Would never tell your doctor about. You ashately over time, winter flu symptoms a lot of what we have been seeing is a lot of people who have gotten pretty sick. I am not in the hospital yet. In the hospital is swelling tremendously in new york city. At the moment, what i am doing is fielding telehealth calls disease,le with the assessing them on video which is a new skill, but something we are all getting killed at doing and trying to figure out if they are sick enough to go to the hospital. Should we have some kind of antibiotic . I have been giving a lot of lessons to people and loved ones about how to open up their lungs, deep breath, banging on peoples backs to help them clear out junk and doing our best to keep hospitals clear. Host if we were having one of those assessments now, how would it go. Guest in some ways it runs like a regular Doctors Office visit. Just on video. Is withs a loved one them, sometimes they are alone. Start with hows it going . Ask about cough, ask about fever. Is tog thing about this ask about the number of days you have had symptoms. What makes covid different is a lot of people have very mild flulike symptoms for week. Fever, coughing, you feel cruddy. Sevendayaround day 12, they will have a downhill turn. All of a sudden they will really start coughing. It may become very difficult for them to breathe. You want to watch people at that point to see if they tip over the line. When you are doing telehealth, some of the very basic tools you have in your office, a Blood Pressure cuff, a finger thing to measure oxygen we dont have those. Little i amam a little like a doctor from the 19th century who goes house to house on a horse and carriage. Is wee decide to do decide is it can you wait a day, or are you ok. I am doingents where what i call nonhospital. I am seeing them every day, checking on them, making sure their status is good enough to stay at home and not put them in the hospital. What r folks who what does a day by . Guest if 70 does not have to be in the hospital, you will not have to have them there. New york now based on published reports, our hospitals are utterly overwhelmed. The hospital ship mercy is coming in. They are building a temporal temporary hospital in central park. I get updates from my hospital about how many units are being converted from normal hospital wards into covid wards. There is no more elective surgery, there is no anything except for taking care of covid. Incredibly sick with other problems as an example, i had a patient with Breast Cancer recently diagnosed. Normal circumstances, they would go to the oncologist, the breast surgeon, get this taken. Are of in a timely manner not an emergency, but making haste. Surgery hasrsons been delayed three months which is something in my career i have never seen. Even after 9 11. One thing we have not thought about yet which is true, a lot of the routine medical care that thatof us do daytoday, medical care has gone to the wind and will be gone for months. Is my assumption. How covid is going to hurt people, but we are spending so much effort taking care of covid patients, but we are pushing up pushing off stuff that in American Health care we never pushed off before. Is ourr. Ira breite guest. If you go to his twitter, you will see a lot of what he does this these days is answer your questions about covid19. That is what we are doing here. The phone lines are split, 202 7488000 in the eastern or central time zone Spirit Mountain or pacific, 202 7488001. Special line for medical professionals we have been , 202 7488002. City,e is up out of palm florida. Caller thanks. Question, itbasic seems like south korea was able to get their kids out and they were testing about 10,000 people a day. In florida and upper kentucky months to, has taken get the test done. Theyut out test kits, and couldnt get certified and they were getting false sin they were sent back. Reason we do not have test kits on the shelf if so, why didnt we have American Airlines and boeing pay for these tests . I am drawing i am going to Grocery Stores and i do not know if people have been tested. Walk into a Grocery Store or a drive through, i do not know if the person has been tested. I have annexed your neighbor who handles a lot of i have a nextdoor neighbor who handles money a lot and she has come down with it. It baffles me how south korea can come up with tests so fast. T guest it is hard for me to comment specifically on manufacturing issues. It is clear there were problems and how we developed tests. Thatf our problems now is hundreds ave haveactice patients who clear symptoms, the number of people that have been tested here in new york, which is the center of this disease in the country at the moment. They basically are only getting tested if you are in the emergency room and they decide they need to test you or you or your actually admitted to the hospital. We no longer test people afterwards to see if they are better, even healthcare workers. If you are a Health Care Worker into have a fever, you are supposed to wait until you have no fever for three days, and then a week. In other words, seven days minimum and just returned to work. Shoe thehis testing issue is huge. Terms of why, there was this mistake as you said that was made with the fda. When i speak to some of my lab colleagues, one of the problems even just from a production point of view. Once we have the tests, that is great but you have to turn it from a simple test for people to a massproduced test. There are shortages of the chemical they used to actually do the tests. The test is in multiple steps. There is a lot of complexity in the current testing. There is new testing coming out which should be more accurate, quicker to do and much easier in the sense that it will not require as many reagents to process. For a nonicu patient, if you take [indiscernible] if youre just joining us, our guest in this segment is dr. Ira breite. One of the hosts of the internal medicine show, siriusxms doctor radio. On thene question is expected death rates. Expected to peak in the next two weeks or so. Can you explain why that is when for the past couple weeks, the social distancing weve been talking about has been implemented around this country more stringently than ever. Why are those rates expected to peak two weeks from now . Covid is whenbout you think about how it gets transmitted, somebody with covid encounters another person. That person gets the virus within them. They will go anywhere from three to four days to up to two weeks without symptoms, then they will get symptoms. Once they get symptoms, for many people. Theres not much thats going to happen. Mild flu thing. Given the sheer mass of people that are getting it, for the small percentage to get worse, most of them will get worse not immediately but somewhere down the line. Day 11, day 12 of the disease. You start socially distancing, it can take two or three weeks to start seeing the results. One piece of good news that i did see in the New York Times last night was that there is a company that is, a thermometer company and they check temperatures. They sort of load them online. They originally had done it to check for flu. Now they see a decrease in the number of fevers in the country on people using their thermometers. So its a small sign of hope. That may be some evidence the social distancing we are doing is working. People as wed for are all cooped up to see how it works. Works as they say, if it works really well, nothing happens. People nowion the district of columbia and puerto rico being urged to stay in home or under stayathome orders in their state. Susan in new jersey. Good morning. Caller good morning. I would like to ask dr. Breite, what about emergency surgery like a first appendix . Where would you go . Burst appendix . Where would you go . My mother is 103. She lives alone in the northern part of jersey. Im in the central part. I go up every other day to make sure she is fed and her place is clean and everything and sanitize everything and prepare meals and whatnot. Make sure that she is well. So what do we do . Should i wear a mask when i get there or on the way . We do take precaution as far as wearing rubber gloves in the house and everything. The first thing is emergencies. Said, what we consider elective stuff. A lot of things that we would consider elective the people who have them would not consider elective like many cancer surgeries we are just putting off. We do not have the resources to do them. Weneed the ventilators that would normally use it during your elective surgery to treat patients with. Plus the hospital beds. But we are still doing emergency surgery. Burst, if youndix had a blockage that didnt resolve. If you had certain types of blood cancers which can spread and kill you almost instantly, we are treating that stuff. We absolutely are. But the problem is that the list of what we do treat has shrunk considerably. But yes, lifethreatening emergencies we are still doing. Severe trauma, all that sort of stuff. One of the good things about social distancing is fewer car accidents. Emergencye who need care for that reason. In terms of elderly people, family members, this is really i think the hardest part for a lot of people. And i dont have a good answer. Obviously if you have somebody who is elderly, who is in firm in your life and they are not living with you. If they are living with you its much easier. But if you are sort of going to them, its tricky as to the right thing to do. If you yourself are socially and youre in firm relative is socially isolating, its probably ok although i say that with some care. I would probably maintain a six foot distance as much as you could from that person in other words if they had several rooms in the house. All the precautions that you can take. On the other hand, its very difficult to do particularly for our elderly population. They need help sometimes and we need to help them and finding the balance is incredibly difficult. The one thing that i really do try to emphasize is do the most that you can both for yourself when youre not there because obviously if you are not having it, they are not having it. Keep your distance even if they dont fully understand why you are refusing to give them a hug. Is maryellen in sarasota, florida. Caller good morning. Theess i wanted to ask at one thing that weve been struggling with. Sincebeen in the house march 14. Make two trips out. Went to the pharmacy, the bank and the post office. We were able to get groceries delivered. But then i had to go to the Grocery Store because we did need extra supplies. And i guess the thing that struck me was that so many people have been careless and they havent been staying at home. And when i went to the grocery mask, i made a homemade and i wore disposable rubber gloves and i was very careful to maintain a clean barrier and keep my distance. What do you do about the people that just arent taking this seriously . Because they are putting the entire country at risk. How do you get through to people that dont realize that this is a crisis and we all have to do the right things and help each other . Difficults been very for i think all of us to do. Im a health care professional. Im a doctor. I am not a government person. So i think about it in terms of as a physician would. Things that i think sort ofe best is education as much as possible for people. And this is how i think of it. Cases,ber of covid newspapers you will see online that there are x number of covid cases. More cases than that. We know most people are going to be fine. Thats not the problem. Thats one of the things that people are like, its going to be terrible for everybody. Most people are going to be ok. The problem is capacity. If you have a large number of people who have a disease in the millions and a tiny percentage of that, even. 1 . Dying,dying end up thats 3 Million People in this country. That is way too many for hospitals to handle so the death rate will go up simply because those people like in italy will be stuck at home. Peopleo emphasize to when they ask me that really what youre doing is protecting your grandmother. Youre protecting your aunt. Youre protecting loved ones in your life. And if somebody doesnt care about that, i think theres a reason we have laws to enforce the socialized relation as well as possible. I think a lot of it is just making people understand that really what they are doing is they are not protecting themselves per se. Because if you get the disease, 95 times, 98 times, you will be fine. Your protecting somebody whos older in your life. Your protecting somebody whos got a medical problem you might know about. There are lots of young people Walking Around with immunocompromised diseases. And of course you dont know it. They are your buddies. And you are really doing it for them. I think this is something that we should come together as a country and do. Weve made sacrifices in this country before. Im not going to lie and say this is awesome. It stinks. But i think its actually a relatively small sacrifice to save a tremendous number of american lives. Host can we come back to the virtual visit you are having with somebody who is feeling symptoms . What advice do you give when you talk about somebody who should ,ake tylenol or advil acetaminophen versus ibuprofen . This has become one of the trickier questions that we get asked. Erred on the side of caution. Reporting that , takingdvil or motrin these drugs can somehow make the covid worse. It is weak evidence. Im not here to say never do this. But theres a little bit out there. For the most part ive been telling people to take tylenol even the choice and thats been my base. Cane are other people who say it is safe to take the other medications. One of the things about this disease is that if you have fever and you dont feel too hot , but youre not having any significant respiratory symptoms , having the fever isnt going to make it worse in terms of your overall course. Tylenol, motrin, advil. Drugs like that make you feel better. They dont help the course of the disease. ,o if there is a small risk ration tylenol for when you feel really lousy and then its not going to change anything. It will just make you feel better. This is tennessee, darcy. Good morning. You are on with dr. Ira. Caller good morning. How are you doing this morning . Im doing pretty well. Caller its an interesting correlation of timeline considering its the passover holiday and we have an invisible viral contaminant amongst us. What do you know or how do you feel about the prophylactic virus withkilling a heat so that you can break down the initial body of the virus and in the process of doing so, minimize the immunological beings obviously of contaminated and with that comes the loading factor. If you are around somebody for example that is presenting with symptoms, the younger longer you stay proximal to that person the more viral load and you have. Wouldnt it make sense to do some type of chamber . What are your thoughts . Who arentome of us as familiar with some of those terms, can you walk us through that . As well as i can. This virusthings is is like all proteins, will be killed by heat. Unfortunately the amount of heat that will kill the virus also tends to kill the people who have the virus. So i think this heat thing has been going around. Im not sure theres a whole lot of stockinette. I will just leave it at that. Interactionsust with other people, yes. Obviously the longer you are with somebody the more likely you are to have the virus. The more likely you are to get the virus yourself. Thats one of the reasons that we talk about casual contact. Maybe just passes by and doesnt touch you. That its very unlikely that the virus will pass from that person to you or vice versa. In terms of other things, i think this is a good point to mention. One of the things that kills this virus extremely well is soap. The virus has a lipid capsule. So the virus itself is surrounded by this sort of fatty shell. And soap breaks that up. As much as it is good to use bleach or other products if you , good soap and water. Soap and water on your hands will help kill the virus. If you touch the virus to your hands but dont touch your face, you have a very good chance of not getting it. Thats why we are so sort of obsessed with handwashing as well as not touching your face which i have to tell you has been very very difficult for me to do. Host about 15 minutes left with dr. Ira breite on the siriusxms doctor radio show. Also with nyu langone health. Is and explain what that what its like right now . Health is one of the large hospitals thats been in new york. Its two medical schools. Its multiple hospitals. Many many offices scattered throughout the tristate area. And a leader in research and health care. We are just a system. Its just a Hospital System in some ways. And whats been going on there, im mostly in the outpatient realm still. In myer words i am still office. Im still seeing people in the office on an outpatient basis. Im still doing telehealth. But one of the things thats happening there and every Hospital System in new york is the converting of beds from one purpose to another. Meaning that the orthopedics ward for example has become a covid ward. A hospital from renovation have become a covid ward. Whats really happening there is an incredible mass of change as we convert over from basically a tertiary Hospital System to a Hospital System that is devoted to taking care of covid with a very small section for those that dont have it or are still in the hospital. Thats the biggest change. The other thing thats happening and this is very interesting is safer somebody like me. I was a medical resident and took care of hospitalized patients extensively in the 90s. But in recent years ive been an officebased physician as many of my colleagues are. Up to be whatned they are calling assistant attendings. Anding that if they need us they are going to need us because i know people who have been called in already. They are going to literally need somebody with a medical license who remembers, i know how to be a doctor, but to go in and actually take care of people in the hospital because between the overwhelming nature of the hospital itself plus the fact that many healthcare workers are getting sick with the disease and have to be out. There really is this incredible shortage of qualified doctors, nurses, respiratory therapists. The whole range of people who well leave this conversatioa from earlier today. Can you see it all online at cspan. Org. Live now as new York Governor Andrew Cuomo isup dating on his States Coronavirus response efforts. Live coverage. Governor cuomo let me go through wher