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