Dr Rupy: My name is Dr Rupy and this is the Doctor's Kitchen podcast. Now, in light of the situation, where I usually talk about food, medicine, lifestyle, I think it's pertinent to direct the conversation for this week's podcast around the current situation. Without again contributing to the pile of information that's already out there, I thought this would be a different take on it. So what I want to do today, which is slightly different to the normal regime of what we do with the podcast, we're actually delaying those and we have some fantastic episodes coming up soon. We're going to talk a little bit about what you need to know regarding the COVID-19 situation, the nomenclature, the current scenario as of the 28th of March, things that I don't think will change in the near future and things to look out for. I also want this episode to be a sort of a how-to guide of dealing with the current scenario of quarantine. Things to look out for from your mental health point of view, from a physical and nutrition point of view, as well as some tips of how to navigate the social media and the media landscape in general because I think it's overwhelming for a lot of us. I'm going to be talking a bit about what I'm currently doing within the NHS and outside of the NHS as well in contributing to the Doctor's Kitchen and everything that we do here. So that's sort of the summary of what's what we're going to be talking about. If you feel that you've heard enough about COVID-19, don't worry about listening to this podcast. There are plenty of more in the library and ones that are going to be coming up soon. We've had to put on hold a whole bunch of super exciting podcasts. We've got a three-part series on reversing ageing with Professor David Sinclair. We have David Levitin coming on the podcast, the author of The Organized Mind. We have an episode on the ketogenic diet, CBD, even eating for the menopause. But for now, we're going to break from that and we're also going to do some AMAs with myself. So anything that you need to know about the COVID-19 situation, as well as other things to keep you equipped during this troublesome time. So without, and feel free to skip through this bit if you've heard enough about Corona, but I thought I'd just go through about what the virus is, what you need to know about it and why it's different to anything else and how to navigate everything. So we know that the cause is SARS. SARS is a term that's being bandied around quite a bit. What it stands for is severe acute respiratory syndrome coronavirus 2, that's the formal name. And the disease it causes is something called COVID-19. It is the same strain as the virus that caused SARS, which back in the day was just called SARS in the media, but officially it was SARS-CoV-1, which affected around 8,000 people in the early 2000s. There is a clear DNA match there. We're not exactly clear where it came from. Largely, it's most likely from a wet market in Wuhan. A wet market is where you have lots of different animals brought at the same time. And yes, it's likely that it came from a bat. There was a suggestion that it came from a pangolin, which is like a reptile, but actually it could be coming from a number of different animals. And actually, this could have started in an industrial farm in the middle of America. It could have come from a whole bunch of scenarios in different agricultural arenas around the UK as well. So I don't think it's fair to squarely blame the Chinese for this, even though obviously that's where it originated from. I think we need to be fair to the fact that we all have particularly poor agricultural practices when it comes to livestock and that needs to be certainly looked at in the future when this is said and done. The actual virus itself, viruses are interesting because they don't have, they're not living things on their own. They have to use the machinery from a different organism in which to survive. And so the structure of this is quite simple, but it works in a sophisticated way. There's four main proteins. One of them is a spike protein, that's what allows entry into cells. The other proteins give it structural integrity, so the membrane and the encapsulating of the RNA, which is the genetic material within the actual virus itself. When the protein spikes into another cell, that's when you get the DNA that's released and that essentially hijacks a normal cell, whether it be an animal or in this case a human, in which to divide. And that's how the virus spreads. We know that it enters through mucous membranes, so that's through nose, mouth, but also eyes as well, which is why when we use personal protective equipment, we have to use things like visors. And the visors that cover your eyes as well because coughing, sneezing or even doing procedures that are quite sensitive like intubation, which is where you put a tube down someone's throat in order to ventilate them, those are exposing procedures. So it's really important to have that equipment. And one of the issues right now is NHS frontline staff are just not equipped to have that protective equipment, which is a massive travesty. And I think to Bill Gates' point and a whole bunch of other people that have been warning of an epidemic for a number of years now, we should have really had the stocks of these stock-piled because this is one of the major threats to humanity that we've been talking about for a little while now. So, in serious cases, what it causes is something called acute respiratory distress syndrome or ARDS. And this can occur with normal, I like to say normal, but influenza as well. It's an overreaction essentially of the immune system that causes a fluid accumulation in your lungs. Now, this is particularly troublesome for a number of reasons. What happens is your gaseous exchange surface, so the surface by which you exchange gases, oxygen and carbon dioxide, become completely overwhelmed with fluid. So you're unable to exchange oxygen and CO2, which is essentially very important, it's how you breathe. What this leads to is mal-oxygenation of the rest of your body, which leads to multi-organ failure. If you think back to biology when you're at school, everything, every cell requires oxygen in your body. And so eventually, if you're unable to oxygenate properly, that's where things start shutting down and that happens quite quickly as well. The chest x-rays that I've seen in emergency departments and certainly in ITU as well have been pretty scary. I will get a little bit into why I think it's scarier than influenza, but there are a couple of other features I think that are unique to this particular virus that make it a little bit more troublesome. The funny thing is, not the funny thing, but the reality is simple soap completely destroys this virus. So this is why the initial campaign was all about hand washing and it still is because as you've got a membrane, the actual virus, simple soap can completely destroy that. So if it sits on your hands or clothing or even things like cardboard, steel, copper, there's a few papers out there that show that the fomites, i.e. the virus that sits on surfaces, can be destroyed with simple soap. So that's why hand washing is exceptionally important. Whenever, to put it in context, when I go out and I get my shopping from the supermarket that I might do twice a week or maybe three times at the most, come back home, the first thing I do, put the food away and I wash my hands. Because even though I've been mindful not to touch other things and you're always going to be coming into contact with the food that you put into your bag or the cash register or when you pay with your card, for example, you're going to be touching the screen. So you're going to be touching things that may have viral particulates on them. So it's really important to do your soap washing as well. And that's it's just very, very simple to do. The other thing that I think is, these are unclear things that I'm going to be talking about, but from what we understand at this point, so a few weeks into this pandemic, it seems highly transmissible, more transmissible than the regular or seasonal flu that we experience every year. So that means the measures that have been put in place right now are even more important because we know that it sits somewhere between a chickenpox virus, which is exceptionally transmissible. You put one kid into a room with 10 other kids, 10 other kids will get it, compared to seasonal flu where the transmission rate might be around one or less than one. I don't the actual figure relates me at the moment. So it sits in between there and estimates have suggested that it can be between one and five. And that's a huge variable that we just don't know the exact number on right now. It does seem to disproportionately affect older patients, which is why we are even more aggressive when it comes to isolating those over the age of 65 and those who regularly get the flu vaccine. So asthmatics, pregnant ladies, those over the age of 65, plus those who have medical conditions that require them to be on immunosuppressants in particular. So, there's a lot of information there that I've already talked about and I think this has been talked about a lot, so I'm conscious not to repeat things, but I think those are the main things that you need to understand. Currently, our approaches are maintaining ventilation and maintaining gaseous exchange. The way we do that is by giving oxygen. Given the nature of this particular virus, non-invasive ventilation, which I'll explain in a second, isn't an option. And we have to go to ventilation, which is where we put a tube down someone's neck and breathe for them on a machine. And that involves us having to paralyse the muscles of the body and actually put people into what would be effectively an induced coma. Non-invasive ventilation is where we apply a specialized mask to the face and we under pressure pump oxygen and gases into the lungs to inflate them. The reason why this is not an option for this particular virus is because it aerosolizes the virus. What does aerosolization mean? Well, essentially, it makes the virus present in the atmosphere around where the patient is. And that aerosolization can be around three hours, which is what I've heard in some studies. The reason why this is particularly dangerous is because the healthcare workers that are looking after said patient are then exposed to a huge viral load. And this is what's led to some really unfortunate cases in Wuhan, China, where healthcare workers have become severely affected. And we have witnessed some of those troubling scenarios here in the UK as well. So, non-invasive ventilation, which is something that we do give for patients who have restrictive lung disease like COPD, in this particular condition is not an option. There are some scenarios which would require non-invasive ventilation, but in general, that's the consideration that we have to take and ventilation is the only thing that we give. There are a few different medications that are being trialled. You may have heard of hydroxychloroquine, an antimalarial medication. There are some antiviral medications as well that we tend to give to HIV patients. As of yet, there isn't anything that is a blockbuster trial that shows that there's definite responses and most of them have been Hail Marys. So a Hail Mary is an American football term. I watch American football all the time. It's essentially where you just throw the ball in the air and you just hope for glory. And that's really reserved at the moment for patients who are really far along their condition in a critical state. So, the things that you need to know at this point, I think, after knowing that there are some medications that we're trying, the mainstay of treatment, which is ventilation, the things that you need to know right now. Something called the R naught. So the R naught is how transmissible and how easily spread this particular virus is. Like I said, chickenpox is highly, highly transmissible. The influenza virus is less transmissible than this one. We could probably fairly say that. What we do not know is just exactly how spreadable this virus is. So we don't exactly know what the R naught is. But estimates vary between two to five. What does that mean? Well, one patient could potentially infect two people when having contact, whether it be a handshake, whether it be a hug, whether it be talking to them quite closely, or five people. And that's a huge, huge number because when you put these different numbers into a modelling system, it gives you drastically different outcomes with regard to how quickly the number of cases can spread in a given population. So that's the R naught and you're going to hear that in the news and in papers being talked about quite a bit. The other thing is the mortality rate. Now, trying to assess the mortality rate during a pandemic, during an epidemic, is a very difficult thing to do and it's a very dangerous thing to do as well because it can massively overestimate what the mortality rate actually is. To put an example, during the last pandemic, so during the last swine flu pandemic, what we had is mortality rates that are grossly, grossly elevated during the time. And that ranged from anywhere between 0.1% to 2% mortality rate. And that's massive. When you look back on it, it was far, far lower than that. The reason why is because in a situation where you have a low number of tests being given out to the general population, you are under-diagnosing the number of potential cases and the mortality cases are ones that you clearly know about because you're going to recognise whether a patient has passed away unfortunately from this condition and you're going to be able to easily count those numbers. So unless you have a clear understanding or a clear number of how many cases there are in a given population, you will always going to underestimate it. And when you do the maths to calculate a mortality rate, it's always going to be inflated. So when you look at the news and they are giving you up-to-date, quote unquote, stats on mortality, they are most likely going to be exaggerated. So at this point in time, I'm not that concerned about mortality rate. What I'm more concerned about actually is the percentage of patients that are critically ill. So the number of patients that will require admission to a hospital with potential for ventilation. And the number that we've been seeing is actually quite high. It's around 10% looking at Chinese data. And when you model that, you look at the number of critical care beds that there are in the UK, for example, it gives quite a scary outcome in that the capacity for patients who may require a critical care bed for something like ventilation is rapidly going to be diminished. And that's why we are seeing this week makeshift hospitals being built across the UK. And I welcome that decision because it's a very wise decision to prepare for that. It's a little bit late in the game, but there's no point pointing fingers now. I think the most important thing is to make sure that we are doing as much as we can in this point. So, looking at all the different variables for a virus, the R naught and the mortality rate, how transmissible it is, the only thing that we really have control of at this point in time is how aggressively we socially isolate. That is the only thing that is within our control at the moment. We can determine whether that will be 30 days, 60 days, 90 days and beyond. And I hate to say beyond, but there are suggestions from people who are a lot more intelligent and a lot more informed that there may be a prolonged quarantine period that might be required for this in so as that we can actually deliver medications, more effective interventions, etc. If that's the only thing that we have, then we should be pulling that lever. We should definitely be using that tool as much as possible, which is why, again, something that I welcome, the government has decided to pull that lever massively and encourage everyone to self-isolate and work from home where possible with the exemption of a few key workers. That being the supermarket heroes, the logistics people that are delivering PPE and other necessary equipment for NHS frontline staff, the police, etc. You know the ones by now. With that in mind, I think that's the only thing that we need to concern ourselves at this point. So, socially isolating, as difficult as it is, as easy it is for me to say this to you through the medium of YouTube, podcasting, whichever medium that you're listening to or watching this on, that is the thing that we have within our control and it will save lives. It will absolutely save lives. The other thing you need to be aware of is the news. And it would be, it's something to expect. Whenever you turn on the news, whenever you listen to something on the radio, whenever you look at something on your phone or social media, you should expect that the mortality rate, the case rate, the number of critical care patients admitted will go up. So when you hear a media outlet say, today is the worst number of cases that we've had in the UK, and the next day, we have had the most number of deaths in a single day, that is to be expected unfortunately at this point because as is the case with all viruses, there is exponential growth. There is a an increasing number of cases. So what we expect until we get over the curve is an rapidly increasing number of cases and a rapidly increasing number of deaths before we see the exact opposite. And and just this little realisation hopefully will make you a little bit more resilient to the anxiety and the fear that is that is among all of us right now, because unless you're expecting that kind of news, then it's always going to come to a shock. And I'm exactly the same. Even though I know the maths, even though I expect what's going to happen, whenever I read that new death count or the new case toll, it my irrational monkey brain goes into, oh, that's terrible news and I can't believe this is happening. But my rational brain, my my my the brain that actually applies a bit of logical thinking, steps in and I need to essentially encourage that and actually say, you know what, this is to be expected. It's unfortunate, but this is to be expected. So hopefully that will give you some some understanding of what's going on. It will give you a little bit of um reprieve from what you're going to be expecting to to hear in the news. Those are the main things I want to talk about with the virus. I don't think we're going to be hearing much in the way of a vaccine, a definitive cure for this for a while. I think there's a lot of chat about it on the news. I think there is um there's definitely reason for hope, but I don't think it's something that we should be expecting in the next couple of months. Um as per the nature of creating a vaccine, um it's sort of like uh building a plane in flight. It's it's just not going to happen at this point. Um and I don't think we should be expecting that, which is why again, social isolation, social distancing, quarantining are the most effective measures that we have right now whilst we try and get a hold um get a hold of the situation. The other thing I want to talk about, and this is the the sort of without without belittling the situation, without uh making a mockery of what I'm seeing in NHS and what I'm hearing about um from my colleagues across London and across the UK, there are a lot of positive takeaways from this. I have never seen uh as much appreciation, as much kindness as I have in the last couple of weeks amongst Londoners and across the world. It's quite frankly breathtaking that the uh human collective nature is so moral and kind-hearted. Um I think social media has really rebranded itself in a way because it's allowing me to um to witness some things um that have just melted my heart and it makes me a lot more passionate when I go into work uh in the understanding and in the knowledge that all these uh kind acts are happening. I've been sharing a whole bunch of these on my social media. Um if you flick through my Instagram or Facebook accounts, I've been trying to chronicle them uh as they go along, but they are quite uh inspirational. So I think there's a lot of positive to come out of this. With that in mind, um I think without uh shying away from the negative, um the uh now has never been a better time to shape your social media landscape. Um and I say that with a bit of caution because I'm not trying to call out any uh people that have made it their business to be aggressive or be uh negative online, but I think now more than ever, we need to try and surround ourselves with positivity because there is negativity coming at every single angle, every single news station, every single radio station I listen to. Um I play a game actually, whenever I'm in the car, which is very infrequent now, um I or whenever I switch on the radio, I should say, I I count the number of seconds before I hear the C word. Um and you know, it's it's usually less than 10 seconds. I think the longest was when I turned on Radio 4 and it was an episode of The Archers, um which is the only place that isn't affected by COVID-19 right now. But um yeah, at the moment, it's it's kind of everywhere. And so now is never been more important time to kind of surround yourself with positive uh energy and positive messages. And I believe that we can do that with social media by uh following accounts and unfollowing accounts that you think that are just adding to the mental burden. And I like a rant every now and then and I like to engage in uh releasing a lot of tension. Um but I just don't think right now is the time to listen to other people rant about whatever it is, whether it be moaning or whatever. I mean, to give you an example, um I was doing my daily walk uh the other day and I saw a bunch of kids um on the corner and they were playing music, they were all hanging out, they were dancing. You know, and the immediate uh sensation I had was one of anger. It was one of pure just I was really upset at the situation. They clearly know what's going on. They clearly have come across the news and they know the advice now. It'd been out for a good five days that they shouldn't be meeting in groups with their friends because it's a risk to everyone, not least their families. But immediately, I caught myself and I was like trying to empathise with them. They're young kids, they don't have the same understanding. They have no idea what we are dealing with on the front line in the NHS. They have no idea about the virus. They probably can't even contemplate this. What they are seeing is that they are being told not to go out and socialise. They are bored. And I was looking at the kids actually, um that were continuing to go to spring break. And I remember thinking again, how selfish, how on earth they do that? Like how how dare they? But at the same time, if I fast if I rewind back to when I was a, you know, 17-year-old, 18-year-old, and I was told that I couldn't go away on my trip that I've been looking forward to for five, six months, I'd probably be just as selfish as them and I'd probably think, yeah, I'm invincible and this is just the regular flu and I'd try and convince myself of that bias as well because we're all privy to bias. Um and we believe what we want to believe as long as it's in our best interest. So, I and I've seen a lot of people practicing this. Um and it's something that I try and practice on a daily basis whenever I'm in A&E or whenever I'm in primary care because I think it's really important to empathise with people's scenarios. Um and for that reason, I would encourage you to listen to an incredible YouTube uh talk by uh David Foster Wallace, This is Water, um because I think we make uh characteristics and we make assumptions of what people are doing. Um we assume that it's from coming from a negative place, but actually there are a lot of other things that we don't understand um with uh with people, with patients, um with people in our lives. Um there are people that are more vulnerable than we'd want to believe. And um I'm not saying that's everyone, but certainly it's something I've been uh practicing a lot. Okay, creative energy. So, uh right now, um when you're, if you're listening to this at home, uh if you are, you know, dealing with children, um if you're dealing with boredom, now has never been uh an a more pertinent time to get creative. Um I'm trying to get back into painting. Uh I'm also trying to uh tick a whole bunch of things off of my list that I've been meaning to do for a number of uh years now. Um I think without belittling again the situation, now has never been a better time to focus on self-help and looking after your mental wellbeing and your physical wellbeing through food and lifestyle, but also mental health practices. I'm going to be getting back into my breathing practices. I've been sharing a a bunch of those actually with a colleague of mine who's a neurogastroenterologist on uh Instagram. I've been uh trying to uh give myself a bit more time for gratitude, something that I've been practicing for a number of years now. And uh I think a lot more people are going to come out of this uh believing a bit more in slowing down and changing their value system to appreciate self-care a lot more. I think corporates hopefully are going to recognise the value of flexible working and how productive people can be um when working from home. Um and uh from from people that I've heard, I've heard that it's never been a busier time for for uh those working in a whole bunch of different industries. So, without again trying to um over-sensationalise the benefits of quarantine because certainly it's impacting a lot of people on the hospitality industry, uh entertainment industry, uh cleaning industry, and a whole bunch of different industries that are adversely affected by this. I think there are some positives to hold on to as well. And hopefully that will come out with um that will come out with with a few more stories that we we hear about too. Um I think uh and unfortunately not for those listening to the US, listening in the US, but um the UK stimulus package is is uh quite incredible. It's very generous. I think there are a lot of uh um amazing things that the government has been responsible for. But I mean, I'm definitely the first person to to think of all the negative things, but again, in light of what I've just been talking about with regards to positive energy, um the stimulus package, um the inclusion of those who are self-employed, um the protection um that they've at least put in theory um out there, um is something definitely to welcome. And I think that's given a lot of people some reprisal from the anxiety of this scenario. Not everyone, um and again, this is me coming from a very privileged position where I still have a job. Um and uh I was actually talking to a colleague of mine the other day about how um we're actually very, very lucky uh in that we get to go to work, we get to uh experience uh like having and maintaining our social um our social bonds, even though yes, we're on the front line and we are we have to deal with uh coronavirus as it is at the moment. Um there are definitely some some benefits to this whole uh scenario to us. Um and I think it's I've never seen a more um encouraging, morale-boosting uh department uh than in the last couple of weeks. So I think there are definitely benefits to us as well, uh even though there are clearly risks too. But uh yeah, we're pretty privileged that we get to uh maintain our social interactions in person, um that I think will rub on a lot of people in the next couple of months, um if this goes on for that long, which I I expect it will do, unfortunately. There are multiple opportunities um at this point in time. Books right now that I recommend are ones that are just spreading positivity. The Language of Kindness by Christy Watson is something that I encourage everyone to listen to and everyone to read because uh I mean, I I had her on the podcast um and I would definitely give that a listen again if you haven't. But it's just an inspirational book uh looking at how the NHS runs regularly and how we are always um there or this organisation from the cleaners to the administrative staff to the managers are always, always working at full capacity. Um and there are multiple crises, perhaps not as big as this pandemic, but certainly uh an undertone of crisis that healthcare workers are always, always dealing with. And so just to give you some perspective of why it's not even a question for people to still go to work despite putting themselves at risk, uh potentially, particularly frontline workers, but it's um it's just like the norm anyway. Um so highly, highly recommend that. Other ways in which you can foster kindness would be um through having uh authentic conversations uh with friends and family. I can't tell you the number of people that reached out that I haven't spoken to in a few months, um who have just felt it upon themselves to just send a message or just check in, see how you're doing. Um there are so many opportunities for us to do that now with things like social media, WhatsApp, email, and Skype and Zoom and all the incredible tele uh video conferencing tools we have at our disposal. It's never been uh a more important time to connect, but an easier time to connect as well. So the opportunities to connect are just incredible. And uh yeah, like I said before, getting creative, um painting, um ticking things off your list that you've always wanted to do or you've you've felt that you never had the time to do. I just think it's it's um a brilliant, brilliant time to to do that. One thing I do want to, and this is a couple of more points now because I feel like I've gone on for a little bit, but one thing I did want to um draw attention to, and I'm sure parents across the UK are feeling that, but perhaps being left out of the conversation are teenagers. Um there are a lot of uh uh accessible um materials for for younger children, um but teenagers are I particularly, particularly um I'm upset for um those who were meant to do their GCSEs, um for which, you know, sets the foundation for A-levels and university, and those who are sitting about to sit their A-levels later on this year, who are going to have university uh issues in the next couple of months. And in the grand scheme of things, whilst there's a pandemic on, I understand why that perhaps is not on the forefront of many people's lives, but thinking through the lens of me as a 17-year-old, um I had to pull out uh some incredible revision techniques and loads and loads of um hard-working hours to get the grades that I needed to get into medical school. I certainly wasn't predicted the grades that I needed to get into medical school. And if I had to uh if if my grades were based on my prior performance for the year before, I probably wouldn't have got into medical school. And I really fear for a lot of teenagers in that particular bracket right now. It's certainly going to have an overarching uh impact on people's livelihoods uh going forward. Uh and I just feel that perhaps teenagers are being left out of the conversation when it comes to um uh their livelihoods and and what they're going through at the moment. And uh if there's one thing I'd love to do is uh teach a whole bunch of them to cook. Um it's it's something that I was taught how to do as a 17-year-old by my mom before I went to medical school. And I'm so grateful for that skill because prior to that, I wasn't cooking whatsoever. And so, over the next couple of weeks, I'm going to be doing a lot more lives, a lot more cook-alongs, and trying to uh give uh teenagers in particular, those who are going through a hard time uh with inconsistencies and uncertainty about what they're going to be doing in the next couple of months and how they're going to be dealing with university applications and and other uh um exam uh modules and stuff, um by giving them uh the tools to to look after themselves. I I I am a huge believer that cooking should be taught in um schools itself and it's just not. So I think again, to my point about opportunities, this is potentially a really opportunistic moment for a lot of uh teenagers as well. Um I mean, yeah, at the time, if this was going on during the time that I was a 17-year-old, I would be livid, anxious, rebellious, all at the same time. Um I don't know how I would feel and I really do feel for those people. So, um if you do know anyone or if you're a parent of a teenager or you're listening to this as a teenager, um I will be doing a lot more stuff for you guys coming in the next couple of weeks whenever I can and uh and giving you some skills to at least look after yourself um mentally and uh and physically as well using food. So, what am I doing right now? So, uh currently I work largely in A&E. My uh current rota has been over the last couple of years, two to three days a week. That crosses paediatrics and adult A&E as well. Um the likelihood is, as per a message I just got from my boss the other day, that I'll be going back full time, which I'm obviously um gearing up for. The um it's definitely not the right tactic to jump straight into A&E immediately. The reason being is because at eventually we are all going to suffer from COVID-19. Hopefully, all of us will get a mild case. Um some of us will be a bit more severe. Um but to to staff everything right now, the calm before the storm is perhaps the wrong tactic. And so I'll be stretching out my um increasing clinical duties over the next couple of weeks um with essentially the expectation that there will be people taking more leave because of sickness. Um and you need to have reserves and you need to space out your staffing needs. And I think a lot of A&Es are doing the same sort of thing when it comes to tactically trying to tackle the wall of water that is coming towards us in terms of the number of um severe cases that are going to be coming through primary care and secondary care over the next couple of weeks. So I'm tentatively waiting for that call. Um and I believe it will start in the next seven to 10 days or so. Um in my downtime, it's never been a more important time to think about my own personal health and to try and encourage other people to think about their health as well. Prior to this, uh as I've always been a firm believer in, you know, we can do better when it comes to our own health. We can do better when it comes to our own mental health. We can put a bit more focus on it. Um and to my point that I said earlier, I think uh this is potentially going to be beneficial in terms of at least encouraging and nudging people to think about their own personal health in a more pragmatic manner. Um we know that we are micronutrient deficient overall and those micronutrient deficiencies uh contribute to a a whole a whole host, a whole roster of different conditions, whether it be obesity, whether it be um inflammation-related uh conditions, high blood pressure, immune um uh deficiencies, etc. And so I'm still going to continue what I'm doing. I still want to release a whole bunch of podcast episodes on how to look after your health using food and lifestyle. Uh and I will continue to do that, but right now the opportunity I think is encouraging people to cook from scratch from home. And that's why I'm so excited to do more lives and I'll be doing some things on uh Zoom so I can actually have an interaction rather than just on uh live social media where you you lack that ability to watch other people and guide them as well. So, yeah, that's perhaps the the biggest opportunity I have right now to influence as many people as possible. And I'd encourage anyone listening to this to please do sign up to the newsletter because that's where you're going to get the links where you can and it will all be for free, um where you can actually cook along. Um and I'll explain to you what the benefits are, all the different foods I'm using and the swaps as well. Um one of the good things, and obviously there are a lot of bad things to come out of the um lack of supplies in supermarkets, but one of the good things, and again, I like to put a positive spin on everything, is that it's encouraging people to get a bit of variety in their diet. If you can't get hold of radishes or celery, then you're going to have to opt for parsnips or swede or turnip, things that you probably have never even used before. Um I doubt many people listening to this perhaps are in the same bucket because if you've been listening to this for a while now, you've probably come across loads of different techniques that I've taught you or other people have taught you how to use uh different vegetables, etc. But um this has never been a more opportunistic time to really uh think about um ways in which to get diversity into your food. And so hopefully, if there is a positive to come out of people's supermarket uh habits, which has been um again, yes, you could easily say it's deplorable and I think that's my initial reactive response to this, like how dare they, how selfish. Um but you never know. They could, you know, when you see someone who's piling up loads of tins for their um uh for their supermarket shop or getting all the veg and stuff, they might have a family of six to feed. We just don't know. Or they might be uh stocking up to help their elderly parents uh in an effort to make sure that they don't have to go to the supermarket more than once a week uh or more than once every two weeks or perhaps they come from a vulnerable household. We just don't know. And so I'm less inclined to uh point the finger or tut or do anything like that against some people. We just because we just don't know what their background is. Um the reality is, on the other hand, there will be more than enough food for all of us in the next couple of months. Um there will be more than enough supplies. So I'm not worried about that whatsoever. Um but uh we we will need to be a lot more exploratory, a lot more experimental, and hopefully I can give you some solace into how we might do that. The other thing is, um I do want to make this podcast over the next couple of weeks uh a helpful resource for you, um a source of positivity, a source uh of solace from the inevitable COVID-19 chat everywhere else. If you do want to engage in those sorts of discussions, I have a whole bunch of uh podcasts that I listen to personally because they talk about the latest literature, they do not shy away from the science, and I find that a uh practical way of getting some overall uh picture of what's going on and then I can do my own uh my own individual research into the papers that are referenced and the wider conversation around that from a scientific point of view. There are a lot of podcasts that do that very, very well and I don't want to add to the the catalog uh and the, you know, avalanche of of podcasts talking about the same subject. This, I think, I want to try and uh give a a little bit more flexibility to and a little bit more um positive spin to it to everything that I do at the moment. So, I want to uh add an AMA functionality to this. So, if you do have any questions about this topic, whether it be about COVID-19, I can direct you, or um if you want to want me to try and give you inspiration as to how to use food or how to uh improve um your quarantine quarantine situation, um just let me know. And what are you sick of as well? What what do you not want me to talk about? Um what do you want solace from? I want to end uh just by summarising what we've talked about, but also how you can potentially help as well. The uh NHS volunteer scheme was just completely overwhelmed by incredible, incredible people trying to volunteer their time and I think that's brilliant. So if you haven't heard of it, um please do go online, volunteer and you can volunteer to do a whole bunch of different things. One thing that I'm particularly worried about and I think will need uh a lot more resources for, and I think is needed anyway, and I'll explain why in a second, um but a lot of frontline workers are going to be experiencing something called PTSD, that's post-traumatic uh stress disorder. Um we're going to be making some difficult decisions uh once we uh run out of resources, um we're going to be making some tough decisions about um clinical uh scenarios. And the aftermath of that is going to be a huge psychological strain to a lot of people who may have only been in the profession a couple of years, but even those who are really senior as well. And I've firsthand seen a lot of that already. Um if you come from a uh a psychology background, um if you have um a clinic uh or if you are able to offer services of that manner, um to improve and to help with people's wellbeing, maybe you're just a very good conversationalist as well and there are ways in which you can volunteer your time for that, um that would be of immense, immense help. It's something that perhaps hasn't been talked about right now, but I think over the next couple of weeks, um we're going to be definitely going to be having more of these kind of conversations uh and I'm worried about that if I'm if I'm truly honest. Um so if you do have any skills in that respect, I would certainly, certainly uh recommend you uh try and uh reach out to your local general practice or your um uh local hospital and volunteer in that respect. Uh there is beatcovid.co.uk, um which has a suite of different resources, so try and look at those too. Okay, so what we've talked about, we've talked about what you need to know about COVID-19. I hope I've given you some structure to approach the news as well. I really hope this gives you some way of understanding the numbers that are going to get bigger over the next couple of weeks, okay? It's going to be anxiety producing, it's going to be shocking, but I've hopefully given you a framework by which to approach that and to rationalise that as well. Okay? It's it's I'm going to have the exact same irrational feelings, but hopefully just with that suite of ideas about R naught, the spreadability of this, the mortality rates, the numbers, if you can expect that, then hopefully that will give you um the ability to to deal with that at a psychological level. Um we've talked about the opportunities, we've talked about the positive takeaways from this. We've talked about dealing with anger online and how I think we should be even more than ever shaping who and what we follow online. Um I would uh encourage you to embrace uh yourself looking at kindness online. Um it's it really is heartwarming a lot of the things that we've seen as well. And I think um we're going to see a lot more of that in the coming uh months. And um also to resonate and to understand the irrational behaviour or the selfish, quote unquote, behaviours of of young children, uh young adults, I should say, because um at first, it seems uh incredibly egotistical and incredibly uh reckless. Um but I I I highly recommend you we try and empathise with what's going on in that respect. Um not to ignore it, not to not say that we shouldn't reprimand people like that, but to approach the subject with kindness and compassion rather than pure anger. Um if you look at Twitter, uh and if you um follow people online, it's very easy and it's encouraging to be reactive to this. What I've tried to do personally is to try to not react um and try to take a step back and a breath before I think about what I'm typing or uh how I'm thinking. Um even if you don't, I mean, I tend not to use Twitter that much. But um uh take a take a breath, uh recognise what your initial feeling is, your visceral gut feeling, and try to um just breathe through it. I've had a few instances uh myself of being a bit more snappy than usual, um being a lot more uh out of my normal character, if I'm honest. Um and I think that's a combination of things, uh a bit of worry, um the uh the anxiety around my family, um the anxiety about uh work uh and what the future is for the Doctor's Kitchen, how uh the world looks in a year's time, the um aspirations I had uh for my own sort of uh commercial interests and uh what I want my non-profits to do. Um there are a whole bunch of reasons and you can certainly rationalise it, but again, breathing through that and and being a lot more mindful of of how you're acting, I think is um a good strategy to have. And and as someone who's pretty chilled out uh by my own sort of uh my my own uh sort of understanding and and my my own degree, I I think it's uh it's quite out of character for myself. So, um if your partner or your family is acting in a strange way, just again, um take the same sort of perspective that I do when I look at young kids and I I think what they're doing is reckless and stuff. I think there's there's certainly a lot of solace in and trying to understand and and approach it with compassion and kindness. Like I said, AMA, uh ask me anything, send me loads of questions. I'd love to do this podcast in this sort of fashion again. If you're watching on YouTube or you are listening online or whatever podcast player you're um listening to, please do leave us a comment, um and a review, and I will try and uh do more of this if you feel that these are helping you. For me, this is kind of like therapy as well. It's kind of like just me opening myself uh up um to what's going on. Um and uh hopefully over the next couple of weeks, I'm going to be giving you some frontline stories from some of my colleagues that are um in different A&E departments and different departments as well. Uh because medicine will still go on. Um the patients that we see aren't just COVID-19 patients. For example, uh on the just a couple of days ago when I was in, we had uh a child that has a new presentation of a growth. We had um a uh another person who had an abscess. We had an appendicitis, we had renal colic, we had complications of cancer therapy, we had a flare of inflammatory bowel disease. Um you know, medicine will still go on. Um but uh there are obviously pressures on the entire system and we are witnessing how flexible we can be. There are some positives to come out of that and perhaps we can discuss that next time. But um if there is anything else that you want me to talk about on this podcast, please do leave us a comment. I will try my hardest to record something even if it is the middle of the night because unfortunately right now, there is no one to cook for in my kitchen studio, um apart from you guys on uh live social. So, I will catch you another time. Please do give this a five-star review and uh I will see you next time. Thanks a lot.
