Oh hey, it's that sticky quarter hiding under your floor mat, just waiting for you to get desperate enough to use it at a parking meter. Ali ward back with a coronasde This is the third installment of coronavirus episodes. The first one was with virologist doctor Shannon Bennett from cal Academy,
and then we had an isolation era March thirty. First episode called All Washed, Hands on Deck with doctor Michael Wells about testing resources, what we can all do to help, and also how to practice self care during a really tough time. So it's been two months and things are starting to slowly reopen in the US and we all have a lot of questions. So I hopped on the horn with past guests doctor Mike Natter. He is a physician in New York City who you know from the
Diabetology episodes. He has been on the front lines in emergency and ICU units and gives us an account of the disease prognoses what to expect next. I also chatted with doctor Shannon be a virologist extraordinaire, to talk about how the virus behaves and how we should behave because
that's a big part of it. But before we get to them quickly, just a few thanks to everyone on patreon dot com slash ologies for submitting questions for this episode this is all your questions, and for supporting for as little as a buck a month. Thank you to everyone sending these episodes around via word of mouth and social media and subscribing and rating and of course reviewing. Your reviews have kept me company during a lonely time, and as proof, I read a fresh one that someone
left each week. This one is from history Kid, who says that this podcast makes learning about topics I've never even heard of so interesting and enjoyable. I have to confess her intro and the shows the music always make this fifty five year old man cry with joyful anticipation. Thank you History Kid for letting me creep your weeps, and everyone who left reviews this week for serious Okay, let's get to the interviews with doctors Natter and Bennett.
You'll learn about her immunity and vaccine progress, what it's been like on the front line, if the virus will mutate, if it's seasonal, what ppe we should be wearing, if picnics in the park are a good idea and when you can hug people again, are handshakes canceled? You will find out it starts off tough, explaining the importance of having flattened the curve, and by the end you will
have a clearer picture of the future. So get comfy and listen up and then bang on a saucepan and applaud into the dusk were physician doctor Mike Natter and virologist doctor Shannon Bennett.
Okay, my goal is to not cry in the thirty minute chat that we have.
Please don't feel like you have to stick to that.
Can I tell you I've been ugly crying like I feel like what I imagine a very very pregnant woman with like lots of hormones flowing through.
So you heard doctor Macnatter in the Diabetology episode, and you may recall that he is a super sweet, super empathetic dude, and he works in a family of three hospitals in Manhattan, and he has seen things not on the news, not explained via press conference, but firsthand, so he knows the real shit. Can you explain to me a little bit of what it's been like since early March. Yeah, mid late March.
It was a lot. There's a lot of volume. We had to basically kind of just to give you some scale, just to like, and it's always tough because like when you're in the hospital, like you see the trees, you don't see the forests, so you don't necessarily know what everyone else's experience is. So I can really only speak to that I was seeing a lot of trees, a lot more trees than is typical for this patch of forest, So just to give you some scale. The hospital and
internal medicine works like this. If you come to the emergency room, they try and gets you better so that you don't have to be admitted if you are sick enough to need admission, which unfortunately many of the folks that have like really bad COVID do need because their oxygenation is so low. If they are sick but not too sick, they go to what's called the general floor. We call it the floor, or like some people call
it the ward, the wards. The general medicine floor is kind of like you're sick enough to be admitted, but you're not on death's door by any means. And then if you get sicker, then you go to what we call the unit, which is short for the ICU. There's different flavors of ICU, but in general they're just all
acute critical care. On average, there will be in one ice you let's say there's maybe thirty forty beds, there will be maybe on my particular team, ten to twenty patients, of which maybe five to seven of them are intubated and very very very sick. The entire ICU, plus a million other floors that we had to kind of make
shift into ICUs, were being overrun with the patients. There was hundreds, literally at the peak at this particular hospital, I think close to two hundred intubated ventilated ventilator you know, necessitating patients. And it was really, really really bad. So that was bad, And that was at one particular hospital, and then I went to I rotate between another one, and the other hospital up the street, which has a lot more resources, was even more overrun than that hospital.
But we had people from surgery, from plastic surgery, from pediatrics, from psychiatry, from neurology who we just needed to kind of help us essentially with the volume, and so it was like an on flought of volume patients.
What was life like in New York at that time. Because you're born in New York, you've lived most of your life in New York. What's it like going from the hospital is back home every day knowing that that's kind of an epicenter in America.
It's scary. I mean, I think, you know, New Yorkers are pretty rough and pretty and nothing really affects anyone and everyone kind of no matter what's going on in the world, everyone seems to kind of be able to do their thing no matter what, and there was this clear sense of kind of unity and camaraderie. You know. The only other time that I've lived through that felt even remotely close, but for very different reasons, I think was nine to eleven, and to some degree a little
bit post Superstorm Sandy. But it just was different, Like it's a very different vibe. It's so eerie and very uncomfortable and jarring for me to see the streets as empty as they are, because that's something that's like a constant of New York. The lights are on, people are moving around, things are going on, no matter how crazy the world gets, and the fact that that's not the case was also i think extremely noticeable and jarring. MM hmm.
How are doctors looking at the curve for New York? Where is it at Now we're in that beginning of May.
It's looking a lot better. I mean, it's all. What I would say is thanks to you good leadership from Cuomo and some degree to Blasio, because it's the idea of shutting things down to limit the spread, and we are seeing a massive flattening of the curve for that reason. Hospital of mission rates are significantly down. Death rates are
coming down each day. There still are packed ICUs and there's still lots and lots of very, very sick, sick patients, but we're able to manage them because the volumes have started to settle down. It's almost indefinitely thanks to the social distancing and the lockdown and the kind of shelter and place orders that have been issued by the governor.
So a few patrons had questions about symptoms of COVID NINETEENVID nineteen is the disease caused by SARS COVID two, which is a new type of coronavirus. Coronaviruses are a type of virus named for the crown or corona of structures on its cell surface that help it bust into ourselves. So A recent Center for Evidence Based Medicine article stated that between five and eighty percent of people testing positive
for COVID nineteen may be asymptomatic. Between five and eighty percent. What, that's a big range, so we don't totally know how many people have it, but experts pretty much settled on
fifty percent are a symptomatic. Patron Lisa Moore asked about neurological symptoms, and in one small Chinese study of two hundred and fourteen people hospitalized with COVID nineteen, more than a third of them had neurological symptoms like headaches and changes in smell and taste, nerve pain tingling in the extremities and kind of wooziness and dizziness, and other observed neurological effects of COVID nineteen are short term memory loss,
difficulty concentrating, so it can affect you neurologically. Patron Toby Chrisnik asked if there's going to be a second wave, will there be new and unknown symptoms? They say, I'm already hearing about corona tose, so yes. Other observed symptoms of this coronavirus have been coronatose, which are lesions on the toes, diarrhea, and perhaps even something called Kawasaki disease,
which has been seen in some children. It presents a little like toxic shock syndrome, with a high fever lasting several days, and abdominal pain, vomiting, a bright red or what's called a strawberry tongue, and peeling rashes on the feet and hands and groin. Other complications of COVID nineteen we did not necessarily know much about a few months ago are blood clots and stroke, inflamed heart tissue, lung scarring, and even issues with male fertility. I know you're like,
what the fuck are all these symptoms? Why are you bumming me out? Dad? Well, there's a chance that you or someone you love might have symptoms without realizing it is the RONA, So I'm here to tell you now. The tough part is that this is a novel virus. We've only known about our a few months, so every day we get more information. So every day yesterday's information might be a little more wrong. But the good news is that people are working around the clock on it.
Doctor Natter explains, that's a good question.
I mean, I think I think, just speaking generally, a lot of the fear around this is that we don't know things. Yeah, we don't understand why some people who get coronavirus have a sniffle and then they get better, or they have a few fevers and they get better, and then the same individual with whose I mean, I saw very young patients with no cool morbid or past medical history who have died, and many others who are on dialysis and ECMO machines and emodialysis and ventilators and
all these things. That doesn't make sense, and so that fear is felt really amongst the pop general population, but amongst healthcare workers. I think we like to intellectualize as a defense mechanism, but you can't intellectualize when you don't know and when you see what you're seeing.
So worldwide, as of this recording, two hundred and eighty five thousand, nine hundred and seventy one people are reported casualties of the virus, over eighty thousand in the US alone. So how is it still spreading any surprises? Myrologist at the California Academy of Sciences, doctor Shannon Bennett, explains, Well.
It's really fascinating. I would say that it's definitely by and large behaving as we would have expected the kind of the way, which was this sort of steep exponential growth rate early on that then flattening and leveling off. And I'm talking about leveling off in terms of the number of daily new cases and the number of daily new deaths. In both cases. The one the death's legs
behind the new cases. But they start to ramp up, then they level off such that the number of daily new cases is almost the same day over day, maybe over a sliding two week a two week window, and then it starts to drop down the other side of the waves. So here in California we're a big surfing culture. So it's just like surfing a wave, you know, you go up, flatten, and then down the other side. And
I do apologize making light of this. This is very serious, but it is an effective analogy I think to indicate that that, just like an energetic wave in water, then the number of cases out there, because any individual case is infecting a certain number of other individual cases, and
that numbers can be pretty high. At the beginning of the epidemic, the doubling time was on the order of a few days, and then it sort of spread out as we flatten the curve, and so that metric represents the energy of the virus to push out and push through a population, just the way that the energy in
a wave that we surf behaves. And so the energy of that course of infection is becoming dampened as the number of daily new cases starts to level off, and then that gets reflected in the reduction in the number of daily new cases day over day until it's close to zero. And that's the bleeding out of the energy of that wave as well as that force of infection. And so that's the way it's rolled in most countries,
including our country here in the US. At state by state, maybe the intensity, the height of the peak of the wave might be a little different. It was certainly the highest in New York. And the timing of that wave is jittered, so some states hit their exponential growth sooner, others have hit it later and to a much lesser extent. And what's interesting to me is looking at different states
or even different countries. Although the form of the wave largely plays out the same with some exceptions, we can really see how country and states have implemented different policies and that kind of plays out on the epidemiologic landscape. Like you can really see the difference. You can see how different states, for example, really managed to keep that curve very low, very flat and delayed start and in very quick time have seen it decrease.
So you're seeing policies have like a direct mathematical effect on that curve. Yes, most definitely. Patron Joanna Gebhard asked, do we know what the mortality rate is yet? And I awkwardly ask doctor Datter how much higher were the mortality rates of your patients than you're used to dealing with and how.
Did you passively massively.
How did you deal with that?
Not? Well, yeah, yeah, well it's hard. It's really hard. While in the hospital. Surprisingly, I think you have like a purpose and you have tasks and you're able to, you know, kind of get your head down and do your work and feel like you're doing something of substance, But then coming home is very difficult.
Do healthcare workers, is there anything any plans in the works for how to deal with that emotionally psychologically for healthcare workers.
I think there's a lot of talk. I think it's very well understood and known that there's a lot of his traumas being kind of dealt with. And I think we know that, and I think a lot of our colleagues in psychiatry have been really great and they've been helping us out, and they're offering us a lot of like WebEx therapy sessions and debriefings and having like kind of group meetings and stuff, which is great, I think for me at least, and I think for most of
my colleagues, like right now, we're okay. I think it's more what's going to happen kind of days, weeks, months, and likely years from now that's going to be interesting. And I also, like I worry a lot about it, Like I have colleagues who've graduated a few months early from medical school so they could come join the ranks with us. And I think it's so traumatic to be an intern to begin with, when you start, you know, when you're your first days as a doctor, it's very
stressful and difficult. And then having to deal with this whole pandemic as your first kind of soare into medicine, I think is you know, could potentially sow some seeds of trauma.
Yeah, how about how about actual PPE? How how well protected are you all? Now?
We're good. I feel as though I don't think I've ever been without, you know, having actual PP. My institution has been pretty good. There's three hospitals in my institution, and one is a public hospital of New York, which is obviously like less fund than others, but the amount of donations and people coming out has been just like phenomenal, the people pouring in either actual money to get PP
or actual PP, and then obviously food. There's like signs and chalk on the street, there's everything you can imagine, free scrubs and all this stuff. So we're being very much showered and pampered, which is great, and it feels kind of I feel kind of shitty in that, like there is such a need for food, like in the country, and there's like a lot of food banks that are going dry, and we literally are just in an dated
with food, like really really good food. And I always feel so bad when I'm like, you know, there's some of this food really needs to be diverted to some of these these other places that need it.
At Doctor Natter's Behest, we made a donation to Food Bank for New York City in his name. So that's twenty five hundred more meals will be made possible in the New York area by him mentioning that to us. Thanks for the heads up, doctor Natter. Now, if up to eighty percent of folks with it are asymptomatic, how many people have or have been infected with SARS kobe too? Doctor Bennett says, what we see is probably the tip
of an infection iceberg. Do doctors have any idea because testing is just so like rare testing in the general population, do we have any idea what the mortality rate of this is.
We have a sense, but I think, like you you you tapped onto the way we you know, calculate rates is that you need to have a numerator and a denominator to figure out all of this, and right, the denominator is based on if you've tested someone. I think we've caught up a little bit in terms of testing. There's a lot of miscommunication and kind of guidelines that were shifting in terms of who should get tested, when
they should get tested. Oftentimes to not overload the er, we would tell people if you have symptoms, but you're not short of breath or you're not becoming hypoxic to really not come in, because we have people that would overrun the ED to get tested when they weren't sick enough to necessarily need to be admitted, and then they were basically either exposing themselves in the ED or creating more volume for the emergency UMAN physicians that they couldn't handle.
This week, the President of the United States, and I'm just going to quote this in a very neutral informational way, said quote, by doing all of this testing, we make ourselves look bad because the case numbers go up. Oh wow,
So there is that information now. I checked in with doctor Michael Wells, who we spoke with for the All Washed, Hands on Deck episode in late March, and I got an update from him just today on his database of scientists willing to help with the testing, and he said, quote, the database has now exceeded ninety three hundred scientists from all fifty states side note, yes, Wyoming, you did it,
also DC, Guam and Puerto Rico. And he now has a large team of coordinators, many of whom found out about the database through ologies, which is awesome to hear. A way to go, y'all, He says, scientists from our database are helping process tests in Los Angeles, DC and Michigan. We even had a few visit SpaceX in Los Angeles to help with some of their COVID nineteen efforts, and we are spending a majority of our time actively seeking
additional volunteer opportunities across the country. They have a new website so people can keep updated on their activities, and I will put a link to those in the show notes. Many of you patrons asked about testing, such as Rachel Weiss and Ira Gray and Sophia Dill asked what is happening with testing and when will we have testing widely available? Sophia, I appreciate your triple and Tara bang on that question.
We really need to broaden the testing and the kind of testing that's happening, you know, it's really we're we're starting to test here in San Francisco. Anybody with symptoms associated with somebody with any symptoms can get a free test. This is a PCR based test, so it's a test that looks for the direct presence of the virus. So it's no point, you know, running off to get tested if you have the virus or you thought you had
the virus three weeks ago. It's really just measuring the direct presence of virus at the moment that the test that the sample is drawn, so it has a very short applicability.
Megan McLean asked about the depth that they plumb into your nasshole, asking quote, why does the test swab have to go so far up into your noggin to get results? And that six inch splunking. I looked it up. It's hitting the back of the naso pharynx, which is where your sinuses meet the back of your throat, kind of like a taint. But for your mouth knows will you
have to do this twice? If this thing you take Many of you, including Eric Astairs, Russa Holtzmann, Anna Okrazinski, Maddox, Cameron Stewart, Stephanie enkl, Anna Thompson, Don Swart, and Kevin
Lay wanted to know about strains and mutations now. A paper came out just in late April by the Los Alamos National Lab that noted the G strain of the virus is more prevalent in Europe and on the East coast of the US, and speculated that it's a more of uralin form, but that paper has not yet been peer reviewed, and many other scientists say there's pretty much only one strain. Coronaviruses apparently mutate at one tenth of the rate as influenza, and that G strain may have
just by chance become more prevalent. It might just be a lucky virus with good odds and not necessarily more dangerous or more infectious. So jury is still very much out on that. Now, if you've had COVID nineteen, are you immune if it mutates?
Even if you do have immunity, when does it start to wane? So are you going to be immune for a couple of weeks, a couple of months, a couple of years forever, We don't know. And then is this virus possibly able to mutate? And if it mutates, then maybe your immunity is not going to be useful. And
the best example of that is the flu. So the flu is a virus, and you have to get a flu vaccine every year because there's something called antigenic drift and antigenic shift, and what that means is that their DNA is very susceptible to mutation, and so you get these tiny little mutations and that's just enough for it to basically kind of evade the antibodies from the previous season. That's not a coronavirus, So maybe it's not the same mechanism.
I don't know, but no one knows. Now. That being said, if you have antibodies and you get tested positive for these antibodies, that should not mean that you're less vigilant about how you go about your life. It might give you a little bit of mental solace, which is good. But you should still wear your mask, you should still be careful, you should still wash your hands. It's just still socially distant when you can all of those things
still apply. The other thing I want to say is that the antibody tests, and this is actually very interesting. So we were so behind on the diagnostic PCR test that basically do you have COVID or do you not have COVID tests? And that was in part because the FDA was so heavily regulating how those tests got rolled out,
which is what their job is. But in this pandemic they really kind of put lay the book down and said like, no, you can't you you know, Medical Academic Center X can't make your own diagnostic test, even though you have a lab and you have their utilities to do so, because we need to regulate it. And that was part of the reason why it took so long to get a wider diagnostic test out there. They went so far on the other end of the spectrum with the antibody test, and they went to the free markets
that have at it. Do it as much as quickly and as many as you can. And what that spawned
was a very large spectrum of reliable antibody tests. And so the same antibody tests from a different manufacturer made not give you the same reliable tests, meaning you can get false positives, false negatives, and you can imagine what that would mean if you get a false positive saying yes you have antibodies, yeah, and people that maybe get a little less vigilant, and then you're gonna have a lot of problems.
So a bunch of patrons like Crystal Mendoza, Oda, Helene Chatz, Michelle Neir, Gwen, Kelly Mariese, the Holsman, and first time question asker John C. Faludi wanted to know about antibody tests and errors in testing.
Antibody tests have to be validated to show that they're sensitive enough to pick it up and specific enough to distinguish between this stars Cove two virus versus other related viruses, and a lot of those validation tests are still ongoing. It's very very very much a work in progress, and in many cases, if those tests are being done by commercial labs, there's not always full transparency into the rates
of false positive or false negative results. Know, there's no point getting a blood sample drawn for a PCR test because it turns out that the virus is mostly in your your mucus membranes, in your nasofringial passage and lungs.
But an antibody test is actually going to want to look for the antibodies in your blood stream because it's not you don't build up a lot of antibodies in your nasofringial and by the way, that you don't build up antibodies until at least ten maybe fifteen days when you start after the virus is cleared, so it's really
challenging or in some cases after the symptoms start. So it's a when you take the sample and what kind of test and from which tissue type it's taken from, and how how much virus you had in your system are all important variables that can change the outcome of the test in an artifactual way.
So can you get it twice? Now? A study out of South Korea thought maybe yes, and then they realized that their tests were so good, so sensitive that they were just detecting old fragments of the first infection. So that is good news now. Patrons Jen Anathys, Jessica Jansen, Carolyn Wolfram, Patti Bergman, Jenny Hoover, Ellen Skelton, Mike Munakowski, and Zoe Buckley wanted to know, can we get it like a double whammy.
If you had it in January and now you're exposed again. We don't think so. Almost all evidence indicates that you cannot get it again, because you do develop immunity, some degree of protective immunity. What we don't know is how long that protective immunity lasts. So you know, it might be that either the virus evolves away from what your immune system has trained on, or it might be that
your own immune response is maybe not that effective. When you get a virus deep into your lungs, there's a really amazing blood viral interactions so that you can develop a really strong immune response to viruses that infect you
at that sort of intimate level. But the viruses we get in our nasophryngial passages, the common colds, we never really develop anything but very transient immunity because we don't there's no opportunity to really have that nice viral blood bath interaction to really develop the strong immune.
Response let the blood that begin.
So with common colds, we only ever get transient immunity, and then the next season, next year, we can get the same cold, and so it goes over and over again, year over year. So the big question is will we develop protective immunity to severe disease to viral pneumonia, but will this virus then sort of kick up a new quasi existence as sort of a common cold like virus where we never really develop a protective immunity to, but only transient immunity to more upper respiratory type virus.
I asked doctor Natter about that too.
So it's a very good question. The truth is, we don't know the answer yet, but we think that if you look at just like what we know in science medical science typically speaking, when your immune system gets introduced to an antigen or a foreign invader like a virus or a bacterium or something along those lines. Your immune system. One path of your immune system is to make antibodies
in order to fight that off. Your body then has things called memory cells or plasma cells that then essentially turn into these factories of that specific antibody, and they just crank them out, and that's how you develop an immunity.
Marisa Holsman and Emma Fury wanted to know about herd immunity, and in patron Wayne Hovey's words, how does this herd immunity thing work? So, as long as I had a smart virologist on the line, I asked this stupid question for all of us.
No such thing.
Okay, I don't quite understand. And we all come out of isolation. How are we not going to just keep spreading it?
Again?
From an epidemiological standpoint, what is going to happen in a couple of months when we're all out and about like we used to be?
Yeah, I mean this is this is a really important concept. It relates back to this concept of herd immunity, and it's it's recognizing that there's a certain proportion of people that we may interact with in our in our populations that might have had the virus and be immune, so they're no longer susceptible. So what we assume is that that you know, when the epidemic wave starts to drop, two things are happening. For whatever reason, policy wise or
or not. The energy in the wave has bled out because you know, there aren't as many infected spreading the virus to as many susceptibles, and so we can we can impact that wave by reducing the number of infected, which you know, we isolate people and their opportunity to impact susceptibles, to interact with susceptibles. So we're reducing those buckets. But when we all go back out and we've seen this in China, you know, why didn't the virus flare
back up to pre peak of the wave levels? And so it's you know, we presume that the virus is basically run out of susceptibles that a certain number of infecteds might run into. So there's like, you know, how many infecteds are circulating, how many susceptibles might they run into? So are there hotspots of transmission? For example, are there these sort of key sectors in the public domain where
people would more likely exchange virus. And that's why people are thinking about different scenarios when we all go back out there, you know, maybe we'll be we'll be getting back up there slowly where we may try to put in place some social distancing mechanisms or you know, trickle back in so that we can keep that contact right between infecteds and susceptibles lo all the while we try to understand the base herd immunity, like how many people
truly were impacted and might be immune, So those susceptibles would be sort of taken out of the equation because they're not susceptible, they're immune. So, you know, we're looking empirically at kind of the way things are rolling in other countries that have seen the end of the wave and have opened back up. They haven't experienced a resurgence, but they're doing a.
Lot of things.
They had a wave, they definitely have some herd immunity, but they're also coupling that with social distancing measures.
What if you have had it and want to put your body fluids to good use. Well, according to the Red Cross, people who have fully recovered from COVID nineteen have antibodies in their plasma that can attack the virus, and this convalescent plasma is being evaluated as a treatment for patients with serious or immediately life threatening COVID infections, so it's called convalescent plasma. Patrons Gwen Kelly, Anakin, Jeniak,
and Marissa Holsman wanted to know about it. Is there a way to donate like plasma if you do have antibodies? Does that even work?
So it's a good question. Yes, there's plenty of ways you can do that. I think you have to reach out to your local kind of hospital, your local academic hospital to find out how they're doing it and where to go. I know that in New York for sure, Mount Sinai and NY you are doing that. But the way that works is actually very interesting. So it's not a blood donation as much as it is a plasma donation, or rather transfusion. And the difference between blood and plasma.
Plasma makes up part of the blood. So the blood is a bunch of cells, it's got white cells and red cells and a bunch of other stuff, but also has plasma. Plasma's kind of like gatorade portion if you took out all the rest of the stuff. You get this kind of like yellowee fluid. It's kind of all the electrolytes and all the good stuff. But in addition
to having all that, it has your antibodies. So if you had coronavirus, you got better, you got tested for antibodies, and you're positive and you're healthy and you're able to donate blood, then you might be someone that could donate
your plasma. They then they do what's called the centrifu, so they kind of spin it really fast to separate the plasma from the blood, and they take that plasma and they can then give it to someone who's very, very sick who has COVID at that time, theoretically giving them the actual antibodies, so that the body hasn't made the antibodies yet you're giving it to them, they get better. We think this might help. Back in the day, they would do this and there was some evidence for it.
We're still testing it, so we still don't have the hard evidence, the hard data to say it will. The science suggests that it should. Same idea with if you have tested positive for antibodies, then the science says you should have some immunity. We think but until we have the numbers and the objective data, you can't say for sure.
And what about the effects on our hearts and by hearts, I mean brains. I just think that there's more of a psychological impact that we maybe won't understand until you know, you touched on PTSD. But yeah, I think that there is a certain kind of psychological trauma of being scared of this invisible thing that could kill you, or if you go into the store to go buy soup, that you could end up killing seven people by doing it.
You know, you would never I would never handle a live firearm, much less just start shooting into an open crowd. So it's kind of like, you know, that level of fear I think is probably pretty exhausting for people.
But yeah, and I think for better for words, I think people are like becoming less vigilant and anxious, and so that's good in some ways, I think for mentality, but I think it's also dangerous because as people are letting up, obviously there's going to be a lot more you know, potential for outbreaks and so on.
So, as we mentioned in the first Virology episode, one of the reasons COVID nineteen spreads so effectively. Is that unlike SARS one, it's transmissible even when you don't have symptoms,
and a lot of people don't have symptoms. Now, a bunch of patrons like Katya Nizzick, Gwen Kelly and A Thompson, Jennifer Lowe, Yano Wiznuski, Gillian Klug and Atalie, Jamie Pickles and Marissa Laws wanted to know what we've learned about how it's transmitted, like how far can our juicy, infectious droplets travel and why is it important to wear masks? And why is social distancing so important?
You know, Originally we you know, we were kind of assuming, or a lot of people were assuming. You know this, the pathology of this virus is viral pneumonia. So we recognized that it was binding to cells in the respiratory tract at a large scale in the lower respiratory tract, and then you know, transmitting through viral pneumonia like symptoms
causing disease like viral p amumonia. And those symptoms were like these explosive coughs and sneezes, and so that's bringing droplets from deep into deep, you know, deep within your lungs up and out and spreading the virus. So what we've learned since is that this virus also pretty efficiently infects the upper nasopharyngeal passages and tissues. So you know, it is infecting those mucous membranes in your nasal passages, for example, even before it gets into your lungs and
can potentially infect your lung tissue. And that means that, wow, that that possibly suggests that you know, maybe the virus could pretty efficiently transmit through the products from our upper nato feryngial passage, like you know, maybe if you clear your throat, or you just have a tickle like a light cough, or maybe you're breathing very heavily from exercising. And so you'll notice there was a change in policy.
Like two sources of information came together. One that from the population level perspective, all the estimates of how transmissible this virus was was pretty high, suggesting that you know, it's maybe not just people with severe disease products that are you know, spreading the virus, but rather than maybe more people could spread it asymptomatically through breath or light
coughs or tickles. And then there was also some laboratory data that showed, especially in hospital settings, when we use equipment like ventilators, we can nebulize the virus into tiny the tiniest tiniest droplets, and these are like a millionth of a meter so point point one microns. Uh, they can the virus can float in the air for up to three hours through the tiniest of droplets. Now, when we cough or sneeze, there's a very very small fraction of droplets that are that tiny, so most of the
droplets will fall down. They're bigger, they fall out of the air at that six foot level. But because there could be a very very small fraction of the tiniest of Chinese particles that could have the virus, that's really why we started. Why you could see policy changed to have masks, even cloth homemade mask be worn as a general protective measure.
A lot of you asked about masks, like Casey Wright says, masks, what's the real scoop on them? Jessica krag Yvon Bustos, Don Swartz, Edgar, Velita Ellen Silva, Syracule, Debra n and Kathleen Ma wanted to know what masks are the best to be wearing Now, Doctor Bennett told me she wears a homemade triple layer, high quality, high thread count cotton fabric mask. It's fitted around her nose with bendable wires and it's two layers of that high thread count cotton
with a layer of pantyhose. And now searchers think a strip of pantyhose nylon stocking can also be tied over a fabric mask to help seal the gaps between your face and the mask. Mind the gaps. Let's say you're just using a flappy cowboy bandana, it's better to at least tuck it into your shirt. Now, Doctor Natter wears a respirator used for spray painting, and that filters out he says, about ninety nine percent of particulates, and it
has changeable filters. What about if you're going running or biking, wear a mask.
So a mask is protecting both you from shedding virus. And remember up to you know, there's a huge variability in asymptomatic rates people that are undetected symptoms. Right, so it ranges from I think thirty to eighty five percent, with an average of fifty percent, So you might be infected. So a mask protects you from shedding virus, not completely, but it blocks big droplets, for example, and it also may protect you from sucking in a virus infected droplets.
So if you're working out, you're going to be breathing more heavily, You're going to be breathing out more heavily and.
In more heavily.
But but you know, it's actually really hard to wear a triple or mask and work out. So I am trying whenever I can to wear a mask. But then as I'm beating along on my hike to the words at the top of the hill, I might have to like whip it off and take a big deep breath and try to get air, and then I try to put it back on. But you know, the places I'm sheltering in place and I'm staying local, and I'm walking up the trails in my neighborhood, and there are a
lot of people out there. So unless I wait until very late in the evening, which I'm now doing to sort of not run into people, I hesitate to exercise without a mask because I just there's so many people you can pass, and you can try to socially distance yourself by moving across the street that it it's really.
Challenging, So that makes sense.
I would recommend wearing a mask all the time.
Listener Caitlin Mills wanted to know if this will go away in the summer, how cyclical will COVID nineteen be.
So in a lot of seasonal viruses, you know they're seasonal because humans in the temperate zone are gathering together in classrooms or in inside spaces where the air is recirculated and it's you know, cool and dry, and they're crowded up. And so it's probably in many cases host
behavior that's driving seasonality in many viral pathogens. But this is a big question that remains to be seen whether this virus needs that seasonality boost of a clustered up humans to kick it back into circulation in the fall. The biggest risk is when you have touched something that has virus on it and then you touch it to your mouth or nose. You might imagine like let's say you get you buy a box of cheerios and you
bring it in the house. If you put it away, and let's say, maybe it has we call them viral full mtes. When you know somebody deposited a virus particle on the surface of something. It's called a full mte. So let's say there might have been a couple of full mites on the box and you put it in the cupboard. So long as you wash your hands before you prepare food, and you wash your hands before you eat, you're going to put in a barrier in between you
and those foemtes and your your mouth or nose. That said there, there definitely you want to reduce the You want to put barriers up at every opportunity, right and and there have been some studies. There was a lab study that you know, this is new new information. We didn't know this at the beginning. We were just inferring how long viruses last on surfaces from what we knew
about other viruses. And we know this viruses it's encapsulated in an envelope, a lipid layer, two membrane layer of lipids, and so it's actually a delicate virus because soap can break that outer layer up and make that virus basically dissolve. And so that's why people are saying, wash your hands with soap. You can wash surfaces with soap, like you know, I'm washing my fruits and my vegetables very well, maybe
well soap okay. So then there was a study that showed that asked the question, if you don't wash with soap or sanol or isopropanol or some disinfectant, how long would the virus last on a surface.
Doctor Bennett cited a recent study that seeded SARS COB two on different materials including cardboard and stainless steel, copper, plastic, and researchers found that on plastic and stainless steel it could live up to seventy two hours. Now, some types of coronavirus leave only a few minutes on cardboard and paper, while others can live for days. We're just not sure.
So in some cases I'm just like getting hum throwing my mail in a bin. I'm not gonna check it in three days. I'm not in a big rush, right. So, in theory, the virus doesn't stick around that long on surfaces because it's kind of delicate, up to so many two hours, and it can be killed by a lot of different kinds of surface disinfectants, including something as simple as just soap and water. And furthermore, if you don't
want to be bothered washing every piece of groceries. Just make sure you wash your hands before you prepare food and before you eat, and don't touch your eyes, nose, the mouth before washing your hands.
Yeah, what about when you're in the grocery store? Devra Lats has a great question. If I'm wearing a mask and gloves, for instance, in the grocery store, is it safe to be less than six feet away from other people who are also wearing masks and gloves or should I wait until the aisle is empty and then grab the butter.
Yeah? No, it's a good question. So you know, in a perfect world you remain six feet away from everyone, But okay, your risk is much more mitigated when you take the precautions of you know where a mask and the other person wearing a mask. But you shouldn't feel like you have your invisible cloak of you know, immunity on that you can kind of walk up it to anyone when you have a mask on. And I would
like to make a point about gloves. It's impossible, like in your everyday life, like it's impossible to properly wear masks and gloves. And I will say this also, these masks and gloves medically are designed to be single use, so like you're meant to wear them into a patient room, have your patient contact, and then what we call doff the ppe and like take off the gloves and the mask and they shouldn't be used ever again because they're contaminated.
But in terms of gloves, my point about gloves is that people wearing gloves like the same kind of risk is there even if you're not wearing gloves, Meaning if you take the gloves and touch your face, then you've done nothing. The gloves have done nothing for you, and any surface that that glove were to touch, if that
you know, were contaminated, then the gloves are contaminating. And so what I always say, especially to my parents who wear the gloves, is pretend wear the gloves, but pretend that the gloves are not on, and wash your hands the same as you would, meaning you can put purel on the gloves. And so I try to kind of indoctrinate them to wash their hands even if they have gloves on. Kind of thing.
Okay. Patron Greg Wallach chimed in and said, amen, on the glove question. Do people even understand how gloves actually work? He says, I saw a woman eating a donut with her gloved hand. She's keeping herself from getting sticky fingers. I guess, and researchers do report that one percent of those eating donuts get sticky fingers afterward. I am researchers. Actually,
what are scientists busy studying right now? Let's get into it. So, both doctor Natter and doctor Bennett mentioned that the cytokine storms that cause organ shut down, those tend to be less severe in younger patients than older patients, and comorbidities like lung disease, obesity, and heart disease can contribute to less optimistic prognosis, and those are less common in kits. Now,
hospitals are starting to prone patients. This is a practice that doctor Natter's colleagues affectionately refer to as Tommy, because laying on your stomach with an oxygen mask gives the lungs more space and has been shown to be a promising option over intubation. Now, other research is being done with medication.
The amount of studies that are currently ongoing, the amount of publications that are coming out. A lot of my colleagues at my institution are like brilliant, and there's a lot of interesting theories. A lot of stuff that's going on, and I think we are going to have nailed down very soon good kind of guidelines and treatments for one to do what you know, none of this, we don't have treatments like the remdesivir now.
Remdesivir side note, is an anti viral drug that, according to a paper published April twenty ninth in the journal Lancet, has been shown to reduce hospital stays by about four days, but it hasn't been shown to reduce the risk of death. Still, it's in huge demand and some hospitals can't even get their hands on it. Doctor Natter explains.
There's a lot of talk about remdesivir, which is a great drug, but it's not a cure and it's not going to necessarily reverse course as much as we hope. Unfortunately, the other drugs that we're getting a lot of hype as well that I've seen anecdotally or doing nothing, the
hydroxy corequin and the zithromycin and zinc. But I will say I am curious to know if those drugs were started very early on in the course before someone was hospitalized, if that would have any effect, because I think once someone gets hospitalized, what we're seeing is less of the vireemia and more of the immune destruction and like a cytokind storm. And I think that's part of why a lot of these antiviral treatments, if they're not started upfront, are not going to have as much of an impact.
That's totally my guess, my theory. I don't know if it's true.
I mean it's I was talking to the virologists right before this, and she was talking about all of the different publications you can look at and what people are working on, and how inspiring that is that there's a lot of people kind of behind the scenes just working on it. It's very diligently.
Oh, it's amazing. It's amazing. And not only behind the scenes, Like there are a lot of physician physician scientists who will literally like work with me on you know, like one of my tennings will be there and we'll be there, you know, on our twelve hours or whatever, and then they'll go home and they'll like basically like type up all this stuff and do all this research and like publish and you know, the next day it's like in jama and I'm like Jesus like, do you not sleep like any doing?
This is what doctor Bennett had said.
One thing I do for Jolly's is I go on to the WHO website. They actually have a registry of all clinical trials worldwide. You have to register a clinical trial for any of these things, whether it's an anti viral or a vaccine, or a test or even an
epidemiologic toolkit that you want to develop. You take it into these clinical trials and you have to register them with WHOW and then the NIH that's our own US National Institutes of Health also has a Registry of Clinical Trial and you would be amazed at how many clinical trials are in progress. And for me, it gives me
a great deal of hope. There are hundreds and hundreds of antibody tests, vaccines and therapies that are currently being tested and examined, and at a minimum, many of these can be used for emergency use, at least the anti the therapies.
Speaking of vaccines, in Amanda Mueller's words, what is causing the hold up? Kathleen Carlson, Eileen Prince, will Plia Law, Caitlin Mills, don Ewaald, Betsy Shephard, Adam Drake, Gwen Kelly, and Sultan Sazi all echoed our universal impatience. And then what about vaccines? Are they taking doctors design to be like, hey, it's going to be to September or are they like, hey, it's going to be never.
I've heard nothing that the general public has heard hasn't heard about vaccines. I do think we are going to see a vaccine significantly faster than we would normally. Normally a vaccine takes about four years. Ou ou Yeah, I think we're going to see a vaccine way sooner than that. And that's partially for a couple of reasons. For one, everyone is in the world is affected by this virus, and so there is a huge impetus to get this done.
But the other thing is a lot of folks have been working on vaccines for similar things, like mers, like ebola, like other viruses, and so some folks had a headstart. I think, particularly in England, they seem like they're doing really well. The other thing is, even if you're able to get the right concoction for a vaccine, you obviously need to test efficacy, but you need to test safety first. But then outside of that, you have to manufacture it.
So on average, like a normal vaccine, the infrastructure is set up to maybe make I don't know, five ten million doses you know, we need on the order of three hundred million in the United States. If it's a single dose vaccine, it might be a double dose in
six hundred million doses of this. So the infrastructure, you know, and I think doctor Fauci already started saying this, but like you need to start working on that now before you have the vaccine, and you need to kind of convert different factories that could potentially, you know, manufacture the vaccine before the vaccine's even ready to be manufactured.
So a vaccine side note is a weakened form of the virus injected into the bloodstream so that your immune system can sus it out and make a good defense army against it. For more on this, you can listen to the Epidemiology episode with guests the doctor's erin of this podcast will kill You Now. In terms of a SARS covy two vaccine, doctor Bennett.
Says, and in fact, some of the vaccine candidates that are being explored are the stars one of vaccine candidates that were just kind of left and never developed and so it's gotten us a head start. We have a a good head start on vaccine candidates borrowed from other
similar related viruses. There are clinical trials happening right now with many vaccine candidates, and that definitely means that it's much going to be much shorter than four years out and I would definitely put it definitely on the twelve to eighteen month track.
So that's great. So we'll get back to your questions in just a second, but quick note on donations for this episode. They were made to the Food Bank for New York City in doctor mac natter's name. We also made a donation to the California Academy of Sciences in honor of doctor Shannon Bennett, who does such amazing work there. Also this episode, we are shouting out another great podcast with tons of coronavirus info science versus with the wonderful
Wendy Zuckerman. So take a listen to that for some great coverage. Okay, back to your questions. So many people want to know Kendall Burnell, Emily Dilger, Madeline Duncle, Tamara Oliver, first time question asker, Kate Strelhow and Michelle Harvey Jamie Thornlan and in Dave Miller's words, are we absolutely nuts to have even partial reopening? Are we opening up too soon?
Oh? Man, this is crazy. I imagine what it's like to be like like a governor Cuomo or like some of these folks like that, like no one knows, No one knows. I am worried because I do think that opening up inevitably will create more potential infection. I think if you just look at the like, the reason that the infection rates are down isn't because we've conquered this illness and COVID somehow like went away, Like it's still
very much there. So if you, you know, allow you know, a city of six million to densely populate the subways all over again, like I don't care how many gloves and maths you have on like, there's going to be more transmission of this disease. But it's it's this balance of you know, how much longer can you keep people
all locked down? And I think it might be this slow dance where you take a few steps out slowly and you you know, you track how many infections are, you track the admission rate, you track the I few admissions you track the death rate. The death rate will obviously lag behind by a couple of weeks, but you track everything you can, and you test as much as you can, and then you may have to kind of go a couple steps back and wait a little bit, and you know, as to not overwhelm the healthcare system
and as to keep infections as low as possible. I don't think it's wrong to try, but I think it has to be done very responsibly and very very slowly, and with a lot a lot of vigilance and testing and everyone buying in in terms of trying to keep their distance, in terms of trying to you know, not spit anyone else's face.
Right, avoid that for now.
It's not recommended.
Let's get philosophical and ethical about it.
But I think, you know, guvnor Cuomo, I think says it really well, and he's like you're at you're essentially asking when you when you have to open things back up, you know, how much is a human life worth? Is the way he sees it. And you know, to him, when you open up, you're going to people are gonna die.
And so he, I think is doing a good job and trying to find resources for people to not have to go back to work, you know, you know, give you know, something to these individuals so that they can have food and they can you know, not worry about getting evicted and all these things. And there's only so much that can be done. Yeah, but don I don't know who knows, who knows.
How do you feel when you see people in Central Park just picnicking?
Yeah? I mean listen, if you can be six feet away from everyone else, great, are you actually six ft away from Probably not? And I think this past weekend I was talking to my friends about it, and it's it.
It worries me a little bit. I think it's a harbinger for the inevitable second wave that's going to come after things start opening up, because I think as things start open up, they are going to get less and less vigilant really and more and more kind of flagrant about, you know, giving up this whole social distancing and stuff. I am worried and I do, unfortunately, think that there will be another wave, and I just hope that it's nowhere near as bad as what it was.
Right. This next question is from patron Anti Se who tapped into our collective consciousness and inquired, simply, so, how fucked are we? I asked doctor Bennett, what we can expect next?
Spring is in the air. We're all getting a little excited, and we miss each other physically, obsensual, everybody's observing that the curves are flattening. I would definitely say that it's definitely too soon to bunch up and we need to stay the course. And so I do cringe when I see people that are clearly not in family groups sort of throwing caution to the wind and bunching up. I understand it, but it definitely is too soon and we need to not do it. We're not ready. We will
be ready. There is light at the end of the tunnel, but we shouldn't sort of be racing for the end of the tunnel just yet.
Speaking of missing each other physically, Star and Shannon Patterson wonders know when they can see their parents and their family again. Marissa Laws asked should we cancel handshakes forever? And Tracy Michael wondered will we ever be able to hug freely again? I really miss hugs, they say.
I would trade out a handshake any day for a hug, Like I don't think we need handshakees. But I miss hugs too, And my mom lives in Canada and I you know, she was supposed to come down and visit for my daughter's birthday and we couldn't make it happen and we miss our family. I myself struggle with this question is when is it okay to hug? It's about risk, right, It's about thinking about the risk of the person you're
hugging to getting a virus from you. And so if that is an older person or an older that's not in your immediate family circle, then you may be bringing
a virus to a vulnerable person. So that that's one thing for sure, But you know, everybody needs to be empowered to sort of assess their own risk, right, So it might be that you know, if the loved ones that you that are in your family are themselves isolated and they have a very very tiny contact sphere, and you yourself has you know, have been really strict about containing your contact sphere, then you know, at some point, as we lift shelter in place and we can start
to interact physically with each other or move to each other, then there's there's probably going to be a way for you to mitigate risk to your older loved ones that you can share hugs. But maybe the proper and official answer because that's kind of my metric as a person, But but the official answer really is that unless and until we know what you know, how many people are immune, and what the true size of the iceberg of this coronavirus population really is, because right now we just see
the tip of the iceberg through the limited testing. But once we really understand how you know, how widespread it is and how many people are immune, and then once we build up our toolkit for responding to the infections by like really really strategic contact tracing and social distancing, and then we also have our toolkit to have therapeutics
and vaccines. I mean all of those things sort of would we would want to come bring them all together to make risk zero, right or near zero for a hug, But many of us live with a little bit of risk every day.
Yeah.
Doctor Natter mentions the mental health effects as well.
This is a really really stressful time. It's very emotional. People are losing their jobs. People don't have the same kind of outlets, they don't have the same social you know, support because physically they can't it's hard, it's very scary, and so I think it's important to recognize what your triggers are. It's important to find things that are safe
to do during this time. But doing them. It seems like people are really liking the baking of bread right now, But you know, finding something that's going to kind of center you and keep you saying and recognizing that, like, this is a really scary, really shitty situation, but I'm seeing a lot of amazing generosity and charity and just like humanity through all this, which is one of the
more beautiful things. And like the appreciation that we're seeing and feeling from you know, us the healthcare workers is like tremendous. And I was thinking about how said I'm going to be because right now, every night at seven pm, everyone comes out collapse and the firefighters come over. And I was thinking, I'm going to be so sad when this ends, because it hasn't ended. It's been going on for months now, and I was like, the day this stops,
I'm gonna be really bummed out. And I'm like, maybe like something like this, I not necessarily like having everyone come out and cheer for us, but something along the lines of appreciating each other hopefully gets you know, salvaged and stays with us. I think it will, at least on some level. I think it will, and I'm I'm hopeful that this is all going to come to an end at some point. I don't think it's going to go back to the same normal that we had. I
think there's going to be a new normal, unfortunately. And I think it's kind of like, you know, living through nine to eleven. I never had to, you know, take my shoes off before getting an airplane, and now that's kind of routine, you know. So I think there will be things that are different but that we will very much adapt to, and that will be, you know, in everyone's best interest in terms of public health.
Yeah, I'm glad that the banging on pots of pants doesn't annoy you as a healthcare worker.
Oh my god, I love it. Why wouldn't you annoy me?
I don't know. Maybe you're trying to sleep. And I think I wonder if there's a nurse out there who's like, shuit the fuck.
That would actually make a great comic. I should do. My mom, who's like the most adorable woman ever. My dad took a video of her on her terrors, like with her little pot and pan.
I look this up and his mom Ellen Natter is an adorable, diminutive blonde woman with stylish horn room glasses. She's hipper than me. She's on her midtown Manhattan balcony smacking a saucepan toward the sky. An appreciation of healthcare workers and hospital staff who every day are putting their lives on the line, like her son, I don't know
how you guys do it. You're amazing. Is there anything any anything you would want people to do or take away from this or continue doing or not do anything that the rest of us who are just sitting around making sour dough can do it for y'all.
No, keep making sour dough. I think it's you know. I think we feel it, like the healthcare workers, at least I can speak for myself and my college. We feel the love, we feel the appreciation, and we really appreciate it. I think, please just follow. I mean, I imagine the majority of your listenership are people that are very socially conscious, so they're probably already doing this anyway,
but just follow the guidelines that are given. I recognize and get frustrated myself when they seem to change minute to minute and they seem to sometimes not make any sense. But if we don't do it all together, then a lot of it's not going to work. And so socially distancing I think is very key. Wearing masks if you know your local government tells you too, I think is very helpful. But just being kind to each other and just making sure that you know, we get through this together.
I should also say, I think it's important to recognize that your neighbors may be elderly and alone, it might need some help, and you know, picking up some groceries for them, and just just kind of being a good human. I think now more than ever, is really.
Important check in on each other and such. Yeah, yeah, that's good. Doctor Bennett says that in person relationships are important and maybe we're all realizing that a little more.
Now.
What do we mean to each other all of a sudden, I think we mean a lot more to each other than we thought.
So let's not take our friend for granted. Check in with each other, even if it's just to send a picture of a flower or an apricot that looks like a butt. We need those moments.
Yeah, and how much we all need other people, whether we're in the US, or whether we're a Republican or a Democrat, or whether or you know, we're a Muslim or Jewish or living in China. I mean, we all need other people.
So call up old friends or new ones and ask them stupid questions, because no question is stupid, and we'll get through this together.
No.
You can follow doctor Shannon Bennett and doctor Mike Natter at the links in the show notes, and I'll also put a link there to aliward dot com slash ologies slash virology too, so you can get more links to the study sided and the Science Versus podcast. We mentioned the organizations receiving donations, database for scientists and more. We are at ologies on Twitter and Facebook. I'm at ali word with one L on both. Thank you Shannon Feltis and Bonnie Dutch of the comedy podcast Do You Are That?
For handling merch. Thank you Aaron Talbert for admitting the Facebook group, Caleb Patten for Bleeping episodes, and Emily White for handling the ology's transcription efforts. Thank you to everyone who works on those transcribing them. The Bleeped episodes and the full transcripts are available for free on my site at alliwar dot com slash Ology Stash extras link in the show notes. Thank you to Noel Dilworth for helping me with scheduling and getting all these interviews all lined up.
Thank you to Jared Sleeper of mind Jam Media for assistant editing, and of course the Jewel in our Corona, Steven Ray Morris of the podcast that per Cast and See Jurassic Rite for editing these altogether and making sure that they go up on time. Nick Thorburn wrote and performed the theme music. And if you make it through the credits without bailing, I tell you a secret. And today, like an hour ago, I made a caesadilla with some corn tortillas that I noticed how to sell by date
of April second, it's over a month ago. But they weren't moldy, and I was like, I'm gonna eat them anyway. And then I went to get some cheese and we had some jalapeno cheddar and it was moldy, but I just cut the mold off and I ate the good parts with the expired tortillas. Now it's been an hour, I'm still alive. I'm just at the part of quarantine where I eat garbage like a raccoon. Also, I made a Caesadia for Jarrett too, but I didn't tell him
about the mold. I cut off the cheese or the tortillas. And since he helps me edit, he saw this in my notes, has my secret and I was like, are you mad? He was like, no, just cut the mold off the cheese, eat it anyway, so everyone does. I was like, okay, bye bye. Pacodermatology, hobbiology, hydo zoology, lithology, technology, meteorology, pedatology, nathology, zereology, elology,