Ologies with Alie Ward - Coronasode: Virology Update (COVID-19) with Shannon Bennett & Mike Natter

Episode Date: May 13, 2020

What kind of masks should you wear? How many people have had COVID-19 and don’t know? Do antibody tests work? When will we have a vaccine? Is it okay to picnic? Will there be a second wave? You need updates and we’ve got ologists. The wonderful Dr. Shannon Bennett from the first Virology episode joins us again, as well as New York City physician Dr. Mike Natter from the Diabetology episode. These two warm, informed professions dispel rumors, explain what life has been like on the front lines, address medications, describe new symptoms, “proning,” rates of asymptomatic folks, where to wear a mask, how to use gloves and whether or not the balcony saucepan symphonies at 7pm every night delight or annoy them. We’re in this for the long haul folks, but we’ve got each other. Follow Dr. Mike Natter at Instagram.com/mike.natter or Twitter.com/mike_natter Dr. Shannon Bennett at twitter.com/microbeexplorer and Instagram.com/microbeexplorer Donations went to Food Bank for New York and California Academy of Sciences Check out the podcast Science Vs. More Ologies Coronasodes: Virology, All (Washed) Hands on Deck More links at alieward.com/ologies/virology2 Transcripts & bleeped episodes at: alieward.com/ologies-extras Become a patron of Ologies for as little as a buck a month: www.Patreon.com/ologies OlogiesMerch.com has hats, shirts, pins, totes and STIIIICKERS! Follow twitter.com/ologies or instagram.com/ologies Follow twitter.com/AlieWard or instagram.com/AlieWard Sound editing by Jarrett Sleeper of MindJam Media & Steven Ray Morris Theme song by Nick ThorburnSupport the show: http://Patreon.com/ologies

Oh, hey, it's that sticky quarter hiding under your floor mat. Just waiting for you to get desperate enough to use it at a parking meter. Allie Ward, back with a Corona Sode. This is the third installment of Coronavirus episodes. The first one was with virologist Dr. Shannon Bennett from Cal Academy. And then we had an isolation era, March 31st episode, called All Washed Hands on Deck, with Dr. Michael Wells about testing resources, what we can all do to help, and also how to practice self-care during a really tough time.

So it's been two months and things are starting to slowly reopen in the U.S. and we all have a lot of questions. So I hopped on the horn with past guest Dr. Mike Natter. He is a physician in New York City who you know from the Diabotology episodes. He has been on the front lines in emergency and ICU units and gives us an account of the disease, prognoses, what to expect next. I also chatted with Dr. Shannon Bennett, a virologist extraordinaire, to talk about how the virus behaves and how we should behave, because that's a big part of it.

But before we get to them, quickly just a few thanks to everyone on patreon.com slash oligies for submitting questions for this episode. This is all your questions and for supporting for as little as a buck a month. Thank you to everyone sending these episodes around via word of mouth and social media and subscribing and rating. And of course reviewing. Your reviews have kept me company during a lonely time and as proof I read a fresh one that someone left each week.

This one is from History Kid who says that this podcast makes learning about topics I've never even heard of so interesting and enjoyable. I have to confess her intro and the shows, the music always make this 55 year old man cry with joyful anticipation. Thank you History Kid for letting me creep your weeps and everyone who left reviews this week for serious. Okay, let's get to the interviews with Drs. Natter and Bennett. We'll learn about herd immunity and vaccine progress, what it's been like on the front

lines, if the virus will mutate, if it's seasonal, what PPE we should be wearing, if picnics in the park are a good idea, and when you can hug people again. Our handshakes canceled, you will find out. It starts off tough explaining the importance of having flattened the curve and by the end you will have a clearer picture of the future. So get comfy and listen up and then bang on a saucepan and applaud into the dusk for physician Dr. Mike Natter and virologist Dr. Shannon Bennett. My goal is to not cry in the 30 minute chat that we have.

Please don't feel like you have to stick to that. Can I tell you, I've been ugly crying. I feel like what I imagine a very, very pregnant woman with lots of hormones flowing through. So you heard Dr. Mike Natter in the Diabetology episode and you may recall that he is a super sweet, super empathetic dude and he works in a family of three hospitals in Manhattan and he has seen things not on the news, not explained via press conference but firsthand. He knows the real shit. Can you explain to me a little bit of what it's been like since early March?

Yeah, mid-late March, yeah. It was a lot. There was a lot of volume. We had to basically kind of, just to give you some scale, just to like, and it's always tough because like when you're in the hospital, like you see the trees, you don't see the forest so you don't necessarily know what everyone else's experience is so I can really only speak to that. I was seeing a lot of trees, a lot more trees than is typical for this patch of forest.

So just to give you some scale, the hospital and internal medicine works like this. If you come to the emergency room, they try and get you better so that you don't have to be admitted. If you are sick enough to need admission, which unfortunately many of the folks that have like really bad COVID do need because their oxygenation is so low. If they are sick but not too sick, they go to what's called the general floor. We call it the floor or like some people call it the ward, the wards. The general medicine floor is kind of like, you're sick enough to be admitted but you're

not on death's door by any means. And then if you get sicker, then you go to what we call the unit, which is short for the ICU. There's different flavors of ICU but in general, they're just all acute critical care. On average, there will be in one ICU, let's say there's maybe 30, 40 beds, there will be maybe on my particular team, 10 to 20 patients of which maybe five to seven of them are intubated and very, very, very sick. The entire ICU plus a million other floors that we had to kind of make shift into ICUs

were being overrun with patients. There was hundreds, literally at the peak at this particular hospital, I think close to 200 intubated ventilator necessitating patients and it was really, really, really bad. So, that was bad and that was at one particular hospital and then I went to, I rotate between another one and the other hospital up the street, which has a lot more resources, was even more overrun than that hospital, but we have people from surgery, from plastic surgery, from pediatrics, from psychiatry, from neurology, who we just needed to kind

help us essentially with the volume and so it was like an onslaught of volume of patients. What was life like in New York at that time? Because you're born in New York, you've lived most of your life in New York. What's it like going from the hospitals back home every day knowing that that's kind of an epicenter in America? It's scary. I mean, I think New Yorkers are pretty rough and gritty and nothing really affects anyone and everyone kind of, no matter what's going on in the world, everyone seems to kind of

be able to do their thing no matter what and there was this clear sense of kind of unity and camaraderie. The only other time that I've lived through that felt even remotely close, but for very different reasons I think was 9-11 and to some degree a little bit post-superstorm sandy, but it just was different, like it's a very different vibe. It's so eerie and very uncomfortable and jarring for me to see the streets as empty as they are because that's something that's like a constant of New York where the lights are on, people are moving around, things are going on no matter how crazy the world gets

and the fact that that's not the case was also I think extremely noticeable and jarring. How are doctors looking at the curve for New York? Where is it at now? We're in the beginning of May. How's it looking? Yeah, it's looking a lot better. I mean, it's all what I would say is thanks to good leadership from Cuomo and to some degree to Blasio because it's the idea of shutting things down to limit the spread and

we are seeing a massive flattening of the curve for that reason. People at mission rates are significantly down, death rates are coming down each day. There still are packed ICUs and there's still lots and lots of very, very sick patients, but we're able to manage them because the volumes have started to settle down. It's almost indefinitely thanks to the social distancing and the lockdown and the kind of shelter in place orders that have been issued by the governor. So a few patrons had questions about symptoms of COVID-19. COVID-19 is the disease caused by SARS-CoV-2, which is a new type of coronavirus.

Coronaviruses are a type of virus named for the crown or corona of structures on its cell surface that help it bust into our cells. So a recent Center for Evidence-Based Medicine article stated that between 5 and 80% of people testing positive for COVID-19 may be asymptomatic. Between 5 and 80%. What? That's a big range. So we don't totally know how many people have it, but experts pretty much settled on 50%

are asymptomatic. Patron Lisa Moore asked about neurological symptoms and in one small Chinese study of 214 people hospitalized with COVID-19, more than a third of them had neurological symptoms like headaches and changes in smell and taste, nerve pain, tingling in the extremities and kind of wooziness and dizziness. And other observed neurological effects of COVID-19 are short-term memory loss, difficulty concentrating, tremor, so it can affect you neurologically. Patron Toby Christnick asked if there's going to be a second wave, will there be new and

unknown symptoms? They say, I'm already hearing about coronatose. So yes, other observed symptoms of this coronavirus have been coronatose, which are lesions on the toes, diarrhea, and perhaps even something called Kawasaki disease, which has been seen in some children. It presents a little like toxic shock syndrome with a high fever lasting several days and abdominal pain, vomiting, a bright red or what's called a strawberry tongue, and peeling rashes on the feet and hands and groin.

Other complications of COVID-19 we did not necessarily know much about a few months ago are blood clots and stroke, inflamed heart tissue, lung scarring, and even issues with male fertility. I know you're like, what the fuck are all these symptoms? Why are you bumming me out, dad? Well, there's a chance that you or someone you love might have symptoms without realizing it is the rona. So I'm here to tell you.

Now, the tough part is that this is a novel virus. We've only known about it a few months. So every day we get more information. So every day, yesterday's information might be a little more wrong. But the good news is that people are working around the clock on it. Dr. Natter explains. That's a good question. I mean, I think just speaking generally, a lot of the fear around this is that we don't

know things. We don't understand why some people who get coronavirus have a sniffle and then they get better or they have a few fevers and they get better. And then the same individual who's, I mean, I saw very young patients with no comorbid or past medical history who have died and many others who are on dialysis and ECMO machines and hemodialysis and ventilators and all these things that doesn't make sense. And so that fear is felt really amongst the general population, but amongst healthcare workers.

I think we like to intellectualize as a defense mechanism, but you can't intellectualize when you don't know and when you see what you're seeing. So worldwide, as of this recording, 285,971 people are reported casualties of the virus, over 80,000 in the U.S. alone. So how is it still spreading? Any surprises? Myrologist at the California Academy of Sciences, Dr. Shannon Bennett explains. Well, it's really fascinating.

I would say that it's definitely by and large behaving as we would have expected, kind of the way which was this sort of steep exponential growth rate early on that in flattening and leveling off. And I'm talking about leveling off in terms of the number of daily new cases and the number of daily new deaths. In both cases, the one, the deaths legs behind the new cases, but they start to ramp up, then they level off such that the number of daily new cases is almost the same day over day, maybe over a sliding two week, a two week window.

And then it starts to drop down the other side of the wave. So here in California, we're a big surfing culture. So it's just like surfing a wave, you know, you go up, flatten and then down the other side. And I do apologize making light of this. This is very serious, but it is an effective analogy, I think, to indicate that that just like an energetic wave in water, then the number of cases out there, because any individual case is infecting a certain number of other individual cases, and that numbers, you know,

can be pretty high at the beginning of the epidemic, the doubling time was on the order of a few days. And then it sort of spread out as we flatten the curve. And so that metric represents the energy of the virus to push out and push through a population just the way that the energy in a way that we surf behaves. And so the energy of that force of infection is becoming dampened as the number of daily new cases starts to level off, and then that gets reflected in the reduction in the number of daily new cases day over day until it's close to zero.

And that's the bleeding out of the energy of that wave, as well as that force of infection. And so that's the way it's rolled in most countries, including our country here in the US, state by state, maybe the intensity, the height of the peak of the wave might be a little different. It was certainly the highest in New York. And the timing of that wave is jittered. So some states hit their exponential growth sooner. Others have hit it later and to a much lesser extent.

And what's interesting to me is looking at different states or even different countries, although the form of the wave largely plays out the same with some exceptions, we can really see how countries and states have implemented different policies and that kind of plays out in on the epidemiologic landscape, but you can really see the difference. You can see how different states, for example, really managed to keep that curve very low, very flat, a delayed start, and in very quick time have seen it decrease. So you're seeing policies have like a direct mathematical effect on that curve? Yes, most definitely.

Adrienne Joanne Gebhardt asked, do we know what the mortality rate is yet? And I awkwardly asked Dr. Natter, how much higher were the mortality rates of your patients than you're used to dealing with? And how did you do that? Massively. Massively. How did you deal with that? Not well.

Yeah. Yeah. Not well. It's hard. It's really hard. While in the hospital, surprisingly, I think you have like a purpose and you have tasks and you're able to kind of get your head down and do your work and then feel like you're doing something of substance, but then coming home is very difficult.

Do healthcare workers, is there anything, any plans in the works for how to deal with that emotionally, psychologically for healthcare workers? I think there's a lot of talk. I think it's very well understood and known that there's a lot of this trauma that's being kind of dealt with and I think we know that. And I think a lot of our colleagues in psychiatry have been really great and they've been helping us out and they're offering us a lot of like Webex therapy sessions and debriefings and having like kind of group meetings and stuff, which is great.

I think for me at least, and I think for most of my colleagues, like right now we're okay. I think it's more what's going to happen kind of these weeks, months and likely years from now that's going to be interesting. And I also like, I worry a lot about like, I have colleagues who've graduated a few months early from medical school so they could come join the ranks with us and I think it's so traumatic to be an intern to begin with when you start, you know, when you're your first day as a doctor, it's very stressful and difficult and then having to deal with this whole pandemic as your first kind of soiree into medicine, I think is, you know, could potentially sow

some seeds of trauma. Yeah. How about how about actual PPE? How well protected are you all now? We're good. I feel as though I don't think I've ever been without, you know, having actual PPE. My institution has been pretty good. There's three hospitals in my institution and one is a public hospital in New York, which

is obviously like less funded than others. But the amount of donations and people coming out has been just like phenomenal, people pouring in either actual money to get PPE or actual PPE and then obviously food, there's like signs and chalk on the street, there's everything you can imagine free scrubs and all this stuff. So we're being very much showered and pampered, which is great. And it feels kind of, I feel kind of shitty in that like there is such a need for food like in the country and there's like a lot of food banks are going dry and we literally are just inundated with food, like really, really good food.

And I always feel so bad when I'm like, you know, there's some of this food really needs to be diverted to some of these other places that need it. At Dr. Natter's behest, we made a donation to Food Bank for New York City in his name, so that's 2,500 more meals will be made possible in the New York area by him mentioning that to us. Thanks for the heads up, Dr. Natter. Now, if up to 80% of folks with it are asymptomatic, how many people have or have been infected with SARS-CoV-2?

Dr. Bennett says what we see is probably the tip of an infection iceberg. Do doctors have any idea because testing is just so like rare testing in the general population? Do we have any idea what the mortality rate of this is? We have a sense, but I think like you tapped onto the way we calculate rates is that you need to have a numerator and a denominator to figure out all of this and the denominator is based on if you've tested someone. I think we've caught up a little bit in terms of testing.

There's a lot of miscommunication and kind of guidelines that we're shifting in terms of who should get tested, when they should get tested, oftentimes to not overload the EER. We would tell people if you have symptoms, but you're not short of breath or you're not becoming hypoxic to really not come in because we have people that would overwhelm the ED to get tested when they weren't sick enough to necessarily need to be admitted and then they were basically either exposing themselves in the ED or creating more volume for the emergency room physicians that they couldn't handle.

This week, the President of the United States, and I'm just going to quote this in a very neutral informational way, said, quote, by doing all of this testing, we make ourselves look bad because the case numbers go up. Oh, so there is that information. Now, I checked in with Dr. Michael Wells, who we spoke with for the all washed hands on deck episode in late March, and I got an update from him just today on his database of scientists willing to help with the testing. He said, quote, the database has now exceeded 9,300 scientists from all 50 states.

Side note, yes, Wyoming, you did it. Also DC, Guam, and Puerto Rico, and he now has a large team of coordinators, many of whom found out about the database through oligies, which is awesome to hear a way to go, y'all. He says, scientists from our database are helping process tests in Los Angeles, DC, and Michigan. We even had a few visit SpaceX in Los Angeles to help with some of their COVID-19 efforts, and we are spending a majority of our time actively seeking additional volunteer opportunities across the country.

They have a new website, so people can keep updated on their activities, and I will put a link to those in the show notes. Many of you patrons asked about testing, such as Rachel Weiss, and Ira Gray, and Sophia Dill asked, what is happening with testing, and when will we have testing widely available? Sophia, I appreciate your triple interrogation on that question. We really need to broaden the testing, and the kind of testing, and that's happening. It's really, we're starting to test here in San Francisco, anybody with symptoms associated with somebody with any symptoms can get a free test.

This is a PCR-based test, so it's a test that looks for the direct presence of the virus, so it's no point, you know, running off to get tested if you have the virus, or you thought you had the virus three weeks ago. It's really just measuring the direct presence of the virus at the moment that the test, that the sample is drawn, so it has a very short applicability. Megan McLean asked about the depth that they plumb into your nasol, asking, why does the test swab have to go so far up into your noggin to get results? In that six-inch spelunking, I looked it up, it's hitting the back of the nasopharynx,

which is where your sinuses meet the back of your throat, kind of like a taint, but for your mouth nose. Will you have to do this twice if this thing mutates? Many of you, including Erica Stairs, Marisa Holzman, Anna Okrasinski, Maddox, Cameron Seward, Stephanie Enkel, Anna Thompson, Dawn Swart, and Kevin Leahy wanted to know about strains and mutations. Now a paper came out just in late April by the Los Alamos National Lab that noted, the G strain of the virus is more prevalent in Europe and on the east coast of the US and

speculated that it's a more virulent form, but that paper has not yet been peer reviewed and many other scientists say there's pretty much only one strain. Coronaviruses apparently mutate at one tenth of the rate as influenza, and that G strain may have just by chance become more prevalent. It might just be a lucky virus with good odds and not necessarily more dangerous or more infectious, so jury is still very much out on that. Now if you've had COVID-19, are you immune if it mutates? Even if you do have immunity, when does it start to wane?

So are you going to be immune for a couple weeks, a couple months, a couple years, forever? We don't know. And then is this virus possibly able to mutate, and if it mutates then maybe your immunity is not going to be useful, and the best example of that is the flu. So the flu is a virus, and you have to get a flu vaccine every year because there's something called antigenic drift and antigenic shift. And what that means is that their DNA is very susceptible to mutation, and so you get these tiny little mutations, and that's just enough for it to basically kind of evade the antibodies

from the previous season. That's not a coronavirus, so maybe it's not the same mechanism, I don't know, but no one knows. Now, that being said, if you have antibodies and you get tested positive for these antibodies, that should not mean that you're less vigilant about how you go about your life. It might give you a little bit of mental solace, which is good, but you should still wear your mask, you should still be careful, you should still wash your hands, you should still socially distance when you can, all of those things still apply.

The other thing I want to say is that the antibody tests, and this is actually very interesting, so we were so behind on the diagnostic PCR test that basically, do you have COVID or do you not have COVID test? And that was in part because the FDA was so heavily regulating how those tests got rolled out, which is what their job is, but in this pandemic, they really kind of laid the book down and said, no, you can't, you know, Medical Academic Center X can't make your own diagnostic test, even though you have a lab and you have the utilities to do so because we need to regulate it.

And that was part of the reason why it took so long to get a wider diagnostic test out there. They went so far on the other end of the spectrum with the antibody test and they went to the free market and said, have at it, do it as much as quickly and as many as you can. And what that spawned was a very large spectrum of reliable antibody tests. And so the same antibody tests from a different manufacturer may not give you the same reliable tests, meaning you can get false positives, false negatives, and you can imagine what that would mean if you get a false positive saying, yes, you have antibodies and people

that maybe get a little less vigilant and then you're going to have a lot of problems. So a bunch of patrons like Crystal Mendoza, Oda Helene Schatz, Michelle Nier, Gwen Kelly, Marisa Hulsman and first time question asker John C. Feluti wanted to know about antibody tests and errors in testing. Antibody tests have to be validated to show that they're sensitive enough to pick it up and specific enough to distinguish between this SARS-CoV-2 virus versus other related viruses. And a lot of those validation tests are still ongoing.

It's very, very, very much a work in progress and in many cases, if those tests are being done by commercial labs, there's not always full transparency into the rates of false positive or false negative results. So there's no point getting a blood sample drawn for a PCR test because it turns out that the virus is mostly in your mucus membranes in your nasopharyngeal passage and lungs. But an antibody test is you're actually going to want to look for the antibodies in your bloodstream because you don't build up a lot of antibodies in your nasopharyngeal. And by the way, you don't build up antibodies until at least 10, maybe 15 days when you

start after the virus is cleared. So it's really challenging or in some cases after the symptoms start. So it's when you take the sample and what kind of test and from which tissue type it's taken from and how much virus you had in your system are all important variables that can change the outcome of the test in an artifactual way. So can you get it twice? Now a study out of South Korea thought maybe yes. And then they realized that their tests were so good, so sensitive that they were just

detecting old fragments of the first infection. So that is good news. Now patrons Jen Anathas, Jessica Janssen, Carolyn Wolfram, Patty Bergman, Jenny Hoover, Ellen Skelton, Mike Monakowski, and Zoe Buckley wanted to know, can we get it like a double whammy? If you had it in January and now you are exposed to gain, we don't think so. Almost all evidence indicates that you cannot get it again because you do develop immunity, some degree of protective immunity.

What we don't know is how long that protective immunity lasts. So it might be that either the virus evolves away from what your immune system has trained on or it might be that your own immune response is maybe not that effective. When you get a virus deep into your lungs, there's a really amazing blood-viral interaction so that you can develop a really strong immune response to viruses that affect you at that sort of intimate level. But the viruses we get in our nasal pharyngeal passages, the common colds, we never really develop anything but very transient immunity because there's no opportunity to really have

that nice viral blood-bath interaction to really develop a strong immune response. So with common colds, we only ever get transient immunity and then the next season, next year, we can get the same cold and so it goes over and over again, year over year. So the big question is, will we develop protective immunity to severe disease, to viral pneumonia? But will this virus then sort of kick up a new quasi-existence as sort of a common cold-like virus where we never really develop a protective immunity to but only transient immunity to more upper respiratory-type virus? I asked Dr. Natter about that too.

So it's a very good question. The truth is we don't know the answer yet, but we think that if you look at just like what we know in science, medical science, typically speaking, when your immune system gets introduced to an antigen or a foreign invader, like a virus or a bacterium or something along those lines, your immune system, one path of your immune system is to make antibodies in order to fight that off. Your body then has things called memory cells or plasma cells that then essentially turn into these factories of that specific antibody and they just crank them out.

And that's how you develop an immunity. Marisa Holtzman and Emma Fiori wanted to know about herd immunity and in patron Wayne Hovey's words, how does this herd immunity thing work? So as long as I had a smart virologist on the line, I asked this stupid question for all of us. No such thing. Okay. I don't quite understand when we all come out of isolation.

How are we not going to just keep spreading it again from an epidemiological standpoint? What is going to happen in a couple months when we're all out and about like we used to be? Yeah. I mean, this is a really important concept. It relates back to this concept of herd immunity. It's recognizing that there's a certain proportion of people that we may interact with in our populations that might have had the virus and be immune, so they're no longer susceptible.

So what we assume is that when the epidemic wave starts to drop, two things are happening for whatever reason, policy-wise or not, the energy in the wave has bled out because there aren't as many infected spreading the virus to as many susceptibles. And so we can impact that wave by reducing the number of infected, which we isolate people and their opportunity to impact susceptibles, to interact with susceptibles, so we're reducing those buckets. But when we all go back out and we've seen this in China, why didn't the virus flare back up to pre-peak of the wave levels?

And so we presume that the virus has basically run out of susceptibles that a certain number of infected might run into. So there's like, how many infected are circulating? How many susceptibles might they run into? So are there hotspots of transmission, for example? Are there these sort of key sectors in the public domain where people would more likely exchange virus? And that's why people are thinking about different scenarios when we all go back out there.

Maybe we'll be getting back up there slowly where we may try to put in place some social distancing mechanisms or trickle back in so that we can keep that contact right between infected and susceptibles low. All the while, we try to understand the base herd immunity, like how many people truly were impacted and might be immune, so those susceptibles would be sort of taken out of the equation because they're not susceptible to their immune. So looking empirically at kind of the way things are rolling in other countries that have seen the end of the wave and have opened back up, they haven't experienced a resurgence,

but they're doing a lot of things. They had a wave, they definitely have some herd immunity, but they're also coupling that with social distancing measures. What if you have had it and want to put your body fluids to good use? Well, according to the Red Cross, people who have fully recovered from COVID-19 have antibodies in their plasma that can attack the virus, and this convalescent plasma is being evaluated as a treatment for patients with serious or immediately life-threatening COVID infections. So it's called convalescent plasma, patrons Gwen Kelly, Anakin Janiak, and Marissa Holtzman

wanted to know about it. Is there a way to donate like plasma if you do have antibodies, does that even work? So it's a good question. Yes, there is plenty of ways you can do that. I think you have to reach out to your local kind of hospital, your local academic hospital to find out how they're doing it and where to go. I know that in New York for sure Mount Sinai and NYU are doing that, but the way that works is actually very interesting.

So it's not a blood donation as much as it is a plasma donation or rather a transfusion. And the difference between blood and plasma, plasma makes up part of the blood. So the blood is a bunch of cells. It's got white cells and red cells and a bunch of other stuff, but also it's plasma. Plasma is kind of like the Gatorade portion. And if you took out all the rest of the stuff, you get this kind of like yellowy fluid. It's got all the electrolytes and all the good stuff. But in addition to having all that, it has your antibodies.

So if you had the coronavirus, you got better, you got tested for antibodies and you're positive and you're healthy and you're able to donate blood, then you might be someone that could donate your plasma. They then, they do what's called a centrifuge or they kind of spin it really fast to separate the plasma from the blood. And they take that plasma and they can then give it to someone who's very, very sick who has COVID at that time, theoretically giving them the actual antibodies so the body hasn't made the antibodies yet.

You're giving it to them to get better. We think this might help. Back in the day, they would do this and there was some evidence for it. We're still testing it. So we still don't have the hard evidence, the hard data to say it will. The science suggested it should. Same idea with if you have tested positive for antibodies and the science says you should have some immunity, we think.

But until we have the numbers and the objective data, you can't say for sure. And what about the effects on our hearts? And by hearts, I mean brains. I just think that there's more of a psychological impact that we maybe won't understand until you touched on PTSD. But yeah, I think that there is a certain kind of psychological trauma of being scared of this invisible thing that could kill you. Or if you go into the store to go buy soup that you could end up killing seven people

by doing it. I would never handle a live firearm, much less just start shooting into an open crowd. So it's kind of like that level of fear, I think, is probably pretty exhausting for people. Yeah. And I think for better and for worse, I think people are becoming less vigilant and anxious. So that's good in some ways, I think, for mentality, but I think it's also dangerous because as people are lighting up, obviously, there's going to be a lot more potential

for outbreaks and so on. So as we mentioned in the first virology episode, one of the reasons COVID-19 spreads so effectively is that unlike SARS-1, it's transmissible even when you don't have symptoms. And a lot of people don't have symptoms. Now, a bunch of patrons like Katya Nizik, Gwen Kelly, Anna Thompson, Jennifer Lowe, Diana Wisniewski, Jillian Kluge and Natali, Jamie Pickles and Marisa Laws wanted to know what we've learned about how it's transmitted. Like how far can our juicy infectious droplets travel?

And why is it important to wear masks? And why is social distancing so important? You know, originally, we were kind of assuming, or a lot of people were assuming, the pathology of this virus is viral pneumonia. So we recognized that it was binding to cells in the respiratory tract at a large scale in the lower respiratory tract and then, you know, transmitting through viral pneumonia like symptoms causing disease like viral pneumonia and those symptoms were like these explosive coughs and sneezes.

And so that's bringing droplets from deep into deep, you know, deep within your lungs up and out and spreading the virus. So what we've learned since is that this virus also pretty efficiently infects the upper nasopharyngeal passages and tissues. So, you know, it is infecting those mucus membranes in your nasal passages, for example, even before it gets into your lungs and can potentially infect your lung tissue. And that means that, well, that possibly suggests that, you know, maybe the virus could pretty efficiently transmit through the products from our upper nasopharyngeal passage.

Like, you know, maybe if you clear your throat or you just have a tickle, like a light cough or maybe you're breathing very heavily from exercising. And so you'll notice that there was a change in policy, like two sources of information came together, one that from the population level perspective, all the estimates of how transmissible this virus was was pretty high, suggesting that, you know, it's maybe not just people with severe disease products that are, you know, spreading the virus, but rather maybe more people could spread it asymptomatically through breath or light coughs or tickles. And then there was also some laboratory data that showed, especially in hospital settings,

when we use equipment like ventilators, we can nebulize the virus into tiny, the tiniest, tiniest droplets. And these are like a millionth of a meter, so point, you know, point one microns. They can, the virus can float in the air for up to three hours through the tiniest of droplets. Now, when we cough or sneeze, there's a very, very small fraction of droplets that are that tiny. So most of the droplets will fall down. They're bigger, they fall out of the air at that six foot level.

But because there could be a very, very, very small fraction of the tiniest of tiniest particles that could have the virus, that's really why we started, why you could see policy change to have masks, even cloth homemade masks be worn as a general protective measure. A lot of you asked about masks, like Casey Wright says, masks, what's the real scoop on them? Driver, Yvonne Bustos, Don Swart, Edgar Valeta, Ellen Silva, Sarah Keelig, Debra N, and Katherine Ma wanted to know what masks are the best to be wearing. Now, Dr. Bennett told me she wears a homemade triple layer, high quality, high thread count

cotton fabric mask. It's fitted around her nose with bendable wires, and it's two layers of that high thread count cotton with a layer of pantyhose. And now some researchers think a strip of pantyhose, nylon stocking, can also be tied over a fabric mask to help seal the gaps between your face and the mask. Mind the gaps. Let's say you're just using a flappy cowboy bandana, it's better to at least tuck it into your shirt.

Now, Dr. Natter wears a respirator used for spray painting, and that filters out, he says about 99% of particulates, and it has changeable filters. What about if you're going running or biking? Wear a mask. So a mask is protecting both you from shedding virus, and remember, up to, you know, there's a huge variability in asymptomatic rates, people that are undetected symptoms, right? So it ranges from, I think, 30 to 85% with an average of 50%. So you might be infected.

So a mask protects you from shedding virus, not completely, but it blocks big droplets, for example. And it also may protect you from sucking in virus infected droplets. So if you're working out, you're going to be breathing more heavily, you're going to be breathing out more heavily and in more heavily. But, you know, it's actually really hard to wear a triple ear mask and work out. So I am trying whenever I can to wear a mask, but then as I'm beating along on my hike to the where's the top of the hill, I might have to like whip it off and take a big deep breath

and try to get air, and then I try to put it back on. But you know, the places, I'm sheltering in place and I'm staying local and I'm walking up the trails in my neighborhood and there are a lot of people out there. So unless I wait until fray late in the evening, which I'm now doing to sort of not run into people, I hesitate to exercise without a mask because there's so many people you can pass and you can try to socially distance yourself by moving across the street, but it's really challenging. So that makes sense.

I would recommend wearing a mask all the time. Listener Caitlin Mills wanted to know if this will go away in the summer. How cyclical will COVID-19 be? So in a lot of seasonal viruses, you know, they're seasonal because humans in the temperate zone are gathering together in classrooms or in inside spaces where the air is recirculated and it's, you know, cool and dry and they're crowded up. And so it's probably in many cases host behavior that's driving seasonality in many viral pathogens. But this is a big question that remains to be seen whether this virus needs that seasonality

boost of clustered up humans to kick it back into circulation in the fall. The biggest risk is when you have touched something that has virus on it and then you touch it to your mouth or nose. And so you might imagine like, let's say you get, you buy a box of Cheerios and you bring it in the house. If you put it away and let's say maybe it has, we call them viral fomites when, you know, somebody deposited a virus particle on the surface of something, it's called a fomite. So let's say there might have been a couple of fomites on the box and you put it in the

cupboard. As long as you wash your hands before you prepare food and you wash your hands before you eat, you're going to put in a barrier in between you and those fomites and your mouth or nose. That said, they're definitely, you want to reduce the, you want to put barriers up at every opportunity, right? And there have been some studies, there was a lab study that, you know, this is new information. We didn't know this at the beginning.

We were just inferring how long viruses last on surfaces from what we know about other viruses. And we know this virus is, it's encapsulated in an envelope, a lipid layer, two membrane layer of lipids. And so it's actually a delicate virus because soap can break that outer layer up and make that virus basically dissolve. And so that's why people are saying, wash your hands with soap. You can wash surfaces with soap, like, you know, I'm washing my fruits and my vegetables

very well. Maybe even a little soap. Okay. So then there was a study that showed that, asked the question, if you don't wash with soap or ethanol or isopropanol or, or some disinfectant, how long would the virus last on a surface? Dr. Bennett cited a recent study that seeded SARS-CoV-2 on different materials, including cardboard and stainless steel, copper, plastic, and researchers found that on plastic and

stainless steel, it could live up to 72 hours. Now, some types of coronavirus live only a few minutes on cardboard and paper while others can live for days. We're just not sure. So in some cases, I'm just like getting home, throwing my mail in a bin, I can check it in three days. I'm not in a big rush, right? So, so in theory, the virus doesn't stick around that long on surfaces because it's

kind of delicate up to 72 hours and it can be killed by a lot of different kinds of surface disinfectants, including something as simple as just soap and water. And furthermore, if you don't want to be bothered washing every piece of groceries, just make sure you wash your hands before you prepare food and before you eat. And don't touch your eyes, nose, and mouth before washing your hands. Yeah. What about when you're in the grocery store? Deverellatz has a great question.

If I'm wearing a mask and gloves, for instance, in the grocery store, is it safe to be less than six feet away from other people who are also wearing masks and gloves or should I wait until the aisle is empty and then grab the butter? Yeah. No, it's a good question. So, you know, in a perfect world, you remain six feet away from everyone. But your risk is much more mitigated when you take the precautions of, you know, wearing a mask and the other person's wearing a mask, but you shouldn't feel like you have your

invisible cloak of, you know, immunity on that you can kind of walk up to anyone when you have a mask on. And I would like to make a point about gloves. It's impossible like in your everyday life, like it's impossible to properly wear masks and gloves. And I will say this also, these masks and gloves medically are designed to be single use. So like, you're meant to wear them into a patient room, have your patient contact, and then what we call DOF, the PPE and like take off the gloves and the mask and they shouldn't

be used ever again because they're contaminated. But in terms of gloves, my point about gloves is that people wearing gloves, like the same kind of risk is there even if you're not wearing gloves, meaning if you take the gloves and touch your face, then you've done nothing. The gloves have done nothing for you. And any service that that glove were to touch, if that, you know, were contaminated, then the gloves are contaminated. And so what I always say, especially to my parents who are the gloves, is pretend, wear

the gloves, but pretend that the gloves are not on and wash your hands the same as you would, meaning you can put Purell on the gloves. And so I try to kind of indoctrinate them to wash their hands even if they have gloves on kind of thing. Okay. Patron Greg Wallach chimed in and said, Amen on the glove question. Do people even understand how gloves actually work? He says, I saw a woman eating a doughnut with her gloved hand.

She's keeping herself from getting sticky fingers, I guess. And researchers do report that 100% of those eating doughnuts get sticky fingers afterward. I am researchers. What are scientists busy studying right now? Let's get into it. So both Dr. Natter and Dr. Bennett mentioned that the cytokine storms that cause organ shutdown, those tend to be less severe in younger patients than older patients. And comorbidities like lung disease, obesity, and heart disease can contribute to less optimistic

prognosis. And those are less common in kids. Now hospitals are starting to prone patients. This is a practice that Dr. Natter's colleagues affectionately refer to as tummy time, because laying on your stomach with an oxygen mask gives the lungs more space and has been shown to be a promising option over intubation. Now other research is being done with medication. The amount of studies that are currently ongoing, the amount of publications that are coming

out, a lot of my colleagues at my institution are like brilliant. And there's a lot of interesting theories, a lot of stuff that's going on. And I think we are going to have nailed down very soon good kind of guidelines and treatments for when to do what. None of this, we don't have treatments like the Remdesivir. Now Remdesivir, side note, is an antiviral drug that according to a paper published April 29th in the journal Lancet, has been shown to reduce hospital stays by about four days. But it hasn't been shown to reduce the risk of death.

Still, it's in huge demand and some hospitals can't even get their hands on it. Dr. Natter explains. There's a lot of talk about Remdesivir, which is a great drug, but it's not a cure. And it's not going to necessarily reverse course as much as we hope. Unfortunately, the other drugs that we're getting a lot of hype as well that I've seen anecdotally are doing nothing, the hydroxychloroquine and the azithromycin and zinc. But I will say, I am curious to know if those drugs were started very early on in the course before someone was hospitalized, if that would have any effect.

Because I think once someone gets hospitalized, what we're seeing is less of the viremia and more of the immune destruction and like a cytokine storm. And I think that's part of why a lot of these antiviral treatments, if they're not started up front, are not going to have as much of an impact. That's totally my guess, my theory. I don't know if it's true. I mean, I was talking to the virologist right before this and she was talking about all of the different publications you can look at and what people are working on and how

inspiring that is that there's a lot of people kind of behind the scenes, just working on it very diligently. Oh, it's amazing. It's amazing. And not only behind the scenes, like there are a lot of physician scientists who will literally like work with me on this, you know, like one of my attendings will be there and we'll be there, you know, on our 12 hours or whatever and then they'll go home and they'll like basically like type up all this stuff and do all this research and like publish

and, you know, the next day it's like in JAMA and I'm like, Jesus, do you not sleep like any day? This is what Dr. Bennett had said. One thing I do for Jollies is I go on to the WHO website. They actually have a registry of all clinical trials worldwide. You have to register a clinical trial for for any of these things, whether it's an antiviral or a vaccine or a test or even an epidemiologic toolkit that you want to develop, you take it into these clinical trials and you have to register them with WHO and then the NIH, that's our own U.S.

National Institutes of Health, also has a registry of clinical trials and you would be amazed at how many clinical trials are in progress. And it for me, it gives me a great deal of hope. There are hundreds and hundreds of antibody tests, vaccines and therapies that are currently being tested and examined and at a minimum, many of these can be used for emergency use, or at least the anti the therapies. Speaking of vaccines in Amanda Mueller's words, what is causing the holdup? Kathleen Carlson, Eileen Prince, Will Pliwa, Lau, Caitlin Mills, Don Ewald, Betsy

Shepard, Adam Drake, Gwen Kelly and Zoltan Sazi all echoed our universal impatience. And then what about vaccines? Are they taking doctors inside to be like, hey, it's going to be to September or they like, hey, it's going to be never. I've heard nothing that the general public has heard, hasn't heard about vaccines. I do think we are going to see a vaccine significantly faster than we would normally. Normally, a vaccine takes about four years. Ouch, ouch.

I think we're going to see a vaccine way sooner than that. And that's partially for a couple of reasons. For one, everyone is in the world is affected by this virus. And so there is a huge impetus to get this done. But the other thing is a lot of folks have been working on vaccines for similar things like MERS, like Ebola, like other viruses. And so some folks had a head start, I think, particularly in England. They seem like they're doing really well.

The other thing is, even if you're able to get the right concoction for a vaccine, you obviously need to test efficacy, but you need to test safety first. But then outside of that, you have to manufacture it. So on average, like a normal vaccine, the infrastructure is set up to maybe make, I don't know, five, 10 million doses. You know, we need on the order of 300 million in the United States. If it's a single dose vaccine, it might be a double dose. 600 million doses of this.

So the infrastructure, you know, and I think Dr. Fauci already started saying this, but like, you need to start working on that now before you have the vaccine and you need to kind of convert different factories that could potentially, you know, manufacture the vaccine before the vaccine is even ready to be manufactured. So a vaccine, side note, is a weakened form of the virus injected into the bloodstream so that your immune system can suss it out and make a good defense army against it. For more on this, you can listen to the epidemiology episode with guests.

The doctors, Aaron, of this podcast will kill you. Now, in terms of a SARS-CoV-2 vaccine, Dr. Bennett says, and in fact, some of the vaccine candidates that are being explored are the SARS-1 vaccine candidates that were just kind of left and never developed. And so it's gotten us a head start. We have a good head start on vaccine candidates borrowed from other similar related viruses.

There are clinical trials happening right now with many vaccine candidates. And that definitely means that it's going to be much shorter than four years out. And I would definitely put it definitely on the sort of the 12 to 18 month track. So that's great. So we'll get back to your questions in just a sec. But quick note on donations for this episode. They were made to the Food Bank for New York City in Dr. McNatter's name.

We also made a donation to the California Academy of Sciences in honor of Dr. Shannon Bennett, who does such amazing work there. Also, this episode, we are shouting out another great podcast with tons of coronavirus info science versus with the wonderful Wendy Zuckerman. So take a listen to that for some great coverage. OK, back to your questions. So many people want to know Kendall Bernal, Emily Dilger, Madeline Dunkel, Tamara

Oliver, first-time question asker, Kate Srelhau and Michelle Harvey, Jamie Thornton and in Dave Miller's words, are we absolutely nuts to have even partial reopening? Are we opening up too soon? Oh, man, this is crazy. I imagine when it's like to be like Governor Cuomo or like some of these folks like that, like no one knows, no one knows. I am worried because I do think that opening up inevitably will create more potential infection.

I think if you just look at the reason that the infection rates are down, isn't because we've conquered this illness and COVID somehow like went away. Like it's very much there. So if you allow a city of six million to densely populate the subways all over again, like I don't care how many gloves and masks you have on, like there's going to be more transmission of this disease. But it's this balance of how much longer can you keep people on lockdown? And I think it might be this slow dance where you take a few steps out slowly

and you track how many infections are, you track the admission rate, you track the ICU admissions, you track the death rate. The death rate will obviously lag behind by a couple of weeks, but you track everything you can and you test as much as you can. And then you may have to kind of go a couple of steps back and wait a little bit and, you know, as to not overwhelm the health care system and as to keep infections as low as possible. I don't think it's wrong to try, but I think it has to be done very responsibly

and very, very slowly and with a lot, a lot of vigilance and testing and everyone buying in in terms of trying to keep their distance, in terms of trying to, you know, not spit in anyone else's face. Right. Avoid that for now. It's not recommended. Let's get philosophical and ethical about it. But I think, you know, Governor Cuomo, I think, says it really well and he's

like, you're at, you're essentially asking when you, when you have to open things back up is, you know, how much is a human life worth is the way he sees it. And, you know, to him, when you open up, you're going to, people are going to die. And so he, I think, is doing a good job in trying to find resources for people to not have to go back to work, you know, you know, give, you know, something to these individuals so that they can have food and they can, you know, not worry about getting evicted and all these things. And so there's only so much that can be done.

Yeah. I don't, I don't know. Who knows? Who knows? How do you feel when you see people in Central Park just picnicking? Yeah. I mean, listen, if you can be six feet away from everyone else. Um, great.

Are you actually six feet away from everyone? Probably not. And I think this past weekend I was talking to my friends about it and it's, it, it worries me a little bit. Um, I think it's a harbinger for the inevitable second wave that's going to come after things start opening up. Um, because I think as things start to open up, people are going to get less and less vigilant really and more and more kind of, um, flagrant about, you

know, giving up the social distancing and stuff. I am worried. And I do unfortunately think that there will be another wave and I just hope that it's nowhere near as bad as what it was. Right. This next question is from patron Annie C who tapped into our collective consciousness and inquired simply, so how fucked are we? I asked Dr. Bennett what we can expect next.

It's spring is in the air. We're all getting a little excited and we miss each other physically. I'm sensual. Everybody's observing that the curves are flattening. I would definitely say that it's definitely too soon to bunch up and we need to stay the course. And so I do, I do cringe when I see people that are clearly not in family groups sort of throwing caution to the wind and, and bunching up.

Um, I, I, I understand it, but it definitely is too soon. And, and we need to not do it. We're not ready. We will be ready. There is light at the end of the tunnel, but we shouldn't sort of be racing for the end of the tunnel just yet. Speaking of missing each other physically, star and Shannon Patterson wanters know when they can see their parents and their family again.

Marissa Laws asked, should we cancel handshakes forever? And Tracy Michael wondered, will we ever be able to hug freely again? I really miss hugs, they say. I would trade out a handshake any day for a hug. Like, I don't think we need handshakes, but I miss hugs too. And my mom lives in Canada and I, you know, she was supposed to come down and visit for my daughter's birthday and we couldn't make it happen. And it's, it's, uh, we miss our family.

I myself struggle with this question is, is, um, is when, when is it okay to hug? It's about risk, right? It's about thinking about the risk of the person you're hugging to getting a virus from you. And so if that is an older person or an older parent that's not in your immediate family circle, then you may be bringing a virus to a vulnerable person.

So that, that's one thing for sure. But, you know, everybody needs to be empowered to sort of assess their own risk, right? So it might be that, um, you know, if the loved ones that you, uh, that are in your family are themselves isolated and they have a very, very tiny contact sphere and you yourself has, you know, have been really strict about containing your contact sphere, then, you know, at some point, as we lift shelter in place and we can start to interact physically with each

other or move to each other, then there's, there's probably going to be a way for you to mitigate risk to your older loved ones that you can, uh, share hugs, but the, the, maybe the proper and official answer, because that's kind of my metric as a person, but, but the official answer really is that unless and until we know, um, what, you know, how many people are immune and what the true, uh, size of the iceberg of this coronavirus population really is, because right now we just see the tip of the iceberg through the limited testing.

But once we really understand how, you know, how widespread it is and how many people are immune, and then once we build up our toolkit for responding to the infections by like really, you know, really strategic contact tracing and, and social distancing, um, and then we also have our toolkit to have therapeutics and vaccines. I mean, all of those things sort of would, we would want to come bring them all together to make risk zero, right, or near zero for a hug, but many of us live with a little bit of risk every day, you know. Dr. Natter mentions the mental health effects as well.

This is a really, really stressful time. It's very emotional. People are losing their jobs. People don't have the same kind of outlets. They don't have the same social, you know, support, because physically they can't. It's hard. It's very scary. And so I think it's important to recognize what your triggers are. It's important to find things that are safe to do during this time, but doing them seems like people are really liking the baking of bread right now. But, you know, finding something that's going to kind of center you and keep

you sane and recognizing that, like, this is a really scary, really shitty situation, but I'm seeing a lot of amazing generosity and charity and just, like, humanity through all this, which is one of the more beautiful things. And, like, the appreciation that we're seeing and feeling from, you know, for us, the healthcare workers is, like, tremendous. And I was thinking about how sad I'm going to be, because right now, every night at 7 p.m., everyone comes out and claps and bangs and the firefighters come over. And I was thinking, I'm going to be so sad when this ends, because it hasn't ended. It's been going on for

months now. And I was like, the day this stops, I'm going to be really bummed out. And I'm like, maybe, like, something like this, not necessarily like having everyone come out and cheer for us, but something along the lines of appreciating each other hopefully gets, you know, salvaged and stays with us. I think it will, at least on some level, I think it will. And I'm hopeful that this is all going to come to an end at some point. I don't think it's going to go back to the same normal that we had. I think there's going to be a new normal, unfortunately. And I think it's kind of like, you know, living through 9-11, I never had to, you know,

take my shoes off before getting an airplane and now that's kind of routine, you know? So I think there will be things that are different, but that we will very much adapt to. And that will be, you know, in everyone's best interest in terms of public health. Yeah. I'm glad that the banging on pots of pants doesn't annoy you as a health care worker. Oh my God, I love it. Why would it annoy me? I don't know. Maybe you're trying to sleep. And then I think I wonder if there's a nurse out there who's like, shut the fuck up. They would actually make a great comic, I should say. My mom, who's like the most adorable woman ever, my dad took a video of her on her terrace like with a little pot and pan.

I look this up and his mom, Ellen Natter, is an adorable, diminutive blonde woman with stylish, horned rimmed glasses. She's hipper than me. She's on her midtown Manhattan balcony, smacking a saucepan toward the sky and appreciation of health care workers and hospital staff who every day are putting their lives on the line, like her son. I don't know how you guys do it. You're amazing. Is there anything you would want people to do or take away from this or continue doing or not do? Anything that the rest of us who are just sitting around making sourdough can do for y'all? No, keep making sourdough. I think it's, you know, I think we feel it. Like the health care

workers, at least I can speak for myself and my colleagues, we feel the love, we feel the appreciation and we really appreciate it. I think, please just follow, I mean, I imagine the majority of your listenership are people that are very socially conscious, so they're probably already doing this anyway, but just follow the guidelines they're given. I recognize and get frustrated myself when they seem to change minute to minute and they seem to sometimes not make any sense, but if we don't do it all together, then a lot of it's not going to work. And so, socially distancing, I think, is very key. Wearing masks, if you're, you know, your local government tells you to, I think is very helpful. But just being kind to each other and just making

sure that, you know, we get through this together. I should also say I think it's important to recognize that your neighbors may be elderly and along and might need some help and, you know, picking up some groceries for them and just kind of being a good human, I think now more than ever is really important. Check in on each other and such. Yeah. Yeah, that's good. Dr. Bennett says that in-person relationships are important and maybe we're all realizing that a little more now. What do we mean to each other? All of a sudden, I think we mean a lot more to each other than we thought. So, let's not take our friends for granted. Check in with each other, even if it's just to send a picture of a flower or an apricot that looks like a butt. We need those moments.

Yeah. And how much we all need other people, whether we're in the U.S. or whether we're a Republican or a Democrat or whether we're, you know, we're Muslim or Jewish or living in China. I mean, we all need other people. So, call up old friends or new ones and ask them stupid questions because no question is stupid and we'll get through this together. Now, you can follow Dr. Shannon Bennett and Dr. Mike Natter at the links in the show notes and I'll also put a link there to alleyward.com slash allergies slash virology too. So, you can get more links to the studies cited in the science versus podcast we mentioned, the organizations receiving donations, database for scientists and more. We are at oligies on Twitter and Facebook. I'm at

alleyward with 1L on both. Thank you, Shannon Feltis and Bonnie Dutch of the Comedy Podcast. You are that for handling merch. Thank you, Erin Talbert for admitting the Facebook group. Caleb Patton for bleeping episodes and Emily White for handling the oligies transcription efforts. Thank you to everyone who works on those and transcribing them. The bleeped episodes and the full transcripts are available for free on my site at alleyward.com slash oligies slash extras. Link in the show notes. Thank you to Noel Dillworth for helping me with scheduling and getting all these interviews all lined up. Thank you to Jared Sleeper of MindGerm Media for assistant editing and of course, the jewel in our corona, Steven Ray Morris of the podcast The Percast and See

Jurassic Right for editing these all together and making sure that they go up on time. Nick Thorburn wrote and performed the theme music and if you make it through the credits without bailing, I tell you a secret. And today, like an hour ago, I made a quesadilla with some corn tortillas that I noticed had a sell by date of April 2nd. It's over a month ago, but they weren't moldy and I was like, I'm going to eat them anyway. And then I went to get some cheese and we had some jalapeno cheddar and it was moldy, but I just cut the mold off and I ate the good parts with the expired tortillas. Now it's been an hour. I'm still alive. I'm just at the part of quarantine where I eat garbage like a raccoon. Also, I made a quesadilla for Jared too, but I didn't tell him about the

mold I cut off the cheese or the tortillas. And since he helps me edit, he saw this in my notes, has my secret, and I was like, are you mad? He was like, no, just cut the mold off the cheesy date anyway. So everyone does. I was like, tight. Okay, bye-bye.