well welcome to another MedCram coronavirus update and as of today we
have 362 deaths which is up from 305 yesterday and we have 17,000 392
infected which is up from 14,000 556 now this ratio that we're looking at here is
simply the ratio of confirmed deaths to confirm infected of course people are
going to be diagnosed with the infection before they might have a chance of dying
so there's a time lag there so it's not an accurate case fatality or mortality
rate but it is something that we can look at and track the other thing that
you might have noticed on the website that we reference and we'll make a link
to it which is a nice official reporting dashboard from Johns Hopkins is this 487
recovered we'll talk more about that as well what are the criteria for recovered
and we'll talk a little bit about the Lancet article and also some reporting
out of China today so in The Lancet article which will give you a link to
some really good information the incubation period on average for these
41 patients that were admitted to a hospital right there in the middle of
this epidemic was 5.2 days but 95% of all of them had the incubation period
within 13 days and you know that for citizens coming to the United States
from that area they're holding them for at least 14 days to make sure that they
do not have the virus incidentally there was a German plane yesterday that flew
in with German nationals and when they screened them on the plane there was two
people that were positive for coronavirus on that plane so let's look
closer at this Lancet article because I think it's very instructive in terms of
periods of time and looking at things so here we have the infection that starts
and that incubation pair would go right in here so on average would be about you
know five or six days and then the time from symptom onset to admission to the
hospital that's a very key thing there because most patients probably don't
even go to the hospital and they may do just fine but for those
that do go to the hospital it was noted to be about a seven-day period and then
from admission that was a hundred percent of the cohort that was looked at
in the study because they looked at those 41 patients within a day of
admitting to the hospital about 51% of them developed shortness of breath
another day later 27 percent went into a RDS and if you want more information
about a RDS look at our med cram video on this channel titled how coronavirus
kills then another day before they got to the intensive care unit and they're
about 10 percent or four patients require mechanical ventilation so what
was the outcome of this study and I think it was very interesting out of the
41 people at the time of publication of this in The Lancet there were 28 people
that were discharged home there were six people that passed away that's about 15%
and of the 28 that is 68% which leaves seven that were still alive and in the
hospital being treated so the question is is what were the criteria and this
gets back to that number that we see on the site what was the criteria for
allowing these people to go home and this is very important so from my
understanding there are some guidelines now that are being instituted nationally
in China about what constitutes someone that's recovered and at least for this
hospital it was 10 days without a fever it was that the chest x-ray was
improving because all 41 patients had abnormal CT scans chest x-rays this next
one is important it's to be discharged home there had to be no virus detected
in the upper respiratory tract and so that's a pretty high bar and with that
68% of those people that enter the hospital were able to go home and deemed
cured we don't know what happened to the other seven so if we look at just those
that entered into the hospital we're looking at about a 15% mortality rate in
the least and from there it could go up depending
on what those other seven did if one or two of those died then the mortality
rate goes up I stress again this is not the overall mortality rate of the virus
this is the mortality rate for those people that have to go to the hospital
because their symptoms were so severe
okay three other stories I want to talk about real quick there was in the local
Chinese media a story that I picked up and I'll work in the link to that one as
well in the description below a doorknob was found to have the RNA PCR of the
corona virus on it so again this highlights the need for hand hygiene
carrying around alcohol-based hand sanitizers make sure you're washing your
hands the other thing I want to highlight is that there was some local
media in China about a patient being discharged home this is a patient that
was 30 years old he was admitted on the 20th of January and he was being
discharged today on the 3rd of February again I looked very carefully at the
media report of what was the criteria and they did mention that this was the
standard criteria for discharging a patient home in this case the patient
had a normal temperature times 3 days and they were doing PCR to look
specifically for the RNA of this virus and it was negative and they were
checking it at every 24-hour intervals so this patient felt better
the PCR was negative for the virus wasn't shedding it in other words and
it's temperature been normal for 3 days so I think that adds a little bit more
in terms of what that number means on the website people that have recovered
think about this though in terms of a timeline the first thing that's going to
happen is someone's gonna be a confirmed case the second thing that could happen
is they could die and then the third thing that would happen is that they
would recover obviously they're not going to recover after they die but
these things are going to happen in this order so it's gonna take the
longest to have a recovery it's gonna take the shortest to have a confirmed
case and it's gonna take intermediate somewhere between that time to have a
death so look for in the future as we progress
through this epidemic that the number of recoveries is going to surpass the
number of deaths and we hope that that is by a large amount let's talk a little
bit about how it spreads so we all are familiar with the common cold the flu
and the importance for a mask and also the need for eye protection in this case
especially in the healthcare setting what may be something that we may have
underestimated and that is the fecal-oral route and the reason why
that's the case and we'll put a link to this in the description it's because the
man in Washington State they found the corona virus in his stool and why this
is important is because this goes back to 2002 2003 where there was a big
outbreak of SARS in a particular apartment complex in China and it was
because of this toxic viral plume after the man had diarrhea and that
aerosolized the viruses into the air and it went into the other apartments and
that's where the other people picked up the virus and so it is possible that
this fecal-oral route may be a big determining factor
but it highlights that fecal-oral transmission of this virus is
potentially in play and so washing hands is an important thing to understand we
are witnessing and in the middle of a human tragedy that is pretty scary to
say the least there are a lot of people that are suffering but there are some
things that we can do about this we can educate ourselves we can understand the
virus we can make sure that we're doing everything that we can to prevent that
virus from spreading we can make a difference thanks for joining us