welcome to another MedCram COVID-19 update we are now officially
over 1 million cases confirmed the united states is well on its way to a
quarter of a million cases if europe was a country then it actually would be
number one in the world in terms of infections keep in your mind the chart
of what is going on here with kovat 19 we have here on day zero the infection
and then the infection persists for about five days of incubation between
day 5 and day 12 is the symptomatic period of growing and building and this
is of course an average and eighty percent of people in this period will
exit out of this cycle without any further intervention no need for oxygen
no need to visit the emergency room no need to be admitted but it's about
twenty percent of those people here that need to be hospitalized and of course
some of those will just need supplemental oxygen maybe some
observation but again some of those may need to be put on a ventilator
I know ventilators intimately well I've trained for most of my educational life
on how to run a ventilator and how to control a ventilator the ventilator is a
major tool in my toolbox of pulmonary treatments so you have to understand
that there was a little bit of disdain when I saw this article titled
ventilators are no panacea for critically ill kovat 19 patients and I
have to say deep down I know this is true for the flu and for these viral
pneumonia in general often we see a tremendous precipitous down trend in
patients who are admitted in shock and intubated and within hours are being
coated on the ventilator and this article goes through some of the data on
this the first sentence of the story says quite a bit
most coronavirus patients who end up on ventilators go on to die according to
several small studies and many of the patients who continue to live can't be
taken off of mechanical breathing machines and they cite a number of
articles but probably the most comprehensive article is related to the
United Kingdom and this report that was just published a few days ago is a
report by the intensive-care national audit & Research Center in London
England and what they did was took information from intensive care units
across the United Kingdom and looking at the demographics of these patients that
were being admitted and looking at them within the first 24 hours and
categorizing them for our benefits here is a diagram of the demographics the
mean age at admission was around 60 years of age there is definitely a
predilection of male versus female here in terms of those patients being
admitted to the intensive care units and here when we look at the body mass index
remembering that a body mass index of 25 to 30 is deemed to be overweight and
greater than 30 is deemed to be obese you can see that the majority of the
patients are definitely in the overweight category with approximately
70% of the patients being admitted to the intensive care service being
overweight here we can see a breakdown at admission what the age of the patient
is and you can see it in relation to male versus female in just about every
category males outnumber females in terms of admission to the intensive care
service perhaps however this is the most interesting table in the first column
we're looking at the data from just koban 19 patients but in the second
column we're looking at non kovat 19 viral pneumonia patients so there are
other viruses that can also cause pneumonia these of course could be
influenza or respiratory syncytial virus in the past non kovat 19 patients
patients with pneumonia 77 percent of them would leave the intensive care
service alive here 52% of kovat 19 patients are ending up leaving the
intensive care service alive and a whopping 48 percent are dying in
the intensive care the other thing that's interesting at least in the
United Kingdom is whether its length of stay or the duration of organ support
when you look and compared to other viral pneumonias the critical care time
either in survivors nonsurvivors advanced respiratory support total
respiratory support total cardiovascular support or renal support seems to be
less time in kovat 19:00 and more time in non kovat 19:00 meaning that things
perhaps are getting better quickly or getting worse quickly in this situation
here's an interesting table in terms of critical care outcomes by patient
subgroup and you can see here that the majority of the patients that are being
admitted are in the 50 to 69 age group when they are discharged alive from
critical care but when they died in critical care the majority of those
patients are coming from the 70 plus when we look at females they have a 62
point five percent chance of being discharged alive from critical care
whereas the males typically have a 50/50 chance of surviving ICU care
interestingly in terms of BMI and those who are in the obese range tend towards
more chance of dying in critical care and of course I wanted to make an
acknowledgement here so you have to realize that if you are ending up the
hospital right here at the end only a fraction of these patients will go to
the intensive care unit and end up on a ventilator but if you do it looks as
though on average it's about a 50-50 chance depending on what age group or
demographic you're part of and here is where you start to realize that you have
symptoms of some sort of viral infection and of course you can't tell if you have
Kovan 19 at the onset of these symptoms you probably have the virus for about
five days and you've got a certain time period between the time of onset of
symptoms until when you might need to go into the intensive care units so in my
estimation the time period between onset of symptoms
and needing to go to the hospital is the golden period of time that you need to
act to make a difference and it seems as though increasingly more and more that
this period here in the hospital is going to be a more difficult time to act
however I do have to acknowledge that this area here is where I am trained to
do my best work but we will tell you this whether or not we are looking at
the prevention of the infection here at this point in the first phase whether it
is after your infection and in the early portions of the viral infection here in
the second stage or whether or not it's towards the end where the patient is
coming into the hospital with severe symptoms towards the third phase we are
going to look at all of these areas and bring you the latest information ok
we'll see you for our next update please take a moment to leave a comment and
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