RHR: Updates on COVID-19 and Answers to Your Questions

In this episode, we discuss:

• Boosting your immune system (5:35)
• The government’s response to COVID-19 (12:45)
• Building immunity to COVID-19 and possible treatment options (18:09)
• How long does COVID-19 last on surfaces? (24:03)
• Advice for immunocompromised individuals (32:15)
• Building a fully stocked, Paleo-friendly pantry (42:54)
• Should you get tested for COVID-19? (53:21)

Show notes:

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Today, I’m going to do a Q&A on covid. It’s on everybody’s mind, it’s on my mind, we’re going to kind of suspend the normal podcast at least for a couple of weeks while we’re still in the really intensive phase of this pandemic so I can continue to answer your questions and share my thoughts. And hopefully, as we flatten the curve and things settle down a little bit, we’ll go back to our regularly scheduled programming.

I want to apologize in advance for any dog barking or doorbell ringing or any other sounds that you might hear during this podcast. I’m recording from my home episode because I am doing my part to flatten the curve and maintaining social distancing. So there’s kids around and lots of stuff happening in the house and hopefully it’s not too distracting for you.

Editor’s Note: The replay of this webinar has moved, but is available here.

So we did a webinar over last weekend, I’m not sure when this will be coming out. So it was the weekend of, I guess, that would be Saturday the 14th. And if you missed that, you can get the replay at Kresser.co/covid. About 1,000 people, 250 questions plus. Didn’t get to all of them, obviously, and we’re not going to get to all of them on the Q&A episode today. I went through and I selected some of the ones that I thought would be of greatest interest to the widest audience and also that were most relevant and timely.

The problem with doing podcasts and webinars on covid is that the information is changing on a daily if not hourly basis. So anything that I say today on this podcast could very well be out of date by tomorrow, literally. So I’m going to keep this relatively short, maybe do a few shorter podcasts rather than a longer one less frequently so that we can try to stay on top of this.

If you still have questions on COVID-19 and what you can do to protect yourself, you’re not alone. Check out this episode of RHR for answers to reader questions about COVID-19. #chriskresser #coronavirus #covid19

Boosting Your Immune System

(5:35) Okay, the first question is from Chris. “Hey, Chris. I’m curious if you have preventative recommendations via nutrition for immune boosting for these types of viruses. Figured zinc, vitamin C, selenium couldn’t hurt. Also, I read that there’s some research about these types of coronaviruses being susceptible to heat and that a sauna can kill a virus if it hasn’t reached the lungs in 130 degree plus temps for more than 25 minutes. Any thoughts on that?”

Great question, Chris. And actually, I want to take this opportunity to revise a couple of the recommendations that I made on the Covid webinar that I did recently. On that webinar, I offered several ideas for boosting immune function, which I’ll cover here as well. But among them were propolis and high dose vitamin A and D. I have since come across research suggesting that propolis and mega doses of A and D may not be a good idea, because at least in theory, they could increase the expression of ACE-2 receptors. Now in many cases, botanicals, plant medicines and nutrients like propolis and vitamins A and D have a modulatory effect, which means they upregulate or downregulate a function like a receptor on the outside of a cell based on what’s needed.

An example of this would be elderberry. Early on in the Covid outbreak, some people expressed concern about elderberry because it can potentially upregulate inflammatory cytokine production, which could contribute to the cytokine storm that makes people really sick with Covid. However, as Stephen Buhner, a renowned herbalist that I really love and follow pointed out, elderberry is a modulator of the cytokine response. Which means it can upregulate it or downregulate it as necessary. I think this may be also true of propolis and vitamins A and D. But since coronavirus can get into our cells by hijacking ACE-2 receptors, I think it’s probably cautious to avoid anything that might upregulate those receptors, including propolis, and high doses of vitamin A and D.

So, for this reason, I would suggest not taking propolis and not taking very high doses of vitamin A and D during the Covid pandemic. You can and should still eat adequate amounts of A and D in food, and you can supplement with lower doses of vitamin D like 1000 iu or maybe 400 or 500 iu per day if you live in a place where you’re getting minimal sun exposure, and/or your 25 D levels are below let’s say 35 or 40 milligrams per deciliter on a lab test.

Now as far as the other steps that you can take to boost your immune system, certainly the four pillars that we often talk about, nutrient-dense diet, sleep, stress management and physical activity, become even more critical in this situation. And in the context of a nutrient-dense diet, certain foods can have an antiviral immune boosting effect like garlic, ginger, citrus fruits and red bell peppers, for example, are rich in vitamin C. Fermented foods can support gut health, which is also important because a lot of the immune system resides in the gut. And then foods like, spices like turmeric are rich in curcumin, which has a number of immune benefits.

Bone broth, I think, is also really helpful because of its impact on gut health. And as I mentioned, gut health is critical for immune function. Zinc appears to be very helpful for all viruses and for coronavirus in particular. Zinc supports immune function, but it’s been shown to be effective in blocking coronavirus from multiplying in the throat and the nasopharynx. So if you can get your hands on some zinc lozenges, you can use these several times a day as you begin to feel symptoms, and it’s best to lie down and let the lozenge dissolve in the back of your throat, and nasopharynx. You can try higher doses of vitamin C. I think the data on this are mixed, but it certainly can’t hurt. So at least 150 milligrams per day. Food is the best source as usual. But if you’re not able to get enough from food, you can also supplement.

N-acetylcysteine is not really so much of a preventative, but it could have a role if you have Covid. It can help protect the lungs. Elderberry, despite some of the claims that have been made in the media, can be very helpful. It’s a cytokine modulator, as I mentioned. So 700 to 1,000 milligrams per day of elderberry extract from syrup or lozenges, or you can also even get it in capsules, is a good idea.

Getting adequate copper. Chris Masterjohn has pointed this out, the importance of this, four to eight milligrams of copper per day. That has an immune boosting impact and some people don’t get enough copper from the diet. So taking copper supplementally can be helpful. Like a zinc supplement where zinc is in a 15-to-one ratio with copper can be helpful too. So you want to always have that right balance between zinc and copper. And since zinc is important, and copper is important, taking a supplement that has both zinc and copper can be a good idea here.

So, those are some basic ideas. We’ve also talked about botanicals like cordyceps, angelica sinensis, rhodiola and astragalus. That can be very helpful. Stephen Buhner recommends a formula with three-parts cordyceps, two-parts angelica, one-part rhodiola and astragalus. As for your question, Chris, about sauna, I haven’t seen those data. But I do think that sauna is right up there with exercise and good diet in terms of just a basic hormetics benefit that we can get. The expression of heat shock proteins and the photobiomodulation if you’re doing infrared saunas, all can support a healthy immune function. And if you have access to a sauna, I think using it regularly during this period makes sense.

(12:05) Okay, next question from Phoebe. “On my last podcast I mentioned the Buhner botanical formula of cordyceps, angelica, rhodiola and astragalus,” which I just mentioned again, “that was for liquid tincture. Do the same ratios apply to a powder formulation? If so, advise on teaspoon dosage.”

The same ratios would probably apply for powder. It doesn’t have to be exact. I can’t really advise on dosing because I don’t know how this particular powder that you’re referring to, was prepared and what the concentration is. But generally, you can just follow the dosing on the bottles, because most botanical producers will put a suggested dosage there.

The Government’s Response to COVID-19

(12:45) Next question from Raphael. “I heard the UK is not doing much, because the government thinks that a lockdown can kill more people than the actual disease. This may have some sense in proof. For example, most people, more than 60 percent, live day by day. Economy is very informal. Essentially, many people if they don’t work, they won’t eat. And here the government’s taking extreme measures which is 20 to 30 confirmed cases. And I agree. I just have mixed thoughts about this. I’d like to hear more opinions.”

It’s a totally valid question. And there’s been a fair amount of discussion about this in the media and I actually just an hour before sitting down to record this podcast, I saw an article about how the UK may now be shifting their stance, because they realized that they may not be able to mitigate the impacts of this as well as they thought that they would. What’s more, there was an open letter penned and signed by over 600 behavioral scientists in the UK that criticized the policy in the UK, which was according to the media articles that covered the policy based on the idea that behavioral fatigue would set in with social distancing requirements and people wouldn’t be able to do it, and therefore it wouldn’t be effective. And the behavioral scientists who challenged that, asked to see what evidence that was based on. Because they disagreed as behavioral scientists, and we’re recommending much more aggressive early measures, like the ones we discussed over the weekend on the webinar and the ones that are now happening in the US. But the UK government didn’t provide any of the justification behind their decisions.

So I think we’re going to see a shift in the policy in the UK. At the same time, that doesn’t invalidate your question, Rafael. It’s completely, it’s worth asking. And it’s true that many people will be harmed by these draconian measures that are being put in place. And as usual, people with the fewest resources will be harmed the most and that is a very unfortunate reality with this kind of thing. And we can see it in developing countries, like Peru, but we’ll also see it with people even in the developed world who are living from paycheck to paycheck, which is actually most of Americans. We’ll see it impact healthcare workers. If a nurse or medical assistant in a hospital has to be at home taking care of their kid because schools are closed, that’s obviously not going to help with our diminished healthcare capacity situation. And all of the closures of things like gyms and bars and restaurants is going to have a profound economic impact that I think we’re only beginning to understand. I am glad that the government is taking steps to stimulate the economy because it’s almost certain we’re heading into a pretty significant recession, even with those steps. But hopefully they can mitigate things a little bit.

Time will tell how long this is going to last. I think we have another question about that somewhere. But I’ll just address that now. I’ve been reading a lot about it. Of course, nobody really knows. No one has a crystal ball and can predict exactly how long these extreme social distancing measures will be necessary. And therefore, how long the effect on the economy will persist. I’ve heard a couple of good analogies for illustrating the kind of predicament that we’re in and I’d like to share with you. One epidemiologist in the US said that asking how long social distancing measures will be in effect is the equivalent of someone asking an exterminator what it will take to get rid of rats in a basement they’ve been too afraid to enter for weeks.

You have to turn the lights on and examine the droppings first to figure out the scope of the problem. And our country’s response in the absence of that knowledge, which in this analogy is adequate testing, has been sluggish compared with that of other countries like South Korea. So basically what he’s saying is, in order to really know how long these social distancing measures will be necessary, we have to be able to determine the force of infection, which is a phrase in epidemiology that’s used to express the rate at which people are becoming infected, how close we are to the peak. and by extension, what the burden would be on the healthcare system, and thus how much we need to flatten the curve. In order to know that we have to know how many people are infected, and we’re nowhere near knowing that. Because we don’t still have adequate testing available.

Another metaphor, which was similar is that asking this question is like asking a fireman when you can move back in your house when your house is still on fire. So our house is still very much on fire. And it’s, we all want to know how long these measures will last, I mean, that’s just human nature and makes perfect sense. But I don’t yet think we’re at the point where we can know how long they’re going to last.

Building Immunity to COVID-19 and Possible Treatment Options

(18:09) So let’s move on the next question here. And this one is from Toria. “What do we know about immunity being built up after catching this virus? Do we know that there are cases of anyone catching this more than once?”

There have been at least a handful of people who have been reported to have had it more than once. But most scientists that I have read and some virologists and infectious disease experts that I’ve spoken with, believe that there was likely a misdiagnosis in those cases, either the first time or the second time. That it was actually a flu or some other viral illness rather than the person having covid/SARS-2 as the infectious agent twice. That would be extremely unlikely given what we know about viruses in general, that someone would catch it twice so quickly. The other possibility is that the person never fully recovered, that it was in a kind of latent phase, but then reexpressed itself. And that could be fairly, could be likely given what we know about the behavior of some other viruses like Epstein Barr.

On the other hand, it’s not unusual for coronaviruses to be infectious later on in life. So we don’t necessarily develop lifelong immunity to coronaviruses. So it’s theoretically possible that you could get this covid/SARS-2 virus now, and then, five years later if there’s a resurgence of this virus, that you could get it again. But in that situation, it’s likely that the second time around the virus would be much, much milder and have a lower morbidity and mortality rate because you would have already developed partial immunity to it.

(20:00) Next question from Anna. “What do you think of the empirical use of angiotensin receptor blockers in covid pneumonia? Is there hope there?”

So this is referring to one of the mechanisms by which covid causes problems. It affects ACE-2 receptors and so the idea is that using these receptor blocker drugs, which you typically prescribe for high blood pressure, might be helpful. I don’t think we know the answer to that question yet. And there’s even some possibility that using these drugs could actually increase the risk of covid complications. And Peter Attia, who’s a colleague in the Functional Medicine space, did a podcast a few days ago where he was discussing this possibility. I think right now, the safest guidance is for patients who are taking these drugs, not to stop taking them. And also, if someone is not yet taking them, not to take them with the idea that they will prevent complications or if you have covid, not to take them without specific guidance from your doctor. Because I just don’t think we know yet.

(21:16) Next question’s from Ed. “What’s the reasonable estimate of the ratio of verified cases to actuals? For example, the official number is 1,000. But in reality, is it 100,000? Because not everyone gets it is tested and registered?”

Yes, that’s a great question. Unfortunately, it’s one that we can’t answer because we don’t, we aren’t doing the testing. Now that said, I saw a study that just came out of Wuhan, that suggested the rate of confirmed or true cases compared to confirmed cases, is anywhere from five to 10X with 10X being more likely. So if there were 1,000 cases documented, in reality, it could be 10,000.

Now keep in mind that that came out of Wuhan, and it’s not necessarily true that the same, we’ll see the same ratio here. The virus may express differently in different populations. We know now that people can be totally asymptomatic with this virus. One of the Utah Jazz basketball players, I can’t remember which one, I read an interview with him and he said, “Basically, I have zero symptoms. If I had to play a seven game series in the finals, NBA Finals tomorrow, I wouldn’t bat an eye. I’d lace up my sneakers and I’d be fine.” That’s disturbing, because of course, if someone is not symptomatic, and especially if they’re not aware of the need to flatten the curve and practice social distancing, then they can be infecting a large number of people without even knowing it.

And we also have a growing body of evidence suggesting that in people who do become symptomatic, that the virus may be contagious two days, at least two days before they start to develop symptoms. So again, that makes, that’s disturbing because this affects the R naught value, which is a measure of how contagious a disease is. And if a disease is contagious even before it’s symptomatic, and people can’t take effective measures to contain or isolate themselves, then the R naught value is going to be higher. And when your R naught value is higher, that means more people will get it. And if more people get it, then more people develop serious illness and die because the morbidity and mortality is a percentage of the people who get it. So, if you increase the number of people who get it, then of course, you’re going to increase the morbidity and mortality.

So how serious a disease like this can be is a factor of both the R naught value, the contagiousness, and of the fatality rate and the morbidity rate.

How Long Does COVID-19 Last on Surfaces?

(24:03) Next question is from Ellen. “How long does the virus last on surfaces like doorknobs and mail and packages?”

Again, we don’t know for sure yet. I just saw a study come out on this. Interestingly enough cardboard was one of the most resistant surfaces. I think it was, the coronavirus survived for about 24 hours on cardboard and also copper. On some surfaces like plastic and glass, it survived three days or more. And in some situations it may be just a few hours. But I think we can safely say it’s more than a few hours and probably less than five days in most cases with maybe a median being anywhere from six hours to three days. So this does make disinfecting surfaces very important.

If you’re sheltering in place and you’re in a high-risk population and you have people delivering packages or coming to the house, then sheltering in place is a good idea. If you’re able to create a kind of staging area in your house where you can leave the packages that have been delivered for at least three days before handling them, that may be a good idea because it’s pretty hard to disinfect cardboard for example. Or handling them with gloves, nitrile gloves, for example, and then discarding the gloves right after you handle the packages and open them and then washing your hands right afterwards. So taking adequate precautions if you’re, especially if you’re in that higher risk population.

(25:36) Next question from Drew. “Would someone with an autoimmune thyroid condition be considered at risk?”

Unfortunately, I’m going to have to say I don’t know, again. There’s so much we don’t know yet. I can give you a kind of an intuitive sense. I don’t think that someone with an autoimmune thyroid condition would likely be considered at anywhere near the same risk as someone with, who is a former smoker or who’s had cancer recently, or who has type 2 diabetes or who has some kind of upper respiratory disease, chronic lung or upper respiratory disease.

What we know, we know about those conditions from the data and based on what we know about how the coronavirus affects the body and the pathophysiology that it leads to, it’s to me less likely that someone with an autoimmune thyroid condition or even some other autoimmune conditions that don’t necessarily significantly lead to an immunocompromised state would be at higher risk. That said, it may make sense to exercise a little bit of extra caution in that situation, just because there is some challenge with the immune system there. Especially if it’s not well controlled.

(26:59) Next question from Dina. “What’s the probability of this virus eventually dwindling out this year but coming back more fiercely the following season and hitting the population that hadn’t contracted it this year even harder than the initial outbreak?”

Unfortunately, there’s a pretty high probability that coronavirus is here to stay. On the webinar, I mentioned that this is probably going to unfold over 12 to 18 months. But when I say this, I’m talking about the initial two waves of it, perhaps. So I think it’s possible that we would have a wave now. There could be, we don’t know this, but there could be a bit of a drop as the summer approaches, both from our efforts to flatten the curve and from warming weather. It remains to be seen how warming weather is going to be a factor here. But then almost certainly we would see another resurgence of it in the fall.

I don’t know that it’s necessarily true that, from what I’ve read, that it would come back even harder than the initial outbreak. And in some ways, there’s reason to believe that the impact of it the second time around would not be as significant for a couple of or a few reasons. Number one, if we’ve been effective in flattening the curve, we should have more healthcare capacity at that time. So people who do get sick will be more likely to have a hospital bed available if they need it. Number two, it’s at least somewhat likely that we will have developed some more effective treatments. It doesn’t necessarily mean a vaccine, which could take 12 to 18 months. Hopefully it will be sooner, but it could take that long. But I heard some encouraging news that I shared on Instagram this morning about a couple potential treatments. One is using the serum of people who’ve had covid-19 and recovered with people who are sick. And there was a small pilot study, I think only 10 people, but that showed promising results.

The challenge there is that it’s difficult treatment to scale because it’s kind of a one-to-one thing. You need people, for every one person who has it, you need another person who has already had and recovered to donate their serum. But it’s promising that that’s an option maybe for people who need it the most. And then another potential treatment is chloroquine phosphate which is an old drug that used to be used for malaria. And that has been shown in some studies in China to be effective for covid-induced pneumonia. So this is still relatively early and we already have a couple of options that seemed promising. So as time goes on, we’ll probably have more of those.

So yeah, I think there will, we’re going to be dealing with this for a while. That’s the bad news. But the hope is that by taking these aggressive measures now, we can lessen the complete overwhelm of the healthcare system that would otherwise happen. And the reason that that’s important is if the healthcare system gets completely overwhelmed, the mortality rate could be more like three to five percent, or even higher, versus what is more likely if the healthcare system is not overwhelmed, which might be something like one percent. And that’s a huge difference in terms of the number of deaths that could come from this disease when you’re talking about such a large number of people infected. So if you do the math and if you’re talking about potentially 40 to 70 percent of a population becoming infected over time, we want to keep the mortality rate as low as possible.

(30:44) Next question from Craig. “What are we looking at for the incubation period based on the existing data?”

From what I’ve seen, and the most recent thing I’ve seen on this is a couple days old, so it might have changed, is two to seven days with a median of four days. But I’ve seen some estimates that it could be as long as 14 days. So that’s another thing that makes this challenging. If the incubation period is that long and especially if people are contagious before they start to become symptomatic, then that makes it really challenging to deal with.

(31:24) Seeley asked about wearing shoes in the house. “If we’ve been at the grocery store or gas station, should we always start separating our shoes from where we walk in the house? Could it be contagious in that way?”

It could be in theory. We’ve always kind of had a shoes-off household. And that’s maybe a good idea to do now if you’re not doing that already. But if it got onto the top of your shoe or your shoe laces, for example, and you touch your shoelaces, this is again why hand washing and hand hygiene is so important and doing that very regularly if you’re trying to keep yourself from becoming infected. When you go out and about, it’s a really good idea to wash your hands right when you get home. So in that scenario, you take off your shoes, put them, leave them in the staging area and you go right to the bathroom to wash your hands.

Advice for Immunocompromised Individuals

(32:15) Lawrence asks, “Any advice for immunocompromised individuals; those of us with chronically low white blood cell and platelet counts or those dealing with poor gut health, etc.”

Yeah, I think everything that we talk about here just becomes more important. So the social, more strident social distancing, still with an eye toward your mental health and making sure you’re doing things to stay engaged. And FaceTime or Skype with loved ones. Because isolation and the impact of isolation is real. And ironically, it can affect the immune system in a negative way. So we do have to be cognizant of that. But everything that we’ve talked about so far, all of the immune boosting measures and making sure you’re getting adequate nutrition, getting extra amounts of sleep and rest, doing whatever amount of physical activity helps support your immune system, and I would say stress management is critical in that state, especially. All of those things become just even more important.

(33:22) Next question from Lynn. “I’ve heard there are cases in Italy that are now affecting people that are much younger. Have you heard this and why would this be happening?”

Yes, I have and it’s true. There are cases from both China and Italy of people in their 40s becoming quite sick and even dying. It’s still a much, much smaller percentage relative to people above 60, and particularly above 70 and 80, which is when you see the numbers really go up. We don’t yet understand that. It’s also true that the people who are younger who are getting more sick tend to be healthcare workers. So we don’t yet understand why that is. It’s possible that it’s a question of the amount of exposure. So a healthcare worker perhaps just getting exposed to massive amounts of the virus and it overwhelms their system, such that, although if they were exposed to it in a more normal fashion, it wouldn’t be an issue. But in this case it is.

Frankly, we just don’t know. But when I shared some of the statistics on the webinar, the mortality rate for people, let’s say, from like 20 years old to 50 years old is not zero. It’s actually pretty close to zero. I think it’s around 0.2 to 0.4 percent. So people have died in that age group, and people have gotten quite sick, but it’s just a much, much lower percentage, than people in the higher age group and may even be a lower percentage than influenza. I’m not sure. I don’t have those numbers in front of me.

(35:00) Next question is Paul. “How comparable in terms of effectiveness of reducing transmission is the current level of intervention shut down in the US to the draconian authoritarian actions that China took?”

I think in the last 24 hours, it’s gotten closer, but we’re still not there. I think China had certain measures like mandatory temperature testing in workplaces. That’s what Taiwan did. If people went to work they had to, their temperature was taken at the door. And if they had a fever they were sent home. That was also true at any other kind of group gatherings. So there was kind of another step in terms of monitoring. China also has, you might say, quite authoritarian digital monitoring measures in place where they can more effectively track their population that we don’t have. I think probably thankfully, because we appreciate and fight, let’s say with our government, privacy, although it’s become a growing concern over the last 10 years, is I think a more fundamental value we can say. And so we don’t have the same kind of, it’s just not possible to institute some of the measures that they’ve instituted.

But I have seen, I’m encouraged by the response that our government does seem to be taking this seriously. I still think the federal government could do more to standardize the response. We’re seeing different response in different states and I’m concerned about that. But we’re moving in the right direction for sure.

(36:40) Next question from another Paul. “My wife and I are wondering about playdates for our kids. Not a good idea.”

Well, it really depends on a number of factors. So you can look at this through two different lenses. Let’s start with just your own personal self-interest. If you and your wife are healthy, and other members of your family are healthy, and you’re not in contact with people who are in higher risk groups, and the same is true for the kids’ families who you would be having, well, let’s limit this to self-interest first, as I said I would. So if that’s all true, then the risk of getting, developing serious complications or dying from coronavirus or covid-19 is quite low in that situation. And so, there may not be much of a reason to limit playdates.

However, as I stressed on the webinar, we have a social I think and moral obligation to help flatten the curve. So not just to act in our own self-interest, but to consider the impact of covid-19 on our local communities, on our states, at a national level and on the global community at large. And if the R naught value is, let’s say two or three, or even four or five, like some are predicting for covid, that means for every one person that’s infected, they’ll infect anywhere between two and five people. So even if you or your child doesn’t get particularly ill, if you or your child are then interacting with a whole bunch of other people, they’re going to infect two to five people each. And that’s how you can see that this turns exponential very quickly.

So if you look at it through that lens of social responsibility, as well as just through the lens of how it will affect you or your immediate family, I think limiting playdates is a good idea. The caveat is that some families, we actually have done this to some degree in our neighborhood, if you are in touch with other families, you’ve talked to them about their response to covid, you know that they are sheltering in place and are just staying home, they’re not exposing themselves to other people who are at high risk or really that many other people at all, then I’ve heard of families doing, and again, we’re kind of working on this ourselves, creating like maybe a network of three families that have playdates with their kids in those three houses and agree to all follow the same kind of social distancing measures and sheltering in place, and not exposing themselves to the broader community and especially not to people at risk, then that might be one kind of way around this.

Again, we’re going to be balancing the need to flatten the curve and halt, slow the spread. We’re not going to halt it. Slow the spread of this, of this condition, this pandemic with our own need for connection and community and avoiding the potentially serious social and economic consequences of isolation. And there’s no, there’s no perfect approach here. We’re dealing with lots of different shades of gray. It’s not black or white. So we’re just going to continually have to be negotiating and renegotiating this.

(40:23) Next question from anonymous. “Should we get enough cash to last a few weeks from the bank?”

I’m going to combine this with questions about electricity and water. We’ve had a few of those. Currently, I’m not seeing it as being likely that we’ll have banks shutting down and runs on the banks. In fact, some states have actually outlawed using cash because of the potential of cash to transmit coronavirus. So you may not even be able to use cash in certain transactions. That said, just standard disaster prep. Like when I lived in California, we had a kind of earthquake prep, and part of that was having some cash on hand. Having three days of potable water, water storage containers, and a couple weeks of shelf stable food in the event that there was a power outage.

Again, I don’t anticipate a power outage here. I don’t anticipate water supplies being shut off. That would be more consistent with something like a serious earthquake somewhere or perhaps like a solar flare that affected the electrical grid. But in this situation, I’m not yet seeing a compelling case for that happening.

(41:45) Next question from Andrew. “What should my wife do that’s 38 weeks pregnant?”

That’s a great question, Andrew and I wish I could not have to say I don’t know. But we don’t know yet what the effects, whether pregnant women are more susceptible to acquiring covid. We don’t know what the effects of covid are on pregnant women. But what I would say is that I would consider, I wouldn’t say a pregnant woman is immunocompromised, but what we know about the physiology of pregnancy is that there are pretty dramatic shifts in immune function throughout the pregnancy and they vary. The specific ways that the immune system shifts during pregnancy varies based on the stage of pregnancy. A woman has a baby growing inside of her and so the priority of the immune system there initially is to not reject the baby, but then later the immune system shifts in different ways.

So I would definitely consider a pregnant woman to be in that at-risk population and take the necessary precautions as a result of that.

Building a Fully Stocked, Paleo-Friendly Pantry

(42:54) Rice asked, “What are some Paleo, good Paleo friendly foods to stock up on if people need to keep a supply of food?”

That’s a really good question. I can give you some ideas of what we’ve done. What we’ve stocked up on. So bone broth is one. I mentioned that I think that that’s really important and helpful in terms of strengthening the immune system and improving gut health. And it’s also, we like Kettle and Fire. They’re the only company that has a shelf stable bone broth. It’s actually simmered for 24 hours and approaches being as healthy and good for you as making it at home. And I, they also make soups that have the bone broth as the base, which is pretty cool. So full disclosure, I’m an investor in that company because I really believed in what they were doing. But we have several boxes of Kettle and Fire. It’s a super easy and fast way to make a quick meal, especially if you’re crunched for time. So you can order some of that if you want and get a discount, Kresser.co/kettlefire. All one word.

Canned fish is a great source of protein and is shelf stable. So that’s something else that you can stock up on. And I like Vital Choice in Washington, they have some super high-quality canned seafood products. I don’t have any affiliation with them. I’m not an investor. But I just like their stuff and I order from them quite a bit. I think a lot of, having fats on hand is important. They’re calorie dense and nourishing. And of course we need them to function well and we also need them to cook. So I like to keep some:

• Coconut oil,
• Ghee,
• Olive oil,
• Avocado oil.

We also use lard and duck fat in our cooking. So we’ve got some of that around. Nut butters are great, they’re shelf stable, they’re nutrient dense. They go well with a lot of different foods.

Coconut milk is another healthy fat. It can be used in smoothies, it can be used for sauces. Lots of different possibilities with coconut milk. Beef jerky or beef sticks or salami can be handy to have around. Again, you can make a quick and easy snack. Olives, great source of fat and quick and easy as well. Then, depending on how you tolerate them, I’m still kind of thinking more of shelf stable stuff here, grains like quinoa and amaranth and millet, which are non-gluten grains are often tolerated pretty well even by people who don’t do well with other grain products. Rice, particularly white rice, is often pretty well tolerated and lentils or split moong dal even can be tolerated by people who don’t tend to do well with other beans. Oats two, particularly like sprouted oats and even if you can’t find sprouted oats, you can soak oats and same with the grains and the beans for 12 to 18 hours and that makes them a lot more digestible and the nutrients are more bioavailable. Non-dairy milks like macadamia nut milk or almond milk or cashew milk in Tetra Pak containers will be shelf stable and can be used for a lot of different things.

If you’re a coffee or tea drinker, good to have those on hand. We have, dark chocolate, I think is nice to have on hand. It can be a good, is very nutrient dense, not a lot of sugar. And we got to keep living life while we’re going through this stuff. Then frozen foods, again, I think it’s less likely that power is going to go out. So we stocked up quite a bit on frozen foods. So we have frozen vegetables, frozen fruits, which are actually more nutrient dense than canned varieties. So I prefer to buy them frozen if I can. We do have some canned food in case the power did go out. We’ve got lots of frozen meat and poultry and fish. And you can freeze butter as well. It will last for quite a long time in the freezer.

And then, with perishables, we got a couple week’s worth of what we needed of vegetables, eggs and cream will last quite a while. Fermented foods like sauerkraut, pickles, kimchi, yogurt, if you do dairy, and kefir and cheese will last for a couple of weeks in many cases. And then things like avocados, potatoes and sweet potatoes, winter squashes, they all store pretty well. Same with stone fruit, apples and pears, citrus, melons and peppers can all last for quite a while. And then a variety of nuts and seeds. Some snack foods like plantain chips to have around in a pinch. We get some almond flour and cassava flour based pancake mix for occasional treats. Let’s see what else? I think that’s the main thing in terms of what we do and what I think would work well in this kind of situation.

(48:28) Okay, so next question from Danielle. “What do you recommend for small business owners, healthcare providers like acupuncturists,” which she is, “in terms of continuing to see patients, considering the social distancing recommendations, but also that we rely on this money?”

Yeah, I totally get where you’re coming from Danielle. It’s a really tricky situation to be in. Unfortunately, a lot of people will be in that situation. People who are massage therapists and do all kinds of hands-on work. Gyms are closing here, so personal trainers. Unfortunately, a lot of people are going to be affected. There’s the dog barking, that means there’s probably a delivery or someone coming to the door. So hopefully it will stop pretty soon.

So, yeah, I mean, I think what we’re going to see is, even if you would like to continue doing these sessions, you’re going to see a drop off unfortunately in the number of patients that are willing to do them. We’ve already seen that a little bit with our in-person visits in our clinic. What we’ve done is switch those visits to Zoom video or phone, which I understand it’s not possible with acupuncture. But is there any other kind of support that you could offer your patients via phone or video? So could you advise them on herbs? Could you talk to them about diet? Could you just be someone who’s there to listen to them and help them navigate this really difficult situation? Could you help teach them how to do acupressure to themselves and their family members at home?

I think we all need to think entrepreneurially and be flexible here so that we can develop alternatives to what we were doing, especially because this is probably going to have an impact for a while.

(50:21) Next question from Sohail. Sorry, if I’m not pronouncing that correctly. “How do we support why being informants to our family members that are being more flippant about being proactive about all of this?”

I may have misread some of that question, but the gist is, how do we talk to people who aren’t taking this seriously. And I’ve heard this question from a number of people. And there are people out there who are not taking this seriously. They think it’s just going to blow over. They think everyone is overreacting. So, and then there are also people who believe that this is a conspiracy to, so that the government can exert more control over us, and that coronavirus is a hoax. I think it probably goes without saying that I don’t believe that. And I don’t think there’s any evidence to support that. And I’ve made it pretty clear that, at least with my interpretation of what’s happening, that the need for social distancing and flattening the curve is very real.

It doesn’t mean that it won’t have a significant negative impact, and that there aren’t risks that are associated with flattening the curve and social distancing. There definitely are. But I think we have to choose between the lesser of evil’s here, and sometimes humans are not very good at that. We want things to be black and white. In fact, that’s one of the cognitive biases that Daniel Kahneman identified in his Nobel Prize winning book, Thinking Fast and Slow, which I highly recommend if you haven’t read, because it can really inform how we understand human behavior in these situations. We want to be able to choose between a perfectly good alternative and a terrible alternative. That would be an easy choice. Nobody would struggle with that choice. But in reality, of course in life, that’s not how it is. We’re often choosing between two not so great alternatives. And that’s definitely where we are with this.

So to answer your question, I would direct them to my covid webinar, which is Kresser.co/covid, where I think lay out a pretty compelling case for why we need to be taking this seriously, as well as my Instagram feed where I’m doing daily video updates with the research. And then I had an initial podcast with Dr. Ramzi Asfour, infectious disease specialist who works in our clinic, California Center for Functional Medicine where we talked about this. And of course, you can refer them to this podcast.

(52:45) So next question from Beth. “Listening to Peter Attia’s podcast today with Dr. Peter Hotez who indicated that 10 percent of the patients admitted to the hospital reported GI symptoms, and therefore they were not at first thought to potentially have covid-19 because their symptoms were atypical. I had not heard this yet.”

Yeah, I referred to that earlier in this podcast. And it’s one of the challenges with covid-19. And the other one is that some people are completely symptom free or just have very, very mild symptoms and thus have no idea that they are contagious. So it’s one of the many challenges that we’re dealing with, with this condition.

Should You Get Tested for COVID-19?

(53:21) Okay, last question from anonymous. “If one is not feeling well, but already they do not know that etiology, what should be done? If it’s simply the flu going to get tested for covid-19 in the doctor’s office may be unwise due to potential covid-19 exposure. But not knowing what one is dealing with may lead to procrastination in necessary care.”

Those are very good questions. And again, I can give you the answer what would be the answer in an ideal world. In an ideal world, if you were not feeling well, you would head down to your local drive-thru testing center, which is what they have in South Korea. We actually have some here in Utah now, but they’re not accessible to most people. I’ll come back to that in a second.

So you drive down to the local drive-thru testing center. You would say in your car. A healthcare professional who is wearing protective gear and a mask would come out and give you a swab. You would do the swab and hand it back to them and drive away. And then they would ideally within a day or two tell you the results. That is not where we are right now. Very few places even offer drive-thru testing right now. And those that do like here in Utah, you have to meet very stringent criteria. You have to have had contact with a covid patient, a known covid patient, and you have to meet five of the five diagnostic criteria or you won’t even be offered a test. So we’re not there.

Dr. Fauci, the infectious disease, I forget his exact position name for the government, but I’m sure you’ve seen him on TV speaking of this. He has publicly admitted that that’s exactly what should be happening, but it’s not happening and isn’t likely to happen anytime soon. So what that means is the answer to your question is that if you feel any symptoms that could be covid, so any kind of flu or cold-like symptoms, including GI symptoms, you should practice isolation. Not just containment and social distancing, but you should isolate yourself as if you have it and act as if you do. And monitor your symptoms and if it’s fairly mild or even moderate flu, then the CDC is still recommending that people shelter in place, because there’s not that much different that the hospital can do for you.

If the fever gets extremely high or you start to develop symptoms of pneumonia, start to have difficulty breathing, and it goes beyond what would be a mild or moderate flu, then that would be the time to go to the hospital. But you’re not likely even going to be able to get tested in the doctor’s office right now, which is the unfortunate reality.

I said last question, but I’m going to do two more. So on the covid webinar on the weekend, I mentioned that going camping might be a good way to kind of get outside and avoid the most severe effects of just staying at home all the time. And some folks in Moab who are in the coaching program and listened to the podcast reached out and explained that may not be a good idea, at least given how many Americans go camping. I’m using air quotes here. They have noticed an influx of people in Moab and other parts of southern Utah, for example, who are coming down there with RVs or trailers, and then they’re eating out at restaurants and they’re using a lot of the services down there, which is not social distancing at all.

I mean, when I think of camping, when I go camping, we bring all of our own stuff and we go out in the woods and try to get away from people. But I realize that’s actually not how everybody camps. And so I think I made a mistake there in that recommendation because we don’t want to send a lot of people to places like Moab or national parks and state parks, if they’re going to be using a lot of the services and spending time in groups and not practicing social distancing. Especially because those places tend to have fewer resources available for medical care. Very small hospitals if they have hospitals at all, and would just be quickly, completely overwhelmed in that situation. So I just wanted to clarify that recommendation and urge people not to go camping, if that’s what camping looks like for you.

The last thing I’m going to bring up, I’ve heard some questions from people early on, of course, and then more recently about wearing a mask. And this is again another one of those situations where we want it to be black or white, and it’s really shades of grey, and we’re choosing between two not good alternatives. There was an article actually in the New York Times today that said that healthcare officials basically knowingly stretched the truth or, lied is too strong of a word, but they lost some trust with the public because they said wearing a mask isn’t going to help you not acquire this virus. And the fact is, that’s really not true. Although a mask is not a guarantee that you won’t get the virus, almost everybody, I think, at this point, especially would agree that wearing a mask, particularly an N95 might reduce the risk of acquiring the virus, and it certainly will reduce transmission if you’re wearing it.

The challenge there and I think the reason that, the very clear and pressing reason that health officials didn’t want to come out with that message was that we have a shortage of masks and healthcare workers do you need them the most. And if healthcare workers don’t have masks, then that can get very ugly very quickly. And so I think the public recommendations of not buying and hoarding masks were based on that very real problem. But in not being really kind of honest with people, they did, possibly did the public a disservice.

So what I would say is if you have masks now in your possession, and you are in, particularly if you’re in a high-risk position, or if you’re in a situation where you can’t practice social distancing as effectively. If you’re leaving the house basically, then wearing a mask could be a good precaution. The challenge there is that we don’t have enough of them. They’re all sold out everywhere. And we want healthcare workers to have the protective gear that they need to fulfill, to be able to keep working and protect themselves and the patients that they’re working with. So, hope that was helpful, everybody.

We’ve got more questions. We’ll probably be back with another Q&A episode soon. If you’re not already following me on Instagram, go search for me there, Chris Kresser. Doing daily updates via video. We also have some more blog content and I’m sending regular emails out. So you can subscribe to the email list at ChrisKresser.com. And I hope you can all stay healthy and well through these crazy times. And I mean, both physically and also psychologically and emotionally and spiritually. I think if there’s one thing that’s clear to me now is that this is a marathon and not a sprint. And so we have to pace ourselves accordingly. There’s a lot of panic happening, a lot of fear. Fear, I think, is appropriate in this situation and it’s natural to be anxious. Panic, I would argue, is not ever an effective response. It’s understandable, but it’s not effective. It actually activates our brain in ways that get in the way of effective action and response.

So, I would just urge everybody to do everything you can to take the edge off that panic if you do find yourself panicking. Now would be a great time to learn meditation, if you haven’t learned it already. If you are a meditator, keep up that daily practice. There’s lots of resources on YouTube, apps like Calm and Headspace. Deep breathing yoga, Tai Chi, Qigong, hot bath, walks outside, spending time in nature. Whatever it is that works for you to manage stress and stay grounded is critical right now. And I also want to put a plug in for laughter, joy, fun, play. It might seem ridiculous for me to say that given the circumstances, but actually, these things become even more important during these times of crisis.

Laughter and joy and play are really the antidote to stress. If you’re laughing and you’re feeling joy and you’re playing, that’s a different response. Different hormones are being released. It’s a whole different physiological response in the body. So, watching funny movies, watching comedy, stand-up comedy, playing with kids and pets, as you shelter in place, playing games, doing things that are fun and even, like I said, spending time outdoors, learning a new hobby. If you’ve been wanting to play, learn to play the guitar or the piano, now would be a really good time to do it. All of these things are super, super important at this point. And I’m going to be continuing to remind you of this. Because while I don’t think that this is going to last forever, I do think that this, we’re going to be settling into a new normal, not only with coronavirus and covid now in the next few months, but as it ebbs and flows over the next 12 to 18 months. And I think these are all strategies that are really actually helpful for living a full, rich and rewarding life at any time. Even during good times.

We’re often dealing with chronic stress and just the challenges of modern life and these practices will sustain us during those good periods as well. But they’re even more critical in times like this. So, again, stay healthy, stay well, take care of yourselves and take care of each other because that’s critical too. We can’t get through this on our own. We have to come together as families, as communities, as nations and as a species. So take care everybody. I will be back to talk to you soon. And until then, be well.