Unsupported Theories, Pneumonia, & ACE2 & nCOV (lecture 12)
Welcome to another MedCram coronavirus update! And before we begin, I just wanted to reach out to a lot of new people that are joining us because of these coronavirus updates. We’ve been doing videos for about eight years, and we do a No-nonsense Explain Clearly approach to medical issues. So I just want you to be aware that we also do videos on chronic diseases like COPD (chronic obstructive pulmonary disease) heart failure ventilator management, acid-base inhalers and things of that nature. So check out the rest of our channel for those videos, and also come visit us at our website.
So getting back to the coronavirus: deaths today 565, confirmed cases is 28,274. Interestingly, the recovered is 1178. And we did say earlier in the week to look for these to go up because of the time period that takes the longest to have a recovered case.
It hasn’t taken a lot of time at all to have confirmed case, takes a little bit more time to have a death because it takes some time for the patient to decompensate. But if they don’t die and they recover, it takes time for them to recover and finally for the virus to be undetectable. Then you have these recovered patients. So, whereas at the beginning of last week or even toward the end of last week, the recovered were less than the deaths, which was kind of concerning now, now the recovered is more than double the deaths at this point.
So I wanted to also address is a lot of comments especially regarding this conspiracy idea where numbers were released, and then taken down, and then put back up again with different numbers.
Let’s go over what those numbers were. So, the deaths that they had were 24,589, and the number of total confirmed cases was 154,023. Now if you look at this ratio, which if we take the null hypothesis and say that this was the correct number, then what you’re looking at here is more like a 16% rate of deaths to confirm cases.
But let’s look at it objectively. So, if we take this ratio, and again it’s not a case fatality rate or a mortality rate. But let’s look at that number 16. I mean if that were the case, we could look at the number of cases that we currently have outside of China. This 16% ratio, whatever you want to call that ratio, should stand regardless of whether the patients are in China outside of China. And if in fact the xxx are covering up the numbers while the xxx can’t cover up numbers that are not in China, right?
So we can look at Japan, and based on the current infected numbers there now, we should have up to about seven deaths. And how many deaths do we have in Japan? 0. If you look at Singapore, if you look at the number of cases that we have in Singapore and apply this ratio, we should have four deaths. And how many deaths do we have in Singapore? Well, the answer is 0. Why is it so high in XXX? But we’re not seeing that in Japan or Singapore.
The other thing I wanted to address that has come up recently is this idea about ACE2? So what is this Angiotensin-converting enzyme 2? Well, if you look in the bronchi, bronchioles tubes, fairly low on down, close to the alveoli, is a receptor on the type 2 Nuuma site called ACE2. and it’s this protein deep down here in the airways when you get down to the very bottom, there is a protein and that is the target of the coronavirus.
Not only is it the target of the coronavirus, which allows the virus to enter into the cells, it is also the target of SARS back in 2002. And so there has been a lot of talk about this potentially, because of its similarity to SARS, we could use the same type of vaccinations and treatments that blocks SARS trying to get into the respiratory epithelium. We’ll talk more about that later.
But the issue is that there’s been again another unpublished, not peer-reviewed, article that looks at ACE2 expression with respect to gender and race, etc. Etc. And what it found was a very small study. It only had about eight subjects in it. But what they found was that the Asian sample had a huge amount of ACE2 expressed whereas the African-American and Caucasian had relatively low ACE2 levels. And their conclusion was potentially that this could explain why there was such a huge outbreak in China as opposed to other areas with different groups.
And so this has been making the rounds on the comments, and I wanted to address that. First of all, I think a better reason why we’re seeing a huge outbreak in China is because it started in XXX, and that’s where it’s going to be precipitating the most. Secondly, any study with an n out of 8 has to be taken with a grain of salt. So as it stands, there’s actually another study that we can look at that tells us far more. So we end this.
Other study, which looked at the tissue of lung cancer patients, but obviously they were not looking at the cancer itself, but the normal tissue in the lung cancer patients. When they did a multivariate analysis, there were no racial differences. There were no gender differences in the expression of ACE2, but what they did see a difference, statistically significant, in this other study that had an n of 224 patients was that those who smoked had an increase in ACE2 distribution.
Now, you should know that in China on average 48 percent of men smoke, and only 1.9 percent of women smoke in China based on statistics that go back to 2017. And so this might explain some of the gender differences in terms of those people hospitalized in China.
But we’ve got two different studies. We’ve got one study that shows n out of 8, which seems to be making the rounds on the internet that Asians have a higher expression of ACE2. Therefore, more targets, therefore more possible infections by the virus. Whereas in another study, 224 different samples, there were no racial differences, no gender differences, but they did notice an increase in ACE2 protein when patients smoked or had a history of smoking in the tissue.
I want to talk a little bit about what goes on. So, here’s the coronavirus, and it’s got these proteins on the outside of it, and these proteins are called S proteins or spike. And they interact with the cell, and specifically interact with a protein called ACE2, and that is the receptor that allows internalization of the virus.
Now inside the virus is a very large RNA molecule that encodes for all of the proteins that are needed for this virus. And there’s the S protein; there are membrane proteins; there’s a whole bunch of other proteins.
So what they’re looking at is potentially blocking this interaction. So how could you do that? Well, you could get proteins like ACE2 that bind this and prevent that from binding. You could also get proteins that look like the virus to bind on here preventing that interaction. You could also put that on an antibody, and if you were to put these soluble proteins here on the antibody, that could bind onto here, and this antibody would then call in the immune system to try to get rid of the virus. So there’s a number of ways that this can be looked at.
And the interesting thing is that this S protein, and specifically this ACE2, is exactly the same protein that was targeted with SARS back in 2002. And so there’s a lot of work that’s already been done on ACE2 in terms of trying to figure out a way of preventing a virus which targets it from getting inside.
And so, I’ve also included in the link two expert opinions on the RNA sequence of the coronavirus. This thing here. Whereas before they were talking that this is from snakes. They were saying that this looks actually very similar to bats. And the fact that it also targets the exact same protein that the SARS virus did, which was also from a bat, and that this coronavirus is targeting human ACE2, and that’s why we’re having a problem.
They also note that ACE2 is somewhere lower down in the respiratory epithelium, and that’s why we’re seeing more of an ammonia rather than upper airway symptoms that we would see with flu for instance.
So, does ACE2 exist more in Asians? I would say at this point, the data seems to indicate the answer is NO, at least with a better-powered study. But is it also possible that it might be related to smoking? Well, it’s possible that smoking may cause a change in the expression of these proteins on the cell surface, which may make you more susceptible to getting coronavirus infections. I think more study needs to be done in that department.
We’ll see you next time. Thanks for joining us!