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Daniel Ingram on Covid-19 - Guru Viking Podcast

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Daniel Ingram on Covid-19 - Guru Viking Podcast Steve James 3/30/20 8:25 AM
RE: Daniel Ingram on Covid-19 - Guru Viking Podcast Linda ”Polly Ester” Ö 3/30/20 10:41 AM
RE: Daniel Ingram on Covid-19 - Guru Viking Podcast Lars 3/30/20 12:29 PM
RE: Daniel Ingram on Covid-19 - Guru Viking Podcast Linda ”Polly Ester” Ö 3/30/20 4:51 PM
RE: Daniel Ingram on Covid-19 - Guru Viking Podcast spatial 3/30/20 2:45 PM
RE: Daniel Ingram on Covid-19 - Guru Viking Podcast Anna L 3/31/20 12:14 AM
RE: Daniel Ingram on Covid-19 - Guru Viking Podcast Jim Smith 3/31/20 3:36 AM
RE: Daniel Ingram on Covid-19 - Guru Viking Podcast Jim Smith 3/31/20 3:31 AM
RE: Daniel Ingram on Covid-19 - Guru Viking Podcast Jim Smith 3/31/20 3:56 AM
RE: Daniel Ingram on Covid-19 - Guru Viking Podcast Chris Marti 3/31/20 7:10 AM
RE: Daniel Ingram on Covid-19 - Guru Viking Podcast Jim Smith 4/2/20 3:40 AM
RE: Daniel Ingram on Covid-19 - Guru Viking Podcast Chris Marti 4/2/20 7:33 AM
RE: Daniel Ingram on Covid-19 - Guru Viking Podcast Linda ”Polly Ester” Ö 4/2/20 8:06 AM
RE: Daniel Ingram on Covid-19 - Guru Viking Podcast Daniel M. Ingram 4/2/20 11:05 AM
RE: Daniel Ingram on Covid-19 - Guru Viking Podcast Jim Smith 4/2/20 1:04 PM
RE: Daniel Ingram on Covid-19 - Guru Viking Podcast Siavash 4/2/20 1:43 PM
RE: Daniel Ingram on Covid-19 - Guru Viking Podcast Jim Smith 4/2/20 1:53 PM
RE: Daniel Ingram on Covid-19 - Guru Viking Podcast Eva Nie 4/13/20 5:08 AM
RE: Daniel Ingram on Covid-19 - Guru Viking Podcast Not two, not one 3/31/20 4:28 AM
Hi everyone,

Here's the latest episode of my podcast, which features Daniel Ingram on the current Covid-19 pandemic.

Let me know your thoughts :-)

https://www.guruviking.com/ep40-daniel-ingram-pandemic-edition-guru-viking-podcast/

Audio version of this podcast also available on iTunes and Stitcher – search ‘Guru Viking Podcast’.

...

From the shownotes:

00:55 - Warning: listen before continuing.
01:43 - Daniel’s background in medicine and epidemiology.
03:44 - Daniel’s ‘Need to Know’ on the pandemic.
11:19 - Further guidance for the lay person.
12:49 - Daniel’s prognosis for the epidemic.
18:17 - Self care during the pandemic.
23:53 - Guidance for those who are anxious, afraid, or panicked.
39:46 - Guidance for supporting those who are sick or suffering.
46:06 - Meditation guidance for those who are sick.
55:24 - Guidance for those who are dying.
57:59 - Daniel’s personal meditation plan for his own death.
1:02:43 - Further comments on supporting the sick and dying.
1:07:15 - Processing emotional storms.
1:14:15 - Guidance for those in isolation.
1:17:16 - How does an arahant experience the pandemic?
1:25:40 - Concluding comments.

RE: Daniel Ingram on Covid-19 - Guru Viking Podcast
Answer
3/30/20 10:41 AM as a reply to Steve James.
It certainly gave me the push I needed to renew my medicine prescriptions... 

RE: Daniel Ingram on Covid-19 - Guru Viking Podcast
Answer
3/30/20 12:29 PM as a reply to Linda ”Polly Ester” Ö.
There are a number of important medications I take, and some of them are running out at the local pharmacies. One particular medication I had to visit the pharmacy three times over a week to get one refill completed (so much for distancing), and even then it wasn't the usual strength, I had to get twice as many of a half as strong version. Refill any scripts you need ASAP, supply problems are already happening.

RE: Daniel Ingram on Covid-19 - Guru Viking Podcast
Answer
3/30/20 2:45 PM as a reply to Steve James.
Thanks for doing this interview...it was very thought-provoking.

That's cute that Daniel thinks there's harshness on the DhO. Compared to several other online communities I'm part of (not related to meditation), I have NEVER EVER witnessed an instance of harshness here.

I wish I could have him whispering in my ear as I meditate...whatever he said about the doer/knower made insight happen for me while listening.

Also, the "ocean of fear" sounded interesting, but I can't seem to find it on Google emoticon

RE: Daniel Ingram on Covid-19 - Guru Viking Podcast
Answer
3/30/20 4:51 PM as a reply to Lars.
Lars:
There are a number of important medications I take, and some of them are running out at the local pharmacies. One particular medication I had to visit the pharmacy three times over a week to get one refill completed (so much for distancing), and even then it wasn't the usual strength, I had to get twice as many of a half as strong version. Refill any scripts you need ASAP, supply problems are already happening.

Thanks for your compassionate advice! I will order the medicines on the mail as soon as I get the prescriptions. 

RE: Daniel Ingram on Covid-19 - Guru Viking Podcast
Answer
3/31/20 12:14 AM as a reply to Steve James.
Thanks for sharing. Great interview emoticon 

RE: Daniel Ingram on Covid-19 - Guru Viking Podcast
Answer
3/31/20 3:36 AM as a reply to Steve James.
I have a background in molecular biology and genetics and have done lab research and have a few publications although most of my career was in software development. I have been reading as much I can about the virus and making my own mathematical models.

I watched the video from 1:43  through 24:00

I agree 100% with what Daniel is saying about he infectiousness and the fatality rate and also the uncertainty of the data.

His prognosis did not mention the drugs that we have and the vaccines being prepared. I think we are ahead of 1918 in that regard. DNA/RNA sequencing and our modern understanding of molecular biology is something they did not have in 1918 which gives us a big advantage in understanding how the virus works, and we already know a lot about other similar strains of covid, which should help us find a solution. Our industrial capacity is also vastly greater than in 1918 we have technologies they could not imagine and we can produce great quantities rapidly.  But I don't mean that as a prediction or contradiction of Daniel's prognosis. I am not qualified to make predictions in this area. Personally, I am more optimistic about the prognosis but that could be due as much to ignorance as knowledge.


https://www.connexionfrance.com/French-news/French-researcher-in-Marseille-posts-successful-Covid-19-coronavirus-drug-trial-results
A renowned research professor in France has reported successful results from a new treatment for Covid-19
US academic study concurs


https://www.cnbc.com/2020/03/30/ford-ge-plan-to-produce-50000-ventilators-in-100-days.html
Ford, GE plan to produce 50,000 ventilators in 100 days

Retooling of manufacturing to produce medical supplies might help to mitigate the economic effects somewhat.

Steve, I thought the part of the interview I watched was really well done - nice job!

RE: Daniel Ingram on Covid-19 - Guru Viking Podcast
Answer
3/31/20 3:31 AM as a reply to Jim Smith.
Jim Smith:

Retooling of manufacturing to produce medical supplies might help to mitigate the economic effects somewhat.



https://pjmedia.com/instapundit/362781/
Carnival Cruise Line has told Trump “We can match those big Navy Hospital ships with some fully staffed cruise ships”.

...
In a project with which I’m loosely associated, a very-effective agricultural disease-control agent was re-purposed and re-labeled specifically for Corona-virus control by the FDA and EPA in under ten days, from initial request to distribution.
...
Distilleries are making sanitizer out of distilling “heads and tails” which are normally discarded. Nasty shit to drink, but effective sanitizer.
...


I've also seen news stories about sit down restaurants converting to take out and delivery.

A pillow manufacturer is switching to production of some type of face masks.

RE: Daniel Ingram on Covid-19 - Guru Viking Podcast
Answer
3/31/20 3:56 AM as a reply to Jim Smith.
Jim Smith:


I agree 100% with what Daniel is saying about he infectiousness and the fatality rate and also the uncertainty of the data.



I think this gives a fair description of the uncertainties of the data:

https://www.nejm.org/doi/full/10.1056/NEJMe2002387

Covid-19 — Navigating the Uncharted
List of authors: Anthony S. Fauci, M.D., H. Clifford Lane, M.D., and Robert R. Redfield, M.D.
March 26, 2020
N Engl J Med 2020; 382:1268-1269
...
On the basis of a case definition requiring a diagnosis of pneumonia, the currently reported case fatality rate is approximately 2%.4 In another article in the Journal, Guan et al.5 report mortality of 1.4% among 1099 patients with laboratory-confirmed Covid-19; these patients had a wide spectrum of disease severity. If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.2


The source of the uncertainty about the fatality rate is that we don't yet know the number of people who are infected but don't show significant symptoms and so are not counted when they calculate the number fatalities per total cases. However because covid-19 is more contagious than seasonal flu, it can still be dangerous and put a great strain on the healthcare system even if the death rate is lower than currently believed.

RE: Daniel Ingram on Covid-19 - Guru Viking Podcast
Answer
3/31/20 4:28 AM as a reply to Steve James.
Thank you, what a great episode.  Excellent questions from Steve and wonderful wisdom from Daniel. May you both be safe and happy through this event. I hope neither of you are reduced to fishing in your canal or hunting your deer, respectively!  

I think the other bit of advice I would add is that all we really need is food, shelter, clothing, and medicine. And maybe a little bit of company.  It doesn't really matter if the Dow Jones loses 80% or if we don't get the next season of Love Island.  We don't really need much, except love and the four requisites.

Metta to all.

Malcolm

RE: Daniel Ingram on Covid-19 - Guru Viking Podcast
Answer
3/31/20 7:10 AM as a reply to Jim Smith.
I'm going to post this as another example of how inaccurate and incomplete the global counts are for this virus. Over the past several months, China never counted anyone who was infected with the virus but was asymptomatic:

https://www.wsj.com/articles/chinas-coronavirus-count-excluded-infected-people-with-no-symptoms-11585650226?mod=hp_lead_pos2

BTW - I'm suspicious of China's counts in any case.

RE: Daniel Ingram on Covid-19 - Guru Viking Podcast
Answer
4/2/20 3:40 AM as a reply to Jim Smith.
At the daily corona virus press conference (4/1/20) Dr. Facui was asked how long social distancing would be necessary. It seems to me he is says by late June or early July there won’t be any new cases and they will by then have the means in place to isolate any that come up so that things can start to get back to normal. He says, I think, a vaccine is a year or a year and a half away.


https://www.youtube.com/watch?v=tZNcnP31Rug

Question

1:03:15

Looking beyond when we're on the other side of this curve, are we looking at living with some sort of social distancing guidelines essentially, essentially until there's treatment or a vaccine. For example people looking forward to the summer talk about you know going to baseball games going to concerts we have political conventions over the summer are things like that possible or safe without a vaccine or treatment place?





Dr. Fauci:

1:03:39

Yeah, I think if we get to the part of the curve that dr. Birx showed yesterday when it goes down to essentially no new cases no deaths at a period of time,


I think this is the graph he is referring to,  they showed it yesterday

https://covid19.healthdata.org/projections

Facui didn’t give a date but to me it looks like by late June or early July there are no new cases.


I think it makes sense that you're gonna have to relax social distancing. The one thing we hopefully would have in place, and I believe we will have in place, is a much more robust system to be able to identify someone who's infected isolate them and then do contact tracing. Because if you have a really good program of containment that prevents you from ever having to get into mitigation - we're in mitigation right now that's what the social and physical distancing is.



The ultimate, the ultimate solution to a virus that might keep coming back would be a vaccine. In fact I was on the weekly conference call with the WHO sponsored group of all the health leaders in the world who are dealing with this, and we all came to the agreement that we may have cycling with another season. We'll be much better prepared we likely will have interventions, but the ultimate game changer in this will be a vaccine, the same way a vaccine for other diseases that were scourges in the past that now we don't even worry about.



I mean the vaccine is, is as I said, it's on target. We're still in phase one. There were three doses that we had to test. We've been through the first two doses. We're on the highest dose now. When we get that data, it'll take a few months to get the data, to, we feel confident to go to the Phase two and then a few months from now we'll be in Phase two and I think we're right on target for a year to a year and a half.

RE: Daniel Ingram on Covid-19 - Guru Viking Podcast
Answer
4/2/20 7:33 AM as a reply to Jim Smith.
Yes, we need a vaccine, but in the meantime...

Here's another huge problem - the U.S. has a just-in-time healthcare system, like most of the rest of the developed world. We don't have the capability to do this pandemic right at the moment as we're beholden for medical supplies to Asian manufacturing partners (many in Wuhan!) who cannot fulfill our needs fast enough. We don't have the capability or the capacity to make the stuff here for now. We let a whole generation of MBAs decide how to do all this manufacturing and supply chain stuff. Nothing against MBA's - I have one - but we desperately need to rethink our supply chains.

RE: Daniel Ingram on Covid-19 - Guru Viking Podcast
Answer
4/2/20 8:06 AM as a reply to Chris Marti.
Yup. Cutting everything too tight to maximize short-term profit, based on ideal conditions, is very vulnerable. It doesn't take much for it to collapse. Better to spend some extra resources on what is really important. 

RE: Daniel Ingram on Covid-19 - Guru Viking Podcast
Answer
4/2/20 11:05 AM as a reply to Jim Smith.
Yes, our scientific capabilities are vastly beyond what was available 100 years ago, definitely, no argument there.

However, from an emergency medicine perspective, we will rapidly be back to something very like the medical treatment capabilities from 100 years ago, and in some places already are, with the nearly singlular exception of having a pulse oximeter that you can use at bedside that can tell you that you are actually as short of breath as you feel.

The notion that there will suddenly be anything like enough rapidly-manufactured ventilators by mid-April, when most states are expected to hit peak resource use in the US, has a level of profound optimism that I wish I shared.

From an emergency medicine perspective, when you have no ventilators, you have no ventilators, even if someone somewhere is trying to make you ventilators. If you have no vaccine, you have no vaccine, even if someone somewhere is trying to make you one and hopefully will in some number of months or a year. When you have no proven effective medications, you have no proven effective medications, even if someone somewhere in some very fancy lab is trying to make them. When you have to tell a patient, "Hey, we have no ventilators, no vaccine, and no proven medications to treat you today as you are dying before my eyes," that's exactly what they had to do back then.

So, that is nearly exactly the situation we were in 100 years ago clinically.

Still, it is true that, perhaps by this late Spring or early Summer or sometime later, there will be more supplies and ventilators and the like, and there is even the possibility that sometime after the peak there will eventually be enough, but those months from here to there will likely be a total medical catastrophe like we haven't seen in a century.

RE: Daniel Ingram on Covid-19 - Guru Viking Podcast
Answer
4/2/20 1:04 PM as a reply to Daniel M. Ingram.
Hi Daniel,

I agree with your prognosis over the next couple of months. In my comment above about the prognosis I was reacting to this part of the video where you said.

(This is from the transcript at youtube)
13:31
I would be astounded if this was done by say next April. That would amaze me. Maybe like you know a year, year and a half, if you know the 1918 flu is any measure. Remember this we have the level of Medicine of basically the 1918 flu at this point we think oh we're so much beyond that.

Above I posted about Dr Fauci's recent statements about how the social distancing will end in a few months when they have a better containment system in place. That is 1918 technology - which is interesting.

Later you go on to call it a catastrophe. I would agree now the next few months look like they may fit that description but I am more optimistic about the next year to year and a half when our advances in science, technology, and industry since 1918 will have an effect.

One thing I would realy like to hear your opinion on is that in the news they like to play up the fact that it's only people with comorbidities that are endanger of dying as if that were a small minority of the population,  but if you look into the details one of the comorbidities is high blood pressure and when I looked it up I found 46% of US adults have high blood pressure. So do you know what that means - does high blood pressure make a 40 year old as vulnerable to Covid-19 as a 70 year old?

Thanks

RE: Daniel Ingram on Covid-19 - Guru Viking Podcast
Answer
4/2/20 1:43 PM as a reply to Jim Smith.
Jim, about your post that you deleted, just remember that air transportation was the main way this virus spread all over the world. That is not an advantage. And also those masks are a way of transmission too.

RE: Daniel Ingram on Covid-19 - Guru Viking Podcast
Answer
4/2/20 1:53 PM as a reply to Siavash.
Siavash:
Jim, about your post that you deleted, just remember that air transportation was the main way this virus spread all over the world. That is not an advantage. And also those masks are a way of transmission too.

There were some other problems with it too.

RE: Daniel Ingram on Covid-19 - Guru Viking Podcast
Answer
4/13/20 5:08 AM as a reply to Jim Smith.
I think the main problem is there is not enough info to make accurate projections.  No country has done enough general testing to know with any accuracy how many people get covid with minimal symptoms.  Therefore we do not know death rate.  Germany is doing a lot more testing but still not testing everyone and they are getting death rate around 1 percent last I looked, unlikely the real rate will be much higher, in fact it is likely going to be lower.  We also can't be sure when covid really escaped China, the lead time between CHina admitting the prob and other cases being found outside China was very very short.  If covid is less dangerous, it also may have take China a while to notice the problem themselves and not necessarily due to any intentional coverup.  It may have been that China at first just thought it was a bad flu season.  If Covid has been here longer than assumed, that will also screw up the projections. 

As it is, the original projections we were told that were said to include the assumption of a lockdown have very much not panned out, real numbers have been far far less and continue to fall far below original projections.  Hospitals in San Diego are near ghost towns due to lack of patients and the canceling of routine scheduled visits and operations.  People with issues like cancer can't get in to get imaging, there will likely be some deaths from that end of the story as well. 

Also at least some footage supposedly of new york's hospitals have turned out to be of manikins and training dummies or by simulation experts.  WHich makes sense because real footage would be difficult to obtain considering New York's strict rules on filming inside hospitals: https://www.propublica.org/article/new-york-city-hospitals-to-end-filming-without-consent.  Media has gotten very click baity in recent years, I don't think we should blindly trust their storyline.  The truth is even regular flu can be deadly to some.  How much worse covid turns out to be remains to be seen.