Prevention, & 24 Day Incubation (lecture 15)
Welcome to another MedCram coronavirus update! So let’s go to the numbers. Again, these are numbers that we take with a grain of salt. These are the numbers that we have. They are coming from the WHO who has been allowed into China as of yesterday, also from the CDC here. We know that these numbers are probably underestimated. We know that because only the most severe cases that made it to the hospital are getting tested. We know that these numbers are underestimated. We don’t know by how much. We may never know how much. Total deaths keep increasing by bigger numbers, 1,018. Total recovered is growing probably the fastest.
Okay, let’s go over to our other website that we look at, which is the Worldometer. At least according to these numbers, there is a suggestion that things are layering out.
Let’s go back though to our death cases. That doesn’t seem to be at all petering out. In fact, if we look at the number of deaths here, February 10th deaths total was 108, and that seems to indicate what we’ve been talking about all along, and that is the number of cases usually represent something earlier in the course, and that takes time for the patient to get sick to the point of death, which takes a little bit longer. So hopefully, here in the next week or so, we might start to see death starting to layer out. We can only hope that that’s the case.
We know that almost all of these deaths are happening in mainland China in the Wuhan area, of course, their system, as with any system, is overwhelmed, inundated, and things that would normally be happening are not happening as they should. They’re trying to alleviate that by building hospitals dedicated to taking care of these more milder symptoms, so they can take the stress off of the hospitals to take care of these more severe cases.
So, of course, the big news over the last 24 hours has been about the incubation period. We’re going to get to what to make about the incubation period of 24 days. Before we get to that, the other big news is San Diego, California just got its first case, and interestingly it was from four people that were hospitalized because of symptoms at UC San Diego. And they had done some testing there at UC. San Diego, apparently they went to the CDC, and the CDC released them. But one of these people actually had further testing done, and it turned out to be positive, and which case that patient came right back to the hospital, and they had quarantined them, and everyone’s doing well. It’s just that we have a patient that’s turned positive. And so again, these are people that flew in last Wednesday from China and are being quarantined at the Miramar base, just north of San Diego.
So let’s talk about this quarantine issue. Actually, the quarantine issue, which is related to the incubation period. So up to this point was felt that 14 days was enough to take care of any potential type infection. In fact, that’s where the recommendation came for just about anyone in the world now that is coming from China. They are quarantine them because the incubation period is about 14 days.
Well, there was this new paper that was published pre peer-reviewed. What does that mean? That means that before a bunch of scientists that are in that field got to look at the paper, pick it apart, and say what about this? What about that? It got published on a server, and it’s out there. Let’s talk about it.
So here is the article, the lead author whose name actually goes at the end is this gentleman Nanshan Zhong. This is a pulmonologist. And you know, I’ve got a soft spot in my heart for pulmonologist because I am one, and here’s the abstract for it. And then here’s the key part. It says the median incubation period was three days range of 0 to 24.0 days.
And of course, they went into a lot of other things. So some things I want to point out here, which is really interesting, is if you were to see our update from yesterday, where we actually quoted the JAMA article. The JAMA article was a publication that looked at 138 patients that were seen in the hospital there in Wuhan.
This one actually looks at 1099 patients. So you’re going to get a much bigger and number. That was at 1 hospital; this is 552 hospitals in 31 provinces through January 29, 2020. So here the median age as compared to the JAMA article was a little bit younger. That was in the 50s; this was 47 years of age. In this case, there was a bigger majority that were males. In the previous one, it was more split half and half. We saw about the same number of people with fever, people with cough. We also saw that diarrhea was uncommon, but it did happen.
But there are ome other interesting things. We saw that lymphopenia, that means low white blood cells were observed. That seems to be a very common finding in any type of viral infection, but in the JAMA article, which was looking at a hundred thirty-eight patients in a single medical center. In that situation, there were 36 patients, or 26 percent, that were admitted to the Intensive Care Unit. Here, only 55 patients, or 5%, were admitted to the Intensive Care Unit.
Let me explain that. Again, the larger study that had more patients in it, and was more of a cross-section of the area, had a much lower admission rate to the Intensive Care Unit, only 5%. And whereas in our JAMA article, 4.3% died at least at the time of publication, the mortality rate here in this publication was only 1.36. So it seems as though the patients included in this study were not as severe.
So, what do we say about this 24 days? Let’s talk about that. The first thing you need to look at is that the median incubation period was 3.0 days. So what would make that outlier exist? Well, they asked the WHO doctor at a press conference on the 10th that very same question, and the response was that sometimes what can happen is there is a reinfection later on, that makes the exposure look longer than it really is. In fact, they’ve seen this in Ebola where there’s a double exposure, and sometimes what can happen is there is a reinfection later on that makes the incubation period look longer than it really is.
So what we mean to say there’s an infection that occurs here on day Zero, and then there’s an incubation period here, or let’s say 10 days incubation period, and then there’s another repeated one, and this one may not cause symptoms, but this repeated one may cause symptoms, and that will be another incubation period, and then let’s say this one happens to be 14 days, and then symptoms occur.
And so they can clearly identify this as one of the potential infection periods, and they look at this, of course, as the symptoms. What they don’t realize though is that there is another infection that occurred and that the total, when added up, yes, it comes out to 24 days. But that’s not the incubation period of this infection to this symptom. There is another one there.
It’s an interesting concept. This is an outlier. And so sometimes you will get outliers, right? There is always a bell-shaped distribution, with most things that as anyway, and so yes, is it possible that you’re going to get an outlier here at the 99th percentile or the first percentile? It’s possible. But it seems as though at least at this point, what we’re talking about in terms of a median, is three days on the incubation period. What we’ll do is we’ll put a link in to the video where the reporter asks the WHO physician about exactly what does this 24 day incubation period means.
Okay. So let’s talk a little bit more about what’s happening, and what it is that we can do. So we spent some time, if you look at our previous videos, talking about things that we can do to help us prevent getting the virus, and that’s what a lot of expenditures going into right now, quarantining, shutting down.
But we’ve also talked about what is the treatment that can occur if somebody actually comes down with the coronavirus and they have symptoms that are severe enough that end them up in the hospital. We’ve already talked a little about some of the medications, and we’ll talk more about some of these medications that are being used.
Realize that medications that are used for diseases at least in the United States or in Europe have to go through rigorous placebo-controlled trials for them to be indicated for that. So in other words, if you have a blood pressure medication, or you have an antibiotic, it has to be tested for that particular indication for it to work.
Now, we can’t do this with a brand-new coronavirus. We will never have randomized placebo-controlled trials ready to go at the initiation of an outbreak. They are planning to have something maybe in April, and that’s really, really fast for some of these medications, but we don’t have anything that we know is going to work, and so as a result of that whenever we give something for treatments, unless a known situation like ARDS, because viral pneumonia can cause ARDS, that’s acute respiratory distress syndrome, there are some treatments that we know work.
We’ve talked about this in our video, which I will give you a link to How Coronavirus Kills. There’s something that we can do called prone positioning, there’s something that we can do called paralysis, and there’s also something called low tidal volumes. So all of these are things that we can do to help improve because that’s been a randomized placebo-controlled trial for ARDS, but in terms of medications for this coronavirus, we don’t have practical things that we can do. We don’t have randomized placebo-controlled trials, which are the best evidence for these things.
So what do we do instead? We look at the biology of things, and we make certain choices, and we say, yes, even though we know that we don’t know for sure if this is going to work, we’re still going to try it anyway because there’s very little risk. So, for instance, for medications that have indications for other diseases, for instance, HIV, it may work in coronavirus. And so what we’ll do is we’ll do this, and it’s called compassionate use, and you have to apply for that to use it.
And so that’s what happened in this case in the gentleman in Thailand where they used medications that were typically indicated for HIV. They used it to see if the man would get better, and that’s the kind of things that we have now. Basically, anything that we say we’re going to throw at in terms of a medication against coronavirus, it’s going to be compassionate use.
We’re not going to have the best evidence to say it’s going to work. So what I would like to do over the next couple of videos, and we’ve talked about this before, is to look at some practical things that the biology tells us may work. But can I tell you for sure that it’s going to help you? No. So what are those things? The things that will fit into the category where there is ? benefit, but very low risk. These are the kinds of things that you can concentrate on to help you if you are ever in the situation where you have coronavirus.
What is it that you can do beforehand, and at the point of, to limit the morbidity and mortality. And I’m telling you right now; you’re going to be surprised at some of the things. But I’m going to show you the evidence for it, and you may say NO, really? Could that really help me? Well, we’ll go over the evidence, and you make your final decision, and if the benefits outweigh the risks, then you should do it. Thanks for joining us!