Fecal-Oral Transmission & Recovery vs Death Rate (coronavirus lecture 9)
Welcome to another MedCram coronavirus update. And as of today, we have 362 deaths, which is up from 305 yesterday, and we have 17,392 infected, which is up from 14,556. Now this ratio that we’re looking at here is simply the ratio of confirmed deaths to confirm infected.
Of course, people are going to be diagnosed with the infection before they might have a chance of dying. So there’s a time lag there. So it’s not an accurate case of fatality or mortality rate, but it is something that we can look at and track.
The other thing that you might have noticed on the website that we reference, and we’ll make a link to it, which is a nice official reporting dashboard from Johns Hopkins, is this 487 recovered. We’ll talk more about that as well. What are the criteria for recovered, and we’ll talk a little bit about the Lancet article and also some reporting out of China today.
So in the Lancet article, which will give you a link to some really good information, the incubation period on average for these 41 patients that were admitted to a hospital right there in the middle of this epidemic was 5.2 days, but 95% of all of them had the incubation period within 13 days. You know that for citizens coming to the United States from that area, they’re holding them for at least 14 days to make sure that they do not have the virus.
Incidentally, there was a German plane yesterday that flew in with German nationals, and when they screened them on the plane, there were two people that were positive for coronavirus on that plane.
So let’s look closer at this Lancet article because I think it’s very instructive in terms of periods of time and looking at things. So here we have the infection that starts, and that incubation period would go right in here. So on average, it would be about, you know, five or six days, and then the time from symptom onset to admission to the hospital. That’s a very key thing there because most patients probably don’t even go to the hospital, and they may do just fine.
But for those that do go to the hospital, it was noted to be about a seven-day period. And then from admission, and that was 100% of the cohort that was looked at in the study because they looked at those 41 patients within a day admitting to the hospital, about 51 percent of them developed shortness of breath, another day later 27% went into ARDS. And if you want more information about ARDS, look at our MedCram video on this channel titled How Coronavirus Kills. Then another day before they got to the Intensive Care Unit, and there about 10% or for patients requiring mechanical ventilation.
So what was the outcome of this study? And I think it was very interesting. Of the 41 people at the time of publication of this in the Lancet, there were 28 people that were discharged home. There were six people that passed away. That’s about 15%, and of the 28 that is a 68%, which leaves seven that were still alive, and in the hospital being treated.
So the question is what were the criteria? And this gets back to that number that we see on the site. What were the criteria for allowing these people to go home? And this is very important. So from my understanding, there are some guidelines now that are being instituted nationally in China about what constitutes someone that’s recovered. And at least for this hospital, it was ten days without a fever; it was that the chest x-ray was improving because all 41 patients had abnormal CT scans chest x-rays.
This next one is important. To be discharged home, there has to be no virus detected in the upper respiratory tract. And so that’s a pretty high bar, and with that 68% of those people that enter the hospital were able to go home and deemed cured. We don’t know what happened to the other seven. So if we look at just those that entered into the hospital, we’re looking at about a 15% mortality rate in the least.
And from there, it could go up depending on what those other seven did. If one or two of those died, then the mortality rate goes up. By stress again, this is not the overall mortality rate of the virus; this is the mortality rate for those people that have to go to the hospital because their symptoms were so severe.
Okay, three other stories I want to talk about real quick. There was in the local Chinese media a story that I picked up, and I’ll work in the link to that one as well in the description below, a doorknob was found to have the RNA PCR of the coronavirus on it. So again this highlights the need for hand hygiene carrying around, alcohol-based hand sanitizers. Make sure you’re washing your hands.
The other thing I want to highlight is that there were some local media in China about a patient being discharged home. This is a patient that was 30 years old. He was admitted on the 20th of January, and he was being discharged today on the 3rd of February. Again, I looked very carefully at the media report of what was the criteria, and they did mention that this was the standard criteria for discharging a patient home.
In this case, the patient had a normal temperature times three days, and they were doing PCR to look specifically for the RNA of this virus, and it was negative, and they were checking it at every 24-hour intervals. So this patient felt better. The PCR was negative for the virus, wasn’t shedding it in other words, and temperature above normal for three days. So I think that adds a little bit more in terms of what that number means on the website people that have recovered. Think about this though in terms of a timeline.
The first thing that’s going to happen is someone’s going to a confirmed case. The second thing that could happen is they could die. And then the third thing that would happen is that they would recover.
Obviously, they’re not going to recover after they die. But these things are going to happen in this order. So it’s going to take the longest to have a recovery? It’s going to take the shortest to have it confirmed case, and it’s going to take intermediate somewhere between that time to have a death. So look for in the future as we progress through this epidemic, that the number of recoveries is going to surpass the number of deaths, and we hope that that is by a large amount.
Let’s talk a little bit about how it spreads. So we all are familiar with the common cold the flu, and the importance for mask, and also the need for eye protection in this case, especially in the healthcare setting.
What may be something that we may have underestimated, and that is the fecal-oral route, and the reason why that’s the case, and we’ll put a link to this in the description, is because the man in Washington state, they found the coronavirus in his stool. And why this is important is because this goes back to 2002, 2003 where there was a big outbreak of SARS in a particular apartment complex in China, and it was because of this toxic viral plume after the man had diarrhea, and that aerosolize viruses into the air, and it went into the other apartments, and that’s where the other people picked up the virus. And so it is possible that this fecal-oral route may be a big determining factor.
But it highlights that fecal-oral transmission of this virus is potentially in play, and so washing hands is an important thing to understand. We are witnessing, and in the middle of, a human tragedy that is pretty scary to say the least. There are a lot of people that are suffering, but there are some things that we can do about this. We can educate ourselves. We can understand the virus. We can make sure that we’re doing everything that we can to prevent that virus from spreading. We can make a difference.