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  • welcome to another MedCram COVID-19 update and I have been off for a few

  • days from the updating because it was my turn to take the helm of the ICU what

  • we're gonna be talking about is number one five new deaths in Washington State

  • yesterday we are definitely in the growth phase here in the United States

  • but we can't tell how much of a growth phase there is because we're gonna talk

  • about testing and the lack of testing and we're also going to talk about

  • preparation what to do before this hits now we'll talk about mutations we are at

  • a total confirmed worldwide cases here upwards of 90,000 total deaths is over

  • 3,000 total recovered is well over 10 times that at 47,000 and those are the

  • published numbers I've heard a number of people talk about the numbers in Asia

  • and the model to look at in some people's opinion is going to be South

  • Korea because it is a country that's doing very aggressive testing and it's

  • an open and democratic country but I think the biggest thing there is the

  • fact that they are aggressively testing and that's not something that we're

  • doing yet here in the United States for a number of reasons which we'll talk

  • about going over to the world ometer website we look at the close cases to

  • kind of get an idea of where we're going on the mortality because these are close

  • cases you've either recovered or you haven't and if you look at this graph

  • you can see that the mortality rate continues to drop these are people that

  • were tested and we're already at about 6% that's good to go much lower than

  • that once we get the full scope of the infection here we have total cases

  • worldwide things were starting to level off here and I think the reason why

  • we're starting to accelerate again is because we're going into the epidemic

  • phase in a number of these other countries and looking at latest updates

  • for today March 3rd maybe a little bit behind because this is a fluid situation

  • by the time this gets published there are 477 new cases and six deaths

  • already today in South Korea of course South Korea being in the part of the

  • world that is the farthest ahead in time

  • if we look at yesterday we have the first case in Morocco this was somebody

  • from Italy yesterday 21 new cases and five new deaths here in the United

  • States and looking to Washington's going to be very important to see what's going

  • to work in this country and what's not going to work

  • notice that a lot of these people who are dying are in their 70s however there

  • is a man in his 40s hospitalized in critical condition in Kirkland one in

  • Rhode Island and that was a teenager contact of the previous case and all of

  • these people again went to the same trip to Italy they're saying here this is

  • precisely why we are being so aggressive in identifying contacts and testing

  • people who are symptomatic there are three people in California and Santa

  • Clara County including a couple whose recently traveled to Egypt and there are

  • now two in Oregon one an adult in a County Hospital in Walla Walla

  • Washington and the other is a contact of the first case in Oregon who is

  • recovering at home there's two new cases in Florida and that is the first one in

  • New York interesting interview on CNBC that's also here on the ward ometer

  • website dr. Mack McCarthy who is a ER physician at New York Presbyterian he

  • says I'm here to tell you right now at one of the busiest hospitals in the

  • country I don't have at my fingertips a rapid diagnostic test I still have to

  • make my case plead to test people this is not good we know that there are 88

  • cases the United States they're going to be hundreds by the middle of the week

  • they're going to be thousands by next week and this is a testing issue quote

  • in New York State the person who tested positive is only the 32nd test we've

  • done in this state that is a national scandal

  • they're testing 10,000 a day in some countries and we can't get this off the

  • ground McCarthy said I'm a practitioner on the firing line and I don't have the

  • tools to properly care for patients today and I can tell you I resonate with

  • that as a health care work I was in the ICU all last week seeing patients in the

  • emergency room we are taking protective measures to make sure that we don't get

  • exposed to people coming in to the hospital with kovat 19 causing a lot of

  • our health care workers to be quarantined and so it's really important

  • that if anybody goes to the emergency room to call ahead make sure that

  • they're following instructions make sure that they're wearing a mask especially

  • if they have a fever and they have symptoms because anybody that they in

  • fact no matter who they are will have to be quarantined and of course if those

  • people that are being quarantined are health care providers well that's just

  • less people to be able to care for other people that need it now the good news

  • there is that as I understand it there are going to be a lot more tests

  • available but they're not going to be available until later this week there

  • are regulations that the FDA imposes on commercial manufacturers of these tests

  • they have to reach certain goals and it's a long and laborious procedure to

  • get these things approved by the FDA those are being relaxed so we can get

  • enough tests on a market and get labs up and running what you ideally want to do

  • and this goes back to the days of medical school when he were trained in

  • surgery it was always a good thing if you took somebody occasionally to

  • surgery for appendicitis and you pulled out a completely normal appendix that

  • means that you were not missing any that means you work finding negative test

  • results true negatives so you actually need to screen widely enough so that you

  • know you're getting enough negative testing what you don't want to be doing

  • is testing so limited that the number of tests that you're getting you're not

  • catching the full magnitude of the infection and so I think everyone

  • believes and everyone's on the same page here that the amount of testing that

  • needs to be done right now in this country needs to be ratcheted up by

  • orders of magnitude over what we're getting right now here's a story that

  • was published in the AP couple of days ago and it talks about what's going on

  • especially up in Washington where the hot spots are says here as Americans

  • prepared researchers at the Fred Hutchinson Cancer Research Center and

  • the University of Washington on Sunday said that they had evidence the virus

  • may have been circulating in the state for up to six weeks undetected a finding

  • that if true could mean hundreds of undiagnosed cases in the area they

  • posted their research online but it was not published in a scientific journal or

  • reviewed by other scientists trevor bedford and associate professor who

  • announced the findings on the virus in Washington

  • State said on Twitter late Saturday that genetic similarities between the states

  • first case On January 20th and a case announced Friday indicated at the newer

  • case may have descended from the earlier one now this is gonna be something that

  • we're going to talk about when we talk about molecular biology is this idea

  • about descendants so the thing that you've got to understand is that the

  • virus when it infects your cell it takes over the cells machinery to create more

  • viruses but the genes that the virus brings in the kind of sloppy and so

  • because of that sloppiness there's a lot of mutations that are made and some of

  • those mutations may actually end up changing amino acids some of those

  • mutations won't translate into difference in amino acids but you can

  • still see those mutations and as you track those mutations in time you can

  • see which virus strain descended from another now those mutations can occur

  • randomly anywhere along the genetic thread the RNA as it turns out in this

  • case with corona virus but if those mutations affect a key component for

  • instance the binding protein or the spike protein on the corona virus that

  • allows it to infect human cells well that virus is just not going to be

  • able to infect the next human cell but because there's millions and millions

  • that are made there's always another one right behind it that's going to happen

  • the bottom line is you rarely are going to see viruses copies of the virus

  • infecting human cells that have a mutation that is critical in the binding

  • of that protein and therefore the binding of that site now in this case

  • the binding site in the human being is the ACE 2 receptor in the cells in the

  • bronchi or the lining of the lungs so that's a highly conserved area why is

  • that it's highly conserved because those are the only viruses that are going to

  • infect the human being but if you look at these just like the human race has

  • different families different last names because they're related to each other

  • different coronaviruses different SARS come to different kovat 19 viruses in

  • other words if you were to look at the ones in wuhan versus the ones in

  • Washington they are not identical to each other they have mutated in some way

  • and what you can do is actually come up with

  • family tree and you can see where these things came from they say I believe

  • we're facing an already substantial outbreak in Washington State that was

  • not detected until now due to narrow case definition requiring direct travel

  • to China scientists not affiliated with the research said the results did not

  • necessarily surprise them and pointed out that for many people especially the

  • younger healthier ones the symptoms are not much worse than the flu or a bad

  • colds he says we think that this has been a pretty high rate of mild symptoms

  • and can be asymptomatic the symptoms are pretty nonspecific and testing criteria

  • that has been pretty strict and this is really the key here up to this point you

  • could not get testing unless you had traveled to that specific portion of

  • China where the virus was so these combinations of factors means that it

  • easily could have been circulating for a bit without knowing suggestin less ler

  • so people are saying that this is high quality work so what I want to do is

  • talk a little bit more about what is going on with this mutation and I want

  • to introduce you to a really cool site and that website is called neck strain

  • and this actually does real-time tracking of pathogen evolution if we

  • click on the latest data and analysis here what we've got here is the SARS

  • cuff to genome and I think this is really cool what you can see here we

  • have the initial strain over here and we can see how through time the DIF

  • mutations have occurred in a different family trees so if we play this you can

  • see that things started out here in Wuhan but as things have spread across

  • the world there's been mutations and we can see what the descendants are as we

  • track it so interestingly the one here in California it shows that there are

  • nucleotide mutations from the original there are amino acid mutations in the

  • ORF 1a gene we'll talk more about that that is the gene in the virus that codes

  • for the protein that allows it to reproduce the RNA genome of the virus

  • and if we look down here we can actually see the genome of the virus

  • is the entire RNA of the corona virus specifically that we're talking about

  • here the ORF 1 aging and the ORF 1b gene for those of you who are molecular

  • biology buffs there's actually a overlap in that gene right here that requires a

  • frame shift on the ribosome to be able to translate both of these and we'll

  • talk more about that in the coming sessions and updates what this here

  • represents is where these mutations in the genome are occurring we see that

  • there's a lot of mutations occurring down here in these small genes and not

  • so much here this s gene right here it codes for the S protein we can see that

  • there are some mutations some of these mutations may not be actually changing

  • amino acids however this s protein is the spike

  • protein on the very outside of the cell this is the protein that is going to be

  • binding to the ACE 2 protein on the human lung cells that allows it to bind

  • and infect them abstence ibly this is the<