Peter Attia· MD
I can tell you we have absolute certainty today no question about it that influenza virus is in part transmitted by ear assaults these are the smaller particles of more than five nanometer particles and people assume when we talk about airborne transmission we're talking about something that's many many yards away and they actually forget that aerosols are produced just where droplets are when right in that first six feet area and so if you're that close if you have a surgical mask on you surely can do a lot to minimize the number of droplets you come in contact with but that doesn't take into account the aerosol where there's droplets there's errors where there's aerosols there may not be droplets but people have assumed its droplets or then it's aerosol somewhere else and so I think from a respiratory protection standpoint one of the challenges we had in China with well close to 4,000 healthcare workers infected right now in Italy there's well over 5,600 healthcare workers who have been infected now some of them obviously got infected off the job but many of them were on job in respiratory protection was a key factor in each one and so I today feel incredibly incompetent incapable and frankly sad that they're going to be many health care workers who are going to risk their lives to help with this will not have in 95 respirator which they need to have because we just don't have enough we won't and when I keep hearing about this additional production the White House continues to talk about that they never give you the numbers of what we estimate will need versus what's being produced and it's so far short it's not laughable because that would imply something funny there's nothing funny about it but the bottom line message is that we're gonna have a lot of health care workers are going to be exposed and infected with this virus because of that what is the number Mike what would we need I don't know I think this is where again we have a PPE challenge here particularly within 95 that was even much more severe than they had in China or to that extent in Italy they did several unique things which I don't know if we'll do here you may have heard but in several of the really high-volume wards in Milan they had Cova infected healthcare workers working if they weren't that sick they were working they went in without mass etc because they didn't have them and so I don't know what we'll do here but I do believe we'll have a real challenge with this now some will say well and this is what I find very frustrating is we have to stick with the science and what happened with CDC to their credit about two weeks ago issued new guidelines for the use of PPE respiratory protection but what they said was if you don't have in 95s then use mass but a number of administrators and some scientists have come forward and said CDC recommendation saying you don't have to use respirators where you can use mass meaning it's just droplet that's not what they said and so I think that today for a healthcare worker they just at least have to know what they're getting into I think many almost don't go to work I mean the camaraderie and you know what it's like to be in that kind of setting these are some of the most amazing heroes in the world we don't send our soldiers into war without some kind of protective equipment or without bullets in their guns we send health care workers into this viral battle and we're gonna be sending them in without bullets or without protective equipment and that to me is really sad but that's what's gonna have to take that's gonna be a big question as to what happens there so really we have a problem on multiple fronts we have a problem on the on the supportive drug front we have a problem on the treatment drug front which I want to come back to in a moment we have a problem on the people who are going to administer care we potentially have a problem on the number of ventilators and actual beds etc so is it a largely irrelevant academic exercise to understand which of those things becomes the first failure because it varies so much presumably by City Hospital geography that it ought to be an all-hands-on-deck for all of them I mean is there a model here where we pick the ten cities that are either in the throws of hell or we know are about to be and we start relocating health care workers to those areas if that's the thing that we believe is going to be the bottleneck first of course that would only make sense if you could provide them with the necessary PPE otherwise you're losing your soldiers in battle unnecessarily without an appropriate risk to benefit trade-off how do we think about this I mean I haven't spent a lot of time truly thinking about this at the full macro level of what the White House would hopefully be thinking about this but I mean what