Sanjay Gupta on COVID-19

[0] My boyfriend's back, and his name is Sanja Gupta.

[1] Hey now.

[2] Hey now.

[3] Welcome to armchair expert.

[4] Our boyfriends here today.

[5] We love him.

[6] The most trusted face and voice in medicine on TV to help us feel like we're getting the real info.

[7] And we were so, so lucky to grab an hour of his time.

[8] He's so busy right now.

[9] He's working 20 -hour days, getting two or three hours of sleep.

[10] Of shitty sleep.

[11] squeezed us in which is so flattering and helpful we're just so grateful yeah he's the best he's on Skype he's not here okay yeah let's start by saying that we are self -quarantined we're recording in rob's garage outhouse lean to he's got his own little studio now at his new house and we're in here and it's wonderful yes and he has better internet than we have at the attic so while we continue to interview people which we're going to do for the people who've reached out and are worried that we will slow down in any way.

[12] We are not going to slow down.

[13] In fact, we're going to pick up the pace.

[14] We're probably going to offer some other distractions for you, some lighthearted distractions.

[15] So those will all be coming.

[16] But for now, we're going to get our arms around what we're all going through with the help of Sanjay.

[17] Yeah.

[18] And he also has a daily podcast.

[19] It's called Coronavirus Fact versus Fiction.

[20] And he's, you know, on all the socials and stuff.

[21] So you can follow him and keep up with what's going on.

[22] Or turn on any channel.

[23] any TV and you'll see his face.

[24] This guy is working so hard right now.

[25] We're very grateful for all of his dedication to this.

[26] So please enjoy our conversation with Sanjay Gupta.

[27] Wondry Plus subscribers can listen to Armchair Expert early and ad free right now.

[28] Join Wondry Plus in the Wondry app or on Apple Podcasts.

[29] Or you can listen for free wherever you get your podcasts.

[30] Oh, my goodness.

[31] Wow.

[32] So good to see you guys.

[33] You guys look good.

[34] Is that the same space?

[35] No. You guys moved.

[36] This is our quarantine bunker.

[37] Can you hear us good?

[38] Looks fancy.

[39] I can hear you.

[40] Yeah.

[41] You can hear me okay?

[42] So good.

[43] This is our first Skype interview, Sanjay.

[44] So thank you for doing this.

[45] Yeah.

[46] We know you've been working 100 hours a day.

[47] Every time we turn on CNN, there you are.

[48] It's, I think, the busiest I've been in my life.

[49] Yeah.

[50] And are you energized by that, or is it fatiguing?

[51] I am energized by it.

[52] And just being honest, I'm having a hard time turning it off, you know?

[53] Yeah.

[54] Like, I'm a big, I think we talked about this last time.

[55] I'm a big quantified self guy.

[56] I measure my sleep and stuff.

[57] I have gotten maybe three to four hours of sleep a night for, we're going on six weeks now.

[58] And then when I go to bed, I can't sleep.

[59] And I'm thinking, I said this thing, and I think I could have described that better.

[60] You know, I explain something, but I want to make sure it hit the mark.

[61] Like we keep talking about numbers, and everyone's caught up in certain things, and there's a bigger picture here with this.

[62] And it just feels very important.

[63] I mean, it is important.

[64] It feels like it matches the significance of this and how it feels to me. So it's intense.

[65] I mean, you are, and I don't think I'm overstating this, sincerely just personally.

[66] when I hear you say something, I go, oh, that's the facts.

[67] Wow.

[68] You know, and so to have that on your shoulders and to want to get it right so much, knowing that people trust you the responsibility, I have to imagine it's quite stressful and also probably invigorating.

[69] Right.

[70] Yeah, you're absolutely right.

[71] I mean, it is, you feel like you want to rise to that for sure.

[72] Obligation may not be the exact right word because that almost maybe denote something negative.

[73] I don't mean in a negative way at all.

[74] Yeah.

[75] I mean, it's a good obligation.

[76] I think that the challenge as well is that there's a lot that I don't know.

[77] Right.

[78] I mean, that nobody knows.

[79] And I've said this so many times.

[80] I mean, look, with all humility, I'd love to be able to tell you that based on 10 years worth of data, based on 20 years, whatever, we're talking not even that many weeks that we've been into this.

[81] I have to imagine, too, it's changing so rapidly that you might say something on a Monday that then Thursday they're somehow asking you to walk back or something or clarify.

[82] That's right.

[83] I mean, even our discussion right now, if I give you some facts, I mean, look, even by this evening or tomorrow, it could be different.

[84] So I have to constantly provide the context to that as well and acknowledge that it's rapidly changing.

[85] And then obviously, too, you're also moving through the world a ton, right?

[86] Because you're doing interviews and you're in a public place quite often.

[87] So what kind of fear level do you have personally?

[88] Well, we've taken a lot of precautions now.

[89] I think we are trying to.

[90] to really practice what we preach and do that in a really, I think, an honest way.

[91] So when I'm doing television now, I'm in a studio by myself.

[92] The cameras are handled remotely.

[93] I mean, even little things like typically you would go to the makeup room and have them put powder on you.

[94] I don't do that.

[95] I just take a little puff and put some on to take away the shine, you know, just trying to be really, really mindful of unnecessarily putting people too close to each other.

[96] Yeah.

[97] It's hard.

[98] I mean, you find yourself just slow.

[99] down.

[100] Right.

[101] Let me slow down.

[102] What am I about to touch?

[103] Do I need to touch that?

[104] Who am I about to be close to?

[105] Do I need to be that close to the person?

[106] In a weird way, it does make you more mindful of things.

[107] And that can be helpful, you know, especially when you're running so fast.

[108] Yeah.

[109] And I wonder, too, because in some sense, you are a performer in addition to being a doctor and whatnot.

[110] And I was thinking this a lot when I was watching some of the late night talk shows that filmed without audiences.

[111] How much of the dynamic involves other people and that that that is the context that you're used to, that you feel comfortable in, that white noise that exists is weirdly comforting.

[112] I wonder when you enter these voids now, does it mess at all with your sense of confidence?

[113] You know, it was really interesting because I did the Stephen Colbert The Late Show, and it was his first show without an audience, and we talked a little bit ahead of time, and I could tell that this felt very strange to him, you know, and he was trying to find energy from different places and talking to his producers to sort of build them up in between segments and the commercial breaks.

[114] For me, you know, it's interesting, Dax, because I, you know, as a news reporter, we're not usually in front of audiences.

[115] You know, usually you're just sitting there looking at a camera.

[116] Oh, that's true.

[117] And you try to make some sort of connection with the lens.

[118] And it's weird because you don't get feedback, good or bad.

[119] So if you think you said something funny, I mean, there's nobody to laugh.

[120] So you have no idea if that landed with a thud or or, you know, it was hilarious.

[121] Yeah.

[122] Like last night, we did this town hall discussion, and we had previously been in the same city, Anderson Cooper and I. Last night, we did it from different cities, and we were both sort of isolated in those places, just talking through earpieces.

[123] And, you know, it was challenging, but very necessary.

[124] Yeah.

[125] Some of the conversations beforehand, like, is this going to seem too strange?

[126] Are you guys going to end up talking over each other?

[127] And I remember saying at one point, look, I mean, people understand what's happening here.

[128] This is not how we normally do things, but this is how we have to do things right now.

[129] It's not going to be forever, but it's really necessary right now.

[130] And, you know, people seem to fundamentally get that, at least the people that I work with.

[131] Well, I will say, I'm always reticent to find silver linings in things.

[132] You're juggling two things, and I think you more than anyone.

[133] We want people to take this tremendously seriously so that they, in fact, act very safely and do everything that can be done.

[134] So you want people motivated to do that.

[135] And then at the same time, there are these lovely things, right?

[136] I was saying to my daughters, who obviously weren't born during 9 -11, I said, you know, when I take my walk in the day and I pass other people and we're all staying six feet apart, there is this beautiful humanity that reminds me of 9 -11, going to the store on the first few days following 9 -11, where we all are starting to look at each other and go, oh, right, we're all humans, we're all kind of scared, and we're all in this together.

[137] And that, you know, is one of the kind of beautiful things that happens in these trying times.

[138] Yeah.

[139] I mean, you know, it gives me goosebumps.

[140] You know, it's tough.

[141] I think, Dax, you and I grew up in a similar place in Michigan, at least for a while.

[142] And, like, I think about our childhood.

[143] I mean, I'm older than you are, but, I mean, similar time frame.

[144] And it was a great childhood.

[145] Yeah.

[146] It was just great.

[147] It was post -Korea, post -Fietnam.

[148] The economy was doing what it was doing.

[149] My parents were employed.

[150] It felt really good.

[151] I have three daughters, as you know, 14, 13, and 11 now, and I think that they've been born.

[152] We've been at two wars.

[153] We've had a couple of major recessions.

[154] I mean, my middle daughter, Sky, who's the sweetest girl, she was born sweet, and she would always tell us when she was younger that this is what I'm going to do.

[155] I'm going to be an architect.

[156] I'm going to get married when I'm this age.

[157] I'm going to have this many kids.

[158] Here's what their names are going to be.

[159] And it was just this funny dinnertime conversation.

[160] And I loved it.

[161] Then just some time ago, I checked in with her again, even before all this coronavirus stuff at dinner one night.

[162] I said, so, Sky, how are the plans going, you know, for your life?

[163] Yeah.

[164] And she said, none of that's happening.

[165] I said, what happened?

[166] Why not?

[167] And, you know, I've been watching these climate change reports and the world is supposed to end, I understand, 2030.

[168] Is somehow what she took away from what she had read.

[169] First, I, you know, obviously had a conversation with her about that.

[170] But then I thought it's such a different life for our kids.

[171] versus us.

[172] Yeah.

[173] Well, I have had the fear watching my little ones because we're teaching them to not touch stuff and then sanitize.

[174] And I have had the fear, like, are we unleashing a generation of just germophobes like we've never seen?

[175] Is that what we're, you know, sewing right now?

[176] Yeah, I think the same thing.

[177] I mean, my kids are a bit older than yours, and I think that they kind of get it, that this is important for now.

[178] And they should always be clean.

[179] and hygienic, but what we're going through right now is not forever.

[180] It is a moment that they're going to reflect on.

[181] With that, the germophobia, but then the climate change, two wars, the economy up and down.

[182] We never had to think about that.

[183] Well, but Sanjay, I'll remind you of the TV movie that was on when we were younger called The Day After.

[184] So we did have the threat of nuclear annihilation.

[185] And I do remember my mom, that being the only thing my mom didn't want me to consumed.

[186] She was very liberal about nudity and violence, but she was like, this isn't a concept that a young person needs to be thinking about, nuclear proliferation and annihilation.

[187] So we got through that.

[188] You know, you're right.

[189] And it's a good point as well, because I had sort of forgotten that.

[190] And maybe that means that for all the stuff that our kids are going through, they'll forget the bad stuff and focus on the good memories and stuff like that because that's what they should do.

[191] And that's certainly what Rebecca and I try to convey to them.

[192] But that's a good point.

[193] I just thought of it as a good childhood.

[194] I didn't think about existential threats.

[195] Right.

[196] Okay.

[197] So knowing what you're going through and being very sympathetic to all the things you just said, I'm going to repeat a lot of the things that other people want to know.

[198] Most importantly for me personally, I have a armchair theory that I've been floating by Monica.

[199] It's finding no purchase whatsoever.

[200] I'm so excited you're here to debunk this.

[201] Yes.

[202] And again, I do want to preface.

[203] This sounds very familiar I want to preface this by saying anything I say I am not making an argument at all for not taking this serious.

[204] I am saying that you should absolutely be social distancing, you should be disinfecting, you should be doing everything humanly possible to prevent overrunning our medical system.

[205] So I'm not saying to be loose on this at all.

[206] Now, nearly everyone in L .A., end of December through the end of January, everyone I knew, everyone sitting in this room, had an illness, that included fevers, this cough that just would not go away, and fatigue.

[207] And we all had it forever.

[208] And it was never named.

[209] And my thought was, is it possible that this COVID -19 did not originate in Wuhan?

[210] And that it has already been around and that we simply weren't looking for it.

[211] And once we were able to detect it, then we started testing for it.

[212] And now it seems like it's new, but that maybe it's been around for a while.

[213] Do we know that?

[214] it originated in Wuhan?

[215] Is there any way to do epidemiologists, can they trace the origin of a virus at some point?

[216] Will that be known?

[217] Well, they can trace it to a certain extent.

[218] But even given that, I think your scenario could still be correct.

[219] I'll just give you a little background, which I found fascinating, is that this new novel coronavirus was actually discovered in bats some time ago.

[220] There's these virus hunters who basically, they're looking at animals.

[221] And they're trying to figure out, are these animals carrying pathogens that could possibly make a jump to human beings?

[222] That's their surveillance thing.

[223] And they'll find these bats and they'll basically sacrifice the bat and find all the pathogens and then look and say, well, that one looks suspicious.

[224] That one looks like it can make a jump to humans.

[225] And they'll classify it.

[226] And this particular virus was classified some time ago.

[227] Like how long ago?

[228] Years ago or months ago?

[229] No, it was a few years ago.

[230] I think it was within the last decade.

[231] And they made note of it.

[232] And it was similar to SARS, which was back in two.

[233] 2003 and similar to Mares, which was more recent, but they just made note of it.

[234] And then at some point, the first person that was diagnosed came in sort of similar to what you were describing Dax.

[235] They checked for flu.

[236] They checked for known viruses like rhinovirus.

[237] Nothing sort of clicked.

[238] And then they isolated this other virus at that point in this first patient.

[239] Now, again, we don't know that that was the first patient, but it was the first patient in whom this virus was isolated.

[240] And at that point, when they said, okay, we've never seen this virus before in humans, that's an alert that goes out to everyone in the medical and public health world.

[241] And it's always a red flag, a novel virus detected in a human.

[242] So it could have been already circulating.

[243] People had symptoms.

[244] They weren't bad enough to go to the doctor or the hospital, never got tested, but they had been carrying it.

[245] What was interesting about this guy was that everyone talked about this animal market, if you remember in Wuhan being the source of this.

[246] So it turns out, the first patient diagnosed officially had never had any contact with that animal market.

[247] So it's a good chance it was already spreading in the community, and he had already acquired it.

[248] So, yeah, we don't really know, we may know from where it came animals.

[249] Almost all of our pathogens come from animals.

[250] They're zoonotic diseases, but we don't know for sure how long it had been out there.

[251] It could have been out there a lot longer.

[252] And my guess is that it was.

[253] In fact, if you look at a lot of flu cases in this country now, and maybe even some of the flu debts, if you go back and look at their actual, what the actual virus was, it may end up that they were coronavirus, even going back some time.

[254] That's great.

[255] That leads to another question of mine, which is, is there a way to test people who have already died, I guess, and haven't been...

[256] Autopsy or something?

[257] Yeah, because here's my theory.

[258] So before we were really aware of it, I got to assume that the many people that died in the...

[259] in January in the U .S. of, say, pneumonia, or what would have looked like pneumonia?

[260] If they were an old person in a convalescent home and they had respiratory issues and they died, I can imagine that they would chalk that up to pneumonia.

[261] It's not like they're going to launch an investigation, right?

[262] They're not going to send a sample to the CDC because an old person did what a high percentage of old people do, which is die of respiratory illness.

[263] They wouldn't even know to be curious.

[264] You're absolutely right.

[265] I mean, you know, people do die of respiratory diseases all the time.

[266] There's not value in spending the time to do testing.

[267] You can do some testing.

[268] When the virus is in somebody, the person is considered the host.

[269] If the host dies, the virus dies as well.

[270] Not in all cases.

[271] Like Ebola was different, for example.

[272] Ebola could survive after the host died, which is why there was such a concern about funerals, for example, with Ebola.

[273] But with this and most of the flu viruses and this coronavirus, you need the host.

[274] What you can check, if you really wanted to investigate this, is to see if the body mass, mounted a response to this particular virus, an antibody response.

[275] And you can go back and see, did the antibodies that the person made in their body fit with this novel coronavirus?

[276] And if they did, that would be your answer.

[277] But we haven't been doing that at all.

[278] We haven't gotten to that point.

[279] We can barely test for the virus itself, which has been really hard to develop a plan or a strategy because we just don't know how widespread this is.

[280] Here's my fear about saying, well, I already had it because I don't want a bunch of people saying like, yeah, I was sick in January, so I probably had it.

[281] I had a cough.

[282] And so I'm fine now.

[283] I have some sort of immunity to it.

[284] Right.

[285] Well, didn't you hear my precursor before I said?

[286] No matter what everyone should do every single thing being asked?

[287] I did hear that, but I think not everyone is taking it as seriously.

[288] Also, do we have any more information on that?

[289] Like, can you get it again?

[290] Do we know?

[291] We don't know.

[292] This is one of those things where, you know, the, the humility has to come in.

[293] I mean, I've spent a lot of time with Dr. Fauci, who, you know, is amazing.

[294] Everyone knows this guy's name now, I think, right?

[295] He's the, and he's 79 years old, by the way.

[296] I don't if you knew that.

[297] Whoa.

[298] That guy is amazing.

[299] He should be running for president.

[300] He is as sharp as it gets.

[301] I mean, unbelievable.

[302] He's still, he's a marathoner.

[303] He's 79 years old.

[304] I just was at a press conference with him and the president, and he's on the fly, fact -checking things.

[305] And, you know, I think he's got maybe the hardest job in America right now when it comes to that.

[306] But I asked him this question, Monica, and what he basically said is that you probably do have immunity.

[307] Once you've been exposed to this virus and recover, your body does build up these antibodies.

[308] It's like getting a vaccine.

[309] That's what the vaccine does.

[310] The vaccine is giving you a little bit of the virus and then teaches your body how to fight that virus if ever sees it again.

[311] Same thing happens when you get infected.

[312] The thing we don't know is how long does that immunity last.

[313] Right.

[314] That's the big question marks.

[315] So he's pretty confident that you do have some immunity.

[316] And that's a good thing.

[317] I mean, that ultimately is how these things burn out, is that enough people sort of get immunized to it that's called the herd.

[318] The herd immunity starts to take place.

[319] And you get enough people who are in the herd and the virus has a hard time sort of penetrating through a population then.

[320] So that's what you want ultimately.

[321] But again, because of no testing, we have no idea where we are on that.

[322] Yeah.

[323] expert if you dare What's up guys, this your girl Kiki and my podcast is back with a new season and let me tell you it's too good and I'm diving into the brains of entertainment's best and brightest, okay?

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[325] We've all been there.

[326] Turning to the internet to self -diagnose our inexplicable pains, debilitating body aches, sudden fevers, and strange rashes.

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[328] Like the unexplainable death of a retired firefighter, whose body was found at home by his son, except it looked like he had been cremated, or the time when an entire entire town started jumping from buildings and seeing tigers on their ceilings.

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[334] Okay, so my follow -up question from before, but I'm really glad you brought that up.

[335] I love you, Monica, and I love you, Sanjay.

[336] I love you guys too Can I just say something Before you ask your question It is really good to see you guys You too It is so nice to see you The last time we talked I felt like it was You know I don't want to paint too negative A thing of what's going on the world right now But it was under much happier Circumstances We were talking about Traveling around the world And what all these amazing cultures Around the world could teach us And you guys were just so smart And knowledgeable Wonderland Mall Amazing questions.

[337] Don't forget Wonderland Mall.

[338] That was the most important thing.

[339] That formed us, I'm sure.

[340] It did.

[341] It's good to see you guys and talk to you like this because it feels very familiar and nicely nostalgic.

[342] Yes, I totally agree.

[343] I have the biggest warm spot in my heart for you.

[344] Again, I think because I got to talk to you before, when I see you on TV, not only do I trust you, I go, oh, that's my friend.

[345] I like that guy.

[346] Yeah.

[347] Oh, and on that topic, I will say my wife, who's been just doing a perfect job at protecting our family, I wasn't even allowed to come home until this morning.

[348] I just was reunited after six days in an apartment by myself.

[349] You were quarantining yourself?

[350] Well, I had been traveling.

[351] I was working in Colorado, shooting something, then working in Austin shooting, and then they finally pulled the plug, and then I drove back so I didn't have to fly.

[352] And then she wanted me to hang low for a week to make sure that I didn't have any symptoms, which I don't have.

[353] So I just, Just this morning got to hug my girls before coming here, which was heavenly.

[354] Yeah.

[355] So she's been doing a great job, and she's a warrior, and she's helping disseminate really useful, helpful information to people.

[356] But yesterday she kind of hit the skids and she was crying.

[357] And one of the things she was saying was, I just feel so bad for all these doctors who are putting themselves at the front line of this.

[358] And I said, and I don't know if you'll echo this, I said, honey, this is it for doctors.

[359] They went into medicine to save people.

[360] and this is an opportunity to save a lot of people and do their job like Navy SEAL Team 6.

[361] This is the time.

[362] Am I right about that?

[363] I think so.

[364] The people are really rising to the occasion, for sure.

[365] You do want to have the maximum impact when you're a health care provider of any sort.

[366] You know, doctors, nurses, respiratory therapists are perhaps some of the most valuable people in the health care profession right now because they're the ones who actually know how to operate these breathing machines.

[367] and keep people alive.

[368] I mean, this is their Super Bowl in a way.

[369] And they're really doing an amazing job.

[370] I think the challenge, and maybe this is Kristen's point, is that in so many places, and this is not made up, but in so many places, they don't have enough of the personal protective equipment.

[371] And as somebody said today, I don't remember who it was.

[372] It may have been the vice president.

[373] It's kind of like going to war without having your basic shields and protection.

[374] You're vulnerable.

[375] And in this case, you're vulnerable against something that's invisible.

[376] You can't duck.

[377] You can't hide.

[378] You don't know where it is exactly.

[379] And you have to do your job, take care of these patients.

[380] So I really feel for them.

[381] And then they got to go home like you were talking about.

[382] And do you hug your kid?

[383] Yeah.

[384] I don't think the person I cared for today has COVID.

[385] But maybe they do.

[386] And maybe now I have it.

[387] And the last thing I want to do is give it to my newborn baby.

[388] Yeah.

[389] I talked to an ER doctor yesterday who's kind of similar to what you were saying, but he's living in his garage.

[390] He's an ER doctor.

[391] He's living in his garage.

[392] He's got three kids.

[393] One of them is four weeks old.

[394] Oh.

[395] And I said to him, I said, how long does this go on?

[396] And he says, I don't know.

[397] Yeah.

[398] I have no end date for that.

[399] That is going to be my life for a while.

[400] He wanted to talk to his wife.

[401] She wasn't answering the phone.

[402] So he walked out of the garage through rocks at the window to get her to respond.

[403] Oh, man. That is their life right now.

[404] So I see it both ways.

[405] I love the military parallel because there was a really interesting figure in the New York times today about at the height of World War II, the Ford Motor Company was making B -52 bombers won every 68 minutes.

[406] An airplane.

[407] We can't unleash the power of our industry to build ventilators.

[408] That's the part that's shameful, I think.

[409] And you're right.

[410] When we were sending soldiers without protective gear, it was shameful.

[411] And it was national headlines, as it should be.

[412] These people are putting their life on the line and we can't give them bulletproof vests.

[413] that's unacceptable.

[414] And likewise, we're relying on this tiny sliver of our population to save all 300 million of us.

[415] We're not going to give them the tools?

[416] Are you kidding me?

[417] We're not going to turn some factories over and mobilize some things to make the ventilizers and do these things.

[418] That part is shameful, I think.

[419] I think you'll be pleased to know, and this is still unfolding, but just today, just before I'm talking to you, I heard from the White House that General Motors, interestingly enough, may be starting to retrofit some of their manufacturing capabilities to make ventilators.

[420] Oh, great.

[421] So we are seeing stuff, as you point out, that we haven't seen really since World War II, a complete retooling of our manufacturing capabilities towards this different kind of war, this medical war.

[422] We'll see if it happens, but it sounds like people are really trying to rise to that challenge again, and that's, I mean, I think it's really necessary.

[423] Well, again, and just to take the worst -case scenario models that have been run where they're saying 2 .2 million people, we haven't lost 2 .2 million people in a war since the 40s.

[424] So the severity of the worst -case scenario should be seen as all the wars we fought since World War II combined.

[425] Yeah, it's a little mind -numbing when you look at some of these models.

[426] And I've been really careful, I think, when we present this sort of information to the people watching television, I don't know the right answer to this.

[427] I think in some ways my medical training has come out to be really important as a journalist with this story.

[428] I think doctors, nurses, whoever, are always sort of sitting at this inflection point between hope and honesty.

[429] Yeah.

[430] They're always sort of sitting there.

[431] And what I've learned, and maybe we talked about this before, because I think this is so important.

[432] But I do believe hope just as a thing has intrinsic value for what it is.

[433] I agree.

[434] I agree.

[435] And I don't think it should be labeled as the opposite of honesty, although it often is, right?

[436] People who are hopeful are seen as, I mean, you being a charlatan or you, you know, whatever it may be.

[437] And yet, honesty has to lead the way, right?

[438] You can never sacrifice honesty in pursuit of hope.

[439] I don't know if that makes sense.

[440] But the idea, can you do both, you know?

[441] Yeah, juggle both at the same time, I think.

[442] For your heart and your emotions and your life, you need to juggle.

[443] Because again, Nicholas Christoph wrote this amazing piece, too.

[444] today in the New York Times, that was best case, worst case scenario.

[445] And the worst was the number I just said, which is terrifying.

[446] And then there's also a best case scenario where this flattens out in eight weeks and we make it over the hump of not overloading the medical system and the virus mutates and kills itself.

[447] And there's a lot of vaccines and treatments.

[448] Therapeutics, yeah.

[449] We've got to live somewhere between those, right?

[450] Yeah, totally.

[451] I think it's hard to take in the X factor of, in this case, American ingenuity.

[452] I don't think we ever know what we're really capable of until our backs up are against the wall.

[453] Yeah.

[454] So we're just modeling this based on existing sort of thoughts and ideas.

[455] But this sort of unleashes your imagination, I think, in all sorts of different ways.

[456] I mean, you knew, because you're really well -read person, that Ford Motor Company did that during World War II with the planes.

[457] But I think today when a lot of people heard about general motors, maybe retooling and retrofitting their manufacturing, do ventilators, it was like, wow, that's fantastic.

[458] You know, I would never have thought that.

[459] You know, how does that even work?

[460] Or people who are now creating this personal protective equipment in all sorts of different ways because they're trying to really pitch in and help these health care providers.

[461] So I have a lot of faith in American ingenuity.

[462] Yeah, World War II, we invented nuclear fission.

[463] We also invented vulcanization because we couldn't access rubber trees.

[464] I mean, we invented fake rubber because we had to.

[465] We invented nuclear reaction because we had to.

[466] So there's some mental hurdle where a military threat seems very easy to mobilize around and to sacrifice around and to bring all the resources to bear on.

[467] Yet medical stuff, there's this notion I could escape it.

[468] No one thinks they're going to escape a nuclear attack.

[469] Because there's a real enemy versus an elusive enemy.

[470] Yes, and that's interesting.

[471] That's a bummer.

[472] It's a bummer that, yeah, there's no face to put on Corona.

[473] You can use mine.

[474] Please don't.

[475] Not good for our brand.

[476] First of all, I learned something just now, again, as I always do, talking to you guys.

[477] I mean, you're just, it's amazing.

[478] So thank you for that.

[479] I knew about nuclear fission.

[480] I did not know about the vulcanization.

[481] But, you know, the other thing, and I don't know, maybe this is what kind of got me a little bit choked up earlier when you're talking about this.

[482] There is this notion, even if it's a faceless threat, that it is a universal threat.

[483] It is a common enemy, you know?

[484] Like, I always used to say, like, what is the one thing that would bring the world together?

[485] and I always thought it would be like an attack from another planet.

[486] Right.

[487] That's when the world comes together, right?

[488] Yeah.

[489] Because now we're all in it together and we've got to fight these people who are attacking us from another planet.

[490] Well, I don't want to exaggerate it, but I think this sort of fits into that category, even more so than climate change in a way because climate change gets so politicized.

[491] This is nobody's fault.

[492] This is a pathogen that's circumnavigating the globe.

[493] It does not respect borders or boundaries.

[494] It does not discriminate against young or old, men or women.

[495] cultures around the world are all at risk from this, and we all have a certain obligation or duty to try and do our part to stop it.

[496] So I don't think there's many things that bring the world together like this, potentially.

[497] You're so right.

[498] If you told me two months ago that there would be an issue that would transcend China, Italy, in the U .S. in a way that would make us all brothers and sisters in the exact same fight, it would have been hard to imagine what that could a ban.

[499] Right.

[500] Yeah.

[501] I mean, a little strand of RNA.

[502] A little tiny strand.

[503] I mean, microscopic thing like that can fundamentally change the world, but possibly bring the world together in a stronger way.

[504] I try not to get too polyanish about this because I think maybe it's too early and people are really, you know, they're going to have to deal with this for a while.

[505] But I think you're right.

[506] I think it really can do something that can be good ultimately for the world.

[507] Well, again, there's another paradigm that this mirrors to me, which is people have a very hard time accepting the notion of being compassionate and executing justice in our legal system.

[508] There seems people have a hard time juggling both or think that both can't be juggled at the same time.

[509] And I think this mirrors that in a way, which is we can do all the right things and take all the right steps and we don't have to die from fear.

[510] We don't need that as the motivator.

[511] We can be compassionate and patient and understanding and loving and all these things and do all the right things.

[512] They're not binary.

[513] They're not binary.

[514] Yes, 100%.

[515] So when the narrative of this virus is presented to a lot of people, even right now, and where are we?

[516] We were sort of mid -March, you know, end of March time frame.

[517] It was sort of like elderly people are at risk.

[518] Everyone else is going to be fine, right?

[519] That's what people heard.

[520] And I think for a lot of young people, they were like, well, you know, I'm fine.

[521] I have no problem.

[522] And then you started to learn that, look, you could still be a carrier of this virus.

[523] And even if you were okay or didn't get that sick, you could potentially make someone else sick.

[524] And it was really interesting.

[525] to sort of try and observe people's behavior, this idea that, look, even if I didn't take good care of this for myself, I would take good care of this for the people around me. Like I'm more extrinsically motivated than intrinsically motivated when it comes to something like that.

[526] And I think that's true.

[527] And it seems anti -evolutionary, right?

[528] I mean, if it really was survival of the fittest, we wouldn't care, really.

[529] No, it would just open up more resources for us who survived, yeah.

[530] But for some reason, maybe we humans evolve that way to actually want to care for each other because maybe at some point our evolutionary tree realized that we needed to be stronger together than as individuals, you know?

[531] Yeah.

[532] Well, definitely populations that cooperated outpaced all the ones that did it, you know?

[533] That's not true, right?

[534] That it's only old people and people with immune disorders.

[535] Like, I think a lot of people are like, well, I'm doing it for other.

[536] people, but also it could affect you.

[537] And we are starting to learn that now, you know?

[538] I mean, the point I was making earlier was at that point where we thought young people just be carriers, I was heartened that people did start to change their behaviors.

[539] But you're absolutely right, Monica.

[540] I mean, what we're finding now, there's two things that have really jumped out at me as I've, you know, I spend all my time reading studies and talking to people and all that.

[541] Two things jumped out of me. When you look at the China data now, they have the biggest data sets.

[542] That's why everyone always refers to those studies.

[543] They found that people who were recovered, right?

[544] So they survived.

[545] They were listed in the recovered category.

[546] It was sort of binary.

[547] Did you die or did you live and recover?

[548] That was it.

[549] But when you started to dig deeper into the recovered category, you found that even younger people still had significant lung function loss.

[550] Right.

[551] So 20 to 30 percent of their lung function was lost even after they recovered.

[552] So they were still able to conduct their lives, but maybe they would get winded going up a flight of stairs, where before that they would never have any problem with that.

[553] It would manifest in all sorts of different ways.

[554] But then you're also starting to see in other places around the world like France that I think close to half the people who are currently in critical condition in ICU's are under the age of 60, many of them in their 40s.

[555] So it does seem to affect younger people more than we thought.

[556] It could be that China was such a homogenous population, that it wasn't really reflective of other places with diversity in their population.

[557] We really don't know, as you guys have brought up, what the impact has been in the United States.

[558] It may have already had more impact than we realize.

[559] But it's going to be interesting to see how that data sort of changes.

[560] You know, we really do have to be humble here because we don't know exactly how many people it affects or what the age groups are.

[561] Today, they said that in Italy, the people who died were twice as likely to be men, versus women.

[562] Whoa.

[563] You know, we don't know why that is.

[564] It could just be that it's really early data and it won't play out as you get larger numbers.

[565] But that was a, that was a sort of, you know, a startling thing.

[566] Like, why would that be?

[567] Why would it affect certain populations differently than others?

[568] In China, that was explained as men, I guess, smoke at three times the rate.

[569] Yeah.

[570] Is that, is that consistent with?

[571] That could be in Italy as well.

[572] It could be smoking here in the United States, A little bit more likely to be a man if they die, but closer to like 52 and 48%, so maybe that reflects the smoking.

[573] We don't know.

[574] We just don't know for sure.

[575] We also know that young kids, adolescents, while they can get critically ill, it's a lot less likely than adults, but not negligible.

[576] Adults, 20 % of them get seriously are critically ill. With kids, it's closer to 6%.

[577] That's a lot less, but not insignificant.

[578] Interestingly, with babies, you know, zero to one year old, it was around 11 % of those young children who were getting this infection became seriously or critically ill. We didn't know that out of China, you know, we didn't see that.

[579] It was mostly kids are fine, don't really worry about the kids.

[580] We're continuing to learn more.

[581] These are important data points to keep looking at.

[582] Stay tuned for more armchair expert, if you dare.

[583] What other question did you have?

[584] I know you had.

[585] Oh, you had a fun one about food workers.

[586] We're going to get into some more practical.

[587] And then I have one, again, one last really provocative question.

[588] As he always does.

[589] Yeah, I have just a selfish one.

[590] Well, not selfish, I guess.

[591] But, you know, we also want to keep the economy up as much as we possibly can.

[592] I want to be ordering food.

[593] And I know everyone's saying you can do takeout and delivery, but there's a part of me that's like, can you do takeout in delivery?

[594] Because it's passing from hand to hand.

[595] Can it go on your food and then you eat it?

[596] Like, all of this.

[597] Yeah.

[598] Well, I'll tell you, first of all, we are as a family ordering takeout food a fair amount.

[599] Well, it's good enough for Sanjay.

[600] It's good enough for us.

[601] Yeah.

[602] Yeah, I mean, I, you know, and we went through the decision matrix on this and sort of figured it out for ourselves.

[603] And here's what made sense to me was, first of all, my wife's really busy.

[604] I mean, all the kids are at home.

[605] Right.

[606] They're not in school.

[607] And so just pragmatically speaking, and I'm working all the time.

[608] So just from life decisions, I'm trying to take pressure off of her.

[609] And, you know, ordering takeout is helpful in that regard.

[610] But what we decided to do was everything's done on your phone app, so we pay for it through that.

[611] And personally, usually leave it at the front porch or wherever.

[612] So, you know, you do keep still the physical distance from anybody.

[613] We'll pick it up over there and usually leave the outer bags, things that are most recently touched on the porch.

[614] Right.

[615] Bring the containers into the house.

[616] and if it touches the counter, you know, we're very careful about wiping the counters down, and then obviously washing our hands after we've touched all these things.

[617] If you keep in mind, you touch something like that, a surface that may be contaminated, and then you touch your eyes, your nose, your mouth, that's the concern here.

[618] If you wash your hands right after you touch those surfaces, you kind of obviate that concern.

[619] Right.

[620] It's not transmitted in the food.

[621] Okay.

[622] So it's not a food -borne virus.

[623] There are food -borne viruses, and they give you sort of more the GI stuff.

[624] but this is a respiratory virus.

[625] So, I mean, you know, if the good place that you're ordering from that's hygienic, otherwise, your food should be fine, just follow some basic precautions.

[626] And, you know, look, we're doing it as well.

[627] I think a lot of people are doing it, in part to make things easier for us, in part the same reason you are, Monica.

[628] We want to continue to support the local restaurants and the people that are in our neighborhood.

[629] Sometimes we'll order food for other people in our neighborhood.

[630] My wife went out grocery shopping the other day.

[631] we do have a lady who's older that lives down the street, called her up, get you a few things from the grocery store, so she doesn't have to go, really appreciated it.

[632] So, you know, those kinds of things.

[633] But again, just being careful in terms of knowing how the virus is transmitted and trying to reduce those potential exposures.

[634] Was our biggest failure, the fact that we didn't have tests and that we weren't quick to go, yeah, let's get the test.

[635] Was that probably our biggest initial failure?

[636] Yeah.

[637] I think that was the biggest initial failure.

[638] The tests are really important.

[639] then you can have eyes on this, as the CDC says.

[640] They like these hunting metaphors.

[641] We need eyes on this thing.

[642] It was interesting.

[643] But I'll tell you what, though.

[644] What is concerned me a little bit, though, is that that has become the metric of success now, testing.

[645] Right.

[646] And I think it's a little bit missing the point because we also knew when you look at some of those models, again, federal government models that they had access to, that we knew we were going to need a certain number of hospital bets, that we were going to need a certain number of ICU beds.

[647] a certain number of breathing machines.

[648] We knew this.

[649] And when they bought time for us in China by instituting the largest quarantine in human history, I think it was the largest in recorded human history.

[650] And even, you know, what the president did, bringing that plane back from Wuhan, 195 passengers and quarantining them here in the United States, that was a significant move.

[651] Yeah.

[652] It did slow things down what he did.

[653] And even in this country, we hadn't had quarantines since smallpox 60 years ago.

[654] So there were really, really important strategic things that were done by the Chinese government and also by us to buy us time.

[655] It wasn't saying, hey, we stopped this thing.

[656] It never was.

[657] We knew we couldn't stop it.

[658] But the buying of time should have allowed us over six weeks, two months, whatever it was, to make sure we could have the capacity to handle the surge of patients that everyone knows is going to be coming.

[659] That's also, for me, I think as a doctor, probably even a bigger failure, because, you know, now you're dealing with a situation where health care workers don't have their personal protective equipment, that could have been addressed.

[660] We may have patients who don't, you know, have breathing machines when they need them.

[661] That could have been addressed.

[662] I mean, all these things could have been addressed.

[663] You have big public spaces where you guys are in Southern California that could have started to be retrofitted and modeled to be able to provide some surge capacity.

[664] That could have been done, but we didn't do it.

[665] And part of that's human nature.

[666] I mean, most humans don't like to act until something is literally slapping us in the face.

[667] I mean, with regard to our personal health or with regard to some big public health issue like this, we kind of like to close our eyes, pretend it doesn't exist.

[668] And if we ignore it, it won't affect us.

[669] But, you know, that's not the case here.

[670] And so I think that, I don't even want to use the word failure.

[671] You know, you can't disentangle anything from politics nowadays.

[672] But the reality is we didn't act than we could have.

[673] And I think that was a mistake.

[674] I'm also very sympathetic to the role they have, which is they have to try to prevent panic.

[675] So I am sympathetic to this thing they're juggling, which is they don't want mass panic.

[676] You saw people hoarding toilet paper, which was so beyond me because these people have showers, hop in there and clean your butt.

[677] I don't know.

[678] I mean, of all the things, you can't, there's a workaround for that.

[679] Right.

[680] Okay.

[681] So my provocative question is this.

[682] I can see someone saying, look, everyone's going to get it, X amount of people.

[683] are going to die, that's tragic, but why add on the huge economic apocalypse that will have its own deadly implications?

[684] Wouldn't it be better to just go about business as usual and accept the reality without adding a recession?

[685] I think it's a good question, but I will tell you, though, that it is one of these things where when you look at what will happen, you've got to game this out a little bit, and you have to understand that, first of all, people can get really sick from this, even if they don't die.

[686] We've been looking at this in just binary terms, you know, lived or died.

[687] That's too simplistic here.

[688] You can get really sick and it can affect you, it can affect your life and your function of your life later on.

[689] But the other thing, when you look at these mortality rates and you say, okay, in Hubei province, China, the mortality rate was around 2 .3, 2 .4%.

[690] Outside of that province, mortality rates in China were actually underneath a percent, 0 .6 .7.

[691] So why is that, right?

[692] The same virus, why did it kill so many more people in Hubei versus outside of Hubei?

[693] And the answer really has to do with the fact that it strained the medical system.

[694] Ah.

[695] That there were a lot of people there who could have been saved that died because they didn't have enough medical capacity in the initial stages of this.

[696] Same thing's happening in Italy right now.

[697] I mean, every day again, the numbers change, but the case fatality rate there is 5 -6%, so much higher.

[698] Yeah.

[699] The virus didn't become suddenly that much deadlier.

[700] It's the strain on the medical system.

[701] What a great point, because even I have been trying to frame this in, how deadly is this virus?

[702] But you're right.

[703] It's in a context of how good is the medical system at treating the virus.

[704] It's not an objective number that is standalone.

[705] It's in a context of a medical system.

[706] Yeah.

[707] I mean, let me give you this description.

[708] I've done a lot of reading on what this virus actually does to the body, and this is relevant to what we're just talking about.

[709] But what does this virus do to the body?

[710] Okay, so a virus gets into your body.

[711] It infects a cell.

[712] It uses that cell's machinery to start replicating, dividing, and making more and more copies of itself.

[713] Ultimately, it can overwhelm your body's immune system.

[714] You know, you can't fight it anymore, starts to cause organ failure, all these sorts of things, right?

[715] That's what you typically think of with an infection.

[716] And that probably happens to some extent here as well.

[717] But what I find fascinating is that this virus in particular also affects.

[718] affects a particular enzyme in the lungs that's responsible for the making of something known as surfactant.

[719] Okay?

[720] So here's how I want you to think about surfactant.

[721] Your lungs, you think about your lungs as these sort of big, squishy sponges.

[722] You know, they contract and they expand.

[723] That's how you breathe.

[724] You push out carbon dioxide.

[725] You take in oxygen.

[726] That's what's happening.

[727] But you know, like a dry sponge, a sponge that's been sitting out and it's dry?

[728] It's really hard, right?

[729] So the elasticity is kind of gets depleted?

[730] toxicity is gone, no matter how hard you, you know, it's just a dry thing.

[731] What makes it become pliable again?

[732] Put a little detergent on it, right?

[733] And all of a sudden it's nice and easy to squish again.

[734] Surfactant is the detergent.

[735] What this virus is doing is taking away your surfactant, turning your lungs into these hard, sort of difficult to contract organs.

[736] Now, that's a really challenging problem to treat, but it is treatable, okay?

[737] So if I had a patient like that.

[738] There are strategies that we could use that I know are very confident.

[739] I mean, not everybody, obviously, very confident that we could keep that patient alive.

[740] We could use high -function ventilators.

[741] We could use something called ECMO, extra corporeal membrane oxygenation.

[742] There are great strategies we have to try and keep a patient like that alive.

[743] My point is this, that the virus is a deadly virus.

[744] But if we were running full throttle and I had everything at my disposal for every patient that came in, I think we could lower the fatality rate tremendously because it's really a reflection of whether or not these patients can get medical care.

[745] The virus is bad.

[746] I mean, I don't want to minimize that part of it.

[747] But the reason these fatality rates are so high is because of the strain on the medical system.

[748] And we think, you know, in the United States, that couldn't, you know, that can't happen here.

[749] But maybe it is happening here.

[750] Maybe that is why, you know, Governor Newsom.

[751] is really worried that 25 million people get this thing within the next eight weeks in California, that's going to be a problem.

[752] That's why Governor Cuomo essentially created the efforts that he did the pause New York efforts that he did today, where he's saying only essential people need to be outside.

[753] Yeah.

[754] I don't want the medical system overwhelmed because that is a bigger problem right now than the virus, I think, especially in the developed world.

[755] So that's what we're dealing with.

[756] And again, keep in mind, this virus acts in a different way.

[757] It takes away your surfactant and your ability for your lungs to actually function no matter how much virus is in the body.

[758] So these are all things that, you know, again, we're knowable, we're actionable, that we probably should have been doing something on.

[759] And, you know, we're a little behind the curve here.

[760] I think we still got time, but we're a low behind the curve.

[761] God, Sanjay, I love you.

[762] When you were saying those long words, I was getting horny.

[763] I think Monica was too.

[764] You're just surfactant.

[765] Oh, man. Wait, one real quick thing just to end on, because you were on contagion, the mood.

[766] which I've now watched twice because I'm a masochist.

[767] And is that crazy that you were on that movie, which is eerily, I mean, I know it's so much more intense, but the similarities are eerie.

[768] Yeah, that is a little surreal, actually, you know?

[769] I mean, art imitating life, just in reverse order, I guess.

[770] Yeah.

[771] It was interesting.

[772] I remember when somebody was telling me about the movie before I ever did anything, and they said, you know, the real theme of this movie is obviously.

[773] about this virus.

[774] But it's also, I think, going back to the first point you guys brought up, it was also this idea that sometimes fear and misinformation can spread faster and be even more deadly than the virus itself.

[775] And I really took that to heart.

[776] The job now for me is, if I do nothing else, it's to diminish that fear and obviously try and stop that misinformation because I learned something, Monica, from that whole thing.

[777] And, you know, if I can, strangely how many years ago was that i don't even know 10 nine years ago whatever if i can like now strangely have some sort of role in preventing the outcome that that people faced in that movie yeah it would be it would be great you're unquestionably having a huge uh impact on this truly we're so grateful for you you're kind of like my tom brokaw like i trust you you're the thank you're the steady hand at the wheel i appreciate that because i did a surgical residency and i always thought nothing can hurt me after doing that.

[778] And this has been the most prolonged, busy thing that I think I've ever done.

[779] Yeah.

[780] We love you.

[781] We appreciate you giving us so much of your time.

[782] I know you're nonstop now.

[783] So we just, we're endlessly grateful.

[784] We're always here for you.

[785] If there's anything you want us to get out, please tell us, and we will be quick to disseminate.

[786] I really appreciate that.

[787] Hey, Monica, our Indian heritage now, right?

[788] This has got to be the greeting.

[789] This is the safest way, don't you think?

[790] Oh, that's right.

[791] Yes.

[792] Because even the elbow bump, you get in too close.

[793] If you do the namaste.

[794] I love it.

[795] You're totally clean, huh?

[796] Yay.

[797] I knew you guys were the superior population.

[798] I always knew it.

[799] She wanted to be white.

[800] I know.

[801] It's all coming back around.

[802] I'm learning.

[803] Thank you.

[804] Thank you, Sanjay.

[805] I hope we talk to you soon.

[806] Thank you.

[807] You too.

[808] All right.

[809] Good luck.

[810] Bye.

[811] Stay healthy.

[812] Yep.

[813] Bye -bye.

[814] Amazon music or wherever you get your podcasts.

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[816] Before you go, tell us about yourself by completing a short survey at Wondry .com slash survey.