The Wolf Of All Streets - Jeffrey Swisher, Chairman Dept. of Anesthesiology, California Pacific Medical Center, S.F. on Being a Physician During the Coronavirus Crisis, Why A Vaccine is a Long Shot, the Risk to Healthcare Workers, Being Kara Swisher's Brother and More.

Episode Date: April 2, 2020

Jeffrey Swisher is the Chairman of the Department of Anesthesiology at California Pacific Medical Center in San Francisco and goes into the hospital to treat patients every day. Dr. Swisher and Scott Melker discuss the balance between protecting yourself and caring for your patients, the prevalence of false negative COVID-19 tests, the importance of social distancing, the immense risk that health care workers are taking treating COVID patience with and without proper PPE, why most of what we heard from the media about the virus is a myth (only kills old people, just the flu etc.), why a vaccine is a long shot, the poor handling of the crisis by the US government and what it's like to be the brother of famous tech personality Kara Swisher. --- 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. As you know, my main focus on the show is to provide accurate and factual information from vetted sources about the global coronavirus crisis and global markets. Today's guest is certainly an expert on the former. Dr. Jeff Swisher is the chairman of the Department of Anesthesiology

at California Pacific Medical Center in San Francisco, the Sutter flagship hospital in Northern California. As you likely know, San Francisco was one of the first cities in the United States to go into lockdown. So I'm looking forward to hearing his experiences, both as a physician and a civilian in Northern California. Jeff, thank you so much for taking the time out of your packed schedule to join me. Hey, Scott, it's great to be here. Hopefully we can cover a lot of ground today. That's the plan. So you sent over your CV, which was basically a novella. You have a 10-page list of accomplishments and accolades. Very impressive. But can you tell us a bit about what you're doing now? Okay, so I am the chairman of the Department of Anesthesiology

at Cal Pacific Medical Center, as you said. And so the job is administrative, but it's clinical as well. I'm a full-time clinical physician with a full-time clinical schedule. And my administrative activities are essentially on the side to what I do clinically. So that's interesting. So what is your focus clinically? What kind of patients do you generally see? What kind of procedures do you do? Right. So as you mentioned, Sutter is the hospital in San Francisco. CPMC, is essentially our flagship hospital. It's the quaternary medical center for Sutter. So we basically get everything in our hospital. We do everything from pediatric cases down to newborn neonatal cases, all the way up to liver transplants. My specialty is

liver transplantation and solid organ transplantation. But I do pretty much everything. I don't do pediatrics anymore. I used to, and I don't do cardiac anesthesia because we have subspecialty teams for both of those. But as I said, I do everything else. So tonight, for instance, I'm on obstetrics. So I'm going to be going in at 6 p.m. and doing cases tonight all night, epidurals and C-sections. Go ahead. So you're still going into the hospital on a daily basis? Yeah, I am. We have cut back our schedule dramatically since last week. We stopped doing all elective surgeries last week, and now we're only doing urgent and emergent cases,

which still is quite a bit, but nowhere near. It's a fraction of the cases that we do on a daily basis. So as I mentioned before, San Francisco is definitely one of the sort of epicenters of this crisis. At least that's how the country is viewing it. What are you currently seeing at your hospital with regard to COVID-19? Well, we're starting to see it. I would say it's a little bit more than a trickle now. Last week, we started seeing our first patients that were COVID positive patients in our hospital. And we have what are called PUIs or persons under investigations or persons under interest.

And those are patients that we suspect may be COVID positive, but have not tested positively yet. We have many more of those in the hospital, but we have about currently about 10 to 15 or so COVID positive patients in the hospital. Can you tell me what the protocol is for someone? First of all, for those patients who are of interest, are they of interest because of their symptoms or because they're awaiting the results of a test? Which is it generally?

Yeah, they're usually it's their symptoms that they come in with, you know, with complaints, respiratory complaints, or they have a history which is consistent with being a person of interest, either travel or symptomatic complaints that make them a person of interest. That's interesting. So even if they're there and they're a person of interest, they're not getting tested yet? No, they would be tested. And, you know, fortunately, tests are becoming more rapid. The molecular tests for SARS-CoV-2 is getting a little bit more rapid in terms of the ability to find out. So we should be able to find out for those who are positive fairly quickly.

But still, even though someone is potentially positive, their test may be negative for a while just due to the sensitivity of the test. And so that they may have a negative test, but become positive several days later. I didn't realize that false negatives were an issue. Not false negatives. Yes, false negatives is definitely an issue, right. Yes. So for every test, as you probably know, there's a sensitivity and a specificity. And the specificity of the test is very good. So in other words, if it's positive, it's like 99 plus percent that it is, in fact, SARS-CoV-2. If it's negative, that does not necessarily mean you don't have it it just means that it's not detected yet that's a bit scary yeah because that i would assume that in some

places that means someone tests negative and goes home that's correct um that's right i mean the the the way that someone is tested for this is usually either a nasal or a pharyngeal swab. And depending on how much virus is shedding, how good the specimen collection is, I mean, there's a lot of factors which would alter the way a specimen is taken, whether or not it is positive, whether there's enough molecular RNA to amplify in the PCR test, which is how these molecular tests work, which is why typically you need a couple tests to see if someone has been treated and has recovered from it and is now negative. That's why you have to look for a couple of negative tests afterwards to be fairly confident. Right, because there's been cases where they at least rumored out of China and other places where they believe people were reinfected, but it seems more likely that it was a result of the tests coming up negative and it just being a poor test. Is that correct? an infection that's already there. And they start shedding virus again. There's been some

concern about that and people who have been recovered, but may still be shedding virus. Is there also a chance that like the flu, it sort of evolves on a regular basis and yearly, it's sort of a different version of this coronavirus? Yeah, this particular strain of coronavirus, they've seen from what I've been reading in some of the medical or mostly the scientific literature, like Lancet and science, etc., that it has some kind of drift, a genetic drift. And so the early isolates that were from China versus isolates that they're taking now may have variations, but it's still pretty much the same strain of virus. It just may have some different RNA sequencing inside of it right now. So when someone comes in symptomatic or asymptomatic, but they do get the test and they test positive, what's the protocol? What does it look like? How are they processed in

the hospital? What do you guys do? Well, first off, do they have symptoms which require them to be hospitalized? Number one, I mean, just because someone tests positive doesn't mean necessarily that they're going to be hospitalized. If they're not sick, they are sent home with instructions to isolate and quarantine themselves with obviously careful follow-up to make sure that if they do get sick, that they come back into the hospital. So that represents a lot of people. I mean, there's a lot of people who are asymptomatic carriers of this virus who are not sick at all. So if someone is obviously coming into the hospital, most hospitals, at least in California now, at least in San Francisco, will really only test you if you have some kind of either positive travel history or have symptoms. So screening tests like

we see happening more currently in New York, and certainly that have happened in Korea, Singapore, places like that, those aren't happening to the extent which we would hope they would in California, just due to a lack of test kits. So in a perfect scenario, you would be testing everyone. Yeah, you'd be screening people to see who you would isolate. And, you know, this we can talk about this later about the success of countries like South Korea in terms of how they handle this virus. They were able to screen a lot of people. And as a result, with a combination of social tracking, cell phone tracking, et cetera, with index cases, they were able to isolate them very quickly and get them out of circulation to the population so they couldn't reinfect other people. Right. So I'm curious, as a physician,

how do you reconcile wanting to protect yourself and your family from the virus, but also wanting to care for your patients? That's a great question. Obviously, taking care of myself, I can't be a good doctor unless I take care of myself. And that's true whether or not this was a, you know, we had a pandemic, you know, or just normally I take good care of myself by making sure I get adequate sleep when I can. I exercise, I eat healthy, I don't smoke, you know, I limit drinking, et cetera, like that. But in this current crisis, we really have to be scrupulous about how we take care of ourselves in terms of hand washing, isolation from people, everything that we're recommending to the entire population. We really have to be careful with ourselves. And we have to be sure that when we do have

interactions with positive patients, that we follow very careful protocol, depending on what it is we're doing for those patients. Right. But when you're seeing these patients, we're hearing that the hospitals are woefully underprepared as far as personal protective equipment, that they're running out of essential items. So how do you protect yourself if you don't have the gear to do so? Well, we try to get the gear, number one. So, you know, fortunately, my hospital, the Sutter facilities in San Francisco, at least, we have not seen the type of surge that is happening in New York. And certainly it's happening in Italy and other countries. And so right now, we are pretty well prepared.

We have had a huge amount of donations of things like N95 masks. I was telling someone the other day that the Irish Union workers in San Francisco donated something like 300 boxes of masks. And we're getting a lot of donations from the public. We had a lot of expired N95 masks that we were able to get, even though they would not be used in a normal circumstance. In this circumstance, of course, they're perfectly good. They just have an expiration date on them. So we can use those if we need. And we're trying to get as many other personal protective equipment as we can, including that includes buying some of our own.

Like a lot of members of my group have banded together and have gone out and bought our own personal protective equipment, which would be things like face shields, 3M N100 respirators, etc. And we've gotten permission from the hospital to use our own PPE, you know, because, you know, certainly you can't be too careful. And, you know, anesthesiologists as a group tend to be very fastidious individuals. And so that a lot of our group has gone out and purchased PPEs. How does it happen that hospitals are so woefully short on these essential items? I mean, it almost seems like they've only got a week's worth of backup at any given time or even less. Because like you said, I mean, you're not even you guys aren't inundated with cases and you're already going out and depending on somewhat donations and physicians getting it for themselves.

So why is it that hospitals don't have, you know, a much larger stock of these items? Well, because unfortunately, you know, it's, I likened it to a situation of the old fairy tale by La Fontaine, the ant and the grasshopper, you know, that, you know, the grasshopper fiddles away while the ant is working hard. And a lot of us by nature tend to be grasshoppers. I think it's human nature. And really what we need to be in the light of crises like this is we all need it to be more ants. You know, we need it to prepare better. And I think that, you know, I feel very fortunate to be working at the CPMC because I think we have prepared pretty well. But again, nobody really expected a pandemic. And I think nationally, certainly nobody did. And we can get into issues

about ventilators and various other things. But the last crisis that I remember having to prepare for is when the Ebola crisis happened. We did, you know, increase our stock of PPEs and et cetera. But I think that people just didn't expect, it's human nature. And I think we're as well prepared as any hospital in San Francisco. And I am very actually grateful to the administration of my hospital that they've really been on the ball since this has happened. And they're trying their hardest to try to get us as much equipment as we can. So we haven't been inundated, though, you know, like New York has, certainly like Haiti has. You know, so, you know, we'll see. I mean, I saw pictures of lines of hundreds of people outside New York City emergency rooms today.

And it's just I mean, it's really shocking. It is shocking. It is. It is shocking. This is I have never seen anything like this in my life. I'm 59 years old, you know, and I hope I never see anything like this again. It's just, but you know, this is the nature of living in a global society in a lot of ways. I mean, things like pandemics, even though we knew about it, theoretically, they could happen. Certainly there've been movies like Outbreak and Hot Zone, books like that. And I think that, you know, listen, climate change is real, right? And we're not doing what we should be for climate change. It's just, it's uh it's sort of that you

know i'm sure you've seen the venice canals are clear with swimming yeah yeah the lack of the lack of pollution yeah it'll i mean uh los angeles the skies over la and like i mean i'm really fortunate i live in marin county which is one of the cleanest places on the planet earth uh and you know because of prevailing winds etc that cetera, that I'm very spoiled where I live. I'm right on the base of Mount Tamalpais. So you did just touch on ventilators and those are kind of the talk of the town, certainly. Obviously, they're an essential item for treating this. Are ventilators a life-saving equipment here? Are they palliative? Is it something that makes the person more comfortable or does it actually keep them alive while they fight the virus?

And why don't we have enough? Yeah. Okay. Well, good question. Yes, they're life-saving and they're required. Keep in mind that ventilators are used in hospitals for a lot of reasons. They're just not palliative. I mean, in a sense, palliative is what we do to keep someone comfortable while they're in the process of dying. Typically, if someone says they're going to die, it's very common for patients to be taken off ventilators and left to die. So they are lifesaving, and they're very commonly used for patients who develop ARDS or acute respiratory distress syndrome for a variety of reasons, not just from a viral infection, but you could aspirate, for instance, and develop ARDS. You could have HIV and develop ARDS. You could have surgery, for instance, and develop ARDS. So postoperatively, of course,

a lot of patients are put on ventilators to rest them for the two or three days after very large operations. For instance, let's say you have a cardiac bypass or a liver transplant. It's not unusual to be on a ventilator for at least a day after that kind of surgery. And then there are people who become sick as a result of, let's say, a neurologic condition, where they have brain damage and they require a ventilator

because their brain doesn't trigger them to breathe. And people who have strokes, people who have, you know, various other medical conditions requiring them to be on a ventilator. So hospital intensive care units are already full. I've mentioned this on prior, you know, podcasts and other things that we don't run essentially empty. We run fairly full. So most of our ventilators are in use. And of course, we have a reserve of ventilators in the hospital. In excess of the number of rooms we have potentially to put them in, but we don't have that many in reserve. They're expensive pieces of equipment and they're very high-tech, complex pieces. So you just don't have ventilators lying around in the hallway. So hospitals have a limited number of these things.

And, of course, all it takes is a 10 or 15 percent bump in the number of patients who require them. And all of a sudden you have a lack of them. That's really scary. Yeah, honestly, it is. I mean, you see these images coming out of Italy and places like that where effectively the entire hospitals become a massive emergency room, even thousand bed hospitals or ICU. ICU, yeah. They become ICUs. So there's not a lot of people in an emergency room on ventilators. There's a couple down in the typically portable ventilators to bring them up to the ICU. Another place that we have ventilators that people often don't think about is in the operating room. The anesthesia machine that I use to put people to sleep incorporated in that is a

ventilator because I ventilate people. I take over their breathing for them for a lot of operations. I mean, even small ones, like if you're having your appendix taken out or your gallbladder, I paralyze you after I put you to sleep and then I breathe for you. You're not breathing on your own, right? So the ventilator that I use in the operating room can be repurposed as an ICU ventilator. But of course, that ties up the operating room. So I can't do operations, you know, if I've taken away my anesthesia machine. And so this is one of the problems we face. How many do we keep separate for operations versus the demand for ventilators for this crisis? And so we have to think about that because we just can't shut down the operating rooms. We still need to do strokes and heart attacks and liver transplants, kidney transplants. These are all things that are ongoing that we have to continue to do. And also, we need to leave space in the operating room for those patients, right? Because those people are still coming in.

Right. It sounds like that a lot of people aren't considering that secondary effect, which is that if the hospitals get overwhelmed, even if they're managing to treat the COVID patients, what happens to all these other patients? What happens if you get in a car accident and you need to go to a hospital that's completely overwhelmed with COVID patients? That's right. So that's one of the, you know, the jobs of hospital administration and consultation with people like me, chairman of anesthesia, chairman of surgery, that we have to plan for this by looking at past numbers of cases and try to shunt as much as we can.

Like, that's why we canceled all elective surgery, for instance. So right now in San Francisco, you cannot get, let's say, a total knee replacement or your hip replaced, you know, short of an emergency. If you fracture your hip, sure, we'll do that. But we're not going to do elective surgery, plastic surgery, if you, you know, for cosmetic is done. It's just not happening right now. So yes, you're right. There is a secondary mortality as a result of this disease that care that would have normally been given right now might not be given as a result of overcrowding of the hospitals. Yeah. So I saw actually, touching on that, I saw a video

from a physician in Spain today who was saying that at this point, they're basically having to take anyone over 60 off of ventilators and, you know, give them medication and watch them pass away so that they can save younger people. I know that's that's that's a horrible. Is that what you foresee coming? I hope not. Boy, I sure hope not. I mean, that's that is just a horrible circumstance. I mean, look, I'm going to be 60 this year and I'm a very healthy person. I still think of myself as I as a 15 year old. You know, it's just because that's how people think of themselves. I know.

Exactly right. I'm probably my maturity level is probably about there, too. But but at least my kids tell me that. But but the the fact is 60 is young. It's really young. I mean, think of the average age in this country is, you know, and that's because there's a lot of people who die young is in the 70s. So most people can expect in this country, if they live to 60, they're going to live into their 80s. And to And to be able to say or even further, right. And to basically, you know, say that I'm not going to save the life of a 60 year old. That's

pretty extreme. It is. And so perhaps this is a time to do fact or fiction. With COVID, we keep hearing and we have heard that it only kills old people. Yeah. From what you're seeing, is that true? No, that's fiction. A lot of the people that we see, especially in China, we see some of the healthcare workers in their 30s and 40s. There was a very good article in the New York Times, not this past weekend, but the weekend before, about a young nurse who died, and she was in her 30s of this. And, you know, while I haven't seen many case reports of younger people, I just heard about, I think, a 12-year-old who has who's very sick with this. So, you know, I think it generally it's going to affect older people more, but it's certainly younger people are not immune to this at all. And our health care, I mean, obviously, health care workers are more at risk of contracting it because they're in close proximity to patients. But I also read something that it seemed like healthcare workers, as you mentioned, like that nurse are actually,

you know, seeing worse cases of it. Is that due to more exposure, more of the virus? Why would that be the case? Yeah, I would say, I mean, I'm speculating here. I don't know. I have the science of it, but I would think that the, what's called the inoculum, how much virus that you're exposed to, and how long you're exposed to it, definitely has an effect and how quickly your body is overwhelmed by the virus. So as you know, when you get this virus, and you take it into your body, it attaches to specific receptors on epithelial cells. And, you know, you do have an immune response even to viruses that you don't normally, you know, see, you know, you may not necessarily have a very profound antibody response, but you still have cells that are scavenging your immune

system to invaders. And that's how, you know, a lot of surface, you know, antibodies get rid of, you know, even novel viruses that they encounter. And eventually, if you get enough, you build an immune response to these things. That's what immunity is. But, you know, it's possible that you could be overwhelmed by a viral load, and especially healthcare workers, and people like me, who are really up close and personal with these people, and we're doing procedures, which are quote, unquote, high risk procedures, which aerosolize the virus. So we might get a larger amount of virus. And that's why it's super important to be very careful with our PPEs. So we dispelled the myth that it only attacks old people or kills old people.

Are there other myths that you're seeing, whether coming from the government, mainstream media or just, you know, sort of being disseminated through the old game of telephone on social media that we can dispel? Well, I've seen a lot of crazy things saying that if you can, you know, like my mother, for instance, said, I heard that it's that if you can hold your breath for 20 seconds, you don't have the virus. Do the 10 second test in the morning. I got that one from my mom as well.

Yeah, no, that's not true. So that is completely not true. You know, I'm sure there's, there's lots of myths out there. And, you know, mostly I try to not read the breathless, you know, news articles that I see coming from places like, you know, the New York Post and various other places. But I try to, I try to read, you know, good journals. I try to read CDC. I try to read Lancet, Science. New York Times, I have to say, has been very good with this. And even San Francisco Chronicle, SFGate has been very good. The Guardian has been a great source of information. I have a son who lives in Australia, and he sends me articles from The Guardian from Australia that are quite good.

That's interesting. So what would you say? I mean, we know that I think it's common knowledge that we've had a poor dissemination of information in general, both from the government and media. But would you say that they're largely responsible for some of the bad behavior that we're seeing people out on the beaches, people, obviously, Disney's closed now, but the famous now images that will probably go down in infamy of, you know, tens of thousands of people watching the last fireworks show at Disney World. Yeah. Yeah. The same thing with the beaches on Miami Beach, you know, or Fort Lauderdale, seeing all the students. I think I think I mean, clearly, I think the government is to blame for not getting on this faster.

I mean, I think that it's normal, again, for people to be in denial. I think that this particular administration is not what I would call a science forward administration. And, you know, Trump himself, I think a unique, you know, a unique blend of characteristics, including, you know, toxic, malignant narcissism, germophobia, anti-science, ignorance. He's not a curious man, it seems. And as a result of this combination, he basically has been suppressing information that he probably was getting in January about this. Now, remember, it's not been that long since China basically gave us a sequence of this virus and kind of told us what was going on. It's actually shorter than Trump himself says. He said at some point, well, three or four months ago.

And that's not the case. I mean, they didn't really know what was going on probably until December. And then they started seeing the real problems. And then in January, when we should have been doing something. Of course, you know, the stories about the and obviously I've seen rebuttals to this, etc. But the fact of the matter is that the WHO tests that we could have used for this, the government decided they were going to go their own way. And they did dismantle a good portion of the CDC response team for pandemics, etc. And, you know, I don't want to get into the weeds with, you know, he said, she said about

that kind of thing. But they could have been a lot more astute about warning people, especially when they saw some of the things that were happening over in Europe start to take off. Well, that's interesting that you touched on this earlier, but there are governments like South Korea that reacted clearly in a much more favorable manner than the governments of Europe or us. Can you talk about why South Korea has been so successful in fighting this? Yeah. So South Korea, as you know, is a very technologically forward country. I mean, their internet, for instance, their internet speeds that they have in Korea are so much faster and they're so much more penetrated than we are.

Obviously, they were a lot more penetrated with very high speed cell phone networks that were able to basically track individual movements. And they had, as a result of the MERS virus back in the 2012 to 2014, I think that really got their attention. And as a result of the MERS crisis, they really ramped up their production of these molecular tests. And so they were prepared once the sequence of this virus was known to really ramp up and to be able to do what's called the RT-PCR or reverse transcriptase polymerase chain reaction tests much, much more rapidly and in huge volume, which is why they were able to do the screening that they did. They didn't have the shortage of reagents, for instance, that we're experiencing now because they were on the ball. They had a lot of these tests. The other issue

that Korea had that we don't have is the issue of privacy as much as we have here. So the government was able to really carefully track individual people's movements down to probably feet and yards as a result of cell towers pinging where their locations were. And in combination of the fact that the index cases that they knew were able to share that health information with the government, so they knew a patient was positive with COVID, with the virus. We have HIPAA laws, which actually prevent us from identifying individuals. So while we can use a lot of metadata, they actually can use data, I mean, actual data. And that, I think,

allowed them, in addition to, I think, their society, it's a different society than our country. We're used to a lot more individual liberties. They're used to much more that they trust their government. And if the government says something, they do it. At least that's my take on it. I mean, I suspect it's a simplistic take and maybe a Korean will laugh at me. But I think that's what it seems happened, at least in Singapore and countries like that, that have a little less reliance on the individual and a little bit more reliance on the group and a lot more group dynamic. Yeah. Yeah. I think here that people would view it as a violation of their civil liberties or privacy, as you said. But ironically, those are the things in a situation like this that can save lives en masse. I've talked about

this with other guests before. You know, the very things that we despise about China and their authoritarian government and communism and all those things are the ones that in this very specific sort of case probably play in their favor for, you know, treating their populace and slowing the disease. Yeah, I agree. You know, it's interesting, but I don't know if you listen to my sister's podcast, Pivot, but her and Scott Galloway have had this discussion a lot about the role of individuality versus, you know, personal liberty versus more control. And I know Scott's been a big advocate more of, you know, that we should have a little less personal control. And my sister sometimes argues

the opposite about that. And this is referencing things like Facebook knowledge and various things like that. But it's an interesting discussion. And I think we're going to have a lot of conversations when we do a post hoc analysis of this afterwards. So since we didn't mention it and everyone doesn't know, I guess we can say that you're not the only accomplished person in your family. Can you tell us about your sister and who she is? Yeah, well, she's a hell of a lot more famous than I am. Kara Swisher is the tech journalist that started a long time ago writing about tech, really back in the 1990s. She started off writing a book about America online, and that segued into a career with the Wall Street Journal,

where she started her conference, All Things Digital, which she co-owned with the Wall Street Journal, where she started her conference, All Things Digital, which she co-owned with the Wall Street Journal and Walt Mossberg, really one of the icons of the technology of journalism, Walt is. And then Kara and Walt started Recode Decode, which is then bought by Vox Media. And so it's co-owned by Vox and Kara, I think actually wholly owned by Vox. And now she's also a New York Times opinion columnist, and she puts out an article maybe once a week. And she has two podcasts, one called Recode Decode, which won podcast of the year last year from Adweek, as well as another one called Pivot, which is Scott Galloway. Very impressive family. So I guess to pivot

slightly off of all the COVID and sad talk. So where did you guys collectively get that kind of drive? I mean, what kind of family were you raised in? We had a very interesting family. So my dad was a doctor. He was an anesthesiologist like I am. Unfortunately, he died when he was very young. He was only 34 years old when he died of an aneurysm. I know, very young. I mean, literally out of the blue. And he was a Navy anesthesiologist, a really nice guy from West Virginia. And his career was in the Navy.

And literally a month or two after he got out of the Navy, he just out of the blue of the blue one, one, uh, Sunday morning, uh, just collapsed and had a hospitalized. Yeah, it was bad. I was seven years old. And, uh, you know, a lot of times tragedies, uh, you know, can really ruin people. And a lot of times it can kind of galvanize them. And I think for my family, um, I have another, I have a brother as well, and he's pretty accomplished as well. He chooses to stay more anonymous, but he's a, he's an attorney and he's the CEO of a company. But you know, Kara is, she's a force of nature. She's incredibly smart. So, so we, you know, I think valuing education, it was a big,

I come from a kind of a mixed family where one half of my family are Italian immigrants and the other half have been in this country for over 200 years from West Virginia. It used to be Virginia before it was West Virginia. And I think that there was a combination of pioneer spirit and immigrant spirit that allowed us to be successful, really valued education. My mother is an amazing advocate for education. 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. They integrate with your favorite exchanges so that you can round up into different assets all at the same time. And they do this all without ever holding any of your Bitcoin.

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There's just so much building there. So yeah, I went there as an undergraduate, but my first degree was in international relations, specifically Chinese Soviet foreign policy. Interesting. Yeah. And then when I graduated college, I had sort of this crisis of consciousness and decided that I wanted to be a doctor. And so I went back to college again. I got another degree from UC Santa Cruz, and then I went back to Stanford for medical school. Wow, that's actually very similar to digress, but to my father, who's also a physician, he had a very similar sort of path. It's interesting to hear. But I

also went to the University of Pennsylvania in Philadelphia, But it's funny, it was the late 90s and maybe it was like, you know, a top 20 school or something. And now it's always a top five school. So I get the added benefit down the road of pretending that it was one of the best schools in the country. Right. Exactly. It was very similar. So just to jump back to the topic at hand. Sure. There's a few I think there's a few simple things we can discuss that maybe people don't understand that would be really helpful. Like, for example, what's the proper way to wash your hands? Okay. So there's a good Internet video that's going on right now. Somebody, and I don't know where I saw this on Twitter, a guy who basically takes black ink in a pair of gloves.

Did you see that? I did. It's great. It just goes to show you that you can't just do a little five second, you know, you know, squirt some soap on your hands and, uh, you know, rub them for a few seconds and then wash your hands and you're done. Uh, this really shows you that it really takes a good 20 or 30 or 40 seconds of really vigorous hand washing, uh, including, you know, you know, bunching up your fingertips into your palm and rubbing it around and basically try to cover your thumbs. That's the one that got me. Yeah. Yeah. The thumbs just don't get washed. So soap is the number one thing that will kill.

Well, again, kill is a relative term because viruses as you know are not actually living things right they are they're a they're a compendium of rna and and protein uh and they only can live by taking over a host cell replicating and then going on to do they're you know they're like the quintessential zombies you know um and so so getting rid of a uh a viral particle is not that hard because the lipid bilayer, which encloses the RNA, is very easily disrupted by soap. So even though Purell, et cetera, works fine as long as it's above 60% isopropyl alcohol, which does the same thing. Isopropyl alcohol will disrupt cell membrane or the viral capsule, not a cell membrane, but a viral capsule. Soap really does it. And you don't even need hot water. It just water will do.

And it'll get rid of the virus on your hands. So you have to be very scrupulous about how you wash your hands. And then you have to be really careful about touching things, especially around your face and mouth and nose and eyes. And that's really hard to do. I mean, it's really hard to do. I find that now that you think about it, you find that you're touching your face like 10 times a minute. It's constantly, constantly, you know, and the same thing, you know, you have

all kinds of actions that you do that are involuntary. Like some people lick their finger when they turn a page, I mean, for instance, or they rub their eyes when you get up in the morning. Well, you know, your eyes are a mucous membrane too. And so by rubbing your eyes, the virus can enter your eyes as well. It turns out that this virus as well is, it's definitely in the GI tract. So obviously wash your hands after you go to the bathroom. Oral fecal transmission. Yeah. Yeah. Oral fecal transmission. I mean, that's how a lot of viruses spread. You know, hepatitis A is a good example. I had it when I was a freshman in college, actually, from eating a bad tomato in Egypt. Yeah, yeah, sure.

Like, you know, vegetables, et cetera. You know, lettuce in the fields are covered with dirt, which dirt is, you know, you use dirt as a lot of manure. Right. And so, yes, you have to be very careful about very, very careful personal hygiene with this. It's funny, our science experiment with my five year old who now, of course, is homeschooled like everyone else last week was to put pepper and water and then drop, you know, drops of soap in there to see how it dispersed. Right. Because we wanted to teach her how important washing hands was. So we decided that better not to do it now with a science experiment and get her interested but i you know it's really unbelievable even with something that simple to see how effective soap is right right soap is

amazingly effective and the other thing too is there's a lot of it i mean people have been hoarding uh purell and that one guy down in florida has like 17,000 cases of it. I mean, yeah. Uh, you know, so yeah, that, that's super important to understand that just plain old soap and water is one of the best things you can do to, to, for hand hygiene and, and just be careful about what you're touching. Obviously when you sneeze, don't sneeze onto your hand, you know, use your elbow, et cetera. And this virus can live on surfaces for quite a long time and various surfaces. They can live longer, less so on organic surfaces, but it still can live quite a long time. So that is this whole social distancing thing that we have to be really careful of.

So speaking of it living on surfaces, let's talk about things like food delivery, grocery delivery. Are those things safe? You know, I think it's safer than going out to the grocery store and interacting with a whole bunch of people. So I actually feel for the delivery drivers because they are actually putting themselves out on the line and risking themselves. So, you know, a shout out to all of those guys. You're doing, you know, you're doing great work and it's unbelievable. There's so many heroes in this i think we're going to see profiles of some amazing people when we're all done the food service workers are our heroes i mean people

who prepare our food um and so the um i think that you have to be careful with vegetables that come in remember that when you buy food in the grocery store uh all the fruits and vegetables that sit out you know they're exposed to virus i mean they're just you buy food in the grocery store, all the fruits and vegetables that sit out, you know, they're exposed to virus. I mean, they're just sitting out there in the produce shelf. So wash your produce when you get home. You should be doing that anyway, of course. Of course. It's double important that you can do.

You can wash, you know, vegetables with soap and water as well. And then just, you know, rinse them off good. And that's really important. Wow. Yeah, that gives you a lot to think about so are there certain foods say you're actually ordering from a restaurant and a lot of people want to support local restaurants in this their time of need here are there certain foods that you know are safer than others I mean personally I wouldn't order a salad I'm not ordering anything to be clear. I'm just not doing it. But yeah,

like if you live in a urban center, San Francisco, New York City, small apartment, you just can only store so much food. Right, exactly. So, you know, I'm certainly not a food expert. I mean, I like cooking it. If you look at my Twitter bio, you see it says amateur chef, because I love cooking. But I'm also amateur carpenter, but I don't know if you'd want me to build your house. But the, you know, common sense. I mean, I think you're right. Salads, it's hard to know where, you know, the salad is sourced from and whether it was washed, et cetera. But anything cooked, cooking will definitely inactivate the virus.

So that's a good thing. But if someone sneezes on it after they cook it. Yeah, then it's hard to know, right? You have to try. I mean, this is true outside of this pandemic. I mean, there's a lot of foodborne illnesses. And a lot of times when people get sick, they think they're getting sick with a cold or something. But it could be that they have food poisoning from, you know, bacterial as well as see, let's not forget bacteria in this whole thing to bacteria is what caused a lot of infections, E. coli, et cetera. One of the reasons that we wear masks, the main reason we wear masks in the hospital is to protect you, the patient against us, you know,

against us spreading, you know, oral bacteria on a surgical wound or E. coli or, you know, any of these enterococcus bacteria that just lives normally on our bodies. We try to avoid... It's hard not to spread a virus. It's a lot easier not to spread a bacteria. Right. That makes sense. I mean, I've seen some sort of studies on it and it's always astounding at how much bacteria lives in the human mouth. Oh, yeah. It's tons. I mean, it lives everywhere. I mean, we're just. And we're, we're, we're just from, from, from everything we do, we're surrounded by, you know, little cooties and bugs and everything. Uh, but, uh, the important thing in, in that we do in the operating room, sterile technique is to try to avoid bacterial infection, uh, uh, even above viral infection.

Clearly we don't want to transmit hepatitis or uh or uh you know any of the other you know hiv etc uh but bacterial infection is you know that's very dangerous people get septic from bacterial infection and can die from it yeah i mean you hear all the time about people saying you know i don't want to be stuck in the hospital they're generally not afraid of viruses they're afraid of getting a bacteria exactly yes yes. Exactly. Yes. Yes. Yes. Staph, you know, staph sepsis. That's the kind of thing that kills patients who are stuck in the hospital more. That's right. Yes. Then viruses for sure. Yes, definitely staph sepsis. And the body has very, you know, nasty reactions to, you know, let's say E. coli, which is a very common, you know,

gut bacteria. But if you develop E. coli sepsis, that's very dangerous. And it produces enterotoxins that cause your body basically to shut down. And it can be very fatal if it's systemic. And a huge part of that is hand washing by nurses and physicians as well, correct? Absolutely. 100%. Yeah. We practice this. I mean, we have when Jayco, which is the organization that surveys hospital, they come and they actually have what are like the equivalent of secret shoppers that come into hospitals and watch how frequently doctors wash their hands. My dad, I mentioned previously he was a physician, but he's also a pretty prolific inventor of specifically emergency medical devices, but others. But he had a company that's actually out there. It's called High green. And what it did was forced physicians and nurses to wash their hands. It basically was like a breathalyzer. They put alcohol in the soap.

It sensed it and it lit there. They had a badge they wore that lit it up green or red. Yeah. Wash their hands. But it was funny that actually all the insurance companies and everyone was resistant to it because they didn't want the liability of the crew that their nurses and physicians had. Yeah, I believe it. It reminds me of that Farside cartoon of the guy coming out of the bathroom and a bell

goes off that says, didn't wash his hands. You know, it's true. I mean, it's true. I mean, we definitely need to be very, as I said earlier in the podcast, very scrupulous about hygiene. So we touched a bit on social distancing. I think we all understand that that's probably the key to mitigating the spread. Do you think that after this is all said and done, when there's a vaccine, do you think that to some degree,

more social distancing will become the norm? I would like to think maybe it would, especially, you know, again, there's this is, you know, COVID-19. Will there be a COVID-21 or COVID-24? You know, who knows? I mean, the answer is, well, yes, there will be because it's only been, you know, six years since we had MERS. And before that, we had SARS, we had Ebola. I mean, this is the nature of the world that we live in, as it becomes more global, because we have the ability to, you saw that one, there was a very good internet thing of people leaving Wuhan, China, and each dot showed a person leaving. And it was just like the steady stream of people all over the world. I think if anything that it might happen is like this country is going to kind of wake up to the fact that we've maybe over-relied on globalization for our supply chain. And that we need to, I mean, so many of the materials that we use, one of the reasons we have a PPE shortage isn't necessarily just negative. Yeah, it comes from China. It's mostly made in China. And same thing with iPhone components and everything else that we make, you know, we may have gone a little bit overboard in the quest for cheap labor to, to make ourselves more vulnerable to this kind of, you know, catastrophe. I mean, do you think in the future that things like handshaking should just basically

be eliminated for a good fist bump or elbow tap or a nod? Yeah, maybe. I mean, you know, I'm a pretty social guy and I'm a handshaker and it's been really hard. Yeah, it's really been exactly. Like I said, I'm half Italian. It's hard because the Italian side of me wants to hug people. The West Virginia side of me makes me nod. So, but it's a, you know, you'd hope that, you know, big change happens. But as you know, often it's very typical for our country to stumble from one crisis to the next. Yeah, exactly. So I was seeing it in the financial markets, repeating everything from 2008 if it never happened. So yeah, yeah, no, that's a very interesting thing. I've been very carefully following the financial markets. I know that you have a great interest in Bitcoin and I've been I have a very big intellectual interest in

Bitcoin. I can't say I'm an investor, but I think it's really interesting watching the market in Bitcoin, especially what the 12th it was that it dropped 40% in one day. And it would seem to be the opposite, you know, to me since I kind of always thought of Bitcoin like it was like gold, right? That it would follow the same market as gold. But it seems like you've got two sort of Bitcoin investors right now, those people who are believing it's a hedge against inflation, and then those people who are just speculators and they're using, seeing it like a commodified, you know, backed by cash resource that they can either, that they can speculate on. Yeah, I love sell higher. Yeah, I love sell high, right, as opposed to, you know, like gold, you know, you buy it and you hold it. Yeah, I think the inflationary hedge narrative is still very accurate. I think that the, you know, digital gold store value off, obviously took a hit. But you know, it's a very risky asset.

There's never been a time in history when people rushed to something more risky when they're losing all their money and what they consider stable assets. So I don't find that drop necessarily surprising. I also I mean, this is something for another conversation. But, you know, I believe it's generally orchestrated by a few people who have a ton of Bitcoin and they generally move the market. So, yeah, more likely it's not a bunch of people selling their Bitcoin because they're scared. It's just, you know, taking advantage of news. These few people just kind of frictionless order book. Right.

Well, there was that whole thing with isn't there some kind of Ponzi scheme in Korea where there's a token? Yeah. Yeah. Yeah, that's exactly right. And I think some of that market volatility may be as a result of some of that activity. But it's interesting, though. I mean, you know, one of the, of course, you take it to the extreme. If we really have sort of go back to the, you know, Mad Max scenario,

if we don't have any computers to generate any more Bitcoin, we're going to have a problem on our hands. But God help us if we ever get to that. Yeah, we talked about that. I've talked about that with quite a few guests, actually. I always reference Mad Max, or in this case, I Am Legend has been the other one that's been coming around in New York City. But it's interesting, you know, talking about people sort of patterns repeating themselves, I mean, with markets, but also just in general. And I think with these diseases, going back to whether we will, you know, go to more social

distancing, I think, you know, human emotion is the same, whether it's in markets or in behavior. And so I don't, I mean, I'm not really that confident that people's behaviors will change just like with anything else. They'll probably just forget and go back to the way it was because. Yeah. Well, it would be interesting to go back into history and look at after the, you know, the black death back in, you know, the, you know, the 1100s and see, you know, how did people change? I do think fundamentally that we're going to have some change in society. And listen, I think we're still at the very beginning of this thing. I think that we're going to see a lot more mortality, a lot more morbidity. This is not going away anytime soon. And I think that's going to be the biggest

key thing. Like reading today that Trump says he wants to wrap this thing up within 15 days. I don't know. I was just going to ask you about that. What is he talking about? But he's the kind I mean, we can all, you know, I think whether you're a fan or not, I think we know that he's a somewhat impatient person and he's watching the markets dump and you know he's probably just sitting there biting his nails and freaking out at every minute as the market continues to drop and wants to get the economy back on track and yeah yeah but the problem is my big fear is that you know like Fauci or something those guys are going to leave there's going to be no more scientists and it's going to go back to you know the Boris yeah herd mentality thought there's going to be so much financial pain. Yeah. You know, actually, this is a good point to talk about this whole concept of,

you just said the word about herd mentality. There's a lot of, you asked me before, is there a lot of kind of misconception? And I think the concept of herd immunity gets a lot of play and it's used a lot incorrectly in the context of this virus. So do you have a second to talk about herd immunity? I've got plenty of time. Go. Okay, good. So the idea of herd immunity is that when the herd, and calling ourselves a herd, has enough exposure to a pathogen that we develop an immune response. An immune response is not a population-based thing. It's an individual-based thing. So individuals within the herd develop antibodies to the bacteria or viruses, whatever the pathogen is. And once you develop enough people within that population that

has developed immunity, it basically blocks the spread of the virus from one person or the bacteria from one person to another. So then you become, you know, as a society or as a population, relatively immune from it. And the virus essentially dies out or the bacteria dies out. So the crisis or the pandemic ends. That does not mean the virus goes away. It means that every now and then it'll crop up, but because enough people have developed immunity to it. Now, in this particular situation, to like Boris Johnson, for instance, said, well, let's just have a big chicken pox party, and we'll all get, you know, Coronavirus, and then we'll all become immune. Well, that's a very naive belief, because number one, you're discounting the fact

that, you know, maybe 3%, maybe 4%, maybe 1%. It's hard to know, but a lot of people are going to die of this thing. And so basically, it's saying, you know what, we'll sacrifice 1% or 3% of our population to develop herd immunity. That's a very steep price to pay. Especially when you may not develop the herd immunity in the end. Right, because I know this coronavirus may, you know, mutate to something else. And so it may become another virulent virus that doesn't have the capacity for the antibody response to be effective. The more common way in modern societies to develop herd immunity is what's called vaccination, which you've mentioned. And the idea of vaccination is we inoculate people with a facsimile of a virus or a bacteria or these are, you know, an attenuated or a non-live version. And we generate, you know, essentially we fool the body into thinking it actually had the infection.

And we vaccinate everybody, as many people as possible, so that it doesn't spread. That is the kind of herd immunity which would be great. And people want to develop a vaccine for this, although it's very difficult for coronaviruses to develop a vaccine. For instance, we don't have a vaccine against the quote unquote common cold virus, which is a coronavirus, or one of them is a coronavirus, several of them are coronaviruses. And I think it's going to be difficult to develop a vaccine against this particular virus because of scientific characteristics of the immunologic nature of the virus. I'm not saying it's going to be impossible, but it's going to be hard. That's funny because I think the overwhelming consensus, if you listen to the news and stuff, is, hey, they're already testing it.

We're 18 months away. Right. Because we need to track you know, track a patient for 14 months to make sure that the vaccine isn't worse than the virus, right, doesn't kill them. But so it sounds like that's, that's more hope than fact at the moment. Yeah, I mean, you have to develop enough of a, of an antibody. And so in order to do this, you have to have people who've been infected with this virus, who've recovered, who developed antibodies. You have to isolate those antibodies, test them against live virus, et cetera, et cetera.

This is a long process. And then you have to do phase two studies where you have a small population, et cetera, before you release it to the general public. Because you're right. One of the risks of a bad vaccine is that it can, let's say it precipitates an immune response, which the body, it's not, it's overwhelming to the body. And you develop a cytokine storm, for instance, to the presence of this. I mean, I'm basically not talking as a virologist because I'm not a virologist.

But as I understand from some of my reading, developing vaccines is a very tricky business. So let's go with the best case scenario, which is that a vaccine is 18 months away. So if it takes 18 months to approve, does that mean that at-risk people will be isolated until that time? Or can we hope for antiviral treatments to appear first that will lessen the mortality rate while we wait for a vaccine? Yeah, I think the latter. I think that ultimately, you know, I think some of the research that's being done now, let's say on chloroquine and azathioprine and some of the other antiretrovirals, if those are successful, the idea is that we've isolated people, that the number of people infected goes down, thereby decreasing the

pool of people who can get infected. And then we can pick the ones off with medications and treat them in anticipation of getting a vaccine. So I think that's the strategy for a lot of infectious diseases is that you develop. I mean, HIV is a very good example. We haven't, quote unquote,, uh, people still get infected, but we've, we've been able to produce medications, uh, that have basically been able to control HIV. So the mortality of developing, uh, AIDS, uh, or HIV, you know, related infections is far, far less than it was back in the late eighties and early nineties.

But they've been working on that vaccine for 30 years. Yeah. We don't, we don't, we don't, we don't. We don't have an AIDS vaccine. We don't have an HIV vaccine. But we have very, very potent anti-viral drugs that people can live full 100% normal lives with HIV. And maybe that'll be the case with the coronavirus. Maybe we'll develop drugs that can control the pathogenicity or the mortality of this virus by these kinds of medications. I mean, that's the hope at least. Is that a faster timeline? I mean, testing, because there's less risk, I would imagine, in giving someone an antiviral than there is in giving them a vaccine that hasn't been tested. So yeah, yeah. And I think that the exactly right, I think that, that, you know, you're gonna have to have a relatively large sample size and, you know, a good research study,

a crossover study that has got, you know, for good science, you know, a lot of studies are started where they have, you know, classic double blind crossover studies, and they, they unblind them because they see the results of one pool is so much better than the other that they basically stop the experiment. There's certainly a lot of cancer drugs where that's the case, right? And so it's important that, you know, we do support basic science research and try to figure out if there's a medical strategy that we can do this. So there's a public health strategy, and there's a medical strategy, and then there's a virology strategy. So all these strategies combined will help hopefully mitigate this and get us out of the pandemic phase and back

into a more controlled phase so we don't overwhelm our hospitals. So before we, you know, to eliminate that pandemic phase or during that phase, people who are highly at risk are going to remain effectively in self isolation or quarantine. I mean, is that correct? This notion of two weeks or a month or any of this is absurd. I think so. I mean, certainly two weeks is, is ridiculously absurd. It's like saying, okay, I'm done. I'm bored with this. I mean, that's what it sounds like to me. It sounds like a toddler who's saying, I'm bored. Yeah. And I mean, and that's sort of, I mean, again,

I don't want to get overly political because I trust a doctor, but the man's a toddler. He just does not have an attention span. And so I think that we really have a problem here with, you know, figuring this out in this current political administration. I'm very hopeful. You know, I heard the other day on my sister's Recode podcast, Ron Klain, K-L-A-I-N, who was, he worked for Joe Biden in his campaign, and he was Obama's Ebola czar during the Ebola crisis.

And this is a man, he's such a comfort to listen to, if Biden does win, he will have intelligent people like that directing policy as opposed to people like Wilbur, you know, economists, you know, who want to, you know, basically make the markets go back up. Right. And but, you know, that's when you're a parent right now, like myself, who's at home with two kids waiting for when my children will be able to go back to school. It's such a double edged sword because you're like, I want my child to have a childhood and to play with other five-year-olds and to have a life, but I also don't want my parents to be at risk, right? Exactly. Exactly. Listen, I'm with an argument for sending kids back to school, period, till next year. You know, I really don't. And I think that that's what I'm personally

prepared for. Yeah. Yeah. I mean, you know, it's my wife is a second grade teacher. And I have to say, I had a very heartwarming moment this morning because she had her entire second grade class on her Zoom application. And I just I walked into the room and she's there with her little pet dragon teaching phonics to a whole classroom of second graders in our dining room. And just, you can see on these kids' faces the absolute joy of being able to connect even like that. And there's another group of people, you know, of course, it's a little self-serving to give my wife credit, but I will. Because teachers are, you know, they're the backbone of this nation.

They are. And watching them and their dedication in this kind of setting to give hope to parents and to give hope to kids and to continue a routine because, as you know, as a parent of a five-year-old, kids thrive on routine. And it's really important that we have those kind of people in our society. Yeah, we're fully doing school here. We have our whole routine and every hour we change it. And it's really hard to work in between. But she does need that, as you as you mentioned. Maybe one of the silver linings of this whole thing will be more appreciation for our teachers, because I know there's a lot of parents at home going, what am I going to do with this?

Oh, yeah. Yeah. Yeah. I don't know how to teach them much less, especially like if you have a kid who's taking AP high school classes or something. I mean, I don't remember calculus. If my child was doing calculus, I'd be pretty much up for breach. You will. I've raised three kids into their twenties and I had to relearn calculus. I had to relearn basic chemistry. I had to relearn, you know, like the, uh, you know, basic, uh, you know, quadratic equation and all that again and again. And, and I'll tell you, it was really actually fun. It's like, I look forward to that. That's good. Yeah, it is fun. It really is fun. My five-year-old's already smarter than me in a lot of ways. So I'm

learning a lot of things I didn't remember even now. Um, so generally what is life in San Francisco like at the moment on lockdown? Well, I'll tell you some of the benefits of living in San Francisco. I lived in Marin County, just north of the bridge. But the main benefit is there's no traffic. So I can go to work now in record time. In fact, people have to be careful because the highway patrol is still out on the roads. There was a guy here that was in the paper the other day that got his Ferrari going 120 miles per hour on 101. And he was surprised when the cops pulled him over. He's like, well, I didn't think anybody would be out. It's like, yeah, they're out. But number one, no traffic is great. I mean, it's a little bit kind of strange.

It's a surreal experience. It's a bit of a ghost town. I mean, Van Ness Avenue, which is the street where my hospital is, when I look out the window of my office, Van Ness is empty. You know, you never see that. The stores are closed. Restaurants are closed. Bars are closed. That's a little unusual.

The hospital, the main difference with the hospital is restricted access to the hospital. So now you can't have visitors if you're a patient in the hospital at all. Even in obstetrics, you're only allowed to have one visitor, which is the, you know, the other partner of the patient having the baby. I saw they eliminated that in a lot of, in a whole hospital system in New York City now already. They did. And that is something that we're still, you know, we still allow a partner to be with the, uh, the mother having the baby, but, uh, we don't, uh, we are considering not, and that is just devastating, not seeing your child be born. Uh, so that's, that's a big thing. The other thing is, is that when you walk into the hospital, you're screened very carefully. Even if you're an employer or a physician or a nurse or whatever, everybody

gets their temperature monitored walking into the hospital. All visitors get screened with a series of verbal tests, have you traveled outside the country, et cetera. It's a little bit more of a lockdown mode in the hospital. I think that a sense of purpose, that's the other positive thing, is that everybody in the hospital, you know, regardless of your job, whether you're a housekeeper, whether you're a technician or surgical tech, anesthesia tech, scrub nurse, circulating nurse, physician, surgeon, et cetera, they all seem to be pulling together. And, you know, that sounds kind of trite and it sounds a little bit Pollyannish, but it's true. It really is happening.

I don't think it sounds trite at all, actually, because I think everyone's hope is that that's how society in general will react, you know, pull together rather than even though we have social distancing, there's really a chance that people will, I mean, especially if people start to get hungry or don't have money that, you know, as you mentioned, that Mad Max sort of element, there's certainly a fear that it could go that way. So even seeing it in a microcosm like the hospital, I think, can give people hope that people will pull together that way everywhere. Yeah, I've been very impressed with how people are generous. And UCSF medical students, for instance, organized a drive to have N95 masks, et cetera, donated to the hospital. You know, medical students in this setting aren't particularly that useful in the hospital. And I don't want to denigrate medical students because they're

amazing. They are literally the future of our group. but they haven't had enough experience yet to be particularly helpful in the hospital, but they have a tremendous amount of knowledge and they have the ability to help outside the hospital and they have definitely the ability to educate people. So whether they're on Twitter or anything like that, I've been a little disappointed in some of the things that I've seen, like you said, the Fort Lauderdale or places like that, that people really need to get the message. And today I, um, actually I published a very long, like 12 part tweet today, uh, which, uh, fortunately, uh, Kara retweeted and then a bunch of other people have been retweeting it, um, that it kind of goes out, um, uh, on my,

you know, I'm at Jeffrey Swisher, if you want to look me up on Twitter. I was going to ask you that at the end, so perfect. Yeah, yeah. And so I try to not overwhelm my feed with all kinds of tweets. But every now and then I'll post something that I think is important for people to know. And last night, one of my friends, who is an amazing person, he's a toy inventor. Have you ever played Bop It? Of course.

Well, my friend Dan Klitzner invented Bop It. And he's one of my neighbors and a long, longtime friend of mine. So last night, he called me and he said, you know, he has two sons that are the same age as my sons, you know, in their mid 20s. And he said, you know, how do I educate these guys? They're, you know, one's down in Los Angeles, one is up here, that really the social distancing thing is important in that they're not immune to this. So I thought about it a bit and I wrote about it yesterday. And I really hope that people get that message out there that social distancing works. And it works for a good reason. There was a tweet that was running around last week that was a really good, it was

an English mathematician who was explaining the whole multiplier effect. Like, for instance, coronavirus, just by casual contact, one person could easily affect seven to eight people with just casual contact. And that is like saying hi, you know, being a foot away, shaking hands, giving somebody a hug, playing basketball. You know, these kind of common things that we do every day. Contrast that to the flu virus, influenza. It's not that easy to catch relative to coronavirus. I'm not saying it's not easy, but it's not that easy. One person infects about 1.3 people that they contact on average. But if you multiply that out by 10 iterations, in other words, one person does to another, to another, to another. By 10 people, that one contact,

that one index case for the flu, only 14 people are infected after 10 iterations, whereas with coronavirus, it's about 50,000. It's parabolic. Yeah. Yeah. It's amazing. It's just because of the numbers associated. You can really see how it's possible that so many people can get affected so fast. The other problem with coronavirus, as I've mentioned, is that it has a longer latency period. So you could be carrying this virus for four to seven to 10 days and not know that you're infected, all the while infecting a lot of other people.

Hence the importance of social distancing until we get a handle on this thing. Well, this has been beyond informative. And I think that there's a lot of practical knowledge here that people can really grapple onto and use, certainly going forward. Once again, is there anywhere else that you would like people to be able to find you? Obviously, we've got at Jeffrey Swisher on Twitter. Yeah, that's the best place. You can always reach me, you know, if you if you just Google me on the internet, you'll see I'm at the Chairman of Anesthesia at California Pacific Medical Center in San Francisco. And if you call

the hospital and you can talk to my secretary, leave a message. I'm pretty good about getting back to people who either write me or email me. My email is jlswishmd at gmail.com. That's my first two initials, JL, just swish, not swisher, just swishmd at gmail.com. Uh, that's my first two initials, J L just swish, not swisher, just swish MD at Gmail. And again, Twitter is probably the best way. I'm also on Facebook, um, um, and Instagram as well. Uh, I'm pretty for, for a 59 year old, I'm pretty lit, you know, and LinkedIn as well. I'm on LinkedIn as well. Awesome. So there actually, now there's one more question I want to ask before we get back. How can the average individual help beyond the social distancing and staying away from people, but like with supply shortages or food or any of those things as this progresses and people realize it's not just a two week thing and maybe people start to get hungry or broke? Well, so certainly people can donate to food banks and they can donate money to food banks, places that'll help. San Francisco has got a huge percentage of homeless people in it.

Of course. And all cities do. But San Francisco, in particular, and so these people are out there, it's very difficult for them to socially distance because they rely on other people in order to live. And we're going to start seeing a big percentage of these people fall ill to, you know, any kind of societies in your cities that help these homeless people who really need the help. They'll need it, you know, even if we weren't having a pandemic. It's a crisis. And then, you know, think about elderly neighbors who might be shut-ins. You know, again, you don't want to be contacting them, but there are, if you want to have food delivered to them, you could always call up, you know, Amazon and, you know, have food delivered to them if the need be. I think the biggest thing is think about your neighbors and think about who needs what and what you can donate, whether it's, you know, again, we don't

want you contacting people and getting in physical presence, but there's a lot of way to help people through just checking in by telephone, by Facebook, by Zoom, by whatever mechanism, and make sure that your elderly relatives are taken care of, that they're not, you know, there's a tendency, especially among the elderly, to kind of like shrug a lot of this off. It's important that they don't shrug it off. It's really important because they're the most susceptible to this. So I think that's, that's the best thing that you can do. If you have a whole supply of N95 masks, get them somewhere. A lot of people got them for the fires. And I think that's where we're seeing a lot of donations to the hospital.

People stocked up on them. And the other thing is don't, don't hoard toilet paper. Like why why? Why? Why are you hoarding toilet paper? I don't get that. You know, you don't need 5,000 rolls of toilet paper. I don't know what you're doing with it, but... Make a mattress or something. Yeah, something. But, you know, just think about other people. I see people in stores just cleaning out whole shelves of Trader Joe's. Think about what you need and take what you need and give what you can give. Well, that's great advice. And thank you once again so much. I think that, as I said,

this is going to be extremely valuable and that there's a lot here for people to process and it's going to be really, really helpful. So I do really appreciate your time once again. All right. Thanks so much for having me on. I really appreciate it. 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.