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Adam Naddelman, MD 0:00
My name's Adam Naddelman. I'm a pediatrician at Princeton Nassau pediatrics in Central New Jersey.

Scott Benner 0:10
Hello, everyone. Welcome to Episode 314 of the Juicebox Podcast. Today, we're going to talk about the Coronavirus situation. This one's going to be an overview with one of the brightest, most thoughtful doctors that I know personally. Adam and I met. A long time ago when Arden was born. Dr. Adam Needleman joined the Princeton Nassau pediatrics group in 2001. He completed his pediatric residency from New York hospital, Cornell Medical Center, and was chief pediatric resident the following year. Dr. Edelman received his medical degree from the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson medical school in New Brunswick, New Jersey. He attended the University of Pennsylvania in Philadelphia, where he received a BA in biological basis of behavior. Dr. Edelman is board certified in pediatrics, and is a fellow of the American Academy of Pediatrics. So please don't judge him. You know, because he knows me. He's a pretty smart guy. Despite his tastes and friends. I'm going to ask you to please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. Today's episode of the podcast is sponsored by the Omni pod tubeless insulin pump, you can go to my Omni pod.com forward slash juice box or click on the links right here in the show notes of your podcast player to get an absolutely free no obligation demonstration pod sent directly to your house. Omni pod will send you a non functioning pump but otherwise it does everything else meaning it looks the same. It's the same weight you can wear it and find out if you like it in my experience wearing a demo pod. You forget that the only pods even there after a very short time then it's kind of up to your imagination what's it going to be like to live with it to shower with the to work out with it? Normally I would say go to school or something but you know right now maybe you'll just in your house what it would be like to wear the Omni pod anyway, to get an absolutely free no obligation pod experience kit. Like I said my on the pod.com forward slash juicebox. Not even the Coronavirus should stop you from making plans to take better care of your type one diabetes. Please don't tell me I was thinking of getting a pump. But oh, this whole thing happened. Don't do that. Just keep moving forward with your health. podcast is also sponsored by the dexcom g six continuous glucose monitor. That is the CGM that my daughter has been wearing for ever and ever. It's the continuous glucose monitor that we use to make decisions about ardens. dosing. Right? When does she eat the stop below? When does she give herself insulin to stop a Hi, how do we Pre-Bolus for meals? What are the trends look like? How do we set her basal rates overnight during the day while she's in school while she's at rest when she's sick when she's well. The data that comes back from the dexcom g six tells you everything that you need to know to make great decisions. And then you can make those decisions with your needles with your pens with your Omni pod, however you get your insulin dexcom.com forward slash juice box. Find out about it right now. Okay, so my Omni pod.com forward slash juice box dexcom.com forward slash juice box. And when you're all done, and this whole Corona thing is overwhelming you you need a happy place to go touch by type one.org. Go watch some little kids with Type One Diabetes living well for a little while, check out what they're doing. Find out how you maybe can even get involved. That'll be good for your soul, touched by type one.org. And now, my friend, Adam Needleman. My goal here is for people to have a really firm understanding of what's going on because I feel like the media, you know is actually I'm seeing them try really hard to do a good job. But it's all piecemeal, right? you'll flip it on, you'll hear one thing, you can't listen all day, you can't listen every time they update their thoughts. And people have been listening for two weeks now. And two weeks ago, it was, hey, there's this thing happening somewhere else in the world. And maybe it won't happen here. And I just think that everybody's got fragments of an idea. So I guess I want to start like simply by saying it's a virus, right. But Corona isn't just this thing that we're dealing with right now. Am I wrong about that?

Adam Naddelman, MD 4:43
No, that's correct. So coronavirus is just the name for the family of viruses. Like for instance, I'm sure most people have heard of SARS from a few years ago and there's another one called MERS that was a basically in the Middle East. Those are both in the same family of viruses. They're different strains of this Same virus

Scott Benner 5:00
family. Okay. And and so do viruses just appear? Do they mutate from other viruses? How do they happen?

Adam Naddelman, MD 5:10
Well, so they typically will mutate. So the thought here is that this most likely originated in an animal, the thought is perhaps probably a bat, in bohan, where they have these open air markets, where there's a, yeah, there's a lot of food, a lot of animals really, that are alive and in these markets. And the thought is that perhaps the virus was sort of native to an animal. And again, the thought is a bat. And then it mutated in some way that allowed it to jump from an animal to a person. It's similar to what happens with like, avian bird flu, where you see this in Asia every once in a while where there's a some strain of a bird flu that gets into chickens. And people get really panicked that it's going to mutate and jump to humans. So they start literally just killing off like hundreds and hundreds of chickens, in order to prevent that from happening. So this happened, it may it may have happened and jumped to multiple people at once. Nobody really knows. But the cluster clearly is the cluster of cases, that seems really seems like it started this all came from that area of China, right. And what

Scott Benner 6:16
I've been able to kind of glean about these wet markets is that they bring the animals in, and they keep them alive for freshness reasons, and then they start they slaughter them as you buy them and cook them right there. Except you have a situation where one kind of animals in a cage stacked on another kind of an animal, they would never be that close to each other in nature and,

Adam Naddelman, MD 6:36
and they wouldn't be that close to someone who was actually like preparing them for sale and for food. And they it kind of reminds me of like the old time butcher shops where you had like the animals hanging sort of in the window, but they were never alive, like you didn't go, you know, you'd go into the back and pick out your lamb or something they were hanging in the window. This is similar to that, except that the animals are alive. And they're stored, like you said, kind of in close quarters. And I don't know exactly how whether or not the those markets would meet the same kind of hygiene and sanitary requirements that we have in the US, etc. So you just don't know. But that's where the thought is that it came from.

Scott Benner 7:12
Yeah, some some of the images I've seen online, these things are being cooked on just wire grates or trash can lids and being slaughtered at the same place, they're being cooked in the same place they're being eaten. It really is. I mean, not that I know a lot about it, but it's it's overpopulation people need to eat, you know, and when there's not when there's not farm produced food, they have to go out in the, in the wilderness, and in this case, find bats and whatever else they can find to stay alive, you know.

Adam Naddelman, MD 7:38
So yeah, but the thought is that it probably jumped. So the virus must have mutated from whatever form it was in before and then jumped to a person and it was highly infectious at that point, and very efficient. So it would, it was very easy to pass from person to person, which is why it's spreading as quickly as it is. And then on top of that it unfortunately has the added characteristic of being quite a bit more dangerous than like a typical flu or a cold virus would be.

Scott Benner 8:07
So let's talk about how it transmits. It's, when they first started talking about it, it was I heard a lot of like, wash your hands, you know, but now I'm hearing more than it's airborne, or be on surfaces,

Adam Naddelman, MD 8:19
there are very few viruses that are actually airborne. measles is probably the best example of one. measles is probably the most infectious agent that we've ever encountered. Like if you take a person with measles, and you stick them in a room with 100 people that have either not had it or not been vaccinated, and you just let them kind of hang out in that room for a while 90 people in the room will get it, then so that's airborne. And that's like incredibly infectious. This is not that at least as best we can tell this looks like it's actually through droplets, which that just means you sneeze, then the virus is expelled from your mouth, your mouth and your nose. And it's on a little droplet of you know, fluid. And that either lands on a person or lands on your hand. And then I shake hands with someone and then they touch their face, and it gets passed that way. So the problem though, is with droplets, it can look like it's behaving like it's airborne, because if you sneeze on a surface, it can survive on the surface for sometimes as long as you know, several hours, then if someone else comes along and touches the surface touches their face or mouth, they can pass it to themselves that way.

Scott Benner 9:23
Is that uncommon for viruses to be able to survive like that on the surface of something

Adam Naddelman, MD 9:28
in a dry? No. I mean, the ones that are through droplets can survive. It's just this one seems to be a little bit more kind of Hardy and how long it can survive. It just it seems like it's it survived for a while. What they're saying now about this virus in particular is you really need like, this is what the guidance says it has to be more than 10 minutes of kind of face to face contact with a person that's less than six feet away. So you can see where all this social distancing stuff and I know I'm kind of getting ahead of myself a little bit but that's where a lot of this these thoughts Coming from,

Scott Benner 10:00
right. So if we just don't have those interactions, we won't pass it around. And, and I guess one of the bigger issues must be that the incubation period takes a while, right. So once I'm affected by it, I might not show symptoms for a while or at all.

Adam Naddelman, MD 10:18
Yeah, so you can be infected and be completely asymptomatic. And some of the data that's coming out from what we're seeing overseas is, looks like people who are asymptomatic are sometimes the highest shadows of the virus, which is why it's so crucial to do the 14 day thing, because the thought is, you probably can be asymptomatic for as many as four or five days before you start either showing symptoms or your body just lights it off. But once you start showing symptoms, the guidance now is that you really ought to be symptom free for a week before you put yourself around other people again, so you could see where the 14 days certified before seven after that kind of a thing. And now it's not precise. And if you're sick with the virus, and it's confirmed, it's probably a little bit different in terms of timeframe, because it depends on how sick you get, how long it takes you to recover. But that's kinda where that comes from.

Scott Benner 11:13
All right, that makes sense. So there's just, there's no end to be really when you stop and think about regular life. You don't realize when any of these situations are happening, honestly, like if somebody sneezes like, it's just you're like, oh, God bless you. You don't think right? Now I have this because even if we get sick, it's interesting, isn't it? Like we don't live, at least I don't live thinking, Oh, I'm gonna get sick. And if I do get sick, I just think, Oh, no, I got sick, and then I'll wait it out or lay down if I depending on how bad it gets. But I never think I'm sick. And this can be passed on to so many multiples of people without me knowing it's happening.

Adam Naddelman, MD 11:52
Now, it's a great point. And one of the things with this virus, too, that makes it a little bit unique, I guess are not unique, but it just makes it more dangerous is it's a little bit more infectious. We think then what the flu even is. So they talk about viruses. And they use this our number, which is basically just a, a variable that gets factored into how they do a lot of these calculations in terms of how infectious thing is, but it basically how many people are you likely to infect if you yourself get sick with that illness. So like I said, before, with measles, if you're in an unvaccinated population, you're going to infect a whole ton of people, just a ton of people, right? with the flu, the average flu and an average season, you're probably you're like, say somewhere between one and two and a half people on average. With this, this appears to be more like two to three and a half or four. Now that doesn't sound like a big difference. But imagine a class of like 30 kids. And if you're gonna if every person and there's likely to infect three other kids, the whole class is going to be sick unless you split them all apart, right? If you only get infected one other person, then you're probably it's probably not going to get to everybody before there's some level of protection within that classroom because you have kids that are now immune.

Scott Benner 13:11
So I've seen a lot of those people are making visual representations of what you're just talking about where, you know, there's like 1000 dots bouncing around in the box, and they give, you know, three of the dots the Coronavirus, and as they start banging into each other, it moves across. And it is fascinating to watch how quickly that happens, how quickly three can turn into six that can turn into 12. And it just multiplies so amazingly fast in random ways that you would just just couldn't imagine, I guess.

Adam Naddelman, MD 13:40
Yeah, I mean, that's exactly what we're talking about. I saw another good one the other day, which was like just a matchbook with four matches close to each other, and one that was further away, and you just like the first one, and then they're all gonna light. And then the fifth one that's further away, it doesn't like the same idea. But the one that I saw the same simulation you're talking about, I think was from the Washington Post. And that, to me was the best example. It was just sort of the random movement of people in a grocery store. And if, if, you know, that's really if it was airborne, like if you all if all you needed to do was sort of walk past someone and you could get it, then yeah, that really makes sense. But it's the same concept. And the more infectious it is, the more likely you're going to be in a scenario like that. I just

Scott Benner 14:19
think it's important to remember that most of the actions that are going to cause this the transfer from person to person are not things that you're aware of, you can't you know, you can you can say don't touch your face, for instance, but, you know,

Adam Naddelman, MD 14:31
it's impossible

Scott Benner 14:32
doubt yourself from doing that. Right, just the same as you when you approach somebody, it's really common to feel like you want to reach out and shake their hand or if you're closer to them, you want to give them a hug and you don't you don't imagine like, hey, that guy sneezed five minutes ago, and then I'm gonna hug him. Then his collar is going to hit my collar then later I'm going to adjust my collar and then later I'm going to pick my nose and then I've got the Coronavirus, right.

Adam Naddelman, MD 14:54
Exactly. Nobody thinks like that. And that's why I think it This has been such a challenge for so many people. Just the process. I mean, I think, you know, it's easy to say, Oh, you know, these people should all understand why they need to do this distancing. But it just doesn't. We're not, we've never been in a situation like this before, where you have to have such a high level of awareness of your personal space, and who you're letting into that space and whether or not you let your kids do certain things. It's just not normal for us to have to deal with it. And it sort of runs counter to everything that we do, like you're saying, on a regular basis. I mean, you're supposed to greet people, you're supposed to hug people that you care about, you're supposed to go visit your relatives, you're supposed to have, you know, fun with your friends at a restaurant or a bar or something like, it's to think that you have to sit in your house and spread yourself out and not get near anyone, it's just, it's really hard to fathom that we could be in this situation, but there is no doubt that we actually really are in this situation.

Scott Benner 15:48
This is not someone's imagination, this isn't media hype, it's

Adam Naddelman, MD 15:51
now is happening, I think you can make a really strong argument that we were actually pretty slow on the uptake of all of this with the knowledge that we had about what was going on to the rest of the world. And that's, I think the fear that a lot of people have, it's just that it may be too late. Like, there's a lot of people that believe once you get to, say 1% of the population, or, you know, maybe 2% of the population, once you get to numbers like that in terms of people infected, you can't contain it the way that we are trying to it. That's why now they're clamping down so hard so quickly. Because I think finally it's really sunk in. And I think the governors are the ones really leading the way on this, because they're the ones that have the costumes right in their backyards. But that's really where that all comes from. I was talking to Kelly, and she said, if this persists into a second season, I don't see how most of the population won't have had this in one way or another a year from now. Yeah, well, it's a lot like the Spanish flu, or the h1 and one from 1918. That's exactly the model of what we're talking about here. And that's exactly what happened. So you had this time of year, incredible outbreak where no one had any level of protection, there was no flu vaccine back then, like we have now. And there were no antivirals. And the conditions were not what they are now. And so a lot of people got sick, and then it kind of started to Peter out a little bit. And then when the fall came, it came roaring back. And now this is probably a little bit different than that. That particular strain of flu was just for whatever reason seemed to really kind of persist for longer than you might expect. But yeah, I mean, this virus, nobody has any native protection to it. And so we're in a similar situation where you could end up with a second wave, like we're talking about later in the fall.

Scott Benner 17:40
I think for people who can't believe that it could reach everybody, at some point, think of this, if you can, it's it's apples and oranges. But it's apples and apples in the same way, I think and you'll stop me if I'm wrong. We all have the common cold at some point during the year, nobody goes through a calendar year and doesn't have a cold, right? Like it happens eventually, which means these things get passed around in ways you don't imagine is that is that a similar way of thinking of transmission? Well, it would be if you weren't doing all the things that are happening out. So the whole goal of all this social distancing, and the you know, getting rid of all the

Adam Naddelman, MD 18:18
sports and Broadway and restaurants and all that is, the thought is that if you can get that coefficient of infection, that R value down to like under one. So if you get it, you're likely to only give it to just one other person instead of two, or three or four, that changes the whole thing. Because then you can get, like, let's say it gets into my house, just God forbid, but let's say that, and I get sick, and I give it to one of the other, you know, four people in my house, then and then the two of us both get better. After the 14 days we self quarantine, we're better in 14 days. And between the two of us we only I only give it to one person. So you can make an argument that the are like in my house was point five, right? Okay, you can see how then it died out, you know, and like my little cluster of it just stopped. I didn't go that I didn't go and give it to 10 other people, it just stopped. picture that all across the country. So if there's, you know, I don't have any cases are reported. Now it changes by the minute, but say there were 10,000 cases. If everyone did that, and only gave it to half of another person, then all of a sudden the new cases being reported that number will start to drop. And you'll get to a point where it doesn't have a way to get around enough in the community. But that's exactly why if you're going to make this these kinds of measures work, they have to be across the board across the country, you have to lock down travel you have to do all of that. Otherwise, like you're saying it what's to stop it from you know, okay, we do that we do a great job for three weeks and then a whole bunch of people come over from wherever they're from. They're where they all have it on a cruise ship and they get off they get off the cruise boat, you know, cruise ship in Miami, and boom, it just started here it starts up again. So everyone has to do it at once

Scott Benner 19:56
right so there's a way to affect there's a there's going to be a curve either up or down. And we can impact it by doing all the things that people are talking about, we're gonna talk about those things, too, so that people understand, I just think it's really important for people to hear, there's no way to just ignore this and stop it. You know, you're not gonna do that.

Adam Naddelman, MD 20:16
I mean, what I was saying earlier today, when I was talking to somebody else, just, I think you have to think of this as not so much that you don't want to get sick, it's that you don't want picture the person in your life who is the most well, most vulnerable, you know, whether that's a grandparent, or it's a relative that's fighting cancer, or it's a, you know, newborn baby that has medical issues, what whoever it is, and picture like these actions being put in place to protect that person from getting it. That's really I think, the way you have to think about it, because those are the most vulnerable people. And that's who we don't want to see all piling into emergency rooms, all at the same time.

Scott Benner 20:54
Yeah. And you have the diligence that's involved is, is extraordinary, actually, because if you think about when you're sick at home, maybe I'm just speaking for myself and about the gross people out. But you know, you make this you live in a family, you make an announcement, at some point, Hey, no one touched my drink, I don't feel well, you know, you mean or you've got kids and there'll be like, Hey, Dad, give me a drink your water that happens all the time. But you know, after a couple of days, once you're not not in anymore, you don't think to say to anybody, your kid comes by and grabs a water or you hug people or give them a kiss again, this is where I think it's going to be difficult for people not just to remember not to do it, but to be militant about the time that it takes, right, you know, now say I do that, say in your scenario, you come home, you have it, you end up only giving it to one other person your house, you wait the 14 days, you're both good. If the third person your house, gets it and brings it back in, can you get it again?

Adam Naddelman, MD 21:46
So that's a great question. It looks like I mean, again, it's just so hard because there's not enough testing to really prove all of this. But when you look at the what people are experiencing overseas, because they're ahead of us, they are not seeing reinfection at all. They're just not now, is it possible that the virus at some point mutates and there's a second strain of it, and maybe you can get the second strain? I guess it's possible. But that's not what's being reported at all at this point. Which is actually very promising, because when a vaccine does get developed, it can be against this particular strain of coronavirus. And you would hope that it would be effective. For that reason? Is there a chance that it could just morph again? Yeah, no, there's, it can mutate and change. I mean, there are lots of I that's what happens with the flu virus every year now that this is a different kind of virus. But the whole reason why you have to get a flu shot every year is that the strains will shift and change over time and turn into slightly different strains than they were the year before. And if you have just last year's flu shot, it's not going to be as effective as the one for the current season. Now, this is not the same type of virus, so it doesn't behave exactly the same way. But that's, in general, that's just a kind of a, like a

Scott Benner 22:58
kind of nonspecific or broad way to think about it. Is that in I realized this is a layman's term, example. But is that the virus or the flu in that other scenario? Is that that thing just trying to stay alive? Like, is it does it adapt? Like, is it adapting the way I think of, you know, we don't need our appendix anymore. Like,

Adam Naddelman, MD 23:19
sort of so think of it this way. It's not so much. Yeah, that I mean, that is the way to think about it. But it's, I think you have to just think about it as more like a series of random events, right? So you have these, this flow that's out there, it's probably mutating slightly over time, and the antigens that kind of get presented on the flu virus that ended up being what triggers the antibody reaction, and you, those are shifting slightly over time. And there's some, at some point, like one of them hits the jackpot and says, okay, we shifted, now we can infect people more easily now we can evade the antibodies that this person has from the flu shot they got last year. So now I can get past person a person. It's really just evolution, it's just shifting, there's little mutations that caused it to shift slightly, that at some point conferred advantage. And that advantage allows it to be passed person to person more easily or allows you to, you know, evade Tamiflu or allows the abaza to evade the the antibodies that are in your body that are from your Western flu shot like that's sets the way it works, typically. So thinking out into the future, it's completely possible that this will run through society will build up some sort of an immunity to it, it will dissipate. And as long as somebody doesn't decide to eat monkey brains next year, we should

Unknown Speaker 24:38
be like, like, don't I mean, like, is

Adam Naddelman, MD 24:39
this? No, I mean, yes, yes or no? Say it that way. I just wanted.

Scott Benner 24:45
This is our new normal, like, Have we reached a new level, like five years from now? Is there just going to be Corona season?

Adam Naddelman, MD 24:50
No, not necessarily. I mean, I think that this is probably going to look more like what happened with SARS and MERS. The difference with the with SARS especially Which is a coronavirus that was in Asia, but never really got out of Asia. And the only reason was for some reason that back that virus, when it jumped person to person, it tend to weaken a bit. So I know I'm not I'm not sure anyone really understands why this is. But by the fourth or fifth jump, it kind of petered out, it became much less infectious. So it was hard for it to get out of where it was, it infected a lot of people in those areas, a lot of people got really sick, but it never like, made the leap onto a cruise ship and ended up in the United States or ended up on an airplane. And, you know, there might have been isolated cases here and there, but it wasn't infectious enough. But ya know, it's look, I think that we're in a very connected world, it is very easy for an infectious agent like this, to jump and end up in the US or to start in the US and end up somewhere else. I mean, with the way people travel now, it's virtually impossible to expect that this wouldn't happen again, at some point down the road.

Scott Benner 25:55
Well, so then. So then I guess the question is, I think what people's there, I think fear, obviously is alive around the subject. I think most of its around the disruption of life, even more than health, at least the people I've talked to so far, I think we've done such a good job in America, at least in building a world a life for people where they get to do mainly what it is they want to do. Like, we're not used to being told no. Right? Yeah. You know, like that, that sort of thing doesn't isn't a custom. I think people don't want to get sick. But I actually think that it really, it really is more towards the people who are at risk. I think the people who feel like they're not at risk are probably like, whatever. So if I get sick, I get sick.

Adam Naddelman, MD 26:38
Well, and I think that explains why you saw so many people who thought it was a good idea to go to restaurants and go to bars and basically forced these governors to say, all right, you know what, you guys, that's it, you're done. Like, it's almost like when your kid won't get off his phone, and you have to eventually take it away from them. I mean, I think you're right, people are not used to this. And they don't believe it's a bad combination, because they're not used to it. And there's also a pretty significant level of mistrust. Among the way the population looks at authority figures and expertise and the media and the politicians and everybody else. Everyone's like, yeah, whatever, it's fine here. But this thing's all the time, no big deal. And people don't don't take it seriously. I mean, they're pictures of people at Disney World. Yesterday, it looked like any other day at Disney World, or, you know, people in restaurants or there was a data clear out Bourbon Street a couple nights ago, because people were out partying till all hours of the night, not taking it seriously. And you know, it's not their fault. I mean, this is like you said, this is the society we're in and, but you need really strong, really clear and kind of consistent messaging.

Scott Benner 27:43
explain to people why this is so important. That's why I wanted to do that's why I appreciate you doing this so much, actually, because I just I don't know, I, you look around you think this this is your reaction to this, like you know, it that Oh, I'm not in the in the group that's at risk. And by the way, too, for people listening. Watch how you say something like that out loud. Oh, it's only killing old people and sick people? Well, you know what, that's a hurtful statement to older people. And you know, people who have pre existing conditions, especially for most of the people listening this podcast, and I want to talk about that too, and find out if people with type one diabetes are at a greater risk. But I want to first find out how you're treating people. So you're a pediatrician, and are you getting massive amounts of calls from everybody now? I guess we'll go back for a second. I was with my son a few days ago, he was playing baseball, and he got sick. It started with a runny nose. And then he got kind of wiped out his throat started to hurt. He had a little bit of an intermittent cough. Looking back on it. He was in a warm weather place and he's got allergies. So the nose and the cough were probably the allergies and the sore throat ended up being most likely strep. But in that moment when it all started happening, and we were like, intermittent cough, it's not wet, his throat sore, you're like, Okay, he's got Corona. You know, like, your brain just jumps right to it. Now luckily for me, I was able to text you, but I texted you from right from urgent care because I took him right out of a situation took him right to urgent care. And I thought, Let's find out. You know, what's up with this kid. But the first thing I find out when I get there, so big sign hanging up, says, Hey, if you think you're the coronavirus, we don't have any test for that. So you know, put this mask on and wait your turn. So it turned out that gave him antibiotics. And he's of course significantly better now because he had it he had strep throat. But I'm trying to imagine all of the people in all the towns across the country calling their doctors offices that that is that your exists

Adam Naddelman, MD 29:47
right now. We're pretty much

definitely you know, my friends like you who text me and said

no, but it also is just No, it's okay. In all seriousness, yeah, I mean, everyone is concerned I mean, I'm sure, you know, for all the people that are hearing this, I'm sure there you have friends that are saying, Oh my god, I'm congested. I wonder if I have it. Or I'm coughing, I wonder if I have it, you know, and it's difficult because the numbers that we're seeing from China and from Italy, as best we can tell, at least 80% of people that get it are going to have a mild illness. Probably even more than that, it's probably a higher number than that, because we can't actually test everyone who's walking around with the symptoms like you described, but at least 80%. You know, it could be as high as 90%. But at least 80% of the people are going to have a mild illness. So what we're doing because we can't test, as you said, at least not yet, there are very strict criteria for who can actually be tested. But what we're doing is just saying, Listen, thankfully, and children, for whatever reason that it appears that the virus is actually quite mild, in general. So we feel very comfortable saying to the vast majority of our patients, if you're congested, if you're coughing a little bit, if you have a little low grade fever, you're okay to just hang tight at home, stay away from other people as best you can. And let's see what develops in the next couple days, and the vast majority of those kids are going to define as if they had a cold. Now, would it be great to be able to do a swab like we do for strep to say, hey, look, you have it, and then to prove to people that you had it, and you were fine, of course, but that doesn't exist right now. When you say in children, is there an age range you're seeing, they're saying that from all the numbers I've seen, it's really, it's really lm under 18. There are a few reported cases in overseas of, of older teenagers that got a little bit sicker than you might expect. But again, without knowing the background on them, it's hard to really say, but everything that we've seen so far is that kids under 18 are really my whole, almost our entire population other than the college age kids are, are really gonna have a mild illness. And it does look like you're the risk factors in terms of being hospitalized or ending up in an ICU. It really ages a huge part of it. So we've interpreted that to mean that if you're young and healthy, which most of our population is, those children are going to be fine. Now, you asked before about type one, there's no data yet that shows that type one is a significant risk factor for especially for the pediatric population. For severe illness with this, I would assume like any other infection, very poorly controlled type one is going to put you at a higher risk for for just getting sick in general. And the virus itself is likely to assuming Yeah, and it will also like in the way that all of you that are listening to this know that when your kids get sick, their sugars are all over the place, it's harder to manage their insulin, that is likely to happen with this too, but not to any extent any not at any greater extent than any other illness that they might get.

Scott Benner 33:01
Okay. It's It's funny, I was making a note to ask you a question, you kind of lead into it. The one thing that occurs to me while we're hearing numbers, you know, five guys found it, you know, had here and another thousand people here and you start hearing this thing? Is it? Is it your health? We don't ever think about that you don't ever get to see the person, you know, is it a person who's in poor health in other ways? Is it perfectly healthy people like it? Does it skew more one way or the other? Have you seen any data data about that yet?

Adam Naddelman, MD 33:30
Well, so there's no doubt that pre existing medical conditions are more likely to lead to more severe illness, like if you look at the population of people that ended up in the ICU in China or in Italy, like the average age of death from this in Italy is 81. Now Italy is a very as a much older population than we have in the United States. And their health care system is a little different. And there's all kinds of rules and regulations that are there. But so that's one, you know, one piece of information that I think is important that 81 for Italy. When you look at the numbers in Wuhan, China, it looks like being older than 50. And definitely being older than 60 or 70 are risk factors. Now 50 is probably I don't know how significant it is. 60 is starting to get significant. 70 definitely significant. So age is a factor. They found that men who were hypertensive with uncontrolled blood pressure that clearly was a factor. And now in that cohort, but again, without being able to do widespread testing, you really don't know these are all the sickest people they're looking at. They're not looking at every person who's sniffles and turns out the habit like some of these famous people that you're seeing in the media, right? Tom Hanks has it. Idris Elba has it now the player on the jazz that has it. Those guys got tested. Like they were sick for like five minutes and got tested and prove that they had. As far as I know, they're all doing just fine. Now if we could test every person that had that level of symptoms, it would probably be a little bit more reassuring because we could say it's About 80% that are mild, it's a higher number than that. The only thing that I think has us worried is, in some of the countries where you're getting a lot of testing now, like in China, the the rate of serious illness and the rate of like ICU admission, and even death, they haven't decreased as much as you would hope, the only place we're seeing the numbers come down in South Korea, and that they are doing an unbelievable amount of testing. And so the mortality rate there, it looks like it's significantly lower than it is in places like China, or in Milan, in Italy.

Scott Benner 35:32
I think that it's interesting, too, that you're seeing some, you know, the really well controlled places are seem to be smaller countries, that is countries that aren't as landlocked sometimes, you know, like they're having, it's just like you were talking about earlier there, it's easier to restrict people from coming in and out, which should say to you, if you're listening, it should say to you, I need to restrict people coming in out of my life, just like you need to restrict them coming in and out of your country. It's it's all the same thing. You're, you're just trying to limit contact with people,

Adam Naddelman, MD 36:03
right? To keep this from happening. And so yeah, you could see why like, going to an NBA game, going to march madness, yeah, going to a concert, or a Broadway show. All those things are tremendous, tremendously dangerous in a situation like this. So it makes sense to not be doing them now. It made me wonder

Scott Benner 36:22
from the conversation so far, if as we get further away from where this began, if you will see it impact less people at younger ages, like will it get? Will it weaken? Or will this be a virus that doesn't weaken as its past? And I guess there's no way to know that now. Really?

Adam Naddelman, MD 36:43
Yeah. So so far, it's not showing the same signs of weakening the way that SARS did like I was talking about earlier. But the hope is, like, if you look at what's going on, in Wu Han China, now, they clamp down an unbelievably crazy amount compared to what we could ever do here. And because they did that, they essentially got all of the active cases, away from everybody else, quarantine them, force them, essentially, to not even be with the people that they wanted to be around that all like they pulled him out of their houses in some cases. But by doing that the person each person fought off the virus, and then they're not contagious anymore. And so they can go back to society. And if you look on the news, now, you'll see videos of people walking around, whoo ha, and like, you know, I mean, not like nothing ever happened. But they're getting back to normal, because they took they took what we're doing here, and they turned it up about 10 more notches, and

Scott Benner 37:36
they were able to because I guess freedoms, not such a concern there.

Adam Naddelman, MD 37:40
Yes, there is a bit of a trade off, which I wouldn't I mean, there's videos of them, like spraying down the streets and crazy stuff. And pulling people out of houses like that, that will never happen in the US. But that just means it's going to take us probably a little longer than it took them.

Scott Benner 37:53
I saw something online that really made me smile The other day, some it said, your grandparents were asked to fight a World War, you're being asked to sit on your sofa.

Adam Naddelman, MD 38:00
Yeah, I mean, in all seriousness, like you, I mean, we all have like 40 hours of TV we'd like to watch and probably, you know, at least 50 hours of podcasts and books to read and all kinds of stuff. Just go and enjoy that stuff. Just go sit down and relax. My son

Scott Benner 38:14
said the most thoughtful thing about it so far. So you just said to me He's like, this is just like summer vacation. I don't really need to do anything. And I was like, yeah, hundred percent. Just go relax. I said, just take a vacation. We're just gonna take it here in the house. Yeah. Now when I when I find myself in the grocery store, are there ways to protect myself? Like when I do have to go out? What do I do?

Adam Naddelman, MD 38:35
Yeah. So I think ideally, you go at a time when perhaps it'll be less crowded. A lot of the grocery stores are doing some clever things like only every other register is open. They're putting a shopping cart between customers. So you can't get within six feet of the person in front of you or behind you. You're not going to stand in line with some guy on the line next to you and watching sneezing and coughing or whatever. So you're going to be spread out. I think you want to get in and out. It's not the time to like, you know, debate which peaches you want to buy for 10 minutes. Like, grab what you need to get out.

Scott Benner 39:08
I am we were so Kelly and I went together. And it was hard. First of all, it was very interesting for anybody that's been out. It was quiet, solemn, almost like there wasn't a lot of extra talking people were very, I think they were trying to be calm, but felt like on edge. Everybody looked at each other a little weird, you know, like when you are passing by. And I watched Kelly pick up a jar of pickles, and put them down and decided against them. And then she changed her mind and pick them up again. And I was like, well, you stop handling everything. Even though if that made sense or not. But I was like, decide if you're gonna buy the pickles by looking at them. And then that made me think about that, like you start your brain starts going. So somewhere there's a woman who's a nurse and she came home at the end of a night shift and she's got the virus on her. She kissed her husband, her husband came to this grocery Or put these pickles on the shelf? My wife touched him. Now we got it. Right. And it's hard not to do that calculus in your head while you're while you're looking at things and doing

Adam Naddelman, MD 40:08
Yeah, this is this is a difficult time for people that have any level of anxiety. And in all seriousness, I mean, you really can make yourself insane. By running those scenarios in your head about every single thing. I mean, the good, the good thing is, like I said before, over 80% of people are going to get a mild illness. So even if you were unlucky enough to pick up the pickle jar that was handled by the nurse who kissed your husband, or whatever you said before, you're likely going to be okay. I mean, even though we worry a lot about the rates being higher than what you'll see for like a typical flu season. I mean, we're not talking about like some movie, you know, some crazy like outbreak in a movie where half the people who get it end up in the hospital, that's that's not going to happen. The problem though, is we just don't have the capacity that we would need in our hospitals to deal with all these people stick at once. And that's really the point of the measures is to, is to flatten that curve that jump that spike in cases, like if you just picture like you were saying before, how fast but just look at how fast the numbers are changing. And then when you hear about it in the media, the whole goal is to get that to slow down and spread itself out so that the people who do unfortunately get more, who are more sick and need hospitalization have a place that they can go and the resources aren't being taken up by too many people all at the same time.

Scott Benner 41:25
So the basic idea is that we don't, we only have a certain amount of hospital beds, ventilators, things like that. And for people who listen to the podcast, it's actually an interesting overlap, because we talk about stopping rises in blood sugars before they happen. Because if you never get high, then you don't have to deal with the things that come with being high, you know, extra insulin crashing, getting low later. So we're really trying to stop the spike of, of infection, not because we think it's going to stop people from getting sick, but so that it spreads out illnesses over time, so that hospitals can handle people's illnesses, if everybody gets sick at once they'll overwhelm the healthcare system, right, we can spread it out a little bit, then your grandmother gets to go in and get the treatment she needs and come out alive. Instead of ending up in there with four other people's grandmothers. When there's only three ventilators and then they got to do any meenie miney. Mo to find out which grandma doesn't get a ventilator.

Adam Naddelman, MD 42:17
Right. Right. That's I mean, that's exactly what the hope is that you can let the healthcare system catch up, like, I don't know if you saw last couple of days, but some of the governor's now are starting to really ask the military as the federal government to even deploy the military and let them put up a 500 bed, you know, mobile army type hospital that they do all the time. You know, they have a lot of experience over the last 20 years doing this. And it would be incredibly helpful. I mean, there are abandoned warehouses, there are all kinds of buildings, how about taking some of the dorms that no one's living in now, and using them if you need to, there's all kinds of structures that could fulfill this. And that would just give everyone a big sense of relief that they're that, you know, the capacity is there, it's temporary. When we're done with it, you can take it all down. It's when there is a tremendous need for it.

Scott Benner 43:07
I think people think that's crazy. But it seems a little morbid, but my wife's lobby of her building was used as a mortuary during 911. Like the need to take bodies, and they just, they use the building, they did what they had to do,

Adam Naddelman, MD 43:20
right? I mean, this is this, it seems like you know, because I think part of the problem is we have a hard time with the notion of this is likely going to happen. So let's prepare for it versus, oh, no, this is happening, we need to do something now. We tend to be more reactive. And I think the governors are, to their credit to being much more proactive and trying to get ahead of this so that we don't end up in a situation like you're talking about. It's, you know, a lot of those calculations that were being done when people were talking about things like you know, rationing care. That was before all these measures were put into place and they and every study that's been done and every calculation that's been done really does show that even a day or two earlier with these measures can make a huge difference. So we're gonna have to wait and see whether or not it was enough and how and whether or not it was early enough.

Scott Benner 44:14
Yeah, we got we got to a too late by waiting that that that week in there because I know people talk about it as this has been ramping up for a few days. But I think if you really look back, it's been happening for a week or so in America.

Unknown Speaker 44:26
It's been a

Adam Naddelman, MD 44:26
week of, hey, should we be doing something about this? No, don't worry about it. Like that's been about a week. I you know, I was away. Like in the beginning or so of February and I saw in the paper an article about a novel Coronavirus in China. It was like a little blurb like on page, you know, 52 or whatever the newspaper. And I remember thinking like how that's interesting. I wonder if that's anything like SARS or MERS or these other ones. That was like six weeks ago. Yeah. And you think about where like, think about where you this was a week ago, think about two weeks ago. If I told you three weeks ago Hey, guess what in three weeks your son's cancelled, a college canceled kids are home from school all the major sports are canceled. There's nothing on TV for them to watch. It's It's amazing. And that's the worry is are we good? Three weeks from now? Are we gonna look back and go? Yeah, you know, when we were complaining about how we had the kids home from school, that's nothing compared to what's going on at hospitals. Now

Scott Benner 45:21
I got lucky. It was really lucky because I did more traveling this year than I have previously. And I've never been a hand sanitizer person. But I just thought, I've so many commitments, I can't get sick. So I bought one with a little pump. And I put in the door in my car. Every time I got in a you know, I got back in my car from a public place. I gave a little squirt. And I rubbed it around. And I even like thought, like I put it on my cell phone like dirty me like I thought, well, let me see what I can do here for myself. And so you'll find this. I hope you find this funny. But then if you do it with the kids, you know, like when Arden gets in the car, like here, and she rubs it around, and she always goes now I smell like Dr. Edelman.

Adam Naddelman, MD 45:58
That's great.

Scott Benner 46:01
And now I'm thinking looking back, I'm happy. It was random. But I'm happy it happened because I have been in a lot more public places and traveling through now. But I've just been kind of cognizant about it. I've been like, you know, like, I go through places, thoughtfully not touching things. I was on a train the other day, I just thought you know what, let me practice my skateboarding skills here. I'm not going to hold on to the bar, you know, and if I hold on to the bar when I get out of the train a little thing, is that stuff really? Is that just in my head? Or is that stuff valuable?

Adam Naddelman, MD 46:30
No, it's valuable. It definitely is valuable. You know, old fashioned soap and water is just as good. If you're worried that you can't find PRL anywhere. Now, you can't find hand sanitizer anywhere, but it No, there's no doubt that it's valuable. So yeah, I mean, practicing this hygiene all the time. Like even something as little as Hey, before you eat your dinner, Go wash your hands. Like I'm sure we're all saying that to our kids, our our parents did that to us. But you know, just like you said earlier, like you get lacs about it, oh, they're outside, they're having to catch thrown a ball around, they come in, they eat a piece of pizza, they don't always wash their hands. Now, I think people are saying, you got to really wash your hands you got to be good about and you got to really wash them, it's not enough to run them into the water for two seconds and say you washed your hands, you got to wash them with soap and you got to, you know, count to 20 at least, and really take your time and wash your hands. But no, there's definitely a value in what you're talking about. Now, for a while we used we were thinking for a while that people were getting like way overboard with the hand sanitizer and not exploiting their kids ever be exposed to any germs. There's a danger that we're going to go all the way back to that and never let kids that playdates anymore, and we're going to shut all this down. There's a value in your immune system being exposed to a wide variety of things over the course of your lifetime, especially when you're young. So there, there's going to have to at some point be a bit of a pullback from all of this, like when when the world returns to normal. But for now, you can't be too careful with this. If you want to use hand sanitizer, every five minutes, do it if you want to wash your hands 20 to 50 times a day do it.

Scott Benner 48:01
Okay, so let's recap here. And I'm gonna let you get back to life. I think, um, Adam has been talking about this a lot lately. By the way, how did you end up on crisc comos radio show talk. So

Adam Naddelman, MD 48:11
I listened to that show a decent amount just because you know, if I'm driving between offices or running home for lunch, I'll put it on and I just called it there was no nothing more than that. I called in and the guy who picks up the phones, asked me who I was I told him who I was. He said, Oh, that's great. Let me you know, I'll put you through first time I got on. He put me through, like almost right away. And then at the end of the call, Chris Cuomo said, Hey, you know, why don't you call back, you know, each day and kind of let me know what you're seeing and whatever. So I figured today that was Friday, I figured let me just see if I actually can get through I thought maybe there was like a back number. I don't know how, how it works. But I called again today. And it got right there again. So I don't know if they set my my number up now to be able to call through or what but I figured lucky. You know, he's talking about this topic. And he wasn't doing it necessarily from a political angle. It was more from the kind of conversation you and I are having. I figured let me offer a medical perspective because not not one of his callers was someone who was actually dealing with this for real and from the health care side. And it sounded like he appreciate I was on there today for I don't know, eight or nine minutes, I think. Okay,

Scott Benner 49:20
well, one day we'll get you back on here and you can tell people the story of how I called you in the middle of the night and you sat on your computer in your underwear finding a hospital to take art into while she was being bad. Yeah,

Adam Naddelman, MD 49:29
it was Virginia Beach right? What are you doing the beach?

Scott Benner 49:33
Yeah, we're on our way to the wrong hospital. And I heard you clacking away on the keys. And it was it had to be like 130 or two o'clock in the morning and you found a hospital that had a kid some kids dedicated center for for diabetes and that's it

Adam Naddelman, MD 49:48
all those kids they're all the people that were there were people that had trained I think at the Children's Hospital Philadelphia so we remember saying he like I have a feeling this might be a better option than whenever the closest place was at that point. You should Did you like turned around and drove in the other direction? But got there?

Scott Benner 50:02
Yeah, it was really. It was really something a long time ago. But uh, so I, I'm embarrassed that I didn't think of you first I for two weeks I've been like, Who am I gonna get on the show to talk about this if this really needs to be talked about. And then I got I landed coming home from Kohl's baseball thing, and I picked up Facebook and there you are talking to, you know, on on the Cuomo show about I was like, why

Adam Naddelman, MD 50:24
am I not thinking of this? So I really appreciate you doing this because I know you've been slammed, your your practice is going to go to is are you going to go to like, this kind of thing? Are you gonna start Skyping with people to see people. So we actually, about a week ago, when we started to realize where this was heading, we about as fast as we possibly could do anything put in place, the whole plan for starting to do telehealth. And so tomorrow is the morning we're going to have a couple training sessions with the people that we're doing it with. And then our hope is that by the afternoon, if not the afternoon, by definitely by Wednesday morning, we will be offering telehealth appointments for basically anyone who has I mean, we could do it for almost anything at least as a starting point. But especially for the kids who parents are worried. You know, just just like you said before, they're calling the office thing, oh my god, he's congested, he's coughing, he has this, he has that, instead of the nurses trying to just triage it without seeing him, we are going to actually do a virtual visit where we can see them and actually observed the child and talk to the parents and do a whole basically like an office visit, it's a good idea. But do it over the phone? Or do I have to do it on the computer, I genuinely think that

Scott Benner 51:37
you know, a lot of bad is going to come out of this whole thing. But a lot of good is going to come out of it too. We are going to become more agile, but we take care of things, you're going to see a lot of businesses follow suit, and maybe some of them won't go backwards again. Or maybe this is the thing you'll keep

Adam Naddelman, MD 51:52
you know, maybe we're definitely gonna keep it I mean picture like even the example you just gave about that awful night all those years ago, imagine if we had telehealth and you said to me Look at her now like you saw her a few days ago, look at her now what do you think's going on? Like, that would be a very different interaction than a cell phone at one o'clock in the morning. And I think I think you're 100%, right? I mean, look, there are times when we all think the world is changing in a way, and we're never going to get back to where we were, and it's all atrocious and good can come out of it. And I think this is one of those situations, it's just gonna take everybody thinking about it in terms of what can they do for each other and not just about themselves, you have to think about it in terms of your neighbors and your community. And if we do that, and I think businesses like you're saying are clearly going to adapt. And I've been saying for years, what in the world do we have to have all these people traveling all over the place to have these in person meetings? for like an hour that you fly to California for an hour meeting and you fly back? like that just seems so foolish? Now when you look at what people are going through, right? Yeah, I more recently?

Scott Benner 52:53
I do I do a fair amount of traveling to give these talks, right. And I just go about, I talked about how we do things on the podcast with blood sugars and stuff like that. And it's really valuable. And I see that I see the people having sometimes very instant, like significant changes in their health. But recently, someone contacted me and they were like, would you come to Japan? I was like, No, but I'll do it over the computer. And we did it. And it worked great. Yeah, I mean, there was really no difference between me not being there and being there.

Adam Naddelman, MD 53:22
Right. I mean, I could see like, for a live presentation in front of a lot of people, and especially question and answers, that can be a real value in a face to face. But, you know, these these meetings that you have some times where you have to really put yourself out in terms of travel, just to spend a couple hours in the, you know, there are certain industries where the face to face thing is still super important. And I think this was is likely going to change that for a long time. Like you're going to do a lot more of this a lot more skypes a lot more kind of video sessions, where you know, as the technology improves, and everyone's in super high def, and the cameras improved. It's not gonna be that different from sitting around a table if you have five computers set up and you can see everyone's faces.

Scott Benner 54:01
Oh, my daughter did her first day of high school from home today. She said she liked it. Is there a way I can keep doing it like this? A couple hours later, Cole got word from his school. They're going to distance learning for the rest of the semester, which is the rest of this year. And Kelly's working for him for for the foreseeable future.

Adam Naddelman, MD 54:21
Yeah, I'm in the same situation. Dana is now working from home. She's not they're not going in at all. My kids are all doing virtual learning. The boys are doing virtual learning with like, they're using zoom where you literally are watching a lecture and the kids are all on the screen at the same time and they're all participating. I think our kids generation is going to be really good at this. Like they actually in some ways, some of them probably will prefer it and may get more out of it because they can it's more condensed like that their lesson plans are right there. There. It's there's not a lot of like walking around between classes, and they're gonna find they can actually accomplish a lot this way. I think it's interesting when you think about the universities, I would I would it would be interesting to talk to people who are in that line of work. But you have to think that there's a real concern among some of these universities that someone is going to come around with a real good online platform for education. And it's going to cost like a third as much as what people are paying, now, you're going to get a degree that's actually really worthwhile, and you're going to be able to do it from your living room. I mean, there's no doubt that the social aspect of college is probably a bigger piece in some ways than the academic piece. But if you can do it for third the price, and this market,

Scott Benner 55:31
yeah, there's right. There's no reason not to try. So I, I just think it's, you know, it's not dissimilar to I say this about diabetes a lot. And sometimes people think it's odd, but, and I don't, I always say like, don't get me wrong, like I would genuinely do anything for Arden's pancreas to work, right. But because it doesn't, we've also had all of these amazing experiences, and she's become a much more resilient person than I think she would be at 13. So goods come from it, too, you can't ignore the good that comes from it, you can hate the bad, but you don't have to, you don't have to ignore the good stuff that's coming. So

Adam Naddelman, MD 56:06
I agree, I agree. And my office is about as crazy as you could ever imagine anything. Right now, there's no doubt about it that we would be life would be much easier right now for everyone who was working in my office and putting in the hours they're putting in if this wasn't going on, but I also have no doubt that when it's finally over, we will be a better practice and better physicians and better nurses. And more probably empathetic even to people like we will all be a little better. Because we worked through all this. It's hard to see it now because we're not at the end of it yet. But I really do, I really do believe that. But you got to really you got to just work it you got to you got to think about everything that's going on, you got to take the measures that the experts are recommending you got to believe the scientists, you have to you have to really think about what you can do for each other. You got to you know, all of those things, I think are critical for all

Scott Benner 57:01
you people who are always my wife said she heard you saying this earlier today. But I've seen it on Facebook a little bit for everybody's always bemoaning I don't have enough time with my kids. there's now an equal amount of people were thinking and saying out loud in some points. I don't want to be around my

Adam Naddelman, MD 57:14
kids this Oh, it's so true. And I was saying earlier that, you know, for every time you complained about all how to want to go to that practice, I really have to take into this. Now, how many people would you know, pay $1,000 to be able to have their kid just go to softball practice.

Scott Benner 57:29
I told my son tonight I said, you know, it's interesting. We live in a time, unlike any other time in history, so you have so much ability to do so many varying things. And he was home from school for three hours yesterday and told me he was bored.

Adam Naddelman, MD 57:43
They're bored out of their mind.

Scott Benner 57:44
Yeah. I said, I don't know how you're bored. You have a computer in your hand that could watch a space shuttle. You could, you know, I you just maybe you needed to dial in one time to the internet in your life to realize how amazing this is televisions that you have and contact with other people. You can speak to people if you want to face to face and all this stuff. And he's like, I don't know what to do. Like.

Adam Naddelman, MD 58:05
Yeah, I mean, it's amazing. I actually kind of hoped that maybe. And this probably isn't gonna happen. But just simple things, pick up a book, go for a walk, like go for a walk around the neighborhood, just you know, the weather's not bad. Get outside, sit outside for a while with a book like something that's just not the constant incessant, you know, in front of the screen and make you anxious and make you crazy because reading every last thing and hearing every last thing I feel

Scott Benner 58:32
I feel the worst for people who just not in the financial place for this for people who don't have a job that sends you home but just tell you can't come in, but you're not getting paid. That's a hard thing to fathom.

Adam Naddelman, MD 58:41
Oh, it's um, but it's unfathomable. I mean, imagine if you owned a coffee shop, or if you owned a restaurant or, you know, you're you're just an employee that's per diem somewhere or you just you're, you know, an hourly employee that you have no benefits, or I mean, it's just, it's unfathomable to think like what in the world is the certain industries going to do? Right? I mean, imagine being like a pilot, for instance. I mean, those guys aren't flying anywhere now. American Airlines cut 75% of their international flights yesterday,

Scott Benner 59:11
I saw that there's 75% of one of the European airlines just shut down. Yeah, they say they said we have no Scandinavian maybe I'm not sure one of them was just like, we don't have any. There's no call. Right. So you know, we're just not gonna fly planes anymore.

Adam Naddelman, MD 59:26
No, I mean, I agree with you. And I think Unfortunately, that's the next big me on top of the fact that the illnesses are going to pick up you're going to start hearing more and more about companies that are not doing well and employees getting laid off and it's going to be really, it's going to be awful for a while. That's why it has that we have to do these things now to hopefully shorten the duration of this and decrease how painful it does get.

Scott Benner 59:50
Yeah, no, I hope people believe that. Is there anything that I didn't bring up or that you didn't say that you think is important?

Adam Naddelman, MD 59:56
No. I mean, the only thing is I do just want to reiterate the social distancing thing. Think keeping yourself six feet apart, you know, with from people around you, including the kids. So no sleepovers, no birthday parties, this is not a snow day, there's a great post circulating about that too, that I saw. Don't treat this, like, you know, it's snowing, and we're gonna pile 20 kids in my basement and let them all watch a movie, you can't do stuff like that. You just have to stay apart. If you have elderly relatives, the best thing you can do is call them and talk to them, don't go visit them, stay away from them. Just because they're family, it doesn't mean that they might not have it. So you really need to take it seriously. If you are going to visit with people do it outside, you know, be outside be six to 10 feet away. Do it for a brief period of time. And but no contact like no hugs and kisses and all of that that has to stop now going to the bow.

Scott Benner 1:00:47
I'm just a genuflect a little bit. And you said that I I called my mother last night who's 76. And she lives by herself. And I just said, Mom, listen, Kelly and I talked about bringing you up here. But I think you're better off where you are by yourself. Yeah, I'm like, Well, you know, text every day and we'll call and everything but I think just you know, she's like, Oh, my card clubs not meeting anymore. And I was like, Yeah, that's good. I was like, don't do any of that stuff. I say go outside. I said the same thing to her. So it's so what I'm hearing, at least between you and I and you and I think pretty similarly about some things but common sense, right? Just use your common sense and don't get in contact with other people. You can't just decide that people look okay, it's you know, right, you know, you should

Adam Naddelman, MD 1:01:31
prompt exactly right just just and be patient because it's going to take some time this is not going to be over in two days. It's going to take some more time.

Scott Benner 1:01:39
Well listen in a world where social There are apps for dating apps that have never once warn people about like sexually transmitted diseases but those those apps are popping up now I'm hearing and telling people listen that Coronavirus blah blah blah, you know, so so I'm gonna let you go with this. What do you call it? You call it COVID-19 or do you call it the Coronavirus? I mean the medical world is calling it COVID-19 I think when we talk to patients and when I just talk about it with friends I'm always calling it the Coronavirus. I think you know COVID-19 just sounds like it just doesn't sound like a virus. I don't know. It just sounds like something different. COVID-19 is really like what they're calling the illness that people get. I'm using Coronavirus. I don't think the people at Corona are so happy that this is the Coronavirus, but it is what it is you must be out of their mind actually. Okay, so I'm going to um, I'm going to in a number of weeks when there's more to say I'm gonna force you to do this again. Just

Adam Naddelman, MD 1:02:29
you know, I'm happy to do it. I mean, look, this is changing unbelievably fast, like incredibly fast. Just thinking back to where we were a week ago. So I'm happy to do it again. If you think it's useful for you, all your listeners find out.

Scott Benner 1:02:42
So thank you very much.

Adam Naddelman, MD 1:02:43
No problem.

Scott Benner 1:02:46
This episode was recorded on March 16 2020. And Adam will be back if there's more to talk about and I think that there's going to be much more to talk about. huge thank you to Omni pod Dexcom and touched by type one for being fervent and long term sponsors of the Juicebox Podcast I appreciate your dedication to the show. Get yourself an absolutely free no obligation demo of the Omni pod sent to your house right now my Omni pod comm forward slash juice box but the links right there in your show notes. Were the ones you can find at Juicebox podcast.com. Start today with the Dexcom g six continuous glucose monitor by going to dexcom.com forward slash juice box again, where the links that you'll find all over the place. And of course touched by type one.org. Head over there, check them out. They're doing amazing work for people with type one diabetes. And you know what i guess if you're in the central New Jersey area and you're looking for a beautiful pediatric center, Princeton Nassau pediatrics, I've been taking my kids there for a very long time. So okay, everybody, listen. Let's do this together. Right, let's look out for each other like Adam was saying, to be cautious and careful. Let's try to ignore the fact that we don't want to stay in our houses for a couple of weeks. Just do the right thing here. And let's get past this as quickly as possible. And if you absolutely have to go out for any reason financial the buy food, whatever. You know, again, what Adam was telling you, keep your distance from people wash your hands. Let's not get in spitting distance, sneezing distance, will be kissing people you don't know or Come to think of it people you do know don't kiss anybody. You understand what I'm saying? Right? If you touch the handrail and something, try not to touch anything else till you handle yourself. Soap and water. Good, good, good, you know like this really get in between the fingers. I think together we can put an end to this pretty quickly and get life back to normal course. The next episode of the podcast will be out in a couple of days. Jenny Smith and I are going to talk about Sick Day management for respiratory illnesses. You know, like the Coronavirus