days from the updating because it was my turn to take the helm of the ICU what

we're gonna be talking about is number one five new deaths in Washington State

yesterday we are definitely in the growth phase here in the United States

but we can't tell how much of a growth phase there is because we're gonna talk

about testing and the lack of testing and we're also going to talk about

preparation what to do before this hits now we'll talk about mutations we are at

a total confirmed worldwide cases here upwards of 90,000 total deaths is over

3,000 total recovered is well over 10 times that at 47,000 and those are the

published numbers I've heard a number of people talk about the numbers in Asia

and the model to look at in some people's opinion is going to be South

Korea because it is a country that's doing very aggressive testing and it's

an open and democratic country but I think the biggest thing there is the

fact that they are aggressively testing and that's not something that we're

doing yet here in the United States for a number of reasons which we'll talk

about going over to the world ometer website we look at the close cases to

kind of get an idea of where we're going on the mortality because these are close

cases you've either recovered or you haven't and if you look at this graph

you can see that the mortality rate continues to drop these are people that

were tested and we're already at about 6% that's good to go much lower than

that once we get the full scope of the infection here we have total cases

worldwide things were starting to level off here and I think the reason why

we're starting to accelerate again is because we're going into the epidemic

phase in a number of these other countries and looking at latest updates

for today March 3rd maybe a little bit behind because this is a fluid situation

by the time this gets published there are 477 new cases and six deaths

already today in South Korea of course South Korea being in the part of the

world that is the farthest ahead in time

if we look at yesterday we have the first case in Morocco this was somebody

from Italy yesterday 21 new cases and five new deaths here in the United

States and looking to Washington's going to be very important to see what's going

to work in this country and what's not going to work

notice that a lot of these people who are dying are in their 70s however there

is a man in his 40s hospitalized in critical condition in Kirkland one in

Rhode Island and that was a teenager contact of the previous case and all of

these people again went to the same trip to Italy they're saying here this is

precisely why we are being so aggressive in identifying contacts and testing

people who are symptomatic there are three people in California and Santa

Clara County including a couple whose recently traveled to Egypt and there are

now two in Oregon one an adult in a County Hospital in Walla Walla

Washington and the other is a contact of the first case in Oregon who is

recovering at home there's two new cases in Florida and that is the first one in

New York interesting interview on CNBC that's also here on the ward ometer

website dr. Mack McCarthy who is a ER physician at New York Presbyterian he

says I'm here to tell you right now at one of the busiest hospitals in the

country I don't have at my fingertips a rapid diagnostic test I still have to

make my case plead to test people this is not good we know that there are 88

cases the United States they're going to be hundreds by the middle of the week

they're going to be thousands by next week and this is a testing issue quote

in New York State the person who tested positive is only the 32nd test we've

done in this state that is a national scandal

they're testing 10,000 a day in some countries and we can't get this off the

ground McCarthy said I'm a practitioner on the firing line and I don't have the

tools to properly care for patients today and I can tell you I resonate with

that as a health care work I was in the ICU all last week seeing patients in the

emergency room we are taking protective measures to make sure that we don't get

exposed to people coming in to the hospital with kovat 19 causing a lot of

our health care workers to be quarantined and so it's really important

that if anybody goes to the emergency room to call ahead make sure that

they're following instructions make sure that they're wearing a mask especially

if they have a fever and they have symptoms because anybody that they in

fact no matter who they are will have to be quarantined and of course if those

people that are being quarantined are health care providers well that's just

less people to be able to care for other people that need it now the good news

there is that as I understand it there are going to be a lot more tests

available but they're not going to be available until later this week there

are regulations that the FDA imposes on commercial manufacturers of these tests

they have to reach certain goals and it's a long and laborious procedure to

get these things approved by the FDA those are being relaxed so we can get

enough tests on a market and get labs up and running what you ideally want to do

and this goes back to the days of medical school when he were trained in

surgery it was always a good thing if you took somebody occasionally to

surgery for appendicitis and you pulled out a completely normal appendix that

means that you were not missing any that means you work finding negative test

results true negatives so you actually need to screen widely enough so that you

know you're getting enough negative testing what you don't want to be doing

is testing so limited that the number of tests that you're getting you're not

catching the full magnitude of the infection and so I think everyone

believes and everyone's on the same page here that the amount of testing that

needs to be done right now in this country needs to be ratcheted up by

orders of magnitude over what we're getting right now here's a story that

was published in the AP couple of days ago and it talks about what's going on

especially up in Washington where the hot spots are says here as Americans

prepared researchers at the Fred Hutchinson Cancer Research Center and

the University of Washington on Sunday said that they had evidence the virus

may have been circulating in the state for up to six weeks undetected a finding

that if true could mean hundreds of undiagnosed cases in the area they

posted their research online but it was not published in a scientific journal or

reviewed by other scientists trevor bedford and associate professor who

announced the findings on the virus in Washington

State said on Twitter late Saturday that genetic similarities between the states

first case On January 20th and a case announced Friday indicated at the newer

case may have descended from the earlier one now this is gonna be something that

we're going to talk about when we talk about molecular biology is this idea

about descendants so the thing that you've got to understand is that the

virus when it infects your cell it takes over the cells machinery to create more

viruses but the genes that the virus brings in the kind of sloppy and so

because of that sloppiness there's a lot of mutations that are made and some of

those mutations may actually end up changing amino acids some of those

mutations won't translate into difference in amino acids but you can

still see those mutations and as you track those mutations in time you can

see which virus strain descended from another now those mutations can occur

randomly anywhere along the genetic thread the RNA as it turns out in this

case with corona virus but if those mutations affect a key component for

instance the binding protein or the spike protein on the corona virus that

allows it to infect human cells well that virus is just not going to be

able to infect the next human cell but because there's millions and millions

that are made there's always another one right behind it that's going to happen

the bottom line is you rarely are going to see viruses copies of the virus

infecting human cells that have a mutation that is critical in the binding

of that protein and therefore the binding of that site now in this case

the binding site in the human being is the ACE 2 receptor in the cells in the

bronchi or the lining of the lungs so that's a highly conserved area why is

that it's highly conserved because those are the only viruses that are going to

infect the human being but if you look at these just like the human race has

different families different last names because they're related to each other

different coronaviruses different SARS come to different kovat 19 viruses in

other words if you were to look at the ones in wuhan versus the ones in

Washington they are not identical to each other they have mutated in some way

and what you can do is actually come up with

family tree and you can see where these things came from they say I believe

we're facing an already substantial outbreak in Washington State that was

not detected until now due to narrow case definition requiring direct travel

to China scientists not affiliated with the research said the results did not

necessarily surprise them and pointed out that for many people especially the

younger healthier ones the symptoms are not much worse than the flu or a bad

colds he says we think that this has been a pretty high rate of mild symptoms

and can be asymptomatic the symptoms are pretty nonspecific and testing criteria

that has been pretty strict and this is really the key here up to this point you

could not get testing unless you had traveled to that specific portion of

China where the virus was so these combinations of factors means that it

easily could have been circulating for a bit without knowing suggestin less ler

so people are saying that this is high quality work so what I want to do is

talk a little bit more about what is going on with this mutation and I want

to introduce you to a really cool site and that website is called neck strain

and this actually does real-time tracking of pathogen evolution if we

click on the latest data and analysis here what we've got here is the SARS

cuff to genome and I think this is really cool what you can see here we

have the initial strain over here and we can see how through time the DIF

mutations have occurred in a different family trees so if we play this you can

see that things started out here in Wuhan but as things have spread across

the world there's been mutations and we can see what the descendants are as we

track it so interestingly the one here in California it shows that there are

nucleotide mutations from the original there are amino acid mutations in the

ORF 1a gene we'll talk more about that that is the gene in the virus that codes

for the protein that allows it to reproduce the RNA genome of the virus

and if we look down here we can actually see the genome of the virus

is the entire RNA of the corona virus specifically that we're talking about

here the ORF 1 aging and the ORF 1b gene for those of you who are molecular

biology buffs there's actually a overlap in that gene right here that requires a

frame shift on the ribosome to be able to translate both of these and we'll

talk more about that in the coming sessions and updates what this here

represents is where these mutations in the genome are occurring we see that

there's a lot of mutations occurring down here in these small genes and not

so much here this s gene right here it codes for the S protein we can see that

there are some mutations some of these mutations may not be actually changing

amino acids however this s protein is the spike

protein on the very outside of the cell this is the protein that is going to be

binding to the ACE 2 protein on the human lung cells that allows it to bind

and infect them abstence ibly this is the portion of the RNA genome of the

virus that they would be injecting into your cells as a possible vaccine so that

your cells could take this instruction make the S protein inside your body

which would cause a antibody response which would then give you the vaccine

against the corona virus at this point I'd like to talk to healthcare providers

and people who are leaders in their community people who are members of

medical groups this is the time now to start communicating with your patients

educate them what are they supposed to do if they get sick if they develop a

fever if they develop a sore throat if they are otherwise healthy they don't

have shortness of breath they're not hypotensive the best thing to do is to

self quarantine and stay home do not overburden your health care delivery

system they're going to be plenty busy with people who are worse off if you are

going to go to the hospital make sure you call ahead find out what the

procedures are because they're going to want to make sure that you're isolated

they're gonna probably give you a mask things to think about as well as make a

plan on where to go there are hotlines people are going to

be calling in if you have a nurse advice line make sure you double it or

Triplette because the volume of calls are going to increase people are going

to be very concerned if you have the ability to do telemedicine that's what

you should do the corona virus cannot infect somebody

over the phone next thing we need to do is plan for a surge so that means that