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  • welcome to another MedCram coronavirus update so I wanted to go over the recent

  • numbers and total deaths is 910 that means that it surpassed SARS total

  • recovered is a good three and a half times now the total number of deaths

  • about a week ago they were substantially below the total number of deaths so

  • we're seeing an improvement here in the total number of recovered now these

  • numbers are provided to us from the w-h-o the CDC and a number of other

  • agencies recently here there's been some news that China seems as though but that

  • w-h-o is now being allowed to go in and that team is being headed up by dr.

  • Bruce I'll would according to the New York Times article if we look here the

  • others that they have listed here is actually on the cruise ship

  • just south of Tokyo you can see that they're wanted to talk about a recent

  • article that was just published in JAMA the Journal of the American Medical

  • Association on February 7th and we will put a link in the description below that

  • links to the article I think is an excellent article and basically it's a

  • description of 138 patients that were admitted to a university hospital in

  • Wuhan and describes exactly what happened to them this is an article that

  • looked at patients that were admitted from the first of January until the 28th

  • of January and at this hospital there was a total of 138 patients how do they

  • diagnose these all of these were positive for coronavirus but they did

  • not look at serum viral titers or serum viral load they looked at sputum so

  • that's one of the weaknesses of the study the other thing I want to mention

  • here is these are 138 patients that were sick enough to come to the hospital

  • that's really important to understand because this is going to give you a

  • limited look at what happens to patients who are sick enough to come to the

  • hospital and seek medical attention so what they noticed in the article is that

  • first of all the patient has symptoms then they typically developed shortness

  • of breath then they became admitted to the hospital

  • then after they admitted to the hospital one of two things happened either they

  • were admitted to the intensive care unit or they were admitted to the regular

  • floor and then we'll talk about where it goes from there now in terms of timing

  • that's important to get to as well from the time of symptoms to the time of

  • shortness of breath was about five days according to their survey and then from

  • shortness of breath to admission here at the 138th was two days on average and

  • then from admission to intensive care if they were gonna go to the intensive care

  • was one day so let's talk about what those symptoms were so first of all the

  • average age of patients admitted into the study was 56 years old and unlike

  • previous reports that showed a real high predilection to men only 54% of these

  • patients were male when I say only it looked more like a 50/50 kind of mix as

  • opposed to 60 or 70 that had been shown before so what were the symptoms fever

  • was seen in ninety eight point six percent of the patients kind of an

  • ironic figure given that 98.6 degrees Fahrenheit is the average temperature

  • for a human being a fever is defined by the way as a temperature of greater than

  • 100 point four Fahrenheit or 38.0 degrees centigrade fatigue was seen in

  • about 70% of patients cough was seen in 59 percent of patients low lymphocytes

  • what we call lymphopenia a common sign that you can see in viral infections

  • that was seen in as high as 70 percent of patients a prothrombin time PT that's

  • of a measure of the Bloods ability to coagulate when you have a high PT that

  • means that your blood is a little bit more thin and that was seen in about 58

  • percent of patients an elevated lactate dehydrogenase which is another lab value

  • typically seen in viral infections that was seen in about 40 percent now when

  • they looked at CT scans a hundred percent of those patients have what they

  • call ground-glass opacities that's inflammation in the lungs and that's

  • consistent with what we see in a viral pneumonia of any type so

  • in other words what we're seeing here is not very specific for coronavirus but

  • could in fact be seen in a flu could be seen in other types of viruses that

  • could do this one of the things though that they saw is that there was a

  • substantial amount that had just nausea and vomiting and that was kind of

  • unusual it wasn't as high as eighty to ninety percent but it was there in terms

  • of treatment for these patients almost all of them receive a settlement which

  • is the flu medication also antibiotics were used on the majority and in about

  • forty five percent of patients steroids were used they weren't really able to

  • tell whether or not any of this stuff had a benefit to the patient

  • of course this study was not designed to look at that so let's look at the 138th

  • patients that came in the first thing I'm gonna mention to you and we're gonna

  • talk about this at the end I think this is probably the biggest thrust and the

  • biggest surprise out of this paper was that 41 percent of these patients or a

  • total of 57 patients were patients that did not come to the hospital with the

  • corona virus but in fact picked it up there we call that a nosocomial

  • infection so yes there were patients at the hospital that were there for a

  • completely different reason and they developed corona virus at the hospital

  • and there were health care workers that went to work without corona virus and

  • picked it up taking care of patients at the hospital what percent of the

  • patients in the hospital that were treated for corona virus had that a

  • substantial amount 41 percent we'll talk about that at the end of this

  • presentation so of these 138 patients regardless of whether or not they came

  • to the hospital with it or not or developed it there what happened to them

  • so of 138 and on average after about one day there was a decision to have them

  • move to the intensive care unit about 36 patients or 26 percent of the 138 went

  • to the intensive care unit and 74 percent were stable enough to be

  • admitted to the regular floor so let's focus our time a little bit on what

  • happened to the patients in the intensive care unit so why did they have

  • to go to the intensive care unit well there's many reasons why somebody could

  • go to the intensive care unit for instance they could go into a RDS they

  • could have a serious arrhythmias or they could go into shock sometimes

  • you can have more than one of these things so don't expect all of these

  • things to add up but if you look at of the hundred and thirty-eight how many of

  • them had a RDS 16 percent of patients admitted to the hospital had to go to

  • the intensive care units for a RDS reasons of the people who are admitted

  • twelve percent of the hundred and thirty eight had arrhythmias and eight percent

  • of people admitted to the hospital had to go to the intensive care unit because

  • of shock now if you want more information on a RDS please look at our

  • a RDS video how coronavirus kills and that describes what a RDS is in detail

  • and what are the treatments that the intensive care unit can use to treat

  • these kind of things now of those that went to the intensive care unit

  • what kind of oxygen supplementation did they need there's three basic types of

  • oxygen supplementation that you'll see in the intensive care unit one is known

  • as high flow oxygen the other is non-invasive positive pressure

  • ventilation this is kind of like CPAP but it's actually called BiPAP because

  • the ventilator helps you when you take a breath in so it gives you a higher

  • pressure when you're breathing in and it'll lower pressure when you're

  • breathing out we call that non-invasive positive pressure ventilation and then

  • of course full out ventilators so of those people that went to the intensive

  • care units how many have to go on high-flow 11 percent how many had to go

  • on non-invasive positive pressure ventilation basically wearing a tight

  • mask 42 percent and how many actually had to go on the ventilator up to almost

  • half the patients 47 percent and of those people four patients had to go on

  • ECMO ECMO is basically where you bypass the heart and lung on a machine to

  • oxygenate the patient until their lungs get uninflated are recover from the

  • infection so overall here you can see that these patients which were fully in

  • the phase of the viral infection where patients were coming to the hospital

  • they were very sick we can see here that of the hundred and thirty-eight a

  • quarter of these patients more than a quarter are going to the intensive care

  • unit meaning that this cohort looked to be a little bit sicker than previous

  • descriptions again I caution you to understand that this 26%

  • not 26% of all people who get coronavirus infection but rather 26% of

  • people who get corona virus infection and then develop symptoms severe enough

  • to have to have them go into the hospital so let's talk about what's

  • happened to these patients so the last update as of February 3rd 2020 let's get

  • an update of all of these 138 patients 47 patients have been discharged home

  • there have been six patients that have died and the remaining 85 patients are

  • still in the hospital so the six that have died out of the 138

  • leaves us with a mortality of about 4.3 percent that's the base of the mortality

  • based on the hospitalization because we don't yet know what's going to happen to

  • these 85 patients let's talk a little bit about what happened to these people

  • in the ICU specifically so there was 36 people that went into the intensive care

  • unit what's happened to them since they were admitted to the hospital well of

  • those 36 patients we know based on the report that 11 still remain in the

  • intensive care unit that nine have been actually discharged home that 10 have

  • gotten well enough to be transferred to the floor and that of all of the six

  • that died all of them were in the intensive care unit so you can see here

  • that of the 36 that initially came in 19 of them have improved to the point where

  • they are either gone home or on the regular floor and 11 still remain and

  • we're gonna see where that goes okay let's talk about 57 patients of the 143

  • or 41 percent of them develop the infection in the hospital of those 57 17

  • of them were actual patients that were in the hospital for another reason but a

  • full 40 of these were healthcare workers let's go back to these 17 patients that

  • were there they said that seven of them were on the surgical ward and that five

  • of them were on the internal medicine ward and that five of them were on the

  • oncology ward now of these 40 patients that were actually healthcare workers

  • there at the hospital 31 of them or 78% were working on the wards seven of them

  • or 18% were in the emergency room and two or 5% were working in the intensive

  • care units they talked in the paper about one patient who presented with

  • nausea and vomiting which we said was kind of atypical and he was admitted to

  • the surgical ward well he had coronavirus and they believe based on

  • history and based on deductive reasoning that about 10 people were infected

  • because of his symptoms and his virus so what this paper highlights I think is

  • the transmissibility of this virus and what we really need to highlight here is

  • hand-washing and the key here is that you've got to wash for 20 seconds and as

  • we've said before that's like singing happy birthday twice wash your hands

  • with soap and you need to do this before of course before you go into patient's

  • room before you put on gloves before you dawn a gown and you need to do it after

  • and why is that because you're using your hands to take off your personal

  • protective equipment that would have the virus on there and really avoid touching

  • your face with your hands now what about masks well if you are suspicious that

  • the person that you are about to examine has the corona virus and your healthcare

  • worker they're recommending n95 masks if you suspect that the patient is the one

  • that has the virus then they ought to be wearing a regular surgical mask in

  • addition to n95 masks so this is for the patient and this is for you as a

  • healthcare worker you should also be doing eyewear protection and you can see

  • what the workers over in China are now currently wearing they got the message

  • they understand what it is that's going on and they're going to make sure that

  • that doesn't happen again and what this article I think really shows is the

  • delicate balance that you have to strike when you have patient

  • with a virus coming into a setting where there are other patients that don't have

  • the virus and I believe that is really the thrust as to why they are building

  • these hospitals dedicated to the virus so that they don't cross infect other

  • people other health care workers and that they can have the infrastructure in

  • place to deal with the contamination that can occur in these places please

  • stay tuned for other videos that we're gonna really delve into what it is that

  • you either as a health care individual or as a citizen can do to improve your

  • chances of a not getting the virus or number two if you do get the virus

  • needing it so stay tuned for those videos coming up

welcome to another MedCram coronavirus update so I wanted to go over the recent

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