Infections in Italy, Transmissibility, COVID-19 Symptoms (Lecture 24)

Welcome to another MedCram lecture. We’re talking about SARS-2- COV, or covid-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 want to go over where I think MedCram 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 the niche that MedCram serves, and we 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 was a 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 compared the WHO, 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 covid-19 resource center. That’s at the bottom. This is where you can get updates on interesting articles that are published across the Lancet 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 will leave a link in the description below.

但是,我想让您看的一件事就是这个相关的中心。那就是covid-19资源中心。那是底部。在这里,您可以获取有关在Lancet平台上发布的有趣文章的更新。当然,《柳叶刀》是一本非常有名的医学杂志。我希望您看到的另一个地方是Nucleus Wealth的此站点。他们在这个网站上有很多不同的图表,我们将在下面的描述中保留一个链接。

They’ve got, for instance, some graphs that I haven’t seen before, where it shows here the change in cases based on the season. So the winter countries obviously are having an increase, whereas the summer countries are not of course. There may be some confounders here because a lot of the countries that are having in increase happened to be next to China, and of course, they’re 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 4 days, what does mortality look like it is doing in the rest of China? Delay of 8 days 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 the World, excluding China and Iran, the mortality rate using different lag periods, you can see we’re back to around two to three percent. And of course, there’s more analysis, and just like any good site, they give 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 covid-19 statistics.


Of course, our favorite one that we always go to is the WorldOmeter, which gives us the updated coronavirus cases: deaths, recovered, and 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 are 78 new cases as of today, and one new death in Italy. This was a woman being treated for cancer. There are four new cases in Bergamo, two new cases in Venice, and a 70-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 units. 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 Ricciadi of the WHO, adding that within two weeks, we will know if we are facing an epidemic, and that we should avoid crowded places over the next two weeks. So what they have done is their movie theaters are closed, more than 40 football matches have been postponed. There are games. There are fashion shows. All of which have been canceled.

有趣的事情之一是不同国家如何处理此问题,以及一些引号。世卫组织的一位瓦尔特·里恰迪(Walter Ricciadi)补充说,在两周之内,我们将知道我们是否面临流行病,并且在接下来的两周中,我们应该避免拥挤的地方。因此,他们所做的就是关闭电影院,推迟了40多次足球比赛。有游戏。有时装秀。所有这些都已被取消。

If we look down here to South Korea, and this is as of February 23rd. 166 new cases, 4 new deaths in South Korea, and they have risen the alert level to maximum, and you can see what the cases have done. The total cases from 31 to 58, now up to 602, and the numbers are still rolling in at this point.


I want 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 disconcerting article showing a presumed asymptomatic carrier transmission of covid-19, which is the disease caused by the SARS-2-COV virus.


What they did is they looked at a familial cluster of about five patients, with fever and respiratory symptoms, who were admitted to The Fifth People’s Hospital of Anyang, China, and one asymptomatic family member. Then here’s the key, and it showed that this asymptomatic carrier, a 20-old woman, was living with, and had close proximity to, five relatives. And they visited another hospitalized relative, and you can see this in the figure. There was no report of covid-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 on January 26, she was positive on testing for real-time polymerase Chain Reaction or RT- PCR.


She then once again tested negative thereafter. Despite this, 2 patients, two through six, developed covid-19, the disease. 4 were women in ages from forty to fifty-Seven, and none of the patients had visited Wuhan. In other words, they believe that they got it through her.

然后,她此后再次测试阴性。尽管如此,仍有2例(从2到6例)患上了covid-19病。 4名年龄在40至57岁之间的女性,没有患者去过武汉。换句话说,他们相信他们是通过她得到的。

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 covid-19 within one day. When they looked at these patients sympathetically, they had ground glass opacities, which is the finding on chest CT, and they all had reduced lymphocyte count, which is compatible with covid-19.


So, their analysis says that on the previous study reported an asymptomatic 10-year-old boy with covid-19 infection, but he had abnormalities on his chest CT. If the findings in this report of presumed transmission by an asymptomatic carrier are replicated, the prevention of covid-19 infection would prove challenging. The mechanism by which asymptomatic carriers could acquire and transmit the coronavirus that causes covid-19 requires further study.


So it’s looking as though it’s going to be difficult just based on fever symptoms and self quarantining 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 going to talk about the molecular biology of this new SARS-2, covid virus. I haven’t seen much out there in terms of describing what actually happens.

正如我们之前提到的,我们将要讨论的将来更新中的一件事是,我们将讨论这种新的SARS-2 covid病毒的分子生物学。关于描述实际发生的事情,我还没有看到太多。

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 going to 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 going to use, because what I’d like to do is go through and really step by step show you what happens when the SARS-2-COV virus 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.



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