welcome to another MedCram coronavirus update and before we begin I just wanted
to reach out to a lot of new people that are joining us because of these corona
virus updates we've been doing videos for about eight years and we do a no
nonsense explain clearly approach to medical issues so I just wanted to be
aware that we also do videos on chronic diseases like COPD heart failure
ventilator management acid-base inhalers things of that nature so check out the
rest of our channel for those videos and also come visit us at our website so
getting back to the corona virus deaths today 565 confirmed cases is 28,000 274
interestingly the recovered is 1178 and we did say earlier in the week to look
for these to go up because of the time period that takes the longest to have a
recovered case it doesn't take a lot of time at all to have a confirmed case
takes a little bit more time to have a death because it takes some time for the
patient to decompensate but if they don't die and they recover it takes time
for them to recover and finally for the virus to be undetectable then you have
these recovered patients and so whereas at the beginning of last week or even
toward the end of last week the recovered were less than the deaths
which was kind of concerning now the recovered is more than double the deaths
at this point so I wanted to also address a lot of comments especially
regarding this conspiracy idea where numbers were released and then taken
down and then put back up again with with different numbers and let's go over
what those numbers were
so the deaths that they had was twenty four thousand five hundred and eighty
nine and the number of total confirmed cases was one hundred and fifty four
thousand and twenty three now if you look at this ratio which if we take the
null hypothesis and say that this was the correct number then what you're
looking at here is more like a sixteen percent rate of deaths to confirm cases
but let's look at it objectively so if we take this ratio and again it's not a
case fatality rate or a mortality rate but let's look at that number sixteen I
mean if that were the case we could look at the number of cases that we currently
have outside of China this 16 percent ratio whatever you want to call that
ratio should stand regardless of whether the patients are in China or outside of
China and if in fact the Chinese are covering up the numbers while the
Chinese can't cover up numbers that are not in China right so we can look at
Japan and based on the current infected numbers they are now we should have up
to about seven deaths and how many deaths do we have in Japan zero if you
look at Singapore if you look at the number of cases that we haven't
Singapore and apply this ratio we should have four deaths and how many deaths do
we have in Singapore well the answer is zero why is it so high in China but
we're not seeing that in Japan or Singapore the other thing I wanted to
address that's come up recently is this idea about a stew so what is this
angiotensin-converting enzyme - well if you look in the bronchi bronchioles
tubes fairly low on down close to the alveoli is a receptor on the type to
nuuma sites called a stew and it's this protein deep down here in the airways
when you get down to the very bottom there is a protein and that is the
target of the corona virus not only is it the target of the corona virus which
allows the virus to enter into the cells it's also the target of SARS
back in 2002 and so there's been a lot of
about this potentially because of its similarity to SARS we could use the same
type of vaccinations and treatments that block SARS from trying to get into the
respiratory epithelium we'll talk more about that later but the issue is is
that there's been again another unpublished not peer-reviewed article
that looks at a Stu expression with respect to gender and race etc etc and
what it found it was a very small study it only had about eight subjects in it
but what they found was that the Asian sample had a huge amount of ACE 2
expressed whereas the African American and Caucasian had relatively low ace 2
levels and their conclusion was potentially that this could explain why
there was such a huge outbreak in China as opposed to other areas with different
groups and so this has been making the rounds on the comments and I wanted to
address that first of all I think a better reason why we're seeing a huge
outbreak in China is because it started in China and that's where it's gonna be
precipitating the most secondly any study with an N of 8 has to be taken
with a grain of salt so as it stands there's actually another study that we
can look at that tells us far more so in this other study which looked at
the tissue of lung cancer patients but obviously they were not looking at the
cancer itself with the normal tissue in the lung cancer patients when they did a
multivariate analysis there was no racial differences there was no gender
differences in the expression of a stew but what they did see a difference in
statistically significant in this other study that had an N of 224 patients was
that those who smoked had an increase in ace 2 distribution now you should know
that's in China on average 48 percent of men smoked and only 1.9 percent of women
smoke and based on statistics that go back to 2017
and so this might explain some of the gender differences in terms of those
people hospitalized in China but we've got two different studies we've got one
study that shows enovate which seems to be making the rounds on the Internet's
that Asians have a higher expression of ACE - therefore more targets therefore
more possible infections by the virus whereas in another study 224 different
samples there was no racial differences no gender differences but they did
notice an increase in ace - protein when patients smoked or had a history of
smoking in the tissue wanted to talk a little bit about what goes on so here's
the corona virus and it's got these proteins on the outside of it and these
proteins are called s proteins or spike and they interact with the cell and
specifically interact with a protein called ace - and that is the receptor
that allows internalization of the virus now inside the virus is a very large RNA
molecule that encodes for all of the proteins that are needed for this virus
and there's the s protein there's membrane proteins there's a
whole bunch of other proteins so what they're looking at is potentially
blocking this interaction so how could you do that well you could get proteins
like a stew that could bind this and prevent that from binding you could also
get proteins that look like the virus to bind on here preventing that interaction
you could also put that on an antibody and if you were to put these soluble
proteins here on the antibody that could bind onto here and this antibody would
then call in the immune system to try to get rid of the virus so there's a number
of ways that this can be looked at and the interesting thing is that this s
protein and specifically this a stew is exactly the
same protein that was targeted with SARS back in 2002 and so there's a lot of
work that's already been done on a stew in terms of trying to figure out a way
of preventing a virus which targets it from getting inside and so I've also
included in the link to expert opinions on the RNA sequence of the corona virus
this thing here whereas before they were talking that this is from snakes they're
saying that this looks actually very similar to bats and the fact that it
also targets the exact same protein that the SARS virus did which was also from a
bat and that this corona virus is targeting human ace too and that's why
we're having a problem they also note that ace 2 is somewhere lower down in
the respiratory epithelium and that's why we're seeing more of a pneumonia
rather than upper airway symptoms that we would see with a flu for instance so
does ace 2 exist more in Asians I would say at this point the data seems to
indicate the answer is no at least with a better powered study but is it also
possible that it might be related to smoking well it's possible that smoking
may cause a change in the expression of these proteins on the cell surface which
may make you more susceptible to getting corona virus infections I think more
study needs to be done in that department we'll see you next time
thanks for joining us you