Increase in Deaths, Questions about Asymptomatic Spread, & More Sleep Tips (lecture 18)
Welcome to another MedCram coronavirus update. Let’s take a look at the numbers since the updated criteria for the diagnosis has gone to just a lung scan and a clinical history consistent with coronavirus. 64,436 total confirmed; total deaths 1,383; total recovered is 6886; about five times the total deaths is the total recovered.
Let’s take a look at the WorldOmeter. And we can see here total cases outside of China have kind of remain constant because there hasn’t been that redefinition causing a slew of new cases. Let’s take a look and see what’s going on inside China, or total cases overall. If we look down here at new cases, there’s been a dramatic drop in the number of new cases, probably because there were a number of cases that were reclassified. We’ll have to watch this and see how things go.
Now, remember we’re talking about these total cases is based on the number of people presenting to hospitals that can get work done on them. Based on some reports that we’ve been seeing, especially at New York Times, there’s been a crackdown and a rounding-up of people, and holding them in quarantine, and not getting the medical treatment that they need. Some people of course too scared to go, and not wanting to get treatment, and so it’s unclear exactly how many people are not being counted here, but it’s apparent that this is still being undercounted. In terms of total deaths, there has been a jump, and that doesn’t seem to be cooling off anytime soon, unfortunately. For the same reason why the total number of cases may be underestimated, the total deaths may be underestimated as well.
On the WorldOmeter, latest updates for February 14. We see that there’s a report from Hubei Province for yesterday that there were 4,823 new cases, including 3095 that were clinically diagnosed. We can see here that the testing was just kind of underestimated in those chronically. 160 new deaths and 8 clinically diagnosed. So we can see that the clinical diagnosis, addition to the count, is greatly influencing the number of new cases; whereas it’s not affecting the number of deaths as much.
Total accumulative cases, we can see here that 15,384 clinically diagnosed we talked about that. What’s interesting here is that 36,000 are currently hospitalized. That’s an incredible amount of people that are hospitalized, and you can see here that 73%, so the vast majority of them are in mild condition whereas 8,000 are in serious condition, and about 4.6% are in critical condition. There’s a number of people that are undergoing medical observation because of either their contact or other symptoms that they may have.
Two new cases in Japan. One of them being a surgeon at a hospital who developed a fever and still continue to work as usual and saw patients for three days. So that’s probably going to have to be followed up on as well. Okay. I want to discuss three things today. I want to talk about the New England Journal of Medicine article that actually we referenced back at the end of January. I want to talk about cell phones in China, and I also want to talk just briefly about sleep and circadian rhythms and some more reading.
First of all, let’s talk about the New England Journal of Medicine. So there was this article that was published in the New England Journal, talking about a visitor from Wuhan, China who visited in Germany for business meeting, and it was reported in the New England Journal of Medicine that this woman who came over was asymptomatic, and then when she flew back to China she developed symptoms of fever and the symptoms of the coronavirus later tested positive.
And when they tested her friends that were at the business meeting in Germany, they had already become sick and then got better, and they tested positive for Coronavirus, and it was touted at that time that this was evidence that coronavirus could be spread even though the patients were asymptomatic.
Well, as it turns out there’s been a correction on this New England Journal of Medicine case, and will post the link in the description. What they found out was that before they printed, they had not actually reached out to this index case from China and discuss what if she actually had symptoms. They reported that she was asymptomatic, but in reality, she actually was symptomatic. In fact, she was taking medications to suppress a fever, and was having very mild symptoms, but was having them nevertheless.
So what does this mean? Does this mean that coronavirus does not shed when the patient is asymptomatic? No, there are still people that believe that and they may be correct. All it means is that you can’t use this New England Journal of Medicine case to support that theory. So I think that’s an important distinction that needs to be made, and it tells us that we’ve got to be careful in this world of rapid information that we get it right before we spread the information because spreading false information can have consequences.
The other thing I wanted to mention was cell phones. We will link to an article also in the New York Times about what they are doing right now in China in terms of cell phone use. Of course in China, they have three cell phone providers that are run by the government, and wherever you go, of course, that phone has GPS, right? So if you go to any particular province, it’s going to keep track of that on the phone. Well, what they’ve currently worked out through these phone companies is if you text a particular number to them, it will show on the phone right in front of you exactly which provinces in China you have been in in the last two weeks, one month, however, they want to do it. And they’re just listing it. And so what’s going on now is people are coming into various places to various checkpoints, the customs agents, the military personnel who are enforcing these bans, are actually asking people as they come off to text on their phone exactly this number, and up there will pop where they have been in the last month or so, and of course if Wuhan is on there or specific province Wuhan is in, pops up.
They’re in some cases not letting them go, and they’re redirecting them. So I thought I’d make you aware of that. The last thing I want to talk about real quickly is circadian rhythms. Now, there’s been a lot of questions, and what I’m really trying to do is balance how much we talk about the virus and how much we talk about sleep, and this is the reason why I’m really gung-ho here about sleep.
Number One is according to the studies that we’ve talked about in our last updates, you can prevent getting the colds with sleeping appropriately up to five times. Imagine if I could tell you that if you took this pill, you could reduce the chances of you getting the coronavirus by 80%, that would be an amazing way of curtailing the R-O (naught), or the spread factor of coronavirus.
That’s what we’re seeing, not necessarily the coronavirus but in rhinovirus, and so I think this is actually significant enough in a discussion of what we can do practically. So in that vein of things, there’s been a lot of comments specifically about some things that I wanted to talk about.
Shift workers, circadian rhythm, lights, and insomnia. First of all, shift workers. I know there’s a lot of health care workers that work night shift. So that’s like going in at 7 p.m. and getting home at 7:00 a.m. Or 6 p.m to 6 a.m., etc. Here’s the key about shift workers. If you’re going to do shift work, it’s better to always do shift work, and not go back between day and night. That’s number one. So stay at same shift. The reason why this is important is because of the second thing we’re going to talk about, and that is your circadian rhythm. If you don’t do that, you confuse your body’s circadian rhythm.
Number two is make sure that your nights are days and that your days are nights. In other words, if you’re going to be up at night, make sure that it is bright where you work at night. It’s also very helpful sometimes to take naps when you’re working if your job allows for that, even if 15 to 20-minute nap can be very restful.
Number three: if you are a shift worker, and you get home, make sure you go to sleep right away, as soon as you get home. Don’t go out shopping. Don’t do the kids laundry. Don’t go work outside. Go to sleep and make sure that the room is dark. Make sure that the curtains are sealed. Make sure the window is sealed. You are working different shift from what the rest of the world is doing, but you still need your sleep. And so what you need to do is get your circadian rhythm on a completely different cycle, and that way you’re going to get your sleep. The problem occurs is when you want to be one way on the weekends and the other way during the week, that doesn’t work.
So number four: continue your routine on the weekend. I’m going to put a link into the American Academy of Sleep Medicine website that gives very, very good tips on not only shift workers, but people who have other issues with their sleep.
So the other thing I want to talk about that affects all of us is circadian rhythm and lights, so there are two cycles that have to be in perfect harmony in your body for you to get the great night sleep. Number one is the homeostatic, and this is just a funny word that tells you basically as you are awake more and more and more, you start to become increasingly more and more and more sleepy; as you sleep more and more, you start to become more and more and more rested. It’s just like eating and hunger, the more you eat the less hungry you are; the longer you go without eating, the more hungry you are.
And that’s pretty easy to understand, but there is a bedtime that we have and there’s a wake time that we have, and so the other one is circadian. And this is what happens when you go on a jet plane, and go to different time zone, and you get off, there’s a certain circadian rhythm that occurs. And when both of these are combined together, the perfect thing happens is you are asleep until the morning, and then you wake up, and then you are awake until the evening and then you go to sleep, and what makes you go to sleep all of a sudden, which makes you get tired around 10 o’clock normally or 11 o’clock normally, is the combination of the drive to go to sleep and the drive to stay awake, finally goes away, and both of those combined for you to go to sleep.
The problem is that the circadian rhythm can be shifted either to the left, Advanced, or to the right, Delayed. And what is it that can shift circadian rhythm? It’s light, and this is the thing that is the bane of our existence as people who look at electronic equipment, whether it’s coming from a TV screen, a cell phone, whether it’s coming from the lights in our house. All of those things at that time of the night, when we should be going to bed, especially blue light, is going to delay your circadian rhythm so that you become tired later and later and later. And so what happens is you stay up later and later and later, and you don’t feel tired until later and later and later, but you still have to get up in the morning to beat the traffic, to get into work, which starts at eight, or nine, or whenever it starts.
So that squeezes the amount of time that you have to go to bed and to get the sleep. So by eliminating light at night, the light that causes this delay in your circadian rhythm, is particularly from blue light, but bright light exposure at the beginning of your day when you’re starting to get up in the morning has the opposite effect, and it can actually advance your circadian rhythm
So what I tell my patients is that if they have a situation where they’re going to bed very, very late because they don’t feel sleepy until they go to bed very late. And they love to sleep in till 8:00, or 9:00 or 10:00, kind of like my teenager. What they need to do is to advance their circadian rhythm. So what I tell them to do: make sure that they’re exposing their eyes to nice bright light around 7:00 or 8:00 in the morning, and to avoid light exposure late in the evening.
Let’s talk really briefly about insomnia. So some people have an issue with going to bed. And for those of you who have a separate room where your bed is as compared to other parts of your house, this works. But many, many people have the situation where they feel tired. They’re in the kitchen, and as soon as they go into the bedroom now, they are wide awake. They can’t go to sleep, and they become very concerned about their insomnia.
And there’s a number of issues going on here. It has to do with classical conditioning and things like Pavlov’s Dog that you may have heard of an experiment. And the situation is that you’ve got your bedroom, and there are things in your bedroom that you have associated with insomnia, and so that comes to your mind as soon as you go into the bedroom, and you can’t sleep because you see these things that you’ve associated with yourself in your brain for many, many times that you can’t sleep when you’re in this bedroom.
And it’s sort of like a performance anxiety, and it’s because you’ve associated that bedroom with your inability to perform, and the performance that you need to do in that bedroom is sleep. So what do you do? If you cannot sleep in your bed, you should leave your bedroom and go to another part of the house and associate that other part of the house with inability to sleep. We want your bedroom to be associated with you sleeping. So in the same vein, if it’s possible, and you have insomnia, you need to toss out other things in that bedroom that aren’t there for sleep. So in other words, if you have a TV in your bedroom, you should get rid of it; if you read in your bedroom, if you work in your bedroom, you should get rid of it.
Essentially, there are only two things you should be doing in that bedroom. And one of them is sleeping so that when you go into that bedroom, you are going to associate that very, very strongly with sleep, and you’re going to eliminate the feeling of performance anxiety because you’re not going to be associating that bedroom with inability to sleep, because you will be getting out of bed and going to another part of the house until you are ready to go back to sleep.
The reason why people get this is because they watch videos like mine, and they get the wrong impression. They say I must go to sleep earlier. I must get more sleep, so they go to bed earlier when the circadian rhythm is not ready for them to go to sleep, or they say I’m going to sleep in this morning, even though it’s 9,10 o’clock, and it’s time for them to get up, and their circadian rhythm is saying get up, but they stay in bed, and they can’t sleep, and when they can’t sleep, they become more anxious, and when they become more anxious, they associate that with the bedroom, and that causes the issues. So thanks for joining us.