since the updated criteria for the diagnosis has gone to just a lung scan

and a clinical history consistent with coronavirus 64,000 436 total deaths 1383

total recovered is six thousand eight hundred eighty six about five times the

total deaths is the total recovered let's take a look at the world of meter

and we can see here total cases outside of China have kind of remained constant

because there hasn't been that redefinition causing a slew of new cases

let's take a look at see what's going on inside China or total cases overall if

we look down here at new cases there's been a dramatic drop in the number of

new cases probably because there was a number of cases that were reclassified

we'll have to watch this and see how things go now remember what we're

talking about these total cases is based on the number of people presenting to

hospitals that can get work done on them based on some reports that we've been

seeing especially out in New York Times there's been a crackdown and a rounding

up of people and holding them in quarantine and not getting the medical

treatment that they need some people of course too scared to go and not wanting

to get treatment and so it's unclear exactly how many people are not being

counted here but it's apparent that this is still being under counted in terms of

total deaths there has been a jump and that doesn't seem to be cooling off

anytime soon unfortunately

for the same reason why the total number of cases may be underestimated the total

deaths may be underestimated as well on the worldA meter latest updates for

February 14 we see that there's a report from Hebei province for yesterday that

there was four thousand eight hundred and twenty three new cases including

three thousand and ninety five that were clinically diagnosed we can see here

that the testing was just kind of under estimating those chronically a hundred

and sixteen new deaths and eight clinically diagnosed so we can see that

the clinical diagnosis addition to the count is greatly influencing the number

of new cases whereas it's not affecting the number of deaths as much total human

of cases we can see here that five thousand three hundred and eighty four

were clinically diagnosed we talked about that what's interesting here is

that thirty six thousand are currently hospitalized that's an incredible amount

of people that are hospitalized and you can see here that seventy three percent

so the vast majority of them are in mild condition whereas eight thousand are in

serious condition and about four point six percent are in critical condition

there's a number of people that are undergoing medical observation because

of either their contact or other symptoms that they may have two new

cases in Japan one of them being a surgeon at a hospital who developed a

fever and in still continue to work as usual and saw patients for three days so

that's probably gonna have to be followed up on as well okay I want to

discuss three things today I want to talk about the New England Journal of

Medicine article that actually we referenced back at the end of January

want to talk about cell phones in China and I also want to talk just briefly

about sleep and circadian rhythms and some more reading so first of all let's

talk about the New England Journal of Medicine so there was this article that

was published in the New England Journal talking about a visitor from Wuhan China

who visited in Germany for a business meeting and it was reported in the New

England Journal of Medicine that this woman who came over was asymptomatic and

when she flew back to China she developed symptoms of fever and the

symptoms of the corona virus had later tested positive and when they test heard

her friends that were at the business meeting in Germany they had already

become sick and then got better and they tested

positive for coronavirus and it was touted at that time that this was

evidence that coronavirus could be spread even though the patients were

asymptomatic well as it turns out there's been a correction on this new in

Journal of Medicine case and we'll post a link in the description what they

found out was that before they printed they had not actually reached out to

this index case from China and discussed with her if she actually had symptoms

they reported that she was asymptomatic but in reality she actually was

symptomatic in fact she was taking medications to suppress a fever and was

having very mild symptoms but was having them nevertheless so what does this mean

does this mean that coronavirus does not shed when the patient is asymptomatic no

there's still people that believe that and they may be correct all it means is

that you can't use this New England Journal of Medicine case to support that

theory so I think that's an important distinction that needs to be made and it

tells us that we've got to be careful in this world of rapid information that we

get it right before we spread the information because spreading false

information can have consequences the other thing I want to mention with cell

phones we will link to a article also in The New York Times about what they are

doing right now in China in terms of cell phone use of course in China they

have three cell phone providers that are run by the government and wherever you

go of course that phone is GPS right so if you go to any particular province

it's gonna keep track of that on the phone well what they've currently worked

out through these phone companies is if you text a particular number to them it

will show on the phone right in front of you exactly which provinces in China you

have been in in the last two weeks one month however they want to do it and

they just list it and so what's going on now is people are coming in to various

places to various checkpoints the customs agents the military personnel

who are enforcing these banned are actually asking people as they come

off to text on their phone exactly this number and up there will pop where they

have been in the last month or so and of course if Luhan is on there or specific

province that Wuhan is in pops up there in some cases not letting them go and

they're redirecting them so I thought I'd make you aware of that the last

thing I want to talk about real quickly is circadian rhythms now there's been a

lot of questions and what I'm really trying to do is balance how much we talk

about the virus and how much we talked about sleep and this is the reason why

I'm really gung-ho here about sleep number one is according to the studies

that we've talked about in our last updates you can prevent getting the cold

with sleeping appropriately up to five times imagine if I could tell you that

if you took this pill you could reduce the chances of you

getting the corona virus by 80% that would be an amazing way of curtailing

the arnott's or the spread factor of corona virus and that's what we're

seeing not necessarily the corona virus but in

Rhino virus and so I think this is actually significant enough in a

discussion of what we can do practically so in that vein of things there's been a

lot of comments specifically about some things that I wanted to talk about shift

workers circadian rhythm lights and insomnia first of all shift workers I

know there's a lot of health care workers that work night shift so that's

like going in at 7 p.m. and getting home at 7 a.m. or 6 p.m. to 6 a.m. etc here's

the key about shift workers if you're gonna do shift work it's better to

always do shift work and not go back between day and night that's number one

so stay at same shifts the reason why this is important is because of the

second thing we're going to talk about and that is your circadian rhythm if you

don't do that you confuse your body circadian rhythm

number two is make sure that your nights are days and that your days are nights

in other words if you're going to be up at night make sure that it is bright

where you work at night it's also very helpful sometimes to take naps when

you're working if your job allows for that even a 15 to 20

Neb can be very restful number three if you're a shift worker and you get home

make sure you go to sleep right away as soon as you get home don't go out

shopping don't do the kids laundry don't go work outside go to sleep and make

sure that the room is dark to make sure that the curtains are sealed make sure

the window is sealed you are working different shift from what the rest of

the world is doing but you still need your sleep

and so what you need to do is get your circadian rhythm on a completely

different cycle and that way you're gonna get your sleep the problem occurs

is when you want to be one way on the weekends and the other way during the

week that doesn't work so number four continue your routine on the weekend I'm

gonna put a link into the American Academy of Sleep Medicine website that

gives very very good tips on not only shift workers but people who have other

issues with their sleep so the other thing I want to talk about affects all

of us is circadian rhythm and light so there's two cycles that have to be in

perfect harmony in your body for you to get the great night's sleep number one

is the homeostatic and this is just a funny word that tells you basically as

you are awake more and more and more you start to become increasingly more and

more and more sleepy as you sleep more and more you start to become more and

more and more rested it's just like eating and hunger the more you eat the

less hungry you are the longer you go without eating the more hungry you are

and that's pretty easy to understand but there is a bedtime that we have and

there's a wake time that we have and so the other one is circadian and this is

what happens when you go on a jet plane and go to a different time zone and you

get off there's a certain circadian rhythm that occurs and when both of

these are combined together the perfect thing happens is you are asleep until

the morning and then you wake up and then you are awake until the evening and

then you go to sleep and what makes you go to sleep all of a sudden which makes

you get tired around ten o'clock normally or 11 o'clock normally is the

combination of the drive to go to sleep and the drive to stay awake finally goes

away and both of those combined for you to go to sleep the

is that the circadian rhythm can be shifted either to the left advanced or

to the right delayed and what is it that can shift

circadian rhythm it's light and this is the thing that is the bane of our

existence as people who look at electronic equipment whether it's coming

from a TV screen a cell phone whether it's coming from the lights in our house

all of those things at that time of the night when we should be going to bed

especially blue light is going to delay your circadian rhythm so that you become

tired later and later and later and so what happens is you stay up later and

later and later and you don't feel tired until later and later and later but you

still have to get up in the morning to beat the traffic to get into work which

starts at 8:00 or 9:00 or whatever it starts and so that squeezes the amount

of time that you have to go to bed and to get the sleep so by eliminating light

at night the light that causes this delay in your circadian rhythm is

particularly from blue light but bright light exposure at the beginning of your

day when you're starting to get up in the morning has the opposite effect and

it can actually advance your circadian rhythm so what I tell my patients is

that if they have a situation where they're going to bed very very late

because they don't feel sleepy until they go to bed very late and they love

to sleep until eight or nine or ten kind of like my teenager what they need to do

is advance their circadian rhythms so what I tell them to do make sure that

they're exposing their eyes to nice bright lights around 7:00 or 8:00 in the

morning and to avoid light exposure late in the evening let's talk really briefly

about insomnia so some people have an issue with going to bed and for those of

you who have a separate room where your bed is as compared to other parts of

your house this works but many many people have this situation where they

feel tired they're in the kitchen and as soon as they go into the bedroom now

they are wide awake they can't go to sleep and they become very concerned

about their insomnia and there's a number of issues going on here it has to

do with classical conditioning things like Pavlov's dogs that you may

have heard of in experiments and the situation is that you've got your

bedroom and there are things in your bedroom that you have associated with

insomnia and so that comes to your mind as soon as you go into the bedroom and

you can't sleep because you see these things that you've associated with

yourself in your brain for many many times that you can't sleep when you're

in this bedroom and it's sort of like a performance anxiety and it's because

you've associated that bedroom with your inability to perform and the performance

that you need to do in that bedroom is sleep so what do you do if you cannot

sleep in your bed you should leave your bedroom and go to another part of the

house and associate that other part of the house with inability to sleep we

want your bedroom to be associated with you sleeping so in the same vein if it's