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