Dr. Cleavon Gilman, M.D. With guest co-host Amy O'Rourke!

We got some feedback that we needed music and graphics on this Instagram live show and Amy, and so I got you all three. That's I Fought the Law, originally written by Sonny Curtis of the Crickets in 1958, later recorded by the Bobby Fuller Four from El Paso, Texas. It was a top 10 hit in the 1960s, and that version is The Clash, I think recorded in 77 or 78, and though I'm a loyal El Pasoan, I think The Clash's version is the best of all of them. Hope everyone's doing well, and we're grateful that you could join us again, and we're really looking forward to introducing you to someone that we've become big fans of. His name, he's an emergency room doctor in New York City, and is on the front lines of the coronavirus. His name is Cleavon Gilman, and I'm really excited for you to meet him, really excited for him to be able to tell you what he is seeing, and we're going to make sure that we have some time for him to answer your questions. Again, he's at the forefront of what's going on with coronavirus. Got a message from Cynthia saying that Dr. Gilman is ready to come on, so we'll have him come on in just a minute, but we thought we'd provide a quick update. I don't know if you watched the president's press conference, but I have not. I feel like it's my responsibility as an informed American citizen to stay informed, to traffic only in the facts, and for that reason, I'm going to trust the journalists, those who will take the facts or take what the president says that is not factual, and make sure that we have an understanding of what's happening in this country right now. Our hats off to every news organization that has refused to carry the president's press conferences live. In order to meet the deficit of facts and truth, we join millions of others who are going to talk to those who actually know what's happening, and for us, in this case, it's Cleavon Gilman, who is an emergency room doctor in New York City. A couple of facts to make sure that we're all understanding what's going on in this country right now. We now have, and this is according to the New York Times website, more than 156,000 of our fellow Americans who've tested positive for the virus, and as of last check, 2,897 of them have died, have lost their lives in the United States. Now, that number, 156,000 and nearly 3,000 dead, everyone who understands this, and certainly those who are working on the front lines, agree that this is a gross under-reporting of what is truly happening. We know that we don't have enough tests to understand who has coronavirus or who has died of coronavirus, and we know that it's very hard to report when somebody has COVID-19 or has died of COVID-19. That might be something that we get into with Dr. Gilman when we have him on in just a second. 2,900 cases, this is according to the Texas Tribune, in the state of Texas. Again, we have a fraction of the number of tests that we need to actually know what the real number is, so who knows? But 2,900 officially reported so far, and there is still no shelter-in-place order statewide in Texas. There is in El Paso, there is in Dallas County, there is in Harris County, there are in the big counties, but we don't have it statewide in a state of nearly 30 million people with 254 counties with no statewide testing system and no contact tracing. This is a recipe for disaster. We, along with hundreds of thousands of other Texans, implore the governor to do the right thing and make sure that there's a true statewide shelter-in-place order. That will save lives in the state, and by extension, it will save lives in other states because human beings travel across state borders as do infections like the coronavirus, so we want to see that happen. Unfortunately, Governor Abbott and state leadership have taken us in the wrong direction, not just on this, but they've tried to ban all abortion procedures in the state of Texas using coronavirus as the excuse. Luckily, a federal judge has enjoined that order for the time being, some small good but important news that we have right now. And then another unfortunate decision on the governor's part, he has suspended Texas bail laws that would allow a judge to release somebody on a no-cost bond. That means, remember, if you're in jail, not prison, if you're in jail not yet convicted of a crime, charged with one, and you pose no threat to the public, why should you be locked up in jail with other people who may or may not have coronavirus, further ensuring that we spread that virus instead of being sent home where you can self-isolate and keep your distance from everyone. So, we want the governor to change that decision as well. So, those are some updates in Texas. Because we have Amy here, and because so many of you have shared with us that you're homeschooling your kids right now, I reported on every single day of the O'Rourke homeschool for the gifted last week. Amy taking the majority of those classes. I took history, PE, and lunch for the kids. This week, El Paso Independent School District, as have many ISDs across the country, has changed to kind of a distance learning program. And I thought maybe you could talk a little bit about what that was like since you were overseeing that for most of the day. And I was very grateful for you doing that. So, our kids are in the El Paso Independent School District, and they rolled out their distance learning program today. And, you know, I think everyone has to be patient. There were some technological glitches. We're working on a platform called Schoology that, I think because the amount of users on it all at one time, has been a little glitchy throughout the course of the day, but have had contact with, I think, almost every teacher that the kids have, either through video conference or through Zoom, which our kids are having a fun time with, because not only do they get to talk with their teacher, but they also get to talk with their classmates who they haven't seen in a few weeks. And so, I think it was a good day so far. I think Ulysses and Molly are going to be pretty independent, and Henry's going to need a lot more assistance from us to complete the assignments. And so, Beto and I are both trying to get work done during the course of the day. And so, after this is over, we're going to have a conversation about how we can split up the day so we can both also get the work done that we need to, and help Henry along the way. That's Amy's very nice way of saying that she wishes that I would pick up a little bit more of this responsibility, which I will. And the little bit I had today is I oversaw Henry doing his science, his online science learning, where he had to identify where each of the planets were in their order in the solar system. And tell him what you told me when I came in. I said, hey, if I happen to fall asleep while we're doing this, wake me up before mom gets down here. I did not fall asleep. We got the assignment completed, and now we're here with you all. But I will just stress that teachers that have spent their time in the classroom working in person with kids have had to adjust to this distance learning in a week's time. And that is incredibly challenging to not only understand the platforms and the technology, create the curriculum that you're going to be providing for the kids, but then also to provide that individual attention to kids. And it's just going to be really difficult. And so, everyone needs to be patient and understand that. Absolutely. And the feedback we got from our kids is that the teachers, given all of those high hurdles and some of the technological barriers, did an amazing job today. So, we're grateful to you. Please keep up the great work, and we'll find a way to make this work. Now, I want to talk to Dr. Gilman. Okay. Everybody wants to hear from Dr. Gilman. I want you all to hear from him, and I want you to be able to ask him questions. Let me give a little bit of an opener. First of all, Dr. Gilman is an emergency room doctor in New York City, which is the epicenter of coronavirus in the United States of America. I mentioned that nearly 2,900 have been officially reported to have died from coronavirus in the US. 1,200 are in New York alone, so more than a third just in New York City. The official report is that 66,000 have tested positive in New York City. We know that a Navy hospital ship just docked in New York City to try to accept some of the excess that hospitals are no longer able to admit or to take in, or at least to anticipate that moment. Cleavon Gilman, who we're about to have on, was a combat medic in Iraq, is a ER doctor chief resident at the hospital that he works at, and keeps a journal that I want you to read. The address for it is cleavonmd.com slash journal. That's where Amy and I first discovered him, and just really well-written reflections on what's going on. Very personal, but also has a lot of very valuable information that I think you would like to see. Let's see if we can bring him on now. There we go. Christina on too. Christina, another doctor in New York City who we've had on before. All right, says that we're connected. There we are. Dr. Gilman. Thanks for joining us. Appreciate it. Thank you as well. I mentioned to the people watching that we've really loved reading your journals, and I've noticed that so many of them talk about the sound of sirens. Let me just read the most recent one you posted from the 29th. It was a difficult night to sleep through. I kept waking up to the endless wailing of ambulance sirens. My paramedic friends tell me it's a war zone in the community. More and more patients are pronounced dead on arrival and never make it to the emergency room. Another one that you published on the 27th talked about those sirens triggering almost a PTSD reaction from your time in combat. Tell us what it's like there. Are we seeing ambulances racing down the streets nonstop? Are we seeing hospitals overwhelmed? You certainly paint a picture of an unprecedented situation, at least from my understanding of what's happened in this country before. Tell us a little bit about what you're seeing. I'll let you know what I'm seeing. First of all, I just want to say thank you for having me on here. I have a speech impediment, so I have trouble speaking at times. Also, I do not speak for the place I work at. It's very interesting. About three weeks ago, we began seeing a certain type of patient. This patient was usually the elderly patient who was very hypoxic and having trouble breathing. Hypoxic means not enough oxygen getting to their tissue? Exactly, exactly. They would present to the hospital, and we would put them on the monitor, and they're like, oxygen is that would drop. That's just very unusual. Usually, we think of a pulmonary embolism, a blood clot of some sort. These patients had a fever, and a few of them had traveled to Italy, had also had contact with patients who had this. Over the past week, however, over the past week, it's been unprecedented. We've had 20-year-olds, 30-year-olds, 40-year-olds of every age who have presented very hypoxic. When I talk about very short of breath, I mean unable to walk a few steps. Walk five steps and be very short of breath and exhausted. There's a few types of patients out there. I look at them, there's probably five types of patients. There's the Trojan horse, I call it. The asymptomatic patient who has it and spread it to every person in the community. There's the walking well patient who has a cough, however, it can be at home. Then there's the patients who have a more severe outcome. These are the patients who present to the hospital, and they're very short of breath, and they have to have oxygen. Then there's the patients who have acute respiratory distress, and we have to place a breathing tube in them. In one of your journal entries, I think back on the 27th, you talked about, first of all, how many people were passing away, were dying of COVID-19. You talk about this eerie or creepy feeling. You're in a room, you might be changing, you're about to make a phone call, and there's a deceased patient in that room that you didn't realize was there. You talk about attempting to report those who died of COVID-19 and being on the phone. You're an emergency room physician. You're needed in the emergency room, but you're on the phone for more than an hour trying to report this death. Ultimately, you give up, and you talk about a physician's assistant or someone perhaps on your staff who has a similar problem. Then you speculate about what kind of underreporting we might have. If you're not able to register these deaths, or if you don't know if that went through, how do we as a country know how bad this is yet? Are you able at all to speculate or estimate if we're seeing that New York has 1,200 dead? Is that a factor of 10 underreporting? Is it a factor of five, or do you have any idea at all? I don't really have an idea of how much it is. I do have a few concerns, though. The medical examiner's office is trying their best. They're being overwhelmed right now, and they're getting calls about deaths all over New York. They're just trying to do their best. One thing else I also wonder is, are the patients who are dying in the field, are they being swabbed for COVID? I don't know. I don't know if they're being swabbed at the morgue or not, but every patient who I have who passes away, I've swabbed, and they've all been positive. Every one of them? Every one of them. Wow. One of the most recent posts that you wrote about the makeshift nature of the response. We know that many hospitals are converting wings, or rooms, or entire floors that were devoted to one specialty to the COVID-19 response. You also talk about an occurrence of polio in Copenhagen in 1952, and it was perhaps epidemic in its proportions. They had to bring on medical students to manually hand pump ventilators or respirators. I don't know what the term of art is for the patients. You kind of muse about whether we're going to need some kind of response like that if we're not able to produce the ventilators necessary. Can you talk about the makeshift nature that you're seeing in New York of how physicians, and nurses, and frontline medical staff, the hospitals that they work at, are meeting this? I'd love for you to also tell us a little bit about what you're seeing when it comes to a phrase we've all learned, PPE, or personal protective equipment, gloves, visors, masks, the gowns that protect you and your patients from infection. Tell us how these hospitals have changed in the midst of COVID-19. Right. Well, we're in a war right now, and like any war, it's a cat and mouse game. I think the leadership, I've been so impressed with Governor Cuomo. I've been so impressed with Mayor de Blasio. I've been so impressed with the leadership at our hospital. When the amount of patients coming in had to be intubated, 10 patients per day at least, they created a team of anesthesiologists to intubate the patients. When those amount of patients increased, they created two of those teams. They provided us surgeons from the floor to help put in central lines in the neck to allow us to provide pressers. They've also provided us multiple positions of assistance and ED as well to help us. Nurses from the floor come down as well. We are well equipped from that aspect. To get to your other question in terms of PPE, I've always had PPE. I think there was a period a week ago where a change was to have us wear it the whole day. I've worn my mask the whole day, and I haven't been sick yet. I've intubated multiple patients. I always feel safe at my job. I've treated hundreds of patients, and I feel well. I feel great right now. It's working, it appears. We have to conserve the PPE as a country, and that's a very important point. I'm going to ask you one more question, unless Amy has one, and then we'll take some questions from some of our viewers. You mentioned that you feel good right now. I also noticed that so many of your journal entries include a description of exercise, that you go on a three-mile run, and that if you're not well, then you're not going to be well enough to treat your patients. You also mentioned that you're no longer drinking alcohol. You're really watching what you eat. Amy turned to me when we were reading that together. She's like, Beto, maybe you should stop drinking alcohol too. You may end up changing our practices as well. Tell us how you personally are doing and how you're able to keep up your stamina, your health, the energy in a very demanding situation. You've compared it to war a couple of times. Does this feel at all like when you were serving in Iraq and the readiness that you had to maintain at all times to help your fellow service members there? This is a lot harder than being in Iraq. I'll tell you why. When I was in Iraq, I was 25 years old. I worked at a surgical platoon where we had battlefield casualties flown in, and we treated them. I put a lot of 18-year-olds in body bags, and I threw them in a freezer. This war here is different in the fact that I'm treating people in my community. I'm treating the banker. I'm treating the lawyer. I'm treating the grocery worker. These are people who I know in the community who are presenting very short of breath and having trouble breathing. The other hard part of it is that when I was in Iraq, I did not have to call a loved one and tell them that their family member had passed away. I'm doing that almost every day on a daily basis. In terms of how do I stay well, yes, I run. The virus affects your lungs, so I believe if I run and if I train that it's going to afford me some type of benefit, so I do that. I don't drink. I'm not a smoker anyway at my baseline, so that's how I stay well. Also, I think writing in my journal as well and just reflecting on the day has helped out a lot. For anyone who wants to read this journal, again, I think it is the best first-person account of what's happening in this country from the front lines of the crisis. It's cleavonmd.com and then slash journal. One day I'll figure out how to pin that or post it or do a little graphic on this, but we've got smart people listening to this, and they'll be able to figure it out. I'm going to browse for some questions. Amy, while I do that, you're welcome to ask a question. Dr. Gilman, would you be willing to perform your COVID rap song? I have to put on the beat or something, right? Up to you, and we put you on the spot, so if you don't want to, that's also an option. Let me see if I can put on my beat on the song. Let me see if I can find it. Take your time, and we'll look for another question. COVID, there we go. You got it? Yeah, I got it. All right. One second. So this track is about the pandemic. I made it to raise awareness about it, and I put on the beat and the hook. It goes like, pandemic, you can get it. If you can't breathe, then that means you should get tested. Otherwise, stay inside so you can't spread it. COVID-19's on the rise. It's a pandemic. We are in the dark because we're a week behind the start. Try to scream for a cause. We're the fever and the cough. Most of the nation is still not taken by chill, but viral shedding while infecting is making others ill. They're more likely hard to breathe than elderly and heart disease, hypertension, diabetes, and lung pathology. If you're sick, stay at home so the risk doesn't grow. At least two weeks with no cough or runny nose is contagious. If you're sick, wear a mask to contain it because it spreads like a fragrance. Even lives on objects and the pavement. Three days after the latest pandemic. All right, y'all. That's a verse. Yeah. On the spot. So you were able to rhyme viral shedding, right? That's amazing. That's really good. All right. We're going to take another question from a viewer. Here's a good basic one that you should be able to answer first. When do you know you have COVID-19? What symptoms should our viewers be looking for? Right. That's a great question. So usually people will present with a high fever. It could be a low-grade fever of 101, 103, and then also a cough as well. But this virus is very insidious. It can present with no symptoms at all. But if you have a cough, if you have a fever, and you're well, just stay at home for two weeks and just self-isolate. You should go to the emergency room. If you're very short of breath, you walk. I would go to the emergency room. Otherwise, do not overwhelm the emergency room, please. So that's very helpful advice. So you may have COVID-19, but if your symptoms are not extreme and you can isolate and take care of yourself and not infect anybody else, don't go to the emergency room. Right. Because from everything that I've heard, as bad as it is in New York, we have not yet seen the peak. And so we want to reserve those emergency rooms for people who are truly in emergencies. There are a lot of questions I see on the comments about whether or not COVID-19 is airborne and just what that means. Can you address that question? Yeah. There's some thoughts if you, when you're putting in a it gets in the air for maybe an hour or so, an hour to two hours, possibly. That's the airborne portion of it. However, it's mostly spread by droplets and contact as well. Somebody asked if you have shortness of breath and you're at home, is there any way to address or treat that? What should you do, say, before you have the chance to go to an ER? That's a tough one. If you're short of breath because you have asthma, you should probably use your inhaler. But the kind of the treatment I've seen here is that you need oxygen and, you know, and the oxygen is in the emergency department. And maybe in the future, we do how they're doing in Italy. They're actually bringing the oxygen to the patients in their house and they're decompressing their hospitals like that. I don't know if that's a possible option in the future. Yeah. Somebody asked, and I think this has been addressed a lot, perhaps as a point that bears repeating. There are a couple of comments coming through saying, listen, hundreds of thousands of people, maybe millions, get the flu every year. Tens of thousands of them will die from the flu. Isn't this just another flu? And what are we closing down the country for? I love that one. This is not the flu. This is nowhere near the flu. The flu, this is 10 times worse than the flu. I've never seen the flu wipe out nursing homes as this virus is. It's wiping out all nursing home patients. This virus is also taking down 20-year-olds, 30-year-olds, and all age ranges. This is way worse than the flu. And the flu, we have a vaccine to treat the flu, right? We don't have any treatment for this. We also have a drug to treat the flu as well called Tamiflu, and we don't have anything to treat this virus at the can their blood or blood platelets be used to treat those who do have COVID-19? Yeah, the thought is that patients who recover from the virus have immunity. There's no reason at the moment to believe that these patients are able to be reinfected from the virus. If the virus mutates and creates a new strain, that's a whole other question. And what they're trying to do is a few things. They're actually trying to get the antibodies from the patients who have recovered from the virus, and they're trying to extract those and see if they can inject those possibly patients who are critically ill. But all that is just like in the beginning stages at the moment right now. You asked a lot of questions in some of these journals, speculation or questions we all have about how long this will last and why people congregate in grocery stores and why people aren't eating the best public health advice. One of the questions that you pose in one of your journal entries is about what's happening at Rikers Island in New York. Can you tell us a little bit about that insofar as you know what's happening there? You may not know any more than we do from what we're reading in the press, but it seems like a really bad situation where you have a contained population of corrections officers and prisoners who are all probably infecting one another right now. Any thoughts on that? Yeah, I came across that in an article, and I was just very concerned about that. I believe there's 100 prisoners who have the virus and about 80 correction officers who have it as well, too. And we know that this virus is very contagious. It spreads from one person to one person very quickly. I just hope that these prisoners are going to get the care that they need. I don't want to be judge and jury. I don't want to have to, when the time comes, if we run out of ventilators, to be having to choose who gets one and who does not. But this virus is very contagious, and it spreads. And I can just kind of picture it spreading through a prison very easily. Just as a side note, I have two girls, 12 and 10. They're my nieces, my fiance's sisters in prison, and we took them in. And she's on lockdown in California. So that's kind of what they've been doing. They've been putting them on lockdown. And how does that affect a person to be on lockdown for 24 hours a day as well? That's just even worse. So this coronavirus is changing our society in many ways. Here's a great question from Jack. And I've read about you doing this in your journals, but you mentioned the toll that this takes on you, and you just talked about your family a little bit. What are you seeing from your colleagues? Yeah. You know, a few of my colleagues are young. You know, they're 25 years old or 30 years old. They haven't seen trauma like this. And a lot of them are having a hard time for many different reasons. It's hard if you have a 30-year-old you're intubating who look like you. Also, I think a few of my other colleagues have actually have small children, and they've actually moved their children out of New York. And so a few of them have newborn children who they haven't seen for three weeks. And that really affects them at their job, and they don't know when they're going to see their child again. We want to have hope right now, and it's hard. We saw that Virginia is going to have a shelter-in-place order until the end of June, which gives us some idea of how long this might last, but we really don't know. We know the president extended some federal distancing measures for an additional month. By definition, because this is novel, we don't know how long this is going to last. But we want to ask you, is there anything that you're seeing that gives you hope? Anything that you want to share with us that has been inspiring in the response that you've seen to this? And any idea about what the future might hold for us in terms of some of the crisis issues that we hear about in New York, the need for ventilators, the overwhelming of some ERs, and the way that you all are meeting this? Tell us your thoughts on what's hopeful or what's inspiring so far. There's a lot of questions in there. Let me see if I can. Yeah, sorry. So I think this will probably be here till June or July, if I had to guess how long it's going to take. Things that make me hopeful are how people have come together at my job. We've really banded together like we're in this all together. We check in with each other. We've also had residents help donate PPE. We've had pizzerias donate pizzas and help us in the community. Things that people can do, I think, is to just stay in the house, stay apart and stop the spread of what's happening. If the whole country did their job and just stayed in the house, the virus would die out in a matter of four weeks or so like that, I'm thinking. But it's very hard. There's 300 million of us here. It's hard to get everyone on that same page. But if everyone isn't on the same page, we're going to begin all over again. It's going to be like a new four-week period. But I'm very hopeful. I know that people... I guess just one thing I want to bring up is that there's some thought out there that all this is a hoax. I've kind of heard that and seen that. But this is real. People are dying every day from this. People are placed in the ICU. I don't know if they get out of the ICU yet. We've only been doing this for about two weeks now. I don't know what the outcome is. There are people who have pneumonia and they're placed on oxygen, like non-rebreather. But the people who get a breathing tube, I don't know if they get off the ventilator. That's something that we have to explore in the future. It's so new that you just don't know. No, we just don't know. One thing that's pretty interesting is that the hospital, that people are thinking ahead. They're saying, well, can we put two people on a ventilator and double up our capacity like that? Can we do how they did in the polio crisis? Can we have a person at bedside and squeeze their bag? We have millions of people who could do that. You would probably have to protect them in some sort that they don't get the virus. You could probably create a machine or some sort that could squeeze the bag. We are a very smart country. We're very driven. I think all of us put our heads together. We can find a solution. There's one comment I want to read to you. It's from Natalie Chisholm. As a pre-med student, this is really helpful info. Thank you so much for this live. I've got to tell you, it is, again, reading your journal, and somebody provided the link and we pinned it at the bottom of this feed. Listening to you, following you on Twitter, following your Facebook, just knowing what you're doing out there, that gives us a lot of hope. That's really inspiring to us. You have this passage in your latest journal entry where you talk about moments of war, moments of crisis, really force us to reveal ourselves, who we are. That can be for the worse. You talk about all of these doctors and nurses and frontline healthcare providers who stepped up. Though it's not in their job description to do a certain thing, they're going to do it until you don't need them to do it anymore. The way that people have banded together and really just the way that you have stepped up. I don't know another word to say it. I'm so proud that you're doing this work and that you're offering such a great example to the rest of the country. We wanted to share that with those who join us on these Instagram lives. We're so grateful for what you and others are doing. Please keep it up. If you can ever think of a way that we can help, any message that we can get out on your behalf or the behalf of other healthcare workers, please let us know. We'll continue to follow you, continue to reach you, and continue to cheer for you and others who are doing this important work. Awesome. I'm going into a shift right now, so we're going to see what it is. All right. We wish you the best of luck. Be safe. Thank you so much. It's so good to meet you. It's a pleasure meeting you all, too. I appreciate the opportunity. Thank you so much. All right. Bye-bye. Thank you. Wow. Our thanks to Christina and Nick, who first sent us a journal entry that Amy and I read on Saturday morning. Just so blown away, and something I'm going to be reading on a daily basis. Again, our thanks to Dr. Gilman, to everyone who asked questions. I know I didn't get a chance to ask all of the questions that you posed, but we tried to get to as many of them as possible. Please continue to support our healthcare workers wherever you are. If they're in your family, check in on them. Make sure they're okay. Amy's sister is. My sister is. They're both healthcare workers. Also, I thought Dr. Gilman had great advice. If you don't need to go to the ER, do not go to the ER. If you don't need to go to the hospital, do not go to the hospital. Make sure that we keep that hospital capacity open for people who really need it, and we think about the health and well-being of those doctors, nurses, and providers. Make sure that they're okay. Any parting words, Amy? And then just what he said, just stay home. That'll shorten the time span of this whole pandemic. Do not leave your house unless you need to leave your house. There are some who have to. Dr. Gilman's got to leave his house because he's got to go care for people who need it. Those who are working at the grocery stores need to leave their house. Our police officers, our sheriff's deputies, our first responders, many of whom are themselves getting ill, we've got to make sure that we are doing everything we can to support them by staying home ourselves. One other essential group that I want to talk about very quickly, and those are the folks who work at or volunteer at our food banks, we already have a very high level of food insecurity in this country. In the El Paso region, for example, routinely more than 200,000 people in a county of under a million are food insecure and depend on the local food bank. El Paso is fighting hunger. Now that demand has shot through the roof. I mentioned when Amy and I volunteered last Thursday, there was a line. Sorry about that. There was a line two miles long to pick up food for people who needed it. So if you can donate your time and you don't meet any of the criteria that should keep you at home, you know, you're an older American, you have underlying conditions. If you're relatively young and healthy and you have the ability to, please volunteer at your local food bank. Make sure you wash your hands, you wear gloves. Typically they will provide the gloves and a hand washing station. Keep more than six feet apart from your other volunteers. But those volunteers are needed to pack the boxes of food and then distribute that food to people who need it in the community. And then one more thing. If you have the financial capacity to donate to a food bank, please do that. They need the money to purchase the food that is packed in those boxes and then distributed to our fellow Americans at an unprecedented time of need. Millions of people now filing for unemployment. Millions of people unable to make ends meet in their homes. Millions of people unable to feed themselves. If you have the ability to help, please do right now. Do not wait another minute to do that. All right. We wish you all luck. We wish you all health. Please stay home. Stay apart from one another and then find ways like this to come together without being within six feet of each other. We'll see you tomorrow and throughout the week and we're grateful that you joined us today. Adios. Bye-bye.