Coronavirus Epidemic Update 24: Infections in Italy, Transmissibility, COVID-19 Symptoms

welcome to another MedCram lecture
we’re talking about czars to Cove or Cove at 19 this update is for February
24 2020 a lot has happened over the weekend and we’ve got a lot of stuff to
talk about not the least of which is Italy and South Korea but before I get
to that I just wanted to go over where I think med cram fits into this whole
thing because there’s a lot of news sources out there you can read a lot of
things on the internet about a lot of aspects of the coronavirus and what I
think a niche that make cram serves and will continue to do this is to take the
medical aspect of this and try to explain it as best as we can because I
think that’s our wheelhouse where did this coronavirus come from what are the
true numbers what are the political ideological aspects of it we try to stay
away from that kind of stick to the medical information that’s coming out
and try to explain it to you as best as possible so with that being said here’s
the map from the johns hopkins site we can see here that the total confirmed
cases are increasing although not as fast as they were total deaths are also
increasing but not as fast as they were totally recovered seem also to be kind
of leveling off there is a site here in the link where it says Lancet article
and I want to go to that to show you what they are doing over there at The
Lancet they have a number of articles they also have their own graphs where
they compare the whu-oh the chinese CDC and the Johns Hopkins University site
but one of the things I want you to look at is this related hub and that is the
kovat 19 Resource Center that’s at the bottom this is where you can get updates
on interesting articles that are published across the lancets platform
The Lancet of course being a very reputable Medical Journal the other
place that I wanted you to look was this site from nucleus wealth they have a lot
of different graphs on this site and we’ll leave a link in the description
below they’ve got for instance some graphs that I haven’t seen before which
shows here the change in cases based on the season so the winter countries
obviously are having an increase where the summer countries are not of course
there may be some confounders here because a lot of the countries that are
having an increase happened to me next to China and of course there in the
northern hemisphere and so they’re currently in winter but you can see here
a number of the different graphs we’ve got the doubling time which I had not
seen before and then one of the graphs that I thought was really interesting
was total deaths of course but then this issue that’s been brought up all
throughout the last month or so which is the mortality rate using lag periods and
so what they did on this graph is that if you were to delay for days
what does mortality look like it is doing in the rest of China a delay of
eight days a delay of 12 days you can see they’re all kind of leveling out
here as time goes along just below 1% for the mortality or the case fatality
rate however in Hubei Province doing the same kind of analysis you can see that
we’re coming up with a different mortality rate if you look at these
numbers based on this if you looked at world excluding China and Iran the
mortality rate using different lag periods you can see we’re back to around
2 to 3 percent and of course there’s more analysis and just like any good
site they gave their data sources so I thought this was a good site to add to
your armamentarium for those of you who are liking to look at the kovat 19
statistics course our favorite one that we always go to is the world ometer
which gives us the updated coronavirus cases deaths and recovered our active
cases closed cases another reason why I like to use this site is because if you
scroll down below all of the country specific data you will see an update and
this is very helpful so let’s go through this of course the Italy outbreak being
the biggest over the weekend there’s 78 new cases as of today and one
new death in Italy this was a woman being treated for cancer there’s four
new cases new Voter Gamow the two new cases in Venice and a seventy year old
male in Valtellina and a couple in Turin who visited their child at the Regina
margarita Hospital yesterday those are all new cases we’ve got 114 cases in
Lombardy 25 cases in Veneto and you can see the other ones trailing up at least
26 patients are in critical condition in the
intensive care unit and if you look at that number 26 and divide it by the
number of cases that are there which is quite substantial it is coming out to a
little bit more than we would expect to see in the intensive care unit we have
11 towns 50,000 people placed in lockdown and we have the Armed Forces
and the police forces that have been mobilized to form an insurmountable
health belt as they call it and they’re going to be sentencing people if they
break that roadblock to up to three months in prison so they’re very serious
one of the things that’s been interesting to see is how different
countries deal with this issue and some of the quotes as well there is a Walter
Ricci Rd of the w-h-o adding that within two weeks we will know if we’re facing
an epidemic and that we should avoid crowded places over the next two weeks
so what they have done is they’re movie theaters are closed more than forty
football matches have been postponed there are games there are fashion shows
all of which have been cancelled if we look down here to South Korea and this
is as of February 23rd 166 new cases four new deaths in South Korea and they
have risen the alert level to maximum and you can see what the cases have done
in the total cases from 31 to 58 now up to 602 and the numbers are still rolling
in at this point wanted to talk to you about this JAMA article that was
published on the 21st of February now the issue has been containing this virus
and one of the ways to contain the virus is to be able to screen for it using
symptoms this is a disconcerting article showing a presumed asymptomatic carrier
transmission of Cova 19 which is the disease caused by the SARS to cover iris
what they did is they looked at a familial cluster of about five patients
with fever and respiratory symptoms who are admitted to the fifths People’s
Hospital of an yang China and one asymptomatic family member then here’s
the key and it showed that this asymptomatic carrier a twenty old woman
was living with and had close proximity to five relatives and they visited
another it allows relative and you can see this
in the figure there was no report of covin 19 at the hospital this number one
patient was isolated and observed and as of February 11 she had no elevated
temperature no self reported fever no GI symptoms or respiratory symptoms
including cough or sore throat and yet on january 26 she was positive on
testing for real-time polymerase chain reaction or RT – PC R she then once
again tested negative thereafter despite this – patients 2
through 6 developed Kovan 19 the disease forward women in ages from 42 to 57 and
none of the patients had visited Wuhan in other words they believed that they
got it through her they did develop fever and respiratory symptoms between
January 23rd and January 26 they were admitted to the hospital on the same day
all of them had rt-pcr tests for kovat 19 within one day when they looked at
these patients symptomatically they had ground-glass opacities which is the
finding on chest CT and they all had reduced lymphocyte counts which is
compatible with kovat 19 so their analysis says that on the previous study
reported an asymptomatic ten-year-old boy with Kovan 19 infection but he had
abnormalities on his chest CT if the findings in this report have presumed
transmission by an asymptomatic carrier are replicated the prevention of kovat
19 infection would prove challenging the mechanism by which asymptomatic carriers
could acquire and transmit the corona virus that causes kovin 19 requires
further study so it’s looking as though it’s going to be difficult just based on
fever symptoms and self-quarantine to be able to prevent this from spreading
based on this article now we don’t know exactly how often asymptomatic people
are carrying this virus and able to spread it but we do know that it is
possible based on this article at least one of the things that we’re going to be
talking about coming up in future updates as we mentioned before is we’re
gonna talk about the molecular biology of this new stars to cover iris I
haven’t seen much out there in terms of describing what actually happened
I’m used to having these videos made for people in the medical field people who
have an understanding of biology people understand what DNA is and RNA and
polypeptides and things of that nature but I realized that we have probably a
lot of people out there that don’t really understand the molecular biology
of the cell and what DNA polymerase is and RNA polymerase and what transfer RNA
is and what’s the difference between translation and codons and transcription
so I’m going to put a link in the description below of a nice youtube
video that describes a little bit about that of course I’m not gonna be leaving
you out in the cold so I will do a little bit of description and I will
upload a video on a primer for understanding the terminology that we’re
gonna use because what I’d like to do is go through and really step-by-step show
you what happens when the Czar’s to cover iris infects one of your cells and
exactly how does that work and how is that different from the other viruses
that were used to including HIV so we will be helping out with that
understanding thank you for joining us


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