welcome to another MedCram update so first things first we have 427 deaths
and 20600 confirmed cases and again we look at this ratio here not as saying
that this is a death rate or a fatality rate it's just a ratio of confirmed
deaths divided by confirmed cases but as we predicted the total recover has gone
up and I refer you once again to the dashboard at the Johns Hopkins
University de site for the Wuhan coronavirus so there are a lot of things
to go over today first of all there was a paper that was trying to calculate the
RO or the basic reproduction number this is basically if the virus is in somebody
how many people does that virus get passed on to
you
and I will put a link to the in a description shows about 2.2 for
23.5 8 is the number which is respectable number measles is of course
one of the worst it's about 14 or 15 next big thing three new cases in
California and currently California has about six out of the eleven cases in the
United States and that's not surprising given that California is probably the
biggest destination from Asia to the United States the second death outside
of China if you want to consider hong kong out of china was in a relatively
young gentleman although apparently this guy had underlying illness other big
thing in the news patient in Washington state was released to home isolation and
the key here is home isolation so they don't say much about him however the
thing that I would like to know is whether or not he's virus free why did
he go home on home isolation and is in fact is he's still infectious and he's
just not sick enough to be in the hospital and that's a that's an
interesting question to note but we'll have to see I've gotten a lot of
comments asking about stuff from China like mail or packages we just talked
about yesterday how on a door handled they were able to pick up the RNA of the
corona virus on PCR and I've seen at least two or three articles now with
experts biologists looking at the corona virus and saying that mail from China is
fine now we bring up bats so there seems to be some disagreement among scientists
when this originally came out there was a study that showed that the Wu Hank
rotavirus was very similar and probably most similar to that found in snakes
there seems to be some additional data that it could be from bats the news
there are more evacuations coming and the US government is going to be taking
those two Air Force bases since that seemed to work out well for March Air
Reserve Base in Southern California a Travis Air Force Base seems to be one of
the ones that's targeted they need to have big enough places where they can
have single rooms to isolate and as we mentioned yesterday in our video there
was two people on germán flight to Germany with German
nationals that tested positive for the corona virus finally in weird news
Pakistan is bucking the trend they're good or resumed flights with China which
leave a lot of people scratching their heads because they believe that Pakistan
is in no way able to deal with a corona virus outbreak there they do note in
some of the articles that I read that there is a pretty strong relationship
between China and Pakistan of recent notes China has loaned them billions of
dollars for infrastructure right now there are no cases in Pakistan and what
about the fact that this is a year that the Olympics are occurring in the Summer
Olympics in Tokyo so the question isn't where are we gonna be when the summer
comes around and I will put some links in the description of epidemiologists
hoping that the summer is a slowdown because generally these viruses don't do
very well in the summertime but remember this is a completely novel virus to the
human body and the diamond Princess cruise ship is in complete quarantine
just off the coast of Japan and that's because there was one person in late
January that tested positive for the Wu hen Khurana virus and currently there
are seven people on board that are ill of course that's not too surprising if
you've been on a cruise ship you'll know that you're bound to get somebody that's
ill the testing is not going to be completed on these people until Tuesday
night okay the next thing I want to talk about is they check that this patient
out in Washington State and found that he definitely tested positive in his
stool for the RNA for this wuhan corona virus well this reminded people of what
happened back in 2002 with SARS and as you may recall and you'll also link to a
paper that describes this that there was a whole outbreak I mean hundreds of
people were exposed to one man having the SARS virus and where is this gonna
happen and and that's the next thing we got to talk about is public restrooms
public bathrooms there's some good evidence even that
Chinese are agreeing that this is a potential issue as to how this thing can
be spread just the flushing of the toilet itself that can also aerosolize
things just by flushing so the question is what do you do well I've got no
studies can't tell you for a fact that this works but here's some steps that I
think you may want to consider number one is avoid public bathrooms if
possible number two wash hands and what I would
say here is use paper towels if possible to touch anything in public bathrooms so
walking into the bathroom usually it's a push you can use your foot obviously you
want to have a barrier between you and the toilet seat when you're done if you
can you probably want to close the toilet cover so if you flush it doesn't
aerosolize of course that's gonna be for you not to spread it's that someone else
but of course you can't prevent other people from doing that washing your
hands for at least 20 seconds okay some people say sing happy birthday and
you're mine twice to get to 20 seconds I would also carry hand sanitizer you
would not believe how many times you touch your face you scratch your nose
you put your finger in your mouth these are all entryways another big thing if
you have children teach them all of these things so the second thing I
wanted to get to really quickly was this Lancet article where they included now
99 which is the most to date people with pneumonia with the Wuhan coronavirus and
the average age here was 55 years old 67% men 50% chronic disease 83% had
fever 82% had coughed 31% had shortness of breath
interestingly only 2% had diarrhoea 17% had a RDS and 11% died as opposed to the
original paper which said 15% now we're getting a little bit more granular
because we have more n now this brings us to another interesting thing which
was the prediction score for those that were going to die followed something
called an M u L B Estie a score for viral pneumonia and
I'll include that in the description below it's a very nice article and what
did it look for well there are a number of things that you could look for in
these patients to help tell you is this one that's going to die or is this
someone that's not going to die number one was multi lowbar infiltrates number
two was lymphocytes less than 0.8 number three was bacterial co-infection number
six was someone who had hypertension which I'll abbreviate HTN number seven
was age greater than sixty years of age so for multi lowbar infiltrates they got
five points and you want to have the least amount of points possible for low
lymphocytes they got four points for bacterial infection four points acute
smoker three points if you were a quit smoker two points hypertension was two
points in age greater than sixty was two points so I'll give you some examples
here if you had zero points your chances of dying from viral pneumonia was 0.47%
if you had six points it was two point nine percent if you had twelve points it
was fifteen percent and if it was twenty two points and of course this can go up
to as high as twenty two points but it was basically greater than 69 percent
and this was a very nice prediction method to determine in a viral pneumonia
if someone would die and it followed it pretty closely even for other viruses
so the one that I see a lot comments is this coronavirus and HIV and
this probably started out because of a paper that was uploaded to bio
rx IV not too long ago that found by looking at the RNA that there were four
regions in the novel coronavirus that looked like they had come from HIV and
this was a paper that was not peer-reviewed it was uploaded to a
particular part of the site where those papers can go before they get reviewed
by other scientists there was a disclaimer in that area that
specifically said that but the conspiracy theories abounded and I have
to admit I saw it as well and I was concerned about it because of what the
implications could mean these HIV stretches were coding for gp120 which is
involved potentially in the binding site of cd4 cells so what they actually found
out two of those areas are actually found in bat coronavirus okay so it's
normally there and the other two one is found in HIV but it's only six amino
acids long and I don't think that based on the number of matches that they have
to go through the fact that you would find something that matches six amino
acids would be a wash statistically speaking nevertheless this paper was
removed Sunday by the author's saying that they could have relook at this but
people will say well why are we using HIV meds then in this current outbreak
why are they trying it and why are people getting better on the HIV meds
well this is not a new theory back when SARS broke out in 2002 they also used
HIV medications well why well because corona virus is an RNA virus and HIV is
also an RNA virus and so so in the machinery and getting RNA viruses into
species that have DNA primarily they're going to be very similar and they may
help it of course we already have it we know that it's relatively safe and so
there's these questions about people being readmitted to the hospital people
who have recovered yet they get sick again only to have to end up on this
well I haven't seen any cases out there of this
particularly if you see any I would love to hear from you please put actual case
reports in there there was the the gentleman in the Philippines who did die
but you've got to realize that a lot of these people who have viral infections
will get secondary bacterial infections and in fact I see this all the time
personally in my practice is people will come in to the hospital with severe
bacterial pneumonia but if you check their history they've had a viral
infection prior to that that they've got better from the virus moves in it de
nudes the respiratory epithelium and then the bacteria moves in as an
opportunistic infection so these people being readmitted to the hospital could
be opportunistic infections of bacteria well you say well what about the fact
that a lot of these people have decreased white blood cells I mean
couldn't this be the virus tearing up cd4 cells T helper cells well if you
look back at that article that I was talking about with the viral pneumonia
is you'll see that part of the way they differentiate is that many times
regardless of the viral pneumonia there's going to be a lymphocyte count
that's low in fact that was one of the criteria that we used in figuring out
whether or not the patients actually have a higher risk of dying that
remember that was the MU L B sta score and these people that are being
discharged from the hospital as part of their criteria at least in China is that
their viral loads are undetectable they cannot detect the virus on PCR so the
point of this is be careful there's a lot of theories out there that may be
based on less than scientific data and I guess I'll take this opportunity to
thank everyone for all of the nice comments I'm glad that this is helpful
thanks for joining us and remember what we said about hand-washing pray for this
to turn around and we will see you next time