welcome to another MedCram coronavirus update and we've got some news today
this is for the 12th of February 20 20 so the new name that the WH o is given
the virus is called Tsarskoe v2 and the disease that it causes is being known as
kovat 19 so that's the new nomenclature this is the name of the virus and this
is the name of the disease sort of like HIV and AIDS this is the virus this is
the disease and let's take a look at the update again just the word about these
numbers we believe these numbers are probably under reporting here we don't
know how much they're under reporting it's because only the most severe cases
in China are actually being tested if you look here of the total deaths and
total recovered that leaves another 40,000 people that are somewhere between
death and totally recovered so only time is going to be able to tell that if we
go to our friends over at world ohmmeter you'll see here a nice graph of where we
are in total cases we can see that it's kind of been leveling off a little bit
if we go to logarithmic you can see again a little bit more of a leveling
off unclear whether or not that is related to the number of test kits like
we were talking about or whether or not there's an actual leveling off it's kind
of interesting to see something that they've added that we talked to them
about is this cases outside of China and we'll get to that here so if we go down
to the bottom of this page now they start looking at total cases excluding
mainland China and in terms of those cases we are not seeing a leveling off
but more of still this epidemic so it looks as though things are still taking
off outside of China we are not seeing an asymptotic leveling off but rather
still going up when we look at cases per day we can see here that just in the
last couple of days we've had the most number of cases outside of China being
diagnosed I want to talk a little bit about the viral infection itself and
immunity for that we're going to draw out a little bit of a schematic here and
how this happens so the first thing that happens is of course you have this virus
particle which will draw as stars and these stars are outside
the body so this could be an airway this could be inside the GI tract etc etc so
this virus goes in and latches on to cells receptors and it causes these
cells to become infected with the virus and of course the virus takes over the
machinery of the cells and it causes it to make more of it and proteins and so
these cells will be coated with these proteins on the outside and of course
more particles are made these cells explode and they release more and more
of these virus particles so what is going on at this point is you've got
here on the blood side you've got things called
cells which are blood cells and one of those cells is called an antigen
presenting cell and so these cells start to go in and extravasated blood into the
tissue and they're able to recognize these cells that are abnormal because of
these abnormal proteins on the surface so these antigen presenting cells
envelop and destroy these virally infected cells so let's show a little
bit more of a close-up of how that happens so we have this antigen
presenting cell and inside the antigen presenting cell is the cell that is
infected with virus and it's got virus particles on it and so what's very
important what this antigen presenting cell does is it presents the antigen so
here is the antigen presented on the outside of that cell this is the most
important thing that the antigen presenting cell can do because what it
then does is it meets up with something called a th one response or a cd4
positive cell and this cell here is the mastermind behind your cellular mediated
immunity because this antigen here will latch on to this cd4 positive th one
cell and it will release il-12 which is a chemical that comes from the antigen
presenting cell that stimulates the cell to go and fight anything that looks like
this on it that antigen and so there's major responses that can occur number
one is that these th one cd4 cells will then stimulate another type of T cell
called the cd8 cells and those are killer cells and they go
out and all they do they will kill any cell that has those antigens on it
that's a very important thing and the way that that happens is it has little
proteins on the surface that will recognize this and cause docking to
occur so you want that connection to be very very tight another thing that this
th one can do is it can stimulate in the blood and tissue B cells and these B
cells will produce antibodies that look like this and these antibodies will bind
to these antigens and neutralize them so this really is immunity and this is the
key that allows you to survive a viral infection let me be very clear about
this this is probably one of the most important things that you can have going
for you when you have a viral infection this is what determines whether or not
you get admitted to the floor or whether or not you go to the intensive care unit
because if this reaction doesn't occur correctly and this immunity doesn't get
on top of the viruses quickly and limit them kind of quarantine in this then you
get wide viral infections all over the body and the amount of infection causes
more immunity which causes more inflammation and that's why people die
and so while the best way to prevent you from ending up having something bad
happen from corona virus is to avoid getting the virus in the first place if
you do get corona virus you want your immune system working perfectly and
wouldn't it be nice if there was something that we could do to enhance
this il-12 response to enhance the ability of this binding to occur to
enhance the ability of cd8 killer cells to bind their targets and to destroy to
enhance the ability of th one cd4 cells to create and stimulate actually these B
cells to make antibodies well there actually is something that we can do
that can enhance this number one it's not a drug number two it's absolutely
free there's no money involved number three you can do it anywhere and I'm
sure by this point you're probably saying what possibly could this be and
you pulling my leg on this this is probably one of the biggest things that
you can do to protect yourself from this viral infection causing a problem or any
other viral infection and there are absolutely no side effects to it and the
answer is sleep that's right sleep and enough of it greatly enhances
the ability of the antigen-presenting cell binding to the th1 and promoting
il-12 sleep also prevents the breaking up of this binding site with cd8 killer
cells with the antigen and we'll show you the research that's done this I have
peer reviewed papers in extensive research over the last 20 years that
sleep has a tremendous effect on your immune response against viruses I will
show you a paper here here we have on the left side a cytotoxic T cell this is
the cd8 cells this of the cells that kill and here we have an infected cell
with either CMV or EBV in the paper so what they showed was that there is a
g-protein receptor here on the cell and when it is activated by either
isoproterenol epinephrine or norepinephrine these are hormones
typically that are elevated in wakefulness that this wakefulness
hormones would activate this receptor in the killer T cells and it would cause a
inhibition of these beta to integrand proteins that allow binding to these
infected cells and destruction and so the opposite was true when the patients
were sleeping because these hormones were at very low levels that prevented
the inhibition of this GA s G protein which caused better binding and more
effective killing of these infected cells so do you know how much sleep in
adult in the United States should be getting according to the recommendations
and you can look this up at the CDC they should be getting between 7 & 9 hours a
night do you know how many people actually get at least 7 hours of sleep
per night about 60% that means there's about 30 to
40% of us that are getting less than 7 hours a night these are the people that
are at the highest risk for the effects sleep deprivation and these are exactly
the same conditions that a lot of our health care workers in the United States
are under these are physicians these are nurses these are respiratory therapists
who are chronically sleep-deprived because of shifts because of working at
night and these are the ones that are gonna be on the front line dealing with
this virus think about a lot of the physicians that are working in China
right now and all of this is to the detriment of their immune system at the
beginning of the night when you go to sleep normally let's say around 10:00
p.m. the first thing that occurs is that you should be having more slow-wave
sleep at the beginning of the night and towards the end of the night more REM
sleep well they're starting to see that slow-wave sleep is integral in the
production of growth hormone and growth hormone has tremendous effects on
immunity and this is especially involved as the papers will show that I'll upload
to the description in the secretion of il-2 elv which is what we recall is the
thing that causes the antigen-presenting cell to stimulate the th1 response with
the cd4 cells so that's tied to slow-wave sleep this is the sleep right
here that occurs generally speaking between 10:00 p.m. and 1:00 a.m. in the
morning and this is the sleep that we cut off the most by going to bed late
and so we're losing out on growth hormone and our immunity stinks because
of it I want you to think what's happened to our ability to sleep over
the last number of decades so this is when we would normally go to sleep
around 9:00 to 10:00 p.m. and occasionally people would wake up in the
middle of the night and be awake for a little bit and then they would get up
again in the morning around 5:00 to 6:00 a.m. this is the time that we used to
have for sleeping and how much time is that so for about 9:00 to 5:00 would be
about eight hours of sleep according to the CDC and most of the research plenty
of time but what's happened because we've moved away from an agrarian
society to more of a urban society we've had to push this back because we have to
get up earlier because of traffic and what's happening is we're living out in
the suburbs we're living it further out and all the jobs are in the cities and
so there's traffic and so sleep has taken a big toll there and we're not
able to get as much sleep but on the other side there's also been a push and
why is that because of electricity and the other thing is electronics so think
about iPads smartphones in general 20 years ago television movies internet all
of those sorts of things and so the key here though is all of this is light
that's stimulating the eyes and when you stimulate the eyes with bright light it
pushes your circadian rhythm and delays it and so what you're losing out on is
sleep there and so what's happened is we've gone from society where we were
getting eight hours of sleep before and now getting five to six hours of sleep
that is going to translate into decreased immunity so the question is
how can we get this back because I believe this is one of the things that
we can do in the face of this coronavirus that we don't have to ration
we don't have to worry about do we have enough of this to go around for
everybody in an epidemic because this is something that's available to everybody
is getting plenty of sleep to help with immunity
in addition to me being a pulmonary and critical care specialist that takes care
of the unfortunate effects of the virus with people with a RDS and on the
ventilator I also happen to be a sleep specialist and I know that there's a lot
of people out there that have problems with sleeping some have insomnia some
have sleep apnea some have a number of these things and for each person it
might be an individual thing but there are some basic things that we can do to
improve our sleep and so for the next couple of updates we're going to talk a
lot about coronavirus or as it's called now SARS Cove 2 or cove at 19 but we're
also going to talk about practical things that we can all do as individuals
to help bolster our immunity and be prepared for anything that might come
thanks for joining us