The private/public partnership to stop Covid-19, Facebook’s board sees more shakeups, and Kara’s brother Dr. Jeff Swisher on hospitals prepping for coronavirus

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Hi, everyone.

This is Pivot from the Vox Media Podcast Network.

I'm Kara 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 and 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 the government to open up parking lots and supply chains to help mitigate the spread of COVID-19.

Walmart, Target, CVS, and Walgreens are going to all give up parking lot space for drive-through testing once it gets in place, which it 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.

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 in the Bay Area with hopes of expanding it more broadly over time.

Google kind of saved Trump here, who overspoke and said there were 1,700 engineers working on it, and 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, but the stuff they've got up is pretty bare bones.

And

they're putting, you know, they're doing a lot of other stuff.

Google is and and a very important site to be doing that because of the search mechanisms there and the capabilities of the 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 a panic.

And one of the things, so on Friday, everybody says, or over the weekend, that the rate cut triggered this plunge in the markets.

I would argue with the Friday press release and 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 the, I'm sorry, the vice president then goes on to congratulate.

the president for the next 15 minutes.

And then 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 want to 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 that 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 is congratulating.

Decisive leadership and the good people behind me and

a bunch of kind of the tests are coming.

I think quite frankly, I hate to say this, I think Dr.

Fauci is losing credibility because he's been talking about a surge in testing, which doesn't seem to show up.

And 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 New Rochelle.

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 or they put on a good face.

The trigger for me, the thing 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 are they lying about?

Right.

But then, of course, Google 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 that 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 Verily and said, oh, this would be a good idea.

They must have stuck 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 a bad idea.

It's not that it's something that shouldn't happen.

It's that it's just like 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 yourselves on the back for closing borders and then not doing what it takes to make closing borders organized.

So 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?

How could we?

Well, we're not.

It's this president who just refuses to prepare.

Like, I don't, yeah.

I've seen this country do things in an organized fashion in other times.

So it has to be that everyone is just worried again about his reaction, which I'm like, why doesn't 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, very opening very noisily today, again, after it went up a little bit after Trump's speech.

Yeah, volatility is back.

The market's 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 or the panic is on the same slope of trajectory as the virus.

And that is,

you know, 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 a,

their health is not as big a risk.

I don't want to say it's not serious, but a 24-year-old has a different level of risk threat than a 74-year-old.

But we said, all right, let's distance.

By Thursday, we had closed the office.

By, I'm sorry,

By Thursday morning, we decided 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 a bunch of 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 your concern about this.

It's just incredible.

If I look back 48 hours, if I look back seven days, if I look back

14 days, it feels as if the level of threat level, the perceived or 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 is the mood there right now?

Well, you know, everybody was out in the park yesterday.

There was some Twitter stuff.

It's interesting.

Twitter's a really good way to get a lot of information in this.

And I have to say, this is, as much as there's a lot of idiotic information, there's a lot of great information on Twitter from people.

And also, it 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 mood is better, too.

I think people are being nicer to each other.

Yeah, 100%.

Except for like the woman who's like, you know, I've gone to a red robin and 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, the most despicable people on earth.

But it's interesting that everybody was out.

And there was someone who posted people in the park, in Prospect Park.

And,

you know, people were not,

the photos, people were separating from each other, but they were all outside.

There were a lot of people.

It was a beautiful day.

And the question is, do you go outside at all?

Like, if you weren't getting near each other, you know, people felt they were making that small risk, was okay.

But I have to 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 going to close gyms and everything else.

But

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 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 question of 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 going to get to the to the to the latter at some point in the next week or two.

Yeah, but you had talked about the impact on business and you're going to see a ton of businesses will do the right thing, which is close their stores, especially in retail, will send their people home, but they just won't survive it.

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 going to sink to the bottom of the ocean and those people are never going to 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 the people who own equity there's a lot of 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 there's just no doubt about it.

You're going to have a lot of bankruptcy across services companies, across retailers.

Some can afford this, and

this is Darwinian and it's harsh.

But when we get through this, a lot of businesses will come out the other end, the ones that survive.

When there'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've written about Zoom, Skype, Peloton.

Those are all going to be doing well because this is at-home kind of stuff in each area.

You know, obviously, whoever comes up with this vaccine is going to be doing well, and all the pharma companies,

the people who make Purel 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 figure out a 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 isn't?

And then we're going to move on to another story,

although this is the only story really.

Well, in terms of the markets and companies, I think there's offense and defense.

And that there's companies that are actually, the business is going to accelerate as a function of this crisis.

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 largest 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, the bottom line is this virus is

impacting and killing the weak and the 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 hardwares of the world, the Urban Outfitters of the world, the Lululemons of the world, the ones that survive this will come out the other end, quite frankly, with just fewer competitors.

And the market will come,

I believe the market's going to come ripping back.

The other thing is, and 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've talked 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 the pandemic is a form of famine.

And

I think about this, Kara, 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 the manufacturing was outsourced.

And then we have these carriers come back to these Western nations with this incredible inequality and spread this virus.

And while we talk a lot about how the poor and the middle class are most vulnerable, what you're going to have economically here is a redistribution of income.

Because the reality is the poor in the middle class didn't have a lot to lose.

And I do think the economy is going to come back.

Employment's 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 to 50% if it hasn't already.

And quite frankly, they're going to get to buy an apartment in Brooklyn at 30% to 40% less.

They're going to get to buy Amazon and Apple at a lot less.

And you're going to see a redistribution or an equalization again.

And what's 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 the surge in 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 have rather just elected Bernie Sanders, but I don't know what to do.

But 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 wallpapering over the notion that government doesn't matter.

And then we end up with something like this.

I do think that the history and the franchises 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 New York Times on the front page today talking about how coronavirus and inequality feed off of

each other.

The pandemic is widening social and economic divisions and also make virus deadlier, a self-reinforcing cycle that experts warn could have consequences for years to come.

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 over 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.

In other news, Facebook board member Kenneth Chennault stepped down in a statement.

He said, I am stepping down from the board because I have a once-in-a-lifetime opportunity to work more closely with my friend Warren Buffett, the Berkshire Hathaway 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 unhappy with Mark Zuckerberg and the way the company was going and how he had no impact on it, which there's been several changes to the board over the last couple of years.

Very good board members have left,

ones that were firmer and more independent, like Chennault.

Earlier in March, Facebook announced that former McKinsey executive Nancy Kellefer and S.D.

Lauder Company's chief financial officer Tracy Travis would come on the board.

And last month through Houston, Houston, the CEO of Dropbox and a friend of Mark Zuckerberg's, joined the board.

This is not good.

This is not a good thing that he has left the board.

He just feels like he is useless.

And just the way Reed Hastings left,

Erskine Bowles,

Susan Desmond-Hellman, all the really independent people are gone, it feels like.

The organization deciding the communications and tone of communications that the population of the southern hemisphere plus India receive has had, has decided, has brought on their chief legal counsel is the woman who convinced Congress to pass laws that

enabled

enhanced interrogation techniques, better known as torture.

And the people who can't survive there are people of integrity who have real concern about the Commonwealth, people like Ken Chennault.

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 reeks of integrity.

He is 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 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 Desmond-Hillman on this board.

We would want an Erskine Balls.

We would want a Reed Hastings.

We would want a Ken Chennault.

Any person you think, oh, okay, they're smart, but they're a little bit unusual and perhaps even dangerous, a Peter Thiel, or maybe they don't have an objective viewpoint of their buddy, oh, the C 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.

It is frightening.

Yeah, 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 chatty with him.

He didn't call me, just so you know.

And it was interesting because he said the difference between good and I wasn't thrilled with this column, honestly.

I thought it was a bit of giving Zuckerberg a lot of pat bat packs for making sure that 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, you just don't have to lie egregiously every minute of the day to win that award.

And then he said, the question which I put to Mark Zuckerberg, chief executive of Facebook in an interview, is why it took the global health crisis for them to do so,

which is clean up their platforms.

Mr.

Muckenberg said the difference between the good and bad information is clear in medical crisis than in the world of, say, politics.

When you're dealing with a pandemic, a lot of stuff we're seeing just crushed the threshold.

So it's easier to set policies that are a little more black and white and 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 it anytime 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 at Amazon, they're going to get rid of the guy who bought, you know, they're going to get rid of price gougers.

Well, thanks a lot.

You should have done that in the first place.

But just taking a bow right here, just, I don't like that.

I don't like that.

Well, there's, I mean, you 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 what the first Iraq war was to CNN.

I think that'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 now a shareholder on Twitter.

The other thing is big, big tech is going to roar out of this stronger than ever.

Because think about, if you think about the media landscape, it used to be a fairly robust landscape, and Nassim Talib's definition of robust is that there's a lot of players, and that if anyone goes out of business, you're fine.

The fast food industry is a robust industry, and that if McDonald's goes out of business, we're all going to be able to get burgers somewhere else.

Whereas the financial services industry, if JP Morgan goes under, it could take the global economy down, then you'd argue the financial services is not robust.

The services industry has been typically, and 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, data agencies.

You're going to see a ton of these little services companies and 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, and Google.

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

a buying opportunity, quite frankly.

Yeah, okay, I'm not not going to do that because I really didn't

like that.

And then this is the last part of this thing.

When I talked to Mr.

Zuckerberg and other social media executives last week, I kept returning to the same point.

Will the flow of responsible information last beyond the crisis?

Could it extend into our upcoming presidential campaign?

I hope so, Twitter's Mr.

Dorsey wrote, up to all of us, which is a decent response.

Mr.

Zuckerberg less sang, when right now Facebook is tackling misinformation as imminent risk of danger, telling people if they have certain symptoms, don't bother getting treated.

Things like you can cure this by drinking bleach.

I mean, 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 and support each other and recognize people are heroes on the front lines.

Given the pandemic, Madam College is literally going along for a while.

He said it's hard to predict exactly how it plays out beyond that, and 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 bat packs.

I'm sorry.

You don't get bat packs.

Yeah.

I know people think I'm relentlessly negative to Facebook, but honestly, this is the lowest bar to get this crap off people that threatens people's life.

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.

Sorry.

Well, and the PR machine is going strong.

There's been food bank announcements and they're just very, and 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 your good, you know, in your efforts, I think they're important.

I don't think anyone should be criticized for them, but just don't.

Thanks for the masks, Jack Maw.

Yeah, just

keep your, just keep it to yourself right now.

I would say this is a time when 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 there's a, 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 watching the speech.

I don't know where it was, the Rose Garden, and I remember seeing, oh my God, I've woken up in a better world.

And Doug McMillan was speaking at the podium in front of Trump.

And I'm like, Trump has said, look, I'm overwhelmed.

Doug McMillan's our new president.

And I thought.

Yeah, I know.

He's a great guy.

Actually, a terrific guy.

Very, talk about someone who doesn't brag.

I mean, he was there, obviously.

All the CEOs had to show up, and I get that, and they should have.

But Doug McMillan 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.

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Okay, Scott, we're back and I want to introduce you to a very close friend of Pivot, my brother, Dr.

Jeffrey Swisher.

He is 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 U.S.

Preparedness, 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 U.S.

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 obliged when we go out to keep a distance of one 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.

Well, sorry to put that bummer on you.

Yeah, I was going to say that's

certainly a little splash of 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 in San Francisco.

San Francisco and Seattle have been sort of the first areas of seeing a lot of activity with coronavirus.

Obviously, it's 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 a disclaimer, I am not a virologist.

I'm not an epidemiologist.

I am literally a ground-level anesthesiologist, and I'm a 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 to, do you 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 kind of go, whoa.

And after about three minutes, you go, holy shit.

Because, you know, it's 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 going to be coming in the next one to two weeks.

So what do you think that is?

What is the, what is the, what is the, you have to have projections, right?

You guys are getting ready, you're creating tents outside of hospitals.

Is that correct?

Right, right.

My understanding is that UCSF is

has some tents outside.

We don't have tents, but we've certainly restricted access to our hospital tremendously to the public.

Even, you know, let's say today is the last day that we're doing quote-unquote elective surgeries.

Starting tomorrow, we are only doing emergency surgeries.

And that's an amazing amount of surgeries that we're just not doing starting tomorrow.

Let's say today, for instance, I'm going to be doing some total knee replacement surgeries.

That's it.

You know, you're not going to be able to get a 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 And what does that look like?

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

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, of 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, or 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, I'd like that your person you had recorded, anywhere from 10 to two weeks, that's where we're going to be in a couple of weeks.

But more, because we have more people in this country.

Dr.

Swish, I have a question.

First off, thanks so much for doing this.

My pleasure, Scott.

So if you think of total capacity of beds as being 100,

where are we now?

And

where do you think the infrastructure is going to be in the 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.

They're 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, is how do we repurpose beds in the hospital or how do we repurpose ICU beds?

So we have operating rooms, for instance, and

my wife didn't know this, for instance, which is kind of amazing since she's been married to me for 30 years.

But

the anesthesia machine in an operating room is also a ventilator.

So we can use operating rooms as intensive care units to use them as ventilator 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 good percentage of people with coronavirus get SARS.

And what does that take?

Explain very quickly what that 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, you know, came from the word, you know, three, and that, you know, 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, you know, I don't want to be an 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 and who shouldn't.

And people must be on these ventilators, correct?

Once they got

if you get SARS, yeah.

I mean,

the coronavirus causes in severe cases, SARS stands stands for severe acute respiratory syndrome, and that is an interstitial pneumonitis in which the lungs basically become inflamed and stiff, and

you're unable to oxygenate adequately at normal pressure.

So you have to intubate them, which is putting a breathing tube down their trachea,

and then positive pressure ventilation with what's known as PEEP, which is positive end-expiratory pressure of 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 an anesthesiologist care about this kind kind of thing?

And I'm like, duh.

We have, you know, we intubate people.

So we are literally a foot from the face putting a breathing tube down their throat in, you know, most of our operations.

So are people worried?

Go ahead.

Go ahead, Scott.

Well,

I was going to 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 competence 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 the federal government to request additional supplies?

Or is the attitude pretty much we're on our own here?

What's the relationship between people on the ground such as yourself and the federal government?

Well, so our hospital certainly has a command structure.

You know, we were very fortunate that the chief executive officer of CPMC, California Pacific Medical Center, 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 in 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 it 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 hook or 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 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?

Some were 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,

one of the biggest concerns that I think I have and members of my group have is the whole concept of asymptomatic transmission.

And that kind of goes into some of the issue about

the studies from Korea showing that the highest group of people who are asymptomatically transmitting is youths from the age 20 to 29.

who are all getting together in Fort Lauderdale and partying it up like there's no tomorrow and 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, et cetera.

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, oh, bye-bye, Felicia, and they just blast everybody away.

So, all right, Jeff, Jeff, Jeff.

Sorry, sorry.

All right, that's okay.

This is my brother, Scott.

So, but is there still time to flatten the curve?

You can have a little joking in the middle of a pandemic.

It's fine.

Is there time to flatten that curve?

What should people do?

The cities, and New York City, where I am, is now shutting down all restaurants.

Offices have been already closed a lot of places.

They're going to, you know, every big city is closing down everything.

And I just was watching Mural Bowser from D.C., where I'm headed to, getting into a fight with the Hill Restaurant Group who refuses to shut down.

But

what can people do?

And we got to go get out soon, but what can we do?

One, to mitigate the overwhelming the 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 going to need a ventilator.

Not everyone's, they're just going to 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, if 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've got that's what you got from Stanford Med School, but go ahead.

Okay, it's a very good analogy, by the way.

Okay, thank you, Jeff.

But the

thing is, so, so, 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 it to other people, every person that you contact with then

gives it to someone else.

And you're right.

The numbers are such that it's going to 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

we just don't know the number because we don't know the denominator.

And I think that that's the most important thing.

And especially, you know, a message to kids out there, you know, the youth who are all home from college partying, guys, stay away from each other.

Just try to, you know, Netflix and chill, you know, 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.

And, you know, Kerry, you know, you and I both know Gavin.

He really

governor of California.

He really demonstrated what I would call leadership skills in how he talked about this and the tone that he put out.

I'm going to contrast to Devin Nunes.

I don't want to get sued, 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 should all 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.

Or we're not going to eat.

Scott, any other questions for Dr.

Swisher?

No, other than that 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 are our front lines makes people feel better.

I think you demonstrate exactly the types of communication style and leadership style we should 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, and I want to 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 work day.

Every single nurse, every single intensive care unit doctor, every single ER doctor, frontline nurse,

housekeeping, you know, 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,

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, you know, we'll get through this.

It's just going to be a bumpy ride for probably the next month or so.

You know, I'm hoping less.

And I'm, you know, I'm hopeful that we'll get through this as best we can.

Jeff, you're the best brother, and you're the best doctor.

Thank you so much for doing that.

I really appreciate it.

Jeff Swisher.

My brother.

All right.

Hey, if you, if you guys, anybody, any questions that you want to ask me, I'm on Twitter at Jeffrey Swisher.

And Kara 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.

Okay.

Take care, everybody.

Bye.

Okay, Scott, that was really depressing and also good at the same time listening to my bro.

Isn't he a good bro?

Yeah, you're just an insufferable group of overachievers.

What happened at the family?

Is the third guy, is the other brother an astronaut?

Or wait, I hope he's a meth addict.

I haven't

met him yet.

I've got a jumper, but 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.

Of course, my mom's sitting down in Florida right now, you know, spewing Fox News bullshit, 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, had a big part in it.

Anyway, let's talk only 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.

Well, you go first then.

Go ahead.

Well, I got to say, I liked the episode of Grumpy Old Men last night on the Democratic debate.

I thought it was a a substantive they got a little bit grumpy at the end, like a little bit 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 going to have one and not anybody else, so all the dudes can step down.

And that he was going to appoint an African-American person to the Supreme Court if he became president.

I liked that.

I thought it was forward.

I thought he looked good.

I thought Bernie did a great job, too.

I didn't agree.

I don't agree with everything Bernie says.

I thought they were great.

I thought it was a great subject.

It was such a contrast in leadership style to Trump just free associating things that I don't even know what he's saying sometimes.

Like, we have it under control, the virus, it's big, you know, all this idiotic 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

Neuin and Lufkalloons,

it just makes you feel better.

You laugh a little more.

There's a lot of meanness back and forth, but a lot of it's super funny and super enjoyable and a way to feel like that everybody is sort of going trading really good information.

When that works, it works great.

And so I have to, I'm going to be writing my column 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 this information 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 agreed.

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 algorithms 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 is times a billion.

Whereas when you put two people on stage, you moderate it well, they're decent people, you have a thoughtful conversation, you just learn a lot.

And it just struck me that we're in the midst of the worst ongoing debate ever.

Anyways, my win, I actually think the media, I think about when I watch, I've been watching media nonstop and I think, well, no one's really talking about, we're talking a lot about the frontline healthcare workers, such as your brother, that are taking risks.

And, you know, they grow up that way, though.

They're the people, and I don't mean to in any way diminish their contribution, but they're the kind of people that grow up just more caring and empathetic about other people.

It's just, they're sort of wired that way.

Like, do no harm.

They're the people when when you're nine years old are taking your heartbeat.

And they're just sort of built that way.

And what your brother said didn't didn't surprise me that they just sort of just immediately hear about this, put on their scrubs and

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 at Stanford, he did go to Stanford undergrad also.

And he had an opportunity to go into tech right when he should have, right?

You know what I mean?

It would have been like very financially lucrative.

And he became a doctor like my dad was.

And I, you know, I think a little bit of regrets not wanting 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

really good thing.

I mean, it's, it's, it's, it's meaningful work.

But what I was going to say is, I actually think the media, I was thinking about when going into work every day into a crowded studio, you are taking some risks.

And I've been watching a lot of CNN and I think they, I think they're doing a fantastic job.

They are.

I watched Fareed Zakara yesterday, and 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.

Yeah.

So smart, so good, clearly focused.

I'm not sure I could be that focused.

These guys have families too.

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, people with any resources have, for the most part, are self-quarantining.

Or 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 rain 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 heard.

Yeah, and you know, oddly enough, Tucker Carlson is the one who's actually doing that.

I think Tucker's done a great job.

I think Tucker's done a great job.

Doing the right thing and giving good information.

So, hopefully, that.

Oh, my other win, my other win.

If not, Rupert Murdoch really is Satan on Earth.

If he does it,

there's the Murdoch Satan on Earth swisher that I know.

That's right.

That's right.

Uncle Satan.

The other win is there's a wonderful

HBO.

If people, I know, I imagine people have a lot of time to watch.

I'm very good at TV.

I am very good at TV care.

It's one of my core competence.

Yeah, I picked it up.

Anyways, a win is if you have some time at home and you're spending more time on watching streaming video platforms.

The Outsiders is fantastic.

Or The Outsider, excuse me.

It's a horror film.

It's based on a Stephen King novel who I think is going to, I think there's some artists that are, I don't want to say underappreciated because they're unbelievable, but in 100 years,

I think he's a huge talent.

In 100 years, we're going to look back on them and think, you know, we're going to think, okay, I think Prince and you know, Elvis or whoever you want to think, or even Barbara Streisand, I think she has the best voice of the 20th century.

I'm aging myself.

But

Stephen King,

his ability to combine relationships with horror is unmatched.

Anyways, the outsider,

it's a guilty pleasure.

Okay, that's a good thing.

I'm going to do a terrible thing, and I'm going to, even though we had wins here, I just want you to know, I want you to react to it very quickly before we end.

Dow plunges 2,250 points, 9.7%, as more of the U.S.

economy shuts down because of coronavirus trading temporarily halted.

Scott,

circuits are breaking.

And by the way, people have asking why don't they just close the 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 to the bank.

And also, I just, just a point of light, 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 1920 29.

Today, Scott.

Yeah, well, like, how about this?

Don't look at the markets, people, if you don't have to.

That's right.

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 and clean it up when it's over.

My hope is the new administration has, or many hopes, but you know, whatever it is, it really does, as Mauren Buffett said, speaking of Kenneth Genald's greatest friend, when the tide goes out, you see what people really were wearing.

Yeah, and I know people ask you, I'm getting a bunch of emails saying, what are you doing in the markets?

And I say, well, this is what I think you could do.

And this is to be aggressive, super aggressive, and kind of crazy if you wanted 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.

Yeah, my stock person says that this might be a time to buy.

And I was like, you know what?

You just don't want to think about it, boss.

Just don't want to think about it.

Can't do it.

I said, can't do it.

Don't do it.

I'll just die if you spend all my money.

Anyway,

we will be back on Thursday with more.

There's lots to talk about.

Remember, those of you who want to see us, we'll be cross-posting this episode on our YouTube channel, youtube.com slash pivot.

We will be making pivot episodes as long as you promise to stay inside and self-distance.

We really are in this together, right?

100%, Jungle Cat.

Who are you not distancing with?

I know your little girl.

Oh, my beautiful

partner, Amanda.

My son Louie is with me right now, which has been a delight.

He cooked dinner last night.

And obviously, my lovely new child, Clara.

And we were having a great time.

Clara ate rice for the first time last night.

Actually, you know what?

We're spending a lot more time not online and spending a lot more time together.

That has been the pleasure of this.

And so that's been nice.

Who are you doing that?

What is your group of people?

I'm with my family, and it's wonderful.

We did a mini Olympics yesterday.

We're playing a lot of soccer, watching a lot of TV and it's been, yeah, it's been

wonderful.

And

yeah, I mean, it definitely puts things into perspective, but

I'm glad you're safe and with loved ones.

And I hope that that's true of everyone else on the phone, or excuse me, on the phone.

Yeah, and we're going to try to be optimistic.

We're going to collect moments of optimism.

A great idea from Rebecca to share

what is making you hopeful and happy right now.

Please write us on Twitter and we'll send us a voice memo of a happy anecdote, a song, a poem, your family home hobbies, your pets advice for anyone feeling anxious, something to spread the love.

We are very huggy here at Pivot.

Not for long.

When this is over, we'll go back to our nastiness.

But email us at pivot at boxmedia.com to be featured on the show.

Scott, would you mind reading us out?

Today's show was produced by Rebecca Sinanis.

Our executive producer is Erica Anderson.

Special thanks to Drew Burroughs and Rebecca Castro.

We are thinking about you as I know you are thinking about us and the country and the world.

We'll be back later this week with a breakdown of all things tech and business.

Have a great rest of the week, Kara.

Stay safe.

Thank you.

And also thanks again to our staff who is continuing to produce this, everybody, during this time.

I know everybody's nervous, but we really appreciate it.

This month on Explain It to Me, we're talking about all things wellness.

We spend nearly $2 trillion on things that are supposed to make us well.

Collagen smoothies and cold plunges, Pilates classes, and fitness trackers.

But what does it actually mean to be well?

Why do we want that so badly?

And is all this money really making us healthier and happier?

That's this month on Explain It To Me, presented by Pureleaf.

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