COVID-19 Medical Update March 16 | With Dr. Zubin Damania

– Hey guys, it’s Dr. Z. Alright it’s time for our COVID update, which could not be more timely. It’s March 16th, 2020 and
the ish is hitting the fan. And when I say that, I
mean it both medically, which is one piece of this. And also psychologically,
socially, economically. The (laughs) much like the disease itself, COVID-19 disease, much of
the damage that we’re seeing may come from the body’s response, rather than the disease itself. And what we’re seeing now
is fear, panic, hysteria, as city after city goes under a lockdown to try to mitigate the
spread of the virus. So what I wanna do today as a physician, as someone who’s connected to a lot of the people working on this stuff, who’s been following carefully, and who has a lot of skin in this game. I’m in the Bay Area of California. This is one of the epicenters. People at Stanford are
seeing lots of cases, my wife who is a chest radiologist, specializes in diseases
and infections of the chest is reading out these cases
and we’re seeing a lot of it. So we’re starting to see an increase again in the number of cases. Now, what’s happening though
nationally is people are loosing their minds. They’re panicking. So what I wanna do is
first of all talk about updates as we know ’em. Overall course of the disease
from a medical standpoint and I’ll use some medical terminology. But it’ll also be accessible to people who are patients and are interested. Alright so let’s do this. Because we really have, the
only way you fight anxiety, panic and hysteria is through knowledge, understanding, preparation
and a rational look at the situation. And looking at the situation rationally, I could tell you that we’re
gonna get through this. We’ll get through it. We’ll manage it if we prepare and we don’t we don’t respond in a way that
actually makes things worse. Because that’s what I’m seeing
happening in many cases. Runs on the grocery stores. Today I went to just go get some milk. They just announced
the Bay Area’s gonna go on lockdown starting tonight. People are losing their minds. And yet, I’m seeing kindness. I’m seeing courtesy. I’m seeing a degree of solidarity that only Americans can pull off. And I’m proud to be a part of it. So we wanna encourage more of that. Okay so here’s the update. COVID-19, which is the
name, not of the virus but of the disease but I will
use them interchangeably. The virus is the SARS-2 Corona Virus. Is now at a point where
we’re past the initial phase where we were hoping
to actually contain it. And there’s a lot of
theories as to why this is what happened, what ball
was dropped, et cetera. And at this point, it’s less important to try to start pointing
fingers and blaming. Although, there will be plenty of that. It’s more important to
kinda see what’s happened so that we can understand
where we might be now and where the puck’s gonna be. Okay and skate to that. So when the first cases started
getting reported in China, it had probably been
circulating for a little bit. Not a long time. But then you’re starting
to see sort of a lot of very sick people coming to the hospital. Round about then, there
was probably travel. And the first cases were peculating, maybe Washington State, et cetera. Now because this is such an
interesting disease, medically, it’s pretty clear now
that COVID-19 disease caused by this corona
virus does not necessarily have to show really exuberant symptoms. So I think many people,
especially young people, maybe children can be
infected, can have virus replicating in their body and
can spread the disease without actually showing a whole
bunch of symptoms or signs. Which makes it very difficult. Maybe you won’t have a fever, maybe any of the typical
signs are fever, dry cough, some people get headaches, muscle aches and then that can progress
to shortness of breath. The medical term being, dyspnea. So, there’s other symptoms though. 10% of people can have these
gastrointestinal symptoms, where they get stomach
pain or nausea vomiting as their first symptom. And there’s a reason for that because the way this
virus actually works is it enters the body and has these proteins on it’s surface that give it its name, the corona, the crown. This sort of, you know if you think about the corona of the sun
or a crown on a king. It’s these little things that come off. Those bind to receptors on specific cells. Those receptors are called Angiotensin-converting
enzyme 2 receptors, ACE2. Turns out their present in pneumonocytes, which are cells of the lung,
as well as intestinal cells, heart cells, et cetera. Now why does this become important. People seem to have
gastrointestinal symptoms, and pulmonary symptoms. That’s where the virus may
first bind, enter the cell, replicate and cause cellular damage. And as a result, you see these initial phase of symptoms. Now again, it’s pretty
non-specific in the early phase. So you can imagine that people are running around the community. Spreading this person to
person and it turns out that the reproductive
number, in other words, the number of people that get
infected from a single person who’s already infected,
seems to be between two to four for this disease. And that’s pretty exuberant. You know some influenzas, two to three. By comparison, something
like measles is like 12. So one person infects 12
people, highly contagious. And the ideas is that it’s
spreading around the community. Now that infectivity, the ease with which this virus spreads, is actually a crucial
component because it tells you how rapidly through a population you’re gonna get the spread. Now since this thing is pretty infective and very important point, that infectivity is not
necessarily a pure property of the virus, it contributes. It’s also a property of
how the people deal with the virus when they’re infected. So here’s a good example. Out in the wild, the
reproductive number may be three, so three people get infected for every person that’s infected. On the cruise ship, the Diamond Princess, that reproductive number was 15. One person infected 15 people. Why? Because it’s closed loop ventilation. People are in closed quarters. There weren’t good isolation techniques. And how does this virus
spread in the first place. So let’s review that. The virus spreads through
a couple of means. Alright. One is droplets. And technically these are
large respiratory droplets. So I cough or I sneeze, it
aerosolizes these droplets and they’re pretty big. So they fall to earth in
about a six feet radius or so, plus or minus. And if those end up going
into people’s eyes or mouths, you can get infected but another way that it’s gonna happen is
that they spray this area and then people touch objects on which the virus is sitting
through their droplet spray or through an infected
person rubbing themselves and touching stuff. And as a result, it
turns out that this virus can live, it appears,
anywhere between two hours and 24 plus hours on different surfaces. So wood is different than
plastic is different than paper, but it can live on all of those things. So why is this important? Well, this is a bit of foreshadowing. Because in the hospital,
it’s crucially important then to clean surfaces with a bleach solution or an alcohol solution or
however you’re disinfecting that’s approved and that takes time. So you’re already starting
to see a challenge with preventing, what they
call nosocomial infection, in other words infections in the hospital. Because each room has to be clean and that means environmental services needs to be staffed up. It means there’s time involved. It means if you do a CT
scan, it can take 40 minutes to clean the scanner, to disinfect it so that you can see other patients in it that aren’t COVID patients. You would need like a dedicated scanner. So for all these reasons, this particular mode of transmission can be highly problematic. And this is why people are telling you, don’t touch your hands. Don’t touch your nose. Don’t touch your eyes. Don’t touch, if you touch
stuff wash your hands for the duration of a
couple happy birthdays using soap and water. It doesn’t have to be antimicrobial soap. Just plain old soap and water. And you know, these
hand sanitizers can help but their not as effective. So they can help, they’re not
as effective as hand washing. So the idea then that this
stuff is in the environment. It can live for hours to longer. And then you’re touching yourself. That’s one mechanism of transmission. And so as a result, we’re seeing that. Now, what about aerosol
or airborne transmission. People talk about this,
airborne transmission. Measles is airborne. That’s why it can infect 12
people from a single person because it actually travels on the currents of air, long distances. It’s one of the most infectious
viral diseases we know. And in this case, with COVID, it seems to be becoming increasingly clear
from our experience with it in hospitals that generally,
it’s droplet spread and then people touching and so on. So the kind of precautions
that a healthcare worker might use or someone out in the field, or in the community,
would be hand washing, a healthcare worker with a known exposure, or a known patient with COVID would wear, a standard surgical mask, eye face gear to protect eyes
in case there are droplets. Contact gown, right. Gloves. Maybe a hair net thing. So that kinda thing, you
would do kind of at baseline. But if it were airborne, aerosolized, it’s different. You need a different type
of mask, the N95 mask. Which is much tighter and
sealed against air currents and things like that. And what we’re seeing
is maybe that this virus becomes aerosolized in healthcare settings when you’re doing stuff to people. So you’re doing a bronchoscopy
or you’re intubating somebody who’s sick, that can cause aerosolization. The other concern is that
if you ventilate somebody without using a closed loop ventilator, something along those lines
and stuff is escaping, that can aerosolize the virus. And this is a particular important for my healthcare colleagues because you wanna make sure you have the best protection that you can. And so it depends on what
you’re doing to that patient, which means you wanna do
as little as possible, if it’s not necessary. And you wanna be safe
and be cognizant of this. Now the key thing for
my healthcare colleagues that we’re seeing is and
this was in Ebola as well and other sort of outbreaks. If you don’t know how to put the personal protective equipment on, and more important, take it off right. You’re gonna put yourself
and others at risk. And that means like, there are different and again, this stuff is online. I can include some links. How do you pull the gown over. How do you take the mask
off and the gloves off without touching virus that could be on those surfaces and then
later touching your eyes. And there’s a process for that, that you go through and
if you do it correctly and you wash your hands afterwards and you follow a protocol,
you’re gonna minimize your risk. We need all hands on deck
because there’s two things we have to think about here. The first is number of
infections are going up because what I’ve been talking about. It’s been circulating in the community. Many infections are silent. And we’re only seeing
the sickest ones, right. So when you look at Italy,
they’re talking about these huge numbers of very sick people. They have a very old population, a lot of rural medicine issues, and there’s probably
a lot more circulating in the community and so they’re not able to calculate mortality
numbers that are like less than 5% because they’re only seeing the sickest people and
they don’t know actually, it’s out of how many. They don’t really know. Where as in South Korea,
a lot of younger people, much more aggressive testing. And so because of that great testing, you can actually calculate more
accurate mortality numbers. They’re looking at maybe half of 1%. That’s a vastly different
number, isn’t it? So again, how you get these
numbers really matters. Now one thing we should talk about, how is it that the horse got
out of the barn in the US? Well part of the problem
was we weren’t screening and testing early. There were problems with the tests. Labs couldn’t get access to the virus. The CDC and the government and FDA have these, FDA mostly,
have these arcane rules about how you can test in outbreaks because they wanna make
sure like with Ebola and things like that that
the tests are accurate. But in this rapidly moving situation, it became very difficult for outside labs to be able to generate tests. Then the CDC zone tests
had a flawed component which delayed everything. And by now we’ve already,
it’s a series of events. Now each government agency has good people and they’re trying to do the right thing but they’re not communicating well. They’re not coordinating well. And so that was another potential problem. And then getting access to the
virus itself was a problem. Because the Chinese have a policy of not necessarily
sharing the virus itself. And so, getting the virus was a problem. So for all these reasons,
we’re now way behind. And so, the idea now is
things are gonna start to really potentially take off
and that could overwhelm the healthcare system. So we have the healthcare
system side of it, which are my colleagues who are now, we’re seeing real, real,
real numbers, you guys. Like this is not a made up thing. This is a real thing. Now does that mean that
people in this side, the community should panic. Absolutely not. The panic is what’s
driving a lot of problems on the healthcare side. Should people showing up to clinics with coughs and runny
noses and sore throats saying do I have COVID and freaking out and demanding testing and all that and the truth is, that’s gonna
be very counter productive. Because we’re already
out of the phase where containment would’ve helped. At this point, if you have
symptoms, call your doctor. Connect with your team
and they will tell you what the next step is. Alright. But showing up to your doctor’s office, I’ve already done a video on this. So I would watch that. How to prevent COVID from getting worse. So that being said, now, we’re in a situation where
you have the healthcare system that could get overwhelmed
because the need in sick patients for ventilators will outstrip very rapidly our infrastructure to do this. And we’re starting to see
that this is a danger. It happened in Italy. It’s gonna happen in Spain, and they’re on national lock downs now. So that’s why you’re seeing
this very exuberant response by government officials, a little late. ‘Cause if you’d done this earlier, and actually tested effectively like what the South Koreans did, you would’ve had a much lower slower slope of infection
and you wouldn’t have necessarily overwhelmed the system. So now we’re in the situation where we have to be more
reactive than proactive. Typical American healthcare. So all that being said, in patients themselves,
there seem to be two phases of the infection itself. There’s the first phase where again, the virus enters the body, binds to these Angiotensin receptors in the lung or in the gut, however, because the thing can also
be transmitted through feces. That’s another way of getting it. Again wash your hands. Wash your hands. Cover your cough. Right. Keep a distance from people. This is what we’ve been telling everybody. And once it enters it start replicating. And it seems like this is the first phase, viral replication. In the majority of people, 80% plus, the immune system of the host, keeps that viral replication in check. Has a proper response, you
get symptoms at that point but they’re not severe. And you get better over
some time, one to two weeks. In patients for whom, this doesn’t happen and they tend, not exclusively,
but they tend to be older, have some cardiovascular disease, in fact more so than lung disease. So there seems to be a trend reported that it’s people with
cardiovascular disease, hypertension, other
kinds of heart disease, on cardiac medications,
that sort of thing, and that seems to put them at higher risk for going into this next phase, which is this adaptive immunity phase. So several days later,
people might be feeling okay and then all of a sudden
they get potentially worse. This is when the body’s
immune system really kicks in and viral replication
might go down a little. But at this point, you
have this immune response. Now that can lead to damage to lung cells. Now it seems to be there’s some debate. Is the virus itself
damaging these lung cells, which would explain why older
people tend to get it worse because they have weaker immune systems and can’t mount this exuberant
response in the beginning and young people are able to fight it off. But the virus itself is
what they call cytotoxic, in other words it’s actually
damaging pneumonocytes, lung cells, kidney cells, heart
cells that it can bind to. And in that way is
actually causing the damage that then the immune system compounds by piling on with cells and debris. What we’re seeing clinically
and pathologically, seems to maybe support some of that. In at least some patients. So what happens is people
are doing better and then all of a sudden they start to get a little more short of breath. And now remember this,
there are some patients, particularly elderly patients
who will not manifest symptoms of shortness of breath. But if you put an oxygen probe
on them, their oxygen is low. So called silent hypoxia. So those older patients, you
really have to be more careful. Those are the ones that
end up hospitalized. You wanna monitor them more, whereas younger, healthier people, it seems to be less of an issue. Again, there’s always outliers.
But it’s less of an issue. So in these patients
then, you might develop some shortness of breath
and then it’s a rapid deal. So then they fall into a couple buckets. The kind that do okay with oxygen by mask or by nasal canula. Trying to avoid these high flow oxygens where you’re actually blowing virus around and that kind of thing. So that’s another thing
you have to think about. Alright. And when you intubate,
there’s a series of procedures you wanna think about. There’s online researches
that I might link to that show good sequences
of how to intubate safely. Because when you’re
putting a breathing tube in to someone that needs help, that’s when you can aerosolize virus and put everybody in the
room at risk, alright. So something that again, very important for healthcare colleagues. So in patients who are
just on the nasal canula, some of them do okay and they get better. But the other parts, they start needing more and more support very rapidly. If turns out you’re
thinking about using BiPap, one of those face masks with the BiPap, the sources online are really saying, at that point, just intubate them. Just go mechanical ventilation because they’re gonna need it. It’s just pretty much
assured at that point. Because at that point,
there’s an exuberant reaction called ARDS, Acute
Respiratory Distress Syndrome. And what they are seeing pathologically is diffuse alveolar damage. So, the little alveolar
sacs become sledged up with material and gunk and it impedes the ability to exchange gas from the blood and the
air through the lung and that’s why people have big trouble. What they’re finding
is when you, and again, it’s more it seems,
they’re starting to think maybe there’s a direct
viral cytotoxic effect. And so, it seems that they’re requiring the kind of ventilation that
you would require for ARDS, with one exception. It seems there’s less
of the very stiff lung that we sometimes see,
stiff noncompliant lung, like a very stiff balloon. We’re not seeing as much of that. We’re seeing more the sort of need to prone ventilate,
so put the patient prone because there may be
changes in VQ mismatch. There may be changes
in secretion management and congestion in those
alveoli that may be benefited by the prone positioning. So it’s pretty clear that
from the Italian experience in others that prone
ventilation seems to work. ARDS protocols, sort of Permissive hypercapnia, for people who are speaking my language here. Those kind of things that would manage a typical viral influenza, pneumonia with in an elderly patient or another patient. There’s nothing particularly exceptional about COVID-19, so we would
treat it very similarly. Right with some caveats. So it seems that that kind of ventilator
management, which means we gotta support our
respiratory therapist, our ICU docs or ICU nurses
’cause they’re gonna be running and managing those ventilators and there’s gonna be a lot of patients who need this assistance. A lot meaning if there’s
a ton of infections, the small percentage that need those are gonna represent a lot of people. That’s another reason
we don’t wanna overwhelm the healthcare system. So this being said, now you have, people who are requiring ventilation. So what happens in those patients. Okay. What would you end up doing there. And by the way, given that there’s two phases of this infection that means maybe there’s two different approaches in the different phases. In the first phase,
there’s some speculation that antivirals like the
experimental, remdesivir and chloroquine and these kinda things, the people are talking
about could they be helpful? Kaletra, which a HIV antiretroviral. Could those be useful in the first phase, early rather than later,
when virus is replicating. And it’s not so much as an
immune response compounding it. And then later, it’s less helpful but maybe later what may be more helpful is immune modulation. Now it seems clear from data that steroids are associated with worse outcomes. And so the idea of
putting people on steroids is not, it’s not a
comfortable thing right now. Because we may be making things worse and again, is it because we’re
allowing viral replication to occur and it’s cytotoxic. Or is there some other reason. Are we allowing, the higher likelihood of
secondary bacterial infections associated with ventilators
and other things like that. Or is there some other reason we’re promoting
cardiomyopathy or other things that can happen with
steroids, we don’t know. But we know that the association is bad. But there’s some theorizing
that maybe steroids earlier sorry, steroids later in the disease might be more effective if
there’s an immune component that we’re trying to suppress. So we don’t know yet,
but the current teaching is don’t steroids if you can avoid them unless somebody’s needs
them for other reasons, bad COPD et cetera. So at this point, you have
these ventilated patients. Now what happens to the
ventilated patients. Some of them get better with
conservative management. Now what you have to watch
for are a couple of things. What their seeing is that
this COVID-19 disease, and again I apologize
because I’m doing this out of my brain. I don’t have notes or anything. I have a laptop but I can’t
keep track of any notes. So I apologize if it’s
a little desequenced but I do it as I do it. In the beginning of the infections, you can look at certain
laboratory parameters. Now one of those laboratory parameters, it’s really interesting is that
your white blood cell count is typically normal or low. It’s very rarely high. So if you see a high white count, you may wanna think there’s
a second co-infection, whether it’s bacterial or something else. You just wanna think about that. The second thing to think
about is procalcitonin. Procalcitonin is often used in IC settings to look for infections,
so bacterial infections, things like that can raise
your procalcitonin level and give you a sense that
there’s an infection going on, particularly in patients who are septic. In COVID-19 disease, procalcitonin without other complications
is often normal. So it’s a good thing to
follow a procalcitonin because if it becomes abnormal, that may be a sign that you’ve
got a secondary infection, at which point, something
like an antibiotic or other cultures, or even
rarely bronchoalveolar lavage through bronchoscopy may be necessary. In general, you wanna avoid
that because it’s a great way to get your healthcare
professionals infected. And it’s not really helpful
in standard COVID disease. But if you’re looking
for secondary infection, that can be helpful so procalcitonin. The other things that you see that are abnormal are
liver function tests. Now this becomes important because, there’s been some people
out of Washington, I see docs that have
been writing in saying, you know remdesivir, this
compassionate use protocol for this experimental drug
developed by Gilead for Ebola, there’s been problems
getting patients approved because you have to have LFTs that are too liver function tests
that aren’t too abnormal. And the problem with this
particular disease is the liver function tests
are often abnormal, and we don’t know if
that’s a direct effect or some secondary effect of the virus. So something you can watch
are again liver function test. Kidney function does tend to take a hit. Although not often sever initially. So creatinine’s still less than two. Creatinine clearance
still greater than 30. In a lot of the experience
that people have had, now remember, people who are older have a lot of comorbidities. All bets can be off because
they can have problems with all kinds of things,
including something called cytokine storm. So cytokine storm is
where the immune system just goes totally belligerent,
and you get shock, a picture of sepsis, multi organ failure and potentially death. So again, in that case, all bets are off. But otherwise you’re looking at kidneys, liver, slight abnormalities. We talked about procalcitonin, the complete blood cell count, and then this is something I should mention. Well, let me keep with these
particular labs, alright. What they found is that
because these patients aren’t necessarily super
dehydrated or shocky, pouring these fluids
in is a terrible idea. So you wanna be very
conservative with the fluids in these patients. It’s not like your standard sepsis where you still have to be careful but in this case, it’s
particularly salient that you don’t wanna flood with fluids. So you wanna keep an eye, maybe
don’t do maintenance fluids if you don’t have to, that sort of thing because it can be counterproductive, especially when we talk about what seems to be killing some of
these patients, which is acute asystole or other cardiac arrest. So this is an interesting thing. People start to get better sometimes. They even maybe come off the vent, and then they have cardiac arrest. And all of a sudden someone who had a normal ejection
fraction, normal heart, has an EF of 10. They’re running a code, it’s
often asystole or V-fib. And there done. That’s it. And the thought is there’s
a myositis going on. Myositis is inflammation or
damage to the myocardial cells. The cells of the heart. Well, it turns out we don’t know if that’s due to a direct viral effect. ‘Cause we know that ACE receptors. We don’t know if it’s due
to some of the medication or treatment or stress of being ICU, especially why, remember we talked about it’s people with cardiac
disease that seem to have the highest problems with this. Could there be pre-existing stuff? Or is it secondary to the
cytokine storm itself, which can cause a myopathy. Or is it a direct viral myocarditis. We don’t really know yet. There’s some speculation
but we don’t know yet. The bottom line is you have
to watch very carefully for this dreaded complication. The questions about early pacing, careful cardiac monitoring,
that kind of thing, those things arise, making
sure electrolytes are good. But again, until we know exactly
kind of the etiology of it, it’s hard to have a good course of action for how to manage the myocardial stuff. Now this is why people have
talked about ACE inhibitors. By giving an ACE inhibitor,
could you prevent viral binding and this kind of thing but what the data seems to
preliminary show is that people on ACE inhibitor seem to do worse. Again this is associational data. So they’re already on ACE
inhibitors, which means, they already have a cardiac
issue, hypertension, heart failure, diabetes,
that is requiring an ACE so it’s an associational thing. So it’s hard to tease out, right. The reason, by the way,
people are talking about Advil and nonsteroidal anti inflammatories early in the disease, the
French health minister says don’t use these, right. It’s based on the idea
that it may be slightly immunosuppressive in the
early replicative phase of the disease where virus is replicating, where you want the immune
system to tamp it down. Now again, there’s not really
good evidence for this. It may be associational so,
making a blanket statement like that may not be a good idea. But think of it this way. If you’re gonna end up developing some renal insufficiency, kidney problems, stress ulcers from being ICU-bound NSAIDs are not a good idea to begin with. So Tylenol or Paracetamol if you’re nasty, is a better idea in that case anyways. So you wanna think about that. All right so, at this point, now let’s
back up for a second. Remember I said I’m disjointed because I don’t really go by notes. I’m trying to synthesize
what we’ve been learning over the course of the last few weeks. From colleagues, from data online, from a lot of stuff. Why, okay. What would we want, first
of all, in our testing when we’re screening
patients for this thing, for this type of disease to contain it. We would want a test that is rapid, that is available at the point of care, and that has very few false negatives. What is a false negative? A false negative means you do the test and it falsely tells
you that it’s negative. So in other words someone
with COVID-19 disease is told they’re okay. They go out in the community,
the infect a ton of people. Well it turns out, false
positives are less problematic. In other words, the test
tells you you’re infected. ‘Cause what happens to that person? They go into quarantine. So at least, it’s damaging to them. Right, psychologically
but it’s not damaging to society as much. A false negative is damaging to the fight against this thing. So what we find with this particular test, the PCR, at least early on. It’s got a pretty poor sensitivity. Meaning there a lot of false negatives. Maybe it’s 60% sensitive. So that means you’re
sending home a lot of people that may still be positive. So what the Chinese were doing to overcome that was CT scans. They were screening with CT. Because it’s more sensitive, when you have a high clinical suspicion. And in this country, we’re
not gonna really do that. Alright and part of the problem is disinfecting those
scanners takes 40 minutes. It’s not a very good way. You can look at patients
clinically and do the rapid test and put two and two together, hopefully. So you want a test that’s
got good sensitivity and you combine it with other things. So chest Xray, not very
sensitive, 50, 60%. But you see findings. So my wife showed me quite
a few and it’s quite, look if you don’t read Xrays
a lot, you’re gonna miss ’em. But to somebody who reads a lot
of Xrays, it’s pretty clear. You see these sort of patchy,
often peripheral opacities. We’re not seeing a lot
of pleural effusions, pleural thickenings, things like that. It’s kind of atypical. So if you see that, you
may wanna think about coinfection or a complication. The CT shows ground glass opacitites, often peripherally in the lung and basilar and often bilaterally. And they can be confluent
in severe disease. So it does kinda correlate
a little bit to severity. You’re not seeing a lot of
lymphadenopathy, big lymph nodes. You’re not seeing pleural effusions. So those are interesting findings. And so, our screening tests
are kinda still pretty crappy. So we have to go a little bit on clinical clinical intuition and
that’s another reason that again, the Koreans did it very quickly. But now we’re already late. So at this point, we wanna
do a lot of telemedicine. We wanna kinda screen
people over phone and video. Asking good questions,
risk stratifying them. What’s your age, your
comorbidities, that kind of thing. Now the other twist in this
is there’s some speculation that since this virus replicates, as it replicates it mutates. We’re seeing maybe changes in patterns. So early on mortality was very high. Later on, we’re seeing mortality rates maybe dropping and is that
because there are now two strains of virus. One that has a higher
mortality, in other words, it’s more virulent. And the other that has a lesser mortality and how are these changing over time? We don’t entirely know. We also don’t know how temperature is gonna
effect this thing long term. Is the summer gonna give us a relief. Like it does for influenza. Perhaps the virus doesn’t
live on surfaces as long when it’s hot. Perhaps there’s less
people packed together. People are outdoors more. We don’t know so these are things that are still unknown. So looking at again, so
we talked about radiology, what you see on CT, what you see on Xray. You can also do pulmonary ultrasound. There’s some resource online. EMCrit is a great resource
for all this stuff. E-M-C-R-I-T .org. My friend, Scott Weingart runs that site and it’s got a great set of resources for all these things for
managing these patients. Highly, highly recommend it. I’ll link to it in the notes. So, you have ultrasound, chest Xray, CT scan. You have the lab testing
that we talked about. The other thing we notice
is coagulation parameters, D-dimer can sometimes be elevated. Over time you can develop disseminated intravascular coagulation and so you wanna monitor
coags fairly regularly and that may be just part of
this inflammatory cascade. C-reactive protein is another test that has shown some
interesting correlations to disease severity so,
people who are very sick have higher inflammatory markers like C-reactive protein, CRP. And so there may be some
utility to checking it just to understand the
potential for severity. And where the patient is
but again, you can also do that clinically and without
doing a bunch of blood. I’m trying to think if there’s
other major testing on this, I am not recalling anything
off the top of that. Those are the main
things that stick with me when I think about this. So, you know again,
for these patients now, they’re gonna require ventilators. They’re gonna require safe
intubation, safe for the staff. They’re gonna require
environmental services to turn over rooms, which
means we have to be staffed. They’re gonna require
respiratory therapists to help manage the vents. They’re gonna require ICU level beds, and cardiac monitoring. They’re gonna require
looking at new therapies like remdesivir and I hope
I’m even saying that right because I’ve never had to say that word. Thankfully. Kaltera, chloroquine. It doesn’t look like ACE
inhibitors are a thing. And other sort of
speculation around steroids and those kind of things. So we’re in a state now where we’re on the healthcare side of this equation, people are going to get extremely busy. They’re gonna be very stressed. They’re gonna need all our support. That’s what keeps me up at night. Alright, the community side of it, I’m gonna be totally honest with you, does not keep me up at night because you are more
likely to die from flu because you’re more likely to get flu because it’s much more widespread. Even with a lower mortality. Flu kills, listen, let’s just be very clear here. We’re scared of this virus
because it’s an unknown. Because it spreads rapidly and it does have a mortality rate
that’s higher than flu. However, this 10 times higher
thing is a panic number. You need to look at absolute
risk, not relative risk. What’s your absolute risk of
getting and dying of this? It’s so low. It’s higher in elderly people,
people with comorbidities. But they can take precautions. Staying home, isolating, et cetera. But what we’ve had to do now is put a draconian hammer on everything. It’s already out of the barn. Draconian hammer on everything. Which is gonna harm our poorest people, middle class business owners, our economy. It’s gonna harm people long term, because we’re
wrecking their livelihoods. This is something we really
have to think about, guys. Now we’re in this position because the ball was dropped
early on on containment. And now we’re here having this discussion so the community, I
don’t worry about that. I know the community’s panicked. I’ll tell what I worry
about, fear and stupidity. And the idea that people
are capitalizing on this to really blow it up for the average Joe and make it such that they’re panicking and running to the doctor. Who I worry about are my
colleagues in medicine because they’re gonna deal with this whether it’s a lighter
epidemic or a serious one. They’re going to be slammed. And we need to help them. And that means, if they’re
telling you work from home, if they’re telling you keep
away from other people, if they’re telling you
don’t have big gatherings, if they’re telling you
wash your damn hands, if they’re telling you
those things, just do it. Alright. Let’s do it with a smile and understand that we come together in these situations to help our most vulnerable. That’s what it is. And that’s this group of people. The caregivers and the sickest patients that are gonna suffer through this. Now bottom line is we’re
gonna get through it, period. It is going to be a tough
few weeks, maybe months, but we’re gonna get through it. And it means that we have to be rational. It means that we cannot let fear drive us. And you know, one thing I’ll say is I have been trying
really hard every morning to get up very early and
do at least 30 minutes of meditation and that keeps me centered. Because even I can get very phased if I sit and watch the news. You start second guessing and going wait, what about this, what about. The truth is, this is
something that is explainable, there’s some unknowns. But we know what we need to do now, which is slow the rate of new infections. Help learn and understand how to manage the infections we have. Support our healthcare professionals. Support each other. And then work hard on
vaccines and future prevention and future coordination. That’s the key thing. There’s a lot of politicization. There’s a lot of blame. Non of that is gonna be helpful right now. What’s gonna be helpful
is the task at hand. Then we can throw the feces later, okay. Hopefully, COVID negative feces. So do me a favor, I hope this was helpful. Again I do this kind of the top of my head and sometimes that’s good
and sometimes that’s bad. But I just hate that rehearsed
like reading off notes thing. It makes me wanna stab myself in the eye. I would rather get COVID than have to watch a lecture like that. But for some people, that’s better. There’s plenty of
resources online for that. I’m gonna put links in the thing. But I’d love it is if you share this, if you leave a comment, if you hit like. If you really want to support what we do, becoming a supporter, our supporter tribe has a private discussion group. It’s about I don’t know,
a few thousand people now. And we have discussions
in under closed doors. That you can’t have that are very helpful. We support each other and share data and then spread it out to the world. So the supporter tribe on Facebook. You can support us on
YouTube by becoming a member. Patreon is another way. Alright guys. Do me a favor. Chill. To everybody on the front lines, we’re thinking about you supporting you. We’re gonna try to continue
to educate with these updates. And stay safe out there. We are out, peace.

100 thoughts on “COVID-19 Medical Update March 16 | With Dr. Zubin Damania

  1. This is my “day off” current routine…studying COVID-19…..
    I used to drop Tylan off, catchup on business (paying bills, organizing kids schedules, setting doctor apts,etc.) at my favorite Starbucks while sipping on a specialty drink…now I’m learning as much as I can about COVID-19 and how to protect myself & the non-COVID-19 patients I provide care. Beyond that, I want to walk in a COVID-19 patient’s room with confidence and make them feel human….not like they are trapped or isolated from the world. They are human still….it breaks my heart to hear stories of COVID-19 patients not being feed or offered baths because healthcare workers are scared! I have concerns too, but I have been doing my best to stay safe. Learn, protect, save!

  2. Here the worry isn't just about vent supplies, but also ECMO. We have the biggest hospital in this region of our State and even they don't have that much equipment available if we saw an influx.

  3. @ZDoggMD: Do you think I could ask my doctor for a script for Remdesivir or kyletra NOW as a preventative measure, so that I could take it if/when I develop symptoms? If this virus is responding to HIV medications, in some cases, could PREP prevent infection of Coronavirus?

  4. In Dallas County Texas 3 patients in critical care one is in their 20’s, one in their 30’s and a 60 year old the press stated none of these patients had underlying conditions and were completely healthy. It’s mutating and not only harming the old. If you are young you aren’t immune. This isn’t mild listen to the Italians.

  5. Sorry Doc. You've lost all credibility. Your old videos praising China for handling it (how'd that work out?) before it blew up and spread to the world are still up. Those are trophies in your Wall of Shame.
    Oh, don't forget to praise their welding skills we saw.when they locked people in their houses and died (Chinese gvt said they were sleeping).

  6. Thank you for the up to date information and explaining it in such a way that most people can understand how the virus spreads and how it can affect different populations. This is information that I think is incredibly important not just for the medical community but for everyone. The lack of information at the moment is driving a lot of the panic which is leading to the "me first" mentality instead of how can I best serve my community

  7. (from NEJM study ) The virus's median half-life was about 1 hour as an aerosol. No viable virus was detected after 4 hours on copper, 24 hours on cardboard, and 72 hours on plastic and stainless steel.

  8. Thanks for this, so much misinformation out there just to spread panic and fear and not using at least decently accurate information. I am a CNA and been listening to video after video on you tube instead of relying solely on the media. The best people can do right now is stay safe and healthy, wash hands, avoid gatherings, and find the information for yourself via you tube or online searches because the media certainly will not be truthful or factual with their information, because they would rather put politics above the health and well being of the masses.

  9. Dr. Damania I wasn't a fan of your last DocVader video. As a healthcare worker in the ED in Washington it rang as very very dismissive of the gravity of the situation. We are on fire here and you reinforcing the ideas of "oh it's just like the flu" is damaging.
    It's damaging to hospital culture.
    Arguably the thing that has probably caused the most danger in my coworkers has been that attitude of ambivalence toward the situation.

  10. Fear is more contagious than the virus. When one has faith in God, there should be no fear. This is no biblical plague. The plague of locusts in Africa recently flew under the news. As did the bird flu that erupted 6 hours from Wuhan. Two weeks after the corona virus. 1000’s of fowl foul were killed. Was that discussed? No, cause everyone’s head is underneath a sanitizer and worried about butt preparedness. The corona virus has nothing on Ebola Zaire or Marburg. Both of them are filovirus’s. They’re hemorrhagic fevers. Viruses fool cells into opening for them. Posing as protein structures or other bodily organelles to breach the cell membrane. Once inside they begin switching their RNA blueprints for the DNA within our own. Corona has around a 2% mortality rate. Which is slightly higher than the flu. Those that die from it are very old, very young and the immune compromised. In 1989 Ebola Zaire made itself known. It has a whopping 90% mortality rate. The virus literally explodes the cells. Causing a massive internal hemorrhaging. They puke it out. It begins coming outta every orifice. It’s a short illness, thankfully. There is no cure nor vaccine for it. And it hasn’t been eradicated! So when they tell me that Ebola Zaire or Marburg is stateside, then I’ll panic. Until then it’s biz as usual. Meaning living my life not fretting about my death. Y’all put the pan-ick into pandemic.

  11. I live in London and got sick yesterday likely from covid-19 (symptoms are more similar to covid19 than influenza ) luckly I'm young and healthy so it doesn't seem any worst than an average flu… Is that the case? I have the impression that the desease itself is not any more deadly and dangerous than flu. It seems to me that the reason it's causing such a crisis and so many deaths is because it is new. Nobody is immune and we have not a vaccine. Anybody who is at risk for coronavirus would be very much at risk for the flu as well, except that they would probably have a vaccine and herd immunity for that…

    It seems that this coronavirus spreads more quickly than the seasonal flu, but I'm not sure if that is an actual difference between the two deseases, but rather because of the lack of immunity by anybody in the community

  12. My girlfriend and her mother got sick mid February, before we were really concerned about the virus. But looking back, their symptoms were spot on..were in idaho, what are the chances it could have been the virus?

  13. The percentage of people infected and subsequently the death rate on the princess cruise ship we’re both very low. I’ve seen some simulations that insist 100% infections if people aren’t “social distancing”. Why didn’t 100% of the people on the cruiseship get infected?

  14. How come only americans show kindness, curtesy and solidarity? Really? The rest of the world isn't that much different. Typically american to be this naive.

  15. As an ENT, I really appreciate you taking the time to post these videos. They have been so helpful and informative. You've been my go-to for up to date information.

  16. how exactly does smoking make an individual higher risk? Is it just because you are touching your face area more? Does it chemically make your lungs more susceptible somehow? Does it just suppress the immune system which leads to greater vulnerability? People keep saying that now is the time to quit smoking, but haven't yet heard an explanation as to why, with respect to this disease. Anyone who's come across an explanation please enlighten me

  17. Young people are not at risk of developing sever COVID 19- UNLESS they are working several jobs, working overtime and/ or living in their cars or are homeless.

  18. Zdogg, have you heard anything about the cases of myocarditis that have been developing in people who aren’t part of the “vulnerable population”?

  19. Testing is based on WHO tests which were shown to be not accurate: too many false positives and negatives. Thats why the CDC has properly used US companies to produce the tests. The other problem was that Korea was using SARS tests that were not specific to COVID but they deduced the results to implicate COVID.

  20. I am grateful for this post. I recommend substituting “exuberant” with a wide like extreme or elevated. Exuberant doesn’t fit here. I’m not a grammar nazi I just think exuberant is ill-fitting and offers the wrong connotation. (Unless in the medical field it means something that’s lowly regular Joe like me wouldn’t know).

    Otherwise an excellent post, Dr Z!

  21. I really like the way you break this down, thank you. Will be keeping an eye out for your videos. Take care and stay safe

  22. Thank you. THE most thorough and easily understood professional video I’ve watched. Our thanks to the “front line” docs & nurses

  23. There's been new information on airborne spread and viral lifespan on surfaces since this video was made. I wish I had a good source. I guess I'm just fear mongering. Sorry. But look it up anyway.

  24. The TRUTH about Coronavirus!
    The entire document he is citing:


  26. Dr. Z, what do you think of high doses of Vitamin C????? Chinese are administering vitamin c intravenously to some patients now and it seems to help.

  27. I've read that only Italy has been transparent with their numbers. Any thoughts on this Doctor? Thanks, fellow healthcare provider.

  28. Does anyone agree that "Just in time" ordering, and keeping PPE stocks low due to the idea of "lean" medical offices has attributed to this mess?
    When our physician's office transitioned to this whole idea a few years ago, I remember our office manager telling us "we don't need to stock our closets, because we can just order what we need from our suppliers and get it in a day or so".
    Ya right.

  29. Doc, anabolic steroids is the answer to kick this virus out of rhe body. Deca-durabolin binds to receptors in the heart………..

  30. Thanks for this – got to it late. Seeing patients, answering questions, being on the front lines with my dedicated colleagues doing the best we can. Beds are going to run out – that's the next thing we need to be prepped for. Keep the updates coming; my public health hat has been put on too many times in the past 20 years.

  31. I would love to hear your thoughts on what smaller hospitals can do to cope with this entire situation. I work in a 6 bed ER, and we have 1 isolation room that was used for TB patients back in the day. We transfer out all of our serious cases to bigger hospitals, but what are we supposed to do with the sudden influx of cases like this when we literally only have 7 people working in the entire building? (1 doctor, 3 nurses, a lab tech, ct/xray tech, and registration.) We can't even handle 2 codes at once…

  32. What about blood type? I recall an article speaking to blood types where 45% were 0 and majority’s patients with worse symptoms were that of blood type A

  33. Soooo, if I’m already on Plaquenil would that maybe help shield me from this SARS Cov-2 and Covid-19 disease? I have lupus and several comorbidities.

  34. Getting around to this video today as a friend sent it, and I must say… ZDogg… You have made me feel a lot better about things, I am of course taking every precaution and reducing as much contact as possible — but no longer am I dwelling in the hype and fear that the media had tried to instill.

  35. As a former respiratory therapists it gives me chills just thinking about putting multiple patients on one ventilator. That would be a genuine hail Mary pass.

  36. Meantime my country is currently talking about going into a lock down. Its panic clearing shelves from grocery stores Round 2.

  37. Thank you. You have a wonderful way of giving information and keeping it real. No hype or BS. Peace and stay healthy!

  38. A lot of what is said in this post seems to come directly from the anonymous post that was being passed around that was "forwarded from a Hopkins Intensivist." Specifically the topics of going straight from BiPAP to definitive airway, steroids and cardiac arrest after seeming improvement. My only issue with using that as the main source of info is that from working in the Baltimore/DC area, I've heard multiple hospitals have tried contacting whoever wrote this info and can't get anyone to confirm it's validity. So that's kind of concerning if it's the basis for this video.

  39. Thanks doc. I have been watching Dr. Michael Osterholm videos and updates. He has repeated the primary transmission path is "just breathing." With what you know, can you close the gap between what he has been saying and how you described aerosolization?

  40. Can you please cite where you got the 60% false negative testing stat? I’m interested in looking into this further.

  41. Thank you for calmly, rationally, intelligently explaining in laymen’s terms how this disease is affecting everyone, and how its being managed. It takes a village!

  42. You are one of the only physicians online I trust.. shared this video with family and loved ones to calm the storm .. I am a surgical icu rn and we are utilizing the icus for rule out cases and positives cases.. I appreciate all the information on the lab results. I can take much of this info with me to the unit… thanks

  43. As a retired nurse and the wife of a working pediatrician who both have medical issues, I cannot thank you enough for this very informative and reassuring video.

  44. Past the stage of containment and we shouldn't blame fingers….I told everyone not to let citizens go back to their country until this Coronaess was over and I'm not a medical anything,COMMON FUCKING SENSE…if you leave the sick and possibly sick in Wuhan the virus can not spread period.tgis isn't a airborne Illness this is contact to for rights,fuck your rights this is a virus whi h is more harmful the we've seen before. But nope our government and medical community that knew just as much as the next person decided to say "hey during this quarantine and sensitive time…maybe we can bring our citizens back home and leave them in our own little quarantine set up to prove to everyone else that we have the bigger dick complex…and if it fails we can always say this is nothing but a bad flu,let's bring our citizens home and endanger millions" smart

  45. I thought it lasted 4 to 72 hours on surfaces? Like closer to 3 days on plastic, but far less on metals like copper? Can a UV goggle cabinet kill this virus? What temperatures kill it?

  46. Regarding mitigation of symptoms and severity of illness (so people don't even need to go to the hospital), I have been researching all the Vitamin C advocacy (including your interview with Dr. Mariks –, and while I find the Orthomolecular News Service to be *a bit hyped up*, their advocation of increasing Vitamin C intake to around 1500-3000mg (500-1000mg in the morning, noon, and in the evening) would be warranted…

    And IF someone feels a bit ill, to even try Dr. Cathcart's (*oral* not IV) "Titrating to Bowel Tolerance" protocol ( I dare say, at the risk of sounding like a 'quack', this would likely be helpful to lessen the severity of the symptoms of illness in most cases.

    While this is *not a cure*, and *will not make people immune*, it A) Won't hurt people, B) Will ensure people's Vitamin C levels will be 'topped off' preillness.

    I think there is enough data to support this will be helpful, and if we can decrease people slamming the hospitals with sever cases by doing this, it is worth advocating.

    Obviously if that doesn't help and symptoms start getting more severe, go to the hospital.

  47. What type of permanent damage can this disease do, and how well can we create antibodies to prevent it from reoccurring? I am particularly scared of lung damage as I get the sense that among body healing abilities, the lungs suck at it.

  48. Found your channel because of the My Corona music video. Stayed for the informative, well laid out facts. Thank you, sir, for your efforts.

  49. PROOF the DOJ, HHS, CDC, VICP covered up Causation Correlation between Vaccines & AUTISM Dr. Andrew Zimmerman WHISTLEBLOWER (US Govt./VICP EXPERT Witness), as of Sept. 7th, 2018, which he informed several DOJ attorneys on June 15, 2007 that;
    #8. … "there were exceptions in which Vaccination could CAUSE Autism ." …
    #9. … "in a subset of Children an underlying mitochondrial dysfunction, vaccine induced fever and immune stimulation that exceeded metabolic energy reserves could, and in at least one of my patients, did cause regressive encephalopathy with features of Autism Spectrum disorder . " …
    #10. … "I explained that my opinion regarding exceptions in which Vaccines could CAUSE Autism was based upon advances in science, medicine, and clinical research of one of my patients in particular." …
    #20. … "In my opinion, it highly misleading to allow the Department of Justice to continue to use my original written expert testimony , as to Michelle Cedillo, as evidence against the remaining petitioners in the O.A.P. in light of the above referenced information which I explained to the DOJ attorneys while omitting the caveat regarding exceptions in which Vaccinations could CAUSE Autism. " … (In Layman's = The DOJ LIED, committed Purgery) (This is what a REAL Unbiased Journalist sounds like, Folks) ( Dr. Zimmerman's Affidavit , don't Believe me read it for yourself)

    We ALL live in a Corporatocracy, where as the Bottom-Line matters more than Human LIFE, even our CHILDREN'S LIVES. The DOJ omits data/evidence just as the CDC omits data-sets (Scientific Findings) to protect the Bottom-Line & SALES of BigPharma, RISKING the Health of the Population & targeting our CHILDREN 1st and foremost, then our Seniors and then Mother's-To-BE!! There's no difference between these two.

    The O.A.P. Omnibus Autism Proceedings, which consisted of over 5,400+ petitioners of Vaccine Injured, ONLY 6 Cases were reviewed that determined the outcome for the 5,400+. Doesn't sound like Due Process to me Folks (Violates the 5th Amendment) in the 1st place, this is how our Justice System works today and further evidence of the CORRUPTION within the VICP. The VICP has PAID out more than $4,033,000,000.00 BILLION DOLLARS in DAMAGES due to VACCINES!!! This figure should be 10X's that, at over $40 BILLION In DAMAGES, but alas the VICP are CORRUPT PAID SHILLS. The 5,400+ Injured CHILDREN represented an additional $1,000,000,000.00++ BILLION DOLLARS in DAMAGES to add to that VICP Total and do you know what happens IF that TRUST runs out of MONEY?? The VICP would be REVOKED and BigPHARMA would be LIABLE once again, paying out 10's to 100's MILLIONS each year, instead of us Tax Payers! So, there were plenty of REASONS why these DOJ Attorney's LIED, as well as the DOJ Admin's & the VICP Kangaroo Hearings . Until this program is ended, BigPHARMA will continue the POISONING of our Children & our Seniors & all our Pregnant Mother's to be ( there's NO SCIENCE demonstrating Vaccines are Safe for developing fetuses–ZERO!..NEVER EVER! ). Besides, EVERY FDA Vaccine Clinical Trial VIOLATES the SCIENTIFIC METHOD FACT!!…because NO CONTROL (Saline-Placebo) is EVER used in the Experiments! (a 7th Grade Biology Student would know this is WRONG/FRAUD! ) Yet, our "White Coats" in lockstep, follow their orders Jack-Boot style, Damn COWS is all they are, with no Critical Thought what-so-ever.

    BILLIONS in DAMAGE FOLKS, THINK!! What Drug, Plain Train, Car or Tool would you CONTINUE to USE, IF it CAUSED BILLIONS in DAMAGE? HMM??? LOL! Folks better WAKE UP or it WILL literally cost you TIME from your LIFE or WORSE a Loved One!!! FACT!

    These are 2 perfect examples that demonstrate exactly how the Federal Government & BigPharma, intentionally violate the Scientific Method, committing Fraud.

    Dr. Gary Goldman CDC WHISTLEBLOWER Official Statement….."When research data concerning Vaccine used in Human Populations is being suppressed and/or being misrepresented, this is very disturbing and goes against all scientific norms and compromises professional ethics."…..
    Take a listen to Dr. Gary Goldman (CDC) at the 21:42 & 30:00 mark….this should Help everyone understand what we're ALL dealing with, from the *Horses-mouth.*

    Dr. William Thompson CDC WHISTLEBLOWER Official Statement…."I regret that my coauthors and I omitted statistically significant information in our 2004 article published in the journal Pediatrics. The omitted data suggested that African American males who received the MMR vaccine before age 36 months were at increased risk for autism. Decisions were made regarding which findings to report after the data were collected, and I believe that the final study protocol was not followed."….

    Dr. William Thompson, CDC WHISTLEBLOWER …still one of their TOP Scientist (he's protected, thank God). In August of 2014, Dr. Thompson came forward and stated: He conducted a FRAUDULENT Study, his Colleagues conducted a FRAUDULENT Study and Top CDC Admins conducted a FRAUDULENT Study, that was ordered by Congress via the DOJ. The study in question was the last Federally funded study that looked at the Causation Correlation concept between the MMR Vaccine & Autism. Sadly, all of these Scientist & Admins OMITTED Scientific Data (Data-sets), that demonstrated Causation Correlation between the MMR Vaccine & Autism. They ALL Violated the Scientific Method.

    In a science experiment, One is not allowed to OMIT data that does NOT fit the Scientists Hypothesis, this is FRAUD. A scientists is supposed to adjust their Hypothesis based upon the data collected, not the other way around. Due to the Conflicts of Interest/Corruption that exists within the CDC, FDA, NIH, HHS, etc. not even Science is safe or effective in the United States or with our Allies as a matter of Fact.

    African American Males have a 340% INCREASED RISK of an Autism Diagnosis, IF that CHILD receives the MMR Vaccine PRIOR to 36 months of age. FACT!!

    This was the data-set (Scientific Findings) the CDC Covered up & literally threw in the Trash. When Dr. Thompson was ordered, along with his Colleagues to dispose of this information. Dr. Thompson knew it was a violation of Federal Laws, like FOIA and he kept all of his data. He gave Congress (Posey (FL)) over 10,000 pages of this evidence as PROOF of the FRAUDULENT SCIENCE. Sadly, since our Congress & Senate are CORRUPT as well…..Nothing has come about because of this? Not even so much as a WARNING to AFRICAN AMERICAN PARENTS ???? Sadly, the DOJ has FAILED to ACT as well, which confirms their CORRUPTION! The Scientific Journal "Pediatrics" that published the paper, has yet to RETRACT the paper, despite the testimony of FRAUD, by a Author, so the Pediatrics Journal is CORRUPT, a worth-less RAG!

    What I have stated is a FACT and not up for debate … if anyone could debate these FACTS anyways, but simply IGNORING the 10,000 pages of EVIDENCE and Testimony of Dr. William Thompson is the norm today. There's no way to disprove/debunk this, one can read Dr. Thompson's Testimony & Listen to Congressman Posey's statements before Congress.

    Next…..Research Dr. Judy Mikovitz WHISTLEBLOWER An accredited Scientists that has exposed Retro-Viruses that exist within EVERY Vaccine. Retro-Viruses are viruses that reside in other animal kingdoms and when injected in Mammals, can lay dormant, but upon activation, can create a firestorm of illness (Your Dr. won't have a clue what's wrong). SV40 is such a Retro-Virus, that resides within the Polio Vaccine, which has contributed to the mass epidemic of 1,000.000's of Cancers we see today.

    What everyone should know & consider about Vaccines :
    1. ALL Vaccines contain Retro-Viruses (cause Cancer++).
    2. ALL Vaccines contain Round-Up/Glyphosate & 1/3rd contain ARSENIC (cause Cancer++).
    3. All Vaccines contain TOXIC Chemicals (Neuro-Toxins/Chemo Drugs/Aborted Fetuses).
    4. The Science behind Vaccines is Fraudulent (Pseudo-Science).
    5. Safe Vaccines could be manufactured, but purposely they are left TOXIC.
    6. Federal Regulators have been Captured by Industry (All Credibility Lost).
    7. The Scientific Method is DEAD within the United States & with our Allies (AND it's NOT just Vaccines, think again!)

    What ACTUALLY ELIMINATED & Controlled the Dangers of ALL Childhood Diseases & REDUCED their Mortality Rates by 93-98% in North America, as well as the World for that matter? ….(even Countries that DIDN'T have Vaccine Campaigns) This is NOT TAUGHT at BigPharma's Universities for some reason. Hmm? Wonder WHY?

    #1. Proper Waste Management & Clean Water (Thank a Plumber or a Trash-man, NOT a Dr.)
    #2. Nutrition (Bread Basket-Vitamin C CURED Scurvy & Vitamin C CURES Tetanus when infected & Reduces Whooping Cough/Pertussis to a couple day-week-long infection instead of the dreaded "100 Day Cough", Vitamin A Eliminates the Measles Mortality Rate & complications, etc)
    #3. Quarantine (CURED Spanish Flu)
    #4. Less Confined Living Conditions
    #5. A Clean Terrain

    It's US against THEM (the Remorseless Psychopaths, Fraudulent Scientists & SKEPTIC Paid SHILLS )

    Either, you're with the PEOPLE or the Psychopaths in Washington (& their buddies; DOJ, Saddam, VICP, Osama, CDC, Noriega, FDA, the Shah, EPA, Council on Foreign Relations (CFR), HHS, Trilateral Commission, NIH, Saudi's, AMA, Likud Coalition, Stalin, Israeli Govt., BigPharma, Hitler, CIA, FBI, etc.). It's real simple Folks..

  50. This guy is all hype. You will do better to follow David Sinclair phd and you can tell he has a greater breadth of knowledge than this person and he doesn’t like listening to himself talk psh unreal

  51. According to the Coronavirus Resource Center at the coronavirus is airborne. "The researchers also found that this virus can hang out as droplets in the air for up to three hours before they fall. But most often they will fall more quickly."

  52. I work in a community pharmacy. This disease has turned my job into a mad house. People are getting their dr's to write scripts for them such as inhalers and antibiotics to stock pile them at house. Its to a point where we don't have any inhalers in stock and running low on other medications. Its not fair to those who need to use their inhalers on the daily and need their monthly refill. I still try to remain positive throughout the chaos.

  53. Curious about the CRP for those of us who already have an elevated CRP due to autoimmune inflammatory conditions?

  54. If a virus is a disease then we have a lot of diseases in our body already. We should be careful how we use words.

  55. I appreciate what you're saying buddy. It's obviously a real virus. But like you say, we need to approach it rationally and quit acting foolish and buying all the stores out. Thanks for making these videos.

  56. to compare seasonal influences on covid 19, we can look to the southern hemisphere data. While we are going from winter to spring,, they are going from summer to fall.

  57. Z DOGG provides more vital info than my employer does… Dr Z I am forever grateful and appreciate you!


    A patient that’s recovering describing his symptoms. He mentions healthcare workers are getting harassed for helping patients

  59. -Absolutely brilliant and thorough explanation. The first 80% of vlog time, details the issues in medical terminology. the last 20% of this vlog explains the Real issues, those exponentially exasperated by naivete' and politicization. Meditation, as mentioned, is also powerful, far more than non-believers can fathom.

  60. Maybe we just have a similar thought process, but this was very easy to follow and the links between speaking points were easily discernible. Keep up the good work!

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