these are numbers that we take with a grain of salt these are the numbers that

we have they are coming from the w-h-o who has been allowed into China as of

yesterday also from the CDC here we know that these numbers are probably

underestimated we know that because only the most severe cases that made to the

hospital are getting tested

we know that these numbers are under don't know by how much we may never know

how much total deaths keep increasing by bigger numbers 1018 total recovered is

growing probably the fastest okay let's go over to our other website that we

look at which is the worldA meter at least according to these numbers there

is a suggestion that things are layering out let's go back though to our death

cases that doesn't seem to be at all petering out in fact if we look at the

number of deaths here February 10th deaths total was 108 and

that seems to indicate what we've been talking about all along and that is the

number of cases usually represents something earlier in the course and that

takes time for the patient to get sick to the point of death which takes a

little bit longer so hopefully here in the next week or so

we might start to see death starting to layer out we can only hope that that's

the case we know that almost all of these deaths are happening in mainland

China in the wuhan area of course their system as with any system is overwhelmed

inundated and things that would normally be happening or not happening as they

should they are trying to alleviate that by building hospitals dedicated to

taking care of these more milder symptoms so they can take the stress off

of the hospitals to take care of these more severe cases so of course the big

news over the last 24 hours has been about the incubation period we're gonna

get to what to make about incubation period of 24 days before we get to that

the other big news is San Diego California just got its first case and

interestingly it was from four people that were hospitalized because of

symptoms at UC San Diego and they had done some testing there at UC San Diego

apparently went to the CDC and the CDC released them but one of these people

actually had further testing done and it turned out to be positive in which case

that patient came right back to the hospital and they had quarantined them

and everyone's doing well it's just that we have a patient that's turned positive

and so again these are people that flew in last Wednesday from China and are

being quarantined at the Miramar base just north of San Diego so let's talk

about this quarantine issue actually the quarantine issue which is related to the

incubation period so up to this point was felt that 14 days was enough to take

care of any potential type of infection in fact that's where the recommendation

came for just about anyone in the world now that is coming from China they are

quarantine them because the incubation period is about 14 days well there was

this new paper that was published pre peer-reviewed what does that mean that

means that before a bunch of scientists that are in that field got to look at

the paper pick it apart and say hey what about this what about that it got

published on a server and it's out there let's talk about it so here is the

article the lead author whose name actually goes at the end is this

gentleman nan Xiang Zhang this is a pulmonologist and you know I've got a

soft spot in my heart for pulmonologist because I am one and here's the abstract

for it and then here's the key part it says the median incubation period was

three days range of 0 to 24 point 0 days and of course they went into a lot of

other things so some things I want to point out here which is really

interesting is if you were to see our update from yesterday where we actually

quoted the Jama article the Jama article was a publication that looked at a

hundred and thirty-eight patients that were seen in the hospital there in Wuhan

this one actually looks at 1099 patients so you're gonna get a much bigger n

number that was at one hospital this is at five hundred and fifty two hospitals

in 31 provinces through January 29 2020 so here the meeting age as compared to

the JAMA article was a little bit younger that was in the 50s this one's

47 years of age in this case there was a bigger majority that were males in the

previous one it was more split half and a half we saw about the same number of

people with fever people with cough we also saw that

diarrhea was uncommon but it did happen but there's some other interesting

things we saw that lymphopenia that means low white blood cells were

observed that seems to a very common finding in any type of

viral infection but in the jam article which was looking at 138 patients in a

single Medical Center in that situation there were 36 patients or 26% that were

admitted to the intensive care unit here only 55 patients or 5% were admitted to

the intensive care unit let me explain that again the larger study that had

more patients in it and was more of a cross-section of the area had a much

lower admission rate to the intensive care unit only 5% and whereas in our jam

article 4.3 percent died at least at the time of publication the mortality rate

here in this publication was only one point three six percent so seems as

though the patients included in this study were not as severe so what do we

say about this 24 days let's talk about that the first thing you need to look at

is that the median incubation period was 3.0 days and so what that means is that

this 24 days was a real outlier so what would make that outlier exists well they

asked the w-h-o doctor at a press conference on the 10th that very same

question and the response was that sometimes what can happen is there is a

reinfection later on that makes the exposure look longer than it really is

in fact they've seen this in Ebola where there is a double exposure and sometimes

what can happen is there is a reinfection later on that makes the

incubation period look longer than it really is so what we mean to say there

there's an infection that occurs here on day zero and then there's an incubation

period here of let's say 10 days incubation period and then there's

another repeated one and this one may not cause symptoms but this repeated one

may cause symptoms and that will be another incubation period and then let's

say this one happens to be 14 days and then symptoms occur and so they can

clearly identify this as one of the potential infection periods and they

look at this of course as the symptoms what they don't

realize though is that there is another infection that occurred and that the

total when added up yes it comes out to 24 days but that's not the incubation

period of this infection to this symptom there is another one there it's an

interesting concept this is an outlier and so sometimes you will get outliers

right there is always a bell-shaped distribution with most things that is

anyway and so yes is it possible that you're gonna get an outlier here at the

99th percentile or the first percentile it's possible but it seems as though at

least at this point what we're talking about in terms of a median is three days

on the incubation period what we'll do is we'll put a link in to the video

where the reporter asks the w-h-o physician about exactly what does this

24 day incubation period mean okay so let's talk a little bit more about

what's happening and what it is that we can do so we spent some time if you look

at our previous videos talking about things that we can do to help us prevent

getting the virus and that's what a lot of expenditure is going into right now

quarantine shutting down but we've also talked

about what is the treatment that can occur if somebody actually comes down

with the corona virus and they have symptoms that are severe enough that end

them up in the hospital we've already talked a little about some of the

medications and we'll talk more about some of these medications that are being

used realize that medications that are used for diseases at least in the United

States or in Europe have to go through rigorous placebo controlled trials for

them to be indicated for that so in other words if you have a blood pressure

medication or you have an antibiotic it has to be tested for that particular

indication for it to work now we can't do this with a brand new corona virus we

will never have randomized placebo-controlled trials ready to go at

the initiation of an outbreak they are planning to have something maybe in

April and that's really really fast for some of these medications but we don't

have anything that we know is going to work and so as a result of that whenever

we give something for treatment unless it's a known

situation like ARDS because viral pneumonia can cause a RDS that's acute

respiratory distress syndrome there are some treatments that we know work we've

talked about this in our video which will give you a link to how corona virus

kills there's something that we can do called prone positioning there's

something that we can do called paralysis and there's also something

called low tidal volumes so all of these are things that we can do to help

improve because that's been a randomized placebo-controlled trial for a RDS but

in terms of medications for this corona virus we don't have it practical things

that we can do we don't have randomized placebo-controlled trials which are the

best evidence for these things so what do we do instead we look at the biology

of things and we make certain choices and we say yes even though we know that

we don't know for sure if this is going to work we're still going to try it

anyway because there's very little risk so for instance for medications that

have indications for other diseases for instance HIV it may work in coronavirus

and so what we'll do is we'll do this and it's called the compassionate use

compassionate use and you have to apply for that to use it and so that's what

happened in this case in the gentleman in Thailand where they used medications

that were typically indicated for HIV they used it to see if the man would get

better and that's the kind of things that we have now basically anything that

we say we're going to throw at in terms of a medication against coronavirus it's

going to be compassionate use we're not going to have the best evidence to say

it's going to work so what I would like to do over the next couple of videos and

we've talked about this before is to look at some practical things that the

biology tells us may work but can I tell you for sure that it's going to help you

know so what are those things they're things that'll fit into the category

where there is question about very low risk these are the kinds of things that

you can concentrate on to help you if you are ever in the situation where you

have corona virus what is it that you can do beforehand and at the point of to

limit the morbidity and mortality and I'm telling you right now you're going

to be surprised at some of the things but I'm gonna show you the evidence for

it and you may say no really could that really help me well we'll go over the

evidence and you make your pre final decision and if the benefits outweigh

the risks then you should do it thanks for joining us