welcome to another MedCram COVID-19
update and as you can see this is now become a pandemic this is validated with
the numbers that are coming outside of China if we go to the world ometer site
you can see clearly we’re in the acceleration phase here and as a result
of this we are seeing some things that are very unusual not withstanding of
course the stock market which is taking a tumble at this point but we’re also
starting to see things that we’ve never really seen before we’re starting to see
official statements made because of the fact that there are groups there are
fans there are stadiums where when you have people congregated together it can
spread disease and we’re seeing that from the NHL we’re seeing that on the
NBA website we’re even seeing spring training Major League Baseball being
postponed governor Newsom of California is now able through an executive order
to commandeer hotels motels to house coronavirus patients patients in the
state have already been moved to hotels the Desert Sun reported that a 120 room
hotel in San Carlos which is near San Francisco has already been tapped to
housed passengers from the Grand Princess cruise ship there was an
executive order released on Thursday that includes the authority for
Sacramento to take over hotels and motels for medical use for coronavirus
patients in a move he said will help the state of 40 million to prepare for any
widespread outbreak we’re also starting to see here at the municipal government
level Garcetti who’s the mayor of Los Angeles urging residents to take steps
to protect themselves but they also banned all events or conferences with
more than 50 people they called these common-sense measures in San Bernardino
County which is the largest county in the United States there’s not even a
single confirmed case of kovat 19 and so this website here is a very instructive
which I’ll put a link to in the description below and it has to do with
this notion of flattening the curve and that’s what I want to talk about today
so here’s the curve if you have everybody congregating together
of course the virus is going to move fairly quickly it is thought and if you
don’t have protective measures that transmission is going to be very rapid
but then just as quickly because you have burned a large swath in the
population of people there’s gonna be immunity that is built very quickly in
the survivors and then the curve is going to flatten out quickly as well but
there’s going to be so many patients so fast coming into the hospital that we’re
not going to be able to take care of them as it shows here this is the
healthcare system capacity way down here in terms of the daily number of cases if
however we’re able to distance ourselves and to shut down the transmission of the
virus by spreading us out so we’re not in close contact with each other if
we’re not congregating together in large masses then the daily cases it is
thought is going to come up slowly even if it’s the same number of people we can
spread those out so that the amount of cases that we’re seeing on a daily basis
doesn’t exceed our ability to take care of those people and we can kind of see
that happen in the early phases of this epidemic in China in the epicenter of
this outbreak in Wuhan the mortality rate was calculated to be higher than
the mortality rate outside of course this is not a case fatality rate because
we don’t know exactly the toll and we don’t know exactly the denominator in
the numerator involved in that but if you were to compare those two you would
see that the number of deaths divided by the number of confirmed cases was lower
outside of Wuhan than it was inside of Wuhan and of course the reason for that
was that the hospital capacity was just not there and that was part of the
reason why the Chinese felt it was necessary to build thousand bed
hospitals it was to take care of this swell of daily number of cases and that
distancing is going to slow down the virus but as it has turned out here from
this not peer-reviewed paper that is ready for publication they did extensive research to answer a
question that I have been asked several times and that is how long does this
SARS cough – lasts on surfaces and in the air
the results are disconcerting it showed here that the h k– of 19 or the SARS –
was investigated and they showed the overall stability is very similar with
the original SARS cough one that was found back in 2002 they found that the
viable virus could be detected in two aerosols up to three hours post
aerosolization so this is when somebody sneezes or if there is an aerosol ation
event like if the patient is being intubated or if they’re on a positive
pressure mask this could be seen up to four hours on copper and up to 24 hours
on cardboard and up to two to three days on plastics and stainless steel which of
course has real implications in hospitals and in operating rooms these
two viruses SARS cover one and SARS Cove – exhibited similar half lives in
aerosols with meeting estimates around 2.7 hours both viruses show relatively
long viability on stainless steel and polypropylene the median half-life was
around 13 hours on steel and around 16 hours on propylene so basically they
found that these viruses can remain viable and aerosols for multiple hours
and on surfaces up to days so you can see that the importance here of masks is
there but really the key is not touching things where this virus may exist and
making sure things get wiped down on a frequent basis which may give you a
question about exactly what could you use to make sure that SARS cough – virus
would be eliminated and we’ll put a link in the description below – EP a website
that lists that information going back to this flattening of the curve when we
eliminates sporting events and meetings things of that nature we’re able to drag
this out and even though the same number of people might become infected we’re
able to better take care of them I know exactly
what it’s like being on the frontline and being in the intensive care unit how
frustrating it is to have more cases than you can actually take care of it
doesn’t happen often and it might happen for just a short period of time but
imagine trying to take care of a very critically ill patient and have another
patient becoming critically ill right at the same time and then as that’s
happening something else is happening downstairs in the emergency room that
they need help with right away you just can’t be in three places at once
oftentimes when this happens I call in a backup physician who’s a colleague of
mine who’s in clinic that has to cancel clinic and come in and help me instead
of being an exception to the rule could be the rule itself and obviously nobody
wants to have a loved one or be that patient in that situation because you
want the attention of the doctor to be on you when this is happening and of
course that’s assuming that everything gets done correctly what you don’t want
to have is what’s described here in this medical staff update and that is
distracted doctoring and patient safety so imagine someone being interrupted by
their interruptions and it’s hard to put two thoughts together you’re not dealing
with computers when you go into the hospital even though there are many
computers there you’re dealing with physicians physicians who are human
beings who have to think and have to decide what needs to be done on a
patient and they need to take all those things into consideration and if they
get interrupted because there’s such a influx of patients coming in that’s when
mistakes can also happen and that’s what this article points out and I’ll put a
link to this article as well an example of this point is a recent event a
physician was busy trying to complete progress and consult notes while waiting
to get a callback on a page that he had placed realizing that there were orders
that needed to be put on in patient a the physician inadvertently placed a
medication order into patient B’s record which was opened in epic epic for those
who don’t know is the medical record system the staff complied immediately
with the order with patient B getting the medication intended for patient a
fortunately patient B did not get injured by the event but the root cause
of this error was the physicians momentary distraction while trying to do
several routine things out once and that is the key and that is
generally going to happen more often if this is the situation that we have
versus this being the situation that we have we just don’t have enough hospital
beds physicians nurses ancillary staff respiratory therapists to be able to
deal with this in a safe way Popov says that if everyone practices
social distancing and practices good hygiene it will help slow the spread of
the virus so that everyone who will eventually need medical care can be
properly treated so that what is happening in Italy and China doesn’t
happen here even though in many parts of the country where there are no cases
because we really don’t know how widespread this virus is because really
we’ve under tested so on this update we took a little bit of a break from the
molecular biology but next week we’re going to be getting into a lot of the
details of this ace to receptor this is the receptor that is targeted by the
virus itself and there’s a lot of interesting things about this receptor
not only from a vaccination and from an entry point but this ace to protein is
not in isolation it does have a function and that function may be modified by the
binding of this virus it’s interesting to talk about the implications of that
modification we’re also going to talk about practical things that you can do
and what does it mean to have immunity please subscribe to this channel if you
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