welcome to another MedCram coronavirus update so I wanted to go over the recent
numbers and total deaths is 910 that means that it surpassed SARS total
recovered is a good three and a half times now the total number of deaths
about a week ago they were substantially below the total number of deaths so
we're seeing an improvement here in the total number of recovered now these
numbers are provided to us from the w-h-o the CDC and a number of other
agencies recently here there's been some news that China seems as though but that
w-h-o is now being allowed to go in and that team is being headed up by dr.
Bruce I'll would according to the New York Times article if we look here the
others that they have listed here is actually on the cruise ship
just south of Tokyo you can see that they're wanted to talk about a recent
article that was just published in JAMA the Journal of the American Medical
Association on February 7th and we will put a link in the description below that
links to the article I think is an excellent article and basically it's a
description of 138 patients that were admitted to a university hospital in
Wuhan and describes exactly what happened to them this is an article that
looked at patients that were admitted from the first of January until the 28th
of January and at this hospital there was a total of 138 patients how do they
diagnose these all of these were positive for coronavirus but they did
not look at serum viral titers or serum viral load they looked at sputum so
that's one of the weaknesses of the study the other thing I want to mention
here is these are 138 patients that were sick enough to come to the hospital
that's really important to understand because this is going to give you a
limited look at what happens to patients who are sick enough to come to the
hospital and seek medical attention so what they noticed in the article is that
first of all the patient has symptoms then they typically developed shortness
of breath then they became admitted to the hospital
then after they admitted to the hospital one of two things happened either they
were admitted to the intensive care unit or they were admitted to the regular
floor and then we'll talk about where it goes from there now in terms of timing
that's important to get to as well from the time of symptoms to the time of
shortness of breath was about five days according to their survey and then from
shortness of breath to admission here at the 138th was two days on average and
then from admission to intensive care if they were gonna go to the intensive care
was one day so let's talk about what those symptoms were so first of all the
average age of patients admitted into the study was 56 years old and unlike
previous reports that showed a real high predilection to men only 54% of these
patients were male when I say only it looked more like a 50/50 kind of mix as
opposed to 60 or 70 that had been shown before so what were the symptoms fever
was seen in ninety eight point six percent of the patients kind of an
ironic figure given that 98.6 degrees Fahrenheit is the average temperature
for a human being a fever is defined by the way as a temperature of greater than
100 point four Fahrenheit or 38.0 degrees centigrade fatigue was seen in
about 70% of patients cough was seen in 59 percent of patients low lymphocytes
what we call lymphopenia a common sign that you can see in viral infections
that was seen in as high as 70 percent of patients a prothrombin time PT that's
of a measure of the Bloods ability to coagulate when you have a high PT that
means that your blood is a little bit more thin and that was seen in about 58
percent of patients an elevated lactate dehydrogenase which is another lab value
typically seen in viral infections that was seen in about 40 percent now when
they looked at CT scans a hundred percent of those patients have what they
call ground-glass opacities that's inflammation in the lungs and that's
consistent with what we see in a viral pneumonia of any type so
in other words what we're seeing here is not very specific for coronavirus but
could in fact be seen in a flu could be seen in other types of viruses that
could do this one of the things though that they saw is that there was a
substantial amount that had just nausea and vomiting and that was kind of
unusual it wasn't as high as eighty to ninety percent but it was there in terms
of treatment for these patients almost all of them receive a settlement which
is the flu medication also antibiotics were used on the majority and in about
forty five percent of patients steroids were used they weren't really able to
tell whether or not any of this stuff had a benefit to the patient
of course this study was not designed to look at that so let's look at the 138th
patients that came in the first thing I'm gonna mention to you and we're gonna
talk about this at the end I think this is probably the biggest thrust and the
biggest surprise out of this paper was that 41 percent of these patients or a
total of 57 patients were patients that did not come to the hospital with the
corona virus but in fact picked it up there we call that a nosocomial
infection so yes there were patients at the hospital that were there for a
completely different reason and they developed corona virus at the hospital
and there were health care workers that went to work without corona virus and
picked it up taking care of patients at the hospital what percent of the
patients in the hospital that were treated for corona virus had that a
substantial amount 41 percent we'll talk about that at the end of this
presentation so of these 138 patients regardless of whether or not they came
to the hospital with it or not or developed it there what happened to them
so of 138 and on average after about one day there was a decision to have them
move to the intensive care unit about 36 patients or 26 percent of the 138 went
to the intensive care unit and 74 percent were stable enough to be
admitted to the regular floor so let's focus our time a little bit on what
happened to the patients in the intensive care unit so why did they have
to go to the intensive care unit well there's many reasons why somebody could
go to the intensive care unit for instance they could go into a RDS they
could have a serious arrhythmias or they could go into shock sometimes
you can have more than one of these things so don't expect all of these
things to add up but if you look at of the hundred and thirty-eight how many of
them had a RDS 16 percent of patients admitted to the hospital had to go to
the intensive care units for a RDS reasons of the people who are admitted
twelve percent of the hundred and thirty eight had arrhythmias and eight percent
of people admitted to the hospital had to go to the intensive care unit because
of shock now if you want more information on a RDS please look at our
a RDS video how coronavirus kills and that describes what a RDS is in detail
and what are the treatments that the intensive care unit can use to treat
these kind of things now of those that went to the intensive care unit
what kind of oxygen supplementation did they need there's three basic types of
oxygen supplementation that you'll see in the intensive care unit one is known
as high flow oxygen the other is non-invasive positive pressure
ventilation this is kind of like CPAP but it's actually called BiPAP because
the ventilator helps you when you take a breath in so it gives you a higher
pressure when you're breathing in and it'll lower pressure when you're
breathing out we call that non-invasive positive pressure ventilation and then
of course full out ventilators so of those people that went to the intensive
care units how many have to go on high-flow 11 percent how many had to go
on non-invasive positive pressure ventilation basically wearing a tight
mask 42 percent and how many actually had to go on the ventilator up to almost
half the patients 47 percent and of those people four patients had to go on
ECMO ECMO is basically where you bypass the heart and lung on a machine to
oxygenate the patient until their lungs get uninflated are recover from the
infection so overall here you can see that these patients which were fully in
the phase of the viral infection where patients were coming to the hospital
they were very sick we can see here that of the hundred and thirty-eight a
quarter of these patients more than a quarter are going to the intensive care
unit meaning that this cohort looked to be a little bit sicker than previous
descriptions again I caution you to understand that this 26%
not 26% of all people who get coronavirus infection but rather 26% of
people who get corona virus infection and then develop symptoms severe enough
to have to have them go into the hospital so let's talk about what's
happened to these patients so the last update as of February 3rd 2020 let's get
an update of all of these 138 patients 47 patients have been discharged home
there have been six patients that have died and the remaining 85 patients are
still in the hospital so the six that have died out of the 138
leaves us with a mortality of about 4.3 percent that's the base of the mortality
based on the hospitalization because we don't yet know what's going to happen to
these 85 patients let's talk a little bit about what happened to these people
in the ICU specifically so there was 36 people that went into the intensive care
unit what's happened to them since they were admitted to the hospital well of
those 36 patients we know based on the report that 11 still remain in the
intensive care unit that nine have been actually discharged home that 10 have
gotten well enough to be transferred to the floor and that of all of the six
that died all of them were in the intensive care unit so you can see here
that of the 36 that initially came in 19 of them have improved to the point where
they are either gone home or on the regular floor and 11 still remain and
we're gonna see where that goes okay let's talk about 57 patients of the 143
or 41 percent of them develop the infection in the hospital of those 57 17
of them were actual patients that were in the hospital for another reason but a
full 40 of these were healthcare workers let's go back to these 17 patients that
were there they said that seven of them were on the surgical ward and that five
of them were on the internal medicine ward and that five of them were on the
oncology ward now of these 40 patients that were actually healthcare workers
there at the hospital 31 of them or 78% were working on the wards seven of them
or 18% were in the emergency room and two or 5% were working in the intensive
care units they talked in the paper about one patient who presented with
nausea and vomiting which we said was kind of atypical and he was admitted to
the surgical ward well he had coronavirus and they believe based on
history and based on deductive reasoning that about 10 people were infected
because of his symptoms and his virus so what this paper highlights I think is
the transmissibility of this virus and what we really need to highlight here is
hand-washing and the key here is that you've got to wash for 20 seconds and as
we've said before that's like singing happy birthday twice wash your hands
with soap and you need to do this before of course before you go into patient's
room before you put on gloves before you dawn a gown and you need to do it after
and why is that because you're using your hands to take off your personal
protective equipment that would have the virus on there and really avoid touching
your face with your hands now what about masks well if you are suspicious that
the person that you are about to examine has the corona virus and your healthcare
worker they're recommending n95 masks if you suspect that the patient is the one
that has the virus then they ought to be wearing a regular surgical mask in
addition to n95 masks so this is for the patient and this is for you as a
healthcare worker you should also be doing eyewear protection and you can see
what the workers over in China are now currently wearing they got the message
they understand what it is that's going on and they're going to make sure that
that doesn't happen again and what this article I think really shows is the
delicate balance that you have to strike when you have patient
with a virus coming into a setting where there are other patients that don't have
the virus and I believe that is really the thrust as to why they are building
these hospitals dedicated to the virus so that they don't cross infect other
people other health care workers and that they can have the infrastructure in
place to deal with the contamination that can occur in these places please
stay tuned for other videos that we're gonna really delve into what it is that
you either as a health care individual or as a citizen can do to improve your
chances of a not getting the virus or number two if you do get the virus
needing it so stay tuned for those videos coming up