Coronavirus Testing – Who, Why, When, Where, & What

Coronavirus Testing – Who, Why, When, Where, & What

March 26, 2020 11 By Jose Scott


So welcome it’s Wednesday March 25th
2020 and this is an update on the COVID-19 coronavirus pandemic and I’m Ford
Brewer so we’re going to talk today about testing programs we’re going to
talk about the types of tests but first of all let’s talk about why testing
programs are important have you had a chance to look at the different
countries here’s a good graph of how the epidemic curves happens in countries
like South Korea Spain and Italy as you see a dramatic difference in how the
curves happened what did South Korea do differently well
these are the number of tests per person and look down at the bottom South Korea
did more tests per person than any country and look up at the top the US
has done the least tests per person so what happened was South Korea and
Singapore both have been a thing called contact tracing quarantine so they
didn’t depend on just voluntary social isolation like we’ve done so far in the
US they did testing of folks they for example these guys lived in South Korea
lived through SARS so they’ve been there before they know what they need to do
we’re going to talk about testing here in just a minute so how did you like that
Cliede set that up for us and I hope that’s taking us a little bit better
into a little bit better level of editing so for today we’re gonna be
talking about the coronavirus update March 25th testing programs the role of
testing programs virus testing versus antibody testing and the status of the
program that I’m working on right now we’re also going to talk about PPE that
stands for personal protective equipment and the quote from John Mandrola an
electrophysiologist cardiologist in Louisville Kentucky he’s also a
physician blogger and the title of his blog yesterday was Some of Us Will Die
he’s talking about doctors and medical centers basically saying look we don’t
have the masks we need we don’t have the other equipment either but we still have
to do our work in fact there were some docs saying that their hospitals were
telling them just continue to work and do not tell anyone outside of the
hospital that we don’t have adequate equipment that appears to be a pattern
right now all right there’s certainly evidence
when you begin to look around that that’s a pattern and I can tell you from
the activities that we have in terms of sourcing for this upcoming national
testing program equipment is a big big deal so I will end up with some comments
about preventable disease I think we know Dr. Mandrola is right we’re going to
lose some very good health care providers we’ve already lost a lot of
good people and there’ll be a lot a lot of continued preventable death disease
and disability but there’s real hope and the hope is founded in reality we’ll
talk about some of that so the next steps talk about viruses and antibodies
and testing so when you look at let’s talk about the virus test for a few
minutes the there’s a virus test and an antibody
tests the virus the virus test is actually looking at the viral genetic
material which in this case is RNA as opposed to DNA you don’t need to
remember that a virus test which is what we’re setting up on a national basis
it’s called PCR polymerase chain reaction it has to be incubated for a
couple of days it tells you if you’re contagious or not the rough time
estimates for veremia or virus in the blood or positive tests if you have an
infection with this are typically around days two to maybe up to 15 during the
infection process the antibody test is different it’s the test that they’re
calling the quick test or the home test there have been some scans on that I
know but there is an antibody test that’s becoming available and it will be
important as well it looks at the human antibody so human antibody
develop antibodies to most of these viruses around day 14 so what does it
tell you it tells you if you’re immune so the virus tells you the virus test or
the PCR takes a couple of days and it tells you if you have virus in your
blood it tells you if you’re infectious the antibody test takes about two weeks
in terms of the infection and then it starts to tell you if you’re immune to
it at this point and if you’ve been infected
so we’ll go a little bit deeper if that sounds a little bit confusing but before
we do just want to make this comment I’ve said a few times that the antibody
test is going to be important later actually folks in Singapore have already
said look we are now using the antibody tests in terms of contact tracing as
well here’s a an article about that basically what they found were as you
may remember there were two people I believe it might have been a husband and
wife that were very important to a couple of meetings a couple of church
meetings in Singapore which resulted in a lot of spread
they were able to go back test the husband and the wife the husband had the
virus test positive in other words he was still infectious they were able to
quarantine him the wife was virus test negative her PCR tests negative but she
was antibody test positive indicating that she was probably the first one of
the two to get infected and then shared that with her husband so again that
helped them piece together the puzzle which resulted in finding the cluster
finding the transmission and helping them draw a quarantine around the
transmission that was going on that’s just basic public health activity
unfortunately we don’t have that yet in the US because we don’t have enough
enough testing available so again both types of testing can be used to find
transmission we look for outbreaks clusters with quarantine and cap off
these episodes and that’s what South Korea and Singapore did now this is not
the first virus that we’ve dealt with this is not the first virus that there’s
been tons of testing associated with and in fact when you start looking up these
these antibody and symptom and infection curves for viruses you really can’t find
or I haven’t been able to find a good curve yet showing even just showing the
the antibody development for COVID-19 coronavirus the novel coronavirus
SARS cuff to whatever you want to call it it’s just too early I’m not finding a
lot of this kind of curve so I’m going to give you some examples for these
curves using other viruses viruses that we know what we’ll do is we’ll look at
the time to infection at the time to developing spread of the virus and then
the time to developing an antibody and put all of those in a time line that
will then help you understand how the or PCR test works and compare that to
the antibody or quick test or home test it’ll also help you understand the
differences between the two in terms of use now here’s a typical antibody
pattern antibodies as you know is where our immune system gets up and rolling
starts recognizing the infectious agent and starts developing a specific
antibody or reaction against that the first thing that we get is IgM and then
second we get IgG usually IgM happens they about day 14 IgG which is more
specific and lasts longer as you see it’s it’s one chain here the IgM is a
five chain um antibody the IgG comes in at about day
21 again it’s more specific its longer-lasting and it provides us with
the keys to immunity in the future that was this one for example is parvovirus i
believe and here you see day zero where in fact is that in day you’re infected
then you start developing viremia virus emia meaning in the blood so you can
measure levels of virus in the blood it peaks at about day 14 and that’s the day
that IgM is getting started and as IgM gets started it begins to decrease the
amount of virus in the blood and over the next week then IgG begins to get
involved in terms of helping us fight that virus Zika virus you’ve heard of
that same type of thing day zero and then over the next few days you get
spread of the virus within the body you get increased via virus in the blood you
start developing symptoms fever onset is peaking at the time of the viremia then
you start getting development of antibodies and as you do fever symptoms and
viremia begin to decline that’s a pattern you’re gonna see over and over
and over again back to the parvo virus if you look at a little bit look at this
a little bit more deeply days zero to three is when you have early incubation
you can’t detect the virus yet but you’re starting to get virus and
replication throughout the body and spread through the body parts you get
increased viremia or virus in the blood up until again about day 10 to 14 when
IgM starts to kick in as you start peeking with your viremia that’s when
your symptoms peak fever flu-like symptoms and again as the IgM begins to
gear up these symptoms and the viremia begin to come back down over the next
few weeks then you’re going to start getting IgG days 3 through 15 virus in
the blood or viremia and days 10 through 15 is when you start getting the
antibody similar pattern another another disease that most of us have had very
personal experience with measles this gets a little bit more into detail in
terms of the spread of the virus so with measles you get infection at day one
over that are a day zero days one two and three you start getting it in the
respiratory tract measles is like the current coronavirus COVID-19 it’s
transmitted by the air by breathing so the first place you get infection is in
the respiratory tract the next place there goes is to the lymph nodes that
drain the respiratory tract next about day five you’re starting to get see the
virus measles virus in the blood then in the spleen other lymphatic tissue the
lymph drainage tissue it’s a I won’t get into that
then more in the lung the thymus deliver the skin other places
now as you start getting that viremia increase in virus in the blood it
days three five eight ten you start getting symptoms the first symptoms you
might remember are complex of spots if you don’t know what those are that’s
okay and then the rash starts at about week
two as is typical with these we start seeing development of the IgM at about
the ten day to two week period and then at the about the three week period you
start seeing IgG the more specific more effective antibody so we’ve talked about
other examples what about COVID-19 itself well this is really all
I can find right now regarding what we would call viremia or amount of virus
in the blood or tissues now what it does appear at this point it clearly appears
to be consistent with what we’ve seen with the we see with your typical virus
you don’t find a whole lot in this is a throat swab and a sputum source for
viral load and you don’t really see much days zero one two three but then about
day three and four five six up to day nine you start seeing significant viral
load this was in beta the patient one of this study then patient to a similar
sort of thing not seeing very much on days one two and three part of the
question is what kind of sampling were they doing then but again as you see
significant peaks at days three to five three to seven and then they’re starting
to come back down about day ten when we would expect IgM to get started now that
appears to be consistent with what we’re seeing with the study we talked about
yesterday from the New England Journal talking about the median incubation
period in other where it’s time from infection to
disease appears to be about five and a half days remember we also talked about
the fact that about 95 percent of folks will show symptoms within two weeks so
again this appears to be going right along the pattern that other viral
diseases have gone now let’s talk again just very briefly comparison of the two
tests so the virus test or the PCR is looking at the viral genetic material
you’re gonna see that positive around days 2 to 15 again it takes a couple of
days to get that one compared to the antibody tests which you can get within
an hour the antibody test is similar to the pregnancy tests you know you get a
well you’re gonna get some available at home probably and again there’s scams
right now I would not suggest anybody go out to look this up on the internet and
find it you’ll get your money taken but I do expect them to become available at
home the kind of testing that you see in these centers right now that are popping
up all over the country are the PCR it’s looking at viremia
it’s looking at the genetic material out of the virus because it’s looking at
genetic material that’s just getting started in days 2 3 4 5 it takes a
couple of days you take it back to the lab you incubate it you use the
polymerase chain reaction that’s why it’s called PCR to multiply the genetic
material that matches that virus’s genetic material and see if it’s in
there that human antibody test is again simpler easier and quicker so I hope
this has been helpful in terms of helping understand what’s going on with
viruses how why it’s so important and what needs to happen next
speaking of what needs to happen next we know what’s going to happen next
John Mandrola he’s a electrophysiologist cardiologist in Louisville and a popular
blogger he wrote a blog yesterday that basically said some of us will die and
he’s talking about Docs and you know the story you know the situation here we are
in the the most advanced wealthiest country that’s ever been and with the
most health care manpower the the largest most well-trained team of health
care physicians and providers that we’ve ever had and we’re going to be putting
those folks out the CDC actually came out with with statements saying we know
that people are going to start doing homemade masks up to and including
bandanas you know like John Wayne and Roy Rogers and Gene Autry used to wear
when they were shooting at the bad guys and that’s gonna result in some of us
dying in terms of physicians and they know it there’s also some significant
stories coming out of the hospitals that the hospitals don’t have the equipment
and they’re telling their medical staff not to tell anyone whether that’s going
on or not you know I’m not an investigative journalist I suspect it is
having lived in those spaces it is I can tell you a little bit more
from my side what’s going on in terms of our sourcing of equipment but I’ll do
that in just a minute so speaking of the CDC in their position on this they’ve
said look here’s strategies for optimizing the supply of face masks
that’s just in the CDC website you can find that they’ve they classified this
problem into three levels conventional capacity that measures measures consist
of providing patient care without any change in daily contemporary practices
this set of measures consist of engineering administrative and personal
protective equipment PPE control should be implemented in general infection
prevention and control plans and healthcare settings so that’s
conventional capacity then contingency capacity contingency capacity as
measures may change daily standard practices but may not have any
significant impact on the care delivered to the patient or the safety of the
healthcare personnel these practices may be used temporarily during periods of
expected face mask shortages then we have crisis capacity strategies that are
not commensurate with u.s. standards of care these measures or a combination of
these measures may need to be considered during periods of non facemask shortage
and they go into some of the other suggestions the next to the last group
of suggestions was consider using ventilated headboards I’m not going to
get into what that is and then healthcare personnel HCP use of homemade
masks in setting where fast face masks are not available HCP may use homemade
masks for example a bandana or a scarf for care of patients with COVID-19 as a
last resort however homemade masks are not considered PPE since their
capability to protect healthcare personnel is
unknown caution should be exercised when when considering this option homemade
masks should ideally be used in combination with a face shield at least
use the face shield which covers the entire front that extends to the chin or
below and sides of the face well in terms of some of the own you know we’ve
we’ve had some of the same challenges everybody else has had but originally
our lab would say things for a couple of weeks like we’ve got capacity for four
million test kits per day that’ll be coming up blind in two weeks then last
week they said that and then earlier this week we heard well we’ve got a
total of 5,000 test kits these are meant to last indefinitely we are getting
geared up but we’ll have to parse these out to use you and others that was this
past week then we go to well so frustrating okay thank you Cliede it is
what it is women will continue to move on with that how can you see the screen okay
so where we were was we’ve gone from we supposedly will have four million test
kits available per day to we’ve got a connection that has a connection in
South Korea he says he’s got a lot of them but he wants cash up front
so obviously that doesn’t sound very encouraging we’ve developed further
further capacity but again we’re having challenge everybody’s having challenges
right now we talked to recently in a couple of other videos about the CDC
guidelines for coronavirus testing I’m not going to go through that whole
section again right now but we’ll give you just a couple of comments here’s how
to find those guidelines I’ll tell you a little bit about how to find the
guidelines what they say and why they loop back to practical symptom
management so you can go to this this link cdc.gov/coronavirus/2019-ncov/
cases-updates-testing-in-us.html or just Google CDC coronavirus testing
and the first choice that comes up in the search engine result page the SERP
number item number one should be corona virus testing with CDC the ones that
we’re talking about as you see they will go into this is the page that you’ll
find you’ll see that they talk about symptoms and testing you click on that
you can go into testing in the US and that testing will take you a little bit
into a loop instead of taking you into discussion about testing like I’ve been
having over the past a few minutes it takes you more into symptoms a symptom
checker and helping you understand that if you have serious symptoms like
difficulty breathing severe chest pain then you need to get
immediate emergent care and not worry so much about getting testing so there you
go why would they do that when they’re in in the CDC section on testing for the
same reason and the same problems that we just brought up they know testing and
test kits and the PPE to do the testing are at a major major shortage right now
so back to John Mandrola’s comment again some of these people will die we know
that and again we’ve got heroes out there who are seamstress heroes who are
out making masks out of materials that that were just I’m sort of struggling
obviously so we’ve got some heroes out there doing a lot of good work they’re
also making gowns out of Tyvek house wrap but here’s the thing a lot we know
a lot of people are going to be dying in the health care area we know a lot of
people have died already in health care as well as I outside of healthcare if
you look at our trends we’re back on a major major uptick in terms of cases
globally most of the people that are watching this have seen things about the
New York lack of containment right now and you can see it here on this picture
so there’s going to be a lot more that die as well we’ve had plenty of warning that’s
what’s one of the things that’s majorly frustrating this is a picture of Michael
Osterholm and his book Deadliest Enemy you go to chapter 13 and it says it talks
about SARS that’s this is the picture of SARS a diagram above it where SARS
is one of the coronaviruses that’s now endemic in the camel population in the
Middle East and the WHO has been checking for humans we we’ve expected
this to cross over into the human population and it has several times
already that’s what the SARS outbreak was that’s what MERS was chapter 13
Deadliest Enemy and this is only one of many warnings that we’ve gotten he was
talking about SARS and worse harbingers of things to come and he starts it with
the quote “and the dawn comes up like thunder out of China cross the bay” quote
from Rudyard Kipling so yep you know what a lot of people are gonna die we
had warning we didn’t heed the warnings but you know what this is not the only
time this has happened no I live in that world I’ve lived in that world my entire
professional career in fact for the past what ten years I’ve focused mostly on
heart attack and stroke prevention and guess what every week 30,000 people in
the US die from heart attack and stroke the vast majority of these are
preventable there were 250,000 I think they died in the Vietnam War so we’re
getting another Vietnam War every what two months and it’s preventable and we
are warned on a daily basis and we ignore the warnings so welcome to my
world so things don’t look good right now
obviously you’ve seen this before we’ve all seen it and you get the little
cartoon with the frog that’s being swallowed by the the stork and he says
you know he’s doing everything he can he’s squeezing the stork the storks
throat and people say you know what that may sound cute it may sound
“inspirational” but it’s really not reality especially if you’re the frog
looking down the throat of a heron but you know what mm that’s what some people
like Neville Chamberlain said about Winston Churchill when he said don’t
give up so we need to not give up there is plenty of hope this is not the first
preventable disease that we’ve let happen
this isn’t not the first time that we’ve had a huge number of deaths this is
going to happen they will the deaths will happen the disability will happen
the unnecessary infections will happen and then we’ll move on we’re going to
start I don’t know if it’s going to be I don’t think it’s gonna be to two weeks
but we’ll have a very different world here two weeks and we won’t have people
having to preach about staying inside it’ll become very very clear while we
need to stay inside why we need to focus on prevention hopefully next week I’ve
had a few commenters talk to me about well Doc you really didn’t focus enough
on stimulating the immune system with things like supplements yes
supplements help I’ve got dozens of videos on supplements they help with the
immune system for the cardiovascular disease it makes every sense and reason
to believe that it would help for for this disease as well as any other
disease in terms of the human body repairing itself that’s the most
important thing that we have you go back in this specific set of slides and you
saw multiple times what really saves us is our immune
system we get that increasing viremia virus in our blood starting anywhere
from days three to twelve and then a days you know starting around day 14 our
immune system kicks in so there’s research on on that specifically BCG
(bacillus Calmette-Guerin) I can’t remember the the be CEO
something like that the BCG is a is a vaccine it stimulates the immune system
it has been used in the past outside mostly outside of the US as a stimulant
for the immune system for decreasing tuberculosis there’s a lot of research a
lot of focus right now when you look at the internet guys like Med Cram the ed
Cram Channel covered that past couple of days and hopefully I’ll get a chance to
get into those in some of the next videos thank you for your interest we’ll
go and see if there’s anybody asking any questions so here we go yes quite a few
Hull39 if high serum zinc does not raise
cellular zinc unless another medication is used then why take zinc when on an
ACE inhibitor well again I think the goal is to take zinc with with some of
the ionophores and you may remember one of the critical ionophores is
quercetin and you may remember we covered this I thought I covered this in
the video yesterday quercetin is a plant flavonoid what does
that mean you find it in fruits you find it in plant plants in your diet so those
those of us who are on a carnivore diet really need to be focused on getting flavonoids you know look at something
like maybe adding fruits back to your diet
figs those of us who are really worried about carbs blackberries blueberries
raspberries all of those have flavonoids in them so make sure that you get those
and get zinc and supplement with zinc as I’ve shared many times one of our
volunteers sent me some zinc because I was complaining and whining that
had run out Kevin McChord thanks for attending again Kevin Kevin is a great
preventive doc up in the Cincinnati area thanks for the timely update sounds like
we still have a long way to go here in the US yep in regards to widespread
testing yes we do Laura Rance greetings from Texas what do
you think about humidity and heat killing this virus I don’t think there’s
a that that’s a good plan they recently did a study on going back to the Diamond
Princess they found stuff on equipment surfaces after what two weeks already
so mmm you know if you use things like hydrochloric acid it does kill this this
is not an incredibly strong virus but just depending on heat and humidity add
I don’t think is very it’s very good Kevin McChord again Kevin could you could
you comment on the use of split ventilators I wish I could I saw that
comment sounds as though you there using a single ventilator to support two
patients while somehow keeping all the tubing separated as you know people get
really worried about things like mixing air and where’s it going in it I’m not
quite so concerned about that I’m just concerned about doing a having a a
totally unprecedented new process but you know what looks like we’re gonna
have no choice very very interesting topic wish I could give you some more
information on that Thomas Russell does multiple exposure lead to higher higher
viral load than then and therefore more severe illness concern for doctors and
nurses I don’t think we know that I think bottom line either way what you’re
doing even if you get a lower exposure then you take it takes that virus a few
more days to get up to the viremia the higher load that causes disease so
I’m not actually convinced that that’s really gonna cause more of a a stronger
disease I’m just guessing from what I know but what it will do for sure is
create the disease quicker it’ll it’ll get them to that tipping point for
symptoms and viremia a lot quicker so Robert Pinsky can you explain the rash
does the coronavirus have a rash also well I mean if you’re talking about the
rash that happens with some of these other viruses it happens because you get
infection in the in the viral I mean viral infection in the in the skin you
get inflammation that causes redness and things like that
rash has not been a major component of coronavirus at least that I’m aware of
you have GI symptoms the biggest thing at GOG I mean and gastrointestinal the
biggest thing by far has been the the respiratory symptoms Linda Alexander I
read that the measles virus is more contagious than COVID-19 it sure is
it’s like what was what was measles I think COVID-19 we still argue about
whether it’s 2.5 or 3 and this setting etc and isn’t measles something like 12
in terms of the are not the reproduction factor far more infectious or contagious
than almost than anything I know up so is that true yeah mass inoculations have
kept it down yeah again it gets to that whole thing of herd immunity and I know
a lot of people don’t like to be referred to as being part of a herd but
I can’t a lot of us just say moo yes herd immunity is a major protection
factor for us you get to those folks that are vaccine haters and refused to
use vaccine quite often they still themselves are there kids still miss
getting the the infection and when they do is simply because everybody else has
taken that hit taking the vaccine and created that herd immunity but again
something like measles it’s hard to imagine herd immunity just being enough
because it’s so infectious Kinpatu oh Larry Griffiths I heard there are three
strains of COVID-19 now yes I’m not surprised I expect we’ll get a
couple more I mean all of these viral diseases as you see a virus is nothing
but a a “living end” hypodermic it’s got the protein and
glycoprotein core and on the inside it’s got the mechanism for hijacking our
genes our selves genetic material so this is nothing but a genetic replay
with all that genetic replay you’re gonna get some miscommunication
misreading and that by definition is a mutation and those mutations will happen
as this pandemic continues so Kinpatu N95 mask shortage is a
failure to plan unforgivable well you know and like I said we’re gonna have
probably well we’ve already had a lot more people die this year from the
regular flu and we continually routinely have more people die from heart attack
and stroke and those have major failures to plan components as
well so yeah we don’t prevent very well we don’t plan very well as a as a
species PCG I’ll take 70% not sure what that means
PCG N95 shortages due to relying on China for your medical supplies well
I think there’s a major debate and focused around that and you know the
last time I mentioned what one of our political leaders said I got pilloried I
think one of the the things that are medical I mean that our non-medical
leaders are saying is look we cannot depend on China for critical supplies
and I think we’re living through some of that right now
Larry Griffiths The Lone Ranger rides again
yeah unfortunately and I think the lawn Rangers bandanas it was about as much
protection against bullets as bandanas are gonna be against the coronavirus
Eric Janse experts in Europe say when being infected 24 hours after you feel
recovered as in no more fever no more cough you are immune and not able to
infect others anymore do you have the same perspective on this well again Eric
if you go back and you look at the the viral load and the antibody patterns
that I showed earlier that’s the pattern that we see over and over and over again
now are there exceptions of course there are HIV is one of those exceptions you
know you can still be infectious afterwards I don’t think this is turning
out that way if you look at whether you’re a CDC
hater or not if you look at the CDC’s comments the last time I looked one of
the number three of their top five items a believable facts is that once you’re
done with this disease you’re no longer contagious for it you’re no longer
spread it so I think that’s true I have heard several stories mostly from
Chinese Government TV that that you could get reinfected and that you could
spread it again afterwards I haven’t seen anything from any kind of credible
source saying that that’s true is it possible that you could have one or two
where these are happening of course that’s possible but I do that’s my
expectation that once you get over and beyond this you won’t be contagious you
won’t be able to infect others okay so this one is not showing up Larry
Griffiths if we reduce cases of severe flu then more ICU units are available
for COVID-19 exactly right exactly right so failure to plan for the regular
seasonal flu failure to get the flu vaccine is compounding the problem with
COVID-19 and to that point I’m not doing a lot of primary care these days
or at least I haven’t been up until recently I’ve been focused mostly on
heart attack and stroke prevention and you know but I still talk to guys like
Kevin McChord and other folks who have a significant component of primary care
and all of them are saying the same thing Kevin David right others yep we
got a lot of people with the regular flu and 90% of them at least got the regular
flu and said yes I did not get the flu shot so you’re right Larry those folks
are helping helping it make it more difficult to manage the COVID-19
pandemic Larry Griffiths again so far 16,000 people have died and 280,000
people have been hospitalized during the 2019 2020 flu season according to
preliminary estimates from the CDC February 1st 2020 Erik Janse Dr. Brewer
do you have any idea of what the average ICU time is for corona patients that
need to go to the ICU no I don’t I have read it is I’ve read
conflicting statements most of them have been on the side of saying this is
taking a little bit longer than you might have expected to get them weaned
back off of that respirator and back out of the ICU but again what’s happening is
the inflammation is filling the lungs up with fluid and it’s taking time to get
those lungs dry again so they can breathe Kevin again Dr. McChord
unfortunate when some public officials overpromise and underdeliver
well yeah it’s lethal when that happens and when overly optimistic conjecture
obscures the reality of facts and data for the sake of public opinion or
political gain yep so Bob Weis well we had something on Bob Weiss and then
again this is sorry is it skipped over a lot of comments guys if I’m missing your
comment please accept my apologies Hotwheels go Brewer thank you Bob Weis
North Georgia Mountains the dentist in North in Georgia printing a mask filter
is attached to the front easily changed uses dental putty to seal he’s making
the file available well good for him and our friend in Cyrillic script from
Russia the Kiev I hope things are going well there
low serum protein 60 normal albumin indication for low immunoglobulins not
sure of the question D2row what about vitamin D from sun exposure
vitamin D has always been helpful in a lot of places we always thought that
vitamin D in the past needed to be between levels of 20 and 40 as you know
a lot of people thought some doctors were kooky when they were saying no
that’s actually a relative deficiency I think that battle has for the most part
finally been won and science and the literature higher levels
of vitamin D3 are are better they do help with things like warding off and
decreasing diabetes which as you might remember is one of the major risk
factors for serious disease with COVID-19 because prediabetes and especially
significant diabetes decrease our immune function so yes you’d have to follow
some chain of events and you have to think in a causation type of manner but
yes vitamin D3 is very important i got a comment from from again several comments
from several people saying Doc please mention supplements and things like
vitamin C now again there’s been a lot of hot debate right now about whether
how important vitamin C is I would clearly take vitamin C you should have
it in your multivitamins and again just like everything else when you look at
cardiovascular disease you look at other diseases you can’t medicate your way out
of a bad lifestyle you can’t supplement your way out of a
bad lifestyle but sometimes each one of those helps just just like you can’t
stent or surgeries your way out of a bad lifestyle for heart attack and stroke
either lirik but sometimes they help
so Larry Griffiths the SNS signals the adrenal glands to release hormones
called adrenaline epinephrine and cortisol yes correct
Felix the Cat I wonder who else remembers that are there any updates on
ACE inhibitors no not yet not that I’ve heard of I think the jury’s still out on
whether to take them not to take them and I’m clearly in the mode of saying
I’m still taking mine and I’m not changing until and unless I hear an
update which would indicate that I should I was reading up in ACE
inhibitors do not bind ACE2 have they done any data mining to see if the
severity is higher on ACE and on patients with ACE inhibitors it seems
like it would be simple enough to get that information
and out doesn’t it and I expect that probably to happen over the next week or
two but I have not seen anything yet obviously if anybody does I would love
to see and hear it Larry Griffiths any research on UV light
if you UV light kills the virus and what UV light wavelengths would kill it I
have not seen anything on that I have seen again it’s very susceptible to very
simple extremely common household cleaners that include things like
hypochlorous acid but again that’s getting and that’s about my level of
knowledge at this point Rich SJT is it appropriate for a family physician to
order the BCG vaccine for a greater than sixty year old with low EF low ejection
fraction ah that’s a really good question that sort of catches me by
surprise from my perspective given what’s going on right now I would not
I’m not for me you know I used to study the BCG vaccine quite a bit back in my
earlier public health days I don’t remember a huge amount of bad side
effects from it so you know you’re weighing maybe not a whole lot of side
effects but still very unproven unproven benefit William Perry good to hear from
you William can a CPAP help with breathing problems turn up the pressure
a lot of folks have asked that question I’m a little bit skeptical that the CPAP
is going to create the a the type of pressure and be controlled the way it
needs to be to to help in this space so I’m not putting a lot of hope on a CPAP
hi from Florida Z50-Z6 I wonder if is that it that wouldn’t be Tracy would it
the the Corvette nut fan okay so let’s look Bob mister I heard about a week ago
a report I believe I believe was from China that people with blood type A were
a higher percentage patiets do you know any more about that
I don’t and that would be a surprise but it would be a very interesting surprised
if it had it A Schultz no one said that is there William Perry again is there
any reason to believe it takes multiple years to get a vaccine for coronavirus
that is not as effective as the current flu vaccines oh well you’ve heard it
multiple times it’s not it’s not the sequencing of the virus that takes time
anymore it’s not the development of the amino
acid sequence for the vaccine what’s taking time at this point is the the
testing of the virus so I mean the testing of the vaccine so at some point
if this continues to be as dangerous it is as it is right now you’ll you might
begin to start thinking or see some rethinking about the clinical trials for
these for this pandemic including the clinical trials for the vaccine for this
pandemic if you’ve got known very high rates of disease death and disability
and you’ve got unknown levels of of potential problems with the vaccine you
may see some I suspect we may see some accelerated testing for vaccines Rita I
have a question that it’s not about testing but hope you can address another
day if not today well as you see Rita we’ve got questions that are not about
testing as well that’s what we do when we open up these the YouTube live OAG
my vitamin D level is 87 and you know that sounds high to a lot of people if
you look at the labs most labs still say 20 to 40 is the right number the level
that I recommend is between 60 and 90 when it starts getting close to 90 like
that I get a little bit nervous but I I’ve never seen and I’ve done some
research in that space I’ve seen problems when it gets to 110 and higher
and vitamin D can you can get too much of it and it can be it can kill you so
be very careful about it but don’t and don’t get higher than nine thank you for
sharing that OAG and good to hear from you Jackie Shahin Bob he was speaking
about HIV infections list the podcasts hmm interesting thanks Jackie okay OAG
again the problem is most people that problem most people have is they do not
take enough supplements to truly do any good Alabama we should be eating more
vegetables well don’t tell OldAlabamaGardener that that’s what his channel is
all about he is the ultimate local farm-to-table guy he teaches people how
to do that for a living in his youth in his channel
Larry Griffiths no man is an island said COVID-19 isn’t that the truth yes For
Whom the Bell Tolls it tolls for you mister Lp(a) Joe oh okay Joe Riley
that’s who’s Z50-Z6 is okay very good good to hear from you Joe Larry
Griffiths again take vitamin K and magnesium to put the calcium to the
bones and they share enzymes this has been a great meeting today folks I
appreciate the interest again as before a lot of interests on this issue and in
this channel things are have gone from ugly to bad to worse and they’ll
probably continue to go that way but again think about it this is not the
first time we’ve had a lot of unnecessary death and disability it goes
on on a regular basis there are better ways to do things we’ll dig out of this
just like we have dug out of many problems before and we know a lot of the
things that we’re supposed to do again thank you for your interest