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  • welcome to another MedCram update so first things first we have 427 deaths

  • and 20600 confirmed cases and again we look at this ratio here not as saying

  • that this is a death rate or a fatality rate it's just a ratio of confirmed

  • deaths divided by confirmed cases but as we predicted the total recover has gone

  • up and I refer you once again to the dashboard at the Johns Hopkins

  • University de site for the Wuhan coronavirus so there are a lot of things

  • to go over today first of all there was a paper that was trying to calculate the

  • RO or the basic reproduction number this is basically if the virus is in somebody

  • how many people does that virus get passed on to

  • you

  • and I will put a link to the in a description shows about 2.2 for

  • 23.5 8 is the number which is respectable number measles is of course

  • one of the worst it's about 14 or 15 next big thing three new cases in

  • California and currently California has about six out of the eleven cases in the

  • United States and that's not surprising given that California is probably the

  • biggest destination from Asia to the United States the second death outside

  • of China if you want to consider hong kong out of china was in a relatively

  • young gentleman although apparently this guy had underlying illness other big

  • thing in the news patient in Washington state was released to home isolation and

  • the key here is home isolation so they don't say much about him however the

  • thing that I would like to know is whether or not he's virus free why did

  • he go home on home isolation and is in fact is he's still infectious and he's

  • just not sick enough to be in the hospital and that's a that's an

  • interesting question to note but we'll have to see I've gotten a lot of

  • comments asking about stuff from China like mail or packages we just talked

  • about yesterday how on a door handled they were able to pick up the RNA of the

  • corona virus on PCR and I've seen at least two or three articles now with

  • experts biologists looking at the corona virus and saying that mail from China is

  • fine now we bring up bats so there seems to be some disagreement among scientists

  • when this originally came out there was a study that showed that the Wu Hank

  • rotavirus was very similar and probably most similar to that found in snakes

  • there seems to be some additional data that it could be from bats the news

  • there are more evacuations coming and the US government is going to be taking

  • those two Air Force bases since that seemed to work out well for March Air

  • Reserve Base in Southern California a Travis Air Force Base seems to be one of

  • the ones that's targeted they need to have big enough places where they can

  • have single rooms to isolate and as we mentioned yesterday in our video there

  • was two people on germán flight to Germany with German

  • nationals that tested positive for the corona virus finally in weird news

  • Pakistan is bucking the trend they're good or resumed flights with China which

  • leave a lot of people scratching their heads because they believe that Pakistan

  • is in no way able to deal with a corona virus outbreak there they do note in

  • some of the articles that I read that there is a pretty strong relationship

  • between China and Pakistan of recent notes China has loaned them billions of

  • dollars for infrastructure right now there are no cases in Pakistan and what

  • about the fact that this is a year that the Olympics are occurring in the Summer

  • Olympics in Tokyo so the question isn't where are we gonna be when the summer

  • comes around and I will put some links in the description of epidemiologists

  • hoping that the summer is a slowdown because generally these viruses don't do

  • very well in the summertime but remember this is a completely novel virus to the

  • human body and the diamond Princess cruise ship is in complete quarantine

  • just off the coast of Japan and that's because there was one person in late

  • January that tested positive for the Wu hen Khurana virus and currently there

  • are seven people on board that are ill of course that's not too surprising if

  • you've been on a cruise ship you'll know that you're bound to get somebody that's

  • ill the testing is not going to be completed on these people until Tuesday

  • night okay the next thing I want to talk about is they check that this patient

  • out in Washington State and found that he definitely tested positive in his

  • stool for the RNA for this wuhan corona virus well this reminded people of what

  • happened back in 2002 with SARS and as you may recall and you'll also link to a

  • paper that describes this that there was a whole outbreak I mean hundreds of

  • people were exposed to one man having the SARS virus and where is this gonna

  • happen and and that's the next thing we got to talk about is public restrooms

  • public bathrooms there's some good evidence even that

  • Chinese are agreeing that this is a potential issue as to how this thing can

  • be spread just the flushing of the toilet itself that can also aerosolize

  • things just by flushing so the question is what do you do well I've got no

  • studies can't tell you for a fact that this works but here's some steps that I

  • think you may want to consider number one is avoid public bathrooms if

  • possible number two wash hands and what I would

  • say here is use paper towels if possible to touch anything in public bathrooms so

  • walking into the bathroom usually it's a push you can use your foot obviously you

  • want to have a barrier between you and the toilet seat when you're done if you

  • can you probably want to close the toilet cover so if you flush it doesn't

  • aerosolize of course that's gonna be for you not to spread it's that someone else

  • but of course you can't prevent other people from doing that washing your

  • hands for at least 20 seconds okay some people say sing happy birthday and

  • you're mine twice to get to 20 seconds I would also carry hand sanitizer you

  • would not believe how many times you touch your face you scratch your nose

  • you put your finger in your mouth these are all entryways another big thing if

  • you have children teach them all of these things so the second thing I

  • wanted to get to really quickly was this Lancet article where they included now

  • 99 which is the most to date people with pneumonia with the Wuhan coronavirus and

  • the average age here was 55 years old 67% men 50% chronic disease 83% had

  • fever 82% had coughed 31% had shortness of breath

  • interestingly only 2% had diarrhoea 17% had a RDS and 11% died as opposed to the

  • original paper which said 15% now we're getting a little bit more granular

  • because we have more n now this brings us to another interesting thing which

  • was the prediction score for those that were going to die followed something

  • called an M u L B Estie a score for viral pneumonia and

  • I'll include that in the description below it's a very nice article and what

  • did it look for well there are a number of things that you could look for in

  • these patients to help tell you is this one that's going to die or is this

  • someone that's not going to die number one was multi lowbar infiltrates number

  • two was lymphocytes less than 0.8 number three was bacterial co-infection number

  • six was someone who had hypertension which I'll abbreviate HTN number seven

  • was age greater than sixty years of age so for multi lowbar infiltrates they got

  • five points and you want to have the least amount of points possible for low

  • lymphocytes they got four points for bacterial infection four points acute

  • smoker three points if you were a quit smoker two points hypertension was two

  • points in age greater than sixty was two points so I'll give you some examples

  • here if you had zero points your chances of dying from viral pneumonia was 0.47%

  • if you had six points it was two point nine percent if you had twelve points it

  • was fifteen percent and if it was twenty two points and of course this can go up

  • to as high as twenty two points but it was basically greater than 69 percent

  • and this was a very nice prediction method to determine in a viral pneumonia

  • if someone would die and it followed it pretty closely even for other viruses

  • so the one that I see a lot comments is this coronavirus and HIV and

  • this probably started out because of a paper that was uploaded to bio

  • rx IV not too long ago that found by looking at the RNA that there were four

  • regions in the novel coronavirus that looked like they had come from HIV and

  • this was a paper that was not peer-reviewed it was uploaded to a

  • particular part of the site where those papers can go before they get reviewed

  • by other scientists there was a disclaimer in that area that

  • specifically said that but the conspiracy theories abounded and I have

  • to admit I saw it as well and I was concerned about it because of what the

  • implications could mean these HIV stretches were coding for gp120 which is

  • involved potentially in the binding site of cd4 cells so what they actually found

  • out two of those areas are actually found in bat coronavirus okay so it's

  • normally there and the other two one is found in HIV but it's only six amino

  • acids long and I don't think that based on the number of matches that they have

  • to go through the fact that you would find something that matches six amino

  • acids would be a wash statistically speaking nevertheless this paper was

  • removed Sunday by the author's saying that they could have relook at this but

  • people will say well why are we using HIV meds then in this current outbreak

  • why are they trying it and why are people getting better on the HIV meds

  • well this is not a new theory back when SARS broke out in 2002 they also used

  • HIV medications well why well because corona virus is an RNA virus and HIV is

  • also an RNA virus and so so in the machinery and getting RNA viruses into

  • species that have DNA primarily they're going to be very similar and they may

  • help it of course we already have it we know that it's relatively safe and so

  • there's these questions about people being readmitted to the hospital people

  • who have recovered yet they get sick again only to have to end up on this

  • well I haven't seen any cases out there of this

  • particularly if you see any I would love to hear from you please put actual case

  • reports in there there was the the gentleman in the Philippines who did die

  • but you've got to realize that a lot of these people who have viral infections

  • will get secondary bacterial infections and in fact I see this all the time

  • personally in my practice is people will come in to the hospital with severe

  • bacterial pneumonia but if you check their history they've had a viral

  • infection prior to that that they've got better from the virus moves in it de

  • nudes the respiratory epithelium and then the bacteria moves in as an

  • opportunistic infection so these people being readmitted to the hospital could

  • be opportunistic infections of bacteria well you say well what about the fact

  • that a lot of these people have decreased white blood cells I mean

  • couldn't this be the virus tearing up cd4 cells T helper cells well if you

  • look back at that article that I was talking about with the viral pneumonia

  • is you'll see that part of the way they differentiate is that many times

  • regardless of the viral pneumonia there's going to be a lymphocyte count

  • that's low in fact that was one of the criteria that we used in figuring out

  • whether or not the patients actually have a higher risk of dying that

  • remember that was the MU L B sta score and these people that are being

  • discharged from the hospital as part of their criteria at least in China is that

  • their viral loads are undetectable they cannot detect the virus on PCR so the

  • point of this is be careful there's a lot of theories out there that may be

  • based on less than scientific data and I guess I'll take this opportunity to

  • thank everyone for all of the nice comments I'm glad that this is helpful

  • thanks for joining us and remember what we said about hand-washing pray for this

  • to turn around and we will see you next time

welcome to another MedCram update so first things first we have 427 deaths

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B1 hiv rna pneumonia viral people china

Coronavirus Epidemic Update 10: New Studies, Transmission, Spread from Wuhan, Prevention (2019-nCoV)

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    林宜悉 posted on 2020/03/13
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