Momentum Podcast: 637

Coronavirus From the Frontlines with Michelle Charfen, MD

by Alex Charfen

Introduction

Today, I want to introduce you to my sister, Michelle. She is currently an ER doctor in Los Angeles county. Every week since the coronavirus first hit California I’ve been able to talk to her. Listening to her perspective after having been in emergency rooms for the last 19 years has clarified a lot for me.

Episode Description

When I talk to someone who believes that the seriousness of COVID-19 is overblown or a hoax, I ask them one question. “Have you talked to anyone on the frontlines, someone who is actually dealing with this?”

The majority of the time their response is “no”.

I understand that most people do not have the ability to call up an ER doctor or epidemiologist and ask them questions. At the same time, the fear and confusion around what is happening is real. I am lucky enough to have the ability to ask a professional for information, and a platform to share it with entrepreneurs like you.

Today, I want to introduce you to my sister, Michelle. She is currently an ER doctor in Los Angeles county. Every week since the coronavirus first hit California I’ve been able to talk to her. Listening to her perspective after having been in emergency rooms for the last 19 years has clarified a lot for me.

Michelle joined me on my podcast this week and I'm excited for you to meet her. It was a unique experience having Michelle as a little sister. When my mom asked me what I wanted to be when I grew up, I'm pretty sure I told her a fire truck. Michelle knew she wanted to be a doctor for as long as I can remember, and she is younger than me. The principal at my school had to give me an exception to graduate because I had missed so many classes, she had the highest GPA in our high school's history.

While I was transferring from college to college before finally dropping out, Michelle went to Stanford for her undergrad and obtained her MD from Harvard Medical School. She then completed a residency in Emergency Medicine and a Fellowship in Research at Harbor-UCLA Medical Center during which she obtained a Masters of Epidemiology from UCLA.

Michelle was gracious enough to sit down with me and answer the questions that so many people have. The conversation that we had was enlightening, revealing, and insightful. I'm excited to share it so that you can understand what is happening with the virus and how you make the right decisions to keep you and your family safe.

Resources Mentioned:

https://www.lung.org/blog/covid-masks

Full Audio Transcript

Alex Charfen: This is the Momentum Podcast. Today's podcast is different and I'm excited to share it with you. Since the beginning of the coronavirus crisis, I feel like I've had an insider's view of what's going on because each week, I've been able to talk to my sister Michelle, who is an epidemiologist and an ER doctor. And she has a background in understanding disease and also treating disease. And so, each week, she's been able to give me an inside view of what's going on in her hospital in California.

And whenever someone in the public says the coronavirus isn't real, or it's a hoax, or things are being made up, I always ask them, have you had a chance to talk to anyone working on the frontlines in a hospital treating patients and seeing what's going on? And the answer is, predictably, typically, no. I don't think a lot of us have relationships like this one where we can just call up an ER doctor who also happens to be an epidemiologist and get real information about what's going on.

And so, I asked Michelle if she would be willing to sit down with me for a half hour and answer some of the questions that so many people have. And she agreed. I think this is going to be an enlightening and insightful podcast for you. I'm excited to introduce you to a person that I love and have a tremendous amount of respect for. I'm excited for you to hear from my sister, Michelle Charfen, about the coronavirus.

I'm Alex Charfen. And this is the Momentum Podcast made for empire builders, game changers, trailblazers, shot takers, record breakers, world makers and creators of all kinds, those among us who can't turn it off and don't know why anyone would want to. We challenge complacency, destroy apathy, and we are obsessed with creating momentum so we can roll over bureaucracy and make our greatest contribution.

Sure, we pay attention to their rules, but only so that we can bend them, break them, then rewrite them around our own will. We don't accept our destiny. We define it. We don't understand defeat because you only lose if you stop and we don't know how. While the rest of the world strives for average and clings desperately to the status quo, we are the minority, the few who are willing to hallucinate there could be a better future. And instead of just daydreaming of what could be, we endure the vulnerability and exposure it takes to make it real.

We are the evolutionary hunters. Clearly, the most important people in the world because entrepreneurs are the only source of consistent positive human evolution. And we always will be. Michelle, I know you're super busy as a physician and mother of three and a spouse and you have a lot of stuff going on. So, thanks for taking the time to share with me and with my podcast listeners today. I really appreciate it.

Michelle Charfe...: Oh, it's my pleasure, Alex. Thank you for inviting me.

Alex Charfen: Yeah, no, this is actually since you agreed to do it, I've been really excited about this. It's interesting how our paths have not crossed that often. We both met 45 and 47 and I just been excited about this. I'm excited to expose my audience to you. I think they'll get some insights about me just by listening to you. And so, I've been looking forward to this. So, you and I talked this weekend. And you conveyed a story to our family on our family Zoom calls.

We used to have family in person meetings. Now, we have family Zoom calls. And you were talking about how, Christian, your husband had gone to see a health care provider and the health care provider wasn't wearing a mask. And that kicked off a cascade for you. Can you share a little bit about that? Michelle Charfe...: Yeah. So, I guess a little background. I work as an emergency medicine physician, and have been working since the middle of March treating patients with COVID and been in this. And being in this and seeing it, as a family, we've actually been very conservative and try to follow the instructions to stay at home and not have close contact with people outside of our household, to keep physical distance, to wear masks when we're out. And we've been pretty meticulous with it.

And it was actually our first time accessing a health care provider was Christian was having really bad headaches and neck pain. And it's somebody that we've trusted and has helped us a lot in the past. And so, he went to see them and we talked it through. And we talked through being careful that he would wear his mask. And what would happen and when he came back, he shared with me that the provider had not been wearing a mask. And I was so mad. I had actually just gotten home from work. So, I had just been in the midst of this.

I had just been eight hours with an N95 on my face and a mask on and a shield over my head. I just decontaminated myself and come inside, and I thought, "What?" And my first anger was actually at my husband. I said, "You went inside? With all the conversations that we've had and he didn't have a mask on, you went inside?" And he looked at me like a deer in headlights. He knew this was not going to be good. But he was like, "What was I supposed to do?" And then, my second flare of anger was this provider. Let's just call him Mike. I know Mike actually, personally. And how could might not have had his mask on? What was he thinking? And my mind started to spin. And I thought and I said, "I don't want to talk about this right now because I'm actually too upset. I need some time to think." And I thought and I thought and I thought. Both for my husband, he doesn't want to put us at risk. We live with our father, right, Alex, who's 76 years old.

Alex Charfen: Yeah. I mean, I remember when you brought it up. One of the things that I leaned in on the conversation was because our father who is in his 70s and has had COPD and has had some other stuff that puts him at risk, it really made me think like what's going on here?

Michelle Charfe...: Yeah. And that was my first thought, too, was like, "You did that but you came home to Dad. You know what I mean? Like, "You came home with my dad, what were you thinking?" And I thought, my husband doesn't want to put my father at risk. He loves him more than anything. What was he thinking? And as I thought about him, he wasn't comfortable saying something to the provider. So, that's going to be our conversation.

How do you talk to somebody that's in a situation of authority where you want to tell them, "I'm not comfortable, or I want more safety, more distance, a mask," whatever it is that you need in a situation. And then, second, I thought, I need to understand what it was that Mike was thinking because I care about Mike and I want to be able to go to Mike if I'm having a problem, you know what I mean? So, what is it going on?

So, I knew I had two conversations that I was going to need to have. And let me say that both of them were really challenging. I've never had so many challenging conversations between family, right, between family, between friends. And I think that's part of what's made me willing to do this interview with you is that I think that we all have a series of very challenging conversations that we're needing to have with each other and with other people.

And that we don't know how to have them. We're just learning. This is a totally new scenario and way of living of where we need to think beyond ourselves and about other people in our community. And we don't know how to hold those conversations. So, that's actually what led me to be willing to do this talk with you today to maybe try to let some other people listen because I'm having a lot of individual conversations.

But I think we all have a lot to learn and how to talk to each other about concerns during this time, how to respect each other's differences and share what we know and what we're feeling so that we can have more accurate information and figure out how to keep our communities safe. So-

Alex Charfen: Before we go into the conversation, you said, "I had just gotten home. I had my N95 as a mask on my shield," totally, all you've been donned. When you say I was just in it, tell us how does being in it today compared to being an emergency medical doctor for the last 19 years. Because you became a doctor in June of 2001. Right? So, that's a tremendous amount of time. How does today compared to your previous experience as a doctor?

Michelle Charfe...: Well, it's very, very different. It's very different right now, especially working in an emergency room. Before when I would go to the emergency room, I would put a mask on occasionally for certain patients. So, myself, if I'm going into the room with somebody that sounds like they have influenza, I will put a mask on to go in and look in their mouth and get close to them and examine them. So, for a brief few minutes, I would have it on and come out, okay?

And occasionally, if I'm seeing somebody that were suspicious for tuberculosis or something, I might be actually putting on an N95 mask, which is very different and fits your face tight and you pinch it down on your nose and you have an airtight seal. I have always felt like I was going to die inside of one of those masks. I get into the room, do as quick as I couldn't get out and get that thing off of me, right?

So, I maybe would wear it before for 10 minutes or something to do an exam and see people. And now, I'm wearing it the entire eight to 10 hours that I'm on without removing it. And so, how does it feel is very different. It's been a learning curve for me as I think it's a learning curve for anybody which I have a lot of empathy for people in trying to learn how to wear a mask. It actually takes practice and wearing a cloth mask or a surgical mask is also very different from wearing an N95 masks.

So, I had to really get used to it. I had to really be uncomfortable and be like, "Wow, I'm uncomfortable but I'm not going to die." And even though it feels like I'm not breathing great, I'm actually breathing fine. And I'm thinking the same and I'm able to function. It's just not comfortable. That's the bottom line. But for me, I've been very meticulous about my precautions when I'm in the hospital for my children, for my husband and for the fact that we just talked about, I live with my father who's 76 years old.

So, it's very different. So, it's very different to be underneath that mask, under another mask and underneath a shield the whole day. But I'm willing to do that because I want to be there to take care of people. And it allows me to safely take care of people. Nothing's 100% but it makes it a whole lot safer for me in that interaction.

Alex Charfen: How does being in the ER today compared to stuff that you had in the past? I know at the very beginning of this issue, you were telling us how when it's new, you don't really know what you're dealing with.

Michelle Charfe...: Yeah. Yeah. I think it's been a huge learning curve for all of us. And we don't really know. And I remember from the first day of the first patient that I had to screen to try and to develop safe practices about how we were screening. And it's taken a lot of teamwork. And I feel very blessed to work in a hospital where I feel like our administrators have been super responsive to our needs and really helped us. And hired consultants to help us and figure out how to address it.

I'll just say that there's been a huge learning curve for all of us. But what I will say with that learning curve is that the amount of stress that I experienced at the beginning, trying to go in and don this gear and do this, even to now a couple months into it, it's diminishing, and that I'm more capable and able to do it. And so, I think it's all of us learn safer ways of interacting with each other in a pandemic. Life is different. Nothing is going to be totally normal.

So, as we figure out how to, let's say, be around with our friends at a park 10 feet apart with a mask on her face, that's going to feel so weird, and it's so awkward, and you get through it. And then, you do it and you're like, "I could do this again. If this keeps everybody safe, and this keeps people in the community safe, then I could do it." I feel like everything is a learning curve. And if we don't ever get to practice, we don't know how to do it.

And we can't be good at something until we practice it. So, interacting in different ways, I feel like for all of us in the whole entire hospital staff is learning new ways of interacting to keep everybody safe and then doing that. But I think that what we've shown is that as a whole, you can find safe ways to still deliver care or get products to people or do things. But it's just not going to be what it used to be. It's going to be in this way where we're following different precautions.

Alex Charfen: So, Christian went to see this health care provider. And I really like what you said and I believe it too. I don't think that anyone out there, whether they are saying that this whole thing is a hoax, or they're saying that this is the worst thing that's ever happened, I don't think anyone is purposefully trying to hurt anyone. There is a lot of opinions. There's a lot of misinformation. There's a lot of confusion out there. So, when you called this health care provider, how did that conversation go?

Michelle Charfe...: Well, I've known him for many years. And I have a tremendous amount of respect for the work that he does. I see him myself and count on him when I'm in pain. And so, I called him and first checked in to see how him and his family were doing. And then, I just shared really honestly, and I said, I was very grateful that he had seen my husband, but that when I heard that he didn't have a mask on, that I was actually really upset and that I was really upset with Christian. And then, when I sat with myself, I realized I was really upset with him and that I wanted to talk to him and try to understand where he was coming from.

I said, "I know that you care about your patient. So, please explain to me where it is that you're coming from, that you would not have a mask on in these interactions." And he was very willing to share his opinions with me and share information that he had. He had concerns about the safety of mask, about people not being able to breathe as well and oxygen dropping in mask. He had concerns and shared some data he'd read that he felt that this was just similar to the flu and that we just needed to let it run through us. And that we all needed immunity and that it wasn't a big deal.

He shared concerns about that statistics were inflated and not really true and that not as many people were dying as it looked. And that it really just like wasn't a big deal and that it was okay and that we all just need to get immunity. And I could tell he really believed this. And so, I don't think at any point in time he ever wanted to put anybody at risk. I think he actually believed if this is just something that needs to come through us, then let it come through us. Let's get immunity and I'm here to care for you.

And I think that's probably the experience of most people that are choosing not to follow social distancing guidelines right now or wearing masks is that I don't think people are out there wanting to hurt other people. I think people really have a misperception about the data, about the risk of what this is, about what's happening, and they don't think they're going to hurt anybody. They feel actually okay and justified in what they're doing.

Alex Charfen: So, how did you counter that? So first, I think that what you said when we first started talking that there's a lot of difficult conversations happening right now. It's very true. Obviously, I wear mask, I social distance, we've been very cautious throughout this thing. A lot of the reason is I talk to you every week and it encourages an abundance of caution. And let's just knock some of these down. Because I think that what's happening is people show up somewhere with a mask.

And then someone says, "Hey, you don't need that," and they go, "Oh, maybe I don't." And they get into this place where they lose resolve, or they start thinking maybe they're being overly cautious. So, let's go through, you brought up three of the biggest ones that I'm hearing. The first one is masks may be more damaging than they help. The second one is this is just the flu. And the third one is inflated stats. Let's go through them one at a time. So-

Michelle Charfe...: Before we go there, can I actually just reflect on something that you said? Because I think it is a really important point that if you are the only person wearing a mask, it feels incredibly awkward, right? It feels incredibly awkward. And I earlier on, before universal masking was even a policy in our hospital, I was wearing a mask all of the time. And I felt that awkwardness. I'd be in meetings with a bunch of people that weren't wearing a mask.

And I'm like, they think I'm crazy. They think I'm too, you know what I mean, conservative and your head is chattering the whole time. And I think that it's actually important to know that because I have friends right now that are trying to make moves to be more cautious and wear a mask and they may be the only person in their workplace. And when I talked to them at the end of the day, they're like, "My head was just so busy."

And I said, "Yeah, your head's so busy wondering what people are thinking about you, you know what I mean? And what's going on? And do I need to be doing this?" And I think it's important to understand that that's part of the learning curve for all of us. But that as you're in communities and places where more and more people wear the masks, and you're taking the precautions and you're being careful with each other, that chatter does get quieter. And you start to understand we're all doing this for each other and it gets quieter.

But it's important to know that when you first put the mask on and maybe you're the first person in your social group or somewhere that does it, to just to expect that it's going to feel weird. And what I have to always remind myself when I'm doing something is why am I doing this? And I'm like, "Because I value safety, I value being safe. If I'm going to come into this meeting in the hospital, I value being able to go home to my father and not transmit something to him. I value not transmitting it to my children that have asthma," or whatever it is.

Alex Charfen: You value not transmitting to the other people at the table in the hospital.

Michelle Charfe...: The people that I'm going to see to whatever. And so, I think we need to remind ourselves of that. And it's really so fascinating to watch how that fine line between somebody taking appropriate precautions, do they look like they're crazy and too conservative? We're watching that line get crossed all of the time right now as we learn new things and the risk changes. When you're in a community that has high transmission, you've been in in Texas, right?

Whereas, previously, when I would talk to you, right, on the weekends, you'd say, "I don't know, we're not really seeing it, Michelle, right? We're not really feeling it." And I'm like, "I know. I know, love. Not yet." You know what I mean? Not yet, but when you get there, you know what I mean? "When you get there, you'll see." And I really do feel like for most communities right now, it's either we're here, we're on our way, we're there, we've been there. This virus is not going to spare communities.

If somebody comes into a community with it, they're going to have some effects, right? And so, that when we're there, and we're seeing higher rates of transmission, and numbers are going up, it's an invitation to us to actually act differently and decrease transmission, right? And we can talk about some of those reasons why. But I just want to acknowledge how hard it is actually to be taking distancing measures, how hard it is if you see everybody else getting together and having play dates to say, "I'm not going to be doing that with my kids right now."

These are really challenging conversations. But I think they're important conversations. Part of, I guess, what I wanted to do is support people that actually already know and are looking at it and wishing that their behavior was different and the behavior of other people around them were but you're feeling odd or weird or you don't know how to support yourself in it, I want you to have a voice to understand how to have some of these conversations.

Alex Charfen: So, how did you answer the argument the masks are unsafe?

Michelle Charfe...: Okay. So first, the argument masks are unsafe. I explained it to him that I actually wear one all day long and that I'm perfectly fine. And that I'm not dropping my oxygen saturation or feeling dizzy or not uncomfortable. That's the biggest thing. The biggest problem you're going to have with wearing a mask is that it's uncomfortable. And there are certain populations, let's say if you have very bad obstructive lung disease and problems breathing at baseline, if you put on the N95, you might actually struggle.

But for the general healthy population, and we're not talking about N95 mask for the general population, we're talking about cloth masks and face coverings, you're going to feel uncomfortable but it's not going to cause any problem. It's permeable. You're not going to drop your oxygen saturation. You're not going to have a hard time. You're going to feel super irritated, you have an irritating thing over your mouth. You know what I mean? And it's on your face.

But it's not actually dangerous. There's not danger to it. And I can send you a link to the American Lung Association, answers a lot of the questions that people have about mask and their safety. And it's a very succinct short thing. I'll send you a link to that. For people that have concerns, because it's really truly not unsafe to have a mask on your face. I've been wearing masks on and off, if you're a surgeon all day long that operate.

We all do this to keep precautions in the hospital. And there's nothing about it that's unsafe. I'll tell you what, the one thing that I see as being unsafe is if somebody puts a mask on and thinks that they're invincible, and that they can go up close to anybody that has it because you're still at risk at getting it. So, I'd say the only risk you really need to worry about is understanding that a mask is not 100%. That is an additional measure to help you.

But that you still need to take your other precautions which is maintaining at least six feet of distance and really staying out of close contact with other people that you don't need to be in contact with.

Alex Charfen: That was interesting, what you said in one of our discussions was that, it's interesting how the arguments about masks. Mask is the third or fourth or fifth thing down the line. The first one is stay home. The second one is don't be around other people. The third one is if you are at the outside. The fourth one is if you're inside social distance. The fifth one is you add a mask to all of those things, and you're going to be even safer.

Michelle Charfe...: Yeah, that's exactly right. I mean, I think the very most important thing that you can do to keep from getting this virus and transmitting it to others is to not be in close contact with other human beings, which why the number one piece of advice is to stay home as much as possible. We all understand that in the household that you live, there's going to be close contact. We've all assumed the risk of the close contacts of our household. But beyond that, the number one way we can prevent this transmission is to not be in close contact with other human beings.

Because this virus doesn't do anything by itself. It needs to be inside of one of us to be active. And so, if we're not passing it to each other, we're not causing new cases. Physical distance is the most important but like you said, then if you do need to be around each other, you try to maintain the six feet of distance and wear a mask. And if you're going to do it, do it outside if you can, because of the way the airflow mechanics work is going to be a lot less risky to be outside than inside where air is stagnant.

Alex Charfen: So, first was mask. So, thank you for that. The second one is the argument that this is just a flu. And it needs to pull through and just needs to work through everything. We need to get our immunity.

Michelle Charfe...: Yeah. All right. So, yeah, the argument that this is just the flu. Flu is something that we deal with annually. And we lose a certain amount of patients every year to flu. There's a certain number of deaths. And so, flu is something to be careful with also. But the number of people that we are losing to coronavirus is much larger than what we lose to flu. And the truth is, to me, it's not even so important that this is a coronavirus or a flu virus.

If we had a pandemic strain of flu, which would mean a strain of flu that was passing at the rate that this is passing within populations, we would be in exactly the same situation. So, it actually doesn't matter which virus this is. The point is, is that this virus is causing infections at a rate that is rapid enough that it's leading to spread and then causing illness that's severe enough that it's requiring hospitalizations and ICU level care, at rates at which are overwhelming systems, right?

So, it doesn't matter. Let's look at New York and how overwhelmed their system got. It wouldn't matter if that had been coronavirus or an influenza virus that overwhelmed the system. If the system is overwhelmed, then we don't have regular ability to deliver health care to people for all the things that they need, or to deliver the quality of care that we can if you have this illness, right? So, if you have this illness, and you're able to get good quality care, you're very ill with the inside of an ICU, your chances of surviving are much better if it's an ICU.

Where it's not overwhelmed and it staffed and you have somebody that can watch you because it takes very individualized care. If you're in a system where you're boarding hundreds of patients in emergency rooms on ventilators, you know what I mean, throughout cities, you can't deliver that same level of care, right? So, what we want is as this disease progresses through our population, we want it to progress at a rate where we are still able to deliver the care that people need.

Not just for this disease, but for other disease processes, right? One of the collateral damages that we had in first dealing with this was people were so scared to come into the emergency department that they were staying home with other illnesses like heart attacks and strokes and appendicitis and becoming very ill, right? And people were lost in that way, too. So, what we want to understand, we want our health care system to be able to function, right?

We want it to function for us if we have COVID. And we want it to function for us if we have another illness. So, if this disease is spreading in a population at a rate which is going to overwhelm the health care system, that's when you really have to say to people, "Well, we can't just let this run through us." Let's say that you had a population that said, "I never want a vaccine, and I want it to run through us." So, let's just make that argument which I said to my friend, "Let's make the argument that you really want this to run through everybody."

Even if you said that and each person was willing to take the risk and just get it, we need it to happen at a rate at which we can deliver care unless you want people dying unnecessarily. Because we do know that oxygen helps in prolonging people and doing these other measures. And then, people that are hospitalized, we do have a few things that are helping. We have our ventilators. We have a few drugs that are showing promise, not a lot.

But we do have things. We want those to be available. At some point, you only have a certain number of oxygen tanks, ventilators, ICU beds, physicians. And you have things happening like what happened in Italy or New York. So, the point is we cannot just let this run rampant through communities where rates are going up at levels that are looking like they're going to overwhelm the system. It's not just you getting it, it's the number of people that are getting it at once. So really, this whole disease process asks us to have to think outside of ourselves. Even if I think I'm just young and healthy and I want this to run through me, I have to realize that if I let this run through me, whoever I come into contact with, I'm potentially giving it to them. The health care providers that helped me I'm exposing them. Every one of you that are exposed comes into one of us that need to take care of you. Does that make sense? And leaves a strain of exposure.

And so, it's really asking us to think beyond ourselves. And that can be hard because it's not a way that we're used to thinking. It's actually we're not used to thinking in this realm of thinking about how does what I do affect everybody else. And this is a time we're being called to action to think not just about what we want for ourselves or even our immediate family, but really thinking of our whole community and those members of our community that are most vulnerable. Because it may, through one of us, just run through as a mild illness, but we have the potential to spread it to other people. And then, Alex, like we've talked about, there's also the potential that we have young healthy people that don't have medical problems that are also dying of this. Not at the same rate as older people or people with medical problems. But we do lose young and healthy patients. And so, it's not selective. It definitely hurts some populations more than others. But it's not staying away. You know what I mean? Or sparing some.

Alex Charfen: And Michelle, in some of the younger people who have, this feels like a very binary argument, "Oh, somebody got it and they didn't die so everything's okay." We actually have a member who got it. He's, I think, 42 years old. And he had to put his membership with us on hold, because for two months, he's had such horrible fatigue and problems breathing. He's "recovered." But he said he's operating at a fraction of his capacity. So, aren't we also seen that in the younger population, if there is a recovery, that there's often still some lingering issues?

Michelle Charfe...: There are a lot of lingering issues. And there's data coming out on that and more will be revealed, right, as time goes on, as we see more people get infected. But yes, that's absolutely true that you may have a milder course of illness but then have prolonged issues afterwards. And so, that's another one of the things that we are going to have to see. And back to that thing about the flu, I hospitalized many patients every year from the flu. We lose patients to the flu.

And so, that argument again, that this is just the flu, if this was a flu that was this infectious, you know what I mean, and causing this many problems, we wouldn't be approaching it any different. I mean, we have a few drugs we use for the flu. We have more experience with the flu. But the same precautions that we're asking people to take of physically distancing, of isolating at home, of using mask when you do have to be out and about, we would use those same measures in preparation for a pandemic flu. So, that's the reality of it.

Alex Charfen: So, even if it was a flu, if it acted like this disease X, we'd be doing the same thing?

Michelle Charfe...: That's exactly right. And there's many epidemiologists and infectious disease experts that have been writing for years about our need to plan for a pandemic strain of flu because it's very real. Some years, the flu that we experience is worse than others. And when it's a tough flu season, I feel like I'm drowning in the emergency department and people with flu. And at the beginning of this, we were still experiencing flu.

At the beginning of this, in the middle of March, I was hospitalizing people with their tests were taking a long time to get back. I didn't know if they were flu or if they were COVID. Some came back as flu. Some came back as COVID. And some came back as flu and COVID, together. And that is quite a confusing situation to be in. So, right now, we're dealing this without flu. That's something to keep in mind. Right now is the season where we don't have flu and look at what we have happening. Okay. So-

Alex Charfen: So, when we do have flu, we can just [crosstalk 00:28:18].

Michelle Charfe...: For me, yeah, it's hard to imagine what that's going to look like.

Alex Charfen: Michelle, I've known you for a long time. And you are the least sensational person I know. You just stated facts and you do so in a way that's very straightforward. When you say like I don't know what that's going to look like, what are you thinking it's going to look like? What are your concerns? Michelle Charfe...: Well, my concerns about that is that it's already hard to deliver health care in our health care system during the flu season. We're pretty strained during the flu season to have capacity to take care of it. So, it is very hard for me to imagine what that will look like. And we're talking right now a lot about public health, Alex, but when I'm in the emergency department, it's each person in front of me is the most important person at that moment that I'm seeing. It's all about them. At that point, nothing else, you know what I mean? It is about them and what they need.

And it's just it's very disconcerting and frightening for me to think about what that would be like trying to care for people with a level of strain of having influenza and COVID on top of it. Because I already know how strained we are, how much I struggle to give the care that's needed during flu season with long waits and people who need it and hospitalizations and everything that's already happening. So, it's hard for me to imagine. And like you just said, you actually made a comment, you said you're the least sensational person that you know.

I think I don't like motivating people out of fear. I never have. I don't like being motivated out of fear. I don't like how it feels. I actually like to walk towards what it is that I want more than to try to be running away from something. I'm always trying to reframe things and how do I go towards what I want, not what am I running away from. What I think is important to understand right now is that fear and anxiety are there for a reason. We have fear for a reason, because it is there to motivate us to look for danger and understand how to respond.

Right now, it's close to impossible to have conversations about COVID-19 and what it is that's happening without people experiencing some level of fear and anxiety because there truly is a danger. That's the bottom line. We actually truly are facing a danger where our actions today are going to impact what happens in a couple of weeks and a couple of months. And so, even though I don't like having conversations where fear, you know what I mean, needs to be the motivator.

There's no way to honestly address what's going on right now without addressing that fear and anxiety is actually an appropriate response right now. It's actually appropriate to have some level of fear and anxiety so that you take the necessary precautions to keep yourself and your community and other people safe. And that's not a fun place to be. I think we'd all much rather not feel afraid. And I think that part of that desire to just be like, "Oh, well, it's not a big deal." "And it's just like this." It's really this deep desire that people have to not be feeling fear all the time and to not be an anxiety, they want to feel better. They want life to be back to normal, they just want to operate. But the bottom line is, is that in so many communities like the community that you're in in Texas, in the community that I'm in in Los Angeles and all over our country and the world, that's just not the truth of the matter.

The way that we need to operate to keep ourselves safe, our family members and our community as a whole is to understand that there is something right now to be worried about. There is something to attend to. Fear and anxiety have a reason. They motivate us. They come as an emotion to motivate us to pay attention. And right now, we need to pay attention. Alex Charfen: I appreciate you sharing that, Michelle, because I think that a lot of people in the public right now feel like there is so much fear being thrust on them. And it's like there is so much that feels sensational and feels over the top and feels unbelievable and feels completely unfamiliar. But at the same time, just bringing it down and saying, "Hey, some fear, some anxiety, some precaution here, those things that create precaution, that's appropriate."

So, the third thing that you said that you had discussed with the health care provider that you talked to was the inflated statistics, which is something I'm hearing about all the time. I actually have heard other medical professionals talking about how the statistics are just fundamentally inflated because anyone who dies in the hospital right now is a COVID-19 death. How did you answer that?

Michelle Charfe...: Yeah. Well, the truth of it is that first of all, not anybody who dies in the hospital right now is a COVID-19 death. If they're not COVID-19 patient, it doesn't go on the death certificate. But if they are COVID-19 patient, and it's contributed, it does go on the death certificate. And this is the way that it works. When you get a disease, let's say flu or COVID-19, and you have it, you don't just get it and die right away, right? You get it, you have an illness, a series of reactions happens in your body. And then, downstream, other reactions and other things happen. So, let's say COVID-19 causes increased inflammation. It causes inflammation in the lungs. It causes inflammation at the level of the heart. It got in the blood vessels, all kinds of other problems happen. So, you may get COVID-19, then develop a serious bacterial pneumonia, then no need to be on a ventilator, and then have acute respiratory distress syndrome and then die. So, what your death certificate would look like, the way that it would be filled out is it would say you died of acute respiratory distress syndrome due to pneumonia due to COVID-19. Because it's a chain of events.

And it is actually very important for us to understand how COVID-19 has contributed to death so that we understand what it is, is going on. But there are multiple processes. So, when somebody says it wasn't COVID-19, it was pneumonia they died from, a bacterial pneumonia, they need to understand that it was the damage to the lungs and the being in the hospital and the ventilator and this that led to the bacterial pneumonia that led to this, that led to death. Or another example is that, this happens also actually for influenza also, there's an increased inflammatory state in general.

So, we see increased myocardial infarctions and cardiomyopathies and strokes, because there's increased inflammation in the system. So, COVID-19 is contributing to these deaths. If they weren't in a place where they were in this inflammatory state, that next thing and that next thing and that next thing may not have happened. And so, it's actually really important for us as epidemiologists, as practitioners of everything to understand the series of events that lead to deaths that occur.

Alex Charfen: That makes total sense. So, I want to go back to the story. So, you had this conversation with the health care practitioner. And we've just spent about 35 minutes talking about it. You told me that the conversation you had was about 45 minutes or 42 or something like that. What was the conclusion of the conversation after you explain what you've explained here?

Michelle Charfe...: Well, after I explained those things, mostly what I just said to you, I took a pause because I realized I had a lot of feeling. And I'd been talking for a long time. And I just said, "Mike, okay, how mad are you at me?" You know what I mean? Like, "How hard is it been to sit and listen to all this?" And he said, "I'm not mad, Michelle," you know what I mean? "I'm not mad at you. I'm just listening."

And I said, "With everything that you've heard and all of your concerns, does the point that I've tried to make about us needing to have the resources to be able to give people the care that they need as simple as oxygen or whatever, does it make sense to you that if we let this run rampant without control and social distancing measures and masking, et cetera, that if we don't do this, that we will be overwhelmed and not like be able to deliver the simplest of measures that people need?"

And I just wanted to know what that point got across. And he said that it did. He said that it did. He said it makes sense. You know what I mean? It makes sense. And he said, "If Christian had said," and also someone else that I know and love went to see him and didn't say anything about the mask either. He said, "If either one of them had said anything, I would have put a mask on." And I said, "If my husband and that other person that came to see you that I know who both have pretty strong voices weren't comfortable telling you to put a mask on, I don't think anybody's going to be."

Because as health care providers, we're in a position of authority, right? And so, if we say I'm comfortable and I don't need it, then the people that come in are confused, and they go, am I wrong? Did I not need it? What is it? I said, "I want you to be that safe person that people can come to and that they can trust. That when they come to you, you know what I mean, that they're going to get the care that they need." "So, they didn't feel safe to ask you that. You need to be the person that's taking that precaution for them and for you."

And I think he understood that. At least he said to me that he did and comfortable to wear it. And I really actually have to say that I trust him. I really trust him. We had a long and meaningful conversation. And he said that he would be willing to wear it. And there was not hard feelings between us when we got off the phone. Actually, my I love him and his family and I wish them all the best. And I want him wearing that mask for his patients and for his children and for everybody right now when he comes home.

Because another point that I'll make is that even if you want to be in the camp of it, at some point, you just want to get this and let it run through you and have immunity, there's a couple of things. One is that as we get better at treating this, we get better at providing medical care. So, if you do run into problems, the more time we have to deal with this and study other drugs, the more of a chance that if you do end up having a bad case, that we can help you through it, right?

So, the longer that we wait for other people to get infected right now is actually quite helpful. As we've discussed, what we know now and what we can do is different from even three months ago. So, imagine from three to six months from now actually where we might be and what it is that we can offer. And then, the second thing is that we have no idea how long immunity will last. So, even if you get this right now, that does not mean that in six months or in next season that you're not going to get it again.

There's no reason for us to believe that with this virus having it one time is going to lead to a lifetime of immunity. That doesn't happen for us for influenza, it doesn't happen for the common cold, it doesn't happen for strep throat. So, we have nothing to say like, "Let me just have this and be done with it." You might have it for now. It might give you protective immunity for the next few months. These are unanswered questions. So, that's something that's really important to keep in mind. Alex Charfen: Michelle, thanks for sharing all of this. I really appreciate it. Like I've like I've said from the beginning of this crisis, when somebody has told me that they don't believe what's going on or it's a hoax or masks are a tool of political manipulation, any of those things, I always ask a simple question. How many frontline health care providers have you talked to? How many people in a hospital have you talked to? I've talked to dozens including you.

And I've reached out around the country to the friends that I have and the stories that I'm getting are very similar to yours. Here's what's interesting, there is a tremendous amount of confusion in the marketplace and in the news and in the media and in politics and everywhere else. There is no confusion with frontline providers. They all say the exact same thing that no one has said anything different from what you've said.

In fact, the arguments fall in line to exactly what you've said. For anyone who's actually seen patients who's seen the effects of this illness in human beings, they all have the exact same, but not exact, they all have incredibly similar opinions and experience to what you're sharing. So, I really appreciate you being willing to do this.

Michelle Charfe...: Yeah. It's no problem. It's no problem. And like I say to anybody, it's very easy to get confused by information that's out there. So, I really encourage people and I realize I'm in LA County, you're in Austin, we're in very different places. I really encourage you to follow your own Department of Public Health website. Because that is where there's epidemiologists and physicians working together to try to give you the most up to date information about the risk within your community and what's being asked of you.

And I think, Alex, before, you didn't have a mandatory mask statement, but now you do. I would just encourage you, it's really important to listen to what the public health officials in your area are saying. Because risk of disease are different in different areas. And it's important for you to understand what is happening and to know that they have your best interest and the interest of your community. That's what public health is actually all about. It's about how does the disease run within the population and what do we do with that?

And so, I encourage everybody to get familiar with the website for your own Department of Public Health, and the recommendations that they're making and to know that it's okay to have already been going in one direction and not be doing something and to decide, "Hey, new information that's coming out. I'm getting different information. And now, I want to do things differently. Maybe I was seeing more people than I want to see now. Or maybe I wasn't wearing a mask and now I want to."

We're all learning in this together. And there's no shame in that. We don't know what we know until we know, right? And part of that is that I think what you're experiencing now in Texas and everybody's knowing it is not really real to you until you start to see it. But when you're in one of these communities where it's coming and it's getting worse and it's happening and you know more and more people that are getting affected, it becomes very real. And we can wait til we're hit over the head that way, we also have this opportunity to listen and learn from each other. Right? We had the opportunity to watch New York, watch LA right now, watch Florida, watch Texas, and learn. And learn about what you can do to decrease your risk and keep your community safe.

Alex Charfen: Yeah. I appreciate this, Michelle. I think it really comes down to us understanding, watching what's going on and understanding that this is about it. I think what you said is so important, it's not just about us. This is one of those issues in life in the world right now that cause us to look beyond ourselves to the greater community and say, "How do we help all of this? How do we make it better? How do we make sure that we don't get into a place where everybody's at risk?"

Because if we put ourselves in a place where all hospitals that are 100% capacity, any medical emergency or any medical issue now becomes a massive emergency. And so, I really appreciate you sharing this and being so candid and transparent. And hopefully, we can have you back in a couple months.

Michelle Charfe...: Yeah, no, thank you for having me. It's always weird to talk to an audience that I've never seen. So, to all of you that are out there, I just want to say that my heart goes out to every individual and family right now. I think this is one of the most confusing times in history that we've had. And I know that each of us wants to do the best by everybody, and that there's a lot of confusing information.

And I truly believe as we all learn more and actually see things unfold in front of us, we have a lot more people in the community that have better understanding, and we're going to be able to work together to keep each other safe. And to realize that in keeping each other safe, we keep ourselves safe. We've never had a chance to see how interrelated and interconnected we all are. And I know that everybody actually wants to do right by everyone and that we just need the adequate information and understanding and time to learn.

Alex Charfen: That is really profound. We will make sure that the link that Michelle mentioned is in the show notes if you want to check it out. And we'll see you on our next episode. Thanks, everybody.

Michelle Charfe...: Okay.

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