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A Deep Dive on COVID-19 with Dr. Tom Moorcroft

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Content By: Ari Whitten & Dr. Tom Moorcroft

In this episode, I am speaking with Tom Moorcroft, DO – who is an expert on infectious diseases, board-certified in family medicine and osteopathic manipulative treatment, and has treated adults and children with chronic bacterial and viral infections for more than a decade. We will dive deep into the latest science on the latest COVID-19 epidemic. 

In this podcast, Dr. Moorcroft will cover:  

  • The science on COVID-19 – what we know so far!
  • The best way to become immune to a severe viral infection
  • The powerful recommendations to help people recover from the Spanish flu (and why it is critical for your health)
  • The pros and cons of the “flattening the curve” approach  
  • The latest research on COVID-19’s incubation time (the time from exposure to symptoms) and when you are most infectious
  • The interesting data on the common flu
  • The detrimental results that can come of the current society lockdowns
  • The biggest flaw with current testing methods 
  • The current situation on vaccines (are they worth the hype?)
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A Deep Dive on COVID-19 with Dr. Tom Moorcroft - Transcript

Ari Whitten: Hey, everyone. Welcome back to The Energy Blueprint podcast. I’m your host, Ari Whitten, and today I have with me infectious disease expert, Dr. Tom Moorcroft. He is board-certified in family medicine and osteopathic manipulative treatment. He’s been treating adults and children with chronic bacterial and viral infections for over a decade. He’s the former acting president and board member of International Lyme and Associated Diseases Society. He’s a member of that, it’s called the International Lyme and Associated Diseases Society, it’s ILADS, Lyme and Co-infections Evidence-Based Fundamentals Working Group. He’s a reviewer of the ILADS Lyme disease treatment guidelines. He’s also a member of the Connecticut PANDAS/PANS Advisory Council and he’s been studying this field of infectious disease for over a decade, so very, very excited to have him on the show to talk about COVID-19, the coronavirus outbreak and get his take on this.

First of all, just for people who don’t know what the heck is PANDAS/PANS.

Dr. Tom Moorcroft: Thanks for having me, Ari. It’s a mouthful. It’s basically an infection caused or triggered autoimmune encephalitis, so it’s a pediatric autoimmune associated neuropsychiatric disorder after streptococcal infection, which obviously, we had to shorten that up. That really was an interesting thing, because we saw kids with behavioral disorders after they had [inaudible 00:01:39] and it was like OCD and rage and weird regressions.

After they saw it in strep, they started to [inaudible] and they realized a whole bunch of different infections and even toxic exposures could do it. PANS is sort of [inaudible] version, where it’s like, “Hey, we’re going to look for whatever the cause of this autoimmune neuropsychiatric syndrome is and we’re going to treat that,” which I think is an interesting way to start talking about what’s going on with COVID-19 is, we started out thinking we had it nailed with strep, and then we realized we didn’t really know what we were talking about and the truth is actually a much broader picture.

What the current science tells us about COVID-19

Ari Whitten: Let’s jump into COVID-19. I want to present maybe a bit of context here. There is a range of opinions among experts about this situation we were just talking before we started recording, about the New England Journal of Medicine article that was published a few days ago by Anthony Fauci and a team of other researchers, where they’re basically saying, “The mortality rate from this may have been greatly overestimated and the real mortality rate may be closer to that of a severe seasonal flu.”

There’s also a Stanford professor and world-renowned researcher, John Ioannidis who is basically saying something similar to that effect. He’s basically saying that we don’t have great data yet, so we can’t make really strong conclusions. We’re all guessing about what the real numbers are, given the limitations of data. It’s possible that the mortality rate could be on par with the severe seasonal flu.

Then there’s other people who are basically, especially people on the front lines of this in the ICU, in the ER, who are basically saying, “This is nothing like the flu. We are seeing very severe stuff going on, and this is extremely serious. Anybody who is suggesting that this could be anything similar to a flu is nuts and they’re misleading people and endangering lives by taking things that lightly.”

Mortality estimates range from 10% to 0.2%. Then there’s widely varying opinions among experts on how many young relatively healthy people are being affected. Some people are saying they’re seeing a lot of young healthy people in the ICU, other people saying, “Hey, this is only really a risk to older people with pre-existing illness.” Given that range– Actually one more thing I want to add to this thing which is-

Dr. Tom Moorcroft: One more thing to add on top.

Ari Whitten: -there are people who are drawing very firm conclusions in the general public about which of those opinions is the correct one, “is the truth”, and then attacking viciously and slinging insults towards anybody who doesn’t agree with them. What is your take on this whole landscape of the seriousness of this pandemic and all those things I just mentioned?

Dr. Tom Moorcroft: I think the first thing is, it’s unfortunate that we’re at that place, but we like to grab on to something that resonates with what we’re feeling inside and run with it rather than look for the data. We could see even our early government response is like, it’s very unclear, probably because they were just going, “Hey, I’m focusing on the economy, or I’m focusing on this thing.” We just grab on to that and miss it.

I think the truth in the end of this is going to end up somewhere in between. From the very beginning of this, I said, I don’t think it’s going to be as bad as a lot of people think it’s going to be, but I think it’s going to be a hell of a lot worse than some other people think it’s going to be. What we’re seeing is the numbers are all over the place. Dr. Ioannidis, it was a really interesting conversation, an article that he wrote to because we’re seeing limited data out of small areas and we also see the data that comes out today, in two days will be completely different as we have a broader perspective.

I’ve been tracking– When this first broke in the US, we had a 3.5% to 4.5% mortality rate, and now our mortality rate has been closer to 1%, 1.5%, whereas Italy just keeps going up and up, and they’re at a presumably 10%. Again, the biggest problem that I have seen from the very beginning is, we don’t understand the width and the breadth of the whole problem, and we’re asking the correct questions, but we’re taking them out of context because what we have to look at is we really don’t know how many people have this. If the current number of a million across the globe have it, and we have a 2.5%, 3.5% mortality rate, well, that’s pretty bad, but the reality of the situation is, there’s probably a gazillion more people who have it, and that mortality rate will be a lot less.

Ari Whitten: I’m so glad you brought that up because one of the biggest things that seems to be going on from my perspective, and granted I am not an infectious disease expert, don’t claim to be one, but what it seems to me is that testing is very limited. To really have solid data, it seems like we would have had to test a large portion of the population. My understanding of the situation as it is now is probably less than 1% of the US population has actually been tested for this. Much less than 1%. Maybe that we can bookmark this to come back to, but there also is questions from what I’ve seen about the accuracy of the test. We don’t even know if somebody gets tested, how reliable those results are.

Then we also have the issue of the fact that something like estimates are, from what I’ve seen, around 50% of people at least who get this infection may be asymptomatic or have only very mild symptoms, and then the people who are being tested are the ones who are going to the hospital with severe symptoms, and then the mortality rates that we’re drawing from the people being tested. Are there for taking the most severe cases and looking at the percentage of the most severe cases who are dying as opposed to the general population? If I’m wrong about any of that, please educate me.

Dr. Tom Moorcroft: No, you bring up a super important point because we have a selection bias. Because right now, I’ve, in the last couple of weeks, tried to send people for testing and if I send someone from my private practice for testing, it’s very difficult to get and the hospitals are triaging and they’re selecting out the worst people for testing, which from a perspective of we have limited test kits available, and we need to ration them to the most appropriate people, that makes a lot of sense.

However, when we break it out and we try to make a broader population decision where we talk about epidemiology, it’s like we’re not trying to pick up every severe case and know what to do with that one person, but we’re trying to pick up what’s going on in the whole country, in the whole world, so we can make a decision for the population. That’s a different story. We’re selecting out mild cases, asymptomatic cases or minimally symptomatic cases.

We’re selecting out– Most of the people I know who are positive with mild symptoms in Connecticut are first responders. We’re saying we want to test them because they’re on the front lines. Now we’re doing what you were referring to as we’re not looking at all these people who are mild. What we’re seeing in the research is two things. One is testing. We’re testing for viral replication with genetic tests.

We’re actually trying to see is the virus reproducing in your nose, in your mouth, or if you happen to be in the hospital, down in your lungs to a point where you’re infectious. We’re saying you have the infection.

How people may have been exposed to Coronavirus earlier than believed

We’re not checking who’s previously been infected, which would be, maybe I was exposed before, it’s possible I have immunity right now. We would need an antibody test for that, which they just this morning finally announced that we have one, which I’m sure none of us will be able to get for a while.

I actually think I probably had this in early February.

Ari Whitten: I think I had it in January. I thought it was whooping cough at the time because it was unlike anything I’ve ever got before in my life. Other than when I got mononucleosis in my early 20s, it was the most severe sickness of my life. I was coughing my lungs out for about three weeks and I wasn’t able to exercise for a month.

Dr. Tom Moorcroft: Same thing. My wife and I had traveled with our daughter. We came back. I was really sick. My wife was pretty sick, darn sick and close. I’ve had some pretty cool infections in my life, I’ve never had anything like that. Then our daughter who is 10, nothing. It starts to fit the picture. We’re in our 40s, she’s 10. Then I remember Jill was saying to me, right after I was starting to get better, she’s like, I was reading about a bunch of people who are traveling and about a week or a week and a half later, they got sick. It sounds like the flu but it was worst. Then it doesn’t affect kids as much as you would expect. We were like, ha. Then a week later, COVID-19 exploded.

Ari Whitten: Then just a side note, and this is anecdotal, totally anecdotal, I have posted in numerous of my groups with thousands of people exactly what I just said to you and there’s a huge amount of people instantly responding, saying the exact same thing back in January or February even December that they had these exact symptoms, the most severe sickness of their life. Many of these people are even reporting they went to the hospital, got tested for influenza and came back negative.

Dr. Tom Moorcroft: Negative.

Ari Whitten: Yet this doesn’t fit with the official narrative of when it supposedly emerged out of China, who knows whether we can believe whatever they’re telling us and it doesn’t fit with that narrative. Then there’s also people saying, “Hey, that also doesn’t fit with the rise in the surgeon in cases that hospitals are seeing now,” which I don’t know how to answer that. Well, I’m hoping it doesn’t mean that I got some other horrific bug. I still have to deal with COVID-19.

Dr. Tom Moorcroft: Well, it’s interesting because– We’re trying to pull the data and use it as best we can. We know that they’re like a molecular or a genetic clock a lot of these viruses have. You can start to see by tracing the genetics of different samples, how it’s changed. It does look like the SARS-CoV-2 virus however it came into humans because it’s very, very similar to bat coronaviruses. We know that coronaviruses do skip here and there. That’s how we get the bad ones. It looks like it happened pretty at the end of November, middle of November.

We think from the early genetic testing that is true. We also have a look at the mutation rates. It is mutating, like all viruses, but it’s not mutating so quickly that we think we’re going to have a completely different COVID-19/20 virus that happens in May or June. It looks like it’s going to be one thing. Maybe that’s helpful. This is where the data is hard to interpret because, like you said, there’s this massive surge recently. Some of it, I wonder when we look back on this, because we’ll be able to do that and say, “Well, were all the people who are getting sick and going to the hospital already there?” Because we know that in the flu season, our medical system is already bursting at the seams and we know it just bursts even harder.

I remember my days spending lots of time in the ER and in the critical care unit, people are lined up in the hallway in flu season. Now we ask and the question is, are we having more moderately ill people who are aware of the disease rushing to the hospital and flooding the system more than it would be or are we really seeing different in rates? Like you said, the numbers you look at are different and it’s hard to draw that conclusion.

Ari Whitten: I think this is a little bit inflammatory to some people. Especially, there’s the fact that the people on the front lines who are treating people in the ICU are saying, ‘Hey, this is severe, this is not a flu, this is really much more severe than what we normally see.” Having said that, and I’m not debating that at all. I’m sure I’d take their word for it, but I think it’s also unreasonable to ignore everything that’s known about the placebo effect.

The fact that if you’re seeing all over the news, and since the whole society is being shut down, and there’s terrible fear and panic and anxiety spreading about this disease, of course, people are also going to be more likely if they start to have symptoms, to want to get tested, to want to go to the hospital to get care, because, of course, if they’re starting to experience a cough and cold symptoms or flu symptoms, it’s like, “I don’t want to die from this. I want to go get tested and treated if I need to be.” I think it’s totally unreasonable to not assume that there’s a lot more people going to hospitals seeking medical care just by virtue of how much publicity this virus is getting.

Dr. Tom Moorcroft: Well, I think the important part too, is we can actually have both of these things be relatively accurate. If you’re a provider on the front lines, and you’re in the hospital all day with a deluge of patients. Basically, look at it one way, we have instead of one, seasonal flu, we have two seasonal flus. We were already about to burst with one, traditionally, right? We know if we doubled the rate of seasonal influenza, we would have essentially what looks like a pandemic.

I’m not even saying that, let’s just pretend coronavirus is as mild as a seasonal flu, it’s going to annihilate the hospital system. We’re just not set up for it. We don’t have enough ventilators. We don’t have enough staff. We don’t have enough supplies. When you’re on the front line, even if this turns out to be way, way, way more mild than it looks like it is in the media and with the– You bring as a fighter, and the patients in the hospital are getting less than optimal care because of the sheer number of people. That’s a reality.

What I saw– Did you see that he said viral video from the ICU doc in- it’s like Weill whatever Medical Center, Weill Cornell Medical Center in New York, where he just talked to his pals and he said, “Look, what we do know, is if you wash your hands and you don’t touch face until you’ve washed your hands, we can actually not be spreading this. We’re talking about aerosol maybe and this thing and that thing, but really, it looks like it’s respiratory droplets, and unless you’re in an enclosed room with somebody, you’re relatively safe.” He’s like he used to be scared, now he’s feeling empowered and really good because from his experience with past influenza, and this kind of double down influenza/ COVID-19 thing, if you take the right precautions, it’s not that bad. That’s not to say that they’re not overwhelmed, but it’s just maybe not as easy to spread as people have made it out to be or as scary as it needs to be.

Ari Whitten: Got it. One of the things that I shared some data on this in a group that we both are a part of recently. I was actually mainly sharing this data and my analysis of it to basically seek out infectious disease experts, such as yourself to basically say, “Hey, is my analysis of the situation wrong? If it is, please educate me, tell me how it’s wrong.”

This data was on ventilators in the hospital. It’s early data. I’m sure the numbers will change as the months go on. Looking at people who have severe enough symptoms from COVID-19 that they need to be put on ventilators, the data looks unfortunately pretty bad as far as survival rates with estimates, to be specific from this one meta-analysis, non-invasive mechanical ventilation had a 92% rate of death and 8% rate of survival for people that were put on non-invasive mechanical ventilation. For people who were put on invasive mechanical ventilation, the survival rate was 3%.

There’s some maybe estimates that it might be higher, it might be as high as 20% survival rates, but basically, I was looking at this data and saying, like, “How much sense does it make for our entire public conversation to be dominated by the shortage of ventilators?” If at the end of the day, let’s say, 250,000 people get sick and severe symptoms from this, it would be the difference between 250,000 people dying versus, let’s say, 225,000 people dying or 230,000 people dying by a generous estimate.

In contrast to that, we know that preexisting conditions like insulin resistance, diabetes, high blood pressure, and cardiovascular disease increase your risk of this by two to three-fold. I’m basically saying, of course, we should work on the ventilator issue, and absolutely save as many lives on that front as possible, but we should also recognize that there’s an opportunity here for shifting a lot of this conversation towards also including a focus on nutrition and lifestyle factors and how people can reduce their risk of death from this condition by improving their overall health with nutrition and lifestyle.

Dr. Tom Moorcroft: I think there’s so many things contained in there, so maybe knock them off one at a time. One of the things is, my experience has always been in medicine, it’s been very hard to have a conversation with people like maybe we shouldn’t go on a ventilator, you’re probably not going to make it. In the duration of my career, we’ve gotten much more, I hate to use the word aggressive, and it’s probably the wrong word, but more assertive in saying, “Hey, look, we’ve done this a long time. Maybe hospice or end of life is a better thing to do, not only for the system but really for you as a person.”

That’s a hard conversation because statistically speaking in the United States, 80% of our lifetime medical expenditures in the last weeks of our life. I know those numbers they’re astronomic, what it costs to go in the CCU. Now, we’re in a different situation because it’s a new thing we don’t know. To try to figure out what to do, I looked at the rates, a lot of people have heard about acute respiratory distress syndrome, which ARD, which is coming out of having COVID-19. That is what lands you on a ventilator. The problem is with ARDS that’s severe in a non-COVID-19 patient, the mortality rates about 45%. There is a gap in there, and I wonder it is going to show in the end with that, but that’s an interesting piece.

When everybody’s looking at all these big things to do like the medicines to treat, the hydroxychloroquine and the chloroquine and they’re talking about how they increase pH and how they help the zinc get into their cells better, a lot of people are speculating that children are less impacted by this because their melatonin is really high, and a lot of the way these viruses work are they basically induce inflammation through these particular viral protein things and melatonin can counteract that. Melatonin can actually help counteract some of the lung injury from ventilators, but it’s presumably all anti-inflammatory.

I go back to, and this is getting into your natural life, supporting health naturally. When this whole thing started, I said, we need to do a couple of things. One is we need to wash your hands, we need to stay away from sick people who are coughing on us, and we need to, if we touched the surface, wash your hands before you touch our beard or [inaudible]. That’s still what everybody’s saying.

The other things I said were, we need to get really good sleep, and if we need help, we need to boost it up through blue blockers and turning off the tablets, turn off the Wi-Fi, use melatonin. We also need to get out in the morning for some sunshine to turn on our melatonin production and to get fresh air. We need to eat a really good diet. We need to exercise and we need to chill out.

I was staying that back January and February about this in particular and that still holds true. That’s really [inaudible] have. We can get zinc from food. We can get melatonin from sunshine. I mean, it’s like everything we’re trying to do with medicine, people can do at home by minimal dietary change and everything else is free.

Ari Whitten: I have to say how unbelievably good to hear and refreshing it is to hear an infectious disease experts say that. I posted that kind of analysis, which is basically exactly what you’re saying. Basically saying, “Hey, I must be wrong about this because there’s so few infectious disease experts that are out there who aren’t saying anything about vitamin D, about it boosting immune health and nutrition and lifestyle and the fact that we know that these pre-existing conditions, which are largely diseases of lifestyle have a massive influence on your risk of having severe symptoms and dying from this condition.” Why is no one talking about that? [crosstalk] So, I said I must be missing something.

Dr. Tom Moorcroft: It’s crazy because it’s like we talk about– There’s two real things. I think we should work on both sides. One is we have a virus. Let’s learn about the virus and how to medically address the virus, but the other thing we have is the host. My goal for myself, my family, my patients, for everybody listening is that we decide that we are going to become the world’s worst viral host possible. It’s your chance to optimize your health because this is the part of the equation that we have a lot of evidence on lifestyle changes improving immunity and longevity and what you do now not only is going to help you get through COVID-19 but it’s going to help you moving forward and let the doctors and the researchers work on this thing. It’s just so important.

Then if you look, we talk a lot about the Spanish flu pandemic of 1918. Well, if you look at the– I’m an osteopathic physician, so it’s nice to be able to have a long tradition of supporting self-healing, meaning number one is your body’s trying to heal. If it’s stuck somewhere, I want to help, I want to be a catalyst. I’ll use medicine if it helps you get better, but I’m not going to just go, “I’m going to take that power away from you. It’s your body’s job to heal.” If you go back to the Spanish flu, we had a 10-fold decrease in mortality compared to other physicians. What they said was, if they applied common sense, if you were [crosstalk]–

Ari Whitten: Anyway just to clarify, relative to other physicians or other–?

Dr. Tom Moorcroft: Other doctors, yes. So, basically, at that point, MDs. Again, there is some bias potentially in these numbers because a lot of the MDs were serving in World War I overseas because the osteopaths at that point were not allowed to. Again, we had some selection bias of data that’s really old. We don’t even know how many people that Spanish flu killed, but we saw a dramatic decrease in death rate. They said a couple of things. If you can walk, go outside and get fresh air and walk. If you can’t walk and you’re infirm in bed, your family must open the windows a couple of times a day to get you fresh air. Then when you’re lying down, they did a pedal pump. They shift the feet back and forth, top to bottom to move the fluid to help the lymphatic system work better as if you were balancing on a rebounder or walking outside or doing some yoga.

They saw that this helped improve outcomes. This is not something new that you or I invented or all the functional medicine people said for COVID-19. We have a long history of this stuff working. I just think we should do both.

Why remaining calm is essential to overcoming the pandemic

Ari Whitten: Yes, 100%. I agree with you. There’s something worth emphasizing here because right now a lot of people are in a state of fear and panic and basically think the only thing that they can do right now is stay home, lock themselves in their home, minimize their contact with anyone. Basically they’ll just wait for this thing to go away on its own or wait for a vaccine to be invented that is going to save us all. I just want– I want to be clear asking you to speak to people who are operating in that frame of mind. What’s wrong with that position?

Dr. Tom Moorcroft: The first thing is that we have a mindset of fear and illness to start with. I do think that we don’t know the right thing to do right now. I do know panic is not it, being proactive is. We’ve described the physical distancing a whole bunch of different ways. I like physical distancing because social distancing suggests we’re cut off from everybody, which we should not do.

At the moment though, I’ve talked to friends of mine and it’s like they’re at home with their kids and they’re going out. They want to go for a hike. They go pull up to the parking lot and there’s gazillion cars. They’re like, all right we’ll come back at another time. We go outside and we run, we ride our bike. My daughter and I take the dogs for a walk. It doesn’t mean you have to be confined to your house. At the moment–

Ari Whitten: Assuming you’re not living in a place that’s truly under lockdown. I have some friends in Puerto Rico and in the UK, lockdowns or restirct–

Dr. Tom Moorcroft: Don’t break the law. It’s interesting though. I was looking at the data in the UK though because they basically said let’s go for hard immunity, which right out of the gate, that’s probably not the best idea because you need to get like 65% of the population infected in order for it to potentially work, but their numbers are, today, now granted, they’re a little behind us, but they’re not looking all that drastically different in terms of their trajectory, but I will caution everybody. A couple of weeks ago, we had 1600 cases in the US and now we have a gazillion. It is rapidly changing, but I think that we should follow the rules.

A lot of experts have been talking, we need to make a decision in the next couple of weeks. We can’t keep doing this forever. We’re hoping that there’s a seasonal variation in this, just like there is the flu. I don’t know that that’s going to happen. That would give us more time, but I do think that we need to be having a conversation where the public is demanding more testing, but particularly antibody testing, so we know who could be immune. Then once we know who those people are, we can figure out if they actually are immune. That way say like, let’s say you and I actually had it and we confirm we’re immune, then we would be safe to go back out into the workforce. We could start to let more people go out. We could say, “Hey, kids are safe, people are immune or have been exposed are safe.”

Now, maybe some of our higher-risk population we can isolate them. If you look at what they did in Singapore and Taiwan, they did early testing, they did early isolation of those who are infected and early contact tracing, meaning if I had it, and I was in touch with 10 people, they would check if those people were sick and maybe quarantine them. They really just nipped it right in the bud, whereas the problem that we’re in right now is we didn’t act decisively in the beginning, and there’s a lot of mixed messages. Right now, we’re stuck in doing this.

We know that the flattening the curve conversation is going to help the load at the hospital, but it’s not going to stop the total number of people getting it, it’s just going to spread it out over time.

Ari Whitten: That’s such an important point, I just want to emphasize. I think there’s a lot of people who are– There’s been so much of the message around flatten the curve, which is a very useful endeavor that absolutely will help minimize deaths due to lack of being able to receive treatment at the hospital, but there’s a lot of people I think who are confusing that objective with, by doing that, the virus will go away.

Dr. Tom Moorcroft: Right. It’s probably not going to happen. It’s literally just figuring out how many people per unit of time are going to be in need of care. The other thing is flattening the curve could potentially help us if there’s a seasonal variation, meaning going into the summer we get a reprieve, but likely it’ll just shift to the southern hemisphere and come back up like influenza. The question is, what do we do then? but at least we would have time.

We don’t know the answers, I think that the truth really lies between everybody just go back out into the world and let’s just see what happens and stay on lockdown forever. Again, it’s hard because I don’t have the influence over the industry to make antibody testing. I know we need more [unintelligible]. Even today, as of last night, we had only done 180,000 tests in the United States, which I don’t think is crazy because we actually have more cases recorded than we have done testing. Some cases are presumed positive-

How the common flu affects the population on an annual basis

Ari Whitten: Right. I almost want to go on digging into the data, but how much of the rise in the number of cases can we really say this is solid data giving us a really good picture of how fast this is spreading or how much of it is just a function of, as you said, that we’re presuming [inaudible] and just the simple fact of we’re testing more people, so the number of cases that are being reported every day are going to skyrocket just by virtue of testing tons more people every day? How can we discern out, what is the actual rate of how fast this is spreading, given those limitations of the data?

Dr. Tom Moorcroft: Yes, it’s a tough call because you’re definitely going to see a rise in positives because you’ve done the testing. You’re just accounting for more truly positive people. What’s going to be really interesting is, when we get through the acute phases of this and we start to look at antibodies who’s been exposed, the number of total people exposed will be most likely astronomic compared to those who are confirmed during illness. The current testing is looking at who’s infectious right now. We know that most people from the time of exposure to the time that they’re sick are getting sick within about five days, a little sooner, a little later, but around five days.

We also know that there is asymptomatic spread, and we know that the highest amount of virus found in samples are people in the first five to seven days. Typically, before you show symptoms or when you’re mildly sick. If you go on and have severe disease, you’re more likely to spread it to the people in the hospital because everybody’s over top of you. But realistically, your viral load is actually lower than early in the infection. Our numbers are going to be hard to interpret because we have to say– It’s almost like you have to set up and say, What’s the ratio of testing availability compared to number of people tested and then reports? We’re so far behind, that really– The problem is the numbers that we’re seeing are representing people who are actively infected. Again, how many people are– The numbers, if you look at influenza, we’re going to have 35 million to 60 million people in the United States every year have it with 30,000 to 50,000 deaths, which is a lot of people. We’re talking a couple thousand deaths at this point in the US from this, it’s hard to say.

Ari Whitten: What percentage of those– How many millions did you say get influenza every year?

Dr. Tom Moorcroft: 35 to 50, dependent. Sometimes 60, even per year.

Ari Whitten: 30 million to 50 million, 30 million to 60 million per year get it. Roughly, let’s say 30,000 to 50,000 people die from it.

Dr. Tom Moorcroft: It’s like a 0.1% mortality.

Ari Whitten: Then there’s this other figure which is the percentage of those 30 million to 50 million that would seek medical care, which is I’m guessing maybe 5% 10%. Something like that, maybe 15%.

Dr. Tom Moorcroft: Something like that. Medical visits, I think last year were about 16.5 million. I have the CDC app. We estimate overall they’re at 35.5 million last year. A little less than half, but hospitalizations are under 500,000, even though we had like 16.5 million people seek medical care for it.

How the current lockdown can have financial ramifications in the future

Ari Whitten: Got it. You were talking about this a minute ago. I want to come back to it. I think it’s an important point, which is right now there’s a discussion as it pertains to solutions to this. We’re already operating in one solution which is shut down the entire economy, everybody stay at home. That’s the solution we’re operating in currently. There are people who think that’s a bad solution and there are people who are suggesting other potential solutions. Some people obviously the extreme is like everybody should just go back to work. This is nothing more than a flu. More detailed and specific suggestions are we should not be shutting down the entire economy. We should be protecting those at risk of getting severe symptoms or dying.

We should have only a very partial shutdown of the economy and allow people who are not at risk for severe symptoms to get back to work and various nuances to that. There’s this dichotomy that’s being presented, which is lives versus money, which is we either say, “Hey, we are concerned about this. This is killing people. This pandemic, this infection is killing people. We need to save as many lives as possible by shutting down the entire economy.” To be concerned about money in the economy is nonsense. We need to save lives. Well, there’s this other aspect of that discussion which is really important, which is an old quote David Katz here who is the head of Yale’s Prevention Research Center. He said, “The unemployment, impoverishment and despair from the job loss bankruptcy, tens of millions of people losing jobs, tens of thousands or hundreds of thousands of businesses going bankrupt, that are likely to result from this epinomic shutdown will be public health scourges of the first order.”

I’ll also mention there’s actually research showing how the unemployment rate links with increased risk of all-cause mortality. This has been quantified in numerous studies. Political economist Toby Rogers says, he calls them deaths of despair and they include heart attacks, suicide, alcoholism, homicide, mental health, and prison issues. There are widespread health problems and death that result from economic shutdown. I don’t think that it makes sense to say it’s lives versus just money. No, that economic shutdown cost lives as well.

Dr. Tom Moorcroft: Yes, well. It’s interesting. Unfortunately, the group of people you just mentioned are disproportionately hit from the economy turning down. It’s like the upper echelon. They’re good for a long time. It’s unfortunate, the people who are most at risk of all these conditions are the ones who are going to be hit the hardest and the people who are having a hard time paying for food or making their rent or whatever are going to be the ones who are worse. I know a lot of working moms who the day cares are shut down. Even people work for me, I mean, we can have them work, but they can’t because they don’t have childcare anymore.

At least in Connecticut, they’re doing some stimulus there and covering some of that bill, but in the long run. The state of Connecticut and the government of the United States are not going to be able to foot the bill for every single person not going to work because our tax is what’s paying that. I’m not an economist, but what I do know is that kids are relatively safe in this. When you look at the data, I mean, it’s still at people 55, 60 and over are still the highest risk groups.

We also know that three or more medical conditions pre-existing, especially like you were saying, there are lifestyle diseases, for the most part, are super high risk to not so much one a little less. The mortality rate and the morbidity, the severe outcomes shy of death from this in a group that have no pre-existing medical conditions is infinitesimally small. It’s less than a percent in most studies, sometimes 1% or 2%, but I mean, the risk to a lot of us is low. Now, with that said there are also people who are at higher– It’s almost like a vaccine conversation with people who don’t want to get vaccinated, which is a whole another thing. I’m probably going to have people throwing stuff at me, but a lot of it, regardless if you want to get a vaccination or not get a vaccination, my daughter, they wanted to give her a Hepatitis B in the first 12 hours of life. I’m like, she has no risk of exposure to Hepatitis B until at least she goes to sleepaway camp based upon what we do in our lives. It’s an exposure risk.

First responders, people working at the hospital, obviously, they have a different risk than someone working at the grocery store possibly, or someone working at an accounting office. I do think that we need to really get some data that’s a little more global and broad because like if you look at the data coming out of Iceland, their rates of infection across their entire population, because they randomly selected people who weren’t sick to be included. We should do some of that random testing people have recommended, then we would have a better idea. There’s no doubt that a lot of what I saw in my ER days were– We talk all the time about social admissions, because people, you have to keep people around because they’re not safe to go home, but they don’t really need to be in the hospital.

It’s because their social situation doesn’t allow them to be safe and healthy, not because they currently have a medical problem. If I send you home tonight, you’ll be back next week really severely ill or dead. It is a significant concern that I’m not going to have the answer to for the whole country. I do think that like we’ve been talking the answer is somewhere in between full lockdown and then just like everybody run to the store and go back to work. Who knows, maybe the answer is everybody can go back to work, but the data is just unclear at this point.

Will vaccines save us?

Ari Whitten: Right. What about vaccines coming to save us? I’ll mention, do you know who Paul Offit is?

Dr. Tom Moorcroft: Yes.

Ari Whitten: Paul Offit for people listening, I would say he’s maybe the face of the pro-vaccine movement. He’s the most staunch pro-vaccine person you could possibly ever imagine. He’s a author of textbooks, medical textbooks on vaccines and owns a patent on vaccine, makes money off vaccines. If I remember correctly, is aligned with pharmaceutical companies and so on. I’m not saying he’s a bad guy. I’m just trying to say the facts here.

Dr. Tom Moorcroft: Give his background because it’s important for this.

Ari Whitten: Yes. From some people’s perspective, all of that stuff is he’s doing the most amazing public service in the world and that’s he’s a boon to humanity for all of those things. Depends on where you’re polarized on that spectrum of the whole vaccine issue. I saw an interview with him a few days ago where he was talking about a potential corona-virus vaccine and I believe he himself said that he would not take it if it came out because in order for a vaccine to be released into the public, it needs to have years of safety testing on it first. I hear some people on the public conversation who are like, “Well, if we just stay in our homes for a few more weeks they’re going to have a vaccine.” It just seems to be wildly misguided thinking that is just not realistic.

Dr. Tom Moorcroft: Yes, and I heard the same thing if I saw the same information interview that you did, it was like five or six years would be fast. A lot of people have been throwing around, “Hey, 14 months will be really fast.” The problem with fast-tracking any of these is kind of like what’s happened. We see that we overshoot, we undershoot, whether it’s safety or efficacy and toxicity. We’ve made so many errors around this SARS 2 outbreak that you could just go, “Hey, I have–” and people are losing money over this thing. Now think about a vaccine where people are going to make money and they are trying to help people and you just are going to dive in in this whole scenario where if you rush it, you could potentially kill more people than you actually were going to get harmed by the virus.

Now, I think that there’s no doubt that some vaccinations are helping the right [inaudible ] and from a public health perspective. That’s always the problem, it’s public health versus the individual and they don’t always meet in the middle nicely. I think that if we rush this to market, it’s going to be dangerous. I’ve looked at your review, the different types of vaccines and there actually one company that’s really at the front of this is making one that’s based on the model of messenger RNA so they’re basically trying to take the genetics and stimulate your body to make antibodies to the virus.

They’ve done this successfully in animals and other things, they’ve never been able to successfully do it in humans in all the previous testing yet this is our best option at the moment. How does it go to the front, when we have other more tried and true methods but this way could be faster. All of a sudden because we’re panicked and I just remembered something, my daughter when this all started when I started to try to preach calm, she said, “Daddy, we need to all remain calm because if our brains are going crazy, we can’t think rationally or scientifically.” I was like she’s 10, it’s exactly it because if we go, “Oh, this vaccine is the best choice because we could make it go the fastest to market.” That doesn’t make sound scientific or medical sense.

Ari Whitten: Yes. I believe you may know more about this than I do, but I believe there’s, I read something about a vaccine for coronavirus that was tested in an animal model that actually showed worse outcomes when the animals were exposed to the coronavirus after being vaccinated, have you seen that?

Dr. Tom Moorcroft: I didn’t read it. I did hear something about it, but I haven’t followed up on that particular one.

Ari Whitten: Okay. I think maybe even Paul Offit mentioned that in the interview, maybe that’s where I’m remembering it from but I mean–

Dr. Tom Moorcroft: You just reminded me of something really important too, is there’s so much information being disseminated now because of the internet and social media. It is next to impossible to keep up on everything. One of the things that I’ve heard– I got one of my staff members, who’s also in physician assistant school, was reading a paper from a website it has all these references and they sent this, it’s just so long and it’s so much cool information, and I was reading it and they’re saying, “Well SARS-CoV-1 and SARS-CoV-2 are similar this way,” and then they’ve put a line, “This is why SARS-CoV-2 is worse.”

They never actually said anything different. They said they’re the same but it might be worse and they have all these references that have nothing to do with coronavirus, but they reference what the statement was, but completely out of context. We’re getting inundated as consumers of information with tons of information that’s not always corroborated by the actual science. Then you look at some of the other docs we’ve talked about, like our friend from Stanford, and he’s well known for saying, “Hey, you have to actually read the clinical trial and know what’s in it and what it really means.”

We take a lot of times, I remember when I was reviewing some Lyme treatment guidelines, there was a paper written in 1996 or so that said, “This one particular infection would persist after short and long term courses of treatment,” and then the year 2000 it was used by that author who wrote the previous paper in a different guideline to prove that we shouldn’t use longer-term treatments because that’s not been proven to work. They came there with completely different conclusions and they just said, “Oh, this sounds good let’s plug it in there,” and unless you go and read it– It’s just we have to be aware that so much of this can be sensationalized, when we finally, and we’re also in the middle of it. We’re getting a bunch of data today that is going to be evolving for months or years, and so you just can’t draw big conclusions necessarily.

Ari Whitten: Yes. I want to touch on one other aspect of the vaccine issue, which is if we look at the flu as a guide for the potential scenario we can have here. The flu has been around for decades or more, I guess maybe a century and beyond. I don’t know how similar genetically the strains are going back 100 years, but this has been around for decades. The flu vaccine has been around for I don’t know how many years or decades. Do you know?

Dr. Tom Moorcroft: Not exactly. It’s been my whole career. At least before ’95. It’s a long time.

Ari Whitten: At least 25 years or so. Yet every year we have a flu vaccine, and because the flu virus mutates every year, it’s a new strain, the flu vaccine often has very limited effectiveness of between I think often between 30% to 60% or maybe the range is 30% to 80% depending on the year. Often there are many years where it’s very, and correct me if I’m wrong, but my understanding is it’s not very effective at all. Given that we’ve had decades to do that, it seems unlikely that within the span of a few months we’re going to develop a really effective vaccine for this other virus that may be also mutating into new strains. That’s my understanding as a non infectious disease expert. I’m curious what [unintelligible]

Dr. Tom Moorcroft: I think your understanding is pretty good. I’ve heard some good numbers, up to 80%. I’ve heard some bad numbers like 10% to 20% efficacy. Although I think the data really does show it’s somewhere in the middle like your numbers. The problem like you pointed out, is the virus mutates. If you step back and we look at the common cold, we don’t have a vaccine for the common cold because about a third of it’s caused by four coronaviruses. The rest of them are typically rhinoviruses, but they mutate every season, and sometimes in the same season.

We can’t really keep up with it, but we just say, “It’s been around for a long time, so we’ll just let it mutate and we can’t stay ahead of it.” We’re just going say, “You’ve got a cold and a few people will get sick and die, but most of us will just have a cold.” The thing with this novel coronaviruses, we’re not sure what’s going to happen. It’s already mutating. Like I said, it’s mutating sort of slow. The original what they’re calling SARS classic now, the original SARS from 2003, people who were exposed to that have shown immunity for over a decade after exposure, whereas some of the other viruses it might be a couple of months to a year or two. We’re hoping that people at a minimum with this current virus, we’re going to get immunity that would last a year, a year and a half, or at the very least, the genetic variation from one season to the next, if it has to truly stick around, will be that the next year we won’t get it as much. We’ll have some memory of it. It’ll be close enough that we’ll instead of having a moderate to severe disease, we might only have a mild disease if we’re exposed. Really, what’s going to end up happening is, we’re going to potentially design several vaccines trying to chase the genetics of this, and then by the time we actually can get to market with it, then we’re going to have to continually modify it. [crosstalk]

Ari Whitten: By the time we get to market with it, it may very well be a situation just like the flu where we’re guessing as to the strain and how effective the vaccine will actually be-

Dr. Tom Moorcroft: Definitely.

Ari Whitten: – but without the years of safety testing.

Dr. Tom Moorcroft: All right. Basically, what we’re going to end up having to do if it’s like the influenza vaccine is make sure the basic aspects of this vaccination are safe and do all that kind of testing, which will take years. Then we’re going to have to do it just like the flu is one scenario. The other scenario is this whole thing just burns itself out like SARS did, and we don’t really see it. Maybe people will be immune for 20 years, and because everybody gets immune, the virus burns itself out. It doesn’t look like it’ll be like that. Again, we’re not sure. The problem is when we look at the original SARS virus, that was a very lethal and a very small group of people who got it. It was more of a discrete thing. This almost looks like just a second seasonal flu, so who knows where it’s going to be in the end. Any big predictions today on what it’s going to look like in a year or two are probably going to be wrong. [chuckles]

How to prevent corona

Ari Whitten: Yes. What do you think should be the big takeaways for people listening to this? By the way, for me, I found this to be a fascinating and enlightening discussion. I’m loving this conversation. Thank you for sharing your wisdom. What do you think are the big takeaways that you want to leave people with, especially for people who are just feeling like they should just lock themselves at home and wait for a vaccine or wait for a drug to come, or on the other end of the spectrum, people who think, “This is just like the flu, and we should just go about business as usual.” What do you want to be the big takeaways from this conversation for everyone listening?

Dr. Tom Moorcroft: Thanks for having me too. This has been a blast. It’s just so nice to be able to share not only your expertise and years of training, but it’s my passion. I say to people all the time if you think you have COVID-19 the very first thing you should do, take a deep breath and relax, then call your doctor’s office and don’t panic, for a whole bunch of reasons, but I do think we need to put it in perspective. We still know the number of 80% to 85% of people are going to have mild disease if they even get it, is still holding. We also know that another 10% to 15% are going to feel worse than they would like to, but they’re going to have no issue, and less than 5% of people who get this are going to be really sick. Whenever I have these conversations, it’s interesting. I was talking to Alan Christiansen the other day about this stuff too.

I’m always like, “Hey, the hospital person versus the person out in public,” and he’s like, somebody just told me this, “There’s vertical people, and there’s horizontal people.” We’re talking a lot of what we hear in the media are about horizontal people who are gravely ill in the hospital. The vast majority of us are vertical, so let’s stay that way. I still think that for the next at least couple weeks hopefully two, not more, much more, we should let the scientists and the researchers sort through the data, but we have to make a decision soon. We just missed the end of ski season basically. I’m frustrated by that.

Ari Whitten: No other reason than the ski season.

Dr. Tom Moorcroft: Right. I need to move so that I can just go skiing or something when nobody else is on the hill, but in all seriousness, I think that we need to remember that the doctors on the front lines are telling us good personal hygiene is important. If you are coughing, that’s when you put a mask on. Those are just easy things. That’s common sense. How would you protect yourself from the flu?

Then outside of all of that, take all the data with a grain of salt and watch it over time because we’ve seen that it changes every minute, so calm down with that. As we know from our functional medicine practitioners, we know from osteopaths from the Spanish flu epidemic, we’ve got those two pieces, we’ve got the virus, and we’ve got people working on that and we have you. Most importantly, I would suggest that everyone take a moment to figure out what they can do to make themselves the best healthiest version of themselves so that the virus can’t take hold in you.

Ari Whitten: Such an important point. I think there’s a lot of people as I said who are not taking advantage of this window of time right now where they’re at home, where they’re potentially waiting within weeks or months to be exposed to this thing and they’re not taking advantage of it to create their best health by optimizing nutrition and lifestyle factors that we know directly relate to your risk of getting severe symptoms or dying from this thing.

Dr. Tom Moorcroft: If there’s anything that we know about coronavirus is the more lifestyle illnesses you have, the worse it is. If you’re a smoker, stop smoking. I think as Patricia Arquette was doing that, it was either Twitter or Instagram thing where she says like, “I went cold turkey, and I’m dying. Everybody who wants to suffer with me, quit cold turkey and we’ll be here for you every day.”

Ari Whitten: That’s great.

Dr. Tom Moorcroft: Vaping. Stop it. It’s ridiculous. We know enough that it put your lungs at risk. Anything that you can do that will help your lungs be healthier, like fresh air, exercise and not vaping or smoking will help. This is all lifestyle stuff. What I think is really interesting to our– and I’m glad we kind of tangent it a little to this piece, is a lot of what we’re doing in our research is looking for medicines to do things, but some of the medicines work because they improve zinc into cells where we can do that by eating good food and optimizing our gut health. It’s interesting when you look at melatonin and these inflammasomes, we can optimize our melatonin by getting up and getting sunshine, and then going to bed on time and creating a dark environment early in the evening, but other things that-

Ari Whitten: Worth mentioning on that point, there’s research– This is an area of my expertise so I can’t help myself but there’s research showing that standard room lighting in one’s home at night suppresses melatonin levels by over 70%, so people are up– We know melatonin is really important. We know our brains produce melatonin or should be producing lots of melatonin every night, and yet most us have lifestyle habits that we are in front of screens, we are in indoor house without blue blockers on and are suppressing our normal production of this very important hormone that decreases our risk of severe symptoms by upwards of 50%, 70% in most cases.

Dr. Tom Moorcroft: It’s interesting because I’m sitting here at my desk, and I’ve got my early evening blue blockers, my late evening- [laughs]

Ari Whitten: Nice

Dr. Tom Moorcroft: You have to. Now, what is really interesting too is we’re in a society where we look for the magic bullet and the magic [inaudible 01:02:23]. I’m like, “Look, you don’t make melatonin well unless you get up in the morning, get some sunshine, and you don’t release it unless you turn the damn lights off.” I 100% percent agree with what you were just saying. The other part that’s really interesting is some of those inflammasomes that everybody’s looking into, maybe, melatonin helps against because there’s a lot of science behind that, nitric oxide also can inhibit the activation of these inflammatory mediators in the body. Then I’m like, “Oh, well how? What do I know about nitric oxide?” Well, it’s mostly made in our paranasal sinuses, the sinuses around your eyes and your nose. Well, what do I know about that? I know that if we do certain types of breathing, such as Wim Hof breathing or the Buteyko breathing method, not only do I open up my nasal passages, which just as an aside, helps brain detoxification, so you can think better and ward off dementia, but also now we have more nitric oxide which then can decrease inflammation. Then you look at vitamin C.

Ari Whitten: Just real quick on nitric oxide. Sunlight, exercise, green leafy vegetables, all powerful promoters of nitric oxide production.

Dr. Tom Moorcroft: Even ascorbic acid dose-dependently inhibits these particular inflammasomes that are triggered by COVID-19 and are fixed by all these things we’ve been talking about or diminished. We don’t know that doing any of these things actually will make COVID-19 not happen to you or make it not as bad, but think about the people who are getting sick. It’s all the people who choose not to do these things.

One piece about the breathing and stuff, I love throwing out the breathing because whenever you breathe on a regular basis in a way that is you’re conscious, you then start to get more parasympathetic, you get your vagus nerve tuned up, your gut calms down, and that boosts your immune system. It just takes you out of that fight or flight. You have a better chance to make good decisions like my daughter pointed out. Really all these little simple things aren’t that hard to get. Exercise is going to help you become more parasympathetic. Then I think about intermittent fasting can promote cellular recycling like autophagy we call it. Well, that’s also a great way to get at intracellular pathogens, but exercise changes some of the levels that will trigger that as well.

It’s not just you have to intermittent fast, there’s a lot of ways to naturally promote health. I’m telling everyone, pick one. One thing that you’ve heard us talk about that you will do and commit to do for the next seven days, because almost everything I’ve seen where people will do it, whether it’s breathing, EFT tapping, sunlight, if you do it for seven days, we can measure immune markers that are changed, and for the good. Once you make it a habit, then you can start to say, “You know what? I went for a walk 15 minutes every day for a week. Now it’s day eight and I’m going for a walk.”

In fact, that’s how I learned about natural health. I was in regular medical school, knew nothing about it. I felt like crap. I started doing yoga because somebody shared me a DVD and I just got into it because it calmed my brain down, and the more and more I did it, then I was like, “I don’t drink soda anymore. Processed foods, I don’t eat them anymore. Why is that?” Then I started researching and I was like, “My body is smarter than my brain.” Just get out there. I’m warning people or suggesting that they don’t try to do everything. They just take one or two things that they commit to doing and do it.

Ari Whitten: Beautiful. Dr. Moorcroft, this has been phenomenal. This is honestly one of my favorite interviews I’ve ever done and it’s such an important and timely urgent message to get out. I’m recording this on Friday, April 3rd. Normally, I record podcasts weeks in advance to give my team time to prepare them and get the transcripts and proofread the transcripts and get the page up and the graphics and all that stuff.

I’m actually going to rush this and get it out tomorrow, because I think this is such an important message. My team is going to be pretty pissed off at me to be honest. When I tell them they’ve got 12 hours to do this, but this is just phenomenal. Thank you so much for coming on the show, sharing your wisdom. I really appreciate it. I really appreciate how knowledgeable and how sensible you are and detailed in your analysis of all the nuance of this very, very complex issue. Really, really appreciate it. Thank you so much for coming on the show.

Dr. Tom Moorcroft: Thanks for having me. I appreciate it.

Ari Whitten: One last thing. If people want to follow your work, or work with you, or get in touch with you, or whatever you’d like to say as the best way people can follow your work, let us know how to do that.

Dr. Tom Moorcroft: Awesome. The best way to find me is that our website, it’s originsofhealth.com. So plural origins, and if you put a slash coronavirus there I have a coronavirus resource page. I’ve got some downloads. We did a mini alive mini summit with other experts. We’re actually going to be doing a three-night mini series coming up starting next week. Totally free. That’ll be a great resource, hopefully for people. Certainly over on Facebook, I do a ton so nice and simple origins of health, or they can check me out on Instagram, Dr. Tom Moorcroft. I just appreciate it. I’ll throw one last thing out there because I think that it’s so important for people to understand how much power they have, by making small decisions.

I see so many adults and right now where a lot of us are home with our kids. Remember to lead by example, because you have so much influence over your family members and your children, even your teenage children who are telling you that they don’t want to hear from you, they hate you or whatever, they’re looking to you. If you are living in your neighborhood, your family and your circle of friends here, remaining calm and just doing like we did. We had a conversation about what we know is truth, it’ll all come together. Help other people remain calm and definitely realize you have all that influence over everyone.

Ari Whitten: Beautiful message. Thank you so much my friend and I hope to do this again with you.

A Deep Dive on COVID 19 w/ Dr. Tom Moorcroft - Show Notes

What the current science tells us about COVID-19 (02:25)
How people may have been exposed to Coronavirus earlier than believed (10:07)
Why remaining calm is essential to overcoming the pandemic (28:00)
How the common flu affects the population on an annual basis (33:44)
How the current lockdown can have financial ramifications in the future ( 37:37)
Will vaccines save us? (44:04)
How to prevent corona (55:55)

Links

If you want to work with Dr. Moorcroft check out his website here!

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