Dad Time

Respect and Immigrant Parents, COVID-19 Frontline Experience, and School Openings with Dr. Suraj Saggar, Chief Department of Infectious Disease

August 04, 2020 Dr. Suraj Suggar Season 1 Episode 14
Dad Time
Respect and Immigrant Parents, COVID-19 Frontline Experience, and School Openings with Dr. Suraj Saggar, Chief Department of Infectious Disease
Dad Time
Respect and Immigrant Parents, COVID-19 Frontline Experience, and School Openings with Dr. Suraj Saggar, Chief Department of Infectious Disease
Aug 04, 2020 Season 1 Episode 14
Dr. Suraj Suggar

With Coronavirus cases still on the rise, a key debate in the United States is if schools should open or not. 

To help answer this question, the DadCorp Podcast is joined by Dr. Suraj Saggar, an infectious disease specialist and physician who was on the front lines of the COVID-19 virus in New Jersey. He is a wealth of knowledge on the subject and even provides regular medical updates on FOX 5 News in New York. 

Dr. Saggar’s New Jersey facility was in the epicenter of the virus. His team experienced the dangers of COVID-19 first-hand. He discussed the subsequent PTSD they all faced. He compared the onset of the virus at their hospital as a Tsunami. Patients would go from stable to escalated in hours. Dr. Saggar and his colleagues would enter the facility every day to around 60 people on ventilators knowing the survival rate would be around 20%. He describes the personal pain of witnessing young patients in their 30s or 40s asking to Facetime their children to say goodbye.

As a father of an 11-year-old son, he describes how difficult it was to be present during those months for fear of bringing the virus home to his family. He slept in a different room, used a different shower and didn’t start wearing street clothes again at work until June. 

The question becomes: With the Coronavirus still out there, are we better prepared now to start sending our children back to school? Dr. Saggar asserts the importance of taking emotion out of the equation and focusing on the science.

Dr. Saggar explains that in order to feel comfortable with his own child returning to school he would pay close attention to the guidelines that the education system is putting in place. Whether or not kids are wearing masks, if desks are placed six feet apart and adequate air filtration systems are some of the key factors. He asserted that we have a better understanding of the disease, more access to testing and effective treatments.  He explains that the existence of t-cells in your body might be  plausible to protect you and have become the source of a lot research and optimism among the scientific community towards reaching the ultimate goal of herd immunity. 

In addition to his regular segments on FOX 5 News in New York, you can find Dr. Suraj Saggar on Youtube by searching his name as well as Instagram, LinkedIn and his own podcast. He co-hosts a medical podcast called Recommended Daily Dose with his colleague Dr. Clenton Coleman. They seek to put a unique spin on healthcare by incorporating humor and both of their own diverse backgrounds. 


3 Key Takeaways from the Discussion:

1. COVID-19 is not a hoax. As someone who was on the front lines and experienced first-hand the effects of this disease, Dr. Saggar described the virus's devastation. When things don’t directly affect us, we tend to not completely understand them. We need to gather knowledge and look at the perspectives from our health heroes in the field.

2. When considering whether kids should go back to school in the fall, the focus needs to be on science. Although we understand the quarantine fatigue and desire to return to normal life, the emotion needs to be removed. Instead, we must look at the cases in each specific area as well as factor in all the important preventative methods.   

3. We are better prepared now in dealing with COVID-19 but that does not mean that the virus is gone. With more access to testing and a better understanding of the different distinct phases of the virus, physicians are better equipped than they were months ago. We know now that masks and social distancing are still important to help prevent the spread of the virus. 

Show Notes Transcript

With Coronavirus cases still on the rise, a key debate in the United States is if schools should open or not. 

To help answer this question, the DadCorp Podcast is joined by Dr. Suraj Saggar, an infectious disease specialist and physician who was on the front lines of the COVID-19 virus in New Jersey. He is a wealth of knowledge on the subject and even provides regular medical updates on FOX 5 News in New York. 

Dr. Saggar’s New Jersey facility was in the epicenter of the virus. His team experienced the dangers of COVID-19 first-hand. He discussed the subsequent PTSD they all faced. He compared the onset of the virus at their hospital as a Tsunami. Patients would go from stable to escalated in hours. Dr. Saggar and his colleagues would enter the facility every day to around 60 people on ventilators knowing the survival rate would be around 20%. He describes the personal pain of witnessing young patients in their 30s or 40s asking to Facetime their children to say goodbye.

As a father of an 11-year-old son, he describes how difficult it was to be present during those months for fear of bringing the virus home to his family. He slept in a different room, used a different shower and didn’t start wearing street clothes again at work until June. 

The question becomes: With the Coronavirus still out there, are we better prepared now to start sending our children back to school? Dr. Saggar asserts the importance of taking emotion out of the equation and focusing on the science.

Dr. Saggar explains that in order to feel comfortable with his own child returning to school he would pay close attention to the guidelines that the education system is putting in place. Whether or not kids are wearing masks, if desks are placed six feet apart and adequate air filtration systems are some of the key factors. He asserted that we have a better understanding of the disease, more access to testing and effective treatments.  He explains that the existence of t-cells in your body might be  plausible to protect you and have become the source of a lot research and optimism among the scientific community towards reaching the ultimate goal of herd immunity. 

In addition to his regular segments on FOX 5 News in New York, you can find Dr. Suraj Saggar on Youtube by searching his name as well as Instagram, LinkedIn and his own podcast. He co-hosts a medical podcast called Recommended Daily Dose with his colleague Dr. Clenton Coleman. They seek to put a unique spin on healthcare by incorporating humor and both of their own diverse backgrounds. 


3 Key Takeaways from the Discussion:

1. COVID-19 is not a hoax. As someone who was on the front lines and experienced first-hand the effects of this disease, Dr. Saggar described the virus's devastation. When things don’t directly affect us, we tend to not completely understand them. We need to gather knowledge and look at the perspectives from our health heroes in the field.

2. When considering whether kids should go back to school in the fall, the focus needs to be on science. Although we understand the quarantine fatigue and desire to return to normal life, the emotion needs to be removed. Instead, we must look at the cases in each specific area as well as factor in all the important preventative methods.   

3. We are better prepared now in dealing with COVID-19 but that does not mean that the virus is gone. With more access to testing and a better understanding of the different distinct phases of the virus, physicians are better equipped than they were months ago. We know now that masks and social distancing are still important to help prevent the spread of the virus. 

Episode 14 Suraj Saggar

[00:00:00] Dr Saggar. Hey, how are you? Good. How are you doing? The dog was barking. So I had to just kind of go find him down. No problem. I don't think anybody's phased by extra noise in the background these days, right? No, exactly. So thanks for having me. I appreciate it. So on Tuesdays, I, the reason Tuesdays work well is because I usually work with about three.

[00:00:18] Then I come home and I do the news for Fox five, like medical updates for Fox five in the city, in New York city. So I do it from my home office, but just lo and behold, the hottest week of the year, my air conditioning conked out. So I had to sit here in my office and I mean, I'm wearing shorts, but I had like a shirt and a tie and a jacket on.

[00:00:35] You know, it's just for three and a half minutes, but it's brutal. You're send guys like, Oh, we'll be there Thursday. Thankfully we have a couple of zones. So it's only the first floor by then. It's also where my office is. So luckily upstairs is cool in the basement school, but just the first floor is a little bit brutal.

[00:00:49] We have been just kind of suffering towards. Alright, so Washington, your podcast. That's great. And tell me your name. I'm Jonathan, Jonathan. John, where are you located? [00:01:00] So originally I'm from Western Pennsylvania, spent about a decade in the Washington DC area. The last four years have been in New York city.

[00:01:09] So smack dab in the nucleus of COVID. And so we escaped and we're now in sunny, Florida, and I joked that maybe we brought COBIT with us. Oh, okay. Right. Oh, so you live in New York, you're just in Florida, temporarily, or just a quote unquote temporary right now. But I have to tell you, I really liked the income tax laws here and yeah.

[00:01:30] Gotcha. Now look, New York is, I mean, you live in a city, where do you live? Upper West. So we were on 61st and West end. Are you familiar with the new development called waterline square right there at long Hudson. If you go on 61st and 60th. I think of my wife when we were dating, she used to live. She went to Columbia for MBA.

[00:01:49] So I know the whole West side group. Well, and we hung out. I mean, not obviously not in the last few months, I've been up that high lately. I have cousins that live like, well, it used to the former Trump towers on the West side, but that's like in the [00:02:00] upper fifties, is that the same area as that used to be Trump?

[00:02:02] It's like all those like high rises that right on the West side highway. Yeah, it is. You're talking about Riverside. Yeah. Yeah. Yeah. So you live in a city then now we live in Jersey. I live in Ridgewood, which is like, my office is in Inglewood's right by the GW bridge, but when I'm like 20 minutes from the city.

[00:02:17] Okay. So, but you're familiar with the city. It sounds like I've been up here. I've been in New York. Tri-state since 2002. Got it. Got it. Yeah. So I always couch this because I say down there, which seems like it's going to be a farther distance, but we were on 63rd and central park, which is literally four blocks over right in New York city.

[00:02:36] It's like a whole new world, but my daughter got admitted into this Mandarin immersion program. Oh great. That's in way, which was on Riverside and my wife and I looked at each other and we said, we're not going to try across four blocks in Columbus and got Amsterdam. Exactly. So we chose the West end, which literally was three blocks up the road from [00:03:00] us.

[00:03:00] So it made it really nice. And we had moved into this. Waterline square, apartment complexes, new design, and the property development company put this massive investment into a hundred thousand square feet of amenities. So they had tennis court, indoor pools, rock climbing walls, all you could imagine.

[00:03:17] Right. And just as they were supposed to open was March 31st this year. Oh, wow. Yeah. Yeah. So what you end up doing as you pay a lot for those places, but the places are smaller because you have all those amenities. What we ended up with was 1100 square feet and two bedrooms. And my wife and my daughter, my daughter, trying to go to school, my wife watching her real estate business kind of implode in front of us.

[00:03:40] And then it'll cause we did that for about two months and that just wasn't working. So we came down here. We've been in Naples. It's been good. It's been good Naples. Excellent. Very nice. That's the big difference certainly than Manhattan, but I think it depends on how you look at life, but I know financially for all of us, it makes a huge difference.

[00:03:57] I'm sure. Right. So. Yeah. So how long have you [00:04:00] been in the New Jersey area? Surge? I came in 2002 for residency fellowship, and then it was never supposed to stay up in this area. But then just one thing led to another. My wife was at Columbia then without a child, it's just nice. We live in, and then it could be in the West village in 10 minutes on the path and we just enjoy that kind of lifestyle.

[00:04:16] And then we move to. Edgewater, which is right North of Hoboken. And then we had my son and then we moved to the suburbs and then you kind of like get entrenched with work, your private practice, you build for better, for worse and the area, et cetera. And then here we are, I just finished 13 years in private practice, which I started in 2007.

[00:04:32] So it's just, you kind of like up until now, we love living in Jersey with one of the attractions is going to Manhattan and everything's got the offers. So it's kind of a bummer that we, we're not really doing that these days. Is the protocols in Jersey right now, different than what's happening in Manhattan.

[00:04:46] I mean, they pretty much are in tandem in terms of their phases, just like New York, New Jersey, similar restaurants, indoor dining is still not a thing. And we can talk about with the hospital, I'm at them. The chief of the department was the epicenter of New Jersey, you know? And so we had gotten a lot of.

[00:04:59] Unfortunately, [00:05:00] it was an unfortunate press, but we got a lot of the limelight put on us from a national point, just because for better, for worse than for unclear reasons, it really just kind of landed right here in our area and then spread throughout the County Bergen County, just like Westchester and just like Nassau County surrounding Manhattan.

[00:05:14] But yeah, we were, all I was doing was seen COVID patients for March, April and part of may. So it was really a once I hope once in a career type of situation, but it was really insane. Were you able to escape on scab? Yes. Yes. I chose that PPE works. I don't have antibodies. I got tested numerous times. I never got sick.

[00:05:31] I did have two of my colleagues who did get sick and we get several hospital employees who ultimately succumbed and passed away. There was a few doctors who did pass. They were older, but for the most part, the doctors that were quote unquote, the ones on the, on the front lines, on a daily basis, like my infectious disease department, the critical care docs, the anesthesiologist, ER, docs.

[00:05:50] Almost none, except for one anesthesiology doc tested positive. So everyone stayed healthy. So I think it was just because it was a Testament to how originally were with our PPE, you know? So it shows that it works [00:06:00] truly, but that won't be I'll. I will not hear those times in March. That, that truly, I think I thought, I thought we were, you wake up the middle night.

[00:06:06] You think you might not make it? It was really, and I was self quarantining, so I was sleeping in the bed. It's been the guest room, different shower. I'd come home by the way. We're. I know you said it's a free form and you can edit stuff later. So we're just kind of you just recording now and we'll just get, sorry, I should have probably just given you the heads up, but I just start recording.

[00:06:22] So, and I don't know if you got a chance to see any of the, did I got you in quickly? I did though. Yeah, absolutely. So we tried to do a bunch of stuff for our guests as to not only have the podcast itself, but to have some, some videos around the quotes and your principles on dads and being fathers and everything.

[00:06:37] So it's a lot of fun and. We've actually, we've been downloaded now in 27 countries, which is really cool. No, that's excellent. That's excellent. Yeah, it's been a nice little journey. We started out as a little Facebook group. We thought it wouldn't be much. We started putting some memes and stuff, jokes out there.

[00:06:55] Yeah, golf. Before we knew it, we were over 80,000 followers on Facebook and we [00:07:00] created an eCommerce sites where were like, let's create a day mall. Let's get some content out there with blogs. And then in March we went live with the podcast. And a good friend of mine. Who's a one star general in the air force.

[00:07:12] He's also an F 16 pilot. He had to leave his family during an Afghanistan deployment. I think it was actually 15 months, but he had just had his second son and his other one was two years old. And so I was like, what better podcast to start out with then? Uh, somebody that had to actually be. Away from their family for duty calls, being a hero in and having that type of responsibility in a life or death every day, kind of thought process while the youngest son he'd barely got to know before he left.

[00:07:42] And it was really interesting. And so we've been really getting a nice group of. Guests on here that come from all different backgrounds, professions, and perspectives. And it's a lot of fun to hear the different insights we get from them from not only like their profession, which I can't wait to hear your side of it, that part, but also from being a dad and just [00:08:00] managing that everyday life while balancing a career.

[00:08:02] Yeah. Oh, that's great. Because I feel like there's a lot, uh, and there should be a lot about moms, but the dads sometimes get left behind. I think it's great. I mean, obviously I'm biased, but. And I know mom's deserve all the credit anyway, but I think to have that perspective is you need funding. Sometimes people assume that that's a working hard and, but there's a lot of stuff, specific issues I think about being a debt and not just a parent, the right parents is just kind of ubiquitous.

[00:08:23] I mean, about being a dad, I think that's great that you have that niche that you're discussing and having different examples of how people balance busy careers and all different types of things. But at the same end of the day, their identity still is very much represented by being a dad. I'm glad you said that that was one of the key principles, just overall hypothesis.

[00:08:42] So we had one we ever received started the old dad Corp idea. And one part of it was every time I turned and looked around, I would say, I see ads in the media or that the ads on TV presented as, as Homer Simpson, dad's horrible style, kind of dumb, just moping [00:09:00] around and making bad jokes. And. And not really always present.

[00:09:03] However, when I went to the playground in New York city, I'd sit here, look around and you, half of us are more or dads just running around with our kids and really cool people that were super educated, very engaged in the father life, but also very successful professionally. And that was our whole premise is to try to modernize the image of being a dad.

[00:09:23] No. I agree. A hundred percent. I mean, as much Homer Simpson, I don't emulate him or family guy as the quintessential. I haven't used that one yet, but I will start now. I forgot about the family guy. That's another, I mean, I mean, that is a funny show I have to say. And that's beyond ridiculous, perhaps as ridiculous as a Homer, but perhaps even more so, I don't know.

[00:09:43] Yeah. So you have one son? Yeah. Cause we have one son and he is 11 and a half. And my wife works two works full time. She's in digital marketing and business development and much more quantitative than I am. I mean, she's always worked within the biotech and pharma industry. So we both decided that, [00:10:00] Hey, we both professionals.

[00:10:02] I mean, I know for better, for worse, highly educated, but so we don't want compromise on our careers at the same time. We're not going to compromise on, on our child. You know, we have one son and we want to be involved. We're not going to, again, this is not a knock. It's just our own personal. Preference. We were not planning to have someone else raise our kid, whether it's a nanny or this at the other.

[00:10:20] So of course we have employed help, but where we needed it. But so we both have taken a very active role and as much as I can, I didn't use the excuse. Okay. I'm a doctor and I'm busy and I'm working nights and weekends, but yes, it's true, but I never wanted. To not be present in his life, just because of that, which is kind of, you look at the old school docs, right?

[00:10:39] My father was a doctor as well. And you know, he was maybe the exception, but that generation, it was like, you dedicate your life to medicine. That's just the way it is. And of course he worked very hard and I got used to like on the hallway, home from soccer practice or whatever it might be. We got to make a stop at the hospital and he'd have to go to work and I'd have to wait in the doctor's lounge or whatever.

[00:10:54] That was a part of my life. But I was very thankful that he also was always around, but only later I realized, well, he was around because we'd [00:11:00] have dinner and then took me into bed and go back to work at 10 o'clock at night when I was sleeping in at seven in the morning until nine, 10 o'clock, he was working and then coming home.

[00:11:06] So he'd be around when I was awake. So I wanted to go continue that as a physician, but the same time being involved at. So if I look back, that was very much like our goal. As a family, as a family of three, we have a very large extended family, but our nuclear family of three. That was our goal. And so I think there's unique challenges.

[00:11:23] And as an only child, it wasn't planned to be, but it's just the way the life worked out. I have a brother and my wife has multiple siblings and we're all very close to our siblings and et cetera. So, but it just worked out. We would have one, so we decided, Hey, we are going to. Take him everywhere. We go involve in with everything.

[00:11:38] So we talked about living in New York or the New York tri-state. So from an early age, he was going to the met and he was going after his, who examined every of the tambourines. And by the time he was 10 had been to Europe several times. Not because we just want to say, well, he's been in Europe, but we wanted to instill in him.

[00:11:51] Well, we like passions of traveling and this and that. And. So now he's loving to half and my wife will joke and say, but in some ways he is, he's obviously a mini her too, but definitely has a [00:12:00] lot of our interests. And some of them could be viewed somewhat mature for a kid, his age. They love CNN. He loves political science.

[00:12:06] He loves geography, loves travel. Of course he loves support night and all the other things that kids his age to do as well. Don't get me wrong. But I think this is a reflection that we kind of include him and. Involve him with everything that we do despite us being busy. So whatever it might be, I guess we just don't sleep.

[00:12:21] We just make sure that we're trying, I'm trying my best as a dad. So, but focusing on dads as not letting career and work objectives and goals get in the way or being very involved and very present, as I say, I think that's a kind of a buzzword to be present because I would say in medicine, especially from a young age, you're kind of always looking for and let me get into.

[00:12:40] Because let me get to grad school, let me get to med school, let me get a residency fellowship. Let me become partner in a practice. You just kind of looking, it's always like you're always heading forward, you know, and it's something you guys say, look, I just got to enjoy this moment. You know, and one day I can comment as an, as an only child we always are because of the fact that whatever stage he's at, this is it, you know, there's not like another three kids who are going to go through a Cub [00:13:00] Scouts or go through a tennis or flag football or whatever, or swimming class or whatever activities.

[00:13:04] So we try to enjoy every moment as much as we can. Because we are cognizant of that. This is the one opportunity we have to enjoy it. Yeah. So that's kind of our philosophy. She'll probably nothing earth shattering or different than a lot of other parents, professional parents out there. But I think good that a lot of people have similar objectives to be involved as much as possible in their kids' lives.

[00:13:24] It's fascinating to hear you say this because we have a only child right now, and it's still TBD. If that changes. My daughter is six years old. It seems like every year that passes, it's becoming more likely that that's going to be the situation as we're getting a little bit older, but I've always laughed because we talk about our daughter and the way she.

[00:13:48] Interacts with us and others. And it's almost turned into this, the Migos where we sit at a table and you talked about your son being more mature or talking [00:14:00] about things that may be beyond his age. My daughter at six years old will join into a political discussion. Now she may not really realize what she's saying or actually make a point that.

[00:14:13] Generally, it's something that is a well formed opinion, but she hears other people talking and she'll be like, Oh, I can't believe that person said that. You're right. They're a bad person or something like that. And it's just so funny to listen to her because when she's saying it it's as if I don't think she even realizes that she is six years old, she just looks at it as there's, you know, people talking and I'm used to being part of the conversation and.

[00:14:37] This is a celebration. So I should just be part of it. You need to watch it. I'm happy that she has that because I want her to feel confident in giving her opinions and expressing them. And, and I like that. See that type of maturity. So it's neat to hear that that's common along only children. Yeah, I think it is because, like you said, it's not just wife and I having a conversation.

[00:14:55] It's always the three of us having a conversation. And for better, for worse, a CNN is kind of on [00:15:00] our TV, 24, seven by then, or the national geographic channel or the history channel. So whatever. So we're always talking about current events or politics or travel or something, some combination thereof. And he has from an early age is just like you said, like where your daughter had been involved in the conversation.

[00:15:14] So. Having an only child versus siblings, there's obviously pros and cons. And I would never say one is superior to the other. I would just say that there's certain, probably unique tributes, both. And whether one is better or not that's for other people, was it determined or each person determined for themselves or multiple reasons why children are only children as these, in some cases, it's just the way it worked out.

[00:15:33] In other cases, it's a proactive choice, but regardless of that, I think you're right. That. Three Amigos or whatever you might say. My son is also extremely stubborn. So I think he gets that because he, when we tell him, no, you can't do this, you can't do that. He's like, well, I'm part of this family too. He sometimes views himself as an equal shareholder, so to speak, not like, okay, he's a junior stakeholder here.

[00:15:52] He's like, I have an equal vote. I have an equal say, I'm glad he has all that confidence and all that kind of maturity about himself. But sometimes it would be easier [00:16:00] if you would just listen. Look, no Fortnite, no more TV. Why? Because that sets, so that's just the way it is. And I'll share another interesting tidbit because we'll be talking about dad is my parents immigrated from India.

[00:16:10] They're physicians. I'm very, very close with them, but certainly grown and up there was always the idea of, of a immigrant parent. And that's very unique. I think in common. For a lot of my friends who were first generation born here, whether they're from India or anywhere else in the world, because there's always an idea of that.

[00:16:25] Your parents are, you respect them a little bit more. You don't talk back. When my dad came home from the hospital, from his office, all my mom had to say was she stopped working in, she basically, that was a more old school way that she put her medical career aside to raise us. So my dad was working very hard, but all she had to say, when my dad came home, was that wait till your dad gets home.

[00:16:43] Then my brother and I would just shut up right away. And it was like, he would come home. In India tea, China is a big deal. So he would have a cup of tea and then we wouldn't even bother him. Once he had his tea, he always watched the evening news. It was always six 30, Peter Jennings. And then my brother and I would always watch with him.

[00:16:57] So I think it's kinda how we got our interest in politics [00:17:00] and just current events, but that doesn't exist anymore. Maybe that's. Part of the helicopter parent generation, but, and my wife the same way, or if I was a cardiologist and again, immigrated from India, it was never a question that her and her sisters and her brother would talk back to her dad, especially, but both parents.

[00:17:13] So that's a unique thing. I think how parenting and then his dad's had changed because everyone else in my wife meant, I wish it was like the old days, a little bit every now and then, because if my dad says something, it wasn't like, why, why, why, or what do you know? No, because of this. I have rights. My sons even said, I have rights under the constitution and he'll start quoting different things and no one could look on the outside and say, well, this is very, I'm showing you the pretty smart kid, but sometimes it's just easier.

[00:17:34] Just be quiet. Just don't don't tell me about that, your rights and how I'm trampling your individual liberties and things like that. So, But that's a unique, I think, perspective on parenting, because like I said, I'm very close to my father, but there was growing up that I did of it. Might've been a time, the eighties and nineties, especially the eighties, but there was also, I think when you have immigrant parents, no matter where you're from, there's always an idea of the old school way of where you really respect them.

[00:17:57] And now we're the three Amigos and we're best friends and [00:18:00] yes, I'm very, we were friends with him, but also he was your dad, you know? So I think that is kind of a unique and maybe something worth mentioning a. Unique differentiation as generations go on, because I feel like now kids look at their parents across the board as like their friends first and parents second, you know?

[00:18:14] And so, and that has certain access flows, good points, but also like ramifications as well. I'm glad you said that because now I feel like I understand my wife better than I ever have. Just with that comment. I never thought of it from that perspective. My wife is an immigrant from Columbia. Sure. And there would be times where she'll speak to my daughter and say, you're going to respect your mother.

[00:18:36] You don't, you don't speak like that to your mother. And, and respect like that word is the word she uses. And it's not a word that I have ever really thought a lot about. And. It seems like maybe there's something there across cultures you're talking in Columbia, South America. But I think the same thing in friends of mine who were from middle East, from Europe, I think that's a commonality across the board of that idea of respect.

[00:18:59] And I [00:19:00] think a lot of the immigrant experience, whether it was, let's say someone who came as a professional, like my parents or someone who came, but we're more humble means, but there was always an idea that they were working very hard to better their family's situation. And that's a great thing about America, right?

[00:19:11] Is at least what has always been the draws that you call me work hard. And then you can change the fortunes of within a generation of your family. So I think the always idea was that, you know, whatever immigrant, whatever country, when someone may have immigrated from the idea that the kids are going to work hard, they're not going to talk back to the parents or the ones who sacrificed to get here.

[00:19:28] They may sacrifice. I'll tell you that. I also have family friends who may have been dentists or. Doctors in India. And then for whatever reason was able to parlay that into medicine here and took other jobs. And then their kids became doctors, right? They look, I sacrificed and left my professional status in mind country came here, but now you're going to a grade school.

[00:19:45] And now you're a doctor, lawyer, engineer, professional, whatever am I finance business, et cetera. But I think there was always the idea was that the way you pay the back is by showing up most of respect. So I can totally understand where your wife's coming from. And what does that word actually mean? Is that just being [00:20:00] well-behaved?

[00:20:00] Is that listening? What is, what. First of all, let me put a disclaimer, let me not pretend that I was not taught back for when I was adolescent. I called my parents all kinds of headaches or possibly had parties when they weren't around or possibly had parties at our beach house when they weren't I'll leave it at that.

[00:20:18] Yes, yes, yes. But there was always the idea that at the end of the, the day, if your parents looked at you a certain way and just said, no, that was it. You might go in your room and my palette, my slam the door, but that was it. There was no talking to talking back and questioning the authority. Wasn't there.

[00:20:32] You might be upset about it. You might say, ah, man, and just go in your room and not come out for an hour. So you might just have that skull and look that all, I don't know, 12 and a half, 13 year old seem to have, when you tell them they can't do something, but there was that baseline. When you say respect, it was more just understanding that, Hey, my dad's or my parents say.

[00:20:49] It's obviously both. It's not just that it's obviously parents, my mom come in the same level of respect, if not more, but did they have the final authority? And I think that is just a part of the immigrant [00:21:00] experience and very unique not to say that like my friends, so I don't always differentiate my friends.

[00:21:04] So like my yeah. Indian friends, my American friends, I mean friends, but we're not even when I was younger, I'd say, well, Hm. They get to test the waters a bit more. They talk back more. They don't, their parents aren't as hard as on those before, but then my parents would always say, you know what? You'll thank us later when it's like you're 14 and all your friends are out and about, and I'm home doing math class or something on a Friday night.

[00:21:22] That that's how it was, but that, and obviously I'm making a lot of generalizations here, but the underlying theme I think is very true and very present in a lot of different people's experiences who parents maybe immigrated, but it's more the idea of just accepting your parents' authority. And I don't know why that is.

[00:21:37] I have ideas, but. You know, obviously many different cultures, but why even despite different cultural baggage, the kids whose parents made that sacrifice to come over and left their family, maybe just sub constantly understood the, Hey they are they something that for me? And so I have to pay them back by understanding.

[00:21:54] Their authority. And then you fast forward to now, obviously immigrants are not just a whole different story, right? I mean, it's, [00:22:00] it's the helicopter parents. It's the idea of what your parents are, your best friends first and parents second. So it's also just a generational shift even here. So, and did that respect go as far as what you would decide to do for your career?

[00:22:12] Is that how you would went down the medical path or does it stop for that? It's a very unique, interesting conversation. In the 1970s, people who would, especially from India, a lot of parts of Asia who would get visas to come here and then eventually become citizens where, what they call highly qualified.

[00:22:30] There's a term I probably used, but that was actually what was Dean, but it had to be exceptionally qualified. So growing up, almost all of our community of circle of friends, of families who are of Indian origin. I just thought it was normal that everyone parents were either at, I would say doctors, if there weren't doctors, they're engineers or they were university professors, and only later I realized is that generation that immigrated in the seventies was the only people who were let in.

[00:22:54] So to speak. You had to be exceptionally qualified, you know? So you were filling PhD spots, you were filling [00:23:00] physician shortage. So actually I grew up in Southern Maryland, and it's a lovely area. It's right near the beach ocean city, Maryland to Tom called Salisbury. And it's by no means a two light town.

[00:23:09] It's like proper 30, 40,000 people, but you're two hours away from DC, two hours from now. You mentioned you were in D C. So we went to the Eastern shore and round was on the Southern lower Eastern shore of Maryland. Which is beautiful, but especially in the seventies and my dad came, it was a underrepresented area.

[00:23:23] So that was a way for a physician, especially to eventually get a permanent visa and then eventually become in and out. He's a citizen as, as my mom, which is why you, interestingly, you will see a lot of positions of Indian Pakistani, East Asian origin. In small towns and rural areas throughout the South and in the Midwest when you see them everywhere, but that's actually how they filled the void.

[00:23:43] There were medical shortages throughout the country. And so physicians from other places, Philippines as well, but a lot of from East Asia and Southeast Asia filled in these gaps. And so I just thought it was normal that everyone around me was a physician engineer. At least highly educated. And so, [00:24:00] and then the eighties things changed, then you had a second wave of immigration.

[00:24:03] We would have more, let's say people who own businesses. Right. And then they did very well. They may be, have been more humble origins, but they bought gas stations. They bought some, they bought convenience stores, they bought franchises, they worked extremely hard. And I'm friends, a lot of those kids from that generation who also ultimately their parents sacrifice.

[00:24:21] And then they ultimately did very well. With their profession. But I would say in terms of career choice, especially kids in my generation, of course, I'm saying it's kids, but I'm not 46, but kids, I grew up with people now, relative, I'm happy to call myself a kid, hit it hard. A lot of us were, I don't say pushed, but we're highly encouraged to go into medicine.

[00:24:42] So it was a joke. I was like, okay, you can become a doctor. You can come a dentist, you can come engineer. That was whatever you want to do. As long as the doctor is an engineer, you know, so that was kind of the, what we were allowed was, were pushed into as say, pushed into encouraged. And I think a lot of us of that generation kind of went that route only because that's what we knew.

[00:24:59] I mean, [00:25:00] growing up, no, that's what I saw. My father was a physician. My grandfather was in the medical field in India. I grew up going around to my dad because. When he picked me up from school, you would get a page. There's no cell phone, you get paid, you would call from a payphone. Oh, I got to stop by the hospital.

[00:25:13] And so I just kinda got introduced life for early. So for me, that was never a question. But then my brother, he went the science route and then maybe smarter than me because he's doing his MBA and doing very, very well. But he also has a very highly scientific background. He has a masters in chemistry and worked in pharma for a long time until he turned over into the business and still working for a major pharmaceutical company, but now working in the business development aspect.

[00:25:35] But I think that was always there for our generation to listen, encouraged, to go through some kind of scientific rigor. I'll put it another way, at least early on. Uh, majoring in English or the fine arts was not necessarily encouraged. Again, I'm speaking in generalities, I'll say change and over time. But I would say the first generation that came immigrated late sixties, early seventies.

[00:25:55] A lot of them, they expected a lot from us because they already. [00:26:00] We're like the top of the top of India at that time was a huge brain drain. Right. So if you were highly educated, you're leaving, you're going to go. And then the place to go is really United States and they did very well. That has changed dramatically now with both the economy in the United States, as well as the economy in Asia.

[00:26:13] You know what I mean? India is booming now up until recently, it was right behind China. And is now I think the sixth largest topographer Francis six largest at the time in the world. So. It's booming. So I don't mind you much younger cousins and family members. There's not see, they all stay there now, right.

[00:26:26] That they can do very well. And there's a huge middle class there, but the generation that came, we, I think had a lot of expectations that were put upon us by our parents. And you see that today. It's certainly, I mean, where I live in Bergen County, there's a very large Korean population and same, a lot of my colleagues are of Korean origin and they have extremely successful and as a community.

[00:26:45] And I think it's because of that immigrant mentality. Whether you're highly educated or you're owning a less educated owning a business, dry, cleaner, or grocery store, did they demand and expect it's a very large amount from the children because they, I feel that they have given them their sacrifice to bring them here [00:27:00] and they have to make the most of it.

[00:27:01] So I think that's also unique, unique experiences and things was that translated as well as like how we were, and then I'll probably have what we expect from our kids. Now, now fast forward 2020, I mean, I would be lying to you if I didn't expect a lot from my kid, you know? So I guess that kind of just gets continued to generations.

[00:27:18] And after the career you've had in the medical field, and especially the last few months, would you encourage your son to go down that same path? No, I think that's where I would deviate. I would want him, I would expect him to be a top of his fuel, whatever it might be, but if he wants to go on a. Poly PSI.

[00:27:34] He wants to go into international relations. He wants to go into math, whatever it might be. I would say it'd be the best. I mean, I think I would not push him into medicine. Medicine is very different than when my dad practiced. And even when I started practicing in 2007, we won't go into all these shoes, but it's been well publicized.

[00:27:48] The. Bureaucracy and paperwork and loss of autonomy and a lot of these types of things that we see, I would not say it's the be all end all profession for me, it is because I do it as a calling and not as a profession. And that [00:28:00] sounds, I know that sounds cheesy, but that's, that's how I feel. Cause if you view it as just like a job or a nine to five, I think you'd be miserable if you viewed as like, okay, it's who I am.

[00:28:07] I'm not just a guy who was a doctor from nine to five and then come home. It's really who I am. And I think a lot of physicians feel that way. Then you're more willing to put up with some of the, a lot of the BS that you have to deal with. But I think for my own son, I would just encourage him highly encouraged him to whatever you do, try to be the top.

[00:28:23] So, which would mean probably your respect to fuels getting advanced degrees. Et cetera. So he's 11 and a half. He has a long way to go and we just try to encourage him and expose him to everything and be part of it as having books, having books around and says the early agent, I told you, the air conditioning in my room is not working.

[00:28:39] So I'm just sitting at his desk at the moment in his room because there's AC up on the second floor of the first floor, where my office is, where I normally would record a podcast. What have you? It's unbearably hot, but I'm looking around. I happen to see a lot of books and I think that's how I grew up a lot of books.

[00:28:52] And so. Hopefully that kind of imprints in his brain that whatever I do I need to do well at and his future would be dependent [00:29:00] upon him, hard work diligence, and putting his mind to the task. So I think our job as parents is to encourage that, but obviously facilitate that. But at the same time, don't, we, we're all, I'm not a talker dad or whatever, whatever you want to call it, it's summertime.

[00:29:13] And I think he, right now, he's in the basement playing video games. So, and it was listening out there. Don't worry. He has plenty of downtime. And what type of books do you generally encourage him to. That's funny. I mean, he is, I think, early on we would get like these national geographic Almanac, 2015, 2016 animal facts he really got.

[00:29:29] And then all of a sudden I realized this kid's only reading nonfiction. That's all he wanted to read. So then of course, kids kind of pick up from what parents do, my wife and I, when we were dating. I think one of our first dates was like at a bookstore reading a Harry Potter. So he quickly read all the Harry Potter series and why you can watch, if you want to watch the movies.

[00:29:47] I think you have to read the books first and then you can watch the movies. You read all the books, you read them through ISR and three times at the risk of sounding completely nerdy. I'm also a big Lord of the rings fan. So he was, I want to watch the movies I heard. They're really cool. We got to read the book and I thought, [00:30:00] okay, that should take a while.

[00:30:01] But he digested Lord of the rings, which is not an easy book to read relatively quickly. And then we watched the movies and so. He still prefers like nonfiction and he's really into like history. So he reads a lot of history books about world war two and about the civil war, but he's also reading more and more fiction these days as well.

[00:30:17] So we try to encourage him to read variety of stuff. And whether it's like these time magazine has these great books about current events and politics. Different series. I mean, of course there's a series of kids, his age read a lot, the diary of a wimpy kid, but he even read my Hardy boys collection, which I had somehow my mom had saved from when I was already boys.

[00:30:38] I don't think I've heard that for 20 years. My goodness Hardy, actually my mom was a saved the book. She gave it to him and then I thumbed through them and then it took me right back to when I was a kid already and Chet Morgan, the friend the whole day took me back really quickly, but he read those. Yeah.

[00:30:54] So we try to encourage him to whatever he's reading, to be healthy about it. And especially funny, he actually used to get in [00:31:00] trouble because he would read too much because I always tell him, go upstairs, take a shower. And I come down upstairs an hour later, just sitting on the floor and his towel, reading a book.

[00:31:07] So he actually loves to read. So we're thankful for that. But sometimes when he's got stuff to do and getting ready to go to tennis or whatever, leaving the house, he is definitely has not the best manager of times. So that's something we're working on that executive function. Okay. I got to do this and gotta do this.

[00:31:22] So that's great. You're reading. But it's two 57 and you have tennis at three o'clock and you're still sitting here without your shoes on. That's a problem. So when we got on the Fitbit, so he doesn't have excuse of not having a watch, but that is still something we're working on. So again, I think kids at this age can be very uneven.

[00:31:36] They can be very advanced in certain ways. And. Completely not backward, but completely needing some help in other ways. You know what I mean? If I tell you eat every time we take a shower, I walk upstairs as clothes all over the place. You know what I mean? It's just, God forbid he picks up his clothes so well, like all the kids out there, their strengths, weaknesses, and everything in between.

[00:31:52] So we're just trying to help him develop his strengths at the same time. We'll work on any of the words, weaknesses, but work there any gaps he may [00:32:00] have to ensure that he's the best that he can be when he grows up. Here's a question for you. We've been talking about this across different podcasts and we laugh every time that when we look at our kids, if you want to know your worst trait or the one that drives you the most crazy, or that you're most disappointed in yourself, your kid usually has that same trait or which one is it for you?

[00:32:22] Oh man, that's a hundred percent because there's times where there's some issue going on or he's hanging out with my wife or me, whatever. And then I will stop later and go cheese. That's something I would have done at that age too. And I would say unlike my brother who was much more laid back, especially when we were kids and was probably much more, we talk, the whole thing is being respectful, respecting authority.

[00:32:41] I had a time where I would not, and I was fiery. And I like to think that, you know, once I matured that, that every street I was able to stream, it kind of channel it. It's a more positive things like being motivated to work in career and otherwise, and take risks and whatever it might be. But I would say I have a fault to a T of being impatient from my [00:33:00] wife on the other hand is very patient and.

[00:33:02] I can be sometimes irrational and quick, not to anger, but just quick to just kind of like get focused on some issue and negative point in that and not see someone else's point of view. And my wife is much more relaxed and sees the bigger picture. And I think my son kind of takes after me. Sometimes he'll just focus in on something, get impatient.

[00:33:19] You know, for example, when I was a kid, I was never good at like these like logic puzzles. I would just get frustrated. You know what I mean? I was smart, but I just, wasn't my thing to take time and do stuff. And my brother was like the type of guy who would like, just take his time. And even today, if you ask me, do I think it was more a person I would like to say, yes.

[00:33:35] I like to say most of my colleagues and friends and family say yes, but in my handy around the house, know where my brother will put up shelves and do all this because he takes his time and can kind of approach it patiently and figure out what's going on. We're I'll put a nail in the wall, it'll go in sideways.

[00:33:48] I'm like, forget it. This is not for me. You know? So I think those are definite negative things about myself that I do sometimes see in myself. Sunday, he'll get mad. He doesn't really get frustrated, but he just kinda gets zero to 60 in a minute. And then the not seeing the [00:34:00] big picture here. And that was also, I think when I was a kid, sometimes I'm not getting my way.

[00:34:04] I would just get really upset and not just take a step back and see that big picture and same thing with him. So. I'm actually, I'm actually fascinated that you mentioned that because as of late, I've been seeing more and more where I might get upset with them or we'll have a discussion or you'll have to get this video games taken or something because he did something wrong.

[00:34:19] And then as I'm walking away, I'm thinking, man, I would've done the same thing or I did the same thing and I'll see, kids will mirror you for your strengths and for everything. That's good, but they're going to have they reflect back to love. And is that now, as you're older, that were, are your weaknesses, or there were things that you wish that you could have done better at.

[00:34:38] So I agree. I see that. And I think myself, man, I went through that. I put my parents through that and I guess that's probably pretty common. That's why I always say parents when they become grandparents will say, don't worry, you'll get paid back. Well, you put us through because you're can put you through the same thing.

[00:34:49] That must be something that. Parents and grandparents and great grandparents of many generations. I have no one because that's a common thing. Right? So grandparents would have the advantage of like, they don't have to discipline your kids so they can just spoil [00:35:00] their grandkids and what have you. And because they're like our time disciplining has done, but don't worry, whatever, how you put us through are not held a strong word, but whatever right.

[00:35:07] For stress, you caused us and you're going to get it right back at you. So it must be just the thing that just through human nature, that just. It gets repeated throughout time. Yeah. And I think how it might be the word some of the parents would use. So I don't know if it was it's funny because my, I don't know if this was just our own experience, but I joke with some friends of ours that.

[00:35:30] You talked about the grandparents spoiling the kids. Sure. I thought that that generation, my mother she's amazing person, high school educated. She ended up having a divorce and she fought and worked her butt off to make sure we got our opportunities and she raised six kids. Right. And so five before me.

[00:35:47] And then I was the youngest. I was an accident about 13 years later. And. You would think after six kids, which basically from the time she was 18 years old until she was almost [00:36:00] 50 something, she had been a mother because she had a kid in the house. You would think that that would be second nature to her, but whenever we had our daughter, it was like, she forgot how to change a diaper.

[00:36:10] And that was like, what happened? You know, I don't know if it was like this selective memory loss, because she was like, I don't know, like, or it's you talked about us having different generations, but when she goes to watch my daughter and like, make sure you have for this, make sure you do that. And she's like, I have done this six times.

[00:36:25] I think finally, she was like, you know what? I don't even know how to do this anymore. I don't know if you got some help from your parents or not, but I seem to find it, our family. Was a little bit absent during the times when we would like, Oh, it'd be nice for us to be able to go on a little dinner date right now, but yep.

[00:36:40] Nope. Not going to watch the kids. I mean, maybe there's a selective memory loss. You're right. I mean, I think sometimes parents, I think that's true because I mean, I'll tell you, like, sometimes my parents will say, Oh, don't be so hard on him, this and the other. And I'll think to myself, Do you remember how far you were on me or do you, you wouldn't let that stuff.

[00:36:55] Like if they're visiting my parents live in Maryland with when they're visiting, if they're after like this one, my [00:37:00] kid, whatever. No, you can't have, I told you not to. And they'll say just give it to them. I'm thinking myself, are you kidding me? When I was a kid to both the parents as physicians, they would cause no, have an Apple, you know?

[00:37:09] So I think they can kind of forget, I guess, that they've learned it that's the right, that they're not grandparents. And then they went through the whole thing of being parents. So. Yeah, that's the way I look at, I guess they've earned the right to kind of forget those things and that's how we are in life.

[00:37:21] Anyway, you kind of forget the negative and always cuts through on the positive. So promise, pack a little bit for the times that we gave them the rough time. Right. That's right. That's right. Yeah. Yeah. And so what, how are you dealing with. The whole scenario around, go back to school. Don't go to school. I mean, outside of your profession, which I assume you're getting questions every day on that, but personally, what are your views with your son and him going back to school?

[00:37:45] Cool. So this is a hot button topic, and I'm speaking as a dad now and not as a physician, but pardon me? Not to separate the two. So I, obviously, whatever I do, I try my best. To follow scientific data. Right? So not as, let me just backtrack because I have [00:38:00] friends that I have colleagues who will say, well, I have quarantine fatigue.

[00:38:04] I'm so over COVID-19 I'm just done. I need a break. So I get it. I understand the cycle. Yeah. Surgical and mental ramifications of quarantine, this, that, and the other. I didn't really have time to think about it in March. And April was like I said, in the Tristate, our hospital, or I hadn't been head the department was the epicenter and for better, for worse.

[00:38:20] And so. Obviously, I'm talking from a very different experience, but I saw just a lot of terrible things and it greatly affected me and myself and I'm not alone unique. I mean, it was all my colleagues were right there with me, doctors, nurses, all the frontliners DMTs, respiratory techs. What have you, but to say, we all have PTSD from that is not an understatement by any means.

[00:38:37] So. I just wanna give a background. So, but then I use it home to my town, which is a lovely town in New Jersey, but some people will say it's a little bubble here, but it's fantastic. Beautiful town, beautiful downtown wonderful people. A lot of like you can say since you're from New York, X, new Yorkers who sufficiently moved out, so they're educated, they're driven, definitely type a.

[00:38:56] But they're very worldly. And then they also have great opinion, but [00:39:00] a lot of people did the right thing. They quarantine and they weren't personally affected right there. You know, because a lot of people in this town are professionals. So they are able to work from home. They may not have had the same economic and financial strain that people, other people of different socioeconomic backgrounds.

[00:39:15] He says, well-described now I've had. And so I feel that there's a disconnect, you know? And so. Once the weather got it's easy and margin April one's chilly days are shorter. It might be fun. Okay. We're staying home. The kids are home from school. I'm working from home. We're watching Netflix. We're doing this.

[00:39:28] I'm not trying to downplay one's experience, but from a whole. A lot of people that said, Hey, it wasn't so bad and you might see something new. I saw every day, then I would drive home to let people walk and the dog and ride their bike. And I'm like, man, I just went to, well, not me, but I just saw people going through hell and I'm almost done with the patients, the patients' families, but things are okay here, you know?

[00:39:45] And then with a warmer weather came. I think a lot of people that were maybe disconnected from it directly were saying, look, I'm ready to get back to work. And when I can get back to school. So I understand all that sentiment, but what I would just strive what I've tried to strive as a dad, as well as a [00:40:00] physician.

[00:40:00] Because again, it's hard to separate. I mean, I don't separate it, especially in this situation is that let science guide you not feelings, right. Because just because it's summer, it doesn't mean. And you think you need a summer vacation doesn't mean cold was gone just because someone has quarantined fatigue doesn't mean it's gone.

[00:40:13] It's still there. Just like it. Wasn't March and April. We asked we have better testing and we have clinical trials and we have. While we have no cure. We have, you know, drugs and clinical trials and for investigation drugs. And we have studies showing that what interventions work or would likely work and which ones it's still out there.

[00:40:27] And we know that. So it becomes very difficult having this conversation because you need to separate emotion from. Just science. And so I look at this from a typical total scientific background, but with the full disclosure that I was somewhat, sorry, I'll be honest from experience in March and right.

[00:40:45] Well, so first and foremost, as things open up, I think New Jersey, you're doing a great job and New York is doing a good job as well. New Jersey, Rhode Island, up until recently only States. We have decreasing incidents. Compare that to Florida. You know where you are now, mostly Texas, [00:41:00] Arizona. South Carolina, et cetera.

[00:41:02] So why is that? Because they're not letting emotion getting in the way. They're not saying well it's summer and it's just time to go. It's time to have crabs. I would love to have crabs only have seafood to have drinks in a bar inside, but no, you look at the sign. The science tells us that if you're looking at all activities and short of quarantine in your house, what are the low risk activities?

[00:41:19] And we realized early on, okay. Non-contact sports. So golf, tennis, running, anything outside right there. You have a low density people. And why is that? Let's take a step back it's because from a scientific point, even if person a was positive and person B, they were having drinks outside, they were just talking outside.

[00:41:38] The air, the environment dilutes that virus. So the amount of viral load the patient B gets from person B, you get some person a, is a less of a viral load, and there's a good chance if someone's healthy that their immune system can handle it and they never get sick. So we know now that the environment and at that illusion of the viral load makes outdoor activities while not no risk, much less risky than it [00:42:00] would other activities.

[00:42:00] Right? So the higher risk activities are indoor, especially indoor eating. Bars. We see a lot of transmission driven in Florida and Texas, South Carolina from bars and restaurants because it's loud, there's music. It's almost impossible to socially isolate the more. You become under the influence of whatever cocktail you might be drinking.

[00:42:19] And we know that your inhibitions decrease, you're raising your glass to your face. You're touching your face. You're eating inside. You're touching your face. It just is a perfect storm. If you will. And it might be hot, it might be packed full of people, perfect storm for spread of disease. So, so I went back to school.

[00:42:34] I think we have to look at a couple of things. One is what is the ability to keep kids apart from each other? Well the same time and this other second part of the scientific background, what I'm losing is that we realize that masks do work. And on the first to admit that from a scientific community, I think we were slow to the game of having a general public wear masks.

[00:42:53] And then we realized, no, even the, I ask that the most hopeful you're wearing when you're out and about most people that are listening are wearing when they're out and [00:43:00] about. That's a surgical mask. That's not an end 95 and 95 is much more effective, but it's also hard to wear. It creates a very tight seal, especially in the summertime.

[00:43:08] It's very hot, but even a surgical mask, why wouldn't recommend someone, who's a healthcare worker going to see a patient. It still does afford. Now we've seen scientific data to prove that some decent degree of protection, right? So that, along with social distancing hand hygiene, that's touching your face, washing your hands, all of the stuff that we've heard 10,000 times now over and over again are effective.

[00:43:30] So we need to use that scientific backup from, and that scientific discussion. Anytime you're making an argument or a plan for bringing kids back to school, not that well, Mike, which is bad for the kids and they're playing video games, or my kid has to get back to school because they're missing the problem.

[00:43:45] And I get all of that, but I find that's all secondary. We have to really. Approach it from a scientific point of view. So why don't you do it from that point of view and say, okay, so now what is our school's ability to want social distance? Do we have the staff, the infrastructure to keep, let's say 50% capacity now [00:44:00] in Florida, maybe you can have outdoor classes.

[00:44:02] They've even discussed that even here in New Jersey, but we know that's not realistic, you know? I mean, yes, the winters are getting milder and I'm a change and that's a whole, I guess, a podcast for a different day, but. Let's be honest, it's still New Jersey, New York. Tri-state so no, one's gonna expect you to tent classes and yeah, December, January, February, March.

[00:44:20] So the idea is that can we have a system in place where a kids are required to wear masks when they're at their seat? Are they more than six feet apart in a well ventilated area that has adequate HVAC and air filtration systems, and then will kids be compliant? Will the teachers be compliant? And how do you do that again?

[00:44:38] So from a general perspective, I would imagine that most schools will have to have. 50% kids divided into two different camps. And what does an a and P M session? It was a cleaning in between or a Monday, Wednesday, Friday for half the kids and the Tuesday, Thursday, and then alternate the following week. I think those are things that people have to look at, but that is fraught with issues, right?

[00:44:58] Because there's also issues of [00:45:00] a. Teachers who have to wear a mask the whole time. And teachers may say, well, I have an underlying condition. I don't want bring it to my family. I have kids he's at home. So what do you do now? There's two schools of thought. You know what I mean? One would say physicians, healthcare workers also face the same adversity.

[00:45:16] And I have kid home and I have a wife at home I didn't want affect. And, but one might say I signed up for this and, and teachers did so that's, I will see a point of debate. So there's a lot of moving parts. There's a teacher who say, I will teach her labor unions who may assume if they're forced to go back or they may refuse to work.

[00:45:33] Some teachers that are younger. I say my chance of getting infected or getting sick if I'm effective very low and I'm just starting my career and I need to work. So there's a lot of moving parts there. So I think we have to ensure not just the safety of the kids, but we can't forget ensuring the safety and the wellbeing of the teachers as well.

[00:45:48] And then we have to look at what is the, what is the plan in place? Because I can tell you. My kid was having, I think that my school system, the school system, my town did an excellent job, but by 11, 12 o'clock he was usually done because [00:46:00] he's a smart kid. He can finish this stuff early. My wife's still working at home and then he was taking off video games, you know?

[00:46:05] And then, so then she had to divide her time, not only as working full time and job, but also like filling in the gaps. So my kids' education because obviously I cannot work from home. I was in the hospital every day from like eight to. Eight or eight to nine every day for 60 days straight. All of March, April.

[00:46:20] So there's a lot of issues in play. No, of course not. I'm just, you're talking about parents who have professional jobs. What about parents who have to go back to work? Right? Whether their jobs demand them or they have jobs such that it cannot be done. From a distance and then will there be daycare for the kids?

[00:46:34] Is that going to put an unfair economic stream where one parent will have to decide between keeping their kids at home or quitting the job so they can teach their kids? So there's a lot of moving parts obviously, and there's no one right answer that I can provide. So in my answers that may not be right for other people.

[00:46:49] So what I would say, and that's the very broad view, what I would say is that if you let the science guide, you. Then you're much better off than letting emotion and other issues, which [00:47:00] still even economic, socially, et cetera are important. But I think we have to let science guide, so there has to be very strict.

[00:47:08] Policies that are guided by science and not by emotion of one only has to look at your local towns, Facebook, mama, dad's page or something similar to see all the different opinions that are out there. And they're all oftentimes very varying. So in some may say, I trust science. Other people say, forget science, my kid's suffering.

[00:47:25] Maybe he can't go to this sporting event. He can't do this, whether it's from, or, or graduation or what have you. So I think everyone. It should be respectful when they have these conversations and not downplay the importance of one versus the other. But I think we have to make science Paramounts. And so now that's the crux of this discussion.

[00:47:41] What is the sign? The science again is that kids are compliant with wearing masks. If they are socially distant, if there's effective HVAC and air filtration systems, then the overall risk while not zero. Is certainly low. You have to look at low, medium, and high and place an activity in that stage. Having said that there's [00:48:00] still potential risks for teachers.

[00:48:01] And so we'll have to take that to account. And I think then that's where a school system or a board of education or a town can start making policies that are best for the individual in that location. And again, if you're basing on science, we also have to look at the prevalence of incidents of cases in that area.

[00:48:17] So now it's July, July 21st. Think about what was happening January 21st, no one could have imagined what would happen to Mart. So what's going to happen after labor day. And what labor day would that may look like may be very different than what our situation is now. It's a very fluid situation. Always has been, it's only been six months since his pandemic has hit the United States and our shores.

[00:48:36] And it has been extremely fluid in terms of as a physician, what we're learning and our knowledge base. And then of course, how we react to it. So it has to continue to be so when people also have to realize that if things get out of control and more in September and October, and then you have, you had flu and other respiratory pathogens to the mix, then maybe you'll have to put a pause on the back to school, a movement, then even backtrack and go back to that home.

[00:48:57] So. I know, I just spoke about a whole lot of [00:49:00] things and we can discuss anything you want in more detail, but that's a lot of stuff cutting out two at once. I'll take a break. No, no, it was fantastic. So thanks for giving me all of that information and I do have a number of questions and I'll start off here.

[00:49:13] Let me take you back to something you said, right at the beginning, which is the PTSD and the experience that you had, because I think that that would be something that would be really interesting to. Elaborate on it for a number of reasons. And I'll just raise my hand and point the finger at myself as a starting point that I am part of the group.

[00:49:34] Then all of a sudden, now I've become, I'm a civil rights attorney and infectious disease expert, a constitutional lawyer. We, a political analyst and everything else that's happened in the last five months. Right. Because I've read a few things on social media and I've read a few. Articles. And it's interesting, like when you do that, you almost become dangerous.

[00:49:54] Whether you're educated, they're not educated. People are out there and there's. Able to use the internet and we're able to get a [00:50:00] lot of information. So one thing that I don't think has been really out there per se is just how bad it was. I did not realize that you were at the epicenter whenever you and I were going to do.

[00:50:11] And I reached out. So this was kind of a new learning for me as we're going through this conversation. How bad was it? And you said earlier, even before that, that you hope never to see something like that in your medical career. I imagine you've seen some stuff. Was this a volume thing or was this the horrendous impacts of the disease itself?

[00:50:30] I thought I'll tell you. Yes. Our institution had the dubious, I don't say honor, but it was the situation at hand where it became the epicenter. And I've done a lot of media about this, and one can find that online about the effects on the staff, but. All physicians, obviously, and nurses and other healthcare workers are used to death dying and everything in between and bad news and terrible things.

[00:50:52] But what made this especially horrific is it was like a tsunami. And I will tell you giving any patient information. There was a patient again, who was an [00:51:00] employee who came in. With very nonspecific symptoms. It was a weekend was the first weekend of March. It was actually yes, Saturday evening. And I thought he had eaten bad.

[00:51:09] Sushi has some gastroenteritis. I went to see him on Sunday. I was rounding in the hospital and he was watching something, a sporting event on TV. And he said, doc, do I think I have it? I said, no, but I had read one report somewhere from China's saying that sometimes COVID would usually people think about as cough fever, shortness of breath and pneumonia can sometimes present as the nausea, vomiting, diarrhea, like a gastroenteritis.

[00:51:30] And at first I thought it was from the bad sushi and I realized the sushi was earlier in the week. And that didn't make any sense from a medical point of view. So I said, look, why don't you say one more day and then I'll send you home on Monday. Again, this was back in March when testing was very limited, we had to get approval from the state.

[00:51:44] It had to get, go to Trenton. Then it had to get confirmed at the CDC in Atlanta. So it was a whole production to get testing. And then, and you know, I went to see him Monday. He was doing okay. Then they call me Monday afternoon. And he literally went from doing okay, going home, watching [00:52:00] sporting events Sunday, Monday morning, doing fine to have fallen completely apart.

[00:52:03] And we intubated him Monday evening and he was dead a few days later. And yeah. Yeah. You might say, well, gee doc, you've seen bad things happen before that tsunami acuity, where we went from that to a couple of cases too. I would be stuck in the yard with my colleagues from eight in the morning, eight, nine o'clock.

[00:52:21] And then it's like, here's another 10 patients. And Oh my God, the patients in the waiting room getting intubated. That's where we say we've met, ever seen anything. Like it was, it was like a war time situation. That might sound very dramatic, but that's exactly what it was like. And that's how I, and others have described it to the media.

[00:52:34] He was like, it was like war it's, like a bomb had gone off. In the community because person after person, family member coming in three, four or five, it was like every hourly seven, eight people. And they were so sick or they would be okay, well, let me watch you it's and this is one in the 11 in the morning.

[00:52:49] And then by three in the afternoon, you get a call from a nurse documentations crashing, and by four o'clock they're in the ICU, intubated, our institution had to build a 60 bed ICU. [00:53:00] Above it, we call it a shell ICU because it was a space above ER, which was one going to be designated for something else in the future they built.

[00:53:07] And so this, the engineers and the environmental workers that are, they were able to retrofit rooms and build this entire ICU within six, seven days are just incredible and they deserve all the credit. But if you've ever seen the movie matrix, we used to walk in every day, 60 bodies, every single one ventilator, you know, so I don't mean out of disrespect, but I'm just trying to paint the picture.

[00:53:26] We have 60 by symbol too, and that's why every day you'd walk in. And then you quickly realize that 85% of the people are never going to leave here. And this went on and on and on every day, the beds were filled is because two patients would die in two patients come back up and two patients, three patients with died, three would come up and then every now and then you would get someone who we could save.

[00:53:48] But yeah. For the first few weeks, it was like, no one, there was no one. I mean, I think nationally, the percentage is about 14% of people would come off the ventilator, which is dismal. So in other words, 86% never come off and ultimately succumb to the [00:54:00] illness was that kind of the morbid description is like the matrix, you know?

[00:54:04] And then, so there was that, then there was the fear of that, bringing it home to your family and your kids. So. It's one thing that we all deal with, terrible things at home. And so she said, we didn't know exactly every detail of how this virus was transmitted or wiping down surfaces where we're going crazy.

[00:54:17] I mean, I was bleaching my entire body before I left the hospital, wear scrubs the hospital. And then when I left, I was like, almost like wipe my whole body down. I would change into new scrubs and this was like March and April, still cold. I'll come to my garage. I'll take off all my clothes hanging up in the garage.

[00:54:31] And then I would run upstairs and shower before I even said hello to my family. And I would have dinner with them and Watson TV. But then I would sleep in a different room and I'll use a different shower. And that was pretty much my entire daily habit for all of March, April, and most of may only the end of may is when things slowed down that I finally came back to sleeping in the same bed in my bedroom, my wife, and then even though only in early June is when I started wearing normal street clothes back to work until then it was always scrubs, but that is like a tsunami.

[00:54:56] It just happened so quickly. You would see that, that how quickly patients intubated, [00:55:00] if you ever survived. And also because. Can we did have several hospital employees who died and we had issues where the patient's families were not allowed to come in and see their families. So I would FaceTime. Yeah.

[00:55:12] I'll tell you one of the particularly terrible, because the first three or four patients of mine that expired were all upper thirties and mid forties range. And one gentleman who was about to be intubated, but he had some underlying conditions, diabetes and brother obese. He asked me if I could FaceTime as kids say goodbye.

[00:55:31] And so this is just not something that you, that we're used to. I'm used to having an 80 year old nursing, somebody, not someone who was like six and eight year olds saying, dad, we'll see you in the Hills. Like, don't worry, doubt. We'll be right back. And in my mind, I'm thinking myself, because we already realized that the data was that there's a good chance.

[00:55:45] You're never gonna be back. When several days later he was dead. And it's not just me. It's multiple nurses, multiple other physicians. It would have these conversations yeah. On with FaceTime or is, or what have you. And then I had, there was a patient who was actively dying. She a grandmother, and then the [00:56:00] son asked me, could I Skype with them?

[00:56:01] So the grandkids could say goodbye. And she hadn't be of Indian origin. And so the grant kids were saying in the same language that I speak Dolly mom, which means grandmother, please wake up. And so my mind, I was like, I was almost about to lose it. I was like, my God, this is something, this is the same thing, my kid, my niece and nephew, my mom.

[00:56:15] So that's something that I can not tell you that I've ever experienced. Yup. And so it's the younger patients, it's the patients with kids who are, what's why it's all tragic, but if someone's parent passes and they're fully grown adults, whether their thirties or forties, and I'm not minimizing the grief, but you know, these are people who've had a plenty of time with their parents and we're.

[00:56:34] Who are adults and on their own and self sufficient, but then all of a sudden, the six and eight and nine year olds realizing that gee, this kid is never going to have a dad is going to lose their father. That's you just not use to the 40 year olds dying. And we had an unseparable amount of too many. So that's where the PTSD comes in because it happened so fast.

[00:56:52] First we get to March by the third weekend of March and with Arizona, we had a shell ICU built. We had a tent outside. [00:57:00] The ER, we had multi purposing rooms and by the end of March early April, the entire is COVID-19. That's all we saw for entire April. I never saw anything else besides Kobe and anyone, we thought wasn't was not covert, eventually became cool because we then, because we're realizing, Oh, Kobe can present, like this Colby can present this guy.

[00:57:16] Can't smell and taste. Must be some kind of thing, kind of strange. It's not COVID then we realized, Oh no, it is. And then, then it became described in the literature that this is a way Kobe can present or someone's having a seizure. So this can't be covert or ultimate assessment. There's no way to candidate as Kobe can cause and cephalitis.

[00:57:29] So it's a, we call it systemic disease. So. It's a multitude of factors. It's just, I use the analogy of a tsunami. It just washed in it, you know, and we had the warning. And so you have these warnings, tsunami warnings. We knew in January or February that it was coming, it was in China. We knew it wasn't gonna stay away, but we can never predict it.

[00:57:45] And no matter how much planning you do, when the I'll use the word should hit the fan, when it hit the fan, there, no way any of us could have predicted it would be so intense. And then PTSD. I think that I described as related to that. As well as to [00:58:00] when you see that, and then you hear people saying on various news outlets, it's a hoax, it's a liberal and bench it's election year.

[00:58:06] So it was all designed to bad mouth, the incoming presidents. And you realize that how many people in various parts of the country believe that then that's where you get that personal injury. Like, God, I went through all this and forget me, but I went through all of this person as a physician, as a healthcare worker.

[00:58:21] And in these families, that's the first and foremost went through this. Unbelievable. Just terrible situation. And then you have people saying it's a hoax. I would say I like him again, different idea, but you want to think about, I mean, again, I wasn't alive during Vietnam, but I can only imagine we talked about it.

[00:58:35] The people who went to Vietnam, who just did their duty and came back when were spat upon. So I'm not saying anyone's spat upon his, don't get me wrong. We've got a lot of support as healthcare workers, and we're very thankful. But the fact that people would say it wasn't really that bad. Is it really such a big deal?

[00:58:48] I had people call me, text me. Do you think it's such a big deal? Probably a lot of them were driven by the fact that their portfolio businesses were suffering or what have you, like, no matter how much you described in the media, you're describing the literature, how much you try to [00:59:00] tell them on a personal level?

[00:59:01] A lot of people weren't getting it, you know? And then I think that. I have nurses, very good colleagues of mine, friends who would say his heart for me, you talked to someone who didn't go through that because they just don't get it. It's very hard for me to relate. So I think all of that combined is where that PTSD comes from.

[00:59:16] And it's very, I'm now 46. I think guy, I made it through my 40th so far without any midlife crisis and to buy a Ferrari for me. I wasn't planning on buying one, but yeah. That was the first time in my life that I'll wake up at three in the morning with anxiety and the cold sweat insomnia and not unique to me.

[00:59:32] I think that's a well-described phenomenon. I think a lot of it has to do with the anxiety, the PTSD, the fear of bringing it home and say, okay, even if I am know as a physician, when I was training, I dealt with people would have been Hep C HIV stuck with needles. I've had it been tested, but I also know that's part and parcel of what I signed up for as a physician surgeons to take these risks.

[00:59:51] But would come home and say, geez, I don't want, what if I happen to sneeze once? And it was like an April when you start having some pollen issues. And I sneezed like, Oh [01:00:00] my God, what does that do? I have coal in my sneezing and spraying around in my kid who was sitting on the sofa next to me, these things go through your head.

[01:00:06] So. Like I said, all these things combined, I think kind of led to that mental health issues that is well-described across the country for healthcare workers. And I think it's important to talk about it's important for health care workers and myself included to not be ashamed of it. And if need be discuss it with someone for me.

[01:00:21] Well, it's a little bit of light. It's a little bit of a cliche, but I got a Peloton and I got a golden doodle. So that was kind of my therapy, man. I tell you, I guess first thank you for did because that's. I'd say all of us feel it's our duty and we are glad to do it. And we just needed the support which we did in terms of PPE and adequate supplies.

[01:00:41] But the main moral, I guess, to say moral injury comes when you have people, a significant amount of people, maybe not people who I interact on a day to day basis, but on social media, we talk about means. There's one, that's kind of funny. We'll certify Facebook infections cause he's expert. Right? Because everyone always said no, just January, February one was a political pundit.

[01:00:59] Right. And [01:01:00] then everyone's epidemiologists and effects. So I'm joking obviously to make a little a light here, but that is. Where some of that injury came from and I'm like, man, fine. I'm glad you don't have to dealing with it. But then don't now the directions say it's a hoax, or if it's not a big deal or it's all me or it's, so then you have the anti-vaxxers jumping on them or do you have other various groups for their own agendas?

[01:01:22] You know, so don't get me wrong. As I said, we're very thankful for all the support. Healthcare grows, what God, New York, New Jersey, the clap outs, credible, and we needed it and it would kept us going. We have to just keep. That scientific resolve going forward for whatever decisions or however else this plays out until we get a definitive vaccine, which is again, what we're looking at for eventual cure.

[01:01:43] It's interesting what you went through and. As you're walking through that experience as a father, you know, talking about that other father that passed away, we talk a lot of times on these podcasts, how you have such a higher level of [01:02:00] sensitivity and awareness as a parent, because you can put yourself in the shoes of other parents or kids, rarely you use.

[01:02:07] You mentioned about the kids saying goodbye to their grandparents. It's really easy to picture your kids being in those shoes. I always talked about. My daughter was around the same age when the little Syrian kid had drowned. And I remember seeing him on that beach and to this day, like, it just gives me goosebumps.

[01:02:29] I can, he just looked like such a peaceful sleeping child. And I was like, that could have been, it could have been my daughter. Right. And so when you go through that, you had to experience that and you had to keep, you know, your head on your shoulders and be managing the crisis and moving forward. And then I can't imagine.

[01:02:43] The heartstrings had to be like a machete on them. When you're going back, trying to spend time with your family, what little time you could. And not really being able to do that and being worried that you're putting them at risk. I'm sure your family alone was extremely worried about you. So I can't imagine trying to balance the [01:03:00] professional obligations with the personal, yeah, it wasn't easy.

[01:03:04] I credit my wife because I wasn't told I'd be present, but I can't lie to you in March and April. I was not present because. And I grew up, we work every third weekend. It's just the way it is. We can only get to what our job entails. But let me see, you still have two weekends off and we can work, but during March and April, none of us, because the volume was so much, no one could take a weekend off.

[01:03:22] So we were just working every day, every single day, every Saturday, every Sunday. And then I don't want to say we're all going to just implode. If we don't also, we would have a day off, but even if it's a day off, I would say, okay, great. I'll take a day off. I'll hang out with my kid. I'll do this, I'll do that.

[01:03:33] But the amount of anxiety, and then looking at your phone and be 60 messages when people asking questions, other physicians and other things. So I was not present for you. And we talked about being present in the now. With our kids. I was not. So when things finally slowed down, especially here in the Tristate area, I try to really pay that back by spending more time in the now.

[01:03:52] Yeah. You mentioned about the means, and I know I tried to make fun at first, as far as all the different certifications, I've given myself from all the reading I've done [01:04:00] online, but it's true. Like there's this I joke, but I also think that's dangerous in the sense that there's almost too much information, but not enough knowledge.

[01:04:09] And everything in this world has become so hyper politicized that it's really difficult to know what is the right answer. And so I've even found myself like one day thinking, okay, you were mass next day. You're not wearing mass next day. This thing is really not a threat. Next day I read I'm like my goodness, this is really scary.

[01:04:27] And it just really depends on what news source or what information you read. And if you're really got the understanding of the scientific process, and it's interesting though, that. When I came to the collusion was like, listen, like great thing about the dad Corp podcast is that I can bring a dad on here.

[01:04:44] That is an infectious disease expert. And I can just ask question and I don't need to try to lead you into any type of my political opinion or my own opinions. Like I just want to hear from a dad that has to deal with it as both a parent and a professional. And it's a shame [01:05:00] because. I think there's so much misleading information out there that create seas, these stories.

[01:05:04] And I've got a number of questions for you on this, just because I think as a starting point, that's why I asked you to go through the PTSD. It's safe to say this thing serious. And I think that that's where the starting point needs to be for a lot of people's first step in awareness that this isn't a hoax, this isn't something out there that is a flu virus, like many, including myself at the beginning, thought that they would be, Oh, well you never think it's, anything's going to be bad.

[01:05:29] This was almost like a scifi movie, but now you realize this is a serious thing that people need to. He didn't take seriously. And so when you do that, when you look at now, are we as a medical society and as a country, better prepared to treat it. If it does relapse back, if you send your kids to school, do you feel like we're more equipped of kids catch a COVID or parents catch COVID that we're better at treating it?

[01:05:55] So your survival rate will be. No. Sure. It's a great question. I [01:06:00] guess I do. One is that we get a better understanding of it process. I won't get into all the scientific data, but we have now widely described by our institution and others that there's four distinct phases of COVID-19 in terms of its clinical, how it affects the body.

[01:06:14] And interventions are different depending where you are along that line. Can you, um, so for nonmedical folks, I mean, you may be an, a, B, C, and D. Now that we can recognize where you are along that journey. Anyone has certain specific treatments versus B versus C versus D. So that's one event to have the availability of testing.

[01:06:30] Because it was almost like shooting in the dark in the beginning. This could be cool, but it might not be COVID. It could be COVID-19 to wait a week or 10 days or eight days for the results to come back. And why is that important? Not just for that patient, but also for contact tracing, you know, so we can quickly snuff out the spread.

[01:06:43] We can say, okay, you have it. And by the way, you went out with this other couple, so they should get tested and they should all quarantine for look at the results. And then we do have better treatment modalities. I mean the only treatment, I mean, that's all, they, I mentioned one scientific point of view that is not FDA approved, but it's called emergency use authorization.

[01:06:59] Right? [01:07:00] FDA is from desert. I'm sure a lot of your listeners out there have heard of that. And that's, Gillian's drug that's one step before the FDA full approval. So that is a drug that initially was on a compassionate use, then it expanded access. And now you call E-way emergency use authorization, but early on, we were giving it too late because we were waiting thinking with the patients who were intubated and we realized very early on it doesn't work there.

[01:07:21] That would be like, let's say that would be a C. And I, when I talked about that, well, if you give it in B, it actually has a very good, so I just do that as an example to broadly state that. Yes, yes, absolutely. We have a better understanding of disease. We have a better ability to test disease and we have better therapeutics.

[01:07:35] Full disclosure. I'm a investigator in several ongoing clinical trials for a couple of companies that are very promising and interesting and novel therapies against COVID-19. And these are all need to be at the forefront until we establish with the goal of the goal is herd immunity, herd immunity, either you will have in the population enough people anyway, that can dependent anywhere between six and 30%.

[01:07:55] Enough people infected and recovered. So they're immune or enough people who [01:08:00] are vaccinated and subsequent immune to protect those who are not immune. So you're not having widespread in the community. So until we get to that herd immunity, either by natural, we're more likely by vaccine, we need to have effective treatments.

[01:08:12] And we also know that not just because you have a vaccine does not equal vaccination, right? You can have an influence of vaccine, but not everyone gets the vaccination. So. Or you can imagine with all the political, the vital in regards, once we get a vaccine doesn't mean the uptake of the vaccinations will be.

[01:08:26] A uniform across the board. So we still need therapies for, because there will be plenty of people who will get it and say, I'm not getting the vaccine because obviously Gates foundation is trying to inject in microchip, inside me or whatever conspiracy theory, the Jor maybe going on, and then they may catch it.

[01:08:41] And then a vaccine won't work. So you have to have effective therapeutics. So treatments, interventions. Yeah. It's like we have Tami flu. You can get influenza vaccine with some people don't they get sick and we have Tamiflu and other antivirals for influenza. So we are a much better spot than we were before.

[01:08:54] But by no means, should you mean that? Well, we got this it's over, we're in a much better spot for HIV [01:09:00] treatment than we ever were in the nineties, or even the early two thousands when I trained, but 2005 in Newark, we're infinitely beyond that doesn't mean that you want to get it we're way, way better and treating it and still certainly can't cure it.

[01:09:10] So. Maybe not the best analogy, but you get the idea is that yes, we are much better off, but prevention, ounce of prevention worth a pound of cure that that allowed is still, it still holds true. Yeah, absolutely. Hey Serge, I want to be respectful of your time. Let me just rip out a few of these questions that I've been getting from people.

[01:09:27] What's the views on the antibodies. Do people get antibodies right now or is there an immunity after they've had it? It's a great question. And it's a point of great discussion right now. We've been doing our own longitudinal study with Mayo clinic led institutions of doing the same. And we're realizing that.

[01:09:45] The antibody titers. That is how much antibody has certainly wanes over time may disappear within two to three months. Now, initially you might think the average public Joe public will say, my God, that's terrible, but no, cause it may not be antibodies or what we call B cells. You have T cells and you have B cells as [01:10:00] part of your adaptive immune system.

[01:10:02] You have your innate immune system, which is like the hair in your nose. Mucus things are just kind of nonspecific to kind of block out invaders. Then you have to. Adaptive things that can learn. So you can have like carpet bombing and you could have like, there's a missiles. That's what the adaptive immune system is.

[01:10:17] And any new globulins antibodies represent Baeza. So that may wane over time, but there's also something called T cells. And we're now finding the T cells may actually be the major drivers of protection. Against these viruses. So, perfect. Simple. Why are kids less likely to get infected? Is it because they have less of that receptor that may louder listeners out there may have heard this Nicole East too, was a receptor that the virus uses to kind of latch on into the body and the lungs, especially, or is it because kids have recently more than adults gotten a lot of these.

[01:10:49] Other coronavirus infections, which are after influenza the most common cause of the quote unquote, when people say they have the flu or they have a cold, but it goes away in three days, probably wasn't influenza. It may have been rhinovirus. It may have [01:11:00] been one of the other four Corona viruses. There are T cells once you've been exposed to these versus are sensitized.

[01:11:07] So it's like you have these, these missiles that all of a sudden have been exposed and now they're ready to go. They might not be antibodies, but they're these missiles that once the T cell comes, they can quickly just destroy it. And once the virus, sorry, the ones that virus comes in, the virus is called SARS Colby, too.

[01:11:22] So SAR is covered too. It was a virus. It causes COVID-19 as a differentiation. So just because people lose their beasts and lose their immunoglobulins and lose their antibodies does not necessarily mean that they are now run the risk of being infected again. Now full disclosure. This is a point of great research, but there's a lot of excitement out there that know if you've been here exposed in the past.

[01:11:44] Even if you don't have antibodies, there are T cells may be okay. Actually. What are more responsible for protecting you? For example? When we first got the test from Abbott labs and our own institution to run in house so that we no longer had to send it out to an outside lab, we decided to test it [01:12:00] right, because you want to validate the system.

[01:12:01] We test a lot of the doctors, the critical care doctors, the ID doctors, the ER, doctors, anesthesiologists, all the doctors who were kind of on the front lines. Or willing majority, almost like 99.5% were negative. And we're all saying, my God, how is that possible? We were seeing 40, 50 patients a day. They were under duress, even though we're seeing the PPE, the mass, the goggles, the gloves, the gallons, let's be honest.

[01:12:22] Like sometimes you would have a lapse, you would touch your face. You're sweating, whatever. They affidavit. He would think that at some point, one of us would go affected. Is it because we have T cell immunity? So even though we never got immunoglobulins, we never got antibodies. If we measured, maybe our T cells were protected.

[01:12:36] So again, this is again, an area of hot research right now. It's kind of the cutting edge. So it's true that people's immunoglobulins people's antibodies in the blood was just antibodies, fancy word for antibodies. Are decreasing and may disappear over time. It's also true that people's antibodies will be much lower and people who have very mild disease, as opposed to patients who have more severe disease, but that does not necessarily correlate to a lack of [01:13:00] protection going forward.

[01:13:00] That is what remains to be seen. And is it fair to be concerned around the COVID twice? Is that something that can happen? So again, there's not definitive evidence of that. Is it possible? Yes. The elderly people with waning immune systems, maybe even no suppress for whatever reason. A lot of it's going to depend upon how are their T cells it's somewhat normal and robust.

[01:13:25] Maybe their T cells will stay primed. So they're there for a long period of time. Maybe that T cell prime. So prime me, like they're ready to go there. Then they expose the corn of ours. Okay. Now we're looking around. We're ready to go. Ready to go. Where's the next virus coming in or does that wane over time?

[01:13:40] These are all things that we have to look at going forward. So it's not a slam dunk. Thinking about influenza, you get the flu and then the November and get a different serene in March or get the same or get another infection. And the year after. Right? So infection. Doesn't necessarily correlate to protection going forward.

[01:13:57] But the good news is that the T cell, and this is again, very [01:14:00] cutting edge. The T cells are a very exciting and hot button area of research right now. And it's giving a lot of us in the scientific community, a great deal of optics, because if we look at just antibodies, you might, I say, well, gee look, very few percentage of people in the population have antibodies.

[01:14:16] It might be five, 10, 15, 20%, but nowhere near the 60 to 80% you need for that herd immunity that I alluded to earlier. But if it turns out that no, a lot of people may not have antibodies, but they're actually, their T cells are primed. Well then maybe we're closer to that herd immunity than we're really thought.

[01:14:33] So again, these are themes and theories. I'm throwing out there. They're not definitive proven facts, but these are things that are being looked at as we speak. And at what age does it start to be the same? There's been some discussion out there that ages nine to 18 are just as likely to spread a disease as adults.

[01:14:51] Is that right? Or is there, we had known that these kids can shed the virus and just effectively as adults, we call them super spreaders. And that [01:15:00] ILS, since the nine to 18 years of age, young kids, teenagers, what have you, if we had a lessons, you know, that that can be tricky because they may have no symptoms whatsoever.

[01:15:09] They may be the group of people who will be least likely to hit, to perform hand hygiene. The spread to older parents is spread to grandparents, aunts, uncles, or so that's something we have to keep in mind a hundred percent because a lot of people will think, well, you know what? My kids should go back to school because they're getting sick and they won't get symptomatic anyway.

[01:15:25] But no, we now know that asymptomatic people. So isn't vegan people without symptoms. It can be very efficient transmitters of the virus. Got it. And as far as data and metrics, what would you recommend people pay attention to as they're considering whether to send their kids back to school or not? So one is, I would say this is the first pandemic in the social media era, right?

[01:15:48] So. Like we alluded to earlier a little information, a little knowledge can be a dangerous thing. I would urge people out there to always look at the source of the data because there's no shortage, graphs and charts [01:16:00] and pie graphs that 14 year old or someone made in their basement. I'm just joking. But then it looks very official that has no.

[01:16:06] Definitive reference or anything to back it up. So I would make sure that whatever data they're looking at it as a reputable, medically, or peer reviewed medical society, something from Newman journal, from JAMA, from Lancet, from effects, the side of America, the IDSA. So just make sure we're getting your data from, because even the media has been guilty of have sometimes just dumbing down ideas and data.

[01:16:27] So yeah, far down that they're really no longer valid. But in terms of, you have to look at what is the daily moving average in terms of new cases. And is this now going up in relation to certain interventions, have restaurants opened up and someone says, well, two days later a case they haven't gotten up populations haven't done up.

[01:16:46] That's great. No, but you have to realize that it takes. In general up to two weeks, although five to seven days, that incubation period, and then another week of some getting sick before they give you them sick enough to really require hospitalization. So there's always a delay. So you've restaurants. Nope.

[01:17:00] [01:16:59] I'm in August. And you say, well in August 10th and middle of August, you say, well, my community, there's still not an uptick in cases or hospitalizations. Not a big deal. You know, you have to offer natural history of disease and know there's going to be a delay. And if there is a now in terms of what are the absolutes, that's hard to quantify because there are no difference guidelines.

[01:17:19] They say, okay, if you have this percentage of increase, then you should keep your kid home. If it's this percentage. Staying the same or negative that's okay. And unfortunately the planning that's involved. So in terms of metrics, there's no definitive metric that we can say for sure that you go back or not go back a very individualized decision part of it.

[01:17:38] Yeah. Has to do with, what is your certain living situation? Do you have people who are increased risk living at home, whether it's parents or grandparents or extended family members or yeah. Is your child at risk for whatever reason, you know? So I think. It's not a one size fits all approach. I think that a lot of schools are going to have to end up having multiple options for kids and have perhaps a hybrid of at home and at school.

[01:18:00] [01:18:00] And perhaps have also an option for kids who want to be a hundred percent at home. And I know it's not easy. And I know if that's wrought with a lot of difficulties in terms of logistics, et cetera, but that's the reality because we have to understand these things can change very quickly. And I'll be honest as a physician.

[01:18:13] I do have. Some hesitations and concerns about what will happen in the fall and the winter, because I think we've seen in general, the outdoor activities, risks that if people can avoid the indoor activities, restaurants, bars, et cetera, where we're seeing a lot of States having difficulties, we can somehow get ahead of this again, wearing the masks outdoor activity, et cetera.

[01:18:34] But once you add. Indoor school, indoor activities, perhaps now the summer has gone by and people are a little more laps or a little bit more, not as stringent with their hand hygiene. Yeah. Et cetera. And then you add other respiratory syndrome. So right now we don't know what the interaction of influenza and coronavirus at the same time might be.

[01:18:52] It could maybe be very difficult to. Differentiated too. And someone could easily have both of those and that maybe that's a synergistic. So you're going to have not [01:19:00] just disease, one disease, two, but disease one and disease two may equal disease, six. They may have a synergistic effect where he calls even more.

[01:19:06] Diseasing I can't tell you what that's going to look like. I can tell you that we're trying to prepare for that. We are trying to, and there is some trepidation within all of us of what the fall and the winter will look like, because while they're rushing the vaccine and when they keep saying, I don't think it's gonna be in the fall, I think still think first quarter, 2021, before you have widespread uptake.

[01:19:23] We may see doses offered to healthcare, et cetera, in November, December, that remains to be seen. But I think really, as we're talking, you know, early 21, so. This fall and winter, besides being indoors, besides normal viruses that are circulating every year it's concerning. And then we also know that the visits, like say for kids, pediatricians are down.

[01:19:42] So there's also concerned that less kids than usual, or unless adults usual we'll get the influence of vaccine because they're just not going to the doctor that print it off. They're like, well, yeah, I'll go for telehealth, but I don't want to come in and get a vaccine right now. So these are all kind of moving parts that play together along with those moves the averages and what is [01:20:00] the hospitalization rate in my area, et cetera.

[01:20:02] And the problem is, is that, like I said, schools are sending brochures to teachers and to parents right now preparing for after labor day. For most part of the countries are late and August or September, but what our country and what our local region will look like, then it's very hard to predict. So I think people have to be very vigilant about what's going on and understand the different choices that they may or may not have.

[01:20:22] You know, because we're talking as if everyone has the option to stay at home as parents and they may not, or they may not have the resources. Inner cities are a different situation, you know, there's, I mean, they would allow those issues with like free lunches and be on what percent of. The kids depend upon schools provide lunch.

[01:20:36] I'm assuming that everyone has a high speed internet access, and that's not true. You're assuming that everyone can work from home and kids can stay from home. Cause everyone's got a laptop or a Chromebook, but that's not the case always. So these are all things that are gonna have to be addressed because I will tell you one of my last name.

[01:20:50] Yeah. Thoughts here is that this coronavirus pandemic has certainly revealed the great disparity socioeconomic and otherwise in America and as well as the world, [01:21:00] because it comes down to everyone's experiences and how they went through. This is not the same. Isn't that the truth. And as a father and somebody that has to make that decision as well, what is the deal breaker for you that would not make you comfortable with your kid going to school?

[01:21:16] Yeah, but I'm going to have to look at the final plans that the word education has for our own town school system. So it may be as it's a game time decision. Okay. If the prevalence is how much in the community and incidences new cases, but prevalence is the overall prevalence and incidents. Two words. We use a lot in statistics and epidemiology are where they are.

[01:21:35] We're right now. So as of July 21st, 2020, but the New Jersey Tristate area. New Jersey, New York, Connecticut to rest the area. Then I would have no problem sending him back. But if things are dramatically worsening and every day and of August, every September is more and more, then I would obviously have to think twice.

[01:21:51] And then I need to know what is their capability of testing of isolating kids? How are they going to force it? You know, I mean, you hear stories about sometimes [01:22:00] parents who they have to go to work. So they'll give their kids Tylenol y'all are Motrin before going to work so that when they do next, they're a febrile, I mean, that.

[01:22:07] It sounds kind of funny, but I think a lot of parents that probably have done that at one time or another, so right. Well, junior has a stomach. Don't worry about it. Just don't tell the teacher just disclose that have to go to work. So joking aside, these are all things that I'm going to have to look at.

[01:22:20] So I know it sounds very nonspecific because that's kind of purposely because the medicine you're used to saying, if you have ABC, then do deve, you have EFG to page. This is highly individualized. I think it's a reflection of a, how we're still learning everything about this virus. And then B. How everyone's situations are different.

[01:22:37] I think, I think we should look at the bright side of things. So I think because we have technology, he does give us more options. It's not like, okay, everyone stay home, read a book, or everyone's come to school. We have options of through zoom, through Skype, through Khan Academy, throughout school, and through all these other incredible resources online to this offer it.

[01:22:54] So I think we should look at the bright side and say, at least say that even if I make a plan of a hybrid of, you know, part time at school and [01:23:00] part time at home, at least the technology exists. So. There's no perfect answer. That's gonna make everyone happy. We have to trust science. We have to see, I think I'll leave with the fact that a lot of people will tell me, well, what's it matter if my kid gets it, because, because there isn't back.

[01:23:12] Anyway, this disease has been in the country three for six months. We don't know a longterm ramifications in kids, fishing, kids who are developing. We know that the virus has a special tropism or a special like attraction to the brain. We call CNS central nervous system in a kid whose brains still development.

[01:23:27] How do we know that a year from now? It doesn't cause something a year and a half from now. So I think it's dangerous to just say, well, what if my kid gets it? Who cares? They won't have any symptoms anyway, but I think we were going to have to follow kids going forward for a long period of time to see switching kids who are, or in children who are still developing from a brain point of view and central nervous point of view, to see what the overall longterm cost, the qualities of filling longterm effects of this disease truly are.

[01:23:52] Yeah. Well, I tell you what surge, I wish I could keep it do another eight hours because I have so many questions and you just been [01:24:00] incredible resource of information. Really interesting. I don't want you to be sleeping on the couch because of not quarantine, but because of your first introduction for me.

[01:24:08] So real last question for the dad corporate, that's something that I always find very interesting. We have what we call it. The dad owed. Which we had a really good Reimer and he rhymed what he thought his kids would sing about him at one point later on when they talked about that. But I won't make you rhyme.

[01:24:27] But the serious question is when your son one day is talking about that, what would you want him to say about you as well? I would want him to say that I encouraged him. And, uh, gave him the means. I don't mean monetary. I mean, the means like time, resources, energy for him to be the best man, that to go to the best man that he can be.

[01:24:51] So, again, that means is energy tire muse horses interest, but most importantly time, I think so. I hope that he, one day will realize [01:25:00] that everything I'm doing for him is just to make him a better man. And I don't mean just a high paying job or a great Ivy league education school. I mean, just a kind compassionate, successful of course, but giving philanthropic commands.

[01:25:12] So I'm hoping that he will be able to say that one day. Well, it sounds like he has a heck of a role model look up to so search, thank you so much. I'm honored to talk to you. I can't thank you enough. You took this off of LinkedIn cold message. So that just kind of demonstrates the type of person you are with the schedule that you've had.

[01:25:29] So my admiration to you, and hopefully I can do it some justice to everything you've done for us. It's great. Fantastic. I have a podcast too, that I do with a colleague of mine. And we have our own unique niche of talking of medicine with slightly entertaining approach, but also talking about the social and racial issues within medicine.

[01:25:47] So I think that's our niche, but this is fantastic. Yeah, no, I'm glad you said that. And I wanted to give you however long you need to just say work. Where can people find you? I know you mentioned a New York city, the Fox news show. I've watched a couple of [01:26:00] your videos on there, their ground, but where can people find you and just learn more about you and listen to your podcast?

[01:26:05] Sure. So I do have a podcast recommended daily dose it's you can download it on Spotify, Apple podcasts. We have our own YouTube channel. Now I told my goal with Clayton Coleman, who who's in the  and we like to say, we have a unique spin on medicine. He's African American, I'm Indian American. We tried to incorporate our diverse backgrounds and everything.

[01:26:23] We talk about it. And especially in light of current events, we. Like to say that people might say, well, deal with medicine and why talk about other issues. But we always like to say that racism and medical disparities is a public health issue. So we should be addressing these things. We have to be involved.

[01:26:38] So we try to discuss various medical issues, including disparities in medicine, but from at least a what we'd like to hope it slightly, slightly entertaining advantage points. So again, we have our YouTube channel professionally. I'm on LinkedIn. I'm on Instagram. It's either. I do a lot of media. So during the Kuwait, I was on, I was doing a lot of updates on CNN and I have a right.

[01:26:57] Would've been on Fox five in New York city and where I do [01:27:00] medical updates. And so I try to post updates. There's everyone wants to see it. You can always find it on YouTube or my Instagram page or where I also sometimes put a little pictures of my Goldendoodle as well as my kids. So feel free to check it out.

[01:27:12] Thanks. That's awesome. Well, Hey, let me let you get to your family and thanks so much for coming on the show and we'll talk soon. Yeah. Be in touch. Take care. I'll talk to you soon. Bye bye.