The Wolf Of All Streets - Dr. Michael Corrado, World Renowned Infectious Disease Physician And Smallpox Expert on Separating Fact And Fiction With COVID-19, Everything You Need To Know About the Virus and More.

Episode Date: April 9, 2020

Dr. Michael Corrado has been on the front line of the United States's fight against bioterrorism, having worked with BARDA for 15 years to eradicate smallpox. Dr. Corrado and Scott Melker discuss why a smallpox pandemic would be exponentially worse, the proper terminology for the coronavirus, how it infects humans, the difference between contamination, infection and disease, how COVID-19 progresses once you catch it, how long the pandemic may last, the issues with testing, and when there will be a vaccine (if ever). This is a comprehensive guide on everything you could possibly want to know about the coronavirus. --- ROUNDLYX RoundlyX allows you to dollar-cost-average into crypto with our spare change "Roundup" investing tool, manage multiple crypto exchange accounts in one dashboard and access curated digital asset content and services. Visit RoundlyX to learn more about accumulating your favorite digital assets when making everyday purchases. --- VOYAGER This episode is brought to you by Voyager, your new favorite crypto broker. Trade crypto fast and commission-free the easy way. Earn up to 6% interest on top coins with no lockups and no limits. Download the Voyager app and use code “SCOTT25” to get $25 in free Bitcoin when you create your account --- If you enjoyed this conversation, share it with your colleagues & friends, rate, review, and subscribe.This podcast is presented by BlockWorks Group. For exclusive content and events that provide insights into the crypto and blockchain space, visit them at: https://www.blockworksgroup.io

What's up, everybody? This is your host, Scott Melker, and you're listening to the Wolf of All Streets podcast. Every week, I'm talking to your favorite personalities from the worlds of Bitcoin, finance, trading, art, music, sports, politics, and basically anyone else with an interesting story to tell. So sit down, strap in, and get ready, because we're going deep. RoundlyX.com is one of my favorite companies in the entire crypto space. What they do is they take all your small purchases and they round them up to the nearest dollar and invest that money into any of 25 crypto assets of your choice.

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right, free Bitcoin to try out my favorite crypto trading app. Use promo code SCOTT25. This podcast is powered by BlockWorks Group, the only events and podcast production company I trust. For access to the premier digital asset conferences and in-depth podcast content, visit them at blockworksgroup.io. I promise you will not be disappointed. Hi, everyone, and welcome to the show. As the narrative surrounding COVID-19 evolves, it's clear that there's a battle raging between misinformation and fact, rumor and science. Well, this has always been the case to some degree. In a global pandemic, lives are on the line, and it's essential that we focus on what we know to be true and ignore the endless stream of false narratives. Today's guest

can help us cut through the falsehoods and offer us all some much-needed insight and clarity. Not only is Dr. Michael Corrado a world-renowned infectious disease physician and fellow of the Infectious Disease Society of America, but he's a consultant to BARDA, that's the Biomedical Advanced Research and Development Authority for laypeople like us, who has been on the front lines of the fight against bioterror for 15 years, specifically in the smallpox program. He's a former faculty member of SUNY Downstate Medical School and has held senior research positions at Merck and Johnson & Johnson. Perhaps most importantly, though, he is a very proud grandfather. I am very honored to welcome Dr. Michael Corrado to the show. Thank you so much for being here today. Scott, thank you for having me. It's a pleasure to be on with you, and it is an honor to present what I know about this virus and the disease. And what I will be giving you are my opinions. I believe my opinions are in line with the great majority of infectious disease leaders.

And where my opinion is an extrapolation, I will point that out. Now, you mentioned my work with BARDA. BARDA is under the Department of the field of bioterrorism and new and emerging diseases that could be deleterious to our society and other societies. And in that regard, over the last 15 or so years, since late 2004, I have worked with the people at SIGA Technologies and Oregon State University and BARDA in the development of a smallpox treatment. Here at A4, we've only had a vaccine for smallpox we now have a capsule medication and we're working on an intravenous formulation that could be used to treat people who

have smallpox in that regard BARDA is also involved in the acquisition and stockpiling of those medications placed in six or seven depot places that I don't even know the location of in the event that there is an outbreak of smallpox. And one kind of peculiar statement that I will make is that if there is a silver lining in this pandemic, it is that a pandemic of smallpox would be infinitely worse. Conservatively, you could say 15 times worse if you look at mortality rates, but it would be more than that. We'd have a collapse of the medical care institutions. And so we are going to learn a lot of things in this pandemic that we could use to fight other potential pandemics, whether they be spread by man or naturally occurring. So this is a good learning process.

It's nice to know that there is a silver lining. Well, in a manner of speaking, I suppose if you want to try to get anything out of this that is positive, it is that we've made a lot of mistakes, Scott, that's obvious. And not only we in the United States, but in Italy, and in Great Britain, and obviously in China. And we are going to put our collective heads together. And we are going to be able to come up with processes and institutions that would be able to handle pandemics much more easily and efficiently. Just in parting, before I leave smallpox, to give you an idea of just how bad smallpox is, and you can go online and look at pictures and read about it.

Smallpox was eradicated in 1977, the last case. And then the hundred years preceding that, from 1877 to 1977, approximately 500 million people died of smallpox. 500 million people died of smallpox. Wow. 500 million people died. And the population of the world was not 7 billion at that time. It was closer to like 1.5 to 2 billion people. So think about that from that standpoint. What I would like to do today, and certainly, Scott,

you can interrupt at any time for clarification or for questions, is I would like to go through a little bit of the terminology because you're hearing lots of things out there. I want to go through the terminology. I want to talk a little bit about where this virus came from. Talk a little bit about why there have been so many conspiracy theories about this being man-made and loosed on the planet and why that is highly unlikely to be the case. Talk a little bit about what the disease is and how it presents, what kinds of things we could do to mitigate the spread of the disease. And we'll talk a little bit about vaccines, therapies, which I will only speak to in general terms. I don't want to give people

the idea that there are proven effective therapies yet. And then I will make some closing statements on how this disease impacts us as a single family on this planet. That sounds thorough and amazing. Well, you judge that after the facts, Scott. Of course. So let's go back to the beginning of what you just said.otic viruses, meaning that they are found naturally and circulate within animals and then can be spread to man. I understand man as an animal as well, but when I say animals, I'm referring to other kinds of animals. And this family, all of them have the following characteristics. They are single, stranded pieces of RNA, positively sensed. And that is a technical term meaning how the RNA is read in replication.

They are, as viruses go, pretty darn big viruses. They are among probably the largest of the single-stranded RNA viruses. They are a mass of about 28 to 32 kilodaltons. And so that, for a virus, is big. For everything else that you know in your life is infinitesimally small. The family of coronaviruses, and there are seven or eight that cause infections in man now, the majority caused infections that would be characterized, the first four that we know of, that would be characterized as common cold type things. But the last three, SARS, MERS, and this virus, SARS-CoV-2,

have produced infections and diseases that are much more severe and carry significant morbidity, that's illness, and clearly measurable mortality. So in and among these coronaviruses, we split them into class A and class B. And that would be like saying that Mike Corrado has a son, and his brother Lou Corrado has a son, and they are both named Jim, two Jim Corrados. They are clearly related. They are not the same people. So those that are in the B family are going to be much more closely related. So that would be Jim Corrado from the first Mike Corrado, his sister or other brother,

which would be more closely related to him than his cousin Lou would be. So this gives you an example of how they're related. The viruses that we are talking about, MERS is in the other family, side of the family. So SARS and SARS-2 are very closely related, and I will talk about that. And I will talk about that in terms of how they were derived from a common animal source, a bat. But what I also wanted to say is the structure of these coronaviruses all look pretty much alike. If you look at them from an electron microscopic picture, they are round and they all have an envelope, and that's very important.

That's why we were able to use alcohol to kill them. And they have spikes on the end. And these spikes are the Action Jackson sort of part of that virus structure. It is that spike that then has on it a sequence of amino acids that we know attach to a certain molecule in the human, and that is called a receptor-binding domain on the virus. And in that receptor-binding domain, there is a small run of amino acids that we call the receptor binding motif. And that is what specifically attaches to the human receptor called angiotensin converting enzyme 2. This is where people say, wait a minute, there is a virus in bats that then somehow is able to have these little areas

that attach specifically in a lock and key fashion almost to this angiotensin converting enzyme to receptor in humans? And the answer is, that's right, but it was not manufactured. And that happens because RNA viruses are highly, highly plastic. They're mutating all the time. RNA viruses mutate a million times more frequently than we see mutations in animals. And we have mutations every day. And so this becomes analogous to, you know, the old story. If you had an unlimited number of monkeys and an unlimited number of typewriters and an unlimited amount of time, one of them would type Macbeth. Of course.

So this is the same thing. We have these mutations occurring all the time, and by happenstance, one series of mutations, which could be one amino acid change or two amino acid changes, change to something else which changed the structure and the space of this virus, this motif, and it fits into the human receptor almost perfectly or perfectly and is able then to infect the host, the human host. But how does it actually get from the bat to the human?

Now this will be speculation on my part and it's speculation on everyone's part uh there is a currently a uh uh first of all we don't know how many uh coronaviruses are circulating in bats we're not out testing millions and millions of bats every day, but we do test them periodically and we do find viruses. And there is a current virus that's out there that looks very similar to the virus that's causing COVID-19. And that virus looks very, very much like it in terms of that receptor. So it is easy for us to believe that that virus or another one very much like it has been passed around in bats. And then people became exposed to bats because they were caught and used for food.

And this gets into what we call bushmeat in Africa and in Asia. People are desperate for protein and they eat wild animals. You and I would never think about uh wanting to eat and so they uh could be exposed to the blood or other secretions of the bat or alternatively and there's probably a reason to believe this there are there is another mammal that is exposed to the bat secretion. So we believe it's an animal called a pangolin. And it gets into that animal, changes a little bit more, and then humans are involved in the use of pangolins as bushmeat.

And then it goes to man. So by going from one animal to the next, it gets closer and closer to be able to adapting to humans. But we cannot say that it didn't go from the bat directly to humans. That's interesting. So we do know, well, in theory, we can guess that it is by eating the animal, not by being attacked or bitten or scratched or something like that. It could happen either way, but it is usually by the butchering of the animal or close contact in these wet markets. Now, I know you're in Florida. I don't know where in Florida you are. Are you near southern Florida?

I'm not at present, but I lived in Miami for a very long time. You may know that in southern Florida, there are monkeys that have gotten loose and reproduced. Yes. Okay. Those monkeys become infected with a – now this is a DNA virus, a member of the herpes family called monkey B virus. Now in monkeys, monkey B virus is like a fever blister in humans. It's a herpes infection. It's a nuisance, but it very rarely produces

meningitis and kills you. So for the most part, monkey B virus in monkeys is just there for the ride. But if a monkey like a rhesus with monkey B virus were to bite a human, they would develop a fulminating encephalitis, which is almost universally fatal, if not universally fatal. So with that as a background, yes, being bitten or attacked or scratched by a wild animal is another way that humans could acquire a zoonotic infection. And we are coming closer and closer to wild animals all the time as we encroach on their territory in logging and So the current bat coronavirus, which is called RATG13, looks an awful lot like the SARS-CoV-2. And so that may have been the progenitor or another virus like it to the change to SARS-CoV-2 that is now infecting people. Really interesting. That leads me to ask, would we believe that this is a single event, that one person eats one bat or pangolin and gets sick and then it continues from there? Or would

it be something where potentially a number of people get infected and it's easier to spread? Are we literally talking about the genesis of this virus potentially being a single human being? It could be either way. So I can give you scenarios of it is the one person who is butchering the animals in the market and that person becomes ill, goes home, infects his family, and then, you know, the numbers here is each person who has this virus infects somewhere between two and a half to three other people. And so you can think of the geometric spread beyond that. Of course, it is also possible that multiple people at that market were exposed on the same day, and they go their merry ways, not realizing they're sick, spreading the disease. And this, I wanted to mention the difference between being contaminated, being infected, and having disease. That was my next question, actually. I was going to say, now we've talked about the person

being contaminated, going home, spread it around, but that doesn't necessarily mean that person gets sick, correct? You are exactly correct. And this is where this virus is sneakier and smarter than SARS was, or MERS for that matter. You are contaminated when you come into contact with the virus with your skin or body parts. So think of going to the supermarket and buying a can of soup or whatever that has been touched or stocked by someone with the virus who didn't know they were sick at the time. And so the can or whatever other material has these virions, these viral particles on it, and you have it on intact skin. Now, can this virus infect you through intact skin? And the answer is no. However, and at that point, you are contaminated.

And this is why we say, as soon as you come in, wash your hands thoroughly. I want to talk about what it means to wash your hands properly and thoroughly, or to use an appropriate material to decontaminate your skin, which you know, they're all over the place now in supermarkets so that you could put these hand sanitizers on you. And I will talk about what they need to be in a second. So you are told to wash your hands quickly, but let's pretend that you didn't realize you were contaminated or you forgot about it. Or by reflex, you put your finger to your nose or rub your eye or put your finger to your mouth. You now have gone from possibly just being contaminated to being infected.

And the state of infection here is the virus has gained access to you. Its spikes on the end have now approximated your angiotensin converting enzyme to receptor and i'll tell you where they are in a second and it has now become uh kind of melts into the surface of your cell fuses and becomes incorporated into your cell, fuses, and becomes incorporated into your cell, and then takes over your cell, makes it a factory for the virus, and it produces millions of copies. That cell then lices, bursts, and the virus is released to infect many more cells. That is the state of infection but not necessarily disease you may you will feel perfectly well you don't have any symptomatology yet there's no fever yet there's no cough yet there's nothing and that period of time is variable where you could spread this virus. SARS-2 and MERS really spread during the symptomatic

phase. This virus can spread in the asymptomatic phase. And this is why you may have seen where a man went into a supermarket and wanted to be a wise guy, went up to one of the workers there, who, by the way, are angels that they're going to work in harm's way. And he coughs in her face and said, ha ha, I've got the virus. He didn't think he did, and he may not have. But the point is, he was not thinking he had it because he felt well. But he doesn't know whether he had it or not. And I think that guy should be in prison. That's a terroristic threat. Or the licking of ice cream.

Have you seen that? I have seen it all, unfortunately. These are miscreants. I don't understand this. But in any event, you develop disease, and I'll go through nomenclature too in a second, once you have a symptom. the year 2019, caused by the SARS-CoV-2 virus as differentiated from the SARS virus, which we know it is very genetically close to. So the virus is SARS-CoV-2. The disease is COVID-19, and the disease will present with fever, cough, shortness of breath.

It can present with diarrhea. It uncommonly presents with nasal congestion. That's not a common way, but it has been reported. And interestingly, something called anosmia and dysgesia, which is the loss of smell and the loss of taste. Now, they go hand in hand, smell and taste. You can't taste things well if you can't smell. And most viral illnesses can have a degree of anosmia, the loss of smell, because you become congested. What's different about this virus is that you can have that without the congestion. So if you all of a sudden lose the sense of smell, lose the sense of taste, or if you develop a dry cough. Now, the cough in this disease is usually dry, meaning you're not coughing up phlegm. The shortness of breath may or may not be associated, I mean, the cough may or may not

be associated with shortness of breath at the start or with a sense of chest pain or pressure that may develop later. Once people are infected, it can take anywhere from two or three 14 days to 14 days on rare occasions. Which is terrifying. Just terrifying. Yes, before you develop any symptoms. During that entire time, and by the way, the quarantine which developed in Italy, this means 14 days in the Middle Ages, the 14 days of quarantining yourself comes from the fact that you may be able to be shedding this for up to 14 days, and actually, I think longer, before you have symptoms. And by

the way, once you have symptoms, it is not unusual for you to shed virus for 14, 18, 20, 21 days after you began having symptoms, and in some people, longer. So it can be months and months and months that you can infect other people? Or at least a month and a half? I mean, if it's 14 days at the beginning and another 30 days, I mean, you're talking about... That's right. That is a better. Yeah. Most typically, the majority of people, let's talk about the majority.

Majority of people will develop symptoms four to five days after being infected. disease for a week and a half or so, or up to two weeks for mild to moderate disease. And people with severe disease will have disease for three weeks to six weeks. And we do know after people seem to be better and convalescing, they still shed virus, particularly in the feces. So let's talk about where you have these angiotensin-converting enzyme 2 receptors in your body. Well, guess what? The respiratory tract from your mouth all the way down to your lungs. So that's an obvious one. Second, well, diarrhea and shedding the virus in the stool,

your intestinal tract. A third, your kidneys. A fourth, your heart. And if you start reading cases of this disease, we do see cardiomyopathies and carditis occurring where the virus is causing an inflammation of the heart itself. And the kidneys have that receptor and testes do as well, although I've not seen any testicular involvement for this virus. So those are the target organs that this virus, it will go everywhere, but it's only going to infect the cells that have angiotensin-converting

enzyme 2 receptors on their surface. Now I want to say something about women who are pregnant, and then we will talk a little bit more about human behavior and the like. As far as pregnant women go, pregnancy is a naturally occurring, mildly immunosuppressed state. You could think of it as being a selected immunosuppressed state because the mother has a foreign body that she's carrying in her body, the fetus, and she doesn't want to do anything that might cause that fetus to be rejected. So this is evolutionarily, or if you're religious, God's way of saying, let's protect the human progeny.

We have no evidence that the virus passes what we call the placental barrier. So in other words, the fetus is in the womb and it is in a sanctuary there. We also have no evidence that it is carried in mother's milk yet, although that makes me a bit nervous because breastfeeding, even if it's not in the mother's milk, requires the baby to be oh so close to mother that what we are suggesting is that when the fetus is when the baby is born and this is horrible for new mothers that the baby be sequestered for them from the mother for a period of at least multiple days. And each hospital has their own protocol. And I've seen as much as 14 days, which makes sense. RoundlyX.com is one of my favorite companies in the entire crypto space.

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So let's talk about we human beings. Yeah, let's talk about social distancing, generally about human behavior and the disease and what we can do to modify our behavior to help flatten that curve. So when we first talked about doing this talk, I gave you some homework, and that was to read Edgar Allan Poe's Mask of the Red Death. You can go online and get it. It's a four or five page short story. I was a profile in high school and loved reading almost everything that Poe wrote. Prince Prospero gathering up his friends and taking them to his castle out in the countryside, drawing up the moat and being well-provisioned and having minstrels and all kinds of things where they would wait out the pestilence that was going through the countryside.

And of course, the Red Death, who was already in the castle and went through it one night and took everybody home to God. The point being, people were already infected who didn't realize they were infected. And they went into this castle and partied and we're in close proximity and swapping ale and whatever and um passed the disease around and so the the important thing here is if you don't want to get this disease don't come in contact with the virus uh stay in your basement, that's a metaphor for staying away from people. I don't mean that being down below Earth is any safer than being up in your second-floor bedroom, but stay in the house. That's good for Floridians because we don't have basements here.

Yeah, I know that. We'd be flooded. We like to go to the Naples area, and it is always astounding to me to see how you guys prepare for hurricanes and don't have basements. Now, if you were in the Midwest, you'd have basements because that's where you're going to get away from the tornadoes. So the point here is you can't get this. if you were in the Midwest, you'd have basements because that's where you're going to get away from the tornadoes. Yeah. So the point here is you can't get this if you are not exposed to it.

You can't be exposed to it if you don't already have it and you stay in your house. But I know you can't stay in your house all the time. You need to go get more food and, if you're lucky toilet paper which i don't understand but uh is in short supply at least up here we are in a heavily ravaged area new jersey and new york are it it's a it's a terrible pestilence we have i'm outside of philly it's a little bit better but still probably worse than much of the country. So stay alone. Now, suppose you don't live alone. So in the instance where you don't live alone, and you do, or your wife or one of your children has to go out episodically to get something to eat to bring home, each time they come back,

there's a possibility they've been contaminated. So it is best if you stay in separate rooms. So if you live in a large house and all of my children are gone, so my wife and I live in a large house alone, it's easy for us not to see each other, except for when we have a meal. And even then, we are three, four feet away from each other. So it is important to stay away from each other. Even if you go out only one time, once a week, it could last for 14 days before you get disease. Typically, it's much less than that, but it could, and you just never know.

So always be thinking, I might be infected. I don't have disease, but I might be infected. What do you do, though though when you do go out? Well, I have gone out multiple times since I started, and I was preparing for this before everyone else. My wife, who is an oncologist, was even telling me that I was being ridiculous, but I kept saying, this is going to happen, this is going to be ugly. Well, I go out and I buy what I have to buy. I try to stay away from other people. I do things like when I walk by them, I hold my breath. These sound like over um dramatizations but if you were to know me you would know that i wear a belt and suspenders my pants are never gonna fall down and i i just that is my personality my wife is of

personality nothing bad will ever happen right so we you know we're yin and yang. So when you do go out, if you have gloves, use them. When you get home, take those gloves off and then wash your hands. Yes, I know you're wearing gloves. Yeah, but you have to touch the gloves to take your hands off. You have to touch your hands when you take the gloves off with your hands. That is true even if you do it carefully it's still that is true and the second reason to do that is get in the habit of washing your hands all the time. Yeah. Now I want to talk a little bit about how you wash your hands and then about what types of agents we could use other than soap and water. Any kind of soap it doesn't have to be you know antibacterial soap this isn't a bacterium anyway but it doesn't have to be antibacterial soap. This isn't a bacterium anyway, but it doesn't have to be those kinds of dials. Any soap will work.

But when you wash your hands, I will tell you how I do it, and then I'll tell you the way most people would do it. Remember, your wrists are part of your hands. So when you are washing your hands, you should Remember your wrists are part of your hands. So when you are washing your hands, you should go up about four inches on your wrist, all around your wrist. Wash your hands in between your fingers around in your fingernail area as well. And you should be washing for a minimum of 20 seconds. I want to talk about time dilution. Whenever I would have people, I would say, all right, I want you to hold your breath for 20 seconds. They would swear that 20

seconds is up when only about 15 are. So it's always better to err on a little bit longer than less. One of the things we do with kids is find a song or something that they can recite that lasts for a minimum of 20 seconds. It's better if it lasts for 23, 24 seconds, because sometimes they speed up, and tell them to recite that before they rinse their hands off. I do what's called a double wash. And a double wash is I will put soap on my hands and I will wash my hands for about seven or eight seconds and then rinse it off. Get the water off. And what that has done is taken most of the oil off of my hands. And within the oil, these virion particles can be trapped.

After I've done the first wash, I then do a second wash for at least 20 seconds, the way I described it. That ensures two things. One, I'm going to be washing for longer than 20 seconds. And the second is that I've already gotten rid of any viral particles that could be trapped under the oils on your hands. And to show you that you've done this successfully, you will note that the second time you wash your hands, you don't need as much soap to lather up because the soap is actually combining with the oils to rid the oils from your hand. You'll also notice this if you wash your hair twice, the second time you do it in the shower, you don't need as much of the soap, of the shampoo. So that's how I wash my hands. Now I want to talk about using other products.

And the brand doesn't matter if it's Purell or Dr. Jones brand or whatever. You want it to be alcohol content of 60% to 75%. Now, that amount of alcohol will denature the envelope on the virus, rendering the virus no longer capable of infecting you. So you can use that. If you happen to go into a store and you go to the men's room, and this happens all the time, they're out of soap. What I do is use warm water anyway by the way always wash with warm water your hands don't get as trapped uh rinse off with the water dry off with the paper towel use that to open the door walk out and then find some purell or whatever brand you're using and put

that on anyway because water without soap is not going to be effective. So what about plain old alcohol? If you have alcohol, whether it be isopropyl or ethyl alcohol, both would work. If it is greater than 60%, it would work. But it is very drying, and it will cause cracking of your skin, and now your skin is not intact. Now all bets are off if you get the virus on that cracked skin. So alcohol is not optimal.

If I were pinched, come to shove, I would do that, and I would put an emollient on my hands right after. Any kind of, whatever your favorite lotion is. And by the way, they do make these hand sanitizers in a lotion with 62% alcohol. You can find those, particularly if you're using them all the time. If you were a nurse or a physician in a hospital, you'd be washing your hands or using these products all the time. So you can imagine what that is like. I want to say something about pets because we talk about distancing ourselves from our pets.

The most common pets that we have in this country are dogs and cats. This virus primarily begins in other animals, and cats are much more susceptible to this virus than dogs. We do have a report of a dog being infected by this virus and being able to obtain the virus from that dog. But cats are much more susceptible, much more likely to get it. Luckily, most cats leave you alone and they do their own kind of sequestering by nature. Dogs don't. So I would tell you, be very careful around your pets, even dogs, because there is a possibility that you have a reservoir in your house now that your grandkids eventually come to visit and they're exposed to the animal. Although I would tell you, until this blows over, I will talk about how I see this going. I have avoided

my grandchildren. We do this FaceTime thing, you know. We've done the same with my kids. I am mes incompetent when it comes to these things. My wife is not good. She's better than I am as incompetent when it comes to these things, but my wife is not good. She's better than I am, so we're able to do that. Usually, I would get my grandkids to fix these things for me. Of course, and they're not there to do it. That's been the hardest part for us, honestly, is we moved back to my hometown to be with my parents,

and now we have to keep them separated from their grandchildren, especially my father. So that's been a very rough part of this, I think, for a lot of people. You touched on one thing just now that I think is worth talking about. The timeline until a return to normal seems to be somewhat of a moving target, and one that is constantly pushing further away. I mean, I personally believe since the very beginning that this will take far longer to resolve than the powers that be. Our government seemed to be saying, how long, you touched on this, might this crisis last? So, I have been doing some modeling on this with a professor of mathematics and computer science at Baylor University. I won't until he publishes it. And this is really his baby.

I'm just helping him with that. I won't mention who he is, but he just sent me yesterday his modeling. Now, understand that the models are only as good as the assumptions and data you put into them. And he has three models, an optimistic, a realistic, and a pessimistic. And also understand that this is very fluid. If people were to take social distancing and sequestration in one's home seriously. We might look at more optimistic timelines. The way people have been behaving, the kids down in Florida for spring break who are sort of spitting into the wind and pulling Superman's cape and

daring the virus boogeyman with people acting like that. Only God himself knows. If you look at his three models, they come out like this. And I want to say this does not mean the virus is gone. It means that the local epidemic or the global pandemic, but we're going to talk more about epidemic because it's a community thing, in your area or in the United States has quieted down to the point where it is no longer a firestorm. So the optimistic one would be that we could come out of our holes in mid-May. It's very optimistic. the number of deaths per day, and they kept going up and up. It's flattening.

785, and then 750, 742, 710, 680. So you know that people are still dying and there's still new cases, but it is starting to wind down. And that's what we will see. But I want to, particularly for people who were born in the wonderful decade of the 1940s who were listening to this, I being one of them, if we are sequestering in our homes, we have not been exposed to the virus. We have not developed immunity. And when we come back out, if there is a recrudescence of this in the fall,

which I think there will be. Which there will be. I mean, of course there will be. We are now at risk again and that's why when older people or people with comorbid states comorbid meaning diabetics

chronic obstructive pulmonary disease heart disease cancers autoimmune diseases and the like, those people should continue social distancing. And the first sign of it coming back, go back into your homes. So you're saying they can leave their homes, but they need to remain six to eight feet away from people,

wear a mask, wear gloves, basically a new normal vigilant yes not touching your eyes and nose there are some things that you can try that i cannot promise will be a benefit but they won't hurt and that is you could swab your nares the nostrils inside with some materials you do not want to use alcohol there but there are some others i won't mention them because i don't want to give brands out right of course but you could do homework that might protect because they are virucidal, that might protect you if you inadvertently have what I call a oh heck moment. I just touched my face. Oops. Yes. Actually, people would probably say things a lot more strongly than oh heck. Yes. But those are those moments. It is commonplace for us to do that, to rub your eyes because your eyes itch. By the way,

I have allergies. It's a horrible year for allergens. And so you can imagine people are going to do that. So you can try doing that. I can't tell you whether it would work or not. It might, it might not, but I already told you I wear a belt and suspenders. Right. Let's talk a little bit about how much disease is out there, and that gets into the testing. Yeah, I mean, that is the elephant in the room, right? I mean, testing, testing, testing. It's all we hear about, and it seems nobody knows what's happening. Well, I just got, before I came, maybe 10 minutes before I came on,

one of my friends from New Jersey wrote to me and said that the data so far shows that in the state of New Jersey, that 41% of the people who have some type of symptom and get tested are positive for the virus, 41%. What are the others? Probably allergens or some other cold or something. Because, you know, allergies, you can sneeze. So the one thing that I tell you about allergies is, unless it's your first or second year with those allergies, you probably know how you respond. You probably know if it's your normal allergic state, but be on the lookout for developing fever. You shouldn't get that with an allergy. Be on the lookout for loss of smell or taste. Be on the lookout for diarrhea. Those are things that

you don't normally get with your allergies. And so that might make you say, let me go get tested. But 59% of the people who were tested were tested and found not to have the virus. Now, I should point out that that also includes some people who are well, but were tested because they're hospital workers or ambulance drivers or physicians or nurses. Right. They've been exposed, but they're healthy. That's right. You don't know that they have been contaminated. Right. So now let's get into what all of them infected by the virus,

and I went and I tested them all. So all 100 are positive using what we call PCR, polymerase chain reaction for the RNA in the virus. It can detect very, very, very, very, very small amounts of this viral RNA. So all 100 have been exposed. What percentage of them will never develop disease, but be a source of the proverbial iceberg. We don't know how much is below the surface of the water. and test the community, we will be able to say, well, you know, 20% of people who acquire this never really seem to get sick. And maybe we'll find out that most of those are children or young adults. We just don't know. For those who test positive, the reason why we're saying, well, they develop disease is because

we're always testing those people who are symptomatic now. So once you test people who are symptomatic, I'm having fever and cough, dry cough, I'm going to test, I'm positive, it's the fait accompli that they're going to likely have the virus because they have the disease. It's not 100%, but it's approaching that. So once we have enough test kits, we could then start expanding beyond those people who are symptomatic and the health. Well, unless you're on an NBA team, they get tested too.

Of course. Celebrities, politicians, and athletes seem to be disproportionately affected by this disease. Somehow they found a test. A test kit from up here in this part of the Northeast, our expression would be, it fell off the back of a truck. Manna from heaven. Yes, exactly. That's the Jewish expression. The Italian expression is off the back of a truck. So we just don't know how broad spread the virus is in the community. Right. spread the virus is in the community. Now, I want to talk, before I get into vaccines and treatments, I want to talk about who dies and why. So we, in the beginning, said, well, children do

well with this. They really don't get real sick. Well, we've seen children die. It's really horrifying. We've seen children die. We've seen otherwise healthy 30-year-olds die in the strongest they're ever going to be in their life. And certainly, we know older people die. We know people with comorbid conditions, diabetes, heart disease, including hypertension, obstructive pulmonary disease, another reason to never have smoked. And God forbid, if you vape, stop it now. This is the wrong time to be doing those things, those behaviors, people who have malignancies, these people do very poorly. And now we've also found, and we don't know if it's the chicken or the egg, that people who are markedly obese don't do well.

And by that, I mean people who have a BMI of 40 or greater. That's pretty big. Those people don't do so well with this disease. And what happens? Well, they develop disease like anyone else, and they may chug along and start feeling a little bit better and then crash, just crash. Or they may actually believe they've gotten better and then three, four days later, crash again. Well, what we think is happening in these people is something called cytokine storm. If you were watching, television's been running in one of the channels, I can't remember, the 1918 influenza pandemic. Yes, we've always given the names of other people to them. Of course. In the United States, we call that the Spanish flu.

You may not know this, but the great pox, which is syphilis, was also given, you know, the French called it the Spanish pox, the Spanish called it the French pox. It's always like they did it. That's part of tribalism, which I will touch on tangentially at the end. But what happens in these people is that their immune system gets revved up to the point where it can't turn off. And it becomes friendly fire and a feeding frenzy. Think of it as a fire like out in California where the fire feeds the fire. It's so hot. It's like that with the immune system. And the immune system then starts to damage the lungs. And what we see when we do CAT scans of these people is we see what's called a ground glass pneumonitis.

I don't know if you know what ground glass looks like, but it's these opacifications throughout the lung. Usually it's on the periphery in these people, a third of the periphery. It could be the entire both lungs. And what is happening there is the host immune system, particularly mediated through something called interleukin-6, is causing damage to the lungs. The lungs are filling up with edematous fluid and blood. The patient is not able to oxygenate.

The patient goes down, he'll die. These people go on respirators. And in Italy, which the medical system in Italy, I've looked at medical systems throughout the world. Excellent. It's excellent. It's excellent. Australia, excellent. I can tell you the countries that I would want to get sick in and the ones I would never want to get sick in.

Italy has an incredibly good medical system. Per their population, they have more ICU beds, more respirators than we do, but they have something that's interesting. They are blessed to be able to live long lives, which means they accumulate old people in Italy. Japan does too. An older population that loves to kiss each other. Part of the problem. That is part of the problem there. If you are not used to it, men kiss the men and everybody kisses everybody and they hug. That is a problem.

What is happening in these people that are older in particular and people with comorbid conditions, they don't have the reserve capacity to be able to handle this the way a younger person might, and they deteriorate. Now, in Italy and in New York now, we are running out of respirators, and we are putting two people on one. That's suboptimal. It's not good. I mean, it's better than not being able to offer a respirator,

and pretty soon we won't have enough to do that either. Right. When I was living in New York City, I remember Maimonides Hospital very well, and Kings County, and Brookdale, and the hospitals throughout Queens. They're virtually entirely COVID patients now. At Maimonides, which is in the middle of Brooklyn, they're about 80% of the people in the hospital have COVID. So it is a significant problem and something that we have to kind of address. And I will tell you, I can't say how effective they are, but there are a number of drugs and monoclonal antibodies that are being rushed to the scene now that will down-regulate the immune system. And our hope is, in preventing the immune system from going haywire, we decrease the amount of collateral damage to the host,

friendly fire. These people won't have to spend as much time on a respirator, maybe not have to go on a respirator, maybe not even have to stay in the hospitals long, that decreases so much of the stress of the system. So those are in place. The trials of chloroquine and hydroxychloroquine are ongoing in New York. I'm not prepared to say how well or not well they're going, but they are going. And I've seen some of the preliminary data. So far, I'm pleased. But some of the other drugs are not doing as well. So we don't have a treatment yet. Although I will tell you that the amount of work that has been done to identify this virus in the most intimate of terms to be able to be looking at a vaccine we have about 40 or 41

vaccines that are in the works now uh in such a short time is remarkable. Now about a vaccine, that's what we would want. But there's no vaccine for MERS. There's no vaccine for SARS. There's no vaccine for those coronaviruses that you mentioned that are like the common cold, correct? That is correct. Well, let's talk about each of those. So the common cold coronaviruses, we wouldn't bother making them. In fact, the natural disease becomes the vaccine and then you develop immunity to it. SARS, which was like 10 years ago, disappeared. SARS was stupider than his brother SARS-CoV-2 in that you only passed around when you were sick, and it killed a lot of people. So it burned itself out. And this virus is just a lot shrewder. So this virus is different. Whether we will be able to have a vaccine that prevents the disease, I'm cautiously optimistic, but my bet, having been in the

vaccine development space, is we're looking at, if we're lucky, 15 months, 18 months for this to be available and start immunizing people. I also was involved in trying to make a vaccine against malaria, ulcerative malaria. We've never developed that. It's never worked. We've tried many things. So it should be sobering to you that some of these microbes hide from the immune system very well. So with the vaccine, my guess would be maybe 18 months from now. But that is for what we call an active vaccine. There are people up in Tarrytown, New York and elsewhere at individual medical, who are taking people who have survived and whom we presume to have developed immunity. And we plasmapherese them, which means we take their blood,

we get rid of their red blood cells, and we have in them what we call immunoglobulin. These are antibodies directed against God knows what, but at any point in time, if you've just recovered from this, the majority of your antibodies circulating will be directed against this virus. It will be directed against any number of targets on the virus, some of which will protect against the virus, hopefully, some of which might not. So what the people in Tarrytown are doing is separating each of the specific immunoglobulins. I probably shouldn't have named the town because then you could go

and figure out what company is up there. What this company in New York is doing is looking at individual immunoglobulins to see which one neutralized the virus most efficiently and then selectively produced that specific antibody. Now, that is an already preformed antibody, which we would then give to people who were sick. And the half-life of IgG is 14, 15, 17, 21 days in that range. So, one dose will get you through it because even two weeks later, you've only lost half of the immunoglobulin. And so that may be available much earlier, and maybe there are people already getting the hyperimmune gamma globulin directed against SARS-V2. So that's another thing that's in the works. Let me just see if there's anything else. But we do have some hope then. I mean, there's definitely hope for a vaccine. There's definitely

hope for treatments. And it sounds like the world scientific community is coming together in a manner that they never really have before to try to solve this. I've been working in this space for 40 years. And I am gobstruck at how well people have come together in the community. And I will tell you that we have a gem in Tony Fauci. He's a Brooklyn boy. I don't know where you're originally from. My people are from Brooklyn. My people are from Brooklyn.

Yeah, he's a Brooklyn boy. And Tony, who I will tell you I'm even taller than he is, is a very reasoned, intelligent, savvy, and politically astute guy who chooses his words carefully. So I think we are fortunate to have had Tony down there at the National Institute of Health, National Institute of Allergy and Infectious Disease for, he's been there, I don't know, 35 years now, maybe more. So he's a terrific guy. So I think we're fortunate. And I will also say at this time if any of you have the opportunity to see a nurse or a physician whether in the hospital or the community thank them for what they're doing do not give them a hug keep your distance and distance probably 44 feet would be. Yeah, for them.

But the point is, let them know you appreciate it. Physicians don't make what basketball players make. You never could figure that out. But I guess there are a lot more physicians than there are people who play in the NBA. The other thing I would want to point out is if you go to the supermarket, thank those people. You don't have to go up and again, hug, thank them for being there, for doing that in pharmacies, any places where we need people to be functioning, to be able to keep us living, if not a normal life, at least a decent life made possible because of those people. I do want to say something about food that you bring in, that you order in. Please do, because I think that there's a lot of misinformation about

what is and what isn't safe. And I'm assuming there are certain foods that are safer than others and the way that they're prepared and also the way that they are delivered. So I would love for you to go into that. Let's first talk about human nature and what we would hope. What we hope is that if someone were preparing your food for you and they coughed, they would throw that in the trash. You can imagine they may be backlogged and they may be saying, well, I don't feel sick. This is probably okay. And they may send that out to you. So you have to be careful about what you're getting. So what is safe? Anything that is cooked should be safe. What kind of temperature? 180 degrees will kill this virus.

It actually may be lower. But I want to point out to you, your oven, if you were to put it on 180, it's not uniformly 180 in every part of your oven. There are hot spots and cooler spots, maybe only a few degrees, but there are differences. So that's why I would say at least 180, because I think 160 would kill the virus. But 180 for 10, 15 minutes, you're killing it. So suppose you order pizza. Pizza should be clean. I mean, that is cooked at a high temperature. However, sometimes people will sprinkle some oregano over it before it goes out the door.

That I hope they're doing with Glozone or not doing at all even better. But in case it's been done, and in case the box has been contaminated, when I get my pizza in, and I do try to support these local businesses because they need help, I put that pizza back in the oven. Put it in at 180 degrees, put it in for 10 minutes. It'll be a little extra crispy. But I do a tradeoffoff, extra crispy, infection. I'm going to go with the extra crispy.

Sushi is dangerous, even though they usually wear gloves. It's dangerous on a good day. Yes, I didn't want to say that because there are some sushi restaurants. So I would not touch salads. They're not cooked. So if it's cooked, I have never seen anybody make big ziti or orange chicken or Kung Pao chicken and then take their bare hands and run it through the food. It's hot. So those are going to – should be okay.

I just reheat them. The problem with bread, bread is baked and should kill the virus, except it could be handled afterwards. Now, what isn't handled? If you eat the sliced bread in the package, that's not touched by human hands. When that's baked, it goes through slicing with machines and packaged. I think that's, nobody touches those. I think those are more than likely safe. Now, let me talk about something which is controversial, and that is, can you get this virus from the oral ingestion? And I believe you can. And even if I were to be

God himself and knew that you couldn't, I would be telling people, don't take the chance. People, you'll see on the internet, well, the stomach acid kills the virus. And there are two caveats that need to be attached to that. Hepatitis A, we've all seen an outbreak in a local restaurant. 32 people come down with hepatitis A. I've had it. And that's fecal-oral. That got through your stomach. Yep.

How many types of traveler's diarrhea, both viral and bacterial, it goes through your stomach. Some of it depends on the inoculum density. So if you had 10 bacteria, they probably had killed off. You have 10 billion, some of them are getting through, just statistical probabilities. But let me say something even more than that. People over the age of 60, between 3 and 30% are achlorhydric, meaning they don't produce stomach acid anymore. This is part of the senescence of the human body, the aging of the human body. So there's no stomach acid in those people in order to kill anything off. How many people are taking H2 antagonists,

Pepsid, or any of those drugs? They decrease the stomach acid or the proton pump inhibitors, prilosec and those types. They turn it off altogether. They have no... So those people have no protection anyway, and I'm not positive that stomach acid

will kill off the virus sufficiently. That's what I call Russian roulette. And we do know that people get diarrhea and it gets shed that way. So I would be very careful. I had one person tell me the following. People who get this virus in their intestines, it's not from eating food. It's from swallowing the virus from their throat. And I said, well, what's that telling you? It's going through your stomach either way. The stomach didn't protect one. If you have contaminated food, you could get it as well. So just be careful. So that's kind of where I wanted to go on the modes of becoming contaminated and infected. Now I want to make some comments about

our community, because I've seen some things that have disturbed me greatly. I've heard and read about Asian Americans being accosted, shouted obscenities toward. What in the hell is that about? It's not like they have brought the virus here and are spreading it intentionally. They're like the rest of us. They're at risk. This is no different than an Italian-American, Greek-American, Jewish-American, African-American, Hispanic-American. Where your nationality, where your grandparents or great-grandparents came from,

has nothing to do with whether you're responsible for this. It seems that people need to blame somebody. This is akin to a child being born with an anomaly and the obstetrician is sued because it's not possible for me to have an abnormal baby. It had to have been the obstetrician's fault. Great analogy. For some reason, we need to blame somebody for our problems. I would suggest people go and read the book of Job.

If you don't want to read the book of Job, there is a movie called A Serious Man. You want to see when bad things happen to a really good person? Look at The Serious Man. The Coen brothers are among my favorite producers. So this is what, it's the human condition. And you're hearing people say, we're all in this together. We are. I have heard, for example, African Americans cannot become sick with this virus. I shake my head

because I know they have angiotensin converting enzyme to receptors. So much of this stuff where we are blaming each other, if you want to blame the guy who's out there licking ice cream and putting it back in the... Blame him. Blame the guys who are going out knowing they're sick. You had an issue in Florida where people knew they were sick. They got on the plane and flew. I mean, that is unconscionable. It's murder. Really. You know, I mean, so I think what we ought to do is help

each other. And I would like to suggest something. I'm in my 70s, but I still did this. There are people who are shut-ins. Can you imagine how afraid they must be? They can't get out. They can't get out. They can't get things. Go to your shul or your church or your mosque or your temple or your community center and ask if they know if there are any shut-ins or people who are old and elderly that you can go buy them food. Bring it to them and leave it on their door. You don't have to go in their house.

Let them know you're coming and leave the food for them. This is a mitzvah, a gift, a good deed. This is something that we can do for each other, and in fact we should. If you believe in karma, maybe that's a way for you to get through this. So let's try to be gentle, be humans, and be humane during this. And maybe we'll learn some lessons. Yeah. Any other questions you might have?

I mean, I think that actually was a pretty impeccable way. I can't possibly ask anything after that. Is there any other comments you'd like to make before we finish up? No, it's been a pleasure. I wish you all well. Stay indoors as much as possible. Try not to get on each other's nerves. Remember, if your wife is getting on your nerves, you're probably getting on hers too. And be kind. Wow. That's a perfect way to part. Thank you so much once again.

And we'll look forward to hearing more from you in the future. All right. Thank you. Let's go. Hey, everyone. Thanks for listening. New episodes go live every Tuesday at 7 a.m. Eastern Standard Time. Links to our Apple and Spotify channels are in the show notes. You can also follow me on Twitter at Scott Melker to continue the conversation. See you next week.