welcome to another MedCram COVID-19 update and as you can see this is now
become a pandemic this is validated with the numbers that are coming outside of
China if we go to the world ometer site you can see clearly we're in the
acceleration phase here and as a result of this we are seeing some things that
are very unusual not withstanding of course the stock market which is taking
a tumble at this point but we're also starting to see things that we've never
really seen before we're starting to see official statements made because of the
fact that there are groups there are fans there are stadiums where when you
have people congregated together it can spread disease and we're seeing that
from the NHL we're seeing that on the NBA website we're even seeing spring
training Major League Baseball being postponed governor Newsom of California
is now able through an executive order to commandeer hotels motels to house
coronavirus patients patients in the state have already been moved to hotels
the Desert Sun reported that a 120 room hotel in San Carlos which is near San
Francisco has already been tapped to housed passengers from the Grand
Princess cruise ship there was an executive order released on Thursday
that includes the authority for Sacramento to take over hotels and
motels for medical use for coronavirus patients in a move he said will help the
state of 40 million to prepare for any widespread outbreak we're also starting
to see here at the municipal government level Garcetti who's the mayor of Los
Angeles urging residents to take steps to protect themselves but they also
banned all events or conferences with more than 50 people they called these
common-sense measures in San Bernardino County which is the largest county in
the United States there's not even a single confirmed case of kovat 19 and so
this website here is a very instructive which I'll put a link to in the
description below and it has to do with this notion of flattening the curve and
that's what I want to talk about today so here's the curve if you have
everybody congregating together of course the virus is going to move
fairly quickly it is thought and if you don't have protective measures that
transmission is going to be very rapid but then just as quickly because you
have burned a large swath in the population of people there's gonna be
immunity that is built very quickly in the survivors and then the curve is
going to flatten out quickly as well but there's going to be so many patients so
fast coming into the hospital that we're not going to be able to take care of
them as it shows here this is the healthcare system capacity way down here
in terms of the daily number of cases if however we're able to distance ourselves
and to shut down the transmission of the virus by spreading us out so we're not
in close contact with each other if we're not congregating together in large
masses then the daily cases it is thought is going to come up slowly even
if it's the same number of people we can spread those out so that the amount of
cases that we're seeing on a daily basis doesn't exceed our ability to take care
of those people and we can kind of see that happen in the early phases of this
epidemic in China in the epicenter of this outbreak in Wuhan the mortality
rate was calculated to be higher than the mortality rate outside of course
this is not a case fatality rate because we don't know exactly the toll and we
don't know exactly the denominator in the numerator involved in that but if
you were to compare those two you would see that the number of deaths divided by
the number of confirmed cases was lower outside of Wuhan than it was inside of
Wuhan and of course the reason for that was that the hospital capacity was just
not there and that was part of the reason why the Chinese felt it was
necessary to build thousand bed hospitals it was to take care of this
swell of daily number of cases and that distancing is going to slow down the
virus but as it has turned out here from this not peer-reviewed paper that is
ready for publication
they did extensive research to answer a question that I have been asked several
times and that is how long does this SARS cough - lasts on surfaces and in
the air the results are disconcerting it showed
here that the h k-- of 19 or the SARS - was investigated and they showed the
overall stability is very similar with the original SARS cough one that was
found back in 2002 they found that the viable virus could be detected in two
aerosols up to three hours post aerosolization so this is when somebody
sneezes or if there is an aerosol ation event like if the patient is being
intubated or if they're on a positive pressure mask this could be seen up to
four hours on copper and up to 24 hours on cardboard and up to two to three days
on plastics and stainless steel which of course has real implications in
hospitals and in operating rooms these two viruses SARS cover one and SARS Cove
- exhibited similar half lives in aerosols with meeting estimates around
2.7 hours both viruses show relatively long viability on stainless steel and
polypropylene the median half-life was around 13 hours on steel and around 16
hours on propylene so basically they found that these viruses can remain
viable and aerosols for multiple hours and on surfaces up to days so you can
see that the importance here of masks is there but really the key is not touching
things where this virus may exist and making sure things get wiped down on a
frequent basis which may give you a question about exactly what could you
use to make sure that SARS cough - virus would be eliminated and we'll put a link
in the description below - EP a website that lists that information going back
to this flattening of the curve when we eliminates sporting events and meetings
things of that nature we're able to drag this out and even though the same number
of people might become infected we're able to better take care of them I know
exactly what it's like being on the frontline
and being in the intensive care unit how frustrating it is to have more cases
than you can actually take care of it doesn't happen often and it might happen
for just a short period of time but imagine trying to take care of a very
critically ill patient and have another patient becoming critically ill right at
the same time and then as that's happening something else is happening
downstairs in the emergency room that they need help with right away you just
can't be in three places at once oftentimes when this happens I call in a
backup physician who's a colleague of mine who's in clinic that has to cancel
clinic and come in and help me instead of being an exception to the rule could
be the rule itself and obviously nobody wants to have a loved one or be that
patient in that situation because you want the attention of the doctor to be
on you when this is happening and of course that's assuming that everything
gets done correctly what you don't want to have is what's described here in this
medical staff update and that is distracted doctoring and patient safety
so imagine someone being interrupted by their interruptions and it's hard to put
two thoughts together you're not dealing with computers when you go into the
hospital even though there are many computers there you're dealing with
physicians physicians who are human beings who have to think and have to
decide what needs to be done on a patient and they need to take all those
things into consideration and if they get interrupted because there's such a
influx of patients coming in that's when mistakes can also happen and that's what
this article points out and I'll put a link to this article as well an example
of this point is a recent event a physician was busy trying to complete
progress and consult notes while waiting to get a callback on a page that he had
placed realizing that there were orders that needed to be put on in patient a
the physician inadvertently placed a medication order into patient B's record
which was opened in epic epic for those who don't know is the medical record
system the staff complied immediately with the order with patient B getting
the medication intended for patient a fortunately patient B did not get
injured by the event but the root cause of this error was the physicians
momentary distraction while trying to do several routine things out
once and that is the key and that is generally going to happen more often if
this is the situation that we have versus this being the situation that we
have we just don't have enough hospital beds physicians nurses ancillary staff
respiratory therapists to be able to deal with this in a safe way
Popov says that if everyone practices social distancing and practices good
hygiene it will help slow the spread of the virus so that everyone who will
eventually need medical care can be properly treated so that what is
happening in Italy and China doesn't happen here even though in many parts of
the country where there are no cases because we really don't know how
widespread this virus is because really we've under tested so on this update we
took a little bit of a break from the molecular biology but next week we're
going to be getting into a lot of the details of this ace to receptor this is
the receptor that is targeted by the virus itself and there's a lot of
interesting things about this receptor not only from a vaccination and from an
entry point but this ace to protein is not in isolation it does have a function
and that function may be modified by the binding of this virus it's interesting
to talk about the implications of that modification we're also going to talk
about practical things that you can do and what does it mean to have immunity
please subscribe to this channel if you haven't already thanks for joining us