Coronavirus Epidemic Update 24: Infections in Italy, Transmissibility, COVID-19 Symptoms

Coronavirus Epidemic Update 24: Infections in Italy, Transmissibility, COVID-19 Symptoms

welcome to another MedCram lecture
we’re talking about czars to Cove or Cove at 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 wanted to go over where I think med cram 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 a niche that make cram serves and 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 says 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 compare the whu-oh 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
kovat 19 Resource Center that’s at the bottom this is where you can get updates
on interesting articles that are published across the lancets 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’ll leave a link in the description
below they’ve got for instance some graphs that I haven’t seen before which
shows here the change in cases based on the season so the winter countries
obviously are having an increase where the summer countries are not of course
there may be some confounders here because a lot of the countries that are
having an increase happened to me next to China and of course there 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 for days
what does mortality look like it is doing in the rest of China a delay of
eight days a 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 world excluding China and Iran the
mortality rate using different lag periods you can see we’re back to around
2 to 3 percent and of course there’s more analysis and just like any good
site they gave 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 kovat 19
statistics course our favorite one that we always go to is the world ometer
which gives us the updated coronavirus cases deaths and recovered our 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’s 78 new cases as of today and one
new death in Italy this was a woman being treated for cancer there’s four
new cases new Voter Gamow the two new cases in Venice and a seventy 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 unit 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
Ricci Rd of the w-h-o adding that within two weeks we will know if we’re facing
an epidemic and that we should avoid crowded places over the next two weeks
so what they have done is they’re movie theaters are closed more than forty
football matches have been postponed there are games there are fashion shows
all of which have been cancelled if we look down here to South Korea and this
is as of February 23rd 166 new cases four new deaths in South Korea and they
have risen the alert level to maximum and you can see what the cases have done
in the total cases from 31 to 58 now up to 602 and the numbers are still rolling
in at this point wanted 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 is a disconcerting article showing a presumed asymptomatic carrier
transmission of Cova 19 which is the disease caused by the SARS to cover iris
what they did is they looked at a familial cluster of about five patients
with fever and respiratory symptoms who are admitted to the fifths People’s
Hospital of an yang China and one asymptomatic family member then here’s
the key and it showed that this asymptomatic carrier a twenty old woman
was living with and had close proximity to five relatives and they visited
another it allows relative and you can see this
in the figure there was no report of covin 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 yet on january 26 she was positive on
testing for real-time polymerase chain reaction or RT – PC R she then once
again tested negative thereafter despite this – patients 2
through 6 developed Kovan 19 the disease forward women in ages from 42 to 57 and
none of the patients had visited Wuhan in other words they believed that they
got it through her 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 kovat 19 within one day when they looked at
these patients symptomatically they had ground-glass opacities which is the
finding on chest CT and they all had reduced lymphocyte counts which is
compatible with kovat 19 so their analysis says that on the previous study
reported an asymptomatic ten-year-old boy with Kovan 19 infection but he had
abnormalities on his chest CT if the findings in this report have presumed
transmission by an asymptomatic carrier are replicated the prevention of kovat
19 infection would prove challenging the mechanism by which asymptomatic carriers
could acquire and transmit the corona virus that causes kovin 19 requires
further study so it’s looking as though it’s going to be difficult just based on
fever symptoms and self-quarantine 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
gonna talk about the molecular biology of this new stars to cover iris I
haven’t seen much out there in terms of describing what actually happened
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 gonna 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
gonna use because what I’d like to do is go through and really step-by-step show
you what happens when the Czar’s to cover iris 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

100 comments / Add your comment below

  1. This video not that helpful today. Would be cool if you went over vaccines more. FYI this would be the first time a rna vaccine is used…

  2. I'm italian , i live in rome ; to be sure im more concerned people from milan or venice who got back from there to here or other places , simply get in train and come back to work or living place .. the outbreak is rough , our media italian are 24h on the virus coverage .. and people paniking over supply mask( no wehre to be found) or disinfectant that is missing too… And how people sells those things in ebay 80-100€ por piece soo nasty… Italy blocked all flights from china but is always one of top country to visit so somehow it managed to arrive here .. the situations before was so normal , tg was like ( big deal but no relevance here ) and all of the sudden to night and day it happend …

  3. I'm Italian.
    People are going crazy here! They're all in panic, and believe me , they're scarier than the virus itself!
    I always try to stay calm, so yeah I take the whole situation seriously (especially being from Romagna, in the northern area where the virus is spreading quite fast) but I manage to not go crazy quite easily (and I have anxiety so..).
    Why can't the others?
    People are literally emptying the markets, some of them even got into fights for food! (I saw this with my eyes).
    They're just making it worst.
    Also, most Italians have no respect at all, coughing and sneezing without covering their faces at all, no one avoids typically crowded places.. Basically, everyone is going crazy, but at the same time they don't do those simple things that could avoid even more intense spread; more and more people are coming up with stupid crazy and unrealistic conspiracy theories , and also: in the media most "information" comes from politicians whom don't know ANYTHING about the virus, and they only spread fear, or other influential people whom talk about conspiracy theories.

    Luckily, some people from the medicine field are trying to stop this steady growing psychosis.

  4. Small correction at 7:10 – She tested NEGATIVE on the 26th, POSITIVE on the 28th, and negative thereafter. Love all your hard work and thank you!

  5. Here in Germany the authorities seem to be quite laid back : welcome covid 19 to the carnival of Cologne ! Greetings Conny

  6. Well the stock markets crashed all over the world today 24/02/2020. Will the W.H.O declare a pandemic this week now they can't hide behind the stock markets anymore? we will see.

  7. Such sad news. It’s pretty scary with all flu’s going on in the USA , all around our world, I couldn’t imagine catching this. The influenza flu’s are so tough to get through and pneumonia. Prayers going out to you all, all around the world and much love.

  8. Fun fact, they estimated that back in 2002-2003 that SARS had a mortality rate of 2-3%… later we figured out it was 10%

  9. Ok, I have the dumb question….78k diagnosed with it. 20k recovered. 2800 deaths. So what's up with the 56k….rough numbers I know but question remains the same. Are those 56k still sick? Carriers? Has virus but not sick? What shape are they in? Thanks. I only watch your updates.

  10. How come the WHO can't name the people working for them in Hubei? Only now they are creating a joint team with China to visit the infected region..

  11. Doctor, lots of us have a very heavy scientific background, study constantly, have read decades worth of technical information, but did not want to be a doctor for certain reasons. Don't hesitate to say and explain what you need to.
    And thank you so very much for your incredible work here and dedication. Jesus with you always. <3

  12. Isn't all of this assuming China is telling the truth? Seems like a lot of work going into something where the information provider is most likely not completely above board.

  13. Where did the virus start? I read an unconfirmed report of animal sellers making small fortunes, It is possible that a member of the Level 4 infectious unit in Weuhan, was selling some of the experimental animals. it would explain the animal to human cross infection. Again, this is only speculation. But plaussible

  14. Can you please discuss hygiene sterilisation and cleaning supplies, food preparation, restaurant risk, cooking temperature. Etc.?

  15. Thank you for educating us in a calm, scientific, logical manner. I watch your videos because the information is presented without hype or sensationalism. Of course being a nurse I understand most of it but I always enjoy a refresher on some of the biological concepts.

  16. i have one more question. China claims to have restarted its industries and some amount of manufacturing have resumed. What are the chances of Coronavirus being spread via manufactured products as they make their way out of China?

  17. 1) Does anyone have a documented recent estimate of the percentage of asymptomatic infections?
    2) Do large percentages of elderly populations seem to be correlated with high morbidity/ sickness rates? (Japan, S.Korea, Italy)

  18. New case in Spain (Tenerife). An italian tourist coming from north Italy. He's been here during carnival holidays so… bad news… lots of contacts… Previous (and first) 2 cases (a german tourist in La Gomera and another case in Marbella) were already discharged (after total recovery).

  19. Your "niche" on this channel needs to be reviewing the papers that are coming out every few days. A lot of the other medical channels are sorta "dumbing down" their content to support the barrage of questions from the public. But most of us that watch here are healthcare professionals so we want to see relevant research, epidemiology, even updates about SARS & similar infections. I've been looking at how the 1957 flu affected the world, which is fairly interesting since it seemed to have a CFR similar to this disease

  20. Doc thank you so much. I cannot go to sleep without watching your channel for "intelligent updates" on Covid-19. Your explanation, knowledge, and analysis are great. Prevention is better than cure. So it is the time. The gene is out of the bottle. Now we have to prepare.

  21. Just admit it's a pandemic already there is no effective containment, nothing for it but to let it run it's course try and slow it and develop a vaccine like the flu shot this will be with us for generations bottom line first time around the World it will kill Mabye 1 percent in developed countries I'll say as high as 4% in third world after that no worse than the yearly flu.

  22. MedCram please help me and please respond, my family will not listen to what I have to say about the factual information about what has been happening during these past months, they think of this virus nothing more than influenza and they patronize me telling me I'm wrong and they yell at me saying they dont want to hear it, how can I convince them to prepare my family of what is possibly to come?

  23. My question is: how can be Italy being the third country in the world with most infected people, but pratically no one on Europa, although they didn't really controlled people who came from China too? How is it possible to got over 220 cases of coronavirus in 48h,but very few in France, Germany and UK? Is italy stupid to use draconian rules and isolated 50 000 people, or are other countries who are trying to hid the infected people to not get an economical big drop?

  24. So it seems that asymptomatic carriers are possible. Given that, we are most certainly going to see this in the community. I am preparing for that. I am going to plan for 30 days entirely at home to avoid exposure as I am 78, female with diabetes and asthma not to mention all the geriatric things like arthritis, high blood pressure controlled with meds, etc. I also live near a major airport with international travelers living on short term leases in my building which has a 45% vacancy annually. Many residents are airport personnel and this means my elevators and stairwells can be problematic in case of community contagion in my building. This is also a tourist area with people from all over the world coming and staying in several big hotels within a mile of my apartment building. Density is very high in my community, we have 100 apartments in my building and thousands upon thousands upon thousands of residents in a small apartment dense area of about 3 miles square. This is not a good scenario for elderly diabetic women. I plan to stay home at the first report of community contagion in my city and stay there as long as 30 days and having food and medicine delivered by the grocer and by mail for medicine. I have gloves and am looking for a mask or masks. Iwill walk at night when there is less pedestrian traffic and shoes and my cain will be removed upon entering and stored separately in a box. I have laid in a supply of cleaning products like Clorox and Lysol disinfectant. All this not yet but ready when needed.

  25. I really enjoy this video. I also enjoy taking your very clear presentations and explaining to friends and family with a bit less medical jargon just what it al means. This helps prevent panic the best of a KISS philosophy! Thank you.

  26. Thank you for your videos. The situation doesn't seem to be getting better…

    On a lighter note, you sound a bit like Jeff Goldblum, specifically Dr. Ian Malcomn from Jurassic Park.

    I picture him when listening to your videos 🙂

  27. Great video as usual continually loving the updates as they keep us inform about this virus and how it is spreading. Thanks for your work and can’t wait for the next video 👍.

  28. Advanced high schoolers have enough basic biology to understand these lectures, they can google the odd term or two like everyone else. These are excellent lectures.

  29. I’m ordering my masks! They have increased in price dramatically- not nice 3M- since the outbreak. What goggles do we need?
    I may be crazy but I know I get sick all the time from the viruses my students give me. I had Lyme Disease and my immune system and my body has never been the same since that infection. I’m going to protect myself and risk being called names. I’ve considered a full on gas mask- wouldn’t that be the best outside a hazmat suit?

  30. have you talked about bacteria yet? We have more bacteria than cells. First line of defense. Don't poison them with sugar, flour, rice. Eat more vegetables and leafy greens. Sub healthy fats for the calories. I 'had' to do it or take an immunosuppressant to treat psoriasis. Went from being sick every year to not having the cold or flu for six years. Not sure if that is good or bad relative to this virus.

  31. Rough numbers are 2700/80000 = 3.3 if none of the 50000 unresolved cases (who has not recovered yet) results in a death, we still have 3.3% (lower bound). May be they are only calculating outside China for 1.0%. 4 days lag is not a good number. It seems like it takes 3-4 weeks for death (probably more time for recovery). In China the rate is visible because the new infection cases/day are less than old infection cases/day. If Korea had 30-50 infected 2 weeks back and 893 infections (today) and 8 deaths (today), its very likely that a big part of 8 deaths are coming from older cases. 8/893 is not a good representative.

  32. Work on your immune system, i live in Guatemala and i remember when the Ah1n1 virus came here, many people died though me and my family had a good diet back then we excersice we are healthy people and it didn't affect us that much

  33. I'd like to hear a discussion of the semantics and implications of the term 'pandemic'. I believe a couple of experts have already called it a pandemic. Is this something WHO would announce? Would it make any difference in the way countries respond?

  34. You do an outstanding job with these videos Dr. Your delivery style is great and the material is brief but so informative. Thank you!

  35. I would also like some discussion about what it means for health authorities to claim "we are well prepared", if not simply untruthful PR. in my country (Australia) you could expect to wait for possibly hours in emergency under business as usual conditions. I'd be willing to bet they have not acquired the thousands of extra mechanical ventilators, oxygen equipment, beds, drugs, staff it would take to 'manage' a pandemic.

  36. If within 3 feet of infected couple for 5 minutes – no touching or speaking face to face though they were speaking to each other. What is the risk of transmission (airborne?) How to calculate?

  37. Japanese government doesn't check if patients are infected by corona or not because they need to cheat us to have Olympics

  38. I wonder how many people watching this don’t have enough food stored at home to last even a couple days if they had to shelter in place.

  39. Both America and Europe buy ALL their antibiotics and many other
    medicines only from China. We have no factories that make them, because
    the big pharma companies only have their eye on profits for their share
    holders and it's cheaper to make them there. Although the virus cannot
    be treated by antibiotics, this is a huge Security Risk for many other
    health problems. Very foolish to put all your eggs in one basket.

  40. Some people have constant low temperatures, like myself. I’m rarely above 97.1 F.
    So, that should be taken into account!

  41. What I am really curious about is whether the symtoms vary according to age and if so to what extent. Does it severly vary or are the critical symptoms are quite consistent over ages? I cannot really find any resource showing reports focused on this matter.

  42. I don't get sick from cold or flu anymore. For the last 10 years I haven't been sick. Before then I got sick about 4 times a year. Then I started doing this breathing exercise I invented about every 2 hours and it helped change my immune system. What I think happened is I do exposed to cold and flu viruses, but my immune system doesn't respond the normal way your average person's immune system responds. It's as if the virus doesn't have the ability to multiply the way it normally would. All I do is I lay on the ground on my back. For five minutes I breath in and out my mouth, then for 5 minutes I breath in through my nose and out my and then for the last five minutes I breath in and out my mouth. This exercise raises my energy levels. Then I may do a full body self massage, some tai chi and a few dancing kata moves for balance. Also, I drink apple juice a few times a day because it has a natural antioxidant to help the lungs. Then keeping my room at 60 percent humidity and temperature about 75 F helps too. I normally do the breathing exercise after sleeping 4-5 hours after I wake up. Then I go back to bed after doing the breathing exercise for about 3-4 hours. I don't know if this will help if I'm exposed to Coronavirus, but it has helped with cold and flu virus. I haven't gotten any flu shots in the last 10 years.

  43. If full asimptomatic persons can transmit the disease very, very drastic measures need to be taken to contain the disease or we will have millions of people dying in the following months.

  44. I think Singapore is going to struggle to contain this even though they are doing everything right. Even if we didn't have clowns running this global circus our opponent is too strong. Mother nature's way of telling us not to be so cruel to her little creatures.

  45. PCR was part of my public school high school biology curriculum in the 1990s, including labs doing PCR electrophoresis. Don't dumb the content down, don't assume you'll need to speak down to us. Secondly, to your point on asymptomatic cases — Up until four days ago, the Disaster Princess petri dish was publishing daily numbers not only of the infected counts, but of the asymptomatic infected counts. If those numbers are to be any indication of how this plays out in the larger population (doubtful for a couple of reasons, but it's what we have to go on), then we're looking at something like 52% asymptomatic carriers whose swab test reveals the virus. That's scary as hell and indicates to me a much higher infected population than has been previously reported. Based on three different models I'm using from Diamond Princess and Korean numbers, I'm estimating infection worldwide right now to be somewhere between 116k and 221k, with my farthest out model being about 1.5M — I hope that's wrong but we'll know more as Korea develops over the next 2-3 weeks. I'm also estimating the true death rate of all those infected between 2% and 4%, again depending on the model, over the next 6-8 months, with a max possible death rate of about 5% if all hell breaks lose (but I'm not even going to begin trying to estimate indirect deaths due to starvation or riots). These numbers are also dependent on quarantines continuing to being levied and self-imposed around the world and working to at least some small extent to slow the spread. If quarantine doesn't work the numbers get a lot worse. We're looking at tens of millions of people dead. Three million in the USA alone, unless my numbers are wrong and I sincerely hope they are.

  46. I think Korea is bigger problem they didn't even lock down because they are scared the people there will blame the government and they keep blaming this cult saying if they catch all of them it will be over which is outrage they probably spread it to thousands of people already and we know the person in that cult wasn't from Wuhan… Korean government to really wake up and take responsibility and do whatever it takes to contain it asap if not already too late i am worried. Bringing politics and geopolitics into this problem is a big big mistake and giving Chinese fake news saying its not that serious because they say this they cannot act too serious because of this problem stoppable problem is not being stopped maybe the most dangerous atm. someone make huge news about Korean Government's incompetence so people wake up to what is happening i think the virus is already spread in Seoul just got news that in some Chuch in Seoul of Ten Thousand had two people turn positive… that cult was less than a thousand…

  47. I see people taking other peoples temperatures for the virus. Just because they don"t have a fever doesn't mean that they are not infected and spreading the virus to others during the 14 day incubation period.

  48. There are over 50,00 deaths in the U.S. every year from normal flu. Maybe the rest of the world should put the U.S. in quarantine. The Corona virus and all of the misinformation along with it is shutting down trade with China and is meant to cause a test run for world-wide financial collapse. This Corona virus has been found to contain four HIV insertions which makes it a man-made virus. The doctor does have a very good understanding of molecular biology, what he and most doctors don't have, is a good understanding of the great evil that permeates the worlds governments. And btw, there are no legitimate medical journals, the CDC, the Lancet, etc. have been totally corrupted for over twenty years. You need to ask yourself, why is it that The Lancet – and others – , knowing full well that China greatly downsized the Corona virus infections in the first months, didn't use this knowledge to adjust its death rate statistics down?

  49. Its apparent that China stopped reporting cases. They were already underreporting cases and deaths already. This is obviously far worse than is being covered.

  50. I depend on your videos for factual non dramatic clear information. I am an artist w no science background at all. I am white, middle aged and live in washington state.
    Keep up the great work. I await each new video. Thank you very much!

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