Just How Bad Is COVID-19? | Dr Eric Feigl-Ding | Modern Wisdom Podcast 149

Dr Eric Feigl-Ding is an epidemiologist, health economist, and nutrition scientist at the Harvard Chan School of Public Health. The Coronavirus outbreak has been the biggest news story of 2020. For every story claiming it's an oncoming apocalypse, there's another saying it's just the flu. Today we get to hear from one of the world's most central voices on Covid-19. Expect to learn, whether Covid-19 could have been bioengineered, how the virus is transmitted, strategies to protect yourself, the dangers if exposed, what the actual mortality rate looks like, whether containment is a viable strategy, and much more... Extra Stuff: Follow Dr Feigl-Ding on Twitter - https://twitter.com/DrEricDing Check out Stat News - https://www.statnews.com/ Take a break from alcohol and upgrade your life - https://6monthssober.com/podcast Check out everything I recommend from books to products - https://www.amazon.co.uk/shop/modernwisdom #coronavirus #covid19 #outbreak - Listen to all episodes online. Search "Modern Wisdom" on any Podcast App or click here: iTunes: https://apple.co/2MNqIgw Spotify: https://spoti.fi/2LSimPn Stitcher: https://www.stitcher.com/podcast/modern-wisdom - Get in touch in the comments below or head to... Instagram: https://www.instagram.com/chriswillx Twitter: https://www.twitter.com/chriswillx Email: [email protected]

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Speaker 00

  Altogether, this virus is, it's, it's a mean little sucker. In certain ways, you know, SARS and MERS, which have much higher mortality, SARS is 10% mortality, MERS are like 50 or 30%, and Ebola has 50%. A virus that kills more and kills faster is actually easier to control than a virus that kills slower, kills less and spreads asymptomatic. So again, all these reasons, why is it so difficult?

• 0:35Chris Williamson?

  Eric, welcome to the show, man.

• 0:37Speaker 00

  Thank you. How did we be here?

• 0:38Chris Williamson?

  Pleasure to have you on. This must feel like a war zone for you at the moment.

• 0:43Speaker 00

  Yeah, this epidemic, it's been raging. I think the world woke up to it somewhere in late January. But it's, it's gotten really, really bad since. When we, just when we think it couldn't get worse, it's gotten worse. Like just yesterday, the total mortality, the total number of deaths outside of China actually exceeded the daily deaths inside of China. Like the curves have crossed. So now the epidemic is actually worse outside of China. And it's not stopping.

• 1:17Chris Williamson?

  Well, I'm glad that I've got hold of yourself so that you can try and give us some signal to cut through the noise that everyone has been seeing online. I recently saw Shane Parrish is doing the same thing. He's got some coronavirus experts on. And the most common question that people are asking is, is to do with trying to work out where the bullshit ends and the information begins, right? So before we get started, who are you? Why, why should we listen to you?

• 1:43Speaker 00

  Yeah, so I'm a public health scientist. I've been a faculty at Harvard for many years. And actually, I resigned my faculty to run for Congress, but that's a different story. But I, I really enjoy science communication and, you know, public policy and advocacy, and especially raising alarm about this. My doctorate was in epidemiology, so.

• 2:08Speaker 00

  The science of epidemics. And although I I did other chronic disease epidemi, not, you know, infectious disease Epi, it's still in my wheelhouse. And I think sometimes in the world, you know, getting the message out there is something that many scientists are not good at. They know so much in their technical area that that translating it for the world and making the masses listen um is something that's not usually taught. And so it's something I really enjoy. And especially for this um pandemic now, I think waking people up and waking them up early before the tsunami hits is something we have to do in public health and we have to do way better.

• 2:51Speaker 00

  So this is why I'm tweeting nonstop about this COVID nineteen and trying to make everyone listen.

• 2:57Chris Williamson?

  I get it, yeah. It's um, it's interesting that some of the people that are the best qualified to tell us the technicalities and the specifics about what's happening perhaps aren't the best qualified to communicate that out, right? And that's, I I I get what you mean when you say about that. So, okay, let's start. What is coronavirus and what's COVID nineteen? Is that the same thing?

• 3:18Speaker 00

  No, coronavirus is a family of viruses. It's like when you, someone who drives a certain brand of car, but they have different makes and models. Coronavirus is one family. And um, you know, the common cold, there's a few coronaviruses that common cold, but there's although common cold that's other viruses. Uh, SARS is a coronavirus. MERS, uh, which is Middle Eastern Respiratory Disease, a couple of years ago, also coronavirus. And it's it's one of those viruses that has these spiky, you know, aura around it. It's Corona. That, so it looks like it has a Corona around the virus particle on the microscope.

• 3:55Speaker 00

  But um, it's an RNA virus, but it's not a, it's not a uh retrovirus like uh, like HIV is. HIV is an RNA virus that has to convert to DNA, live in your DNA, merge in your DNA, and then replicate.

• 4:12Chris Williamson?

  What's RNA?

• 4:13Speaker 00

  Directly replicates its uh virus particles after it invades.

• 4:18Chris Williamson?

  Okay.

• 4:19Speaker 00

  Yeah. And so this is a, this is a virus that. It ma- made a jump from animals, well, probably a bat or some other animal, to humans. And there's a lot of genetic evidence showcasing that. There's no evidence that showcases or supports that it's a bioengineer, bio weapon whatsoever. Because the more you go, you can, there's, there's these detective clues you can see within the DNA, uh, within the genome, the RNA genome, that suggests it was evolutionary driven, not as opposed to some human kind of insertion.

• 4:59Chris Williamson?

  So that's the first, that's the first myth busting there, that this is created by the Chinese government to drive the price of gold up or something like that.

• 5:07Speaker 00

  Yeah, yeah. There's no, absolutely no evidence whatsoever. And there were some studies that, you know, put out that idea in an unpublished pre-print manner. Um, I even tweeted about it because I thought, oh, it's, it's published. But it was retracted and once it was retracted, I deleted as well. And, and that's all the thing, like, there's a lot of, even, so there's bad websites, but there's also like these pre-publication websites that are not reliable because they're not peer reviewed and anyone can publish onto them. And, um, information is tricky, um, and I, I think people need a, a filter. And, you know, like putting debunking articles right after someone posts it, I think it's really key in this day and age.

• 5:52Speaker 00

  Um, so, yeah, it's, it's not bioengineering, bio weapon. Well, if there is, there's no evidence to date about that.

• 6:00Chris Williamson?

  Oh, that's good.

• 6:01Speaker 00

  At the point right now is, look, it's, it's clearly a virus that's jumped, um, from animals to humans. That's pretty clear. And we, right now, are just trying to focus on solving it. You know, we can discuss and debate how it jumped later, but I think right now, that's, that's not the most important thing as part of the epidemic.

• 6:23Chris Williamson?

  Got you. So are there different strains or are we talking about one thing, COVID-19?

• 6:28Speaker 00

  So strains, you know, strange is like, is it, there are different kind of branching, but all that branching evidence has shown that they all branched pretty recently in sometime in November. So it was one single event that has since spawned all these different small variations. So we, there are like a variation here and there, like for example, the variation in Washington state is, is different from this variation that was in Iran. But we know the British, one in British Columbia that was tested after, from the woman who flew from Iran, came from, Iran, Iran came from Wuhan.

• 7:10Speaker 00

  While it, the Singapore and Japanese and Korean ones came from a different branching. And so using that kind of evidence, we could actually, instead of asking, where did you fly? You can actually look at the virus genome to see where did this version come from? Like British Columbia, Vancouver is very close to Seattle, right? You think that maybe the Seattle version, the Washington state version is the same one? No, they come from different locations because of air travel. So you could actually, you know, use detective work in its genome to see where it originally came from, as opposed to, you know, just asking where did you travel?

• 7:50Chris Williamson?

  I guess it's useful, right? It allows you to see the footsteps of where, where this has been. Okay. So we know that about the different strains. What are the biggest misinterpretations so far that you've seen?

• 8:04Speaker 00

  Besides those conspiracy theories, I think the misinterpretation, the, it's just the flu. That's actually a, a, someone, a lot of, actually early on, a lot of public health officials and policymakers just said, it's just a flu. It's not just a flu because A, everyone has partial immunity to various strains of the flu.

• 8:27Speaker 00

  No one has immunity to Corona, this novel coronavirus, COVID-19. By the way, the, the virus is called SARS-CoV-2. The disease is called COVID-19. The virus causes disease COVID-19. It's analogy is HIV causing AIDS, right? HIV is the virus, AIDS is a disease. So, but, you know, people just call it COVID-19. So this, um, this virus, I think the main, uh, uh, you know, misconception, first of all, is that it's just the flu is very dangerous because we have, A, we have vaccines for the flu. In each year, the we may pick the wrong strains to put into the vaccine, but it's still at least partially effective, right?

• 9:11Speaker 00

  Anywhere from 50 to 80% effective against most of the strains. We don't have a vaccine whatsoever. And we don't have background immunity from you previously having the flu, uh, or previously this, this virus. And secondly, the flu has a mortality of point one percent. This one has a mortality of a full one to three percent. That is 10x to three x higher, 30, 10x to 30x higher. So they're not in the, in the same order of magnitude mortality. Granted, there could be some places like Singapore with super high, um, wealthy healthcare that could actually, you know, the mortality could drop below 1%.

• 9:54Speaker 00

  But on average, you know, WHO said it's 3.4% on so far. And that's pretty scary personally. So again, it's not on the same scale flu. We don't have vaccine, we don't have countermeasures. Um, so it's not the flu. And that annoys me to no end when people say it's just the flu. And also finally, the other thing is, um, the transmission. The transmission reproductive number, which means the R naught for every infected person, that person will infect for the flu, 1.3 more people. For this virus, it's two to four additional people. If you think about it, you know, that is one of the fastest exponential rises you can potentially find.

• 10:39Speaker 00

  Now, granted, there are things like measles that have higher R naughts in the teens. But guess what? We have a ninety-nine percent effective vaccine against measles. All you have to do is take it.

• 10:52Speaker 00

  So we, again, for something with no vaccine whatsoever, this is a very high R naught. And has a doubling time around one week, which is a pretty fast doubling time for, in terms of transmission epidemic. So altogether, it's not the flu. In terms of other misinformation, you know, some people say that men get sicker more than women. I would say it's partly true. Men get infected at the same rate as women. But it could be, and but men seem to have a slightly higher mortality. But that's from a study in China, in which men, like seventy percent of men in China, smoke. And so if you smoke, obviously, this thing is going to kill you faster.

• 11:36Speaker 00

  So is it because that it hurts men more? Or is it because men also smoke more? We haven't figured that out. So I don't know if it's, and there's no genetic variation. I think, you know, you know, right now, people are coming down in Europe.

• 11:53Speaker 00

  And people are dying in Washington State in the US, and they're not Asian whatsoever. So I don't think there's any racial

• 12:02Speaker 00

  explanation of why, you know, there's no racial differences there.

• 12:10Speaker 00

  Yeah. And the other mysterious thing that we actually, is actually true, is children don't seem to get sick from this. Well, they get infected and they get maybe a mild sniffle, but almost all children who are infected have very mild to almost no symptoms. Which is, in certain ways, is good, but very strange, but it's well established. Oh, and finally, the main differential between this virus and SARS and the flu is This SARS-CoV-2, COVID-19, is transmittable while it's asymptomatic. SARS, we were able to stop in nine months without any vaccine whatsoever.

• 12:53Speaker 00

  This one, that's not going to be able to happen because, you know, say you take a plane, right? You're healthy, healthy, get off the plane, two days later you get sick, develop your symptoms. Well, with SARS and many other viruses, well, it's okay. You only got sick two days after. We don't, we're not worried about everyone else that you traveled with. But for this one, it's tricky because you can actually shed viruses even when, before you have the symptoms. And so that is very tricky and very difficult for containment of an epidemic. Because how an epidemic works is that, how containment quarantine works is that you find

• 13:36Speaker 00

  a case, you contact trace, and you quarantine them. And hopefully you've quarantined enough, but based on a seven day kind of thing, it's a, there's a lot of asymptomatic transmission that could have happened. So again, altogether, this virus is, it's a mean little sucker. In certain ways, you know, SARS and MERS, which have much higher mortality, SARS is 10% mortality, MERS are like 50, 30%, and Ebola has 50%. A virus that kills more and kills faster is actually easier to control than a virus that kills slower, kills less, and spreads asymptomatic.

• 14:19Speaker 00

  So again, all these reasons why it's just so difficult.

• 14:22Chris Williamson?

  Got you. I want to loop back around to a few of the things you brought up there, but one of them is the current mortality rate, which you've said between 1 and 3%. I've heard and read some stuff talking about the fact that that is the numerator that we've got on the top, but the denominator on the bottom due to some testing questions may be different. And if That numerator on the bottom turns out to be significantly higher than we've thought. Because the reported cases in some places, yeah, the reported cases in some cases are people that are symptomatic or symptomatic and, you know, the people that died from it are only

• 15:03Chris Williamson?

  people that died from it from the people who had symptoms, whereas it could be people who died from it versus people who were just infected and that number could be much higher. Could you take us through that?

• 15:13Speaker 00

  Very good question and epidemiologists have thought of that. There's two different things. There's, there's a tug of war happening. What you're talking about is under diagnosis. Basically mild people or asymptomatic people, they're just not tested and therefore they don't, they don't show up in the denominator of total, total cases, right?

• 15:36Speaker 00

  And this under diagnosis, you know, was a problem in China for a while. And there's, it's still a problem in almost every country other than Korea. Korea is doing 15,000 tests a day, drive-through style.

• 15:47Chris Williamson?

  What? Korea's got drive-through tests?

• 15:51Speaker 00

  Drive-through tests and doing 15,000 tests a day.

• 15:55Chris Williamson?

  Holy shit.

• 15:56Speaker 00

  Same. Korea's, Korea's, you, you need a company, a country that is like systematically, you know, well managed enough centrally and you have the wealth and you have the capacity for the scientific labs to do it. The United States can't even do that. United States can probably, you know, across all its labs do only like 9,000 and that's across the entire United States right now at the moment. Hopefully we can do more, but when our capacity is not even close to Korea. So my point is under diagnosis. Oh, by the way, Chinese numbers are different than other numbers because if you test positive and you don't have symptoms, China does not put you on the confirmed case count. Everywhere else, if you're a test positive,

• 16:40Speaker 00

  regardless of symptoms, you're a case count. So there's under diagnosis, which if the number at the bottom of this case fatality ratio is larger, then the case fatality will drop in percentage, right? But there's another competing thing and that is the mortality lag. So this disease is a long ass sucker. Mild cases are about 80%, 80% mild to moderate.

• 17:07Speaker 00

  And the duration of mild cases is two weeks, which is, by the way, pretty long. Because most people who have a flu just get over it in a week. But severe cases, which is 20%, severe and critical, 20%, is about three to six weeks long. And, and some of, and the critical people who are basically need hospitalization in ICU, you know, they have a 28-day mortality of 50% in China. And China, by the way, has a lot of ventilators. They can manufacture a lot of ventilators and they have staff, ICU staff, nurses. But the issue is the three to six weeks, it means you have a lot of cases, once you're diagnosed.

• 17:49Speaker 00

  Say someone's diagnosed during Valentine's Day after kissing. Terrible Valentine's Day. But their, their outcome does not resolve to a death or recovery for at least six weeks, or three to six weeks. You see that? There's a lag. From the day that, you have to think of a cohort. You can't think of it of mortality, a simple back of a napkin calculation of deaths over cases. You have to look at it from a cohort perspective. And the problem is, a lot of, most countries, you know, and China still half the people have not recovered. You know? And in Korea, I would still say like 80% of the cases are neither deaths nor recovered and, you know, released.

• 18:32Speaker 00

  You've, you've healed yourself, you don't have a virus, you're over it. Most, two-thirds of them, or three-fourths, have not been death or recovered. Which means they're still part of this, I'm still sick, I'm still have symptoms, or I'm still testing positive. I've not cleared from my body. And that actually causes two problems. One, the lag, meaning this numerator is not finished, right? Is not fit, this cohort, this Valentine's Day cohort of everyone who got on Valentine's, will not be finished until end of March, early April. So we cannot finish calculating the case fatality then. If we just keep testing, testing more, we're just adding more people to the denominator,

• 19:15Speaker 00

  but who have not finished the entire disease course. So there's a tug of war. Underdiagnosis would drag the CFR down, but the mortality lag of incomplete resolution of most of the cases, because they haven't hit the end. You have, this case fatality is only finalized when everyone is either dead or fully recovered. And that has not happened for most cases yet.

• 19:37Chris Williamson?

  Got you.

• 19:38Speaker 00

  Hence, they balance out to around one to three percent, depending on the model.

• 19:45Speaker 00

  And the other key implication of the disease being three to six weeks in 20% of people, which is a lot, one in five people have a three to six week, uh, a disease course, is hospital beds will be completely swamped. Like the United States, terrible. Like Korea has a really high per capita number of hospital beds, really high. Korea is like top five. You know, there's, you know, this is why China built a hospital in 10 days, right? And Korea, um, you know, does not have enough beds and most countries do not have enough beds. And it's just gonna jam up the healthcare system. It's, it's terrible in that sense.

• 20:22Chris Williamson?

  That seems pretty ugly. Why don't you tell us what the virus does? What does it do? I've heard it's bad for people that smoke and it's something to do with COPD. What, what is it?

• 20:31Speaker 00

  It's a pneumonia. Causes, it's a viral pneumonia.

• 20:35Speaker 00

  So it will give you a fever at first. You'll have coughing. It's common. And then you have, you know, you feel like you have fluid in your lungs. You have trouble breathing.

• 20:49Speaker 00

  And then, and over time, it can, an infection can set in, uh, further of your lungs. And not sure if it creates lung scarring. There's, China did one lung transplant on someone with COVID-19, but it's, it's, it's unclear. You only need that if you have permanent lung scarring. Um, and most pneumonia doesn't do that. But if the pneumonia is bad enough, you know, you have problems getting oxygen. And that's why people are on ventilator respirator machines, because they need oxygen. Um, and the...

• 21:25Speaker 00

  And if it just causes really, really bad pneumonia, people just are oftentimes dying for lack of oxygen. That's the truth.

• 21:32Chris Williamson?

  So we've said that children somehow appear to be fairly low in terms of symptomatic. Who are the people that are at the highest risk?

• 21:40Speaker 00

  So I'm gonna give you two answers. In terms of death, elderly definitely have the highest death.

• 21:46Chris Williamson?

  Sixty-five plus?

• 21:48Speaker 00

  The curve goes up like this. It's not like a step. It's not a step function.

• 21:52Chris Williamson?

  It's not a point, yeah.

• 21:53Speaker 00

  Yeah. It curves up and it curves up starting around age fifty and then, you know, definitely above sixty-five, it becomes a high risk. Like in nursing home in Washington State, there's been six deaths already in a nursing home of frail elderly people. It's really bad in just one week. But in terms of, the other thing is, just because you don't die, actually, you know, it's tricky. In terms of healthcare system, I hate to say it, someone who dies quickly actually is cheaper for the healthcare system and for insurance. Someone who's sick for six months, oh, for six weeks, that's actually

• 22:31Speaker 00

  really, really bad, right? Because it jams up hospital beds, ICU services, et cetera. And so I think you can't just look at death. And in terms of ICU, there was a one study that says a lot of young people were actually stuck in ICU as well for this. It's, you know, in terms of their earliest reports in China, there was just as many people under the age of sixty as over the age of sixty in ICU, presumably on the ventilator machine. This is a, this is a really serious issue because, look, people being sick for a long time is actually a really, really taxing thing on the healthcare system. And I think

• 23:15Speaker 00

  the other thing is, you know, there's also many young Chinese doctors have died. There's a twenty-nine-year-old, twenty-nine-year-old, thirty-four-year-old, forty-two-year-old. Like, that's four doctors, like, basically forty or under. It's, it's very troubling. So, and the other thing is, just because you're part of the eighty percent who have a mild and moderate case, you're still spreading it. You're not, most likely those people who are not tested are the eighty percent. But they're spreading it. And young people, you know, old people stay home and watch TV or play checkers or something. Young people are out and about, going to work, bartending, waitressing, going to movies, sports games,

• 24:00Speaker 00

  you know, going to restaurants. They're the ones spreading around. And so in certain, in certain ways, you know, their morbidity may be less, but they actually add to the total number of people infected. So these infectious eighty percent mild is actually much harder to control. Because again, even if twenty percent, only twenty seven percent gets sick, these eighty percent keep spreading and amplifying the total denominator for people who are, who can come down with something really serious.

• 24:35Chris Williamson?

  Yep.

• 24:35Speaker 00

  That's why I don't think, just because it's mild for you, doesn't make this virus any better for the general population.

• 24:43Chris Williamson?

  I understand, yeah. So we touched on it there and you mentioned it earlier on. I really want to try and get some definitive ideas about when your infectious period begins, how long the onset is likely to take before you are either symptomatic or unsymptomatic, and then when you could re-release yourself into the world.

• 25:05Speaker 00

  Yeah, good question. So this is actually a project that I'm working on because right now, based on the early studies, and we don't have incubation times for everyone. Incubation is defined at the moment you got infected to the moment you develop symptoms.

• 25:22Speaker 00

  And sometimes you can't, you don't know when someone first got infected. So not every case has this information. But the limited numbers we have, it says anywhere between five to ten days, five to seven days. But that means, that's just the mean. Half of them are longer than that. And right now, all the quarantine rules are basically quarantine someone who was exposed for fourteen days. You're traveling, entering the country, quarantine fourteen days. The question is, is, you know, there's a normal distribution, right? And if the mean is at five to seven days, the question is, are you sure that by extending it to fourteen days quarantine, you've captured the entire tail? Because what if this tail, centered on five to seven,

• 26:07Speaker 00

  has a very, very long tail? And let's just say ten percent of the people exceed fourteen days incubation. So that which means, oh, I'm perfectly healthy for fourteen days. I'm going to be released on the fifteenth day. They could still develop it if they have a long incubation time on the eighteenth or twentieth day.

• 26:26Chris Williamson?

  Got you.

• 26:27Speaker 00

  And then you've you've because the quarantine time is supposedly if you pass this quarantine time and you haven't gotten sick. We can release you into the wild, right? Uh, you don't have disease, how go have fun again. But the question is, I don't know if it's long enough. And there's some studies of showing someone with twenty one days or twenty five days or something like that. Now, I don't know if they're they're misreported, but it's concerning because is fourteen days fully capturing ninety nine point nine percent of all people? Because if you just let one person out, that one person can have a super spreading event, you know?

• 27:04Chris Williamson?

  What's that mean? I've heard I've heard that term used before, super spreading and super spreaders. What is that?

• 27:11Speaker 00

  Yeah, so on average, uh, one person, you know, I told you the R not one person affects two to four, right? A super spreader is some like some unusual circumstance. It was one person is spreading to tons of people like, you know, five to ten to twenty people. Like a super spreading event is like a sick bartender who serves everyone at a party.

• 27:35Chris Williamson?

  Uh, yeah, yeah, yeah.

• 27:37Speaker 00

  And then that person does not just transmit to the average of two to four, you know, three. But it's in spreading to like a whole party. And from there, you know, it gets loose. And so that's a super spreading event and the person who does it is a super spreader.

• 27:52Chris Williamson?

  So it's got it's nothing to do with um someone's particular physiology or the strain of the virus that they've got. It's more to do with lifestyle and and the way that they interact.

• 28:02Speaker 00

  Unusual circumstance.

• 28:04Chris Williamson?

  Got you, got you, got you.

• 28:05Speaker 00

  So there was another super spreading event years ago in the SARS, first SARS epidemic in which um there was a toilet system in a Hong Kong building. And the toilet system was outgassing septic gas and which held the virus particle. And we went to the ventilation system and went into the hole infected the whole building.

• 28:25Chris Williamson?

  Holy fuck, that is a bad, that is a bad thing to have happened.

• 28:31Speaker 00

  I hate to say, there's a study that basically, now, it's not of this new virus, this is too new, of the old SARS virus, someone did a study, and they they realized that, obviously, you can spread it from a droplet, sneeze, right, or talking at dinnertime to someone. But apparently, it's also in the fecal matter, which means, and they did a study of flatulence. Is the virus particle in the flatulence? And the flatulence, you know, it can go pretty far. Now, I wouldn't say this on camera on TV, but we're a podcast.

• 29:09Chris Williamson?

  Yeah, we are. We can say whatever you want, Eric. Let's let's start to debate about whether or not we can fart our way to a pandemic.

• 29:17Speaker 00

  Yes, it is. I will send you the link. It is, there's a, someone did a study, they should win, you know, the Nobel for this. But they they actually showed that the the virus particle can actually travel quite far, if you if you leave a very, very long trail of fart. So, now, it's not for this current virus, but it's for the old SARS virus, it's a sister coronavirus.

• 29:42Chris Williamson?

  How likely is it that it's gonna be, it's gonna have the same capability?

• 29:47Speaker 00

  Yeah, I think it's likely, because there is another issue in Hong Kong last month as well, and someone who was living, someone was self-quarantined at home, but someone was living like several floors beneath them, got infected. And and they found that it was also something related to septic gas.

• 30:06Chris Williamson?

  Got you. So we've spoken about the fact that it's to do with, at least mostly, droplets? I've heard it's something to do with like, it's not airborne, but like waterborne? What does this mean? How do I get it?

• 30:17Speaker 00

  It just means, like, a lot of these droplets, when you sneeze, like, I chew, it actually goes pretty far. It doesn't have to be fully airborne, airborne. Now, there's some argument that it couldn't be airborne. I think the jury is still out. So.

• 30:33Chris Williamson?

  What's the difference? What's the difference between airborne airborne and water droplets?

• 30:37Speaker 00

  Well, water droplets will eventually settle, right? Airborne means like, it will stay in the air, it will float in the air, like a balloon, right? Well, obviously, it's a tiny particle, but stay in the air. But, you know, a droplet means, these tiny things like when you sneeze, or when you when you speak. It comes out of your mouth, but over time it will settle down. So it's like semi-flying in the air for a short distance. And so we're sure about that. Now, fully airborne, it's hard to say. There's some study that says yes, some study that says no. But in the, I think the main thing is close contact. Uh, close contact. And I think the close contact issue, we've seen it also, um.

• 31:23Speaker 00

  We think a lot of the, for example, the ship, the Diamond Princess ship. It was a Petri dish, literally to grow. And a lot of people, you know, one in four, one in five to one in four people on that ship has tested positive. Which is insane. You know, that ship has three thousand seven hundred people and one in four, one in five people has tested positive. And the reason we think of that is because, um. A lot of the people who are in the inner cabins, besides the food sharing and, you know, public. But people within our cabins, they don't have like a window. And so their ventilation system. Now, is it airborne airborne? Or is it like droplet travel through the system?

• 32:08Chris Williamson?

  Okay, so we, we, we, let's say that we're with someone, we're talking to them, we've got that concern. Um, what about if I touch my mouth and I've got it and then I put my hand on a doorknob or something? How long can it live on a doorknob?

• 32:21Speaker 00

  Yeah, it can live a week.

• 32:25Chris Williamson?

  A week?

• 32:25Speaker 00

  Yeah, a week.

• 32:27Chris Williamson?

  That's a long time.

• 32:28Speaker 00

  Yeah, it's up to a week. It depends on certain things like temperature and humidity.

• 32:35Speaker 00

  It degrades faster in, in warmer and more humid air. But at the same time, you know, we're not like Singapore happened epidemic. Singapore seventy, seventy-five degrees, you know, that's like twenty, twenty-five degrees Celsius. And so that still happened. But the thing is, we're mostly indoor people. Singapore epidemic happened, uh, the super-spreading event was at a Grand High Hotel, Singapore. And that hotel, you know, hotels, it doesn't really matter what the outside climate is, right? If you had an indoor conference center or indoor gym and you get it, it doesn't matter what it is outside. So, you know, I think the there's one of the misinformation actually is about, oh,

• 33:20Speaker 00

  it's gonna all go away when the summer comes. It's gonna be too hot. Except, we are indoor workplace kind of people, and there's something called the southern hemisphere of the earth, and then it'll just go to Africa and Australia and, you know, Indonesia, when it's winter time in the north, in the summertime in the north and winter time in the south. So, I don't think that it's gonna go away in the summer arguments. It might slow down a little, but it could easily come back in the fall.

• 33:51Chris Williamson?

  Got you.

• 33:52Speaker 00

  That's the tricky part. The virus seems to be a survivor, basically.

• 33:59Chris Williamson?

  Can containment work, or are we just past that step?

• 34:04Speaker 00

  Containment, you know, a lot of people say WHO is still trying to be optimistic that containment can work, but I think, I think we may have to move from containment to mitigation.

• 34:17Chris Williamson?

  How do you do that? What's the difference?

• 34:19Speaker 00

  Mitigation is just, you know, reducing the number of people who are exposed. And, you know, you test as much as you can, but in terms of actually stopping the virus, you just, you mitigate its impact, and you mitigate its spread. But containment just means preventing a community transmission event, right? Someone, if someone travels from, say, Iran, lands at the airport, and then we detect that they're sick, and we quarantine them, then that is contained, right?

• 35:01Speaker 00

  But if they can't come back, go, infects their kids, goes to daycare, childcare, goes to a party, infects everyone, and they all go home, and they all test positive, and they all don't know necessarily where they had gotten it, it's not contained anymore. It's community transmission. And community transmission is way more dangerous than a travel-related thing, because it means they picked it up randomly in the community of an unknown source that we can't necessarily trace anymore.

• 35:31Chris Williamson?

  Got you. Okay, so when does it get to the point where we need to just buy all of the rice in Costco and not leave our house?

• 35:43Speaker 00

  I think depending on which country you are, we're already there.

• 35:48Chris Williamson?

  I mean, is that realistic? Do I need to, do I need to do that? Like, you know, I don't think there's any cases in Newcastle where I am like, should I be worried about going?

• 35:55Speaker 00

  No, I said depending on where you are.

• 35:57Chris Williamson?

  Yeah, yeah, yeah.

• 35:58Speaker 00

  I don't think the UK is there. I think Italy is there.

• 36:03Chris Williamson?

  Italy's having a bad time at the moment.

• 36:05Speaker 00

  Italy is so bad. Italy really is bad. Seattle right now is having a really bad one. The Seattle area, you know, Amazon, Amazon has many buildings, but one of their buildings that does Amazon Fresh and Amazon Prime Now. It's called the Amazon Brazil Building. It holds like over two, three thousand workers in this huge building. Someone tested positive on February 25th and they had to send a notice to everyone. Like, ah, and the epidemic is so bad widespread in, in Washington that I think they may have to shut down schools. Um, soon. They might have to cancel all public events.

• 36:45Speaker 00

  Like some places you have to put these moratoriums on, on public gatherings and think some places like Italy's are done. Italy just canceled schools today for like at least two weeks, maybe longer.

• 36:56Chris Williamson?

  Yep.

• 36:57Speaker 00

  Nationwide. I think Washington State may have to do that as well.

• 37:00Chris Williamson?

  Dubai, Dubai already has.

• 37:03Speaker 00

  Yeah. No, but I think this is, this is where, you know, mitigation comes in because you're not containing it anymore. You know it's there. We just have to, you know, lock down people. Um, and I, it does work. Social distance until we have the vaccine, which will take a year to eighteen months. A year if we're lucky. And hopefully the vaccine is, is high enough. Like a sixty, seventy percent effective vaccine might not be enough to stop this virus. Remember, for every infected person, it may infect two to four additional people. So you need to get the R below one. And so with that, you know,

• 37:48Speaker 00

  you, you know, something that say R of three, you need, you need like least, you know, seventy percent higher just to bring it below one. You know, you need a very high, you need eighty-five, ninety, ninety-five percent efficacy. And not every vaccine is the perfect efficacy like that. So, and then that is only a year, a year and a half. There are existing antiviral drugs that could work.

• 38:13Speaker 00

  We're testing this. There's some older HIV and hepatitis C drugs we're currently testing. The drug does exist. It's been phase one tested, but we have to phase two test whether it works with this virus. Again, that might take six to nine months. We could get early results depending on how good it is in late April at the earliest. So we'll have to see.

• 38:38Chris Williamson?

  I get you. Okay. Um, how can I tell if I've got COVID-19 without going to hospital? Where I am might, the hospitals might already be over capacity or whatever. How, how do I know?

• 38:53Speaker 00

  Because the symptoms are very nonspecific at first, you know, fever, coughing, you know, pneumonia. But there's many things that cause that, right? So

• 39:05Speaker 00

  you need to get tested. But at the same time, you know, testing capacity is very limited. So again, what you could, if someone has something, it could be the flu. It really could. Or it can be another endemic, common cold coronavirus that's not nearly so bad. You, you can't really tell until you're totally tested. You could get a CT and it will tell you, a CT will pick up a really bad pneumonia in your lungs. But that's more of an approximation. Again, it's not for certain. In Hubei, anyone who tests a positive for CT pneumonia, they assume you have it because that's because you're in Wuhan, right? But most, you have to go through.

• 39:51Chris Williamson?

  Okay. That, that seems like it's not as easy as it could be or should be, I suppose.

• 40:00Chris Williamson?

  Let's talk about the origin just for a second. I want to get back to how people that are listening can potentially protect themselves and then potentially some public policy implications as well. But there's been some talk, I've seen quite a bit of stuff about, we need to find the origin. Patient zero is important. Is finding patient zero important? The person that it jumped from animals to humans?

• 40:24Speaker 00

  At this point, it's not the most important thing at all. Patient zero would like give you a source initially, but at this point, for all the treatments and containment and public health measures, it's of low importance. You know, so people keep asking, was it the seafood market or not? You know, I would say that it might not be the seafood market, only because, you know, the New England Journal paper actually found that the first two people infected in early December had no seafood market contact. It was only the next wave that had seafood market contact in late December. So it could have been that someone introduced it to the

• 41:05Speaker 00

  seafood market and seafood market was like this super spreading event, right? So, you know, but whether it was introduced to seafood market or it was made to jump from the animal to humans at the seafood market, it doesn't really make that much of a difference, I don't think. You know, the only people who really care are the bioweapon conspiracy theories.

• 41:32Chris Williamson?

  Yeah, yeah, yeah, yeah.

• 41:33Speaker 00

  So it's a moot point. We know that, we know that these, there's tons of, you know, there was a study in which people studied how many coronaviruses are in bats. Oh my God, there's like dozens and dozens that we've never even known about. And so then they tested the blood of all these people, these indigenous people and local rural tribes are exposed to these bats. And they found, oh my God, these people actually have a lot of coronavirus that never been identified before. They've just been mild and we've ignored it because it's not bad. But this one is actually a really bad one because it's selected itself for, you know, over time, the most, the survival, the fittest

• 42:18Speaker 00

  in terms of viral evolution. So this, we have now viral evolution selected one of the most.

• 42:27Speaker 00

  Infectious, severe viruses. And it is perfectly natural and possible and plausible that it happened by itself.

• 42:36Chris Williamson?

  Have we had any indication that this virus could mutate? And is that a concern? Does it matter? And what does it mean?

• 42:43Speaker 00

  Yeah, so it can mutate. RNA viruses mutate more than DNA viruses. That's, that's like a general rule. Cause RNA system is always a little funky. Cause DNA has two helixes, right? And so if you make an error, the other helix realizes the error and something fixes it right away. The RNA is a single strand, so it doesn't have this correction mechanism. But the coronavirus has, is, is a big enough RNA that actually has a special endonucleus within it that actually can fix errors along the way. So it doesn't mutate as fast as the flu.

• 43:24Speaker 00

  The flu has a very funky mutation system that tries to always reshuffle itself and creates some brand new strains every year that causes vaccines to always have to play a whack a mole catch up. But hopefully we can have one vaccine that will work for this. It doesn't, so, you know, we haven't, you know, we have different variations, small variations. And they found that the actual mutation rate is one mutation, one approximately one

• 43:55Speaker 00

  amino acid mutation every two weeks. So that's how they figured out that's the approximate rate. And so you can figure out how, how it diverges. You know, you know, the detective sleuthing of the virus genome I told you about earlier. But it's, it's not, we're not going to get multiple strains. And it could mutate, but at the same time, it could, most mutations are just junk mutations. You could potentially select for a very hyper survival one. But generally you need a very high number of infections for that. And right now overseas, there's still not enough of that. I, I, I don't think the mutation is our current worry.

• 44:38Speaker 00

  You know, I think we will be able to find one vaccine that will work for it for a long time. It's, so it's not like the flu in that sense.

• 44:48Chris Williamson?

  Got you. Right. What are some of the things that the people who are listening can do to protect themselves? What's the 80/20 on that?

• 44:59Speaker 00

  I would stop shaking hands with people. No offence. Wave high at them, fist bump, elbow bump.

• 45:06Chris Williamson?

  I saw, sorry for, sorry for putting in here, but I saw a relative transmission rate graph, which I'm going to presume that you've seen. And it's like, the elbow bump was best, then followed by the fist bump. And then there was like the slow fist bump. I'm like, who's doing a slow fist bump? Like you're from Saved by the Bell in the 1990s or something.

• 45:30Speaker 00

  I think that's just one measure. I think the other key things are, you know, just don't touch your face.

• 45:37Speaker 00

  By the way, really embarrassing, at Washington State, there was a press conference about the epidemic. And as she was fumbling through her papers, she was saying, everyone wash your hands, don't touch your face. She was flipping her paper.

• 45:52Chris Williamson?

  And licking her fingers to get through the bits.

• 45:55Speaker 00

  In the middle of the press conference, telling people, don't touch their face. It was terrible.

• 45:59Chris Williamson?

  What a, what a, what is it? It's not face palm, is it? It's like face, you don't want to face palm. That's the problem.

• 46:06Speaker 00

  Yeah, I know. Anyway, it's a common internet meme now, but, but it's just so terrible. But I think, you know, avoid touching elevator buttons, just avoid touching doorknobs. I know that is really hard, but doorknobs are not disinfected often. Don't touch things in public. You have to kind of be a little germaphobe until this thing is over, you know?

• 46:29Speaker 00

  And public transit is the other thing. Like I see like this,

• 46:36Speaker 00

  you know, the city leaders are always saying public transit is fine, but public transit is also one of the, a confined space, limited ventilation.

• 46:48Speaker 00

  You know what I'm talking about. And it doesn't have, unlike the airplane, airplane at least, it takes in new air every three or five minutes. So the air in the, in the cabin's being replaced every three to five minutes. So in certain ways, the airplane is pretty good, unless you get unlucky and sit somewhere next to a cough. The airplane's actually pretty good in terms of replacing the air. But that's not true on a bus or a train, you know? And so, and I don't know if they use super high, small micron HEPA filters that can filter out virus particles, because not every air filter does. So, uh, you know, I think the other key thing is, people ask, do you travel?

• 47:30Speaker 00

  I say, look, at some point, you know, once the pandemic becomes really real, and it's like, in eighty nine-

• 47:38Chris Williamson?

  What's that number? What's, what's, what's really real mean?

• 47:41Speaker 00

  As in, like, the epidemic is literally everywhere. Eighty, you know, let's just say, if, if I was in the United States, it's in eighty percent of all the states, you know? I'm gonna say, it's probably everywhere. And staying here is no better than getting on a plane and going there. Granted, you know, air, airport is, um, is a place to exchange, but I don't think, I don't think you should stop your life. And people ask me, how anxious am I? My, on a scale of one to 10, I'm a six. I'm worried, but I'm not anxious because I'm anxious about things that is something I can control that I'm

• 48:21Speaker 00

  not doing, right? Like, testing. I'm anxious that we're not getting enough testing. But am I anxious for the inevitable, inevitable? Because the CDC, one of CDC, um, vaccine immunology heads says, and report, reported to Congress, this virus is inevitable. It will be in every single state. In that sense, I am not anxious because it's like, just brace yourself, come what may, right? So I have that kind of stoic mentality. Obviously, not everyone does. But, you know, protect yourself as much as you can. As for masks-

• 48:57Speaker 00

  Um. Surgical masks are pretty useless. Uh. And N ninety five masks do not filter out everything. Um. But N ninety five masks are better. But at the same time, um, if you wear a beard, it's totally useless. If uh, wearing some uh, the N ninety five mask, by the way.

• 49:15Chris Williamson?

  Because you need, you need full, full uh, seal around.

• 49:19Speaker 00

  Full seal around it. Um. And sur- again, the surgical mask, the mask, what they mostly do is it catches your spray from your mouth. When you're talking to someone, hey, how's it going? I have a great idea. And you're spraying, you know? Even if you're someone who's very careful, everyone sprays the saliva when they talk. At dinnertime, it's natural. A mask, it does not actually protect you from inhaling um, the virus if it's in a droplet, tiny droplet in the air. Does that make sense? So, it like, it will, it, some, sometimes people have a false sense of security when they wear a mask. It's not. It's, it's to actually protect others, not to protect yourself necessarily.

• 50:01Chris Williamson?

  Okay, that's not good. I thought, I thought I could just stick a, stick a mask on and I'd be okay. So it turns out that that's, that's not very good. So what about um, helping?

• 50:12Speaker 00

  N ninety five masks are partially effective. They are partially.

• 50:16Chris Williamson?

  But they're also now in the highest demand. No.

• 50:20Speaker 00

  Yes.

• 50:21Chris Williamson?

  Getting hold of, have you seen um, I just got told before this by one of my friends, that um, alcohol hand wash prices, uh, like, some companies charging like ten X, hundred X what it should be.

• 50:32Speaker 00

  Yeah. Yeah. No, there's a lot of price gouging. Although there's actually like do it yourself, like, home um, home sa- hand sanitizer that you can make out of is- isopropyl alcohol yourself. So.

• 50:45Chris Williamson?

  Okay. That's cool. That's pretty cool. You've just, people would be able to search on, on the internet and find out how to make it.

• 50:50Speaker 00

  Find out how to make your own hand sanitizer. Um. It's probably shelf life stability, probably not as good, but you just mix some aloe vera gel um, and this alcohol, and you can, it's, it's good enough.

• 51:03Chris Williamson?

  Cool. Um. That's, that's a really good, that's a really good tip. I like that. What about um, ensuring that I am as robust as I can be? Uh, should I be upping my vitamin D, uh, D three? Should I be, you know?

• 51:15Speaker 00

  Yeah.

• 51:17Speaker 00

  Some people say, take your vitamin C, vitamin D, and vitamin D is good for general immunity. Vitamin C can maybe, you know, shorten of a cold to short or small amount. But we don't have evidence. I'm a scientist. I'm an epidemiologist. I also do clinical trials. Unless you have causal evidence, I'm, I'm, the jury's still out in my sense.

• 51:39Chris Williamson?

  Probably no harm in doing it, but there's also no, no indication that it's gonna move the needle.

• 51:44Speaker 00

  But don't go panic buying on these things without evidence. That's my general thing. Don't go panic buying. Also, by the way, panic buying is, is more of a somatic formic social phenomenon. If you see someone panic buy at the store, you're gonna panic buy. But if you see someone just buying one or two, you're just gonna buy one or two, right? It's, it's the panic buying is, is you see other panic and people panicking and then you panicking. And then that's how stampedes happen. That's how people, people die in stampedes, right? Because often times it's other people running and so all of a sudden you have to run too, or else you're gonna be trampled. So, um, it's, society is a funny little place.

• 52:26Chris Williamson?

  Yeah, man, it is. These weird shaven apes walking around with a brain that really doesn't work right for the environment it's in. I got a couple more questions. First off, we've spoken, it's been in the nicest way possible, Eric, you haven't told me what I wanted to hear. Um, but I'm glad that you've told us what you know. What would be an indication, two, two-part question. First part, what would be an indication that things are getting worse?

• 52:58Speaker 00

  The indication that it's getting worse, um, is if you start, if the epidemic is unchecked, even in a high-income country like Germany, Sweden, Finland, Denmark.

• 53:15Chris Williamson?

  What does unchecked mean?

• 53:17Speaker 00

  Like, community transmission, like really fast community transmission in those kind of places. I would, I would really start to worry.

• 53:28Speaker 00

  Because, you know, those places have some of the best healthcare systems. And the other signal is in Korea, if the mortality, you know how I talked about the cohort? Your, say your Valentine's Day infected person. By the end of March, if the mortality is still pretty high, then I'm gonna still be pretty worried about um.

• 53:52Speaker 00

  About it, because if the mortality is like above one percent, even in Korea. That's, that's pretty bad in my sense.

• 54:00Chris Williamson?

  Got you. Okay, uh, what would be an indication that things are getting better?

• 54:06Speaker 00

  Um, the community transmission stopping. And I wanna see, you know, a high number of tests. And then high number of tests, the proportion infected are steadily declining, assuming the same constant number of tests. That would be a good signal, because the more you test, or at a high test volume, you're not, you're not finding more. That means um, potentially the, the epidemic is winding down. I just wanna say that the test is not perfect. The test has a accuracy about fifty percent or less. Which means, not that there's false positives.

• 54:49Speaker 00

  I- if you test a positive, it's most likely you're pretty much clear it's positive. There's a lot of false negatives. And the false negatives is not an issue when you're first diagnosing a case as much. You know, early on, it's really important to catch every case, but at least catching a case, catching at least fifty percent of cases. Is better than catching none, right? The problem of this high number of false negatives is that when you, it's time to release people. From either quarantine or from hospital, their fever is gone, their symptoms are resolved. And right now, oftentimes, you need two consecutive.

• 55:32Speaker 00

  A one full day apart, uh, negative tests, two consecutive negative tests. But the problem is, um, you can easily have, you know, fifty percent times fifty percent. You could have a twenty-five percent chance just by pure luck that you get negative tests, right? Um, and I don't, and that worries me because. This person's now out there spreading it around, thinking they're fine. And because there's many examples, someone tested negative seven times, released, tested positive a week or two. That's an actual example. Oh, my God, there's like five or six examples in China, in Japan. This happens so many times, just look, right now, they call it reinfection. It it's this, uh, it's, I don't think it's reinfection.

• 56:17Speaker 00

  Misdiagnosis. It's just you were released on based on negative tests that are, that are faulty. Got you. And then, um, and then over time, um, you know, say you get sleep deprived one night and uh, you had a stressful day and then your, your immune system drops a little bit and then the virus flares back up. Got you. Um, but it, but you never shed it, like this happens all the time, like for example, HIV. Um, HIV tests, sometimes they say, oh, the drug was so effective, it is below the limit of the detection. We can't detect the virus, but we know it's still there. So this kind of thing happens all the time, like you could be low, low, low.

• 56:57Speaker 00

  And then tests will give you a negative, but the test might not be sensitive enough to the super low. And two negative tests to release you, you still have it, still shedding. Test positive later, but during that time you may have infected someone.

• 57:15Speaker 00

  That actually is what worries me the most. I would love to see a test with both high sensitivity and high specificity. Sensitivity means all the true cases, how many do you find? You want to find eighty-nine percent of them. High specificity, it means all the people who don't have it. How many percent that you correct, like one minus the false positive? So if false positive is one percent, the specificity is ninety nine percent. You want the specificity, you have a test to have high sensitivity and high specificity. And oftentimes, the problem with the US testing delay was the kit, there was three parts of the kit. The first two was to find the virus. The third was a negative control. Um, the negative control had a whole bunch of other miscellaneous viruses.

• 57:59Speaker 00

  And the test kit was supposed to test positive just for the COVID nineteen, the SARS-CoV-2 virus, but negative for the negative control. But it it somehow cross reacted and the test kept testing positive for even for the ones, the sample that does not have it. Um, because somehow the test is picking up other viruses as well. And that's why the testing in the US was delayed two weeks. But this testing problem, we need to get a better test. Um, but this fifty percent accurate one and and fifty percent based on Chinese Academy of Science analysis is currently the best we have, but hopefully we can find also a more rapid one.

• 58:40Speaker 00

  Because right now, the the lab, the PCR, that you need a PCR machine. So it takes at least twelve hours to, you know, by Sunday, send it to a lab, get it back. And it's pretty labor intensive. Um, if we have like an A1C, like a glucose strip or cholesterol, you know, you basically pin prick, stick it in the little strip and it tells you. Or something rapid, under an hour, that would be really great. There are people working on it, but it still has to go through some approval. But um, and then I want to see how accurate it is, you know.

• 59:11Chris Williamson?

  Man, I can only, I can only imagine some of the, I mean, you're one of them. You're one of the the people that's in the midst of this particular situation. But I can only imagine how chaotic some of the guys working at vaccine laboratories, working at the testing laboratories, you know, working at the control centers. And then take it one step up from there. What about the the doctors, the nurses that are working? It's like every healthcare professional on the planet just got turned up to eleven, right?

• 59:44Speaker 00

  Yeah, yeah, it is, it is really stressful to healthcare professionals. And also first responders, like firefighters and police who first respond to someone who falls ill and needs nine one one or emergency ambulance. And um, and unless you know that this person has a respiratory illness, who could be a potential case, um, they're not, they're not wearing any protection. And the scary part is, look, the quarantine, Japanese quarantine officer who boarded the Princess Diamond ship, you know, the one that was quarantined off of Yokohama. He boarded with masks, with protective gear, did inspection, got off the ship, tested positive.

• 1:00:26Speaker 00

  Another firefighter in Japan, transporting these patients as they were evacuating. He was wearing protective gear, finished transporting, tested, tested positive. Um, and, and so it's really trouble, like right now, in one county in, next to Seattle, Washington, twenty five firefighters have been quarantined, which is a full quarter of their entire firefighting workforce, out of commission for fourteen days. And now half of them have developed flu-like symptoms. All from just transporting, you know, this one patient. This virus is so infectious. It is just, you cough and sneeze and it goes everywhere.

• 1:01:10Speaker 00

  And that's what's such a worrying little, little sucker.

• 1:01:14Chris Williamson?

  Yeah, I get it. So I want to, I want to, I want to wrap back up and just give everyone what they should take away from this, apart from obviously all the information. And thank you so much for giving us your time. I know that you must be crazy busy, you're on Turkish TV and Iranian BBC and ABC and all this stuff. Um, the things that people can do, what should they do? Give us the principles they should take away.

• 1:01:35Speaker 00

  Don't panic buy, slow buy. Um, your stock up probably like two weeks worth of food and water. Um, in case of future panic buy, but remember you're trying to prepare. So part of preparing is slow buy, um.

• 1:01:52Speaker 00

  Avoid touching people and avoid touching your hands. Wash, you know, just generally going to restaurants, be very careful. Don't touch anything, basically, and that's not purely, you know, s- s- s- uh, static clean. Um.

• 1:02:08Speaker 00

  I would avoid social things. I would avoid concerts, sport- sporting events. Parties with poor ventilation, maybe outdoor party, maybe, but I I just. I knowing and seeing how infectious it has been on so many people, uh, different situations. Avoiding these kind of things at all costs. Um.

• 1:02:31Chris Williamson?

  Public transport.

• 1:02:33Speaker 00

  Yeah, and public transport, be very careful, be very careful. If someone coughs next to you, move out of the way, um.

• 1:02:42Speaker 00

  Uh, but at the same time, don't be racist that, you know, someone just because they look like they're from China. At this point, looking like you're some- someone from China is not an indicator of someone having a virus anymore.

• 1:02:56Speaker 00

  Like, you know, in that sense, you know, avoid Italians, but that doesn't make sense either.

• 1:03:01Chris Williamson?

  I get you, yeah, yeah, yeah, yeah, yeah.

• 1:03:03Speaker 00

  I think, I think just social distancing is the most important thing. I hate to say it, until we have these drugs or a vaccine, social distancing is is really the best measure. And, um, again, fist bumps and elbow bumps or something like that.

• 1:03:21Chris Williamson?

  Mm-hmm.

• 1:03:22Speaker 00

  Just avoid touching people. And, you know, even at dinner, if having face-to-face conversation, stand as far away as you can.

• 1:03:30Chris Williamson?

  Mm-hmm.

• 1:03:31Speaker 00

  And, uh, and, you know.

• 1:03:35Speaker 00

  At restaurants, people are very careful. When you're going out to dinner and you're talking, your saliva will naturally go into someone else's food across the table.

• 1:03:45Chris Williamson?

  I get you. And if you're going to do a podcast, do it over Skype like this?

• 1:03:50Speaker 00

  Yeah. Although we're going to have these virtual reality kind of like holograms. And then, you know, it's going to feel real because then you can.

• 1:03:59Chris Williamson?

  If you can, if you can infect me with COVID-19 through a hologram, then technology's gone too far.

• 1:04:06Speaker 00

  Hey, I have an infectious personality. Isn't that enough?

• 1:04:10Chris Williamson?

  I get it. Eric, man, let's say, thank you so much. You are right in the midst of it at the moment. People want to follow you for updates and stuff. Where should they go?

• 1:04:19Speaker 00

  Yeah, follow my Twitter. I have a Facebook as well, but right now I'm just purely on Twitter for those updates at Dr. Eric Ding, D R Eric, E R I C, then Ding, D I N G, at Dr. Eric Ding.

• 1:04:35Chris Williamson?

  Fantastic. Is there any other, other than your Twitter feed, obviously, are there any news outlets or websites or whatever that you think are giving accurate updates where people could follow those as well?

• 1:04:47Speaker 00

  I think Stat News is really good one. Stat News is like a healthcare newspaper there. And they have pretty good updates. You know, obviously WHO has updates, but WHO,

• 1:05:02Speaker 00

  their recommendations are much more optimistic. If you want more realistic in certain ways or more predictively ambitious, I would say, you know, follows, I think, following Twitter COVID-19 hashtag. It's a really good hash because it's something that everyone's using for, for this epidemic on Twitter. Anyways, I try to source everything that's indirectly sourceable from a journalist or a newspaper.

• 1:05:37Speaker 00

  Um. So I'm trying to stick to the facts, but I'm giving the real, the realistic things that the health department people don't necessarily want to say out loud. So.

• 1:05:47Chris Williamson?

  I think certainly, certainly in the environment that we're in at the moment, it makes a lot of sense to err on the side of um prudence rather than optimism with, with something like this, right? Look, Eric, man, thank you. Thank you so much for your time. I uh, I hope in the nicest way possible, I hope that we don't need to do another episode about this. Um.

• 1:06:07Speaker 00

  I hope so.

• 1:06:08Chris Williamson?

  Next time, if we speak again, we can just be talking about, you know, something cool. Isn't that, isn't that virus, isn't that virus that all gives us like really, really good skin? Isn't that like such a, such a wonderful pandemic for us all to have?

• 1:06:22Speaker 00

  As opposed to, you know, how much, how much food do you have left next time? We, we uh, we're in our bunkers.

• 1:06:28Chris Williamson?

  Well, I do know, I do know where you are. If I, if I need to contact you and let us say, if so, man, it's uh, I'm glad that I've got hold of someone who understands what's going on. I'm sure that a lot of the people that are listening do as well.

• 1:06:41Speaker 00

  Thank you so much. And uh, let's, let's chat again, hopefully in a couple of weeks or months.

• 1:06:45Chris Williamson?

  I get it.

• 1:06:59Speaker 02

  Mr. President, my company tore me of the explosion on our rig on October 2nd. Causing massive water displacement and triggering a tsunami. They all keep the blame on me. Tom Cruise is.

• 1:07:10Speaker 03

  Digger got us into this mess and Digger's gonna dig us up. From the director of Birdman and the Revenant.

• 1:07:16Speaker 04

  What would happen if I stopped drilling? You stop, you freeze in there, that's what.

• 1:07:20Speaker 03

  With great power comes great deniability.

• 1:07:23Speaker 04

  I'm not the first daddy.

• 1:07:24Speaker 03

  Digger. See the trailer online. Only in theaters October 2nd. Rated R. Under seventeen out of middle without parent.