before we do let's just review total confirm eighty 2164 total deaths 2800 oh

one total recovered thirty two thousand eight hundred and ninety seven we see

more of a continuation of what we've been seeing in the past let's go to the

world ometer we gonna talk a little bit about testing today and also the

positivity rate and UK they have well over seven thousand tests of which only

thirteen are positive and that's a very low positivity rate of course in Italy

where they actually have an outbreak they've done over nine thousand tests of

which only four hundred and seventy are positive it's about a five percent

positivity rate in France two point two positivity rate in Austria 321 tests of

which two are positive and then in the United States notice we've only done

four hundred and forty five concluded tests of which fourteen are positive and

that's around three point one positivity rate these tests are not as sensitive as

you may think that you're going to be surprised that the sensitivity on these

tests are only around seventy percent and so it is possible to have a negative

test and to still be infected with the corona virus we see that there are so

far 334 new cases and one death in South Korea and the number of confirmed cases

expected to jump in the coming days as health authorities have started testing

more than two hundred and ten thousand members of this church and Daegu if we

look at the numbers coming out of China and the rest of the world in terms of

the total deaths that seems to be leveling off and if we look at the

number of daily new cases outside of China that has hit its highest amounts

ever on February 26 with daily cases of 569 I want to go to a local site

Eyewitness News here in Southern California a new case

that has been detected in Northern California in a resident who has not

traveled overseas couple things that I want you to be

aware of this patient is a resident of Solano County turns out that Solano

County is the home to Travis Air Force Base where Americans returning from

overseas were quarantined the patient was transferred back on February 19th so

that was about a week ago from undisclosed hospital to UC Davis health

and that is the hospital in Sacramento for the University of California Davis

patient had already been intubated was on a ventilator and was given droplet

precautions orders because of an undiagnosed and suspected viral

condition so there are other viruses that can do this now at the time it

seems as though UC Davis had asked the CDC for testing but this was not done at

the time and if you go to the CDC website it tells you what their

requirements are for testing although they do put a disclaimer that they will

look at a case-by-case basis but essentially unless you traveled to Wuhan

or that part of China they weren't really going to be doing that kind of

testing so it's unclear how eventually UC Davis was able to get CDC to test

this patient but they did and eventually on Sunday the CDC ordered the Cova 19

testing of the patient at that time the patient was put into airborne

precautions what does this mean it means that anybody going into that room had to

have an n95 mask and had to go into contact isolation precautions that means

they would have to wear a gown gloves they may even have to wear I wear

protection if they were not able to do that then they would have to go under

something called poppers where they basically go in with a mask that was

vented from Sunday to Wednesday it took for the CDC to confirm finally that the

patient's test was positive the small number of employees were to go home and

monitor their temperature for any kind of fever or things of that nature

and the key here is to recognize apparently this patient had no travel to

that part of the world they go on to say here at this time the patient's exposure

is unknown it's possible that this could be an instance of

they call community spread of kovat 19 which would be the first time that this

has happened in United States it's also possible however they said

that the patient may have been exposed to a returned traveler who was infected

of course this brings up the issue of anybody that comes when with fever or

signs and symptoms of a viral illness and shortness of breath could be

potentially a carrier of this novel coronavirus and that's why it's really

important to have lots of personal protective equipment at hospitals where

they belong instead of running out at hospital so it's really important that

hospitals have the ability to acquire personal protective equipment because

you don't want to show up to a hospital where the employees there or the doctors

or the nurses don't have the adequate amount of protection so that they don't

pass the virus on to anybody else that might show up at that hospital so please

do not take masks and protective equipment from hospitals for your own

use but this really brings up a big issue and that is how do you test people

for coronavirus how do you know quickly whether or not this person that's coming

in has this virus obviously if we see here in this case it took them from

Wednesday when they actually got the causative test all the way from Sunday

when they first order the tests you can see that that's not the optimal

situation especially when we add to the situation that this test is not really

that sensitive meaning that if you have a negative test you can absolutely rule

it out so enter a study that I think is going to be important and that is this

science Daily News article which talks about this article that was just

published in radiology called CT provides the best diagnosis for kovat

19:00 I will put a link to it in the description below basically what they

did is in China they looked at over a thousand patients and they did this

reverse transcriptase polymerase chain reaction which is what rt-pcr stands for

this is where you look for the actual RNA of the patients and compared it to

the classical findings that they see on CT scan here's another news item of the

same article so title as CT provides best diagnosis for kovat 19 and it says

the study from China shows that chest CT demonstrates better sensitivity than

this blood test looking for the actual pcr of the virus

remember that halfway through the epidemic last month they changed the

criteria in the definition for the diagnosis of kovat 19 so you can see

here in a study of more than a thousand patients that was published in the

journal article radiology which we link to so you can look at it for yourself

chest CT actually outperformed lab testing in the diagnosis of 2019 novel

coronavirus and this was looked at in Wuhan China so it's important to

understand that you have to make an early diagnosis of kovat 19 if you're

going to isolate and you're going to prevent the spread of that disease as we

talked about earlier in a early jam article 41 percent of patients who

contracted Co vyd 19 did so in the hospital and the majority of those 41

percent were healthcare workers according to the latest guidelines by

the Chinese government the diagnosis must be confirmed by reverse

transcriptase polymerase chain reaction or the gene sequencing they say here

however that those throat samples are only about 30 to 60 percent positive at

initial presentation having a low sensitivity implies that there's going

to be a lot of people who will be negative initially and you're gonna miss

those people those people are going to come through into your hospital and

potentially infect other people specifically people who are there to

help and causing them to be taken out of work and put into isolation most likely

and so they say here that early diagnosis of copán 19 is crucial for the

disease treatment and control compared to rt-pcr that is the genetic testing

they say here that chest CT imaging may be a more reliable practical and rapid

method to diagnose and assess kovat 19 especially in the epidemic area so why

did they think that well let's take a look and see this

there was over a thousand patients who underwent both CT chest and rt-pcr tests

from January 6 to February 6 and what they did was they looked at all of those

people who had a positive PCR and there was about six hundred and one of those

and everybody that had a positive CT scan and there was eight hundred and

eighty eight of those and then they asked the question well what's the

sensitivity what's the specificity and what's the accuracy and what they found

was that about eighty one percent of patients with a negative rt-pcr

but a positive CT scan were reclassified as highly likely or probable cases with

kovat 19 based on the comprehensive analysis of clinical symptoms typical CT

manifestations and dynamic CT follow-ups what they mean by that they were getting

worse and they were consistent they also found in a lot of these that the initial

tests may have been negative but that follow-up tests turned positive

confirming in a lot of these cases the original CT findings let's review those

results the results showed that 59 percent of these patients that they

tested had PCR results that were positive eighty eight percent had

positive CT scans they said that the sensitivity and this is something that

you want to be very very high in this situation because something that is very

sensitive means that if it is negative you can practically rule it out and as

it turned out that sensitivity of chest CT was 97% based on positive rt-pcr

results in patients with negative rt-pcr results seventy-five percent of those

patients had positive CT findings and of those forty eight percent were highly

likely cases so what we're seeing here is that CT scans may be the way to get a

quick screening of whether or not your patient with fever is likely to have

kovat 19:00 but the question is what are the findings on CT it's good enough to

know that you should get a CT but what is it that you should be looking for I'm

going to link in the description below a youtube video describes the findings

on CT scan of known cases of copán night and that concludes our update for today

realize that many of these videos are made the evening before they get

released because I still am working in the intensive care unit seeing patients

every single day and so this is something that I do at the end of the

day because we as healthcare providers are on the front line and we have to be

prepared thanks for joining us