Provider Wellness Podcast

An Anesthesiologist Discusses COVID-19

April 22, 2020 Matthew Zinder, CRNA Season 1 Episode 8
Provider Wellness Podcast
An Anesthesiologist Discusses COVID-19
Show Notes Transcript

Matthew speaks with Dr Quinn McCutchen, an anesthesiologist at Wake Forest Medical Center in North Carolina.  Dr McCutchen had just finished a night call on an airway team treating Coronavirus patients.  He discusses his experiences and how his institution is handling the crisis.  They also discuss the virus itself and how it has affected healthcare and society in general. 

Be sure to read and download the transcripts to this episode. Click on the tab above.

Check back often for more episodes pertaining to health and wellness and issues concerning the COVID-19 pandemic.

Please send your questions to goingviralpodcast@gmail.com

Website:  https://goingviral.buzzsprout.com/

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spk_1:   0:05
Hello and welcome to the going viral podcast. I'm Matthew Zinder, a certified registered nurse anaesthetist. I'm in advance practice Nurse that specializes in the practice of anesthesia. Scope of this podcast will explore health and wellness from the broad to the specific. My aim is to educate while offering a unique perspective. Thank you for joining me today and let's get right to the show. So today I speak with Dr Quinn McCutchen. He's an anesthesiologist out of Wake Forest Baptist Medical Center in North Carolina. He's actually working on the front lines in North Carolina. He had just finished a night airway team call before we spoke that next day. Eso he was very generous of giving of his time when he probably should have been sleeping. Doctor, my coach and I are friends. We met many years ago on the national lecture circuit, speaking together in many medical conferences. So I've known him for a while, and I knew that he would be able to give a unique and first hand perspective on what's been going on and what he has experienced personally. So I hope you enjoy our conversation and please stay tuned for future episodes I've got some good ones planned where I will be interviewing a gentleman out of Virginia who owns a wilderness survival school, and he will be talking to us about the concept of preparedness and thinking about being prepared for possibly the resurgence that they're predicting or even being prepared for a natural and or man made disaster in the future. Because we know that there is a possibility that any of those things could occur also as promised. Or, as I keep promising, I am going to start getting into the stress management topics, so please stay tuned as well. For those, please also give me any type of constructive feedback that you wish. Or if you have any questions, please go to going viral podcast at gmail dot com and email me and the website for this podcast where you can listen with a player is called going viral dot buzz sprout dot com as usual, thank you very much for all of the feedback I have already received, and I look forward to hearing from more of you in the future. So without further delay, here is my talk with Dr Quinn McCutchen. Well, first of all, How you doing? Great. You, Harry? Well, you know, other than a dire need for a hair cut, I can't really complain. I think, uh, you know, my family is they're all healthy for now, you know? So we've been able to Teoh avoid all the stuff that's been going on so far. But, you know, I work self quarantine. Everything we do is elective surgery. So my practice is shut down for now. First time in 36 years. So

spk_0:   3:08
I'm off all next week. Is there, you know, trying to spread it out.

spk_1:   3:13
I mean, are you do are you guys doing any surgeries at all?

spk_0:   3:16
We're only doing what are called Tom Sensitive cases or cases that have been deemed Teoh result in morbidity or mortality. If they're not addressed within four weeks, everything if you can put it off for a month, and we're not doing it essentially and there are a lot of grayer is in their words, like, could this really be deferred for a month or night? But sure, that's per HHS of North Carolina

spk_1:   3:40
again. Thanks very much for doing this. I appreciate it. And if you want to kind of just give the listener kind of a little bit of a background, and then we kind of just get into a discussion.

spk_0:   3:51
Okay, sure, So I'm an anesthesiologist. I live in Winston Salem, North Carolina, and I finished my residency in 2003 and since that time have been on faculty at North Carolina Baptist Hospital, which is a fairly large academic medical center. It's a Level one trauma center as a burn center with the lots of complex referrals from ISAF are ways West Virginia to the north, Teoh middle of South Carolina to the cell. Teoh, Eastern Tennessee to the West. We are affiliated with Wake Forest University School of Medicine. So we worked with residents. We have a CR in a school, so we work with CR knees and student nurses s this My main areas of interest are Euro anesthesia, obstetrics, Tennessee gin and regional anesthesia in

spk_1:   4:40
And you you did a neurosurgery residency A swell, didn't you?

spk_0:   4:44
I did half of a neurosurgery, Residency said. I did a year of general surgery, internship and three out of six years of a neurosurgery residency, and at that point basically felt like I wouldn't be happy with a career in there a surgery and kind of saw the light and came out of Italian Si Jin, and that's that's not a disparagement against neurosurgery. It's

spk_1:   5:06
more just a

spk_0:   5:07
bit for my my interest in personality. And why not say,

spk_1:   5:12
Oh, sure, I I get it like I mean, you were smart, Teoh know what you wanted? That's for sure. But it certainly I would suspect it probably makes you one of the best. Ah, Euro anesthesiologists around having that kind of background,

spk_0:   5:24
right? And that that's why I was hired. A Baptist was mainly todo De Niro anesthesia, and you're right, it. I feel very comfortable with neurosurgical cases. I feel like I really understand what's going on. And one of the things I do you like about being an anesthesiologist, though, is the variety of things that you can do if you so desire. So that's that's what got me into doing their blocks and regionally and assist Egypt, for example, and in obstetrics and anesthesia is it's a lot of procedurally based things with varying physiology is in in the patient population that you're taking care of.

spk_1:   6:03
Sure, that's I mean, variety is best. That's That's my personality to I. I like to have Ah, a little bit of everything. Keep things interesting. It sounds like because, I mean, you had just told me that you're gonna be awful next week. So it doesn't sound like you guys were overwhelmed at this point or you kind of staying on top of the curve.

spk_0:   6:20
Yeah. So following the Washington models, I don't know if if you're familiar with there's where they predict peak resource utilization and whatnot today is actually the predicted peak resource requirement for North Carolina on guy think nationwide it was four or five days ago. And at Baptist, we are certainly well within our means is faras I see you space ventilator availability, that kind of thing. We, um we've never had more than 20 intubated Kobe positive patients at any point. And now we're actually just under 10 with those numbers and obviously we have a lot more. I see space and ventilators. In fact, the majority of our ventilated patients there are certainly non coated patients in this point. So yes, I think we are, or were able to flatten the curve enough not to hopefully exceed our capabilities in any point.

spk_1:   7:19
Well, that's great. So is there a part, like, projected amount that you may be expecting in the future? Or, I mean, how is North Carolina doing in general is a state on the curve.

spk_0:   7:31
Uh, once again, if we're gonna hit our peak resource utilization and we don't have any major policy changes that would increased the amount of people getting sick, then I think we're actually gonna be OK. Now that you know that mean bust by okay, I mean, not exceeding our resource is now. Obviously, the big question is, when is all this gonna end? How fast is it going to ramp down? How soon are we gonna be able to get back to normal practice? You know, right now, we're not doing any time sensitive cases, so yeah, the question is, how do you best start phasing in these cases there? Quote unquote. Non time sensitive, such that you don't exceed your resource is. And that's kind of what we're in the process of trying to figure out right now. Obviously, there's a lot of uncertainty, and when things will start trending back to getting back to normal is certainly not gonna be the quote unquote pushing a button where everything is respect, a normal one day. Be a gradual phase in process,

spk_1:   8:40
Sure. And is that has the governor of North Carolina kind of given any type of indication on when what the government is thinking?

spk_0:   8:48
Not with definite timetables? No. I mean, there's been some talk of phasing things in, but nothing really hard fast at this point.

spk_1:   8:57
You were you We had spoken earlier in the week. So you were on an airway team last night.

spk_0:   9:02
Yes. So we have 18 of 16 anesthesiologist that air on Kobe Airway call, and basically you probably want to ask me details about it, cause it's a very convoluted thing, but basically, we take in house call 24 7 Teoh deal with Kobe patients there requiring intimations, and we have a whole set of algorithms. You know, we had our own PPE that's that's each available to us, and we have a process that we actually manage the airway in these patients. I was on a 5 p.m. To 7 a.m. Call last night, and then my next covert airway call is 787 p on Sundays. We do 12 hour blocks on weekends, and during the day they try and have an anesthesiologist. He was on our covert airway group there. Who's covering rooms that can deal with any airways to come up dreaming, quote unquote regular hours.

spk_1:   10:06
I got you. And have did you deal with any covert patients last night?

spk_0:   10:09
So I dealt with a P u I or a person under investigation, and I essentially just covered that case myself. One of our see our days, and we actually did not have to intubate that patient, but I just went ahead and cover it. Since I had all the appropriate TP and had been drilled in the donning and doffing and whatnot like Jason discussed with the A few podcast back and that was it. We did not have anybody we had to intubate last night. That's that, to me is a very positive sign that that we're not having intubate one patient after another with Co Vader's suspected Kevin.

spk_1:   10:47
So were you at that point in previous days or weeks, where you were in debating one after another or treating one after another.

spk_0:   10:57
We had never been at the point where we were in danger of exceeding our amount of ventilators or I see you space. We've had people have taken the call and had to do two or three and a shift to the best of my knowledge. But it's never been like where you just come in and you just intubate one person after another the entire time you're on call.

spk_1:   11:21
How are you seeing the treatment Onda outcomes for the patients that you've that you've had so far.

spk_0:   11:27
So I think the deaths overall for fur coated it in North Carolina are actually pretty low, especially compared to places like New York State and home New Jersey area. You know, they say that mortality, once you get on a ventilator is heard, is quoted as high as 80% and I don't know the statistics on that for Baptist Hospital. But I would suspect it's lower than that. And we currently have four intubated Kobe patients I did here. We had one last week that wound up going on BB ECMO. I don't think that person has gotten off ECMO yet, but they're still alive Once again. I don't know a lot of details about what happens to these patients long term. You know, some my critical care colleagues who were working up in the I c u could probably answer that a little better.

spk_1:   12:24
So, uh, when it comes to how the teams are split up so you actually, because you're not quite overwhelmed yet you still have the intensive ists working in the I. C. U. Taking care of the patients. But but your team is dealing with, basically intake and airway things like that.

spk_0:   12:42
That's correct, you know, And in the anesthesiology apartment at that discovers a lot of the icy use and does the critical care. There's a lot of my college from my department are doing that. But But yes, critical care specialists are still staffing all the asi use. We haven't gotten to the extreme situation, you know where I know there a lot of means out there circulating about gynecologists, having the intubate patients and orthopedists managing the ventilators in the I. C. U were nowhere close to that point way still have the appropriate specialists working within their specialty.

spk_1:   13:21
Yeah, you know, it's interesting. I'm sure that is happening in New York. You know, the whole concept of bringing retired physicians back in and reinstating licensure and and how you know there's general reciprocity throughout the entire 50 states, As Faras licensor is concerned. Yeah, just like they're saying it's different every state. What do you think is attributed to why you're not overwhelmed like some of the Northeastern states?

spk_0:   13:46
Well, it sounds a little redundant, but the best way to reduce the numbers or to reduce the numbers. In other words, you know, if you don't have a bunch of people that are infectious out there running around, they're not going. Teoh infect people, and I would credit it. Teoh pretty aggressive early on, measures taken on a statewide level. And I think that we had the luxury of not having this sneak up on us because we saw what was going on and First Washington State and in the New York New Jersey area, and policymakers here were pretty aggressive about closing things down. It didn't happen all at once, but they they once they saw this was happening elsewhere. They got pretty aggressive about social distancing policies. I think the other thing is we don't have a lot of ah, we have Charlotte, but we don't have a lot of really large urban metropolitan areas where people were literally forced to be in very close quarters with each other essentially around the clock. You know, we don't have in New York City a Seattle in Atlanta, for example, and and that may have helped. This is well, that being said, we are starting to see some creep out of the more urban areas, you know, of course, Charlotte, our largest city, is the hardest hit, followed by Raleigh, which is one of the larger areas. We're starting to see that kind of creep out into the more rural, less populated counties. Now that's probably something we're seeing all over the country, I guess.

spk_1:   15:24
Are you are you seeing the spectrum of symptomology that we keep hearing about? I'd find it fascinating that this virus has every I mean, it's almost like six or seven different manifestations, whether be no symptoms, mild symptoms, shorter duration sick. But stay at home just a fever and then all the way up to intubated and then all the way up to unfortunately deaf or recovery. It's just so many. It's like a spectrum of so many different things. Are you seeing those different those different symptoms.

spk_0:   16:00
Yes, we are. And that's that's that combined with the lack of necessary or they're testing that you need is particularly vexing because we you know, obviously there are a lot of people who never have symptoms and become positive. And, you know, you certainly wonder that yourself Ugo in and you work with patients in the hospital and then you might feel like a tiny bit fever should you might cough. And you're like, Is this the total symptoms that I'm gonna have? And I'm positive that you can't get tested to know or, you know, hopefully the antibody testing thing will come through. At some point, we'll know who's who had it just never do it. But yeah, we're seeing people that are totally asymptomatic people that just have very mild symptoms. And then, you know, we're seeing people. Like I said, we had somebody go on Venus Venus ECMO. There there oxygenation was Singapore that even on a ventilator with optimum settings and positioning and and everything we could do, we still can oxygenate him enough to support them, you know, and then obviously people are certainly dying, and there's not a hard and fast pattern. Other than that, the more physiologic reserve you have, the more likely you are to be able to handle things if you do get sick. But but certainly, you know, this is killing young, healthy people in certain situations, which is particularly scary,

spk_1:   17:23
especially since they said that was not possible. Very early on, they said it was an older person's disease or person with pre existing conditions, and now there's a handful of people that are fine and they're not doing so well. Which makes me think and wonder if there actually is a genetic component to your outcomes.

spk_0:   17:41
I think there are a lot of components, you know. There may be some genetics. There may be the amount of virus to your initially inoculated with, You know, they say health care workers across the board tend to get sicker than non health care workers, and it might be due to the fact that they have a much greater exposure to a larger number of virus particles than somebody who say gets it in the grocery store. I don't know was on a subway with some people that kind of thing

spk_1:   18:10
right now, it makes sense to now that leading Teoh How you said you have your own PPE? Is that ah, like full on paper or just at 95. How are you doing with that?

spk_0:   18:21
We're treating everybody way. Intubate or we induce anesthesia if we're gonna intubate and then excavation. We're treating everybody's if they potentially have the virus now that being said and I can go into what we do differently for just our normal surgical patient versus somebody who's a P u I uncovered patients or the people on the airway team themselves, we each have our own personal pepper hood that were responsible for It's kind of like in the military, you know, this is this is my paper head. There are many others like

spk_1:   18:58
is that you have.

spk_0:   19:02
If something happens in that paper did, then it's That's our That's our protection. So there's a big motivation to take good care of it, to sterilize it very carefully after you go up and intubate somebody that you know is kind of positive, that kind of thing. So we have that basically, at the beginning of your call shift, you just put everything in a bag that you can carry with you to the bedside. So that's our personal pepper hood. We have a gown. We use an actual surgical gown because it covers up more of your neck than the flimsy plastic gowns. We have the booties that go up to the knees that the orthopedist and the obstetricians, where when they're doing surgery, we, most of us, were in in 95 under our papper. If we go to the I C U to do an intubation and that goes back Teoh what Jason was talking about and that there's no ante room or room between the area that's completely contaminated in the area where just people are out walking around. So it's good when you take the paper, hit it off to already having in 95 Mask in place on Ben were double gloving. I take my inter glows to my sleeves, and then we have some long outer gloves that go up to about mid forearm when you're to actually do the procedure with and in the paper built obviously, which is blowing the air and creating kind of a positive pressure environment inside the pepper hood, so that that's what I would wear for a known Kobe patient or a P I that I was intimating on their y t. Now, if it's just a normal person who's not suspected, Teoh have kind of it and we're doing an intubation. Then we're asking all the people at the head of the bed doing the airways that might be myself in a C R Day or myself and the incision resident. We were in 90 fives and some kind of eye protection. And usually the person doing the airway themselves is wearing a disposable gown Now, as faras masking mask availability at the beginning of the day, everybody that works in the ER is issued a single surgical mask on Ben. Everybody on the anesthesia team is issued in 95 you use that throughout the entire day unless it becomes grossly soiled. And then at the end of the day we're turning. We're putting them back in a bin where they can be saved and if necessary, uh, sterilized reprocessed reuse, which is a huge break from the way things were done in the past. Obviously, when we intubate a just a normal person, we're asking the other people in the O. R T either leave the rumor if they can't leave the room, get us far away from the head of bed as possible on benefits. A case where there's likely to be a lot of aerosolization of of Barrys particles. So that would be cases on upper airway cases. A tracheostomy, for example, E and t cases. Then everyone in the room is gonna wear in 95 mass for the entire case. Okay, way. Repeat the entire process. An excavation. We asked all non and a seizure people to actually leave the room if possible, which intuitively me makes a lot of sense. You think excavation is actually as far as air socializing particles, and exposing people is actually a high risk situation in intubation just because you certainly is. As you know, coughing is a not uncommon thing when you when you wake somebody in it up and extra bait him, we're trying to take its many steps as we can and minimize coughing, quickly get a mask over the patient's knows now once we x debate. But that's certainly at a time when a lot of a lot of air civilization can occur.

spk_1:   22:52
So right and then once that happens, like, let's say you do that. You do a case where you are. You have a possible covert patient and you x debate. They cough as usual. Uh, now you have this paper that you have been allotted, and it's it's presumed it's presumed contaminated. Do you then do some sort of step to get that cleaned and decontaminated before going and doing your next activity or duty? You know, during that shift?

spk_0:   23:22
Yeah, definitely. So if it's if it's a known, coveted patient or a P, I know that the whole key with managing airways in in this pandemic is minimizing things. So you want to minimize the number of people in the room with the patient when you're possibly aircell izing particles, which would be drink, induction or intubation in the I C. U setting. You want to minimize the amount of attempts at doing the intubation. And that's the one of the rationales, not only and people who are familiar with how to use their PPE, but getting a people that that are doing these airways very consistently, you're gonna have to take the minimal amount of looks with a learning a scope. A lot of people are going straight to video endoscope when they do the intubation, because that's most likely to give you the best view of the lyrics on your first look. So you want to minimize, minimize people around, minimize attempts, minimize things they're gonna Aarhus allies, uh, particles into the air. So were the norm. Now is to do a rapid sequence induction and not ventilate the patient unless there's, ah, pretty compelling reason to ventilate before you attempt to intubate. And we're doing, obviously, if we're doing rapid sequences, which we're trying to minimize, situations where the patient spontaneously ventilating during the intubation and and that's the thing you know in early anesthesia, A lot of what we do are difficult airways, you know, people with broken necks and spinal cord injuries where you don't want to move the head the wrong way. Possibly injured spinal cord further. So you in the past, at least for adult anesthesia airway management Difficult airways have been managed, usually with the patient awake or sedated and spontaneously ventilating. And that, they say, has come out and said, Yeah, that's one of the higher risk things, obviously, which makes sense because you have to top guys, the airway, and that can lead to coughing, further dispersing it particles say we're trying to minimize all these things, But but back to your question, you're asking what you do right after you intubate somebody. Well, if it's a P, you are kind of impatient Way have our buddy that's with us that stands just outside the door and has, you know, all the drugs we need that we might need not not immediately. And they can hand those through the door. They have a junked of airway equipment. So after the airways been definitively secure, go to the door and stand stand there and the buddy. Actually, the way I'm doing is I'm having them spray the hood of the papper with disinfectant solution. And you know, at that point you don't have to really be able to see really well, so they just essentially spray the entire adviser to the top of it. What? Not on Ben. Then I think it's been mentioned in several your podcast. But you you constantly dio disinfect your hands as you take off the layers and then re disinfect. They spray the papper. It can be kind of soaking in so to speak while you doff the rest of your pee pee. And then the last thing you take office, the paper hood kind of reaching back and grasping it by the bottom edges, you know? And then once I do that, I spray it again myself. You know, once off completed all of the doffing of the other PPE, which is disposable. And you know, if I'm up in the I c u to do this, I have the 95 mask on. So you know that should protect me once the paper hood comes off.

spk_1:   27:01
So, essentially you are responsible for decontaminating the paper hood yourself. Yes. Yeah. Okay. What kind of cases are you doing on patients Possible cove it or or otherwise?

spk_0:   27:14
Well, obviously they're only emergencies that literally cannot wait until And it if it's a few I person under investigation that the big goal is to have them get their tests back and know whether they're negative or positive. But the majority of ones were there known. Kobe, if they're going to actually have surgery, it's gonna be something that literally cannot wait. So it's things like traumas were there in danger of exsanguination ng ah, bowel perforations, ballon for actions. Stuff that would would be what we would call me to adapt its or something literally cannot wait two hours to do things on DWI actually air managing our surgical Kobe patients a little differently than somebody. Obviously, if somebody up in the i c. U just needs to be intubated so they can go on a ventilator, that's that suddenly way to support their oxygenation. We're going to those patients, and we're doing the intubation in the icy year. If it's somebody coming down for surgery that needs to be intubated, they they get intubated inside or 19 or 20 once again, following all the principles that just described. And then they stay in the room for 10 air circulations or 10 complete turnovers of the air in the room, which takes about 20 minutes, if possible. You know, obviously, if they're medical situation dictates they need Teoh get their surgery going. We don't wait that long on DWI actually have these big HEPA filter machines in there that have made those rooms in the negative pressure rooms as well. So when the door is open, heavily air boys into the room rather than air from inside the room, going out into the hallway so way get them induced. Intubated, if possible. We wait the 10 turnover times and then the anesthesia team that is going to take care of that patient meets us in the hallways were, well, the patient out and they go to the hour where they're gonna have their surgery transported under general anesthesia. And then that team wears in 95 around the case. There's one in the arm.

spk_1:   29:20
Okay, well, it sounds like you guys are are very well prepared for this situation. That's that's great. That's probably why you're seeing such success, because another thing I'm hearing is how ill prepared some systems were. And that's why there possibly overwhelmed. Are you seeing these pictures of nurses walking around with garbage bags on them instead of gowns and things like that? So it's That's good news that you your institution was very well prepared.

spk_0:   29:47
Yeah, and I have to credit the administration and our colleagues. You know, we have a patient simulation loud, basically used for training students and what not and we we have ran through this these scenarios several times to come up with these algorithms in practiced are donning and doffing in the kind of the whole choreography of this situation. Interestingly, apparently, this is fairly standard practice in some places in Europe, pre committed where they they have induction and emergency rooms, and they actually have the patients go to sleep in the room and take them to the operating room, do their surgery and then bring the patient back to the or take them to 1/3 room, where they wake the patient up while they're cleaning the room up and turning it over to the next surgery. I think the big motivator over there, before all this started was more or efficiency that it seems to have adopted pretty well for minimizing, transmission or spread of possibly infectious patients.

spk_1:   30:52
Absolutely. And you know, that brings up the new kind of common question that most people are asking, whether it be medicine or otherwise. Is, is that whole concept of new normal Uh, what do you think you know from your experience so far? What do you think that new normal might be, or how do you think? How do you think things are gonna change because of this experience?

spk_0:   31:15
I I think there is gonna be a lot of emphasis on having adequate supplies of peopie in the future so that we don't get in this situation again. We're like you're talking about. People are having to wear garbage bags and the CDC saying it's OK to wear a bandanna if you don't have anything else, eso at least hopefully to me. There's gonna be a big emphasis on having adequate PPE and other supplies available. I am really hoping that antibody testing is gonna help us with figuring out who has had this and has not had this. That may have been a symptomatic, and that may help us be able Teoh minimize putting people at risk while whereas we're getting people back to work and taking care of patients have been having their surgeries put off because it's been deemed to be non time sensitive. The other thing I'm hoping is going to come out and some knowledge about immunity to this and whether this is going to be a psychological thing like the seasonal flu or whether once you've had it, you will develop a long time immunity and once again model applied any vaccines we develop, then obviously, the holy Grail of this is gonna be coming up with some kind of good vaccine, the new normal there. I think it's airway management is going to change a lot for for us in the anesthesiology. We're gonna do a lot more rapid sequence inductions wearing mawr PPE than we've worn in the past. There's gonna be a lot more vigilance about Aircell izing particles and transmitting this, especially if it's become some kind of psychological disease process and then as faras the economic consequences for this in health care that that's just kind of scary to me to think about. I mean the the backlog of surgical cases we already have it at Baptist just from delaying old non time sensitive cases for a month is just staggering. It's it's in the thousands of cases already, and it makes me wonder how we're gonna be able to do all these cases and take care of patients and and do what they need, especially with the economy heading the way it is as Kara's norms with just society in general. I think this social distancing to some degree is always gonna be with us.

spk_1:   33:39
Yeah, they're talking about actual formal restrictions on you know, this whole social distancing till 2022 eso that's not gonna go away. And then I think I think society will get used to it, and it will become the new norm. So I think you're right. Uh, and I greet you with the whole elective surgery thing, which is all I dio. I'm just sitting here knowing that a huge backlog of cases is just is just accumulating like crazy. I worry with my practice whether or not I'll have the workforce to cover it because some locations that I've covered that maybe ran one or two days a week is probably probably gonna want to run five days a week. And I'm I'm hoping that I have the providers to cover it. And then also, we also have to think about the fact that a lot of people are out of work and they're they're saying that unemployment could hit 30% and, uh and I mean, the Great Depression was 24% So that's gonna be a lot of Medicaid coverage, which is going to be more of a strain on the governmental monetary stores of whatever we may have or the U. S economy anyway.

spk_0:   34:48
Yeah, and obviously I wasn't around for the Great Depression, but I think this is going to be worse than the Great Depression Waas because of be just the massive halting of the economy. It's it's really kind of scary. It's it's there has not been a single person has not been affected to some degree about this.

spk_1:   35:14
Absolutely. I mean, even if you've kept your job, it is it is affecting. You know how you work, how you go out and do things. And then what you do when you're off of work because you can't leave your home right now or at least your not suppose Teoh. And, uh, I mean knowing you from these conferences, if if you're not speaking, you're off climbing a mountain somewhere. So you must be going crazy when you're when you're not working, having to stay at home generally right,

spk_0:   35:39
that's we love to travel, and that's that's one of the things is going to become. The new norm is I think it's going to be very difficult to travel and possibly even discouraged. We were supposed to g o climb a mountain in Antarctica in November and December. Wow, November. December is a long ways away, but this is such a huge thing. I'm wondering if it's gonna happen at all.

spk_1:   36:04
Well, if there's if there's one place you can go that would probably be free of Govan 19 it would be an orca. It's the

spk_0:   36:13
only con. It doesn't have any cases. No, I understand that. So public health down in an article. They're doing something right. Maybe my patient, that's what it is.

spk_1:   36:25
That's right. That's I think that is the key. It's it is the social distancing and the states that naturally do it just because of their geography or showing that their numbers are staying low just because of that. So it makes sense. And then, you know, the really hot spots are the metropolitan urban areas where everybody's on top of each other

spk_0:   36:43
and just to travel. Teoh. We saw that with Florida in New Orleans, you having Mardi Gras and its people come from all over the road and converge in one spot, and it's just the perfect storm, for we're spreading it all over the country. You're in the glued

spk_1:   37:01
eso. I mean, have you heard anything or done any research on the supposed trials or treatments like the Cork Win or even yesterday I saw something on a lot. Now, of course it was on lines. You have to take everything that you see there is a grant for a grain of salt. But I heard something about some sort of anti lice drug that shuts it down in a couple days. Or even there's a new antiviral, apparently, that is being studied. Have you seen anything on

spk_0:   37:28
any of that? I mean, of course, we've been hearing nonstop about Hydroxy Clark when and the latest thing I heard on that. Now this was on the news, but there was some study in France that apparently showed no benefit. In fact, patients he took it actually did a little bit worse. I'm assuming from side effects that it was it wasn't really slanted towards being super medical in the reporting, But that would be my best guess. I saw headlines about the anti life's medication and the name of its escaping me. Right now I'm here just this morning at work when I was getting ready to leave and everybody was coming on people were talking about the antiviral drug that you were talking about, and once again, I can't remember the name of it off the top of my head, although it is one that's been in the news. But supposedly there some promising studies with that and the my understanding is the mechanism of of that drugs it binds to Thio added meaning. And so it may have something to do with, um, transcription of aura and preventing the virus that way. I'm not sure how it selected for the virus, except maybe it it attacks it outside the cell before it in facts. Mechanistic Lee. That drug would sound more promising than the other two just because Kobe is an or in a virus, and so this is somehow disrupting the ability of the are in A to replicate itself that would make sense for being able to shut down the infect in the infectiousness of the bars. You know, we talk about viruses like they're alive, and they're not. They're not like bacteria. For example, there literally molecules of are in a that are surrounded by some lipid and protein, and the protein has the ability to attach to the ace two receptor, but they don't reproduce themselves. Like you said there a parasite. They depend on host cells that they can get into and kind of hijack. The DNA and RNA replication tiu recreate there are in a rather than sell sailor or in a that's the scary, and I don't think a lot of dead is the right term. It's more like active or inactive viruses, but yeah, and then then autumn or philosophical level. You know, it's it's scary because, you know, we tend to anthropomorphize the virus, and the virus doesn't care if you're older, young or what your political view is or where you come from or why you're out in public. It doesn't work on timetables. It just literally goes in hijack cells and makes more viruses. That is the one thing we have to remember when we're trying to figure out about, you know, flattening the curve. Re phasing back into normal life, as normal as it can be, is that it is not really a living thing. It's just something that hijack cells and makes more viruses.

spk_1:   40:37
I guess when you think about it, the virus itself is not really what is causing our response. It's our immune response that's causing the negative response physiologically, which is which, from from what I understand. That's why the with the flu pandemic. That's why the main demographic of death were like 20 healthy 20 some year olds. Because they had such strong immune systems. They had a new over response to the point where it became an auto immune disorder, where their immune systems basically shut their own organ systems down

spk_0:   41:14
right, and it it's kind of this balance between you. Want your immune system toe work to get rid of the virus, but you don't want it, Teoh. You don't want to get this overwhelming. You know so called side a kind storms and other other sequences that get out of control and cause all of the symptoms and maybe make you succumb so you don't want to give immuno suppressants because you want you want your body to be able. Teoh eventually eliminate the virus, obviously, and build up immunity so you can't get reinfected and gets sick again. But at the same time, if all this gets out of control and you almost need immuno suppressants is, it's interesting. Some of the little things that we would normally do in anesthesia, you know, so decks a methods and we often give small doses of that for the anti medic effect. And were a lot of us are trying not to give that because it has some mild immuno suppressant properties. And we want to do every little thing we can. Teoh help preserve any kind of immune response patients are gonna have it. May it may have not been infected yet are exposed. Or maybe you're clinically infected and we just don't know it, and they need their immune response if they don't get sick. But yeah, it's kind of this balancing act, that's I mean, I've really enjoyed listening in this podcast because, you know, as you're putting it out, our knowledge of this is evolving almost daily, and our knowledge of what is going or not going to happen is evolving. So it's kind of a good resource for staying up on what to expect and what to do.

spk_1:   42:57
So when I really appreciate your time on this, is there anything else that you would like? Teoh make a point of or get through before we before we finish up?

spk_0:   43:11
Uh, no. I appreciate being on. And like I said, I've enjoyed listening in the podcasts and look forward to the upcoming episodes. I would like to thank everybody who's just in the general population, who's doing what it takes to get us through this. Despite the adversity that we're facing at, I think as a nation that role are gonna be fine. It's just gonna be some tough times ahead. So there's there's light at the end of the tunnel,

spk_1:   43:41
right? Well said, Now that's great. You're absolutely right. Please stay tuned. Because, as I keep promising, I think what we're starting to get into is I'll be doing a little bit more stress management topics. Some of these techniques they may find useful, especially the longer this isolation lasts. It's getting a little bit more difficult from, ah, a stress standpoint and a mental aspect, especially if you're working. You know, if your ah hospital worker that isn't dealing with proper PPE or if you're or if you're a restaurant worker, that doesn't have a job, you know any of these things that are that are highly stressful, so we'll start to get into a little bit of those techniques and and then mixing mawr informational things as they come out as best we can. So I appreciate I appreciate you listening. Absolutely. Stay state. Yes. So, uh, thank you very much, and we'll definitely keep in touch. All right, So that will do it for this episode. I hope to see you with the next one thistles, Matthews Ender and the going viral podcast. Please stay safe and stay well.