Cwic Show- Coronavirus, Can US Hospitals Handle It?

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


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


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


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


think of everybody as Pigpen hmm if you

get inside pigpens dust cloud

you're too close and everybody is


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


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


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


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


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



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