good morning everyone today is february 27th at uh 7 44 in the morning
here in the united states you know with this covid 19 epidemic but in my mind this is a pandemic
now which is likely to be cleared an official pandemic in upcoming days i do want to talk about
you know what we can do what we should do moving forward both as a country as a world and as
individuals with covid 19 becoming a pandemic even though it's not official at this moment
we have to strike a balance between overreacting being fearful versus being prepared
i think that's a fine line but i think together as people both as individuals as a side as a whole
as a country and even on a global scale we have to be very prepared for what's going on and so that's
what i'm going to talk about in this video i also want to answer a lot of questions that people are
having that are leaving in the comments section of my previous videos so i hope to get to as many
of those as i can in this one if i can't get to them today in this one i hope to get to in the
next one with this pandemic and with any pandemic really in the beginning phases it's hard to know
what to do a lot of times because everything is so new everyone is learning about it both the public
is learning about it pretty much at the same pace as the professionals are learning about it all the
experts all the epidemiologists all the physicians all of this is a learning process in real time
and everything is being done in terms of the studies as fast as possible studying
the medicine studying the vaccines and i'll get to that in a little bit because we're in the
beginning phases of the pandemic there's still a lot of unanswered questions such as can you become
reinfected with this coronavirus how long is the incubation period what is the case fatality rate
how many people are infected without having symptoms in wuhan china the reported cfr is around
three percent many expert epidemiologists believe that to be an overestimate because many patients
weren't tested many infected people don't have symptoms and hospitals were overwhelmed the
cfr is more likely one percent and this seems to correlate with the cases outside of china
outside of china confirmed cases divided by number of deaths outside of china based on these numbers
is around 1.5 percent now some say well the number of people infected some of those people will die
so those numbers aren't accurate and that's true but so will the numbers of missed cases as well
only time will tell the true cfr but it's important to calculate what that number
is the best that we can because the number will have implications in preparing for the pandemic
the worse the pandemic the more drastic measures that will have to be taken and the severity of
the pandemic is mainly determined by the cfr the number of critically ill patients and the
number of deaths the more severe the pandemic the more school closings the more limitations
on public gatherings and social contact the less severe the pandemic the less sense it makes to
make such drastic actions because of the impact we'll have on social and economic stability
regardless of the amount of drastic action that we have to take as a society there are lots of simple
things that we can do to drastically minimize the spread of the disease these simple things make a
big difference so the more people do these things the less severe the pandemic will be these simple
things include washing hands frequently especially after touching something not touching your face
without having to just wash them avoiding people who are sick if we're sick staying home or wearing
a mask when we go out covering a cough with the inner elbow we touch our face including nose eyes
and mouth an average of 20 times per hour every day and usually this is done subconsciously we're
not even aware that we're doing it we also touch money door handles handrails menus and a thousand
other objects we sometimes inhale tiny droplets that come from someone sneezing or coughing nearby
so the best advice that i can give and this is what my mom asked me yesterday what you call me
is to do this is to be intentional with your hand hygiene this means keeping your hands clean and
especially don't touch your face without clean hands when washing your hands the most common
areas that are missed are actually the thumbs in between the fingers and on the wrists so
sing happy birthday about 20 seconds when you're washing your hands and make sure you cover all the
areas wash them good and especially don't touch your face without having clean hands so being a
pulmonary and critical care physician my risk of getting a respiratory illness is slightly higher
than someone who's not in the healthcare field but the same techniques that i do are the same things
that you can do and that really means hand hygiene now on occasion depending on the circumstances
i have to wear personal protective equipment again it all depends on the patient that i'm seeing but
other than that there's really no difference in terms of hand washing and having good hand hygiene
whether or not you need to wear a mask it really depends on the circumstances and i made a whole
video dedicated to answering this question called should you wear a mask there will
probably be a shortage of medical masks and we need to make sure healthcare workers have enough
and same goes for household members caring for sick relatives and people who are ill and need to
go outside in a severe pandemic there wouldn't be enough ventilators to support patients breathing
health facilities will need to prepare for a worst-case scenario by anticipating a surge
in covid 19 patients who become critically ill if underprepared for a pandemic that can
lead to more people dying from other diseases due to disruptions of day-to-day health care
this is all the more reason why people with chronic conditions should receive three months
of prescription medications whenever possible and also why it's so important to get appropriate
vaccinations depending on individual circumstances this includes things like influenza vaccination
and depending on the person's age and other medical conditions the pneumococcal vaccination
now i want to get to some of the questions that you had so let's go ahead and get started
one of them is regarding vaccine actually there's a vaccine that was just
well created but still needs further study so it's going to go into investigative trials in april
and because it needs to go in these trials to determine how safe it is and how effective it is
it's probably going to be a year before the vaccine is ready
now this vaccine is special because it's actually groundbreaking it's never been done before
this type of vaccine so normally when a vaccine is made let's draw a virus
all right so virus is a very simple structure compared to everything else in biology
it has a outer shell a capsid outer shell made out of protein and inside depending on what
kind of virus it is it's either going to be dna or rna the coronavirus is actually rna that's
the type of nucleic acid rna is very similar to dna so dna is nucleic acid that we have
in our cells it's in the nucleus of our cells and it's double stranded
not the best picture it's two strands that are intertwined double helix okay this has all
in a chemical form has all the information for our genes this is what our genes are made out of dna
so normally this dna unravels to form two strands okay then the rna we have in our cells
comes next to this strand and does a copy say all right this is the message you're telling me
i'm going to take this message that you're that you're telling me and i'm going to go
and deliver this message this genetic code if you will i'm going to go tell them to make the
proteins that you're telling me to make them so this messenger rna mrna is essentially a message
like you said in the mail and then it goes and it's going to tell the other part of the cell
to start making proteins the exact kind of protein is dependent on the genetic code
so a new protein is made a very specific protein
and more and more copies of the same protein can be made and that's what happens
some viruses have dna and some viruses have just rna the coronavirus is rna and what it does
is it actually gets into the cell and starts making proteins for itself for its outer shell
vaccines up until this new vaccine for the coronavirus vaccines have only been made
in two different ways essentially the first kind of vaccine is the live attenuated vaccine
for these types of vaccines a weaker asymptomatic form of the virus or bacteria but in this case
we're talking about virus is introduced into the body because it's weakened the pathogen
won't spread and cause sickness but the immune system will still learn to recognize its antigens
and know to fight it in the future because these vaccines introduce actual live pathogens into the
body it's an excellent stimulation for the immune system so live attenuated vaccines
can result in lifelong immunity with just one or two doses but because they contain live pathogens
these live attenuated vaccines aren't given to people with weakened immune systems such as
people undergoing chemotherapy or hiv treatment and there is a risk that the pathogen could get
stronger by mutation and cause sickness although that's pretty rare for inactivated vaccines
these have a specific virus or bacteria but in this case virus that we're talking about
that is killed with heat or chemicals and its dead cells are introduced into the body
so think of it as like the virus's dead body
even though the pathogen is dead the immune system can still learn from its antigens how to
fight live versions of it in the future these vaccines can be freeze-dried and easily stored
because there's no risk of killing the pathogen as there is with the live vaccines they're also safer
without the risk of the virus or bacteria mutating back into its disease causing form because the
virus is dead it's not as effective as a live vaccine therefore it often takes several doses
and booster shots to train the body to defend itself now with this new coronavirus vaccination
totally groundbreaking instead of doing either of these two what they're doing is they stole i
don't want to say steel but they got the genetic code from the chinese okay they got the mrna
they were able to figure out the exact rna of the virus and they're taking that genetic code
and they're saying you know what that's going to be our vaccine we're going to inject that into the
body and then the immune system with its different lymphocytes they're going to recognize this rna
and then they're going to incorporate that into
their own cells and they're going to start making proteins
okay they're going to start making proteins of that virus
and the body's going to recognize the protein and say listen this is not a good protein for us we
have to attack that protein and destroy it and the next time we see this virus come around knocking
we're going to kill it so that's what happens the only problem with this is we don't know how
safe this is and we don't know how effective it is because it's never been done before
so that's why we need clinical trials before we just start giving this to people
so those clinical trials will probably take a year starting from when they start getting the vaccine
so if it's going to start in april probably realistically speaking it would be april to may
of 2021 before this vaccine is ready another common question is how long does this virus
last on surfaces no there's studies being done on this right now and i plan on making a video
dedicated towards that topic either if not in the next one probably the one after that another
question i was asked was based on intubation because when i did a video on analyzing the
autopsy results of the patient who died from covid 19 i was describing in that video how the patient
actually refused to be intubated and a lot of the questions were what is it like to be intubated
are they sedated are they unconscious for it so when we put a breathing tube in someone
meaning we do an endotracheal intubation we just about always give sedation less commonly
anesthesiologists will do awake intubations in which they still give some sedation
but not to the point that renders them unconscious also these patients get a lidocaine spray to numb
the back of the throat in emergency situations like during a cardiac arrest we don't use any
sedation at all because the heart's not pumping and they're not conscious so there's no need to
give them sedation a lot of people are asking the patient in the autopsy result video
was he a smoker in that study they didn't mention if he was a smoker or not so i don't know
and a lot of people were asking does smoking put your increased risk for coronavirus disease well
the official answers we don't know because there haven't been any studies done on it but i think
we could presume that it would put someone at slightly higher risk of getting a respiratory
illness in general of course you should not be smoking anyway it's bad for you if you want to
talk about having your immune system at full capacity you need to you need to not be smoking
you need to be eating healthy exercising getting good sleep these are all factors that will help
you have your immune system running at full capacity another question is can you get
reinfected with the virus there are some reports out there that some patients have been re-infected
i think this is pretty rare and i think this is more the exception than the rule i think
it's more of an outlier because there probably got reinfected in the window between the time they're
infected in the time that their immune system developed antibodies our immune system develops
several different kinds of antibodies but when we get infected the first ones from a new infection
are called igm and they take about a week to develop and then they have that spike about one
week and then they start to fade away one week later another antibody we have is called igg
and this takes a little bit longer to develop when someone gets infected so i think probably
what happened is the few patients that are getting reinfected they probably got the virus and they
probably caught the virus a second time before their bodies had time to make these antibodies
in response to the virus speaking of antibodies the igm and the igg antibodies can actually
be useful in helping make the diagnosis so if there's a limited amount of pcr tests available
a good alternative would be to test patients serology to look at the igg and the igm serology
and see if they are positive for the coronavirus disease the only problem again because this is
also new it takes time to develop these tests and for every hospital to have this test available in
their lab what about giving plasma from infected patients who recovered to patients who have the
disease so the thought process with this is when we get infection we have antibodies now the idea
is if that person survives if they're better can we take the antibodies that that patient developed
and just like we do blood draws we draw their blood and then we spin it down and we isolate
the plasma from their blood then we take that plasma that contains the antibodies to the virus
and then we transfuse that into someone else i don't know how much this is being done in china
there are reports of that going on either way it needs to be studied one because we need to know
if it actually works and two because we have to know how safe it is generally speaking whenever
we give a patient fresh frozen plasma we have to weigh the pros and cons some of those cons
include the risk of allergic reaction and the risk of trolley transfusion related acute lung injury
ffp is actually particularly prone to causing trolling also ffp is a valuable commodity it
comes from donated blood so that's another reason why we have to be selective in who we give it to
so i'm going to wrap up this video i know there's more questions that i didn't get to
but i'll try to in upcoming videos the biggest takeaway from this one is to be prepared as you
can and as an individual the best thing that you can do is just focus be mindful of hand hygiene
do your best to wash your hands appropriately wash them effectively and do not touch your face
without having clean hands thanks for watching i'll see in the next one