welcome to another MedCram coronavirus update let's take a look at the numbers
since the updated criteria for the diagnosis has gone to just a lung scan
and a clinical history consistent with coronavirus 64,000 436 total deaths 1383
total recovered is six thousand eight hundred eighty six about five times the
total deaths is the total recovered let's take a look at the world of meter
and we can see here total cases outside of China have kind of remained constant
because there hasn't been that redefinition causing a slew of new cases
let's take a look at see what's going on inside China or total cases overall if
we look down here at new cases there's been a dramatic drop in the number of
new cases probably because there was a number of cases that were reclassified
we'll have to watch this and see how things go now remember what we're
talking about these total cases is based on the number of people presenting to
hospitals that can get work done on them based on some reports that we've been
seeing especially out in New York Times there's been a crackdown and a rounding
up of people and holding them in quarantine and not getting the medical
treatment that they need some people of course too scared to go and not wanting
to get treatment and so it's unclear exactly how many people are not being
counted here but it's apparent that this is still being under counted in terms of
total deaths there has been a jump and that doesn't seem to be cooling off
anytime soon unfortunately
for the same reason why the total number of cases may be underestimated the total
deaths may be underestimated as well on the worldA meter latest updates for
February 14 we see that there's a report from Hebei province for yesterday that
there was four thousand eight hundred and twenty three new cases including
three thousand and ninety five that were clinically diagnosed we can see here
that the testing was just kind of under estimating those chronically a hundred
and sixteen new deaths and eight clinically diagnosed so we can see that
the clinical diagnosis addition to the count is greatly influencing the number
of new cases whereas it's not affecting the number of deaths as much total human
of cases we can see here that five thousand three hundred and eighty four
were clinically diagnosed we talked about that what's interesting here is
that thirty six thousand are currently hospitalized that's an incredible amount
of people that are hospitalized and you can see here that seventy three percent
so the vast majority of them are in mild condition whereas eight thousand are in
serious condition and about four point six percent are in critical condition
there's a number of people that are undergoing medical observation because
of either their contact or other symptoms that they may have two new
cases in Japan one of them being a surgeon at a hospital who developed a
fever and in still continue to work as usual and saw patients for three days so
that's probably gonna have to be followed up on as well okay I want to
discuss three things today I want to talk about the New England Journal of
Medicine article that actually we referenced back at the end of January
want to talk about cell phones in China and I also want to talk just briefly
about sleep and circadian rhythms and some more reading so first of all let's
talk about the New England Journal of Medicine so there was this article that
was published in the New England Journal talking about a visitor from Wuhan China
who visited in Germany for a business meeting and it was reported in the New
England Journal of Medicine that this woman who came over was asymptomatic and
when she flew back to China she developed symptoms of fever and the
symptoms of the corona virus had later tested positive and when they test heard
her friends that were at the business meeting in Germany they had already
become sick and then got better and they tested
positive for coronavirus and it was touted at that time that this was
evidence that coronavirus could be spread even though the patients were
asymptomatic well as it turns out there's been a correction on this new in
Journal of Medicine case and we'll post a link in the description what they
found out was that before they printed they had not actually reached out to
this index case from China and discussed with her if she actually had symptoms
they reported that she was asymptomatic but in reality she actually was
symptomatic in fact she was taking medications to suppress a fever and was
having very mild symptoms but was having them nevertheless so what does this mean
does this mean that coronavirus does not shed when the patient is asymptomatic no
there's still people that believe that and they may be correct all it means is
that you can't use this New England Journal of Medicine case to support that
theory so I think that's an important distinction that needs to be made and it
tells us that we've got to be careful in this world of rapid information that we
get it right before we spread the information because spreading false
information can have consequences the other thing I want to mention with cell
phones we will link to a article also in The New York Times about what they are
doing right now in China in terms of cell phone use of course in China they
have three cell phone providers that are run by the government and wherever you
go of course that phone is GPS right so if you go to any particular province
it's gonna keep track of that on the phone well what they've currently worked
out through these phone companies is if you text a particular number to them it
will show on the phone right in front of you exactly which provinces in China you
have been in in the last two weeks one month however they want to do it and
they just list it and so what's going on now is people are coming in to various
places to various checkpoints the customs agents the military personnel
who are enforcing these banned are actually asking people as they come
off to text on their phone exactly this number and up there will pop where they
have been in the last month or so and of course if Luhan is on there or specific
province that Wuhan is in pops up there in some cases not letting them go and
they're redirecting them so I thought I'd make you aware of that the last
thing I want to talk about real quickly is circadian rhythms now there's been a
lot of questions and what I'm really trying to do is balance how much we talk
about the virus and how much we talked about sleep and this is the reason why
I'm really gung-ho here about sleep number one is according to the studies
that we've talked about in our last updates you can prevent getting the cold
with sleeping appropriately up to five times imagine if I could tell you that
if you took this pill you could reduce the chances of you
getting the corona virus by 80% that would be an amazing way of curtailing
the arnott's or the spread factor of corona virus and that's what we're
seeing not necessarily the corona virus but in
Rhino virus and so I think this is actually significant enough in a
discussion of what we can do practically so in that vein of things there's been a
lot of comments specifically about some things that I wanted to talk about shift
workers circadian rhythm lights and insomnia first of all shift workers I
know there's a lot of health care workers that work night shift so that's
like going in at 7 p.m. and getting home at 7 a.m. or 6 p.m. to 6 a.m. etc here's
the key about shift workers if you're gonna do shift work it's better to
always do shift work and not go back between day and night that's number one
so stay at same shifts the reason why this is important is because of the
second thing we're going to talk about and that is your circadian rhythm if you
don't do that you confuse your body circadian rhythm
number two is make sure that your nights are days and that your days are nights
in other words if you're going to be up at night make sure that it is bright
where you work at night it's also very helpful sometimes to take naps when
you're working if your job allows for that even a 15 to 20
Neb can be very restful number three if you're a shift worker and you get home
make sure you go to sleep right away as soon as you get home don't go out
shopping don't do the kids laundry don't go work outside go to sleep and make
sure that the room is dark to make sure that the curtains are sealed make sure
the window is sealed you are working different shift from what the rest of
the world is doing but you still need your sleep
and so what you need to do is get your circadian rhythm on a completely
different cycle and that way you're gonna get your sleep the problem occurs
is when you want to be one way on the weekends and the other way during the
week that doesn't work so number four continue your routine on the weekend I'm
gonna put a link into the American Academy of Sleep Medicine website that
gives very very good tips on not only shift workers but people who have other
issues with their sleep so the other thing I want to talk about affects all
of us is circadian rhythm and light so there's two cycles that have to be in
perfect harmony in your body for you to get the great night's sleep number one
is the homeostatic and this is just a funny word that tells you basically as
you are awake more and more and more you start to become increasingly more and
more and more sleepy as you sleep more and more you start to become more and
more and more rested it's just like eating and hunger the more you eat the
less hungry you are the longer you go without eating the more hungry you are
and that's pretty easy to understand but there is a bedtime that we have and
there's a wake time that we have and so the other one is circadian and this is
what happens when you go on a jet plane and go to a different time zone and you
get off there's a certain circadian rhythm that occurs and when both of
these are combined together the perfect thing happens is you are asleep until
the morning and then you wake up and then you are awake until the evening and
then you go to sleep and what makes you go to sleep all of a sudden which makes
you get tired around ten o'clock normally or 11 o'clock normally is the
combination of the drive to go to sleep and the drive to stay awake finally goes
away and both of those combined for you to go to sleep the
is that the circadian rhythm can be shifted either to the left advanced or
to the right delayed and what is it that can shift
circadian rhythm it's light and this is the thing that is the bane of our
existence as people who look at electronic equipment whether it's coming
from a TV screen a cell phone whether it's coming from the lights in our house
all of those things at that time of the night when we should be going to bed
especially blue light is going to delay your circadian rhythm so that you become
tired later and later and later and so what happens is you stay up later and
later and later and you don't feel tired until later and later and later but you
still have to get up in the morning to beat the traffic to get into work which
starts at 8:00 or 9:00 or whatever it starts and so that squeezes the amount
of time that you have to go to bed and to get the sleep so by eliminating light
at night the light that causes this delay in your circadian rhythm is
particularly from blue light but bright light exposure at the beginning of your
day when you're starting to get up in the morning has the opposite effect and
it can actually advance your circadian rhythm so what I tell my patients is
that if they have a situation where they're going to bed very very late
because they don't feel sleepy until they go to bed very late and they love
to sleep until eight or nine or ten kind of like my teenager what they need to do
is advance their circadian rhythms so what I tell them to do make sure that
they're exposing their eyes to nice bright lights around 7:00 or 8:00 in the
morning and to avoid light exposure late in the evening let's talk really briefly
about insomnia so some people have an issue with going to bed and for those of
you who have a separate room where your bed is as compared to other parts of
your house this works but many many people have this situation where they
feel tired they're in the kitchen and as soon as they go into the bedroom now
they are wide awake they can't go to sleep and they become very concerned
about their insomnia and there's a number of issues going on here it has to
do with classical conditioning things like Pavlov's dogs that you may
have heard of in experiments and the situation is that you've got your
bedroom and there are things in your bedroom that you have associated with
insomnia and so that comes to your mind as soon as you go into the bedroom and
you can't sleep because you see these things that you've associated with
yourself in your brain for many many times that you can't sleep when you're
in this bedroom and it's sort of like a performance anxiety and it's because
you've associated that bedroom with your inability to perform and the performance
that you need to do in that bedroom is sleep so what do you do if you cannot
sleep in your bed you should leave your bedroom and go to another part of the
house and associate that other part of the house with inability to sleep we
want your bedroom to be associated with you sleeping so in the same vein if it's
possible and you have insomnia you need to toss out other things in that bedroom
that aren't there for sleep so in other words if you have a TV in your bedroom
you should get rid of it if you read in your bedroom if you work in your bedroom
you should get rid of it essentially there's only two things you should be
doing in that bedroom and one of them is sleeping so that when you go into that
bedroom you are going to associate that very very strongly with sleep and you're
going to eliminate the feeling of performance anxiety because you're not
going to be associating that bedroom with inability to sleep because you will
be getting out of bed and going to another part of the house until you are
ready to go back to sleep the reason why people get this is because they watch
videos like mine and they get the wrong impression they say ah I must go to
sleep earlier I must get more sleep and so they go to bed earlier when the
circadian rhythm is not ready for them to go to sleep or they say I'm gonna
sleep in this morning even though it's nine ten o'clock and it's time for them
to get up and their circadian rhythm is saying get up but they stay in bed and
they can't sleep and when they can't sleep they become more anxious and when
they become more anxious they associate that with the bedroom and that causes
the issues so if this sounds interesting to you I want to direct you to our
website med cram comm where there is a free course on insomnia that I've
recorded previously and you'll find a lot of other courses that will be
very helpful in explaining chronic illnesses and medical conditions next
week I will be at a medical conference but I hope to continue the updates next
week so thanks for joining us