welcome to another MedCram lecture we're going to talk about the
coronavirus update and we see here 75,000 total confirmed cases based on
the data from the w8 show and CDC coming out of China total deaths over 2000
total recovered 14,000 772 if we look at the roll domitor as it's correctly
pronounced we can see here there's active inactive cases the closed case is
sixteen thousand eight hundred and fourteen eighty eight percent of those
have been recovered or discharged and 12 percent deaths in the closed cases so
far of course these numbers are been
reported
as most of those cases were mild cases however if we break those cases down
again into the difference between what's going on in China what's going on
outside of China we can get another picture you can see here the trends is
that every day there seems to be more and more new cases whereas inside of
China the number of cases are actually diminishing as we can see here overall
if we go up to total deaths over 2,000 deaths total I want to talk a little bit
about what's going on in terms of what the labs are doing to fight coronavirus
the kovat 19 disease specifically nice interview here on NPR regarding
antibodies first one to talk a little bit about antibodies and how they're
made so you have these b-cells and they each have different receptors on these
b-cells these b-cells are made to do one thing really and that is to make
antibodies and these receptors on the cells are there to receive any type of
antigen that you might come in contact with an antigen could be a protein of a
virus or approaching of a bacteria etc etc and what is really quite amazing is
that you have so many different types of receptors on millions and millions of
b-cells that's just about any kind of foreign protein that gets introduced
into your body will make a b-cell against that and so here we can see that
each b-cell has a different antigen receptor and the antigen receptors of
only one b-cell will combine with that antigen so if you have a virus that
virus is going to stimulate its particular b-cell and it will activate
and it will get help from t-cells cytokines and it will cause this cell to
divide and rapidly enlarge into a huge clonal representation of that b-cell so
you have thousands millions of these b-cells and all these b-cells do is they
produce antibodies and these antibodies go out and attack cells that have the
virus in it or the virus itself and finally when the
action is done then these b-cells just kind of go away but there's always a
certain amount of a population of these b-cells ready to strike again if that
virus comes again and this is typically how it works with a particular virus so
if you get a vaccine against the virus like polio if you get a vaccine against
the virus like the hepatitis B virus that vaccine goes through the same way
here you get an antigen stimulating a b-cell of course when we give a vaccine
in some of the cases we give a vaccine that has just the protein without the
virus so you don't get the actual disease and that causes your b-cells to
make a lot of these antibodies in preparation for if you ever were to be
infected with that virus you'll be ready to make an immune response of course
sometimes what happens is the virus may mutate and so that the proteins are
different enough that the antibodies that you have against those proteins may
not be as effective and this is kind of what happens with colds you might get
multiple colds in a year and it's possibly because while it could be a
different virus a rhinovirus versus a regular corona virus or it could be a
rhinovirus that's mutated enough so that the former immunization that you got
against the virus is no longer effective because it's mutated well going back to
this interview what they're looking at is drugs that will prevent the virus
from replicating but there's an interesting company that they're looking
at called AB cell era which they identify antibodies from patients who
have already recovered from infection because they're finely tuned immune
systems have already figured out a way to clear the virus and so what they can
do is they can look through millions of different immune cells and find the one
that is right for corona virus in fact what they've done and this is kind of
amazing as they've taken mice and instead of making Mouse antibodies these
mice are actually using human immune system cells to make not Mouse
antibodies but to actually make fully human antibodies and that's just amazing
so of course the next step is to inject these corona viruses into these mice and
start getting these antibodies out and actually seeing whether or not they
work testing them in trials and then seeing whether or not this antibody
against the coronavirus specifically the one that makes the kovat 19 disease
otherwise known as SARS of 2 is gonna be effective so this is one of the
treatments that's on the horizon and the reason why this is really important for
us to get as we see here in this USA Today article looking again at that data
from China that we talked about yesterday they're looking at statistics
here and they're saying that the corona virus is 20 times more lethal than the
flu based on the case fatality rates as the death toll as we talked about passes
2000 we can see here that based on the calculations that they were doing the
global death toll from the virus was listed at 2009 as of Tuesday evening and
that the total infections rose to more than 75,000 that if you do the
calculation the overall death rate for the virus was 2.3 percent however the
seasons flu death in the United States was at about 0.1% making this of course
a more deadly than the regular flu but not as deadly as the SARS outbreak back
in 2002 which was at around 10%
unfortunately we have to talk about another physician who's died in China
dr. leo he was the director of Chinese hospital
at the epicenter the corona virus outbreak and was one of the
neurosurgeons as well so these b-cells and how they become plasma cells and how
they secrete immunoglobulins or antibodies it's all very specific and
distinct including how viruses infect the human cells this is something that
would like to go into a little more detail there's been a lot of questions
about immunity and what happens after someone recovers and we've seen some
examples in the United States of people who have recovered specifically the
gentleman in Washington but there's been some questions some rumors and some
claims that people can get the virus twice and that for instance people can
have a lot worse reaction the second time around and that there may not be
immunity I haven't seen any reports of that and so it's very difficult to come
up with an answer to that question I think it might be a little early in the
course to see if that is in fact happening and one thing I will make a
point of however is that oftentimes when someone gets a viral infection their
ability to withstand secondary bacterial infections is reduced and so it's not
uncommon to have secondary bacterial infections when someone has a severe
viral infection and so I want to end this update with an excellent article
that was published on the 12th of February 20 20 on the practical
recommendations for critical care and anesthesia teams caring for novel
coronavirus patients and I will put a link in the
description below this article that is written in Canada talks about their
experience with the SARS virus back in 2002 and it talks about very practical
things to do for instance in the intensive care
you know what kind of personal protective equipment to be wearing how
the flow of air in these rooms whether or not they're negative or positive
pressure rooms are very important for instance if you are doing generally
speaking an operation that's in an operating room in that room is run under
positive pressure ventilation something that of course you would never want to
have happen if you're doing an operation on somebody with this kind of virus and
so they talked about switching those kind of patients into negative pressure
rooms to do the operations so that you don't infect other people in the
hospital and so I think it's an excellent read for physicians health
care providers who are going to be taking care of these coronavirus or
kovat 19 patients it also talks about when to use and 95 masks versus these
powered air purifying respirators otherwise known as poppers and who
should be wearing them and talking about for instance hot zones warm zones and
cold zones hot zones being in the patient's rooms specifically where
there's negative pressure ventilation warm zones when you're outside the
patient's room but still in the intensive care unit and then finally
cold zones when you're outside of the intensive care unit so I think this is
really important information and again we will put a link to it in the
description below thanks for joining us