welcome to another MedCram lecture update from the road I'm currently at a
medical conference in Hawaii but will continue to try to do these updates as
they come up if we go to the world of metre website we can see that they've
breaking down the cases now into active cases versus closed cases and you can
see that they are still increasing these numbers are printer represented
we'll get into more of that later then we come to the graph of looking at the
total cases outside of China and those are still continuing to grow although it
doesn't appear as though it's logarithmic in nature we switch over to
logarithmic we can see that it's less than linear if we look at daily cases
excluding mainland China it seems to be more sporadic with some days with up to
79
and the most recent at 22 and if we look at these total death cases here going
from the beginning of the year until mid-february it's quite obvious they're
still continuing to grow what's unique about this virus is that it has infected
not just another mammalian species specifically humans but as infected a
species that can think act and retaliate against this virus and that's where we
come to today and some of you have asked us to talk about some of the medications
that are being developed there's a nice article in nature that was published
just a few days ago there's more than 80 clinical trials currently launching to
test chrony virus treatments and the big thrust of this article is that there's
so many trials going on in China looking at every single thing that you could
possibly imagine see if it's going to work
that there's no standardization what exactly is a recovery what is the
definition of a recovery and if things are not being blinded but things are
being looked at is their nefarious work they're either intentionally or
unintentionally so we'll put a link to this article in the description below
but it talks about exactly what the w-h-o is doing to try to standardize
these trials to make sure that they can be compared amongst each other and that
the outcomes are true in nature and not just to push medications or favorite
drugs onto this coronavirus there are a lot of medications and drugs for
instance chloroquine phosphate which has shown in vitro to have some pretty
promising effects against the corona virus it inhibits coronaviruses growth
and currently this is being tested in about ten hospitals and a hundred
patients another drug that's being looked at is a VIP Rovere which is being
looked at in a clinical trial of about 70 patients and of course the other one
REM des aver and that is currently being looked at in ten hospitals in Wuhan of
course this one was developed for Ebola and worked in vitro but it doesn't seem
to be working in vivo for Ebola but it's being used as a potential source of a
medication to be used against this corona virus another
that they're looking at is something called convalescent plasma this is
basically the plasma of patients who had recovery from this corona virus so
presumably there are antibodies that have already been developed against the
virus and if you take this plasma from these donors and put it into patients
who have severe infections of the corona virus
which all brings us to the big question to really do the right research on this
there has to be blind placebo randomized controlled trials the question that I
have and a lot of people have is if people are saying already that things
are looking promising that things are getting better
are they really conducting the right kind of studies which leads me to the
next thing I want to talk about that's what I do
I'm not a epidemiologist I'm not an administrator I don't work for the WHL
I'm just a pulmonary critical care doctor takes care of patients so when
patients are coming into the intensive care unit and they're crashing I'm the
one that puts a central line in I'm the one who puts the arterial line in we
intubate the patient we do the bronchoscopy so this virus has been a
real interest for me so my full-time job is taking care of patients and wanted to
show you what's been going on at least what I've noticed in my practice in
Southern California in the last month or so I've seen personally at least three
or four cases of influenza A let's come in and these patients have not done well
recently had a young person come in who went from just having reports of the flu
to having severe pneumonia requiring intubation within about two to three
days and she went on to actually require ECMO or ECMO which is where they do
heart-lung bypass and what you're looking at here is a graph of the
influenza positive tests by the CDC and you can see the vast majority of these
cases are h1n1 from 2009 which was a very bad year we're noticing that these
patients have particularly bad cardiac reactions to influenza I've seen a
patient code and go a systolic after being intubated I had another one
who had ST segment elevation from a biomarker Dittus the bottom line being
is that this strain h1n1 is covered in the annual vaccine that's been covered
since 2009 and so because I'm seeing such a huge amount of this this is kind
of a call-out to those who are susceptible it's not too late as you can
see here the flu season still has some weeks to burn through here to get
vaccinated against this potentially deadly strain of the influence
a and for those of you who are interested in our previous discussions
where we talked about sleep boosting your immune system please refer to our
previous lectures and also to med cram comm where we have numerous lectures on
sleep insomnia sleep apnea and other diseases that could be helpful in
understanding thank you for joining us