Amidst the pandemic that we are all facing, we have created the COVID-19 Files to deliver the most pertinent information to keep you safe and well informed.

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All right, welcome KBMD Health and Gut Check Project bring you COVID Files, episode number one. It’s a little bit different setting right now. I am not sitting in front of or next to Ken Brown my partner. What’s up, Ken?

What’s going on Eric? Yeah, you sound a little bit different, but that’s all part of it. We are practicing some social distancing.

We definitely are. Brown does have a nice brick wall behind him. And I’ve kind of got one back over here. So if you happen to be looking on YouTube, you can see we’ve got a wild lamp.

Yeah, just in case just in case somebody accuses us of lying. There’s two brick walls.

Yeah, there’s there’s definitely two two brick walls. So Brown is…Ken you’re sittin’ what about 60 miles from me? And but we both been having to stay up to date with the facilities that we served the anesthesia you and gastroenterology you could call it a hospital that’s actually handled a patient.

We had our first death two days ago from COVID 19. So this is a real thing. I was working in the hospital. This is something that I felt like, it’s time although I’m not a virologist, you’re not a virologist. Neither one of us are epidemiologists, we do have an obligation as healthcare workers to try and describe everything that we’ve been reading to get it out to people. So this is something that we cannot ignore meaning as a opportunity and a platform to give some information. Hopefully, we can give something that anybody watching this will at least clarify a few things. That’s my goal here is to discuss some of the definitions get into what we’re going to look at, should we panic, should we not panic? where’s this going? All the things that I asked? Because I spent a lot of time looking at literature, we’ve got graduate students working for us, we’ve got nurses working for us, that look up a lot of things. So that’s what I want to do in this show today is try and discuss all of it out there. Because the more informed you are, the more that you will be part of the solution. That’s the important thing, and realistic, and a healthy amount of fear is appropriate. But not freaking out is the key here.

I agree 100%. And something else I’ve been home just like you have and in between taking care of work and then keeping up with work. And then obviously, having a great amount of family time while being in a social quarantine, you end up consuming a lot of different information. So what I don’t want our show today to be is just the personal emotional things only really we want to do exactly what Brown said. And that is move into information that you can use. Top to bottom, we want to explain things from the top level down so that we can we want to get everybody into understanding. There’s unfortunately because it’s a new novel virus. There’s lots of misinformation in terms of what does it do? How is it affecting us and rather than take a guess I think that what Ken has for you here today is lots of up to date information, we’re going to try to put it into a, a mode that you can use, accept and improve and protect yourself.

Because I think what ends up happening is a lot of people, especially people that are trying to quarantine themselves, or they’re staying at home, they do binge social media mediaing Is that right? Where they just kind of get on social media and just binge all of it? And it seems like if you look at that, there’s going to be two camps of people. You’ve got the oh, what’s the big deal? Nothing’s going on. And I see these videos in Florida where people are playing tug of war on the beach, and there’s hundreds of people and I’m just like, ph my goodness. And then it’s the no, we’re in a zombie apocalypse and they, you know, take all the toilet paper and hand sanitizer from the stores. So the only thing I’ve learned from that is that apparently zombies really hate toilet paper is the best I can tell about that.

They can’t stand it.

They can’t stand it. So the zombie apocalypse if that’s the case, throw toilet paper at them. Unlike Walking Dead where you have to like smash them in the brain apparently toilet paper is the biggest defense that you can have against zombie apocalypse.

Yeah, we don’t this is not this is not an avenue the COVID File Episode One is not an avenue to drive people to go and make a bunch of unnecessary purchases or to go in and hoard things that your neighbor needs. So this is let’s stay factual. And honestly, Brian, I’m going to kick it off to you and let you kind of lay out the template now outline on how we’re going to address the different things and

Yeah so you know, normally, I mean, one of the things that I really like to do on Gut Check Project because, you know, joke around and make light of things but I’m having a really hard time making light of this particular thing. So I am neither in the camp that this is oh, what’s the big deal and I’m not in the zombie apocalypse, but I do really think that we all need to take this particular thing extremely serious, and we need to get into it. One of the things that I’ve noticed is a lot of people have trouble with the different terms that are being used in the news. I mean, they get on press conferences, and they just throw these terms out. How is this changing the world? I mean, there are single moms that are waitresses that their restaurant it has been closed. And this is there’s a lot of things going on like that. And I’ve actually, I knew that we were onto something when I’ve been trying to get an infectious disease doctor to come on the Gut Check project that physically come on for it really kind of ramped up here in the US, and a few of them were like, nah, I’m good. I think I’m gonna lay low and try and separate myself. And, you know, they basically said, you’re on your own on this and I’m like, okay, so this is, I’m gonna have to learn about this myself. And I just want to share the information that I have uncovered about my concerns. And so my concerns are what are all these different terms after we get that, you know, how do you actually present? What’s going on with the numbers? What are these numbers real? How infective is this? And then I want to get into some good news about what’s going on. And that’s where a lot of the research is happening. So we can talk about all these things. Because when I asked my nurses, hey, these different terms, what do these mean to you? Most people don’t really get it because CNN, and Fox and these different news stations, they interchange all these names. And so let’s start with that. Let’s learn the four virus related terms so that everybody’s on the same page, because when you read medical literature, they refer to it as one way when you listen to the news, they refer to it, and then they lump everything into COVID19. So let’s just start with this. So the definitions, SARS, CoV2, so when people when scientists talk about this, they always talk about as the SARS CoV2, you’ll hear infectious disease doctors refer to it as that. It is a type of Corona virus. In the beginning when everybody kept saying this is a Corona virus virus you Google it and I remember I’ve had friends and stuff go, what’s the big deal? It causes a cold like symptom. Well, the thing is, that’s a family of viruses, the Corona the reason why when they first came out, they said this was a novel Corona virus, which was not the word that they should have used. That is the word that infectious disease doctors would say they should have said we have a scary Corona virus here. That would have been catching people’s attention a little bit more but novel Corona virus meant that it was a different type of coronavirus. So in that family this Corona virus is the SARS CoV2 two because it is a SARS meaning as severe acute respiratory Syndrome type Corona virus like SARS CoV nothing in 2003. That’s how come these names are so confusing. So it’s SARS CoV2 is this virus, which the closest thing we can relate it to, is SARS Cov, which was in 2003. So that’s the virus. The current virus is not called COVID 19. COVID 19 is the infectious disease caused by this virus. So SARS CoV2 is the actual virus, and it owns it basically owes its name to its genetic similarity to the original virus, the SARS CoV. So that is short for severe acute Respiratory Syndrome Corona virus 2. So that’s the definition that’s the actual virus. Corona virus. Corona viruses are this big family. SARS CoV is the 2003 one SARS CoV2 is the novel Corona virus that we’re dealing with. So that’s the guy that we’re actually dealing with. COVID19 is the disease that you get from this. Currently there are seven Corona viruses that can cause human disease. With the three most severe being the SARS MERS, which is the Mediterranean one and then COVID19.

And just for clarification, the D itself does mean disease. So it is CO for Corona VI for virus and then D for disease and then 19, I believe is assigned because it was first discovered at the end of 2019.

That’s exactly right. So this is exactly what like what we’re saying when we first discovered human immunodeficiency virus, and then you would develop Acquired Immunodeficiency Syndrome AIDS. So it’s very similar to that where you can there’s the virus, it causes this disease, and so CoV…so COVID19 is the infectious disease caused by the SARS CoV2 virus. What’s alarming is that as a much higher fatality rate than the flu, so a lot of people were saying I don’t really understand more people died of the flu, more people died of the flu because the flu is more ubiquitous. If this thing takes off, then you’re gonna have a much higher mortality rate. What the people don’t really well, now everybody starting to understand and…so I mean, by the way, everything changes daily. I’ve listened to a lot of experts. And they’re like, as of March 19, this is what we know, because they’re freely admitting that as of March 22, we may have something new information on this. So what we do know is that it’s the incubation period is quite long, which is why it spreads so easily because you may not have any symptoms. And then you’re out there looking and feeling healthy and not taking any precautions, and then you get in contact with somebody, and we’re going to talk about that a little bit later. Same reason why we’re doing the social isolation, we both feel great. We’re not doing it because we have a fever or we have a cough or anything bad’s going on. We’re doing it because we understand that you can already be infected and keep spreading it. So we’re gonna sit there and do this. So I’m gonna now I’m going to quiz you because you’ve been doing a lot of reading. So how does the typical presentation happen when somebody is exposed to the SARS CoV2 virus?

Typical presentation, and I guess you’re asking me if somebody happens to have been infected, and now they’re complaining of symptoms, is that what you’re talking…?

Correct. What is what are the typical symptoms people should be looking out for?

The first thing, or most common, I believe is just a mild fever, followed by a little bit of discomfort and malaise. If they then later in developing something along the lines of a shortness of breath is going to be a key player, which hopefully at that point, the person has then decided that they need to seek help, but unfortunately, the way that I’ve been reading the timeline, oftentimes people are just simply not going until the progression grows. And if I understand correctly, and feel free to correct me if I’m wrong, but what we’re looking at by the time that symptoms generally set up is about a five day play out from the first time that somebody experiences a fever, and unfortunately waiting until the fifth day before seeking to find out if the cause of the fever happens to be related to this particular Coronavirus may be too late for those who are somewhat compromised, because the development of shortness of breath is the early stage of and we’ll get into it, but the inflammation and bring it down to the lung tissue. And that begins a small little snowball that turns into a big avalanche of different things that we’ll get into here in a moment. But it’s interesting and I don’t want to walk backwards here but you said what is the presentation the unfortunate part is the once someone becomes infected and then becomes contagious to the world around them before they show symptoms, that that five day stretch could take off after the second day they’ve been exposed, or can wait all the way until it looks like the 14th day. And unfortunately for the human race, we may be those particular people may be infectious or contagious to the world around them for up to 14 days without ever knowing it, spreading the virus.

Absolutely. So we’re gonna get into that because then we’re going to talk about the epidemiology and why this is a little bit frightening if we all don’t do our part, right. So the bottom line is you’re exactly right sore throat, malaise, fever. In 80% of the infected people we believe right now, that symptoms include this kind of mild situation, we’re going to call that mild so a lot of people think they had a small cold or they had the slight flu or whatever. 20% of the people, you’re going to end up with a 20% of the people, you’re going to end up with a more serious respiratory infection, which is pneumonia. Now approximately 2 to 3% of those people will will die. And if you end up with a severe pneumonia, and a severe inflammatory reaction, then what will happen is that if you end up getting bad enough to go on a ventilator, we’re seeing that 86% of those people die. So the people that do get sick get really sick. So, yesterday, I was actually preparing this and this is one of the things so when I sit there and watch these videos in Florida of people saying, man, it’s not a big deal and I say Florida because somebody sent me a video of people in spring break in Florida. I’m not trying to bash Florida in any way. So I get on a website where I can sit there and kind of track these things sort of real time. Yesterday, March 19 the Corona virus cases were 236,728…236. Today, 266,000. 30,000 people have been diagnosed since yesterday.

It’s a logrith…it’s a logarithmic growth.

Oh, yeah. And we’re gonna get into that why because I think that’s where the real it’s not that the science the science of the of the virus and everything is super. If you’re a virologist, it’s interesting and everything, but when you and this is an epidemiologist’s, nightmare slash, the thing that they went to school for. So a lot of them are geeking out, they’re doing all these modeling and all these other things that are going out there. So there was 9,828 deaths yesterday. Today, we’re up to 11,186. As far as the US yesterday, we had 11,348 cases today, 16,000, 5000 cases 16,491. The death toll went from 171 to 224. So the US here’s the good news is that up until just about a week ago, the US fatality rate was around 3%. Because and this is kind of what’s going to happen when we diagnose more people. Now it’s down to 1.5% what that means is rescreening more people, people that normally wouldn’t even go get screened are going to do this. So but you contrast that to Italy, that over the past three days, the death percentage was around 6%. And then just yesterday, it was 8%. You were gonna say something?

No, no, that’s I was just pointing out I mean, it’s unfortunately their, their rate versus versus diagnosis is actually moving in the wrong direction over the last 48 hours.

Yes, it is. And so Italy is and the the really scary part is, is I sent a graph to all our team members that we were outpacing Italy with our cases, at the at the day to day rate, and I get that we have a higher population and all these other things people can argue that but it’s

But I will say in the balance and it is hard. Just as you and I wanted to always present things in balance. The hard part is we have a limitation of testing capacity just as much as we do carrying capacity. And the hard part is is where are we going to get to the point of growth in number equals the sample, and by the sample the number of people in the United States, so it isn’t nearly as alarming to me and probably not to you either Ken to watch the number of diagnoses skyrocket it probably on the on the on the front end? It’s just that we’re testing more people. It’s just where is our ratio and our rate going to fall for morbidity and unfortunately, also mortality? Because I don’t know. But testing is going to be imperative for to grow.

We’re going to talk about that because some new data has come out about the testing. As I said, day to day Remember, this is a world wide issue. So every single day scientists from China scientists from South Korea from France from Spain from Italy, Everybody’s collaborating, and everybody’s pulling their data. And we’re learning more and more and more on a daily basis, but we’re going to talk about the testing. What we do know is that the doctors in Italy described that most patients displayed this bilateral interstitial pneumonia. So unlike getting a pneumonia, where you have it, so typically what happens is if you have pneumonia, it’s an infection, it will, in fact, a portion of the lobe of your lung or a whole lobe, but basically you have the rest of your lungs to compensate. Here, it’s both sides, and it’s in everything. And when that happens is bilateral interstitial pneumonia, meaning that it’s on well, I’m not going to get into the pathology of it, but basically, the cells get infected, they die and then we lose the ability to produce surfactant. Surfactant is the lubrication that allows your cells, your alveoli to exchange oxygen, and this is a little bit more in your wheelhouse with your anaesthesia. Why don’t you comment on that?

Yeah, no, it’s, it’s it’s exactly what I had some experience managing for several years early on. And oftentimes people that fall into this category long before Coronavirus lent itself to, to this epidemic here there was a situation or a diagnosis called ARDS or acute respiratory distress syndrome. And typically, the way to best describe it is it’s almost like a localized immune autoimmune disease for your lungs. It happens because as the cells begin to break down and we all have these little bitty finger like cilia on our lungs, right, or to help with gas exchange and to hold a surfactant to break down the fluids, so that we can exchange it. The surfactant is breaking you down what happens is is that are immune cells which should.

Eric, just really quick backup to right before you said Sir fact that you froze on me and I missed what you said, what were you saying but right right before the surfactant thing,

Sorry about that it’s surfactant level, it should be breaking down the fluid to allow for better gas exchange. And what’s happening is our immune system in this particular state of ARDS is breaking down cells faster than they can be carried away. And when that happens, we have fluid buildup, it dilutes the surfactant and I don’t want to talk over anyone’s head. But essentially, our immune system begins to attack both bad cells and good cells, allowing for too much degradation or breakdown of our lungs and the tissue that we exchange the gas with. And then things begin to build up. And essentially you begin to drown from the inside we think of drowning or, you know, bringing in water and being being submerged not being able to breathe this being an awful existence. But imagine the fluid building up from in your lungs, you you’re not consuming the fluid. It’s here it’s inside. So, pneumonia itself is kind of like that. But just as Ken said, if we catch it early enough, it’s it’s isolated. That happens in one lobe or one area of the lung with ARDS, which is what this could turn into, it happens all over the lungs all over the body. And what we do with an ARDS patient, is we tried to ventilate them by putting a tube in, we secure the airway, and what we tried to do is more or less force gas exchange by using what we call positive pressure ventilation, by blowing air through the tube, and so that we can force it into the lungs and then it can be exchanged. And then what ends up happening with those same patients is, is we normally would think of laying in bed on our backs and our head slightly raised. The lungs themselves can become damaged if the fluid is allowed to just basically sit there for a while. And the only way to keep the air movement in there is to rotate the bed. So oftentimes you’ll see an ARDS patient who is intubated. And there’ll be on their back side that they face down. And they have to continually be rotated to preserve the integrity of the lungs and actually to facilitate to facilitate good gas exchange. And I’ll stop there with the management of the ARDS patient because you and I both know somebody else who does even the next level, which is the ECMO and we can get into that.

Yeah, we well…so here’s the problem with all that is that we know that from the account from the Italian doctors and our Chinese physicians, even young patients were developing this interstitial pneumonia and they were developing very dramatic, shocking pulmonary situations with this bilateral interstitial pneumonia. Now, the mortality of the critically ill patient of a SARS CoV2 pneumonia is extremely high. If you end up on a ventilator, it’s 86%. Now, Eric, what you’re talking about is the highest level of care. We’re going to get into why almost nobody is getting these very isolated, very unique beds that can actually do this. And we know…

I’m glad you said that. And well, what do I want to I want to just restate what you just said, what I just described is if you happen to be the most serious, that would be the optimal situation that you would be fortunate enough to end up in.

That would be there’s two, maybe two beds like that in a hospital in a large hospital. And when somebody is at that point, you call up for that bed, and you walk in and you watch this incredible science going on where it’s the physiology and the pathophysiology at this battle. But we’re we’re going to get into this and that is the real issue is that getting the appropriate care to everybody. Remember that a lot of these Chinese doctors that first well the whistleblower that first discovered it other doctors. 40 year old doctors were dying from this. So this is and there were doctors in a hospital dying. So this is this is actually very that’s what kind of perked my interest several weeks ago where I went. And I admittedly was the person that was like, why are we all getting all worked up about this because I know and I was trying to defuse the situation and be like, this looks like A Boy That Cried Wolf by the media. It’s not a big deal, quit running out buying, you know, all this other stuff. And then I started reading about stuff going on in China and I’m like, holy cow, wait a minute, doctors and nurses are dying. So this is a big deal. So one of the things that I really started looking into, I’m like, okay, the only comparison we have to this is the SARS of 2003. Now, the reason why we didn’t have to really deal with that, except pretty much stayed in the we’re gonna call it the eastern side of the world. So a lot of these countries like South Korea, that have been so prepared for SARS CoV2 is because they…this is round two for them. They they saw it coming. They had testing kits, they did quarantine immediately. And they really put this thing on lockdown because they’ve already been through this, because the thing about SARS 2003 is that the mortality rate was really high. It was like 20% it was brutal. But we have now shown that this SARS CoV2 scientists believe is 1000 times more infective than the SARS 2003. And this is due to a lot of different reasons but due to the high mutation rate of the spike proteins, everybody’s seen the example of the little spiky ball protein that the the media loves to play. This virus is showing a pattern of much higher infectiousness so a study released in released by some scientists in Germany on March 8, in 2020 found that this particular coronavirus could be found in the throat well before symptoms…well before symptoms. So what they’re seeing is that there could be a huge increase in viral load in the back of the throat, way before any symptoms show up. So upon taking throat swabs from these patients, then they tried to show that all the results from day one to five tested positive for COVID19. But the high viral load from these early throat swabs indicated potential viral replication in the upper respiratory tract earlier. This means that you can have active viral replication in the throat during the five, first five days, and it will continue just like you explained for 14 days, which is why if people are going around, I feel fine. And I’m, you know, by the time we’re asking if you have a fever, we’re learning this is why it’s there. Now, everybody’s like what makes it so inffective. This gets a little bit hairy. And Eric, you and I have talked about this because we’ve tried to figure it out. I was just on PubMed looking at some different studies and one of the studies was discussing specifically the ACE-2 receptor. And people may be talking about this, but it appears that this particular virus binds to at least the H2 receptor, and possibly a Furan receptor. And the names of them are irrelevant. But the thing that’s interesting is that both of these are kind of ubiquitous in the body, but they’re heavily concentrated in the lung, and in the GI tract. So now we’re seeing that you can get this both through your upper respiratory system and your gastrointestinal tract. One of the things a study just came out, Dr. Idim and I were talking about this this morning, because I just saw it this morning. This is how fast it changes. You get on the news and you’re like, oh my gosh, it appears that 20% of people with COVID19 will actually gastrointestinal symptoms before they actually show the upper respiratory type symptoms. So this is what I mean. And it was no joke in the beginning when we were talking, protecting your gut is super important. So this is why a gastroenterologist is talking about COVID19, I at least have a role to protect your gut to make sure that that line of defense is taken care of. So what will happen is, is that this virus super tricky, will bind to this H2 receptor, and then it kind of knocks on the cell door and then the cell lets it in. And then the virus comes in, and basically hijacks a cell and lets the cell become the manufacturing plant for its own mRNA or its own RNA. And by having that happen, then it can develop more viruses. This is actually how the virus works. And so people argue, is it a living organism is not a living organism. I think most people have always felt that they’re not living. But the fact that they can do these things they just need. It’s the classic, or the most perfect example of a parasite. They hijack a cell, they get the cell to do what it wants. And that’s how these viruses work.

They’re just kind of brainless. I mean, they you said it best, the mRNA the RNA is what is taken and replicated. And not to get too scientific. But I’ve always learned that viruses, although we don’t say that they are completely unliving. They’re not really living organisms. They’re just, they’re just RNA in a strand, they’re not even DNA. They’re just programmed to go in and disrupt a cell and basically hijack the replication capacity of a cell and make it to what it wants to become, which unfortunately, is usually to the demise of the cell itself.

Yeah. And so in the most simplistic way, imagine the cell attaching to a lung to a lung cell and it does this then that lung cell gets taken over and it starts producing the virus. Well eventually that cell dies. And then that’s where the cell dies. And it can no longer produce the surfactant can no longer do the other stuff that we’re talking about. And then enough of that happens, and then you have this demise of the lung tissue and you cannot aerate. Well, something else happens. If it gets into other tissues, or if it does this, or if you have a healthy immune system, we now know that young people can actually have something called a cytokine storm. So what happens is your body overreacts to that, like your body goes, this is nuts. We’ve got this viral invasion, we have to get rid of it. And this may be one of the reasons why younger people are having this massive thing. So the only comparison to that is the Spanish Flu of 1918 of the reasons why it was so deadly, is because it actually created the cytokine storm in the most of the people that are infected. So what that means is that people with the healthiest immune systems died-that was 18 to 25 year olds, that’s what made that particular flu so devastating.

Yeah, I even saw a bar graph, it specifically addressed that almost every pandemic almost on the ends. If you’re an infant or very, very old, it’s almost where the highest mortality rate is. And for Spanish flu, it’s kind of interesting. The ends are spiked. And then it goes down in the middle, it comes right back up into a spike, where we generally have our healthiest population and it was for precisely the same reason you described, it’s, it elicits a cytokine storm, which is just people who happen to be in shape and the immune system doesn’t know what to do. So it unleashes everything. It’s almost like just self destruction.

Okay, so that’s our basic science class and I’m sure we’re gonna get some calls from some neurologists to be like yeah, you missed you almost had it right. But whatever, but this is not we’re not getting deep into the science. What we really my my other thing is why do we need to is this a time for some serious caution. And this is the part that I’m gonna get into that is a little bit scary. I’m not the first one to be talking about this. I have been looking at this for quite a while. But now I overheard Governor Cuomo talking about this people, the politicians are discussing all of this, and it’s not the death rate. It’s the need of the hospital system that is the scary part.

Yeah, definitely and needs to the hospital system. And we can get into it. We can get into the specific numbers here just in North Texas. And just to use it as comparison, I think around 80% of our audience that’s watching and or listening happens to be in this area. So we’ll get into some hard numbers on bed availability, ICU availability, what it is that we currently use without the issues of COVID19 and then where our resources get reallocated if we happen to experience which unfortunately, it looks like we most likely will a surge of patients.

Yeah so, so this is not this is not my opinion. Like all things we let’s let’s talk about some of the science that’s out there. So I was listening to Dr. Grewal out of, I think how you say his name out of New York City, and he did some quick calculations. This is actually on the on the Peter Attia, a podcast when he was there. And he was talking about how if they calculated the ICU beds in New York City, and at a growth rate that we’re at right now, which we’ll get into it, which is called the R-Not, I’ll explain that in a second. In two weeks, all of the New York City ICU beds would be taken. Taking it further, a study came out of USA Today yesterday or the day before. It was an analysis that showed if the nation continues to grow at this rate in the effective mount, what R-Not is in epidemiologic terms, it’s written as R-0 so you may see it as that or it’s pronounced as R-Not that means that one person can infect three people. Right now our R-Not is being described somewhere between 2.8 to like four, let’s just say it’s three to be due to be a nice round number even at three, if we don’t stop this and so whenever people talk about flattening the curve, what they’re talking about is the R-Not because we have to change that. So a USA Today analysis show that if the nation continues with this R-Not that we have, there could be almost six seriously ill patients for every existing hospital bed-think about that. Six people needing that hospital bed. Then they got into the whole analysis of based on the data from the American Hospital Association, the World Health Organization is being fairly conservative. It assumes that all 790,000 beds would already be empty, but they’re not. Most hospitals are already almost at capacity, with the other stuff that we deal with like heart attacks and strokes and diverticulitis and gallbladder disease and everything else that happens to humans. Car wrecks, trauma. You know, and so then I saw a really scary one, where somebody was saying that if this continues, then we could have essentially 17, including the beds are already counted already there. We could have 17 people waiting for a bed in the whole United States. Now, Germany just published the paper yesterday, this is how fast it changes, like I mean, you just get on and you’re like, whoa, they said that they haven’t R-Not of two. If it continues like this, that’ll be over a million people and they will lose all their ICU beds in 100 days. So if we sit there and say, well, the mortality rate of this and it will continue to decrease as more people get diagnosed, but then if we utilize the health care system, then the mortality rates going to grow exponentially, because the usual stuff can’t get in then. So that’s two thirds that…I mean, we could literally have 70 people competing for an open bed. And this assumes that we continue with this are not the are not, is based on our social lifestyle. So the reason why we’re doing this podcast this way is because we’re trying to do our part to break this R-Not of 1:3. If we can get to 1:1 or something less than that, then what we’re trying to do is buy a little time by slowing the curve. We need to buy a little time to allow the medical infrastructure to catch up, be prepared or whatever it needs to do, because we are doing a lot of cool things. So you wanna say anything about that?

But just in terms of application, so as a young person and even even back when you and I were probably questioning the the seriousness of the new novel Coronavirus or COVID19, however you wish to phrase it about two and a half weeks ago before it really started to get our attention. So in that, in that element we somewhat dismissed it as flu. But the progression of somebody who’s sick with flu does not require near the resources. And on top of that, they’re, they’re contagious stage is usually commensurate about the time they begin to show symptoms so that they know they kind of should remove themselves from public exposure. This is the opposite. And when you find someone who is young and healthy, who most likely will not have terrible symptoms or even know that they are necessarily infected, the younger that they are, here’s how it can affect you. Or it can it can affect you not infect you but affect you. So Ken just laid it out why we have all these hospital beds and the different resources that will be made available to somebody if the R-Not continues at a factor of three. Here’s some hard numbers with DFW for instance. So in the DFW Metroplex, we have roughly 7.5 million people give or take. And that’s that’s the rough range, right? In this area, though, and all accounting and not including surgical centers, but high level hospital beds, we have roughly 15,000 beds. Well, that sounds okay. But right now before Coronavirus or COVID diagnoses have been affected or played a part in that. Already, two thirds of those beds are being used. Yeah. So we have less than 5000 beds total. Now that does not include Intensive Care Unit beds. So as it begins to break down the numbers, what we’re looking at is roughly 80% of the people that will present and being diagnosed with COVID will be what they call mild to moderate. Even some of those moderate cases. I think it’s around 40% of moderate cases will require some hospitalization. Okay, well, that plays into some of the numbers. How long is it hospitalization, roughly two to four days, then you move into the severe that makes up roughly 14% of everybody else who gets diagnosed with COVID. 14% of those people require supplemental oxygen and check in. Their hospital stay typically is lasting almost seven days. Now, that’s a week. So 14% of the 80% of seven and a half million we’re really starting to press, press out against what we have for a resources. That’s not even the worst of it. If you are critical, meaning you get diagnosed with respiratory or organ failure requiring a ventilator, we typically only count an ICU room is one that has the capacity to handle a mechanical ventilator. That’s less than 2,000 of those beds. And I can’t remember what the current census count is on our ICU beds that are taken right now but I think it’s 60%.

Did you see how long that if you have COVID19 And you’re put on a ventilator, what the average length is?

It’s almost two and 2.8 weeks, isn’t that correct?

Yeah, it’s somewhere between three to six weeks.

So the sad part here is, is it doesn’t necessarily if it were in a vacuum and one person were diagnosed with severe COVID, and we could take them and do everything that we were talking about with a typical ARDS patient, we would have the best chance at a great outcome for that particular person. But that’s not what we’re up against. Now we have, let’s just use some some fake numbers, but we have 1,000 beds, but with 5000 people that need them. And as people begin to pile up, even if someone gets there on a Tuesday, and then you get diagnosed on a Wednesday, you’re going to have to wait three weeks for that bed. That’s where the resources become incredibly stressed. And now how it comes back to those same people who said, well, it won’t affect me, I’m too young. If you’re in a car wreck, or you happen to be in happen to have just a completely different issue where your gallbladder is is giving you fits or you end up with diverticulitis, or you suddenly have a rectal bleed, or you suddenly get knocked while you’re playing sports or whatever. And you require the ICU bed or that high level of acuity, unfortunately, COVID19 now is affecting you or loved one because it’s not going to be available.

I love how you say that because when you when when people are saying, well, it’s not you know, it’s not going to bother me, you know that President Trump keeps talking about how he really needs the millennials to be part of this because they have higher or according to him, they’re not taking it serious enough. But you’re exactly right. If you’ve got, I mean, I have all my patients that have Crohn’s and colitis that are like what happens if I get a flare? What do I do? Well, it’s gonna, and you’re exactly right, putting in those terms. You’re going to be squeezed out. I mean, it would be it would be one of the most horrific tragedies to have somebody die of oh something let’s just say. Let’s just take it out a little ways here. You said diverticulitis. diverticulitis is an inflammation of a diverticulum, which normally is easily treated. But if it doesn’t get treated quickly, then it can form into an abscess then it can perforate, and then you have peritonitis, which leads to septicemia, which leads to death. So something that is completely preventable gets pushed out two weeks to try and get evaluated. And then well, that’s a that’s now we’re…so I hope the whole point is not to do the oh my gosh, it does sound like a zombie apocalypse. But everybody needs to take this as serious as we’re making it sound because the numbers when you listen to experts, these epidemiologists talk, they do not sugarcoat and they get very, very real, like the numbers you’re talking about. Those are easily, you know, extrapolated and you can look at it, it’s not like it’s not Eric Rieger’s opinion. This is just what’s out there.

No it is what’s out there and those are the resources and in fact, when we were doing an inventory of what could be made shift ICU beds just to kind of give a glimpse on what what’s being discussed in terms of people who typically do elective procedures, I do elective procedures predominantly, one of the surgery centers that cover happens to have four ORs. Each one of those ORs has an anesthesia machine. A lot of people don’t know that’s an anesthesia machine really is just a big ventilator, that has the ability to entrain volatile agents to help keep people asleep. Well, those four ventilators now, we now have makeshift ICU beds that’s becoming a part of the count, which has never been a part of the community count of ICU beds before. So some of these surgery centers will be makeshift, more than likely COVID patient care units are where we will be able to monitor these people and give us more capacity, but it still won’t be enough if we’re not all on board to help stop the spread.

So that is a lot of heavy science. That is a lot of doom and gloom. Let’s get into some good news. So because I’m yeah, I’m hopeful we are going to get through this. This is a worldwide problem. And you’ve got some of the smartest scientists in the world collaborating together for the first time. So here’s just a few of the things and this as golly I don’t remember when I was this is a few days ago so who knows what’s all going on right now. But I just mentioned that the US death curve went from 3% down to 1.5%. So that’s awesome. China has flattened their curve as of yesterday, I believe that they did not report any new cases. So today is March 20th. Um in the Peter Attia podcast that I listen to, they were discussing that it could be that the corona test could only be 68% positive. And they were really scared about how devastating that would be if there were false negatives going out. A study just got published out of China. So a lot of this data that we’re getting is the Chinese scientists doing retrospective studies and the Italians and the in the Iranians that have are now being able to look at the data that they have, and they’re giving it to the world. There’s, nobody’s saying, oh, well, this is our information. And so but a study just published out of China was reporting a false positive rate of close to 40%. So the good news is, if that is true, what that means is that we’re at least telling many people that you’re positive quarantine yourself for two weeks, and so you’re giving them a stamp of you have to be isolated. We don’t like false positives or false negatives, but if you’re going to have a poor sensitivity test, make sure that it is a It is a false positive in this particular case. So that people self quarantine. I believe that there are multiple vaccine trials going on. I think that US had its first human participant, and I believe Israel has human participants. Everybody’s saying, when’s that gonna happen? Well, as you know, as well, as I do that, you know, these vaccines probably are not going to be available for a long time. So that isn’t something to hold our breath. But there are a few other things that makes it somewhat helpful. It appears that there are the President has been, well, not just the president, most government leader or most countries are really encouraging the private sector to get involved. And I think at least in the US, there are about 35 companies and academic institutions that are racing to create a vaccine, racing to see if there’s some sort of treatment. So we know that there are studies being done on animals where they’re looking at antibodies. So there’s a lot of really exciting stuff. Now, some of the things that are going on, very hopeful is that some countries are using a drug. I believe it’s by Gilead that was initially made for Ebola called Remdesivir. And they’re combining that with a very old drug called hydroxychloroquine, which is called Plaquenil.

Plaquenil yeah.

Yeah. And they’re seeing some success which is awesome. In fact, University of Minnesota is doing the first trial where they’re going to do prophylactic hydroxychloroquine, called plaquenil versus placebo, and people that have had passive exposure. So that’s another exciting thing. So if we can get people on this earlier, we may be able to take COVID survivors COVID19 survivors and spin down their answers. antibodies and give antibodies to other people so that you can do that they’re doing that right now with macaque monkeys. I saw that that was going on. But all of this, the reason why that that’s hopeful is because we need to buy time. And the only way to buy time is to you have to have this social isolation. I don’t want to use the word social isolation. And we’re going to get into that as the next part of this. Because what you need is the social or you need the physical quarantining. We know that social isolation, now I’m going to use that in a negative way, can also lead to, we’ve done we’ve talked about this on the gut check project that loneliness can be as deadly as smoking. And that’s why I want to make sure that we end this on kind of an up note, and we know that social isolation can actually lead to inflammation. So we went through the science of it. We talked about the epidemiology. We talked about some of the doom and gloom we talked about some of the new things coming. I want to now discuss the fact that you and I are self quarantined. And as much as we can as healthcare workers, we cannot be completely self quarantined. I’ve been working in the hospital all week, tried to get in I’ve got I mean, I’ve, I, I’ve made sure that I’ve got alcohol wipes on me so that I can wipe down my phone I make sure that I’ve got I’m not hoarding, I’m not hoarding. I’ll go to the hospital and say, give me a few alcohol wipes and give me a some some bleach things. I’m working really hard to not put the phone to my face and trying to do Bluetooth thing so I can talk that’s another really important thing. We know that the everybody’s talking about social isolation, but your phone may be a vector because we know that the virus can live from 72 to 96 hours on steel and plastic. It appears to not survive very well on porous material, like cardboard. And they can live in the air for up to three hours. So, you think you wash your hands and everything and then you put your phone down on a on a metal table. And then you pick it up, put your hand on it, put it right to your face, that’s just like shaking someone’s hand and slapping your face. So keep that in mind. Our phones are a vector of vector being something that can carry this,

You know what’s kind of interesting is that self quarantine allows you to let your guard down if you are in your same environment all the time with your same immediate family etc. You really can get to the point where you’ve been around the same people so really self quarantine with your home is going to allow you to not to overthink that kind of stuff so that whenever you leave, you become vigilant in the period of time that you run out to the to the grocery stores. Don’t feel like that, just simply being you that you have to completely change and I’ve got to rinse my hands every three minutes before I go this direction. No, limit your exposure to the outside world. And that’s when you would be on the most heightened alert. And it was interesting. I was listening to a radio show yesterday. And my wife and I were laughing because he was talking about how whenever he had to run to the grocery store, he found himself having to go to the bathroom. And I thought this was very keen. We’ve always been taught how to use the bathroom to wash your hands. But he said, as I walked into the bathroom, I realized before I touch the button on my jeans, wash my hands smarter and do my own pants because I’m going home with these pants. And so it’s that kind of level of breakdown. And he even admitted had he not been practicing his own quarantine And then on the high end alert, he just would have been doing the same routine that he had been doing all along. So.

That’s a that’s a really good point. We’re gonna…I want to get into this but I want to play this because my friend, my childhood friend Brian Abood, it’s his birthday today. So we’re going to do a virtual birthday party and celebrate his birthday. She sent this to me and it’s a I think it’s going around social media. But basically, let’s, let’s hope it plays well.

Because of Corona virus, you are going to be quarantined, but you have a choice, you A. quarantine with your wife and child, or B eaten.

She didn’t allow me in so I thought it was kind of funny. So she was saying that that’s pretty much.

Pretty much all there is to it.

And I’m sure he was implying that Brian said that but that makes sense. Wash your hands before you touch your your jeans. So alright, so we’re gonna end on a happy note. So I was listening to some other podcasts and I was reading the Washington Post article. And the the main weapon to combat this disease is social distancing. But that doesn’t mean that we have to have social isolation. This is where I want to engage with everybody that listens to this, so that we can come up with ideas to try and make it so that you’re not socially isolated. Because, you know, we…on social media, we see all these negative things all the time. But the reality is the majority of people, most of us are compassionate people. There’s something called a carnival of compassion when there is a tragic event. You see it people after a hurricane people come out for volunteers, they want to help their neighbor, they want to help people they don’t know. Carnival compassion, generosity feeds, with, you know, feeding kids and things like that. Most of us really feel that and so, the paradox when there’s a tragedy is that we ultimately want to help and we have this impulse to be near somebody and hug them and say, you know, I want to help you, but that is exactly what we cannot do. So this, the other thing is, is that when we are in this social isolation there are people that may have some long term stigma from this social isolation like psychological fallout, so to speak. So there, like I said, there’s studies showing that you can have increased inflammation, we know increased inflammation, you can have increased brain inflammation, which can lead to anxiety and depression and things like that. So I think here on the Gut Check Project, we want to end with trying to figure out a way that we don’t have to make quarantine lonely, if you know what I mean.

I do, I do know that I’ve got I’ve got a couple ideas that I haven’t even told you about already.

Well, I want to hear him here. I’ll just finish up on kind of the science that I was looking at. People are people that are most physically susceptible to COVID19 or to SARS CoV2 are the same people that are most susceptible to loneliness. And so it’s that double edged sword. So I purposfully you know, I called my mom today she’s 78. And I was like, are you quarantine are you doing that? And she’d said, it’s all these other things. So, you know, this is the thing that we all have in common now we all have this in common with everybody around the world. Don’t get into this idea of panic scrolling through social media and overwhelming yourself, we need to intentionally interact. So I told you that today, I’m going to have a virtual birthday party. So that’s how I’m going to intentionally interact. So I’m going to make sure that we that me and my friends stay connected. It’s his birthday. Let’s do this. I’ve got a green screen that will I don’t want to take down my brick wall. That thing’s I just had that thing put up a few months ago. But I’m gonna do a green screen, maybe put a little club back there, you know, and we can pretend like we’re doing bottle service in Vegas or something. But anyways, that’s kind of that’s kind of what I want to do. And I want to see if our community can help us figure out how we can intentionally interact. What was your idea?

Two things. One, you and I are communicating through zoom. So, they’re not paying us a penny. But if you ever just want to connect with a neighbor or get a bunch of different people on, it’s free. If you want to have a conversation, I think up to what, 10 minutes or 15 minutes.

40 minutes on the free account.

Yeah, so 40 minutes, you can just invite whoever you want.

Limited limited number of invites is the only thing about that. So I think you just have a few here we’ve got our business account. So we can this is what I’m going to do when I host my birthday party with Brian here shortly that we’re going to, you know, invite however many people you want. So

The other thing is is and I just discovered it today. So I’m going to place a couple of orders through Amazon to get a couple of small things that I’m missing but I’m a musician and a want to link up with some other guys. It’d be fun to jam with and we can’t go to each other’s home but there’s a service that also isn’t paying us a penny. It’s called If you’re a musician, you can actually link up and it allows you to real time jam and play music with people as long as you all have a good hard wired connection so I can’t wait to get the stuff that I need to plug into the computer and and do that. So find ways to make community happen and in fact did you happen to see in Italy there were some people that a week and a half ago they’re in their village, they were standing out on the balconies keeping their more than six foot distance banging tambourines and seeing I mean, singing

Yeah, it brought a lot of hope, brought a lot of hope.


Yeah. So we want to do so anybody that’s that’s listening to this, please hit us up. And certainly, any ideas if you’re like, you know what we’re going to host a, I want to host a virtual coffee shop thing or whatever, but book club, we can do whatever. You know, I went on a quick side note, I read, let’s pr…Steven McWilliams gave me a book to read when Lucas and I were in Panama. We were Panama the country and I read a memoir book with not medical, not business, because that’s the first time I’ve read something non medical or non business in a long time. And it was called Let’s Pretend This Never Happened. And I was laughing out loud. And then him and I were talking, we were doing a business call on zoom. And he had read the book, and then suddenly him and I were joking about it. And I’m like, oh, book club, virtual book club. There’s a great way to go with it.

No, that’s awesome. Earlier, I was listening to Panama, by Van Halen. And that’s kind of all there is to that story.

Well, you can do that on your jamkazam, you can rock out some Panama there. So it would be interesting to bring the casual. So a lot of times and you and I do this with the show, you know, we kind of stress the show a little bit. We want to make sure that everything is tight and fine tuned, but in human interaction. It’s never like that the casualness of the interpersonal play. We could start doing this. As we get better at it. We can start doing this virtually just kind of sitting there and you know if I have dinner with somebody where you don’t have to be talking the whole time and it just be like, you know like you would with your, with your significant other or whoever you’re not always just sitting there telling the coolest story ever. You’re just taking a moment taking a bite. Look, I’m going broccolis good. Yeah. What did you do here? Oh, I added.

Now that’s awesome. Well, this is the first installment of COVID19 file for Gut Check Project. There’s going to be plenty more to come we’ll, we’ll keep updating we didn’t want to get out too early from the gate feeling like that we we wanted to have enough information to navigate the waters. There’s been a lot out there before. I feel like that Ken and myself don’t comfortable passing anything along. So let us know many of y’all have been keeping in touch. Just got three emails today from people who enjoy the fact that they could order What they could order obviously keeping your social distancing, but order or not does not matter. Let’s keep the conversation Well, if you have questions that you want to know specifically or if you have a story, let us know. If it affects you directly, let us know. How are you handling it? How are you managing? So rounding out like.

Well, yeah, the only thing that I want to add that I didn’t want to get into today because clearly there was a lot to cover. This is the first foundation, but like something else everybody wants to ask me, what supplements are you taking? And I’m oh, as always, let’s do a little disclaimer. I am a physician but I am not your physician. And so any advice we give here is strictly just an opinion and you’re not to take my advice as medical advice speak with your physician about this and whatever it is that the the the typical jargon that has to be said of this is a show this is for entertainment, but it’s also for information. So whenever reach…I think very clearly your your research, my research, these are not really our opinions, these are based off of us digging through a lot of research, at least during this period on these kind of things. You and I do have very strong opinions about a lot of other things. But we’re not gonna do that here. So what I would like to do is a show based on the science of what supplements have been shown to affect different viruses and things like that is it a one to one translation? Nobody knows it’s too early, but there’s some different things that I think we could be doing.

Definitely. Now, that’ll be a great show in and of itself. And we’ll back up everything that we say, with external science. It won’t just be coming from, from Brown or myself for sure.

Yeah. So hey, Eric, I appreciate you taking the time to do a different format. We’re on the zoom. I do. I do miss your empty chair right here. But fortunately, I have a large cutout of you that I did that I printed a big picture of your head sits right there.

That’s okay. Because you’re in the periphery. You can’t see anything around me but my son’s right here and he’s trying to be really funny. Over here

You think you’re funny.

I do think I’m funny.

A boxing nun.

That’s what happens that’s what happens away from the camera.

Well, you could go ahead and let him know that I don’t find that funny at all because I grew up Catholic and I’ve had some nuns punch me.

That’s gonna do it for the first installment of COVID files. It won’t be long till we get the next one out we’ll keep touch through email. If you are not a member already of the KBMD community just head up to like and share you can sign up to have emailed information out to you. As more stuff becomes available through the weekend and into next week. We will definitely keep you abreast of all this information.

One other thing also is that we’re doing I’m really ramping up my telemedicine practice. So if if you happen to live in the state of Texas right now, I think they’re opening the borders but we we are doing a lot of telemedicine and so just to recap because kind of scary. The virus is real. We need to do our part, there’s a lot of really good things on the horizon, we just need to buy some time on this. And the only way to do that is to do what we’re doing, which is stay your distance away. It is a highly infective virus. But we’re going to get through this, we’re going to get through it as a country. And when we come out the other side, we’re going to learn so much more on the science of everything. There’s never been such a collaboration of all scientists worldwide. Just saying here, what do you got? This is what I got. I think we’re going to come out so much better as a human race as we get through this.

Yeah I certainly hope so. I really do. So installment two, there is no schedule we’re having Paul push this out as soon as he can get his hands on it. So we’ll just keep ’em coming.

But the biggest thing is, please stay in touch with us. If you’ve got questions. We’ve got we’ve got access to a lot of great scientists, a lot of good literature and I want to hear, I want to see you know what I’d like to see, I’d like to see people sending us pictures or small videos of them doing social interaction during quarantine.

Yeah, send us your ideas.

Even if even if you just spend all day playing with the boxing nun.

I didn’t get I did not get Mac’s permission to do that but right, well, that’s gonna I think that’s gonna do it for this particular chapter. We’ll be back in the next one we’ll go through the science of keeping yourself safe with supplementation, etc. And then we’ll just do another update to see where we’re at.

Let’s do it. Stay safe, everybody.