Well, hello. It's great to see you again. Welcome back. Hey listen, this is another video that's going to change your life. So once again, I want to invite you to please watch the whole thing through, because it's really that amazing. Now, I assume that at this point you've probably seen the Breath of Life video, but if you haven't seen that, it might be important to watch that first. This one is kind of a follow-up. You see, when I first started working with the Breath of Life, after several weeks I had this curious thought. What would happen if you did it in reverse? And so I practiced breathing out for seven seconds, holding my breath for three, and then breathing in into my heart. What happened was actually amazing. This breath was equally as powerful as the Breath of Life, but it had a very different purpose, an inverted purpose, if anything. This breath, which came to be known within me as the Breath of Death and Resurrection, is a space for you to allow old energies, stagnant belief systems and thoughts, upset emotions, anger, shame, or other inner states of this nature, to be able to be cleansed and purified and all in all transform those energies into that of a higher nature. So that's what I'm going to show you how to do today. Now, when I began working with this, just like I taught in the first video, I was working with it the seven seconds and three seconds. However, I was also activating my Merkabah at the same time of learning these breaths. After some time, I shifted my breathing to match the Merkabah, which is a pattern of eight second breath and a four second hold. This video we're going to explore using the Breath of Death and Resurrection with a one second increase on both the breath and the hold compared to last time. In this, it'll be a fun experiment to notice how it feels differently for everyone who goes through it together. So afterwards, if you feel called, please share your experience in the comments. It's always welcome.  This one, instead of doing four affirmations that will go through, instead, you're going to focus on one particular thing, some low negative energy that you're feeling that you want to purify, and then we'll cleanse that energy using the breath by doing it 33 times. 33 is a sacred number because it's how many vertebrae we have in our spines. And so by focusing on this breath, you're going to be aligning yourself with a higher frequency through your entire spine, which is why it's very important to have good posture when you do this. And so with that, please take a moment to get yourself into a comfortable meditative position and we'll begin. Now understanding the breath of death and resurrection is very simple. Last time, where there was a visualization of the onc upright, now what we're going to do is turn the onc upside down and put the line under your feet. Under your feet, there is the onc circle shape, which is going to hold the whole earth with the stem of the onc extending up your spinal column and your chakra column. As you breathe out, we're going to be letting all of the energy flow down to the earth below your feet. You're going to be offering to her all of this energy to be transmuted.  So you allow this energy to pass through you and you send it down to the earth. If you're in an apartment and you're above other people, you can set the intention that the energy goes straight to the earth and doesn't pass through any other people who might be in between you and the planet. This will be the visualization for the first 11 breaths. For the second 11 breaths, the earth will change into the sun and then you'll be visualizing sending your energy to the sun below your feet to be transformed and transmuted by the fires of the ultimate flame. And for the final 11 breaths, that sun will become the entire galaxy and your prana or energy column that runs along your spine will be aligned with the center of the galaxy. This was the process that I learned it with as the galaxy, the supreme great mother, is so much more capable of transmuting some of the heaviest stuff. And so you offer yourself to each of these powers of creation and receive their support in the transmutation of those energies.  One final thing I want to speak to before we begin is the acknowledgement that some of our suffering is very great and that this practice may take some time to work with particularly big energies. But I promise you going through it even one time will still cause things to move and you'll feel it and we'll see it in the comments with everyone talking about it after. Please take a moment to feel within you whatever the biggest struggle is that you're facing right now. If there isn't any negativity, then you can just allow your ego to go through this practice so that it might become more aligned with the soul underlying your thoughts and actions. Take a moment now to become present with this struggle, this negative energy. We're not acting on it, we're just being present right now, feeling the feeling and letting it move through us, allowing a gentleness and an acceptance that it is here within you and it's ready to be moved. You can take a moment to just allow this to move through you and know that it's okay. You're healing it now. And now with that, with all of this energy present, let's do the breath of death and resurrection 33 times. Congratulations, you did it. That was 33 breaths of death and resurrection. How do you feel as your breathing returns to normal? Just take the next few minutes to really be present in your body. You can even pause and do some journaling if you'd like to or share your experience in the comments. Thank you again for taking the time to watch this video. Everything is connected. I love you and thank you so much. I'll see you next time.


Lego Mario is finally here. But he does look a little odd. In collaborating with Nintendo, the Lego group has decided that Lego Mario should not be a traditional Lego minifigure, but instead a larger, chunkier figure with a built-in screen. While there's no guarantee we won't get a proper Mario minifigure in future, for now, Lego doesn't want this to happen. Why? Because the classic Lego minifigure simply would be too small for all the electronics they've jammed into Lego Mario. Work on Lego Mario has taken five years from the point when Nintendo and Lego first started talking about a collaboration. The two companies felt that they had a lot in common, both producing creative products aimed at helping families to play together. Enter Lego design manager Jonathan Benink, who was given the brief to create something that combined Lego and Mario. The brief was deliberately vague as to what this should be, so Jonathan and his team put together eight different pictures for how this collaboration could work. Six or seven of these pictures involved a digital Lego hybrid approach, as the team agreed that this would be essential to making something that reflected both Nintendo and Lego. Indeed, Lego has been experimenting with this kind of play for several years. The team had learned from the successes and pitfalls involved with the toys-to-life game Lego Dimensions, as well as the similar hidden-side Lego sets which connect to a smartphone. In truth, Lego has been struggling for a few years to find the perfect technologically savvy approach to toys. While the company is one of the biggest toy manufacturers in the world, their sales have been suffering in recent years as a result of the rise in smartphones and tablets. A collaboration with Nintendo likely seemed like the perfect opportunity for Lego to learn how to compete with their digital rivals. The upper management at both Lego and Nintendo were shown these different design ideas and voted on which one they liked best. They picked a Mario solution that had a small screen embedded in his front. While the team had initially considered making Mario a traditional minifigure, there was just one small problem with the plan. The screen technology simply wouldn't fit inside a figure that small. Said Jonathan, the problem is the size of the technology. He had to have batteries and a display and a speaker. We tried different combinations of technology and to put it all in a minifigure was just physically impossible as you can imagine. A claimed Nintendo developer Takashi Tezuka said, first we spent a long time examining the size and design of the Lego Mario figure. Additionally, while Lego Mario will react based on the color sensor and take action based on what is read, it is unable to read actions such as Mario's traditional action of hitting blocks from below. Once the direction for the collaboration had been voted on, both Nintendo and Lego went away to create prototypes. According to Jonathan, Nintendo made a prototype because they are just really good at all those digital devices with screens in it and they had a bunch of parts lying around. The two companies compared notes to find a good balance between the classic Lego form and Nintendo's understanding of how the technology inside should work. Said Jonathan, from there we decided that he needed to be square. It is easier for the technology to fit in a square so you can make a smaller figure, but also Lego bricks are generally square, the most iconic ones. So we felt it made sense with Mario coming to Lego form if he is square. Nintendo wanted us to make certain elements more organic like the cap because it is so iconic. Then, once both Nintendo and Lego had agreed on Lego Mario's appearance, Lego dropped their prototype on the ground 5000 times to test that it would definitely be sturdy enough to endure all kinds of play styles. They sent the finished Mario prototype to Nintendo, who also dropped it on the ground 5000 times to ensure that it was tough enough to sell. Apparently, both Lego and Nintendo have very similar standards when it comes to product longevity. Joy-Con drift, notwithstanding. So, Lego Mario was unveiled to the world not as a minifigure, not as a computer game, but as some kind of cross between the two. It remains to be seen whether this approach actually proves popular in practice, but if it does, it's likely we'll see more similar products from Lego in future. The moral of this story is that it's good to learn from others. Both Nintendo and Lego had specific skills and talents that they brought to this collaboration, and the result is something that builds on their many combined strengths.


Test Your English Quiz 3 How good are your English skills? This test checks your listening, reading, grammar, and vocabulary. All you have to do is fill in the blanks with the best answer. Ready if you begin? Get out a piece of paper and number it from 1 to 20. In a moment, you will hear a passage written in English. Then you will see the text of that passage. It has been divided up into sentences. Every seventh word has been deleted from the text. Your task is to fill in the blanks with the missing words. Only one word per blank. Good luck. Listen as I read the passage. Moon goes blood red this weekend. Eclipse for the Americas A total lunar eclipse will grace the night skies this weekend, providing longer than usual thrills for stargazers across North and South America. The celestial action unfolds Sunday night into early Monday morning, with the moon bathed in the reflected red and orange hues of Earth's sunsets and sunrises. For about one and a half hours, one of the longest totalities of the decade. It will be the first so-called blood moon in a year. Observers in the eastern half of North America and all of Central and South America will have prime seats for the whole show, weather permitting. Partial stages of the eclipse will be visible across Africa, Europe, and the Middle East. Left out, Alaska, Asia, and Australia. This is really an eclipse for the Americas, said NASA's Noah Petro, a planetary geologist who specializes in the moon. It's going to be a treat. First three blanks, you'll have 15 seconds. Moon goes blood red this weekend. Eclipse for the Americas. Write your answers on your paper. Ready? Begin. Next few blanks, 35 seconds. Next few blanks, 35 seconds. Last three blanks, 15 seconds. Here is the whole passage. You have one minute to review and revise your answers. Here are the answers. Moon goes blood red this weekend. Eclipse for the Americas. Title. A total lunar eclipse will grace the night skies this weekend, providing longer than usual thrills for stargazers across North and South America. If you have a perfect answer, you will get two points. If you have an acceptable answer, you will get one point. Next few blanks. The celestial action unfolds Sunday night into early Monday morning, with the moon bathed in the reflected red and orange hues of Earth's sunsets and sunrises. Next few blanks. For about one and a half hours, one of the longest totalities of the decade. It will be the first so-called blood moon in a year. Next few blanks. Observers in the eastern half of North America and all of Central and South America will have prime seats for the whole show, weather permitting. Partial stages of the eclipse will be visible across Africa, Europe, and the Middle East. Left out, Alaska, Asia, and Australia. Last three blanks. This is really an eclipse for the Americas, said NASA's Noah Petro, a planetary geologist who specializes in the moon. It's going to be a treat. Here is the complete passage for you to look at. The source of this material is Voice of America. Here is the link to the excerpt. How did you do on the test? Here are what your score results mean. If you got 40 points, that's a perfect score. Wow, that's nearly impossible. 36 to 39, excellent. Great, your top notch. 28 to 35, very good. Your English skills are quite high. 20 to 27, good. Not bad, keep trying to improve. Hope that was helpful. If you liked this, please give us a thumbs up in the comment section below. Also, don't forget to subscribe to our channel. Thanks for watching. If you have ideas for our next video, please let us know at the link below. Please check out our websites for more information. eslgold.com and freeenglishstudy.com


Cobra Gold was an exercise where we went to Thailand, we worked with our Thai counterparts and conducted an airborne JFV and aerosol. Training with our Thai counterparts, it was very fluid. We adapted very easily so it didn't take much conversation. We kind of get each other's movements. They're very well versed with the landscape. They fight light and they move quick. All the training that we put into Cobra Gold and the preparation and then executing with the Thai Army, they were great to work with. From my experience, I was pretty excited to do onto that plane and jump. We conducted an in-flight rig. When the doors opened on the C-17, you get an adrenaline rush.  Red backing on the wings, they take very much pride into what those airborne wings look like. It looks very meticulous. It looks hand-woven. I'm proud to say I'm going to put on my ASU. I felt as they were painting the wings on me. Just felt happy in that moment, you know, and I felt like we were creating a bond. There's like a brotherhood here between the two countries. Their wings are like a work of art, so it's just kind of like the pride having that on the uniform now. So you tell it's something that they pride in. They were extremely nice. Every interaction I had, we were talking like old friends. We were taking pictures together. They fight with courage and we respect one another.


Oh, welcome folks, this is Tom O'Brien of TFNN. We're here five days a week, we go seven hours a day, we go 24 hours a day on the internet at TFNN.com. Always remember folks, whatever you think about, you bring about whatever. You focus on grows, hope everyone's having a great day, safe day, make it a great night folks. Surrender and let go of the past. Always do your best. Whatever life takes away from you, let it go. When you surrender and let go of the past, your life is set to be fully alive in a moment. Letting go of the past means that you're gonna enjoy the dream that is happening right here, right now. Market wise, let's take a look at it out here. We have the Dow Industrial's up 65, Nasdaq up 10, S&P's flat. Gold contract down $25.30 trading at 14.85 an ounce. Silver off 46 cents, $17.60 an ounce. Light sweet crude up 73 cents, $57.26 a barrel. Notes and bonds. You get the 10 year down 216, 128, 29. 30 year off a point and a half, 157, 28. King dollar, King dollar, 478 ticks, 97, 983. The euro is at 110. The yen is out here at 109.23. And the pound is at 128 to one U.S. dollar. Our phone number is<PHONE_NUMBER>. Give us a call folks. I know it's going on in y'all world. In the world of the S&P's, let's take a look at it. We get a lot to cover and we're gonna cover it right here, right now because we got metals action, dollar action, S&P action. S&P action out here, we haven't hit an all time high yet. 307.91 we got to today. 307, 308 on the dot was the high out here on yesterday. NDX 100, we take a look at the NDX 100. What do we have with the NDX 100? The three Q's, looking at the NDX 100, that we hit $200.55 and that did go to a new all time high. $200.51 was the high and the Dow certainly is at a new high because we're up 81 points in the Dow. Dow new high out here at 27.560. Okay, notes and bonds, here we go baby, notes and bonds. So what do we have? You get the 10 year note, 30 a bond, they're going after this September 13th swing low. Bottom line is gonna be pretty cool watching how this shakes out. Now, they haven't held price at all. That being said, it's anemic volume as how we're coming into this. We're coming into this with 1.6 million contracts. We did 2.4 million at the 128.16. So we've hit 128.27. I suspect more than like we're gonna go down into that level tomorrow. That being said, what you also have is that you're also going into the August 1st sign of strength. The August 1st sign of strength is that is where bottom line is that we broke top side and went to a new level. If we go take a look at the TLT, you're gonna be able to see a little bit clearer because what ends up happening of course is that the future contracts every three months, you're gonna push these things forward. Inside the TLT, what you'll see here is this. Now the TLT is the 20 year plus ETF structure. That's down to $1.84 today. You're trading $136.87. You have volume out here of 9.8 million. Now, the swing low is 136.54. So we hit 136.73. That number there is 18 million. Not only that, as when we broke top side, you were breaking top side with 26 million and then you went even higher with 32 million. So I do expect tomorrow we're gonna end up getting that tested. Bottom line, we'll see whether price can hold, rejection of price. Our bottom line blows it right through. Gold contract, what do we have with the gold contract? Same type of setup inside the gold market. Gold and silver, they whack gold as well as silver out here today. We take a look at the gold contract. What you're gonna see is that you're down $25. Now this is where this gets really wild. You get a monster volume. You have 565,000 contracts. Yet you haven't even broken the small swing point yet. Now the small swing point in gold is 1478. We went to 1480. The largest swing point gets down to the price, gets down to this October 1st, which is 1465. And then what you're also coming into, and that's what we did test out here today, okay? We got the 1480. You're testing the strength that was from August 7th. And thus far, folks, what you've had here, and this is pretty cool, watching this whole list, you've rejected it. So what does the rejection mean? So on August 7th, you went from 1484 to 1522. You did 652,000 contracts. What we have done over here thus far today is that you went to 1480, which got us under the 1484. You're now above 1484. You're at 1486. We've done 565,000 contracts versus 652,000. So you can see we're still 90,000 contracts shot. You had lighter volume, rejected price, bottom line. We'll see how this shakes out. Meaning that you get a full rejection and you get a ride back top side. So let's go take a look at the 30 year. Now, the way that is set up, that is set up that that's what it wants to do, okay? You know, we understand we're in the probability business, but bottom line when you get a rejection of lower price like this, you get a flush out to the downside, bottom line, you get above the strength again, that says you're going top side once again. We're gonna take a look at the silver contract. Silver contract down 46 cents. You hit a low today of $17.52. Now your benchmark out here, get a few of them. So the larger one is 1694. And we're talking, you got one's 96,000 contracts and now there's 134,000 contracts. And we'll go to the SLV on this one because that way you don't have to string these together. So the SLV, which trades it off the future price, what you're gonna see here is that you're down with 19 million shares. You're going into 29 million. The SLV itself, it hasn't even got into a lower swing point yet, which is $16.15. Pretty wild. The yen, we're gonna go to the yen quickly.  We are at 109.21 and I don't wanna see this yen over, blast over the 109.32. What we had done last week is that we got to the 109.29 and gave it up, we went from 109.29 two days later down to 107. You're charging back here, it's gonna get tested. We'll see how this test runs out tonight. What's also gonna happen in Japan tonight is that you're gonna have soft bank come out with numbers. So not that that trades in the United States but what we do have because we've had so much publicity with WeWork, you know, with some of the Slack with some of the other companies that he does own, that's gonna be a number out here tonight. Stay right there, folks. Coming back with our man, Mr. Basil Shop.


So what this is is, this is just one of the pages on the taste trade platform. But what I was showing you before is just to give you a quick little sneak peek at, this is volatility. And you can see it's at the lower most recent range, but this number here where it is trading around 30, the VIX is trading just under 30 right now, that is twice as high as it was a year ago. And even though it's come down off this spike, which was from a couple of weeks ago, it's really high relative. So what I was trying to say is just that when you have high volatility, you get very big expected moves. Let me show you this for a second. This is the SPY, which is the spiders, which most people, you know, it's kind of the standard piece of the S&P 500 is kind of where we go to for all our research and looking at expected move and stuff like that. And when you go to August right now, you can see the volatility, just what the VIX is right around 30, but the expected move is 21. A year ago, if we went to August, which was 45 days, this is last August, Fausto. If we did last August, the expected move would have been about $10, higher or lower, about $10. Now, it actually probably would have been a little bit less. It probably would have been about $8 or $9. Now the expected move is $21. This is just in the, that means the expected move in the S&Ps, which are the futures over here is 200 points. And that's just for the next 45 days. And so we haven't seen an extended range like this of high volatility since the end of 2008, 2009. So, I mean, when you mentioned before opportunity, you know, opportunity comes in, opportunity looks a little bit weird when you see it because what opportunity really is, it's expected move. And so we are 2X the expected move we've been for the last 12 years, which means that no matter how you wanna play this market, upside or downside, and it's likely not to contract that much where we are right now, there is gonna be plenty of opportunity for you.  But does this tell us anything what's gonna happen probably is expecting the second wave coming around September, October? Is it showing anything on? Actually, what's interesting is if you look at November expiration here, I'll just highlight this for a second. Right, that's what I was talking about. Yeah, this is November expiration. And if you look on the right hand side, if we look at November expiration, we're talking about a $40 move, which is a $400 move in the S&Ps. So if you look at the S&Ps here, this is the, these are ES options, which are the S&P 500, which are the most actively traded futures contract. That's the E-Mini S&Ps. They traded 1.3 million contracts today. And if you go out and you look at the November contract here, which is just after the November elections. So it's this one here. The expected move is about four, it says it's $410 higher or lower. So we're currently trading at 3100. That means the marketplace is looking from 2,700 to 3,500. That is your expected move. And given the fact that we had a pretty much a crash, and then we had a downside crash, and then an upside crash back to back. Cause I would argue that that upside move, which is just as violent as the downside move, that given the fact that we had both of those Fausto in March and then again in April, May, I would say that 400 point range between now and November is good. Like I think that's a good number. Like I don't think that's a number that you necessarily wanna bet on it going outside of. So I like that 2,700 to 3,500 range. I like it a lot.


I'm on Think Tech, I'm Jay Fidel. This is much more on medicine, much more.  And it's very important that we talk to a doctor about coronavirus and see how it has changed her life, her practice and the lives and occupations, I suppose, of her clientele, her patients. And we have Nadine Tensal, who is an extraordinary doctor, I'll tell you why in a minute, to join us today by remote. Nadine, thank you so much for coming around, I really appreciate it. No, thank you for having me. Yeah, you remember the measles, I remember the measles, I don't mean when you were a kid, but the measles about six months ago it was, and you were out there with Josh Green and Samoa, checking out the measles epidemic. And I said, gee, there's not a lot of doctors from Hawaii out in Samoa right now. Nadine Tensal, again, distinguishes herself as a community person. What makes you like that, Nadine? Oh, that's a loaded question. I'm not sure what makes me like that. I think I've had a lot of mentors and colleagues who have equal heart. And I don't consider myself, honestly, this is not false humbleness. I consider myself amongst a great crew of professionals rather than rising above. Okay, all right, that could be my opinion and you can have yours. So, the other thing is you're active in the medical community, you're more than most, you're out there with medical organizations trying to organize the profession and so forth. What makes you do that? I think it's a, for me personally, not to speak for the profession itself, for me personally, it's wanting to commit to the hypocritical, we made a pledge to help people, to serve, to heal and care for the sick and the needy when possible. And then I combine that with the fact that I live in a community, the community being Hawaii and I feel that it's my responsibility and I wouldn't use the word duty to help in any way that I can. And my way is with my profession, something that I am quite proud of, I view it somewhat as an art and I constantly look for ways that I can contribute. And if I'm not contributing, ways that I can help. That's beautiful, I'm sorry I said that, but it is beautiful. So, what about your practice? It's so, pediatrics, what is it? Geriatrics or everything in the middle? Demographically, you are correct. I was trained in internal medicine and pediatrics. The expression is med-pede. So, demographically, it allows me to care from cradle to grave. I have a soft spot for pediatrics. You know, I do quite a bit in pediatrics and I serve as chief of pediatrics at Queens. My private practice, which I maintain a full-time practice, is I would think about 60, maybe 65% pediatrics, the remaining being adult medicine. So, I do practice both. Okay, well, I guess I'm focusing more on the geriatric side of things these days because they're more vulnerable. And here you are, you know, running your practice and serving at Queens and all that. And presto digital, out of nowhere in the left field, we have a viral epidemic, pandemic now. And the mission here today is to try to understand how that affects your practice that you've maintained for years and years. All of a sudden things in the world, things in the community and things in medicine have changed dramatically. How have they changed for you in your practice of medicine? I think I can answer that a couple of ways. Well, I'll give credence to the geriatric population. I'm gonna speak more generally and then aim back in. For my private practice, while I am no less surprised than the rest of the world, there's many aspects of this that I do not find surprising. You've reckoned back to just six months ago with the measles. We have been forewarned in many, many ways that there are things that make us as a community and a society vulnerable. Whether it's something as straightforward as hepatitis A more recently, the measles, while it didn't hit our community, Hawaii as significantly as it did Samoa, the months just 18 months prior hit us. Now we're being hit with even a stronger pandemic, which is coronavirus. So where am I going with this? There's some changes for my practice that I've had to do just like everyone else. And there's others that to me, this is a continuum of us and healthcare being prepared for the unexpected. In my practice, the things that we've had to do is break up for the fact that unlike hepatitis A, unlike the mumps, unlike the measles, we're dealing with something that we don't have our usual tools. And what are our usual tools? Specific ways to prevent vaccinations and being able to test in a timely manner without regard for the number of tests that need to be run. And lastly, then having medication to treat when the patient becomes positive or incurs the disease. So all of those typical tools have been taken away. And then you dump me in coronavirus. What do we do? So in my private practice, we've done a couple of things. I have an incredible team. I have a physician assistant and some really well-trained, well-educated medical assistants. And we've decided how we wanna triage the office. I have to divide my life a little bit in two. The American Academy of Pediatrics is still asking us to see the children.  And particularly the infant and the toddlers. Whereas my adult patients, we have a little bit more discretion. What can we do? What can we vary away from the office? Possibly use telemedicine instead. And then as you referred to also my more vulnerable population which would be my geriatric patients. Geriatric being someone who's about 65 years or older. So we've had a triage system to kind of figure out who should we see in the office and who should we not. Telemedicine has been the big changer, the big game changer. We've all to a certain extent have used telemedicine in the past. And what we are now allowed to do in COVID-19 in less than two weeks I might add is we're allowed to do it and not be penalized for doing it. What was the penalty before? I mean, I remember, was it Queens organized a telemedicine program? Some fellow came from East Coast, one of the big hospitals and tried to build something in Hawaii along those lines but it failed, nobody wanted to do it. Now it looks like it's a good idea. But what was the penalty before that discouraged people? I think if there's any lesson we'll get out of COVID-19 it will be the very question you're asking. Why is it possible now and it wasn't possible before? I think before everyone was caught up in all the things we should worry about whether legal, IT, compatibility, where right now we've basically been given license. If you're essentially doing the right thing, do it, make it work and you will be given credit. Now, when you use the word credit immediately people think compensation. And to a certain extent it is about being compensated but compensation doesn't always mean money. It also means that you can use it officially as a means of having seen the patient. And in two weeks time, after five to 10 years of discussion after discussion after discussion almost all of us are alive on telemedicine utilizing it. And if the authorities that are involved whether it be the insurance company, CMS and other regulatory bodies, if they continue to allow us to do what we're doing we've literally gone light years in less than two weeks what we could not accomplish in five years. And that's why bureaucracy. Yep, fabulous though. It sounds to me like it's a permanent change. And when we come out the other side it'll be with us and we'll be better off for it.  What I'm curious about is how they're gonna try to shove this genie back in the bottle. This telehealth genie that is coming. This is gonna be- Can't let them do that. Well, also now, first of all there's two sides to that equation of course. Let me talk for your side at first. So you have a highly contagious disease and you can try to take preventative steps in your office and the hospital. That's pretty scary because you're never sure if those steps are sufficient. We don't know exactly how this contagion works. And so you're exposed as a practicing physician. The telemedicine reduces that risk, deletes that risk. So that's a really big benefit because we want you to be healthy, Nadine. We want you to be there in this conflagration. The other thing is that I can call you. It was not so clear before. I can call you, I suppose make an appointment to see you and we can talk just like this maybe on Zoom or one of the others. Are you using Zoom? Yes, as a matter of fact, I am. There's several platforms out now and I've done most of them. I'm pretty much circled around maybe three, top four that are usable. So let's role play a little bit just for creativity. So Dr. Tansal, I have this fever and I'm not feeling very good and I'm really tired and I'm having a shortness of breath. You think I have it? Now you're going to ask me some questions. You're going to ask me to take my temperature. What are you going to ask me at that point? Well, interesting because some visits such as this, we might pre-triage. I don't know if I would actually make it a complete visit because the minute you have symptoms like that, I need to put my stethoscope on you and it's very difficult to do with this type of medicine. But that being said, let's assume that you're calling in and you have these upper respiratory track or flu-like symptoms that you want me to understand if you should be tested. The first thing I'm going to try to do is get a list, just as you said, and it's going to sound runny nose, cough, malaise, fevers, other flu-like symptoms, timing them to the degree. Have they all gone away with just simply taking Tylenol and poof, you're feeling better. The second is going to be about your potential risk. A lot of my patients do know in advance that either someone they know has tested positive and they've had significant contact, they've been traveling, something to put them into a higher risk category. And then that begins to put in place, should I test them? The ability to test is becoming a little bit easier. If you had asked me this two weeks ago, if you sounded like I could give you medication, whether over-the-counter or prescribed, and most of what you were experiencing you could do at home, I would highly, highly discourage you from being tested. And that's where we were about two weeks ago. Just recently, our two laboratories in the community, CLS, which is clinical laboratories and DLS, which is diagnostic laboratories, are now able to do testing on Island. And they are at about 200 tests a day. And while that sounds like a lot, we have 1.4 million people. There's an infectivity rate of coronavirus at about 3.5%. That puts us at about 50,000 people who if we do nothing will be exposed or possibly have symptoms that are consistent enough to need to test for the coronavirus. We can't keep up with that. So what I think is sometimes a mixed message is we still need to triage who should really be tested and how important is it to know whether you're positive. And those are about to be hospitalized. I'm thinking of hospitalizing you or you have symptoms that indicate that you should not be at home. And then there's softer categories who you live with might be at so at risk that not knowing may put another individual at risk. Wow, that's a heavy moment, isn't it? But you'd be my primary contact as my primary doctor. And I would call you, make an appointment, talk to your staff and I would present to the extent I could. Maybe I would take my temperature and you triage and find out what else you needed to know. Let me footnote that by saying, I recall the last couple of days that there's this easy test, it's 15 minute test. I don't know if the patient could administer that test himself or whether I have to go to a laboratory for it. But if assuming for a moment that I could administer that test and get a pretty accurate result in 15 minutes. So like a pregnancy test, how about to take the test and it comes back and says, no, you don't have the coronavirus, Jay, but you're pregnant. That would be pretty interesting. So really quick. And then I could tell you that and then we'd be a step ahead and hopefully that is in the near-term future, don't you think? And in a short answer is yes. You brought up about four or five different points. One of them was what would we do with you back in that original scenario at this point? And that would be decide whether or not we thought you were safe enough to come in into my private practice. And if we really thought you had it, it's not likely we would allow you here. We would send you to a place like a drive-through where you could be more safely tested and move on. And then in the community, there are urgent cares, Queens as well as HVH has the drive-throughs to go through and to get testing where you limit the number of people and providers that you might expose to your illness. The second point I think you tried to raise was how can we get to the point of faster testing? So we went from the first testing that the DOH was doing where we're literally sending it back to the mainland. It was taking a minimum of three to five days. Now we're at the point that we can do it on Island and it's called the PCR and turnaround is about 24 hours. And then what you're referring to is the fact that there's just been a release of these rapid tests that are similar to the flu tests that we do in our offices where within about anywhere from five to 15 minutes, you can know your answer. The problem with that is they're not widespread. They're not in every office. And then you brought up another point. A lot of these tests are really once you explain to an individual whether it's a well-trained medical assistant or maybe a most patients could the average person self-administer it. Many of these tests we don't have that you could just drive up to Safeway or Longs and get them. But there's a lot of discussions about that from everything from pregnancy which we have in place to struck throat urinary tract infections. And now you're trying to take the same idea to coronavirus. So yes, yes, yes, but it's not widespread. And we can't use it as a public health measure right now in our presence. But you know what? We learning things now. Now this is going to be endemic I think. It's just going to be there like forever. Maybe in a lesser emergency, but you know, virus is going to be around with us. I saw a very interesting end. Anybody can look it up. It's a TEDx speech by Bill Gates in 2015 where he predicted all of this. I mean, it's a remarkably accurate what was going to happen. And I say to myself, well, after this one there'll be another one.  It's the human condition. And so all of what we're learning today under duress hopefully will be built into the system going forward so we can deal with other newer coronaviruses later. But one thing you said I want to pursue and that is, you know, you may not want me to come into your office because you don't want to catch it and we don't want you to catch it. And we don't want your other patients in the wedding room to catch it. So what kind of precautions do you take?  Are you, how careful can you be? Are you being in dealing with the public in general not just somebody who presents as maybe having the disease but the public in general? I'm going to answer you very specifically which is different than the message you would give to the general public. So when you ask me as a healthcare provider that question I am constantly assessing what particular situation I'm in. So when I'm in the hospital and there's a patient they call them a PUI, a person under investigation and I'm anywhere near that individual maybe they've been formally placed in isolation. The guard that I put on the type of mask, the category of masks that need to have that mask fitted for me such as an N95 is something that I would don. And typically I don't have to do that in my office. I should say I don't have to do that in my office. Quite recently as recently as I shouldn't say quite recently but as recently as yesterday, Queens decided to put forward that on the campus if you're on the campus as a healthcare provider or a staff you should be wearing a mask. Now a mask is a very general term. It has nothing to do with being able to stop N95. But they're taking the steps to somewhat protect our healthcare providers as well as protect others when we might happen to have a mild cough or cold. So it's a two-way protection. But the masks that you're expected to wear now on campus are just a step in between having nothing on. In my office, we went through this in stages. So prior to us actually having a significant number of cases here in Hawaii, I met with my staff in the same way that I just explained to you. I explained that we have something coming. We are going to be at risk. We are not at risk now. We began to triage how patients come through the office. For instance, we do well in the morning and we see sicker patients toward the end of the day. So we somewhat separate patients out. And I understand your next question about asymptomatic patients, but we have to be realistic and just deal with what we can see. We started having the staff wear garb whether it's mask or gloves any time they were near any sick patients. Within a week, we had to transition as the numbers went up that now they have to wear garb whenever they go near patients. And as of two days ago, just reading what was going on in the news, watching where other countries and other states had to change their guidelines as their numbers went up, which means your incidents of coming across it increase. We too are wearing masks. So I'm in my office right now and I'm talking to you in my office, my office within my office and I don't have a mask on, but all day long, we are now wearing masks while the office is open. And then we unmask and then when we leave, it's my staff's discretion whether or not they wanna continue to wear a mask until they go home. So personally and professionally, are you afraid of catching it? And I mean, of all the implications of catching it, it wouldn't just be that you'd be personally at risk, is that the people around you would be at risk. You would not be able to perform your function. How do you feel about that?  It makes it even more complex. I'm gonna answer it two ways. The first is when you refer back to Bill Gates' TED Talk, while it seems incredibly insightful as you look back, I think most doctors and people who are in healthcare and public health understood that these were things that we knew. And that while the coronavirus is very unique, we have been amongst this for a long time. And a lot of this, while I'm not implying that I or anyone else is immune, it is along the lines of the rules that we knew that existed for viruses in the flu. What makes coronavirus scarier is it instead of it happening over an entire season, it's happening within a month or two. It's happening when we have nothing to ameliorate the rise in the curve. Normally, if we had a particularly virulent flu, we would have taken the basic flu vaccine and then made a serotype for that flu vaccine and then passed it out and we would flatten the curve. We have three very excellent anti-flu drugs that will not stop you from getting the flu, but it will at least ameliorate your symptoms and make it less likely that you'll get worse, end up in the hospital, end up on a vent. So when you ask me, am I afraid? I'm not afraid of something that is still by all everything that we can see following the rules of viruses. I do consider the fact that I may be put out of commission if I get it, putting my personal family at risk as well as turning my practice on its head. But I also put things in place such as telemedicine. Like I said, I have a very strong physician assistant which we work with that allows me to then flex as a team. And if we end up having to close the practice, I think that's another discussion. The fact that we've built a healthcare system that does not, is literally unable to deal with crises or flux in healthcare such as outbreaks. And then that's another big discussion that I think after this coronavirus burns itself out and it will, it'll take us two to four months to kind of burn through it. We have to come back to these questions. If this were to happen again, do we think our healthcare system is robust to manage this? Have we created a healthcare system that basically assumes that everything stays the same, there's never any big crises and there will never be a strain on the healthcare resources? You said two to four months and I like to be optimistic along those lines but on what basis do you say that? Is it a medicine issue? I mean, will they come up with a cocktail that can really ameliorate this? Is it the virus itself that it loses its virulence over time? What makes you say two to four months? I also have to be careful. The minute I said it, I realized that I probably should qualify what I mean by that because there's so many ways to measure this. The disease itself, once you get it, it takes about two weeks, right? If we did nothing, we would have probably started to see a peak in our numbers already but because we're an island, we've closed our borders, we have taken a lot of steps and we live in a really good community for the most part, people are being very compliant. So we're seeing that it's not likely if we hit a peak that we're gonna see this peak for at least another maybe three weeks. So we hit our peak. Now, if a significant portion of our population then gets infected, while that is a bad thing, the good thing is that then we'll see a number of people who have had the disease, only a small fraction will actually end up needing hospitalization or ICU. That would mean after say April, you give all of May, or into June, a significant portion of our population should have experienced the coronavirus in some manner, either just getting it, got it and is over with or is starting to get it. That puts us then at about July that it should have burned through. And I'm making this up but I'm following the basic curve that is followed through pretty much in all other parts of the world. You can see that the virus still acted like a virus in a very predictable manner. And that the, when we talk about the curve, it's when the curve of when the virus comes into a community and then when it peaks. And the only thing that seems to change the shape of the curve is how well people were able to distance themselves and that they could spread out how when the peak occurred, instead of the peak occurring all at once, it was over an extended period of time. And no matter how you stretch that out, there's an endpoint to it. Whether or not it will reoccur like a flu, that's a second, you know, like a flu season. That's a second discussion. But for this season, this coronavirus, it seems for all intents and purposes, it will be time limited. And everybody is all a good guess.  But yeah, you have to be very careful when you say time or put a time to this. Yeah, well, nobody knows as part of our adventure. It's just a bad word for this, our adventure with this. You know, and what comes to mind is, you know, I understand that after a certain percentage of people have experienced the disease, whether it's mild or extreme, you know, it is likely to diminish, whether by the herd immunity concept or just the virus changing itself.  I wonder, you know, I really, let me say this, I'm gonna say it publicly. I really don't want to say this. I really don't. I really, really don't. I don't be part of all these statistics. So what's the added thing? What's the most important thing for me to avoid those little buggies getting into my respiratory system? What can I do to be as sure as I can personally be to stay away from danger? Honestly, there has been nothing to show that this bug does not follow the rules. So you cannot get sick if you're not exposed to it. That's one. So the more that you can isolate yourself is probably your strongest tool. Again, I'll give an off-color joke. It's like you can't get pregnant if you don't have sex. Yeah. That would be... That's very good, that's very good. The second one is, in the end, you do need to go out. There are reasons that you have to go out. You may even need it for your own mental health. And how can you protect yourself and minimize your risk of getting it? For all intents and purposes, we have seen this bug is spread by respiratory droplets. And while people will talk about others, such as the overt respiratory droplet of the spray from the cough or the sneeze and that spray out, that's one. Then there's two. Those spray or droplets, how long do they linger in the air? Diseases that are far more infectious than coronavirus, for instance, the measles, that can linger in the air for a long period of time. And the risk of catching the measles after walking into a room of someone else that had the measles, if you're susceptible, is so high, it's like 96%, just to give you how relative it is to catch one versus the other. So your risk of getting is something like catching the flu. You need to have been exposed to someone. But there's so many others line of ways.  So how can you protect yourself from that? Well, avoid touching surfaces. After you do, keep your hands clean or clean them, whether if you're out and about and don't have access to soap and water, then there's the hand sanitizers. The second would be when you do have soap and water, please use them. Those will do everything for you. We're being made to feel very frightened of the asymptomatic carriers. And I'm not saying that they don't exist. It is just, it's less, it's probably less of what you're gonna come across. So what do you do about the mysterious asymptomatic? Asymptomatic means no symptoms at all. Probably the best thing you could do is wear a mask and again, be very aware when you're out and about. Did you really need to lean on that surface?  Those are all habits we probably are going to have to put aside during this time. Yeah. One last thing, can I ask you one last thing? We were running out of time here and that's this. You know, we've alluded, both of us have alluded to the sort of the connection between this incident of the virus and maybe the next one and the connection between, you know, the community of patients, the medical community. And let me add the public health community, which is not the same as what you're doing. It's public health is special people and training and government positions for that. And government in general, seems to me that all of those various, you know, communities are involved in dealing with it and making plans for the future to deal with it. That is the community of patients, the community of doctors. I suppose you could add the community of hospital frontliners, you know, that's kind of different than office pediatrician, geriatric doctor. And finally, the government. So how does that connect up? It seems like what we have seen here is maybe the connection wasn't really good enough for everybody being on the same page to deal with this virus and going forward, it's all got to be connected so we can all play our specialties in some kind of collaborative coordinated way to beat the next wave of virus. What are your thoughts about that? So you got me a loaded question. How much time do I have? Take as much as you want. I think after we get past the scare and the collective shock of coronavirus to me, this is gonna be the million dollar question. What are we gonna do moving forward? We should not allow this to happen again. There's parts of me that agree and disagree with what you just said. I think the solution is about bringing all the parties to the table. And I think if I were to look back what I've seen being part of healthcare and I wanna call myself somewhat of a healthcare leader is we need to put our swords down. There is often a battle of who's in charge and whose school of thought and whose training should lead in this. I think historically the doctors were very dominant. Basically on the doctor I said you do whatever I say and then make it work. Then we went through a period of time where I think the public health, my colleagues came and we needed to build it all so that it would fit very neatly under public health umbrella. And I think where we are right now, not to point any blame, but I think business, business insurers have a disproportionate amount of power and say in the way healthcare is being delivered, the models that are put in place to take care and protect patients. And I would like to see that we reconvene, we rethink our model and we think about the fact that the only way that this is probably gonna work is to work collaboratively because what is being done right now and then just the very recent past, it's clearly not working. And this is the perfect example right now in coronavirus that it's not sustainable, it cannot work and the healthcare system we have in place is only meant for the healthiest and the best of times. I think the last thing I would say, I know quite a few of, I'm gonna dub them healthcare leaders in our community. And that term is not necessarily just awarded to physicians. It could be our public health colleagues, it could be our insurers, the presidents of our insurance. We have the right individuals in this community. We just need to come together with a different intent, the intent to put together a health system that will work that is actually for the benefit of the people of Hawaii as opposed to trying to make it fit into a business model in which you can only be successful when you save and make money. Yep, there you have it. This is, that's a fundamental rethinking though. And I hope we can do that one way or the other. I hope that leaders, both medical and government and public health and business can get together and identify the better model and then implement that better model. Maybe this will encourage them to do that. And certainly your remarks will encourage them to do that. Thank you, Nate. They did pencil out a fabulous doctor, a fabulous member of our medical community coming around and sharing with us. Thank you so much, Nate Dean. Aloha. Take care.


We're at the Squatchy Lodge in Vancouver. We have made a $515,000 contribution to the First Nation Technology Council that's going to allow 40 individuals training in technology, in digital technology, things from Microsoft to global positioning systems. As the students ladder through their career, they will be able to continue their relationship with the First Nations Technology Council and the Bridging to Technology Program with the hope that we will see more and more Indigenous people participating in the technology sector and becoming entrepreneurs and innovators in their own right. For our staff and for the people that work at Lighthouse Labs, these kind of initiatives are extremely important because our mission is making sure that as many people as possible have access to and know how to code. This contribution to the First Nation Technology Council allows Aboriginal youth to get trained in technologies that can have jobs in the tech sector.