welcome to another MedCram COVID-19 update we can see that we're almost at
400,000 total confirmed worldwide if we look here at the new daily deaths in the
united states we can see that that is increasing there's been some interesting
quotes in the news here for March 24th and they anticipate that the peak number
of cases is still two to three weeks away in New York the governor of New
York has said that they need 37,000 ventilators at that point and they need
to get another 30,000 because they've got about seven thousand now at this
point there's an ominous warning coming from New York saying that's because
there first what is happening there could be what's happening in your
community in about four to six weeks they are also saying that hundreds of
thousands of people probably have already had kovat 19 didn't know that
they had it and have recovered and they are echoing what we've said here earlier
which is that antibodies should be checked for because if they're positive
for the antibodies then they don't need to stay home they could go to work which
brings me to this news that was on Yahoo fever map could show just how crucial it
is to stay home to stop kovat 19 spread this is a smart thermometer made by
kinsa which is able to upload the data from people who are taking their
temperatures and put it on a map and what they've shown here through this
article we'll put a link to it is that in Florida there are a number of people
who have had elevated temperatures more than they would have guessed for this
time of year if you look at the data the blue is what would be expected and you
can see here as you go from February 14 to May 14 the percent of illness should
be dropping as we get out of the flu season and that's the typical range that
we see and we can see here the observed in yellow and then when we hit a certain
amount outside of that range that shows an atypical disease pattern and of
course this doesn't require any testing no serological data as soon as the
temperatures taken this is uploaded to the database and during this point there
was isolation measures that were put in place and we can see
immediate drop interesting way of checking to see if there is a response
to public policy the article goes on to quote mr. sang the CEO of kinsa in the
example above Singh says that the spike in the fever's coincides with reports of
Miami residents and tourists ignoring guidance around recommended distancing
the steep drop-off however follows after more extreme measures including beach
closure and other isolation tactics were adopted in the area Singh says that
they're regularly seeing that areas where residents are ignoring social
distancing are seeing spikes and that as soon as those are implemented via lock
downs and other measures within five days of those aggressive actions you
begin to see downward dips in the curve and it's interesting to note that we
know from other data that five days is about the median incubation period for
SARS Cove - they're not actually testing for Cova 19 with temperature but as is
pointed out fever is a key and early symptom of kovat 19 so bear that in mind
I wanted to take this to a bird's eye view and if this represents the total
population then obviously not the whole population is going to be infected there
is some debate on exactly what percent of the population is going to be
infected with Cove at 19 let's say it represents it by this will call this
infection and there are a number of issues that could make this proportion
go up or go down and we know some of the things that they're employing right now
to allow it to go down the social distancing or isolation or even some
medications that would be called prophylaxis prophylaxis is a medication
that would prevent the infection we don't have anything that's FDA approved
but that's where it would go at this point so what are things that could make
the number of people with infection go up that would be apathy or just
carelessness we're trying to do social distancing isolation to reduce the
number of people in the population that might get the infection and that's
important because what we have over here if you can imagine that these bars are
on wheels is we're trying to get these car trains
if you will through a tunnel that has a capacity for the healthcare system and
there are certain things that will increase the capacity of the healthcare
system and there are certain things that will decrease the capacity and we'll get
to that but there's one other intermediate step that really has not
been looked at that seriously and that is this car right here we don't know
exactly how tall these are they're not drawn to scale but these are the people
here from the infection that will be going to the hospital they will be going
in through the tunnel hopefully they are shorter than the tunnel otherwise
there's going to be a problem so what are the things that are going to
increase the height of the tunnel that will allow it to go inside personal
protective equipment on healthcare workers that allows the capacity be
higher because they're able to do more having ventilators that would increase
the capacity of the healthcare system medications not only clinical trials to
see what medications are appropriate but also the manufacturer and the delivering
of those medications are going to be key as well
well what would decrease this well if health care workers have to be
quarantined because they didn't have personal protective equipment or if
there is no PPE either because people are taking the masks or they're just not
enough masks for health care workers to use and so we're we are seeing a lot of
resources spent right now is for the development at the making of personal
protective equipment we are getting the government involved in trying to
convince manufacturers to make more ventilators the FDA is waiting for these
clinical trials to be completed so that it can decide whether or not it's going
to indicate those medications for use in kovat 19 but of course we have other
medications that haven't been labeled for use in kovat 19 and we're using
those as off-label at this point because there are no medications that are FDA
approved for kovat 19 and we are starting to get manufacturers to make a
lot more medication so we have focused a lot of energy
in trying to get this tunnel increased in size because we know that there's a
lot of people coming down the pike there's gonna be quite a number of
people going through and as it turns out we know that about 20% of the people
that become infected will end up needing to go to the hospital to get
hospitalization about 80% of those will simply have a mild case so 80% no
hospitalization what's happening over here well we're having a lot of time and
effort being put into social distancing isolation and things of that nature so
up to this point this is where we've seen most of the effort being made to
handle this situation with Kovan 19 and the question remains what else can we do
and may I suggest to you that where we need to be focusing as well is on this
center section because the question really boils down to well why is it that
80% an infection will not need to go to the hospital and the answer is very
simple the answer is your immune system and the reason why we know that's the
case is because people who are older have more comorbidities typically have
weaker immune systems those that are younger typically have stronger immune
systems and that's exactly what we're seeing in this situation older folks
tend to be the ones that need to go to the hospital that's not a big surprise
there are exceptions of course all the way up and down there are young people
that end up going to the hospital and there's elderly people who become sick
but then recover on their own but by and large the 20% that end up at the
hospital have a lower immune system generally and so in fact the way that
this box gets increased is if you have a bad immune system and the way that this
comes down is if you have a good immune system and not much resources as of yet
has been put into making sure that we have a good immune system and I think
this is a good area to look at because if you had a good
immune system here to prevent you from going to the hospital
it also can work that a good immune system here might have prevented you
from getting the illness in the first place and so I think having a good
immune system is of paramount importance and there's two reasons why that's the
case because for you personally if you're able to improve your immune
system then you're not going to the hospital but even more important if
you're not going to the hospital that means the hospital doesn't need to deal
with you and can concentrate their efforts on somebody else now notice that
we're dealing with about an 80 and 20 percent differential there that means if
we can just improve the immune system by a short amount in other words if we can
improve the immune system instead of 80 percent go to 85 percent so that 85
percent don't need to go to the hospital that means this 20 percent drops to 15
percent that's actually a 25 percent drop in hospital admissions which would
be a massive impact at the hospital level and of course we're all hoping
that if we can reduce this then we can finally slip this car right into the
tunnel without a problem hopefully all of these things working together social
distancing isolation a good immune system medications delivered when they
need to be personal protective equipment ventilators clinical trials yielding
good medications all of these things can work together so that when we have the
peak hit we're able to take care of all the patients that we need to take care
of there are two components to your immune system there is something called
the innate and the specific the innate portion of your immune system is made up
of components of the white blood cells which are the soldiers of your military
immune system that basically indiscriminately take anything that's
foreign and destroy them it doesn't need to have specific knowledge of specific
antigens that's why it's known as innate whereas the specific has to be taught
and shown specifically what the foreign antigen is
so it can make antibodies against that specific and foreign antigen so if you
have here a pathogen when the pathogen comes it must penetrate through the
innate immune system first now what are the components of the innate system you
have things called natural killer cells you have macrophages these are cells
that eat up the foreign substance munch it up and take little pieces of it and
then present it to the specific portion of the immune system so that they can
see what parts of it look like and then make sure that they can identify it
later also neutrophils are part of that innate system and so generally what
happens is you have a pathogen it gets eaten up by either natural killer cells
macrophages neutrophils the macrophages generally speaking take pieces of it and
present it to the specific arm that's called an antigen presenting cell that's
a macrophage and there are two types of cells here there are t-cells and there
are b-cells and generally speaking the t-cells are the things that are involved
with cell mediated immunity where there are cells that are problems and these
t-cells can kill them there's t4 helper cells which can help communicate as well
the b-cells on the other hand secretes antibodies which neutralize antigens be
aware of that what is going on around the world there's something called the B
C G vaccine now the BCG vaccine is given in various parts of the world it's an
injection that's given in young children to protect them from tuberculosis even
though it's not tuberculosis there is a crossover between the vaccine and the
innate immune systems response to tuberculosis the reason why they're
doing this in different parts of the world is because they've noticed that
when they give the BCG vaccine to young individuals not only do these young
individuals have a natural killer cell macrophage neutrophil response or the
innate response they also have a specific
response against it which is helpful in trying to kill tuberculosis but they've
also noticed something else it seems as though the specific arm of the immune
system is talking to the innate after it gets revved up with the vaccination and
it's using a carrier called il-1 beta now when this happens it not only revs
up the specific but it revs up the innate as well to the points where when
they give the BCG vaccine they're noticing a reduction of 30% in viral
infections now there were some criticisms of this study but by 2016 a
review was done that was published in the British Medical Journal that showed
that there was an excess reduction in mortality after the BCG vaccine was
given that couldn't be explained solely by the prevention of tuberculosis
so more studies since 2016 had confirmed that this is what it is that's going on
in fact it culminated in a study where they gave the BCG vaccine and they
noticed that it protected against a completely different pathogen the yellow
fever virus in a weakened form which is also seen as a vaccination something
that was new and interesting was that when you stimulated the specific arm of
the immune system it also stimulated the innate arm and so therefore if you could
rev up the immune system by giving a specific antigen that maybe not even
related to the thing you're trying to protect against that a boosted innate
immune system could be protective against another virus and that's exactly
what they're hoping on doing here with kovat 19 and so there's a number of
studies all across the world including Greece in the Netherlands in Australia
and in the UK that's looking at giving the BCG vaccine to elderly population
and high-risk people like physicians nurses healthcare workers etc and if
they can give them the BCG vaccine they're hoping that the innate immunity
will go up enough that they might not get the infection I'll put a link in the
description below to the art of call describing this technique can a
century-old TB vaccine steal the immune system against the new coronavirus but
you can see here on this graph we're looking at the areas in red as we
mentioned the other area that we should look at is the areas in green even if it
helps a little bit a lot of the problems that we're having over here in red is
the system trying to get the PPE out to enough hospitals that they can use it
our medications we're having shortages trying to get enough of these things out
to the hospital so we'll ask a different question what are some things that we
can do without having to worry about a healthcare delivery system that can
improve our immune system so for future updates we'll go to take a look at the
data of things that can improve your immune system okay thanks for joining us
and don't forget to see all of our med creme videos at our website Med cram
comm we'll see you next time