Dr. Kenny Bramwell is a System Medical Director for St. Luke's Health System
- What happens when hospital staff get infected with Covid-19?
- Are US hospitals ready for Coronavirus?
- How many people will be infected in the US?
- How strict should we be with our quarantines?
- What about Anti-Vaxers?
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Coronavirus Covid-19
I'm not trying to be alarmist here but I
think this was helpful I said
everybody's gonna get there everyone is
going to get this illness it's a
question of do you get it in March you
get it in April or do you get it in May
or June
so coming out of Italy there are doctors
and hospital administrators that are
completely overwhelmed especially in a
couple of the regions there the Lombardy
region down in Venice as well where they
are you know the workers are there some
of them on 18 24 hour shifts the doctors
and the nurses they're making very
difficult decisions as to who is going
to be treated and who's not right there
at that point they do I offer any
respirators for anybody over 65 years
old they're just overwhelmed they're
just overwhelmed and 18 doesn't make
based on I mean they're in a horrible
position of a shortage of equipment with
an overwhelming number of patients who
are ill and in need of respirators it's
it's awful right the other the other
thing that goes on top of that that is
maybe in the next level where you
end up with another huge problem here is
with the doctors and nurses some of the
reports coming out of those regions are
that as many as half of all of the
nurses and doctors are infected and so I
don't know exactly what the measures are
that they're going through right now as
far as seems to me like you have to
almost assign a hospital as a
coronavirus hospital and anybody who's
already infected maybe they're working
there as long as they can but you know
these are doctors and you know
you're an ER doc for a long time
you imagine you bring somebody in who's
infected and then right from there you
go to somebody who's had a heart attack
and you're treating them how do you
possibly manage something like that so
historically the way that you manage
something like that is if you have an
outbreak of this magnitude or something
that is particularly infectious measles
is actually the worst thing as far as
number of people or how infective it is
infectious if you have something like
that you're usually able to isolate
those patients by the
that there in the clothing that you wear
and the number of people that are
allowed to come in and see them so you
try and contain it you try and put them
in a special bubble as soon as you know
that they have it one of the big
problems with this disease is people
have it for 710 days before they
necessarily have symptoms so though that
first week at the least they're out
sharing this virus and potentially
infecting other people which is why the
testing idea is a bit flawed and we can
talk about that in a bit but the
problem is we don't have enough tests to
test everybody so we have to test just
some people and to your point about what
do the health care workers do for my
understanding right now the there are
two groups of people who really need to
be tested the first group is people who
are profoundly ill and need to be
admitted to the hospital regardless of
the reason and those people need to be
tested so you know where to put them to
your point if and we may get there
we're looking at that here locally you
you may want to describe or you may
want to assign certain parts of the
hospital certain wings certain ICUs
that have patients with this
disease and people who don't have that
disease go elsewhere so inside the
hospital it's really important to know
if these patients have the disease the
next thing is health care workers if you
are exposed to this disease and you're
worried that you have it and the answer
is hey you're healthy and you're doing
okay and you don't need to be admitted
to the hospital you wouldn't normally
get tested unless this is just the
second group unless you're a healthcare
worker because we sadly don't have an
unlimited number of people who can work
the shifts as nurses and doctors and
other personnel and if you're sick
or if you're exposed or if you think
you've been significantly exposed
you should quarantine yourself before
teen days so since we don't have enough
staff for people to just go home for 14
days repeatedly that's a group that
needs to be tested because we need them
to come back to work to your point
earlier would you expect though I mean
if let's say that you're you get to a
position your system medical
director over St.. Luke's health system
you have seven hospitals that you're
over right I'm guessing somewhere around
eight hundred beds or so yeah that's
about right about right so if you have
if you have your health your health care
workers what if you if you put
everybody it was it was an all-out alarm
and you had everybody available I'm
guessing they could handle those 800
beds yes okay normally we handle all the
under beds where normally we're fine we
won't okay so what if you what if you
end up with 1200 people in the hospital
then it becomes a problem because we
don't have the place to put that many
patients certainly not each in their own
room and certainly not with the sort of
precautions that you normally take to
separate people so we don't have
room for 1200 people
so usually right now the way you see it
as far as even a plan for going forward
you do not have the capacity to go
beyond that or what most hospitals be in
the same boat I think so the one of the
weird things about hospitals is you have
to be able to demonstrate a community
need to build a hospital
you have to it's almost like you can't
let's see what's an analogy if you want
to build a restaurant you have to find
someone to finance you and if the bank
thinks you're a good risk you can often
get a loan to do that but if you want to
build a hospital you have to demonstrate
that the community needs those beds so
you can't over build the hospital you
have to build it in response to the
community needs so we are frequently
behind the number of beds that people
might need and we are certainly behind
if there's a catastrophe like this well
it seems like it's not even that big of
a catastrophe I mean
if you had manure mentioned that you're
usually somewhere around eighty
eighty-five percent occupation in those
beds right right so you have about
eighty to a hundred beds that may not be
filled on average that's fact and dad
may not take a whole lot to fill another
80 to 100 beds it's not a lot of wiggle
room that's not a lot of wiggle room and
would you say again would you say most
hospitals are in that then because
they're built to built to meet the need
of the region of the area there right
then there are do they mostly run
probably about that amount eighty/eighty
five percent occupancy it varies season
to season and varies hospital to
hospital those are those are sort of
national averages and that's been my
experience in a couple different parts
of the Southwest that that's about where
we run you know different times of the
year
respiratory season right now influenza
is still a big issue we're busier than
we commonly are and say July in August
where it's not respiratory season
anymore
what is your access to testing kits
right now right now we have the ability
to test patients who are needing to be
hospitalized through the state
laboratory we also a few days ago opened
up sort of drive-through testing
facilities at many of our Hospital sites
or near our Hospital sites or you can go
and get tested for coronavirus really is
the only thing that you can get tested
for they come to your car and they swab
you and they send it off and you usually
hear in four to five days I have friends
and colleagues who've heard in as many
as eight and as few as two are that is
that crowded right now are you getting a
lot of that going on a lot of
drive-through we started it this week
and the first date opened I think there
were two hundred patients who drove
through in I'm saying eight-hour portion
of the day I want to say it was ten
eight a6p
we headed at two sites and then each
subsequent day we've opened one or two
more additional hot
little sites and there they're just
running all day long so you said that
you said that the testing is a little
bit flawed yeah what do you mean by that
well I don't think we know yet let me
back up just a little
usually when we when we when we have
something like this like a rapid strep
test or another viral test of this
nature we have a fair amount of lead
time we add a certain test RSV comes
to mind which is part of respiratory
season which my grandson had this
illness a few months ago it's extremely
extremely common it's a test that we're
able to run similar to the other ones
I'm talking about but the benefit of
it is we know how sensitive it is we
know how good it is we know that you
have to get a really good specimen we
know that sometimes if you didn't don't
get enough of the cells you can miss the
necessary material to have the test work
well we don't know that about the
coronavirus test yet it's so new
I've not seen data about how good it is
or how many cases it might miss out of a
hundred we I believe have different
tests here than they have in other
countries and let me let me just
back up a little so the I'm gonna be
somewhat facetious here but I'm actually
really serious about this if let's say
you're worried you've been exposed and
you're a healthy person and you're not
having really any significant symptoms
but you're worried that you're exposed
because you want to know if you have
this test and you go and you get swab
what you should do while you're waiting
for those tests is quarantine yourself
for 14 days while you're waiting for the
test it's very possible you'll get a
result back let's say five days into it
you get a positive result that means you
should finish the quarantine for the
remaining 11 sorry nine days so that
you've been out and not out of the
loop I should say and you're not
spreading it to other people so that's
that's pretty simple but if your result
is negative
your first
is quarantine yourself until you know
that it's negative and in many
situations the best thing you can do is
just stay out of the loop for the whole
14 days anyway so that you're not
possibly infecting people and trying
to just keep this at bay as best we can
I guess what I'm saying is if your test
is positive or if your test is negative
if you're sick stay home and if you're
worried you have it stay home for 14
days that's really the best
advice that I can give at this point I
am kind of leaning on my extended family
there because not everybody believes it
or not everybody feels like it applies
to them but it does you really
just want to be taken out of circulation
so that you're not spreading the disease
so it's always gonna go over that later
let's go ahead and talk about that right
now what I see through the news and
through you know things online is that
there's kind of these two camps that
have developed now on opposite ends of
the spectrum with this and there's those
that are you know very fearful they you
know my wife was talking about some
people she knew that or really really
scared about what's going on younger
younger people and you know there's a
lot of fear of what's gonna happen I
mean if what if I get infectious and
there's you know they're going to act in
their behavior a little bit more they're
gonna quarantine more yeah right there
gonna be more quarantined which is
probably a good thing and then on the
other end of the spectrum you see this
quite a bit I mean everything everyone
from the kids at Spring Break and on
the coast sand beaches out in Florida to
to others that are just kind of defying
you know hey look I mean I'm an American
I'm not gonna be told what to do and you
know this is completely overblown and
this is gonna pass and look at the
deaths that we have compared to what we
have with the flu it's nothing compared
to the flu every year right I think
there's 30 to 70,000 typically deaths a
year in the US just from influenza and
so they're doing the opposite there
kind of like you know I'm you're not
gonna hold me back I'm gonna keep going
you're working where should somebody be
in that spectrum man I would like it if
everybody got scared and hunkered down
in their house and just waited so uh and
I'll tell you why if you think about how
toilet paper was a couple weeks ago
maybe it was just last week and I'm
delusional as far as how time passes but
if you think about the run on toilet
paper what we're trying to avoid is a
run on hospital beds yeah
people here in the United States are
used to getting the attention they want
a need whenever they want or need it and
I would love if that were the case and
nothing got in the way of that
I'm worried with this pandemic that
we're gonna have problems hopefully we
don't get anywhere near Italy or China
hopefully we can do something more
similar to what Japan has done where
they say hey you need to stay home and
through whatever means people are
staying home I would like more people to
stay home and take this really seriously
and let me tell you why if you think
about influenza it comes around every
you're right 50 to 60 thousand people
die every year this happens to have so
far been the worst year in the last 15
for death among children which is my
main focus the challenge with the flu is
everybody seen the flu before everybody
gets the flu you know you get kind of
achy sometimes you have to take a couple
days off sometimes you vomit sometimes
you get short of breath but your body
has seen the flu before and whether you
have gotten immunized against it or you
just get it every few years your body
has seen it before this new virus COVID
19 your body hasn't seen it before so we
have no idea how people are going to
respond some people have very few
symptoms some people are sick enough to
need some additional oxygen
some people a small minority 5% of
people something like that need to be
admitted to the hospital and then 2 / 3
2 or 3% of the whole group dies which is
horrible and influenza has a death rate
that's 1/10 or 120th of that high so the
the challenge with this illness is our
bodies haven't seen it before we have
nothing to rely on the ways that
you're able to fight off an illness like
this are really just three you have
passive immunity through a vaccine you
have active immunity from your body
building antibodies after your exposure
and the third way you get through this
illness is you totally avoid it
when it comes through your town what if
it comes back what if it comes back next
year I think it's gonna come back I
think it's just gonna keep cycling like
influenza does I don't think this is a
one and done I don't think that I'm
I'm inventing a little here because we
don't really know but my suspicion based
on other viruses is that this will keep
circulating and we have to hope that we
get through the first wave and the next
wave we're a little more ready for it
because many of the population has had
it already and they're immune to it and
and we can get to a point where it
doesn't circulate so well and it's not
so horribly contagious because many of
us have had it already but right now
we don't have the option of any sort of
herd or group immunity at all because
outside of certain other countries none
of us have seen it before so we might
see an example next year let's say this
I mean just looking forward a little bit
where this comes around again maybe
maybe not I guess we don't even know
about the summer time if that's even
something that's gonna make a difference
at this point typically does with the
flu but let's say it comes around again
next year flu season let's just say
there is a little bit of herd immunity
event at that point going into next year
on the other hand it could mutate as
well and we have different strains I
believe there's already
two different strains that one's more
aggressive than the other but can also
mutate and I mean is that gonna affect
people that have already had it before
from you Tate's
yeah probably I mean that was I'm gonna
shut her a little bit that was why h1n1
was so bad and back in 2009 is the virus
mutated and made a big enough jump from
where it had been as far as the antigens
and the proteins it made a big enough
jump that people who had seen flu for
many years weren't ready for that and
weren't able to fight it off
particularly well and got exceptionally
symptomatic because the virus had mutant
mutated enough that their prior years
practice if you will what wasn't helpful
at that time I wonder what the I haven't
looked at it but I wonder what the
numbers are as far as deaths go for
those that you know from the first
season to the second season that come
the h1n1 coming around again yeah I've
not I've not seen that I haven't I
haven't looked at that specifically but
I suspect that there's quite a bit of
herd immunity that develops and
decreased mortality and problematic
cases the second time it comes through
because of both the group immunity
and individual immunity now you talked
about the run on toilet paper and
using a metaphor of that to the beds and
in all the healthcare let's just say
healthcare in general for whatever
reason in your region you had a run on
ibuprofen yeah at which actually from
everything I've read is actually
something that irritates the virus it
seems in the most severe cases of
this virus like other really severe
cases of viral infections that ibuprofen
tends to cause people some more trouble
than it's worth and in the most severe
cases it it's not the go-to drug
the challenge is for many other people
or other illnesses it is it's a great
drug but in this in the most severe
cases it seems to be really proud
romantic I'll tell you as an emergency
doctor I I'm a big believer in ibuprofen
for everybody for everything yeah I have
to I have to be careful not so it might
just be that people have there's a run
on it because they don't know if there's
going to be any available just for
people to get headaches or right
everything and our biggest problem here
locally that we're actually addressing
now with our pharmacy teams is is
children's ibuprofen suspension that's
what we had the trouble with in fact you
could go to Costco or Walmart right now
and get a jug Oh ibuprofen you just
couldn't get a big bottle or a few
bottles of children's ibuprofen where
are you guys at is turn in terms of yeah
if you had a run on the hospitals with
other medical supplies respirators masks
etc yeah we have all we need in the
way of respirators right now or
ventilators we commonly call them that
in the news they're commonly referred to
as respirators but I'll try and use
ventilator because that's the term I use
more um we have all we need
I believe we're trying to get more
because we expect the need to go up over
the next weeks to months we have a
handful of days of the various types of
PPE or personal protective equipment we
have historically bought those in three
to seven day a loquats you just always
keep enough on hand for the next few
days we have not historically had a
month's worth of those materials mm-hmm
we're trying to get more than we usually
have right now if we back up to your
question earlier if somebody has the
COVID 19 coronavirus now you know you
you figure the number of people who have
donned is our fancy word for putting on
if that we have if they've donned PPE
it's an unbelievable number of
people who need to put that on just to
take care of that patient each day hmm
so you if you have your normal operating
number of
PPE masks for example and then all of a
sudden you have ten or twenty patients
in your hospital who have the virus
where you need to dawn this stuff all
the time suddenly you're going through
ten and 20 of those sets each day for
that patient and that's the
problem that's why we have to ramp up
what we have on hand and that's why
we're looking at everything we can to
get more what now you guys have gone
through trainings in the past where
there might be whatever it might be I
mean you've give a massive accident or I
don't know what other crises might come
up or you have training for the
hospitals to bring in a lot of patients
at once right yeah so there is some
preparation and training involved with
the hospital systems for this what
might be different about this as
compared to some of the other things
that you guys have already trained for
yeah that's a great question so we what
we trained for is a mass casualty event
you think of something like a school bus
being hit by a train or I remember in
San Diego where I trained the concern
was always a cruise ship comes in and 40
people have food poisoning we had a
marathon complete disaster when I lived
in San Diego where unfortunately they
ran out of food and drink at Mile 20 and
there was a there were a lot of patients
all of us I'm so you trained for those
because I I think those are a little bit
more expected we did a handful of years
ago ramp up everything when we thought
Ebola was coming we went through these
exact same discussions about ventilators
about segregating patients inside the
emergency department inside the hospital
about where to place them about what to
do about backup staff about all of these
things so this certainly isn't the
first time we've talked about it
but it is the first time we're
we have a handful of foreign countries
who are saying we did not do this well
and here are the 10 things that I think
you should do so you don't get to as bad
of a spot as we have gotten what is
the you know what this seems to be a
very selective virus where it hits the
elderly quite a bit there might be some
obvious reasons for that but it hits
it's actually it actually there
are double more than double the number
of fatalities so far our men it hits
people with cardiovascular disease that
might be obviously obvious as well other
respiratory issues that's probably
obvious but diabetes is another one to
that what where people are hit very hard
a lot of fatalities with people that
have diabetes right what are some
of the reasons behind this do we know
that yet do we know what it's hardly any
children I mean it's I think the
youngest person I've seen that's passed
away is 14 yeah that's the same one I've
seen we in my children's hospital work
we look all the time I was talking with
or reviewing some information from
Seattle Children's earlier today I
believe so far they haven't even
admitted a child to their hospital who
has popped positive for COVID 19 in
China I believe they had something like
10 patients in the whole country who
popped positive and they were not
necessarily symptomatic people they were
family members of family members of
people who were admitted to the hospital
who were probably in one of these groups
that you're mentioning so the
interesting thing or the scary thing is
is we have a number of people who are
in the highest risk based on there are
other medical problems
number one seems to be age like you
mentioned and we can come back to that
the other ones that seem to be the
primary risks are cardiovascular disease
pulmonary disease and diabetes mellitus
like you mentioned I haven't seen an
explanation for the
specifically but it's I think it's fair
to say that those are the people those
are the patients who tend to have the
highest complication rate with almost
any infection unfortunately patients who
have diabetes COPD or coronary artery
disease tend to have the roughest go of
anything a very weak reason for the
elderly other than just their older
their immune systems might be more
compromised I haven't seen a good
explanation of why why is so
dramatically different you know it kicks
up somewhere around age 60 and it
pops up higher at age 70 and pops up
even higher I want to say it's between
18 and 20 percent mortality rate for
patients who are 80 so 80 or more so
it's relaxing it's uh it's shocking
that a mortality is that high and B that
it's so disproportionately high in the
that that used to be so far away eighty
he used to be unreachable now it's I can
see it coming but I still had some a few
decades but it it's shocking how
how much just age is a risk factor what
what about men I mean do you think that
might be something where they probably
have there's a lot more cardiovascular
disease perhaps with men high blood
pressure would that be a reason those
are those are very reasonable ideas I
haven't seen anything or let me say that
a different way I haven't read anything
from a medical journal yet that has
really taken a good crack at why the
mortality is higher in men mmm and
that's weird
yeah yeah that's it again it's just it
seems very selective this this disease
so another topic especially for a lot of
our audience here is LDS and there's
there's a certain group of
people that are what has been coined as
the anti bachelors yeah and it seems to
me like this is something that might
change
people's minds a little bit if there
were a vaccination that would come out
for COVID 19 yeah that'll be really
interesting where the anti-vaxxers land
if we get a vaccine for this illness I
mean because they're typically what
you're relying on there right and you
kind understand on one side okay well
they're they want their independence and
they want to be able to decide for
themselves as parents on the other end
of the spectrum there they're really
relying on everybody else to create that
herd immunity yeah right the only way
you can keep going as an anti VAX person
is if everybody else carries you mm-hmm
that's what it is
you know if the herd has an 85 percent
or a 90 percent vaccination rate you can
get by not getting vaccinated kind of
like somebody who has cancer and can't
get vaccinated but once that number
drops and each virus is or bacterial
illness is a little bit different but
once that number drops enough then
suddenly you're getting that illness
when you weren't getting it before
because the herd can't protect you
anymore so in a year which is where I
think we should start thinking about
when this vaccine comes out in a year
it'll be interesting to see where anti
vaccination folks land as far as whether
they want this or not well another thing
that's interesting about that is that a
lot of that has to do with children yeah
right it's the parents saying I don't
want my daughter one of actually my
children and of course this specific
virus doesn't really affect the children
Burbank it seems to just pass them by
yeah you know there may be a whole lot
of change there I'm absolutely right
along to go over so what ya know with
everything that you've seen here so far
with this I mean really just surreal
change that we're going through we're
you know you've got a family where
are you really standing in terms of
behavioral changes with where we are
here on March 22nd for you and your
family it's on I'm driving my family a
little crazy
um but I'll tell you that I also made my
kids wear helmets I made my kids not
jump on a trampoline with three of their
friends so it but at the same time you
know I take my kids kayaking so I'm
not totally averse to being outside and
enjoying yourself but this illness
scares me
this illness scares me to the point that
for example my wife hasn't left the
house this whole week mmm except one
time she ran an errand with me and she
stayed in the car
my 15 year old daughter has run a couple
errands to go shopping
she's kind of having to carry us right
now because I'm at work all day and most
of the evening every day so and I'm
trying to get some of my college age
kids to come home and just hide so
that's how we're living is is
doing what we have to do from the house
we search in our living room you have
enough toilet paper we have paper you
know good good well anything else you
want to add here and if any point you
wanted to bring up so I wrote down a
couple things just to share one is if
you remember the peanuts cartoon
mm-hmm
think of everybody as Pigpen hmm if you
get inside pigpens dust cloud
you're too close and everybody is
Pigpen
everyone has this circle of goo around
them and that's what you need to avoid
is other people's dust clouds another
thing that I wanted to share was a
website that I found really helpful that
has unbiased information which is really
hard to find
it's called Kaiser Family Foundation I
think it's affiliated with but not owned
by the Kaiser company it's just a really
good source of objective non spun
information one last thing I think the
president has gotten some grief this
week about referring to this virus a
couple times as the Chinese virus or
something along those lines
we call viruses all the time we give
them a name based on where they come
from it's a it's a non political thing I
think some people are offended and you
know we're being unkind to Chinese
people well it started in China I
mean we call Lyme disease Lyme disease
because it started in Lyme Connecticut
it's not bigoted it's not that we hate
people from New England it's just we do
that with diseases all the time Rocky
Mountain spotted fever is another one we
don't hate people from the Rockies it's
just that's where that disease was found
the Spanish flu
Spanish flu right yeah yeah it's kind of
interesting because you know as you saw
reports of this coming out you did see
the media if not Chinese they call the
Chinese virus sometimes but usually the
Wuhan you know virus and then from
whatever reason it all changed and
flipped very quickly but I don't see a
whole lot of issues there with
racism but I think it's sad that on
either side that there is a politicization
i of all of this I mean this is
this is a very serious issue and I think
a lot of people cannot shed their
political filters they just can't do it
right right and
and this is it doesn't matter what party
who come from believing or support
you're probably gonna get sick yeah the
another really good source is doctor
foul Chi mmm I think he's great he's
he's phenomenal I mean he's like he he's
so straightforward
yes he's so straightforward and
full of information and yeah I am III
pay a lot of attention in fact probably
more than anybody else or anything else
III pay attention to him yeah he he's
the EF Hutton of the current it miss
he's a fine he say about aging yourself
there a little bit but what do you think
we might be looking at in terms of that
hurt herd immunity this first year what
are we looking at 20 30 40 50 60 70 80 %
of the country getting infected yeah
based on my based on the pictures of
Spring Break yesterday oh I think we're
in trouble I think in a lot of trouble
that and it's not so much it's not so
much that actually I was talking with a
bunch of my wife siblings the other
night and what I said to them and
I'm not trying to be alarmist here
but I think this was helpful I said
everybody's gonna get this everyone is
going to get this illness it's a
question of do you get it in March do
you get it in April or do you get it in
May or June
I don't think that it's realistic to
think if I just stay away I'm not gonna
get this because I mean this is like the
perfect virus for taking people down
because of the incubation period and you
have you have a week to ten days where
you're spreading it but you don't have
any symptoms yeah it's like though
that's worse than movies so what is
you know there's for example my
understanding is that Denmark has taken
a totally different tact on this they’re
quarantining everyone over maybe I
don't know where ages is 65 60 I think I
think they hid their elderly yeah they
basically just you know it's almost like
men
for Cle put them off on an island
somewhere yeah and then and then
everybody else is kind of you know maybe
a few changes but pretty normal
day-to-day and they're expecting herd
immunity that way right and that almost
in a way protects the elderly in the
future right to fur that for everybody
else to get the herd immunity for us if
we're already going to all get this is
the only reason that we're doing what
we're doing I mean because these are
very drastic measures yeah I mean we're
bringing the economy to a halt right is
the primary reason the hospitals is the
primary reason saying is that flattening
of the curve I think the primary reason
is spread this out so that we don't run
out of beds mm-hmm hide so you get it in
two months rather than right now so that
we don't run out of ventilators I think
the whole idea is not if you hide you
won't get it at all
I think it's let's slow this down
let's take many of the Ping-Pong
balls in that Ping-Pong ball mousetrap
video hate a lot of the ping pong balls
out let's just make it so this slows
down enough so that we can catch up I
will share that many hospitals including
my own um we have shut down everything
elective so what that means is if you
are scheduled to have your knee scoped
if you were scheduled to have a shoulder
replacement if you were scheduled to
have repeat surgery for your chronic
arthritis or your sinusitis that hasn't
healed in a year and you were scheduling
this out three months from now those
aren't those cases aren't happening
mm-hmm we are we are in the process
of cancelling or delaying everything we
possibly can so that we have
manpower and rooms to take care of these
patients so then really though I mean if
again just hypothetically if everybody's
gonna get this and this virus is
selective and who it's going to take out
so to speak yeah
the only difference then is well I mean
to me is I think about that the only the
only difference in doing what we're
doing in our behavior here in quarantine
etc is the number of fatalities that we
are going to have with this virus
without the help we need
in the hospital compared to the number
of fatalities we're gonna have if that's
a lower number which should be if that's
gonna be a lower number if we have more
if everybody hopefully can get the help
they need at the hospital that's really
the only difference because there's
going to be a number of fatalities
regardless right if everybody's gonna
get it right right so what we're saying
is if everybody were to have a chance to
get to the hospital who gets it then
maybe we have a change in the number of
deaths yeah yeah those that get the help
they need at the hospital knows they
don't is that is that probably a big
number
I don't think we know I haven't seen
that number described I think that's a
great question but if you if you think
about what you mentioned a little
bit ago where Italy is saying hey we're
really sorry that you're horribly sick
we're gonna take care of you as best we
can but we are out of ventilators or
we're not placing patients on
ventilators who are 70 like you are
we're really sorry
I think that would cause hysteria here
mm-hmm
just like I expect it's causing hysteria
there I don't think Italians are any
different than Americans that way right
but you see how upset people have
gotten in the last few weeks about I
can't have a test for this disease
versus how upset you would imagine they
get with my mom can't get a ventilator
mm-hmm I think that's what we're trying
to avoid we're trying to avoid over
running the hospitals with a wave of
suddenly sick patients and we're trying
to avoid running out of beds and
ventilators because it all happens in a
really short period of time well then
that if again if everybody is gonna get
it mmm it seems to me like that we're
going to have some strict measures for
awhile yeah III told my daughter who's
15 and bless her heart
she's not having a good month and she
said well at least this will be done in
a month and I said honey I think I think
we're in for a long run I mean I would I
would be thrilled if warm weather comes
and we're not seeing this problem and
it's better but I haven't seen anything
compelling I've seen ideas that this is
less infective in higher temperatures
and I can't remember if it was lower
humidity or higher humidity but
there were some differences that made
this virus less infected infectious and
we could look at China in Italy though
again maybe this is a sign we know that
things as well as long as the Chinese
are telling the truth we know that the
numbers have come down drastically for
them now Italy at least in the last
couple days here it looks like maybe the
numbers are actually coming down but
again of course that's because the
behavior is in place well I think there
are two things that have happened in
both of those countries one they have
gotten progressively more and more
aggressive about what I'm just going to
call population requirements and - I
think there's through the worst of it I
think
I think this comes up peaks and goes
down and I think China's on the
other end they the wave of illness
has gone through their country and
they're mostly done mmm
and Italy I think is just peeking
I'm hoping that that the numbers we've
seen in the last three four days are
related to the fact that they're done
with their peak it may be that the sort
of draconian societal requirements have
have finally kicked in as well I don't
know that we know that yet until we get
another couple weeks under our belt and
we can see what their curve looks like
but it's the this this is just different
from other illnesses that we've seen
because our bodies haven't seen it
before this is this is scary that way
well can't appreciate it appreciate you
taking the time to do this and ration
out those squares of toilet paper and
and have fun corn streaming as they call
it nice nice well thanks for talking it’s
pleasure
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