Welcome to another MedCram COVID-19 update.
In the United States, daily new cases are leveling off. But actually in places like
California, it is actually decreasing, whereas
in Wisconsin, it seems to be taking off. Of course the big news is that in
Europe, cases are accelerating. Here is the graph
for the United Kingdom, almost reaching the same levels
as they did at the beginning in March and April.
In France, they're easily surpassing the limits that they set back in March and
April. Similarly, Spain also saw a big increase,
but is now tapering off, whereas with Italy we're not seeing the
huge increase in some of the other countries of Europe,
but nevertheless also an increase. And so as a result of this we're seeing
that the government in Great Britain is making some rules that will be
closing down pubs and restaurants to have 10 p.m.
closing times. The BBC is reporting that the UK's COVID-19
alert was moved up to level four, which
is the second highest level and basically means that the
transmission is high or rising exponentially,
and the prime minister is expected to stress the need for people to follow
social distancing, wearing face coverings, and washing their
hands regularly, and government forecasts warned that
there could be 50,000 new coronavirus cases
a day by mid-October. That's in just about a month
if no further action was taken and it's related to
exponential growth. To really understand exponential growth, you actually have to
think about it in a different way and this is a great website,
moderndollar.com, and it really raises the understanding about what exponential
growth is and why this virus is so dangerous if left to multiply.
So the question is: would you rather have a penny
every day that doubles for 30 days for a full month (so in other words the first
day you get a penny, the second day you get
two pennies, the third day you get four pennies and
then eight pennies, etc. for a month,
and whatever you have at the end of that month is what you get), or
would you rather have a million dollars? Well what this website shows is
that a penny doubled for 30 days, which is actually going to be close to
11 million dollars on that last day. But the point that I
want to make is that most of that growth happens at the end
of those 30 days. In fact you could go more
than halfway into that month and still say,
"wow I should have taken the million dollars," and that's exactly what
people may think now is, we don't see this virus very
often. Problem is, if you wait this could be very hard to contain
at the end, and this is the issue with exponential growth. Our minds are
not designed to think in terms of exponential growth.
The way that we supply hospitals is in a linear fashion
not an exponential fashion, and so when you understand the power of exponents
and how fast a virus can spread, that's when you start to be cognizant of
why it is that if you start to see something growing,
it's going to grow very, very slowly at first and then toward the end
it's going to grow extremely rapidly. Again notice where we start to see and
detect this massive amount of income here
towards the end of the month, but it started way back here, and that's
why for some of us it's not hard to believe
that the virus may have been around for months prior to
detection, because it's growing so slowly at these
low levels, so currently Europe is in the throes
in terms of increased viral replication among its population
and we can speculate as to why that is kids going back to school,
bars and restaurants opening late, people not wearing masks.
The bottom line is the current situation is not sustainable,
and that's why governments in Europe are feeling like they need to do something
to curb the curve, and that's something that a
collective population has to do. The question is
is what can an individual do to prevent themselves from getting the SARS-CoV-2
virus and what is the data that supports it?
Those that have followed our updates will know that we've
stressed the importance of sleep and stress reduction. Now we don't
have data yet specifically for these things
in COVID-19, but we do have data really good data
that shows that it works in other diseases. Now it's interesting that
Dr. Fauci in an interview with Jennifer Garner agreed with some of
these things. For instance, he himself takes vitamin C and vitamin D,
he recommends getting a good night's sleep and
stress reduction, and if you want to see this interview we'll leave the
link in the description below so for you MedCram listeners a lot of this
is not news. It's good to know that the leaders of our country are
coming around to the idea that there are things that we can do
to help our immune system deal better with
COVID-19. but the question is begged: yes, these are things that we can do
to enhance our immune system, but is there behavior that we are
engaging in that is unnecessarily exposing us
to the virus? And if there is, what are the risks
of that behavior? And what are the particular behaviors that we can avoid,
so that we reduce our chances of being exposed to
the virus? Well this is a great report here that we'll link to
and it is put out by the CDC. It's titled "Community and Close Contact Exposures
Associated with COVID-19 Among Symptomatic Adults Greater Than 18 years
of Age in 11 Outpatient Health Care Facilities."
Now the first thing you've got to understand is that this is not a
randomized placebo-controlled trial; this is a case control
trial, and so there are areas here where you can get confounders,
where, basically, association does not mean causation, so we can't say that this
causes it, but we can say that this type of
behavior is associated with a positive test. So here we have in
the left-hand column the case patients. These are people that
came in with symptoms and tested positive
for SARS-CoV-2 virus. The positives are the
case patients and the negatives are the control
participants and you can see here that those n numbers are about the same
now. Where they are statistically different, we get p-values
of less than 0.08, and so what they're saying here is that
age probably doesn't make a huge difference
in terms of who gets it. Certainly men versus women, no statistical significant
difference, and you can see here as this goes down
the line now, they do the evaluations of all of this, and what
they do is they graph it out quite nicely here
in terms of the adjusted odds ratio and the 95 confidence intervals for
community exposures, which were associated with confirmed
COVID-19 among symptomatic adults age greater than 18. So for those of you who
are not statisticians, what we're looking for
is in each one of these the dot is basically the average or the mean and
these brackets show in 95 percent confidence where the
actual value would lie, and if you want to see something that is
truly associated with the disease, you want the brackets to be on the right
side of this dotted line. This dotted line is an odds ratio of one.
So something has an adjusted odds ratio of
one that means there is no difference. So clearly here there is this one here
makes the cut because there is an average and the brackets are
fully on the right side of this line, so going to a restaurant in other words
is statistically significantly associated
with getting a positive COVID-19 test. Now we can't say strictly that going to
the restaurant caused the COVID-19 test, but it's certainly possible that this
could be there. Why because this is one of the indoor
places where people generally are not wearing a mask, because
that's the only way they can eat or drink
whatever it is that they're going to the restaurant for.
Now, one weakness of this study was is that they didn't check if the patients or the
subjects were dining outside or inside. As you can see here
the office setting was not associated, going to a salon was not
associated, could very well be because you can wear a mask in this setting.
A home with greater than 10 persons not associated with it,
going to a gym, you can see there was a wide range, but because
that 95 confidence interval is on the other side of the unity
of one, we can't necessarily say that it is statistically significant,
public transportation as well straddles that
one dashed line, going to a bar or a coffee shop here in the light blue
or the purple, it is statistically significant, however in the dark blue, it
doesn't mean statistically significant and so we can say the blue is the
adjusted odds ratio, but the light blue is the adjusted odds ratio among the
subset with no close COVID-19 contacts, so
among those people who have no close COVID-19 contacts,
going to a bar or a coffee shop was statistically significantly associated
with getting a positive COVID-19 test. Here with a church or religious
gathering, again it's very broad and wide, but it is not statistically significant,
because it does cross the line of unity,
so this caused the authors to conclude that in this investigation,
participants with and without COVID-19 reported
generally similar community exposures except for those two that we saw those
going to locations with on-site eating and drinking options
it goes on to say that adults with confirmed COVID-19
were approximately twice as likely as were control patients
to have reported dining at a restaurant in the 14 days before becoming ill.
Now there's a lot that we don't know about indoor spread,
but there's this interesting article here, that has not yet been published but
is part of the medical archive, that shows that when they looked at
contact tracing in Japan, they were able to see that the
number of secondary cases, those that were
generated by each primary case, when they looked at
the odds ratio it showed that those primary cases that
transmitted COVID-19 in an enclosed environment
was 18.7 times greater compared to an open air environment.
Another way of saying that is if you look at this contact tracing that
the chances of picking up COVID-19 was almost 19 times less
outside a closed environment so we try to support our local restaurants
especially if they have a place to eat outside and I can tell
you living in southern California, that's almost exclusively
where you have to go to eat. We can do all the things that we can to enhance
our immunity, but we can also try to find the riskiest
behaviors and refrain from those type of behaviors. I think
we're going to have a lot more to say about this in terms of where this
pandemic is headed to, especially in Europe at this point.
Look for more updates here from MedCram, and don't forget to see
all of our MedCram videos at our website MedCram.com.
We'll see you next time!