This is an emergency episode of the Cloudbase Mayhem that everyone needs to hear. I sat down with two people on the front lines of Covid-19, my sister Lesley McClurg who is a Health and Science reporter for KQED in San Francisco, who has covered the pandemic since early January, when only 6 people had died; and Terry O’Connor, an ER doctor in Ketchum, Idaho- one of the most affected towns in the country (on par per capita with New York, San Francisco, and Seattle). We are in the largest public health crisis of our times. Covid-19 is being compared to the Spanish Influenza in 1918, which killed 50 million people. No one alive has ever seen anything like this before. But for many people it’s not tangible. It’s all data and numbers, and until it impacts a loved one, a neighbor, or someone you know it’s hard to understand. It’s called the “Novel” Corona Virus because it’s new and we know very little about the disease. What are the common misconceptions? Can our medical facilities and health workers handle what’s coming? How many people might die? What are the economic implications? And…what are the silver linings in this incredibly scary time? Birdsong and blue skies have returned to Wuhan for the first time in decades. We are realizing our own fragility. We’re realizing we are not invincible and we’re not in control. We’re suddenly faced with abundant time to evaluate what’s important in our lives. And we’re seeing the Earth’s resilience and how fast she can recover if we slow down. And finally- how should we recreate during this period? How should we approach risk? We need to think about it seriously.
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Where we’ve gone wrong in our response and what we need to do now, urgently
The biggest misconceptions of the Corona Virus
What we don’t understand about Covid-19
Corona can hit anyone, and YES- it can effect the young and the healthy
“Good for you that your healthy, but stop killing the rest of us”
There is no treatment, there is no cure
What are the numbers?
Can our medical infrastructure handle what’s coming?
How are our health workers at risk?
“At some point we will not be able to manage this”
What Covid-19 does to those infected- it’s not pretty
The frustrations of our health care providers
“This is a beast, and the best wants in”
How our culture compares to Italy
The importance of modeling good behavior
The importance of flattening the curve
How should we recreate right now? Getting hurt is NOT an option
When should we go get tested?
The psychology of a crises
We need to win hearts and minds, but doing it with the numbers isn’t going to work.
“This is a common problem for humanity right now. If you’re looking for a sense of purpose in your life, it’s here”
Mentioned in this episode:
Sam Harris, Chrigel Maurer, Gary Newsom, Andrew Cuomo, USHPA, Cross Country Magazine, Sun Valley, Ketchum, KQED, NPR, Wuhan, Mountain Express, Terry O’Connor, Lesley McClurg, Sun Valley Resort, Blaine County, Idaho; David Concannon, Marc Hanselman, SHV/FSVL, FFVL, SBSA, Neal Bradshaw, St Lukes Hospital, Paul Slovek, University of Oregon, Nick Streuli
0 [00:00:00] Um, you know, and I've, you know, there's, I think people are being pretty responsible about this. They're talking about like, well, Hey, we obviously can't take group rides up to the launch and we've got, you know, we've got a social distance, we've got to just hike and fly weave. We can't go deep. We have to, you know, land in our cars. You know, obviously we can't hitchhike, you know, all those things are true.
0 [00:00:23] But let me just ask you, I mean, should we fly? No one should do anything right now. Anything that could potentially get them hurt, number one, because they don't, I mean, let's just be, let's just look at it from a selfish perspective. You don't want to be in a hospital right now. Number one, hospitals are germs zones. You don't want to get this thing.
0 [00:00:44] You don't want to potentially then need to go to the hospital because you have covid 19 and hospitals are prepared to take care of you. So that's just on your own personal selfish level. You also, we absolutely, if we care, if you have a heart, you cannot put healthcare workers any more strain on the healthcare system.
2 [00:01:10] Hi there everybody. Welcome to this very special, I guess you could call this a public service announcement and emergency public service announcement of the Cloudbase mayhem. I wanted to reach out to two very dear people to meet who are very much on the front lines of covid 19 to find out what their reality is.
2 [00:01:31] And so we could put this out to you. This is not just pertinent of course to pilots. This is pertinent to everybody. Of course, we're all being bombarded with tons and tons of news. Some of, I'm sure there's lots of misconceptions somewhere and as both these folks about that, but I also have been seeing some really great stuff online and in forums and chat rooms and stuff, uh, from pilots all over the world.
2 [00:01:54] You know, should we be flying? I think this is a really important question. Right now they've shut down flying in a bunch of countries in Europe, Belgium, France, Italy. Uh, and I saw a great post yesterday by Kriegel that they haven't shut down flying in Switzerland, but he feels like it's really important not to fly. And if the best pilot in the world isn't flying, I thought, wow, we really need to be paying attention to this because I've also heard a lot of casualness.
2 [00:02:19] Like what don't you know, where are we expected to do? Just not fly. And so I wanted to talk to people on the front lines to get their expert opinion. And the two people I had the talk with, uh, the first is my sister who's a health and science reporter for NPR, for the KQ East ed station out in San Francisco. She has been following this story literally from when the first plane came here.
2 [00:02:43] They think from lawn. Of course there was other people that, you know, hadn't been tested. There are people before that. But uh, this is back in early January. So when this thing was a blip on most people's radar, she has been following this story. She's now of course in lockdown and doing all the reporting from her house. She has been for over a week, they're in San Francisco. But I sat down with her to just ask all the questions that we're trying to find out, you know, what is the death rate?
2 [00:03:09] Who, who's being a more effective and what's happened in the hospitals. Uh, how worried do we need to be about our healthcare workers and our health care system and talk about stats. Are we basically, they think we're 11 to 14 days behind what we've seen happen in Italy and now is very rapidly happening in Spanish and Spain and France.
2 [00:03:32] So, uh, some scary stuff, but also some silver lining stuff. And then I spoke to my very good friend and ski touring partner, kind of avalanche safety expert, but also one of the four ER docs we have here in my little town in Ketchum. And if you haven't heard Ketchum, Idaho is a real hotspot. It's right up there with, uh, New York and in San Francisco and Los Angeles, obviously not those kinds of numbers, but per capita it's one of these, they're calling it black County.
2 [00:04:01] So it's being impacted the worst because it's a ski town, very a vacation town. And when things started getting crazy in places like Seattle and San Francisco and LA, a lot of those second home owners flew back home to get away from it. And then of course it spread like crazy making fire here. They're saying now in this little community, there's not been 100% exposure.
2 [00:04:23] One of those ER doctors is down with covid. So I wanted to talk to Terry about that, but I just also, you know, we're hearing a lot about, you know, a shortage of beds, a shortage of ventilators and um, how are hospitals here very soon are going to be dealing with a real crisis. And so I wanted to talk to him to find out what he's dealing with, even in a small town like this, but also, you know, of course he's very much in contact with that, with his world of medicine all over the country.
2 [00:04:50] So I wanted to find out what she's seeing there. I know he's been incredibly smashed. Uh, he hasn't been able to do anything but work, work, work. And that's one of the problems. These are healthcare workers get a lot more exposure and they get exhausted and that makes a covid much more serious for them. So again, this is kind of a public service announcement.
2 [00:05:11] I think we as pilots really need to be thinking about our healthcare workers right now when we are assessing our own flying, we need to think about, you know, I've heard a lot of things like, well, Hey, it's only got a 0.8% kill rate in our population while yeah, but our population can give it to other populations. And so we need to be thinking about how we behave right now big time.
2 [00:05:32] And, uh, I really liked the critical put out yesterday that he wasn't flying. This is a personal decision for everybody, but I think this is an important one. This certainly isn't just for pilots though. Uh, I learned a ton and I've been following this thing like crazy as I'm sure all of you have. But, uh, please, please share this and this is, there's some great, incredible information here and, uh, everybody needs to hear it.
0 [00:05:58] So without further ado, here are my sister, unless you McClurg and then followed immediately after that by my good friend Terry O'Connor.
0 [00:06:20] Leslie, welcome to the Cloudbase. Ma'am, I never thought I'd be interviewing my sister, uh, for a flying show, but I think given what you've been doing and what you're reporting on, it's going to be really good to spread good information information. When I came back from California last week, uh, I was surprised to come back to Idaho, which, you know, as little red and a lot of people aren't taking it very seriously.
0 [00:06:45] Our town is now unlocked down as well as you guys have been for over a week out there in San Francisco. But let's just start off, explain to the audience you know, who you are, what your history is and what you're currently doing. I'm sitting in my bedroom, I'm on lockdown, uh, reporting most of the time. Uh, I'm a reporter for cake QED, which is the NPR affiliate in San Francisco.
0 [00:07:09] I sit on the health and science desk. So generally I cover medicine and health stories. And so about, um, actually about two and a half months ago, I came into the office and was told to race down to San Francisco international airport SFO because there was a virus in China and the and people were getting off a flight from Wu Han China, which I'd never heard of.
0 [00:07:34] I didn't know how to say it when I got to the airport. Um, but I was supposed to find this flight, meet these people and get a sense of what it was like in China on the ground because this virus was spreading, which I'd never heard of. What we now know is covid 19. So since about late January, I've been the primary reporter in San Francisco, in our station, uh, covering probably the biggest story of our time.
0 [00:07:58] And I have to say, kiddo, I've been really proud because, uh, I've been listening to a lot of your stories. You've been on the radio a ton. You're, you know, you're often on the radio, but you've really been on it lately. I know you're working your ass off. Um, so great reporting, uh, scary reporting. Take us through the arc from when you first went down and saw that flight to where we sit now.
0 [00:08:23] It's so, it, I honestly kind of gives me chills because when I got there, you know, people are getting off the flight and you know, maybe a quarter of the people are wearing masks. That was my only way of really knowing that this was the flight from OU. And otherwise I'm just showing up at the airport going, uh, excuse me. Can I get you to tell me what it's like in China? And as you can imagine, people from Wu Han don't speak a lot of English.
0 [00:08:45] So this is a very interesting story to try to cover. Um, but anyways, you know, I got a handful of people to, to tell me what it was like. And most of them were thrilled. They're coming to the U, most of them, most of them for, you know, lunar new year, this big, huge international celebration. San Francisco's a big hub, uh, to, to take in the lunar new year.
0 [00:09:05] So they're here, they're having a good time. They're telling me like, you know, it's not that big a deal. People just got worried a few days ago. Uh, you know, we're here to have a good time. There was definitely a tenor. I have amazing tape of people saying, we think this is gonna pass really quickly. You know, no big deal. At the time I remember it, six people had died from the Corona virus by that time.
0 [00:09:27] Um, I think there was something like 300 people who had been positively diagnosed at the stance at this point. The very next day they ended all flights. So that was the very last flight that came in to San Francisco from woo hot. It happened that fast. Exactly. I mean at that point there was probably a lot more cases on the ground than they knew.
0 [00:09:47] And the average person, you know, probably similar to last week, even two weeks ago in San Francisco, the average person on the street probably wasn't that worried about the virus and now we're all sitting inside our houses. So, um, it happens so quickly I think is what I'm just still floored by. Just looked at the number before the numbers before this interview. And I went, wow, like hundreds of thousands of people have this virus now.
0 [00:10:12] And I remember when there was, you know, a couple hundred. And so it's, I think by the day watching it into January and then into February and then now has been this, I don't even know. I mean basically feeling the curve basically if you've watched, if anyone's seen that curve of how cases takeoff, every city, they say anywhere between four and eight days, the number of cases doubles.
0 [00:10:36] So if you average that about every six days, the number of cases doubles around the world. And, and, and that is a crazy thing to feel and report on and to very like things that I would never have imagined last week that we would be on lockdown to be on lockdown right now. Um, it's hard to imagine. And so when I try to think about what it's going to be like next week or two weeks from now, I'm just like, I can't even wrap my head around it because they say that San Francisco is probably, or the U S is about 11 days behind Italy and I, if people have been watching the news or paying attention to what they're experiencing and Italy on the front lines, you know, you hear doctors call it, you know, uh, cataclysmic war in, in hospitals that's coming.
0 [00:11:22] I had a friend yesterday that, uh, she did another podcast with Honda yesterday and he, he's out in Davis, California, and I think we should, should we compare it to wartime? I mean, isn't it, aren't we kind of in a war? I think we're absolutely in the biggest public health crisis war that probably any of us will live in.
0 [00:11:42] We'll, we'll live through, you know, I remember early on in New York times reporter who has been doing this for a lot longer than I have, and then has covered many more epidemics than I have. He compared it very early on to the 1918 Spanish flu, which killed somewhere between, yeah, between 20 and a hundred million people, 5% of the population died.
0 [00:12:05] And I remember parroting that, uh, you know, the next few mornings that I was on on forum, which is our daily talk show saying, you know, some people are calling this the next Spanish flu, some really smart people are calling it that. That's what this is. And, and economists and other reporters like laughing at me and now here we are and hopefully we won't see those kinds of deaths.
0 [00:12:29] But there are some strange and very, um, nerve wracking statistics that are similar about how this is crossing and moving through the world. That happened, you know, almost a century ago.
3 [00:12:42] So a week ago and the, and the a week ago, it was like a different epoch. So to me, I mean, this is, it's changing so fast. Like you said, I mean T yesterday, Italy had its biggest numbers yet, 789 or something. I think I read there now worse than China. Um, the article in the times about Italy was pretty scary because the, the countries who have, who are a lot tighter, Australia, Singapore, Taiwan, South Korea testing has been ubiquitous and they literally, the lockdowns, they're serious and they, they took it very seriously pretty quickly.
3 [00:13:24] Um, and so we've got this Petri dish, we've got this live. We get to see what happens if we don't behave like that. Italy's is really terrifying. And, and what, what is happening there? Let me ask the question. Are we doing enough?
0 [00:13:41] No way. No, not even. I mean, I heard this morning, you know, the, uh, there was a bunch of spring breakers in Florida on the beaches and you know, they're just partying and having a good time and you know, it's really hard. It's really hard to wrap your head around a silent threat.
0 [00:14:02] You know, even as I was covering this, I haven't felt it until this last week when I really started to talk to doctors and nurses on the front lines who are, who are really, really nervous. I had to hear it in their voices to really grasp what we're about to face. And I've been covering this for six and a half weeks, reading as much as I can about this thing, but it's kind of like covering a fire before the flames are coming over the Hill.
0 [00:14:25] It's like, you know, it's out in the distance. You can't smell anything. You can't smell the smoke, but you know it's coming. And it sort of like, but nothing's happening. Nothing's changed in your life. And until now, until we're actually sitting inside, I'm starting to feel it. Like I said, I'm starting to talk to people who are feeling it on the front lines, but we are so dramatically and drastically behind where we need to be because of this giant mess up by our, by our government in terms of flopping the testing.
0 [00:14:53] We have no idea how many cases are out there. On top of that, a lot of cases are asymptomatic. So you have a lot of people who are transmitting this virus, which is incredibly transmissible without knowing that they're, they have the virus and if I wanted to get a test right now, I couldn't get one because we don't have enough. So we don't even know who has it. So it is you also, you also don't meet the criteria of getting testing.
0 [00:15:15] So we have, you know, we've, we're in hot zone here in Ketchum. No, we've got the most cases in Idaho. Uh, they put us on lockdown yesterday or last last night. You know, we have more confirmed cases than they do in Boise, but this is the thing with the data. We're not testing anybody. And if you don't have, if you don't have a fever, if you don't have the criteria, you can't even go get tested.
0 [00:15:36] So, alright, Matty and I have been sick. Fallon has been sick. Uh, you know, we, we were sick. We were out in California. Um, do we have a, do we not have it? Who knows, right? I mean, a lot of people, like you said, or ACH, asymptomatic. And so when we look at the numbers, you know, we just went, I think, well over 300,000 confirmed cases in the world.
0 [00:15:58] What does, what's the real numbers? I've heard all kinds of different numbers and we just enlist yourself. Korea unless you're Taiwan list your Singapore. We don't really know Dewey. No, we have no idea. And what's so sad is this didn't need to happen. This was a debacle. He says it because it was so difficult to make this test or it wasn't because this test doesn't exist.
0 [00:16:18] This is honestly because our government, the centers for disease control and prevention have a giant elitist ego and they decided to make their own test in early February. The test didn't come out right. Okay, that's a bummer. Make a new test or use the test that the world health organization handed out to dozens of countries or let the private sector make their own test but fix it and fix it fast.
0 [00:16:42] And instead a bunch of red tape and bullshit prevented the government from allowing that to happen. And now we're weeks, months, and unfortunately probably tens of thousands of lives behind. And that's what, that's what this article was talking about was that this thing seems to be somewhat manageable now.
0 [00:17:03] We don't know. You know when these societies opened back up, does it rage again? Is it the Spanish influenza? Does it come back in the fall? But it seems like if you attack early and you get super aggressive, you know, it sounds like, you know, Cuomo was pretty loose and now he's really cracking down. But it sounds like you've got to be, you kind of have to be two weeks ahead of this thing and it does.
0 [00:17:26] I mean when I read this six weeks finally I was like, Whoa, we're in real trouble here. Absolutely. We're, we're weeks behind. Our hospitals are weeks behind in terms of preparation and when we should have been loading up and taking care of supplies and making equipment and building hospitals. Our president unfortunately was reassuring us and you know, we can go down that line, which I probably shouldn't go down that line as a, as a health reporter to comment politically.
0 [00:17:54] But I will say that early on, even in my own reporting, you know, we were comparing this and looking at this, you know, like the flu and basically saying, look, the flu is a lot bigger threat. You know, between 15 and 40,000 Americans die every year of the flu, including a lot of kids this year, about 150 kids. You know, that was a bigger threat. And so let's focus on the bigger threat.
0 [00:18:16] And we really didn't, I was saying it too, we really didn't wrap our heads around the fact that this was already here because we weren't testing for it. Yeah. So let's, that's a good place to start then. So where, what are the most common misconceptions? Cause we're seeing snake oil. We're seeing that I, I saw a thing yesterday on Fox news, not that I ever watched Fox news, but I've just been curious because I don't like how are people not taking this seriously?
0 [00:18:44] And they were saying, Oh, but the numbers in Spain and the numbers in Italy, these are just old people that would normally die. They're not dying of covid. They're just dying because they're old. Like stuff like that. What are the biggest misconceptions about this virus we start there. It is primarily killing, you know, older people with preexisting conditions. But I thought the New York times did an amazing piece which really hit home for me, which was about a nurse.
0 [00:19:09] These two nurses were both 29 they both had children and they're both fighting. Covid 19 one died, one did not as a 29 year old healthy wine. Yes. It's an amazing piece. I highly recommend everyone read it because it really hits home. This virus can kill anyone. You know, we can look at those numbers just like the flu can kill anyone.
0 [00:19:30] You know, if it gets in there deep enough. What we don't understand very well about covid 19 when I say deep enough, I mean deep enough in the lungs. What we don't understand is occasionally, and especially this happens with people with preexisting conditions, it gets in there and then there is a rapid turn and we don't understand exactly why the people turn for an a bad direction and have deep respiratory issues and and their whole body starts to shut down in a really quick way that we don't quite understand and we don't understand exactly why that happens in certain people.
0 [00:20:04] Other than that, primarily it's happened in, in older people. You know, if we look at the mortality rates, so this can hit anyone. You know, I, I don't think everyone understands that. I saw an amazing headline. I think it was Newsweek that said, you know, something along the lines of good for you that you're healthy, stop killing the rest of us. Which, you know, which is true that, but, but even those of us that are young can die.
0 [00:20:28] I think one of the other big misconceptions is that there's some sort of treatment. I think that's the biggest thing that you see out there. There is no treatment. It's not like if you rushed you that the hospital, you're going to get some magic here. It's not that if you do some prescribed, you know, remedies that, that, that you're going to get better. Unfortunately, there is that doctors can do except for what they would do if you're an emergency situation in a hospital, which is try to keep your lungs alive if you're in that dire straits.
0 [00:20:55] So don't go to the hospital right now. If you're sick, stay home.
3 [00:21:00] I, and I, I've heard, you know, experts with John Hopkins and uh, you know, infectious disease experts that covered mad cow S one N one, you know, you name it, uh, avian flu sh H one N one. Sorry. Uh, eh, you know, and they, they are all talking about, you know, the reason we don't have a cure for the flu or the cold is vaccines are tough.
3 [00:21:25] And you know, we keep saying, well we'll, we'll probably have it in 12 months. Most of the people that I'm hearing are like, if we get an 18, it's gonna be a miracle. Is that a misconception?
0 [00:21:37] Totally true. Earliest we'll see is a year, you know, they are moving surprisingly fast on this much faster than we've seen in any other epidemic. You know, they mapped the genome of this really quickly, which is incredibly helpful for getting testing rolled out. They are starting their first trial. You know, the VAX first vaccine trial is happening in Seattle now.
0 [00:21:57] It takes a long time for a vaccine to roll out because you have to test a lot of people. If you start sending out a vaccine. And it has any sort of, uh, side effects that we haven't tested that you're gonna do more damage than you want to. So we need to take our time. And the earliest, I think we could see that it is a year to two to 18 months. So we might see a little, like you were saying earlier, we might see a kind of big woo like skyrocketing number of cases this spring.
0 [00:22:26] It gets pretty scary. And then the virus could get kind of go dormant over the summer because viruses don't thrive in warm weather. They tend to do better in cold, dry weather. So we might see a drop over the summer and we could see another burst in the fall. Uh, that's still going to be too soon for, for the vaccine to be ready, unfortunately. So this could be very bad.
3 [00:22:48] This hot, the humid hot thing has been really confusing for me. Leslie. I, you know, it's, our boat was just out in the Maldives. They completely locked down the country, put five islands and quarantine. I mean, two people went there from Italy and it went crazy. That's right. On the equator. It's humid, it's hot as hell, I guess.
3 [00:23:07] Humidity's bad, right? It's, it's you, you don't, it cold is bad and humidity's bad, but you know, isn't this just going to transfer to South America and Australia and New Zealand and you know, this thing's all over the world. Is that really going to, I mean, cause they talked about that with the Spanish influenza to Spanish influenza was pretty bad.
3 [00:23:30] It came out about the same time as covid 19 it was pretty bad that winter. Then it got okay and then it came back with a vengeance in the fall. That's a long time ago. That was a hundred years ago. We didn't have planes travel all the world and ships
0 [00:23:46] and boats and you know, it just seems to me like, is that, is that kind of a red herring as, I mean, what, what you point out really well in your question is that we don't know. And we don't, I mean, I've reported several different articles where I'm changing the statistics, you know, three or four days later, I've reported probably six different mortality rates because we don't actually know.
0 [00:24:08] And the mortality rate, we don't know because we don't know how many cases are out there. The denominator of the mortality rate, like you've got to know how many cases are out there in terms of how many people have died out of how many people have it. We don't know how many people have it right now. So that's why the mortality rate changes and that's why we don't know. We don't know if this thing's going to go dormant over the summer and act like other Corona viruses.
0 [00:24:29] It could do really well in hot weather. We don't know. So Leslie, you know, this was again a week ago that I heard this and things are changing so rapidly, but this gentleman that was with John Hopkins and they're doing a really good job of tracking the actual numbers and of course we're not doing enough testing so we don't know the actual numbers. But at the low end he was saying that, you know, if it's got a 0.6 mortality rate, which is the lowest and they think and only 30% get infected, which sounds pretty optimistic right now.
0 [00:25:05] Um, you know, Germany's saying it's going to be 60 to 70 there, but at the low end, uh, I've heard that, you know, when you count that, I think when people hear that they think, Oh, it's only 0.6%, that's no big deal. But when you add it up, that's three times the number that, the number that was killed in world war II.
0 [00:25:25] Yeah. I mean, so the flu every year kills 0.1% of people. For some context that kills hundreds of thousands of people every year around the world. That usually kills between 15 to 40,000 Americans every year. That's 0.1%. So you're talking six times more and that's the lowest I've ever heard. I've heard the lowest I've heard is 0.7%.
0 [00:25:47] It could be as high as 3%. That's very high. We don't actually think it's that high. But if you use the, you know, the current number of confirmed cases by the number of people who have died, it's uh, it's quite a bit higher. It's about 3%. So that is, you know, multiple times. You don't even want to do the numbers of what that could look like. But, but the mortality of rate of this, what's scary about this virus really scary is the combination that the fact that it's quite transparent, quite transmissible, and pretty deadly.
0 [00:26:16] So there's viruses that are more deadly, like Ebola, there's viruses that are more transmissible like measles. This hits us UN UN, uh, scary, sweet spot that was very similar to what you know, people have compared it to the 1918 Spanish flu. And so that's why that comparison is made is that it's a lot of people get this and, and a, and a number of people die from this.
0 [00:26:38] And that's what's scary. What's okay we've got, if we get a vaccine, great. But how do you see this panning out? I think the hospitals are going to be completely overrun and young people, you know, health care workers are the most, you know, vulnerable to this beyond older people because the amount of exposure that you get to a virus does impact the how sick you get.
0 [00:27:06] So if you're around a lot more sick people, you're going to get a lot sicker. So healthcare workers are incredibly vulnerable to this. We already don't have enough personal protective equipment, masks, gowns, et cetera, gloves to protect these people. We're already seeing a run on things and has even gotten bad here yet in terms of what they're seeing at hospitals, and we're already running out of the supplies.
0 [00:27:28] I don't even want to put a sense of of how many people are gonna die from this, but I think we will have never experienced anything like this. Any of us in our, in our lives. Yeah, I, I don't even know. I mean, that's the really bad part of this, right? We can really focus on that and that is going to be, is scary, terrifying.
0 [00:27:48] And what's scary is this is going to happen in the next two weeks that I'm going to start feeling this in San Francisco. You might start feeling it in sun Valley because we've probably flew some San Franciscans and some Seattle folks to you and now you have, right. That's actually, that's actually what they think. It's all the people that were in Seattle and San Francisco that came back to their second home. Exactly. And it's, you know, it's why people in a lot of vacation places around the country are probably gonna get outbreaks because you know, Americans are not used to following these kinds of draconian measures.
0 [00:28:17] Not that it's even draconian at this point, right. We're just being told to stay home. We're not getting ticketed like they are in France, but that's probably coming. We're probably two weeks behind those kinds of measures. You have to think that it is incredibly scary. What if politicians are willing to basically shut down the economy?
0 [00:28:37] I mean, they're shutting down the economy right now in California and in Seattle and in New York. If they're willing to do that, you have to know that they're terrified. And that's what's really, that's what's really scary. So I just did the calculator on that. So at the low end, that's one point. 2 million people. So that's twice the number of cancer in this country.
0 [00:28:59] Um, yeah, pretty nerve wracking for sure. I think one way I would love, we can focus, I mean, one thing that this weekend has just been a turning point for me, which is that there is an amazing silver lining that will come from this and it's hard to focus on that. When we were talking about those kinds of lives lost, but for example, and uh, just uh, a researcher that I heard this morning on Freakonomics, you know, says so 3000, more than 3000 people have died in China from covid 19 50,000 people according to his calculations, are probably saved by the fact that there's less air pollution over the last two and a half months in because factories are shutdown.
0 [00:29:42] Wu Han is seeing a blue sky for the first time in decades, people are hearing the birds chirp. People are waving across apartment buildings. People are slowing down. So not to diminish the people who will die and, and, and the blood and tears and sweat and anguish, anguish and grief that we are all about to go through.
0 [00:30:04] But this will hopefully change us in ways that we can't imagine either. And potentially hopefully make us slow down and look at aspects of our lives that, that are fast paced life didn't allow us to do.
3 [00:30:20] Yeah. I so glad you brought that up. I, I know that there's going to be enormous tragedy and I, before I say anything, I just want to say that those of you who are being affected by this negatively, of course my heart goes out to, you mean one of my best friends is an ER doc in town and I know he's just getting thrashed and I worry so much about him, but the silver linings here are unbelievable.
3 [00:30:47] I mean, it just feels to me like, I mean, if we go right back to the source of the virus, we shouldn't be treating animals like that. We got to shut down wet markets. We've got to make changes. That's not how, I mean, it just seems to me like the earth is breathing a sigh, a temporary sighed relief. You know, we've, we don't have planes.
3 [00:31:08] We don't have ships. Uh, we've got clear skies, we've got our trails were unlocked down here, but we're allowed to walk. Our trails were packed today. Everybody's outside, everybody's walking their dogs. Everybody is reading books. Everybody. I'm cooking like crazy. I've never cooked so much in my life. It's, it's fantastic.
0 [00:31:29] No, I went, yeah, I went for a bike ride today and I literally could hear the difference of the birds chirping like literally in a city to hear the birds chirping and T you know, I live in a condo complex where we all can go stand out in our yard and be six feet apart. And the conversations that we're having and the amount of social interaction that we're having, even though we're supposed to be on lockdown because we can stand far apart outside is, is life changing?
0 [00:31:56] Cause we're not, it's amazing. Have you heard about the dolphins in the mass and the dolphins in, in, in uh, yeah, in Venice there's a fish and dolphins. That's the, that's the meds. That sounded less of your health and science. My 20 hour days. I
3 [00:32:16] know, I know, I know. I don't know. It's, it's, I mean, I really think that, um, it's in a sense it's a little bit of human karma and you know, I, and I also, I think the other silver lining is, I think this is address rural sir rehearsal for the real shit that's coming. You know, when you listen to the experts, it's like this was totally inevitable.
3 [00:32:39] It's not if, and if we get something that is as transmissible as a covid 19, but is as deadly as an Ebola, but is learns how to adapt to live in us longer, you know, you could have something that makes the Spanish influenza and, and I'm not, again, I'm not being a scaremonger, it's just what the professional say.
3 [00:32:59] It's what the, it's what the science says is, you know, we've got way more people that travel around the world way, way easier, and there's a lot of unhealthy things that we're doing to the forest, to the animals, to uh, ourselves. And you know, our immune systems aren't as good at, you know, you, you just, you can tick off a lot of things here.
3 [00:33:20] And you know, you might have a virus that comes out in a few years that's way more deadly. But I think it's good we're going through this so we can learn from the mistakes that
0 [00:33:31] I absolutely think that we're going to get a moment to witness how the planet can, I mean, I mean this is just two weeks and we're seeing dolphins in the med, right? Like we are, we are seeing the planet come back that quickly, that resilient and we're seeing how fragile we are and that our capitalism and that our commerce is actually quite fragile and that we are not an invincible.
0 [00:33:59] We are, we're not invincible, we are not in control. And I think this, this moment is, is really gonna be an opportunity to learn that whether or not we learned that, um, you know, is yet to be determined. And you know, I think we can't have this conversation and not look at you and I are in a very privileged position as we discussed this. And you know, I don't know if it's true, I've heard this on the street, I haven't reported this statistic, but I said early on many times, you know that if you can start talking to your boss about commuting, you know, working from home and dah, dah, dah, well apparently 20% of Americans can work from home, 80% can't.
0 [00:34:33] So you know, the economic impacts and who's going to get hit hardest by this is the same people that always get hit hard. This, you know, the people who don't have means anyways, the people who are homeless, the people who are on the margin who are making it paycheck to paycheck. So this is going to have a massive impact on the people who, you know, our society doesn't take care of.
3 [00:34:53] And this is, this is what to me is really scary. All the countries that we've mentioned that are tackling this, including Italy, have free and universal health care. When you start putting that 40% of our, when you start looking at 40% of our country doesn't have $400 in emergency funds, they're not gonna want to go test it now.
3 [00:35:16] I mean, now testing is free. It wasn't in the beginning, but they're not gonna want to go, go to the doctor anyway. Especially now is they're losing their jobs. And so this to me, I think is the next, this is the next pitfall that we're going to see that actually makes me more scared, um, than the disease.
0 [00:35:37] I mean, I, we're dealing with it personally in our own household and that we have a nanny working for us who makes it paycheck to paycheck. And she's older and she lives in San Francisco. We live in Oakland. It's about a half an hour away. And do we, you know, take away her only income and, and protect ourselves in our little community, potentially protect her.
0 [00:36:00] You know, is it good for her to be traveling or do we make sure she can keep paying rent and, and, and put her in potentially in a risky situation. You know, and she doesn't have health care and she doesn't have extra money. And it's a really tricky decision on T I'm terms of like on a personal level, what to do.
0 [00:36:20] And, and you know, I'm just one person. Imagine that number of stories that ripple out from this.
3 [00:36:26] Yeah, I mean, eh, you know, the, the, the interesting thing about this compared to past, you know, massive, uh, you know, retractions in the economy like in 2008 and 1987 is that this is going, this is hitting the service sector way, way, way harder. And the service sector tend to be the people that don't have a lot bank and it's gonna be, it's gonna be mayhem.
3 [00:36:54] Okay. Final question. Um, there is a really interesting discussion going on and you know, this is a paragliding and hang gliding and free flight. Podcast so I wanna end on, on a question about flying and what you think about doctors and hospitals. There's, there's flying has been shut down in Italy, France, Belgium, number of other countries in Europe.
3 [00:37:19] Uh, a lot of them, you know, like Switzerland sounds like they're getting pretty close, but it's still open. But a lot of the Swiss pilots have just decided this isn't something we can do now. They're shutting it down because flying is dangerous and they don't want to add, uh, they don't want to add any more load to an already over, uh, are already broken system.
3 [00:37:44] And the hospitals are very tax system. And so I read the other day that the United States has 2.7 hospital beds per thousand people. Um, it does seem like that's where we're going to be very soon. Um, you know, and I've, you know, there's, I think people are being pretty responsible about this.
3 [00:38:04] They're talking about like, well, Hey, we obviously can't take group rides up to the launch and we've got, you know, we've got a social distance. We've got to just hike and fly weave. We can't go deep. We have to, you know, land at our cars. You know, obviously we can't hitchhike, you know, all those things are true. But let me just ask you, I mean, should we fly?
0 [00:38:26] No one should do anything right now. Anything that could potentially get them hurt, number one because they don't, I mean let's just be, let's just look at it from a perspective. You don't want to be in a hospital right now. Number one hospitals are germs zones. You don't want to get this thing. You don't want to potentially then need to go to the hospital because you have covid 19 and hospitals aren't prepared to take care of you, so that's just on your own personal selfish level.
0 [00:38:53] You also, we absolutely, if we care, if you have a heart, you cannot put healthcare workers any more strain on the healthcare system. We don't want to get colds, let alone break a leg, let alone break your back, let alone get paralyzed. Right now the the health care system does not have enough people to treat this virus right now.
0 [00:39:16] It is selfish to go flying right now. I'm sorry to all your pilots, but this is a moment to, to K this is such a moment, like one thing I love about covering any kind of, you know, breaking news, emergency, natural disaster kind of story, is that we are ripped bear to our raw humanity and people show up and it's, it always happens in a fire in a hurricane.
0 [00:39:40] And, uh, you know, I've covered a lot of this stuff and people show up like we are, we find our hearts and the sooner we do that in this country, the more lives we'll save. Awesome. Uh, it was the answer. Um, um, I'm glad I went flying today, but you've straightened me out. I appreciate it. Um, thank you.
0 [00:40:00] Thank you. Know, I, you know, and I, that's why I want to have Terry on the show tomorrow. I just know that those guys, they're just slammed. I got and it's just, it's a brutal time and I'm so scared for him. His story of what happened at your hospital. I mean, he talked to me a week before that happened and he said, you know, I'm glad I'm an Idaho. I'm glad I'm not dealing with you guys, what you guys are dealing with. Like, whew, I'm glad I'm in sun Valley.
0 [00:40:21] You know, in a week later, your listeners, listeners will hear what went down and why you guys aren't locked down now. So this thing can change quickly. Yeah. And that's, you know, that's pretty interesting. We don't know. None of us know what happened. So you know what happened. But you know, they're not allowed to talk. They're not allowed to talk about this. Interesting. Let's just say, you know, you have, you have fewer healthcare workers on the front lines, so people do not want to get hurt in sun Valley right now.
0 [00:40:47] And I don't mean people died, but I just mean, you know, there's, there's fewer people and people are sick. Yeah, no, I, I, I had heard that, that people are really sick. Um, Leslie, thank you. I really appreciate it and I appreciate your time and all the energy you've put into this amazing, unprecedented craziness.
0 [00:41:08] It's, it's unbelievable what's going on. And, uh, keep fighting hard. I think what you're doing is really important. Uh, you know, I know that journalists, uh, especially in our country have suffered Llyod under, under this, under this administration. But, uh, you know, you're fighting the good fight and I appreciate it. Thank you. Sorry. It took us, uh, a cataclysmic virus to finally talk.
0 [00:41:33] My
4 [00:41:34] brother who has a podcast is die. His sister who is a radio reporter, but here we are finally signed, only talking. So, uh, yeah. Thanks for having Gavin Terry.
3 [00:41:55] Awesome to have you on the show, man. I had a terrific conversation last night with my sister who I understand you've been talking to a lot lately, but let's just start off for everybody that doesn't know you, uh, what do you do? What are you doing right now?
5 [00:42:11] Uh, doing a lot, Kevin, for right now I'm drinking the last of my whiskey, so you owe me. Um, uh, yeah. So, uh, yeah, a lot of jobs. I am a emergency physician here locally where we live in Ketchum, Idaho, but I also have a couple of other jobs in the big one is being a emergency medical services, medical director for the County.
5 [00:42:38] And some of the other neighboring counties. So basically what that means is I help coordinate the response of ambulances and fire and coordinate that with hospital response, uh, for basically your routine run in the middle EMS calls, but also dealing with natural disasters, planning for big events and, and obviously dealing with a Corona virus pandemic.
3 [00:43:01] And when, when did, uh, for, you know, pardon the language, but when his shit get real for you guys,
5 [00:43:08] uh, just over a week ago, really, um, so kind of Friday the 13th, really, Friday the 13th into Saturday the 14th, if I've got the dates right the whole last week, spend a bit of a blur. But, um, you know, I think, you know, we've, we've got a smart group here. There's a lot of really well trained ER docs and nurses that are here.
5 [00:43:28] It's, it's obviously, it's a very pleasant place to live, so it attracts some good candidates for, for work here. And, um, and I think we all saw the writing on the wall that it might show up here any day, but the scale and speed in which it escalated, I think it surpassed many, much of our expectations.
3 [00:43:49] I mean, that seems to be happening around the world. Uh, if they don't lock this thing down and, and act soon enough and radically enough. T take me through. What does the hospital look like right now? What, what would someone be walking, you know, if someone broke an ankle and came in to see you guys, what are they going to see? Yeah. Well, you know, the first thing you'll be a probably
5 [00:44:11] see when you come to the hospital is that most of the entrances are cordoned off, um, and closed so that we route all traffic through a single entry, um, so that we limit people coming in potentially not being screened for, for having the, and spreading it amongst the hospital.
5 [00:44:33] So if you're, um, you know, there's two ways to get in. Basically it's through the ambulance Bay doors. If you're coming through an ambulance or uh, through the front entrance, which once you come in there, you're greeted by someone new is in a mask and asked you pretty much straight out, if you haven't noticed the signage on the way in whether you have any symptoms that might be consistent with the Corona virus for which right now we're screening for cough and fever and shortness of breath.
5 [00:45:00] The answer yes to any of those. Or if you say you're coming because you're worried about having Corona virus or covid 19 year, immediately have a mask put on you and you're kind of Corenti and off into this other corner of the main four year they're in the hospital. Um, and we have special protocols to kind of bring you back and to minimize, minimize your exposure to other patients that are in the ER.
5 [00:45:23] Um, but you'll also likely be directed to either a drive through testing site, which is pretty obvious to see because, um, it is a long line of cars there everyday. Now, uh, we had 150 vehicles come through today, uh, for drive through nasal swab testing.
5 [00:45:44] Uh, so it's fairly clear, uh, when you pull up to the hospital that something's going on over there by the, um, outpatient physician's clinic. And then there's also direction to kind of direct you to a new
3 [00:45:58] kind of fully serviced urgent care clinic where we're also trying to divert some traffic from the ER is just so we don't get congested. Those of you listening, I'd probably be who's us to talk a little bit about this community, you know, catch him is a town of 3,500 people. Uh, we're in central Idaho, one of the least dense populous places on the planet. And we're also now, I think they're calling us a black County.
3 [00:46:21] So per capita we're right up there with New York and LA and San Francisco. Is that correct?
5 [00:46:27] Yeah. So would you referring to a black County essentially there, there was a independent, um, statistician who essentially put together a graphic, uh, which the colors of the counties in the U S on his graphic, um, were shades of, uh, basically cases per per capita in that County.
5 [00:46:52] So, you know, Idaho is not a very populous state, so we don't have a lot of people. But currently right now in Blaine County where we live Gavin we have one of the highest rates per capita, um, of any other place in the nation. And so we have a high penetrance of disease despite, uh, are kind of low density population here, which, um, I guess you could take a one to two ways and that one, it's not that many cases relative to obviously boroughs in New York.
5 [00:47:19] Uh, but you could take it in another way. And that despite us being a small mountain town with low population density, um, we got a lotta, lotta penetrants, um, and a lot of, a lot of prevalence of this disease here and a really short period of time.
3 [00:47:36] And you know, one of the big news stories that you're hearing a lot right now, Terry here and across the world is of course the comparisons to Italy, how fast they were overrun and the comparisons with our health system. You know, I heard a statistic the other day, 2.8 hospital beds per thousand people in the U S how do you see this art going?
3 [00:48:00] How are hospitals going to be able to manage the coming crisis?
5 [00:48:07] The well, the crisis is already here, but the crisis is here. Yeah, well at some point we won't be able to manage it. Um, which is the reality. Um, you know, based on projections and, and probably the, um, the latest projection which is been getting most of the press lately has been.
5 [00:48:28] Um, actually when I was just reading it from today just to make sure I reference it correctly, uh, but it was, uh, done by a perio college, um, at in the UK and it was a specific projection based on kind of hospital capacity and projection of growth. The disease specifically for the UK and the United States.
5 [00:48:50] Um, it's kind of a collaborating center for the world health organization. Um, and pretty grave prognosis really. I mean, obviously our estimates will get better as time goes on, but we're, we're looking somewhere the end of April into early may when we will effectively have totally saturated every hospital bed available in the United States, um, with the impact of this disease, which is a pretty sobering thing to think about.
3 [00:49:19] And what about equipment? You know, what about protective equipment for you guys, for the people on the front lines, but also ventilators. It sounds like we're way short on ventilators and I mean this is a respiratory disease.
5 [00:49:33] Yeah. Ventilators. Uh, certainly we're, we're looking like we're going to be short on, on those as well. ICU beds we'll be short on as well. Um, the personal or, you know, the PPE or personal protective equipment, that one's tough to Berge act because, um, it's hard to know how much you're going to need even for each one individual patient.
5 [00:49:56] I mean we're required currently to change in and out of this protective equipment, which is, you know, a mask, face shield, um, gown and, uh, gloves each time you go in and out of a room of a person under investigation for the disease.
5 [00:50:17] So, um, there's something unexpected comes up if your patient gets sicker, um, you might have to go in and out of that room multiple times. So I might be efficient enough to be able to get through one patient visit with just one set of PPE, but sometimes I might have to go through four for just one patient and that, that might not even be a patient that needs to be hospitalized at all.
5 [00:50:39] Um, you know, if a patient just asks to speak to the doctor one more time and has another question and I need to go in and do a face to face to answer that question. And that's another set of PPE right there. Um, so it's really hard to project how long, um, or how much supply we're going to have when you have a lot of variable consumption of, of, uh, personal protective equipment.
5 [00:51:00] Um, the ventilators, uh, you know, it's, it, that's another tough one right now. You know, we're kind of building off projections of what, um, of what other countries have, have seen as far as their ICU needs and number of patients that have required, um, intubations.
5 [00:51:21] Um, but yeah, it seems like there's been a little bit of more severity so far in the diagnosis and the disease here. But again, remember that's a little bit of a bias because we're just rolling out the testing right now and we have limited supply of testing, so it's being conserved essentially for the sickest of the sick.
5 [00:51:41] And, um, so you're, you're biasing your current positive hit rate of the disease with those who are likely requiring hospitalization or needed to be an ICU. So it's looking like most people need to be hospitalized. Most people need intubation and the initial fatality rates that'll come out. Um, and the next few weeks we'll, we'll probably be pretty high as well.
3 [00:52:02] How serious is this and how much of what we're hearing? Uh, you know, this obviously depends on who we follow, but when I came back from California about a week ago, I was incorrect. I was amazed by the casualness that most people were taking this and they were very casual about it.
3 [00:52:24] We're just now seeing, you know, we went on lockdown yesterday, but still people aren't wearing gloves or not wearing masks. They're, you know, they're hanging out together. Um, how do you see this playing out?
5 [00:52:37] Yeah, I mean that's, that's the big challenge I think for us as healthcare providers on the front line Gavin is, it's hard to try to make this real to people when they're not CNN in their own lives. And I can remember this is, um, this is a problem. Nobody who is alive right now has ever seen before.
5 [00:52:58] Right. I mean, the last time we've got anything close to this destructive potential on human life was, um, you know, back in 1918 the great flu pandemic then. I mean, we haven't seen a disease. We've had scares SARS and MERS and Ebola and a number of other outbreaks that have made the news.
5 [00:53:17] But, um, this is a totally different beast. Um, and this piece wants in and it's also really elusive, man. It's, it's, it's hard to recognize so people don't know what it is when they see it. And that's also really confusing. So you know, when the threat can look like someone having a simple cough or runny nose or a sore throat, but that person doesn't look too sick, it's hard for an average person to translate that to, um, this is a disease state that can kill my grandma or my next door neighbor.
5 [00:53:52] Um, for those of us in healthcare, uh, we see the sickest of the sick, so it's super real. And we also are dancing around every single day and providing, um, and in a lotta lotta days just kind of just getting away with it, you know, without anybody getting hurt already. Um, and so it's scary to think that with the projections and exponential rise in these cases, um, what's going to happen to the quality of care and how many people are going to be effected.
5 [00:54:25] Um, so yeah, that sense of urgency is a really, it's a really hard thing to convey. And the problem is until it gets to the point that you have a friend or you have a neighbor or your mom or your friend's dad gets effected or gets hospitalized with this disease, it won't really mean anything to you.
5 [00:54:50] Um, because it, you know, people want to relate to it like something they've seen before. This is why you see all this criticism out there about, Oh, it's just another bad flu, right? It's because people want it to be familiar, a familiar threat, but it's, it's most certainly not. And by the time it becomes a familiar thread, it's going to be way, way too late.
5 [00:55:13] Clearly. So what, you know, when we see, uh, that the media is blowing this up, are they blown it up at all? They bone it up enough? No, I don't. I don't think they're blown out of proportion too much. I think, look, I mean, I too, you know, at the beginning of this with the crisis, the epidemic in China and Wu Han's first started, I was a little skeptical too, but I was inappropriately just concentrating on the case fatality rate.
5 [00:55:43] And I, most major outbreaks when they're first starting, when they're first getting reported, uh, the case fatality rate will be amplified to what the truth case fatality rate this, this, this kinda comes back to this idea of a sampling bias. When you're, when you're just starting to see the disease rollout and you're just starting to test and diagnose it, you tend not to test, uh, until someone gets really, really sick and you don't know why.
5 [00:56:06] Right. So say for instance, I had a hundred people come into my hospital and I had to see them all on a day and they all had Corona virus but I'd never seen Corona virus before. I kinda heard about it. Um, but it wasn't very prevalent in my community. It was still a rare and foreign disease and I had maybe two tests for it. I had like two swabs.
5 [00:56:27] I could maybe check out people for it. Now based on the spectrum of how the disease can look. A good majority of those patients, we think about 80%. They may have what looks like a coal, you know, they may just be coughing a little bit, they may have a low grade fever. This ad just don't feel that great doc. And I'm like, okay, well you got a cold, you know, sorry, this is pretty common.
5 [00:56:48] But then I might have this one guy in the ER who looks like a bacterial pneumonia to me and he's got shaking chills and his respiratory rate's high and his auction numbers aren't so great. And I do a chest X Ray and I kind of looks like a pneumonia I've seen before. And um, he's pretty, fab brow has a high fever. So I start throwing some antibiotics at em and I start giving him some fluids and I put them on oxygen, but he just keeps getting worse and worse.
5 [00:57:13] And I don't know why. And so I order a few more tests and I, OK, I'm not, I'm not getting, this is not adding up. It's not looking like anything I've seen before. And this guy's just getting sicker and sicker in front of my eyes, throwing every therapeutic. That's typically in my, my bag of tricks to pull out and fight disease. And then finally, I, I, I go to myself and I think, Oh wow, I wonder if this is that new novel viral disease everybody's been talking about.
5 [00:57:37] And then I finally ordered this test and say, and ideal word world that, that test came back, you know, within 24 hours or six hours or four hours. And then all of a sudden I go, Oh wow. It is one of these guys. Uh, but it turns out at that point, you know, he's clearly super sick. The real reason I did that test is because he was the sickest of those hundred people in the hospital that came in that day.
5 [00:57:59] I couldn't figure out what it was and everything I gave him didn't make them better. So I finally ordered this test to see if it was this rare disease I've never seen before. And so, um, he's a really sick guy. I'm seeing him late in the course of this disease. Uh, he's the sickest of the Corona virus cases. So he may have a fatality rate of up to 50% at this time.
5 [00:58:20] Finally have one or two tests. Uh, maybe I do, another guy's doing a little better off and I test him, but I only have two tests and one of them was on this guy and he ends up dying. And then the case fatality rate, right, is 50%. But if I was able to have a hundred tests and I tested every single person in that hospital that looked like a simple common cold than the case fatality rate would be 1%.
5 [00:58:41] So, you know, early on we kind of know from other pandemics looking at MERS and SARS and even H one N one, uh, when the initial data was coming out, the case fatality rate was, was pretty high and it's alarming. But as you find in time, uh, that case fatality rate will, will decrease in time. As you roll out more testing, you know, what you're looking for in the disease.
5 [00:59:03] You may actually be doing some sort of disease surveillance as people are crossing borders and you're finding out that, Oh, actually everybody that gets SARS and MERS are H one N one, they don't, they don't really die. Um, and so it doesn't look as bad as it's initially built. And so knowing that based on the history of diseases that have spread in the world, in the time of, of my practices, a position that kind of tempered my concern initially, uh, what really alarmed me as I started to read more about the epidemic and I started to read more about these, uh, fairly draconian and an intense measures that the Chinese government was placing, uh, on the region.
5 [00:59:47] You know, I didn't just dismiss it as just a cultural difference. I was like, Oh man, there's, there's something about this that they can't, it can't get a handle on this, you know, with, with routine, uh, infection control precautions. Um, and looking into it, then it became clear to me that this disease has a high, uh, you know, this are not value or essentially the, the probability that if you're infected, what's the chance or how many other people you're likely to infect, which you've as you've probably read, is around the area, about two to three other people.
5 [01:00:21] And, um, the only way to keep from spreading that disease to, to, to other two to three other people if you have it, is to make sure you don't have it anymore. Right? I'm like, you're over it. You're not, uh, someone who has a potential spreading the virus anymore. The problem is unlike a Bola where I'm coughing up blood or dang gay or malaria, where I'm like riding in bed with a terrible fever.
5 [01:00:49] Uh, it appears that the vast majority of people that are spreading this disease have a simple cough and feel fine. And in some frightening recent data, it may not even have any symptoms yet. And they're still spreading the virus. So this thing, its ability to spread to two or three other people, uh, essentially runs totally unmitigated until you just space people out, you know, and uh, this concept of taking ways people's freedoms and not allowing them to socialize and be with their family.
5 [01:01:20] Uh, it's, it's just a really foreign concept for people, but it's, it's the only thing we have in this fight right now in the absence of a known effective therapeutic or an immunization.
3 [01:01:34] This is, this is the thing that scares me the most is these, the, the, you know, South Korea, Taiwan, Singapore, China where you said that they've, they've put in place these quite direct konijn measures that also went with testing. It sounds like testing is, is like the key because you test, you isolate, you use all kinds of technology, you know, a phone tracing and apps and that kind of thing where they ban, who have they been with?
3 [01:02:00] You call those people and you get people isolated. And, and what I had underestimated was that you really have to do that within a family. You know, my, to my mind it was like, well, I don't have to worry about when my family, cause obviously I can't, you know, Maddie, Maddie's going to get sick. Fallon's gonna get sick. But this thing sounds way worse than what I originally thought.
3 [01:02:23] And really to get a handle on it, you have to be thinking about how is it going to spread? How is it, how are we going to stop it? And I don't see that happening very much here. Yeah. So, uh, when you say you don't see it happening and you think that, like you said, this might not turn a little bit more uptight, the draconian measures that you talked about, you know, that you, yeah.
3 [01:02:44] If you don't get strict and early and bold on this thing, um, you know, we've got Italy, we can look at it, we can, okay. Well that's what happens when you don't crack down. Yeah. And I think that's, that's a really good
5 [01:02:57] take home message as far as modeling comparables, right? Uh, are we more like South Korea and China? Are we more like Italy? Uh, with our culture and, and the way our society works. Um, and what we accept as mitigation measures from, you know, health experts in our government.
5 [01:03:20] You know, I think in China, certainly what government says goes right? And so when people are told they need to be in lockdown, they need to be in quarantine. The traffic in and out of an area's is shut down. Think about if you had a positive Corona virus test, uh, being told that you need to leave your home and go to a quarantine camp with a bunch of other people that tested positive for the disease, pulled away from your family, you know, that clearly would not fly in the United States.
5 [01:03:53] Right? And that's something as a culture and as a society that we just do not embrace that, that sort of authoritarian measure. It's, it's a, it's a violation of our autonomy. It's a freedom of rights issue. It's a, you know, a rights issue, uh, for better or for worse, that's the culture we have.
5 [01:04:15] But when you, when you have a culture that doesn't accept those measures and what you're left to rely on is winning hearts and minds and convincing people that they have to decide for themselves, that this is important enough to fight for and to do the right thing for and to, and to, to socially isolate, to limit spread of this disease.
5 [01:04:36] And people just aren't motivated by data. Gavin I mean, that's, it's the reality, you know, uh, that's how it's always played out in my practice as a physician throughout my whole career. You know, we, we give advice and we practice based on best available evidence, right? We read and we call over the scientific literature.
5 [01:04:57] We know what presenting symptoms are most likely with a particular disease state. We know which tests are going to be most accurate to help confirm that. And we know which therapeutics are most likely statistically to make you feel better. But what's tough, but the Corona virus is, it's really hard until someone has seen it with their own eyes, has heard it through a friend or a family member, uh, for them to believe that it's, it's real.
5 [01:05:25] You know, and I think we're seeing in our community now there, there is concern and people have this unsatiable hunger for the news about it because they're starting to be concerned because you know, guess what, they're two degrees separated now from someone they know who has it and now all of a sudden it's like, Oh my gosh, it's, and it's in this rural little ski town in the middle of nowhere in Idaho, man, man, I need to look into what this is all about.
5 [01:05:54] What can it do to me and what can it do to my family members? And people are beginning to care now. But in a lot of ways it, it may be too late because it's a, we haven't contained it. It's probably here and it's probably spreading in the community. And all we can do is our best to mitigate the spread of it further.
5 [01:06:14] And again, the only thing we can do is to, to win hearts and minds of people to, to keep their distance and you know, not hang out. And I'd love to hang out and come over and have dinner with you guys. But like I'm a high risk player right now, man. I, I'm, I'm in the line of fire of, you know, many cases come in through that. ER I've diagnosed and have confirmed hits on many patients at this point.
5 [01:06:38] I'm not sick, but is there a chance that I could spread it to you or your family members or some other good friends and want to have me over for dinner? Absolutely. And I big part of my job, as much as I would love to hang out with people on my free time cause I've been working like a dog, like it's just not modeling good behavior. Right? If I, if I don't make these sacrifices then I can't expect other people in my community to do the same.
3 [01:07:04] So let's, let's, that's a good segue into misconceptions cause you know, I've been hearing a lot of things that I, you know, like I said, it does seem like people are over the Hill here a little bit and they're, they're taking this a lot more seriously. But let's talk about some of the things that you're, you know, that may be aggravating for you. Like one of them that I hear is, well I'm young, I don't really have to worry about this.
3 [01:07:28] I might as well get it now because then I'll be immune to it down the line. And I just don't find this is sensible because it's the opposite of what I keep. We keep talking, we keep hearing about flattening the curve and how important that is. You know, if we all get it in the next month, you guys are screwed. Or the nationwide and that's kinda how it's looking.
3 [01:07:48] But, so we've got to do everything we can. It's better to get it later. It's better than not get it at all. But it's better to get it later. Correct. Yeah. Or just not at all. You know, like clip,
5 [01:07:58] like chlamydia, you know, better not to, I really don't want to get committee right now, so I'm good. I'm good later. I just don't want it. Uh, but others, I mean that, no, no, you're absolutely right. So th that's the thing that this, this concept of flattening the curve.
5 [01:08:17] It's, you know, it's a concept. It's, it's gained a lot of traction in the lay press just within the last week, you know, a Gavin I did a, um, I did a long lecture, about an hour and a half lecture to all my teams and also send it to the County commissioners about a week and a half ago about this concept a for the exact reason you bring it up now in that you have to, you have to create some sort of mental model of what things might look like if we just sit on our hands and wait for it to come to us, you know, and this idea of trying to convince people to adapt and embrace these changes in their lifestyles that are really inconvenient, if not flat out economically and financially and feasible for them.
5 [01:09:07] Right. I mean there's, there's people are not going to be a pay rent this next month cause their jobs have been shut down or they can't go to work or they've been told not to go to work. But when you tell people that it's all about limiting the rate of the spread of the disease, that we don't quickly surpass our medical capacity. In other words, going from a steep climb mountain to a little bit more of a flattened out mound over months, you know, were when you're mitigating a disease, you're still effectively expecting, you're going to get the same amount, you kind of expecting to get the same amount of cases, uh, of people that are going to get sick with this.
5 [01:09:48] But it's the difference of having those cases spread over 18 months versus concentrated over four. Right? And so if you have a bull rush on every medical facility there, hospitals are not gonna have room. ERs aren't going to be able to see you for hours. Uh, you may have a traumatic incident, you may not get cared for, uh, and, and an efficient time manner and have a bad outcome because of that.
5 [01:10:15] And you may be slowly having respiratory failure, but there's no beds left, admit you to, there's not enough oxygen to give to you or there may not be a ventilator for you in that event. If we quickly surpass our medical capacity. So we don't think that we're going to be able to bulk up our medical capacity within a period of a couple months.
5 [01:10:38] And the only thing that can save us is our community's behavior to mitigate the spread of this disease so that that caseload spreads out over that 18 months instead of over that four months. Uh, even then Gavin my, my worry based on a lot of recent analysis is that we're, we're still not going to be able to, to cover the cost of this disease, uh, from an impact on, on people's know, health and, and, and livelihood really, unfortunately.
5 [01:11:09] So now it's really about trying to, you know, we're in defense mode, right? I mean it's, uh, we're expecting to get some hits. We just don't want them to be as bad as they could be.
3 [01:11:20] How should we be recreating right now, Terry? I mean, how should people in this community and all over the world, you know, they have shut down paragliding in a number of countries in Europe, uh, you know, not because they're worried about stuff flying around in the air because they don't want one single other person in a hospital right now. Um, you know, we, should we take that to skateboarding, climbing, skiing?
3 [01:11:45] I mean, how should we be thinking about you guys?
5 [01:11:49] Yeah. Um, yeah, I'd, I'd prefer that you all just by like, you know, a bunch of and slight padding and just duct tape it around your whole body and then perhaps buy one of those like large and flip, you know, those orb? No. Resorbs I'd like everybody to just live in a sore for a while.
5 [01:12:13] It actually, it'd be perfect cause you're going to be insulated from everybody else. You're unlikely to get an exposure. And it's pretty hard, I think to get hurt. And, uh, that's what I'd like to see. Help me come up with a great idea. Actually. I'm going to, and I put that on my notes from my meeting tomorrow with the County. There you go. That could be the next, you know, you want it right now.
5 [01:12:33] You want to be in the business, like making ventilators and sores. Yeah, pretty much. But a serious note, I mean it's never been cooler to be a boy in the bubble. Gavin split it that way. That's my new campaign. Um, no. So the example here, so again, like before, so in our community here, I made a pitch on multiple levels, uh, at the risk of being an alarmist.
5 [01:12:57] But eh, you know, looking at the data, looking at the spread, you know, when this was first happening and the, and the information was coming out of China, it was kind of looking at, I was like, wow, this has a potential to be a big deal. Uh, but I think, I think not as many people will die as they're initially reporting. And yeah, the case fatality rate did go down as they started to and knacks on these measures.
5 [01:13:20] And as I explained before, as they started to test more and more people, right. Cause I found out a lot of people are fairly asymptomatic or had mild disease. Uh, but what quickly became apparent is that a case rates were growing exponentially, right. And then that model was repeated in South Korea.
5 [01:13:40] It was repeated in Iran and then it started to play out in Italy and you have the same experiment replicated in multiple different countries. Then you really start to worry and you know, that it's very likely going to be replicated in your own. And so knowing our limited testing capacity, I knew that, you know, as soon as we started getting positive hits, the United States, it would represent the tip of the iceberg.
5 [01:14:07] And, and because of the lack of adequate surveillance in the subtlety of disease process, when you start getting your first couple of hits, it usually means there's probably a lot more in the community. And so knowing that, uh, trying to send out, you know, a caution both to my hospital but also to my County commissioners and trying to educate and I spent a lot of time up front trying to educate my paramedics and EMT is because if you look at this concept of trusted messengers in the community, they actually have some of the highest trust in a community.
5 [01:14:39] Right? I mean, think about your average American society. You know, people love their firefighters, they love their paramedics, they love your, their ambulance workers. Uh, they may not be so much in love with their politicians and their mayors and their council people. And so you an ego straight to the, that's the one common denominator I have. I may not be in everybody's social tribe, but I've, I've got purview over these trusted member of society and I, I wanted to educate them as I would educate, appear in medicine of like, Hey, this is, this is why I'm worried about this.
5 [01:15:09] Because I wanted them to be able to share with all their friends and family members to win hearts and minds to be behind this effort before it really hit hard or at least understand why we were asking him to close schools, to not go to work, to don't throw that dinner party to uh, you know, cancel our film festival. Right. There were a lot of big things I had to do right at the beginning.
5 [01:15:30] That seems super absurd to people at the time. And, and it's, it's just really tough to give its people to do that before, before it actually hits. And I think he, you know, this concept of just trying to compare ourselves to other, to other countries is helpful, but you know, it wasn't, it also didn't really become real for me Gavin until one of these first nights I had to deal with.
5 [01:16:02] I worked a couple of nights shifts last weekend and it was before we had, it was before we had closed off, you know, entrances to the hospital. It was before we had really good protocols set up to let both our ambulance personnel but also our hospital people recognize what warning signs or initial subtle symptoms of the disease might be.
5 [01:16:25] It was before we had good protection for our registrars. Even in the ed. It was before we were deploying wearing masks and a lot of goggles and personal protective devices like gowns for these, these patients. And uh, we were kind of waiting for it to come to us. We were worried it was going to come in. And uh, then before even we got our first case announced in, in that 24 hour period of time, we went from um, having a case announced to then the next day I worked, I left the night shift, uh, about an hour after I left my shit at night shift.
5 [01:17:01] My partner that was working the day shift had a self-inflicted gunshot wound to the chest. He had to manage in a snow storm. They were able to, his life, at least here, they couldn't fly him out. So they're managing this critical trauma patient in the ER for a long period of time. He had a busy day. A lot of people started to be panicked about Corona. Virus with the ER was overrun with people coming in with common colds, wanting testing for coronavirus.
5 [01:17:25] He didn't have a way to, to divert them to drive through testing. Now anytime a patient that comes in with potential Corona virus case, you got to decontaminate the room, even if all you might do is put a swab in their nose and then discharge them in the hospital and say, Hey, we'll get you the results in a little bit. It's about two hours to turn over that room. Um, so then you've, then you've got all those rooms tied up.
5 [01:17:46] All these people are coming in. Had another patient that came in who had Corona virus who had a, um, a cardiac arrest at the time. I started my shift in the CT scanner. Uh, so we didn't know she had grown a virus at the time. So everybody goes running into the CT scanner to try to save this woman's life successfully.
5 [01:18:06] Resuscitator uh, do what unfortunately is a high risk procedure with someone who has Corona virus and intubate or put a breathing tube, enter or throat save her life. The uh, unwittingly exposed multiple men, multiple personnel to that patient and the virus unprotected cause we just didn't know at that time that that's what was going on with her at the same time, just an hour later.
5 [01:18:32] And I then find out that one of the previous first Sentinel documented cases of Corona virus came through the ER a week before was a settled case. Most people weren't wearing the appropriate protection so they get immediately quarantined. I lose half my nursing staff in the ER that night. So, and so I've got a woman who's intubated on a ventilator who's waiting for transfer for two hours because of bad weather.
5 [01:18:56] I lost half my staff. Over 50% of my rooms are taken up with cleaning because people are coming in with colds and coughs and want to get tested for the Corona virus I'm managing that patient. We have a couple of sick patients come in overnight. I'm working with some, some nurses I don't typically work with and we lent by that night and we get through.
5 [01:19:17] But I just like if that gunshot wound had overlapped in time with just another case or what if we had a, a bad ski accident off the Hill, a bad trauma off the Hill. And this is where it comes back to your point of like what if you had a bad trauma that happened from someone recreating on their own time and you know, and flying, you know, quickly you might over saturate, you know, a system that is getting, you know, rapidly overwhelmed with the impact of this disease if they're not appropriately prepared and staffing is short, you know, and, and they're taxed.
5 [01:19:52] And so, you know, a trauma sucks up a lot of personnel and it's just, it's best if we can just avoid, you know, those cases. I really, we don't like to take away people's personal freedoms, but the reality is we also don't have the best confidence people are going to get the best care possible anymore with the volume of disease out there.
3 [01:20:13] It's a pretty clear answer, Terri. Thank you. The, the other thing that I'm hearing that, uh, I'd like to get your thoughts on, Leslie mentioned, uh, in the, in the talk I had with her last night, that there was this amazing article, which I just read before you and I got on the phone about these two health care workers, 29 years old, female in Wu Han.
3 [01:20:33] Both totally healthy, no underlying conditions. Uh, they were both beaten up, you know, tired, working really hard as you have and everybody else has in the hospital. They both got it. They both tested positive. One of them died, one of them lived. It was terrifying reading through all this. This is a nasty disease. It's, I mean, when you get in bad, uh, it, it's not, you know, I think people think it's like, Oh, it's just the flu and we have to be reminded that, you know, a, the flu can be really nasty if it gets, when they're, and this is not the flu.
3 [01:21:04] It's way worse than the flu. But you know, one of the things I hear a lot of is I'm young. I don't have any underlying conditions. I don't have to worry about this.
5 [01:21:12] Yeah. Yeah. And um, you know, at the initial data from China seem to be how a lot of people were extrapolating that is that this was a disease that was primarily affecting those over 60 years of age, certainly into their seventies and most definitely the highest morbidity and mortality rates in the 80s.
5 [01:21:34] But that does not mean, uh, it, it doesn't hurt or harm those who are younger. I, uh, I had a patient who, uh, was 21 just last week, uh, who, uh, has, uh, you know, subsequently tested positive. He was again, one of the first kind of 10 cases of Corona virus in the, in the County here.
5 [01:21:55] Uh, he looked terrible man. He just looked absolutely terrible. I mean, it just take like the worst case of flu you could ever imagine and just amplify it, dial it up to 11. I mean, this kid looked fit, he looked healthy. He just did not look like kids who typically would whine about anything. His mom is sitting at the bedside and she's just like clearly terrified.
5 [01:22:16] She's never, you know, you read the situation like, okay, this mom has never seen her adult son now 21 years of age, look this miserable before and she's appropriately concerned. And he was just like, yeah, this is the sort of, it's this sort of appearance I've seen with Dan gay or malaria. Like he just wanted to jump out of his own skin.
5 [01:22:38] He looked terrible. I was short of breath and, uh, you know, he's subsequently recovered. But, um, you know, he was one of these guys I was worried about for a long time. Like he might've tipped into developing a lot of this inflammatory response, essentially fluid building up in his lungs and effectively suffocating from this disease.
5 [01:22:58] And it can be really nasty. And I, and I think these are the, these are the stories that, you know, we really do need to tell to give its people to do the right thing because if you tell a bunch of your friends who are in their twenties, thirties, and forties, that it's not a disease of concern for them, uh, then they have no emotional investment to, to, to tend to it, right?
5 [01:23:24] You're, you're going to care about something. If it is an immediate threat to you or an immediate threat to a loved one, you know, and, and until that happens, uh, most people aren't invested. And the only surrogate for that is to be able to tell a good yarn and tell a good tale that's relatable to you. Really, for those of you like you and I who are believed and concerned about this problem, um, we need to empower our friends of like the power of anecdote and a story like, you know, when you hear about with something has happened to your neighbor or to your mom's friend or your grandma or to your buddy, uh, or just telling the story of this, this article that you've read about, these clinicians are in their twenties, nearly dying.
5 [01:24:11] Like one of these anecdotes. Yeah. Uh, these anecdotes are actually what convince people to change. Uh, it reminds me actually Gavin of, um, there is, uh, there's a researcher, this guy Paul Sloate at the university of Oregon who did some really fascinating psychological research about what makes people change their behavior specifically when it comes to making sacrifice.
5 [01:24:38] So altruistic behavior, um, you know, donating, giving money and they, they, they came up with this really interesting experiment where, um, they enrolled this at the university of Pennsylvania. They enrolled a bunch of subjects for another psychological experiment was totally unrelated, but they gave the students five bucks after they're done, right? So this is, this is your money, you got produced quick experiment with us.
5 [01:25:00] But when they got the five bucks, I said, Hey, you know, we've got this terrible famine problem in Africa right now and we've partnered with save the children and we're curious if you'd be willing to donate, you know, a portion of the proceeds from, from volunteering for this experiment, uh, to the cause. And then they presented with the subjects with three different scenarios. Um, one was what they called the identifiable victim.
5 [01:25:23] So they basically, they, they, they told a good tale. They give you this story about a young girl. It tell you her name, where she lives, what she looks like, what she does day to day, why she's starving, what her family is like and how she wants to go to school, but she can't. And um, they just stick with the character, right? They just give the story of the one person.
5 [01:25:45] And then they presented another group with all the statistics about the impact of the famine, how many people were starving, uh, you know, and Uganda and what the drought rate was. And, and then the third group, they actually told the story of this young character, but then they backed it up with the statistics. And, uh, as you would expect where I'm going with this tail, they found out that people that just heard about the identifiable victim, the young girl they gave about twice as much as anybody else.
5 [01:26:12] Uh, and certainly the less, the least amount were in the groups that just heard the statistics. And interestingly, the ones that heard the story about the young girl, but then we're also given the statistics, they ended up giving less, which seems to say that something about statistics and the scale of the problem, it tends to make us a want to not listen or turn it off.
5 [01:26:34] Maybe because it's so scary and, and perhaps that's a cautionary tale of what's happening right now Gavin is that, you know, we're trying to win hearts and minds by telling people how terrible this is with numbers and how many people are dying and this concept of are not values and how many other people you might infect. And this concept of exponential rise, people don't understand what exponential rises, you know, but if you tell them a story about another pilot, you know, in Switzerland who came down with a disease and had to be admitted to the ICU and nearly died and was intubated for a week, clearly that's a story in your listener base that's going to gain some traction, right?
5 [01:27:15] But this isn't just about pilots. And a lot of the pilots that are listening to this podcast have friends who were climbers and our friends who are skiers, but we have many different social circles we run in. There are relatable stories for all those social circles, right? Yeah. Uh, you guys are capable of what I'm, what I'm capable of doing in the job too, and trying to tell a tale that resonates with someone else to change their behavior, to do basically just the right thing to do, uh, for humanity right now.
5 [01:27:46] Uh, and that's, that's our task and challenge right now. Uh, you know, we cannot, we cannot sit in our hands and wait for a immunization. We can't think that we're going to contain it at a communities at this point. And, and frankly, as much as I'd like to see testing rollout, uh, on a much larger scale, you know, I, I'm not counting on it.
5 [01:28:07] Yeah. You know, I just, I think it's, it might be too late. It's going to be great when it shows up, but, you know, I think that's just, maybe that's my bias and my talent as an ER doc, you know, I think we just kind of get served shit sandwiches all the time and we just gracefully eat it and throw a little parsley on it and call it good. Uh, and that's our job, you know, and we expect little and are pleasantly surprised.
5 [01:28:30] Uh, I'm expecting total catastrophe out this, but I think your listeners and their community, eh, that's where the power lies for me to be pleasantly surprised about the impact of this disease. And, and so I appreciate you doing your part to win some hearts and minds and the fight and, and keep, keep people following what seem like really, ah, they seem like such simple measures and it's, I think it's really hard for people to, to understand how it could be doing anything.
5 [01:28:57] Uh, and, and they are, they're inconveniences know, I can't hang out with you and your family. You know, I can't have dinners with my friends. I can't, yeah. I mean it just like, uh, I can't show up to any other public space, you know right now. Sure. Uh, and that's hard and it's also really hard thinking that we might have to do that for months. Yeah.
3 [01:29:18] Yeah. I mean it's, it's easy to say right now, you know, you're not enjoying things cause you're working your butt off. But you know, what I'm hearing from a lot of people is, you know, the trail heads are packed right now. You know, the one I'm hearing from a lot of people is, you know, it's, it's suddenly allowing us to a, you know, contemplate our own fragility in the world and be soak it up.
3 [01:29:41] I mean, it's just, it's an amazing opportunity for some, now again, like Leslie and I just talked about is, you know, there's a lot of people who are going to be really negative affected by this. So, but, you know, it's, it's, it's a time to reflect. It's a time to be quiet, to, to time to listen. So time to breathe.
3 [01:30:01] And that's certainly what the planet's doing. And uh, you know, so yeah, we talked a lot in the last one with the silver linings. I don't think there's a lot for you guys, but, uh, except maybe that this is a dress rehearsal for the next one that might be worse, I guess. But
5 [01:30:17] yeah, there's that. I also think that, you know, I think the other thing Gavin you and I've talked about this too a bit, is that, you know, sometimes it's really nice to have a common problem to, to kind of align behind, you know, and fight for. And this is, this is a common problem for humanity right now.
5 [01:30:38] And, um, I think it's also, I think it's also important to have challenges that matter. You know, this one clearly really, really matters. And, uh, if you're looking for a sense of purpose in your life, I mean, it's here now.
3 [01:30:50] Yeah. There's no doubt. Yeah. Yeah. Terry, thank you man. I have taken up way too much of your time. Get some sleep. You got a night off you. Well, you know, I get to ever get any time off. I know right now, but I appreciate it. Thank you very much. Thank you to you and everybody out there that are fighting the good fight, man, I feel for you. I worry about you all and uh, stay healthy.
5 [01:31:13] Yeah, man. I'm, I'm, I'm doing my best. That's what I'm drinking. Whiskey. Perfect Steris sterilizing my bloodstream that don't botch it out. That's a misconception. That doesn't work. That's, that's the anecdote. That's, yeah, that's anecdote. That's my works for me. It may not work for you and I may not work for all. And now I gotta I gotta I gotta respond to a text from your sister now.
5 [01:31:34] Great. Great. Thanks buddy. I appreciate it. And get some sleep.
