An ICU Nurse on What COVID Actually Looks Like in the Hospital and Why Gloves Don't Work

Vance Crowe [00:00:01] As the crow flies on the Vance Crow podcast. Steve Ernst, welcome to the podcast.

Steve Ernst [00:00:09] What's going on? How you do Vance.

Vance Crowe [00:00:11] So Steve, you are one of my Brazilian juujitsu instructors, but you also happen to be an ICU nurse here in St. Louis. And since I'm doing this coronavirus series, which is taking in as many different perspectives as I possibly can from people that are impacted by this virus, whether it's their industry or actually on the front lines like you are. So I'm glad you're here. You work at a hospital in St. Louis, what are you seeing right now?

Steve Ernst [00:00:40] So I'm seeing a lot. I'm seeing a lot in terms of big moves within the healthcare industry. I'm seeing people, obviously I'm seeing the hysteria on all sides. I'm seeing, I'm seeing the hospital fill up with cases of coronavirus. I'm seeing units at the individual level being converted over to handle this current pandemic that's going on. I'm seeing a fair lot, a fair amount of things. I'm seeing the hospital, the management, WashU School of Medicine, which is the physician side of Barnes, but is technically a different entity, responding in their own way. And I'm trying to see people get information out there on what you can do to be more sensible, what not, and then how we're best gonna manage COVID-19, which is really what the problem is.

Vance Crowe [00:01:38] So when you see a person with COVID-19, what do they look like? How, how, how do they appear? What, what are you seeing when they're in the ICU?

Steve Ernst [00:01:48] Well, I haven't had to take care of one yet, so, but usually the issue here with every other virus is you're gonna see it impact your respiratory system, your ability to breathe, your most important parts of your body. Your vital signs are going to compensate. If you're bleeding, what's gonna happen? Your heart rate's going to increase to try to get perfusion to the rest of your body to deal with the fact that you're losing blood until the, the compensatory mechanisms are no longer effective. You're gonna see shortness of breath, increased workload of breathing. Usually one of the first signs that you're gonna see too, is especially when people are getting really bad, and these are all generalizations, they kind of work amongst many diseases. You're gonna see a mental status change as redundant as it is at the bedside. I will come in probably every hour, every two hours, and I'll ask you, what's your name? Where are you at? Why are you here? You know, and you know, what's the month in the year, you know, person, place, time, situation. One of the first signs and symptoms that you're getting from sick to sicker across the board and anything is you're not gonna know who you are the month in the year, where you're at or why you're there. Person, place, time, situation.

Vance Crowe [00:03:17] And you've seen that before with people?

Steve Ernst [00:03:19] I see it all the time. I see it daily sometimes. And then the hard part is sorting out why it is, is it somebody who's always like that because they have dementia? Or is it just because somebody, it's very transient, you know, it's delirium to where they've taken some drugs and they're just confused. Or is it something that's illness related, like COVID, like usually they're gonna come in, they're gonna have coughing. Usually that's kind of how the virus proliferates itself is, it causes a lot of respiratory diseases in general. They cause swelling. They cause increase in mucus production. They cause an increase in hacking things like that, to get you to shed more of the virus. Now I'm personifying the virus as though it was a person. But the way the virus tends to work is it tries to shed itself. And in that way, that's how it propagates and diffuses across any type of a population.

Vance Crowe [00:04:24] So as you were watching Coronavirus come from a long way off, at what point did you start saying like, Hey, this is pretty serious, and you know, like, what is your analysis of how prepared St. Louis is, for example?

Steve Ernst [00:04:40] Well, you can never really be prepared. Like that's the, that's the problem with something that's new. Like unfortunately in so many aspects of life, we have to be reactive. And unfortunately we have to be exposed to it to then be able to know what we can do to come up with a defense. The only good part about it is that we've had multiple exposures to different respiratory diseases. I believe SARS was actually a variant, I could be wrong, someone can fact check me on this later. SARS was a variant of the coronavirus. And then, you know, COVID or Coronaviruses that we're calling it is COVID, coronavirus infectious disease COVID year that it was discovered 2019. So that's how they're naming it. But there's other strains of the coronavirus. Some of them obviously are more infectious than others. And we've had, obviously other respiratory diseases that we've been exposed to. But there's something in virology called antigenic drift. And that means that the virus changes enough so that your, your immune system no longer recognizes it and the virus. And that's why we never had a vaccine for the common cold.

Steve Ernst [00:06:11] The common cold mutates at such a fast rate that you can't come up with a, an effective vaccination for it. It just keeps changing and changing and changing. It's unfortunately, it's one of those things that we're gonna have to be reactive to it. You know, we can only be as prepared as we were prepared. I know that's a very shallow cliche, but it, we have what we have in place, but it, it is just gonna have to get out there.

Vance Crowe [00:06:42] And are you anticipating that Coronavirus will have the spike in St. Louis that we saw in a place like New York?

Steve Ernst [00:06:50] It could. Obviously that depends on people. People are what spread the virus and what keep it contained. And unfortunately people don't make intelligent decisions. You know, one of the things I saw before I actually started this podcast with you, I went to the gas station and I saw people wearing gloves. Okay, you know, fair enough, you wanna wear gloves, you don't wanna contract the coronavirus, you don't want to spread it to yourself. And then I saw two people actually wearing gloves at that QuickTrip right across the street from the Juujitsu school on Telegraph. And then what did they, and I saw another man inside the QuickTrip getting everything he wanted out of the store, getting in there and leaving. And what did all three people do with these gloves? Well, two of them went and pumped gas, touched the gloves to the pump, pumped the gas, touched the buttons on the gas pump, hung the gas pump up, went over with the gloves still on, touched the doorknob on side on the side of the door, opened the door, got in, touched the gear shift, reached in their pocket, touched their keys, took the keys, put it inside the ignition, turned the ignition closed. The door drove off while holding the steering wheel. And so the old adage was, they used to use this for sex.

Steve Ernst [00:08:22] Every person that you've had sex with, you've had sex with every person that you've, that they've had sex with and so forth. Well, everything that you touched was on those gloves. Everything on those gloves is now on your door. It's on your steering wheel, it's on your gear shift. It's on your keys now. It's on the inside of your door where you closed your door. It's in your pockets because you touched your gloves inside your pocket to pull out your keys. I mean, the gloves are only as effective as, you know, the

Vance Crowe [00:08:47] Person wearing them. You take,

Steve Ernst [00:08:48] Yeah, you take the gloves off and you throw 'em away. That's why they're disposable. Or you sanitize your hands. One of the best things, and this is my college microbiology teacher kind of speaking through my voice, is good hand washing. You know, the is the power of water to mechanically strip things off of your body and clean things by forming hydrogen bonds.

Vance Crowe [00:09:12] So say more about that. That's interesting. I mean, the, I have to say that I didn't really know how to wash my hands. I, I had been a Peace Corps volunteer in Africa teaching public health, but I didn't really know until I saw a guy on TV do it his own way. How do you wash your hands as a medical professional?

Steve Ernst [00:09:28] The same as everyone else. But you know, I sit there, I pump the tube and then get the soap on my hands and I spread it all around. And you're supposed to go in between each individual digit. The good rule for that was, I believe ABCs. And then by the time you got like the tea or something, your hands were clean, then you take your hands. And this is how you would do an antiseptic scrub in a hospital. You'd let the hot water rinse off your hands. And then after that you're supposed to have some type of a foot pedal in a surgical setting. But for the most part, what I try to do to be as clean as possible is I'll then use the sensor hand towel dispenser, pull it off, get some hand towels, dry my hands, use the hand towel to shut off the water valve. And this is how we're set up in the medical. ICU throw the towel away, and then on my way out, I'll dry a couple of pumps of the hand sanitizer that we have in every room that says foam in or foam out.

Vance Crowe [00:10:36] Oh, interesting. So you, in addition to washing your hands, then you use hand sanitizer?

Steve Ernst [00:10:41] Yeah, I, I add an extra layer, but you know, that's just my inner germaphobe coming out. I was doing that long before Coronavirus was causing everyone to become hysterical.

Vance Crowe [00:10:51] So if you're a germaphobe, are you hysterical or worried about coronavirus?

Steve Ernst [00:10:57] It's there. You just have to accept it. It's like crime. You just have to accept it. It's always gonna be there. It's just like poverty. It's always going to be there. But you know, you have to develop a level of comfort with its existence. And I think that's what we do with everything, like junk food. I try to eat healthy now, God knows, but you know, it's still out there and I have to develop a level of comfort with its existence or I have to adapt the fact that regardless of what I like or what I do, it's always gonna be there.

Vance Crowe [00:11:28] So one of the big things in the medical community that we're hearing about over and over and over again is that there is not enough PPE, the protective gear that keeps nurses and doctors safe. What is your thoughts on that? How is St. Louis doing with PPE? How do you feel secured?

Steve Ernst [00:11:46] Correct. We're rationing big time. Let me see if I can find an example laying around. I'd have to get off camera to get it. But that little yellow mass that I sent you a picture of, You know, we're rationing, those obviously manufacturers have been ramping up production, they're trying to meet the demand, but obviously you can't meet that level of demand overnight. And then with PPE, technically what you're supposed to do, according to a policy book, is you strip it all off. Gloves, I believe are you take off your face, it's all in the order. I was on the, I'm on the infectious disease committee two at work, you take off your goggles and gloves. First you strip off your gown, you roll the gown up away from you. And then the last thing to come out is your gloves. And technically you're supposed to double glove underneath that. And obviously everything that was in there goes in the trash. Now you're having to flex on those rules for the sake of rationing because it's going, the spike in numbers is so high that you're having to make it last further than what it was intended.

Vance Crowe [00:13:06] That has to be, I mean, for, for some, so for, for the listeners that don't know, you're kind of a, a hardass, right? Like you're my juujitsu, one of the coaches and

Steve Ernst [00:13:16] Small fish in a big pond.

Vance Crowe [00:13:18] But in any case, not really afraid of much. Right. And able to psychologically handle high intense pressure situations. There are a lot of people that went into nursing or healthcare, imagining they're gonna help people with stitches and broken legs, which are serious, but not this level of fear about them coming into contact with a potentially deadly disease. How are you watching your fellow nurses handle this pressure and how are you handling it? I mean, you, you seem like, you're like, Hey, it's just a reality. How are they handling it?

Steve Ernst [00:13:51] Well, I saw two or three yesterday when our manager announced that we were closing down the medical ICU and in the matter of a few hours converting it into a COVID specific unit, I saw two of them tearing, three of them tearing up and crying and just totally terrified. So you see every end of the spectrum, you see people who accept what it is and you see people who are, you know, they're melting down at the reality that, hey, you know, now I'm gonna be working with these types of patients all the time and I'm constantly going to be exposed to this. And statistically, you know, there's a possibility it can get through, it can infect me. The viral load will cause such a reach, such a level that it will attack my immune system. And then I'll have the disease, meaning

Vance Crowe [00:14:48] That a lot of people can get the disease by just touching gas handle, but maybe it wouldn't be that big. But you might get somebody coughing in your face, meaning that you're gonna get a much larger dose of the disease potentially than, than the way that a lot of people will come in contact with it. Right?

Steve Ernst [00:15:04] Yes. I've had people coughing in my face and then I've been told an hour later that I need to put them on airborne precautions because they have active tuberculosis.

Vance Crowe [00:15:14] Oh man,

Steve Ernst [00:15:15] You know, I and you like coughing in my face. Oh yes, they have tuberculosis or meningitis. Like, okay, well it would've been nice to know that an hour ago. Obviously this is nothing, I can't say anything because this is literally what emergency room nurses deal with all the time. Someone's coughing in your face and you actually have to say to people, Hey, would you mind not coughing in my face? Would you cover your mouth? You'd think that these were things that you wouldn't have to say to people, but you actually do. You actually, I'll have to say to 7-year-old people, hey, you know, cover your mouth. That's not very nice that you've just hacked everything directly on me. I used to wear glasses before I got LASIK done and the lenses on my glasses used to look like a blast shield.

Vance Crowe [00:16:05] Oh no.

Steve Ernst [00:16:06] You know, with droplets and everything all over 'em, it, it was quite disgusting.

Vance Crowe [00:16:10] So,

Steve Ernst [00:16:11] Go ahead.

Vance Crowe [00:16:12] Did you go into nursing knowing, having a clear picture that you could get into a situation like this?

Steve Ernst [00:16:19] Absolutely, but I was already interested in microbiology and virology. I, to me, microbiology and virology, stuff like that. Now I haven't looked, which is surprising considering I really haven't looked too hard at COVID yet. But it's always been something that's interested me. How do viruses move? How do they propagate? How do they spread themselves? The job of any organism is obviously usually the same. It's to proliferate more of itself. And in that way they kind of emulate our behavior, animal behavior, plant behavior. A dandelion ha a dandelion has, what are those little, the

Vance Crowe [00:17:00] Seed scores

Steve Ernst [00:17:00] Up?

Vance Crowe [00:17:01] Yeah,

Steve Ernst [00:17:01] Yeah, the spores. The job of it is the air hits, it hits it, disperses the dandelion and all the little spores or all the little seeds are blown off. And that's how the plant proliferates itself along the air. My maple trees outside or my oat trees, they form the little helicopters. Everything out there, its job is to proliferate itself and to continue it on. And viruses do that too,

Vance Crowe [00:17:27] So, well, I had a, I have a group of friends and we were kind of all talking about what would happen if you get it, what would be the type of person that you would want being your, your nurse. And we kind of had a joke. So there's you. And then at our Jiujitsu studio, we also have a guy, Luke, that's also a nurse. And, and we were talking about, I probably want a guy like you that's pretty tough, but you're probably also not patting people's hands and playing with their hair. 'cause you're all business. If somebody comes in with coronavirus and they're still conscious, what is the best way that they can behave as much as they're capable to make sure that they are making it as easy as possible for somebody to care for them

Steve Ernst [00:18:08] Some. And that's the, that's the issue. I guess that's kind of a two or three part question. Like there's nurses out there and you know what, there's some people aren't meant to do my job. Like some people are literally just meant to go in your room and give you an oxycodone and a Turkey sandwich, you know? And that's, that's okay. There's nothing wrong with that. I mean, that's, for you, doing that means that it frees up someone else to do a more critical job. So we all have a role to fulfill you at the bedside. You know, that's the thing. You'll have the most sane human beings on the earth, all right? The most sane, nice, rational human beings at the earth. But when they have that level of consciousness change where they don't understand person, place, time or situation, they're no longer behaving in a rational way. And sometimes the only thing you can do is, well, for, to protect their airway. Of course a mental status change is one of the big indicators that you're not gonna protect your airway. You know that you're not, you're gonna be able to continue to effectively breathe. And so when people are reaching that level of confusion, usually a doctor will take an endotracheal tube and they'll intubate 'em. And in that process, what we do is we sedate you and we paralyze you. And then depending on the level, sometimes we might take you and roll you over onto your belly, and that's called proning you.

Steve Ernst [00:19:44] And that is to open up your lungs a little bit more so

Vance Crowe [00:19:48] That you can get, I saw that with the Italian hospitals. They had a whole lot of older people turned over and I wondered why they did that. That's to make it easier to breathe.

Steve Ernst [00:19:55] Yeah, it, it's to, so that the weight of your chest, the tissue, a lot of times doctors will listen, doctors, nurses will listen to your back because there's less tissue, less fat, less adipose tissue there in general between your lungs and the stethoscope. So you can get clear breast sounds. That's because there's just literally less mass there. There's more sitting on top of it. There's pectoral muscles, there's fat. If you're a woman, there's breast tissue, which is adipose tissue. There's, you know, depending on how obese you, you are more or less, some people have more, some people have less. Then, you know, if you have heart failure, you have your heart sitting on top of your lungs. And then you also have your, like if they're in heart failure and they have fluid around their lungs, you got all of that sitting on the lungs. So if you rotate somebody on their face and prone them, you actually can, for a time being increase lung expansion and move two, the two parts of, of breathing for someone. The first part being physically moving air in and out, which is called ventilation. And then oxygenation, which is the second part where you take blood and the blood circulates into the lungs and then your body pulls out oxygen molecules, I'm sorry, pulls out carbon dioxide molecules and replaces it with oxygen that you freshly inhaled.

Steve Ernst [00:21:37] So breathing's a two part process and that's, it's two shift the odds in your favor.

Vance Crowe [00:21:44] And so we were talking about how your bedside manner and getting, getting somebody in there that can do the types of things that you're talking about, get people into breathing. The, the, the question I'm really after is if I get coronavirus and I want my nurse to take as good a care of me as possible, what is, if I'm still rational, what can I do to increase that? What, what, how do I be, be the best patient that I can possibly be? Is it to be really quiet?

Steve Ernst [00:22:11] No, well, it's to stay calm, obviously. But also the other side of that is when there's a problem, you need to speak up. I don't need to know when there's a problem before it's too late. Now there's a fine line, you know, it's like people will say, well, my legs hit you. Well then it's your leg. That's different than, that's a different type of a problem than I'm having trouble breathing. I can't catch my breath regardless of what I do. I am, I'm starting to get really short, I'm starting to take these real deep heavy workout style breaths as though I've done a intense two hour workout except I'm just laying there. You know, I, I look like somebody who's run a marathon, but literally all I'm doing is sitting in a chair or in a bed versus, hey, I got a little bit of a headache. You know, speak up for your problems, but you gotta understand sub problems are big and some problems not so much. They need to come later. And so they'll be addressed, but they'll come later.

Vance Crowe [00:23:28] What are you guys anticipating at your hospital? Is it today, tomorrow, a week from now that you're gonna start seeing a bigger wave? Are you confident that the wave is coming?

Steve Ernst [00:23:38] They're saying in the next two weeks to two months, I've heard both that there's gonna be a rapid spike in cases. I've heard that the virus literally doubles in its infectious rate every day. Like literally from one day to the next, your amount of cases of infected people is doubling. And so they're saying like, it's gonna get worse before it's getting better. Then also there's, you know, I've, I've heard this, my wife showed me a, she's an ICU nurse as well. She showed me a video. I think we've now surpassed Italy. But from what I hear, like, you know, this is the, the full force of the storm hasn't hit us yet. It, there's more to come that it's just how it's,

Vance Crowe [00:24:31] And, and it, it seems so odd because we went, my wife and I, she's pregnant, so we went into quarantine about a half a week, maybe a little bit longer than what most other people did. But now you figure it's been almost two weeks of people being in isolation. How is it that the wave would continue building and is it because people are still going out or is it because people were sick at home and they haven't gotten to the point where they need to go to the hospital and that's what's actually building on the horizon?

Steve Ernst [00:25:01] All the above. You know, we still need to go out. That's you. You can only stay bunkered up in your house. And then from what I've heard, this virus also can lie dormant for 10 days where you are totally, totally asymptomatic and suddenly it reaches a point where it escalates in the viral load that you become symptomatic. And usually when that happens, you're shedding more of the virus and then more of the virus is being kicked out. So there's only so much in so, so many ways you can isolate yourself. And then I also heard a, we obviously keep people in isolation at the hospital that we separate them and that's all we can do. But I heard an old ICU nurse telling me about how, well, when someone gets the flu or some type of respiratory disease at my house, I just move them into my bedroom and you know, I keep them isolated from the rest of the house because this is what we do at the hospital. And I kind of had to point out to her like, well that really doesn't make a lot of sense because for one, if you live in a modern house, what do you have? You got hvac, what is, how does HVAC and high efficiency heating, ventilation and air conditioning work? It works by taking the air that's heated in the house, recirculating it through an air conditioner or a heater and then pumping it back into the house. That's how the high efficiency works. It takes cool air, pulls it through a return vent, recoils it or heated air, pulls it through return vent, reheats it, and then just shoots it back into the rest of your house.

Steve Ernst [00:26:40] So to some extent that doesn't really work. All you can do really is focus on, you know, cover your mouth, good hand washing. It's kind of back to basics.

Vance Crowe [00:26:51] You gotta, so if you're caring for somebody, your goal, you know that you'll be exposed to it. In terms of the air being around or just in coming, I

Steve Ernst [00:26:59] Probably already have been

Vance Crowe [00:27:00] Yeah. And

Steve Ernst [00:27:02] I probably already have that.

Vance Crowe [00:27:03] But that you're, you're, if you're caring for, it'd be a good idea not to have the type of thing you're talking about, which is the big cough into your face as best as you can hope.

Steve Ernst [00:27:11] Yeah. Better

Vance Crowe [00:27:12] To get a low dose.

Steve Ernst [00:27:13] Yeah. And then also we've been using goggles, keep it off your eyes or mass with face shields instead of just mass to try to keep it off you as much as possible. But like from what I know, New York is in dire straits, so the manufacturers have been diverting most of their PPE as much as they can to New York to try to meet their surge in demand. And so that's why us, we're starting to ration. Now the issue is too, is it starts at the local level. These community hospitals that we have at the local level have, they're reaching their capacity. And now that's why we converted to a COVID unit is because they've reached their limit to what they can deal with. And now they need to start shifting that to a larger medical center.

Vance Crowe [00:28:07] And for people that don't know, if you're not from St. Louis, the way that the hospital that Steve works at is a, a center point, a major medical complex with a children's hospital and incredible resources. And so outside of that, in all of the other farming communities and little communities outside of it, even the suburbs, the suburbs don't have this sophisticated of a system. So you're saying those are filling up and that eventually that's gonna spill over into the main hospital system?

Steve Ernst [00:28:37] It's already started.

Vance Crowe [00:28:38] Okay.

Steve Ernst [00:28:38] But you, you know, like a good example would be like the president, if Kennedy, somebody shot Kennedy in St. Louis, they would've airlifted him to Barnes because it's the level one trauma center of St. Louis, you know, the most important people would be immediately airlifted there, or the most critical cases or high ri, everything from that to high risk pregnancies to, you know, advanced cancer treatments. They come up with all kinds of new stuff at Siteman Tar. I think the new thing lately has been targeted gene therapy that they're working on, but it's a major medical center and they're trying to keep on the cutting edge of medicine, unfortunately. Here's medicine that, you know, we're having to keep up with it and some things are reactionary.

Vance Crowe [00:29:30] So final question, but well, I have two questions, but Oh, go ahead. Final, go ahead. The final regular one is, what do you think of these on the news we see that people are saying, hey, you can use these types of medicine, the, the hydro chloroquine or whatever those are. What are your thoughts on that? Should you think that's gonna prove out to be correct or a lot of hype or what do you think?

Steve Ernst [00:29:53] Hydro chloroquine, I'm not familiar with that. Oh,

Vance Crowe [00:29:55] It was so I

Steve Ernst [00:29:56] Can't, yeah,

Vance Crowe [00:29:56] I don't, I, there's just a lot of people that have been putting forward ideas, some of which is kind of debunked and some of it, I, I don't know very much about it, but I thought I'd ask you. So

Steve Ernst [00:30:06] I, I can't say that I have either, but I don't watch a lot of news for, one of the reasons is I can't stand the news. The news is a very negative place to go, which is why I kind of try to stay away from it. So, and then obviously with the way people are reacting, they've been fanning the flames of hysteria for the sake of, well it sells it's ratings, you know? Yeah. I've

Vance Crowe [00:30:32] Watched more news in the last two weeks than I've watched in a very, very long time. So I mean, I think that they are, you kind of need to know what's going on, but on the other hand it can become completely addictive to see what the latest numbers are and things like that.

Steve Ernst [00:30:47] Mark Twain nailed it. If you read the newspaper, you're misinformed. If you don't read the newspaper, you're uninformed. So, I mean, that's kind of where we're at. It's as true today as it was 130 years ago when he was the most prominent writer in the 19th century.

Vance Crowe [00:31:07] So my final question, this is one I've been trying to ask everybody, it, where do you think the world is? What do you think the world looks like in two weeks?

Steve Ernst [00:31:16] There'll probably be more sick people, but this is something that's gonna have to unfold for itself. It's, it's gonna have to unravel as it goes. Either what we'll do and what we've been doing will adequate or it will be inadequate, but we're not gonna know until it happens. It was, I don't know if you follow a lot of MMA fights or anything like that, like happen until it happens. Mike Tyson used to say, everyone's got a plan until he gets hit. You know, well we've got a plan, but we're not gonna know until we really get hit and we really get in a scrap with this virus to find out its true potency and how proliferative proliferative it can be.

Vance Crowe [00:32:08] Well, you, along with the other guys from the BJJ Lifestyle Academy are some of the hardest dudes I know. So I am really grateful that you're gonna be out on the front lines. I hope you and your family stay safe and thank you so much, Steve, for taking the time to talk.

Steve Ernst [00:32:24] Hey, no problem. But the, oh, one other thing I wanted to add in there, it just kind hit me in the back of my head is really the people though that are being hardest hit by this are people with two and three and four comorbidities. Let's say you are exposed to coronavirus, but in the background you are already a diabetic. You already have vascular disease to your body, so you're not getting good blood flow. Your body's not healing itself as well as it would be with good blood flow, good circulation, good gas exchange from free radicals in oxygen that can, in carbon dioxide that can damage your body. That's why you gotta drink your green tea. There's on top of that, you know, you've got hypertension, you morbidly obese, all of these things that go together. And unfortunately we are the fattest culture in earth. You know, we're victims of our, of our

Vance Crowe [00:33:29] Own plenty.

Steve Ernst [00:33:31] Yeah. We're victims, unfortunately now of our own success. And so that's what you gotta look at. We've, we have a society that's living longer, but at the same token, it's living longer because we've gotten better with dealing with multiple comorbidities. And so people that might have been killed by one of these are living longer. And unfortunately, there are also the people that are proving to be the ideal vectors for a disease like this to spread itself. They have three or four or five, they've got hypertension, they've got congestive heart failure, they've got chronic obstructive pulmonary disease, which has caused 'em to get pulmonary hypertension. They, they're diabetics too because they're not very active from all this stuff. And they're usually overweight and over obese. And obese, all these things that play in. And that's another reason why the virus has been so successful at hitting these susceptible populations. So we're almost, in a way, we're almost kind of victims of our own success, of our own advancements in medical care. We've escalated and now the enemy escalates. And that's unfortunately where we are. But anyways, I was, that was my, my final thought that just kind of hit me. Hey

Vance Crowe [00:34:52] Man, I'm glad you shared it. I, I think people are searching for what can they do to prolong their, their chances or make their chances as good as possible. And it's probably getting out and exercising, being careful about what you eat and getting good sleep.

Steve Ernst [00:35:06] No, and good hand hygiene.

Vance Crowe [00:35:08] Good hand hygiene. That's right. Yeah. Thanks Steve so much and we'll check back in and let us know how things are going in the hospital.

Steve Ernst [00:35:15] Great. Nice talking to you Vance. Thanks

Vance Crowe [00:35:17] Man.

Steve Ernst [00:35:17] Alright, bye.