peter attia paul grewal covid-19

Coronavirus (COVID-19) FAQ | Paul Grewal, M.D. on The Drive with Peter Attia

Check out The Peter Attia Drive Episode Page & Show Notes

Key Takeaways

  • Peter’s advice to his parents for dealing with COVID-19:
    • “I’ve instructed my parents to stay away from everyone and be as quarantined as possible—to avoid their children, their grandchildren, and any sort of meeting place. I’ve basically asked them to go into a complete quarantine.” – Peter Attia
  • Chloroquine appears to rapidly decrease COVID-19’s viral load at low concentrations with minimal to no harm
  • COVID-19/SARS-CoV-2 can survive outside the human body 
  • New York has 3,000 ICU beds. Given 421 diagnosed cases of COVID-19 in the state, a 1.3x growth rate, and a 20% hospitalization rate, it would take ~13.6 days until every ICU bed is filled.
    • Assuming a hospitalization rate of 5%, this number jumps to ~18.8 days

Intro

When the Gravity of COVID-19 Hit Home

  • On the outbreak: “It’s been a bit like watching a slow-motion car crash” – Paul Grewal
  • Around mid-February, Peter realized COVID-19 had no chance of being contained, and that the U.S. was facing some tough times ahead

A Back of the Envelope COVID-19 Calculation

  • New York has 3,000 ICU beds. Given 421 diagnosed cases in the state, a 1.3x growth rate, and a 20% hospitalization rate, it would take ~13.6 days until every ICU bed is filled.
    • Assuming a hospitalization rate of 5%, this number jumps to ~18.8 days 

COVID-19: By the Numbers

  • South Korea (a country with a relatively young population) acted quickly, and as a result, COVID-19’s mortality rate there was only ~0.68%
    • COVID-19’s death rate in Italy, on the other hand, is hovering around ~6%
  • Of Wuhan’s first 138 COVID-19 patients:
    • ~45-50% of the people hospitalized required ventilation (either invasive or non-invasive)
    • ~20-25% of those hospitalized required mechanical ventilation & intubation 
    • ~5% needed intensive care

COVID-19’s Mechanism of Action

  • With the flu & other influenza strains, a hyperactive immune response occurs. COVID-19 behaves quite differently:
    • The virus utilizes the ACE2 receptor, a surface protein located on cells in the kidneys, blood vessels, heart, and most importantly, the lung AT2 alveolar epithelial cells (AT2 cells are particularly prone to viral infection due to high ACE2 expression)
    • Most often, the virus goes on to damage type II pneumocytes in the lungs (pneumocytes help make surfactin, which aids breathing)—this can lead to respiratory failure

Potential COVID-19 Drug Therapies

  • Chloroquine appears to rapidly decrease COVID-19’s viral load at low concentrations with minimal to no harm
    • How so? By lowering lysosomal PH, it helps the immune system clear the virus much faster.
  • Remdesivir also seems promising
    • This is a drug produced by Gilead, previously used to treat Ebola

Risk Factors for COVID-19 Infect & Associated Complications

  • Hypertension & cardiovascular disease
  • Lung disease & respiratory issues
  • Obesity/type 2 diabetes

COVID-19’s R0

  • A virus’ R0 (pronounced “r naught”) = the average number of cases directly generated by one case in a population where all individuals are subject to infection (AKA there’s no immunity)
    • If a virus’ R0 is 3, on average, every infected person infects 3 additional people
    • It’s yet to be precisely determined, but COVID-19’S R0 seems to be between 3-5
  • Note that R0 isn’t an intrinsic property of the virus; it’s a sum of the virus’ infection capability and it’s ability to access new hosts
    • For instance, if everyone isolated themselves, COVID-19’s R0 would drop significantly

Future Estimates

  • Marc Lipsitch estimates that within the next two years, 50%+ of the world’s population will be exposed to COVID-19
  • A UCSF press release estimates that 1.23 million Americans will die from COVID-19 over the next 12-18 months
    • To put this in perspective, last year, ~2.8 million Americans died from all causes

If Peter had a magic wand and was appointed “health czar,” how would he tackle COVID-19 in the U.S?

  • His objective:
    • Reduce the number of lives lost, total suffering, and economic damage
    • Reduce the virus’ rate of spread (R0), ideally down to 1
    • Reduce the virus’ mortality rate (by reducing the rate of spread, the virus’ lethality would naturally drop)
  • His strategy: 
    • “Do everything from a scientific and policy perspective to reduce R0 and lethality”
    • Enforce social distancing/isolation to the max—this lessens the burden on the hospital system
    • Create a testing system that doesn’t result in a significant number of false negatives (which are extremely dangerous)
    • Re-purpose existing drugs for treatment
    • Make sure healthcare workers and first responders are doing everything possible not to get infected
    • In general:
      • “Time is the single most important asset we have because with time comes options. There’s no magic bullet that’s going to fix this. It’s a combination of a whole bunch of things that bring down Ro and lethality, so the dot product is a lot smaller.” – Peter Attia

Peter’s Advice to His Parents

  • “I’ve instructed my parents to stay away from everyone and be as quarantined as possible—to avoid their children, their grandchildren, and any sort of meeting place. I’ve basically asked them to go into a complete quarantine.” – Peter Attia

What’s Peter’s COVID-19 protocol?

  • Peter is:
    • Self-quarantined with his family
    • Doubling down on sleep (he’s found that phosphatidylserine helps him gets some shut-eye—it reduces cortisol levels)
    • Exercising daily in his home gym
    • Time-restricting his eating

COVID-19 Can Survive Outside of the Human Body

  • A recent paper suggests COVID-19/SARS-CoV-2 survives for:
    • Up to 3 hours in the air
    • Up to 4 hours on copper
    • Up to 24 hours on cardboard
    • Up to 2-3 days on plastic and stainless steel
Drive with Dr. Peter Attia : , ,
Notes By MMiller

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