Covid 19 – Volume 2 – Part 1 – Impact of the Virus

We hope this finds you all well in your hunkered down state of confinement. We want to continue sharing important information for you, your families, and friends about COVID-19. Our initial thoughts were to just do a brief email but as essential information keeps coming at a significant pace we’d like to present you all with another comprehensive report. We’ve been asked by many to detail my personal thoughts regarding the medical and nonmedical factors in regards to this unique coronavirus.

The report is broken up into three parts:

Part 1: I begin with a broad 30,000-thousand-foot view on the impact of the virus, reviewing cultural, demographic, strategic, and leadership issues culminating with two recent interviews on a prominent radio show.

Part 2: I take a deep dive into the science of the virus and the COVID19 disease. Pragmatic issues such as risk factors, symptoms, mitigation and hygiene strategies are reviewed. I also cover local testing resources, review the new testing programs, provide detailed resources for healthcare workers and citizen-scientists alike, and finish with a deep dive into the medicines being used for treating the virus.

Part 3: In the last part, I end with some specific lifestyle strategies and detailed supplement recommendations taken from my personal and professional experience spanning twenty years in this arena. I include the thoughts of leading figures in the functional and integrative medicine sphere, review the vast research on strategies to help the immune system, and end with, as requested, shedding light on my personal program and strategies that have fortunately kept me well and resilient.

This detailed account is based on my personal views and is not intended as a uniform medical or policy prescription. However, I hope it raises interest and discussion.

Here’s the link to our initial report that dives into a good foundation about COVID19. I apologize ahead of time for the length of this write up and for those with short attention spans who may not have the patience to read it in its entirety. However, we’re confident that you’ve all read much lengthier reports and believe you’ll find it interesting and learn something. To paraphrase two great thinkers, St. Basil and Bruce Lee, take what is useful and disregard the rest. We have broken it up into three parts. Future communications will be shorter.

Although we remain long-term optimistic about all of us getting through this, we are pained to see that our early predictions and concerns are proving to be correct. Our goal is to share what we know in a medically sound, detailed, and transparent way to educate our friends and citizen scientists and make sure there is no “ill-informed complacency”.

“Americans will always do the right thing, after exhausting all the alternatives.” -Winston Churchill

  1. Gathering Storm

Unprecedented times: Community vs Individualism

In thinking of the diagnoses, treatment, and impact of this novel virus we must take into account the separate but interconnected health and needs of the individual, the health care system, and the republic. The rapidly changing situation and dizzying and often conflicting data has not only created a fog of war feeling but has caused much stress and worry as many armchair doctors, virologists, epidemiologists, logistic specialists, politicians, and economists have weighed in and opined, often on social media, the best course of action. As a physician trained during residency in an intense but fostering atmosphere that had significant exposure to infectious disease and critical care and who has always tried to marry the fields of disease and health, I have found it all both illuminating and troubling.

I believe in the noble critique from within and thus we will be looking to constructively critique our current efforts and both look back and forward to best practices as we study what can and won’t work. As Dr. David Katz has recently said, “Disagreement is the gauntlet all ideas should run so only the worthy ones survive.” The influential and talented writer, cartoonist, and thinker Scott Adams has said, “This is a good time to maintain some humility about how ridiculous it is to believe any of us, including experts, know exactly the best thing to do and how soon to do it. We’ll be guessing and correcting to the win. Some of us will later seem psychic, but we don’t know who now.” He goes on to add further wisdom, “Judge the speed of corrections not mistakes.” Or to paraphrase a famous joke, “if you want to make God laugh, share with him our plans.”

My twin brother Tom, with whom I regularly collaborate and exchange a variety of ideas, sent me a very good article to share with friends, thus I would like to share it with you. The author recommends how we Americans should think during these unprecedented times, in which the wisdom of Alexis de Tocqueville could be a guide about balancing community and individualism.

Crises reveal our roots and what we believe about our world and ourselves. And this particular crisis seems to be revealing all over again two sides of American life that philosopher Alexis de Tocqueville observed and wrote about in the 19th century. One is praiseworthy, the other dangerous.

There is an opportunity, in the midst of this crisis, to embrace that indebtedness once more- to strengthen the bonds that are fraying or broken, to name each other and know each other, even if it’s from a distance. These are the beginnings of true health. (Ironically, it could be a health crisis that reveals to us the ill health that has long been hiding underneath our façade of national wellness.)

As COVID-19 spreads like wildfire, we are fighting over our loves: the self-interested love of “material well-being” reflected in a healthy economy on the one hand, and the selfless love of our neighbors on the other. But these loves also point to a war between our two American identities: the good neighbor and the free individual. The indebted and the debtless. But we need solidarity and a common good now; not just liberal individualism.

Prophetic insight from a neighbor and deep thinker

Our team has been following this worldwide problem for some time and although we did not predict just how significant an impact the novel coronavirus would have on all systems, we have been trying to share with our friends, patients, and community influencers our concerns and need to be on high alert and prepare for possible drastic actions – in the words of President Reagan in dealing with U.S. – Soviet Union relations, “Trust, but verify”.

One important voice has been our own neighbor, the renowned professor of economics Tyler Cowen of George Mason University, who I believe is one of the most talented and influential thinkers on global and economic matters and who, along with risk analyst and statistician Nassim Taleb, has been doing excellent work on how to think about interrelated systems and how they are impacted by health, economics, business, strategy, and politics to name just a few.

From Professor Cowen’s article that we read with great interest when written on January 28, 2020:

As the Wuhan coronavirus spreads to America, it now seems quite possible the United States will face some considerable logistical challenges. Even if the virus turns out not to be very deadly, or mutates into a safer form, the public will not know that for some time. In the meantime, a mix of justifiable risk-aversion and perhaps panic will strain U.S. institutions. It is worth thinking through what some of the major problems might be.

First, most emergency rooms are not equipped to handle a very high volume of cases, especially infectious diseases. It is not just a lack of beds and medical personnel. Imagine an emergency room crowded with people who had fever symptoms, whether from the coronavirus or not. Then imagine you injure yourself in some other manner and require immediate medical attention. How comfortable would you feel waiting in that room?

The general economic problem is that emergency rooms typically are not equipped with full surge capacity, nor are there enough emergency room add-ons or substitutes available on very short notice. Usually when there is a shortage, economists recommend raising the price to equilibrate supply and demand. Doing so in this case would be prevented by a mix of hospital regulation, anti-price gouging laws, and the public’s views on what is fair in times of crisis. If the virus gains any purchase in the U.S. at all, medical-care shortages are likely.

The good news is that most hospitals and emergency rooms do have contingency plans for such occurrences. The bad news (looking forward, though it is good news looking backward) is that those plans are largely untested by recent experience.

Very often, when a pandemic breaks out, talk turns to macro remedies such as air travel bans and quarantines, as China is instituting. Yet often the more important factor is the strength, resilience and flexibility of local public health institutions, and those qualities cannot be created overnight. Just as the Chinese health-care system is undergoing a major test right now, there is a good chance that the U.S. will too.

Once again, pandemic preparation is about the flexibility of decentralized institutions. These are not problems that can be solved by top-down planning. Instead, they rely on longstanding institutional capacities, high levels of social trust and improvisational skill.

The very first problem the U.S. is likely to face is one of risk communication. Of course the correct message will depend on how the data evolve, but in general there is tension between warnings that get people to take notice, and those that scare them underground or into counterproductive forms of panic.

If you tell people how terrible things are, they feel a loss of control. Many will retreat into conspiracy theories, spread mistrust of health-care institutions, or withdraw altogether from social or professional activity. Those who are sick may be afraid to seek medical attention, for having their movements constrained, driving the disease further underground and distorting the data. Again, trust is of paramount importance.

For all the talk about the U.S. having evolved into a more polarized, lower-trust society, I am optimistic about its on-the-ground capabilities on these issues. Yes, they fall short of ideal – but with any luck, we will never find out how far.

Tyler Cowen: The China coronavirus will test the U.S., too

“There have been as many plagues as wars in history, yet always plagues and wars take people equally by surprise.” -Albert Camus, The Plague


Such prescient analysis by Professor Cowen begs the question why we weren’t collectively as a nation and health care system better prepared for this novel coronavirus. It has been said that virologists are experts in the spread of viruses in the body but know little about the spread of these infections in populations. Philosopher Adrian Bye focuses on our systems, “This is a problem from the top down. Western healthcare has already become very complex and government employees are risk averse. They are not used to situations where critical drug treatments need to be made available within a few weeks. In addition, they don’t understand exponential growth. Things are fine one week, then the next week, hospitals are overwhelmed.”

I would argue there is a better place to start to think about this; beginning firstly with culture and experience. The countries of East Asia have by and large experienced a number of transformational pandemics including, for example, SARS, called the first pandemic of the 21st century, and many Influenza strains and as such are well situated from these painful memories to act more comprehensively and timely. In fact, Hong Kong has been called the sentinel post of influenzas. These regions also are culturally and politically more comfortable with isolation and other mitigation strategies, including using masks and more invasive surveillance and contact tracing techniques. Furthermore, their collective muscle memory has propelled them like a finely tuned Ancient Greek Olympic athlete to act more swiftly and aggressively in the face of this burgeoning demonic virus. Lastly, it must be noted, to paraphrase the famous thinker and investor Naval Ravikant, every Asian Tiger that bent the curve has had, in addition to massive testing, airtight borders. It is still unclear if we were/are willing and or able for such action at a state or country level.

Author and Washington Post columnist Marc Thiessen points to a presence of chronic bipartisan political shortcomings in which there has been a trail of at least ten years’ worth of un-replenished essential stockpiles, unfulfilled contracts, and outsourcing of critical medical supplies. More than just a sclerotic political bureaucracy there is much blame to be shouldered on a healthcare (including both clinical and public health) and hospital systems, including administrators who pushed for lean supply chains and hospital closings, that failed to heed the warning signs of past infectious outbreaks and pandemics and the lessons of 9/11. The media in general, with a few notable exceptions, have not been of enough help. And lastly, these multiple system failures should not absolve the citizenry of some responsibility. It can be argued that an unengaged and bored populace, hooked on Netflix with burgeoning waistlines and increasing diseases of lifestyle and civilization and a cultural amnesia of higher purposes, has often showed little to no interest to learn from past infectious outbreaks, nor uniformly focused on public health, and finally had little desire to optimize their body and spirit for improved resiliency and withstanding unknowns. It has not been helpful that the cognitive elite who have represented the ruling classes have often believed that in scientific matters, climate issues superseded the fields of infectious diseases and global matters such as clean water supplies and prayed to the altar of globalization without much thought to localism and community.

Lastly, more from Professor Cowen, his comments on an economic report produced by a number of prominent thinkers issued in March 2016, The Inclusive Cost of Pandemic Influenza Risk

“In other words, in expected value terms an influenza pandemic is a big problem indeed.  But since, unlike global warming, it does not fit conveniently into the usual social status battles which define our politics, it receives far less attention.”

Having a unique front row view as most of us do here in the DMV, and personally knowing many good people working hard on these complex matters in and out of the government and the many interconnected organizations in the private sector, it has been fascinating to see what can and can’t be done and what actions are being taken. There should be a nod to leaders and officials who tried to raise a warning flag. Senator Tom Cotton spoke passionately and often about this novel viral threat from China in January. Senator Josh Hawley spoke of the need to close flights to China early on. Senator Elizabeth Warren offered an infectious disease pandemic proposal at the end of January. Finally, Bill Gates (whose recent words I highlighted in my first report) warned in 2015 that a disease, more than a war, was a threat to causing millions of deaths in the decades to come. All fell on relatively deaf ears.

With our current knowledge of the origins of the virus, the virulence and potency of its spreading, and the link between the health of the individual and our country’s economy, it is my opinion that we should be thankful for both the initially unpopular and unprecedented actions of President Trump in stopping flights from China (and later Europe) and the early quarantining of those who were sick, and also the bipartisan action by Congress in passing a financial relief package that will hopefully help our friends, family, and businesses. On the flip side, the follow up of both of these actions has not seemed to be optimal. For example, while the government went back to work as usual health organizations were not able to adequately begin testing and the much needed financial relief measures became bogged down and delayed.

Others who deserve acknowledgement include the early actions by public health officials and government leaders in California and Washington state, which seem to be slowing the viral spread in their areas which contrasts with the slower response of New York City’s public health officials and local leaders. The aggressive actions of New York, California, and Washington state governors in partnership with national, military, scientific, business, and community organizations seems to be a good template for local action with outside help as needed to fill in the gaps, and on how to pivot from early missteps and hopefully “correct to the win,” to paraphrase my earlier quote from Scott Adams.

There are sure to be downstream effects of these actions taken and those not done but there should be, as has been recently repeated by Steve Bannon, “unity in substance” which pairs very well with his other important saying, “no ill-informed complacency.” This is not to downplay the shortcomings of solely depending on organizations. As was seen on social media by Naval Ravikant, “WHO isn’t going to warn you, CDC isn’t going to test you, FDA isn’t going to cure you, FEMA isn’t going to feed you- Save yourself.” This is consistent with my long-held belief that one’s health is too important to leave just to the health care system.


As a prescription to remedy the faulty thinking all too present in the cognitive elite and the “Davos Man” crowd, I would recommend for both our ruling gentry and all of us yeoman citizens to more fully engage in Socratic and Platonic wisdom. As my friend and outstanding teacher and scholar Andrew Zwerneman of Cana Academy (whose work I highly recommend) has taught me, the purpose of Socratic dialogues for Plato was primarily to understand:

1. How best to train the Guardian class

2. How to order their loves

To me, this is the true essence of the Greek Paedia, which is best described by Professor Luke Timothy Johnson as a wonderfully elusive word that means both education and culture and training. I believe that all of us should practice in taking ownership as we look to be the guardians of our family, communities, and organizations in these uncertain times.

Peter Zeihan, the excellent geopolitical strategist, has made some unique points that are worth noting and which I’ll paraphrase and summarize:

There may be some positive aspects to the ongoing American panic. Our sublime geography is by far the best on the planet, setting us up for massive current and future success.It is about place, not policy or governance or ideology. The U.S. isn’t good at national governance, when geography takes care of all of the big issues, there is little need for a large, overarching, highly competent national government as opposed to places like Germany and South Korea based on their unique geographic position and needs. We Americans have no sense of proportion and when we face an unexpected challenge we often panic and overreact, with the power of the world’s largest and most stable and most technologically advanced economy and military and we often reshape the world, although not on purpose. Zeihan cites many examples of such manic-depressive behavior and that our allies and rivals understand this. In addition to the Churchill quote at the top of this paper, he references the common Cold War Russian phrase, “Americans feel that if it is worth doing, it is worth overdoing.” Lastly, to quote Zeihan, “Americans are capable of incredible ideological, economic, technological, logistical, military, and cultural leaps when the panic sets in. The coronavirus crisis is by no means anywhere close to being over, but the switch has been flipped.” The American system cannot be copied and has exited every decade in a stronger position than when it entered. It will come through this as it did after the more impactful Spanish Flu pandemic just fine.

The geopolitical, economic, educational, health, scientific, and financial spheres will all be affected and need to adapt; it will be interesting to see how this unfolds. In my opinion, a political and strategic roadmap that includes the following will be essential:

  1. More meaningfully acknowledging the impacts of globalization and trade and China’s role in the global order.
  2. The importance of putting the oxygen mask on our population first, through the sharper focus on the economic and health needs of one’s own citizens.
  3. Improving the ability to manufacture essential goods, especially medical and health products, in our own nation.
  4. Meaningful partnership with the health, science, business, and political communities and the reduction of barriers to innovation.
  5. Better support for the most vulnerable such as the chronically, physically, and mentally ill; the elderly, poor, and those who need end of life care.
  6. Improving the education of the guardian class and the ordering of their loves (to paraphrase the Socratic wisdom referenced above).
  7. The acknowledgment of the importance of community and localism as a buffer to both individualism and the expanding state.

I hope that these thoughts will be amongst some of the many lessons learned in our current new era as compared to the other B.C.- Before COVID.

Leading Beyond the Blizzard: Why Every Organization is Now a Startup

We believe that the COVID infection and downstream medical, psychological, geopolitical, and economic challenges will no doubt have some lasting effects and that more than the current blizzard we are starting to see we may in fact be entering an intermittent time of winter – especially since the virus may or may not respond to warmer weather, that “flattening the curve” can lead to a prolonged exposure to an infection, and predictions based on past pandemics lead some experts to think it could rear its ugly head again in the fall. We believe this may be only the 3rd inning of a long game with some costly but unavoidable rain delays.

An excellent resource that describes the crisis affecting all of us is an eloquent and well thought of essay by a group of principled community leaders and entrepreneurs: Leading Beyond the Blizzard: Why Every Organization Is Now a Startup

Fire in the Hole

Our neighbors up Interstate 95 are starting to get a large wave and we believe this means we are not too far from seeing more widespread confirmed cases in our area and potentially seeing similar stressors on our healthcare system. We know, for example, that there have been a number of cases in the area for a little while already and Fairfax County had its first fatality about a week ago. I have been in close contact with doctors on the frontlines and dedicated researchers- including those both locally and in the Pennsylvania and Philadelphia area- and hospital systems are starting to come under intense pressure.

This article shares an internal letter from the head of surgery at Columbia University Hospital that echoes what I’ve been hearing from colleagues as well. Early signs of “hospital exhaustion”-

Medical experts in New York do not expect the number of cases to peak for another 22 to 32 days, the memo written by Dr. Craig Smith says, and the supplies of masks, equipment, and available beds is well short of the impending need. He estimated the crush of patients will require from 700 to 934 intensive-care beds.

Compassionate Physician In a Time of Crisis

Dr. Smith’s division reports are not only poignantly written but shed an intimate and powerful light behind the scenes of a major hospital on the front lines of this novel infection. From a recent letter:

Healthcare administration and administrators- under the gun and receiving renewed scrutiny for poor leadership.

Letter from a concerned physician

A powerful article from a physician expressing her challenge with the administrative leaders of our healthcare system. Dr. Megan Frost Babb voices concerns in a strident and passionate language and shares quotes from doctors and nurses which is mostly consistent with what I’ve heard echoed by a number of colleagues for many years but unfortunately made more urgent during these tense and chaotic times as chronic problems are left bare for all to view.

Healthcare Administration and its Administrators work hard to suppress us by minimizing our voice, and maximizing our work output.

For as long as I have been practicing medicine, America’s healthcare system has operated on a model of just enough. There always seems to be just enough physicians available to care for patients, just enough nurses to aid patients at the bedside, just enough staff to operate at maximal output with minimal input. Always, just enough of what is needed to marginally practice the art of medicine. Ironically, however, the just enough model never seems to pertain to the warden, his funds or his needs. For decades, the shortcomings of our healthcare system, which restrict the physician’s capabilities to practice medicine autonomously and restrict others’ ability to deliver the care patients need, has been blamed on us, the healthcare workers. But the prison walls that imprison us are deteriorating as we speak.

You have been exceptionally successful at profiting off of the herculean work ethics of physicians, nurses, and all other healthcare employees. You take advantage of our ability, our willingness to be malleable, and to offer care to any and all who are in need. You exploit our altruistic tendencies, knowing they leave so many healthcare workers vulnerable to accepting your often impossible demands. 

But, your lack of action in protecting us and society from COVID has forced us to take action separate from you. Healthcare workers will no longer hold your burdens nor be held accountable for your lack of preparation and unethical decision making. We no longer fear your retaliation or retribution, because society is on our side, already supporting us, giving us the strength to reconcile the deficits you have left behind, the deficits you have expected us to fill ourselves.

NYC hospital executive leads from behind at FL vacation home

While heroic staffers beg for protective equipment and don garbage bags to treat coronavirus patients at a Mount Sinai hospital, two of the system’s top executives are waiting out the public health catastrophe in the comfort of their Florida vacation homes, The Post has learned.

ER doc who criticized a hospital COVID protections has been fired

Private equity -backed healthcare company slashes benefits for doctors while they work on the frontlines

A private equity-backed healthcare company is slashing its doctors’ benefits in response to the coronavirus pandemic, even as many of those same doctors work to treat patients infected with the virus.

Pappas Twins on Authentic Leadership during these troubling times

I asked my twin brother Tom to comment on the governance challenges we are all currently facing. Tom is uniquely qualified to comment on this. He’s a West Point graduate who served overseas for 5 years in Germany and was a vital member of our military that ably served in the Bosnian peacekeeping force of the early 1990s. Being a level-headed Greek Orthodox was especially helpful to his team and was seen by the stubborn fellow Orthodox Serbians as a bonus in their religious and national struggles with their enmity to the West’s point of view. After retiring as a Captain, he pursued an international MBA in the Netherlands where he has since been an executive working for a variety American firms where he has had prominent international experiences. He is married with two children, lives in the Netherlands, and even speaks fluent Dutch. I asked him during these unprecedented times if we need on the whole better leadership.

Yes, we do. I know it’s tough seeing this crisis. It’s tragic and sobering at the same time.

I feel most of our leaders and citizens and haven’t lived through or trained for crisis-like events. The greatest generation of WW2 is mostly gone so there is no individual memory of societal struggle.

This is where our individual character is revealed. History is full of these types of health crises, going back to Pericles and the plague of the ancient Athenians and Justinian and the plague of the Byzantines. I think this ancient Roman poet’s quote says it best: 

“Adversity reveals a man’s character, prosperity hides it” -Horace

When I asked my brother’s take on the inexplicable leadership demonstrated by the CEO of Mt. Sinai’s medical system in New York City, coordinating phone calls holed up in his Florida mansion while vital staff struggled with procuring PPEs and risking their lives while the hospital system experienced exhaustion, he commented:

Generals Patton and McArthur would not have led from behind but would rather have donned Haz Mat suits and coordinated command from the frontlines.

Tom brings unique cultural and strategic views to the numerous discussions we always have and has helped inform my opinions on many changing international and leadership subjects. He has served as a mentor to former military servicemen and women and has coached business leaders in many areas. Like myself, he has a passion for reading, history, international affairs, strategy, and studying a broad range of topics in addition to keeping fit and healthy, for which he’s done an admirably good job as a non-expert.

We both get excited and proud of the accomplishments and uniqueness of our Greek heritage and sometimes will admit that our Hellenic forefathers didn’t create all meaningful parts of our civilization. I won’t comment too much on my slightly better basketball skills over the years or my unique influence as his older brother by 15 minutes. However, he has written frequently about leadership and providing guidance in all the varied aspects of its formation, diffusion, and enlargement. I’ve regularly provided input and advice, especially in matters of health and vitality.

I helped him create a unique resource, called The Leader’s Workout. We integrate insights on leadership growth and personal health to help you become a more effective and impactful leader. Combining the experience of a leader and a healer, we share the same vision of exhorting people to upgrade their leadership health. I think you’ll enjoy this sneak peak into an area of passion from my brother and I that we hope will be a valued resource in these challenging times. We plan to provide continually meaningful content in the days ahead.

April is the cruelest month,

Breeding Lilacs out of the dead land,

Mixing Memory and desire, stirring

Dull roots with spring rain.


COVID hits hardest in cities that are “densely populated and linked by rapid air travel, by movements of tourists, of refugees, all kinds of business people, all kinds of interlocking networks.” “Coronavirus is emphatically a disease of globalization.” Historian Frank Snowden.

Disease of globalization, cities, population density, and cosmopolitanism.

These two articles shed light on why cities in general and New York City in particular, are being hit so hard. Joel Kotkin’s article in tablet mag is especially of value and well written and as an expert in cities and demographics brings up many important points.

Tablet Magazine:

Cities like New York pay a price for being both dense and cosmopolitan. As a new study from Heartland Forward reveals, the prime determinants of high rates of infection include such things as density, percentage of foreign residents, age, presence of global supply chains, and reliance on tourism and hospitality. In contrast, suburban, exurban, and small-town residents get around in the sanctuary of their private cars and have far more room inside their houses.

The New York Times:

“New York City is often the first to get hit because of how dense it is, and how many international travelers come through,” said Thomas R. Frieden, the former director of the Centers for Disease Control and Prevention as well as the New York City health department. “The question now is whether the rest of the U.S. will learn from New York and avoid the situation that it is facing and is likely to get worse in the coming days and weeks.”

After coronavirus, we need to rethink densely populated cities

Joel Kotkin has another excellent article from April 1, 2020 exploring how to think about cities and urban areas in a post coronavirus time. Important to understand as we contemplate policy and next steps to get back to work. His thoughts and many writings on what he calls Neo Feudalism and the societal challenges presented by elites, for example what he calls the Tech Oligarchs, is fascinating reading and I think important.

For the better part of this millennium, the nation’s urban planning punditry has predicted that the future lay with its densest, largest, and most cosmopolitan cities. Yet even before the onslaught of COVID-19, demographic and economic forces were pointing in the exact opposite direction, as our biggest cities—New York, Los Angeles, and Chicago—all lost population in 2018, according to the U.S. Census Bureau. 

The impact of the coronavirus pandemic may be too early to measure, but it’s clear that the great preponderance of cases, and deaths, are concentrated—at least as of now—in dense urban centers, most particularly Wuhan, Milan, Seattle, Madrid, and New York City. This crisis is the right moment for the world to reconsider the conventional wisdom that denser cities are better cities.

Sadly, many of the attractions that make places like New York so unique and appealing also make them more dangerous. Crowds, mass transit, clubs, and huge cultural venues create a perfect terroir for the spread of pathogens. In contrast, the rate of infection has been far lower in less urbanized states like Iowa or Oklahoma, which health professionals say benefit from less crowding and unwanted human contact.

The threat of pestilence has been prevalent throughout urban history. Cities, noted the historian William McNeill, are inherently “unhealthy places” when faced with fateful encounters with pathogens. Even in ancient Rome, Alexandria, and, later, the great cities of the Renaissance, plagues repeatedly devastated urban populations, particularly those most integrated into global trade.

And like their contemporary affluent counterparts in modern New York, the wealthy of these cities escaped to their country estates, hoping to wait out the worst. As for the hoi polloi, they simply got sick or died.

Rather than the Radiant City of glass towers looming over copious parks prophesied by Le Corbusier, we are likely to end up with urban centers more like Frank Lloyd Wright’s Broadacre City concept: vast expanses of low-lying private homes connected by both roads and the Internet. We may lose some of the excitement of our unscripted cities, but also create a way of life that is safer and happier.

7 Major Cultural Shifts the Coronavirus Should Make Happen

This powerful article lays out thoughts on cultural shifts that we should think about post-COVID19 by Joy Pullman.

As the author states: The specter of one’s mortality that a global pandemic raises can be a needed and sobering opportunity to reconsider and reorder our lives, if we’re granted them longer.

1. Massive Shift in Education

2. Prepping for Emergencies, Government Incompetence

3. More Flexible Work Environments

4. Better Social Norms About Sickness

5. Basic Financial Responsibility

6. Learning How to Live through Deprivation

7. Revitalization of Community Relationships

I’ll add a possible 8th shift as relayed to me by my friend and patient, Kathleen Cauley, in discussing our privileged roles in the healthcare sphere that she and I share. “It’s a privilege to listen to people accessing their capacity to stay in their brain and mindset. Don’t let emotions hijack your brain.” As a dedicated and experienced coach to individuals, families, and couples, her words of wisdom should be followed by all.

Radio Appearances

I recently participated in two interviews with my friend and patient Sebastian Gorka for his radio show America First that we hope you’ll find informative and helpful. Sebastian is a unique and valuable resource in these uncertain times. As a principled voice of strategic thinking, son of a Hungarian patriot who was captured and tortured by the Communist ‘secret police’ before fleeing to freedom in the West (U.K.), and long-time expert in the intersection of geopolitics and national affairs, he was an early advocate of the importance in understanding the influence of China on our unique way of life. It was partly based on his early work that I was able to learn of our healthcare systems over-reliance on China for medicines, critical medical testing components, and potential supply chain challenges, the downstream effects of which we are all currently experiencing.

In the first interview we talk about the coronavirus and a better health framework

The second interview was done primarily to answer COVID questions from listeners