Sawbones: A Marital Tour of Misguided Medicine - Sawbones: COVID-19 Q&A

Episode Date: May 17, 2020

It should come as no surprise that the Sawbones inbox has been chockablock with questions about the ongoing ... unpleasantness. This week, we're trying to group your COVID-19 queries in an orderly fashion and answer them to the best of our ability. Well, the best of Sydnee's ability. Justin just talks about dandruff shampoo. Music: "Medicines" by The Taxpayers

Sawbones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. that weird growth. You're worth it. Alright, time is about to books. One, two, one, of Miss Guy at Medicine. for the mouth. Wow. Hello, everybody, and welcome to Saubone's, Emerald Tour of

Miscite at Medicine, I'm your co-host, Justin McAroy. And I'm Sydney McAroy. Whoa, did you like that energy said? It was, I mean, it's up there. It's high, I would say it was high energy. Uh, sometimes this is as close as

you and I get to talking to other adults. So I like to imagine that energy right now. I'm just talking with some friends other adults. So I like to imagine that energy right now. I'm just talking with some friends of mine. Other adult friends we have that we're talking to. This is not sad. This is in no way sad. That's a normal thing.

You know, we could just like zoom or Skype somebody or FaceTime or whatever, like that kind of thing. I don't, I guess that's true, but. You only know how to communicate through podcasting. When I start talking about the mattresses, I enjoy the underwear I like, they're like, they tune out. And I need people who are dialed in and hear for it. So the, the ads that really,

It's the ads that bum my friends out The unpleasantness continues That's a way to put it. That's I mean, that's yeah, that's the actually this the only calendar item that I have It's just an ongoing thing that says the unpleasantness continues. I hope you're hanging in there friends We're doing our best here. Yeah. It's been a rough week. Yeah. I thought, you know, I should put together a medical question type episode, but we've had so many COVID related questions. I thought maybe one specific to that.

Right. We didn't really have to put out a call for them because we've just had so many that I thought we could address some of the, they're kind of kind of grouped as opposed to I know in our usual weird medical question episodes we read like the whole email from the listener, but we've had, I think the general questions fall into several themes. So I kind of have these general things. Well, I'm excited to learn something. I know I've got a lot of questions myself about COVID.

I'm sure they'll all be answered by the end of this episode. And I'm excited to get going. Now, I should caution Justin. We are not going to answer all your questions about COVID because I don't have all the answers. I've only got six questions. Oh, well, okay. I'm just saying. Perfect.

I don't think anyone has all the answers right now. That's true. That's just the truth. That's true. I would distrust anyone who acts like they have all the answers. There was one common question that came up a lot. I read an email from Cat who I summed it up nicely and it's about how likely a vaccine is. Yeah. Especially, I think that this specific email was in light of is, especially, I think that this specific email was in light of family members who are anti-vax and who feel that not only would they, I think, not want a vaccine, but there's also not one coming, specifically for reasons like we don't have any vaccines against coronavirus is right now.

So why would we be able to make a vaccine against this one? Boris Johnson, you may know him better as the British prime minister. Yes. And COVID-19 survivor, to be fair. That is true. He said this week, actually, that a vaccine or last week vaccine may never be found. So I, it's not exactly conspiracy theory at this point. No, I didn't know he said that. Yeah. Now, if you, if you listen to the, the recent, the, what was it? It was a congressional hearing testifying before Congress, the various scientific experts, Dr. Fauci and Robert Redfield from the CDC, some other people who were asked to come testify

as to before the Senate, as to where we are in terms of our response and various things. And I think Dr. Fauci made it very clear then, which was very recent, and he said at multiple times that a vaccine is not only likely, but I mean, it is coming, it will be coming. It is not here now, it takes a while. He has to keep saying that because every time he says it,

other people will say, Do I have some? If you do have it on you. Well, we'll try to speed that up. And he's like, no, that is the speeding up. The speeding up is 12 to 18 months. And they're like, well, maybe we can speed it up. And he's like, no, really, we can't.

Anyway, it is very likely that a vaccine is coming. And I am not telling you that as my self and expert, I'm telling you that because the experts say that. That's what they all say. They agree. The people who make the vaccines and the people who know how to make vaccines and direct agencies to do so,

all agree that yes, a vaccine is quite possible. Now I'm gonna challenge you on that, Sydney. We've never made a vaccine to a coronavirus. That's not really true. Oh, wow. Let's exclude SARS and MERS for a second. Okay. Why have we not made vaccines for other coronaviruses? You may be able to answer this.

My best guess would be that they have not been that serious. We don't have a vaccine against the common cold. Basically. Yes. I mean, we don't have a vaccine for rhino virus either, which also can cause basically a common cold for most people. That's not to say that any of those illnesses in someone who is, who has other chronic diseases or who might be very sick from something else.

Of course, it could be a big deal. But for most of us, the coronavirus, the everyday coronavirus not SARS, not MERS, not COVID, has not been a big deal. That's why we don't have a vaccine against it. We can't have a vaccine against every single virus. Right. We just...

Not in the powers of the day. No, we don't. There are those cool ideas that I've mentioned before where Dr. Fauci said we could have like platform Vaccines that we could tailor to different outbreaks as they occur, but that takes time and money and a Federal focus government that is focused and yeah on that and We've got space for us right now. So other things take precedence. Yeah.

Uh, when the Klingons come though, you will be grateful. So when it comes to SARS and MERS though, because those are, those were big deals as we've covered on this show before. Those were big deal coronaviruses. Why do we not have a vaccine? Okay. Well, we were working on it Really? Yes, there was no reason we couldn't we just hadn't yet

But both of them burned out really quickly If you remember which uh both both SARS and MERS were not I mean I think you do remember that they weren't they did not cause this right they were there There was a lot of worry about those if they didn't exactly, I got, I don't know the sense of way of saying making a splash is, but they didn't make make a splash. Yeah, they were contained a lot more quickly. And so the idea of continuing the funding and the resources to make a SARS vaccine was not of the utmost importance to any of the players who would be responsible for that. And so it kind of stopped.

But the work was being done and it can be and could be. And my understanding is that MERS, as actually the vaccine may still be in process, like they may have a MERS vaccine. They haven't gone through all the trials of any of these yet. Again, not because they couldn't do it. There were certain barriers. You may have heard this idea that if you do the vaccine wrong,

it could harm someone in these specific illnesses. And so they had to do all the appropriate safety tests. You didn't all that right, because you don't, we know that before we give you a vaccine. We know it's not going to harm you. That's why we do them. But they just hadn't done all that, right? Because you don't, we know that before we give you a vaccine, we know it's not gonna harm you. That's why we do them. But they just hadn't done all that yet with these, but they can and they will and they are.

I, yet, you know, as for the past few months, let's just go ahead and just keep working on those. Huh? Let's just go ahead and just go while they just go ahead and keep working on all those vaccines. They're using that research that they've already done and the progress they've already made on those vaccines to help expedite the research on the COVID vaccines. They're using that research that they've already done and the progress they've already made on those vaccines to help expedite the research on the COVID vaccines. In some of them, there are many in process. There are many different companies working on different

types of COVID vaccines. But one way or another, that research is helping to feed into that. So, the idea that, well, we've never done it before. I mean, no, I mean, yeah, we sort of did. We tried to. We kind of did. We thought about murs specifically. I saw a lot of military interest in a murs vaccine. And should we need it? But anyway, so yes, of course, we can do that. And we will do that.

We just need time to do it. A lot of people have brought up, well, what about mutations in the virus? So we'll make a vaccine that was based on our sequencing of the viral RNA back in January, right? That was announced. Do you remember one that was, I love when science things like that float to the top of the announcement, although not so much the reason. But we sequenced the viral DNA or RNA and we were able to, at that point, make a vaccine.

That's great. RNA or RNA and we were able to at that point make a vaccine. Right. That's great. The conspiracy out there has been well, but because the virus will mutate, if we're using that sequence, by the time we have the vaccine, the virus will be so different from that original sequence that it won't work. That's not true. Coronavirus is an RNA virus and RNA viruses do mutate. They do change. And coronavirus has. We know that. We that has been

charted. You can read papers on it. There've been news articles on it. But one thing we know about this coronavirus is that it changes very slowly. The genetic code of it, even the most recent strains are not that different from the original coronavirus that strain as far as we can tell that we have found. So all these are to keep up with? No, well, and the idea of keeping up with it would mean we'd have to change the vaccine. We have no reason to think we're going to have to do that.

We're using a flu vaccine for H1N1 that was developed from the 2009 H1N1 strain, and it still is effective against the H1N1 strains of today, because that's how slowly that virus has mutated. As changed over time, is that a vaccine that works for the ancestor is still typically very effective for its descendants. It is very rare that you would need to change that. A better example would be mumps for which we have used the same vaccine for 50 years. Coronavirus could be more, we believe is more similar to that.

There is no reason to think that the vaccine we make now will be ineffective by the time, you know, it's out there and produced. There's every reason to think it will be ineffective by the time it's out there and produced. There's every reason to think it will be effective. Now, will it be available for everyone at an affordable price? That I cannot say. Well, I will continue to remain hopeful. Yes, I think I would not say I'm hopeful.

I am certain that a vaccine will come. Oh, I'm at about the cost. Oh, yes. I will. Well, we can remain hopeful about that. Yeah. We have gotten multiple questions, including one email from Hasini and Ryan, who asked about vitamin D supplementation for COVID. I think the specific question was, my mom is making me take vitamin D now. Is that really anything? There's been a lot of work done in this area. I think it's a really interesting question. Now vitamin D, if I remember correctly, from our vitamins episode,

I feel like vitamin D was the one supplement where you said sometimes it may be good. Yes, because there are people who are vitamin D deficient. That is something we are finding. And so in those patients, they should take vitamin D supplement. I have been, I'm sure, but now that May is here,

and I'm starting to see those rays peek out from between the clouds, you know your boy is gonna get his day. It's not even a concern anymore. Come to my house, I'll give you some spare D, just off of my shoulders or wherever, because I won't even need all of these beautiful rays. I want to be soaking up. It's through a layer of appropriate SPF sunscreen.

Sun cream. Sun cream. Yes. As our children, of course. Oh, I've watched too much pepper pig and only call it sunscreen and only call them bathing costumes. Yes. But they wear. Mommy, where's my bathing costume? So the idea behind this is that the way the virus gets into your cells is through, like it has to have a door, okay, to get into your cells. And doorways for viruses are usually receptors. Just little things sticking off the surface of the cell. Did the Golgi bodies?

No. I was wondering what those things did. It's called an ACE2 receptor, if you're curious. The idea is that vitamin D can decrease the number of ACE2 receptors you have on yourself so less fewer doors through which coronavirus can enter. Makes sense. Take more vitamin D, fewer receptors, either you don't get an infection or your infection is milder.

That's the other idea. Now, where all this comes from is really based on correlation, which we know is not the same as causation. But there has been a correlation in a number of studies that have simply looked at patients who had COVID measured their vitamin D levels and then kind of came up with like a rating of disease severity. So based on these factors, we would say this person either had mild, moderate, or severe COVID and then their vitamin D level was either normal, slightly deficient or very deficient, right? And then they compared them and they found a correlation between people who had severe disease and vitamin D

deficiency. So as a result of this, because of these correlations that they have observed, in some hospitals, I know they are adding vitamin D to their protocols for treating COVID. You can also, in addition to everything else we're doing for you, here's a vitamin D supplement. I know that some people have elected on their own to start taking vitamin D prophylactically, like the idea being that if I keep taking my vitamin D, I'm less likely to get COVID. Okay. Okay. Now all of that I would say, I have got my Amazon cart fall. So I'm just waiting for you to tell me if I should pull the trigger. Vitamin D is one of the vitamins that it's fat soluble, so you do store it.

So it is possible to take too much vitamin D. It is possible. Now, I would say, if we're being, I'll put that out there, you could take too much. You may already have plenty, in which case, I have no reason to tell you if your vitamin D level is normal that taking extra vitamin D is more helpful. I don't have that evidence. The idea is- It's deficiencies, it seems to be the issue.

If you're deficient, taking vitamin D could be helpful because disease would be worse for you. And you don't know if you're deficient if you haven't been checked, right? So it's hard for me to just say everybody start taking vitamin D because there is a small risk to that. It's small, but there is a risk to that. The other thing though is that there are confounders. What is that? Factors that are not being controlled for in these studies that could also be leading to these differences. We're assuming the vitamin D is the difference, but there are other things about these patients that might also be playing a role. For instance,

There are other things about these patients that might also be playing a role. For instance, vitamin D deficiency is more common in people who are at risk for nutritional deficiencies, especially because of socioeconomic status. We also see an overlap with obesity and vitamin D deficiency. We also see racial disparities when it comes to vitamin D deficiency and all the different like social determinants of health that can come with, you know, all of those factors within our American health care system. So are we really, is it the vitamin D or is it all the other reasons why somebody might be more likely to be vitamin D deficient?

And right now I don't think we have a clear answer to any of that. So, what I would say is, if your vitamin D deficient, vitamin D is, you should be on it. I mean, I guess. Sure, that's, that one I could have figured out. I have diagnosed and treated vitamin D deficiency many times, and I absolutely support that. I would always support that. But I would certainly not take vitamin D as a supplement and believe I am now safe from COVID. There is no evidence that it is not going to prevent it.

Soley, it will not cure it. It will not treat COVID itself. It will treat vitamin D deficiency. I would not, it's kind of like I have a lot of patients who would have leg cramps and so they would start taking over the counter potassium, which when I say that, I know there are people listening who are like in the medical field, like pharmacists who are like, when seen, like, no, don't do that. Because you can definitely take too much potassium and it's very dangerous. Most of the time your

leg cramps aren't potassium. If you have low potassium, yes, it could be due to that. But if you don't, taking extra potassium won't fix your leg cramps. What'll it do? Well, it could make you have two high potassium and then you could have a heart rate with me. Great. Like, don't do that.

Yeah, okay. Fine, Sid. Okay. You go get your levels checked. Are we buying the vitamin D or not? Only for deficient. Okay. So I don't know if I'm deficient.

It's a real, it's a real, uh, Schrodinger's cart that you set up for me. I don't know if I'm buying the D or not. If you have questions or concerns about your vitamin D level, please talk to your primary care physician and they can help you with that. And get some rays, get some volleyball going. Wear your sunscreen, wear your sunscreen. I want to talk about our immune system, but before we do that, can we go to the billing department?

Let's go. The medicines, the medicines that ask you let my God for the mouse. So said you were going to talk about the immune system, which I can only assume means you want to discuss the hit and 2001 animated film Osmosis Jones, starring David Hyde Pierce and Chris Rock. No, as a white blood cell, white blood cell, and a cold bill that team up to bring down a virus. I don't know any. I've never seen that.

You have a same bill, Marys, isn't it? I don't know. In Bill Marys' body, do you imagine? Wow. Yeah, it's wild. It's wild. No, I don't wanna talk about that. The Farley Brothers produced the live action parts

of Osmosis Jones. Yeah. That's wild. I'm shocked that you have it. Are you a fan of Osmosis Jones or were you out on it? I don't know anything about it. Are you a fan of us, Mr. Jones, or were you at on it? I don't know anything about it. I mean, like this. This is the first time I've seen it. No, I've never seen it.

I don't know anything about it. Okay, you say you love medicine and stuff. Yeah. And yet, a movie about medicine, and you're not watching it. That's it. Cancel your plans for tonight. We're watching.

Right, my big plans for tonight. What were they? Oh, that's right. A cancel your plans for tonight. We're watching. My big plans for tonight. What were they? Oh, that's right. Stay in. Not watch osmosis, Jones. Scratch that out and right in. Do watch osmosis, Jones.

To date. I'm Laura asked either, but it looks good. Laura asked me about social distancing and whether or not we can our immune system. And Laura was not the only one to ask that question. Many people have asked that because it was one of the things in that the video, the press conference from those two urgent care doctors, they mentioned this. And I, it was on my list of things to address, but I got lost in statistics and I forgot to mention it.

So if you have heard people say that, and I think it's in that, actually I know, it's in that pandemic thing too, that other completely false bogus thing, that the idea that staying inside is making our immune systems weak and we're more at risk for general disease, COVID specifically, whatever.

This is false. I think here is what I think they are trying to, I think they're trying to make connections between things that aren't connected to confused people. Okay. Okay. I think they're sort of referencing the hygiene hypothesis.

Have you heard of that before? Mm, I feel like you've talked about it before. I think we've mentioned it. It's a way of explaining why there's more like incident of allergies and like contact dermatitis like atopic disease and asthma and things like that nowadays. It's very being that we make ourselves too clean and so our body doesn't develop the immune responses that we need to. Well, we have exaggerated immune response really is what we're assuming because we're

not exposed to these things early enough. It's similar to the idea if you have little kids or if you have in the past, you know, if you have bigger kids that used to be little or you have a lot of contact with little kids, you may have heard the recommendations about food introduction change through the years. We used to say wait when it comes to like nut butters, things that have a higher likelihood of having allergies to, and now we say you should introduce them earlier. It's even like since we've had kids, right?

Yeah, it has changed even since then, like give a baby peanut butter because then they're less likely to be allergic to peanuts later. And because they love it and their little mouth scum They do love peanut butter So I think that's what they're kind of Trying to talk about with this the idea that like when we're younger If we're not exposed to a lot of stuff maybe we're more likely to have allergies to stuff later on I

But that's a whole first of, allergy is a whole other thing that isn't a virus or a bacteria, obviously. So they're not related, but I think that might be what they're talking to. It is fair to say that you can't develop antibodies to a specific infection until you're exposed to it, right? Like you and I, as far as we know, have not been exposed to coronavirus, to this specific to novel coronavirus. So we do not have antibodies to it.

Now in this example, I am a healthcare worker. I have probably been exposed to and developed antibodies against maybe a higher number of pathogens than you. Let's theorize that. Okay. I don't know if that's true. Sounds right. Let's, let's say I do some, I get up to some nasty stuff, so I'm not going to just 100

percent grant it to you, but okay, let's assume it. My, now you and I though have not been exposed to coronavirus. If we are exposed to coronavirus, neither of us have antibodies to it. We both are at risk for an infection. That's it. It does not matter how many other things us have antibodies to it. We both are at risk for an infection. That's it. It does not matter how many other things I have antibodies to. My immune system is not stronger than yours. It's a one to one thing. So this is a really weird argument to try to make with people. The idea that you need to be out in the world exposing yourself to other viruses in bacteria so that you'll be ready for when you get COVID.

It's like the idea that just because you've seen a lot of movies, you're more likely to have seen osmosis Jones. That's true. Or that I would know anything about osmosis Jones because I've seen a lot of other movies. Yes. On a lot of other David Hyde Pierce movies. Exactly. It's really a one to one thing. So you can get coronavirus anybody can who hasn't had it. That's it. And so there is no weakening of your immune system that happens because you're staying in your house or in your yard or not around other people.

I think that's a common myth really when it comes to the immune system. The idea that we all have these like varying, like some of us have really weak and some of us have really strong immune systems and all this, no, unless you've been diagnosed with an immunodeficiency, either genetic issue or from a chronic disease state or from a medication you're taking something like that unless you've been diagnosed with that. There's no reason to think your immune system isn't going to function fine.

Well, that's a nice consumption even I had. So that's good to actually, good to know. Obviously, you need to support it with proper nutrition, with good sleep, with management of chronic diseases, all those things play into a functioning immune system. But the idea that you stay in your house is going to damage your immune system. That's not, it's not founded on, I mean, anything. They're just pulling that out of nowhere. Now the one thing I will say is if what they're trying to say with this is that if there was a way for us to

expose people to coronavirus or maybe like part of coronavirus in such a way that they wouldn't actually get sick from coronavirus but would develop an immune response to coronavirus if that's what they're trying to say that like that would be better. That's science fiction that doesn't seem possible. No that's what they're trying to say that like that would be better. That's science fiction. That doesn't seem possible. No, that's a vaccine is what they're saying. I should have said vaccine. So, that I support. A vaccine.

A vaccine. Let's talk about masks. I feel like I've seen here in West Virginia, there's just a real wide array of mask usage and non-usage, I would say. More non-usage than I would like to see. Yeah, especially since we've started to slowly reopen things. The comeback. We're making the comeback. Yeah, the comeback.

Since the comeback has begun, I think I've seen fewer masks, which is counterproductive, but okay. There are two big categories of myths that I've seen to address one briefly, it's that they don't work. And I think we've talked about this on the show before, and I hate things like this where they're couched in truth, but they're promoting a false action. So but they're promoting like a false action. So it's not that masks don't work. If you're wearing a cloth mask, which is what we recommend, right? If you are just going out into the world to go to the grocery store or whatever, you should wear

cloth mask. If you're a healthcare worker, obviously, we're hoping you have other masks, but in this situation, if you're going out into the world, wear a cloth mask. The reason we mainly suggest that is to protect other people from you. You are less likely to spread viral particles all over the place if you have covered your face with a cloth mask, your nose and mouth. That is why. No, they do not completely protect you against getting sick. You the wearer of the mask could still, through that fabric, inhale viral particles from other people. That is absolutely possible.

And I think we've covered that pretty clearly. The rate of transmission is even more greatly decreased if both you and I are wearing a mask. And they are not replacement for social distancing. So just because you're wearing a mask doesn't mean you can now like go to a keg party. You shouldn't be having parties. You shouldn't be going to parties. We should still be trying to keep six feet away from people as much as possible and staying home when we're sick. A mask doesn't replace any of

that. It's just another layer of protection. So anybody who's saying that they don't work, it's like, well, I mean, yes, they do help, but they're just one piece of it. Right. The other thing I've seen are some really wild ideas about how like it will make you re-enhail your viral particles and push them into your brain and make you sicker. Now that does happen I fell with burps for sure.

I don't, I mean, I don't know why. First of all, if you're wearing some sort of like N95 or something like that, no, it's trapping the viral particles in there. But like the other thing is, if you are wearing a cloth mask, you can still breathe through it. Like there's still stuff making it through. So that's not, I mean, I guess if you're wearing like,

just a face shield like completely, but if it's something you can't breathe through, you shouldn't be wearing it. It's important that whatever mask you're wearing, you can breathe in. If you can't breathe in it, please take it off immediately. If you are still awake. Please.

To that, to that note, there's been some talk of the masks actually make you more at risk for infection, as we've talked about, unless they're wet and dirty, and you're not properly handling them, no, they don't. Now, if you're mishandling them, if you're throwing them down on contaminated surfaces, and then putting them back on your face, if you're touching them a ton, if you are wearing gloves that you don't know how to wear properly, so you're cross contaminating

your mask and your face and your gloves and all the items of Walmart and all that, sure. But if you're following proper mask hygiene and washing your hands and washing the masks and letting them dry completely like you're supposed to, they're not a risk to you. They're just not 100% protective. Also, quick reminder, if it's not over your nose, it's not doing anything. I can't tell you how many people I see working at stores who, and I get it because it's got to be uncomfortable. Yes, they are. I'm comfortable. 100% get it. But just, especially if you're going about your day today, whatever, just remember you've got to cover your nose and your mouth with

the mask or else there's no point. And there's no worry. I saw somebody out there saying that you're going to re-inhale so much carbon dioxide, because you know, you breathe in oxygen, you exhale carbon dioxide. But now because of the mask, you're going to, you're going to breathe in so much carbon dioxide that you're going to like pass out or something get confused. Again, if your mask is functioning properly, no, you won't. If you can't breathe through your mask, you need a new mask. It should not be made of a material that you can't breathe through. That's... Yes. Yes. Yes. That is essential for the mask to function.

Justin, I want to talk about testing. Yeah, yeah, yeah. We got a ton of questions about testing and because there's been a lot in the news lately about how the tests maybe don't work very well There are two broadly speaking there are two basic types of tests There's the tests that tells me if you have Corona virus right now Got a PCR test. It looks for RNA, looks for the virus. We're trying to find the virus itself in your body. So it tells me if you have it right now, then there are the antibody tests. The antibody tests either look for IgG antibodies, IgM antibodies,

or maybe both. And what that means is these are these are things that your body made in response to the virus. It makes IgM antibodies in response, like those are the first things it makes. So if I find those, it usually means you have an acute infection. You're sitting. It makes IgG later. So if I find those, it meant you had coronavirus. And in a perfect world, if I thought you had it right now, I could run the PCR test on you and it would be positive if you have it negative if you don't.

And if I thought you had it last month, I could run the antibody test on you right now, and it would have IgG antibodies if you do, and no IgG antibodies if you don't. Okay. In a perfect world, that's what those two tests would do. Now I don't know if I'm the first one to tell you that we don't live in a perfect world, that's what those two tests would do. Now, I don't know if I'm the first one to tell you that we don't live in a perfect world. No, but you probably have surmised that by now. The PCR test, the one that says, if you have it, was initially the numbers at least, I know we were working with, were that they had a 20 to 30% rate of false negatives,

meaning 20 to 30% of people who do, in fact, have coronavirus are gonna test negative with this test. I mean, it's kinda high. It is, yeah, it's not great. Especially with something like this, where we're trying to contain a public health threat. That's a scary number. Now you've probably seen some recent reports that are out that it's worse.

That it's actually, it might be even as close, even closer to 50%, which is like a coin flip. It's almost worse than not getting it. Obviously, you can rerun tests. There are other diseases out there, like one that springs to mind is it can be hard to diagnose tuberculosis. Sometimes, we have to do multiple tests on you before we're sure you do or don't have it. Before we're sure you don't have it, I should say. False negatives are not uncommon. But the nice thing is,

if I'm trying to diagnose you with tuberculosis, I can order as many of those as I need. Right now, we're still in a situation in a lot of places where being able to test you repeatedly for coronavirus Is not really possible. We don't have enough tests to do that for everybody Which puts us in a bad situation if we really think you have it But the test came back negative, but we still really think you have it. Yeah, what do you do? It's tough like how do we how do we ration our testing supplies to cover for that? Yeah, it's about you know So that's that's part of the problem right now The antibody test has some similar issues in that a

Positive test could be a false positive now. Why would that happen? Why would I look for antibodies to coronavirus in your body and think I found them But they're not really there. Maybe you had another coronavirus. That's exactly it. Woohoo! Good job, Justin. Yeah.

The tests are supposed to control for that, but they're not perfect. And so sometimes they accidentally pick up an antibody to a different coronavirus and not to this one, which would lead you to believe that you'd already had it when maybe you hadn't. Yeah. And the reason that this is really dangerous

with the antibody tests comes down to statistics. This is really like, even in my, even as I have learned this stuff in school and studied it and still I know it, I find this stuff very dense and not intuitive. When it comes to these different tests, what you will often hear quoted are their sensitivity and specificity. Okay. And these are two statistical measures of basically how likely this disease is, or how likely this test is to rule in or out a disease. Okay. They will tell you that a lot of these antibody tests either have, you'll see

different numbers quoted. 90% sensitivity, specificity, 95% some of them are out there saying 100% sensitivity and 99% specificity which sounds awesome, right? Like if you saw those numbers, you'd think, Good, yeah. Absolutely. This is a great test. Yeah. I mean, they can't get much higher than 100 and almost 100. So, here's the problem.

The other end of that is the positive predictive value and the negative predictive value. Okay. And these are slightly different concepts. The positive predictive value is how many people who test positive, so of all the people who get a positive test, how many of those people actually do have it. And then the negative predictive value is of all the people who test negative, how many

people really don't have it. How many times did it get it right? Those numbers are slightly different and they're really based on prevalence is how we figure that out. Because like otherwise, how do we know what we don't know? How do you know how often it got it right? Oh, I guess it is. You need a gold standard.

And that depends on the prevalence of the disease. How often is it out there? Okay, right now in the US the prevalence of coronavirus is like 5% and in some areas it's way lower Like here where we are and in some areas. It's way higher in New York. Okay the problem is if you're in an area like here in West Virginia, and you have a prevalence that it's even less than 5%, when you do that test, even that test that has, let's say,

a 99% sensitivity and specificity, there is still a 16% chance that the disease is not present when the test is positive, so that the test is a false positive. If you take that sensitivity and specificity down to 95%, there's a 50-50 chance that that disease is not present even when the test is positive, meaning a false positive. And if you take it all the way down to 90%, 67.9% chance of false positive. This sounds so bad. So in an area like this, if you get a positive antibody test, it's more likely to be a false positive than a true positive.

So you just switch it. You just switch it around. Look at it upside down and it's better. Now these tests will become more effective, more important when we can target them to like areas where there's a lot more of it, right? Like in New York, those numbers are gonna be different because there's a higher prevalence,

especially depending on what neighborhood you live in. So I'm not saying these tests are useless. I'm just saying that right now, especially in parts of the country where we've had a pretty low case number, I don't know that these tests have a huge utility for us. The antibody tests are the other tests. The antibody tests. I just don't know how to, I mean, they're great from a research perspective, but like to actually guide your actions, I wouldn't, if you told me you had a positive here in Huntington, West Virginia, I would tell you to continue social distancing and wearing a mask and acting as if you could still be infected or get it.

I would not tell you to behave any differently. And so I mean, I think that's the problem with them right now. So I would not, I would not encourage everybody to go running out and get these antibody tests right now. A lot of insurances aren't covering them. People are paying out a pocket for them. There's a ton out there and there's sensitivity specificity are all over the place. And as I've said, that doesn't always even matter depending on where you live. So I would not encourage people to run out and get these tests right now.

And even if you do get a positive antibody test, I would still continue to do all the things they're recommending where your masks in social distance, because we also don't know for sure that you can't get it again. Careful, do you have any other big things that you want to address? Yes. Okay, good.

I have two, I'll be quick. I know that's your way of saying I'm going on too long. No, no, no, no, no, I think people are starting to get that they should continue to social distance and where mass women public uh... well then i will answer ed's question pretty quickly he asked me about visiting friends and family a lot of places like here are starting to quote-unquote open up the question starts to be like we don't't know how long this is gonna go on.

Is it okay for me to start expanding my pod or seeing my relatives or? That's what, this is such a nice way of putting it. This Christmas, let's expand our pod. I think that it's hard and you, you're not gonna like my answer, which is, I don't know. But, Sid, I love my dad. I know. And I I love my dad. I know.

And I want to see my dad. And I would say that, you could, if you have family members who have all been social distancing, who've been even an isolation, to some extent, I mean, we haven't gone anywhere but the grocery store. You could perhaps, especially in a low prevalence area, arrange for some sort of low risk. It's not no risk. If you're gonna see other people, there's gonna be risk. But I'm envisioning like people outside,

outside is definitely safer than inside. Still wearing masks, still maintaining six feet apart. But like you can't do things like share bathrooms. So like if somebody's gonna come over to your house, it would have to be for a short enough visit and a short enough distance that they're not gonna need to use your restroom.

Mm-hmm. Do you know what I mean? They gotta have like a stadium, pal, kind of a catheter deal. I'm just saying like those kinds of things would be risks again. And I mean, maybe those are risks you're willing to take with your family member. If they're medically at risk in some way, a high-risk population, you may be less likely

to take it. But I think there's a great article that I would reference by Professor Aaron Bromage, who's a comparative immunologist and professor of biology at the University of Massachusetts Dartmouth. And there's a great article called The Risks, know them, avoid them, that kind of talks about whether or not we should be opening up and seeing people and doing these things.

Let's put that aside, because I think that's highly debatable. But if you're going to do these things, what are higher risk and what are lower risk? And how can you do the best to make it as low risk as possible? I think that that's a great article to reference. And a lot of it focuses on outside, you could get it, like it can be transmitted outside,

but it's much less likely outside than inside. So there are a variety of outside options. If you're going to enter the world in some extent, there are outside options that are safer. So I would say that that would be a great reference. If you've decided I am going to go back into the world and I wanna know how to do it, and I say for, even if it's a not completely safe way.

So my dad, I'll just text him. Maybe we could have like a driveway meeting. We'll sit on our porch, they can stand on the driveway. Cindy, I didn't drive to Ion to see dad when things were good. I'm certainly not gonna drive to Ion to see dad now. I have a perfect excuse. The important thing to remember

is that the effects of your state changing the regulations and opening up won't be seen for a couple weeks. So don't assume that if things are okay, they're going to stay okay. I would use some caution and wait and watch before you make big decisions. And I want to talk about one more thing that Emily asked about. Yeah, please. Emily wrote an email asking several questions among them.

Right now, a lot of friends are talking about feeling kind of forgetful and spacey right now. And what is this? Is there a name for this that's happening? Because a lot of people seem to be feeling this way. I would include myself. And what I would say, what not just me, but what a psychologist would probably tell you,

your experience in right now is related to trauma. This is an intensely traumatic experience for all of us to some extent, for some of us to a huge extent. We are, most of us spend most of our time at the top of Maslow's hierarchy of needs, up there trying to like, self-actualize and those kinds of things.

Tain their respect to others. Exactly. This, a pandemic, an immediate threat to your health and safety and the health and safety of the people you love forces your brain, or at least a big chunk of it, back down to the bottom of the pyramid. And for a good bit of us, we have been lucky enough in life to not spend a lot of time at the bottom of the pyramid.

Not everybody, but I think I would say I don't spend a lot of time worrying about direct threats to my life on a regular basis and the lives of the people I love. But right now your brain is thinking about that. Even in the background, if you're not aware of it, your brain's doing that. That's very stressful. And one of the symptoms of that is that inability to concentrate or focus feeling like you're just kind of in a fog and spaced out. I know for me that's manifested in a really great amount of difficulty being creative and innovative problem-solving, doing podcasts, forming coherent sentences even. And you're going to experience it in different ways on different days, and everybody's different

too, so maybe it's not affecting you that much. There's also a time dilation aspect, which I think is tied to my best guess at least, would be that I know that your brain, it's like the people talk about time going faster as they get older and it doesn't actually, that won't surprise you. But there's an effect where your brain, when it's getting novel information, is recording it more diligently.

And so, when you're young, you're getting a lot of novel information, so it's writing everything down, like, oh, this is all good stuff. As you get older, it's like, oh, like, all this is all good stuff. As you get older, it's like, oh yeah, I've absolutely seen this. I'm not gonna actually remember this.

This isn't as important. And right now we're all putting our brains in this state where it's like the same thing over and over and over again. So. And if you layer on top of that, that kind of lack of new stimulus and input, if you lay it again behind it, is this constant fear and worry about yourself and the people around you.

And then also about like the economy in terms of you, like your family, your job, you know, how are you going to continue to keep your home, pay your rent, your podcast to yours. All those things. Plus, like the more figurative losses, just experiences and time and connections with people and opportunities that you may feel like you're losing. That's a lot. I know a lot of people initially said this would be a great time to do some sort of creative project like write a book or something. And if you can do that, that's awesome. You're a superhero and I idolize you.

If you can't, that's okay too. You can join me. I will not be writing the next great American novel during this pandemic because my brain could not support that. And I think a lot of people are in that boat. And that's fine. Which takes us to the last thing and I thought Justin, you could address this better than me.

Last time I mentioned being comfortable with discomfort and a lot of people responded positively to that idea as being a helpful idea. I think the other thing that comes with that is the concept of self-care. Yep. I, Justin, thing that comes with that is the concept of self-care. Yep. I, Justin would probably call me out on line if I told you that I was great at practicing self-care. I think I'm better at preaching it. So I would just and defer to you to talk about that. I mean, I guess that, you know, trying to meditate when you can is good.

Takes 10 minutes. Just don't think about anything for 10 minutes. It's pretty easy. Not particularly easy right now, but you know, give it a shot. Yeah, you know, what I have been doing is trying to address like appearance stuff that doesn't really matter that much. Like I obtained like dandruff shampoo, you know what I mean? Which I wouldn't have done before,

but I'm like, let's get this look right. Let's see, man, not cause I care about dandruff and I shouldn't, it seems counterintuitive to like be more focused on appearance type stuff right now, but I think doing it reinforces the sense of like worth to me to like to use the dandruff shampoo and let's try that charcoal toothpaste that everybody's on about, that kind of junk. That's I believe Olaf called it controlling the things we can control.

Yeah, so yeah, that stuff there's you know there's lots of other great ways to take care of yourself. Well, I mean, make sure that you're sleeping and drinking plenty of water. Oh, I drink wild nuts of water, it's on fire. Eat food that makes you feel good and nourished and well, get some sort of physical activity and some sort of mental activity as much as you can. Those are those things are good.

And connect with people. Try to learn stuff too. I know the, I think creation is really difficult right now, but I feel like for some people probably, like being with like education is maybe more, a little bit more attainable, it's a little bit more passive. We did them, like we signed up for the master class, we're doing one on gardening,

just like that kind of stuff. I've been using a babble to work on Spanish and stuff like that, just trying to keep my mind active. And I'm trying to, if you're somebody who has children, and so you're doing the home school thing, it's so hard and frustrating and you're not alone. I only have to pre-K. I can't imagine how hard it would be

if I had to do anything more than that. But I think like cutting us all some slack is the number one thing. Cut your kids some slack, cut yourself some slack. Try to do things that interest you and your children to make it more of like a collaborative. I try to learn things that interest you and your children to make it more of like a collaborative. I try to learn things with Charlie. I find things she's interested

and we read about them together. And then I'm learning, she's learning, I can pet myself on the back for educating. Cindy just learned the names of the planets, actually, which she was really excited about. Yeah, well. She'd always been curious and she finally nailed it. No, I already knew that. We learned a ton about turtles. I don't know a lot. I've said this on the

show many times. I don't know a lot about animals. So we decided one day we were going to learn everything we could about turtles. Charlie, Charlie and I learned some mime techniques today. She decided that's her true calling is the art of mine. She did. We watched a Marcel Marcel video. Did you? Did you do my work? We did my work. Oh God.

All right. Listen, that's enough podcasts. We've enjoyed talking to other adults like ourselves and the children that listen. We'd appreciate you as well. I hope your parents are grateful for us occupying you for 52 minutes or so. So thank you so much for listening. Thanks to the taxpayers for these, their song medicines is the intro and outro of our program. Thanks to the Max Fun Network for having us as part of their extended podcast and family.

And thanks to you for listening. We sure appreciate it. Yeah, thank you so much. Take care of yourselves. Take care of each other. Hang in there. But that is going to do it for us. So until next week, my name is Justin McRoy. I'm Sydney McRoy.

And as always, don't drill a hole in your head. Alright! Maximumfun.org Comedy and Culture Artist-Oat? Audience-supported. Hey Max Funsters, it's Jesse Thorn. This week on my public radio interview show Bullseye, I'm talking with Tina Fey and Robert Karlock about creating unbreakable Kimmy Schmidt, 30 Rock, and also just kind of

why they're the best at everything. There was a window of time when we would just go to awards things and pick up our prizes and party with the people from Mad Men. You can find bullseye at MaximumFund.org or wherever you listen to podcasts. Just search for bullseye with Jesse Thorn. you