Hello gut check project fans and KBMD health family It is now time for COVID believe it or not episode installment number eight. We can't escape it. It will not go away this this is going to be probably the most controversial episode to date that we've ever done on on COVID. Your co host here, Dr. Kenneth brown along with me, Eric Rieger. Ken, what's happening?

Not much, Eric. I mean, this is this this episode the way that we're getting into some murky waters. Now we're talking about some controversial things here. And, you know, after watching that video of that Scottsdale woman, barge into the target, and tear apart that mass display. She was wearing that $40,000 watch and it really got me wondering, What is she doing shopping at target with a $40,000 watch on I mean isn't that more of a Neiman's thing or she used to be tearing apart the mask station at Neiman's or I don't know.

You'd think you could use that watch to get somebody to go shopping for you.

It's just such an odd world we're living in. All of this stuff is being captured. And it's not like somebody filmed her. She sent out front filmed herself said this is what I'm gonna do. With a $40,000 watch on. I'm gonna go into this target and I'm gonna destroy this mask display because masks. So Eric Rieger this episode is controversial. What are we going to talk about today?

Well, it sounds to me like we're going to be talking about Karens on Reddit. Is that right?

No, not even close we're gonna be talking about.

Honestly you know what I'll get we got some fans out there and I know two friends of mine whose names are Karen and I think that sucks that they always have to be under fire for a good name. 

Oh, your poor Karen friends. They're taking a beating right now. 

Ridiculous. But regardless, so no, Karen's on Reddit, what are we going to be doing?

Well, we're gonna talk about masks, and we're just gonna kick some science like we always do. So this isn't a political thing. This isn't a controversial Well, it's controversial for some people. And I don't really understand why because I just want to go over the science of this. So before we get into that, let's talk about what's going on locally. And certainly one thing happened that you and I could not participate in, and it's our good friend, Nick and Jessica's wedding that happened on Friday. Why? Because big shout out to them. Congratulations. That's awesome. Nick is one of our most valued employees. He started the company with us. Love the fact that he got married and I hate the fact that you and I couldn't go.

Yeah, unfortunately, the procedure center that we do all of the endoscopies at...we had a confirmed at least two cases of people that came through we were advised as healthcare providers that we needed to be diligent for at least five days and make certain that we did not insert our presence into crowds of more than 10 publicly and that was, I mean, not to be able to go and support someone that we care a lot about such as Nick and then his new wife Jessica was no fun at all. But on top of that, it also led to doing next to nothing for five days over the Fourth of July weekend. So our freedom was basically sit at home and just trying to get people sick.

That's exactly it. I've got a great firework display of me with a one of those little sparklers in my backyard alone.

Yeah, that's that's about as far as is it gotta be here. We fortunately I live in the country. So there is a handful of folks who shot off fireworks but that pretty much concluded the Fourth of July weekend for 2020.

A quick shout out to my mom just turned 78 on July 4th, got a bunch of pitches from her love the fact that she's still kicking it staining her own deck staining her own deck, taking care of her own yard. 78 mom Happy birthday.

Happy birthday. Diana Brown. That's awesome.

Um, so this is a really interesting thing. I'm a little bit shocked about the whole way that we're kind of approaching this whole mask situation and all these other things right now. This is July 2020, we're in the middle of a pandemic, we're having a resurgence of everything. Everybody's flipping out again, we had the first flip out, and now we're having flip out number two, and everybody's wondering what the government's gonna do, but I don't blame them because we're six months into this pandemic. And there's so many things that have had misinformation from organizations that we traditionally would say, Oh, they said it, it's perfect. So like the CDC and the who the World Health Organization. Let's just go over a couple quick things. And if you look back at the earlier episodes of gut check project on COVID. We've been ahead of the science the whole time, and we've really just tried to talk science not conjecture, not scary, nothing like that. So this is initially, the who said, there's no evidence that this has human to human transmission. Wrong, learned that very quick, that was very wrong. And then the CDC came out and said masks don't matter. And wrong. Now they're mandatory. And we were told that hydroxychloroquine plaquenil was a panacea, it's gonna fix everything. It's gonna cure everybody. And then this article comes out and it says, no, it's harming people. And then everybody retracted articles from the Lancet and the New England Journal of Medicine and said, what are we doing publishing this, this crap? And really, an article came out last week that said, no a much more refined, well done study actually shows that it saves lives. And then when they looked back and looked at the original study, that it was probably poorly done, and they didn't equate for certain risk factors and stuff. So it's really hard to know what to actually do this is, this is unprecedented times, this is not something that we have ever dealt with before. So it's okay to be wrong. just own it and know that you're wrong.

It is. And I do want to point out something before we get too far if you're watching this and you feel as if something's going to be presented from a political slant, trust me that is the furthest thing from what Ken and I want to do on this topic whatsoever. Science should be agnostic to any political affiliation. And I think what you're going to hear from Ken and I as we move forward, is just utilize data. That's what science is about. And that's how we save lives. It has zero to do with a with a political party whatsoever.

Dude, this totally reminds me This is deja vu for me, though. I mean, you have to understand remember, I take polyphenols every single day. So I remember back in the 1940s and 50s when seatbelts were first proposed Getting in huge arguments with people. Oh, yeah, just like yeah, seat belts. It aroused heated debates, despite increasing scientific research. It was between, I think it was in 1947 I get in a huge argument with somebody that affirming that the this actually saves lives. And among the arguments put forth against the seat belts, there were all these other things. And they were all disputed by researchers. But the opposition to seat belts remained in place and it took all up to the 1980s to actually make it so that you all cars had to have three point seat belts. And I don't even know when the law went into place where basically you get a ticket if you don't so, I've been through this before I've been through arguments for science tries to win. And so I remember 1948, that was tough.

That's it's amazing how young you look for having been around just after the World War Two and old enough to have that kind of conversation. So my hat's off to you for being around in the 40s. And, and and really just kind of keeping it together and passing for a 40 year old yourself now, so that's kind of weird.

You know it. It's odd. It's a little bit odd.

Yeah, it's really, really strange. I mean, like, seriously, you were so far ahead of the curve on polyphenols alone that, well, I don't even want to go through it. But regardless, that's amazing that you were there for 40 for four decades, just to...the 80s.

But isn't it funny because we're going to talk about masks here for a second and the seatbelts went through the same not quite with the, with the, I guess, emotional power that's going on. But a lot of people fought seatbelts and said, that's my constitutional right. If I want to die, I can die. And it took forever, from 1940 to 1980 to actually make it that it was a mandated thing in cars. 

My grandmother was one of those who was vehemently opposed to having to wear seatbelts so much so that she had talked about that she was going to sew something that looked like a seat belt on to her shirts just so that she wouldn't have to have one on, but.

Not to put you on the spot here because I know how much you loved your dad. But tell me that story about you driving with your dad in the car. 

Oh, in the 70s Yeah, some of my earliest memories of riding with my dad. We lived in a small town and there was a lake nearby and I can still remember my dad and his buddy Jim. We it was commonplace, I guess for us to go out to the lake. Well, occasionally, dad, let me was probably about three or four years old sit in his lap, and, you know, work the steering wheel while he worked the pedals and he would hang his left hand up the, at the window, so he could ash his cigarette, you know, it was all the good stuff.

Was that was certainly that was certainly the time so. So now it's, it's 2020 I hop on Reddit, you know, the front page of the internet, whatever. And I see all these public freak outs and a lot of them are over this whole mask issue. So I just wanted to talk some science. I don't want to make it political. I just want to have some fun dialogue about viruses, and masks. And I found three studies that are pending publication meaning they've been accepted. They're not in print yet. They just came out like last week that I just want to talk into that I just want to talk about a little bit. 

Let's do it. I mean, this is this is what it's about. Let's get into some data on why we would believe one thing or another.

Yeah. So all right, starting one article from China, which is really interesting, because when everything first came out, 

Hey Ken your sound went off.

Oh, my goodness. It sure did that. Sorry about that.

Sorry about that. You said in China just start over you're good.

Yeah. So in China, so this article comes out of China. It's it's pending publication here. What I thought was really cool is that they went back and they looked at the very beginning. And they said, well, let's do a deep epidemiological dive, it's a hard word for me to say, of a cluster of people. And so they looked at a group of people in the Zhang province, which next to the Wu Han area, which I forgot what the province is called, has had a very, very high concentration of COVID. But they're going back to the beginning of covid. So this is like early January, that kind of thing. They tracked down a person that came from Wu Han, so he was probably exposed there. And then he ultimately very quickly infected seven other people, then what they did, it's really cool because this has not been done yet. They tracked out who ever they had contact with. Primary contact, secondary contact. So we've been speculating about a lot of different things. And what they're able to show is that these seven people had contact, direct or indirect, meaning close or not close with 539 people in a very short period of time. So that's shows how much we interact with people, even though we don't really realize it. What they what they were able to determine. And all these people, the seven people were asymptomatic. So they didn't had no idea that COVID covered was just breaking on the scene. It's all this other stuff. And what they showed is that all these people, if they had close contact to somebody, almost 30% or 29% of the people actually contracted COVID-contracted it: proven positive and had symptoms and all this other stuff. The secondary contact, meaning no direct contact, and what I'm talking about is people that did have never actually talked to the people that they talked to the person that talked to the person that may have done that, or maybe it was a waiter that delivered food, that kind of thing. It was .6%. So this is the first article to come out and actually delineate the exposure to risk of infection. So .6%. So what this does, is this strongly highlights a droplet theory because I remember, and I remember having like very early on Mike Logsin asked me He's like, Hey man, is this aerosolized or is this droplet and that's what we're gonna talk about today. Because it's terrifying. If you start talking about this being aerosolized, this kind of thing, and this is what all this is about. So what this highlighted was a droplet theory, meaning that if you're close to somebody, then you have a higher likelihood of getting infected. The US published a very similar article to this and this is why the CDC said it appears that it could be droplet transmission, as opposed to aerosolized. Now, a couple interesting other caveats that we won't get into because I think it should be its own show, is the median incubation period was seven days of these people to develop symptoms. And the people that actually had it, almost all of them initially had negative PCR tests, and then they continued to go back and then they'd started then they go back and they look and they go, Oh look, you had an elevated CRP and an elevated ferritin. And they kept checking them and then they got a PCR positive. And what I mean by this is, maybe when we're sitting there saying go get tested. So I recently had a patient that was PCR negative on one day PCR negative two days letter, because you're like, man, she's gotta have COVID this is crazy. And then PCR positive three days later, which is very odd in the sense that you develop a seven day incubation period, your viral loads peaking at that time, that's why you're having these issues. And two PCRs were negative. So hanging your hat on the fact that it's a PCR meaning that nasal swab where they poke your brain, it's it even happened in this study. So I don't know what your thoughts are, but definitely, the odds are way higher than what the R not meaning the number of people that could be infected. If it's a close familial unit, what they showed is when you're in close contact with somebody, you have a very high likelihood of contracting COVID if you take the necessary precautions. And they were they weren't even taking the necessary precautions at this, but the secondary to secondary transmission. So this brings up the whole idea that if we can squash it before other people are carrying it makes a huge difference because this is early on in COVID. I don't think you'd see those same numbers if they did it again.

No, I totally agree. And what you just described for the patient isn't, I mean in and of itself as what could be seen as anecdotal. However, there's a couple of different stories that have played out exactly like that. There's a there's another anesthesia provider that you and I both know. And she experienced the same thing after coming into exposure she had two PCR negatives only to have really bad symptoms set up. I think it was three days between the first two and then three days after she had the next test showed up positive because she had bad symptoms, and sure enough, she was COVID positive at that point. So that that's not really that big of an anomaly. I don't I don't think at all. 

No, I don't think it is either. And, you know, we did a whole show on antibodies and we are still sitting on the, we're still waiting to determine what is the best antibody test. And we really at the data that we had, we were so confident. This is what it's this is what we were going to do. This is how it was going to be. And it was gonna be so exciting. And now that is pulling up. So all we can do is just kind of look at the data that's here. So this article shows that if somebody has it and they're in close contact, they can easily infect seven close family members, those seven family members have contact to 529 people or 39 people really quick because they went to a wedding which is why you and I didn't go to Nick's.

Precisely the reason we didn't go

Yeah. And so what they the now the the critique that I have of this article is that what they did is they they did a great job of tracking down 529 people or 39 can't remember what it was. 539 sorry, 539. And they just called him up and said, Did you have this? Did you have that? So and So, and they didn't. So those people that didn't have symptoms, they said they probably didn't get it. And we know that's not right anymore. We know that a lot of people are essentially asymptomatic, or they just blame it on allergies or whatever. So the point of this is close contact. Proximity makes a difference.

Yeah, yeah, I'm sure it does. And knowing that proximity matters, what do they call the, and maybe one of the studies that you're gonna reference today shows it but not the...graph, that's what shows the displacement of air whenever we breathe in, but there's, there's these UV light and infrared light scanners that show the airflow that comes out of your mouth when you're uninhibited, right? And then you can see distance etc. But having an object even if it happens to be really crappy cloth really does drive down the distance and area by which your droplets can travel.

Yeah, that's awesome. Next time you do that, say spoiler alert, please, because that's all we're going to talk about for the rest of the show. 

Just so y'all know, he never tells me which studies he's gonna reference. I'm learning as we all go.

You know what I always like about this is this is why you always ask great questions because you're a healthcare provider, you're super smart. And you know, and that's exactly where we're gonna go. But we're not just going to say, Oh, do this, I'm gonna get into the science of it. So now let's talk about the second article. All right, so we already have an article from China that shows close contact makes a difference. We believe it's more droplet than aerosolized meaning in the air. And an article from Germany came out two days ago, actually, and they looked at the effectiveness of mask wearing after masks were made mandatory countrywide. So there is a general perception in Germany that public wearing og face masks reduces the incidences of COVID-19 significantly. Now this perception came mainly from one city. So one city named Jena spelled jena Jena immediately said we should all wear masks, which was really cool of Mayor there to say let's do this. So they introduced mass on April 6 2020. And the number of new infections fell to essentially zero. So based on that one city, the country of Germany said okay, we need to make it compulsory in all federal states, and it started on April 20, and worked its way through to April 29. That all the all of Germany has to wear masks. The conclusion is that the introduction of face masks reduced the number of new infections over the next 20 days by 25%. Impressive 20 days 25% drop. Then they compared this to a synthetic control group so they had a control group where they could actually look at this, it was, admittedly, it's a lot of science, epidemiologic manipulation and stuff like that, because you can never have a control group where you say you can't wear a mask. But what they did is they synthetically did it. It's pretty easy to do that because you can look at certain states in the US where the majority people don't wear masks and you could say, what is the rise? So, the conclusion of the authors was that they believe that the reduction in the growth rates of infection, were at least between 40 to 60% is the best estimate. And then they stressed that if you use the model like Jena, that 40 to 60% reduction in viral transmission is really lowball estimate. Because if you would have started it earlier, you would have decreased the number of people that had the virus, the R not meaning the number of those people that they could have infected would have gone down significantly. So we have a country like Germany that looked at one city and said It's down to zero. We got to do what they're doing. And they immediately jumped on it. And that's pretty impressive. So I think it's if we're arguing whether or not masks work, it's pretty easy to look at other countries like Japan and Germany that were very aggressive about this. Now, Japan has always had a pretty liberal roll of masks. It's it's part of the culture. So it's not a big deal. Germany didn't. Germany, it's not like people were walking around wearing masks. But they all collectively agreed to do this. And it is just if you looked at their worldometers, their cases are just plummeting. So I just want to say those two articles. So one from China talks about close contact two from Germany, where a country that isn't used to doing that clearly is showing a significant drop in this. And so the third article is all about how and why that's it.

No, that makes sense. And then when you reference the fact that you have Germany being a country that didn't typically wear them. I think historically, when you look at the way they apply engineering, the way they utilize the base stem, they probably embrace the idea that science is at least supporting a reduction in transmission only to see it play out, as you said, I think you said 20 days a reduction of 25%. That's awesome. Probably not accounting for non compliance and some probably pockets of people that didn't really embrace it as a whole. So that would probably be that would equate at least to a trigger on why there was still some transmission afterwards.

Yeah, it's just it's super impressive. We'll get into why a lot of this is going on. But so now I found this super cool article. It's pending publication. And it's the article is actually titled COVID-19 and aerosol's point of view from expiration to transmission.

Whoo nice. I like the crowd noise there too.

For everyone listening the studio audience is all wearing masks so they're actually just a little bit so this is really cool because this is you know, we have these people that are flipping out but let's let's talk about the physics of stuff. Let's talk about what's actually going on how, what masks do what viruses do. So this whole article is about that and it's I just found it super interesting that it's, it gets in all this stuff. I don't know what are your What are your thoughts?

No, I that's this is the explanation This is why I think that we can remove the the politics behind the use of a mask and the oddity of of using a mask and then start getting down to the explaining of why a mask and it hopefully this makes sense to those who may be on the fence. It'll be less of a I don't know your your heels in the dirt right. You'll be more open to like, whenever you're going into a communal area, just throw on a mask, at least you're not going to be contributing to the problem. Totally.

Hey, Karen, can you not? Can you not? All right? Let's just be quiet for the show for now. Okay. That's the last time I do a live audience. Alright, so anyways, let's talk about a few things for you to become infected. For a respiratory infection to happen there needs to be a sufficient amount of virus, you need to have a viral load. Now, here's something that's interesting when you read the literature, when they discuss when a virus is outside of a body, it is referred to as a verion. So the verion is being car is being carried in an aerosolized vessel which is a droplet. So we know that h2 receptors you and I did the original podcast on how co on how SARS cov2 infects us and becomes COVID-19 on the h2 receptors, those h2 receptors are located in the lungs and in the GI tract. They're heavily populated in the posterior pharynx. And bronchus, which you know, much better than I do, because you did the whole episode on the lungs. But that's the conductive zone and then the respiratory zone, the alveoli is the gas exchange area. So that's further down in am I saying that right?

Yeah, pretty much. But does those h2 receptors of course they affect if y'all remember correctly, pneumocytes, there are two types of pneumocytes in your lungs. And one of them in particular has more ACE2 receptors, and it happens to be the ones that help us breathe. And so when these things get disrupted, we don't breathe through those pneumocytes anymore.

That's right, go back to that COVID episode because Eric goes into crazy detail about surfactant and all these other things and why we get so sick and that was back early on when we were trying to piece it together and you know fortunately I think we found the right literature that makes sense. Because it's true.

Yeah definitely I believe that.

So what you're describing is when you get down into the alveoli, and what I'm talking about is the conductive system, which is your trachea and the main bronchus. What we're talking about is, what size of aerosol meaning if something is in the air is important on making this virus infective or how do we control it? So who the World Health Organization says that the virus is primarily spread through droplets from sneezing and coughing, when these droplets reach a person's nose, mouth or eyes, pow. Now you have an infection. And then the indirect way is when these droplets land, then they land on something called a fomite. Fomite is a fancy term for anything that a virus lands on. So this pen could be a fomite if I sneezed it. And if you touch it and then touch your eyes, you could potentially have an infection. So, right now, don't touch my fomites. All right?

Hands off your fomites for sure. 

Hands off my fomites. I think one of the reasons why people are fighting the mask thing is the confusion on what the CDC said early on on this COVID-19 pandemic. And basically, they almost implied if you don't have an N 95, that fancy mask, then are you going to be safe, and we didn't know all that stuff. And so now we know quite a bit more about this. And the CDC essentially was saying that to protect healthcare workers, I don't think they really understood it. But in this is unprecedented times in a pandemic, they have to sit there and land on a stance, and it's okay to have a hard stance to try and make sure that we have enough protective equipment for everyone out there. And then it's okay to retract. So at one point, they're sitting there saying, the masks don't help. And then they're saying now they're mandatory. And I think that's why we're having this emotional response. So

Well, I think an invasion into anyone's normal everyday activity with a poor explanation, which, if we're going to be honest, in the early days of all of this, things, things happened quickly, but it didn't. I would say, for many people, it didn't appear as if the right information was always readily available. Everything seemed very ambiguous and with ambiguity, you, you allow people to breed some elements of content, and they just weren't, weren't excited about what they were hearing. And then when you go back and forth, I think that people, they they say, Well, once you told me this, and now you're telling me this, without a full understanding that sometimes the things change, and they were they require just just different things from people to do different activities. So it there's there's definitely some vitriol from people who don't want to give up more of their liberties, I think is probably a big piece of the issue 

100% we're going to get into that about all this. This is not trying to shove it down. You're not trying to placate one side to the other. This is the science of what's going on. And what we do know is you're like, Well, why do you care if you touch my fomite well, you would be shocked at how many people touch their eyes after they touch something you're always scratch your eyes. That is a that is also a point of entry, which this article did not get into. But that's how come we say we're 

I'm guilty of doing it on this podcasts already. I mean, I know I've done it.

It's it's super hard not to so it's alright, so one of the things is that airborne transmission when it first came out, it is somewhat terrifying to think that this thing could be just floating around in the air. But when Mike asked me, is this aerosolized or is this droplet what I'm going to say is airborne transmission is through the air. So they're both airborne transmission and that that is another part of the confusion that the that the news media was saying this is not transmitted airborne, but it's transmitted through droplets. I'm saying that a droplet is that. So droplets and aerosolized are airborne transmission, it just comes down to size, which is the definition of it. So a respiratory droplet is saliva and secretions expelled from the upper airway, posterior pharynx. nose. And this happens with sneezing, coughing, talking, even breathing, you're going to be expelling some of this. Generally, they are considered to be between five to 10 microns in size. And this is just relevant for the masks when we start talking about that. But due to the size, they are brought down by gravity after shooting out, so when I cough or sneeze, they get shot out. And you could say, Oh, well, how do you know that? Well, the reality is in 1934, a doctor named Dr. Wells came up with this really cool wells, evaporation, falling curve, which I always find interesting as a scientist. So you could I always think it's funny when these guys do these things. The I joke around like somebody named the fever that you get with malaria is called a double quotidian fever of not Nagle. I always have this funny vision in my head that somebody walks into doctor not nagels lab because you're never amount to nothing, you're worthless. He goes screw you. I'm gonna name this double quotidian fever of not Nagel, and this is kind of what I feel about this. So like, I'm gonna prove to that when I sneeze. My droplet has a predictable mathematical equation on when it evaporates and when it lands. In other words, when does it become a fomite? And when does it become aerosolized, and there's actually a math equation on this. So once the wells curve has evaporated, the droplet is now a is now a verion, and then that verion is aerosolized and it can hang out in the air for an hour. We can kind of explain that. So there's reasons why this is relative. So if it's less than five microns, then it can hang out in the air for up to an hour, up to an hour. So all right, so my question to you, Eric, is, we're hanging around, and then I want to know how far back you should stand when I do this.

It sounded like a sneeze. And then how far back should I stand? When you sneeze, I would say probably just knowing how hard people sneeze, probably, at least 10 feet back would be the beginning of the edge, it seems to me I mean, there's lots of turbulent flow that happens once it exits the body. And that's by design believe it or now but at the same time the virus is is smarter, quote unquote smarter than what we give it credit for. They know why they want in mammals because they want to be transmitted. They want people to sneeze. That's how it gets passed around. 

Yeah so that's, that's better. I thought you're gonna say I thought you're going to use the old CDC rhetoric of six feet away now, but if I sneeze, my particles can be in the air droplets. Large droplets can be in the air for around 19 feet a little over 19 feet. 

Wow so tens not even get enough wow okay.

Yeah. So that's that was little shocking to me to find out that because we talked about six feet, and then a droplet nuclei. And what I mean by droplet nuclei means that in the wells evaporation curve, you've got these big droplets that land on a fomite, right? And then you touch your eye and then you get infected, or in a dry area evaporates and becomes less than five microns. And then it floats and it can actually travel almost two miles. Yeah, so two miles. And that is a little bit scary in the sense that we think about that. So now, why? Why isn't it worse? Because, I mean, you're talking about the fact that I can actually sneeze if I'm outside or cough and I have COVID-19. And it's dry, my verion will be carried in the air and travel up to two miles. And they've actually documented this it isn't it isn't. It isn't specifically related to COVID. It's related to all viral protocols and things like that. And so what you were referring to earlier are those either heat or laser or different ways to show the transmission of different things but when you get out when other studies have been done, and these are studies from 2004 studies from 17. That's pretty wild. Oh shit, we're screwed if I can infect somebody two miles away. So now what we have to talk about is that's the physics of the virus. Now let's talk about how do we get infected? Are you up to speed on yours?

Yeah, hundred percent. I would say that small caveat would be, even though we know that the virus probably can travel up to two up to two miles in a really dry environment, etc. back to what you said earlier in the podcast, it's in all likelihood, it still requires several strains of RNA to all basically kind of be there wants to overcome mucus, saliva, different things that actually our body's always producing to prevent invasions or infections like that.

So hundred percent. And so now let's talk about how we actually get infected. So there's several. So this is not all. Now this particular article is directly in relation to COVID-19. But the references we have the data from other viruses and things like that. So several factors do play into the infectivity. So the virus characteristics we know that SARS cov2 is unlike anything else we've ever faced the fact that the infectivity due to the Furin protein, the binding furin protein that won't get into it but Weinstein talks about about how it's inserted there. And then the ACE2 receptor, which is a ubiquitous receptor, would explain how easy it is to get infected. You get infected through your GI tract, through your eyes, through your nose, breathe it in, get it in the back of your throat, all you got to do if you if you're 18 feet away, I don't know you and you sneeze and I go. I could be infected.

You could be that easy. Absolutely

It's crazy. Alright, so we know that the infectivity of this virus is exceptional in the way that it is exceptionally good at infecting other people. Now the other thing is the host the sneezer. So what if you have the virus and let's depend on your viral load. So this is why I brought up the original article about the epidemiologic study out of China. If your viral load is really high, and you're a powerful sneezer, you're going to send a lot of virus out in droplets, where it's going. And so the hosts themselves could potentially have a high viral load. And we know that it took up to seven days or the mean of seven days before they started showing symptoms, which means six days and a half. They're sneezing, coughing, thinking, it's just allergies, it's nothing. And there, that's where the R not are the other people that could be infected. So that's the other thing. So there's the virus characteristic. There's the host, the sneeze, are we going to say something? Sorry? No, no, I completely agree with that. And then the really thing that nobody's talking about is the transmission, the big drop or little drop, and that's kind of what you were getting at right there. Before we get into this 

Yeah. Now when you have a big drop are we gonna want to talk about the number of RNA viral strands all in one drop, that's kind of the concentration of the vehicle. 

We're gonna get into that. And then something else that nobody's really talking about is that the victim, I'm going to call them the victim. So you're the host of the virus, your sneeze. several aspects come in play also. The victim's breathing patterns play a role that nobody's talking about yet. And I just I just got the book by Nestor. His last name's Nestor heard him on Ben Greenfield podcast about breathing like, we're apparently breathing wrong, but anyways, breathe through your nose helps. If I'm breathing deep and fast, I'm creating an environment where I'm bringing in further air there. So the victim's breathing capacity, meaning if you're breathing big, you're getting in more air you have the you have the possibility and then of course the victim's immune system. And we always say healthy gut equals a healthy immune system if you are under stress, you're not sleeping well, you're, you're a target. So imagine being a stressed person. And somebody with the virus is 19 feet away, they sneeze, you hear the sneeze, you're already freaked out and you start mouth breathing, bringing in posterior pharynx, the conducting system of the lungs, the trachea, tons of ACE2 receptors. All you need is a couple the viral load coming in, gets there. So my recommendation if you're out in public, you're not wearing a mask. That person is not wearing a mask. You see somebody sneeze, shallow, control breaths through your nose is at least a physiologic way to not back yourself into the corner. So...

No without question, you know, and maybe someday just go over the we could we could even talk about the physiology of breathing and we have these little bitty structures in our nose called turbinates and they are specifically designed to make it Air swirl so that the mucus which is already in place that doesn't just protect us from COVID. It protects us from all kinds of stuff. It's really there to trap things like a virus, and.

You've got IGA sitting there. You've got IGG sitting there IGM sitting there, those are your antibodies. So when you take in a big breath, we should all be nose breathers, not mouth breathers. But anyways, that's a whole separate. That's a whole separate discussion. So these are several factors that play into it, the host and the infected person play into it. Now getting back to what you're talking about, which is really where masks come into play. big drop, drop top, cooking up drugs in the crock pot. Is that right?

Hip hop show.

It's really hard to try and throw a little levity into a discussion that's...

Into disease and pandemics. Yes. 

All right, so big drop. When you have a big drop the big droplets, when they come out, you're exactly right. They're a drop and they hold more virions, meaning they hold more virus more virus to infect you. Big drops deposit in the upper airway, and the pharynx, where there's lots of ace2 receptors, droplet nuclei, which is the scientific term for little tiny virions. So what happens is, I sneeze, cough, talk, droplets come out, and in the wells evaporation curve, big drops carry these viruses down and imagine them splashing, microscopic splashing down and then that fomite could be there. worse. I sneeze and my big droplets go 19 feet and you inhale a big droplet. That's super dangerous, the evaporation curve when the big droplet starts to go down. As it evaporates with speed, now you have a tiny little droplet called a droplet nuclei. This has much smaller amounts of virions, the so if you inhale one of these droplet nuclei, the ability of those virions to infect you is much less than a big droplet that just you're taking a bolus of something. So, keep that in mind because you're exactly right, smaller amounts of virions, you have to expose yourself to higher levels of these droplet nuclei to infect. Now, the downside is that they're so small that you can inhale them into those type two pneumocytes which is a whole separate deal. Yeah, and once again, I keep saying the same thing. We're going to get to this because it all just kind of ties up together. So the who states that droplet transmission is the primary way of infection. But if there's enough concentration of these droplet nuclei, then your infection rate goes up. Hence the health care workers that are our frontline people that are sacrificing their lives. So a nurse that's taking care of an ICU patient or not an ICU patients not ventilated, not in a closed loop that is just continually breathing out these droplet nuclei. Well, it's hard to get infected by them, but if you put enough of them in a concentrated area, you can be infected. So the who is not completely right on that, but it's the best that they can do for the general public. And it has been shown that exhalations, sneezing and coughing have droplets, but also this is interesting what you're talking about why viruses want to infect mammals. One of the reasons why is because they come out with a cloud of mist. In other words, the humidity surrounding it. you sneeze out your own little clouds. And that is an evolutionary thing that keeps the humidity up. So that the viruses do not disperse immediately. So big, the virus wants to be in a big droplet. And as we do this, our bodies end up doing this through evolutionary reasons. So it keeps this cloud of mist that keeps the humidity up. And it's looking to delay that evaporation curve. Because it's survival is best if it either goes in somebody right away, or if it lands somewhere. And we know that SARS CoV2 the causes COVID-19 can live on like plastic for what what do we say 96 hours or something like that?

Yeah, something like that. A couple of days anyway.

Yeah. All right. So now, what's finally unmasked how masks play a role into this by wearing a mask and this is this is the easy part of the podcast. So it shouldn't be too difficult, but I think it's really important to understand the physiology because when you understand it, maybe public freak outs will slow down a little bit. So by wearing a mask, we introduce a resistance barrier to the droplets. And this is exactly what you said in the first five minutes of the show. You're exactly right. It doesn't have to be an N95 you produce resistance to the droplets, the mask will reduce the expired air velocity. So as I'm talking to you, if you're sitting across the table from me, and I'm shouting, or I'm singing, or I'm doing things that create a lot of air, that is the viral that is the velocity of the air, which can shoot a viral load further out. So just by creating a little bit of resistance, and I have worked out with a mask, and it is a little it's a little you know, I mean, I like it personally because I feel like once we get out of this, we're all gonna be like, you know, phenoms aerobically, because if you go out for a jog with a, with a mask on, it's a, you're like woo, it's it's a, it's a little bit harder. So the mask will reduce the expired air, thus slowing the, the droplet down, and it will essentially fall quicker. So it's like, think of that your pitcher throwing a really fast 90 mile per hour, you know, fast pitch and me throwing with my left hand, you know, just barely making it halfway to you know, home plate, the virus is gonna drop. And as long as we're using proper contacts, fomites stuff, and there's some new evidence to show that maybe the whole fomites transmission and we can talk about that later. is probably less important than we initially thought. So putting it there, if you have it, you're not gonna put it out there. You're not gonna be able to eject a virus so far and it will shrink the radius of Where the virus goes. So we know that on those different laser type shots where they show where a sneeze goes, it's like a cloud. And it just goes and kind of covers this big radius. Well, when you do that you actually control the radius. So it comes like here and here. So that's at least does that now the droplet nuclei, the tiny little micron things are now moving slower, which means they evaporate quicker, so they can't join the droplet. Yeah, although it seems dangerous that you're like, Yeah, but you said earlier that the nuclei can travel two miles. But what I'm saying is that those nuclei, they have to gather in sufficient amounts, otherwise, your own immune system can kick their ass, and that's what you really want. You want to be able to fight something as opposed to being overwhelmed by something. Now, the mask wearer also has something which is really interesting and this gets back to the exercise your your reduced inhalation velocity. So you're 19 feet away. you sneeze. I'm wearing a mask I breathe in. Well, I'm only breathing in air that I can that's just nearby my mask. It protects me also. So it's all physics, about how when you're wearing a mask, you're decreasing the velocity and you're decreasing the velocity out. Which is why a lot of people are flipping out with a like I'm having trouble breathing. I'm like, that's okay. Any type of mask is there trouble breathing if you breathe through your nose and you do it controlled, you get enough oxygen in it is I understand there's a million reasons why people feel claustrophobic and all this other stuff but you know, the six feet away thing that makes sense. If everybody's wearing a mask that makes sense because your my ability to inhale your virus is decreased your ability to expel your virus is decreased. Now, the who World Health Organization got everyone all scared and felt If you don't have an N 95, then you're completely screwed. This is not true. And that's part of the problem is that and I've, I'm part of it, I go to the hospital, I wear a surgical mask. And people say that's doing nothing for you. And I actually had this conversation with a couple doctors. And they're like, I'm not wearing a mask because I don't have an N 95 not true. from day to day standpoint. Any barrier helps, I don't care, any barrier help you pull your shirt up, wear whatever, but the more layers, the better. So they did do this show on ABC, where they show different ways through a laser of how far a sneeze goes. And definitely the N 95 is the best and then followed that would be like a multi layer with some sort of filter in the middle or some sort of quilt. So that's awesome. So let's get back to the frontline workers really quick. They still need those in 95 because if someone is shedding droplet nuclei in a room, the overall amount of virions goes way up and the longer that healthcare worker is sitting in the room Have a statistically higher chance of becoming infected through these aerosolized or droplet nuclei. So that is, if you're an extreme environment where you're treating COVID people 12 hour shifts. Yes. But if you're going to the supermarket, it's so easy to block this Germany showed us.

Yeah, without question. I mean, what you're talking about is I love the way you use the word extreme, because what we're talking about here is environmental air turnover time. If I'm, if I'm in an enclosed environment in a closed room with somebody else who is sick or infected, and they're sneezing. There's obviously a high concentration probably, of trends of virions, right? All in the air suspended, falling on objects, etc. It's kind of all around me. But if I'm in a grocery store, where doors are constantly opening up over and over again in a gigantic, you know, 30 foot ceiling, air turnover time is actually rather rapid everywhere that you stand, and there happens to be airflow or you're outside. So really open air space, not closed in environments, avoiding people who are sick. Having a barrier. All of these things play a role. It's it's really just physics. It's not

It's physics. This is not politics. This is not a constitutional or any of that. It's physics. The physics and ineffective process just makes sense to wear something around other people. Not only to protect others, but it's also to protect yourself. So I've heard from people, I've had several patients where I've talked to them, I'm just like, hey, out of curiosity, are your friends wearing masks they're like no. And the answer usually is because they've not been directly affected, which is something that we've heard and what what I think we're seeing is burnout of the information. And so what it's what's happening is intelligent. Fact somebody that you know, then it becomes important again What I'm saying is, it's not a big deal wear something cover up anything, and you can make a difference. So this is this isn't I don't really understand how it's become. Well, I think nothing of putting on my seatbelt now. And at one point that was a huge political and constitutional thing. Do you wear a seatbelt? 

Absolutely, definitely do because if I were to be in an accident, I want to survive it. I've got a family that I still want to see. I mean, I I assume if you don't want to or if you're okay with being mamed then don't that don't buckle up. But that's not where I'm at. I like buckling up.

Yeah. And so it's it's just it's just that I don't know. I really, I hate seeing other countries do so well and controlling it and I hate being in this position right now where we're we can't go to weddings because we're being exposed where my hospitals 99 percent full. Houston looks like most of the ICU beds are filling up scary just because it hasn't happened to you or a friend doesn't mean that it's not actively going on. So I don't know just physics don't make it about you know, let's get some assets just physics. 

You just real quick I know we don't want to keep the show going going too long specifically on this but what are your thoughts on on people who probably more or less just don't want to wear a mask but they they've heard other rhetoric I guess you could say over I have asthma or I have some type of breathing condition and I probably can't, can't stand wearing a mask just for me personally, we you and I have several colleagues and co workers that have asthma. And just like us they wear a mask all of the time when at work and have for years long before Coronavirus or COVID issues whatsoever. So I don't know, I hear the excuses. And it's unfortunate because I feel like that it's that's it's it's a it's a pathway that's not really genuine. And it drives more angst than it does solutions.

You know, I don't know if I totally agree with you, because I think if somebody has that feeling that is genuine to them. And I think if they educate, then they can do this, then they might be able to tolerate the mask a little bit better. So if somebody were to have, let's say, I'm going to go through different scenarios. I have, I have claustrophobia. 

And I didn't, I didn't say claustrophobia. I was just talking asthma. 

Yeah, I'm just I'm just thinking of arguments by having a background as to why and the protectiveness and the fact droplet versus droplet nuclei and an understanding that educating yourself to understand I'm going to put this on, I'm not very comfortable. You and I have to wear N 95s at work and we both frickin hate them. They hurt.

They give you  a bloody nose. I mean, they do lots of really cool stuff.

All kinds of stuff. So I'm just thinking of I'm just trying to think of different things. So somebody may be claustrophobic somebody may be I'm trying to think of anything physical, the asthmatic, the the person, just something away from the political stance, because I don't think that I think anybody that's doing this from a political perspective, or a constitutional perspective probably has some cognitive dissonance. And I don't really want to address that what I want to address is the person that has, let's just address the asthmatic person, so the asthmatic person is already at risk that if they get exposed, then they have a higher likelihood of having a bad outcome. Right. If you have asthma and you're listening to this, what I suggest is you continue to pursue the type, any barrier, any barrier that you can tolerate, just find some sort of barrier. It doesn't have to be the thing. That face shield where face shield that helps a ton. That stops those droplets realize that those droplets are coming out. We should I mean, I'm, I'm a I'm a very salivary person. Can't even imagine what's on this microphone right now. So I, you know, I mean I'm animated when I talk and stuff and I know that I'm probably causing lots of saliva and things to come out a face shield. That's a great example just a simple face shield, if you're asthmatic. Do me a favor and just wear a face shield, because that's not for, yes, you're helping other people. But that's also for you. Because if you were to get it, then you have a higher likelihood of having a bad outcome. The claustrophobic person should probably do well with the face shield as well. And I don't know I'm.

I guess I guess my point was there, there are alternatives versus trying to find a subversive way to get around what some are seeing as a rule rather than a measure of public safety and really for your own safety, if you're already subjected to respiratory issues similar to asthma or even asthma, then you're right. You're actually already at higher risk if anyone should be taking some cautionary measures it's you and let's let's talk about ways that that if a mask is going to work for you, that's fine then then 20 feet is something that you may want to examine and a face shield or some kind of alternative. But the takeaway is, just because you have a reason where there may not be a suitable fit for a mask does not eliminate the need that you need to watch out for your own health.

Just want to reiterate, we had one study from China that just got published last week showing that close contacts have a very high likelihood of if you're talking to somebody, we have a study from Germany, which shows that the effective decrease in viral transmission countrywide. It absolutely was completely proven. And now we're looking at the physics of this. It just makes sense. So just look at the science. Look at the physics of it. I don't want your big ass droplet landing in my upper airway.

That's right. Well, you know what else, we have something special and an email will go out. We've got a patient. And I should have brought the mask and we will show them next time, but we have a patient who actually showed up and made masks for you and I so for Miss Unger, we will. We'll add a little place where if you would like a designer mask, she'll make you one that'll look cool. 

Gave you a Texas Tech mask and I got myself a Nebraska Cornhuskers mask.

Definitely and they're really really cool and might I add far more comfortable than the ones that we get when we're working at the endo centers. So But anyhow, yeah, so there's there's all kinds of alternatives, I guess is is the takeaway and we'll definitely share that with everyone so that they can get outfitted if they'd like.

Yeah. And so if you're listening to this, you know, we try and make a little bit of science fun we try and talk about some different things go to KBMDhealth.com, we've got some downloadable we've got a great downloadable ebook because I personally believe that you need a healthy endocannabinoid system to have a healthy immune system you need a healthy gut to have a healthy immune system all the above we're offering you know these free downloads so just go and take a look at it to try and augment your life.

Yeah, so as we as we put together all these podcasts Ken is exactly right. Be sure and send people to gutcheckproject.com or to KBMDhealth.com it's technically right now go to the same spot anyhow to our homepage, but start showing people that they can begin to build their knowledge base. So many of you who write to us every single week, we certainly appreciate it. And that's really why we're producing this particular one. both in person and online. We've been asked, okay, y'all are in healthcare is a mask really going to help? And that's exactly why Dr. Brown put together the research, etc. on why we're talking to everyone today specifically about this, because it's a burning question, as cases kind of took a dip and are hitting back up, we got tons of email questions, phone calls, like I said, in person, is this really something that I need to be doing? So we want to build upon that go ahead.

Yeah, I just gonna say I think if you get one thing out of this podcast out of today's episode, the one thing that I really learned, if you ever want to own a $40,000 Rolex shop at Target not at Neiman Marcus if you don't know what I'm talking about just look at the news.

And major apologies to all of our Karen fans out there. For Sir, we know that you all did not pick for that name to be the brunt of bad behavior in public. But unfortunately, that's just the way it's going at the moment.

Alright, so I convinced myself that I will always have some sort of barrier on when I'm in public.

Oh without question. Without question. 

I hope you feel the same way. And I it just makes sense. If somebody says, Why are you wearing a mask? I'm gonna be like, Oh, it's all about droplets. It's all about virions. It's all about the distance that I can hit you with my droplet and so on and so on. It just there's science makes sense physics. 

Definitely science. Definitely. Well, what an awesome episode and keep the emails coming. We as we as we keep trying to shape up the the next the next topic. A lot of this stuff is driven by we've got an influx of questions just like we did over the last two weeks, let's hear from you. This is what we're here for. So thanks to all of you who wrote in and wanted to hear a little bit more about masks and none of the thing we got to controversial, but at the same time maybe for some, it's it's a, it's not exactly what they thought that we would say, but that's okay. Because it's not like we we contrived the message. This is what the data says.

Yeah, and I'm not gonna raise a big ruckus if I go to Costco or something and somebody isn't wearing a mask rather than be six feet away. I'm gonna mean 19 feet away.

That's exactly right. that'll probably do it then for installment number eight, of the COVID files for gut check project. Thanks for bringing all the info. That was awesome.

All right, Eric. Thank you so much. And as always, you didn't even have to read the articles. You knew the answers before I even started so strong work. 

I don't know if that's an as always, but yeah, we'll see.

Everyone, everyone like liking share, please. We're really trying to get some of these messages out there. If you have any questions, please send it to us. We will try and contact if we don't know it. If we can't find the literature on it, we will at least find an expert on it. And like, share, subscribe, whatever it is all the other things people do, go to our website, download that ebook, because it is very informative. So.

Stay safe everyone. See y'all next time.