the stories that were kind
of spinning in our heads, and and that doesn't help
us in any way. Well, what makes us go as
human beings too? That dark place? I know that in therapy,
you're you know, this better than I. But sometimes people
do say to patients, what's the worst that could happen,

(03:44):
as a way for them to help kind of conquer
their fears. But you believe in this case, that's not
super helpful. I don't think that that's helpful. I think
that one of the things that can really help ground
us is instead of thinking about what might up and
in the future because it hasn't happened yet, is to
stay grounded in the present. So one of the things

(04:06):
that I think happens is that when something extraordinary happens,
we long for the ordinary. We want we want our
routines back, We want all those things that we complained about,
you know, when when we didn't have something, we weren't
in a heightened state like this. Um, we want it back,
and yet it's still right in front of us. So UM.
I like to talk about the concept of both, and

(04:27):
which is, yes, something horrible is happening, and we can
also enjoy certain things like the ordinary. We can enjoy
the time that we're having connecting with people that we
normally don't really pay attention to in our daily lives.
We can enjoy cooking together. We can, you know, in

(04:48):
our own isolated family units, um, we can enjoy having
the time to read a book or to think our
own thoughts, or to um, you know, actually face time
with one and actually listen when you ask how are you?
I think one of the one of the kind of
nice things to come out of horrible experience like this

(05:10):
is that people are very kind. Kindness comes out. There's
sort of a resurgence of kindness in this world where
civility has been lost, and so I think that both
at both can exist, and if we can focus on,
you know, holding our fear and feeling our feelings, not
being in denial of our anxiety, and not being in

(05:30):
denial of what's going on around us, but also really
trying to stay present in what's happening in that moment.
We have so many questions. But before we get to
some questions from people who follow me or listen to
the podcast, Laurie, I'm a fairly normal person in that
I don't have huge anxiety, but I'm finding I'm feeling

(05:54):
a little neurotic about my health. If I have a
little bit of a sore throat when I wake up
in the morning, or if I cough, then I start thinking, oh,
my god, am I sick? And I'm sure I'm not
alone in that because it's part of catastrophizing. I'm sure,
what what is that about? How can we kind of
calm ourselves down? Well, I think the first step is

(06:17):
just realizing it that it's human nature to do that.
So I remember when I was in medical school, we
we talked about sort of medical school disease, which was
every disease that we were reading about. We all thought
we had all of a sudden we felt the symptoms
of it. You know, it's like, oh, my god, I
have this now because my my gland feels inflamed or whatever.
Um that now that we're reading all the time about

(06:38):
the symptoms of coronavirus, you know, it's almost like the
power of of uh implanting it into your suggestion. Right. So,
so I think just realized that the power of suggestion
is very powerful. And and so when you notice that,
of course be aware if you are having symptoms, but
also take a breath. Um. Part of part of the

(07:00):
problem is that we're reading about and I always tell
people that, yes, you need to get daily updates, but
you don't really need more than that. I think that
the more that we're just you know, kind of it's
kind of like we're binge, like binge watching a television show,
but it's kind of like binge eating junk food. That
the more you sit there and click from this article
to that article to the other article, it makes you sick.

(07:23):
It does not fill you up, It does not help you.
It actually makes you psychologically ill. How do you talk
to kids about this? I'm sure that a lot of parents,
you know, my children are older. Your son is in
high school now, right, he's in middle school, middle school,
so he's he's at home. Is he expressing concern? And

(07:44):
how do you suggest people talk to their kids about this?
I think that the way that we model our response
to this is going to impact the way that our
kids handle their anxiety around it. So it's kind of
like I think, you know, when when you're on an airplane,
they always say put on your oxygen mask first before
you put on your child. But I think it goes

(08:05):
beyond that. It's how does the pilot handle it when
there's a problem and the pilot doesn't say, oh my god,
we're all gonna die, you know, if there's something the
pilot says very calmly, Hey, we're gonna experience some turbulence
coming up. We want all of you to fasten your
seatbelts and please don't walk in the aisles right now.
And I think that's very calming. And I think that
for our kids, we need to say, yes, here are

(08:27):
the rules, here are the boundaries. You can't go and
play basketball. I say this to my kid, you can't
go play basketball with your friends right now because we're
social distancing, um, you know, and and we're gonna do
this instead. And and just to kind of, you know,
under help them understand. I think giving them a sense
of purpose to around this, which is we're not just
doing this for ourselves. We're doing this for our community.

(08:48):
We're doing this for our neighbors, for the elderly people
that we know. Um, we're doing this for people with
compromised immune systems. And I think that kids really engage
in that when they realize that it's bigger than them.
It's not just oh, this is a bummer. I'm stuck
here and I can't play with my friends, and I
can't do the normal things I like to do. Um.
There's there's something about being connected to the larger community

(09:11):
that really resonates with with tweens and teens. Well, let's
play dear therapist Lorie, because we've got so many questions
and I don't want to be sort of a pig
about just asking my own Rosanna says, how much information
should we deal with on an everyday basis, especially with
the situation changing by the hour or day. Do you

(09:32):
have any suggestions for what is a healthy media diet? Yeah?
I do. I think once a day is plenty. And
I think that's because we all know what we're supposed
to be doing, regardless of how many new cases are reported,
regardless of whether they're saying you can't go here, you
can't go that. We know we're supposed to be social isolating.

(09:54):
We know we're supposed to be washing our hands constantly. Um,
we know that we're supposed to be cleaning the the
all the handles and um, you know, door knobs and
things like that in our homes and all the sort
of high touch surfaces. We know what we're supposed to
be doing. Nothing is changing in that regard. So and
we also know if you're having symptoms what you're supposed

(10:14):
to do. So there's no information that's going to happen
during the day. That's going to change the basic facts
of what we need to do in our lives. And
we really need to protect our psychological immune systems as
much as we're protecting our physical immune systems, and that
means not overloading ourselves with information. Here's another question. What
are some tools new moms or expectant moms like me,

(10:38):
She said, uh, can use to get through this uncertain time.
Bringing a new baby home is tough enough, but limiting
the village from visiting and helping will put a strain
on many Thanks to you. Yeah, um, you know, I
think that it's really important for parents to kind of
trade off time so that they get a break. So

(11:00):
I think that when you've got a baby and you
don't have your village around you a lot of times, um,
you know, you need each other as adult as a couple.
But sometimes you're gonna have to say, you know what,
it's your turn, and I'm going to go take a
bath or I need to go just um, you know,
I need to go take a walk whatever it is,
and and hand off to the other parents. And you

(11:21):
really have to work as a team. So I think
that's really important, you know, if you're living in a
multigenerational household and you have, um, you know, other people
to help, that's great. I think it's also important that
you you connect again for your own mental health, that
you connect with your friends through technology and you take
some breaks and you laugh about how hard it is,
and you laugh about the dirty diapers, and you laugh

(11:42):
about the naps that are not being taken and all
of those things because you need someone to vent too. Yeah, definitely,
and laughter is really helpful. Here's a question, j P.
As I'm an addict in recovery, are twelve step groups
and meetings are shutting down. What is the best advice
to stay out of your monkey and stay connected even

(12:02):
at a time of much needed social distancing. So if
you have a sponsor that you can connect with virtually,
that would be really helpful. If you have other people
from that you know, from the group that you can
connect with, that would be helpful. There are also so
many online resources, um that you can listen to podcasts, um.

(12:23):
You know, uh M. I was gonna say, there's groups
online where you can you know, write in real time
and connect like that. So I would really search the internet.
I think the internet is our friend right now, not
in a sense of getting an overload of COVID information,
but in a sense of how we can get creative
around connecting with other people when we need it most.
Vivian says, how can I stop obsessing and stockpiling groceries?

(12:46):
I think that's such an interesting sort of primitive instinct.
People are going and kind of sometimes hoarding food. They're
so worried that the grocery stores are going to close
and that they're going to starve to death. You saw
that with the toilet paper shortage. It's fascinating thing to
observe just from a human behavior standpoint. Um, what advice

(13:10):
could you give Vivian and other people who are feeling
that way. There's a difference between being prepared and obsessing,
and that line is going to shift the more that
you kind of think about, oh, what's going to happen
in the future. I think being prepared means that, yeah,
you have some provisions in the house, and you you know,

(13:32):
you you have things that that you're going to need.
But you know, when you start getting to the point
where you've already gotten the provisions and you think, oh,
I need more, and then I need more and then
I need more. Um, that's when you need to step
back and say, you know what, I am prepared. I
will be able to get more later. But I have enough.
I've done my preparations and I've done what the recommendations are.

(13:53):
And then you really have to let go. And that's
again we're staying in the present. Helps where instead of
thinking about, um, you know, do I have enough, and
and you know, spending your emotional real estate on that,
do something else. And I know that sounds like I'm
trivializing this, but I'm not. Um, you know, go do
a puzzle, Go get those art those art supplies out,
Go read a book, Go take a walk, Go call

(14:15):
a friend. You have to take breaks, you have to
let go, and you have to stay active. I think,
even though you know the whole it seems anathetical with
the idea of staying home. There ways to stay active
at home. Clean out your closet, get rid of all
the clothes or put them aside that you can give
for dress to dress for success or to the goodwill.

(14:38):
You know, it is a good time to do some
serious spring cleaning, open the windows and and you know,
get the winter winter out of your house and out
of your things and maybe downsize a little bit. Andy asked,
I have a friend who suffers from anxiety. This is
kind of an obvious question, but it's a good one.
How can I best support them during this time? How

(14:59):
can you support people who you know? What can you
do for them? One of the things that happens with
anxiety is logic doesn't help. So you can't really talk
somebody out of their anxiety and try to tell them
that things are going to be okay. What you can
do is you can connect with them, and that's that
naturally sues people. So why don't you say, hey, let's

(15:22):
do let's have a virtual dinner together. Um, hey, let's
watch a movie together virtually? Um, you know what, whatever
it is that you can do. Um. You know some
people are exercising together and virtually, which is fun, so,
you know, and just moving your body helps so much
with anxiety. So if you can somehow get your friend to,

(15:43):
you know, move around, and you can do it with
that person virtually. You can support the person through actions,
as opposed to your words will not really help them,
but your actions will avas how to focus on work
while acknowledging that we're all scared. No, I think you
and I know that when you are worried or stressed out,

(16:06):
it's hard to concentrate. Actually, I know that from when
my husband was sick. I would read the same paragraph
over and over again in a book and I could not,
for the life of me, concentrate. So how can you
How can you fight that? Is there anything you can do?
I guess reducing the stress will help you concentrate more.

(16:27):
There's also something you can do with your body, which
is that sometimes when we kind of leave the present,
we need to physically ground ourselves. So what you do
is you close your eyes, and you start with your
feet and you say, I feel my feet on the floor,
and you feel them, and then you move up and
you say, okay, I feel put your knees together. I
feel my knees, and you move up and you just

(16:47):
keep and you feel your breath and you feel your diaphragm,
and you feel the different parts of your body and
it brings you back to the present moment and you
take some breaths, and then you move on with your work.
Kristen wants to know how do you cope with the
idea that we don't know how if when this is
going to end. I think that's in addition to the
unpredictability of this, This kind of not knowing when life

(17:12):
will resume, I think adds to people's stress levels. Right,
I mean not just am I going to get this
and what's going to happen? But how long is this
going to have to be the new normal? So how
do you cope with that? I think we have to
acknowledge that humans don't do well with uncertainty, and so

(17:32):
this is a good opportunity for us to build up
some resilience around uncertainty, which means that we just instead
of trying to figure it out. You know, this news
report says that, or this physician says that, to just
say we don't know, and to try to get comfortable
with that and say, what can I do in the
meantime to have as normal of a routine that I

(17:54):
can possibly have under these circumstances. You know, I don't
want to let you go before asking you if someone
is having real trouble, you know, if the anxiety reaches
a point where it's untenable or it's affecting someone's physical
health health, Um, you know, I I don't want to

(18:15):
trivialize the seriousness of this. So what can people do
if they really feel there at the breaking their breaking point, Laurie,
They should absolutely reach out to a therapist. And so
many therapists are doing online sessions specifically right now for this,
and they should reach out. And this is not a

(18:36):
time for shame or stigma or you know, oh my
problems aren't that bad minimizing our problems. Um, everybody else
is going through this, So why why why should I
get help? You know, all those things we say to
ourselves that prevent us from reaching out. This is a
time to say, I need to prioritize my emotional health
just as I'm prioritizing my physical health. And if you

(18:57):
need to talk to someone, you do not need to
be in a christ is. You can just be having
a moment. You can be feeling kind of free floating anxiety, depression,
whatever it is, or you just want to connect with
someone because you feel like preventively to kind of preserve
your emotional health. Please please please reach out. You can
find you can do a quick Google search and you
will find somebody who is available to do that for you. Well,

(19:23):
Lourie stays safe and call me and maybe we'll have
a virtual glass of wine together a cup of tea.
I don't want to encourage people to drink during this time,
but a glass of wine isn't going to hurt, right,
That's right, that's right. Thank you so much, Katie. Okay, bye, Laurie,
all right, take care or stay safe. Laurie gott Lee's

(19:45):
latest book is called Maybe You Should Talk to Someone.
She's also coming out with a podcast called Appropriately Dear Therapist,
co hosted Buy Another Therapist, Guy Wench. It's due to
come out from my Heart hopefully this summer. You know,
I really like what Laurie said earlier about how kindness
tends to emerge out of times of crisis. People are

(20:07):
kinder to one another, they want to help, And I'd
like to know the large or small ways you're seeing
kindness or promoting it in your own community. If you
want to share your story, please call and leave your
name and a detailed message for us at Next Question.
The number is eight four four four seven nine seven

(20:27):
eight eight three. That number once again is eight four
four four seven nine seven eight eight three. You can
also email me a voice memo or a written note
at info at Katie currect dot com. Just put next
question kindness in the subject line and you might hear

(20:48):
your story right here. On next question coming up, we're
going to be checking in with the doctor who's a
friend of mine and one of the smartest people I know,
to get a better sense of how the coronavis irs
affects our bodies and also our health care system. Dr

(21:20):
Peter Atilla is a Stanford and Johns Hopkins trained physician
living in San Diego. His clinical focus has been on longevity,
how to live better and longer, but since the outbreak
of coronavirus or COVID nineteen, he shifted gears, focusing his
research towards understanding the current situation, what we can do

(21:42):
to protect ourselves, and potentially the implication of what's to come.
And now he's here to share some of that with us.
So where are we now understanding? This story seems to
change on an hourly, if not minute I minute basis.
If you had to assess the situation right now for

(22:04):
our listeners, what would you say, Well, you know, I
think of these things through the lens of um. Is
the rate at which we are seeing infections growing or shrinking?
So you can think of being on one side or
another of that peak. So, for example, if we look
at mainland China, we know that they're now on the
tail end of this response. Again, there's always possibilities that

(22:27):
there's another outbreak as they go back to work and
begin to mobilize society again. But notwithstanding that, it's clear
that they're on the right side of that curve. Both um,
you know, right and correct um, we're still on the
left side of that curve, which means each and every
day it appears that we are seeing more and more
people get infected, or the rate at which the infections

(22:50):
are increasing is is still increasing. Now the million dollar
question for which a lot of people, you know, really
smart people, epidemiologists and such, are trying to project is
where is that peak? Because the peak is sort of
what gives us a sense of that maximum rate of
infection um, and that is, once you know what that

(23:11):
looks like, then you kind of have a sense of
what the overall number of infected people will be, and
then you can extrapolate, hopefully from the data we see
in other countries, what the impact is going to be
on the health care system. And of course the things
that really matter, like how many people are going to
potentially die or otherwise be debilitated by this. Why was

(23:32):
Italy so overrun with this virus? What was the perfect
storm that made it go through that country like wildfire?
So I think we can speculate on a couple of things.
First of all, I think part of it is bad luck.
I mean, it's it's important to understand that if um,
let's let's just make the math simple and say, let's

(23:52):
let's pretend there were a hundred infected people in China
as where the epicenter was, and that you know, ten
of them got on a plane aine and happen to
travel and go someplace. Well, the ten places that they
land are going to have a head start in terms
of where this virus is going to spread. And if
one of the places they landed was Italy and one

(24:12):
of the place that they landed was Iran, then those
places are going to have a bit of a head start.
So I think there's just a little bit of a
luck component, which is it probably got an early start
on the virus reaching there other factors that seem to
matter seem to be the age of the population. So
Italy has a relatively old population compared to other countries

(24:34):
in Europe and relative to the United States, meaning they
have more people who are in that high risk category
based on age alone. Furthermore, there seems to be a
slightly higher prevalence of smoking, and smoking is definitely one
of the major risk factors for people who, if they're infected,
are more likely to get ill. And then I think
the other component is, you know, some of the sort

(24:56):
of just societal things about the proximity that people are
to each other. So in other words, if you look
at the place like Wyoming, if someone had landed, if
one of the first people infected had landed in Wyoming,
it still would have likely spread slower than landing in
a place like Italy, northern Italy, where the population density
is such that there's more contact with an infected person

(25:19):
to another. And then I think, finally, just at the
policy level, they were probably a little bit later to
realize what was happening an institute the measures necessary to
slow the rate of spread. You have said it, Italy
taught us that it is the morbidity rate, not the
mortality rate of the disease that is grave for us.

(25:40):
Non doctors who may be listening, including myself. What is
the difference. So, mortality is kind of a binary variable.
It's to live or to die, and there's a lot
of attention that is appropriately being placed on the mortality rate.
It's often described through a case fatality rate, which is

(26:02):
another way of saying how many people die for a
given number of people who have this infection. And obviously
that's very important, but morbidity is more about the you know,
long term impact on quality of life, an illness that
has suffered that does not ultimately result in death. And
I was reading a paper this morning, UM that did

(26:24):
a ten year follow up on people who were infected
with the first STARS virus that we talked about stars
covie one. This was the two thousand three epidemic. This
was a pretty lethal virus, certainly appeared more lethal than
the current virus. About ten percent of people infected with
this virus died, so that's a staggering amount. But what

(26:45):
this paper followed up on was what were the long
term consequences of the people who were infected but survived.
And it was quite disheartening, frankly, that you saw much
higher incidence of cardiovascular disease in those people, much higher
incidents of lung disease in those people as the so
so if they didn't die from the disease, they were
still somewhat debilitated by it. And I think that that's

(27:07):
something that we're going to see a lot more of,
and I think the consequences of that, you know, economically,
will be significant. There are going to be people I
suspect who won't be able to go back to work
in the same capacity a year from now when all
is said and done, And the people who are most
susceptible to that are obviously the people who come in
with the greatest amount of pre existing medical conditions. So,

(27:29):
for example, diabetes. Why as diabetes a risk for this?
And I don't think we know entirely, but one thing
we know is that people with diabetes might already have
some underlying degree of insult to their kidneys, to their heart,
and it might be that they are less likely to
recover from this, even if they're fortunate enough to not
succumb to it. Yeah, I was interested in the diabetes

(27:52):
angle because I would understand smoking because correct me if
I'm wrong, Peter. But this virus does create some kind
of fibrosis and the lungs. Is that right? Eventually, Yes,
this is a virus that has a kind of unique
pathology relative to influenza, for example, which would be a

(28:13):
cousin of it um. The virus gets Every virus has
to replicate by getting into a cell within our body.
So it's you know, maybe we're taking a step back
to understand what the heck of virus is. A virus
is not quite like a bacteria. The bacteria is totally
self sufficient, meaning it has all of the equipment inside
of its cell to fully replicate on its own outside

(28:35):
of the body. That doesn't mean it won't in fact us,
but a virus is different. A virus doesn't actually have
much to it. It's a much much simpler piece of
you know, biologic you know entity. It has in this
case just some RNA and that's about it. And so
for it to replicate and survive, it must get inside

(28:58):
of a host, and in this case, you have now
become the host. Prior to this, of course, animals were
the host, and it uses our DNA replicating machinery to
replicate itself. So if you were going to think about
this sort of teleologically, the virus really has no intention
of hurting us. That's just an unintended consequence. What it
wants to do is replicate. From an evolutionary perspective, and

(29:21):
the most successful viruses, by the way, the ones that
can go on forever and ever, don't hurt their host
at all. It's the viruses that destroy their host that
don't really survive, much like ebola. Ebola didn't spread very
much because it was so devastating to its host. So
when this virus comes in, it has to pick a
cell that it targets, and that just happens to come

(29:43):
down to sort of the molecular biology of how this
virus works. And this cell it targets most commonly is
a cell in the lung called a pneuma site because
of a certain receptor that that cell has that allows
this virus to enter. When it gets into that cell,
it basically hijacks it. It takes over and uses the

(30:03):
cell's ability to replicate and says, hey, I'm going to
take this over for myself and replicate myself. And it
does that and it ends up destroying that cell. And
it turns out that in this case, that's a really
bad cell to lose because that cell, called a type
to numa. Site makes a chemical called surfactant, and you've

(30:24):
probably heard of surfact and it's like a detergent that
allows the air sacks in our lungs to not collapse
on themselves because of the surface tension. And so when
we lose enough of those, the lungs begin to collapse
and we aren't able to exchange air, and ultimately that
results in a type of pneumonia, or really something more

(30:47):
severe than a pneumonia called acute respiratory distress syndrome, where
a person can't exchange gas, and ultimately that will result
in potentially fibrosis of the lung. It turns out, by
the way that that cell um that that that the
virus can also gain access to um muscle cells of
the heart, and so we believe that we're going to

(31:08):
see sort of fibrosis of the heart going forward. In fact,
thirty or forty percent of patients on autopsy, people who
have already died from this virus are showing injury to
their heart. This sounds very, very bleak, but that's one
of the reasons smokers are particularly susceptible because they already

(31:29):
have some of the some damage to the cells that
you were discussing, yep, and they just have less what
we would call pulmonary reserve. They have less lung capacity
in excess. So you know, someone like you, Katie, who's
really healthy, you know you're not utilizing your full lung
capacity when you're sitting here at rest right now. You're

(31:50):
using a fraction of it. But let's say that you
know you're using of your lung capacity. Will imagine somebody
who has smoked for a long period of time. For
them sitting at as they might be relying on six
of their lung capacity, so they just have less of
a buffer. You know. You can think of it as
like how much does someone have in their savings account? Well,
the person who has less in their savings account is

(32:12):
going to be more likely to suffer the shock of not,
you know, having a job. Before we talk about being
better prepared, and I know that you watched the Bill
Gates Ted Talk, which I thought was eerily prescient in
its message. But let's talk just briefly, because I think
people are desperate for this kind of information to Peter,

(32:34):
and you have access to the latest, most accurate information
in terms of protecting yourself. Um, tell me what you're
doing in your home with your kids and your wife. Well,
we we sort of probably came across as a little
bit crazy at the outset. In mid February, I sort

(32:57):
of woke up to what was happening. I had been
largely and denial through January, and UM, I think had
naively assumed that this would be much more like the
First Stars outbreak, or like the Murs outbreak, except less
deadly and less likely to spread. In other words, I
hadn't fully dug into the properties of this virus that

(33:20):
make it a little more troublesome, which is namely its
capacity for spread. But in mid February, when I sort
of woke up to this, UM, I started to think about, well,
what what could we do if we wanted to buy
more time? And so that basically came down to much
greater social distancing, and UM that meant, you know, canceling
all travel plans. And then eventually it just you know,

(33:43):
came down to making a decision that was difficult to make,
and not a decision that everybody has the luxury of making,
because many people don't have the luxury of working from home.
But it was a decision to basically quarantine ourselves, UM,
and so that meant that, you know, we don't leave
the house and people don't come to us in the house.
And the thinking would be that after two to three
weeks of that period of a quarantine, absent having an

(34:05):
accurate test to measure UM, if you are infected, if
you're completely asymptomatic, you know, no temperature changes or anything
like that, the likelihood that you're infected is low. And
now at least you're in sort of a safe spot
while you wait for time to sort of play this out.
And time does a lot of things right. Time allows
us to potentially develop a vaccine. Although I think that's
a longer term strategy than most people think, it certainly

(34:28):
allows us to repurpose existing drugs and that's something I'm
really excited about. So if we're going to talk about optimism,
I actually am quite optimistic that there are a suite
of drugs that already exist that we're now learning how
can be repurposed for this And most importantly, it's giving
the hospital system and the health care system a chance
to slowly expand to meet the needs that are necessary.

(34:51):
Because again to your point about Italy, the real problem
in Italy is not the total number of people that
are infected, it's the speed at which those people needed
medical care. And so you can you've heard the term
flattening the curve. Why are people saying that. It's like
saying if a hundred thousand people are going to require hospitalization,
it's a big difference if they required in one month

(35:14):
or one year. And so it's not clear that we're
going to reduce the number of people that are ultimately
going to be infected, but we want to spread it
out as much as possible. So on a personal level,
my view is what can I do to make sure
I don't need healthcare resources anytime soon. I talked to
the director of an urgent care center, Peter, and he said,

(35:35):
do not go to the doctors, do not you know,
try to seek medical care unless it gets bad. But
I wondered, is there an inflection point, because I think
people are so paranoid. Every time I cough, I get
neurotic and uh and and when is that point where

(35:56):
you should seek medical care or at least talk to
a healthcare provide because we don't want to clog the system. Listeners,
I'm sure agree with this, but we also don't want
to ignore an illness that could worsen if we don't
get it, if we don't get the proper attention. Yeah,
I mean, that's such an important question, and truthfully, it's

(36:18):
one for which I think the answer is not entirely clear. Um,
we probably do need to think a little bit about
how to stratify. So I would agree with the advice
that your colleague and friend gave you, which is, we
certainly don't want everyone who, um, you know, thinks that
they have a little sniffle or a sneeze or a
sore throat to then expose themselves to an infection by

(36:42):
going out and seeking medical care, especially when we don't
have testing readily available yet. That's the important thing to
understand is what is it going to accomplish to go
and put yourself in harm's way If we don't even
have a test yet that's viable, are going to offer
as much. So I think we have to stratify patient. So,
you know, the way we are looking at it in
our practice is we're taking the patients who we think

(37:04):
are at highest risk. So these are people who are
you know, sort of in their sixties and older people
who have existing conditions like high blood pressure or heart disease,
atrial fibrillation, these sorts of things, and we're saying we're
going to have a lower threshold for getting them tested
or getting them in to see someone if we have
any concern. You know, my wife yesterday was called by

(37:27):
a friend of hers who lives in Colorado now, and
she has a lot of underlying medical conditions, and you know,
it was really difficult to spend the time on the
phone with here today and triage. What I couldn't fully
understand was either a panic attack or legitimately an illness,
and you know, we had to make a call, and
in the end we saw it. We decided after an

(37:47):
hour she probably did need to go into the emergency
room and get checked out because I just couldn't be
comfortable that this was just anxiety and I and she
has so many underlying medical conditions that I was actually
concerned that. You know, she's the type of person who,
if infected, could very precipitously, you know, fall off that
proverbial cliff. And what happened, Um, you know, she we

(38:09):
went there. I It's it's still unclear because of course,
the testing takes days to get back. So, but now
she is at least, you know, her blood pressure is normalized,
her oxygen levels are normalized. Um, the thing we are
most sensitive to is shortness of breath. That seems to
be the biggest single predictor of people who do versus
do not need medical attention. So people who do not

(38:32):
develop shortness of breath at any point in time are
generally going to recover in what we call a self
limited way. I hate to ask you this, doctor a
tea of a what is how do you know if
you have shortness of breath? I know that probably sounds
like a dumb question, but is there something you can
do to figure out? Is it walking upstairs? I mean

(38:56):
I get sometime shortness of breath if I try to
run a mile. I mean when when can you tell
you have that? Actually, Katie, that is not a stupid
question at all, and we've actually tried to explain that
exactly to our patients. So I'm glad you asked. Um.
We think one of the best litmus test is for
litmus tests for shortness of breath is air hunger while

(39:18):
speaking in long sentences. So when someone who could normally
rattle off, you know, three minutes of talking with just
the simple breath in between, all of a sudden has
to take longer pauses to take breaths in between speaking
to me, that's true shortness of breath. You use an
example of walking up a flight of stairs. I think,

(39:38):
if somebody knows what they're you know, normal exercise tolerance
is when that dramatically decreases. So if a person you
know lives in an apartment where they have to go
up and down a flight of stairs and normally that
poses no risk to them, and all of a sudden,
now they think, oh my god, like I'm really winded
walking up this flight of stairs, that that might all

(40:00):
so constitute shortness of breath. Um. The other thing to
keep in mind is shortness of breath by itself probably
doesn't show up without some other symptoms, such as, um,
you know, a fever, which is the single most common
symptom we see in people who are infected. But of
course it's important to understand people can develop fevers for
any sort of you know common you know, cold or

(40:21):
anything like that orl right, absolutely, and so all of
this I think points to something which is, you know,
do as much as you can buy phone right, call
your doctor, walk through all of these things and and
let you let your doctor help you decide if you
actually need to take the next step of getting tested,
which again we're currently in a testing environment that is

(40:44):
not adequate. So the CDC guidelines on testing are actually
quite stringent compared to what I think they should be
due to these limitations. So you know that that does
raise the question who should be tested and who shouldn't
and uh, sort of thinking about the common good and
not just yourself in these situations. But gosh, you know,

(41:07):
we're talking about in some cases life or death, peter
and so people I think, you know, they have this
primal survival instinct. So uh, in terms of testing, you
have to rely on your health care provider. But they're
making some tough decisions in Italy about who who gets

(41:28):
medical attention and who doesn't because of the crowded conditions
of hospitals, etcetera. I mean, it's it really feels like
the makings of a of a sci fi movie. Yeah,
they are making these decisions in Europe um already, and
it's not clear if we're not going to be in

(41:50):
the same position in the next two to three weeks.
UM as far as testing goes at the time, at
right this moment, Katie, the CDC sidelines are that testing
should be reserved for people who are symptomatic only. Now,
why do I think that that's insufficient? Um? I think it.
If you really want to control the rate of spread,

(42:12):
you should also be testing people with known exposure, even
if they are asymptomatic. Because this virus has such a
long latency period. Let's assume that you know, you are
around somebody who then went on to test positive or
frankly even went on to be symptomatic. In an ideal world,
if we had a sufficient number of tests and a

(42:33):
sufficient infrastructure for testing, it would actually be important to
know that you were negative before you know, we told you, hey,
it's you know. The fact that you're not symptomatic means
you're not at risk. In other words, the thing that
makes this virus so particularly troublesome is that people who
have no symptoms can spread the virus, and they can

(42:54):
do so for a long period of time, for fourteen days, right,
I mean, isn't that the inky bastion period and the
fact that some people can be vectors and yet never
symptomatic that makes it really freaky. Right, Yeah, that's the
that's the superpower of this virus. So if you were
gonna like create a you know, a list of all

(43:16):
the things that make this virus sort of troubling, that
that would be its superpower is that it has this
ability to very subtly get you know, get from one
person to another, usually without that person knowing it. And
again we'll use Ebola as a stark contrast. Right, why
was Ebola not really a big issue once it got

(43:39):
into um the United States? Because people were so sick
when they got it that there was no ambiguity about
whether that person had it and it was only during
that period of extreme sickness that they could go on
and shed the virus. If in fact, people are practicing
social distancing, now all these cities are closing down, I

(44:03):
guess you know San Francisco is a shelter in place
city other cities as well. Is that going to ameliorate
or mitigate some of the conditions that will be prime
for spreading this virus around or have we missed that
window of opportunity, Peter. It will absolutely have an impact.

(44:26):
I mean, in an ideal circumstance, if we had a
time machine. I think we would have done this, we
would have taken these precautions a month sooner. But I'm
actually still optimistic. And you know, we have a team
of analysts that are building forecast models, reviewing every piece
of data that's available and including data that aren't publicly
available by you know, you speaking with people on the

(44:49):
front lines to pressure test assumptions. I don't think that
it's a foregone conclusion how this ends. So um you know,
I can't even sit here and project how many people
are going to be infected in the United States, although
there are lots of estimates, and some of them are
quite scary. You know, Mark Lipsitch at the Harvard School
of Public Health projects that you know, more than the U.

(45:13):
S population will ultimately be infected by this, and that
the mortality rates we're seeing those are staggering numbers. That
that the implication of that, by the way to put
it in some numbers, is more people would die from
this virus in a year in the next year than
die of all other things combined. I mean that that's
a staggering statistic. Do I think that that is set

(45:35):
in stone yet, that that is our fate? I don't.
And I do think that the more aggressively we can
socially distance ourselves, the more aggressively we can implement testing
which will enable this stratification of distancing between people, and
the more readily available we can be pressure testing existing

(45:55):
drugs to then bring on treatments that can reduce the
mortality and morbidity. I think we still have a chance
to bend the curve of this thing. We're going to
take a break, but we'll be right back with more
critically important information from Dr Peter A Tilla. Hi, everyone,

(46:24):
I'm so happy we were able to get in touch
with Dr Peter Attia and he was able to spend
a good hour talking to us about this scary pandemic
because I think his knowledge, his experience, and his connections
are really unparalleled. So let's get back to that important conversation.

(46:45):
Let's say someone goes to the hospital, Peter, and they
have COVID nineteen. I know that ventilators and respirators to
help with lung capacity, but are there any medicines that
these people are keetting or are they just going to
the hospital? And uh, I mean, how are the how

(47:06):
are doctors fighting it right now? It's varying by hospital.
So myself and my team, we have enough friends in
hospitals that we're hearing, you know, we're finding out this
hospital in Boston is using this protocol, this hospital in
New York is doing this, etcetera. UM, So right now,
I would say, Katie, it's not standardized, but you're crazy.

(47:29):
I mean, that seems insane to me. That it's not
that it isn't standardized, that it's sort of kind of
a piecemeal approach. Well, the primary approach, as you said,
is supportive care. So the single most important thing for
a person once they're in the hospital is maintaining sufficient
respiration because that's the thing that's going to put a

(47:50):
person in the hospital. So the most common thing that
people are presenting with his respiratory failure as opposed to
say cardiac failure, renal failure, or other organ failure. So
you know, the first, second, and third line of defense
is through you know, oxygen and supplemental respiratory care, hopefully
not requiring mechanical ventilation, but obviously at some point that's

(48:11):
happening for enough people. That's that's the sort of supportive
side of things. UM. And I think we are seeing
more and more patients being treated with um chloroquin and then,
of course if the doctor's treating the patient have reason
to believe that they're now developing secondary infections, then things
like antibiotics are coming on board. And if it turns

(48:34):
into pneumonia exactly if it's a pneumonia that they believe
is an actual bacterial pneumonia versus sort of a viral
pneumonia for which the antibiotics wouldn't provide any benefit. There's
also HIV drugs. There's a drug that that is a
protease inhibitor that I think is sort of weakly um

(48:55):
potentially helpful. It's still too soon to say, but the
of using it seems relatively low, so it's it's also
being tested. UM one drug that I think to three
weeks ago we thought might be valuable that is looking
less valuable as the common anti flu drug called tama flu,
so I think most hospitals are moving away from that now.

(49:18):
But again UM it is unfortunately not a fully standardized
protocol because even though the CDC will have a recommendation,
ultimately the physicians are the ones at the bedside that
are going to be able to make the decisions. Can
you reverse this? So let's say someone goes to the
hospital they're having respiratory failure. Can those individuals with you know,

(49:43):
breathing assistance, with the ventilator a respirator, can they then,
um get the virus that, as you said, was sort
of taking over the cells and their lungs. Can they
how do they get that? How do they get it
out of their lungs? I know this ounds sort of elementary,
but I'm just trying to figure out, you know, is

(50:05):
that kind of support enough to eradicate this virus? Um. No,
it's actually not an elementary question at all. It's a
very important question. What's actually happening is there's a war
going on between the virus and the immune system, and
the whole purpose of supportive care such as ventilation is
to buy time for the immune system to win that fight.

(50:28):
Now it becomes a bit complicated because the immune system,
in its best effort to win that fight, can also
cause a lot of damage to the host. So you
think of it like a war going on in a country.
You have the good guys the bad guys. At the
risk of oversimplifying it, well, both of those entities when
engaging in war caused collateral damage, and so it's like

(50:51):
immunotherapy and cancer, it becomes too refed up and that
can create all kinds of autoimmune issues. Correct. Absolutely, So
the you know, the checkpoint inhibitors, which you know are
probably the most exciting thing in all of immuno oncology
right now, um, exactly have that as a side effect,
which is autoimmunity. The immune system goes a little too

(51:11):
far now in in this type of response to the
immune system. It's not so much autoimmunity that we're seeing
as the problem, but it's the sort of um, what's
called systemic inflammatory response syndrome or this cytokine storm that
is sort of you know, wreaking havoc both to kill
the viruses, but it's also the thing that can you know,

(51:32):
cause capillary leaking in the lungs that can lead to
other things like edema, and it can damage other parts
of the body. So basically what you're saying is that
it's a delicate balance between the immune system, which can
cause inflammation and damage if it's overly compensating for the
virus and sort of keeping the virus in check. YEP.

(51:56):
And we use supportive measures like ventilation to base sally
by time to augment what the lung needs to do
to to create that amount of time and space necessary
for the immune system to ultimately win that fight. But
winning the fight means that the virus has gone, you know,
winning the fight means that the number of actual copies

(52:16):
of that virus goes down to some insignificant level um
and you know, to you know, to contrast that with
other things, like when you look at the Spanish flu,
the one and one pandemic, that was kind of a
different animal. You know, that was an animal where so
much of the damage actually came from the hyperactive immune

(52:37):
response and then this immune paralysis that followed it that
led to these secondary infections. So you know, paradoxically, the
people that were most vulnerable to that flu were people
that had the most robust immune system and therefore the
strongest immune response. We're not seeing that here, which suggests
again it's just a suggestion that a hyper active immune

(53:00):
response is less of a problem than the actual damage
the virus is causing to the cells. That's fascinating. Um.
That raises a couple of questions about ventilators and respirators
and I don't even know the difference, and maybe you
can explain that. But uh, there's a real shortage of

(53:21):
medical equipment. How serious a problem will it be if
there is a lack of ventilators or respirators to buy
the time these patients need and what is being done
about that? So it's a huge problem. Let me answer
your first question. So, respirators are non invasive. So um
for example, you've probably visited somebody in the hospital and

(53:43):
you see like a little oxygen mask that they have on,
or even something called a nasal canyla where there's a
little device that goes under their nose that's just passively
blowing oxygen at them. So you know, you can you
can provide a person with supplemental oxygen in that sort
of passive manner. But when a person becomes really dependent

(54:05):
on oxygen, they require something called mechanical ventilation, and to
do that you have to undergo a procedure called intibation,
which anybody who has had surgery has has you know,
under general and aesthetic has had that. But that's where
a tube is actually placed into the main airway called
the trachea. So it's called an endotracheal tube. When a

(54:26):
person is intibated, they also have to be paralyzed and sedated.
It's not a comfortable thing. You You couldn't be wide
awake sitting there intibated um, so you have to be
sedating the patients and paralyzing them. And the reason you
have to do that is that their own voluntary muscular
movements can't fight the ventilator, so you actually have to

(54:47):
basically shut them down to let the machine do the breathing.
And you're absolutely right that these ventilators are very, very
specific and specialized pieces of medical equipment, and at some
point we will run out of them. In fact, was
just speaking to someone today at a small hospital outside
of New York City and they are now they have

(55:08):
just used their last ventilator, and they are now what's
called double venting patients, which means using one ventilator to
treat two patients, which you would normally never do because
of the contamination. Those two patients are now fully sharing
all their respiratory pathogens. But of course, you know, desperate
times call for desperate measures, and if these patients both

(55:29):
have the same virus and they are both suffering from
you know the COVID nineteen disease, then we we you know,
we'll do what we have to do. And then technically
a ventilator can probably be split up to four ways.
But at some point soon and it could be within
two to three weeks, this could become an enormous problem,
and so well can can can We are manufacturers kind

(55:51):
of speeding up the production of these pieces of equipment.
They are, but is still another bottleneck. And the one
thing that we can't make more of is doctors, nurses
and respiratory therapists, and so these pieces of equipment can't
work on their own. You know, a doctor is necessary

(56:12):
to put the end of tracheal tube in. Nurses and
respiratory therapists are necessary to actually run the ventilators and
manage the medications on a minute to minute basis. And
so it can't be overstated that a really fundamental break
point in this system could occur when the health care system,

(56:33):
through its workers, is so overwhelmed that we can't actually
have people on the front lines that are doing this work.
So how do they protect themselves because obviously we need
them desperately to be treating patients. We probably need to
and I know that a lot of retired medical professionals
are being called in UM. Are are they getting sick?

(56:58):
I know that some are, and should I mean, how
worried are you about that? I'm actually quite worried about
it because of some data that we're seeing from around
the world, including China and Italy, which is that when
healthcare workers get it, they seem to get a worse
version of it, suggesting at least preliminarily, that there might

(57:18):
be something about the amount of virus or the manner
in which they're exposed to it that is otherwise making
it worse than if they just acquired this virus out
in the community. So that's the first thing that has
me somewhat concerned. So how do you think they're getting it? UM?
Probably just through a greater concentration of respiratory droplets, given

(57:40):
the you know, the proximity that they have to people
who are sick. And obviously, if someone is sick and
they're in respiratory distress and you're intibating them, you're leaning
over a person, and you're just being exposed to a
much greater amount of virus than say, if you bumped
into somebody at the supermarket. The other thing that is
in short supply is ppe. It's the protective equipment that

(58:04):
the doctor's, nurses, respiray therapist, all the people in the
hospital need to protect themselves against this virus. And so
inasmuch as we need to be making more ventilators, we
also need to really be ramping up on the production
of all of the protective equipment. And the countries that
have done this well, I mean China did this very
well in the second wave. So in the second wave

(58:26):
after Wuhan, very few of the healthcare workers became infected.
So once they dialed in on how to protect their
healthcare workers, um, they were able to do this in
a much safer way. So you know, if I could
wave a magic wand we'd be making more ventilators, we'd
have more actual beds and spaces in the hospital, we'd
have more protective equipment for the healthcare workers, and obviously

(58:49):
we'd have more testing available so that we could more
quickly identify and stratify patients at risk. Speaking of that,
I know that a one thousand bed naval hospital ship
is being dispatch to New York Harbor. We may be
seen some of these medical ships that are often used
in times of war being deployed in specific ports all

(59:12):
around the country. Yeah, it's it's sort of hard to
believe how much has happened in one week. Um. And
and it's it speaks to the nature of non linear
exponential growth and and and again. You know, the irony
of it is that which we're talking about today, in
a week or two weeks will seem pedestrian in terms

(59:34):
of what we will know because of how quickly things
are changing, including you know, the rate at which you
know hospitals are running out of ventilators. We should uh
mention one thing, and that is a failure to comply
with CDC guidelines. I hope we're not seeing as many
kids in bars, and not just kids. You know. My

(59:57):
neighbor in New York City who lives on the Upper
Side said the bar was packed for St. Patrick's Day.
And it's so infuriating. But not only young people. I
read an article this morning about children of baby boomers
trying to get their parents in their seventies to not travel,
to not go to casinos. Um. It seems insane to

(01:00:18):
me that people are being uh so stupid and in
some cases so selfish about this or ignorant what is
that about? It's it's so interesting you say that because
I have noticed two extremes um and again these are anecdotes,
so I can't speak to this from sort of real
aggregated data. But you're absolutely right. I have noticed far

(01:00:40):
more concern from my patients about their parents than their kids.
First for starters, So the you know, I just I
could rattle off ten stories about, you know, people who
are in their seventies who have decided, Yep, we're gonna
we're gonna to the casino this weekend and we're gonna
go do this, and we're gonna go and do that,

(01:01:00):
and none of this stuff matters, and we're going out
and you know, doing all those things. And again I
have no idea what it is that. You know, I
could speculate and say, look, people at that age have
been through a lot and they've decided, hey, if it
hasn't got me, now it's not going to. And there's
sort of a false sense of confidence. Potentially, I think
they survives the stars outbreak and they've been there, done that. Yeah,

(01:01:22):
there's a little bit of that. Um, we certainly saw
a little bit of that Machismo in New York two
weeks ago, which I haven't seen. I've seen it damned
down a bit, which was, hey, look, we survived nine eleven.
This thing is not going to get us. Um. Obviously
that's apples and oranges. So it's sort of a nonsensical comparison. Um.
But I do share your concern with the number of
people who aren't respecting these quarantines. In fact, our nanny

(01:01:44):
who's in college, one of her classmates was an exchange
student in Italy, so he had to come back from Italy,
and he tested positive upon arrival, and so he was
placed in a quarantine, which he violated. So he was
seen out on social media three days after testing positive
and being forced into a quarantine, out at a party,

(01:02:06):
and so, you know, that kind of stuff is really upsetting,
and I think it is a bit of a communication
breakdown because I don't think that these people would really
be doing this if they understood the significance of what
they're doing. I just don't think people are that selfish
or that evil if they really understand the significance, which is, hey,
you can feel fine. You know, you college student who's

(01:02:27):
twenty years old, who tested positive who you know has
a little bit of a sore throat. It's not about
you getting worse. It's about what you could do to
somebody who could then go and do it to somebody else. Right,
It's like you infect another kid at that party, they
go home and infect their grandmother or something like that. So,
you know, my hope is that we're just going to
educate people a lot more about why the stakes are

(01:02:49):
high and how we all kind of have a responsibility
here to not just protect ourselves, but to then protect
others through that protection. I don't want to play the
blame game, but was critical time lost when this wasn't
taken seriously by the administration and frankly by some in

(01:03:11):
the news media. How how much damage was done by
that two or three week period where it just wasn't
treated as a serious threat to public health? Well you
alluded to the the Ted talk by Bill Gates, which
is now five years old, and he sort of predicted, uh,

(01:03:34):
in pretty frightening um, you know, reality, what was potentially
going to come if I were going to, you know,
really say, if if I could go back in time
and change one thing in the last three months, what
would it be. It's the following on January, the genome
of this novel, coronaviruns was sequenced and it was made

(01:03:58):
public another Chinese you got it. So the Chinese immediately
figured out what this was, immediately confirmed it was a novel,
brand new, never before seeing coronavirus, and put that information
out to the world, and some companies immediately ran and
developed pcr kits. And you know, one of those companies

(01:04:19):
in China has basically gone on to do over a
million tests already and have incredible data with specificity and sensitivity.
They can do a four hour turnaround. In fact, they've
already built fifty laboratories in China, each one capable of
doing fifty thousand to a hundred thousand tests per day.
What we did, in my opinion, was the biggest mistake,

(01:04:42):
which was basically ignoring that information, and then when push
came to shove sort of doing a botched job, the
CDC sort of put together its own um set of
primers that ended up not working very well. And then
eventually we got around to potentially doing something with a
company called Row. And where we are right now at
the time of this discussion is we still don't really

(01:05:04):
have any viable means of testing. We're probably just a
little bit over fifty thou people have been tested in
the United States, which is you know, two log orders
below where we need to be. So if you can
we just use the testing that's being used in other
places like South Korea, the one that was developed by
the w h O. Did the CDC simply think that

(01:05:26):
that test was inadequate? It seems to me that was insane.
At least use them while we develop a more specific test. Yeah,
that that is absolutely correct. So we are now in
a situation called emergency use authorization where I think the
CDC has finally realized that they're not going to be
the ones to solve this problem, and they're basically saying,

(01:05:49):
you know, so the Secretary of hss UM, the Secretary
of Health and Humans has has basically said, you know,
you can go and do this test on your own.
So I think right now what we're going to see
as states making their own decision on what to do,
and in fact, we're working with one state right now
to try to help them to actually just get that

(01:06:10):
test from China directly, because in my opinion, not does
that not seem insane to you. I mean, does that
not seem a massive failure of the federal government. Yeah.
And again I'm not the conspiracy guy, so I I
attribute these things more to just you know, negligence than
anything nefarious. And I've certainly heard people speculating that, you know,

(01:06:32):
there's sort of you know, an anti China bias and
all of these things. But but I have to be honest.
I think China has been very forthcoming here, and I
think this demonization of China UM, either either you know,
covert or you know or sort of explicit or implicit,
has really hurt us. UM. I think I think China
has been very forthcoming with their data, and for some reason,

(01:06:54):
our decision to not utilize exactly what they offered us
as far as testing has set us back, put us
on our heels. And my hope is that in the
next week the bell gets rung pretty loud on that
and we you know, we we take on these tests
because again, it's not an economic question. The United States
is very fortunate we can afford to do the testing. Um.

(01:07:15):
It's really a question of deployment and other things. You know,
you asked questions about running out of things, Well, we
don't even have enough swabs right now, so we're not
just having to buy the PCR test gets. We actually
have to make sure we have enough re agents to
use them, enough swabs to actually you know, test them
on the people. Um. And that's the stuff that really
we should be stockpiling that stuff, right and and and

(01:07:35):
we certainly in early January should have been preparing for
this to spread. And again, I I think Bill Gates
spoke to all of those things five years ago at
the tail end of the Ebola outbreak, when he said, look,
it's not a question of if, but when this happens again.
And yet the group responsible for a pandemic response, or

(01:07:57):
the Pandemic Response Team, was disbanded in two THO. Yeah,
I mean Michael Lewis's book The Fifth Risk, I think
does a great job of explaining all the non sexy
parts of government that we tend to forget about until
disaster hits um And it's funny I read that book
when it came out, so I don't even remember if

(01:08:18):
in the book Michael Lewis talked about this particular side
of the government. But you're absolutely right, this is this
is a part of government that when things are good,
it's easy to forget about It's easy to say, hey,
we can, we can, we can cut costs by getting
rid of them. Um. But but you know, you think
of this like you think of insurance, right, You don't
buy insurance for your home after it burns down. You

(01:08:40):
have the insurance in place before there's a fire. Before
we go on, one last question, even though I could
talk to you for hours, Peter um, and that is,
is there any evidence that once you get the this
pathogen or this virus, you build some immunity to getting

(01:09:01):
it a second time? Or is that just a complete unknown?
I think it's an unknown right now, Katie. There are
two issues at hand. The first is is this going
to be like influenza, where if you get it in
a given season, you're not likely to get it again,
but you'll always be susceptible to it in subsequent seasons
because it has enough genetic migration or drift year upon

(01:09:25):
year upon year. Or is it something like you know,
the measles or polio, where once you are vaccinated against it,
once you know it doesn't that the virus is not
moving around genetically very much. And you know, either getting
vaccinated against it, or in this case, if you acquire
the virus and recover, you're fine. We certainly think in

(01:09:46):
the short term there is immunity, and that's one of
the other really exciting potential therapies right now is something
called convalescent serum, where you actually take blood from a
person who has recovered, you ident deify the you know, uh,
the sort of the antigens and things that are in
the blood, and you can then infuse them into people

(01:10:07):
who are sick as a form of therapy at high
doses or at low doses to impart short term immunity
on people. So given that we're seeing um reasonable evidence
of the efficacy of convalescence serum, that tells us that
there must be at least some immunity that's acquired from this. Peter,
thank you very much for spending some time with us

(01:10:27):
talking about this very scary situation. Well, Katie, thank you
for what you're doing. Your podcasts on this topic have
been fantastic, So anything I can do to to help
you get this message out. It's an honor that was

(01:10:48):
Dr Peter Attia. You can follow more of his coronavirus
coverage on his Twitter at Peter Attia empty and on
his podcast which is called The Drive, and that does
it for this episode of Next Question. A reminder to

(01:11:10):
all of our listeners are reported episodes on topics like
maternal mortality and the environmental impact of meat are still
to come, but in the next season coming out this summer.
The rest of this season, as we mentioned, throughout March
and into April, will be dedicating to the coronavirus. You
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(01:11:33):
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(01:11:54):
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(01:12:17):
very trying times. Stay safe, Stay indoors and we'll get
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and until next time and my next Question, I'm Katie Couric.
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(01:12:40):
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(01:13:02):
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