Under the Saddle - Coronavirus Special

The Coronavirus pandemic has already hit the equestrian world hard. We don't know how long the virus will stop events or what long term effect it will have on our industry. Social media is filled with misinformation so to try and get the facts, Adam has 3 guests on this special edition of Under the Saddle. 

Barb Blasko - Associate Clinical Professor, Emergency Medicine (USA)
Nicola Schaible - Accident and Emergency Doctor (UK) 
Emily Sandler - Equine specialist and FEI Vet 

Follow Adam on Instagram: https://www.instagram.com/adamcromarty/

Transcript

spk_0:   0:00
really people really stories. Riel Insight on all straight from the horse's mouth. If it's equestrian, it's on another installment of Under the Saddle with Adam Crumitie. Welcome to Episode 10. It's a little bit earlier than normal, and that's because I wanted to try and squeeze in a special edition focused on the current Corona virus pandemic. It's definitely affecting everyone around the world, and I don't think I've seen anything like this in my lifetime. Now, before we go any further, I should point out this podcast was recorded on the 16th of March. Things are changing by the hour. By the time you listen, some of the information maybe I ts of dates and I've just come back from Florida. I was out in a couple of events there, and when I was on my way home, I heard about show's starting to cancel all over the place. From the end of the Winter Equestrian Festival to the World Cup finals, which were due to be held at the end of April in Las Vegas, the FBI issued a release that stated that we as a community have to make our contribution to limit the spread of the virus. And shortly after that, there was a joint statement from the European Equestrian Federation on the International Jumping Writers Club, which have called on national federations to stop all competitions with the media effect. Some have some haven't. And whilst health should always come before, businesses could have a huge knock on effect for those who work within the equestrian world, from show organizers to trainers to write their support. Staff officials, everybody, I want you to find a little bit more about the disease and discuss how it's going to affect us, and I've got some great guests coming on. I've got Bar Belasco, who's an associate clinical professor in emergency medicine at the University of California, Riverside. Nicholas Shibley, whose are any doctor accident? An emergency doctor here in the UK And of course, we've got to talk about the horses as well because they'll be getting some time off. There's not gonna be any competitions for at least a month and most parts of the world. So I've got echoing specialist an FBI vet, Emily Sandler, coming on, too quick reminder to subscribe to the podcast following on Instagram. Just search Adam Cromarty and get comfy because this is going to be a bumper edition. We start with Bar Belasco, who specializes in emergency medicine. She's seen everything over the years on. It's certainly well qualified to talk about this subject. I've been practicing for about 22

spk_1:   2:16
years after graduating from residency. I

spk_2:   2:19
specialize in emergency medicine, which is actually a specialty. Uh, some people don't know it's really a specialty, but we do do training for three years after we graduate medical school specialized in emergency medicine. And, um, you know, we work on the

spk_3:   2:36
front line of just about everything. So anybody that comes to the hospital with any problem we're trained

spk_2:   2:43
to deal with that. I'm a associate clinical professor associated with the University of California, Riverside do teaching of medical students on residents and I also work what's called locum, meaning. I work in a few different other states, primarily New Mexico, Arizona and Texas, doing some work in emergency departments there. But that's been, uh, my clinical background.

spk_0:   3:12
And before we get into Corona virus, what we're gonna average shift be like, is it exciting? Is Yare or any other kind of medical programs you

spk_2:   3:22
know, it's It's not really, I'm dramatic. I don't think

spk_0:   3:26
a lot

spk_2:   3:28
of Stephanie see on TV actually goes on, You know, um, but, you know, it is exciting. It's challenging a different every day. I love it. Um, it's a fun place to work. We never really know what we're gonna deal with on a day to day basis, which, which I really enjoy. Um, and I enjoy being able to take care of multiple people with multiple conditions and, you know, really make a

spk_3:   3:54
difference for people who come to the hospital in their worst time of need.

spk_0:   3:59
That kind of worst time indeed is gonna happen for so many people around the world right now with Corona virus, something we've never experienced in our lifetime before. What what is Corona virus? We'll start there.

spk_2:   4:11
Sure. So Corona virus is as as its name suggests, a virus meaning it's like influenza. It is a virus. It's not a bacteria, so antibiotics don't don't work to treat this. Um, it's a serious type of virus because of the way it is it's made. It can attach thio cells in your body and called bad infection. And one of the places that likes to attach is the respiratory system so it can attack to the lower respiratory system and caused a pretty serious, uh, pneumonia. And that's the main thing that that we worry about. Um, we've seen some viruses like this in the past. Back in 2012 there was a

spk_0:   4:59
virus called murders that was the Middle Eastern Middle

spk_2:   5:02
Eastern respiratory syndrome and a type of Corona virus. Um, also stars was another one. So stars on the Corona virus are very similar in there, both Corona viruses, and they acted very similarly. We have seen viruses like this in the past, but I think the concerns of Coronas that it's something that is very virulent meeting it's usually transmitted, and it does cause pretty serious infections.

spk_0:   5:35
And about looking a strange question. Where does it get his name? Why is it called Corona virus?

spk_2:   5:39
It's called Corona Virus because of the name for the crown like spike on the surface. So if you Google and you look up picture, it looks like a circle with the little things that are like projecting off of it. And they know little things that attach to the respiratory system,

spk_0:   5:59
afraid of what people say, You know, it's just like the flu. If you if you get it, it's like the flu and it goes away. Are the symptoms the same?

spk_2:   6:04
So it is like the flu in the sense that most people that get this virus so if you or I or healthy person gets this virus, it tends to be a cough respiratory. You know, some things where you have a cost, you may have a fever, you may have been chilled, and it does act like the flu. The problem with it is that for people that have other co existing

spk_0:   6:28
illness, like very

spk_2:   6:29
old people, people with lung problems, people with high blood pressure or diabetes tend to get the more serious. Actually, I wish no, uh, the other problem with this is that it has a very, um, have a higher fatality rate. So the fatality rate for people that get sick with serious, uh, type of it is about. It could be anywhere from 12 to 14 times the rate of death that people would experience if they got the run of the mill flu.

spk_0:   7:02
Okay, is easily transmitted, is the regular flu or is a bit more off anxious.

spk_2:   7:07
So it's It's transmitted like the flu with droplets. And that's why, uh, people are practicing what's called social defusing. So they're they're asking people to stay, stay away from other people. They're asking people to try to stay about six feet away from people. If you cough or sneeze, Uh, this can be transmitted to other people. Um, and they're not exactly sure how long it lives on surfaces for I read anywhere from three to up to 12 days that it can live on a

spk_0:   7:43
longer than flu, isn't it? Because flu doesn't live with that surface is

spk_2:   7:48
correct. Yeah, and I think that there because it's so new, the the people doing research on it on epidemiologists don't even actually know all the ways that it is transmitted as well as how long it actually left. One thing they have found, though, is that if you are, you know, if you call for you to me is make sure that you're covering your mouth with your elbow, not your hand. Um and then they're trying to stay away from other people. Um, is really what they're doing to prevent transmission.

spk_0:   8:26
And do you think people are overreacting. I went into into Costco the other day to get some just a normal shop, and everyone else seemed to have two trolleys And as I was common, eh, I was thinking, Should I go back in? Have I know about enough? Our people over reacted.

spk_2:   8:42
Um, I think that the unknown is probably the curious thing for people. I think that they are overreacting in the sense that they're buying months and months worth of supplies such as paper goods on food. I actually went to the store yesterday for the first time since it's really started. And, um, you know, there was basically no meat. There was very minimal water. There was no toilet paper. Um, I think that social media has probably contributed

spk_0:   9:13
a lot

spk_2:   9:13
to misinformation as well. A spreading panic. Um, you know, we look at other people. We think that they're buying everything. We think we should buy everything. Um, we worry about our basic needs. Um, and I think that our instinct to panic buys is driven by being other people doing the same. Um, So I think you know, I think people should have probably enough supplies to be prepared for a few weeks. Um, maybe maybe two weeks or so, but I don't think that, you know, buying. Ah, grocery carts full of meat or toilet paper is gonna do anybody any good

spk_0:   9:57
in terms of medication you can stock up on. Is there anything that we should be buying? I read somewhere today that anti inflammatory medication has been phoned to sort of make it worse.

spk_2:   10:06
Yes. What they have found is that taking, uh, anti inflammatory medications, uh, specifically, the nonsteroidal anti inflammatories, like ibuprofen or Motrin, can cause this, uh, the construction to be a little bit worse. Just because of how the virus attaching to be to the the areas in the lung that can be affected most be affected worst by this. So they're saying that Tylenol, the space motion, it might not be so good and cold and cough medicine, you know, the run of the mill Motrin and cold and Tylenol cold. I think it's fine again. Miss this catching. And most people like you are I It's gonna be a run of the mill coffee cold that lasts maybe a week or so and then going away on a phone

spk_0:   11:09
and this is different from other pandemics. I remember things like swing Feli. It kind of came and went and we didn't have any of the serve hysteria. That seems to be a range of snow.

spk_2:   11:18
Exactly. So the swine flu occurred in April 2000. Fine. Um, and it was a new form of, uh, h one n one virus, which was kind of a combination of a bird, swine and human virus that sort of combined to make a novel virus. Um, and back then, the global population at that time was about 6.8 billion people, and about 700 million to 1.4 billion people contracted the illness. Um, with a fatality rate of somewhere around 150 toe 500 100,000 fatalities. So at that point in time, it was classified it as a pandemic. But then a follow up study done the next year showed that the H one n one flu was really no more severe than the regular nearly seasonal flu. So I'm not really sure how Corona virus will compare. Well, sort of just have to wait and see. And, um but that's why we're testing people now, you know, epidemiology. Um, we're looking at who's getting infected on how how it's affecting them. Um, and that's that's why we're running tests on most people who come to the hospital.

spk_0:   12:36
And where do you think it came from? I mean, I've seen lots of different things online, ranging from, you know, it's just a different strands of the flu all the way through to be nexus or a manmade weapon that's been released.

spk_2:   12:46
What they found, uh, for sure is that it is a regular virus that originated in, uh, Wu Han China in late 2019. Um, I know there's some theories out there that you know, Ah, biological weapon. Um, and it's not. It is a virus, just like murderers and stars. Um, and it was bound to start in China and unfortunately, spread to other countries because people were asymptomatic when they traveled and then passed it on to other people.

spk_0:   13:23
So we shouldn't worry too much. Is he isn't a weapon. No, no, no, no. How do people tell the difference between a normal kind of cold and flu on Corona virus? Because I was flying back from the States and I had a bit of a cough. And every time I coughed on the plane, it was just horrible away. Exactly. You felt everybody was looking at you?

spk_2:   13:48
Yeah. Um, so you know, it's very similar to a regular coffee cold. I think that people who get the more serious form of the Corona virus or the probate next scene,

spk_0:   14:03
as it's termed medically, you will probably get

spk_2:   14:07
a fever, a cost and shortness of breath. Uh, the corona virus

spk_0:   14:12
tends to cause

spk_2:   14:13
more of, ah, lower respiratory symptoms. Meaning you will feel short of breath when you walk. You might feel short of breath when you cough. People are a little bit thicker than the general flu.

spk_0:   14:26
And do you think it's gonna be running for a while? Like, don't. This is gonna be till the end of the year, or

spk_2:   14:31
I sure hope not. You know, I think of the weather warms up. I tend thio revolve on their own. Um, I think that, um, just will probably be around for the next few months. Um, I'm hoping that, you know, with um, social distancing and people self quarantining and, you know, transmission rates being, uh, hopefully made lower by the fact that we are having these, you know, um, event cancelled on big gatherings cancelled on people asking the self quarantine that we'll do what's called threatening the curve. Meaning will prevent transmission. And it will just resolve on a song. So I'm hoping in the next 30 to 60 days, but this is something we're not we're not faced with.

spk_0:   15:22
Well, my face masks do they help? She will be wearing a face mask. You know, I I

spk_2:   15:27
actually do a lot of traveling for work, and I flew. Um, just this weekend, I was working in New Mexico and flew back to California. Where are layer on the planes were basically empty for the first time in years and years. I had three, you know, three feet around me that were empty. Um, down those furry face mask. Um, you know, really, case marks are used to prevent symptomatic people from transmitting it to other people. So I think if you're out in public and your you're trying to stay at least six feet away from other people, wearing a face mouth in public and in general is not gonna help you

spk_0:   16:13
because I hate them. and I look ridiculous in themselves. Have todo so Yeah, and it's funny because I

spk_2:   16:22
saw people walking in the airport with different types of cases. Smell, you know, these black face mask and face masks that were obviously you could purchase off of Amazon. Um, so, yeah, I think maybe it just makes people feel better, but it's not really gonna help them.

spk_0:   16:39
And these kind of material ones, they probably start coffin to them, then take them off with their fingers. Andi, you can't help thinking that probably touched three or four surfaces, but the time to go wash their hands anyway, So, yeah, I think Is there anything people can do to protect themselves?

spk_2:   16:58
So, yes. I mean, obviously, you know, washing your hands with soap and water. Um, it's recommended that you actually wash your hands for 20 seconds. And if you think about it, 20 seconds is kind of a long time. You know, try to avoid touching your eyes or your nose your mouth with your hands. Um, when you're when you're coughing or sneezing, use a tissue or sneeze into your elbow, you know, staying away from other people that are sick with any respiratory. Uh, injection is is probably a good practice. And then, you know the guidance from the public health officials, Um, is going to follow, you know, they're really on top of you know how many cases are occurring in your area? What? You know how many people are sick and that's why they're really recommending people try to say no. Self quarantined away from the gathering,

spk_0:   18:00
Have things changed in hospital night. Like when people come into the yeller, are you gonna dress differently or you taking more precautions? So So, yes. And

spk_2:   18:08
as I mentioned before, I do work at different hospitals and, you know, on a day to day basis are, uh the way we, uh the way we work is changing. When we when we first started on, you know, people were told to just wear a

spk_3:   18:26
mask, and then that changed to a mouse

spk_2:   18:28
with a shield over your eyes on. Then it changed to wearing a mask and a gown. Um, so So if we identify somebody that that potentially had this and they're coming in and they're getting examines when they're getting tested, now we're we're wearing, you know, full personal protective equipment, meaning we're wearing a face mask that covers our eyes on our mouths. Were wearing a disposable gown were wearing gloves. Um, we're wearing little bonnets. Cover our hair So we are trying to protect ourselves to the fullest extent. Some hospitals have set up a tent where people are coming in and getting screened actually outside the hospital. And we're doing this to prevent no transmission to other people that might be there for other other problems which are not related to this. And some places have actually set up like Dr Cruz, where you drive up in your car and you're identified as needing testing and the testing's actually done while you stay in your vehicle.

spk_0:   19:40
So a

spk_2:   19:41
lot of people have come up with creative ways to, uh, do do testing and keep these potential people away from other people that are in the hospital for other concerns.

spk_0:   19:52
What about hand gel? Because it's almost sold out in the shops as well? And I read something that you can actually take off the sort of good bacteria that would normally fight infection. Is that Is that true? Is that I think

spk_2:   20:03
so, uh, hand Joe on hand sanitizer is definitely indicated for, um, for protecting yourself for this, um, your husband, you know, in the past, some, um I think maybe some mixed out there that the antibacterial hand gel will take off good bacteria. But in a situation like this, I think it's definitely something you could use to protect yourself.

spk_0:   20:29
And you think this is gonna become, like, a routine vaccination is gonna be, like the new flu job for Corona virus. You know, that's really hard to say.

spk_2:   20:37
Um, think specs that they are working

spk_0:   20:40
on a

spk_2:   20:40
vaccine, but I think it will depend on, um, you know how this pans out in terms of how many people are affected, what the mortality rate is They were actually working on a vaccine for the stars virus. Um, and it never became a routine vaccine because the SARS virus, basically, you know, it affected people, um, and then pretty much went away. Um, good thing about bad is that the club is 19. Virus is very similar to the stars virus. So researchers on drugs hopping you have something to start with in terms of this being very similar. So there they're working on the vaccine with the premise that the they've already started on a vaccine for something very similar.

spk_0:   21:31
And I mean, there's no treatment to this. So is it working a vaccine? Is that why we're testing for it?

spk_2:   21:36
They really were testing for it for epidemiology. Studies were looking. You know how long how long it lasts in people. What types of people get it. Um, what the more quality is and who's most acceptable to it. The testing actually is variable from state to state. So when I was in New Mexico, we were testing anybody that was presenting with concerning symptoms. But in California, we're testing only people that were getting admitted to the hospital. So it really varies on a state to sea. Bass is who we are testing.

spk_0:   22:17
I'm over here in the UK. We've got the National Health Service. Obviously. Do people have to pay to be tested in the us or is that gonna be free

spk_2:   22:24
right now? Um, you know, if you're coming in and you do get tough, Did it is, um, probably part of your bill for your emergency department. So right now there's not there. True price. That would be a good wicket, but I'm not really sure how that that work.

spk_0:   22:44
And have you heard any strange myths about about the Corona virus? I mean, I know there's so many online at the moment that gonna work in an emergency medicine of you. You've been asked any strange things,

spk_2:   22:53
Um, starting. You know, uh, we

spk_3:   22:56
talked about it a little bit earlier, Like a

spk_2:   22:58
biological weapon. Terrorism. Know that? That's not it. Um, you know, um, stocking up on toilet paper definitely won't prevent

spk_0:   23:08
you from getting this. Um, I've heard them on Facebook. That garlic can get rid of that.

spk_2:   23:15
Um, I haven't heard that yet.

spk_0:   23:17
Um, you know, garlic always

spk_2:   23:18
been proud of a

spk_0:   23:19
good supplement overall.

spk_2:   23:22
Um, I don't think so.

spk_0:   23:24
It would keep flies away, but I think that's probably And also drinking every 15 minutes will help flush out your system.

spk_2:   23:33
Dehydrated. It is a great way to stay healthy overall, but I don't think that drinking every

spk_0:   23:41
15 minutes will

spk_2:   23:43
be more

spk_0:   23:44
just away from being a doctor. You're also a competitive equestrian. You've bean right in all your life. Watch what? Your plans with your horses. Are you going to try and keep them fit still, or you gonna give him some time off for?

spk_2:   23:59
Um, so I have been writing since I was a kid. I ride the amateur jumper. You know, my horses, um, they living stay in training, we're gonna keep getting written. Obviously, we want to keep them for when competition starts again. So, you know, I plan on keeping them healthy and keeping them written, Uh, just waiting till, you know, we could get back to showing.

spk_0:   24:26
I've also it's mentioned. Actually, you're starting a new business. And also

spk_2:   24:29
one of the means of being over the past few years. A need for some medical service is at horse shows and in an emergency medicine physician. I feel that I'd be very quiet to provide this service is. So while starting in May of this year at the illusion to question her shows, I'm gonna be setting up a trailer, which is a mobile urgent care. Um, it's gonna be called show Andy. I'm gonna be providing all emergency service's care at the horse show. We'll be replacing the current E m T. I'll be providing urgent care. Stare is anybody that needs it. And also doing some coffee years. Medicine with ivy balloons, oxygen bar and some primary repair service is for people that can

spk_0:   25:22
get to the doctor. So I'm really excited about that. Free to hear that from Barb. I learned so much in that one conversation. Compared to all the nonsense, it's falling nearby on social media. Next guest is Nicholas Shiebler, who works in a hospital in the north of England. The any chaser already stretched just with normal winter illnesses. And she really is on the front line. So I'm

spk_1:   25:44
on any doctor in a local hospital. I've got six Children on dhe. We over tools are missing Children, right that we kind of combine with you around the country, doing for various things with what courses in different disciplines with working full time in accents emergency

spk_0:   26:04
on with your job. I mean, how do you start juggle that at the moment? Are you kind of more busy than you would normally be?

spk_1:   26:09
Well, I think the difficulty that we're facing now is that we have bean at a level off 45 years ago, we used to talk about the A lead. You know what we called into pressure on dhe typically around about around mid December through you to kind of January, February. March? Well, probably about march. We would know that we would be on our knees. Really? That it would be the department would be busy. That bed would be short on DDE that, you know, there was no end in sight. But then over the last 2 to 3 years, gradually we've seen you know what we would normally have seemed to be. Winter pressure's just extending. You know, We'll we'll come. I'll come in for a night shift in July on bed block, and we have nowhere near capacity on. That really has Bean the situation for the last, certainly for the last two years. You know, five years ago, we would have hours through the night where we would be able to clean, would be able to sort things restock. Now we're just increasingly finding that that doesn't happen. And obviously the most recent turn of events are incredibly worrying just simply because we are already running at capacity.

spk_0:   27:25
There were a lot of people coming in kind of scared half Corona virus are coming into the any departments.

spk_1:   27:30
Well, we're pretty. We're pretty well marked in terms of you know, the door's sign post if you feel you might have Corona. And of course, the problem with people presenting Is that the goal? Post changing every day, in fact, hour by hour. So three weeks ago,

spk_0:   27:48
there were

spk_1:   27:48
very clear areas. If you've come from these areas and you have these symptoms go around to the Carina port. Um, at the beginning of last week, we were aware that the goal posts were changing in that people wouldn't necessarily have known that they were in contact with somebody who was positive on then. You know, public health has done a brilliant job of contact tracing, but it's inevitable that you're going to see people now. And we are seeing people now. Health miss that they haven't had any recent travel. We know that, people. Now we're going to be infected in this country. Now that makes it harder to screen. Um, and I think it makes people more wary.

spk_0:   28:34
The problem is

spk_1:   28:35
that what we're trying to avoid is our health service. Our system is being closed up by people who don't need to be there, essentially

spk_0:   28:42
on. Do you think we're gonna be in a similar situation to Italy.

spk_1:   28:46
Well, it's very difficult. Italy actually up, you know, figures that that they have produced just that they are actually in a slightly better position in terms of intensity. Intense cabin. We know you know that most of our to use operated and you know, between an 80 and 90% occupancy on that's the critical care. It's not my area of expertise. It's just what I know to be the case from From you know, referring up to any from any story is that are critical care that other low Well, I know that they're the lowest per head in Europe and that potentially put her at risk of being overwhelmed quite rapidly, potentially.

spk_0:   29:31
Do you think the numbers in Italy are are so high because a lot of kind of grandparents live with younger members of family?

spk_1:   29:38
I mean, that's one. That's one possibility. We know that Italy do. You have quite a high aging population, Um, and and Italian typically are more touchy feely than ours. But I think the other. The other thing that we need to consider is that initially all of the information that we had regarding this new disease was coming from China, a different environment and a you know, a completely different structure. I suspect that the Italian figures are closer to being more accurate, although it's very difficult because genuine later situation changes day by day. We know that people most what I think the important thing to remember is that most people that get this virus will be fine. They'll feel Russian. They'll feel like they have, you know, genuine flew rather than a cold. But most people will be. We'll get through it and be fine that we know that it's, you know, it's less Love falls off if you have a municipal Asian or if you're elderly. The problem is that there's always going to be a cohort in the middle, people who we can't really explain why. But people who don't fit that you're the typical demographics but don't do well. And our concern is that if we get overwhelmed by people who would be would fit the criteria for intensive care, that if that happened too quickly, we wouldn't be able to manage. The problem was closing the schools and stop it, putting everyone on lock down first of all it's it's how do you function Most of the people I work with. Most of our nurses and doctors have young Children, so if he closed down the schools, you immediately have a staffing crisis, because who is going to look after the Children of the workers who were at the front line? There's been various possibilities, and I think it's brilliant that people are trying to rally round. I saw a post from Edinburgh University saying that medical students, because they have reduced the number of clinical out because of the outbreak, are offering to do child care for an excess. Workers, You know, things like that are great but not sustainable. People will do it for two weeks, three weeks, four weeks. But ultimately you're going to reach the point that even if the numbers settle because we have essentially self, I want not completely self isolated. But stop people from being out and about a scene as we return to normal pattern, the number that came to fight again and it's spike that that puts the energy at, you know in potential danger because it's how quickly the number of patients who require intensive care would would increase. And I know that from doctors that have posted in Italy, that is their crisis. At the moment, they're simply don't have the support that they need or the beds that they need for critical patients that would would qualify and intend to qualify. We know that people who have multiple co morbidity, ese, you know, did these background on dhe. Very elderly are unlikely to survive the process of being intubated and ventilated, going to like you so that in Italy now they're making that decision. These patients wouldn't be for that line of management, so we're going to keep them comfortable.

spk_0:   33:02
Sure, I mean, sorry. Saw something in the media over the weekend that they may be asking people over 70 to isolate for upto up to four months. That's likely to happen. And I mean, that's that's a long like,

spk_1:   33:14
I think the problem is that it well, I can understand the rationale behind it because you're looking at a sub groups of the population that are more vulnerable. I don't think it's sustainable. How do you genuinely isolate four months

spk_0:   33:30
is a long time.

spk_1:   33:31
It's an awfully long time. And how do you then do you actually go about your normal job yourself? Isolating? How do you go shopping? How do you How do you get to doctor's appointments? Other things that you know that would otherwise be considered fairly essential on? I think the other problem is that if you put extreme motors in early or too early, then it's much harder to to try and bring them back again because people will say, Well, held a minute. We've done this already.

spk_0:   34:00
Sure,

spk_1:   34:00
it didn't work last time. Why do we feel that we might need to do it now? And I think it's very difficult when you see lots of what will undoubtedly scary posts in the media. Um, but I think, well, I can see the logic of it. I did it again. I don't think it's sustainable.

spk_0:   34:21
And you think social media is a little bit to blame because for similar crisis is we've had in the past. Social media wasn't quite so involved with our day to day life.

spk_1:   34:31
I mean, I jokingly said it's because we've got you here and got Brexit

spk_0:   34:34
and way needed

spk_1:   34:37
something else to fill our headlines. But the problem is that at the end of the day. It is a new disease. It's a novel disease. It's a virus that appears to be able to change. We already suspect that there are subgroups and off the actual strain on DDE that those subgroups may act differently. And the problem is that, you know, week, if somebody reads something on a Monday morning, it may be absolutely valid for that moment in time. But then, because of social media and and how rapidly information can be spread, it contained again by lunch time, and then it can change again by four o'clock. So it's very difficult to look at all of that information and try and work out, which is accurate.

spk_0:   35:24
You know, what

spk_1:   35:24
should I be doing right now? Because, actually, if you put in a single word in a certain tension, you may come up with something that triggers a post from four weeks ago or something that crops up from an hour ago. Yeah, so I think we have to follow the lead that you know, our Department of Health is using evidence based information. So I think, for people who are really concerned, because the other problem is the anxiety over Karina on people. I had a long discussion with a patient who the end result cause we do telephone triaging in any thing, end result of which it went something along the lines of what I want to be tested. And I said, Well, I'm afraid that wanting to be tested isn't the criteria that we are using because we can't you know, it's it's silly to screen people who are asymptomatic. We always know that we're going to miss because some people are asymptomatic are carrying the virus will be spreading it. But on the whole, when people are truly symptomatic with a fever and a cough, then they feel fulfilled the criteria and actually then we will swap the difficulty again is that you know, a week ago we were only solving people who had returned from certain areas and people who had had direct contact with people who were either positive or who had come from those areas. We are ultimately going to have to change it to screening people who clinically fit the criteria on dhe. Ultimately, when as the disease becomes more widespread, I suspect we will be sort of following similar lines. Thio flu epidemics where you actually only screen people who are needing intensive care, who know no eggs important that people, the people working with them are going to know whether they're posted or not, and therefore no, which level of protection to take in terms of their nothing.

spk_0:   37:23
And is there any way of knowing, you know, home, whether it is a current of flu or or whether is actually Corona virus?

spk_1:   37:31
Essentially, we know the features of the features of current appear to be that the coffee's quite prevalent. Most people notice notes that they have a fever, which isn't coming with the cold. But of course, both of those things are definitely seen in flu. So clinically there really isn't going to be a lot that's going to distinguish it. But ultimately what? What you will what we will end up being is saying to people we you know, we only want people to attend in hospital who are feeling short of breath, who are feeling above and beyond the unwell level off a nasty flu. Because, of course, people, how many can't really hear people gotta have flu last week with them right now. Well, that doesn't really happen if he had flu on Monday. You have flew on Tuesday and Wednesday and Thursday and Friday, and it takes you a while to get over it. Uh, if you had a cold on, yes, I would agree You probably could feel better by Wednesday, but it I think the problem is that it is going to be incredibly difficult being all this joke about toilet roll

spk_0:   38:46
buying

spk_1:   38:47
hasn't so we I actually, our household has run out of toilet paper. So when I was dropping my son off the bus this morning, asked him to pop into the local shop and pick up some toilet paper into milk if you'd run out of both and chocolate, which, of course, is an essential on. I put my hand out to get the change from the £20 note that he gave me, and he said, Oh, it was £20.19. But the man said that that was okay.

spk_0:   39:13
He would just you

spk_1:   39:14
know, he didn't need the 19 pence on Guy said what now? He had brought six world of toilet paper to flake on people. Two cartons of milk,

spk_0:   39:24
which would normally be like £8 maybe 90. So

spk_1:   39:27
I think the only person in England

spk_0:   39:30
who has actually with

spk_1:   39:31
her toilet paper to a shop

spk_0:   39:33
went back in

spk_1:   39:34
and said, I am sorry, I don't think this can be right And he said it £14. Now what distresses me about that is that it's a local shop that is used by people who don't have the means to be able to drive into biggest stores. You know, the elderly people who don't have cars now I feel that in circumstances we know that people are always going to. I see an opportunity to make money. But I think in these circumstances we have to start thinking, trying to think more about the community and think how best to manage for everyone and certainly hating up the price of six toilet rolls £14 in an area where some people that will be the only place they could get it just seems completely responsible, I feel, although then of course, I came back and started looking on Amazon, and in fact they're doing exactly the same. It's either out of stock or ridiculously expensive.

spk_0:   40:32
It's crazy and why Why was it happened? Thio that sort of product, twice everyone creasing toilet paper. Which

spk_1:   40:40
is why I thought it was all a joke. I can't

spk_0:   40:42
you and you don't know. It's not going to

spk_1:   40:44
need more than

spk_0:   40:46
that.

spk_1:   40:47
Britain more worried about

spk_0:   40:48
running out? Who knows? It's the same in the U. S. So I've just come back from the U. S. It's exactly the same.

spk_1:   40:53
Absolutely crazy. But I got my chocolate.

spk_0:   41:00
And if you were to look into a crystal bowl, when do you think this is all gonna be over? And do you think it's gonna keep coming back year after year?

spk_1:   41:06
Well, E today's again. It's impossible to know, and I think you'd have to speak Thio on Expert in and And what they would probably say, certainly from the bit that I have read, is that we know that viruses are capable of changing. We know that that infront the virus changes on DDE that that's what makes it difficult to manage that it becomes clever. We produce a vaccine. It then changes its protein on the vaccine is no longer useful. It's feasible that the same could happen with this illness, but I think it's important to remember that at the end of the day. At the moment, the mortality appears to affect people who are have underlying illness or age on. But it's still at the moment, not that much higher than normal flu on. We don't we don't have this panic over normal flu that that we're having over Karina.

spk_0:   42:01
Well, thank you so much. It's been fascinating and good luck trying to find some toilet paper as well, right? We've talked a lot about human health, but with so many events, councils, a lot of horses air having some time off. So let's no catch up with Emily. Sound like she's an echoing specialist. He's an FBI vet. She's based in the U. S. A. On can horses carry the virus? Even though obviously we can't get the virus. Horses

spk_3:   42:26
do not get Cove in 19. They don't get the human form of Corona virus, but are susceptible to their own form of Corona virus, which is which is actually a G I bug.

spk_0:   42:37
And why can't he gets it like, Why does it not touch to their to their cells?

spk_3:   42:41
Because their species specific So most mammal species actually are affected by a Corona virus or a virus with them Corona virus type, but in general they don't cross species. However, obviously it's an exception with what's going on with Kobe 19 and the Kangol in another wildlife involved.

spk_0:   43:02
And then obviously shows and most locations around the world have decided to stop, which is that it's the right thing to do for those horses are going to be getting, you know, at least four weeks off. If they are thinking of given them, you know, some proper rest should they be changing the diet and change in the management

spk_1:   43:17
for sure. I mean, I think

spk_3:   43:19
in most instances, yeah, horses aren't gonna be going in our high level performance. Horses aren't gonna be going to horse shows, but I think in most cases they're going to remain in work. But if that work is at a decreased rate for sure, the diet needs to be adjusted. You know the concentrate in grains should be reduced, and any sort of these changes should be made very gradually to not institute metabolic problems

spk_0:   43:44
and when you say can reduce, how much less should you give on average? You talking like that for? I

spk_3:   43:50
think it probably should correlate with the reduction and work. So if they're getting half a much work, I think that's probably a good guideline that we goto half a much concentrate. And all of these changes should be made gradually, if possible. If the horse is going to go from extensive work to know work, honestly, I'd probably cut the concentrate completely out and just maintain sort of vitamin mineral supplementation. So the diet's Alan

spk_0:   44:15
and what would you be recommending to your clients? Do you think we should give them complete Taymor for? Because we just don't know if we're gonna be back up and running in a month or two months or three months.

spk_1:   44:25
I think for my clients, I'm gonna recommend as long as they still

spk_3:   44:28
have access to go into the barn on a regular basis and all of those normal thing. But the horses stay in a sort of moderate, reduced level of work. But we're probably not gonna be turning turning our horses out, especially since we don't know what yet happening with Tokyo. You have some some hearts that need to stay in at least some work,

spk_0:   44:47
and it's a little bit different in the U s because most amateur writers there do have a trainer and the horses. Or perhaps there but in places like the UK and Ireland and stuff where people have them a home, how long would it take? Roughly depend. You know, it's obviously depended on the horse, but roughly to get them back from being unfit to bean set.

spk_1:   45:03
You know, I think usually people

spk_3:   45:04
assume they need at least as much time as they were off, and usually more so, if you're really gonna turn one out for an entire month, you know, you may have a month from even more than that to bring it back to that level of fitness

spk_0:   45:21
And assuming that the same applies with the with the heart beating with the concentrate as you bring them fitter, don't suddenly addle back in

spk_3:   45:28
suddenly increase their their ration. Yeah, you can get problems like tying up by changing their ration and workloads very quickly. And I guess that's another good point. The return to work should be gradual. Well,

spk_0:   45:42
that's probably gonna be the most common thing. If people do keep given so much concentration. No work is as a tree are tying up. What's the what's the kind of symptoms that people should look out for. For that,

spk_1:   45:51
you know, force has become very

spk_3:   45:52
stiff, reluctant to walk. Sometimes we'll see dark colored urine. Those are all. No indications that horse may have been may be tied up, and definitely that's time to call your veterinarian. They may need, ah, fluid, hydration and non steroidals et cetera,

spk_0:   46:09
and you shouldn't try and walk the walk them off if you If you do suspect that, should you

spk_1:   46:13
correct? Yeah, forcing them, forcing them to move when they're

spk_0:   46:16
reluctant To Emily to Barb Answer. Nikola is definitely going to be a strange few weeks filled with the unknown. I'm gonna continue to have guests on the podcast over the phone because we can't travel anywhere. The next episode will be very soon, so remember to subscribe. Lever of you Follow me on instagram on Wherever you are in the world. Stay safe. Tune in again next time. If it's equestrian, it's on under the saddle with Adam Crumitie