welcome to another MedCram COVID-19 update we're gonna talk today again
about the numbers about the epidemiology we're actually going to talk about the
case fatality rate and the age specifically a lot of you have asked
about how age affects that we're also going to talk about testing there's been
some interest in how we test for SARS cuff too and in light of what we talked
about last update which is what the sensitivity and specificity were we
talked about how the sensitivity of the kits that have been made public and
available in certain situations is not the best we're also gonna talk about
healthcare workers and this all sort of ties in together
here is the Johns Hopkins dashboard total confirmed eighty three thousand
three hundred and eighty-nine total deaths twenty eight hundred fifty eight
total recovered is thirty six thousand five hundred and sixty three these are
the numbers that are being put out to by the various organizations moving over to
the world ometer coronavirus cases and if we exclude the Chinese numbers we can
see here that we are definitely in an epidemic phase outside of China and if
we look at the pie chart we can see here that that slice of the pie is definitely
growing and I think you can expect that that is going to grow even more here in
the next number of weeks if we look at the number of cases outside of mainland
China a huge swath of that is from the Diamond Princess in terms of new cases
the fastest-growing one is South Korea in fact for the first time there's more
cases coming out of South Korea and there is coming out of China also here
we have our outcome of cases and you can see that the death rates as more and
more of these undetermined cases go to the side of recovery that death rate is
falling that is not a case fatality rate we're going to talk about that here in
just the bits again looking at the latest updates one new case in Canada
this used to be a very small section here where you could
look at multiple dates and now things have just taken off in different places
North America here on February 27th new case in Ontario the husband of the
previously confirmed case in Toronto we've got Europe in the Middle East and
you can see here all of the different cases 20 new cases in France for
instance five new cases in Sweden 14 new cases in Germany Italy has now actually
relaxed its testing criteria recent travelers to outbreak areas will not be
tested anymore unless they show symptoms and that may be because they may be low
on testing that's just speculation not exactly sure if that is the case we've
got two new cases in the UK four new cases in Switzerland in Asia the number
of new cases in South Korea has actually topped to China for the first time this
is the article entitled coronavirus fatality rates vary widely depending on
age gender and medical history some patients fare much worse than others
this is in a jam a review article where they actually looked at 72,000 copa 19
cases and there was a dramatic shift we'll put the link to this article in
the description let's go right to the actual article characteristics of an
important lessons from the corona virus disease 2019 outbreak in China this is
seventy two thousand three hundred and fourteen cases pretty big numbers
realizing of course this doesn't capture the entire picture but it's a good peek
at what it is that's going on let's just jump to the box findings I like JAMA
that they box these findings for you very concisely so out of seventy two
thousand three hundred fourteen cases confirmed cases were forty four thousand
suspect the cases sixteen thousand diagnosed cases ten thousand
asymptomatic less than a thousand here's the age distribution of actual
infections in this study and you can see the vast majority of infections occurred
in people thirty to seventy nine years of age that may be because most of these
people were out and about but you can see here that as you get younger ten to
nineteen less than ten there was a reduced population what about the
spectrum of disease overall eighty one percent of these cases were mild
fourteen percent were severe and five percent were critical
the thing that everyone's looking for is the case fatality rate so overall all of
those cases had a case fatality rate of 2.3 percent but how did that get
distributed you can see that one of the highest age-related case fatality rates
was in people aged 80 years and over and that was fourteen point eight well if
you're in the decade before that seventy to seventy nine eight point zero percent
you can see that it came down dramatically
what about those who were less than nine if you were to go down into the body of
the paper there were no deaths in anybody nine years of age or younger and
if you did have a critical case your chances of making it were about fifty
percent so what about all those people that are 30 to 80 years of age well if
you actually calculate the numbers you get approximately a one point two
percent case fatality rate let's look at healthcare personnel that were infected
of the forty four thousand that were confirmed 3.8 percent of them were
healthcare personnel and sixty three percent of those were in wuhan in total
there were only five deaths in this group and they also tell you about how
they determine which ones were mild and which ones were severe etc mild was
determined as non pneumonia or mild pneumonia
however fourteen percent were severe well what is severe these are people
that had shortness of breath a respiratory frequency rate of greater
than thirty per minutes a blood oxygen saturation that was less than 93% or a
partial pressure of oxygen fraction to the oxygen ratio of less than 300 what
is this less than 300 mean it's a determinant of how much oxygen they have
to give you to keep your oxygen levels up the more oxygen that they have to
give you to keep your oxygen levels up the lower this number goes so you want
to have a high number this is called a PF ratio a lung infiltrates that is more
than 50% within 24 to 48 hours and 5% were critical respiratory failure
they're on ventilators they're in septic shock or they have multiple organ
failure no deaths were reported among mild and severe cases however among
critical cases the case fatality rate was the flip of a coin those with
pre-existing comorbid ditions 10.5% for cardiovascular disease
7.3 percent for diabetes six point three percent for chronic respiratory disease
six percent for hypertension five point six percent for cancer and among the
forty four thousand cases a total of one thousand seven hundred and sixteen where
health care workers or about three point eight percent a lot of whom were in
wuhan here is a key point kovat nineteen rapidly spread from a single city to the
entire country in just 30 days the sheer speed of both the geographical
expansion and the sudden increase in numbers of cases surprised and quickly
overwhelmed health and public health services in China particularly in Wuhan
City and Hebei province epidemic curves reflect what may be a mixed outbreak
pattern with early cases suggestive of a continuous common source potentially
zoonotic spillover at the Hunan seafood wholesale market and later cases
suggestive of a propagated source as the virus began to be transmitted from
person to person and here we have this graph this is a great graph we see going
along here rather undetected and then all of a sudden we see this huge
increase depending on whether or not you're looking at the date of onset of
the cases or the data of diagnosis of the cases in either situation if we look
at the date of onset we can see here that things start to spread very very
quickly and overwhelm the healthcare delivery system no deaths were reported
among mild and severe cases I think that's a pretty extraordinary statement
whether you believe the numbers or not especially seeing based on this study
the majority of the cases were mild and severe and 5% are critical and half of
those are dying so we can see by looking at this that the key is going to be
early detection and this brings up another interesting article here Co
diagnostic stock soars 57 percent on a high hopes for its coronavirus test so
if you looked at our last update you would have seen that the current CDC
kits are not performing like they should be you may remember the case in
San Diego that was released early after they determined initially that the
patient was negative only to retest and find that the patient was in fact
positive and that could be because of a somewhat lower sensitivity of the test
instead of it being 97% it's as low as 70 percent well here is possibly a new
test that is developed by Co Diagnostics it's a month to date gains to 333
percent after the company said it received AC e mark for its tests and
this indicates that the test is compliant with health and safety
standards and is now gonna be allowed to be sold in the European Economic Area
there is an analyst that says that this test is easier to use than the test in
use by the Centers for Disease Control and Prevention well we'll see what
happens with this and hopefully if it does work it'll be more available and
faster than the current testing that we have because of this article about the
California issue that we have in Sacramento with the patient that was
diagnosed as we talked about in our last update some California health workers
held in isolation quarantine after exposure to corona virus patient this is
what we've been talking about and that is if somebody comes in to the hospital
and has corona virus but we don't know that and we can't detect that until
they're on the ventilator and then we're worried because they have a viral
pneumonia and none of our tests are positive then we get it tested and it's
positive we're gonna look back and see which healthcare workers were in contact
with that patient and then we're gonna have to quarantine them dozens of health
care workers in Solano County California are under isolation and some will be
quarantined after being exposed to a patient who recently tested positive for
the corona virus now we talked about this as it turns out this patient
visited centers at two hospitals in North Bay vaca
Valley Hospital in Vacaville and the UC Davis Medical Center in Sacramento after
the patient was transferred there now we don't know how many people had to be put
on isolation and taken out of service basically but they say it was under a
hundred people now for them to save that high of a number I'm thinking here that
it's not far under one people and it kind of goes to show that
at just the point where you need to have as many health care workers as possible
to deal with this epidemic you're gonna be knocking out a lot of health care
workers if you can't get the diagnosis right and quickly so the quote here by
dr. Matias the county public health officer said at both hospitals we are at
present aggressively evaluating everyone who may have had contact with this
patient they are being identified and their risk for exposure is being
assessed efforts are made to identify all workers who may have been exposed a
spokesman for north bay health care said and the number of health care workers
impacted was a moving target the announcement comes hours after County
Health officials declared a local emergency and activated its Department
Operations Center to identify and screen those potentially exposed to the
coronavirus officials called the virus a public health threat but cautioned that
the risk to the public in Solano County remains low so that leads me to give you
some advice on what to do and we have to stop thinking about what am I going to
do to protect myself and myself only because what we need to do is we need to
start and think like a group to protect ourselves from this virus and what I
mean by that is we need to take steps not only concentrating on how to prevent
ourselves from getting the virus you really need to think about this hard if
you get the virus what are you going to do to prevent somebody else from getting
the virus if we all think this way and we all act this way together we can
prevent a lot of problems so we need to think together as a group and cooperate
and so the number one thing I'm going to tell you here is get a thermometer and
the reason why I'm telling you that is so you can know objectively if you have
a fever the definition of a fever by the way is a temperature greater than 100
point 4 degrees Fahrenheit or 38.0 degrees centigrade and I know some
people will say well I'm always very cold and therefore this is a temperature
for me I understand that but I'm just letting you know that when you come to
the hospital and we check your temperature these are the criteria that
we're going to use a temper 100.4 or 38.0 if you get a fever I would
say the second thing to do is don't go to the hospital unless you need to and
what I mean by that is be reasonable if it is only a cold or if it is only mild
flu symptoms that you don't need to go to the hospital for if you have
shortness of breath if you have severe cough things of that nature
those are the things that you need to go to the hospital for talk to your doctor
call in to your nurse do those sorts of things because if you go you're going to
inundate yourself into the hospital system you're going to be another
patient that they have to see and you're going to expose yourself potentially to
other people who might be infected number three don't hoard masks there's 2
types of masks there's the regular surgical masks which we all know and
then there's something called n95 masks let me just tell you right now a regular
surgical mask other than preventing you from touching something and then
touching your nose isn't going to prevent you from getting coronavirus if
you're breathing in air then you're breathing in the viruses in the air and
those surgical masks are not designed to filter air that you breathe in only the
n95 masks do that so wearing a surgical mask if you're perfectly healthy other
than the fact of just trying to remind yourself not to touch your nose your
mouth is going to do you no good so don't take those masks those masks are
needed for people at the hospital to put on patients who are already sick
now as far as n95 masks those masks are needed by physicians and nurses and
respiratory therapists and other ancillary service people at the hospital
so that they can continue to treat people there and still be healthy and
not have to be quarantined it's important that they get that equipment
because if they don't have that equipment they're gonna get sick and
they're not gonna be there at the hospital when you need them to be there
number four if you are having severe symptoms if you are having shortness of
breath you're having dis Nia chest pains symptoms that are more severe or you're
lethargic that means sleepy you're not being responsive these are all things
that you should definitely go to the hospital for it and especially if you're
not getting better but you should call ahead and find out where you should go
because you don't want to expose people at the hospital to your virus what they
will do is they will probably put a mask on you like a surgical mask so that you
don't spread the virus to other healthcare workers if you or your kids
have symptoms don't see Grandma and Grandpa we just went over what the
mortality rates were for people above 70 years and 80 years of age these are some
very basic things that you can do to help prevent spread of disease and to
keep our hospitals healthy so that they can take care of you if you get sick
we're going to take a break and we will come back on Monday morning thanks for
joining us you