#247: James Todaro, MD on Coronavirus, What Makes it Unique, and Potential Vaccines

James Todaro is the Managing Partner at Blocktown Capital and a Physician with a Medical Degree from Columbia University. In this conversation James and Anthony discuss the Coronavirus, applying existing medication to treat it, timelines for potential cures, how we can prevent it from spreading, and what to expect in the coming weeks. =============================== LEDGER----- Ledger hardware wallets empower you to optimally secure, own and control your crypto. Visit ledger.com and give yourself peace of mind by knowing that your cryptocurrencies are safe. ~If you enjoyed this episode and want to stay updated on everything Bitcoin, blockchain, and crypto. Check out Off the Chain newsletter by visiting offthechain.substack.com and join 35,000+ other investors currently subscribed to my daily investor letter.

• 0:00Speaker 00

  What's up everyone, this is Anthony Pompliano. Most of you know me as Pomp. You're listening to Off the Chain, simply the best podcast in crypto. Let's kick this thing off.

• 0:11Speaker 00

  James Tadaro is the managing partner of Blocktown Capital, a cryptocurrency investment fund and a physician with a medical degree from Columbia University. In this conversation, James gives us an overview of COVID-19. He explains why this is different than other viruses and flus. He walks us through the vaccine and cure process for production. And then he talks to us about a potential cure that has recently been identified. This entire conversation was super enlightening and I learned a lot from it. I'm thankful to James. But before we get into this episode, let's talk to one of our sponsors, Ledger. I'm going to play a recording now that they've made to tell you more about what they're doing and then we'll get into the episode with James. I hope you enjoy it.

• 0:55Speaker 01

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• 1:33Speaker 01

  funds. Visit ledger.com/vault to learn more. Control, scalability, agility, because security is not enough.

• 1:44Speaker 00

  Anthony Pompliano is a partner at Morgan Creek Digital. All opinions expressed by Pomp or his guests on this podcast are solely their opinions and do not reflect the opinions of Morgan Creek Digital or Morgan Creek Capital Management. You should not treat any opinion expressed by Pomp as a specific inducement to make a particular investment or follow a particular strategy, but only as an expression of his opinion. This podcast is for informational purposes only. All right, guys. Bang, bang. I'm here with James, who's going to teach us everything we need to know about COVID-19 and potential vaccines and cures. Before we kind of jump into this conversation, I just want to kind of caution everybody, we're recording this remotely.

• 2:27Speaker 00

  Normally, we do everything in person, but given the remote recording, the audio may be a little shaky, so just bear with us if anything happens. But James, thanks so much for joining us on Short Notes.

• 2:38Speaker 02

  Thanks for having me.

• 2:41Speaker 00

  Let's start with your background. You know, I kind of want this to be the ultimate explanation of COVID-19 vaccines and cures, but where do you, what does your knowledge base come from, or kind of your training that gives you the perspective you have?

• 2:54Speaker 02

  Sure. So I guess I really have kind of two backgrounds. So one is in medicine. So I graduated from medical school at Columbia University in New York back in 2014, and then went on to do ophthalmology residency, so residency in eye surgery, and graduated from that in 2018. I also studied epidemiology during college, during medical school, and did some research in that as well, which kind of gave me another perspective, I think, on coronavirus and this epidemic pandemic. Parallel to that background, and what most people on Twitter and in this whole universe know me, is for cryptocurrency, for Bitcoin. It was in the last year of medical school, so end of 2013, 2014, when that first wave of people kind of got interested in it, it really caught my attention. And within a

• 3:38Speaker 02

  couple of weeks, it just made sense to me. It was sound money, scarcity, censorship resistance, just bank account in your pocket, all the things that you've said many times. And then I basically divided my time, where half of it was spent in residency, which that's already busy, but I also spent about 30, 40 hours a week studying cryptocurrency, investing in it. And so that worked out very well in 2017, gave me the ability to actually step away from clinical medicine. So in 2018, after I finished residency, I stepped away from clinical medicine entirely to focus on cryptocurrency investments in this space.

• 4:10Speaker 02

  Ironically, it's cryptocurrency that kind of got me back into the medicine space again now with coronavirus.

• 4:17Speaker 02

  The, uh, so I guess quick aside, so Blacktown Capital is kind of what I've been focusing attention on lately. That's our GP only fund, and so that's what we've been publishing research under. But with cryptocurrency, we manage a lot of investments in this space and it's very volatile and it's very impacted by world events. And so when I started seeing evidence come out of Wuhan and China of this coronavirus, it really caught my attention. And I was like, is this going to come to Europe and then America and is it going to wreck the markets? Wreck havoc on my investments? And it didn't take long for me to become convinced that there's a really good chance it would.

• 5:02Speaker 02

  Especially when it started to seed in Europe. And then, uh, and then, yeah, for the past couple of weeks, it's been a whirlwind where I feel like every single day there's a new announcement that is surprising to a lot of people.

• 5:17Speaker 00

  Got it. So let's start with a kind of COVID-19 or coronavirus. I think everyone at this point has heard about it. Most people are being quarantined or staying at home and staying away from people through social distancing. Give us kind of just a one minute, like what exactly is this? And why is it different than all of the other kind of seasonal things that we would see that are somewhat related?

• 5:42Speaker 02

  So I think from a high level, one of the big differences from coronavirus is it's mortality rate. That was the big controversy back, you know, three or four weeks, a month ago. At first it was, this is only going to stay in China because it's not very, it's, it's, why would it spread to anywhere else? And so what you have to look at is the R naught. So that means for each person that's infected, how many people will that one person infect? And if it's more than one, and that means this has the potential to turn into an epidemic or pandemic. It's not more people are being infected than recovering.

• 6:17Speaker 02

  Coronavirus did. That's what first caught my attention, which was makes it not different from the seasonal flu like that can have an R naught above one. But then that combined with this amounting evidence, especially with that ER doctor that was kind of the whistleblower on this, when he died, that really got my attention. You can't, uh, that death was prominent. He was a young, supposedly healthy ER doc. This was more fatal than the seasonal flu. You rarely see people from the seasonal flu that are young die. Maybe sick and then elderly people, sure. So the R naught is one thing. And to compare this to other historical, because I know, which I got a lot of flack for this early on in Twitter when I kind of started talking about coronavirus in early February, they were like, just talk about Bitcoin, don't talk about this. Don't you, what do you know about that?

• 7:01Speaker 02

  And one of the things people kept saying is how is this different from the flu? This is no different from the flu. And, um, it was that, or, or, or I was actually so not, I don't know if it was the flu, but the second thing is someone is, is like, people felt like they were being tricked again by the media in the sense that SARS was supposed to be this big outbreak that didn't really seem to amount to much Ebola. But the, the differences with SARS, which is why I realized early on this wasn't playing out that way, is SARS was not very contagious before you started having symptoms. So it was much easier to, this is longer than a minute, but it was much easier to contain. Because once you got sick, you, you stayed home and then you didn't really infect anyone else.

• 7:45Speaker 02

  The big difference with COVID-19, novel coronavirus, is that you can be contagious while you're asymptomatic. So you don't know and you're spreading it and then you get sick a few days later, but you're already infected two, three, four people. So I'd say that's why this is different than say Ebola or SARS. And then it also combines that more fatal element than the seasonal flu. Our bodies are not used to this virus, essentially.

• 8:12Speaker 00

  Got it. And so before we get into what I'll call kind of the vaccine and cures component of this, a lot of what you just described, your analysis, kind of those original alerts that you saw, red flags, is all about data, right? And one of the questions I think a lot of people have is, we've got a pretty good sense of the accuracy of the deaths, right? The aggregate number of deaths, somebody died, you can test them, did they have it, did they not? Maybe to before or after death. But the denominator to that mortality rate is how many people actually can get infected, and then how many people die. There's not a lot of testing that's gone on. So how did you, using that kind of caught your attention in the beginning, the sort of red flags you saw, etc. I think

• 8:56Speaker 00

  that there's a lot of confidence in the death number, just given that people are actually dying, it's pretty easy to confirm that. And you can either have tested before or after death to see if they have this. But the actual number of infected, given the low amount of testing that's available, especially in the United States and parts of Europe or beyond, how did you think through the accuracy of the data, or kind of understand, you know, how bad is this? Or could we just be looking at bad data?

• 9:28Speaker 02

  So that's a great question. And that's still actually an important question is, how many people are we actually detecting that have coronavirus? That was one of the big problems is ruling out this testing to be able to determine that. And so, and even today, a lot of the experts on this, including myself, my opinion is a fatality rate probably is lower than what's coming out of, say, Italy, which is 5% or so. There's a really good chance that people with mild or symptoms, maybe aren't going into the hospitals to get tested, are staying home. And sure, they're bedridden, it could be the worst flu of their life, but they recover. But those would all be people that lived and didn't die. So that still could be the case.

• 10:08Speaker 02

  I guess one thing though that pointed me to guys, it kind of goes in the other direction of the mortality rate is because this is a pandemic, the amount of cases was rapidly increasing. So back in January and early February in China, when it was still increasing, you actually had to compare the number of deaths to about the number of cases 10 days ago. Because when you, right when you test positive or get it, you don't die. There's a 10 day delay. So looking at that delay, when it's rapidly rising in China, it gave me the impression this mortality rate was, there was actually a fact the other side is might be higher than those numbers. But then also there were maybe undetected cases. So I kind of balanced that out and it's, you know, you just have a rough number, but it looked like there was still, there was, it was a reasonable fatality rate, far worse

• 10:53Speaker 02

  than the flu.

• 10:56Speaker 00

  Got it. That makes sense. Okay, so now that we understand kind of what this is and the fact that the infection rate and kind of the symptomatic versus asymptomatic are all reasons why this is more concerning, let's walk through, why don't we already have either a vaccine or a cure for this? Like, what's kind of the scientific explanation behind the lack of that stuff being available today?

• 11:24Speaker 02

  Sure. So you really, it's, it's difficult to make a vaccine for a virus that you don't know of. So this is novel coronavirus, it's new. So you wouldn't expect us to have a vaccine for it. What we can do is isolate parts of this virus and then introduce it in cultures and form a weaker version of this virus that we can then give to people. That's essentially what you're doing either. When you get a vaccine, you're getting either a dead version of the virus or a weakened version. And so your body, most of the time you don't even feel anything. Sometimes you feel a little bit under the weather. And so what that does is now you don't really get sick, but now you have immunity to that disease. So that takes knowing the virus, studying it, and then coming up with a vaccine. That realistically, we're not looking to have that until mid 2021. Early 2020 would

• 12:09Speaker 02

  be a shock. If we even are able to successfully come up with one. Regarding a

• 12:16Speaker 02

  Cure for it, viruses are very hard to cure. So coronavirus on a molecular biology level, the single-stranded RNA virus. So what this means is it mutates quite rapidly. So there are times when we can cure viruses. We have cured certain viruses like hepatitis C in the past with medicine, but it's notoriously hard. A lot of times what you can have is find a treatment that can work some part of the time and kind of flatten the curve in how fatal this virus can be or how much it will spread.

• 12:54Speaker 00

  Got it. And so what's the process? Let's start with maybe the cure first and then we can go to the vaccine. What's the actual process that people will go through to test and actually validate that yes, there is something out there that can be a cure?

• 13:11Speaker 02

  It's a long process. So you have very early studies in cultures and then next you have very small trials of, you know, 50 patients and then you kind of keep rolling it up from there. The US is very cautious, very regulated when it comes to studying and approving, FDA approving medications. And that has saved the US in the past from certain medications being harmed, like thalidomide is a chemical that's actually very toxic to pregnant women. And so this was rolled out in Europe, but the US had wait, hold the brakes on that. And that turned out to be a good decision. In the situation of a pandemic, though, it kind of works against us because we don't have six months a year,

• 13:55Speaker 02

  18 months to be like, we're going to find a vaccine or a medication to treat this and go through all those proper steps, which we usually do. And so that's where, you know, I've kind of been focusing on a treatment, potential treatment that's already widely available, known safety effect profile, and something that about a million people or so globally are already on. So if this could actually cure or help reduce the symptoms or reduce the amount of people getting infected with coronavirus, that could be huge. It wouldn't really, you could expedite those trials and that process much more quickly

• 14:36Speaker 02

  than developing a whole brand new treatment over the next six to 18 months.

• 14:42Speaker 00

  Got it. And then is it similar process for the vaccine as it is for the cure? Or is there a completely different process with different timelines and complexities?

• 14:53Speaker 02

  I would say a vaccine would even probably take a little bit longer.

• 14:58Speaker 02

  Especially if you talk, because now you're talking about rolling this vaccine out to a large number of people. So if you're going to also start making like the flu vaccine where you're recommending just about everyone in America or in the world gets this vaccine. You don't want to mess that up, right? Whereas a treatment, you can be like, okay, well, this person is already sick. We know that there is a three percent mortality rate. We know that this treatment has a very favorable side effect profile potentially. And so it's much easier to prove that as opposed to rolling out something that's in healthy people. That we don't, you know, the side effect profile has been studied less.

• 15:31Speaker 02

  Because there's always that concern with the virus, there's always that concern with the vaccine. That that weakened virus could mutate into a harmful virus. And then you don't want to die from the vaccine.

• 15:42Speaker 00

  Got it. And I think that I saw, this is like the Imperial College paper that recently came out. Their whole thing was even if you start identifying what you think could be a vaccine. It's got that really long timeframe, kind of 12 to 14 months, they said at the earliest. Until you could confirm it. And it sounds like a lot of that, sort of what you're saying is revolves around just like. You can't go tell people this can save you from COVID-19. But oh, by the way, there's 20% chance it could kill you at the same time. Right? You've got to.

• 16:13Speaker 02

  For sure. You know what?

• 16:16Speaker 02

  Right. The first three in medicines do no harm, right? So you don't want to introduce them to something that's going to actually be more harmful than just, you know, maybe living up the course of the disease.

• 16:27Speaker 00

  Got it. Okay. And so talk to us a little bit about the, the potential cures that, that you're looking at. I know that there's some, some encouraging, I think, reports and data that is starting to come out now. As to how, there may be some things that will actually cure this or at least reduce the symptoms.

• 16:45Speaker 02

  Yeah, so what I've been focusing on with with one of my colleagues is basically about it was about two weeks ago now, I started seeing evidence coming out in guidelines and from China and South Korea about chloroquine being a potential treatment for coronavirus. And started doing a little bit more digging into that. There was some mechanisms of action that showed how hydroxy chloroquine or hydroxychloroquine, they're only kind of use them interchangeably. They're very similar drugs. I can talk about the differences in a little bit. But it has mechanisms to decrease viral replication in cells and actually eliminate that process entirely, at least in vitro.

• 17:25Speaker 02

  And they studied this in the SARS version of coronavirus. And so there's already in vitro, these are base of in vitro studies for that.

• 17:35Speaker 02

  This kind of idea, which wasn't really talked about yet about chloroquine being a treatment for coronavirus, was kind of justified in my mind where I started to see the United Kingdom banned export of the active pharmaceutical ingredients in chloroquine. China did similar. They essentially announced in early February, but the priority, they brought it back in the Chinese New Year early and said, hey, look, we need you to produce hydroxychloroquine in high volume. We're going to stop all exports of this. And we need to prioritize Wuhan in our own country to make sure that we can stop this. And then in March 9th, I had been contacted pharmacies and

• 18:14Speaker 02

  one of the pharmacists I contacted, the manufacturer of rising pharma of chloroquine and announced and told us there's a national shortage of it. And so all these things in my mind was like, you know, basically triggered, there's something big going on. It seems either they think chloroquine may be an effective treatment, or it already potentially is an effective treatment. And so that's when I started talking about it on Twitter and to a lot of colleagues and

• 18:39Speaker 02

  This is when one of my colleague on Twitter contacted me and I said, hey, I've been studying chloroquine for a number of years. It looks like, you know, I know the mechanism of action behind this very well. I have a paper that I put together, take a look at it and see what you think. And I looked at it, I changed, added some clinical elements to it. I was actually already familiar with chloroquine on a clinical level because one of the main side effects is vision loss. You can have, it's very rare, but you can have vision loss from it. And so I've seen a lot of patients that were on it. And so I was able to add those elements to it and more of a clinical, I guess, impression of it. And again, that's because I was an ophthalmologist, so I saw, that's why I saw those patients. And we released that paper and it got a ton of attention.

• 19:23Speaker 02

  It was retweeted by Elon Musk shortly thereafter. And it just kind of blew up from there and we were contacted by press, the media. My co-authors, Greg Rigano has now been on the Laura Ingraham show. He was on Tucker Carlson last night, I think he was on Glenn Beck today as well. And it's, you know, it's really, it's starting to become a little bit more justified. So what we had was this kind of summary of all this evidence, I think, to show that chloroquine might be an effective treatment. And then what I announced yesterday, which was we remain in contact with Didier Raill, this very famous infectious disease doctor, MD, PhD out of France. And he's been studying this for the last few weeks as a treatment for patients with coronavirus.

• 20:08Speaker 02

  And he had very positive results. It was a very, it was a small study, just about 36 people that stayed enrolled till the end. But it showed the combination of hydroxychloroquine plus azithromycin. So again, hydroxychloroquine is like chloroquine, it just actually has a safer side effect profile. So it's kind of used more often than chloroquine. But it showed a very small sample size still, but showed 100% decrease in viral load. And in the 100% of the patients received both hydroxychloroquine and azithromycin. And so this is a small, I've got a small sample size, but very positive results regarding this treatment method.

• 20:47Speaker 02

  This was announced by my co-author on Dr. Carlson last night. And it seems like Donald Trump reacted to that as he in his press conference today talked about, he specifically talked about anti-malarial medications, hydroxychloroquine, how this needs to be expedited and cut through the red tape if possible to allow physicians, to make physicians feel comfortable in using this drug to treat COVID-19 positive patients.

• 21:14Speaker 00

  It's pretty crazy that it seems like many of these people are getting their news from television or from Twitter, but it's human nature at this point, right? A lot of this content that gets shared around, that's where people are learning from. Walk us through, what is the difference between the hydroxychloroquine, I think is how you say it, and zithromycin? What are those two things kind of at the core, right? And understanding that most of the audience isn't going to be highly scientific, which is how would you describe those?

• 21:49Speaker 02

  So hydroxychloroquine is really used mainly as an immunosuppressant. So it's actually used for treatment in patients with rheumatoid arthritis or lupus. Kind of suppresses the immune system in a way to keep the body from attacking itself. It also again has antiviral properties and anti-parasitic properties. So it's used as a prophylactic or treatment for malaria. It's very popular in Africa.

• 22:16Speaker 02

  Zithromycin is typically known as being an antibiotic. Usually prescribed for bacterial infections, but studies have shown it has antiviral properties. So coronavirus is a virus, it's not a bacteria. So that's a very important difference. That's why they can't give you antibiotics for just a seasonal cold. I mean, you could ask for them, people often ask for them, but it really isn't going to actually help because it's a totally different type of species. But as zithromycin actually has antiviral properties in bronchial epithelial cells, and this is where coronavirus will attach and infect is a lot of the respiratory tract. And so zithromycin, it makes sense why it could help treat or be preventative, treat or prevent coronavirus.

• 22:59Speaker 00

  Got it. And then when you talk about those being used in unison, is this actually like a scientific mixture, right? Meaning that you're creating one single solution by combining these two? Or is this two separate either shots, or however they're actually administered, they're kept separate, but you basically take them at the same time?

• 23:20Speaker 02

  Correct. So in the French study, which is really the most data we have at this time on this combination therapy, it's two separate pills. So you take your hydroxychloroquine, and then you take your zithromycin. And so what he did with the hydroxychloroquine, it was a 10 day treatment of it at 600 milligrams a day. And then the zithromycin was a 500 milligram loading dose the first day, and then 250 milligrams for I believe the next four days. So oral form, separate pills, but used in tandem combination.

• 23:53Speaker 00

  Got it. And so where do we go from here, right? We've identified these two drugs that we think have the potential to be effective in treating this. We've got what I'll call kind of an initial early study that shows some encouraging results. We obviously don't have time to go through kind of the traditional process. But as you mentioned earlier, we want to make sure people are safe and actually can validate the efficacy of this. So like, what does that process look like? Or where do we go from here?

• 24:23Speaker 02

  So I think one of the, what I kind of alluded to earlier, one of the interesting things about hydroxychloroquine is so many people are already on it. So you already have a million or so people. So if there is a way to analyze that data that already exists and see if any of those people are getting infected with coronavirus. And as the incidence or prevalence of coronavirus goes up, you should start to see overlap. You should start to see lupus patients, or rheumatoid arthritis patients who are on hydroxychloroquine as becoming infected. And so if you were able to create a study that could analyze that group of people, and maybe it's too self-reported, or some other means, then I think a safe way to evaluate the efficacy of this drug very quickly,

• 25:05Speaker 02

  as opposed to doing a controlled trial where you placebo and all that.

• 25:13Speaker 00

  Got it. And so, once we get past kind of those studies, so I think of studies maybe correctly or incorrectly as the way to gather data, where, like, what are the milestones or kind of the stamps of approval? Like, what does that look like? Is that the people who run the study saying, "Hey, stamp of approval, this works"? Is there some kind of overarching, like, governing body or government organization? What does that kind of approval process look like before it can actually start being given to patients kind of on the ground?

• 25:46Speaker 02

  Yeah, you, so there's basically two different ways. You either have to come to the FDA with sufficient evidence to show this medication is safe and beneficial in a treatment of a specific disease. That's the, if you want to call on-label use. So that's, you know, what the prescription is designed for, let's say. Doctors also have the option, though, to use medicines off-label, which means this is not the FDA-approved indication for it, but doctors still have the ability to prescribe medications where they think appropriate or necessary in patients that it's not the, the specific indication that the FDA approves. This is where things get interesting, though, because in, in America, medicine is fairly litigious.

• 26:29Speaker 02

  So if you, as a physician, deviate from that standard of care, and then something goes wrong, even if that something went wrong was, you know, a small percent, and that could happen to either, you know, if someone, if an FDA-approved indication, it still makes you vulnerable to a lawsuit. And traditionally, it's academic physicians or people, physicians are very comfortable experimenting with new use cases for these drugs, and will see those patients. The problem we're seeing in a pandemic is those physicians, those academic, they're kind of becoming overwhelmed. You have patients all over. So it's not just a very rare case of something where you're looking for a physician that will, will treat this thing with this off-label, off-label use. You have physicians everywhere that are kind of stuck in this thing

• 27:14Speaker 02

  where, "Do I use a certain medication off-label to treat all these coronavirus patients that are coming into my ward, or do I give them IV fluids and, you know, hope they get better"?

• 27:27Speaker 02

  And that's, I think, the question that a lot of physicians in the US are dealing with right now. And so they're looking for some guidance from the FDA, essentially saying, hey, you can use, which that's kind of what Trump did a little bit today. The FDA, I think, backed on that a little bit, but he essentially said, look, I'm approving people for approving physicians to use this medication, hydroxychloroquine, in coronavirus patients. I don't know if it's really that hard of a, that really passed through. I think there's still some red tape that maybe needs to go through. But that's essentially, I think, what he's aiming at.

• 28:00Speaker 00

  Yeah, it's really interesting to see a lot of kind of bureaucracies and red tape in the healthcare system being almost broken down in this crisis, right? So everything from what you're talking about, kind of the acceleration or approval process, to, you know, the ability for a doctor to actually administer healthcare services to a patient in a different state, right? A lot of telemedicine stuff, et cetera. For those that aren't aware of how bureaucratic healthcare is, there's a lot of rules that, I think you kind of mentioned earlier, make sense sometimes, and other times they seem really stupid, right? And so it takes a crisis like this to kind of break some of those down. And then maybe some of them get reinstated later, or maybe they don't. But it's just been fascinating to me to kind of watch this

• 28:45Speaker 00

  almost tennis match between, here's the rules today, well, should we keep them? Or is this kind of an emergency situation? Let's get rid of them.

• 28:54Speaker 02

  Yeah, exactly. You kind of take a hard look and say, wait, which of these rules are actually high yield? And which ones are just, you know, vestiges of old bureaucracy that is maybe due to lobbyists, or who knows?

• 29:09Speaker 00

  For sure. And sort of finish up here, obviously, you've got kind of two parts of your brain right now, I must think of, right? You've got the medical side and the training that you've done there. And obviously, the hours and hours that you've spent kind of looking at this, and starting to identify some of the potential solutions. But then you also are an investor, and you're managing capital and things like that. Where's the crossover in terms of how do you see coronavirus and the economic impact kind of continuing over across different markets in the coming weeks and months?

• 29:43Speaker 02

  Yeah, so it's constantly changing, but I think you have to kind of look out for three different potential paths coming up over the next few months or years. So there's the first path where we do find a medication, a treatment, or a prophylactic that can flatten the curve, reduce the symptoms, reduce the fatality rate, or reduce the number of people that get infected. And that could buy us time until maybe vaccines develop, or even until we have herd immunity, and this thing in coronavirus just becomes almost like the flora of the seasonal flu and not really a big deal. The second path is the virus mutates a little bit, so almost like H1N1, where it was kind of thought it was a big deal, a higher fatality rate, and then it kind of mutated in a way

• 30:25Speaker 02

  where a lot of people got it, so it infected a lot of people, but the mortality was actually quite low, so that's why I didn't even hit the radar all that much, and most people don't know how many people are actually affected by it. And then the third path would be if the virus does not mutate, if we do not have a medication or vaccine for it, then that's scarier, obviously, and what I think you could be looking at is maybe, and this is based off China and South Korea, how the cases have stabilized, a number of new cases is dramatically dropping, that is this have to do with the warmer weather coming in? And are we going to see a second wave come the fall? And that's what a lot of people compare this to, the Spanish flu of 1918, where it had

• 31:10Speaker 02

  its first wave, that kind of ended around June, July, and it wasn't until about October, November, the second wave came in, and that's the one that really wiped out a lot of people. And so that's something that you're going to be looking out for, is if this does settle down, that's great, that's fantastic, but keeping a close eye for reinfections in areas come the fall. On a short-term basis,

• 31:37Speaker 02

  For Americans, look at Italy. We're running about ten days behind Italy. So what Italy is going through now will be America most likely in ten days. And this just seems so obvious to me over the past couple of weeks. And so that's why it was interesting. A couple of weeks ago, almost no one was really talking about it. It was almost like a joke. And it was awkward if you were to shake someone's hand or something. Now, it's not. If you actually just look at those stories coming out of Italy about people living there and what that life is like, prepare for that, because that could easily be America in ten days. And I think it's already getting very close to that. And so looking for stabilization of coronavirus, again, look at Italy. When those cases stop going up

• 32:21Speaker 02

  and stabilize, I think that's good news. And I think that there's hope for this stabilizing, at least over the summer, and then we'll have to revisit it in the fall. And then I think the markets of Bitcoin and Bitcoin cryptocurrency, I think that all kind of goes in something this massive, it seems like it kind of is trading along with the, when the economy is going down, it's, it's, you know, a risk on asset and it goes down as well.

• 32:47Speaker 00

  Yeah, one of the things that I've heard, and I don't know if it's true or not, is that once you get coronavirus, you basically can't get reinfected, right? So the population itself, some portion could get infected, it goes away and comes back and could reinfect other people. But is it true that the individual itself, once you have it, you can't get it again? Or is it just too early to know whether that's accurate or not?

• 33:13Speaker 02

  So that's typically how viruses work. Once you get a viral infection, you can't get that really exact same viral infection. There can be different strains of it, though. That's why you can get the flu multiple years. It's not like you get the flu once and you're not, you never get the flu again. Another strain can come out the next year. Or you might get infected with a different strain even that year. They are finding though that they are patients that test negative after they've been treated later than test positive again for the virus. And so that's concerning in some ways in the thought that are they not treating patients long enough? Is this some type of reinfection?

• 33:52Speaker 02

  And so that that that data is being studied now, but I'm inclined to think that's how you get herd herd immunity is potentially as you get infected, you won't get it again. So that's kind of the hope, but it's not definitive at this point.

• 34:09Speaker 00

  Got it. And in those different strains, I think the other thing I've heard is basically when the warm weather comes, it may kind of migrate south to South America, Latin America, et cetera. But there could be mutations and then when the cold weather returns later this year in North America, for example, that's where really there could be some problems because now you're not just talking about the coronavirus, but there could be multiple strains of this or kind of mutations that even if you already had it, you're still susceptible to the new stuff.

• 34:40Speaker 02

  Yeah, exactly. I think that one thing that people argue that we're going away during the summer is increased temperature will dry out the the virus in some ways. And then also the increased humidities, it's kind of like you have this heat, tennis sun drying effect, but then you also have the humidity in the air, which will stop the spread of the virus because if there's enough air, water particles in the air, it'll stop the the viral particles from kind of, you know, projecting when you talk or sneeze or cough.

• 35:09Speaker 00

  Got it. That's super interesting. Okay. And then what do you think is kind of the, if you had to guess right now, what does this look like over the next kind of six to eight weeks? Do we flatten a curve, you know, two weeks from now and and kind of start moving back towards, you know, everyday life? Do we stay in kind of this self quarantined, you know, even some places shelter in place for for weeks, months? Like, how do you think this plays out, given the information you have today?

• 35:41Speaker 02

  You're gonna be quarantined for at least weeks. I would say at least a month.

• 35:47Speaker 02

  Could be couple months, three months. It kind of depends on this thesis on this thing slowing down for the summer. But I think we're in for a rocky few weeks coming up. And it looked like Italy was stabilizing a little bit, but then they recorded a record number of new cases yesterday and another record number it looks like today. So it's, we haven't had any, there's been no evidence this is slowing down really for Italy or Europe. And so that, that's not good news for us right now either.

• 36:14Speaker 00

  Got it. And then what do you take in terms of China? I think today we're recording on a, on Thursday, March 19th. It was either yesterday or today, they reported no new cases. So, you know, quote unquote, zero new cases. Can we trust the data? You know, how, how do you kind of fit that data point into this whole thing?

• 36:36Speaker 02

  So I'm in contact with people that have come back from China and they feel convinced that China has it under control and that that data is real. That's always been the question though, is from the very beginning. You know, China didn't really want to announce this was the virus. She had the whistleblowers that were originally persecuted and now praised. And so there is this always this distrust of the embracing from China. But South Korea has kind of very positive results. I think Singapore has been doing a good job controlling this. And so it's, it's possible. It's also possible on the kind of social infrastructure side of things. I think in China and South Korea, you know, the social distancing is maybe a lot easier, or if the government recommends it or imposes it, it's done much more effectively. Whereas in Italy and the US, you know, a lot of people are like, well, you know, screw that.

• 37:22Speaker 02

  I, I'm gonna go kiss whoever's cheek I want. I'm gonna go to the bars. And so I think that it really takes a little bit more to scare people. And now people are starting to get scared where maybe they're scaling back on that a little bit. But if you read a lot of the Italians, what they're telling Americans right now is, do that now. Don't, don't wait until it gets so bad that you, you know, there's a curfew, you can't, if you're outside, like in Italy right now. If you go outside, you have to essentially have a pass or a very good evidence or reason for being out. Otherwise you get fined. And the only reason you're really allowed to go out is to go pick up medication or to go to grocery stores.

• 37:58Speaker 00

  Yeah. The other thing I just saw, literally before we started recording, and again, so I'll caveat with, I haven't had the time to look at the accuracy of it, is Israel is actually implementing martial law. So like actual true martial law where the government or the military is going to enforce people staying inside, curfews, you know, all of this kind of non-essential traffic, etc. And so I think that we're probably far away away from that, you know, in the US, for example, or other places. But, you know, depending on people's reactions, I think that, you know, there is this overarching feeling of like, we've got to flatten that curve and kind of fight back against this.

• 38:41Speaker 02

  I would say there's a non-zero chance some version of martial law comes to the US as well in the next two, three weeks. I mean, if this thing continues to spread and people aren't voluntarily kind of isolating themselves, then it's definitely possible. It wouldn't surprise me the next two, three weeks. Which sounds crazy for Americans, especially because a lot of Americans have guns. It's a little bit of a different.

• 39:10Speaker 00

  Well, I was explaining to somebody the other day, if you would have said four or five weeks ago, you know, hey, the stock market's going to go down 30%. There's the possibility of martial law, you know, all these different things. People would have looked at you like you're nuts. And in a very short period of time, you know, here we are.

• 39:27Speaker 02

  Yeah, exactly. And I think that people could be in for a bit more surprises in the next couple of weeks.

• 39:34Speaker 00

  Yeah, well, let's, let's all hope not, and hopefully we can get back to normal. Absolutely. James, listen, I really appreciate you coming on on such short notice and helping us understand this. Where can people find you online and kind of find more about what you're tracking and paying attention to?

• 39:54Speaker 02

  James Sidero, MD is my Twitter account. It looks like Joe just put it on the screen there. That's the best way to follow.

• 40:01Speaker 00

  Joe's a legend. Look at him, man.

• 40:03Speaker 02

  I know, he's quick. That's where I talk about coronavirus updates. A lot of times it's the effect on the Bitcoin cryptocurrency markets. And that's where I talk about all my crypto insights as well.

• 40:13Speaker 00

  Awesome. Before I let you go, I got two questions that you could ask me. One, favorite book or most important book you've ever read?

• 40:22Speaker 02

  Most poor book I ever read. Um, gosh.

• 40:29Speaker 02

  I guess Treasure Island. For no real reason, except it was a book that was probably the first very sophisticated book that my dad read to me. He read it to me when I was very, very young. And it was actually funny because he, I felt like he was too slow. So after he read the first, maybe few chapters of it, I actually just picked it up and read the rest of the book on my own. And so that always stands out in my mind.

• 40:50Speaker 00

  I love that. It's one of those things where it's not only the book, but the time of your life when you read it, that that makes something important. So that's pretty cool.

• 40:56Speaker 02

  Exactly.

• 40:57Speaker 00

  Aliens, believer or non-believer?

• 41:03Speaker 02

  I think there is life somewhere out there in another universe in some way. It isn't, I think that's definitely possible.

• 41:13Speaker 00

  Well, just because the world's so, you know, kind of the galaxy's so big or some other reason?

• 41:17Speaker 02

  I mean, with infinity, you have an infinite number of possibilities, right? So you can have an infinite combinations of matter that can form humans or people or animals or life.

• 41:30Speaker 00

  It's a fair way to view the world. What one question you have for me to finish up?

• 41:38Speaker 02

  Does anyone ever call you Anthony or is it always Pop?

• 41:44Speaker 00

  So my mother still calls me Anthony. And my, my family, they actually all call me AJ. My Anthony John, Pop, that was my name. So they call me initials for first and middle name. But pretty much today, if somebody calls me Anthony, it's usually followed up with, by the way, can I call you Pop? Or is that, are we not like close enough yet? And I tell people that you can call me whatever you want. Just don't call me an asshole. It will be good. It's Anthony, Pop, whatever it all works for me.

• 42:18Speaker 02

  All right, man. Well, it was great talking to you. Thanks for having me on the show.

• 42:22Speaker 00

  Yeah, thanks so much, James. Appreciate it.

• 42:25Speaker 02

  All right. Have a good one.

• 42:29Speaker 00

  Hey everyone, Pop here. If you liked this episode of Off the Chain and want to help us take crypto to the top of the Apple, Spotify, and other podcast charts, please do us a favor and rate, review, and subscribe. To review, simply go to the Off the Chain homepage, scroll down until you see the five blank stars. Taking 15 seconds to fill those stars in and leave a quick review goes a long way in helping us take the entire crypto ecosystem to the top of the charts. I appreciate you listening and see you next time on Off the Chain.