welcome to another MedCram coronavirus update so let's go to the numbers again
these are numbers that we take with a grain of salt these are the numbers that
we have they are coming from the w-h-o who has been allowed into China as of
yesterday also from the CDC here we know that these numbers are probably
underestimated we know that because only the most severe cases that made to the
hospital are getting tested
we know that these numbers are under don't know by how much we may never know
how much total deaths keep increasing by bigger numbers 1018 total recovered is
growing probably the fastest okay let's go over to our other website that we
look at which is the worldA meter at least according to these numbers there
is a suggestion that things are layering out let's go back though to our death
cases that doesn't seem to be at all petering out in fact if we look at the
number of deaths here February 10th deaths total was 108 and
that seems to indicate what we've been talking about all along and that is the
number of cases usually represents something earlier in the course and that
takes time for the patient to get sick to the point of death which takes a
little bit longer so hopefully here in the next week or so
we might start to see death starting to layer out we can only hope that that's
the case we know that almost all of these deaths are happening in mainland
China in the wuhan area of course their system as with any system is overwhelmed
inundated and things that would normally be happening or not happening as they
should they are trying to alleviate that by building hospitals dedicated to
taking care of these more milder symptoms so they can take the stress off
of the hospitals to take care of these more severe cases so of course the big
news over the last 24 hours has been about the incubation period we're gonna
get to what to make about incubation period of 24 days before we get to that
the other big news is San Diego California just got its first case and
interestingly it was from four people that were hospitalized because of
symptoms at UC San Diego and they had done some testing there at UC San Diego
apparently went to the CDC and the CDC released them but one of these people
actually had further testing done and it turned out to be positive in which case
that patient came right back to the hospital and they had quarantined them
and everyone's doing well it's just that we have a patient that's turned positive
and so again these are people that flew in last Wednesday from China and are
being quarantined at the Miramar base just north of San Diego so let's talk
about this quarantine issue actually the quarantine issue which is related to the
incubation period so up to this point was felt that 14 days was enough to take
care of any potential type of infection in fact that's where the recommendation
came for just about anyone in the world now that is coming from China they are
quarantine them because the incubation period is about 14 days well there was
this new paper that was published pre peer-reviewed what does that mean that
means that before a bunch of scientists that are in that field got to look at
the paper pick it apart and say hey what about this what about that it got
published on a server and it's out there let's talk about it so here is the
article the lead author whose name actually goes at the end is this
gentleman nan Xiang Zhang this is a pulmonologist and you know I've got a
soft spot in my heart for pulmonologist because I am one and here's the abstract
for it and then here's the key part it says the median incubation period was
three days range of 0 to 24 point 0 days and of course they went into a lot of
other things so some things I want to point out here which is really
interesting is if you were to see our update from yesterday where we actually
quoted the Jama article the Jama article was a publication that looked at a
hundred and thirty-eight patients that were seen in the hospital there in Wuhan
this one actually looks at 1099 patients so you're gonna get a much bigger n
number that was at one hospital this is at five hundred and fifty two hospitals
in 31 provinces through January 29 2020 so here the meeting age as compared to
the JAMA article was a little bit younger that was in the 50s this one's
47 years of age in this case there was a bigger majority that were males in the
previous one it was more split half and a half we saw about the same number of
people with fever people with cough we also saw that
diarrhea was uncommon but it did happen but there's some other interesting
things we saw that lymphopenia that means low white blood cells were
observed that seems to a very common finding in any type of
viral infection but in the jam article which was looking at 138 patients in a
single Medical Center in that situation there were 36 patients or 26% that were
admitted to the intensive care unit here only 55 patients or 5% were admitted to
the intensive care unit let me explain that again the larger study that had
more patients in it and was more of a cross-section of the area had a much
lower admission rate to the intensive care unit only 5% and whereas in our jam
article 4.3 percent died at least at the time of publication the mortality rate
here in this publication was only one point three six percent so seems as
though the patients included in this study were not as severe so what do we
say about this 24 days let's talk about that the first thing you need to look at
is that the median incubation period was 3.0 days and so what that means is that
in fact they've seen this in Ebola where there is a double exposure and sometimes
what can happen is there is a reinfection later on that makes the
incubation period look longer than it really is so what we mean to say there
there's an infection that occurs here on day zero and then there's an incubation
period here of let's say 10 days incubation period and then there's
another repeated one and this one may not cause symptoms but this repeated one
may cause symptoms and that will be another incubation period and then let's
say this one happens to be 14 days and then symptoms occur and so they can
clearly identify this as one of the potential infection periods and they
look at this of course as the symptoms what they don't
realize though is that there is another infection that occurred and that the
total when added up yes it comes out to 24 days but that's not the incubation
period of this infection to this symptom there is another one there it's an
interesting concept this is an outlier and so sometimes you will get outliers
right there is always a bell-shaped distribution with most things that is
anyway and so yes is it possible that you're gonna get an outlier here at the
99th percentile or the first percentile it's possible but it seems as though at
least at this point what we're talking about in terms of a median is three days
on the incubation period what we'll do is we'll put a link in to the video
where the reporter asks the w-h-o physician about exactly what does this
24 day incubation period mean okay so let's talk a little bit more about
what's happening and what it is that we can do so we spent some time if you look
at our previous videos talking about things that we can do to help us prevent
getting the virus and that's what a lot of expenditure is going into right now
quarantine shutting down but we've also talked
about what is the treatment that can occur if somebody actually comes down
with the corona virus and they have symptoms that are severe enough that end
them up in the hospital we've already talked a little about some of the
medications and we'll talk more about some of these medications that are being
used realize that medications that are used for diseases at least in the United
States or in Europe have to go through rigorous placebo controlled trials for
them to be indicated for that so in other words if you have a blood pressure
medication or you have an antibiotic it has to be tested for that particular
indication for it to work now we can't do this with a brand new corona virus we
will never have randomized placebo-controlled trials ready to go at
the initiation of an outbreak they are planning to have something maybe in
April and that's really really fast for some of these medications but we don't
have anything that we know is going to work and so as a result of that whenever
we give something for treatment unless it's a known
situation like ARDS because viral pneumonia can cause a RDS that's acute
respiratory distress syndrome there are some treatments that we know work we've
talked about this in our video which will give you a link to how corona virus
kills there's something that we can do called prone positioning there's
something that we can do called paralysis and there's also something
called low tidal volumes so all of these are things that we can do to help
improve because that's been a randomized placebo-controlled trial for a RDS but
in terms of medications for this corona virus we don't have it practical things
that we can do we don't have randomized placebo-controlled trials which are the
best evidence for these things so what do we do instead we look at the biology
of things and we make certain choices and we say yes even though we know that
we don't know for sure if this is going to work we're still going to try it
anyway because there's very little risk so for instance for medications that
have indications for other diseases for instance HIV it may work in coronavirus
and so what we'll do is we'll do this and it's called the compassionate use
compassionate use and you have to apply for that to use it and so that's what
happened in this case in the gentleman in Thailand where they used medications
that were typically indicated for HIV they used it to see if the man would get
better and that's the kind of things that we have now basically anything that
we say we're going to throw at in terms of a medication against coronavirus it's
going to be compassionate use we're not going to have the best evidence to say
it's going to work so what I would like to do over the next couple of videos and
we've talked about this before is to look at some practical things that the
biology tells us may work but can I tell you for sure that it's going to help you
know so what are those things they're things that'll fit into the category
where there is question about very low risk these are the kinds of things that
you can concentrate on to help you if you are ever in the situation where you
have corona virus what is it that you can do beforehand and at the point of to
limit the morbidity and mortality and I'm telling you right now you're going
to be surprised at some of the things but I'm gonna show you the evidence for
it and you may say no really could that really help me well we'll go over the
evidence and you make your pre final decision and if the benefits outweigh
the risks then you should do it thanks for joining us