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So why not you try Odoo for [email protected] that's o-o o.com hi everyone, this is Pivot from the Vox Media podcast network. I'm Krish Swisher. And I'm Scott Galloway. All right, let's talk about the big story, COVID 19, which really does touch on everything including tech business, which we cover.
On Friday, Trump gathered CEOs from Walmart, CBS, Target, among others to talk about how they would be working with the government to open up parking lots of supply chains to help mitigate the spread of COVID 19. Walmart, Target, CVS, moreties are going to, I'll give a parking lot space for drive through testing once this gets in place, which is not. Trump did over promise on this because it's not in place yet. Then he announced that Google is developing a national website to triage COVID 19 cases and this turned out not to be true, which was really appalling.
Another Alphabet company, verily was working on a website for the Bay Area specifically in a very early stages of development and was planning to roll out testing the Bay Area with hopes of expanding more broadly over time. Google kind of saved Trump here who overspoke and said there were 1700 engineers working on it, was almost ready and it was not like websites of the past. I'm not sure what he was talking about. But Google did announce by the end of the weekend they would work government and try to roll out this website, it's partnering with this website that the stuff they got up is pretty bare bones and they're, they're putting, you know, they're doing a lot of other stuff Google is.
And a very important site to be doing that because of the search mechanisms there and the capabilities, engineers to really create good systems to get people good information. But Scott, what do you think about this public private approach and what's been happening? Well, the private sector, I think, is filling a void. I think the private sector is coming to the realization that to think that the federal government is going to.
So I think of triggers and that is what triggers a market decline, what triggers panic. And one of the things. So on Friday, everybody says over the weekend that the rate cut triggered this punch in the markets. I would argue with the Friday press release in a series of press releases, when the president comes out, says we're doing a beautiful job, says two or three things that are not accurate.
And then the president starts to congratulate. I'm sorry, the vice president then goes on to congratulate the president for the next 15 minutes. And it feels like other than Dr. Fauci, the B team or the C team, they got a call to the major leagues from their junior varsity team from high school, is asked to come up and speak.
And I think that has created such a pattern of, I don't call it distrust, but a lack of faith in the federal response that the markets are absolutely panicking. And I don't think it was a fed cut. I think it's the fact that the markets have come to the realization the federal government here is a mix of incompetent and disingenuous. And these speeches, you know, as you know, I think I'm a big fan of war history.
If you just listen to the speech, all the press conferences that the president has given over the past week, it's as if it's V day as opposed to D Day. It's not talking about logistics. It's not a sober analysis. It's not getting people ready for the fight.
It's a bunch of congratulations as if they've won the war. Yeah, it's weird. It's like 10 minutes of the beginning of every show. Decisive leadership and good people behind me.
And a bunch of. A bunch of kind of the tests are coming. I think, even quite frankly, I hate to say this, I think Dr. Fauci is losing credibility because he's been talking about a surgeon testing which doesn't seem to show up.
And I think, I do think governors are stepping up to the plate. We're getting drive through testing in Colorado. It sounds like it's happening in Michelle. I do think we have incredible leadership in this country.
Unfortunately, it just hasn't bubbled up to the, to the top. And then the trigger for me, everybody has their own triggers where they kind of just, they ignore it. They put on a good face. The trigger for me, I think that really freaked me out, Kara, was when Google came out and said the statement regarding the website we're supposedly building is just not true.
So I thought, what else, what else are they lying about? Right. But then the person who walked it back, that was weird. I've been trying to get them on the phone on this and I think what they don't want to do, very similar to what Tim Cook did with Trump, is they just let it go and sort of saved his ass in terms of talking about, well, we are going to be working with it.
And you know, people inside Google I talked to were horrified and did not know, you know, it was one of these things where that Jared, that imbecile son in law of his, got on the phone with someone at barely and said, oh, this is a good idea, that he wants to suck it in Trump's notes. And then he made something up that it was like ready to go. And you know, it's not that it's bad idea. It's not that it's something that shouldn't happen.
It's that it's just like with the, with the airports this week, this week, where they announce something and don't even get ready for what happens. Once you announce something, it's like just a lot of announcements and then patting yourself on the back for closing borders and then not doing what it takes to make closing borders organized. There was like petri dishes at all the major airports this weekend. That was horrifying.
Those images. It's literally like, how could we be this stupid? We're not. It's this president who just refuses to prepare.
Like, I've seen this country do things in an organized fashion at other times. So it has to be that everyone is just worried again about his reaction, which I'm like, why does he go off TV for three to six weeks and then we'll probably be okay if he just stops talking for a second. But I mean, and then of course the impact on the economy. But you know, it's.
Most people don't want to talk about this because of these medical issues that we have to focus on first. But again, the market's closing, opening very noisily today again after it went up a little bit after Trump's speech. Yeah, volatility is back. The markets plunged.
I mean, we record this on Monday, so we don't know. But the other thing, the other observation I have is I just can't. It feels as if the level of the mood of the panic is on the same slope of trajectory as the virus. And that is on Wednesday.
So my office is in New York. On Wednesday I came in and said we need to distance just here and that is my entire office is young, so I don't think it's quite. Their health is not as big a risk. I don't say it's not serious.
But a 24 year old has a different level of risk threat than a 74 year old. But we start at this distance. By Thursday we had closed the office by. I'm sorry.
Yeah. By Thursday morning we started to close the office. By Thursday afternoon I had decided to go to Florida and pull my kids and my wife out of my in law's office where we're staying because we're renovating our house because I thought the last thing we need is much asymptomatic carriers going back and forth into a seven year old couple's house. And by, I mean it's just the level of threat, the perception, the panic seems to be a panic or you're.
You're concerned about this. It's just incredible. If I look back 48 hours, if I look back seven days, if I look like 40, 14 days, it feels as if the level of threat level, the perceived, a real threat level is following the same trajectory as the virus and that it is increasing exponentially. It's just, it's just crazy.
You're still in New York. I left New York. How was the mood there? Well, you know, everybody's out in park straight.
There was some Twitter stuff. It's interesting. Twitter is a really good way to get a lot of information. And it's not to say this is as much as there's a lot of video information, there's a lot of great information on Twitter from people and also makes you feel better because it feels like you're in it with a lot of people.
You know, in some weird way I think the movie is better too. I think people are being nice to each other. Yeah, 100%. Except for like the woman who's like, you know, I've gone to a red Robin, I'm coughing on everybody.
That woman who is literally the most despicable human being except for Devin Nunes and then the guy who saves hand sanitizer. But you know, it's like that should be our new esports. Most despicable people on earth. But.
But it's interesting that everybody was out and there was. There was someone who posted people in the park, at Prospect park, and. And, you know, people were. Not the photos.
People were separating from each other. They were all outside. A lot of people. Beautiful day.
And the question is, you go outside at all, like, if you aren't getting near each other, you know, people felt they were making that small risk was okay, but I could tell you the restaurants were full. And now, of course, Mayor de Blasio has put down the. Finally put down the hammer on that. And they will be closed except for takeout.
And I assume he's gonna close gyms and everything else. But. But it was. People were just walking around like life was fine.
I mean, I think everyone was aware of it, and you could hear snatches of conversation, but it was pretty full. And today I actually did leave the house to do this, but. But I. There's fewer people.
There's nobody in the subways. You know, people are being very careful about touching things and keeping a distance from each other, which I think you can't. It's interesting to question whether we go to a complete mandatory quarantine like they have in Italy, or we do something that's a little looser here in this country. I suspect we're gonna get to the latter at some point in the next week or two.
Talked about the impact on business, and you're gonna see a ton of businesses will do the right thing, which is close their stores, especially in retail, send their people home, but they just won't survive it. And. But the thing is, the thing to know is they won't survive it. From a legal standpoint, that entity will go under, but those assets and those people and those concepts will survive.
Even if Carnival Cruises goes out of business, it's not as if the ships are gonna sink to the bottom of the ocean. Those people are gonna have jobs again. It's just that the bondholders will take control of the assets, the equity gets wiped out. And quite frankly, the majority of people own equity there, people who own it through funds.
But the majority of people who own stocks in this country are wealthy. And then the business will re. Emerge. So companies are doing the right thing.
What you're going to have, though, is just about it. You're going to have a lot of bankruptcy across services companies, across retailers. Some can afford this. And you know that this is Darwinian.
It's harsh. But when we get through this, a lot of businesses will come out the other end, the ones that survive when it's a culling of the herd and then the rains return, there's less foliage to compete over and fewer animals. So who is that left? You know, I read about Zoom, Skype, Peloton, those are all going to be doing well because it's, you know, at home kind of stuff each, in each area.
You know, obviously whoever comes up with vaccine is going to be doing well. And then all the pharma companies, the people who make Purell are doing great and they will then not do great once it clears, once the virus clears and there is some mitigation and then a vaccine eventually. But I think we'll see a lot more mitigation before that. Like in terms of just treating it properly as we did with every crisis we figured out way to treat it best and most efficiently.
So what, what's, what what is give me from a, from a crisis management standpoint, what is going to emerge? Okay, right now and then what is, and then we're move on to another story though. This is the only story. Well in terms of markets and companies, I think there's offense and defense, there's companies that are actually the businesses can accelerate as a function of this crisis.
You know, in addition to being in the midst of the largest at home work experiment which benefits Zoom and Teams and slack, we're also in the midst of the large workout from home experience. I can't see how Peloton doesn't benefit from this. But the bigger story will be that anyone, any business that is strong, I mean this, the bottom lines of this virus is, is impacting and killing the weak and vulnerable and it's doing the exact same thing economically. So the retailers that survive this, the Walmarts, the Walmarts of the world, the restoration hardware of the world, Urban Outfitters of the world, the little lemons of the world, the will come out the other end, quite frankly.
We just fewer competitors and the market will come, I believe the market's going to come ripping back. The other thing is I'm thinking about this and I'm thinking about writing about it for my Friday post, but it's a delicate issue is that we talk a lot about economic history when you get to certain levels of income inequality that the self correcting mechanisms are war, revolution and famine. And technically a pandemic is a form of famine. And I think about, I think about this.
Cara and I haven't fully baked this but if you think about the absolute center, the epicenter, the ground zero of income inequality, it's been the Fact that western nations have outsourced their manufacturing to China and as a result incredible prosperity but very little progress because we didn't protect the middle class workers who were left most vulnerable because manufacturing was outsourced. And then we had these carriers come back to these western nations with incredible inequality and spread this virus. And while we talk a lot about how poor the middle class is most vulnerable, what you're going to have economically here is a redistribution of income because the reality is the poor and middle class didn't have a lot to lose. And I do think economy is going to come back and plus going to be full and who does this benefit?
When I'm sitting around the table at my office my net worth is going to go down 30, 50% if it hasn't already. And quite frankly they're going to get to buy an apartment Brooklyn at 30, 40% less. I'm going to get to buy Amazon and Apple at a lot less. And you're going to see a redistribution or equalization again.
And what's also quite interesting and again I don't know if it's just heat or other factors, but the continents that haven't experienced the same level of income inequalitization if you will, while they come from a lower base but they haven't had a surge inequality so far haven't been as affected Latin America and Africa. So I wonder if in a very strange Darwinian way this is some form of recalibration around severe income inequality where we see a crisis that self corrects and while the spoils. I think I would rather just elect to Bern Sanders but that's the, that's the key point here. What happens when you don't protect the middle class?
The rich gain more power than the middle class. They overrun government, they cut taxes, they elect people who cut the CDC pandemic budget by 80% hoping wallpaper the notion that government doesn't matter and then we end up with something like this. I do think that the history and the practice here are going to show that in a very weird Darwinian way this is what happens when a species ignores that is a really interesting point. There's an excellent story in the York Times from Headshake talking about how coronavirus inequality feed off the pandemic.
Is widening social economic divisions also make virus deadly. Are self reinforcing cycle experts consequences for years to come? I think I agree with you. I think it's a really interesting question and we'll see where it goes.
We will obviously be talking about this a Lot more for the next couple of weeks and we appreciate you listening and not just talking about tech, but we will talk a little bit about tech. Another news, Facebook board member Kenneth Chennaul stepped down and state me that I'm stepping down from Ward because I have a once in a lifetime opportunity to work more close with my friend Warren Buffet, the merchant halfway board and the management team. I also believe good corporate government entails limiting the number of board commitments for any director. Yeah, you know, there was all these stories about him being very happy with Marcel park and the way the company was going and how he had no impact on it, which there's been several changes board the last couple years.
Very good board members have left ones that were firmer and more independent like Chenault. Earlier in March, Facebook announced that former McKinsey executive Nancy Kellefer and SDR Company's chief financial officer Tracy Travis would come on the board. And last month through Houston, Houston, the CEO of Dropbox and friend of Mark Zuckerberg joined the board. This is not good.
This is not a good thing that he's boarding. Just feels like he's useless. And just the way we read Hastings left, Erskine Bowles, Susan Desmond Hellman, all the really independent people are gone. It feels like the organization deciding the communications and town of communications that the population of southern hemisphere plus India receive has had, has decided, has brought on their chief legal counsel, the woman who convinced Congress to pass laws that enabled enhanced interrogation techniques.
Veteran of torture and the people who can't survive. There are people of integrity who have real concern about commonwealth, people like Henchenhaud, that's who's leaving, that's who's showing up and thriving at this organization. This is the most dangerous organization in the world. I know Ken, I don't know him well, but he breaches of integrity.
He's a thoughtful, measured guy. For a guy like that to leave the board of Facebook mid cycle or after whatever, he's been on the board for a year, year and a half. Says, I am so out of here. I am so uncomfortable being associated with this.
I am not being listened to. I do not want my grandkids to know I was on this board. This is just more and more evidence that this organization has terrible corporate governance, that we have a sociopath who cannot be, who cannot be elected or has not been elected, that cannot be removed from office that will be around for another 60 years. This is a dangerous organization.
And every piece of data around individuals who you would think, oh good, this is the kind of person we would want on this board. We would want a Susan Desmond Hellman on this board. We would want an Erskine Balls. We would want to read Hastings.
We would want to Kenchenal. Any person you think, oh, ok, they're smart, but they're a little bit unusual, perhaps even dangerous. A Peter Thiel. Or maybe they don't have an objective viewpoint of their buddy or the seal of Dropbox who goes on.
We are now entirely. We have a governance around the most powerful organization in the world of people you would not want on this board. And anyone you would want on this board goes on and bounces out. This is frightening.
They're not going to pick. Yeah, it is. It's interesting because Zuckerberg gave an interview to Ben Smith, the new media reporter. Suddenly he's chatting with him.
He didn't call me. And it was interesting because he said the difference between good. I wasn't thrilled with this poem, honestly. I thought it was a bit of giving Zuckerberg a lot of backpacks for making sure that information on the site was not horrible.
And so the headline of the piece, which. When Facebook is more trustworthy than the president, of course that's a low bar. So it's not like you just don't have to lie egregiously every minute of the day to win that award. And then he said the question to put to Mark Zerberg's executive interview is why did the global health crisis for them to do so, which is.
Which is clean up their platforms. Mr. Nucker said the difference between the good and bad information is clear in medical crisis than in the world. To say politics.
When you're dealing with a pandemic, a lot of stuff we're seeing just cross the threshold. So it's easier to set policies that are a little more black and white, take a much harder line. I think this is so much bullshit. I can't even.
I don't even know what to say. I just like, we can do this. They can do any time they want any day of the week and they choose not to. And so this idea is like, yeah, we'll keep away the shitty information about coronavirus from you or clean up, you know, even if Amazon, they're going to get rid of the guy who, you know, they're going to get rid of price gouges.
Well, thanks a lot. You should have done that in the first place. But just taking battle right here, I don't like that. Well, there's.
I mean, we were talking about. We were talking about tech and business first off, you had referenced Twitter and I think that Corona will be to Twitter where the first Iraq war was to cnn. I think it's a defining moment for Twitter and people. I think you're going to see metrics that are absolutely off the charts.
Full disclosure, I'm not shareholder on Twitter. The other thing is big, big tech is going to roar out of this stronger than ever. Because think about, you think about the media landscape. It used to be a fairly robust landscape and now some talent's definition of robust is that there's a lot of players and if anyone goes out of business, you're fine.
The fast food industry is a robust industry. And then if McDonald's goes out of business, we're all going to be able to burger somewhere else. Whereas the financial services industry, if JP Morgan goes under, it could take the global economy down. Then you argue financial services, it's not robust.
The services industry has been typically in the media industry, typically fairly robust. The local station in Palm beach is cleaning up because Bloomberg was doing ads there. There are a decent number of small niche agencies, state agencies. You're going to see a ton of these little services companies, media agencies and little TV stations go out of business from this because people are just turning off the taps.
And then when the economy comes back and everyone knows they need to buy adwords and keywords and advertise and hire services, there's going to be Apple, Amazon, Facebook. I mean, can you imagine what Amazon's going to come out of this with when more people decide how important home delivery is? And when you think about Apple in terms of communication, how important that is, these companies are. It's a buying opportunity, quite frankly.
Yeah, okay, I'm not gonna do that because I really didn't like, like that. But then this is the last part of this when I talked to Mr. Sackart, another social media. Because last week I kept returning to the same point.
One look, responsible information last beyond the crisis could extend into our upcoming presidential campaign. I Hope so. Twitter's Mr. Dorsey wrote up to all of us, which is a decent response to Chicago.
Less sanguine. Right now, Facebook is tackling misinformation as imminent risk of danger. Telling people they have certain symptoms, don't bother getting treated. Things like, you can cure this by Kingly Jamie.
That's a different class. It's just, it's a positive sign. Despite how polarized people are worried about society as people can pull together and try to get things done as boards other than recognized people here on the front lines, given the pandemic Memphis Legal, while on royally said, it's hard to break down the Howple Police up again. That's really not my job anyway.
Ah. Ah. I literally, I just like. Because you do a good job here.
You don't get backpacks. I'm sorry? You don't get backpacks. Yeah.
I know people think I'm relentlessly negative to Facebook, but honestly, this is the lowest bar to get of people that threatens people's lives. And by the way, it extends all the way into politics. It extends into every single life. It shouldn't be just in difficult times that they can behave at.
Sorry. Well, and the PR machine is going strong. There's been. There's been.
There's been food bank announcements, and they're just very. I think Mark is doing something, and they're just very quick to sort of put their name on stuff. And it's just, you know, just keep it to yourself for the time being. Your philanthropy and, you know, in your efforts, I think they're important.
I don't think I should be criticized for them, but just don't. Thanks for the mask, Jack. Ma. Just keep it to yourself.
Right now, I would say this is the time you want to do it. And unfortunately, it comes from the top, where they want to constantly assign credit before it's even due. You know, I think it's in a situation like this, it's just. This isn't a time they should be thinking about, I don't know, manicuring their image, if you will, and you feel sorry.
I mean, to a certain extent, some of them are doing their best and trying to figure out. I remember looking at. Watching the speech on where was the Rose Garden? I remember, oh, my God, I woke up in a better world, and Doug McMillan was speaking at the podium in front of Trump.
And like Trump has said, look, I'm overwhelmed. Doug McMillan's only president, and I thought, I know. He's a great guy, actually, a terrific guy. Very.
Talk about someone who doesn't. Right? I mean, he was there. All the SEOs had to show up, and I get that, and they should have.
But dougmillan is really quite a terrific leader, I think, and always seems to always do the right thing. All right, Scott, time for a quick break. We'll be right back with a special friend of Pivot and Wins. Only Wins recommendations can be amazing.
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That's why over thousands of businesses have made the switch. So why not you try Odoo for [email protected] that's o d o o dot com. Okay, Scott, we're back and I want to introduce you to a very close friend of pivot, my brother, Dr. Jeffrey Swisher.
He's a doctor in San Francisco and currently getting prepared for the weeks to come in hospitals there. First, before we get to some questions about US comparisons, I want to play an extra friend of Pivot. It comes from our producer Rebecca's friend, an expat living in Milan, where the country is now under complete mandatory quarantine. Projections show that the spread of COVID 19 in the US is following a similar trajectory as Italy.
And we are thought to be about 10 days behind Italy in terms of the virus spread. My name is Leah. I live in Milan, Italy. We are now on day seven of the full quarantine.
We are allowed to have one person go out per day to go pick up only essential supplies. So we are legally oblig when we go out to keep a distance of 1 meter between ourselves and whoever we're around. It's actually marked on the ground by a piece of tape. So all stores, all bars, all restaurants, theaters, cinemas, gyms, parks, everything is closed.
This disease is a lot more serious than I think anyone ever thought that it was going to be. There are so many young people here, really, really young people who are in hospital, in really serious condition. And we are getting to the point where doctors are having to choose. Actually, it's already in effect now.
Doctors are having to choose who they're able to intubate and who they have to let go. Okay, Jeff, welcome to Pivot. Sorry to put that bummer on. I was going to say that they'll splash a cold water.
Yeah, well, I want. So I want you to start talking. Scott and I have a lot of questions for you. I'll start.
So talk about sort of the landscape right now. San Francisco, San Francisco and Seattle have been sort of the first areas of seeing a lot of activity with coronavirus. Obviously spread across the country into 38 states at this point, I think. So why don't you give us sort of a general landscape there in the hospital scene?
Sure. Sounds good. I mean. Well, first of all, I just want to just disclaimer.
I'm not a virologist. I'm not an epidemiologist. I'm literally a ground level anesthesiologist, and I'm chairman of a very large anesthesiology department here in San Francisco. So we are literally the frontline troops that will be seeing these patients as they come into the hospital.
Again, most anesthesiologists work in the operating room, but many of us work in intensive care units as well. And my suspicion is that we're going to be requisitioned. Not my suspicion. I know we will be requisitioned to probably repurpose ourselves to function more as intensive care unit doctors.
So what's happening in San Francisco? I kind of liken this too. Remember that video of Fukushima when the tsunami happened? And the very first couple seconds of the video shows the water slightly receding and then slowly coming in, and then you kind of go, wow, that's interesting.
And then you gotta go, whoa. And after about three minutes, you go, holy shit. Because you have buildings and everything is getting swept away and cars and boats and everything. I think we're at the point where the water is just starting to come in here in San Francisco, and it's getting, you know, it's very scary.
My partners are all very concerned about what's gonna be coming in the next one to two weeks. So what do you think that is? What is the. What is it?
What is it? You have projections, right. Guys are getting ready. You're creating tents outside of hospitals, Is that correct?
Right, right. My understanding is that UCSF has some tents outside. We don't have tents, but we certainly restricted access to our hospital tremendously to the public, even, you know, let's say today's the last day that we're doing, quote, unquote, elective surgeries starting tomorrow. We're only doing emergency surgeries and that's an amazing amount of surgeries that we're just not doing starting tomorrow.
Today, for instance, I'm going to be doing some total knee replacement surgeries. That's it. You know, you're not gonna get total knee replacement in the city probably for the next month, I'm guessing at least. But so, yeah, we're preparing, and we're obviously preparing our intensive care units for what we expect is going to be a large influx of patients.
And what does that look like? What is that? What is the. What is that?
Generally you have no numbers though, right? You have no idea except for what's happened in Italy or in China or anywhere else. Correct. I think, you know, I've been looking very carefully at the numbers.
In Italy, just this weekend alone, there was on, I think on Sunday an additional 386 cases. I mean, it was a real mortality of death. There was a big spike and I anticipate that spike, that number to double pretty much every two days. And so we're tracking the, I'm tracking the numbers in Italy, as are a lot of people in medicine and trying to project.
And actually we're slightly ahead of the curve here in terms of Italy. So, you know, if you project forward about, you know, 10 to like, like that, you're a person, you recorded anywhere from 10 to two weeks. That's where we're going to be in a couple weeks, but more, because we have more people in this country. Doctor, a question.
First off, thanks so much for joining us. So if you think of total capacity of beds as being 100, where are we now? And where, where do you think the infrastructure is gonna be in San Francisco area in a week, two weeks? What can it pulse up to?
Can we increase capacity by 10%, 50%? And where are we now as a percentage of capacity? That's a good question. I mean, the thing about intensive care units, listen, we're full.
I mean, before this whole thing started, we have to shuffle beds. We even use sometimes the post anesthesia care unit after surgery to house patients going into intensive care units because of the fact that we don't, you know, just have a bunch of ICU beds lying around. There are full. People are still coming in with strokes, they're coming in with heart attacks.
I do a lot of liver transplant, anesthesia, kidney transplant. That doesn't stop. So we have a full house already. The question is, how do we repurpose beds in the hospital or how do we repurpose ICU beds?
So we have operating rooms, for instance, and you know, my wife didn't know this, for instance, which is kind of amazing since she's been married to me for 30 years. The anesthesia machine in an operating room is also a validator. So we can use operating rooms as intensive care units, to use them as validator units. That's the real issue is the number of ventilators that we have to take care of.
People with sars, which is, you know, a percentage of people with coronavirus get sars. And what does that take? Explain very quickly what you have to put them on the ventilators and then you have to pick who gets to go on these ventilators, Correct? Yeah, that's the whole concept of triage.
I mean, triage came from the word three and that one person lives, one person you treat, one person dies. And that is a very tough decision. I mean, in Italy I've heard situations where they're deciding whether or not a 45 year old with two kids is worth more than a 45 year old with three kids on the ventilator and some doctor has to make that decision. That is a terrible decision to have to make.
And I don't want to be alarmist, but the fact of the matter is we are going to be making decisions like that about who should be put on a ventilator, who shouldn't, and people must be on these ventilators. Correct. Once they get. If you get sars.
Yeah. I mean the coronavirus causes in severe cases, SARS stands for severe acute respiratory syndrome and that is interstitial pneumonitis in which the lungs basically become inflamed and stiff and, and you're unable to oxygenate adequately at normal pressure. So you have to intubate them, which is putting a breathing tube down to trachea and then positive pressure ventilation with what's known as peak, which is positive and expiratory pressure of, you know, 15 or 20 millimeters of mercury in order just to get the blood to oxygenate for them to be able to live. And there's all kinds of mechanisms by which you ventilate them.
You sometimes have to turn them over onto their stomach into a prone position, then onto their back. It's a very labor intensive thing. And remember, all these healthcare workers that are taking care of these patients are constantly being exposed when you intubate. Someone somebody asked me on Twitter, some troll said, you know, why does Nancy's all this care about this kind of thing?
I'm like, duh, we have you Know, we intubate people. So we are literally a foot from the face putting breathing tube down their throat in most of our operations. Well, I was, I was gonna ask what. I mean, if you think of this as a sort of a war footing, and what I've been seeing a lot is the contrast between the federal government's response in terms of its perceived confidence or actual competence and what they communicate and then how state and local officials are dealing with it.
I'm curious as how often are you guys meeting as a group and what is the role the federal government is playing in this? Are they sending additional supplies? Is someone in your organization been organized to communicate with federal government to request additional supplies, or the attitude, pretty much, we're on our own here. What's the relationship between people on the ground such as yourself?
Well, so our hospital certainly has command structure. You know, we're very fortunate that the chief executive officer of cpmc, California Pacific Medical Centers is a physician named Warren Browner, who is an epidemiologist himself, originally from ucsf. And he is, along with the other hospital administration, is obviously communicating with both state, local and federal officials about supplies. You know, you hit the nail on the head in terms of what the big problem is, is supplies.
I mean, we need to use things called PPEs, which are personal protective equipment, in order to prevent ourselves from getting this. That is an incredible shortage right now because of the fact that, first off, there wasn't that much to start with for this kind of thing we had for Ebola. But, you know, there's very complex procedures for putting this stuff on, taking it off. And as I tweeted like a week or 10 days ago about a mask shortage.
We have literally masks that are leaving the hospital by hooker, by crook. People are taking them. And so now we have a shortage of just regular masks and N95 masks. And remember, a lot of this stuff came from China, which was completely.
Is now shut off. So, you know, we are looking to the federal government to help resupply us with this critical equipment. And that has. You know, I'm not even going to get into the whole testing thing.
I mean, obviously we don't know the denominator because we haven't tested enough people. Is that critical people somewhere? We're talking about that. It's already here.
And you should assume everybody has it or is going to get it. Well, that's true. That's true. I mean, you know, one of the biggest concerns that I think I have in members of my group had is the whole concept of Asymptomatic transmission.
And that kind of goes into some of the issue about, you know, the studies from Korea showing that the highest group of people who are asymptomatically transmitting as youths from the age 20 to 29 who are all getting together in Fort Lauderdale and partying up like there's no tomorrow and, you know, slobbering over each other and, you know, sweatily dancing on the dance floor, and they're all like, you know, getting coronavirus, and they are bringing that to, you know, their parents, their grandparents, etc. It reminds me of that scene from that movie Independence Day where they're all dancing on the roof of the skyscraper and the aliens. Remember that scene? The aliens just kind of go up, bye, bye, Felicia, and they just blast every fucking away.
Sorry, sorry, sorry. Okay. This is my brother, Scott. So is there still time to flatten the curve?
We can have a little joke in the middle of a pandemic, it's fine. Is there time to flatten the curve? What should people do? The cities in New York City where I am is now shutting down restaurants, offices have been already closed.
A lot of places, they're gonna, you know, every big city is closing down everything. I just was watching Muriel Bowser from D.C. where I'm headed to getting a fight with the Hill restaurant group who refuses to shut down. But what can.
What. What can people do? And we gotta go, get out soon. But what can we do?
One, to mitigate the overwhelming healthcare system. Two, to protect healthcare workers in the weeks to come and just yourselves. What is the critical thing to do? Because as many people do know, not everyone's gonna need a vendor.
Not everyone's. They're just gonna get a very bad version of this. And it's just to get away from people. What is the three or four things people have to do?
Okay, so just consider the fact that it's kind of like, you know, zombies. You know, one zombie bites another zombie, and then you create tons of zombies. Stay away from each other. Social distancing really does work, you know, so to avoid the zombie apocalypse, I mean, we got.
That's what you got from Stanford med school. Go ahead. Okay. It's a very good analogy, by the way, but the.
Yeah, definitely do not. It's not business as usual. People do really need to take this seriously and consider the fact that if you're asymptomatic and transmitting to other people, every person that you contact with then, you know, gives it to someone else. And you're right.
The numbers are such that it's gonna be a huge number that get it. And eventually we will all develop herd immunity. But in the meanwhile, who knows what the percentage of mortality is to this thing? Is it 0.9%?
Is it 1%? Is it 5%? Italy is tracking right now at about 7% from the data that just came out this weekend. And that, you know, we still know the number because we don't know the denominator.
And I think that that's the most important thing. And especially, you know, the message to kids out there. You know, the. The youth who are all home from college, partying guys stay away from each other.
Just try to sit, you know, Netflix and chill, you know, just. Just. Or maybe just Netflix. Just try to, you know, make sure that you do not give it to people that you love, because that's what this is going to come down to.
I think Gavin Newsom gave a great talk the other day. You might both know Gavin. He really. He really demonstrated what I would call leadership skills.
And how he talked about this and the tone that he put out, I'm going to contrast to Devin Nunes. I don't even sue Devin, so don't sue me. You know, but that was a moronic thing to have to come out and say, you know, that, oh, we shall go out and go to bars and restaurants. I feel for all these small business owners and restaurant owners, but at the same time, you know, we need to take care of our health first.
Oh, we're not going to eat. Scott, any other questions for Dr. Swisher? No, other than just.
We're thinking about you. And I think the leadership style and the communication style you represent here, where you're very sober and you provide data, but you're obviously on it. And to hear the competent, intelligent people, our front lines, makes people feel feel better. I think you demonstrate exactly the types of communication style, leadership style which you have during crisis.
And I wish that a lot of people in D.C. took notes. Jeff, what is giving you hope right now? Give us.
Leave us with one bit of hope. Okay, I'll give you a bit of hope. The fact is that I give a shout out to every single person that is here. I'm in the hospital here today.
We're just about to start our workday. Every single nurse, every single intensive carrying a doctor, every single ER doctor, frontline nurse, housekeeping, everybody. You know, we have a purpose here. And one of the joys of being a doctor and being in medicine is the fact that, you know, we are here for other people.
And I just Want to let everybody know that the nurses, the everybody. The respiratory therapists, the techs who come in the operating room, these people are all putting themselves in harm's way, but they're doing it because they know it's the right thing to do and that we love to do what we do. So I think my hope is that we have a lot of people like that, not just in the healthcare system, but in other places as well, and we'll get through this. It's just gonna be a bumpy ride for probably next month or so.
You know, I'm hoping less, and, you know, I'm hopeful that we'll get through this as best we can. Jeff, you're the best brother and the best doctor. Thank you so much for doing that. I really appreciate it.
Jeff Swisher, any questions that you want to ask me, I'm on Twitter. Effrey Swisher and Karen can post a link to me if people want to ask questions. 100%. He loves Twitter.
He loves the Twitter. All right, Jeff, thanks a lot. Get to work now. And be careful, please.
Be careful, sir. All right, take care, everybody. Bye. Okay, Scott, that was really depressing.
And also good at saying kind of. Robert, wasn't he good, bro? Yeah. You're just an insufferable group of overachievers.
What happened to the family? Is the third guy? Is the other brother an astronaut? I hope he's a method.
He's a good guy. He's a lawyer. He's a little conservative for Jeffrey. Oh, he's a lawyer.
He's only got one graduate degree. Okay. Yeah, yeah, yeah, he's a lawyer. My mom's sitting down in Florida right now, you know, spewing Fox News.
But she's trying her hardest. I love my mom. Lucky did something right. My gosh, the three of you?
Yeah, she did. She did. And my dad, who died a long time ago, certainly did a big part in it. Anyway, let's talk about wins, because people need wins.
We want to, as they say, look out for the helpers. And so I would like some wins from you. I have one or two. Will you.
The first one. Go ahead. Well, I gotta say, I like the episode of Grumpy Old Men last night on the Democratic debate. I thought it was a substantive.
They got a little bit grumpy at the end, like a little screaming at each other. But I thought it was a substantive debate among smart people. I thought Sleepy Joe was quite awake, and he looked. He got better and better throughout the night.
And I think the win Was he talked about having a woman vice president. He's gonna have one and not anybody else, so all the dudes can step down. And that he was gonna appoint an African American person to the Supreme Court if he became president. I like that.
I thought it was forward. I thought he looked good. I thought Bernie did a great job, too. I don't agree with everything.
I thought he was great. That was a great stuff. It was such a contrast in leadership style to, you know, Trump just reassociating things that I don't even know what he's saying sometimes. Like, we have under control the virus.
It's big, you know, this chaotic talk. So I like that. That was a win. And I felt good.
And hopefully Biden will be the president. That will be great. I will be very happy about that. Secondly, I think The Germans doing 99 Luftwin's, it just makes you feel better.
You laugh a little more. There's been a lot of meanness back and forth, but a lot of it's super funny and super enjoyable and a way to, like, feel like everybody's sort of trading really good information. When that works, it works great. And so I have to.
I'm gonna be writing my poem about that this week in the Times, because when it works well, it works well. And so I'm very pleased with that. And I know there's disinformation on there, and they should be doing everything to get off of it, but in general, I'm seeing a lot of great information. Yeah, I agree.
The thing that I noticed about the debate last night, and I was trying to think, why is this more substantive and civil? And a lot of it is the cadence and the format of it. And that is when you think about having 12 people on the debate stage and they're not known that well, they immediately go, I have to be outrageous. I have to be short.
I can't be substantive. I have to be aggressive. I have to pick a fight because I have to get my message heard. And if you were to take that times a billion, that describes social media, because social media says, all right, the algorithm go.
How do you get noticed? How do we create more clicks? Well, we find conflict, and we find fast thinking and quick, quick, angry pieces of information. And so if you think about the worst debate, where you think, wow, I just really feel bad about our country after listening to that kind of hostile food fight, that is what social media times a billion words, when we put two people on stage and moderate, well, they're decent people.
You have a thoughtful Conversation just learn a lot. It just struck me that we're in the midst of the worst ongoing debate. Anyways, my win. I actually think the media, I think I've been watching media nonstop and well, not only talking about, we're talking a lot about the frontline health care workers such as your brother taking risks.
And you know, they grow up that way though. They're the people and I don't mean to anyway diminish their contribution, but they're the kind of people that grow up just more caring, empathetic about other people. Just they're sort of wired that way, like do no harm. They're the people when you're nine years old, are taking your heartbeat and they're just sort of built that way.
When your brother said, didn't surprise me that they just sort of just immediately hear about this, put on their scraps and head to their head to their place of work. That's what they do. It is, it's amazing. You know, my brother had an opportunity to work at Microsoft in the very early days.
All his friends, he goes to Stanford undergrad also and he had an opportunity to go into tech right when he should have. You know what I mean? It would have been like very financially good. And he became a doctor like my dad was.
And I, you know, I think a little bit of regrets, not only an island right now to escape to, but, but he definitely, they definitely have that kind of, they love doing what they do and it's really, it's a, it's real work. Right? I mean it's, it's meaningful work. But what I was gonna say is I actually think the media.
I was thinking about when going into work every day in a crowded studio, you are taking some risks. And I've been watching a lot of CNN and I think, I think they're doing a fantastic job. I watched Reed Zakari yesterday. I just thought he had so many.
That guy is such a blue flame thinker that Trump has copied the wrong Korea. He's going after the incompetence, propaganda and fear mongering of North Korea and he forgot to do the intelligence and the execution of South Korea. I just think these guys are so, so smart, so good, clearly focused. I'm not sure I could do that.
Focus. These guys have families too. Every time they go to, every time these men and women go to work, they've got to be thinking about the risk they're taking and are they taking it home to their families. Meanwhile, most of us have decided people with any resources for the Most part are self quarantining.
That's what I would recommend that people do. Yeah, it's absolutely true. And you know, even Fox News is sort of. They're reaping the shit that they rained down on people most of the time.
In terms of that Trish Reagan was thrown off the air, I guess, and Hannity's getting drubbed. Is that right? I haven't been reading about that. I haven't.
Yeah. And you know, odd. Oddly enough, Tucker Carlson is the one who's actually. I think Tucker's done a great job doing the right thing and giving him good information.
So hopefully that. Oh, my other win. My other win, not Rupert Murdoch really is Satan. There's the Mitt, there's the Murdoch Satan on our switcher.
That I know. That's right. That's right, Uncle Sid. The other win is there's a wonderful hbo and people imagine people have a lot of time to watch.
I'm very good at tv. I'm very good at TV here. I want to core comics. Anyways, a win is if you have some time at home and you're spending more time on watching some video platforms.
The Outsiders is fantastic. Or the Outsider. Excuse me? It's a horror film.
It's based on Stephen King novel. I think it's gonna. I think there's some artists there. I don't say underappreciated because they're unbelievable.
In 100 years, I think he's a huge challenge. In 100 years we're gonna look back on them and think, you know, we're thinking, okay, I think Prince and you know, Elvis or whoever you want to think, or even Barbra Streisand. He's just the best Stephen King. His ability to combine relationships with horror is unmatched.
Anyways, the Outsider, it's a guilty pleasure. That's a good thing. I'm gonna do a terrible thing and I'm gonna. I know we had wins here.
I just want you to know, I want you to react to it very quickly before we end. Plunges 2250 points. 9.7% is more. The US economy shut down because the coronavirus trading temporarily halted.
Circuits are breaking. And by the way, people asking why are there closed markets? You need to let the markets do their thing. Otherwise the panic builds up when they open it just.
They may never reopen again. This despite the Fed dropping rates. And also just to point about a point of perspective, even with this drop, and I can't pull up the chart, the markets have plunged to where they were last year. It's not, we're not.
This isn't 19. This is so far from 19, 20, 29 today. Scott. Yeah, well, like how about this?
Don't look at the markets, people, if you don't have to. Don't look at the markets if you don't need the money. And hopefully we will get a more competent federal government that will be able to deal with this one and clean up when it's over. My hope as the new administration has many hopes, but you know, whatever it is, it really does, as Warren Buffett said, speaking of channel Grayson, when the tie goes out, you see what people really were wearing.
People ask you, I get a bunch emails saying, what are you doing in the markets? And I said, well, this is what I think you could do. And this is to be aggressive, super aggressive and kind of crazy if you want to take real risk. But the answer is, what am I doing?
I'm doing absolutely nothing. The last thing I want to do is add the stress of trading into this right now. I'm doing nothing. My stock person says that this might be time.