Name: Coronavirus Epidemic Update 28: Practical Prevention Strategies, Patient Age vs. Case Fatality Rate
Uploaded: 2020-03-06T03:17:25.000Z
Duration: 16 min 48 s
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welcome to another MedCram COVID-19 update we're gonna talk today again

Adverbs of manner

about the numbers about the epidemiology we're actually going to talk about the

case fatality rate and the age specifically a lot of you have asked

about how age affects that we're also going to talk about testing there's been

some interest in how we test for SARS cuff too and in light of what we talked

about last update which is what the sensitivity and specificity were we

talked about how the sensitivity of the kits that have been made public and

available in certain situations is not the best we're also gonna talk about

healthcare workers and this all sort of ties in together

here is the Johns Hopkins dashboard total confirmed eighty three thousand

three hundred and eighty-nine total deaths twenty eight hundred fifty eight

total recovered is thirty six thousand five hundred and sixty three these are

the numbers that are being put out to by the various organizations moving over to

the world ometer coronavirus cases and if we exclude the Chinese numbers we can

see here that we are definitely in an epidemic phase outside of China and if

we look at the pie chart we can see here that that slice of the pie is definitely

growing and I think you can expect that that is going to grow even more here in

the next number of weeks if we look at the number of cases outside of mainland

China a huge swath of that is from the Diamond Princess in terms of new cases

the fastest-growing one is South Korea in fact for the first time there's more

cases coming out of South Korea and there is coming out of China also here

we have our outcome of cases and you can see that the death rates as more and

more of these undetermined cases go to the side of recovery that death rate is

falling that is not a case fatality rate we're going to talk about that here in

just the bits again looking at the latest updates one new case in Canada

this used to be a very small section here where you could

look at multiple dates and now things have just taken off in different places

North America here on February 27th new case in Ontario the husband of the

previously confirmed case in Toronto we've got Europe in the Middle East and

you can see here all of the different cases 20 new cases in France for

instance five new cases in Sweden 14 new cases in Germany Italy has now actually

relaxed its testing criteria recent travelers to outbreak areas will not be

tested anymore unless they show symptoms and that may be because they may be low

on testing that's just speculation not exactly sure if that is the case we've

got two new cases in the UK four new cases in Switzerland in Asia the number

of new cases in South Korea has actually topped to China for the first time this

is the article entitled coronavirus fatality rates vary widely depending on

age gender and medical history some patients fare much worse than others

this is in a jam a review article where they actually looked at 72,000 copa 19

cases and there was a dramatic shift we'll put the link to this article in

the description let's go right to the actual article characteristics of an

important lessons from the corona virus disease 2019 outbreak in China this is

seventy two thousand three hundred and fourteen cases pretty big numbers

realizing of course this doesn't capture the entire picture but it's a good peek

at what it is that's going on let's just jump to the box findings I like JAMA

that they box these findings for you very concisely so out of seventy two

thousand three hundred fourteen cases confirmed cases were forty four thousand

suspect the cases sixteen thousand diagnosed cases ten thousand

asymptomatic less than a thousand here's the age distribution of actual

infections in this study and you can see the vast majority of infections occurred

in people thirty to seventy nine years of age that may be because most of these

people were out and about but you can see here that as you get younger ten to

nineteen less than ten there was a reduced population what about the

spectrum of disease overall eighty one percent of these cases were mild

fourteen percent were severe and five percent were critical

the thing that everyone's looking for is the case fatality rate so overall all of

those cases had a case fatality rate of 2.3 percent but how did that get

distributed you can see that one of the highest age-related case fatality rates

was in people aged 80 years and over and that was fourteen point eight well if

you're in the decade before that seventy to seventy nine eight point zero percent

you can see that it came down dramatically

what about those who were less than nine if you were to go down into the body of

the paper there were no deaths in anybody nine years of age or younger and

if you did have a critical case your chances of making it were about fifty

percent so what about all those people that are 30 to 80 years of age well if

you actually calculate the numbers you get approximately a one point two

percent case fatality rate let's look at healthcare personnel that were infected

of the forty four thousand that were confirmed 3.8 percent of them were

healthcare personnel and sixty three percent of those were in wuhan in total

there were only five deaths in this group and they also tell you about how

they determine which ones were mild and which ones were severe etc mild was

determined as non pneumonia or mild pneumonia

however fourteen percent were severe well what is severe these are people

that had shortness of breath a respiratory frequency rate of greater

than thirty per minutes a blood oxygen saturation that was less than 93% or a

partial pressure of oxygen fraction to the oxygen ratio of less than 300 what

is this less than 300 mean it's a determinant of how much oxygen they have

to give you to keep your oxygen levels up the more oxygen that they have to

give you to keep your oxygen levels up the lower this number goes so you want

to have a high number this is called a PF ratio a lung infiltrates that is more

than 50% within 24 to 48 hours and 5% were critical respiratory failure

they're on ventilators they're in septic shock or they have multiple organ

failure no deaths were reported among mild and severe cases however among

critical cases the case fatality rate was the flip of a coin those with

pre-existing comorbid ditions 10.5% for cardiovascular disease

7.3 percent for diabetes six point three percent for chronic respiratory disease

six percent for hypertension five point six percent for cancer and among the

forty four thousand cases a total of one thousand seven hundred and sixteen where

health care workers or about three point eight percent a lot of whom were in

wuhan here is a key point kovat nineteen rapidly spread from a single city to the

entire country in just 30 days the sheer speed of both the geographical

expansion and the sudden increase in numbers of cases surprised and quickly

overwhelmed health and public health services in China particularly in Wuhan

City and Hebei province epidemic curves reflect what may be a mixed outbreak

pattern with early cases suggestive of a continuous common source potentially

zoonotic spillover at the Hunan seafood wholesale market and later cases

suggestive of a propagated source as the virus began to be transmitted from

person to person and here we have this graph this is a great graph we see going

along here rather undetected and then all of a sudden we see this huge

increase depending on whether or not you're looking at the date of onset of