113a. The Corona Virus- Critical Choices in a Critical Time

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 to, you know, we've got to social distance. We've got to just hike and fly. 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? 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 germ 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. You also, we absolutely, if we care, if you have a heart, you cannot put healthcare workers any more strain on the healthcare system.

Hi there, everybody. Welcome to this very special, I guess you could call this a public service announcement, an emergency public service announcement of the Cloudbase Mayhem. I wanted to reach out to two very dear people to me who are very much on the front lines of COVID-19 to find out what. Their reality is. 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. I'm sure there's lots of misconceptions. I wanted to ask both these folks about that. But I also have been seeing some really great stuff online and in forums and chat rooms and stuff from pilots all over the world. 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. And I saw a great post yesterday by Chrigel 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, like what 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 the first is my sister, who's a health and science reporter for NPR for the KQED station out in San Francisco. She has been following this story literally from when the first plane came here.

They think from Wuhan. Of course, there was other people that hadn't been tested. There were people before that. But 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 of her reporting from her house. She has been for over a week there 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? Who who's being more affected? And what's happened in the hospitals? How worried do we need to be about our health care 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 Spain.

In Spain and France. So 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 New York and San Francisco and Los Angeles. Obviously, not those kind of numbers, but per capita. They're calling it Black County. So it's being impacted the worst because it's a ski town, very vacation town. And when things started getting crazy in places like Seattle and San Francisco and LA, a lot of those second homeowners flew back home to get away from it.

And then of course, it spread like crazy, like game fire here. They're saying now in this little community, there's been 100 % exposure. 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. You know, a shortage of beds, a shortage of ventilators, and how our 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. So I wanted to find out what he's seeing there. I know he's been incredibly smashed. 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 COVID much more serious for them. So again, this is kind of a public service announcement. 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. Well, 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. And I really liked that Chrigel 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. I learned a ton. And I've been following this thing like crazy, as I'm sure all of you have. But please, please share this.

And this is there's some great, incredible information here. And everybody needs to hear it. So without further ado, here are my sister and Lesley McClurg, and then followed immediately after that by my good friend, Terry O 'Connor.

Lesley, welcome to the Cloudbase Mayhem. I never thought I'd be interviewing my sister 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. When I came back from California last week, I was surprised to come back to Idaho. Which, you know, is a little red. And a lot of people aren't taking it very seriously. Our town is now on lockdown 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.

Well, I'm sitting in my bedroom on lockdown, reporting most of the time. I'm a reporter for KQED, which is the NPR affiliate in San Francisco. I sit on the health and science desk. So generally I cover medicine and health stories. And so about, 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 people were getting off a flight from Wuhan, China, which I'd never heard of. I didn't know how to say it when I got to the airport. 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 as COVID-19.

So since about late January, I've been the primary reporter in San Francisco in our station, covering probably the biggest story of our time.

And I have to say, kiddo, I've been really proud because I've been listening to a lot of your stories. You've been on the radio a ton. You're often on the radio, but you've really been on it lately. I know you're working your ass off.

Great reporting. Scary reporting. Take us through the arc from when you first went down and saw that flight to where we sit now.

It honestly kind of gives me chills because when I got there, people are getting off the flight and maybe a quarter of the people are wearing masks. That was my only way of really knowing that this was the flight from Wuhan. Otherwise, I'm just showing up at the airport going, excuse me, can I get you to tell me what it's like in China? And as you can imagine, people from Wuhan don't speak a lot of English. So this is a very interesting story to try to cover. But anyways, I got a handful of people to tell me what it was like. And most of them were thrilled. They're coming to the U.S., most of them for Lunar New Year, this big, huge international celebration. San Francisco is a big hub to take in Lunar New Year. 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. 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 going to pass really quickly. You know, no big deal. At the time, I remember six people had died from the coronavirus by that time. I think there was something like 300 people who had been positively diagnosed 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 Wuhan. Jesus,

it happened. Did it happen fast?

Exactly. I mean, at that point, there was probably a lot more cases on the ground than they knew. 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 it happens so quickly, I think, is what I'm just still floored by. I just looked at the numbers before this interview, and I went, wow, like hundreds of thousands of people have this. 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 take off, every, they say anywhere between four and eight days, the number of cases doubles. So if you average that about every six days, the number of cases doubles around the world. 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, 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 if people have been watching the news. Paying attention to what they're experiencing in Italy on the front lines.

You know, you hear doctors call it, you know, a cataclysmic war in hospitals. Like that's coming.

I had a friend yesterday that I actually did another podcast with Hansa yesterday. And he's out in Davis, California. And I think we should, shouldn't we compare it to wartime? I mean, isn't, aren't we kind of in a war?

I think we're absolutely in the biggest public health crisis war. That. That probably any of us will live in, will live through. You know, I remember early on a New York Times reporter who has been doing this for a lot longer than I have. And been, has covered many more epidemics than I have. He compared it very early on to the 1918 Spanish flu, which killed somewhere between.

I heard that

show. Yeah, between 20 and 100 million people. 5 % of the population died. And I remember parroting that, you know, the next few mornings that I was. On, on forum, which is our daily, um, talk show saying, you know, some people are calling this the next Spanish flu. Some really smart people are calling that, 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, 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.

So a week ago and the, a week ago is like a different epoch to me. I mean, this is, it's changing so fast. Like you said, I mean, yesterday, Italy had its biggest numbers yet. 789 or something. I think I read they're now worse than China. Um, the article in the times about Italy was pretty scary because the, the countries who have. Who are alive. A lot tighter, Austria, Singapore, Taiwan, South Korea, testing has been ubiquitous and they literally, the lockdowns there are serious and they, they took it very seriously pretty quickly. 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 is, is really terrifying. And what, what is happening there? Let me ask the question. Are we doing enough?

No way. Not, 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. 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. 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. 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's 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 government in terms of flopping the testing. 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 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. Well, you also

don't meet the criteria of getting testing. So we have, you know, we're in a hot zone here in Ketchum. We've got the most cases in Idaho. They put us on lockdown yesterday or 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 a fever, if you don't have the criteria, you can't even go get tested. So Maddie and I have been sick. Fallon has been sick. You know, we were sick when we were out in California. Do we have it? Do we not have it? Who knows? Right? Exactly. I mean, a lot of people, like you said, are 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.

What's the real numbers? I've heard all kinds of different numbers. And we just, unless you're South Korea, unless you're Taiwan, unless you're Singapore, we don't really know, do we?

No. We have no idea. And what's so sad is this didn't need to happen. This was a debacle. This isn't because it was so difficult to make this test or it wasn't because this test doesn't exist. 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. OK, 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. And instead, a bunch of red tape and bullshit prevented the government from allowing that to happen. And now we're weeks, you know, 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, we don't know, you know, when these societies open back up, does it rage again? Is it the Spanish? 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 doesn't. I mean, when I read this article in Italy, I was like, whoa, we're in real trouble here.

Absolutely. 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 could go down that line, which I probably shouldn't go down that line as a health reporter to comment politically. 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. 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? Because we're seeing snake oil. We're seeing that. I saw a thing yesterday on Fox News. Not that I ever watch. Fox News. But I've just been curious because I'm like, how are people not taking this seriously? 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? If 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. It was about a nurse. These two nurses were both twenty nine. They both had children. They were both fighting covid-19. One died. One did not. That's a twenty nine year old healthy. Twenty nine. 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. 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? 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 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, other than that. Primarily, it's happened in older people. You know, if we look at them. The mortality rates so this can hit anyone, you know, 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. 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 rush to the hospital. You're going to get some magic cure. It's not that if you do some prescribed, you know, remedies that that that you're going to get better. Unfortunately, there is nothing that doctors can do except for what they would do if you're in emergency situation in the hospital, which is try to keep your lungs alive if you're in that dire strait. So don't go to the hospital right now. If you're sick, stay home and

I I've heard, you know, experts with John Hopkins and, you know, infectious disease experts that covered magic. MedCal, S1N1, you know, you name it, H1N1, avian flu, H1N1, sorry, 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. And, you know, we keep saying, well, well, 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 going to be a miracle. I

think I think

is that a misconception? No, I think

that's absolutely true. 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 map the genome of this really quickly, which is incredibly helpful for getting testing rolled out. They are starting their first trial. The first vaccine trial is happening in Seattle. Now 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 side effects that we haven't tested. You're going to do more damage than you want to. So we need to take our time. And the earliest I think we could see that is is a year to 18 months. So we might see a little like you were saying earlier, we might see a kind of big like skyrocketing number of cases this spring.

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. That's still going to be too soon for for the vaccine to be ready, unfortunately. So this could be very bad. This

this hot, the humid, hot thing has been really confusing for me, Lesley. I, you know, it's our boat was just out in the Maldives. They completely locked down the country, put five islands in 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 humidity is bad, right? It's it's you don't it cold is bad and humidity is 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, because they talked about that with the Spanish influenza. The Spanish influenza was pretty bad. It came out about the same time as COVID-19.

It was pretty bad that winter. Then it got OK. And then it came back. With a vengeance in the fall. That's a long time ago as a hundred years ago. We didn't have planes travel all over the world and ships and boats. And, you know, it just seems to me like is that is that kind of a red herring? I

mean, 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. 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 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 is going to go dormant over the summer and act like other coronaviruses. It could do really well in hot weather. We don't know.

So, Lesley, you know, this was, again, a week ago that I heard this. Listen, 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 point six mortality rate, which is the lowest and they think and only 30 percent get infected, which sounds pretty optimistic right now. You know, Germany's saying it's going to be 60 to 70. 70 there. But at the low end, I've heard that, you know, when you count that, I think when people hear that, they think, oh, it's only point six percent.

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 Two.

Yeah. I mean, so the flu every year kills point one percent of people for some context that kills hundreds of thousands of people every year around the world. It usually kills between 15 to 40,000. Americans every year. That's point one percent. 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 point seven percent. It could be as high as as three percent. 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 it's quite a bit higher. It's about three percent. 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 transmissible, quite transmissible and pretty deadly.

So there's viruses that are more deadly, like Ebola. There's viruses that are more transmissible, like measles. This hits a scary sweet spot that was very similar to what 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 a number of people die. And that's what's what's scary.

What's OK. 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 how sick you get. So if you're around a lot more sick people, you're going to get. A lot sicker. So health care 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 hasn't even gotten bad here yet in terms of what they're seeing at hospitals. And we're already running out of those supplies. I don't even want to put a sense of how many people are going to die from this. But I think we will have never experienced anything like this, any of us in our lives.

Yeah. Yeah.

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. 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. Yeah, that's

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, yeah, and it's, you know, it's why people in a lot of vacation. Like places around the country are probably going to get outbreaks because, you know, Americans are not used to following these kind of draconian measures. 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, we are shutting down the economy. Right. 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 two million people. So that's twice the number of cancer in this country. Yeah. Pretty nerve wracking for sure. I

think one what 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 just a researcher that I heard this morning on Freakonomics, you know, says so 3,000 more than 3,000 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 year. In the last two and a half months in China, because factories are shut down. Wuhan 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 the blood and tears and sweat and anguish and grief that we are all about to go through. 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 our fast paced life didn't allow us to do.

Yeah, I so glad you brought that up. 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. I 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 on believable. 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've 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 sigh of relief.

You know, we've we don't have planes. We don't have ships. We've got. We've got clear skies. We've got our trails. So we're on lockdown here, but we're allowed to walk. And 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. I went. 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, 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 life changing because we're not. It's amazing.

Have you heard about the dolphins? Yes.

And the dolphins in Britain in. Yeah. In Venice, there's fish and dolphins. That's the

mad. That's the mad. That's the mad lesson. You're health and sciences. And I'm the geography expert here.

I'm tired. I've been working like 20 hour days and I have a child. I know. I know. I know. I know. No, it's it's I mean, I really think that it's in a sense, it's a little bit of human karma. And, you know, I also I think the other silver lining is I think this is a dress rehearsal rehearsal for the real shit that's coming. You know, when you listen to the experts, it's like this was totally inevitable. 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 influencer. And then I'm not again, I'm not being a scaremonger.

It's just what the professionals say. 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 ourselves. And, you know, our immune systems aren't as good. You know, you you just you can tick off a lot of things here. 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 we're making.

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. We are we are not invincible. We are not in control. And I think this this moment is really going to be an opportunity to learn that whether or not we learn that, 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 discuss this.

And, you know, I 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 da da da. Well, apparently 20 percent of Americans can work from home. Eighty percent can't. 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. Right. 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.

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 percent of our. When you start looking at 40 percent of our country doesn't have four dollars in emergency funds, they're not going to want to go test. I mean, now testing is free. It wasn't in the beginning, but they're not going to want to go go to the doctor anyway, especially now as 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 than the disease itself.

I mean, we're dealing. 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 is older and she lives in San Francisco. We live in Oakland, which is about a half an hour away. And do we, you know, take away her only income and protect ourselves and our little community, potentially protect her? 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 in terms of like on a personal level what to do. And, you know, I'm just one person. Imagine that number of stories that ripple out from this.

Yeah. I mean, you know, the the the interesting thing about this compared to past, you know, massive, 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 of bank. And it's going to be it's going to be mayhem. OK, final question. There is a really interesting discussion going on. And, you know, this is a paragliding and hang gliding and free flight podcast. So I want to end on on a question about flying, what you think about docs. And hospitals, there's there's flying has been shut down in Italy, France, Belgium, a number of other countries in Europe.

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. They don't want to add any more.

And so I read the other day that the United States has two point seven hospital beds per thousand people. It does seem like that's where we're going to be very soon. 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. We have to get up to the launch and we've got to you know, we've got a social distance. We've got to just hike and fly. 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. 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 germ 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. You also we absolutely if we care, if you have a heart, you cannot put health care workers any more strain on the health care system. We don't want to get colds, let alone break a leg, let alone break your back. Let alone get sick. Let alone get paralyzed right now. The health care system does not have enough people to treat this virus right now.

It is selfish to go flying right now. I'm sorry to all your pilots. But this is a moment to care. 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 bare to our raw humanity and people show up. And it always happens in a fire. And a hurricane. And, 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. That was the answer. I'm glad I went flying today, but you've straightened me out. I appreciate it. Thank you. Thank you. No, I, you know, and that's why I want to have Terry on the show tomorrow. I just know that those guys, they're just slamming. And it's just it's. Brutal time. And I'm so scared for 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 in Idaho. I'm glad I'm not dealing with you guys. What you guys are dealing with. Like, whoo hoo. I'm glad I'm in Sun Valley. You know, in a week later, your listeners, listeners will hear what went down and why you guys are on lockdown 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.

Interesting. Well, let's just say, you know, you have you have fewer health care workers on the front lines. So people do not want to get hurt in Sun Valley right now. And I don't mean people died. But I just mean, you know, there's fewer people. People are sick.

Yeah. No, I had heard that the people are really sick.

Lesley, thank you. I really appreciate it. And I appreciate your time and all the energy you've put into this amazing, unprecedented craziness. It's unbelievable. What's going on and keep fighting hard. I think what you're doing is really important. I know that journalists, especially in our country, have suffered under under this under this administration. But, you know, you're fighting the good fight. I appreciate it. Thank you.

I'm sorry it took us a cataclysmic virus to finally talk. My brother, who has a podcast, has done his sister, who is a radio reporter. But here we are finally, finally talking. So, yeah, thanks for having me. Yeah.

Terry, 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. What do you do? What are you doing right now?

I'm doing a lot, Kevin. But right now I'm drinking the last of my whiskey. So you owe me.

Yeah. So, yeah, a lot of jobs. I am an emergency physician here locally where we live in Ketchum, Idaho. But I also have a couple other jobs. And the big one is being an emergency medical services medical director for the county 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 for. Basically your routine run of the mill EMS calls, but also dealing with natural disasters, planning for big events and and obviously dealing with the coronavirus pandemic.

And when when did for, you know, pardon the language, but when does shit get real for you guys?

Just over a week ago, really.

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's been a bit of a blur. But yeah. 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. It's obviously it's a very pleasant place to live. So it attracts some good candidates for for work here. 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. I

mean, that seems to be happening around the world. Yeah. They don't lock this thing down and act soon enough and radically enough. Take me through. What does the hospital look like right now? 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 you'll probably see when you come to the hospital is that most of the entrances are cordoned off and closed so that we route all traffic through. So a single entry so that we limit people coming in, potentially not being screened for for having the disease and spreading it amongst the hospital. So if you're 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 through the front entrance, which once you come in there, you're greeted by someone who 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 coronavirus, for which right now we're screening for cough and fever and shortness of breath. The answer yes to any of those. Or if you say you're coming because you're worried about having coronavirus or COVID-19, you're immediately have a mask put on you and you're kind of quarantined off into this other corner of the main foyer there in the hospital. And we have special protocols to kind of bring you back and to minimize your exposure to other patients that are in the ER. But you'll also likely be directed to either a drive through testing site, which is pretty obvious to see because it is a long line of cars there every day. Now, we had 150 vehicles come through today for drive through nasal swab testing.

So it's fairly clear when you pull up to the hospital that something's going on over there by the outpatient physicians clinic. And then there's also. Direction to kind of direct you to a new kind of fully serviced urgent care clinic where we're also trying to divert some traffic from the ERs just so we don't get congested. Those of you listening, it probably

behooves us to talk a little bit about this community. You know, Ketchum's a town of 3,500 people. 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. So per capita, we're right up there with. New York and L.A. and San Francisco. Is that correct?

Yeah. So would you referring to a black county? Essentially, there there was a independent statistician who essentially put together a graphic, which the colors of the counties in the U.S. on his graphic were shades of basically cases per per capita in that county. 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 of any other place in the nation. And so we have a high penetrance of disease despite our kind of low density population here, which I guess you could take it one or two ways in that one.

It's not that many cases relative to obviously boroughs in New York, but you could take it another way in that despite us being. In a small mountain town with low population density, we got a lot of a lot of penetrance and a lot of a lot of prevalence of this disease here and a really short period of time. 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 the statistic the other day. Two point. Eight hospital beds per thousand people in the U.S. How do you see this art going? How are hospitals going to be able to manage the coming crisis? Well, the crisis is already here, but.

The crisis is here. Yeah. Well, at some point we won't be able to manage it, which is the reality, you know, based on projections and and probably the the latest projection, which is. It's been getting most of the press lately has been actually when I was just reading it from today, just to make sure I reference it correctly, but it was done by Imperial College out in the U.K. And it was a specific projection based on kind of hospital capacity and projection of growth of the disease specifically for the U.K. and the United States. It's kind of a collaborating center for the World Health Organization.

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 with the impact of this disease, which is a pretty sobering thing to think about. And

what about equipment? You know, what about protective equipment for you guys, for the people on the front line? But also ventilators. It sounds like we're way short on ventilators. I mean, this is a respiratory disease.

Yeah, ventilators. Certainly, we're looking like we're going to be short on on those as well. ICU beds will be short on as well. The personal or, you know, the PPE or personal protective equipment. That one's tough to project because, you know, it's hard to know how much you're going to need even for each one. One individual patient, you know, we're required currently to change in and out of this protective equipment, which is, you know, a mask, a face shield, gown and gloves each time you go in and out of a room of a person under investigation for the disease. So if something unexpected comes up, if your patient gets sicker, 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. 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, that's another set of PPE right there. So it's really hard to project how long or how much supply we're going to have. When you have a lot of variable consumption of of that personal protective equipment, but the ventilators, you know, it's it's that's another tough one right now. You know, we're kind of building off projections of what of what other countries have have seen as far as their ICU needs and number of patients that have required intubations.

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. And so you're you're biasing your your current positive hit rate of the disease with those who are likely requiring hospitalization or need to be in ICU. So it's looking like most people need to be hospitalized. Most people need intubation. And the initial fatality rates that will come out in the next few weeks will will probably be pretty high as well.

How serious is this and how much of what we're hearing? You know, this obviously depends on who we follow. But when I came back from California about a week ago, I was I was amazed by the casualness that most people were taking this. They were very casual about it. We're just now seeing, you know, we went on lockdown. Yesterday, but still, people aren't wearing gloves. They're not wearing masks. They're, you know, they're hanging out together.

How do you see this playing out?

Yeah, I mean, that's that's the big challenge, I think, for us as health care providers on the front line. Gavin is it's hard to try to make this real to people when they're not seeing it in their own lives. And I remember this is this is a problem. Nobody who's alive right now has ever seen. Before, right? I mean, the last time we've got anything close to this destructive potential on human life was, you know, back in 1918, the great flu pandemic then. I mean, we 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. But this is a totally different beast.

And this beast 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 a runny nose or sore throat, but the person doesn't look too sick. It's hard for an average person to translate that to. This is a disease state that can kill my grandma or my next door neighbor. For those of us in health care, we see the sickest of the sick. So it's super. And we also are dancing around every single day, improvising and in a lot of a lot of days, just kind of just getting away with it, you know, without anybody getting hurt already.

And so it's scary to think that with the projections and exponential rise in these cases, what's going to happen to the quality of care and how many people are going to be affected? So, yeah, the sense of urgency is. It's 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 affected or gets hospitalized with this disease, it won't really mean anything to you because, 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. Oh, it's just another bad flu. Right. It's because people want it to be familiar, familiar threat. But it's it's it's most certainly not. And by the time it becomes a familiar threat, it's going to be way, way too late. Clearly. So what

you know, when we see that the media is blowing this up, are they blowing it up at all? They blown it up enough.

No, I don't. I don't think they're blowing it 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 Wuhan first started, I was a little skeptical, too, but I was inappropriately just concentrating on the case fatality rate. And most major outbreaks when they're first starting on the first getting reported, the case fatality rate will be amplified to what the true case fatality rate. This this this kind of comes back to this idea of a sampling bias when you're when you're just starting to see the disease roll out and you're just starting to test and diagnose. It you tend not to test until someone gets really, really sick and you don't know why. Right. So say, for instance, I had 100 people come into my hospital and I had to see them all in a day and they all had coronavirus, but I'd never seen coronavirus before.

I kind of heard about it, 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. Right. I had like two swabs. 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 percent, they may have what looks like a cold. You know, they may just be coughing a little bit. They may have a low grade fever. They say, I just don't feel that great, doc. And I'm like, OK, well, you got a cold, you know, sorry, this is pretty common. 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 rates high and his oxygen 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 he's pretty febrile, has a high fever.

So I start throwing some antibiotics at him and I start giving him some fluids and I put him on oxygen, but he just keeps getting worse and worse and I don't know why. And so I order a few more tests and I'm like, 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 is 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 go to myself and I think, oh, wow, I wonder if this is that new novel viral disease everybody's been talking about. And then I finally order this test and say an ideal worth world that that test came back, you know, within 24 hours or six hours or four hours and all of a sudden I go, oh, wow, it is one of these guys. 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. I couldn't figure out what it was. And everything I gave him didn't make him better. So I finally ordered this test to see if it was this rare disease I've never seen before. And so he's a really sick guy. I'm seeing him late in the course of his disease. He's the sickest of the coronavirus cases. So he may have a fatality rate of up to 50 percent at this time. Finally, have one or two tests. 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 is on this guy and he ends up dying. Then the case fatality. Rate rate is 50 percent. But if I was able to have 100 tests and I tested every single person in that hospital that looked like a simple common cold, then the case fatality rate would be one percent.

So, you know, early on, we kind of know from other pandemics looking at MERS and SARS and even H1N1, 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, that case fatality rate will will decrease in time. As you get older. You roll out more testing. You know what you're looking for in the disease. 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 or H1N1, they don't they don't really die. 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 practice as a physician, that kind of tempered my concern initially.

What? What? And so, I think that's what really alarmed me as I started to read more about the epidemic, and I started to read more about these fairly draconian and intense measures that the Chinese government was placing on the region. 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 infection. Brickle. of 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 are you likely to infect, which as you've probably read is around the area of about two to three other people.

And, um, the only way to keep from spreading that disease to two to other two to three other people, if you have it is to make sure you don't have it anymore. Right. Um, like you're over it. You're not, uh, someone who has a potential of spreading the virus anymore. The problem is, is unlike Ebola where I'm coughing up blood or dengue or malaria, where I'm like writhing in bed with a terrible fever. 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, they 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 away people's freedoms and not allowing them to socialize and be with their family.

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.

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 draconian measures that it 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, uh, phone tracing and apps and that kind of thing. Where have they been? Who have they been with? You call them, you call those people and, 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 it with my family. Cause obviously I can't, you know, Maddie, you know, Maddie's going to get sick. Fallon's going to get sick, but this thing sounds way worse than what I originally thought.

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 know, I don't know, I don't see that happening very much here.

Yeah. So, uh, when you say you don't see it happening, you think, well, I guess I'll explain that to me a little bit more.

The draconian measures that you talked about, you know, that you, you know, if you don't get strict and early and bold on this thing, um, you know, you, we've got Italy, we can look at it. We can go, okay, well, that's what happens when you don't crack down.

Yeah. And I think that's, that's a really good 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, 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, that traffic in and out of an area is shut down. Think about if you had a positive coronavirus 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.

Right. And that's something as a culture and as a society, 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. But when you, when you have a culture that doesn't accept those measures, 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. It's 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. And people just aren't motivated by data, Gavin.

I mean, that's, it's the reality, you know, and if I, 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. We know what presenting symptoms are and what not. And we, are most likely with a particular disease state. We know which tests are going to be most accurate to help confirm that we know which therapeutics are most likely statistically to make you feel better. But what's tough with the coronavirus is it's really hard until someone has seen it with their own eyes, has heard it through a friend or a family member for them to believe that it's, it's real, 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 in, it's in this rural little ski town in the middle of nowhere in Idaho, man, man, I need to look into what, what this is all about. What can it do to me? And what can it do to my family members? And people are beginning to care about it. And I think it's, but in a lot of ways it, it may be too late because it's 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.

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. You know, 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 coming through that ER I've diagnosed and have confirmed hits on many patients at this point. 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 that 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, Because 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.

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. I might as well get it now. Cause 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 nationwide. And that's kind of how it's looking. But so we've got to do everything we can.

It's better to get it later. It's better to not get it at all, but it's better to get it later.

Correct. Yeah. Or just not at all. You know, like, like, like chlamydia,

better not to get it. I really, I really don't want to get chlamydia right now, you know, so that, so I'm good. So I'm good later. I just don't want it. But others, I mean, no, no, you're absolutely right. So that's the thing that this, this concept of flattening the curve, it's, you know, it's a concept that's, it's gained a lot of traction in just within the last week. You know, Gavin, I did a, I did a long lecture about an hour and a half all of my teams and also send it to the county commissioners about a week and a half ago about this concept, uh, for the exact reason you bring it up now in that you have to, you have to create some sort of a 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 infeasible for them.

Right. I mean, there's, there's people are not going to be able to pay rent this next month because 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, we're, when you're mitigating a disease, you're still effectively expecting, you're going to get the same amount. You kind of expect and get the same amount of cases, uh, of people that are going to get sick with this, 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 going to 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, in, in an efficient time manner and have a bad outcome because of that. And you may be slowly having respiratory failure, but there's no beds left to admit you to, there's not enough oxygen to give to you, or there may not be a ventilator for you. 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. And the only thing that can save us is our community's behavior to mitigate the spread of this disease.

So that caseload spreads out over that 18 months instead of over that four months. Even then, Gavin, my worry based on a lot of recent analysis is that we're still not going to be able to cover the cost of this disease from the impact on people's health and livelihood, really, unfortunately. So now it's really about trying to... We're in defense mode, right? We're expecting to get some hits. We just don't want them to be as bad as they could be.

How should we be recreating right now, Terry? How should people in this community and all over the world... They have shut down paragliding in a number of countries in Europe, not because they're worried about stuff flying around in the air. It's because they don't want one single other person in a hospital right now.

Should we take that to skateboarding, climbing, skiing? I mean, how should we be thinking about you guys?

Yeah. Yeah. I'd prefer that you all just buy like a bunch of insulite padding and just duct tape it around your whole body. And then perhaps buy one of those large inflatable... You know those Zorbs? You remember Zorbs? I'd like everybody to just live in a Zorb for a while. It'd actually be perfect because 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 in a Zorb.

That's what I'd like to see. Help me come up. Great idea, actually. Let me put that on my notes for my meeting tomorrow at the county. There you go. There

you go. That could be the next... Right now, you want to be in the business of making ventilators and Zorbs. Yeah.

Yeah. Pretty much. But on a serious note, I mean, it just doesn't sound... It's never been cooler to be a boy in a bubble, Gavin. Let's just put it that way. That's my new campaign.

No. So the example here... So Gavin, like before... So in our community here, I made a pitch on multiple levels at the risk of being an alarmist. But looking at the data, looking at the spread, when this was first happening and the information was coming out of China, I was kind of looking at it, I was like, wow, this has a potential to be a big deal. But 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 enact some of these measures. And as I explained before, as they started to test more and more people, as I found out, a lot of people are fairly asymptomatic. Or had mild disease. But what quickly became apparent is that case rates were growing exponentially.

And then that model was repeated in South Korea. 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. Yeah. And so knowing our limited testing capacity, I knew that as soon as we started getting positive hits in the United States, it would represent the tip of the iceberg. And because of the lack of adequate surveillance and the subtlety of this 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, trying to send out a caution both to my hospital, but also to my county commission.

And trying to educate. And I spent a lot of time up front trying to educate my paramedics and EMTs, because if you look at this concept of trusted messengers in a community, they actually have some of the highest trust in a community, right? I mean, think about your average American society. People love their firefighters. They love their paramedics. They love their ambulance workers. They may not be so much in love with their politicians and their mayors and their council people. And so you go straight to the, that's the one common denominator I have. I may not be an everybody's social tribe, but I've got purview over these trusted members of society. And I wanted to educate them as I would educate a peer in medicine of like, hey, this is why I'm worried about this. 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 them to close schools, to not go to work, to don't throw that dinner party, to, you know, cancel our film.

Right. There were a lot of big things I had to do right at the beginning that seemed super absurd to people at the time.

And, and it's, it's just really tough to convince 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, it, also didn't really become a thing. And I think it's, real for me, Gavin, until one of these first nights I had to deal with, I worked a couple of night 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.

It was before we had good protection for our registrar, 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 we were kind of waiting for it to come to us. We worried it was going to come. And then before even we got our first case announced in, in that 24 hour period of time, we went from having a case announced to then the next day I worked, I left the night shift. Uh, about an hour after I left my night shift, my partner that was working the day shift had a self-inflicted gunshot wound to the chest. He had to manage in a snowstorm. They were able to save his life, at least here, but 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 coronavirus. So the, the ER was overrun with people coming in with common colds, wanting testing for coronavirus. He didn't have a way to, to divert them to drive through testing. Now, anytime a patient that comes in with potential coronavirus 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. All these people are coming in, had another patient that came in who had coronavirus, 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 coronavirus at the time.

So everybody goes running into the CT scanner to try to save this woman's life, successfully resuscitate her, uh, do what unfortunately is a high risk procedure with someone who has coronavirus and intubator, put a breathing tube into her throat, save her life, but, uh, unwittingly expose 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, I then find out that one of the previous first Sentinel documented cases of coronavirus came through the ER a week before it was a subtle 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. I lost half my staff over 50 % of my room.

So it's a lot of work. So, so my first, my second patient, uh, I'm managing that patient. So I have a couple of other sick patients come in overnight. I'm working with some, some nurses I don't typically work with. Um, and we limp by that night and we get through, but I just like if that gunshot wound had overlapped in time with just another case, or what if we had a bad ski accident off the hill, a bad trauma off the hill. And this is where it comes back to. So I'm just working with, to your point of like, what if you had a bad trauma that happened from someone recreating on their own time, you know, and flying, you know, quickly, you might oversaturate, 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 they're taxed.

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 mean, we don't like to take away people's personal freedoms, but the reality is we also don't have the best confidence that people are going to get the best care possible anymore with the volume of disease out there.

It's a pretty clear answer, Terry. Thank you. The the other thing that I'm hearing that, uh, I'd like to get your thoughts on, Lesley 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 Wuhan, 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 it bad, uh, it it's not, you know, I 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 way in there, and this is not the flu.

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. Yeah,

yeah and um you know with the initial data from china it seemed 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 70s, and most definitely the highest morbidity and mortality rates in the 80s. But that, that does not mean, uh, it, it doesn't hurt or harm those who are younger. I, uh, I had a patient who was 21 just last week, uh, who, uh, has, you know, subsequently tested positive. He was again one of the first kind of 10 cases of coronavirus in the county here. Uh, he looked terrible, man. He just looked absolutely terrible.

I mean, 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 a kid who typically would whine about anything. His mom is sitting at the bedside and she's just like, clearly terrified. She's never, you know, you read the situation, like, you know, okay, this mom has never seen her adult son, now 21 years of age, and she's never seen her adult son, and she's never seen her adult son, and she's never looked this miserable before, and she's appropriately concerned. And he was just like, you know, this is the sort of, it's the sort of appearance I've seen with dengue or malaria, like he just wanted to jump out of his own skin. 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, I'd have tipped into developing a lot of this inflammatory response, essentially fluid building up in his lungs and effectively suffocating from this disease.

And it can be really nasty. I and I think these are the—these are the stories that, you know, we really do need to tell to convince people to do the right thing, because if you tell a bunch of your friends who are in their 20s, 30s, and 40s that it's not a disease of concern for them, uh, then they have no emotional investment to to to tend to it, right? You're—you're going to care about something to them, and you're going to tell them that you're something, if it is an immediate threat to you or an immediate threat to a loved one, you know, 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 story. Like, you know, when you hear about what 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 who are in their twenties, nearly dying, like these anecdotes. Yeah. Yeah. Uh, these anecdotes are actually what convince people to change. Uh, it reminds me actually, Gavin, of, um, there's a, there's a researcher, this guy, Paul Slovak, 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.

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, uh, 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 for doing this quick experiment with us. 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 were 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, well, they called the identifiable victim.

So they basically, they, they, they told a good tale. They give you the story about a young girl. They 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, um, 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. And then they presented another group with all the statistics about the impact of the famine, how many people were starving, uh, you know, in 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'd expect where I'm going with this tale, they found out that people that just heard about the identifiable victim, the young girl, they gave about twice as much as anybody else.

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 were 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, uh, want to not listen or turn it off 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 the 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? But this isn't just about pilots. A lot of the pilots that are listening to this podcast have friends who are climbers, friends who are skiers, but we have many different social circles we run in. There are relatable stories for all those social circles, right? 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. 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 our immunization. We can't think that we're going to contain it out of communities at this point. And, and frankly, as much as I'd like to see testing roll out, uh, on a much larger scale, you know, I I'm not counting on it. 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 mentality 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. Uh, I'm expecting total catastrophe out this, but I think your listeners and their community, uh, that's where the power lies for me to be pleasantly surprised about the impact of this disease.

And, and so I appreciate you, you know, doing your part to win some hearts and minds in the fight and, and keep people, keep people following what seemed like really, uh, they seem like such, simple measures. And it's, I think it's really hard for people to, to understand how that could be doing anything. Uh, and, and they are, they're inconveniences. You know, I can't hang out with you and your family. You know, I can't have dinners with my friends. I can't, I mean, it's just like, uh, I can't show up to any other public space, you know, right now. Uh, and that's hard. And it's also really hard thinking that we might have to do that for months. Yeah.

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 trailheads 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. I mean, it's just, it's an amazing opportunity for some now again, like Lesley and I just talked about is, you know, there's a lot of people who are going to be really negatively affected. By this. So, but you know, it's, it's, it's a time to reflect. It's a time to be quiet. It's a time to listen. It's a time to breathe. And that's certainly what the planet's doing.

And, uh, you know, so yeah, we talked a lot up 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 yeah,

there's that. I also think that, you know, I think the other thing, I think 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, uh, align behind, you know, and fight for, and this is, this is a common problem for humanity right now. 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. Yeah. There's no doubt about it. Yeah. Yeah. Yeah.

Terry, thank you, man. I have taken up way too much of your time. Get some sleep. You got a night off. Well, you know, I can't 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.

Yeah, man. Um, I'm, I'm doing my best. That's why I'm drinking whiskey. Perfect. Sterilizing my bloodstream. Don't put that out there. That's a misconception.

That doesn't work. That's, that's,

that's anecdote. That's yeah. That's anecdote. That's my, it works for me. It may not work for you. That may not work for all. I know I gotta, I gotta, I gotta respond to a text from your sister now. Great. Great. Thanks buddy. I appreciate it. And, uh, get some sleep.