ASM217 How long will this last?

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you know there's a lot going on in the world right now and it feels overwhelming and i've been doing much more regular uh social media posts than i think people are accustomed to for me i've been doing a lot of live videos and on monday i released a podcast that you've probably heard on covid19 and my goal in that podcast was to share information that wouldn't change as this pandemic unfolded and response to that episode has been overwhelming it is by far the most popular episode of ask science mike that has ever been released and it gave people a lot of questions people want to know more uh people have curiosity they have a lot of concern around having questions they don't know the answers to and in particular there's one report that came out from imperial college in london and that report raised a lot of eyebrows it's actually what got the trump administration to begin taking this pandemic seriously and so tonight just a couple of hours ago i did a live broadcast something i've never done before it went out on facebook and on youtube and on crowdcast at the same time and several thousand people joined us live for that broadcast and for those of you who listen on the podcast channel and those of you who are dealing with small children and don't have the time to watch streaming video but you can put a couple of earbuds in and and listen as you do other things i wanted to take the audio from that live presentation and share it here with you it includes a coverage of uh of the imperial port of london what the next year or year and a half could look like according to experts as well as a time of question and answer uh with viewers at the end so i'm going to present that now in its entirety i hope that as you listen you pay attention to what i'm saying about listening to feelings and that everything i'm sharing is with the goal of helping you find peace and find calm and de-escalate and my goal is never to frighten you or sensationalize what is happening and even before we cut the audio of this program i just want to remind you that we can get through this by working together and i believe that we will so without further delay here's the special midweek edition of ask science mike from a live broadcast i did this evening hi everybody how are you gosh what a week we're having um if you're familiar with me you know i'm mike mccarg host of a podcast called ask science mike i'm an author and science educator and communicator and i've been doing more social media lately as we all process together this weird thing that's happening in the world called covid19 a global pandemic and there's two things i want to let you know if you're going to watch this little program we'll do tonight that i expect will probably be 30 to 45 minutes for the content presentation and then a q a to follow and that will go however long people would like it to go with me you can expect two things one we are going to only offer evidence-based information we are not going to work on rumors or pseudoscience or woo and the other thing you can expect from me is that there is going to be an emotionally focused component to this presentation our goal today is to address and relieve fear and anxiety not to escalate it i'm not in an ad based news media where sensationalism makes me more successful what i'm trying to do is equip you to make good decisions in your life in a way that protects your life and your livelihood and helps you to do the same for others that's how societies are built so before we really get started with the content presentation i'd like to let you know a couple of things number one if you're joining me on crowdcast right below me there's a button that says ask a question you can use that to send me any questions you have although i will also be glancing at the chat as we go along the other thing i want you to know is that some of the things we're going to talk about right now are genuinely frightening there is no one alive who has faced something like this or i i suppose there's a handful of people who are around in 1918 but this is a global pandemic the likes of which we have not seen in generations and so some of the numbers that i'm going to share with you that come from scientists and researchers that are evidence-based will be frightening and will be overwhelming and i want you to know again that my goal tonight is not to make you more afraid but before we begin i need to make you aware of how your feelings work when we have feelings that feel unpleasant and overwhelming we often try to escape by thinking we often try to escape by seeking out new information so that we can control the situation and what i want you to know is that there will not be any resolution or satisfaction in that cycle as we speak together this evening if things come up that frighten you i want you to take a moment and pay attention to your body i want you to pay attention to what you feel what sensations you feel in your body where you feel them and how big those feelings feel so that would mean sometimes when we're afraid we'll feel a tightness in our shoulders and in our chest we might feel a burning in our belly and those feelings might be big and if we check in with those sensations in our body they can actually make us more afraid as we start to think about why and what i'd encourage you today is that when you're getting in touch with your body and your feelings is to not go into a thinking space you can turn the volume down on me this format this this material will be available as a replay on instagram tv on youtube on facebook on my podcast channel you'll be able to hear all of this stuff anytime you want to so what's important is that as you listen you take all the time you need to listen to your body and your feelings and begin to calm down to accept your feelings as valid and real and okay and if that's all the work you do with me today i think that we will have spent a very good time together but we also want to talk about specific things as i've been doing more and more social media appearances again people have been asking me over and over about the imperial college of london report regarding covet 19 and that's what we'll talk about today i'll be honest i've been reticent to talk about this because it is in fact quite scary and quite frightening the information within it and so my hope is that by having an emotionally focused discussion we can have a conversation that's productive and helpful and not paralyzing okay i just want you to know that i'm here for you and that i care for you as we go through this discussion if you're not familiar with me my name is mike mccarg i'm an author and a podcaster and a science communicator and a person on a journey of emotional growth and that influences how i talk so if i sound like i don't know too calming like i'm putting you to sleep it's because i'm taking great care to speak calmly and speak slowly because i know that i'm not just talking to the part of your brain that thinks i'm talking to the parts of your brain and body that feel too and the way i communicate and the entire focus of my work is by talking to the different parts of our body brain system at the same time i'm going to assume you're already relatively familiar with covid19 and if you're not i've already made a great primer it's episode number 216 of ask science mike which is available on sciencemike.com and anywhere that podcast can be downloaded i'd encourage you if you need background on covid19 and not specifically on the imperial college report to go download and listen to that episode it is available i would also like you to know that um there's a real potential when we talk about these things to have two different reactions and both of them trouble me deeply you can see an image here too actually one is people partying at spring break after experts have recommended that we do extreme social distancing and isolation measures and in the other hand the other picture we see people panicking hoarding food and hoarding supplies in a way that is making it difficult to secure their basic necessities these two things represent a cycle of grief that we're in i think that most people understand that what comes next will be frightening and overwhelming and so we are beginning to grieve together some people are at spring break and they are in denial and other people have moved straight on to panic and are hoarding and neither of those reactions will allow us to protect lives or livelihoods so for the crowd who thinks there's nothing worth paying attention to here's what i want you to know even young people as young as 20 years old stand between a one in five and one in seven chance of being hospitalized when they contract covet 19 and we expect that 60 to 80 percent of the population of most countries will contract covid19 so if you think that these social distancing and isolation measures aren't worth paying attention to or if you think that they're you know a liberal hoax or over the top or an overreaction friends you are wrong and you ignoring these measures right now puts yourself and others in risk of contracting a disease that is potentially deadly so if you are in denial friends it is time to wake up on the other hand if you're moving into panic and your emotional brain is trying to get you to say oh no we're going to run out of toilet paper or we're going to run out of food oh no what are we going to do the thing i need you to know is there is no interruption to our food supply and no interruption is expected even in the most extreme presentations of this pandemic we're not going to run out of toilet paper we're not going to run out of basic necessities there is no need to clear out store shelves okay so let's all either wake up or calm down depending on where you are in your process with this pandemic here is what you should be doing right now according to health experts number one you should be focused on hygiene and disinfection you should be washing your hands well and often i've got a video about that but it's 20 seconds where you're doing these kinds of motions to thoroughly get your hands soaked up and covered in soap in order to get the virus destroyed and off of your skin so you want to wash your hands well wash them often you don't want to touch your face you want to sanitize common surfaces around your home and work space um that includes your desk that includes countertops light switches door knobs things that people touch often and most importantly if you're exhibiting any cold or flu symptoms stay home the entire time that you exhibit those symptoms doing so as we'll discuss together will save lives the second thing you should be doing and we'll talk about this in great detail in conjunction with the the report from tonight is social distancing if at all possible if you can work from home and telecommute you should already be doing so if you're in a position to make a decision about whether other people can work at home and not go ahead and make that decision and facilitate that process now if possible you want to work at home and keep working we don't want the economy to shut down we're going to talk about that as well it's time to eliminate all unnecessary travel and most travel at this point is in fact unnecessary but don't cancel meetings don't cancel commerce move those things online and this is very critical it is time to avoid large gatherings pubs clubs restaurants anything where there's more than 10 people in a room you should avoid under all circumstances um except for specific cases where your job allows society to function if you're a health care worker if you're in in essential retail distribution there are jobs that have to keep going but you're going to see really soon it's important that as many people as possible immediately avoid large gatherings and engage in significant social distancing and you need to be responsible you should prepare for interruptions in supply chains sure so i'm talking about slowed down shipments but don't panic or hoard when you go to the grocery store just buy a little bit extra compared to what you would normally buy don't walk out with a cart full of toilet paper don't walk out with all the food please do not buy face masks you don't need them and they will not help you hospitals need face masks you don't you don't know how to use them frankly they are to help people from spreading diseases not to prevent you from catching them bottled water is not going to be an aid right now the water supply will not be interrupted and a closet full of toilet paper will not help you so just again shop for your essentials and add a little on each shopping trip here's to the main event this is what we're all here for um the imperial college of london report is frankly um why the u.s government went from saying that covet 19 was no big deal to taking radical action the imperial college of london is a gold standard in epidemiology they are a huge player in public health and the data driven models they produce help policymakers and governments make responsible decisions about how to protect lives and so this report that has come out uh is pretty scary and so the first thing i'd say is as we go through this stuff don't panic this report is preliminary it's based on a data model it represents a reversal from the earlier positions of the imperial college of london frankly and that makes it more trustworthy covid19 is such a new disease and sars cov2 is such a new virus that we're seeing a lot of movement day by day as we get more data it's allowing us to get a finer picture of what could come so while i'm going to tell you what's in the imperial college of london report i also want you to tell you that everything i'm about to tell you could change and likely what i'm about to share with you represents a worst case scenario and there's a chance that the way this plays out is not as intense or severe as what i'm about to share with you so don't panic be calm be informed and be responsible so what researchers did is they used data modeling to predict what could happen as covid19 spreads through societies in order to do that they had to you know guess about certain factors about the infection rates of 19 the total number of cases that were out there what the mortality rate would end up being which is a really hard thing to do because the mortality rate of covet 19 is going to depend on our actions it's less a function of the virus and more response on how well we organize as a society we have immense of control or power to influence how many people ultimately die from this disease and so they have to make a lot of assumptions to build this data model but they have to build a data model so that we're not going in blind do you see the the bind that policy makers might be in here as they try to work through these things so this is not a crystal ball different models absolutely predict different outcomes what we know about the imperial college of london is that their models are among the best available and have been proven to be pretty reliable over time so this is this is information worth knowing and worth planning based on but it's not a prophecy okay i just i just want to keep uh driving that home this report is really useful if we use it to make plans and preparations and that's the context we should be using for this report is dangerous if we allow it to drive us to a state of panic or debilitating fear remember most people who contract coveted 19 in every age group are going to be okay most people covet 19 does not represent an existential threat to humanity or to human civilization but it is an actual pandemic we could face a significant loss of life and a significant economic disruption so we kind of have to be careful in how we respond we don't want to say well it's no big deal everything's going to be fine that's not true but we also don't want to say this is the apocalypse and the world is ending most people will be okay and most people will lose someone they love and care about as this pandemic unfolds again this report may be what drove the presidential administration in the united states from apathy and into action and here is why this is this is the scary stuff um it's it's the total death toll cdc estimates have pegged total deaths from covet 19 at somewhere between 200 000 and 1.7 million based on our actions this report says that uh basically if we do what we're doing right now a quarter of a million people will die and if we do nothing over two million people will die i'm gonna pause there those are scary numbers those are historic terrifying numbers two million lives is unimaginable in one country 250 000 is still terrifying this is why people are are behaving uh on on a leadership perspective in in the public health community with such concern why they're recommending such drastic actions to close schools and keep them closed and close bars and close restaurants and shut down businesses is because the consequences of doing nothing is potentially two million people die now what we're going to talk about tonight is how you and i can work together to avoid that but that's why we feel such an intense need to act and again this is a really frightening thing to think about two million people is unimaginable it's just something we really no one alive can really uh place what that would feel like and this report also shows that even taking major actions like we're taking now could still result in a quarter of a million deaths these are very high numbers so how do we avoid that well let's look at what the model predicts so if you're listening in podcast land i've got some graphics here i'll try to drop these as links in the show notes so you can look at them with us this first graph i'm showing is a timeline uh that quarter of a million is in the united states alone denise thank you for asking for that clarification uh the timeline we're looking at here on these graphs you have this blue bar where we're imagining that for five months we just we just do social distancing and shut everything down so this is kind of built into the model with those uh two uh orange and green curves you see on that side of the screen on the other side we're assuming we shut things down the blue the black line is what would happen if we do nothing at all and the axis you're seeing here is the critical care beds occupied per 100 000 people and there's a red line way at the bottom of that chart that you can see easier in the second chart below labeled b and that is the total number of critical beds available in our health care system so this is why we're afraid of a high mortality rate coveted 19 has the potential to debilitate every health care system in the world bar none full stop i'll say it again covet 19 has the ability to overwhelm and shut down effectively every health care system in the world the black line is what happens if we do nothing now if we just social distance and close schools and universities and do case isolation and general social distancing you'll see a green line that is just as big as the black line only it happens in the winter that's not encouraging that's not helpful so if we add additional measures like household quarantines for people showing symptoms plus case isolation and general social distancing that's where we get the orange line the orange line is 250 000 deaths so that this is what we're up against this is why uh this graph is so scary so the the one labeled a up top is so you can see the total size of these curves the one labeled b is so you can see a finer detail in compared to the total number of effective health care services we have to respond to this crisis here we have another view of different strategies and what they do to the overall critical case care load you'll see that they all exceed our medical systems capacity it's a question of how much uh that we exceed that with a you know three four five month social distancing period so the what the um what these numbers show us uh sorry if i i seem distracted i actually read the chat of what's happening in here um what you're seeing here is that everything we can imagine if we yes this is recorded you can watch it later everything we're doing right now if we do it for two months or three months or five months it won't be enough to prevent a lot of people from dying this is the takeaway that you get from these two slides which brings us to a third slide and what is likely going to be a strategy if the kind of numbers we're seeing come out of italy hold up again all this can change based on new data but if we're what we're seeing come out of italy and what we're seeing come out of south korea right now if those numbers hold up then we're looking at a strategy that looks like this graphic and what this graphic is doing is we're trying to gate icu cases we're trying to keep as few people in intensive care units with covet 19 at a time as possible and what you're seeing in this graph is social distancing over and over and over until a vaccine is available so effectively what this would look like is extreme social distancing starting right now and lasting into july i'll say that again social distancing beginning now we're behind the curve because we didn't act quickly enough and lasting well into july so that would mean schools don't open again this year we're going to talk about what we'd have to do about that as well but we're social distance all the way july and then an easing of social distancing because it's going to have a mental health cost it's going to have an economic cost we will need periods where people are less restricted and so then we open up social distancing for a period of time until the icu caseload hits a critical threshold and then we begin social distancing again and we continue with the kind of social distancing that we should be doing now in a cyclical fashion with icu admissions being the criteria that determine when we are and are not social distancing you can see right now that this graphic has that going potentially into pretty deep into 2021 so let's take a moment and breathe and check in with our bodies because these graphics aren't hysteria these graphics come from very well informed scientists and epidemiologists about what being what may be necessary to prevent widespread loss of life until we have a vaccine for covet 19. i know this feels overwhelming what i'm describing to you right now is in the data we have today the worst case scenario in terms of the number of deaths that we could face and in terms of the amount of time that we'll have to engage in significant social distancing what i will tell you for sure is it is very unlikely that three weeks from now we're sounding the all clear and saying that social distancing is over i am also telling you it's likely that the precautionary measures taken by state federal and local governments the united states and abroad are more likely to increase than decrease and that the legal consequences for bypassing social distances are likely to increase as well why because we are trying to save people's lives from a deadly and dangerous pandemic and we actually can do that because when we combine all these factors together repeat social distancing case isolation in home quarantines closing schools in universities people working from home limiting travel when we do it all we get closer and closer and closer to a manageable caseload that our health system can accommodate for especially when you realize that right now even the us government is mobilizing quickly to build additional emergency health care capacity bringing hospital ships from around the world back to the united states one to new york one to california as well as engaging the army corps of engineers to build additional hospital bed capacity as well as we've got a lot of empty hotels right now state governments including the government of california have been looking at basically turning hotels into hospital care centers those actions are happening quickly that's the level of mobilization that's going to be required remember this is essential we don't have definitive values for the variables in the model that created this report like how contagious the virus is we don't know exactly it is too new how deadly the disease is we don't know the mortality rate or the case fatality rate yet those numbers are still coming in and we also don't know how many cases there are right now the number one priority for the healthcare system in the united states is to get testing supplies out as quickly as possible so we can actually realize the magnitude of the problem we are dealing with i saw one scientist say that asking how long we're going to be in social distancing right now is like you know hiring an exterminator and asking them to tell you how long it'll take to clear out the basement whose door you're afraid to open because the problem is so bad we don't have the information to create those estimates right now this is a quote from the report itself in the second scenario suppressing the outbreak the researchers show this is likely to require a combination of social distancing of the entire population social distancing of the entire population home isolation of cases and household quarantine of their family members and possible school and university closure the researchers explained that by closely monitoring disease trends it may be possible for these measures to be relaxed temporarily as things progress but they will need to be rapidly reintroduced if and when case numbers rise and i bold face this last sentence on purpose they add that the situation in china and south korea in the coming weeks will help inform this strategy further experts are doing their best with limited data right now so if you're listening to me and you're catastrophizing and you're imagining oh my gosh two years they're gonna be trapped in my home friends don't do that i'm giving you this information in the hopes that being aware will help you satisfy an information seeking instinct and help you to focus on what's important and right now what is important is making it each day a day at a time um household quarantine uh i've got a question from aya in the chat she said uh they said what is the difference between case isolation and household quarantine case isolation is any mechanism you use to keep infected people by themselves where they can't spread the virus household quarantine is when a case of coven 19 is found in any home you quarantine the entire household until two weeks have passed with no one having symptoms of covet 19. that's what those measures are thank you that is a very helpful and useful question so again the report is telling us that likely this is what we could see happening long-term closures of schools and universities that last months and not weeks we could see a significant period of social distancing followed by additional periods of social distancing all based on the number of cases that reaches intensive care units per day case isolation will be a huge part ongoing social distancing for people over 70 and other people in high-risk groups they're probably going to be or potentially be in social distancing situations not for three months or five months before potentially a year or more in order to reduce the infection rate and the mortality rate and these measures will likely have to continue until the time that we have a vaccine according to this report public policy makers should take these findings seriously and act on them immediately so if you are a governor or an administrator or a bureaucrat or a legislator by all means act on literally every word of this report and act on it right now not only plan for the interventions we need in a public health perspective you should also be planning and acting on the economic stimulus measures that will be required to keep the economy functioning in the face of such extensive countermeasures to save millions of lives however if you're like me and you're a private citizen you should take these findings as preliminary and you should know that we can't definitively say what the next year is going to look at and so for you and i regular folks our job is to be informed to not panic and to take it a day at a time and do our best because if we do that and we work together we're going to save lives i'm so i'm so excited right now even as i'm sad because i know that by following the guidelines and recommendations of public health experts i can save lives how often do we get to save lives now this begs the question you would say well what do i do what should i do right now and that information has not changed that information is consistent here's what you should be doing number one you should grieve this is so frightening and this is so overwhelming and we're so fixated on trying to fix and solve the problem with information that very few of us are giving ourselves the space to be angry and to be sad and to be afraid and to process those feelings i believe one of the most important things that you can do right now is grief change is hard especially changes like these and our body's natural response to these situations is to grieve especially when we have fear that we could lose people we love let me tell you a story last year we had to put my dog max to sleep we had to euthanize him he had canine dementia he was a big dog and he was becoming dangerous and so we set a point on the calendar a couple of weeks in the future because we wanted to spend a little more time with max and in those two weeks waiting for that dreadful day to come i was more sad than i've ever been in my life because i knew something i knew something painful was coming and it was so heavy that by the time it finally came it felt like a relief and what's happening to all of us right now is our social brains which care about people and love each other are imagining who might live and who might die and it and it puts us in a state of preemptive grief so i just want you to know it's okay to be in pain right now we are all in pain right now including me i do a good job of having a warm voice and being encouraging when i turn on these cameras and parts of the day i do so as well but my friends there are so many moments when i sit in this very room and with my beloved bookshelf and my dungeons and dragons toys and all the things that i have here and i just cry i just cry because now is a good and right time to cry we want to take life a day at a time there's no need to think a month out right now just make it to the end of the day each day while we figure out better information about the virus and by we i mean the health community epidemiologists public health experts for the rest of us we need to take life a day at a time we need to hold new findings and information in news media loosely the news cycle they need something new to tell you so you'll keep watching and keep paying attention and keep their ratings up and keep their advertisers happy they're afraid too they don't want to see layoffs at their company and so they need to tell you new information as fast as it comes out to get a competitive edge i sat on this report for two days so that i could process it and think about what was responsible and safe to share and how so if you're going to watch news media and read newspapers all i'm saying is take a deep breath and understand that they haven't had the time to do a lot of analysis on this follow the recommendations of health experts immediately so a health experts are saying do social distancing do it absolutely do it do it now again i talk extensively about social distancing in my covit 19 episode of ask science mike but you need to know you need to be seeing as few people as possible as in often as possible and with as much physical distance from other people as possible all the time you need to maintain a six foot perimeter around yourself now is not the time for drop-in visits dinners and coffee dates because that increases the spread of the disease especially now right now is the most critical time the next three to four weeks gosh they are make or break moments in this disease now we're going to talk during the q a about what to do if you live alone i don't want anyone spiraling into abject depression loneliness or suicidality some amount of physical and social contact is essential to our survival so we'll talk about how to thread that needle and strike a balance but in general who should you be seeing if possible no one other than the people who live in your home with you continue to social distance i know it's hard i know it's scary i know it's depressing but social distancing right now will save millions of lives millions of lives globally potentially millions of lives in your country and this is a big thing let's dream of ways to make and do things for other people especially online in the context of grieving and taking it a day at a time you don't have to rush to this but i've been thinking and scheming about things we can do together i've been thinking and scheming about services that i can offer we've got to keep money moving why because that's where all of our incomes come from and the economic disruption that's coming with covet 19 stands to really put at risk people who can't afford to be put at risk we're closing schools that children rely on for their nutritional needs who are economically disadvantaged hourly workers all over the country they're not getting paid immediately and they still have bills so we've got to think about how we can continue to keep culture and society and an economy functioning while we are all at home and finally and i think this is very important tell your elected leaders that we won't allow people to be left behind in this process that we're not going to leave behind homeless people or poor people or hourly workers or small business owners or anyone who stands an immediate existential economic threat from this pandemic tell your elected leaders that we demand immediate and continual action to keep people's material needs met i don't i don't care what your political ideology or political orientation is who you voted for or how you label yourself the choices that we make in the next few weeks will be the difference in millions of lives and the difference in a homelessness epidemic that it grows to a a wildly unmanageable scale or not of children going hungry or not this is not a moment where i'm terribly patient with the question how can we afford that we need to know that saving lives and protecting livelihoods will take significant and coordinated global action sustained over a period of time this doesn't go away quickly i just lost my my slideshow it crashed this doesn't go away quickly this doesn't end uh easily this is going to be something that we have to work together for a period of time that is sustained and if we don't do that we're going to face some serious loss of life and livelihood but we do have the ability to work together and as we do so we can save lives friends and we can make sure that life is worth living so i'd like to do now is just talk about this with all of you it looks like we've got quite a few questions there in the ask a question box so let's uh explore those together right now just give me a second to rearrange my screen uh i am also the camera operator and director of this little production all right so many questions okay let's see uh we'll start with this one okay this is one we all care about uh this question says today news came confirming the first death of a dog due to covet 19 even though the world health organization said before dogs cannot get the disease can you expand on that topic remember what i said about holding new information loosely we have conflicting information about whether cats pets can be infected by whether they can spread covet 19. we don't know so what does that mean it means if you engage in social distancing as experts recommend you're protecting your pet whether or not they can be infected do you see what i mean so we don't have to be able to definitively answer that question today the precautions experts are recommending will preemptively handle that question in the time when we're working to answer it do you see i love this question because it's so such a good illustration for the approach here the latest information won't save lives the latest information won't protect livelihoods the things we already know about precautionary measures and social distancing and case isolation will so thank you for that wonderful question uh here's another question that i think is is uh one that we should cover together it says does a person who has contracted and recovered from covet 19 have any resistance to getting it again based on the most recent data i can resoundly say probably it's likely that people who have covered 19 develop a resistance to it but we don't know for sure uh you know how quickly is covet 19 mutating once you get it do you have immunity or can you be reinfected it's just too new for us to know things definitively and the tiny bits of data we have tend to be in conflict so what does that mean it means the best thing to do is what say it with me social distancing we've got to continue social distancing until we get the answers to those questions thank you for a wonderful question cynthia caitlin has a wonderful question here that i think so many people are going to identify with and it says i'm living alone and social distancing self-isolating my partner and her mother are also both social distancing is it okay if she and i see each other like once a week so we don't lose our minds being alone i've been sure to make sure i take advantage of video chat but i don't know if i can go upwards of 18 months without so much as a hug no one can go 18 months without a hug and no one's going to ask you to go 18 months without a hug here's what i would recommend right now everyone and i mean everyone who can completely self quarantine for 14 to 21 days 21 days you want to be absolutely sure and then if you have a few close people who all do that who all do this three-week quarantine you know you're good at that point re-engage with a small number of people for that essential social contact so for example in your case if you do a three-week quarantine and mom does a three-week quarantine depending on her age at the end of that three quarantine absolutely i'd get together and have a hugging party i'd have dinner i'd open a bottle of wine and i'd celebrate making it three weeks and just plan those things create your own social distinction pattern in the middle to make make play dates with people and make those play dates uh three weeks from now and in the meantime don't see anybody and that's a way we can have regular social contact and we can do so without uh increasing the rate of infection from this disease and disorder believe me i have so many friends that i hope and i'm talking to about taking social distancing and self quarantine seriously because i'd love to see them in a few weeks i'm getting lonely too yeah okay another question oh this is such a great question uh av says at what point am i sick enough to get tested i cough once every hour or two and i have a sore throat that doesn't feel like enough to add more stress to the health system but my work also i think it's bad enough that i need to stay home and self quarantine that is bad enough that you need to stay home and self-quarantine and that is not bad enough for you to get tested 88 of cases in early studies of covid19 have a high persistent fever that's kind of the number one criteria you look at to think you might have covid19 a high persistent fever but it's only 88 percent of cases something frustrating and difficult about covid19 is that its symptom presentation is not consistent but it means the only way to know for sure if you have it is a test and the tests are rare and difficult to find in the united states right now it's getting better city by city so when you have a cough and you have a sore throat yeah stay home until you don't and until you have it for 14 days your work should be making provisions for that they should be increasing their sick leave understanding that you doing the right thing in um doing social distancing shouldn't cost you your livelihood and your company should partner with you in that if telecommuting is at all possible don't have it be sick leave have it be working remotely that's probably the wisest strategy and on that note now is the time you need to get familiar everyone not just the question asker but everyone should get familiar with their telemedicine options your first line of defense should be a video call with a health care professional who can ask you on an interactive basis about your symptoms tell you tests that you can perform yourself that helps them triage you and figure out how likely you are to have the virus and how necessary testing may or may not be okay so your first step is telemedicine if telemedicine is not available contact your primary care doctor or urgent care center at first via telephone of course going to medical care facility right now increases your risk of catching coveted 19. what a wonderful question uh thank you for that um here's a question from lori it says the new information today suggests that younger people are now at risk what infu info do you have on this young people have always been at risk from covet 19. children under 9 seem to be the group's safest but even teenagers and especially people in their 20s this disease is wildly more infectious and wildly more deadly than influenza it has always been something every group should take seriously it's just that young people are at less risk than people in their 60s 70s and especially people older than 80. young people are at less risk than people who are obese or have diabetes or hypertension or a pulmonary condition like asthma or copd or heart disease or these various factors immune if they're immunocompromised those people are higher risk but this is a pandemic it is dangerous for everyone and most people in every group who get it will be okay those things are both true at the same time what a wonderful question thank you um i got another great question here i'm just taking them in the order they're kind of popping up here that says my teenager has two autoimmune diseases which are under control she currently has a job at a fast food restaurant working 25 to 40 hours a week should i consider letting her work i am concerned for her help you have to make your own decisions part of what i've tried to do in my podcast i released monday and then in this detailed look at the imperial college report today was to equip you to make your own decisions i'm not a doctor and i'm not a health care professional and i am not qualified to make determined or recommendations like this if it was me and it was my daughter i would not have her working at a fast food restaurant 25 to 40 hours a week right now so that's all i can do all i can tell you is what i would do if it would me with the caveat that my advice is worthless so a great thing to do would be to contact a telemedicine service uh co-pays right now on that or something like five or fifteen dollars depending on your insurance program okay um oh another great question gosh thank you cynthia this one says an alert from science alert yesterday said that the world hate health organization recommended not using ibuprofen to treat covet 19 symptoms science alert is an accurate resource they do tend to do pretty well i agree but i could not find the reference on the world health organization website which is correct it was likely something that was said by a world health organization employee in an unofficial capacity because this is a point of difference in opinion in the medical community about ibuprofen used to treat fevers some doctors and researchers believe that by interfering with the fever cycle you increase risk of mortality and lengthen the overall period of infection while other doctors believe that ibuprofen lessens your symptoms but doesn't actually shorten the disease if you want to be absolutely self safe i guess take tylenol but again don't take too much time at all because uh it's not great for your liver so we don't have a definitive answer there i would say if it feels unbearable you're probably okay taking ibuprofen jacob has a question in the chat i'd love to look at that says is it safe to meet outside in very small groups if everyone agrees to see keep six to 10 feet away from one another yes if your city doesn't have a shelter in place warning if they do don't do that but you gotta be really disciplined to say six to ten feet further than you think but i've been doing a lot of time outside in parks that feels nice another great question regarding social distancing if i meet a friend in a public place like a store but i'm frequently washing my hands not touching anything and staying six feet away from my front while talking is that sufficient social distancing or is there still risk there there is still risk there covid19 is not airborne but it can live in microdrop its droplets of saliva in the air for three hours or more so this kind of six foot bubble around you gives you a reasonable level of precaution but if you're a sustained point of conversation in contact with another person you're you are increasing the likelihood that an infection vector occurs as these droplets float through the air and they touch what your eyes your nose your mouth or they get on your hand and then you touch your eyes your nose and your mouth you have a high chance of contracting covet 19 in that situation if it was me i'll tell you right now i'm doing total social distancing and having a lot of face time calls with my friends uh let's see oh gosh caleb i don't even know if i could answer this but i'm going to bring it up on screen do you have any suggestions on handling family members who don't care about this issue my sister is an anti-vaxxer and she is acting like nothing is even happening i'm angry with her and i need some advice with what to do excuse me i don't have cover 19 but i did aspirate on that water um the first thing you need to do is sit with your feelings i'm so lucky my friend is hilary mcbride more accurately doctor hillary mcbride and our feelings are about us that's what she told me and if our feelings are about us your anger is about your values your values for justice the fact that you care for people it makes you angry to see someone else behaving in a way that puts other lives at risk but now you know you're angry because of your value system you don't actually have the ability to control your sister she has to make her own decisions so the the best thing you can do in my opinion is be honest and communicate with her and understand that anti-vaxxing is not a belief system so much as a coping mechanism like all belief systems and at some point there will be a reckoning in her life either someone she knows and loves dies or the cumulative number of deaths in the news media will likely impact her or she and her family will survive and she'll attribute that to the fact that she didn't take a vaccination and reinforce that cycle and unfortunately listen to me caleb there's nothing you can do about that you have to take care of your life and your feelings and your emotions and give your sister the space to grieve and process in her own way the people who can do something about your sister ignoring any recommendations are world governments and we may get in a situation if too many people don't pay attention where governments take actions that none of us as citizens could should or would do um okay here's a question from kathy i read about a town in italy that was able to reduce transmission rates to 0.3 percent they tested everyone and quarantined those who tested positive how realistic is that to do here test every person pull out positives re-test everyone a week or two later etc uh the scale of the united states is a problem we have over 300 million people on an absolutely massive land mass uh the theory there is probably sound the practical execution gosh i don't think it's going to be possible in the next six to 12 months excellent idea an excellent question okay um let's see uh we're right at we're right at an hour so maybe just do a couple of more questions i don't want this to go all night because we're going to do these regularly uh oh gosh courtney this is a great question so we'll we'll address this one i think this will be our last question tonight i want to thank you all for for sticking around as long as you have the question is i'd love to know how to deal with roommates who aren't taking quarantine and distancing seriously we're having a conversation soon but we have very different expectations for what all this means am i safe if i continue hand washing isolation in my room etc are shared spaces with people are not quarantining putting me at the same risk as just going out public no it's not putting at the same risk as going out in public but it is putting you at risk in my situation if it was me i would pretend you had the disease and then do that level of isolation which could be really maddening if you want to use shared spaces that's fine keep that bubble between you and them and rigorously sanitize any surfaces you get near and do vigorous hand washing anytime you enter and exit the common areas of the home hopefully i've created some media in the last few days that can help you have a data driven emotionally focused conversation with them about the consequences of their actions to themselves and to other people thank you all for your questions thank you all for spending this time with me today it has been a joy for me to talk with you all remember we are not doomed neither your death nor the death of any person you know is assured we can work together we can take meaningful action and our actions can save lives so please my friends be patient with yourself please take the time to let your feelings out process this experience emotionally and not just intellectually with information and as you do that take the recommendations of health experts seriously and know that i am going to be here every day for you that every day i'll have the same evidence-based non-anxious presentation of the latest developments and we will get through this together my friends be well not just in your bodies but in your minds and in your hearts and i'll talk again with you very soon