welcome to another MedCram COVID-19 update and we are well on our way to a
million plus cases confirmed and almost 50,000 deaths worldwide and the large
majority of those cases are in the United States at 215 thousand and a
large proportion of those are in New York followed by New Jersey and then
California wanted to apologize for no video yesterday it's been a busy week
I'm back in the intensive care unit and for the first time this week I have seen
the eyes of the enemy I am working in the intensive care unit where I'm taking
care of kovat 19 patients and it's completely changed how we do work we are
very conscious about personal protective equipment there are negative pressure
rooms we've expanded negative pressure rooms going into one of these negative
pressure rooms is literally like getting ready to go out on a spacewalk you have
to have n95 masks of course covered up with a surgical mask and you also have
to wear I wear protection which is not your typical eyewear protection it's
goggles so that the virus if it is in the air doesn't get into your eyes you
also have to have a hair cover like a cap or a hat not to mention that you
have to have gloves on and a gown usually you have to have shoe covers as
well of course putting all that stuff on is not so difficult if you're clean and
you're outside the room that's not the hard part the hard part is after you've
gone in the room and done what you're supposed to do and now you're about to
come out because you've got to assume that the virus has landed on every part
of your exterior surface and so what you have to do is take off all of these
things in the right order without contaminating yourself and putting on
the materials called donning and taking it off is called doffing and it's the
doffing part that you can kind of mess up and you have to be careful and at
each step of the process of taking one thing off first and then the other you
have to make sure that you're using hand sanitizer on your hands your gloves at
first and then finally down to your hands and as soon as you are finally
done and you're out of the room you've to go and wash your hands very carefully
and make sure you don't contaminate yourself we now walk around the units
with a mask on to make sure that we don't touch our face it significantly
slows things down but it's a necessity and it's something that we have to live
with and our Hospital is resilient and it's making it work in terms of what we
talked about last time and those huge collections of patients that are coming
to the hospital but don't meet the criteria to be admitted we talked about
the role of hydrotherapy and especially since we looked at those accounts in non
peer-reviewed journals back in 1918 and 1919 and some of the things that we
could do I'm actually in touch with and experts in hydrotherapy and in terms of
what the protocols would be based on their experience I plan on revisiting
this in the future but there's a lot of other topics that we want to talk about
so first to this interesting article published in The Washington Post showing
some good news social distancing works the earlier the better California and
Washington data show and it goes through very nicely about how the curve that
we're trying to flatten was flattened this is per 100,000 cases and you can
see here from March 13 to March 31 the United States an average in terms of the
growth in Seattle can see how this kind of was flattened in comparison to what
happened here in New York we can see here in Miami that there was a regional
order to stay home and there was some flattening but not as much in the Boston
area certainly not as much in San Francisco there was a flattening of the
curve here and you can see that there was two orders there was restaurants and
public events vans and then there was a county order to stay at home in the San
Francisco Bay Area and of course that spread to just about all of California
also some good news is that California Governor Gavin Newsom is feeling more
confident that the state can handle what's coming based on what he's seeing
with this flattening of the curve and as we've talked about before here on med
cram takes some time remember there's about a five day
occupation period median another seven or eight days before about 20% will need
to be hospitalized because of pneumonia shortness of breath etc so it's almost
about two weeks before you start to see the effect of that and we're sort of
getting into that period now about two weeks since we've had this thing called
social distancing in isolation here in California the other thing I wanted to
talk to you about is this study post exposure prophylaxis and treatment for
SARS coronavirus - the type of enrollees that would fit the criteria are number
one exposed without symptoms and number two exposed with symptoms in other words
if you were closely exposed to a person with a confirmed test within four days
of enrolling and live in the same household as this person or are a
healthcare worker or if you have symptoms and currently diagnosed with
confirmed kovat nine teams within four days of symptom onset this is a way of
testing to see whether or not hydroxychloroquine might prevent you
from coming down with the virus and here's the sheet that you get when you
sign up they can tell you here about what happens with the SARS cover one
virus that was the initial SARS virus and what happens when you increase the
chloroquine here so this is an important trial that you might be able to be
involved with but remember that you've got to be involved within four days
we'll have a short video today just because it's a busy week but we do
intend to get into a lot of questions and recommendations and requests that
you've had we look over all of the comments and we try to answer as many of
those comments as we can we've had a lot of requests about care certain zinc
about hydroxychloroquine about chloroquine about nutrition about diets
we're going to try to get to all of those things in due time please
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us