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

1. 0:00 – 15:00

   So again, altogether this…

   1. EFDr Eric Feigl-Ding0:00

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

   2. CWChris Williamson0:36

      Eric, welcome to the show, man.

   3. EFDr Eric Feigl-Ding0:38

      Thank you. Happy to be here.

   4. CWChris Williamson0:39

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

   5. EFDr Eric Feigl-Ding0:44

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

   6. CWChris Williamson1:18

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

   7. EFDr Eric Feigl-Ding1:44

      Yeah, so I'm a public health scientist. I've been, uh, a faculty at Harvard for many years and, um, actually I resigned my faculty to run for Congress, but that's a different story. Um, but I, I, I really enjoy, uh, science communication and, you know, public policy and advocacy and especially raising alarm about this. My doctorate was in epidemiology, so the science of epidemics, and although I, I did other chronic disease epidemi, not, you know, infectious diseases epi, it's still in my wheelhouse. And I think sometimes in the world, you know, getting a message out there is something that many scientists are not good at. They know so much in their technical area that, that translating it for the world and making the masses listen, um, is something that's not usually taught and so it's something I really enjoy. And especially for this, um, pandemic now, I think waking people up and waking them up early before the tsunami hits is something we have to do in public health and we have to do way better. So this is why I'm tweeting nonstop about this COVID-19 and trying to make everyone listen.

   8. CWChris Williamson2:57

      I get it. Yeah, it's, um, it's interesting that some of the people that are the best qualified to tell us the technicalities and the specifics about what's happening perhaps aren't the best qualified to communicate that out, right? And that's, I, I, I get what you mean when you say about that. So, okay, let's start. What is coronavirus and what's COVID-19? Is that the same thing?

   9. EFDr Eric Feigl-Ding3:18

      No, coronavirus is the family of viruses. It's like when you ... someone who drives a certain brand of car, but they have different makes and models. Coronavirus is one family (coughs) and, um, you know, it's the common cold, there's a few coronaviruses that are common cold, but there's other common cold that's other viruses. Uh, SARS is a coronavirus. MERS, uh, which is Middle Eastern respiratory disease couple years ago, also coronavirus. And it's, it's one of those little viruses that have these spiky, you know, aura around it. It's corona, so it looks like it has a corona around the virus particle on the microscope. But, um, it's an RNA virus, but it's not a, it's not a, uh, retrovirus like, um, like HIV is. HIV is an RNA virus that has to convert to DNA, live in your DNA, merge in your DNA, and then replicate. This-

   10. CWChris Williamson4:12

       What's, uh, what's RNA?

   11. EFDr Eric Feigl-Ding4:14

       It directly replicates its, uh, virus particles after invades.

   12. CWChris Williamson4:19

       Okay.

   13. EFDr Eric Feigl-Ding4:20

       Yeah, and so this is a, this is a virus that, (sighs) it made a jump from animals, well, probably a bat or some other animal, to humans, and there's a lot of genetic evidence showcasing that. There's no evidence that showcases that or su- supports, um, that it's a bioengineered bioweapon whatsoever. Because the more you g- uh, go ... you can just ... there's these detective clues that you can see within the DNA, uh, within the genome, the RNA genome, that suggests it was evolutionary driven, not as opposed to some human kind of insertion. Um, so-

   14. CWChris Williamson5:00

       So that's the first, that's the first myth-busting there-

   15. EFDr Eric Feigl-Ding5:02

       Yeah.

   16. CWChris Williamson5:02

       ... that this is created by the Chinese government to drive the price of gold up or something like that.

   17. EFDr Eric Feigl-Ding5:08

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

   18. CWChris Williamson6:01

       But this does.

   19. EFDr Eric Feigl-Ding6:01

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

   20. CWChris Williamson6:23

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

   21. EFDr Eric Feigl-Ding6:29

       So strains, you know, strains is like, is it... uh, uh, uh, it, there are different kind of branching, but all that branching evidence has shown that they all branched pretty recently in, sometime in November. So it was one single event that has since spawned all these different small variations. So we, there are like a var- a variation here and there. Like for example, the variation in Washington State is, is different from the variation that was in Iran. But we know the Brit- one in British Columbia that was tested after, from the woman who flew from Iran, came from ir- Iran, uh, uh, Iran came from Wuhan, while it, it, the Singaporean, Japanese and Korean ones came from a different branching. And so using that kind of evidence, we could actually, instead of asking, "Where did you fly?" you can actually look at the virus genome to see where did this version come from. Like British Columbia, Vancouver is very close to Seattle, right? You think that maybe the Seattle version, the Washington State version is the same one. No. They're, they come from different locations because of air travel.

   22. CWChris Williamson7:41

       So...

   23. EFDr Eric Feigl-Ding7:41

       So you could actually tr- uh, you know, use detective work in its genome to see where it originally came from as opposed to, you know, just asking, "Where d- you travel?"

   24. CWChris Williamson7:51

       I guess it's useful, right? It, it allows you to see the footsteps of where, where this has been.

   25. EFDr Eric Feigl-Ding7:55

       Yeah.

   26. CWChris Williamson7:55

       Okay. So we know that about the different strains. What are the biggest misinterpretations so far that you've seen?

   27. EFDr Eric Feigl-Ding8:04

       Um, besides those conspiracy theories, I think the misinterpretation that, "It's just the flu," that's actually a, uh, someone, a lot of... Actually early on, a lot of public health officials and policy makers just said, "It's just the flu." It's not just the flu because, A, everyone has partial immunity to various strains of the flu. Um, no one has immunity to the coronavirus, this novel coronavirus, COVID-19. Uh, but the virus is called SARS-Cov-2. The disease is called COVID-19. The virus causes disease COVID-19. It's, it's like, it's analogy is HIV causing AIDS, right? HIV is the virus, AIDS is the disease. So, but, you know, people just call it COVID-19. So this, um, this virus, I think the main, uh, uh, you know, misconception first of all is that it's just the flu, is very dangerous because we have, A, we have vaccines for the flu. And each year the, we may pick the wrong strains to put into the vaccine, but it's still at least partially effective, right? Anywhere from 50% to 80% effective against most of the strains. We don't have a vaccine whatsoever, and we don't have background immunity from you previously having the flu, uh, for previously this, this virus. And secondly, the flu has a mortality of .1%. This one has a mortality of a full 1 to 3%. That is 10X to 3X higher, 30, 10X to 30X higher. So they're not in the, in the same order of magnitude in mortality. Granted, there could be some places like Singapore with super high, um, wealthy healthcare that could actually, you know, the mortality could drop below 1%. But on average, you know, WHO said it's 3.4% on so far, and that's pretty scary personally. So again, it's not on the same scale as flu. We don't have a vaccine. We don't have countermeasures. Um, so it's not the flu. And that annoys me to no end when people say, "It's just the flu." And also, finally, the other thing is, um, the transmission. The transmission reproductive number, (coughs) which means the R0 for every infected person, that person will infect, for the flu, 1.3 more people. For this virus, it's two to four additional people. If you think about it, you know, that is one of the fastest exponential rises, uh, you can potentially find. Now, granted there are things like measles that have higher R0s of in the teens, but guess what? We have a 99% effective, uh, vaccine against the measles. All you have to do is take it. Um, so we, again, for something with no vaccine whatsoever, this is a very high R0 and has a doubling time around one week, which is, is a pretty fast doubling time, uh, for, in terms of transmission epidemic. So all together, it's not the flu. Um, in terms of other misinformation, you know, some people say that men, um, get sicker more than women. It's, I would say it is partly true. Men get infected at the same rate as, as women, but it could be... and, but men seem to have a slightly higher mortality. But that's from a study in China in which men, like 70% of men in China smoke. And so if you smoke, obviously this thing is gonna kill you faster. Um, so is it because the, that it hurts men more or is it because men also smoke more? We haven't figured that out. So I don't know if it's... And there's no genetic variation. I think, you know, um, you know, right now people are coming down in Europe, um, and people are dying in, in Washington State in the US and they're not Asian whatsoever. So I don't think there's any racial, um, expla- explanation of why, you know. There's no racial, uh, uh, differences there. Um, yeah.And the other mysterious thing that we actually, is actually true is children don't seem to get sick from this. Well, they, they get infected and they get maybe a mild sniffle, but almost all children who are infected have very mild to almost no symptoms. Um, which is, in certain ways good, but very strange, but it's well established. Um, oh, and then finally, the main differential between this virus and SARS and the flu is this CO, SARS-COV-2, COVID-19 is transmittable while it's asymptomatic. SARS, we were able to stop in nine months without any vaccine whatsoever. This one, w- uh, that's not gonna be able to happen because, you know, say you take a plane, right? You're healthy, healthy, get off the plane. Two days later, you get sick and develop your symptoms. Well, with SARS and many other viruses, well, it's okay. You only got sick two days after. We don't, we're n- we're not worried about everyone else that you traveled with. But, um, for this one, it's tricky because you can actually shed viruses even when, before you had- have the symptoms. And so that is very tricky and very difficult, uh, for containment of the an epi- epidemic. Because how an epidemic works is that... How contain and quarantine works is that you find a case, you contact trace, and you quarantine them. And hopefully you quarantined enough, but, um, based on a seven-day kinda thing, it's, uh, there's a lot of asymptomatic transmission that could've happened. So again, all together, this virus is... It's, it's a mean little sucker. In certain ways, you know, SARS and MERS, which have much higher mortality... SARS had 10% mortality, MERS had like, um, 50 or 30%, and Ebola has 50%. A virus that kills more and kills faster is actually easier to control than a virus that kills slower, kills less, and spreads asymptomatically. So again, all these reasons why it's just so difficult.

   28. CWChris Williamson14:23

       Got you. (clears throat) I wanna loop back around to a few of the things you brought up there, but one of them is the current mortality rate, which you've, uh, said between 1% and, and 3%. I've heard and, and read some stuff talking about the fact that that is the numerator that we've got on the top, but the denominator on the bottom, due to some testing, um-

   29. EFDr Eric Feigl-Ding14:47

       Yes.

   30. CWChris Williamson14:47

       ... questions may be different. And if that numerator on the bottom turns out to be significantly higher than we thought, um, because the reported cases in some places-
2. 15:00 – 30:00

   Yeah. …

   1. CWChris Williamson15:00

      people that are symptomatic or sym- symptomatic and, you know-

   2. EFDr Eric Feigl-Ding15:03

      Yeah.

   3. CWChris Williamson15:03

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

   4. EFDr Eric Feigl-Ding15:13

      So, very good question. And, um, epidemiologists have thought about. There's two different things. Um, th- uh, there's, there's a tug of war happening. The, wha- what you're talking about is under-diagnosis. Basically, mild people or asymptomatic people, they're just not tested and therefore they don't, they're, they don't show up in the denominator of total ca- total cases, right? Um, and this under-diagnosis, you know, was a problem for in China for a while, and there's, it's still a problem i- in almost every country other than Korea. Korea's doing 15,000 tests a day, drive-through style. They, they're, they're-

   5. CWChris Williamson15:49

      What? Korea's got drive-through tests?

   6. EFDr Eric Feigl-Ding15:52

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

   7. CWChris Williamson15:55

      Holy shit! (laughs)

   8. EFDr Eric Feigl-Ding15:57

      It is, it is insane. Um, Koreas, Koreas... Uh, you, you need a comp- a country that is like systematically, you know, well-managed enough centrally and you have the wealth and you have the capacity for the scientific labs to do it. The United States can't even do that. United States can probably, you know, across all its labs do only like 9,000. And that's across the entire United States right now at the moment. Hopefully we can do more, but, um, we're n- our capacity is not even close to Korea. Um, so my point is, under-diagnosis. Oh, by the way, Chinese numbers are different than other numbers because j- if you test positive and you don't have symptoms, China does not put you on the conf- confirmed case count. Everywhere else, if you're, uh, test positive regardless of symptoms, you're a case count. So there's under-diagnosis, which if the number at the bottom of this case fatality ratio is larger, then the, uh, uh, case fatality will drop in percentage, right? But there's another competing thing and that is the mortality lag. So this disease is a long-ass sucker. Mild cases are about 80%. 80% mild to moderate and the duration of mild cases is two weeks, which is, by the way, pretty long, 'cause most people who have a flu just get over it in a m- in a week. But severe cases, which is 20%, severe and critical, 20%, is about three to six weeks long. And, and some of... And the critical people who are basically need hospitalization in ICU, um, y- you know, they have a 28-day mortality of 50% in China. Um, and China, by the way, has a lot of ventilators. They can manufacture a lot of ventilators and they have staff, ICU staff nurses. Um, but the issue is the three to six weeks. It means you have a lot of cases, once they're diagnosed... Say someone's diagnosed during Valentine's Day after kissing, terrible Valentine's Day-

   9. CWChris Williamson17:56

      Mm-hmm.

   10. EFDr Eric Feigl-Ding17:56

       ... but their, their outcome does not resolve to a death or recovery for at least six weeks, or three to six weeks. Do you see that? There's a lag. From the day that... Uh, you have to think of a cohort. You can't think of it, of, uh, mortality as simple back of a napkin calculation of deaths ro- over cases. You have to look at it from a cohort perspective. And-The problem is a lot of- most countries, you know, i- in China, still half the people have not recovered. You know? And in Korea, I would still say like 80% of the cases are neither deaths nor recovered a- and, you know, released. You've- you've healed yourself. You don't have the virus, you're over it. Most of- two thirds of them or three fourth have not been death or recover, which means there's still part of this, "I'm still sick, I still have symptoms," or, "I'm still testing positive. I've not cleared it from my body." And that actually causes two problems. One, the lag, meaning this numerator is not finished, right? It's not fi- this cohort, this Valentine's Day cohort of everyone who got it on Valentine's will not be finished until end of March, early April. (smacks lips) So we cannot finish calculating the case fatality then. If we just keep testing, testing more, we're just adding more people to the denominator, but who have not finished the entire disease course. So there's a tug of war. Underdiagnosis would drag the CFR down, but the mortality lag of incomplete resolution of most of the cases because they haven't hit the end, you ha- th- this case fatality is only finalized when everyone is either dead or fully recovered, and that has not happened for most cases yet.

   11. CWChris Williamson19:38

       Got you.

   12. EFDr Eric Feigl-Ding19:38

       So hence, they balance out to around 1 to 3%, depending on the model. Um, and the other key implication of the disease being three to six weeks in 20% of people, which is a lot, one in five people will have a three to six week, um, disease course, is hospital beds will be completely swamped. Like the United States, terrible. Like Korea has a really high per capita number of hospital beds, really high. Korea is like top five. You know, there's- you know, this is why China m- built a hospital in 10 days, right? And Korea, um, you know, does not have enough beds, and most countries do not have enough beds and it's just gonna jam up the healthcare system. It's- it's terrible in that sense.

   13. CWChris Williamson20:23

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

   14. EFDr Eric Feigl-Ding20:32

       It's a pneumonia. It causes vi- it's a viral pneumonia. So it will give you a- a fever at first. You'll have coughing. (coughs) That's common. And then you have- you know, you feel like you have fluid in your lungs, (gasps) you have trouble breathing. And then- and over time you can- an infection can set in, uh, uh, further of your lungs. And I'm not sure if it creates lung scarring. There's- China did one lung transplant on someone with COVID-19, but it's- it's- it's unclear if it cre- You only need that if you have permanent lung scarring. Um, and most pneumonia doesn't do that. But if the pneumonia is bad enough, you know, you have problems g- getting oxygen, and that's why people are on ventilator respirator machines, because they need oxygen. Um, and the- and if it just causes s- really, really bad pneumonia, people just are oftentimes dying from lack of oxygen.

   15. CWChris Williamson21:32

       Got you.

   16. EFDr Eric Feigl-Ding21:32

       That's the truth.

   17. CWChris Williamson21:33

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

   18. EFDr Eric Feigl-Ding21:41

       (sighs) So I'm gonna give you two answers. Th- in terms of death, elderly definitely have the highest death. You know, the curve-

   19. CWChris Williamson21:47

       65 plus?

   20. EFDr Eric Feigl-Ding21:49

       It- the curve goes up like this. It's not like a step- it's not a step function.

   21. CWChris Williamson21:52

       Oh. There's not a point-

   22. EFDr Eric Feigl-Ding21:53

       It's a curve.

   23. CWChris Williamson21:53

       Yeah.

   24. EFDr Eric Feigl-Ding21:54

       Yeah. Uh, it- it curves up, and it curves up starting around age 50 and then, you know, definitely above 65 it becomes a high risk. Like in a nursing home in Washington State, there's been six deaths already. In a nursing home of frail elderly people. It's- it's really bad, you know, in- in just one week. Um, but in terms of- the other thing is just 'cause you don't die, actually, you know, it's- it's tricky. In terms of the healthcare system, I hate to say it, someone who dies quickly actually is cheaper for the healthcare system and for insurance. Someone who's sick for six months- uh, for six weeks, that's actually really, really bad, right? Because it jams up hospital beds, ICU services, et cetera. And so I think you can't just look at death. And in terms of ICU, there was one study that says a lot of young people were actually stuck in ICU as well for this. Um, it's- you know, in terms of the earliest reports in- in Ch- in China, there was just as many people under the age of 60 as over the age of 60 in ICU. Um, presumably on the ventilator machines. This is a- this is a really serious issue because look, um, people being sick for a long time is actually a really, really taxing thing on the healthcare system. And I think the other thing is, you know, there's also y- uh, many young Chinese doctors who have died. There's a 29-year-old, 29-year-old, 34-year-old, 42-year-old. Like that's four doctors like basically 40 or under. Um, it's- it's very troubling. So- and the other thing is just 'cause you're part of the 80% who have a mild and moderate case, um, you're still spreading it. You're not- most likely those people who are not tested are the 80%, but they're spreading it. And young people- you know, old people st- stay home and watch TV or play checkers or something. Young people are out and about, going to work, bartending, waitressing, going to movies, sports games, you know, going to restaurants. They're the ones spreading around. And so in cert- in certain ways, you know, their morbidity may be less, but in th- they actually add to the total number of people infected. So these infectious 80% mild is actually much harder to control because again, if- even if 20%, only 20% gets sick-... these 80% keeps spreading and amplifying the total denominator, uh, for people who are, who can come down with something really serious.

   25. CWChris Williamson24:36

       Yep.

   26. EFDr Eric Feigl-Ding24:36

       That's why I don't think ... Just 'cause it's mild for you doesn't make this v- virus any better for the general population.

   27. CWChris Williamson24:44

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

   28. EFDr Eric Feigl-Ding25:05

       Yeah, good question. So, this is actually a project that I'm working on because right now, based on the early studies (coughs) , and we don't have incubation times for everyone. Incubation is d- defined as the moment you got infected to the moment you develop symptoms. Um, and sometimes you can't, you don't know when someone first got infected, so not every case has this information. With the limited numbers we have, it says anywhere between five to 10 day- uh, five to seven days, but that means, that's just the mean. Half of them are longer than that and right now all the quarantine rules are basically quarantine someone who was exposed for 14 days. If traveling, entering the country, quarantine 14 days. The question is, is you know, there's a normal distribution, right? And if the mean is at five to seven days, the question is, are you sure that by extending it to 14 days quarantine you've captured the entire tail? 'Cause what if this tail, m- centered on five to seven, has a very, very long tail and let's just say 10% of the people exceed 14 days incubation. So that, which means, oh, I'm perfectly healthy for 14 days, I'm gonna be released on the 15th day. They could still develop it if they have a long incubation time on the 18th or 20th day.

   29. CWChris Williamson26:27

       Got you.

   30. EFDr Eric Feigl-Ding26:27

       And then you r- you've ... Because the quarantine time is supposedly if you pass this quarantine time and you haven't gotten sick, we can release you into the wild. Right? Uh, you don't have disease, h- go have fun again. But, the question is I don't know if it's long enough and there's some studies of showing someone with 21 days or 25 days or something like that. Now, I don't know if they're m- they're misreported but it's concerning because is 14 days fully capturing 99.9% of all people? 'Cause if you just let one person out, that one person can have a super spreading event. You know? A lot of epidemics are-
3. 30:00 – 45:00

   Got you. So we've…

   1. EFDr Eric Feigl-Ding30:00

      them got infected, and, uh, and they found that it was also s- something related to septic gas.

   2. CWChris Williamson30:06

      Got you. So we've spoken about the fact that it's to do with at least mostly s- droplets. I've heard it's something to do with like-

   3. EFDr Eric Feigl-Ding30:14

      Yeah.

   4. CWChris Williamson30:14

      ... it's not airborne but like waterborne. What does this mean? How d- how do I get it?

   5. EFDr Eric Feigl-Ding30:18

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

   6. CWChris Williamson30:34

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

   7. EFDr Eric Feigl-Ding30:38

      Well, water droplets will eventually settle, right? Airborne means, like, it will stay in the air, it will float in the air like a balloon, right?

   8. CWChris Williamson30:46

      Yeah.

   9. EFDr Eric Feigl-Ding30:46

      Well, obviously a tiny particle, but stay in the air. But, you know, a droplet means these tiny things like when you sneeze or when you, when you speak, it comes out of your mouth, but over time it will settle down. So, it's like semi-flying in the air for a short distance. And so we're sure about that. Now, fully airborne, it's hard to say. There's some study that says yes, some study that says no. But I- in the... I think the main thing is close contact. Um, close cont... And I think the close contact issue, we've seen it, uh, also, um, we think a lot of the... For example, the ship, the Diamond Prince, Princess ship, it was a Petri dish, literally, to grow. And a lot of people, you know, one in four, one in five to one in four people on that ship has tested positive, which is insane. You know, that ship has 3,700 people and one in four, one in five people has tested positive. (coughs) And the reason we think of that is because, um, a lot of the people who are in the inner cabins, besides the food sharing and, you know, public, but people who were in their cabins, they don't have, like, a window. And so their ventilation system... Now-

   10. CWChris Williamson32:02

       All infernum, yeah.

   11. EFDr Eric Feigl-Ding32:03

       ... is it airborne, airborne or is it, like, droplet travel through the system?

   12. CWChris Williamson32:09

       Okay.

   13. EFDr Eric Feigl-Ding32:09

       And-

   14. CWChris Williamson32:09

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

   15. EFDr Eric Feigl-Ding32:22

       Yeah. It can live a week.

   16. CWChris Williamson32:26

       A week?

   17. EFDr Eric Feigl-Ding32:26

       Yeah. A week.

   18. CWChris Williamson32:27

       Fuck. That's a long time.

   19. EFDr Eric Feigl-Ding32:29

       Yeah. It's up to a week. It depends on certain things like temperature and humidity. Um, it degrades faster in, in h- warmer and, uh, more humid air. But at the same time, you know, we're n- Like Singapore happened w- epidemic... Singapore is 70, 75 degrees, you know, that's like 20, 25 degrees Celsius. Um, and so that still happened. But the thing is we're mostly indoor people. Singapore epidemic happened... Uh, the super spreading event was at a Grand Hyatt Hotel, Singapore. And that hotel... You know, hotels, it doesn't really matter what the outside climate is, right? If you're at an indoor conference center or indoor gym and you get it, it doesn't matter what, what it is outside. So, you know, I think the, the, th- one of the misinformation actually is about, "Oh, it's gonna all go away when the summer comes. It's gonna be too hot." Um, except we are indoor workplace kind of people, and there's something called the Southern hemisphere of the Earth. And then s- it'll just go to s- in Africa, in Australia, in, you know, Indonesia, in d- when it's winter time in the north... In the summertime in the north and winter time in the south. So I, I don't think that it's gonna go away in the summer arguments. It might slow down a little, but it could easily come back in the fall.

   20. CWChris Williamson33:52

       Got you.

   21. EFDr Eric Feigl-Ding33:53

       Um, that's, that's the tricky part. The, the virus seems to s- be a survivor, basically.

   22. CWChris Williamson34:02

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

   23. EFDr Eric Feigl-Ding34:06

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

   24. CWChris Williamson34:18

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

   25. EFDr Eric Feigl-Ding34:21

       Mitigation is just, um, you know, reducing the number of people who are exposed. Um, and no... And, you know, you test as much as you can, but in terms of actually stopping the virus, um, you just... You mitigate its impact, um, and you mitigate its spread. But containment just means preventing a community transmission event, right? Someone... If someone tra- travels from, say, Iran, lands at the airport, uh, and then they... We detect that they're sick, uh, and we quarantine them, then that is contained, right? But if they can come back, go... Send... Infects her kids, goes to daycare, childcare, goes to a party, infects everyone, and they all go home and they all test positive, and they all don't know necessarily where they had gotten it, it's not contained anymore. It's community transmission. And community transmission is way more dangerous than, uh, a travel related thing, because it means they picked it up randomly in the community of an unknown source that we can't necessarily trace anymore.

   26. CWChris Williamson35:32

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

   27. EFDr Eric Feigl-Ding35:42

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

   28. CWChris Williamson35:48

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

   29. EFDr Eric Feigl-Ding35:56

       No. I said depending on where you are.

   30. CWChris Williamson35:58

       Yeah, yeah, yeah.
4. 45:00 – 1:00:00

   I saw a, um...…

   1. EFDr Eric Feigl-Ding45:00

      I would stop shaking hands with people. No offense. Wave hi at them, fist bump, elbow bump, foot bump.

   2. CWChris Williamson45:07

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

   3. EFDr Eric Feigl-Ding45:31

      I think that's just one measure. I think the other key things are, you know, just don't touch your face. Um, by the way, really embarrassing, at Washington State there was a press conference about the epidemic and as she was fumbling through her papers sh- she was saying, "Everyone wash your hands, don't touch your face." She was flipping her paper like-

   4. CWChris Williamson45:53

      And licking her fingers to get through the bits of-

   5. EFDr Eric Feigl-Ding45:55

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

   6. CWChris Williamson46:00

      Ah, what a, what a f- um, what is it? It's not face palm, is it? It's like face-

   7. EFDr Eric Feigl-Ding46:04

      Yeah.

   8. CWChris Williamson46:04

      You don't wanna face palm. That's the problem.

   9. EFDr Eric Feigl-Ding46:06

      Oh, god. Yeah. I know. Anyways. It's become an internet meme, uh, now.

   10. CWChris Williamson46:10

       Got you. Okay.

   11. EFDr Eric Feigl-Ding46:10

       But it, but it's just so terrible. But I think, you know, avoid touching elevator buttons. Just avoid touching doorknobs. I know that is really hard, but doorknobs are not disinfected often. Don't touch things in public. You have to kind of be a little germaphobe until this thing is over, you know? Um, and, uh, public transit is the other thing. Like, I see like this... You know, the city leaders are always saying, "Public transit is fine." But public transit is also one of the p- a confined space, limited ventilation. You know what I'm talking about. It, and it doesn't have... And unlike the airplane. Airplane at least it takes in new air every three or five minutes, so the air in the- in the cabin's being replaced every three to five minutes. So, in certain ways the airplane is pretty good. Unless you get unlucky and sit someone next to a cough, the airplane's actually pretty good in terms of replacing the air. But that's not true on a bus or a train. You know? And so... And I don't know if they use super high small micron HEPA filters that can filter out virus particles, because not every air filter does. So, uh, you know, I think the other key thing is people ask, "Do you travel?" (sighs) I say look, at some point, you know, once the pandemic becomes really real and- and it's like in 80, 90-

   12. CWChris Williamson47:39

       What's that number? What's- what's "really real" mean?

   13. EFDr Eric Feigl-Ding47:42

       As in like the epidemic is literally everywhere. 80... You know, let's just say i- if I was in the United States, it's in 80% of all the states, you know, I'm gonna say it's probably everywhere and staying here is no better than getting on a plane and going there. Granted, you know, air- airport is, um, is a place of change, but I don't think, I don't think you should stop your life. And people ask me how anxious am I am. My an- on a scale of one to ten, I'm a six. I'm worried, but I'm not anxious because... I'm anxious about things that is something I can control that I'm not doing, right? Like testing, I'm anxious that we're not getting enough testing. But am I anxious for the inevitable? Because the CDC, one of the CDC, um, vaccine immunology head says in report, report to Congress, this virus is inevitable. It will be in every single state.... in that sense, I am not anxious because it's like, just brace yourself, come what may. Right? So, I have the kind of stoic mentality.

   14. CWChris Williamson48:50

       Mm-hmm.

   15. EFDr Eric Feigl-Ding48:50

       Obviously, not everyone does.

   16. CWChris Williamson48:51

       Mm-hmm.

   17. EFDr Eric Feigl-Ding48:52

       But, you know, protect yourself as much as you can. As for masks, um, surgical masks are pretty useless. Uh, N95 masks do not filter out e- everything. Um, but N95 masks are better, but at the same time, um, if you wear a beard, it's totally useless if y- w- wearing some, uh, the N95 mask, by the way. And the-

   18. CWChris Williamson49:16

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

   19. EFDr Eric Feigl-Ding49:20

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

   20. CWChris Williamson50:02

       Okay. That's, that's not good. I thought-

   21. EFDr Eric Feigl-Ding50:04

       Unless you have (overlapping dialogue)

   22. CWChris Williamson50:04

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

   23. EFDr Eric Feigl-Ding50:13

       N95 masks are partially effective. They are partially.

   24. CWChris Williamson50:16

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

   25. EFDr Eric Feigl-Ding50:21

       Yes.

   26. CWChris Williamson50:21

       Getting a hold of-

   27. EFDr Eric Feigl-Ding50:22

       Yeah.

   28. CWChris Williamson50:22

       Have you seen, um ... I just got told before this by one of my friends, that, um, alcohol hand wash prices, uh, like some companies charging like 10X, 100X what it should be.

   29. EFDr Eric Feigl-Ding50:33

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

   30. CWChris Williamson50:45

       Okay.
5. 1:00:00 – 1:07:01

   Yeah, I get it.…

   1. EFDr Eric Feigl-Ding1:00:00

      um, and unless you know that this person has a respiratory illness, who could be a pot- potential case, um, they're not, they're not wearing any protection. And the scary part is, look, the quarantine, Japanese quarantine o- o- officer who boarded the Princess Diamond ship, you know, the, the one that was quarantined off of Yokohama, he boarded with mask, with protective gear, did inspection, got off the ship, tested positive. Another firefighter in Japan transporting these patients as they were evacuating, he was wearing protective gear, finished transporting, tested, tested positive. Um, and, and so it's really trouble. Like, right now th- in one county in, next to Seattle, Washington, 25, um, firefighters have been quarantined, which is a full tw- um, quarter of their entire, uh, firefighting workforce.... out of commission for fif- 14 days. And now half of them are, have developed cr- flu-like symptoms, all from just transporting and, you know, this one patient. This virus is so infectious. It is just, you cough and sneeze and it goes everywhere, and that's what such a worrying little, little sucker. Um-

   2. CWChris Williamson1:01:15

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

   3. EFDr Eric Feigl-Ding1:01:34

      (sighs) Don't panic buy, slow buy. Um, your s- stock of probably, like, two weeks worth of food and water, um, in case of future panic buy. But remember, you're trying to prepare, so part of preparing is slow buy. Um, avoid touching people and avoid touching your hands. Wash, you know, just generally going to restaurants, be very careful. Don't touch anything, basically, that's not purely, you know, s- s- s- uh, static clean. Um, I would avoid social things. I would avoid concerts, sport- sporting events, parties with poor ventilation. Maybe outdoor party, maybe, but I, I just, uh, knowing s- and seeing how infectious it has been on so many pe- uh, different situations, avoiding these kind of things at all costs. Um-

   4. CWChris Williamson1:02:31

      Public transport?

   5. EFDr Eric Feigl-Ding1:02:33

      ... total... Yeah. And public transport, be very careful. Be very careful. If someone coughs next to you, (laughs) move out of the way. Um, uh, but at the same time, don't be racist that, you know, someone just 'cause they look like they're from China. At this point, looking like you're f- some- someone from China is not an indicator of someone having a virus anymore.

   6. CWChris Williamson1:02:55

      (laughs)

   7. EFDr Eric Feigl-Ding1:02:56

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

   8. CWChris Williamson1:03:02

      I get you.

   9. EFDr Eric Feigl-Ding1:03:02

      Um-

   10. CWChris Williamson1:03:02

       Yeah, yeah, yeah, yeah, yeah.

   11. EFDr Eric Feigl-Ding1:03:04

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

   12. CWChris Williamson1:03:22

       Mm-hmm.

   13. EFDr Eric Feigl-Ding1:03:22

       Just avoid touching people. And, you know, even at dinner, if you're having t- face-to-face conversation, stand as far away as you can.

   14. CWChris Williamson1:03:31

       Mm-hmm.

   15. EFDr Eric Feigl-Ding1:03:32

       And, uh, and, you know, at restaurants p- people are v- very careful. When you, when you s- when you're going out to dinner and you're talking, your saliva will naturally go into someone else's food ac- across the table.

   16. CWChris Williamson1:03:46

       I get you.

   17. EFDr Eric Feigl-Ding1:03:46

       So-

   18. CWChris Williamson1:03:46

       And if you're gonna do a podcast, do it over Skype, like this.

   19. EFDr Eric Feigl-Ding1:03:50

       Yeah.

   20. CWChris Williamson1:03:51

       We should-

   21. EFDr Eric Feigl-Ding1:03:52

       Although, some day, we're gonna have these virtual reality kind of, like, holograms and then, you know, it's gonna feel real 'cause then you can all ...

   22. CWChris Williamson1:04:00

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

   23. EFDr Eric Feigl-Ding1:04:07

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

   24. CWChris Williamson1:04:10

       (laughs) I get it. Um, Eric, man, I would like to say thank you so much. Y- you are-

   25. EFDr Eric Feigl-Ding1:04:14

       Yeah.

   26. CWChris Williamson1:04:15

       ... right in the midst of it at the moment. Um, people wanna follow you for updates and stuff, where should they go?

   27. EFDr Eric Feigl-Ding1:04:20

       Yeah, um, follow my Twitter. Um, I have a, I have a Facebook as well, but right now I'm just purely f- on Twitter, uh, for this update. It is @DrEricDing, D-R, Eric, E-R-I-C, then Ding, D-I-N-G, @DrEricDing.

   28. CWChris Williamson1:04:36

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

   29. EFDr Eric Feigl-Ding1:04:46

       Um, I think, uh, STAT News is a really good one. STAT News is, like, a healthcare newspaper. They're... And they have pretty good updates. You know, obviously WHO, uh, has updates, but WHO, um, uh, their recommendations are much more optimistic. (laughs) If you want more realistic in certain ways or more predictively ambitious, um, I would say, you know, uh, follow s- I think following Twitter, COVID-19 hashtag, it's a, it's a really good hash 'cause it's something that everyone's using-

   30. CWChris Williamson1:05:25

       Mm-hmm.

Episode duration: 1:07:01