Dr. David Katz: Different Perspective on early Covid 19

We're living in a world of 24/7 corona virus news and alerts. As such, we reached out to Dr. David Katz, a physician well known for his expertise in the public health arena. In this special fast tracked episode, Dr. Katz shares a contrarian perspective that is certainly worth a listen. HOWEVER - please do not misinterpret his message - SOCIAL DISTANCING AT THIS TIME REMAINS CRITICAL FOR ALL OF US.

Dr. Katz was also recently (3/14/20) featured in the Wall Street Journal and has written further about the topic here: https://www.linkedin.com/pulse/coronavirus-mortality-reality-check-david/

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Transcript

Dr. Cooper:   0:07
Welcome to the latest episode of The Catalyst. Health, Wellness and Performance podcast. Where we bring engaging, evidence based practice to health and wellness coaches and others who are looking to improve their own lives and those around them. I'm your host, Dr Bradford Cooper, and today we're fortunate enough to have Dr David Katz joining us to provide some perspective on the Corona virus, what we're learning, and what we can be doing. Dr Katz joined us is a guest last October. It's Episode 55 if you want to look back. In addition to being the author of a new book that came out last week titled How to Eat, he's also a physician who specializes in preventive medicine and public health. He was kind enough to schedule this interview in the midst of what you can imagine is an incredibly busy time for him, and I think you'll be glad you tuned in. It's absolutely important that we all do our part, and I know everyone listening to this is doing just that. At the same time, Dr Katz also provides some important perspective that you may not be hearing from the mainstream media, who frankly, their primary job is to keep us tuned in 24/7.  

Dr. Cooper:   1:09
Now, before we jump into the interview, two brief highlights. Due to travel restrictions we've worked with in NBHWC to ofter an at home fast track Wellness Coach certification. It's available as of this week for those who want to pursue the national board certification before those requirements increase, but you want to complete everything from home. Details are now available at CatalystCoachingInstitute.com or, as always, feel free to email us anytime for information Results@CatalystCoachingInstitute.com. The second thing is, starting next Monday, we're launching a bonus weekly series titled The Monday Morning Catalyst. Every Monday morning in five minutes or less we'll provide you with a boost to launch your week to a new level. We thought maybe this was a good time to get that rolling, and we could all use that little boost right now. Our more traditional episodes, don't worry, they're not going away. They will simply be moved to a Wednesday release date. Now let's jump into this interview with Dr David Katz on the latest episode of The Catalyst Health, Wellness and Performance Podcasts. Dr. Katz, it's great to have you join us. Thank you for doing this on such short notice.

Dr. Katz:   2:25
I'm glad to join you again, Brad. Thanks for having me.

Dr. Cooper:   2:27
There have been many additional developments over the past weeks since we scheduled this interview. How would you summarize the latest insights you've gathered from what we currently know about what's going on with the Corona virus?

Dr. Katz:   2:39
Well, the contagion of anxiety is even greater than the contagion of the virus. And, you know, I think just the level of preoccupation with the number of cases, the number of deaths is inevitably going to cause that result. One of the things I'm very committed to, Brad is helping people contextualize this. So you know, for example, in the United States, in an average year, about three million people die. We have a population of well over 300 million, so three million people, is a little less than 1% of the population. And those deaths are of course, highly concentrated among people with chronic illness, and the elderly especially. And we have to accept that's part of being mortal. We get old and and we die eventually of something. And if we were to fixate on any of those causes of death and sort of, you know, if we gave them an exotic name, we gave flu a new name, we gave heart disease a new and unfamiliar name, and the press 24/7 were reporting another death. I mean, we would absolutely be freaking out. I mean heart disease kills, in the United States alone, every three and 1/2 days more people than the Corona virus has killed all around the world in the past several months. And I don't say this to in any way reduce the attention that Corona virus commands and deserves and the respect it warrants. But we are all caught up in a significant degree of risk distortion. And again, this tends to happen when something is new and shiny and in the news all the time.  

Dr. Katz:   4:21
So, you know, I think we're doing a lot that's probably unnecessary. I think in many ways, the degree of societal upheaval that we're imposing on ourselves, we're sort of doing it instead of the virus. So, worst case scenario where lots of people are sick and can't go to work. Everything would shut down. Well we just went ahead and shut everything down. So we kind of have the worst social situation. It remains to be seen whether or not this will help curtail spread of the virus. But the practical advice I want to offer people is we should all be working very hard to identify those members of our personal networks who I would call EV, especially vulnerable. And the global data, we can get further into this as you wish Brad, but the global data, indicate quite clearly that overall, 99% of Corona virus infection is mild, meaning no risk to life, no need for hospitalization. You don't feel great, but you get better and some people probably don't have any symptoms at all. And the severe cases are highly concentrated in those over age 70 and even more highly concentrated in those over age 80. So I think we could achieve massive good if we all figured out ways to protect our chronically ill, immuno compromised, frail and especially elderly loved ones from potential exposure. And that means things like you know, them not gathering with the college students we've just sent home to everybody from college campuses. Them not staying in gatherings that are multigenerational, where the younger members have been traveling and exposed to others. Them not being in big crowds in the supermarket, and on and on it goes. And you know, I think that targeted effort is really important and potentially a much better way for us to do something as individuals to help one another, but also for the public health system to respond.

Dr. Cooper:   6:20
Let's talk about symptoms just for a minute. What what are some of the first symptoms someone might note? You said, in some cases you won't even know you had it. But what are some of the first symptoms someone might note if they're potentially infected?

Dr. Katz:   6:31
Aches, fever, cough. This is, you know, it's a deep respiratory infection, so if you're sneezing, if you have a runny nose, that's actually not likely to be Corona virus. There are lots of other respiratory viruses that could be, but typical what we would call cold symptoms are not characteristic and actually tend to help rule it out. So deeper respiratory infection causes pain in the chest, shortness of breath, fever, body aches and a dry cough. This viral pneumonia that results from COVID 19 typically produces a dry cough, so you're not coughing anything up. So those would be symptoms of early infection, it can progress from there to a deeper involvement of the lungs. We've got a real challenge in striking a balance between what individuals can do to minimize the risk and what we really need the public health system to do. So you know, if you think you have this, but you're not in severe condition, the last place you want to go is to a hospital or clinic. You don't want to go there because if you don't have it, you might get it there, because everybody else who thinks they have it is going there. And you don't want to go there because if you do have it, those are the very people who can't afford to get it. So, you know, I honestly I think it's going to be difficult for us as individuals to do all the right things unless the system is helping us and the system should be providing things like mobile testing. Certainly testing in sites well away from where sick patients or elderly people are gathered.  

Dr. Katz:   8:05
So you know, we're all going to be somewhat dependent on a well orchestrated public health response. We perennially under fund public health and prevention in the United States. We really don't have the robust system in place that we need, but there is a lot we can do nonetheless, as individuals and as family members. So again, you know, if you feel you're robust and healthy and young and you've got a dry cough, you're achy. You should contact your doctor's office via telephone and ask, is there a way for me to get tested? Because if I have this, we we want to know because we're still trying to figure out the global epidemiology of this. We need to know who has it. We need to isolate who has it. So call your doctor's office, do not rush out. Don't take your symptoms out into the world where you risk transmitting this, and see if there's an opportunity for testing that may not be available right now, but those resources are being developed and deployed. Obviously, you know, if you're in distress, so if you're an older person and your symptoms are severe, if you have to call 911 you have to call 911, and no one should hesitate to do that. But we definitely want to limit the allocation of the health care system resources to those that really need it. And again, overwhelmingly, people with this infection don't. Young people tend to get mild infection, and by young, it looks like almost everybody under the age of 50, very few cases of severe infection. It happens, it's not completely out of the question, nobody gets a guarantee right? I mean, that's true about anything.

Dr. Cooper:   9:45
Absolutely. 

Dr. Katz:   9:46
I mean we could say the same about heart disease, right? I mean, you know, heart disease rarely affect somebody in their twenties. But every now and then there's an anecdote of this person who is 22 and had a massive heart attack but very, very rare. So almost all of the risk is concentrated over 50, much higher over 60, vastly higher over 70 and monumentally higher over 80. So, you know, really, as you get into the age group that is at risk of everything else, just dying from any cause in any given year. That's where most of mortality is concentrated. That's where the vulnerability to severe Corona virus infections concentrated as well.

Dr. Cooper:   10:20
Okay, we keep hearing this two week thing. Once we're infected, how long does it last? Is that two weeks fit into the overall picture in terms of the quarantine phase, when you're not gonna give it to somebody else? Can you talk us through why we keep hearing this two week phrase it all?

Dr. Katz:   10:36
Well, there are a couple of issues here. I don't think we can say with confidence yet what the recovery time line is. I've been tracking the data pretty much on a daily basis and I guess we have 78,000 people worldwide, just shy of 80,000 people recovered. And it looks like the full recovery for people who don't get very severe disease requiring hospitalization, runs its course in 2 to 3 weeks. But before that there's an incubation period, and that also looks like it could be as long, in relatively rare cases, is three weeks, but not infrequently a week or two. And that's the time during which you've been exposed, you are infected, but you haven't yet developed a clinical syndrome, so that's referred to as the incubation period. The problem with that incubation period from a public health perspective is it looks like people can transmit the virus before they show any signs of it, which is why, you know, again, we really do need a robust public health system. So South Korea is really the one place in the world that has very effectively documented the cases and the distribution of the disease. And they did this not by waiting for people to report symptoms, but by systematically testing the population at large. And the result is, I think we're getting the best window into the real epidemiology of this disease from South Korea.  

Dr. Katz:   12:06
So, for example, I think everybody's heard about the terrible situation in Italy, northern Italy, especially. And, you know, the health care system is being overwhelmed there. What's going on? Well, several things. First, you know, I think the disease was introduced to Italy directly and without any interruption from the epicenter in Wuhan, China. Secondly, this happened before anybody was really aware that they should be doing anything to interrupt further transmission of the disease within Italy, so I think it became very widespread. Third, there's been no systematic testing, so I don't think Italy has a clue how many cases they have. And one thing people need to realize, Brad, and you're aware of this, but it's an important issue in epidemiology. So if we're trying to figure out, how bad is this disease? How often does it produce severe infection? Death? Well, the numerator that is, let's say, deaths from Corona virus, we're not gonna miss those. You know, that's really hard to miss. But the denominator is everybody who has it. And if a whole bunch of those cases are extremely mild, that's easily missed. In fact, it's almost inevitable that you're gonna miss that unless you go out and look for it. Well, the Italians didn't go out and look for it, and frankly, we haven't done that yet here in United States either. And so, based on the data, I think Italy has 200,000 cases or more or Corona virus throughout the population, and that's why they're experiencing so many deaths all at once because it's essentially, there's been massive exposure at the national level, and all of the deaths that this virus can cause in frail elderly people are happening at the same time.  

Dr. Katz:   13:47
The other issue is that Italy happens to have the oldest population, greatest concentration of people in the eighth decade of any country in Europe, so they have an older population, they had massive, widespread transmission, no effective surveillance, looking for cases, no effective interdiction preventing the spread. They are a cautionary tale for us. If everybody in United States were to get this all at once and 1% or something like that were to get severe infections, that would be a very big number of people all at one time. So we certainly don't want that to happen. Which is why there were all these arguments for social distancing. Again, I think that makes sense up to a point. I just think we could be practicing social distancing in a more concentrated way. So we are distancing those most prone to severe infection while allowing young people, healthy adults to go about their business and keep society running. Because the level of disruption is extremely concerning in its own right.

Dr. Cooper:   14:53
So let's run down that path just a little bit. If you were able to give guidance, if you were the man that everybody's come to you and said okay, Dr. Katz, you are in charge from now on. What are we telling everybody? What would your recommendation be for the broader population as a whole, for a governor of the state? What should he or she be saying? What should we be telling people to do? Because you're right. The big message right now is drastic. It's shut all down.

Dr. Katz:   15:22
Yeah. So for better or for worse, Brad, I have gotten my ideas to the governor here in Connecticut, to the public health leadership, I'm routinely corresponding with people in positions of decision making authority. I say for better or worse, because, you know, all I can do is use my training and my intuition and the data to produce my best speculation on the right responses because nobody's gonna know what the right response is until this is all over. And we have 2020 hindsight. And maybe not even then because, you know, the problem will be that we'll only have the data based on what we did. We won't have the data based on what we didn't do. So we may never know the absolute best response. There are all sorts of uncertainties here. When people get over this, are they completely immune, are they immune for life? Are they immune for the season? Does this go away forever? Does it come back annually like the flu? So much we don't know.  

Dr. Katz:   16:21
But to the extent that I can reach authorities and to the extent that I am working to disseminate my point of view, it's captured in my latest column, I'll share that link with you Brad so you could post it, Corona virus mortality reality check. Basically, what I'm arguing for and so far as I know, I'm the only person arguing for this, which makes me nervous, to be honest, because I'm not sure I'm right. I kind of feel like we're doing everything wrong, and I can't stay quiet, but I don't want anybody to think I'm sure. I mean, nobody should be sure. Anybody tells you they're absolutely sure about what we should do, you should, you know, run the other way. But I think we should be doing what I call vertical interdiction rather than horizontal interdiction. So again, I use the word interdiction to refer to anything we can do to shelter people from this disease and protect them from getting infected and getting severe infection and being at risk of dying from it. And some of that's personal hand washing keeping, you know, don't hug, don't shake hands. Stop touching, you know all of that. And some of it's public health, like, you know, having testing away from hospitals and clinics and providing people safe ways to access food and essentials they need and all of those things. Horizontal interdiction is what we're doing, which basically has shut everything down. Send kids home from schools, send kids home from college, shut down businesses and, you know, essentially try to prevent spread at the level of a population of 360 million people at large. And by way of analogy, you know, I don't know if this is a great analogy or not, but it's the one I put in my column today. This, to me seems a little bit like saying, okay we're gonna take all of our lifeguards, send them randomly out to the population to kind of shout the message that everybody should learn how to swim. I think we should have the lifeguards at the beaches and pools. And so that's what I mean by vertical interdiction. And by that I mean, I think kids could be in school, and I think what we should have is, and again, if I ran the zoo.

Dr. Katz:   18:34
And I'm reluctant to share a message that's at odds with what people are hearing because I don't want to give them another reason for anxiety. But again, you know, I think kids, there has not been to my knowledge a single death of this disease anywhere in the world in someone under age 30 and if there has it's been extremely rare. But none at all in children. So you know, they seem to be especially prone to mild and even asymptomatic infection. Now is there concern for teachers and school administrators? Yeah, we need to identify the vulnerable among them, and all schools and all public places should have policies for allowing those who have chronic illness, immuno compromised, or elderly to stay away. So, you know, even if we were to continue running our society as usual, we'd have to poke holes in it to protect the vulnerable. Same thing, really, with all other work. I think you know, young, healthy people under 50 could go about their business. The economy could keep humming. And we should be clear, Brad, you know, I do think there are potential costs, even in lives of shutting everything down. You know, at some point, disruptions and goods and service and things people need, you know, have the potential to prevent somebody from getting a prescription medication they need. And, you know, I'm not sure we have fully collated the society spanning consequences of kind of shutting everything down for an indefinite period of time. So I would I would say we identify the especially vulnerable based on everything we know. We've had several months of watching this virus spread around the world. We've seen who's gotten better. We've seen who's got really sick. There's a lot to learn, but we know a lot already, and we could leverage what we know to preferentially direct our resources to protect especially vulnerable. Let elderly people stay home. Develop means to deliver their groceries to them, keep them away from large gatherings, do not let them gather with the college students we just sent home from places like Chicago, L. A., New York, which has the highest concentration of Corona virus in the country. And for instance, I've got three of my own kids back at my house and they're all in the age group, one's from New York, two are from Boston. They're all in the age group where they had been at parties, they interact with lots of people. Some of their friends have traveled, who the heck knows if they've been exposed. So what we're doing in my own family is saying, okay, it's fine for you to be home with mom and me, but, your grandparents, my parents, not happening. They've got to stay away. And we actually had a very significant family event yesterday, we lost one of our our dogs. And ordinarily, my parents don't live too far away and would have been there for this somber ceremony of remembrance for Zuzu. But we had to just share that with them digitally because we don't think they should be home where we've got three young adults who have come to us from two large cities where the level of exposure is certainly not zero. You know, we don't know, that kind of thing.  

Dr. Katz:   21:35
So I would say we ought to be doing that society wide. And my worry is, you know, we sort of carved society up into don't go to school, don't go to work, but gather any which way you want in multigenerational households and, you know, we may be creating innumerable little pockets of transmission. So again, I'm reluctant to share what I think, I don't tend to be a contrarian, I like consensus. I prefer agreeing with my colleagues. I just have the deep concern that we are producing the maximal level of social disruption without achieving highly efficient protection of people who are most clearly vulnerable to severe infection. So I would say, under those very trying circumstances you ought to do all you can and, you know, confer with the health professionals you trust to the extent possible. But identify the especially vulnerable, and again people over 70 in particular, those over 80 and figure out strategies to help keep them away from crowds until we can issue the all clear. I don't know for sure what the all clear is gonna look like. That's another thing that worries me about let's just shut everything down. It really is indefinite. I mean, what's the all clear? It's a little like, you know, when we're debating military conflict Brad, I think one of the questions the public at large and Congress rightly poses is okay. What's the exit strategy? You know, when is it mission accomplished? When do we get out of Iraq, Iran, Afghanistan? You know, whatever, Vietnam, for that matter, you know whatever the potential quagmire might be. And if you get involved in battle without any clarity on what constitutes the all clear, the exit strategy, that's really ominous. So here, what would it be? When do kids go back to school? Is it when there's zero transmission in a state? In the nation? Is it when we confirm that everybody has immunity? Is it when there's a cure? An effective treatment? A vaccine? Some combination of those? I don't think there's been any clear dialogue on that topic. I would say, you know, if you practiced vertical interdiction, we spare the particularly vulnerable. We have much greater clarity on the all clear. You know, a lot of us are gonna get this. Those of us who are vulnerable to getting it are going to get it and get it over with. And with that span that we just talked about, you know, some small number of weeks, you know, potentially were we to adopt my approach, most of us would have it and be over it and presumably be immune. And you know what we'd have to then verify is that, you know, people post recovery don't transmit the virus. At which point, you know, these elderly relatives we've been sheltering from us can come back out and resume their normal lives. Otherwise, I don't know when they get to do it.

Dr. Cooper:   24:27
Good question. Good question. Let's kind of run down that path a little bit. You're very connected with the health and wellness coaching community. What recommendations would you have for them to help their clients and others to actually thrive during this period? Not just get through it, not survive, not just put your head down, but to actually thrive through this period, however long that ends up being?

Dr. Katz:   24:48
So one thing would be, and I'm finding it hard to take my own advice on this. And you know, you're part of the reason not in a bad way, Brad, in just the right way you're providing a service. But everybody needs to talk about this right now. So I'm trying to do my day job. I'm trying to look away, and I can't because basically every time I go back to my inbox there's 72 more questions, right? We just can't escape. But I would say if you can, if you're not a source of guidance, everybody else, advise your clients to look away. Again, three million people die in the United States every year. And before there was ever a pandemic, three million people every year. What is that? 10,000 people a day. I mean, if you were paying fixed attention to every one of those,  you'd be going mad about the risk of living every day all the time. So, yes, there is a new cause of illness and death. But you know, so far in the United States, we've had a total of I think it's 70 deaths from Corona virus. We've had 50,000 from seasonal flu, so look away. Seriously, look away as best you can.  

Dr. Katz:   26:03
Second, I mean, I would, especially for those vulnerable to severe infection, so if we want to make the cut point 50, 60, 70. Do all you can to minimize social contacts. So, you know, other than people you already live with, and, you know, essentially, with whom you are committed to sharing your medical destiny. So you and your significant other are in this together, right? But everybody else, no touching, no hugs, no handshakes, we need to make some adjustments. Keep your distance. Stay away from anybody who is coughing or ill and we asked those who feel ill or are coughing to stay the heck away from everybody else until they know what's going on. And then, you know, I do think this is a great time, since everything is sort of shutting down to turn a little bit inward. And, you know, if you don't do some relaxation method, meditation, for example, this is a great time to learn it. The resources are all available online, so take up meditation. I think being outside in sunlight is extremely therapeutic. First of all, most viruses have a hard time surviving in bright sunlight. I hope you have some where you live. If you don't, I hope it's coming soon to a place near you. Get out in it. You'll make some vitamin D. You'll be in a relatively safe place. You'll be outside where you're not closely packed with other people. You can get some exercise to the extent that you can bathe in nature. It's good for your soul. But, you know, I really do think that's highly therapeutic. If you didn't have an optimal diet before, you've just sort of been tinkering with the idea. There's no better time to start that than the present. If you have any questions about that, I don't know if you mind if I throw in a personal pitch here but,

Dr. Cooper:   27:54
No I was gonna actually ask you about your book in our next question. So feel free to throw it out there now.

Dr. Katz:   27:58
Yeah, yeah. I mean, I again, I've had all sorts of questions about, you know,  every industry, I think, they want to help, they're sort of freaking out. But I also think there's a little bit of opportunism here, right? So now is a great time to tell people what supplements to take and what their diet should be and what superfoods are best. I've been pretty reticent about that. I really do want to focus on, you know, sort of the infectious disease epidemiology. But the reality is that the great vulnerability to this, like all things, resides with failing health and sub optimal immune responses. To the extent that that happens because we get old, well, you know, we can't prevent chronological aging, but we actually can forestall biological aging. So, you know, you could be younger biologically than you are chronologically. I was asked one of those gazillion questions about Corona virus earlier today was, you know, what do we know about the experience in the blue zones? And my answer was, I don't know anything yet, but it would be very interesting because it may be that in the blue zone, you know where everywhere else in the world of mortality is concentrated in those over 80. In the blue zones, it may be concentrated in those over 95. Essentially, if you live in a place where health is optimally preserved with diet and lifestyle until you're 100 you know, your 95 is everybody else's 75? You know, so we're waiting to see that. But, you know, in the absence of data, I would say everything we know suggests the likelihood of that. And so you know what we know with the blue zonians do is they eat an optimal diet of real food. Not too much, mostly plants, lots of vegetables, fruits, legumes, grains, nuts, seeds, and drink plain water when thirsty, they tend not to smoke. They're not excessively stressed out. So again those relaxation techniques, tend to be quite physically active. Get enough sleep. They have great social interactions, which is a bit of a problem right at this moment. So we do have to rely a little bit more on digital tools to interact with one another. But I would say there is a real advantage to, again physical activity, sleep, stress management of avoiding toxins like too much alcohol or tobacco as ever and optimizing diet. And there's a lot about getting diet right that is directly related to immune system function. You know, whether it's balancing immune system responses with healthy unsaturated fats. Fostering the functioning of our lymphocytes, which fight viruses with optimal levels of zinc from mushrooms, grains, nuts and seeds. To some extent, seafood. Whether it's getting the right balance between potassium and sodium, whether it's getting a rich array of antioxidants that protect ourselves and those come from a variety of vegetables and fruits as well. Those whole grains and all the usual suspects many, many reasons both right now and in general to focus on optimizing diet. So the book we mentioned, this is my latest co authored with Mark Bittman, and you know what were the odds that this book that we've been so excited about for so long called How to Eat came out right now. 

Dr. Cooper:   31:09
Seriously, right now and even your article in the Wall Street Journal last weekend. I thought that was fantastic. And you talk about timing of it. It was perfect. It was perfect. We needed it. We need to hear that.

Dr. Katz:   31:20
Okay. Well, thank you. Good. Yeah. But you write a book, and everybody in this country is constantly and forever focused on diet, except when there is a massive pandemic. And so, naturally, our book came out right in the middle of a massive pandemic. But first, you know, if you're stuck at home, you may need something good to read and the book is really fun. And again, it's called How to Eat, all your food and diet questions answered. And it's available in all the usual places in stores if anybody's still going the stores or online. But you know, we do, we talk about immune system function and specific nutrients and specific foods. And there's no question getting that right is extremely important to health over time, but it absolutely is relevant to right now. And you know, we don't have perfect control. And there are a lot of unknowns, but making yourself, you know, as healthy and robust and vital right now as we wait to see how all this plays out is pretty much the best you could do. So I would definitely factor optimal eating into your personal strategy.

Dr. Cooper:   32:20
No question. No question, Dr Katz. Really appreciate it. Again, you're getting hammered from all sides asking questions, and I so appreciate you joining us at short notice. Great job and keep up the great work.

Dr. Katz:   32:34
Thank you very much, Brad. And I appreciate you because, you know, a platform like this is helping to get the word out. And I think the final thing I want to stay, this is important for people, you know, I'm just like you. My world's disrupted. I've got family, my parents are 80 you know, we're all in this together. So, you know, I would say let's do the best we can to practice sensible prevention and protection. Look away whenever you can. Keep calm. Carry on.

Dr. Cooper:   33:01
Perfect. Great way to finish. Thank you again, as always for joining us. The reason we exist, obviously, is you. So thank you for tuning in each week, for sharing with friends and peers. And an extra big thank you to those who have taken the time to leave a positive review and subscribe on Apple, iTunes and other places. If you ever have questions related to health and wellness coaching, you can always reach out to us. Website is CatalystCoachingInstitute.com, email is results at CatalystCoachingInstitute.com. Now folks, let's go get better. Today's the day, I know there's a lot going on. I know you're struggling. I am, too. But that doesn't change the fact that the next step in our journey starts right now. So let's do this. This is Dr Bradford Cooper signing off. Make it a great rest of your day and I'll speak with you soon. In fact, I'll speak with you Monday morning on the next episode of The Catalyst Health, Wellness, and Performance Podcast.