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Welcome back to the Outcomes Rocket, Saul Marquez here.

And today I had the privilege of reintroducing Dr. Amy Baxter. Dr. Amy Baxter is the founder and CEO of Pain Care Labs, founded in 2006 with a mission to eliminate unnecessary pain.

She invented and patented Vibra cool vibrational cryotherapy to treat tendinopathy ease and decrease opioid use. And she’s hurt. Her interview on the podcast was extraordinary. If you haven’t listened to it, go to Outcomes Rocket, that health type in Amy Baxter or type in pain care labs and you’ll find the episode. They’re just extraordinary. Contributor to health care, one of the top women in tech to watch as well. Also known for turning down Mark Cuban on Shark Tank. Pretty fun fact there. But today we’re going to be discussing COVID19. We’re gonna be discussing just myths, controversies and what does the future look like? And so Amy’s also a a licensed physician, E.R. physician. And so with her perspective, I really hope to to nail down some of those things that that may still be questions in our mind. And I hope you enjoyed today’s episode. So, Amy, thanks so much for for joining me today.

Oh, Saul, thank you for having me back. It’s a pleasure to be here.

Absolutely. So so let’s chat. COVID19. You know what are some of the myths out there that you want to help us bust than, you know, guide us through that?

Sure. Well, I think the scariest myth was one that was introduced to me by my bank teller. I put on a mask she had on a mask, and we’ve known each other for years. And she said confidentially, is this really a thing? Because I’ve got a friend in Brooklyn who says she drives by the hospitals and no one’s there. Is this really happening? Mm hmm. So the biggest myth is that covered is not a serious disease, that it’s the same as flu. A study this week showed that there actually are 21 times more fatalities from combat in New York than there were from flu. So the biggest myth is, is this going away and is this really a thing? And the answer is no.

I definitely appreciate that.

And it’s real, you know, and a lot of us in the healthcare space. I definitely feel it. But there might be that doubt. And so as we as we think about it, you know what? What are some of the questions you’re getting and seeing that that you feel the listeners could benefit from knowing around the around this virus?

Sure. I think that the interesting things are how this virus is different from other viruses and some of those attributes we could leverage for treatments and for care. And some of them make it really scary because we don’t have a way to treat it. One of the papers I read yesterday said this virus is unlike any other. And I think it’s true. This pathogen is doing things that other viruses haven’t. So, first of all, the biggest difference is in infectivity by age. Usually we have what we call a U or a V shape, where at the very young ages we have a lot of infections and morbidity, which means bad things happening. And at the old ages, we have a lot of morbidity and mortality and we don’t see that. This one is very much a along J. It’s very, very low with young ages because we’re at the top. The other thing that’s strange about this is how long it takes to become infected and how precipitous the drop is when people have a problem. So I think that you probably know that from the time of infection until you show symptoms can be five to seven days. So that incubation is very long. The scary part is that 44 percent of infections come during that asymptomatic phase.

So it’s very easy to spread without. And then when you have it, which makes it hard to track. Hard to trace and hard to know who to test.

It’s it’s different. And and so how about the ideas of, like where it came from and, you know why?

Any any thoughts are on that?

Sure. Well, it turns out that bats are natural reservoirs of coronaviruses. So, for example, Ebola was initially in a bat in a cave that a young boy outside the incident town was playing with. And that’s where that particular virus came from. As habitats change and as the climate changes, bats go out of their normal territories and they happen to have corona viruses as a very common infection. It doesn’t kill them. So it can be transmitted directly to humans. Now, the certainly the time that this virus started wasn’t Wuhan and was from a back, but it looking at the strains and the genetic typing of it, it seems to be mutating fairly slowly and it makes it very easy to see when it started, where it came from. So the wet market in China is still the most likely place it came from. But no matter what. This is the kind of virus that comes from bats directly to humans.

You know, I’d heard that and I wasn’t sure if it was true or not. Mike, is it is it really from bats? I mean, and then I also hear people saying it came from a lab somewhere.

It’s a chicken egg thing or a bat lab thing. Yeah. There was a there is a lab and move on because of the risk of coronaviruses. It had been studying bats heavily since Saar’s and mrs. So both Saar’s and birds are corona viruses. And there had been increased studying of bats in that lab. But it’s because they’re dangerous and because they’re a risk, not because they’re trying to create coronaviruses or create infections. It’s the fact that somebody was looking at it and researching it because it was dangerous, not that it became dangerous because someone was researching it.

Fascinating. Fascinating. I didn’t know that that connection. Thank you for that.

So as we as we explore this J. Shaped curve, you know, I’m curious, Right..

I mean, I’ve got a three year old and and I’ve got, you know, aging parents. Well, tell me more about that and particular things that you’d recommend for safety and and, you know, just things that we need to keep on our mind.

Sure. Well, I have a couple of theories about why the J. J shaped curve is typically the U. Shaped curve has to do with immunogenicity. So how well your immune system protects you and young people don’t have very well-developed immune systems, so they tend to be more vulnerable to respiratory diseases. And older people also have decreased immune systems. So the the very heavy incidents on people who are over 65, which seems to be where the cut off is to have a dramatic increase in risk that probably isn’t due to decreased immunity. One of the theories is that it’s due to increased immunity, that there was there were two corona viruses, coronavirus, alpha and beta cleverly named, that were circulating in the late 50s and identified in the 60s. And so it may be that those people who were alive in the 50s and 60s before it kind of petered out have some immunity that was developed at that point, which causes an excessive immune response in the older patients. Now, the other possibilities are this virus doesn’t seem to enter the body and then get into the bloodstream and spread everywhere.

It seems more like this virus comes into the body and marches a bit at a time, almost as if the the troops come in and they set up fortifications. And it’s like World War Two. And so the battalions multiply and spread a little at a time. So with that being the case, the interesting thing is that a paper in Nature last week determined that the tissues that this virus is attaching to before the lipid fatty layer of the virus fuses with the cell in the nose and the nose. There’s something called an ace to receptor. That is where the little spiky protein pops onto and holds on. And there two receptors all over the body. But the ones that we’re interested in are the nose. And children don’t have big noses. They also don’t have sinuses. You don’t get a full set of sinuses until you’re a teenager.

Hmm. Hmm. Interesting. So because of that, maybe that’s why they they’re less less at risk to get this.

Yeah, absolutely. If what we’re talking about is something called viral load, which is literally how many virus particles you have, that is. It’s going to be difficult to accumulate in a small child. One of the interesting things I found out was that the nasal cavity size is dramatically increased over the age of 70 and it’s most males. Oh, is that right? Oh, yeah. Certainly we’ve seen that males tend to be more at risk of fatalities, more at risk of catching the virus than females do. The ratio is about five to three. Some studies find about 60 percent of males are the ones who are affected and die and only 40 percent females.

So once somebody gets it, Amy, can they be reinfected?

That’s an interesting question. I don’t think we know yet. Most carone of the answer is probably no. The most corona viruses have immunity from about four months to a couple of years. So this is why circulating colds, you can catch over and over. You get a little bit. But it doesn’t last that long. So here’s a paper just this morning that I haven’t read. That said that those people that tested negative and then tested positive again, it was almost definitely mathematically because the tests weren’t sensitive enough. But time will tell on that one. But most likely there will be some protection for some period of time.

Fascinating. Yeah. Yeah. It’s like the flu. Right. So so I guess if you think of COVID19, like the flu. Is it here to stay?

Well, first of all, the flow is a really different virus. And so while the flu does have parts of it that change on the outside every year. So it’s almost like the reason we get a vaccine, it’s almost like you have a vaccine is a criminal. And every year the virus is a criminal and every year the virus puts on a different mask. So it’s the same criminal. But but you have to make your vaccine recognize the new face every year.

Ok, that’s a good analogy.

All right. Thank you. Thank you. Off the top, my head.

So I think it’s it’s a huge question about coronavirus. Certainly we could stop it and contain it just as they’ve done in New Zealand. But the only way to do that is to maintain quarantines for anyone coming into a new area. If you’re not an island and people can travel easily back and forth, I don’t think there’s a way to get rid of it because it’s too stealthy. It takes too long before you show symptoms. And the the big problem is that you can transmit it without having any idea that you have it. And it can be very subtle. So I think that our best hope vaccines are going to take at least.

Eighteen months. There are some good news that came out from Oxford yesterday. They have a vaccine that they’re now testing in rhesus macaws, which are apparently the closest kin to humans in terms of how you respond to vaccines. But they’re. Going to be a while, and one of the risks of vaccines in humans is that, again, you’re giving your body a little bit of a hint of what to go after so that it can attack the virus. But with respiratory viruses and with the fact that the immune system seems to be such a part of what causes problems with this, the virus, the vaccine itself may actually cause your immune system to overreact when it’s exposed to the virus. This has happened before with respiratory and social virus. It’s one of the reasons why it’s been hard to get a dinghy virus vaccine. So the risk is that even if we can teach the body to ready most, the virus is just going to make the immune system go crazy.

Yeah, that makes a lot of sense. And so it’s a it’s a different animal altogether.

How about along the lines of I mean, we’ve covered transmission, we’ve covered diagnosis and testing.

We could talk about risk. Let’s talk about risk. So as as different communities open up their bars and I’m in Georgia, so opening up the tattoo parlors and the hair salons and bowling alleys and other essential places, people are saying, yes, we’re opening this, but we want to protect those who are vulnerable. The problem is this virus is so new that governments don’t know how to tell people whether they’re vulnerable or not. So we all know that people over age 65 or more vulnerable. But someone asked me yesterday, what about 50? Well, there are three different large studies that have come out in the last two weeks that look at large numbers of people in different communities to show what the risk factors are. I think the most interesting novel discovery is that obesity is a very highly correlated risk factor regardless of age. So why would this be? Well, it turns out that obesity actually up regulates and stimulates these ACE2 receptors. So people talk about ACE2 in hypertension and is two blockers, which you should keep taking if you’re on it. But ACE2 receptors, which is where the virus hooks on, are highly regulated by obesity. So the interesting thing about comparing our results in other countries results is that, as you probably know, United States is 36 to 38 percent of our population with obesity.

And that is way higher than any of the Southeast Asian countries. China has four percent. The United Kingdom has 26 percent. So so looking at what factors these different countries come up with in terms of who is at risk and who has morbidity really depends on what their underlying level of obesity is because it’s so highly correlated. I think the best connection we can make is to have a fantastic study with forty nine thousand people that is submitted, but not yet peer reviewed. But the methodology was sound and they have about a thirty two percent incidence of prevalence of obesity in Mexico. So what they found that was really important is that diabetes and obesity and age, yet less than 40 is a risk factor. They made a a one to seven risk factor chart. And so it was four points which put people all by itself in the moderate risk category of dying from COVID. So there are people who are under 40 who are at risk. And it’s if you have type two diabetes and you’re obese. The other interesting things they found were that immunosuppression, obesity by itself age greater than 65. Kidney disease and chronic obstructive pulmonary disease, but not asthma.

All of those were about equal levels of risk and diabetes by itself without obesity was about half the risk of those. So so there’s risk categories were pretty interesting. The difference in what we have found in our data from New York and in the U.K. is that the top risk factors in both the UK and China, cardiovascular disease was the biggest co morbidity. Diabetes was a second and respiratory problems were the third. But in the US, hypertension was the number one cause morbidity in New York. And the second was obesity. And the third is diabetes. So I think that looking at that is important because what it means is if you are between 50 and 65, all of those groups are probably in about the same risk category. And the more the percent in that age group, the dogs about one point six percent. So much higher than with younger people, but still nothing like the fourteen point eight percent of people that were over 80 there died in China. So the 65 to 80 range is certainly at risk. But young people younger than 65 who have hypertension, who are obese or who have diabetes, those are really the risk factors we need to be protecting.

That’s that’s really interesting. So really, it’s not an age thing.

It’s the things that a company age that oftentimes are present in younger people. But obesity is a big thing. Diabetes is a big thing. Hypertension in.

And so fascinating to to think about this. What are your thoughts about? Look, I it’s so like right now, Amy, I have my wife’s in the medical field. I’m in health care. And so, you know, we’re kind of both busy thinking about taking my son back to school to to the to the his his day care school. He’s three years old. So we’d like we don’t want to do it unless we have to.

And sometimes we do. What are your thoughts about that? I mean, are we really kind of putting ourselves out there?

You know, honestly, I was asked this question about Sleep Away Camp by someone on my Buzzy helps Facebook live that I’m due out on Monday, Wednesday, Friday, and I would let my kids go to sleep away camp. The issues are for people in the house who have immunosuppression or have all the other risk factors that I have mentioned and kids just don’t have those. So unless the child has something that puts them at risk, I think it’s OK to go back to school and think it’s OK to go back to day camp for those guys. This really isn’t any more risky than flu. And could something bad happen? Sure, but we’re talking one to one hundred thousand. Very, very low risk. The idea that I am most excited about is combining some of this information we have about we know that it enters through the nose. We know that older people have bigger noses. We know that it takes a long time for the virus to keep making itself. A couple other things we know are that the virus in the nose can’t reproduce unless the fatty layer confused with the fatty layer of the cells. And it only does that in acidic P.H.. So every little bit lower, P.H., the normal. Well, it turns out that, for example, African-Americans who are a risk factor in themselves and we don’t know why, but their acidity in their nose average is six point four instead of whites, which is six point eight. And one idea is to alcohol, analyze the nasal tissues to use a little baking soda in a nasal rents to make it more alkaline so that if the virus gets in, it can’t fuse. The other thing we know is that betadine, which is a priest surgical.

And on microbial. So, yeah, I’ve never done that. That orangy stuff. You wipe on before you get surgery. So that’s paid a dime. And it happens to be exquisitely good at killing corona viruses.

And specifically, Saar’s code to steadily. Yes, it is exquisitely good at that. So the thing is, people have been using baited on rinses in the nose for about the last five, 10 years before surgery to get rid of a viral load in patients who’ve got chronic sinusitis. The National Health Service actually has a recipe for a nasal rinse that has a half a teaspoon of Eighty-Nine and salt and baking soda. So so we are looking at the concept of finding patients who are positive for rotavirus and then randomising them to do either what they would normally do or to do nasal rinses twice a day with baited on and with a little bit of baking soda in the sailing water. So there’s another factor about this. I don’t know if you’ve ever done a nasal once before. I had not. I haven’t. Do. It’s something to get used to digits.

I did try it. I tried it actually on my on my YouTube channel. And. And that was copied from the three p.m. things on my mother. Buzzy helps Facebook posts.

Hey. So let’s let’s pause for a second there, because that sounds really interesting. So you do something on an on a Facebook alive. And you share stuff about Corona. Like, tell me, because that would be an interesting resource to share with the listeners, too.

What do you do with that? But just kind of take a break to talk about that, because I’m not sure that I know about that.

It started about, well, really when grandma started. We make devices that decrease pain. And our primary audiences are needle pain. So people who have to give themselves injections at home or their arthritis or Crohn’s disease, but also for postop and for people who are on opioids that want to use something else. So because one of the ways to deal with pain is to go to your massage therapist or to go to a physical therapist. We started giving people non pharmacologic solutions they could do at home in a broadcast at three p.m. on Buzzi Helps Facebook Channel or Bazley, if I see you be OK. Well, people started asking me more and more questions about rhinovirus. And I an NIH researcher, once you know how to research one thing and once you know how to dig into Club Med, which is where the published studies are now, it becomes pretty easy to digest and to give answers. So over time, I kept giving solutions for pain and fear and focus. But I started talking about all things COVID right off the bat. And now it’s come to the place that almost all my questions are about COVID. So I’m answering questions about masks and about how to which vitamins you should be taking, which supplements are relevant for rotavirus. And I started thinking about the mysteries of this disease. Why is it that the death rate in Southeast Asia and Vietnam is zero? Why did they have a patient who came in and was in a very populated street and nobody on that street caught the virus? And as I started digging into it, I came to realize that in Southeast Asia, they practiced nasal irrigation like we practiced toothbrushing.

Oh, is that right? Yeah. It’s just a normal part of hygiene and real. So this incredibly low death rate that they have. I started wondering, could this be because they’re using Nair’s or irrigation? And that was even before the study came out that found that the nose is definitely where COPD isn’t. Right. So I started looking at things and I thought, well, you know, if nasal irrigation is the issue, if it if the sinuses are the issue, it would explain the age factor because young kids don’t have sinuses and their noses are small. Males have bigger news cavities than women. It would explain the the timing factor. You know, if you do nasal irrigation, you’re wiping out those troops every time they try to rebuild. So it gives the body time for the immune system to figure out how to respond without being overwhelmed because it’s still only located in the nose. It hasn’t marched down to the throat, to the larynx, making that dry cough. And then down to the lungs where it can spread like crazy. So then I found one of my friends who’s a really amazing ear, nose and throat specialist in Cincinnati, which is where I trained. He said, well, you know, the National Health Service has been sending around to all of the E and T’s this recipe for.

Nine nasal irrigation. And I told him my theory about the alkalinity. And what about using baking soda? And he said, yeah, that’s fine. But it’s been it’s been proven that betadine on is quickly kills the virus. It kills the viruses really fast. And so he said that’s probably why they’re using betadine, because there’s really good data that it doesn’t take much to kill it. So there are a couple other interesting studies. There is a a chemical formula. And I don’t know what it is. It’s E.K. one twenty three and they squirted it in mice’s nose and the mice eat whether they they had already been exposed to corona virus or they had not yet been exposed to coronavirus. They still did not get the disease. So what was. So there’s something that you can put up your nose that was tough. I mean if you’re a mouse, if you’re a mouse. So all of these things together are, you know, as I’ve been learning that I’m sharing them on my Facebook page. And the the hard thing is that in medicine, we are taught to like drugs. We are up on drugs and we have multiple choice tests. And we know this disease goes with this drug. So it’s difficult to get physicians who do research to try something like a randomized trial of assailing rents when it’s not what we do in America. And it’s not a drug.

Yeah, and that’s the challenge, Right..

Let’s park there for a second.

so, folks, if you’re curious about Dr. Baxter’s Facebook channel, Will or her live weekly feeds will leave a link in the show, notes of this podcast for you to tune into those. They sound really interesting and I guess they’re covered focus right now. But but the the the her her focus and her company’s focus, which is not what we’re talking about today, is pain and resolving pain without opioids, with some of the devices that they offer, but also just the different things that they have to offer around this area of pain management and in avoiding opioids. But fascinating stuff here. Amy, let let’s let’s talk about the future. I mean, you know, what does the future look like? People talk about vaccines. People, you know, say, I don’t know, are we ever gonna find one or it’s close. Let’s talk about that.

Yeah.

The vaccine availability is not going to be around soon enough for us to avoid deaths. And regardless of when it shows up, you are still going to have people who can’t get it because there’s not enough. There are going to be people who are so afraid of needles, they decide to wait. Thus reducing our herd immunity. It’s going to be an issue and it’s not something that we can rely on. So one thing is masks. We are going to see masks widespread. All of the airlines now are recommending them not only recommending they’re requiring JetBlue started Delta American. The others came on board yesterday. So for homemade masks, there is really nice data looking at what materials are the best at blocking out corona virus. And so this research that was done found that pillowcases and cotton blend t shirts, the lockout between 68 and 70 percent. Now, it’s not as much as things like vacuum cleaner bags and a surgical mask box out. Eighty nine percent. But the nice thing about cotton blend and the pillowcases with the highest thread count you can get are that they’re very reasonable. So if you’re making a mask at home, those are good materials to use that are not going to be uncomfortable.

And I believe that we will be seeing a long time period of requiring masks in tight and enclosed spaces. The reason that masks are important is not just about not sneezing on things and not pushing other things out when you breathe. The problem is that it’s now been proven. Another study that came out two days ago from from one that there are still aerosolized particles of cubitt in the air. And so anything that blocks out the aerosolized particles that you’re breathing in is going to protect you from getting exposed. Now, based on the other stuff, is mouth breathing better than nose breathing? Probably. But having a mask doesn’t just protect other people as Pence was. Assuming when he’s touring Mayeux, it actually is also about protecting yourself. And given the false negatives and testing, given how long it takes for the virus to replicate and to be able to be found. And the fact that you’re still infectious during that. For him, it’s critically important that he wear a mask because he can still be breathing in particles that are in the air.

And so these these aerosolized particles, Amy, are they they do they happen when other people are around. And that’s why we have the six feet rule or are they just out there and floating?

Well, so the things that they found in the Chinese paper that make a difference are circulating air matters a lot. There is a case of three cases that got a coronavirus in a restaurant because they had the type of air conditioner that just circulates air around. It doesn’t filter it. So if you’re in an enclosed area where it’s circulating around, it absolutely is a risk. And wearing a mask absolutely protects you if you are out jogging. And it’s not a windy day. You are heavily breathing out particles and they do stick around in the air near for a while and the distance from a sneeze can be as much as 18 feet. So the six foot rule is because the corona viruses on respiratory drops are have a little trajectory that’s going to go out. And then gravity pulls them down within about six feet. But when it’s not on a respiratory droplet, when it’s in an aerosol spray, it can linger for a while. So I would jog on a windy day without a mask, but I would not jog or ride a bicycle on a still day without a mask to protect myself.

Wow, that’s interesting. Fascinating stuff. You know, and I’ve gone on a couple of bike rides and I haven’t worn my mask. I have to fill out the air now. Well, this is fascinating stuff, Amy.

And certainly I appreciate your your depth of knowledge and and your willingness to share with with the listeners. Folks will. We’ll make sure to to include a link to to Dr. Baxter’s resources and her company inside of the show notes. Just go to outcomesrocket.health Type in. Amy Baxter in the search bar and you’ll find all of the resources there.

Amy, anything that you want to leave us with?

Sure. I just want to say, if you are someone in pain, we have reduced the price of our by cold devices by 30 percent. And we have a number of pain partners who make everything from pain creams to cooling creams to hot and cold sauces and all of those pain partners. We’re putting the samples in with the viral for free. And we still have some disinfectant that someone donated that we’re putting in for free. So that little plug, if you happen to be somebody with chronic pain, I’ll put that in there and. You know, it’s gonna be fine. We are going to conquer this. We’re gonna figure it out. And so long as we’re transparent about who is at risk and we don’t succumb to conspiracy theories and just really listen to the scientists overall and know that the longer we can stay home and stay safe, the more time it gives his incredible machine that’s putting out so much new science every day, a way to prove what can actually help people keep us safe and get us past this.

Dr. Baxter, I appreciate your insights and and that glimmer of hope in all the things that we’re experiencing. And so I appreciate that. And listeners, again, go to the show notes.

And in there I’ll include not only a link to to Dr. Baxter’s channel, they could tune in, but also a link to the little kits that she’s talking about. If you do have pain or have patients or, you know, deal with populations, employees that have pain, a great resource with multiple options there to help deal with that, especially now that you can’t go to the misuse or physical therapist or do those things like acupuncture Right. that you would otherwise be able to do without COVID amongst us.

So thank you so much, Amy. This has been fun and definitely look forward to having you on again. I enjoy every single time. So thanks for having.

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