Coronavirus Pandemic Update 36: Flatten the COVID-19 Curve, Social Distancing, Hospital Capacities

By | March 14, 2020

Coronavirus (COVID-19) Update 36 with pulmonologist & critical care specialist Roger Seheult, MD of https://www.MedCram.com

Flattening the coronavirus curve has become an important recommendation by many experts. Dr. Seheult explains the idea behind this concept as it relates to a busy intensive care unit as well as other COVID-19 international updates.


00:02
welcome to another MedCram COVID-19 update and as you can see this is now
00:08
become a pandemic this is validated with the numbers that are coming outside of
00:13
China if we go to the world ometer site you can see clearly we’re in the
00:17
acceleration phase here and as a result of this we are seeing some things that
00:22
are very unusual not withstanding of course the stock market which is taking
00:27
a tumble at this point but we’re also starting to see things that we’ve never
00:30
really seen before we’re starting to see official statements made because of the
00:35
fact that there are groups there are fans there are stadiums where when you
00:41
have people congregated together it can spread disease and we’re seeing that
00:45
from the NHL we’re seeing that on the NBA website we’re even seeing spring
00:50
training Major League Baseball being postponed governor Newsom of California
00:56
is now able through an executive order to commandeer hotels motels to house
01:02
coronavirus patients patients in the state have already been moved to hotels
01:06
the Desert Sun reported that a 120 room hotel in San Carlos which is near San
01:12
Francisco has already been tapped to housed passengers from the Grand
01:15
Princess cruise ship there was an executive order released on Thursday
01:19
that includes the authority for Sacramento to take over hotels and
01:23
motels for medical use for coronavirus patients in a move he said will help the
01:27
state of 40 million to prepare for any widespread outbreak we’re also starting
01:33
to see here at the municipal government level Garcetti who’s the mayor of Los
01:37
Angeles urging residents to take steps to protect themselves but they also
01:41
banned all events or conferences with more than 50 people they called these
01:46
common-sense measures in San Bernardino County which is the largest county in
01:51
the United States there’s not even a single confirmed case of kovat 19 and so
01:58
this website here is a very instructive which I’ll put a link to in the
02:02
description below and it has to do with this notion of flattening the curve and
02:06
that’s what I want to talk about today so here’s the curve if you have
02:11
everybody congregating together of course the virus is going to move
02:16
fairly quickly it is thought and if you don’t have protective measures that
02:20
transmission is going to be very rapid but then just as quickly because you
02:25
have burned a large swath in the population of people there’s gonna be
02:31
immunity that is built very quickly in the survivors and then the curve is
02:36
going to flatten out quickly as well but there’s going to be so many patients so
02:42
fast coming into the hospital that we’re not going to be able to take care of
02:46
them as it shows here this is the healthcare system capacity way down here
02:51
in terms of the daily number of cases if however we’re able to distance ourselves
02:56
and to shut down the transmission of the virus by spreading us out so we’re not
03:01
in close contact with each other if we’re not congregating together in large
03:07
masses then the daily cases it is thought is going to come up slowly even
03:12
if it’s the same number of people we can spread those out so that the amount of
03:17
cases that we’re seeing on a daily basis doesn’t exceed our ability to take care
03:22
of those people and we can kind of see that happen in the early phases of this
03:25
epidemic in China in the epicenter of this outbreak in Wuhan the mortality
03:31
rate was calculated to be higher than the mortality rate outside of course
03:37
this is not a case fatality rate because we don’t know exactly the toll and we
03:41
don’t know exactly the denominator in the numerator involved in that but if
03:45
you were to compare those two you would see that the number of deaths divided by
03:50
the number of confirmed cases was lower outside of Wuhan than it was inside of
03:56
Wuhan and of course the reason for that was that the hospital capacity was just
04:01
not there and that was part of the reason why the Chinese felt it was
04:04
necessary to build thousand bed hospitals it was to take care of this
04:09
swell of daily number of cases and that distancing is going to slow down the
04:15
virus but as it has turned out here from this not peer-reviewed paper that is
04:20
ready for publication
04:25
they did extensive research to answer a question that I have been asked several
04:31
times and that is how long does this SARS cough – lasts on surfaces and in
04:38
the air the results are disconcerting it showed
04:43
here that the h k– of 19 or the SARS – was investigated and they showed the
04:49
overall stability is very similar with the original SARS cough one that was
04:53
found back in 2002 they found that the viable virus could be detected in two
04:59
aerosols up to three hours post aerosolization so this is when somebody
05:04
sneezes or if there is an aerosol ation event like if the patient is being
05:09
intubated or if they’re on a positive pressure mask this could be seen up to
05:13
four hours on copper and up to 24 hours on cardboard and up to two to three days
05:20
on plastics and stainless steel which of course has real implications in
05:24
hospitals and in operating rooms these two viruses SARS cover one and SARS Cove
05:30
– exhibited similar half lives in aerosols with meeting estimates around
05:35
2.7 hours both viruses show relatively long viability on stainless steel and
05:40
polypropylene the median half-life was around 13 hours on steel and around 16
05:46
hours on propylene so basically they found that these viruses can remain
05:50
viable and aerosols for multiple hours and on surfaces up to days so you can
05:57
see that the importance here of masks is there but really the key is not touching
06:02
things where this virus may exist and making sure things get wiped down on a
06:06
frequent basis which may give you a question about exactly what could you
06:10
use to make sure that SARS cough – virus would be eliminated and we’ll put a link
06:17
in the description below – EP a website that lists that information going back
06:22
to this flattening of the curve when we eliminates sporting events and meetings
06:28
things of that nature we’re able to drag this out and even though the same number
06:33
of people might become infected we’re able to better take care of them I know
06:37
exactly what it’s like being on the frontline
06:40
and being in the intensive care unit how frustrating it is to have more cases
06:45
than you can actually take care of it doesn’t happen often and it might happen
06:49
for just a short period of time but imagine trying to take care of a very
06:54
critically ill patient and have another patient becoming critically ill right at
06:58
the same time and then as that’s happening something else is happening
07:01
downstairs in the emergency room that they need help with right away you just
07:05
can’t be in three places at once oftentimes when this happens I call in a
07:11
backup physician who’s a colleague of mine who’s in clinic that has to cancel
07:14
clinic and come in and help me instead of being an exception to the rule could
07:19
be the rule itself and obviously nobody wants to have a loved one or be that
07:23
patient in that situation because you want the attention of the doctor to be
07:27
on you when this is happening and of course that’s assuming that everything
07:31
gets done correctly what you don’t want to have is what’s described here in this
07:37
medical staff update and that is distracted doctoring and patient safety
07:41
so imagine someone being interrupted by their interruptions and it’s hard to put
07:46
two thoughts together you’re not dealing with computers when you go into the
07:50
hospital even though there are many computers there you’re dealing with
07:52
physicians physicians who are human beings who have to think and have to
07:57
decide what needs to be done on a patient and they need to take all those
08:00
things into consideration and if they get interrupted because there’s such a
08:04
influx of patients coming in that’s when mistakes can also happen and that’s what
08:09
this article points out and I’ll put a link to this article as well an example
08:13
of this point is a recent event a physician was busy trying to complete
08:16
progress and consult notes while waiting to get a callback on a page that he had
08:21
placed realizing that there were orders that needed to be put on in patient a
08:25
the physician inadvertently placed a medication order into patient B’s record
08:30
which was opened in epic epic for those who don’t know is the medical record
08:34
system the staff complied immediately with the order with patient B getting
08:39
the medication intended for patient a fortunately patient B did not get
08:43
injured by the event but the root cause of this error was the physicians
08:47
momentary distraction while trying to do several routine things out
08:50
once and that is the key and that is generally going to happen more often if
08:58
this is the situation that we have versus this being the situation that we
09:02
have we just don’t have enough hospital beds physicians nurses ancillary staff
09:08
respiratory therapists to be able to deal with this in a safe way
09:13
Popov says that if everyone practices social distancing and practices good
09:18
hygiene it will help slow the spread of the virus so that everyone who will
09:23
eventually need medical care can be properly treated so that what is
09:28
happening in Italy and China doesn’t happen here even though in many parts of
09:33
the country where there are no cases because we really don’t know how
09:36
widespread this virus is because really we’ve under tested so on this update we
09:42
took a little bit of a break from the molecular biology but next week we’re
09:48
going to be getting into a lot of the details of this ace to receptor this is
09:54
the receptor that is targeted by the virus itself and there’s a lot of
09:59
interesting things about this receptor not only from a vaccination and from an
10:05
entry point but this ace to protein is not in isolation it does have a function
10:11
and that function may be modified by the binding of this virus it’s interesting
10:17
to talk about the implications of that modification we’re also going to talk
10:23
about practical things that you can do and what does it mean to have immunity
10:28
please subscribe to this channel if you haven’t already thanks for joining us

>

09:59

interesting things about this receptor not only from a vaccination and from an

10:05

entry point but this ace to protein is not in isolation it does have a function

10:11

and that function may be modified by the binding of this virus it’s interesting

10:17

to talk about the implications of that modification we’re also going to talk

10:23

about practical things that you can do and what does it mean to have immunity

10:28

please subscribe to this channel if you haven’t already thanks for joining us

Speaker: Roger Seheult, MD
Produced by Kyle Allred, PA

MedCram medical videos are for medical education and exam preparation, and NOT intended to replace recommendations from your doctor.
#Coronavirus #COVID19 #SARSCoV2

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