Spike in Confirmed Cases & Fighting Infections with Sleep (Lecture 17)
Welcome to another MedCram coronavirus update. Just wanted to review SARS-COVID-2 is the name of the virus, and covid-19 is the name of the illness that the virus is causing. That’s an important distinction because up to this point, the criteria for a confirmed case has been looking at the RNA using PCR (polymerase chain reaction) technique in test kits specifically for this virus.
What they’re noticing, of course, is that they don’t have enough kits to test everybody. As a result of that, and this has been a major push there in Wuhan, China, is to look at something that is not as specific, but as much easier, much more rapidly, able to make that assessment, and that’s looking at the illness, and parts of the illness, the characteristics of the illness, is an infiltrate on chest x-ray or CT scan.
So these lung scans have been central in making the determination of whether or not we’re dealing with the virus. So again, moving from something that’s very specific but takes a long time to make a diagnosis, couple of days to confirm it, versus something that’s very quick but not as specific. In other words, you may catch other things in there, but given the fact that there’s an epidemic, the chances of that happening are pretty low, and the key here is that it’s very fast.
So it looks like today they made that switch, and as a result of that we’re seeing a lot bigger numbers. Let’s go to the numbers. 60,000 now total confirmed cases; 1369 total deaths; total recovered is 6,061, about four times the number of deaths has totally recovered, and I will show that in a little bit what that looks like.
Here’s the WorldOmeter website. Huge jump in cases, and that’s because of the change in the definition. Not much probably has changed in terms of the reality on the ground, as we’ve been saying before this number is probably been underestimating, but it has been systematically underestimating. Now we’ve gone from apples to oranges, where this is probably closer to the true number because now we’re looking at lung scans.
Still, there’s probably a lot of people that haven’t come into the hospital. There could be many people outside of this testing parameter that were not picking up. Let’s keep looking here. In terms of daily cases worldwide, huge jump in the total number of cases.
Now, another graph we’ve been looking at here recently is the total cases excluding mainland, China. So what are things looking like? Actually, because we’re not overwhelmed with the number of cases, right? Total cases only 517, we can be very careful, and we can do those RNA tests that are very specific. Again here, some of the smallest numbers to date as of February 12; we will keep watching those numbers as they go.
Okay. I want to follow up a little bit more on some of the things that we were talking about before, and that is what we can do in terms of our immunity, and I want to be clear about this. Some of the things that we’ve been talking about in terms of sleep in the last videos, if you haven’t watched these, is that we don’t have any randomized trials for specifically coronavirus. Everything we’re gonna be talking about has to do with what evidence do we have in terms of viruses in general or immunity. I want that to be clear.
What we’re looking at here is a methodological way of going through all of the risk factors and trying to reduce our risks in this kind of situation. Remember, in this situation, we don’t have medications or vaccines, and so what is it that we can do to reduce and minimize the risk of becoming infected, and if we are infected, of surviving an infection? So one of the easy things we talked about is sleep, and we made the point last time that by sleeping more, that actually improves the immune system. But we’ve got to realize that not everybody sleeps well, right? Some people have insomnia.
The other thing that people don’t realize is that if your body is not ready to go to sleep, and you try to go to sleep and go in bed, what’s going to happen is you’re not going to be able to sleep, and you’re going to get anxiety because you can’t sleep. Then you’re going to associate that with the bedroom. And when you walk into the bedroom, you get more anxious. I’m not going to leave all of you hanging here. There are things that we can do for people who can sleep, people who have insomnia.
There are many other things that can happen when you’re trying to sleep, including obstructive sleep apnea. There are people that can’t sleep because of medical problems, and I’ll try to address all of those. However, remember that each person is an individual, and we are not here to give out medical advice. So all of this needs to be reviewed with your personal physicians, but there are some guidelines, there are some things that you can do, that are going to help, and we’ll be happy to go over some of those things in general.
So, I wanted to review another paper that was put out to study by Van Cauter. Basically what they did was they took some healthy men, and on average they were around 23 years of age, and there were some criteria that they had to have.
Number 1: No influenza vaccine in the previous three years. And all of them had to have a specific sleep routine. In other words, they normally went to bed between 11:00 p.m. and 1:00 a.m. They typically woke up between 7:00 and 9:00 a.m. And their total sleep time was around 8 hours (+/-) 30 minutes.
There were about 25 of these men, and they split them up into two groups. The first group, which had 11, was the Intervention Group. These are the ones that were prevented from sleeping, and then there was another group of about 14 that were the control group.
They did something very interesting. Those 11 in the sleep deprivation group were only allowed to sleep for four hours, and they did this for six nights. Whereas the Control Group were allowed to sleep for the eight hours for those same six nights. Then, after those six nights of only four hours sleep per night, they were allowed to sleep for 12 hours to recover, and they did that for seven nights. Here, of course, they were allowed to sleep again for the eight hours for the same seven nights.
What they did was they took measurements of antibody titers, and they did it just before they were given an immunization. So I’m going to write here when they were given immunization was on the fourth night, so right here fourth night of minimal sleep, and this was an immunization against the flu vaccine.
Okay, so flu vaccine given there, and flu vaccine given the same point over here. And what they measured was at this point right here what was the antibody titer to the flu vaccine, and they also measured again 10 days later, and then they measured again 21 to 30 days later.
So they wanted to see what the effect was of sleep deprivation on the body’s ability to make antibodies against, in this case, the flu vaccine, basically a challenge immunologically to the patient’s immune system. So even though the patients had never had a flu shot before, as we mentioned, in the previous three years, they did have antibodies against the flu because of course people have had the flu in the past. And so there was no Statistical Significant difference here between these two, so there was no difference, and over here on the sleep deprivation side, it was .07, and I’m rounding it off, and over here on the control side it was .09. So there was no Statistically Significant difference.
Now, after the immunization, these people here were sleep-deprived; these people here were not sleep deprived. And so the question is what was the difference here at this point, even though remember now this is 10 days in; they had the ability of recovering some of their sleep even at 12 hours.
So four days into recovery sleep, how much would it be? Well, the tighter here in the sleep deprivation group was .50, whereas the tighter over here on this side was 1.15. It was over twice the amount now when they looked at it after about 21 to 30 days after they had gone both back to a regular sleep schedule. Again, there was no difference in terms of antibody titer.
So they discovered was that sleep deprivation could reduce the body’s ability to fight off the flu as measured by antibodies, but that difference seemed to go away after a period of 21 to 30 days. But please remember that they also stopped the sleep deprivation that they were doing. So the question is what would happen if someone had chronic sleep deprivation.
Okay, let’s look at another study. This one was by Cohen, et al. In this one, this is a bigger study, they took 153 patients, and they were age 21 to 55 years of age, and they asked them about the previous 14 days of sleep, and they looked at two things. They looked at sleep duration. How long were they sleeping for, and they looked at sleep efficiency.
And then they put in rhinovirus, one of the viruses that cause the common cold. They dropped in with nasal drops into their nostrils; these drops in to infect them. Okay, so we know exactly how much duration they sleep, their efficiency, and we’re taking 153 of them, and basically inducing a cold, they monitored them for five days, and they looked at the results of it. Two sets of results.
The first one had to do with duration. Remember we looked at the duration, and we looked at the efficiency. Let’s talk about duration first. They were able to divide them into two categories: those that had less than seven hours of sleep and those that had greater than or equal to 8 hours of sleep in total. Those that had less than seven hours of sleep were anywhere between 1.18 and 7.30 times the likelihood of having cold symptoms, and on average, that was 2.94. So in other words, based on the duration of sleep, if you had less than seven hours, you were on average 2.94 times more likely to develop a cold when exposed to the same exposure than those who slept for greater than eight hours.
There was another category and that was efficiency. Now efficiency, sleep efficiency, is simply the amount of time that you are asleep divided by the amount of time that you are in bed. And they divide that into two categories: those that were asleep greater than 98% of the time versus those that were less than 92% of the time. And what they found was that those that slept less than 92% of the time were 5.5 times the likelihood of getting the cold, and that was a range of 2.08 to 14 .48, meaning that it’s not just how long you sleep, but with efficiency you sleep with as well.
Now when you’re looking at statistics, they noted that it was just these things, duration and efficiency, that made the difference. When they look for confounders, things that did not predict, pre-challenge antibodies did not predict it, demographics, the season of the year, the BMI, the socioeconomic status, and their health or lifestyle, none of those things affected whether or not they got the cold, but the strong predictor was duration and the efficiency of sleep.
So I believe that even though these two studies are not specifically testing the 2019 coronavirus, I do believe that they do have some appropriate information for us in dealing with what is it that we can do right now in terms of protecting ourselves from the virus and realize that it’s not a 100%. You can still get the virus even though you sleep well, just like some of these people got the cold even though they did sleep, but it was less likely.
So the purpose of these last couple of updates was to show you the importance of sleep. Now. The question is what can I do to make my sleep better? And I think that’s what we’re going to attack in the next couple of videos is what is it that you can do personally if you have such and such a problem. Let’s say, you have difficulty falling asleep. Let’s say you have difficulty staying asleep. What are the things that you can do that are fairly simple and effective in making your sleep better?
Let’s talk about those and also update the news and the numbers as we go through this epidemic. Thanks for joining us!