How to Be Prepared for COVID-19

In this webinar, we discuss:

How to think about COVID-19
The growth of COVID-19
How contagious is COVID-19?
What is the mortality rate for COVID-19?
How long will COVID-19 last, and what will the impact be?
Steps you can take to flatten the curve
Resources to help you focus on staying healthy
Tips on boosting your immunity
Q&A: Answers to questions on COVID-19

Show notes:

“RHR: Everything You Need to Know about Coronavirus, with Dr. Ramzi Asfour,” Chris Kresser
“Exponential Growth Isn’t Cool. Combinatorial Growth Is.” Medium.com
“Coronavirus: Why You Must Act Now – Tomas Pueyo,” Medium.com
Coronavirus Resource Center – Interactive Map, Johns Hopkins University & Medicine
Coronavirus Update (Live), Worldometer
COVID-19 #CoronaVirus Infographic Datapack, Information Is Beautiful
FlattentheCurve.com
Coronavirus Telehealth Assessment, Ro
Education Companies Offering Free Subscriptions due to School Closings

Hey, everybody. Welcome to this special webinar on COVID-19 [coronavirus disease 2019]. I wish we were gathering under better circumstances. But I really wanted to take the opportunity to share some of what I’ve learned over the past several days. And, of course, this is changing almost hour by hour. I just heard some new updates that France and Spain [will] be going on lockdown, much the same as Italy. And I think that’s even being considered here in the [United States] now. So, when I was preparing some of the notes this morning, that wasn’t the case just four or five hours ago. And this is a good indicator of the exponential nature of how a viral infection can spread, which we’re going to be talking a little bit more about.

So, before we dive into all of that, let me just make sure that you can hear me and see me. So if you could type into the chat box and just let me know that you can hear and see me, that would be great. Awesome. So thanks, everybody. I see we’ve got about, coming up on 500 people on the call, which I’m happy to see. So we can all be change agents in our families and local communities, and spread this knowledge so that we can protect ourselves and our families and our communities and the global community at large as much as possible. It’s really important. We all have a role to play. So thank you for being here.

Okay, so let me just give you an overview of what we’re going to cover today. I’m going to start with how to think about and frame COVID. I think this is an important step that’s often overlooked, and it really determines our response. So we’re going to talk a little bit about the psychology of a pandemic like this, the basics of human psychology and heuristics, and how to even think about this and approach it. And then we’re going to talk about the virus in some general terms, its characteristics, transmission rates that we’re seeing now, what I think the trajectory might be based on everything that I’m reading, and what we’ve learned so far about the morbidity and mortality rates.

Those of you who know me, you know I’m not an infectious disease expert. I’m just a concerned citizen, Functional Medicine practitioner, [and] researcher who is paying very close attention to this, and I’m gathering together the work of many different experts that I’ve been in contact with over the past couple of weeks, including our infectious disease doctor at California Center for Functional Medicine, Dr. Ramzi Asfour, who used to work for the WHO [World Health Organization] and some other public sources. Then we’re going to cover the impacts, likely impacts on our healthcare system and social, political, and economic impacts. We’ll cover prevention, things like social distancing, hygiene, what to do when you go out of the house, things like that. We’ll talk about preparation, how life is likely to change, and how to prepare for that. And we’ll talk briefly about what to do if you become infected with coronavirus.

On March 14, I held a live webinar to share information on COVID-19 and answer your questions. Check out this webinar recap for those answers and a list of resources to help you prepare yourselves and your family. #chriskresser #coronavirus #covid19

How to Think about COVID-19

Okay, so let’s start with how to think about COVID. So, Tyler Cowen, who is a professor of economics at George Mason [University], has argued that you can basically split people’s response into two broad groups: Base Raiders and Growthers. So Base Raiders believe that the severity of COVID will resemble seasonal flu, or it will burn out and fade relatively quickly, whereas Growthers believe that the virus may grow exponentially, and this could be what Nassim Taleb might call a black swan event. Now, of course, we all bring our own personalities and worldviews and belief systems into this, and that affects how we respond to something like this. And people will respond in really different ways.

I will tell you, frankly, that I am in the Growther camp firmly. I think if you look at the chart that compares exponential growth to linear growth, you quickly see that it’s very, very different. So I’m going to show you an example of this just to give you a visual, because I’m a visual person myself and I imagine many of you are, as well. So let’s see here. Everybody see that? Let me just check and make sure you can all see this. Can everyone see this on screen? Yeah. Okay, good. So what we see here is the difference between a linear growth curve and an exponential growth curve. This is really the one we should be looking at. So, as you can see, the purple line, linear growth is just kind of a gradual, steady growth. And that’s the type of growth line that we’re all more used to in our own lives. This is a much more common function than the exponential function.

But you can see with an exponential growth curve, it starts out pretty close to linear. And these were the early days of COVID in the [United States] for those of us [who] are in the [United States]. But you can see that it can very, very quickly look like an upside-down hockey stick; that’s the exponential growth curve. And this is, of course, what happened in Italy and to a lesser degree in South Korea, which we’ll talk about why. And then Iran and, of course, China. So when we’re talking about exponential growth, it’s really important to keep in mind that we don’t have a lot of analogues for this in our own life. So when I look at the data, I see that COVID appears to be growing exponentially. Some scientists have estimated that the number of cases is doubling every seven days. I don’t think that’s quite accurate at this point. It depends on the place. And it’s very difficult to know for sure, because we don’t know what the true number of cases is.

Now, I mean, that’s one of the biggest problems in the [United States]. We don’t have enough testing. And it’s very likely that the number of actual cases is dramatically higher than the number of documented cases. So when you see news reports showing a certain number of cases, those are obviously the only, they’re confirmed cases. We know from data out of China that the number of true cases is much higher than that. So we’ll cover that in a little while. Now, of course, doubling won’t happen forever. It’ll be limited by natural immunity. And once a certain percentage of the population gets it and develops immunity, that would slow down the growth curve. But a lot of people could get it before that happens, and that’s something that’s very important to keep in mind.

We could easily get to a number of cases in the [United States] and in many other industrialized countries, as has already happened in Italy, that would overwhelm the national healthcare system, as we’ve seen in Italy. So it’s also really important to be aware of cognitive biases and heuristics. There are other aspects of human psychology and decision-making that become really important in a situation like this. Daniel Kahneman, author of The New York Times bestseller Thinking, Fast and Slow, identified several that are relevant here. And, in fact, one of my favorite quotes of his is very germane to where we are right now, which is:

“Overconfidence often arises because people are blind to their own blindness.”

So some of the heuristics that he identified, one is black or white thinking. So all or nothing.

So an example of this might be if I can’t practice 100 percent containment, there’s no point in practicing at all. That kind of thinking gets in the way of taking effective action. What you see is all there is. As humans, [we] tend to be much more likely to believe things that we can see and experience ourselves versus things that we can’t see. So if we look around and things look relatively normal, we figure that they must be relatively normal, and it couldn’t really get much worse. So that can lead to underestimating the effect. Confirmation bias, we tend to seek out information that confirms our worldview and ignore information that doesn’t support it. And that, of course, affects how we find information, where we look for it, and then how we process what comes in. So these are all natural; we’re not going to get rid of them. It’s just important to be aware of them so we can expose our blind spots and think clearly and effectively about how to respond.

The Growth of COVID-19

So let’s talk a little bit about COVID, and the growth of COVID. I’m going to show you some stuff here on screen. It’s definitely clear that it’s growing rapidly. So back, this is an article on Medium. We’ll send out the links to these articles with the replay. So let’s see here. That’s not what I want to show. Sorry, I’m looking. Give me a second here. Okay, here we are. So this was written a couple days ago, so [it’s] already a little bit out-of-date. But you can see on the chart here, this chart of total cases going back from January 22nd to March 10th. But look at the chart showing the total cases of coronavirus outside of China. If you remember what I showed you back here, the exponential curve, this looks very much like an exponential curve. This is not a linear growth curve.

And then we have coronavirus cases per country excluding China. These curves also look very exponential. And then, if we look at coronavirus cases per country excluding China, South Korea, Italy, and Iran, we also see some pretty exponential curves there. So, the Johns Hopkins map, if you’re not already familiar with it, is another good source of information for coronavirus cases. This number is going up precipitously fast. I just checked it this morning. And it’s already up a few thousand cases globally. You can zoom in or out on the map. And you can use the part on the left here to find out the number of cases in different countries, and also, they used to have different states here in the [United States]. But it looks like they don’t have that anymore.

And then you can see the number of deaths and the total number of people [who have] recovered, using China and other locations. And then the Worldometer is another good case here. So let’s see. They’ve got active cases, closed cases, and some other helpful charts and statistics.

How Contagious Is COVID-19?

So how contagious is COVID? Scientists use something called the R naught value to measure how contagious an infectious disease is. And we don’t have the answer for sure to that question. But currently, the estimate is that the COVID R naught value, as you can see on the screen here, is somewhere between 1.5 and 3.5. Now to put that in perspective, as you can see the R naught value for the Spanish flu pandemic in 1918, which caused a number, which was a very serious pandemic, probably the one that’s closest to what we’re looking at with COVID, although it had very different characteristics; it was obviously over 100 years ago. I’m not saying that the number of deaths is going to be the same, but look at it in terms of how contagious it was; Spanish Flu had an R naught value of just over two. And then if you look at seasonal flu, it’s much lower than that. It’s a little bit below one. SARS [severe acute respiratory syndrome] was closer to three. [The] common cold is about two. And then measles is way up here at nine. So somewhere between 1.5 and 3.5. If we choose a median of 2.5, it would be a little bit more contagious than the Spanish flu and the common cold.

So another thing that I alluded to before that we really need to keep in mind is the difference between diagnosed cases and undiagnosed cases. And to understand what’s likely to happen here in the [United States] and other countries, we need to examine what happened in China and Italy, because they’re a little bit ahead of where we are. So if we go back to that Medium article, this is a very, very important chart here.

The gray-greenish kind of bars are the true cases, and they estimated the true cases by asking patients during the diagnostic process where they were, became confirmed cases when their symptoms started. And then the orange or yellow bars are the diagnosed confirmed cases. So what this shows is that the number of actual or true cases precedes the number of confirmed cases significantly, which makes sense, right? Because they hadn’t been diagnosed yet. And this is likely a situation that we’re in now, in the [United States] where a number of people are already infected, but they don’t know it because testing is not widely available.

So this is almost certainly leading to a dramatic underestimation of the number of cases in the [United States] and other countries. So if we look at, like, January 21st on this chart, as an example here, there’s a red arrow where it says official cases start exploding. So there are only 100 new official cases there on that day, but there were 1,500 actual cases. So that’s 15 times the number of true cases versus diagnosed cases on that date. And then you can see that the number of true cases was expanding exponentially from there, as was the number of diagnosed cases. So this is likely almost certainly what’s happening in the [United States] and also in other countries around the world.

Similarly, if we look at, this is a chart that was done overlaying the number of cases in Italy versus the [United States] a few days apart. So you can see they compare Italy, which is about 10 days ahead of us in terms of the outbreak on February 22nd. It looks very similar to the [United States] on March 4th. And we’re actually now on day 11 here. And you can see that on day 12 in Italy, all the schools were shut down. Well, as of today, Utah shut down all of its schools across the state. Many states have shut down schools or individual districts have shut down in various states. As I said at the beginning of this call, France and Spain are now taking much more restrictive measures and are basically going to be shutting the whole countries down, including most businesses, except for essential businesses like pharmacies, food shops, and things like that.

So I tend to think, at this point, that we’re going to follow a similar trajectory to Italy. Unless we can make more testing available much more quickly. We really mishandled that to begin with. It seems like there have been some more positive signs recently. But it remains to be seen how many people will have access to this kind of testing. Now, if you contrast this with Taiwan, it’s a very, very different story. And this is an example of why it’s so important to respond early and aggressively.

Taiwan is a country with 23 million people, yet they only have 50 cases and one death, which is just remarkable and so different than what happened in a country like Italy. And what they did is they tested aggressively very early. They were doing things like employers were taking employees’ temperatures when they showed up for work, and if they had a fever, they were sent home. I think even [at] sporting events, they were doing that. They limited flights from Wuhan and then other cities in China early on. They got hit pretty hard by SARS many years ago, and they learned their lessons and were much better prepared for this kind of thing. And they did take aggressive action early on. And that’s what accounts for the different growth curve that they’ve had versus a country like Italy.

What Is the Mortality Rate for COVID-19?

So let’s talk a little bit now about mortality or morbidity and mortality. There’s definitely good news and bad news here. The bad news is that the fatality rate for COVID by most estimations seems to be significantly higher than it is for the seasonal flu. And again, it’s very difficult to pin down a fatality rate, an exact number, for many reasons. Number one, we don’t know the denominator. We don’t know the true number of cases because testing is not widely available. And as I showed you on that chart a while back from China, the number of true cases is almost certainly much larger than the number of confirmed cases now. Also, the number of, the mortality ratio will vary from country to country, depending on how well it’s managed, how much capacity they have in [the] healthcare system, and whether the healthcare system is overwhelmed. We’re seeing this in Italy versus Taiwan, for example, or even China. And then it varies from population to population. As I’m sure you know, [for] kids, the mortality rate is extremely low in children and it’s much, much higher in the elderly. And it’s also higher in people that have certain pre-existing health conditions. But the best estimates that I’ve seen as of today, and again, this is changing quickly, is an average of about 0.5 to 0.9 percent mortality rate in countries where COVID is well-managed. And then the rate may be as high as 3 to 5 percent in countries whose healthcare system is totally overwhelmed.

Now as a reference point, the mortality rate for seasonal flu is 0.1 percent. So the mortality of COVID could be between five and 50 times higher depending on where you live, what your health status is and age is, and how well the pandemic is managed in your area. It also means that countries that act fast and do manage it well and flatten the curve, which we’re going to talk a lot about shortly, can reduce the fatality rate by a factor of 10. And that’s one of the reasons I wanted to have this webinar and one of the reasons it’s so important to get the message out that we need to act aggressively and early in order to manage this so that we can reduce the mortality and morbidity of COVID.

So how severe is it? I’m going to take you back to another chart. I’m not sure why that’s … Okay, here we go. So, as you can see here, about 81 percent of cases are mild, relatively mild. That’s good news. But the downside is:

About 20 percent of cases require hospitalization,
5 percent require hospitalization in the intensive care unit, and
5 percent require extremely intensive care.

So those are relatively low percentages, but if you do the math, that’s a lot of people in the hospital. So let me come back to that. Let’s first look at the morbidity for different age groups and people of different health status.

So I earlier said it’s [a] much higher fatality rate for people that are elderly. So, as you can see here, [for] people over 80, the mortality rate is approaching 15 percent, which is really scary. And then you have on the other end of the spectrum mortality rate for people ages 10 through 39, [which] is 0.2 percent, and only goes up to 0.4 [percent] for people between the ages of 40 to 49. And then 1.3 [percent for ages] 50 to 59. So it really starts picking up after age 60. And we see the biggest increase after age 70 and 80. Having said that, people with pre-existing conditions like cardiovascular disease are at much higher risk; [people with] diabetes, chronic respiratory disease, hypertension, and cancer all have [a] higher mortality rate. And I would say it’s likely that other conditions that adversely affect immune function would also have a higher mortality rate. We just don’t have enough data to have exact numbers on that for sure.

Some of the data out of China have shown that obesity increases the risk and cigarette smoking increases the risk, not surprisingly, because of how it affects respiratory function. The mortality rate in older Chinese men was extremely high—much higher than in older Chinese women. And the current thinking on that is the rate of cigarette smoking in older Chinese men is much, much higher than it is in older Chinese women.

How Long Will COVID-19, and What Will the Impact Be?

So how long will this last? Of course, nobody knows. But most of the virologists, epidemiologists, and infectious disease experts that I have spoken with and have been following believe that this is a marathon, not a sprint. So we’re talking about months, not weeks. I think it’s pretty unrealistic to assume that this is going to intensify for a week or two and then just peter out after that. There’s really no evidence that that is going to happen. We’re on the, unfortunately, still on, if we go back to the exponential curve here, we’re still on the bottom part of this curve. We’re nowhere near the top. So we’re going to be dealing with this for a while. And what it looks like over the next weeks and months will largely depend on how effective and aggressive our early response is. The more aggressively and effectively we respond now, the less of an impact it will have later and the less serious the consequences will be.

So what will the impact of COVID be? Again, we don’t know for sure. Nobody has a crystal ball. But I would say that I’m pretty confident that it will be like nothing we’ve seen in our lifetimes. And the closest analog in terms of the impact that it may have on our day-to-day life might be something like the Spanish flu pandemic back in 1918. I think it’s very likely that healthcare systems will become overwhelmed. There are about a million hospital beds in the [United States], and that’s just not enough. According to the American Hospital Association, I’m going to scroll down here to find that, just give me a second. So here we are. American Hospital Association. This is from a webinar that they did recently. They estimated the R naught value of 2.5, which is about the median of what I said before, 1.5 to 3.5. So it would take about seven to 10 days for the number of cases to double.

Estimating that about 30 to 40 percent of communities in the [United States] could become infected, that is an astronomically high number. If 5 percent of cases require hospitalizations, that’s almost 5 million hospital admissions in the [United States]. Now remember, we have a million hospital beds. If 1 to 2 percent of cases require [the] ICU, that’s almost 2 million people in the intensive care unit. And if the mortality rate does settle at around half a percent, then that’s almost half a million deaths. So, yes, this is very serious. I’m hearing stories of people and even seeing evidence in my life of people who are kind of brushing this aside and saying that everybody’s overreacting, and it’s not going to be that big of a deal. I desperately hope that they’re right. But I think that they’re wrong. And I think we need to treat this as if it is as serious as it certainly seems like it could be. And it’s far, far better to be over-prepared in this situation than it is to be underprepared.

If you’re reading a little bit of this text here, you’re seeing that the other problem is that we have a dire shortage of critical supplies like masks, ventilators, and other protective gear, and also medications. It’s very unfortunate that business leaders in the [United States] chose to outsource our production of these things. I consider it to be a national security issue, and now we’re finding out why. Because we cannot ramp up production of these supplies. We don’t have the manufacturing capacity here in the [United States]. And we saw this with saline bags. Something like 90 percent of the production of saline bags happens in Puerto Rico. And when they got hit by the hurricane, we were in dire straits with that. And now we’re seeing it with things like N95 masks and ventilators, which will be needed for people experiencing respiratory distress. Other protective gear for healthcare workers. And we’re also experiencing and likely will experience medication shortages. The other issue is that healthcare workers are certainly going to become infected. It’s very difficult to protect them without the proper gear, and even with it, it’s difficult. And it’s not easy to replace them. It takes many years of training, as you know, to train a doctor, a nurse, or another healthcare professional. And if they’re overwhelmed with COVID, we can’t just grab people off the street and bring them in to treat patients.

In Italy and China, particularly in Italy, recently, people were being treated in hallways. Doctors were having to make extremely difficult triage decisions about who to save and who to let die. And, unfortunately, I think that could become a reality here in the [United States]. Now I imagine this is difficult to hear for some of you. It’s difficult for me to say. I wish this wasn’t the case. And I still hope that I’m wrong and that we’ll be able to intervene aggressively and prevent some of the worst effects of this. But I think we all need to be prepared psychologically and otherwise for this type of outcome.

Socially, we’re already seeing a lot of the impacts, of course. Gatherings, conferences, [and] sporting events [were canceled, like the] NBA, March Madness, [and] soccer league[s]. All these things involve large gatherings of people, which, of course, [is why] many of our social events are being shut down. School closures are happening. As I mentioned, the state of Utah closed all of its schools for two weeks; districts are closing in California and New York and other states. I think that’s going to pick up. I think it’s very, very likely that if school in your area, especially if you’re in one of the more affected areas, has not been closed yet that it will be closed. This is very difficult because, of course, healthcare workers like doctors and nurses and other hospital staff have kids. And if they have to take care of their kids because their kids aren’t going to school, it makes it very difficult for them to do their job. So these school closures were not done lightly. That was very much factored into the decision-making process. But most infectious disease experts will tell you, and you can look at what happened in countries like Taiwan that managed this better than in countries like Italy, that those kinds of closures and shutting things down, and increasing social distancing, which we’ll talk more about earlier on, can make a huge difference in the number of cases that you see later on in the process.

It’s possible that we will see more draconian measures soon. I mentioned in the beginning of the call that France and Spain are now basically locking down the whole country. Spain is on lockdown. There’s a possibility that non-essential brick-and-mortar businesses like those except for pharmacies, grocery stores, [and] infrastructure-related businesses like water and electricity would close. The economic effects, of course, are significant. The stock market is already showing this and will likely get worse. Supply chains will be disrupted and already have been. I’m sure you’ve noticed. You’re trying to order things and shipping dates keep getting pushed out further and further.

People are losing their jobs, particularly if they work for businesses with very narrow margins or who businesses that depend on, for example, conferences and large gatherings happening. If they don’t have cash reserves or a plan B, they may not make it through this. So it’s really a difficult problem. And as usual with these things, people of lower socioeconomic status and means are most likely to be affected in the most severe way. And that’s another reason why school closures are problematic because some poor kids depend on the meals that they get in schools. And one of the ways that that’s being handled, like in Utah, is the schools are, they say they’re dismissed rather than closed because the kids who depend on the schools for meals are still able to get the meals at schools. I think the schools are actually even trying to deliver the meals to the kids’ home. So we really need to keep that in mind as we make decisions around this.

So let me just scroll back here. There’s another chart I wanted to find. This animation here shows why it’s so important to act early on COVID-19. This is called flattening the curve. You may have heard this phrase already. The big spike on the left is what happens if you don’t flatten the curve. Meaning if you don’t respond aggressively and early, you get a huge spike in the number of cases, and that completely overwhelms the medical system. Another way to look at it, let’s see if it’s on here. This is a nice chart, too. You see that without protective measures early on, you have overwhelm of the healthcare system, which leads to a much higher fatality rate, because people can’t get the care that they need.

If we take actions to flatten the curve, which I’ll tell you what those are in a moment, then it doesn’t necessarily reduce the total number of cases; it might somewhat. But what it does is you can see here as it spreads them out over time, and that’s very critical in terms of reducing the morbidity and mortality. Because the hospital, the healthcare system will be able to handle that number of cases much better than it would if there were no protective measures, as represented with that orange mountain spike. And it also gives researchers time to find treatments and possibly an effective vaccine, which is not possible in a short period of time, [and] that’s represented by that orange spike there. So this is one of the reasons why it is so important to act quickly and flatten the curve. And there’s another chart down here, if I can find it, [which] shows this graphically. Let’s see.

So you can see here, this is a projection, not based on real data, but just epidemiology. If measures are not taken to flatten the curve, this just keeps going exponentially up. And you can see, the purpose of this chart is to show how much difference even a day could make. That’s why I’m here doing this webinar on Saturday, rather than waiting until Monday to do it. Because even one day’s difference of social distancing within a community can result in potentially hundreds or thousands more cases. And if you’re talking about three or four days’ difference, that would be much higher up on that exponential curve. You can just draw a straight line from, let’s say, day 23 up, and you end up at 12,000 cases instead of if you did it on day 20, under 5,000 cases. And that, again, is the cost of the exponential function.

Steps You Can Take to Flatten the Curve

So this one shows a little, what happens if it’s a little later, that’s a 40 percent difference between the distancing on day 20 and distancing on day 21. So sorry about that phone ringing in the background. I forgot to turn it off. All right, so let’s get back here. So how do we flatten the curve? This website, not coincidentally called Flatten the Curve, is one of the best collections of steps, recommended guidance that I’ve seen. It’s compiled by Julie McMurry who has a Master’s in Public Health at the London School of Hygiene & Tropical Medicine, which is one of the premier institutions in the world for this kind of thing. And you can see here she’s got a very comprehensive list of do’s and don’ts and also some other great data that’s similar to what I’ve been covering in this webinar so far. So I’m not going to go through everything that she lists; you can do that on your own. But I’m going to cover some highlights.

So again, just to create the general frame here, there’s a spectrum between complete isolation and doing everything you could possibly do to protect yourself and doing nothing at all on the other end of the spectrum. And, of course, different people will approach this differently according to their own psychology and worldview and belief system. My recommendation is to err on the side of caution to flatten the curve but not go overboard. We still have to consider our mental health and our well-being, especially because those are very closely related to our immune function. If we just get completely overwhelmed with stress and panic, then that will actually weaken our immune defense. So there’s, not to mention make life miserable for ourselves and those around us. But it has a definitely a negative impact on immunity.

And we have to keep in mind that this is a marathon, not a sprint. So a lot of us have stocked up on food and essential supplies. And that’s not a bad idea when there’s panic buying happening. But I don’t think that grocery stores and things like that are going to be shut down for six months. This is going to take, play out over a period of time, and so we need to be prepared for that marathon and not exhaust ourselves psychologically over the next week or two. So here are some things we can all do both as individuals and as families and as local communities to flatten the curve. Number one, perhaps the most obvious, is to practice good hygiene. Wash your hands frequently and correctly. I’m sure you’ve seen this a million times by now online, but in case you haven’t, that means washing with soap and water, [for] at least for 15 or 20 seconds. So that’s “Happy Birthday to you. Happy Birthday to you,” singing the “Happy Birthday” song twice. You see my inquisitive daughter, Sylvie, is in the background here.

So that’s washing your hands frequently. I would say every time you come in the house, if you’ve been out, and then even when you’re in the house, if you’re touching surfaces, especially if someone’s been sick, even if you haven’t had a positive test result. [Use] hand sanitizer when you’re out. That’s important. If you go to the grocery store, for example, you may want to use gloves and then dispose of the gloves right after you finish, and then use hand sanitizer immediately after that. Or wipe down the cart first. A lot of grocery stores have those wipes near the carts, and then use hand sanitizer after you leave the store. Then you would sanitize frequently used surfaces at home. So you can use, like, Clorox wipes or any wipes that are shown to kill germs.

So what about gloves and masks? I’m sure you’ve seen a lot of discussion about this online. Masks like an N95 surgical mask, if worn properly, would certainly reduce the risk of you contaminating someone else if you have coronavirus. They’re vital for healthcare workers to have who are working in close proximity to people who are coughing and expelling droplets in their direction. If you don’t already have a mask, unfortunately, you’re probably not going to be able to get one right now because they’re out of stock, and we desperately need them for healthcare workers. I’m often asked [if] people should wear masks when they go out. I think it partly depends on your risk profile. My parents, for example, are in their late 70s. If they were to go out and go shopping, and they lived in a place where there was community spread, and they had an N95 mask, I think that would be a sensible precaution for them to take.

Gloves. As I said, they can be useful in some situations. The virus can get on gloves and stay on gloves, and you can’t wash gloves like you can wash hands. So I don’t think it makes sense particularly to wear gloves for an extended period of time, like as you’re moving through an airport, unless you’re disposing of the gloves every time you touch a surface that could be contaminated. But if you’re going to do a discreet activity or errand, like you’re going into the store, you’re touching things, and then you can take the gloves off and wash your hands or use hand sanitizer right after that, dispose of the gloves, then I think that could make sense.

The next precaution that I think is as important as hygiene, or right up there, is social distancing. This is really the one that’s most important on a community-wide level for flattening the curve. So this means keeping your distance from other people. Six feet or more is safest to prevent the spread of infectious droplets, and this is even more important for people who are at higher underlying risk. Like, if they’re older, they’ve had recent major surgery, [they have] cancer, they’re immunocompromised, or they have respiratory issues like asthma, or cardiometabolic issues like diabetes, or obesity or cardiovascular disease. The more of those factors you have, the more you should be avoiding crowds and practicing social distancing. And, in fact, the CDC [Centers for Disease Control and Prevention] currently is recommending that the elderly stay home as much as possible right now. But we have to be aware of the effects of social isolation over time.

As I’ve said a few times now, this is going to play out over months, not weeks. So it’s very important to stay connected with friends and family, but do it wisely and with precaution. So, for example, you could take a walk outdoors where you’re six feet apart if you’re someone who’s at high risk. You could go to a park, a beach, or another outdoor location where there’s plenty of fresh air and open space. You can take a bike ride. You can play a sport like golf or tennis that doesn’t involve close proximity or contact with other people. You can do FaceTime or video chats with your friends and family to stay connected. So we have to balance this need for social distancing and flattening the curve with our mental health and well-being and that of our friends and family members who might be more isolated than we are.

I recommend canceling all non-essential travel. Of course, non-essential means different things to different people. I had one of my patients ask me, he was planning a ski trip to Aspen and was feeling like that was pretty essential. But for me personally, I can just tell you that I’m not doing any travel through an airport or on an airplane right now. I’ve canceled the trips that I had planned. A couple of them were conferences that got canceled anyway, but I think at this point, in order to do my part in flattening the curve, it makes more sense just to stay home and put off any of those trips that might have been planned. Only you can decide your risk and reward profile. And, of course, it will vary depending on your situation based on all the factors that I mentioned. But camping might be a great vacation idea right now instead of air travel.

Likewise, we want to avoid larger groups of people. A lot of states have already instituted measures to make that mandatory. Utah’s outlawed gatherings of more than 100 people. They’ve kind of canceled those. Different states have set different thresholds for that. And they’re taking different measures based on their own assessment of the situation. But even if your state hasn’t taken action, I think it makes a lot of sense not to spend time in large groups, especially indoors. The problem now is that most people who have coronavirus don’t know that they have it because there’s not adequate testing available. So by the time you find out that there has been community spread in your area, it’s too late to prevent it.

I’m also personally avoiding smaller groups depending on the situation. So, if it’s a group of six people sitting in a very tight space, or in an elevator, for example, something like that, I would not really want to put myself in that situation. But I would have no problem attending a birthday party, let’s say, at an outdoor park, where people are a little bit more spread out, particularly if there’s an awareness of social distancing in that group. We just kind of have to evaluate these things on a case-by-case basis. And again, we have to consider our mental and emotional well-being. But generally, the easier it is to maintain the six-foot distance, the better. If it’s outdoors, it’s better than if indoors. The more control you have over your own personal space, the better.

Most authorities now are recommending using telemedicine instead of going to the doctor. Certainly, doctors’ offices are going to be places that are much, where you’re much more likely to get exposed to COVID. Many doctors are now offering telemedicine or phoned visits. Ro, which is a telemedicine company, is offering free telemedicine assessments now. So here’s the website. It’s GetRoman.com/coronavirus and you start, you fill out, like, an online assessment here. And then if you meet certain criteria, they connect you with a telemedicine doctor, and you may be able to get testing depending on where you are.

So, again, we’re not choosing between a perfect alternative and a terrible alternative. We’re often making choices that are a little bit more blurry. So we have to keep that in mind and not let the perfect be the enemy of the good. So, for example, non-contact sports would be better than contact sports. Tennis is better than rugby or tackle football. Takeout or delivery is better than eating on a restaurant patio. But eating on a restaurant patio is better than eating inside of the room. Streaming a video at home is much better than going to a movie theater. Going to outside events is better than inside events, and small events are better than large ones. Ordering supplies to be delivered to your house is better than going in person. But if you do go in person, shopping at non-peak times is better than shopping at peak times. So this is an example of where it’s important to avoid black and white thinking, and realize that some precaution is better than no precaution.

What about stocking up on essentials? Well, I alluded to this earlier, but this is going to be a marathon. Hopefully, many of you already have some supplies for the next week or two. That can limit the number of trips you have to make. But there’s a great quote from the FlattentheCurve.com website that I want to share with you. It goes,

“Experts aren’t telling you to stock up on essentials because they think you’re going to run out of food and society is going to collapse. It’s because a few days of panic buying and high demands cause more panic and stress systems unnecessarily. Also, being in line with hundreds of people isn’t wise. Go off peak. Buy a little more than what you need [each time you do go out]. Preparedness isn’t about doing nothing, but also about not overreacting. It’s about doing your part to put the slack in our systems so that short disruptions are as smooth as possible, can absorb extra load, and resources remain available for those most in need.”

So, again, this is going to be a marathon. I think you’ll have a chance to go to the store again. Things will come back in stock. But if you’re able to go shopping during those off-peak times and just get a little bit more than what you need, for the next few days, you can gradually build up more of a reserve. And being prepared for an emergency is never a bad idea. When living in a state like California, for example, that has earthquakes and wildfires where the power can go out, that’s just [a] sensible precaution that most people take. And having a couple of weeks of food on hand for a situation like this, now we’ve all seen how useful that can be, as well. So this will play out over time, and it’s important not to panic and get too worried that we’re going to all run out of food in the next couple of weeks. I don’t think that’s going to happen.

Right now, I don’t see any reason to believe that power will go out or tap water will not be available. That doesn’t mean it couldn’t happen. I’m just not seeing a reason that that would happen at this point, which is a blessing. It means we have a lot more options for stocking up on food. We can have frozen food and food that requires power to cook. And it means that even if water purification stopped, we could boil water that’s coming out of the tap and be able to drink it. It’s not a bad idea to have three days of water on hand for an emergency, but I don’t see a huge need to stock up beyond that. And then lastly, at least what I’m going to cover, there’s, of course, much more you can get on the Flatten the Curve website, working from home as much as possible is really helpful. That’s going to be mandated by a lot of companies. It already has been by some. And we might actually do a separate webinar on this at some point because we’re a virtual company. We have a lot of experience working virtually, and [we] might be able to share some valuable tips for folks who are new to it.

On the don’t do list, I would say don’t wait to see how this plays out. As I hope I’ve gotten across, acting aggressively and early is extremely important. Try not to touch your face. That’s hard. I’m a face toucher myself, and it’s very difficult not to do that, which makes the hand hygiene and other protective measures even more important. Of course, don’t shake hands. Don’t touch public surfaces with your fingers.

Resources to Help You Focus on Staying Healthy

Okay, so let’s shift over a little bit into how to get through this. For me, as I’ve reflected on this, what’s been even more clear than ever before is the importance of staying healthy. I mean, we all know, we want to be healthy. We want to extend our lifespan, [and] we want to live free of pain and discomfort as much as we can. But if there’s ever been an event in our lives that has brought the importance of maintaining optimal health into focus, it’s this one. Because what we see is that people who are healthy at any age have a much better survival rate than people who are not healthy. And this is one of the things that worries me so much about how this will affect the [United States]. We have 45 percent of the population [that] is obese, and obesity is a risk factor. We have one in three Americans with pre-diabetes or diabetes, and diabetes is a risk factor. Many of our elderly who are at the highest risk have obesity and diabetes and possibly cardiovascular disease, which just exponentially increases their risk. And this is different than in many of the other countries that have been affected so far. Our rates of these conditions are much higher than these other countries. So I’m very concerned on that level.

As the American Hospital Association data suggested, up to 30 to 40 percent of Americans could become infected and people around the world in industrialized countries that don’t respond as well as they could have. So fortifying your immune system is critical at any age. There are four pillars to staying healthy, which you’ve heard me say a million times, [and] I’ll say them again:

So staying on top of these is even more important in this time. I would argue that stress management is one of the most important and often one of the things that people tend to do the least in situations like this, and in life in general. I’ve found from more than 10 years [of] working as a clinician, it’s the thing people struggle with the most.

As humans, and really any animal, any mammal and animal, we’re paralyzed by fear and panic. It turns on our fight-or-flight response, it increases the production of cortisol and adrenaline, and a lot of that prevents us from taking effective action, especially on a longer-term basis. So it’s absolutely imperative to take steps to manage stress, fear, and panic. I have kind of doubled my meditation practice since this started. I just intuitively felt like [it] was necessary to spend more time doing that. It really helps me to stay grounded and clear. It helps me to sleep, [and] it helps me to manage all this stress that comes with this. If you’re new to meditation, there are apps like the Waking Up [app by Sam Harris], Calm, [and] Headspace; they’re all great. [If you Google] Mindfulness-based stress reduction, there’s some really good free audio programs you can download that help you learn how to do that. It’s a scientifically validated practice [out of the University of Massachusetts] that combines breathing and meditation to help manage stress.

[For] deep breathing, [there are] lots of videos on YouTube on how to do that. If you’re new to yoga, YouTube is your friend. There are amazing yoga videos. I like Yoga with Kassandra; Yoga with Adriene is another good one. There’s an app called Down Dog that allows you to design your own yoga classes based on your preferences and ability level. Things like warm baths, spending time with animals and pets, listening to meditative or calming music, and spending time outdoors can all be critical at this point. I also think we need to focus on cultivating resilience. And that’s more important than ever. The definition of resilience is the capacity to recover quickly from difficulties or toughness and grit. And staying healthy, of course, is a crucial part of resilience. But there are other important factors, as well, like mindset. Employing positive psychology. Keeping a positive attitude. Hardwiring happiness is another way of putting this. There’s a great book called Hardwiring Happiness that I really like and can be helpful in situations like this. Pema Chödrön has a book called When Things Fall Apart that’s really good. And then Jon Kabat-Zinn’s Full Catastrophe Living. Those are all books that can help to manage very difficult circumstances.

Likewise, joy and laughter become essential. They are the antidote to stress. You can’t be laughing and be stressed at the same time. Those are incompatible systems in our body. So watching funny movies or playing games or spending time with your kids, more quality time with kids, and playing and wrestling and roughhousing. Whatever it is that brings you joy and makes you laugh is critical right now. Social connection. Of course, this is a double-edged sword when we’re talking about social distancing. But for people that are in our immediate vicinity that we’re connected to, or even spending time with adequate social distance with friends or family members, taking walks outside, some of the things I talked about before. Doing FaceTime or other video chats. It’s really important for us to stay connected during a time like this.

Play is critical. It’s another thing that helps to combat stress hormones; it releases endorphins, and it helps us to build resilience. And then, last but not least, purpose and service. I’m going to talk about that a little more in a minute here. But that’s really critical to cultivating resilience. It’s important to stay engaged and grounded. So again, YouTube is your friend. There are so many things you can learn at home through YouTube now. You can learn a new language, you can learn a new hobby, you can pick up a musical instrument, you can learn to cook better and try new recipes, [and] you can improve your vocabulary. You can read a lot. I know a lot of people have a lot of books on their list that they want to read. Now’s the time to catch up on that. And I would highly recommend reading fiction or nonfiction, not just the news. Because the news can really trigger that stress response and be overwhelming. Spending more time outdoors in nature, slowing down, resting, napping more, allowing this kind of enforced break to happen. Play board games, make art, do puzzles, do home improvement projects.

One of our staff members, Jill, found this great list of free educational offerings from companies that are being offered during COVID. And we’ll send out a link to this. But these are great things that you can do at home to keep yourself engaged through this period. Be of service. So we have to come together as a community locally, nationally, and globally. Vulnerable populations are always the most affected by these kinds of outbreaks. And we can help the elderly, [and] we can help the sick in our community. You might consider helping an elderly neighbor or someone who is already dealing with a challenging health situation. You could do shopping for them, using adequate precautions, of course, or do errands. If you have financial means, you might consider helping people that don’t, to stock up on some essential supplies. So crisis can bring out the best and the worst in humanity. But let’s all do our part to make sure it’s bringing out the best in us.

Tips on Boosting Your Immunity

Okay, last section here. I’m going to talk a little bit about some tips for boosting immunity above and beyond diet and sleep, and stress management, and physical activity. So extra vitamin A can be very helpful. It improves immune function by several mechanisms. If you’re eating liver or other organ meats, that’s probably enough for maintenance. If you’re not taking cod liver oil, a teaspoon a day is a good way to get it. If you feel like you’re coming down with something, even just a cold, taking 50,000 IU two times a day for up to five days can be very, very helpful. Don’t do that long-term because high doses of vitamin A taken over a long period can be toxic. But in the short term, it has been shown [to] boost immune function. Getting enough vitamin D, but even taking higher doses of vitamin D for short periods of time, like 10,000 to 50,000 units a day for one or two weeks to bolster your immune system, can be helpful. Again, don’t do this long-term because vitamin D can be toxic at high doses over an extended period.

Zinc lozenges. Zinc [has] actually been shown to be effective in blocking coronavirus and other viruses from multiplying in the throat and nasal pharynx. So you can use those several times a day if you start to feel symptoms. Propolis has been shown to increase cellular immune response and act as an antiviral. My favorite propolis product is from Beekeeper’s Naturals propolis spray. They also have several other products from the hive that I really like, including B. Powered, which is a combination of honey, propolis, [and] royal jelly. And in the near future, if they don’t [have it] already, they are coming out with a cough syrup that combines honey and elderberry and a few other things. So I can get you a discount with the Beekeeper’s products. So if you go to Kresser.co/Beekeepers, you can get a discount on some of those if you’d like to order them.

Bone broth is critical, too. So that’s really important for immunity; it’s critical for gut health, and gut, 30 to 70 percent, depending on what numbers you look at of the immune system, exists in the gut. You can make broth yourself if you have bones either from ruminants or chicken, chicken bones or chicken carcass. It’s pretty easy to do. You can look that up on Google. If you don’t want to deal with making [it] yourself, Kettle & Fire is my favorite broth company. They simmer it for 24 hours. It’s thick, there’s plenty of collagen and glycine in there, and they have different flavors. And you can order it and have it delivered to your house. You can get a discount from them, as well, at Kresser.co/kettlefire, all one word.

And then, lastly, some botanicals can be helpful in boosting immune function. Cordyceps is one, Angelica sinensis, which is dong quai, and TCM, [or traditional] Chinese medicine. Rhodiola and Astragalus. So one formula that’s recommended by herbalist Stephen [Harrod] Buhner would be:

Three parts Cordyceps,
Two parts Angelica or dong quai,
One part Rhodiola, and
One part Astragalus.

And then you take one teaspoon three times a day for prevention and just boosting your immune function. Okay, that was a lot. So we’re about an hour and 10 minutes in. I see that there’s a lot of questions. So I’m going to do my best to answer a few of these questions and see how far we can get in the amount of time that I have allotted. Okay. Just give me a second here. Take a sip.

Q&A: Answers to Questions on COVID-19

All right, I’m going to stop the screen share, as well, and just get my screen set up for questions. Okay. So the first one is from Kristen.

Q: “What canned or frozen goods are most nutrient-dense and [which] brands are recommended?”

A: I think frozen vegetables and fruits are more nutrient-dense than canned vegetables and fruits generally because they’re typically frozen soon after they’re harvested. So I don’t know that it comes down to a particular brand, but generally, I prefer frozen to canned for that reason. Canned, of course, are shelf-stable. So it’s good to have some canned foods around in case there was a power outage, in which case the frozen goods wouldn’t last very long.

Next question from Jennifer.

Q: “It seems that inflammation is the way this disease kills. Should we be loading up on anti-inflammatories or antihistamines?”

A: That’s often the case with viral illnesses, and the Spanish flu pandemic was a good example of that. And in fact, [it] was the reason why 18- to 25-year-olds actually had the highest mortality rate from Spanish flu, because they had the most robust cytokine response. And it was the cytokine response that killed them, not the virus itself. So that is true. But at the same time, that doesn’t lead me to think that taking anti-inflammatories or antihistamines would work, because those are essential parts of our immune function that we need to protect against infections.

Terry says:

Q: “Is high-dose vitamin C a concern for those of us who have iron overload?”

A: It does increase the absorption of iron. It’s hard for me to specifically respond without knowing your actual iron numbers and how responsive you are to iron in various foods. But I will say that high-dose vitamin C, the actual data on its efficacy for viral infections is mixed. And I’m actually more persuaded by higher-dose vitamin A and, [in] some cases, vitamin D. Although I think for most people taking high-dose vitamin C, it might be a sensible hedge, even if the data are mixed. If you’ve got iron overload, I would just take the vitamin C well away from any iron-containing food as a precaution.

I’m going to scroll through here. Some of the questions that were asked earlier on, I’ve already answered. Emily asks:

Q: “What do I mean by a black swan event?”

A: I’ll just speak briefly to it and then you can Google Nassim Taleb, Black Swan. Essentially, it’s an exceptionally rare event, and we tend to discount the possibility or the likelihood that something like that will happen, because we’re so used to seeing white swans.

Next question, [from] Ruth.

Q: “Should rideshare drivers stop working if they’re seniors with chronic conditions? Should they be tested?”

A: If it’s possible without severe hardship to stop working, I would be cautious in that situation if someone is elderly and has a chronic condition. Because [in] a car, there’s not going to be six feet of distance. And it’s an enclosed environment. As for being tested, if you’re displaying any symptoms at all, then yes. If not, I think it’s going to be pretty hard for you to get a test right now.

Seton asked:

Q: “Do you think people that are creating hysteria are not living and eating [a] clean lifestyle and are not confident about the immune system fighting off viruses and disease?”

A: No, it’s hard for me to know what you mean by creating hysteria. I think people who are, some people who are just taking it very seriously understand the exponential nature of these kinds of viral infections and know that flattening the curve early on will dramatically increase the survival rate and lessen the likelihood of overwhelm of the healthcare system. But if people are panicked and hysterical about getting it, it may be that they do lack confidence or they’re afraid that there’s something going on in their body that might not play well with the virus. Or they’re concerned about their loved ones; they’re concerned about getting it themselves and then passing it on to someone who is at risk. I think that is a valid concern. Because once these things start spreading through the community, it can be hard to stop it.

Michael asks:

Q: “How risky is shopping for food at a grocery store?”

A: I think there’s no simple way to answer that question. But if you practice some of the social distancing and other recommendations, like going at off-peak times, maybe if you wear a mask, if you wear gloves, if you use hand sanitizer before you enter the store and after you take off your gloves, if you maintain at least six feet of distance while you’re shopping, then you’re reducing the risk. We can never get to zero. But that’s what I’m saying. To avoid black and white thinking, taking some precautions is better than none. And we have to eat. So if you need to go to the grocery store, or you need to eat, that’s better than not eating and starving yourself.

So on the other hand, maybe for a period of time as we continue to watch and see how this plays out, if you’re able to order food very easily, which some people are. If you have Amazon Prime, you can order Whole Foods and [have it] delivered to your door in two hours in a lot of metropolitan areas. Some other places have grocery delivery, then maybe that’s a better option. Now, of course, if someone’s handling those bags or packages and they’re not wearing gloves, or even if they are, and their gloves have been contaminated, you could ask the question well, don’t we need to disinfect everything that’s been carried in. Some have recommended creating like a kind of holding area in the home for packages and other things that have been delivered where you wait a period of days before you handle them. Obviously, that’s not going to work for perishables or groceries, but the idea was that you lessen the likelihood that the virus will survive on those surfaces.

I’m not sure how practical or realistic that is, and I’ve seen some data that the virus may survive up to seven days or even more on some surfaces. So I don’t know that that’s really practical.

Next question, Becky.

Q: “I heard that [a] large percentage of those not elderly and not immune-compromised would not even present with symptoms, or if so, perhaps, like, a mild cold, and not even flu. Is there any truth to this?”

A: There is some truth to that. [For] some people, it’s extremely mild, and they don’t even, they probably don’t, it just passed relatively quickly, and they didn’t know that they had it. On the other hand, I’m aware of some healthy people in the younger age groups in their 30s and 40s who have had a pretty severe case that required hospitalization. And these people were, at least as far as they knew, they were healthy and didn’t have any pre-existing conditions. So there’s no guarantee. There’s no guarantee that if you’re 30 to 40, or 40 to 50, and you get it, it’s going to be mild. And there’s also no guarantee that if you’re over 80, and you get it, it’s going to be severe. We’re just dealing with probabilities here. And that’s really important to keep in mind.

Next question.

Q: “Is this a virus you can get more than once? Or you’re completely immune once you’ve had it?”

A: Almost certainly, you’re immune once you’ve had it. There was a story in The New York Times yesterday or today about a man in China who was quarantined or isolated because he had tested positive, or I believe they, he had tested positive for coronavirus or they had diagnosed him with coronavirus. Then [the] people in his apartment building had a party for him once his isolation was over, and a day or two after that, he was diagnosed again with coronavirus. So they were concerned and thought that maybe that means you can get it more than once. But most of the scientists and people that were consulted [by] that article believe that there was probably a misdiagnosis initially. That he didn’t initially have coronavirus, [that] he might have had, it was just influenza and then [he] did get coronavirus. Which brings up an important point. It’s a good idea to avoid getting the flu as much as you can, too. And all these measures we’re talking about will help with that. Because flu can weaken your immune system and could make it more likely that you would get coronavirus or more likely that you would have a more severe case.

Let’s see here. Jennifer is asking about:

Q: “Data suggesting that warm weather will slow the spread.”

A: I’ve heard, I’ve seen mixed data on this. Some are arguing that it is. Others, like [an] infectious disease expert whose name unfortunately is eluding me, that was on Joe Rogan[’s podcast], he’s at the University of Minnesota Center for Infectious Disease [Research and Policy], believes that that’s not the case. So I don’t know that we fully know the answer to that question yet. Certainly, if you look at influenza, that’s true. We have a flu season that’s during colder periods, or colder weather for most people, and drier conditions. So humidity and warmth, [it] wouldn’t be surprising if those were beneficial. But I don’t know that we fully know the answer to that with COVID.

Leah asked:

Q: “What concerns, recommendations can you express [to] those that still must work but are on biologics and comorbidities? Concerns or recommendations for the elderly that must continue to work with comorbidities?”

A: Yes, just taking as many of the precautions that we’ve talked about as possible. If they have access to masks, just being extremely diligent about hand hygiene and social distancing, if possible. Doing some of the immune support things that I mentioned. Really focusing on diet, stress management, [and] physical activity as it’s possible. And just, like, being extremely diligent. Unfortunately, that’s really, if they are required to work and they do have those comorbidities, that’s the best they can do.

Okay, so Tom asked:

Q: “Is it too late for the [United States] to flatten the curve?”

A: That’s a great question. I think it would have been better for us to act more quickly, particularly with testing. You see that that’s one of the biggest differences with, like, Taiwan and South Korea who handled it better, is South Korea was offering drive-through testing [for] anybody that wanted it relatively early on. Not right away, because they got off to perhaps a slightly slow start at first, but then remedied that very quickly. And [they’re] testing something like 10,000 people a day, if I remember the numbers correctly, which is more people than we’ve tested, period. So I am seeing some optimistic signs now, just in the last 24 hours, even in the last eight hours, that we’re ready to take more aggressive action. And I hope that will have some impact on flattening the curve. I think we could have made it flatter if we had acted more aggressively in these cases.

Q: So [there’s] a question about [the] flu shot.

A: I mentioned before, it’s a good idea to prevent influenza. And the flu shot this year from, I did a podcast with Ramzi Asfour, infectious disease doctor, and the data he shared suggested the flu shot might be about 50 percent effective. But we’re also at the end of flu season. And the infectious disease expert on the Joe Rogan episode mentioned that it’s likely, if I remember correctly, to not have as big of an impact, of course, as it would have had if someone had gotten it in back in November or December. So you have to take that into consideration and also consider the risk profile. I think [for] elderly people and people who are at higher risk, it might make more sense for them.

Louise asked:

Q: “Where do we go if we think we’re sick but don’t want to catch COVID in case we’re not?”

A: That’s a great question. I shared the Ro telemedicine website, Ro Health. They’re offering free telemedicine assessments. I just heard that in Utah, they’re going to be ramping up and starting to offer drive-through testing. So basically, you drive up to kind of a tent-like structure. Somebody comes out, hands you a swab, you swab your cheek, you give it back to them, and then you get results after that. It could be four days, [or] it could be shorter as some of the newer, faster turnaround time tests come online. That’s the best-case scenario if you’re not, if you don’t have symptoms that require hospitalization, drive-through testing is the best option if that’s available.

Karen asked:

Q: “Is there a downside of considering everyone positive and acting accordingly?”

A: Probably, because you will be, if this plays out for six, for several months rather than weeks, you would be pretty isolated in that situation. But I think, I mean, that’s kind of not too different than what is being recommended here, which is to practice social distancing. You’re not going to probably do that if you have young kids and the people you’re living with in close proximity, that’s going to be difficult. But if you want to maximize your prevention and lower your risk of getting it, then you would be practicing that kind of social distancing with other people because you don’t yet know if they have it. Over time, more and more people are going to get it, and they’re going to recover and they’re going to be immune. So that’s actually how these pandemics do peter out over time, is the sufficient number of the population gets the disease and develops natural immunity. And then, after some period of, or there’s a vaccine that’s developed or some other treatment, which results essentially in the same natural immunity.

So next question [from] Emily.

Q: “Any sense of how to get accurate info about how long the virus can live on surfaces?”

A: I don’t know that we know with absolute certainty, but I’ve seen anywhere from three to seven days as an estimate, which is a substantial amount of time and definitely argues for disinfecting surfaces.

Ed asked:

Q: “What’s the reasonable estimate of the ratio of verified cases to actuals?”

A: It depends on where we are in the curve. And that would be different in different places. But if you remember that graph I showed from China, when there were 100 confirmed cases, new cases on that one day on January 21, there were actually 1,500 cases. So that was 15 times the number of true cases versus confirmed cases. So we know that that’s at least possible to have that kind of differential or delta. It could be higher in some places, [and] it could be lower in some places, depending on the amount of testing that’s being done.

Q: So there’s a question about elderberry and COVID, and some people are recommending against elderberry because it could increase the inflammatory cytokine response.

A: Let’s see if someone who’s on, maybe Jill, if you can link to Stephen [Harrod] Buhner’s response to that on Facebook. Buhner is an herbalist who I have great respect for. He does very, very deep research. He understands the traditional uses of botanicals, but he also has encyclopedic knowledge of the modern clinical research on these medicinals, and he has argued that elderberry is actually an immune modulator and it modulates the inflammatory cytokine response. It doesn’t amplify it. We’ll see if we can find a link and post that in the chat area so you can read it yourself and come to your own conclusion.

Lynne asked:

Q: “How do we deal with a family member if they’re coming into the house after being away? Do we quarantine them? How do we create health safety when a family member comes to visit?”

A: That’s a really good question. And it’s, there’s no right or wrong answer here. It’s going to depend on your level of comfort and your approach to this. And also, I think, it depends on where you fall on the risk spectrum. So, for example, if you have someone in your life, or if you yourself, were someone in your 80s, or in your high 70s, and you’re overweight or obese, and you have diabetes, and cardiovascular disease, or any other kind of immune-compromising factors, then I think it would be actually probably a pretty good idea not to have other family members coming and going, at least in the short term. Because you’re at the highest risk. If the family member is not taking adequate precautions when they’re out and about, and then if they’re not maintaining adequate social distance and practicing really, really diligent hygiene when they’re back in the house, then that may be a situation where it’s a good idea not to have that family member coming and going.

However, in situations where the household is mostly people under 40, they’re healthy, the family members that are coming and going are under 40, and they’re healthy, the reality [is], you can do your best. And I still recommend following everything that we’ve talked about in the webinar today. But it may, the stakes are a little bit lower. If one of you does become infected and infects the other people, then it’s a lot less likely that that’s going to have serious consequences. So the stakes are lower in that situation. And then, if you isolate yourselves and prevent yourselves from infecting other people and you develop immunity, then that’s not a terrible outcome. It’s not absolutely the end of the world if you’re a healthy person and you get this, and you experience a kind of mild to moderate flu-like illness and then you become immune to it.

In fact, that’s not a bad outcome at all. That’s an outcome that is likely to happen for a large number of people already at this point. And what we want to prevent in that situation is from you infecting other people who are at much higher risk and would result in a hospitalization because we’re trying to keep from overwhelming the healthcare system, or potentially something worse than that.

Okay, I’m going to answer a few more questions and then we’re going to wrap this up. I’m sorry I wasn’t able to get to all your questions. I know this is very much on your minds and there are many unanswered questions still for all of us. Let’s see here. Let me see if I can find a couple that I haven’t addressed at all in the webinar.

Corrie asked:

Q: “Do we know why children are not at greater risk?”

A: We actually don’t know that right now. Different flus, or different viruses rather, have different profiles in this regard. I mentioned earlier the Spanish flu; the population that was at the greatest risk was 18 to 25. And I think we learned that that was because their immune response was the most robust and it caused the greatest cytokine storm. But we don’t yet fully understand why kids are at so much lower risk.

Q: “Is it okay to eat raw foods or does everything need to be cooked, since we don’t know who handled the groceries?”

A: Again, we’re on the spectrum here of how much precautions you want to take. Cooking, cooked food, [is] definitely better than raw food for that reason, and you’ve got to filter it through the same kind of decision-making process that we’ve been talking about all along.

Q: “If someone coughs or sneezes on your food, is that a way you could get infected? Or does the sneeze have to get into your nose or mouth?”

A: I think it’s plausible that you could become infected that way. The initial transmission of this jumping from animals to humans was probably from a human eating an animal that was infected.

Let’s see. [The] question was:

Q: “What are your thoughts on those of us with autoimmune conditions?”

A: I would take additional precautions. In some cases, people with autoimmune conditions where the Th1 response is extra active are actually less likely to get influenza and viral infections and even things like the common cold. I’m sure many of you who have autoimmune diseases can relate to that. But we just don’t yet know what the data are on people with autoimmune conditions. I haven’t seen any statistics about that. So I would take a little bit extra precaution.

Next question from Diane, who’s an old friend. Hi, Diane, great to hear from you.

Q: “So what’s your understanding if the virus is airborne, other than the six-foot social distancing?”

A: So the expert on Joe Rogan’s show from the University of Minnesota said that he believed the virus was, you could acquire the virus just through breathing air in a room where other people are sick. This is different than what most other experts are saying, which is that you have to, basically someone would have to cough or sneeze in your vicinity within six feet, and then it would have to get into your nose or your mouth. I haven’t been able to find data, published data corroborating what he said, that we can just get it through breathing. I’m not saying that he was wrong. I have no idea. But I haven’t found any other published studies that confirm that. So, right now, I’m still operating on the idea that maintaining six feet of social distance is sufficient, but I don’t know that that’s the case. I hope it is. Because if it’s not, we’re going to see even much, much more of a spread.

All right, last question.

Q: “How does the virus affect pregnant women? Does it spread through the placenta?”

A: I don’t think we know the answers to this yet, but I would definitely put pregnant women in the group of people that need to exercise extra caution for obvious reasons. Pregnancy is a time when there are pretty profound shifts in the immune system, which can predispose or make immune defense different than it would be at other times. And just the nature of being pregnant and nurturing a new life warrants extra caution.

Okay, everybody. I just want to send my love to all of you and tell you that I really send the warmest wishes for good health and staying safe and sane in these crazy times that we’re living in. Please remember the importance of mental health and emotional health through this period. It’s very easy to get overwhelmed by fear and panic. It’s easy to get depressed by reading the news and what’s happening, by thinking about the economic and social and political impacts of this. Yes, it’s appropriate to stay connected to what’s going on and to stay informed. I think that’s vital, but it’s also absolutely imperative for us and our families to cultivate that resilience. To find opportunities for laughter and joy, to make sure we have time to play, to connect with the people that we love and that are important to us. That’s critical because this is going to play out over time and we have to pace ourselves, and we have to still live our lives in these really difficult circumstances.

So, after I turn off this call, I’m going to go up and grab my wife and my daughter and turn on some music and dance a little bit, move my body and smile, because this is, even in the most difficult circumstances, the human spirit is formidable. And I just want all of us to keep that in mind. So thank you for being here and thank you for sharing this information with whoever you think would benefit from it so we can all do our part in flattening the curve. Be well, and I’m sure I’ll be talking to you soon. Take care, everybody.