Coronavirus Epidemic Update 28: Practical Prevention Strategies, Patient Age vs. Case Fatality Rate

By Paul Henry / in , , , , , , , , , , , , , , , , , , , , , , , , , , , /

welcome to another MedCram COVID-19
update we’re gonna talk today again about the numbers about the epidemiology
we’re actually going to talk about the case fatality rate and the age
specifically a lot of you have asked about how age affects that we’re also
going to talk about testing there’s been some interest in how we test for SARS
cuff too and in light of what we talked about last update which is what the
sensitivity and specificity were we talked about how the sensitivity of the
kits that have been made public and available in certain situations is not
the best we’re also gonna talk about healthcare workers and this all sort of
ties in together here is the Johns Hopkins dashboard
total confirmed eighty three thousand three hundred and eighty-nine total
deaths twenty eight hundred fifty eight total recovered is thirty six thousand
five hundred and sixty three these are the numbers that are being put out to by
the various organizations moving over to the world ometer coronavirus cases and
if we exclude the Chinese numbers we can see here that we are definitely in an
epidemic phase outside of China and if we look at the pie chart we can see here
that that slice of the pie is definitely growing and I think you can expect that
that is going to grow even more here in the next number of weeks if we look at
the number of cases outside of mainland China a huge swath of that is from the
Diamond Princess in terms of new cases the fastest-growing one is South Korea
in fact for the first time there’s more cases coming out of South Korea and
there is coming out of China also here we have our outcome of cases and you can
see that the death rates as more and more of these undetermined cases go to
the side of recovery that death rate is falling that is not a case fatality rate
we’re going to talk about that here in just the bits again looking at the
latest updates one new case in Canada this used to be a very small section
here where you could look at multiple dates and now things
have just taken off in different places North America here on February 27th new
case in Ontario the husband of the previously confirmed case in Toronto
we’ve got Europe in the Middle East and you can see here all of the different
cases 20 new cases in France for instance five new cases in Sweden 14 new
cases in Germany Italy has now actually relaxed its testing criteria recent
travelers to outbreak areas will not be tested anymore unless they show symptoms
and that may be because they may be low on testing that’s just speculation not
exactly sure if that is the case we’ve got two new cases in the UK four new
cases in Switzerland in Asia the number of new cases in South Korea has actually
topped to China for the first time this is the article entitled coronavirus
fatality rates vary widely depending on age gender and medical history some
patients fare much worse than others this is in a jam a review article where
they actually looked at 72,000 copa 19 cases and there was a dramatic shift
we’ll put the link to this article in the description let’s go right to the
actual article characteristics of an important lessons from the corona virus
disease 2019 outbreak in China this is seventy two thousand three hundred and
fourteen cases pretty big numbers realizing of course this doesn’t capture
the entire picture but it’s a good peek at what it is that’s going on let’s just
jump to the box findings I like JAMA that they box these findings for you
very concisely so out of seventy two thousand three hundred fourteen cases
confirmed cases were forty four thousand suspect the cases sixteen thousand
diagnosed cases ten thousand asymptomatic less than a thousand here’s
the age distribution of actual infections in this study and you can see
the vast majority of infections occurred in people thirty to seventy nine years
of age that may be because most of these people were out and about but you can
see here that as you get younger ten to nineteen less than ten there was a
reduced population what about the spectrum of disease overall eighty one
percent of these cases were mild fourteen percent were severe and five
percent were critical the thing that everyone’s looking for is
the case fatality rate so overall all of those cases had a case fatality rate of
2.3 percent but how did that get distributed you can see that one of the
highest age-related case fatality rates was in people aged 80 years and over and
that was fourteen point eight well if you’re in the decade before that seventy
to seventy nine eight point zero percent you can see that it came down
dramatically what about those who were less than nine
if you were to go down into the body of the paper there were no deaths in
anybody nine years of age or younger and if you did have a critical case your
chances of making it were about fifty percent so what about all those people
that are 30 to 80 years of age well if you actually calculate the numbers you
get approximately a one point two percent case fatality rate let’s look at
healthcare personnel that were infected of the forty four thousand that were
confirmed 3.8 percent of them were healthcare personnel and sixty three
percent of those were in wuhan in total there were only five deaths in this
group and they also tell you about how they determine which ones were mild and
which ones were severe etc mild was determined as non pneumonia or mild
pneumonia however fourteen percent were severe
well what is severe these are people that had shortness of breath a
respiratory frequency rate of greater than thirty per minutes a blood oxygen
saturation that was less than 93% or a partial pressure of oxygen fraction to
the oxygen ratio of less than 300 what is this less than 300 mean it’s a
determinant of how much oxygen they have to give you to keep your oxygen levels
up the more oxygen that they have to give you to keep your oxygen levels up
the lower this number goes so you want to have a high number this is called a
PF ratio a lung infiltrates that is more than 50% within 24 to 48 hours and 5%
were critical respiratory failure they’re on ventilators they’re in septic
shock or they have multiple organ failure no deaths were reported among
mild and severe cases however among critical cases the case fatality rate
was the flip of a coin those with pre-existing comorbid
ditions 10.5% for cardiovascular disease 7.3 percent for diabetes six point three
percent for chronic respiratory disease six percent for hypertension five point
six percent for cancer and among the forty four thousand cases a total of one
thousand seven hundred and sixteen where health care workers or about three point
eight percent a lot of whom were in wuhan here is a key point kovat nineteen
rapidly spread from a single city to the entire country in just 30 days
the sheer speed of both the geographical expansion and the sudden increase in
numbers of cases surprised and quickly overwhelmed health and public health
services in China particularly in Wuhan City and Hebei province epidemic curves
reflect what may be a mixed outbreak pattern with early cases suggestive of a
continuous common source potentially zoonotic spillover at the Hunan seafood
wholesale market and later cases suggestive of a propagated source as the
virus began to be transmitted from person to person and here we have this
graph this is a great graph we see going along here rather undetected and then
all of a sudden we see this huge increase depending on whether or not
you’re looking at the date of onset of the cases or the data of diagnosis of
the cases in either situation if we look at the date of onset we can see here
that things start to spread very very quickly and overwhelm the healthcare
delivery system no deaths were reported among mild and severe cases I think
that’s a pretty extraordinary statement whether you believe the numbers or not
especially seeing based on this study the majority of the cases were mild and
severe and 5% are critical and half of those are dying so we can see by looking
at this that the key is going to be early detection and this brings up
another interesting article here Co diagnostic stock soars 57 percent on a
high hopes for its coronavirus test so if you looked at our last update you
would have seen that the current CDC kits are not performing like they should
be you may remember the case in San Diego that was released early after
they determined initially that the patient was negative only to retest and
find that the patient was in fact positive and that could be because of a
somewhat lower sensitivity of the test instead of it being 97% it’s as low as
70 percent well here is possibly a new test that is developed by Co Diagnostics
it’s a month to date gains to 333 percent after the company said it
received AC e mark for its tests and this indicates that the test is
compliant with health and safety standards and is now gonna be allowed to
be sold in the European Economic Area there is an analyst that says that this
test is easier to use than the test in use by the Centers for Disease Control
and Prevention well we’ll see what happens with this and hopefully if it
does work it’ll be more available and faster than the current testing that we
have because of this article about the California issue that we have in
Sacramento with the patient that was diagnosed as we talked about in our last
update some California health workers held in isolation quarantine after
exposure to corona virus patient this is what we’ve been talking about and that
is if somebody comes in to the hospital and has corona virus but we don’t know
that and we can’t detect that until they’re on the ventilator and then we’re
worried because they have a viral pneumonia and none of our tests are
positive then we get it tested and it’s positive we’re gonna look back and see
which healthcare workers were in contact with that patient and then we’re gonna
have to quarantine them dozens of health care workers in Solano County California
are under isolation and some will be quarantined after being exposed to a
patient who recently tested positive for the corona virus now we talked about
this as it turns out this patient visited centers at two hospitals in
North Bay vaca Valley Hospital in Vacaville and the UC
Davis Medical Center in Sacramento after the patient was transferred there now we
don’t know how many people had to be put on isolation and taken out of service
basically but they say it was under a hundred people now for them to save that
high of a number I’m thinking here that it’s not far under one
people and it kind of goes to show that at just the point where you need to have
as many health care workers as possible to deal with this epidemic you’re gonna
be knocking out a lot of health care workers if you can’t get the diagnosis
right and quickly so the quote here by dr. Matias the county public health
officer said at both hospitals we are at present aggressively evaluating everyone
who may have had contact with this patient they are being identified and
their risk for exposure is being assessed efforts are made to identify
all workers who may have been exposed a spokesman for north bay health care said
and the number of health care workers impacted was a moving target the
announcement comes hours after County Health officials declared a local
emergency and activated its Department Operations Center to identify and screen
those potentially exposed to the coronavirus officials called the virus a
public health threat but cautioned that the risk to the public in Solano County
remains low so that leads me to give you some advice on what to do and we have to
stop thinking about what am I going to do to protect myself and myself only
because what we need to do is we need to start and think like a group to protect
ourselves from this virus and what I mean by that is we need to take steps
not only concentrating on how to prevent ourselves from getting the virus you
really need to think about this hard if you get the virus what are you going to
do to prevent somebody else from getting the virus if we all think this way and
we all act this way together we can prevent a lot of problems so we need to
think together as a group and cooperate and so the number one thing I’m going to
tell you here is get a thermometer and the reason why I’m telling you that is
so you can know objectively if you have a fever the definition of a fever by the
way is a temperature greater than 100 point 4 degrees Fahrenheit or 38.0
degrees centigrade and I know some people will say well I’m always very
cold and therefore this is a temperature for me I understand that but I’m just
letting you know that when you come to the hospital and we check your
temperature these are the criteria that we’re going to use a temper
100.4 or 38.0 if you get a fever I would say the second thing to do is don’t go
to the hospital unless you need to and what I mean by that is be reasonable if
it is only a cold or if it is only mild flu symptoms that you don’t need to go
to the hospital for if you have shortness of breath if you have severe
cough things of that nature those are the things that you need to go
to the hospital for talk to your doctor call in to your nurse do those sorts of
things because if you go you’re going to inundate yourself into the hospital
system you’re going to be another patient that they have to see and you’re
going to expose yourself potentially to other people who might be infected
number three don’t hoard masks there’s 2 types of masks there’s the regular
surgical masks which we all know and then there’s something called n95 masks
let me just tell you right now a regular surgical mask other than preventing you
from touching something and then touching your nose isn’t going to
prevent you from getting coronavirus if you’re breathing in air then you’re
breathing in the viruses in the air and those surgical masks are not designed to
filter air that you breathe in only the n95 masks do that so wearing a surgical
mask if you’re perfectly healthy other than the fact of just trying to remind
yourself not to touch your nose your mouth is going to do you no good so
don’t take those masks those masks are needed for people at the hospital to put
on patients who are already sick now as far as n95 masks those masks are
needed by physicians and nurses and respiratory therapists and other
ancillary service people at the hospital so that they can continue to treat
people there and still be healthy and not have to be quarantined it’s
important that they get that equipment because if they don’t have that
equipment they’re gonna get sick and they’re not gonna be there at the
hospital when you need them to be there number four if you are having severe
symptoms if you are having shortness of breath you’re having dis Nia chest pains
symptoms that are more severe or you’re lethargic that means sleepy you’re not
being responsive these are all things that you should definitely go to the
hospital for it and especially if you’re not getting better but you should call
ahead and find out where you should go because you don’t want to expose people
at the hospital to your virus what they will do is they will probably put a mask
on you like a surgical mask so that you don’t spread the virus to other
healthcare workers if you or your kids have symptoms don’t see Grandma and
Grandpa we just went over what the mortality rates were for people above 70
years and 80 years of age these are some very basic things that you can do to
help prevent spread of disease and to keep our hospitals healthy so that they
can take care of you if you get sick we’re going to take a break and we will
come back on Monday morning thanks for joining us

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