welcome to another MedCram COVID-19 update we are headed close to two
million total confirmed and 114 thousand total deaths and turkey actually is
moving up in terms of new cases the United States and the UK are both also
at the top in terms of new deaths when it comes to the University of Washington
model we can see here that we may be at the peak or coming very close to it here
in the United States it also seems as though in New York we're getting close
to the peak as well and hopefully we'll start to see some decline very shortly
of course New York is a bit ahead of California I think California is gonna
see some worsening here at least over the next week it looks as though by
April 15 we should start to see a decline in the deaths as well I want to
talk a little bit about testing because that's gonna be something that's gonna
be in the news here for the next couple of weeks I want to make sure you
understand what's going on in terms of testing now up to this point the testing
that's been going on has been something called reverse transcriptase polymerase
chain reaction I want you to understand what that is so the sample is obtained
from your nose basically at nasopharyngeal swab is put up there and
they get some of the mucus and they put it in a test tube before testing what
we're actually looking at here is the RNA and so here we have a strand of
viral RNA and it's single-stranded so the base pairs are exposed and those
base pairs are in a very specific order what we do at this point is we add
nucleotides in that will bind to these in a complementary pattern and will form
a DNA strand and we use something called reverse transcriptase because we've got
to go from the RNA to the DNA great now we have a DNA and then what we do is we
basically go through a cycle where these things will unpair and then we'll use an
enzyme to copy that one and then we'll tear them apart by heating them up or by
using some other means and then we'll do the process all over
again and you can see so for and so forth and so basically what you're doing
is you're taking one strand of viral RNA and you're going to start to make a
whole bunch of strands that are the same as in complementary to that original
strand and then what you'll do is you'll be able to detect a specific pattern by
putting a probe down and if it's in a specific order you'll be able to detect
it somehow with a probe that matches up particularly with that sequence and
you'll get a positive result you can see that there's a lot of steps involved in
this process and if anything goes wrong at any point along this process you're
gonna get a negative result even though the virus is actually there this is
called a false negative result and sometimes it's not that bad sometimes
you don't get a lot of false negatives but as the false negatives go up the
sensitivity of the test goes down so you want to increase the sensitivity in this
case because that's going to reduce your false negatives and in this case it's
very important not to have false negatives because you might have a
patient who is positive for Cova 19 that you're gonna treat as if they were
negative but the thing that I want you to understand is the reverse
transcriptase pcr is looking for actual evidence of the virus inside your body
and so if we find the virus either in your nasal secretions or in the stool or
in any sort of samples that means the virus is still there now that's
completely different than what we're about to talk about which is antibody
testing so you have these cells called monocytes macrophages which eat foreign
particles and present it to the adaptive immune system and they detect cells that
have been infected with the virus so here's a cell that's been infected with
the virus and a macrophage will come along with a nice big nucleus and it
will basically engulf it kill the cell and now what happens is this macrophage
which is now eaten part of the cell or all of it perhaps
we'll chomp up and put on its receptors out here parts of the cell and then you
will have a t-cell come along and we're trying to be as generic here as we can
it will present the antigen to the t-cell and then the t-cell will cause
memory to remember this it will also stimulate B cells to make antibodies
plasma cells generally speaking are the ones that make antibodies and it turns
out that these antibodies will specifically bind to these antigens and
destroy and so what does this mean if we start to see antibodies then that means
the body has built-in adaptive immunity and you can actually test for these
antibodies so if you have a positive antibody test here on this side this
does not mean that you have the virus necessarily it's possible to have the
virus but what it does mean is that you have been infected in the past number
one and now you have immunity because you have antibodies the only way you
could have antibodies built up against this virus is if you had this first part
here known as the innate immune system which finds these viral particles and
presents them to the T cells and the T cells stimulate the B cells and plasma
cells to make antibodies so why is this important because if you have antibodies
then that generally speaking means that you can't be reinfected again now that
is a probable statement it is possible that if the virus mutates enough and is
able to get in you won't have an immune response against it because if this
antibody is against a particular part of this virus that mutates now the virus
can go and get into your body and not be attacked by the antibodies now we've
talked before about this in med cram update 42 so if you go back to update 42
you'll hear us talking about the study with the monkeys and what they did with
the monkeys was they infected them and then once antibodies were made and the
tests were negative they tried to reinfect them with the same virus and
they were unable to so that is a reassuring study but we
still don't know how long those antibodies last and if the virus mutates
whether you could be re infected again this is what happens with the cold this
is what happens with influenza right influenza mutates every year and that's
why you need a shot every year for the new version of the flu virus and that
may be what's going to happen with corona virus we don't know yet it seems
as though the experts believe that the corona virus will come back on a yearly
basis at least for the next couple of years hard to say well they are planning
on doing a number of large-scale kovat 19 antibody testing in the Southern
California area and they're gonna probably be doing it a lot in your area
because this may be the key to getting people back to work because if people
have the antibodies these are the people that could probably go back to work and
not have to worry a lot about re infection or spreading it and the reason
why this is important is we believe that we're missing a lot of coronavirus
positive cases and if we're able to figure out how many people in the
population might already have been exposed to this then we can know better
about when to end this social distancing and this isolation so let me give you a
little bit of a rundown on antibody testing currently it's kind of what they
call the wild wild west and that's because the FDA has relaxed its
restrictions on what companies can make so the first thing that you ought to
know is there's a lot of scams that make you think that you're getting an FDA
approved test but you're not really getting an FDA approved or even a test
that's even worthwhile doing there are no FDA approved home kits so if anyone
tells you that you can buy a home kit and this is gonna tell you whether or
not you've got antibodies it's a scam this is on April 12 2020 there may be in
the future now in terms of lab base in other words all
the antibody tests have to be run in a specific lab of some sort and one lab
based company that has been FDA approved is in North Carolina called cell X but
there's 70 other companies that according to this article have
legitimate tests and they have to give you that kind of a documentation but
these have not been FDA approved because they're trying to get these tests up and
running as quickly as possible and there's a number of news articles that
are describing this and we will give you a link in the description below so how
is antibody testing going to tell us about the population well what you first
have to do is define your population and if this is your population here what you
want to do is take a random sampling of that population and figure out what
percent of that population is positive and then you can make extrapolations to
your actual population in total and that's the key though is defining what
population that is so you want to make sure it's a random sampling I remember
when I was in college at the University of California Riverside we had a
population biology class and one of the things that we did was we went up into
the hills and we collected this is very memorable for me
we collected 100 pill bugs a hundred of them and we have to take liquid paper
with us and we had to paint a specific color of liquid paper on the backs of
these poor little Roly Polys or pill bugs as we call them and that was what
we did the first week and then we released them all back onto the ground
and let them go and what we were figuring is that they were going into
their population whatever their population was and then what we did was
a week later we came back and we collected another box of a hundred pill
bugs of course it wasn't the same hundred pill bugs because those first
hundred pill bugs went back into the population and they mixed around at
random do you know how many were colored with the same color a liquid paper there
were two two pill bugs that were the same color so what we were able to do
was make an abstraction based on first that the hundred pill bucks that we
collected represented just one fiftieth right because we had to out of the whole
hundred of the actual population and so we were able to figure out what the
total population was of those pill bugs based on doing this experiment that's
not exactly what we're doing here but it kind of tells you how to define the
population it's important if you define the population because when you take a
sampling of that population it's gonna have to be homogeneous enough for you to
make an assumption that if five percent of this small portion of the population
is infected that in fact five percent of the larger population is infected or in
this case since we're looking for antibodies if five percent have
antibodies against a SARS cuff - then five percent in the entire population
would my lab partner who helped me with this was my girlfriend and is now my
wife so we always reminisce about the pill bugs a couple other points to talk
about in terms of antibody testing if you're a healthcare provider and you
have a positive antibody and if they are immune to it then they wouldn't have to
wear PPE above and beyond what they would normally have to wear if you're a
teacher for instance you don't have to worry about going back to school and
getting infected you're not going to be able to pass it off to anybody the other
thing that's important to know is if we've really underestimated the number
of infections out there and it's already up to 20 30 40 50 percent we could
already be heading into the herd effect or the herd immunity effect the herd
effect is that if you have a person that is positively infected that virus only
has a certain period of time before it's going to disappear in that person either
because the body takes care of the virus or because unfortunately the virus takes
care of the body either way the only way that virus can live on with progeny is
to get into another human body and at the beginning it's really easy because
all of the bodies around it that it could jump into are going to be negative
it's never seen that virus before and so it's really easy to make that jump
however if you have a situation where a lot of the people around you have
already been infected and have antibodies it's going to be harder for
that virus to find a person that it can jump to and in fact and if in fact it
can't do it it eventually dies and now the virus doesn't spread anymore
it's are not starts to go less than one and when that happens the virus has only
a matter of time before it becomes extinct and this is one thing that I
would love to put on the endangered species list as kovat 19 so look for the
discussion the next couple of weeks to shift from the number of people that are
positive and the number of deaths in the hospital because those will start to
come down we believe here in the next week or two and the discussion will
start to shift to what do we need to do to get back to work
what kind of antibody tests do we need to have what documentation do we need to
have I think that's going to be a very interesting discussion so a lot of you
have commented and asked for some practical approaches to exactly what
does hydrotherapy entail or hydrothermal therapy and this website is the result
of a lot of work put in by a physiotherapist or a physical therapist
in Australia who's had a number of years of experience setting up hydrotherapy
sites throughout Asia and also painstakingly researching the approaches
and the techniques that were used a hundred years ago during the 1919 flu
pandemic so as many of you know there's opportunities to volunteer your services
in New York the National Health Service in the UK reached out to us and wanted
us to make you aware that they are also looking for help there in the UK and
they are looking for registered and unregistered healthcare workers as well
as a range of key roles in non clinical areas I have a special connection to the
United Kingdom my mother trained in nursing at the Queen Elizabeth School of
Nursing in Birmingham back in the 1960s and of course she's retired now but if
there's anyone that can help in this situation please go to this website
we'll put a in the description below don't forget to
see all of our mayhem videos at our website Med cram comm we'll see you next
time