welcome to another MedCram COVID-19 update and if we look at
yesterday's we had a total of thirty thousand new cases in the united states
and france with five thousand if we take a quick look at the united states new
york is at the top and they are supposed to peak around april 9 or 10 california
is supposed to peak around april 26 testing has been a big issue here
recently if you look at the total number of tests per million population you can
see that New York is followed by a Louisiana and of course Washington which
is really where things started in the first place interestingly if you look
and see where California is on the other hand its way down near the bottom of the
list with only three thousand three hundred and thirteen tests per 1 million
population being performed if you look at where the new deaths are coming from
in the States we have the average here USA total but if you look at the deaths
per million population the average is around 33 those states with a higher
than average death per million population are these lists to here and
these states here are less than the national average and that could very
well be because of where they are in position of surge these states here are
going to be surging later and I'm sure there's gonna be a flip flop of these
states relative to the neighbors above the average and we'll talk more about
surging and peaking and resources so I wanted to show you this very interesting
and useful website and this is put out by the University of Washington it
basically is a model that will tell you when the pandemic of kovat 19 is going
to peak in terms of resources and in terms of deaths and it's being
constantly updated in real time by real data the köppen 19 projections here are
assuming full social distancing through May of 2020 and there's a FAQ here but
what you can do as you can see here is you can put in the district that you'd
like to look at here is the United States of America and it will tell you
here nine days until the peak resource use on April 15
it'll show you how many beds are needed what the bed shortage is nationally ICU
beds that are needed and the ICU bed shortage and the number of ventilators
that are needed you can actually see it here in the graph you can click on all
beds what the predicted will be and the range of those from top to bottom and
then the number of invasive ventilators if we scroll on down here we can see the
number of deaths per day as you can see here the solid red line is real data and
after it is projected data based on the models that the computers have run now
of course this is the United States of America what we can do is we can go and
see what things are like in your particular state and you can do that
here on the website let's go to New York which has been in the news recently of
course there are ahead of us in terms of the curve you can also see here what
happened in the state in terms of what date so you can see here on March 22nd
for instance was the stay at home order on March 18 had educational facilities
that were closed so we look at all beds we can see that the number of beds that
will be needed peak here on April 9th which is just a few days away and then
come back down there is a bar which is the beds that are available and you can
see that we're already exceeding the beds that are at least available based
on the model we can look at the number of ICU beds the number of ICU beds far
exceeded and you can see those are the kind of issues that they're having in
New York in terms of deaths per day you can see where we are right now and where
things predict it to be if we go to for instance my neck of the woods in
California you can see things not as severe as what's going on in the eastern
seaboard there we are predicted to peak in California in terms of resources on
April 14 and you can see the resources here that will be needed if we go to all
beds apparently here in California we're well under that bar so we should be able
to meet that in terms of ICU beds according to this model we should be
able to meet the demands so we're all watching this as participants on the
front lines as health care providers because we want to know exactly when
this peak is going to come and when we can expect things to subside and with
this pandemic have come different hold these in terms of Diagnostics how
do you image the lung and how do you deal with the contamination issues when
you're taking somebody from one room to another you know one of the modalities
of imaging that we had to use quite a bit of this last week in the hospital
was the cat scanner it's a very integral part of the system that we use the
problem however is that anybody that comes in to the emergency room that has
a cough or a fever or even less than that is going to be considered as a
person of interest in terms of being infected the term that we used is a Pui
or a person or patient under investigation the problem with that is
that when you send that patient to the cat scanner they do the cat scan but
then they have to spend the next hour or so wiping down that cat scanner because
if it turns out that that patients positive and the next person that comes
in there is not then you could spread that virus to that patient and so the
number of cat scans that you can do on a regular basis is really reduced and that
can impede your ability to do appropriate work up in the emergency
room something that's much quicker much easier to wipe down and something that's
portable in fact you could even put a transparent plastic cover over it and go
from room to room simply changing the plastic cover is an ultrasound well as
you know as they say necessity is the mother of invention and in this case the
inventions have already been made it's just that we're getting more creative
and even more so a portable ultrasound machine that can be hooked up to a small
device or iPad is even more convenient and can be wiped down very quickly now I
want you to understand what's going on with ultrasound in Cova 19 and the best
person to do that is the one who taught me ultrasound
dr. Joshua JK is the emergency ultrasound director at the Cleveland
Clinic Akron General in Akron Ohio you can read more about dr. JK on our
website but let's get a better understanding of what's going on with
ultrasound in kovat 19 well thank you Roger I just want to take a second to
appreciate you in the Med cram team for all that you've done to release these
amazing kovat 19 update videos as I've been following along with you I've won
to discuss lung ultrasound before the pandemic I utilize lung ultrasound in
the care of my emergency department patients routinely mostly the diagnosed
respiratory illnesses and that's because it's more accurate than chest x-ray
which we routinely use and more accurate than our stethoscope and it rivals the
accuracy of CT imaging so it's not surprising to me that in the Cova 19
pandemic people are starting to utilize lung ultrasound more because of its
advantages you can see in this article ultrasound useful for detecting Kovan
19:00 pneumonia emergency medicine providers say and this is a group of
italian imaging experts and they're using the word here urging for
ultrasound as one possible alternative so why would these imaging experts urge
us to be utilizing lung alter Sun Roger already did a video that described the
advantages of CT in the accuracy early in the Cova 19 illness but CT has some
major disadvantages and here's a paper findings of lung ultra sonography of
novel coronavirus pneumonia this was published in intensive care medicine in
the primary purpose of this study was to compare the CT findings with the lung
ultrasound findings so if CT is accurate and we can compare the findings then we
can suspect that lung ultrasound is accurate so the reason I bring out this
article here is because they considered in their experience lung ultrasound to
have major utility in the management of these patients due to some advantage as
they point out it's safe there's no radiation radiation increases your
cancer risk over time and chest x-ray and CT both use radiation it's
repeatable meaning you can do the exam as many times as you clinically need to
and repeat it quickly it's low cost compared to other imaging you can use it
at point of care meaning right at the bedside I can get information that will
help me manage my patient you can do a rapid assessment of the patient at
presentation you can track the evolution of the disease so
in real-time if there's a change it'll show up on lung ultrasound and then they
point out many other decisions that the doctors have to make especially in the
intensive care unit those decisions many times are complicated an ultrasound can
be used as a piece of the puzzle to help make those decisions so here's another
article this is a correspondence published in The Lancet by several
Italian doctors encouraging us in this covin 19 outbreak use less stethoscope
in more ultrasound is lung ultrasound the stethoscope of the new millennium
definitely yes and so they're showing the advantages of using a portable
ultrasound system we see a picture of it here where you could have a tablet and a
ultrasound probe attached by Bluetooth or Wi-Fi and you can cover these with
sterile covers so as not to transmit the infection to another patient after
you're done and so they point out here in their opinion the use of ultrasound
is now essential in this safe management of Cova 19 outbreaks since it can allow
can come and execution of clinical examination and lung imaging at the
bedside by the same doctor meaning the doctor can come in talk to you do the
exam and get lung imaging with ultrasound right there instead of having
to send you two chest x-ray or cat scan and here's another video showing the
advantage of having a portable device you can cleanse and disinfect it and
cover the entire thing in a sterile cover so if you go into the hospital or
are in a triage setting and you need to get an ultrasound this is just a little
bit of what that might look like so the probe just touches your body
there's gel between the ultrasound probe in you and then the Machine shows a
picture of what your lungs look like on the inside so this is one of the first
articles that describes the lung ultrasound findings in kovat 19 they
looked at 20 patients in China and compared their CT images with their
ultrasound images and just to give you an idea on cat scan this white patchy
areas where Co nineteen is affecting the lung and on
ultrasound that may appear like these vertical white lines which we call B
lines coming down from the lining of the lung on another patient
this white patchy area here and here are both areas where kovat 19's affecting
the lungs a nun lung ultrasound you see this irregularity of the lining of the
lung and this kind of white out shadow area that it produces so on this patient
you see more this white rounded consolidated area on cat skin with these
black lines which is air still trying to get into that area of the lung and on
lung ultrasound that shows up as this kind of dark blob here with these white
dots inside which are air on ultrasound so how might you see healthcare
providers using lung ultrasound in kovat 19 was discussed they may use it in
triage when they're seeing a bunch of patients instead of chest x-ray or cat
scan and that may help us know how severe the illness already is and who is
at risk for it getting worse we may be able to also utilize it while we're
waiting for that PCR test to know if that's positive or negative and here's
an article showing an example of this under pressure one Italian doctor triage
is by ultrasound other areas as can ultrasound help us predict who is going
to get worse before they do most believe that it's very advantageous to follow
the progression of the disease in as we talked about before it can help make
some of the tough decisions that we need to make in these kovat 19 patients and
remember it's not just patients that are being affected by this pandemic but
healthcare providers are as well here's an example of dr. Holly Chen who
contracted kovin 19 he's an emergency physician in Spain and he shares a diary
on Twitter daily of his symptoms in his lung ultrasound findings
so as we're following the progression of his symptoms while he's at home were
also able to follow the progression of his lung altars
findings and learn from him both how he's feeling in the progression of
disease as well as the progression of his lung ultrasound findings so for all
the reasons we discussed today you're going to see lung ultrasound utilized in
kovat 19 more and more now if you're a healthcare professional and you need to
learn more about lung ultrasound there are many resources so at Med kram we've
released lung ultrasound and kovat 19 educational videos we've added them to
our lung ultrasound explained clearly course and we'll also release them
separately on YouTube these will be free and open access to any provider who'd
like to educate themselves on how to utilize lung ultrasound and kovat 19 so
we are praying that this virus is eradicated and this pandemic ceases but
in the meantime health care professionals are utilizing every
resource at their fingertips to take the best care of their patients
you