Well with Arielle Lorre - 48: DR. CLAUDIE BOLDUC, MD, MPH - Cvid-19 Facts, Fiction and Misconceptions

Episode Date: March 17, 2020

In this episode I talk to Dr. Claudie Bolduc, an emergency physician in California on the frontlines of the coronavirus pandemic. We strip away histrionics and talk about the FACTS around this virus, including: SYMPTOMS HOW IT’S DIFFERENT FROM THE FLU WHEN TO SEEK HELP HOW IT SPREADS HOW HOSPITALS ARE HANDLING IT TESTING FOR THE VIRUS HOW WE CAN PROTECT OURSELVES AND OTHERS HOW WE CAN “FLATTEN THE CURVE” WHO IS AT RISK   ...and all of your most pressing questions about covid-19. This is a rapidly evolving situation so things are sure to develop over the coming weeks and months, but this episode will give you everything you NEED to know right now to be informed.   For up to date information about covid-19, visit:   https://www.cdc.gov https://www.who.int/emergencies/diseases/novel-coronavirus-2019   Follow Dr. Bolduc for daily updates:    www.instagram.com/pulse_check_md     Follow me!   www.instagram.com/ariellelorre www.instagram.com/theblondefilespodcat www.theblondefiles.comSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

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or sunnycars. combe. I'm Ariel Lorry, and this is the Blonde Files podcast, where I talk to experts, influencers, and inspirational people in the world of wellness and beyond. Whether it's mental health, spirituality, nutrition, gut health, hormones, exercise, meditation, entrepreneurship, beauty hacks, and procedures, I cover it here with real conversations and even realer guests. I know you're as curious as I am, so I'm asking the questions for you and you get to listen in.

Hi everybody, welcome to the show. I know things are really weird right now, and I felt like we could all use an informed, rational, grown-up voice to talk to us about the coronavirus and this pandemic that we are living through. So my guest today is Dr. Clody Boldzick, an emergency physician here in L.A. She also has a master's in public health, and she has a special interest and experience in disaster emergency medicine. We strip down all of the histrionics and just talk about the facts. I want to point out here that there is limited data as she will talk about, and this is developing very quickly, hence why I'm putting out this episode a day early. But you're going to hear in the episode that she says this isn't going to just. be cured by one brilliant doctor. It's going to be made more manageable by all of us. So I think on some level, some hysteria may be necessary because it mobilizes us and it gets everyone to do their part. But as she points out, this isn't the end of the world. It's not

going to wipe out civilization and there are measures we can take to protect ourselves, protect our loved ones and to slow this thing down. So as always, if you find this episode helpful or you like the show in general, please take a second to rate review and subscribe. It's the only way you can directly support the show right now. And I appreciate you. I hope you guys are all safe and healthy and that your loved ones are safe and healthy and that you're staying the F home if you can. So with that, please enjoy Dr. Clody Boldzuk. So we are going to be talking all things coronavirus. We were just talking off mic here about how this is the first pandemic in the age of social media. And it just seems like there's so much misinformation out there. There's also a lot

of misinformation coming from our government. So it's not just social media. But it just seems like there's so much to navigate and obviously this is inciting a lot of fear in people. So I'm really grateful to have you on here and just talk about some facts and hopefully raise awareness. Well, thank you for having me, Ariel. I really appreciate it. It's definitely the topic to talk about right now and dispelling misinformation is very important. Yeah.

So why don't we start by just having you tell people about yourself, about your training and what your specialty is now? Sure. So I'm a medical doctor working here in Los Angeles. My specialty is emergency medicine. So I have been and will continue to be on the front lines for this. My training is I have a medical degree from McGill University. I also have a master's of public health degree from UCLA. And I've had a lot of involvement at a systems level, both in research, as well as consulting, as well as I've been a speaker at the World Association of Disaster and Emergency Medicine. I'm a former board member of the Quebec Medical Association, and I just have a very special interest in disaster emergency medicine.

So is this the first, is this the first time that you're seeing? this on this level or is there anything that you can compare it to? I think that we've prepared before for something this large, but we've definitely never really seen it hit our doors like this. The last time we've we've kind of mobilized like this was around the H1N1 and it wasn't exactly at this level and we never saw it explode the way that it that COVID-19 is now. So why don't we just start by talking really simple terms, like what exactly is COVID-19? Yeah, so let's start at the beginning. So COVID-19 is a virus.

I think everyone's heard that now. But a virus is not the same thing as bacteria. There's kind of two main types of pathogens that infect us, viruses and bacteria. So antibiotics work only against bacteria. bacteria, not viruses. And so when we say we don't have treatment for that, that's part of the reasons. I want you to remember that this is a virus. It's a coronavirus that is a family of viruses, not only just one simple virus. Coronaviruses are named like that because they look like they have crowns under a microscope. They have little envelopes around them. And usually they're actually pretty

wimpy viruses in that they can be removed from surfaces very easily by cleaning them, and they simply cause common colds. Usually, that's four different strains of coronaviruses. However, sometimes they mutate, and they mutate in animals and become zoonotic illnesses. And sometimes they mutate just enough to jump from that animal into humans and cause a new strain of virus that humans haven't seen before and infect us just enough to cause very severe disease. And so that's what we saw in 2002 with SARS, and we saw it in 2012 with MERS. And now this is what's happening with COVID-19, which is actually called SARS-CoV-2. That's the name of the actual virus. And COVID-19 is the illness that it's causing.

Okay. So what does the illness look like? What are the main symptoms? So because it's a respiratory virus, it tends to affect our respiratory system. Unlike the common cold, it really affects the lower respiratory system. So when I say pneumonia, or people have heard pneumonia before, that means the virus really gets in deeper into your lungs and causes disease lower down. So it will cause cough, a few, feeling of shortness of breath, and like a lot of viruses will cause fever and body pains. We see cough in about 80% of cases, shortness of breath, about 40% of cases, and fever in about 85 to 90% of cases. What we're really not seeing is a lot of upper respiratory illness, such as

congestion and what you would think of as your common cold, really higher up in the face and in the throat. I don't know if you can say, but what are the first signs of this? Because I think the thing that is really scaring a lot of people is that it can look or feel a lot like a cold, right, at the onset or like the flu even. Yeah. So it's actually very different from the common cold, but you're absolutely right that it can look like the flu.

A cold comes on a little bit more gradually, it comes on with sneezing, you kind of know that it's coming on, whereas the flu comes on all of a sudden you feel like you were hit by a train, you were fine at 3 p.m. And by 5 p.m., you're completely under the weather. That's a little bit what we're seeing with COVID-19. So it's acting more like the flu. In terms of the first symptom, we don't really know. Some people are having cough, some people are having shortness of breath, and some people are having fever, but there are still 10 to 15% of people that have no fever. So it's not so much

which symptom will come first as a constellation of one or more of those symptoms and it hitting you all of a sudden. And I just saw an article. Do you know Dr. Eric Topal? Yes. So he just put out, or he tweeted an article that's circulating where I think the doctors were saying that like 86% of the people who have contracted COVID, got it from people who are asymptomatic? It's possible. I think I'm getting that right. I'm not sure. Yeah.

I don't think we know the exact number of people that are walking around asymptomatic yet, but we do know that it's a significant number of people. Yeah. So stay home, everybody, right? Exactly. How is it transmitted? So it's actually transmitted through droplets. And that's very important for people to understand because it's less scary than what people are making it out to be.

So droplets will come out of an infected person's mouth when they either cough or sneeze or spit. They're watered droplets. So they'll follow gravity. They will not stay around in the air and you can't get infected by walking into a room where someone was, you know, 15, minutes earlier just walking around. You really need to contract that droplet. When it comes out of someone's mouth, it will fall to the floor within six feet. And that's why we're saying social distancing is so important. The other way it can be transmitted to a lesser degree is through fomites. Fomites is essentially once it's fallen on a surface, there's particles on that surface

that can end up on your hand. And if you touch your mouth or nose or eyes, then it can get into your body, which is also why we're saying, wash your hands and don't touch your face. Okay, so I kind of want to go back to the comparison to the flu and differentiating from that because, you know, people sent me in questions on Instagram and that seemed to be the main concern. And people want to know, like, how they can tell if they're having symptoms, how they can tell if it's this or if it's something else. or is there any way to tell?

The truth is when you're actually experiencing symptoms, it's going to be rather impossible to tell if it's COVID-19 or the flu. But for the vast majority of us, it doesn't really matter in the sense that both of these illnesses will make you feel very crummy. You'll have fever. You'll have cough. You'll be staying at home on your couch and in your bed and you'll be drinking a lot of fluids and waiting for it to pass. Whether it's COVID-19 or the flu, it's not recommended to go to

the hospital or go somewhere and get tested. It's not going to change anything. We don't have treatment. And if you're not severe, you're not going to get hospitalized. So you're going to go to the emergency room, overwhelm the resources for no reason for us to say you should go back home and take care of yourself. You're not severe. We're not going to test you. So the bottom line is it won't really matter unless you get severe disease. And the way that things are differentiated between the flu and COVID, just generally speaking, is the flu has an incubation period of about one to two days, and in most people, it'll last about a week. The recovery after the flu is, you know, only a couple of days to really feel much better. With COVID,

for more serious cases, we're seeing two weeks of disease. And in the very severe, cases, meaning those hospitalized, it can last about six weeks. Complication rates for the flu are about 1% and for COVID is about 5%. So we're going to see about 5% of people get severe disease. And is that, or can you speak to why it's deadlier than the flu? Because a lot of people are saying, well, the flu kills more people. And obviously we don't, this is just starting, right? And we don't have enough data. But that seems to be like kind of a common, I don't know if it's a misconception or what about COVID, but that it is deadlier and that it's more contagious.

And I mean, do you guys, do you have enough data right now or is it just hard to measure? We definitely do not have enough data, but we have at least some data in order to kind of extrapolate what we think might be the case fatality rate or the mortality rate. What we're using as the best guess is looking at South Korea. And the reason this is the best guess is they really, they had testing abilities. When this hit their door, they tested everybody. They tested the entire population almost. And so their case fatality rate was closer to 0.6%. And so we think that's actually the upper limit of what the case fatality rate might be as long as we don't overwhelm our health care resources. The inherent case fatality rate of the virus is probably around 0.6 or less.

And the flu, it's about 0.1%. So it still is deadlier than the flu, but that's still significantly less than the currently reported 2 to 3%. I've even seen some reports of up to 6%. So regarding how contagious COVID-19 is, it's still very early again, as we alluded to, there isn't that much data. And what's really making it difficult for us to know how contagious it is, is that rate of asymptomatic carriers, people walking around not knowing that they're infected with COVID, or simply having a mild cough and, you know, not thinking too much of it. So we really don't know what the denominator is or how many people have the disease and how how many people are spreading it and how quickly. Right now, our best estimates are that there's an

R not, and I'll go over that concept without getting too technical, it is an important concept. R not simply means for every one person who's infected, how many people will they infect? And so if you have an R not of one, that means one person will infect one other person. And basically, you'll always have the same amount of disease in the community. If you have an R-Nod of 2, then one person will infect 2, 2 to 4, 4 to 8, to 16, and that'll be an exponential growth. So that's what's scary about COVID-19 is that right now the R-NOT seems to be 2.2. And so that's very contagious and we expect it to rise very rapidly.

but AR-NOT is not this inherent quality of the virus itself. It has a lot to do with how we're transmitting it. So if we're not being careful and we're all around each other at large gatherings, and you can see how it would be much easier for one person to infect six people. And so that R-N-N-Kin-be changed dramatically, and that's part of the reason why these containment methods or social isolation is being put in place so that we can drive down that number and not have this blow up exponentially.

So who is at higher risk right now? I mean, obviously there are measures in place. I think Garcetti, he didn't order, but he recommended that adults 65 and over stay home. So the highest risk, I mean, risk increases with age and an increases with comorbid conditions. So the age group above 80 years old who may have one or more chronic illnesses such as cardiovascular disease, diabetes, or lung disease, that's going to be your highest risk group. And this group actually has a case fatality rate of around 15% as reported right now. So your risk will increase with age and we see it kind of spike up around the age group of

60 to 69 where their case fatality rate is being reported around 3.6% right now. and then it goes up with each age group after that. For comorbid conditions, the highest group seems to be those with cardiovascular disease and hypertension with about a 10% fatality rate. So can you speak to why that is? I mean, you would think that it would be highest in people with the lung or respiratory issues. Yeah. So why is that?

Yeah, we're not 100% sure yet why that is. I can speak to some of how we do know the virus is affecting us. And the disease process in a lot of people is that it is causing something called ARDS, acute respiratory distress syndrome. And that is not dissimilar to flu. But another way that it is affecting people is called myocarditis, where it does impact the heart itself. So this may be one of the reasons that we're seeing it more in cardiovascular disease.

It's not a major difference from those with respiratory disease who have a case fatality rate about 6.3. And you have to remember that a lot of these comorbidities coexist in one individual as well. Okay. So let's talk prevention. How much social distancing should we be doing now? What are the specifics around this? So many people had questions of like, well, should I go to the market? should I, you know, should I let my kids have a play date? I mean, what at this point is safe practice?

Yeah, I think that at this point in time, and I mean this for maybe the next week or so, if you can limit it as much as possible. So no play dates, really only staying around your family or anybody you at least, you know, know has no contact with sick people in the last week or two, people you know haven't traveled anywhere. So your immediate family members, potentially your neighbors, if you absolutely must, but really doing your social responsibility for at least one week until we see what kind of explosion we see in the numbers, do your best to really take social distancing very, very seriously

and try to keep, if you go out at least a six-foot distance between you and other people. I think that in a week or two, as we see more of the trend, we'll be able to loosen up a little bit on that. And of course, you do have to take into consideration your mental health. And if you live alone and try to find other ways to get your social interactions. And, you know, on the one hand, social media has caused a lot of misinformation about COVID. But on the other hand, it allows us to be at home and still interact with our friends and family. and we can FaceTime, and this is a good time if you have kids to do a project with them and FaceTime Grandma and Grandpa or do a project where they're sending letters to nursing homes because people in nursing homes can't get any visitors right now so they feel extra isolated. So just taking it very seriously now and finding kind of those creative ways to be social.

I love those. Those are great ideas. And then if we do have to go out, like say we have to go get a prescription or anything that maybe we didn't take care of last week, what are there preventative measures? I mean, you explained how it's transmitted. So are things like gloves, masks, are those necessary or what's your opinion on that? Yeah, so I don't think they're necessary. And I think sometimes they can give you a false sense of protection. and actually put you at a higher risk in certain ways.

So the whole thing with gloves makes sense if you're going to be interacting with a lot of different people very quickly and you don't want to spread those germs to the different people. But you don't get the virus from actually touching it with your skin, with your fingers. You get it by touching it with your fingers and not washing your hands before touching face. And so if you're wearing gloves and you touch your face, you're going to get the disease. So whether you're wearing gloves or not,

the whole point is you need to just wash your hands very, very well and not touch your face. Regarding masks, this one's tricky. I'm still in the group that believes that masks are not recommended, and that's the same as the CDC has as their recommendations, and I'll tell you why. Masks, in theory, they cover your mouth and your nose, but they don't cover your eyes for one thing.

And secondly, we've done research on this before, and it looks like when people wear masks, they actually tend to touch their face multiple more times a minute than when they're not wearing masks. And that is paradoxically putting you at, you know, increased risk instead of protecting you. Masks like those, even in hospitals, are recommended for people when they're the ones who are sick,

so that when they sneeze and when they cough, the mask catches their own. droplets so that it's not spread all over. It's really not meant to be a protective measure for people against other people who are sick. Side note, I shared this on my Instagram, but I saw people at Air One in full-on gas masks. Oh, my gosh. It's like, of course, with that Airwine of all the case. Okay, so gas masks are not necessary. Not necessary at all. Okay. Good to know. Okay, so let's get to listener questions because we have.

a ton. Let's start with, well, let's start with how prepared our hospitals. Yeah, that's, that's an excellent question. And I'm sure a question that a lot of people have. I think that, you know, all hospitals across the U.S. have very good disaster plans in place. So you're not blindsided when something like this happens. There's already protocols in place, extra staffing, extra resources. And for the, for most of the U.S., we at least had a little bit of a head start in that we saw this happen in China. They announced it to the World Health Organization the 31st of December and then the first case in Seattle was on January 15th. So we've been ramping up efforts since January 15th. So we've had a bit of a head start, whereas Washington had a little

bit less of a head start. But for the rest of the country's hospitals right now, we've really been able to mobilize. So some of the things we're doing is we're canceling elective cases. So we're not doing surgeries at this time that will use up an ICU bed for the care after that surgery if it's not a necessary surgery. And there are a lot of those in all hospitals. So that frees up quite a few ICU beds. There's been changes in processes. So if you show up at emergency rooms right now across the nation with symptoms of possible COVID, it's not a walk right in and infect everyone in the waiting room. It's an outside triage process. Some hospitals are setting up tents. There are different processes, but we are really creating streamlined testing

processes for those who are very sick versus those who don't meet testing criteria. We're sending them home and asking them to take care of themselves versus come right into the hospital and create a larger problem. And then there's the question of resources. So, you know, we don't have unlimited resources. We have less than 100,000 ventilators in the United States. And a lot of those are being used already. And part of the reason they're being used is that the flu season isn't over. And it's still, flu is still spreading. And this year was actually a very severe case of flu.

But we do have some capacity. We have ventilators ready. We're not overloading our capacity yet. And there are a lot of plans in place to increase capacity. We're being creative with certain types of ventilators. and we also have the option if things were to get out of hand to build field hospitals, the federal government can ask the military to start building field hospitals and have more resources that way.

One resource I'm worried about, though, is staffing as we do close schools. And if we're not serious about social distancing, if our nurses have to stay home with their kids or if they start feeling sick or having fevers, they'll be quarantined. and they'll be asked to stay at home, of course. We don't want them infecting patients. But if staffing gets slow, then that's where we'll have to get even more creative. Okay, I want to go back to something that you said, and we kind of have, like, danced around it a little bit, but people want to know, like, at what point should they come to the hospital? So you said that, you know, you have these kind of triage areas set up, and obviously only the really, really sick people can get treated.

but at what point, like what does that look like? Right. So really the question to ask yourself is if COVID-19 wasn't going on right now and the way that I'm feeling, would I go to the emergency room yes or no? That's really the question you should ask. If you are struggling to breathe, you're having shortness of breath and you need help to breathe, that's a reason to go to the hospital. If you have a cough and a fever and normally you would stay at home and not go to work for a few days,

you probably do not need to come to the hospital. And I just want to point out, we don't have a treatment for COVID. So even if you come to the hospital with your fever and your cough, if you're not having breathing difficulties, oxygen requirements, not showing signs that you have severe disease, we will send you home. So the trip to the hospital was for nothing. That being said, if you're short of breath, number one,

you'll know, you'll really feel this is severe. I need to come to the hospital. But if you're in any way, shape, or form having questions about whether you should or not, every hospital, look up the hospital in your community, every hospital has set up a health line and telemedicine so you can call and talk to a nurse in real time. You can even do video conferencing if they have more questions or want to see you and talk to you in more detail. There's telemedicine options at most hospitals. And you can call your own doctor and at least give them a heads up, hey, I'm thinking of coming into the hospital or going to see you so that preparation is going

in place to meet you when you come. I cannot even imagine how many panicked people are coming thinking that they have it and they don't have anything. I mean, even anxiety. Like, people sent me messages saying, like, I have tightness in my chest and I feel short of breath, but I might just be anxious. Like, what was I just going to ask? you, oh, testing. Yes. Is there testing? I mean, what, I know that you can't talk specifics, but it seems to be, it doesn't seem

to be very clear. Right. So testing is extremely limited. It's not as limited as it was a few weeks ago in the sense that a few weeks ago, only the CDC could run the test. And so local health departments had to approve every single test. So if you're a hospital, you want to test someone, you're literally picking up the phone, talking to the health department, and you are sending the test to the CDC.

So things have gotten a lot better than that, but we're still very limited in our testing capabilities. We now can use private testing, so we can use lab core and quest diagnostics, for example. And some academic centers across the nation are working on or have developed, to testing capabilities inside their hospitals, but even those, again, are extremely limited. And if you go to the hospital asking for a test, you're most likely not going to get it. And that's not recommended. We're really only testing very sick patients, amino compromised old patients that we are admitting to the hospital so that we know what we're dealing with.

So that would also imply that the numbers that we're seeing are grossly inaccurate, right? Correct, but that should make people feel better because we are only testing the very severe cases for the most part. In the beginning, we were also testing cases with travel history, but for them to even present to the hospital for testing at that point, that means they were having, you know, symptoms. So we're talking about a gross, you know, overestimation of the severity of this. There's a bias in the testing for sure, and a lot of asymptomatic or mild cases are not being captured in the next. numbers that people are seeing. So that is kind of encouraging. Okay. Can you, well, actually, since we've been talking all about the symptoms and all of that, how long does it take for someone to be quote-unquote cured of COVID? That's a really great question. So overall, we're seeing this

disease last anywhere between two weeks to six weeks, as I alluded to before, but the mild cases, anywhere between one to two weeks, and the very severe cases requiring ICU admissions that we are seeing recovering, they last about six weeks. To say that someone's recovered right now, we are actually testing them twice within a 24-hour period, and they have to have two negative tests to be considered recovered. The reason for this is that you can be recovered clinically, meaning you feel better, you have no more symptoms, but still be shedding some virus for up to seven days afterwards. And the test would pick that up. And so we are really only calling people recovered that have negative testing and can no longer even pass on the disease.

Okay, so that was my next question was can you spread it to others if you had it and recovered? Correct. So you can for seven days after you feel recovered, but not with the testing. the testing will really make sure that you're no longer shedding any virus. Does the virus burn out on its own if we limit the spread? So that's also a very good question. And unfortunately, it's too early to really know the answer to that. We saw murs and SARS burn out on their own.

And diseases, if they're not infecting more than, you know, as we talked about, R not, if the R not is less than one, it will burn out on its own. So really we are trying to get to a point where we get to that are not less than one and perhaps it can burn out on its own. But right now the way that this is acting, we do see it acting a little bit more like cold viruses. So maybe it slows down in summer months and maybe it returns. And for how long that happens or whether it becomes endemic, meaning it just stays around and has a seasonality to it or it goes away completely. but in more than a year, it's still way too early to really understand how this will act. And it might be too early for this, but do you know if somebody has it once,

if they develop immunity to it or if they can catch it again? Yeah, it's also a little too early to know for sure. Although right now, there are no, in a scientific community, we have not accepted any real case of catching it twice. We've had people who have had it recovered and then tested. positive again at a later date. But we, again, those are problems with testing and also viral shedding or shedding of viral components where they can't actually infect someone again versus the real thought that someone has actually caught it twice. We do think that you have immunity to

it at this point in time when you catch it once. However, if it acts like some cold viruses, it may mean that you can catch it more than once at a later date. And again, I understand that there isn't like a ton of data right now, but do you think that most of us will get this or will it get contained before then? So the best estimates that have been out in the scientific community and by some of the smartest epidemiologists on the earth really have been estimates that about 30 to 50% of us will get it. But that isn't in the next week or two weeks.

That is actually estimates over more than one year. And so that speaks to the fact that we don't think this is something that is ready to just disappear after a couple of months. We hope to be on the downward slope of the curve and understanding the virus a lot better in a few months. And hopefully that fear and panic and these drastic measures we're taking won't be a round, but we do think that over a period of 12, 18 months, 12 to 18 months, we could say about 30 to 50 percent of people having had it. Again, a lot of us won't even know we had it. Right. So a lot of

people asked me if all cases present with a fever, but it sounds like not all of them if some of us won't even know that we had it. Correct. And so we do believe that number to be pretty high, 85 to 90% of people will have fever, but not having fever does not exclude it. So if someone comes in with just shortness of breath, for example, and their oxygen levels are low, we will test someone like that for COVID, and it is still possible that they have it. I got a question from somebody who asked what she should do as she lives with older parents, but she still has to go to work. That's also a very good question. So anytime there's a situation where some, someone is co-inhabiting with a high-risk group and not showing any symptoms at all.

So no fever, no cough, no shortness of breath. But, you know, may have COVID because we know you could be asymptomatic or you could at least be asymptomatic before you start to show symptoms and still be spreading it. Then all of these social distancing things apply. So stay six feet apart. Disinfect surfaces that you've touched before someone else touches them. Do a lot of cleaning, laundry, making sure that no one is. touching surfaces that you've touched and staying those six feet apart.

Now, if you're showing symptoms, that would, and you're with a high-risk group at home, such as elderly parents, elderly parents with comorbidities, that's a time to self-quarantine. So try to find an alternative plan for 14 days to not be around them. Do you have any thoughts on long-term effects on the immune? system or the lungs or I know it's very early on, but is there anything that you can compare it to? Yeah. So in terms of long-term effects on the immune system, I haven't heard of any downside. In terms of the immune system, basically when you get sick and you recover, your immune

system tends to be more robust as long as you didn't catch a virus that affects the immune system, of course, like HIV. But your immune system actually tends to be more robust in the sense that it's created. antibodies against that disease. So I don't think there's any downside long-term effects of catching this virus on the immune system. Now on the lungs, it could be a different story, but again, we don't have enough information to know for sure yet. We do know that, again, this causes acute respiratory distress syndrome in a small percentage of people. And a percentage of people with ARDS do get lung complications such as fibrosis in the long term. But that's not unique to

COVID-19 per se. It's something that can happen with any critical illness affecting your lungs for a long period of time. You will get some effects, long-term effects of your lungs, not unique to COVID-19. I had quite a few cancer patients or people who had recovered from cancer who asked me if they or at higher rest? So if they have completely recovered from cancer and they're not on any kind of immune modulating therapy, there's no reason for them to be at an increased risk of either catching or having severe disease with COVID-19

just based on their prior cancer alone. And again, that's as long as they're not currently on any immune-modulating or chemotherapeutic medications. Okay. And what about pregnant women or women with young infants? That's also an excellent question. And I myself had to refer to the CDC website because the studies don't have that much information yet, just a few case reports. But the case reports that we've seen, we have not seen COVID-19 show up in either amniotic fluid or breast milk. So even an infected mothers, this didn't seem to be transmitted in that way. Now, that being said, being pregnant or pregnancy is a slight immune compromised state.

So it theoretically may put you in a slightly higher risk bracket, but we haven't seen this affecting pregnant women at higher rates. We have seen slight uptick in preterm labor, but not dramatic preterm labor, just before the 30. week mark in infected mothers, but no long-term sequelae that we can tell on their children. On their children, of course, we are basing this on a handful of case reports. But currently, the CDC does not recommend any special requirements for pregnant women, just the same precautions as we all have, which is washing our hands and staying six feet away from each other. and if you are infected and your breastfeeding, for example, I've had that question come up quite a few times. Because we don't think that COVID-19 is spread through breast milk, the current CDC guidelines are that you can pump your breast milk and have someone else feed it to your infant.

As it pertains to infants, that's a really good question as well. We have actually not seen any deaths or serious cases in children or infants. some of the theories behind why that might be wouldn't apply to infants so I would continue to be extra careful with infants and this would be time to practice a little bit of social distancing from your infant as well as much as possible as much as reasonable so just not a time for open mouth kisses and things like that and if you're feeling symptoms I would stay away from your infant and that's because they just don't have the conferred immunity that some of these other children might have.

How worried should we be about packages that we're getting delivered? I think a lot of people are relying on Amazon right now. I've seen videos of people in like their gloves and trying not to touch and should we be worried about that? The answer to that is pretty much no. To a certain degree in the sense that if someone sneezes on their hand, touches as the box and hands it to you, such as the UPS driver or whoever delivers things for Amazon, then yes, and then you touch the box and you touch your face, that's one way that there could

be spread. Again, within a few hours, let's say. But there shouldn't be a worry that because, you know, your product came from China or something like that, that your box is infected. That's not the way that this virus works. We didn't really talk about this. I mean, I know you mentioned that the percentage of people with GI symptoms, was lower than the other symptoms, but a lot of people did ask me this.

Have you been seeing GI symptoms, or is it kind of the exception rather than the rule? So we actually are seeing GI symptoms, no real vomiting, but we're seeing diarrhea. The only thing about that is we're not seeing it as an isolated symptom. So we're seeing it in about 5 to 15% of cases right now. But most of the time these patients have cough, shortness of breath, or fever as their primary presenting symptom and diarrhea may be a secondary symptom in some people. And that makes sense with the way that this virus acts in your body. But diarrhea does not seem to be an isolated symptom. So I wouldn't be worried if you're just having diarrhea. It could be the anxiety.

Exactly. People with a really sensitive system. Absolutely. Do you think that in general, we are overreacting, underreacting, or neither? That is the question of the moment. It's really hard to know where we are on that spectrum right now. But that being said, we would probably prefer to look back at this and laugh and say that we really overreacted rather than the other way around. We're also at the beginning of a curve that we have no idea how steep that curve will be. And if it is really steep in the new number of cases per day, that could have devastating consequences if it overwhelms our health care resources. And if we do what we're doing to really flatten that curve, and I'm sure everyone's heard that out there,

if we do what we're doing now and overreact or at least, you know, really do crazy things like cancel all social gatherings that will have a tremendous impact on flattening that curve and making sure we don't have a situation like that on our hands. Yeah. And can you speak to why flattening the curve is so important because it's this hot term that we're all hearing? And I think people kind of generally understand that like the resources and hospitals are being overwhelmed. But what does that really look like if we don't flatten that curve and we see that just spike up what is that going to look like for us yeah unfortunately that's what happened in italy and why they're seeing what they're seeing which it can have devastating consequences so flattening the curve means if you know 10% of us are

meant to get this over the next six months well if 10% of us get it in the next month and 10% of that 10% are severely ill needing hospital resources, we won't have those resources. That's too many people all at once requiring ventilators, requiring ICU care. There will be difficult decisions that need to be made as to who can have that care and who we just don't have enough resources for. And that is a almost unthinkable situation and what we have to do everything in our power to prevent, which is why flattening the curve is so important. Flattening the curve means that if 10% of us are meant to get it, we don't get it all in March and April.

We spread that out over March, April, May, through August, September, and the severe cases, there's always hospital capacity to take them. What do you think are the most common misconceptions right now about COVID? I think that a lot of people think it's a death sentence, that if you get a diagnosis of COVID-19, your world is ending, that's absolutely not true. We know that for the vast majority of people, this is a very mild illness, and that if it is a severe illness, we have some of the best critical care units on the planet. I would argue the best critical care units on the planet who know how to take care of cases

like this. And, again, that is a very small percentage of people who will get that. Other big misconceptions is, honestly, it's just this fear and panic that, you know, this is it, this is the disease that is going to end the world as we know it. And you go to grocery stores and people are acting that way. And fear propagates fear and people just, you know, buy into that panic and that creates more panic. And of course, there's this cycle that goes out of control. That is not where we are.

I really want people to stop the panic. need to be smart. We need to, you know, make big moves to make sure that we don't get into a situation like Italy was in. But there's really no reason to panic. And this is not a disease that is killing everything in its path. So what can everybody do right now? I think that the number one thing, everyone's duty to society right now is to really listen to health authorities and take it seriously. have been telling you to wash your hands since you were a little kid and it's kind of just this like, yeah, sure, I'll run my hands underwater. No, you really need to wash your hands, don't touch your face, disinfect surfaces and keep your distance, six feet away from people, don't go out, no mass

gatherings, cancel those birthday parties, there'll be a time to do it at another, you know, another time you really just have to do your part because this isn't something that some hero doctor is going to fix. It's something that every single one of us by doing our part can control. And who are those health authorities that we should be listening to? Great question. So, I mean, the health authority in the United States really is the CDC, and they're the ones that will be abreast of what's going on first and put out great information on their website. There's information for almost any question you can think of before you even, you know, know, they just anticipate everything.

They have stuff on their website about animals, about pregnancy, about breastfeeding, every single question. So they're the health authority. The World Health Organization, WHO, would be another source. And then for each individual community, look at your public health department. So for Los Angeles, that's the LA Department of Public Health, has great stuff on their website. Another great resource is the hospital in your community. So the hospitals have great information on their website.

and they have phone numbers for those who might feel like they're having anxiety and they're not sure and they really want to talk to somebody, but they don't want to get in their car and rightfully so and drive to an ER, there's great resources on hospital websites. And you've been sharing a lot of really helpful information on your Instagram. So where can people find you? So I just started that Instagram. So that's at Pulse Check MD. I'm trying to do my very best to dispel all the misinformation.

out there on this. And right now that is the only place that I'm putting this type of information. I'm working on a website right now, and I'll put that out on my Instagram once it's up. And those will have articles and more detailed information than my Instagram. So I want to thank you so much for coming on. That was so, so helpful. And I really appreciate you being gracious with your time. I'm sure you were absolutely slammed.

And hopefully we all do our part in flattening the curve for you and all your fellow doctors and that we get through this quickly. Please, please do. And thank you for having me and for doing a show on this. Very important. Thank you.