Coronavirus Epidemic Update 21: Antibodies, Case Fatality, Clinical Recommendations, 2nd Infections?

Coronavirus Epidemic Update 21: Antibodies, Case Fatality, Clinical Recommendations, 2nd Infections?

welcome to another MedCram lecture
we’re going to talk about the coronavirus update and we see here
75,000 total confirmed cases based on the data from the w8 show and CDC coming
out of China total deaths over 2000 total recovered 14,000 772 if we look at
the roll domitor as it’s correctly pronounced we can see here there’s
active inactive cases the closed case is sixteen thousand eight hundred and
fourteen eighty eight percent of those have been recovered or discharged and 12
percent deaths in the closed cases so far
of course these numbers are been reported as most of those cases were mild cases
however if we break those cases down again into the difference between what’s
going on in China what’s going on outside of China we can get another
picture you can see here the trends is that every day there seems to be more
and more new cases whereas inside of China the number of cases are actually
diminishing as we can see here overall if we go up to total deaths over 2,000
deaths total I want to talk a little bit about what’s going on in terms of what
the labs are doing to fight coronavirus the kovat 19 disease specifically nice
interview here on NPR regarding antibodies first one to talk a little
bit about antibodies and how they’re made so you have these b-cells and they
each have different receptors on these b-cells these b-cells are made to do one
thing really and that is to make antibodies and these receptors on the
cells are there to receive any type of antigen that you might come in contact
with an antigen could be a protein of a virus or approaching of a bacteria etc
etc and what is really quite amazing is that you have so many different types of
receptors on millions and millions of b-cells that’s just about any kind of
foreign protein that gets introduced into your body will make a b-cell
against that and so here we can see that each b-cell has a different antigen
receptor and the antigen receptors of only one b-cell will combine with that
antigen so if you have a virus that virus is going to stimulate its
particular b-cell and it will activate and it will get help from t-cells
cytokines and it will cause this cell to divide and rapidly enlarge into a huge
clonal representation of that b-cell so you have thousands millions of these
b-cells and all these b-cells do is they produce antibodies and these antibodies
go out and attack cells that have the virus in it or the virus itself and
finally when the action is done then these b-cells just
kind of go away but there’s always a certain amount of a population of these
b-cells ready to strike again if that virus comes again and this is typically
how it works with a particular virus so if you get a vaccine against the virus
like polio if you get a vaccine against the virus like the hepatitis B virus
that vaccine goes through the same way here you get an antigen stimulating a
b-cell of course when we give a vaccine in some of the cases we give a vaccine
that has just the protein without the virus so you don’t get the actual
disease and that causes your b-cells to make a lot of these antibodies in
preparation for if you ever were to be infected with that virus you’ll be ready
to make an immune response of course sometimes what happens is the virus may
mutate and so that the proteins are different enough that the antibodies
that you have against those proteins may not be as effective and this is kind of
what happens with colds you might get multiple colds in a year and it’s
possibly because while it could be a different virus a rhinovirus versus a
regular corona virus or it could be a rhinovirus that’s mutated enough so that
the former immunization that you got against the virus is no longer effective
because it’s mutated well going back to this interview what they’re looking at
is drugs that will prevent the virus from replicating but there’s an
interesting company that they’re looking at called AB cell era which they
identify antibodies from patients who have already recovered from infection
because they’re finely tuned immune systems have already figured out a way
to clear the virus and so what they can do is they can look through millions of
different immune cells and find the one that is right for corona virus in fact
what they’ve done and this is kind of amazing as they’ve taken mice and
instead of making Mouse antibodies these mice are actually using human immune
system cells to make not Mouse antibodies but to actually make fully
human antibodies and that’s just amazing so of course the next step is to inject
these corona viruses into these mice and start getting these antibodies out and
actually seeing whether or not they work testing them in trials and then
seeing whether or not this antibody against the coronavirus specifically the
one that makes the kovat 19 disease otherwise known as SARS of 2 is gonna be
effective so this is one of the treatments that’s on the horizon and the
reason why this is really important for us to get as we see here in this USA
Today article looking again at that data from China that we talked about
yesterday they’re looking at statistics here and they’re saying that the corona
virus is 20 times more lethal than the flu based on the case fatality rates as
the death toll as we talked about passes 2000 we can see here that based on the
calculations that they were doing the global death toll from the virus was
listed at 2009 as of Tuesday evening and that the total infections rose to more
than 75,000 that if you do the calculation the overall death rate for
the virus was 2.3 percent however the seasons flu death in the United States
was at about 0.1% making this of course a more deadly than the regular flu but
not as deadly as the SARS outbreak back in 2002 which was at around 10% unfortunately we have to talk about
another physician who’s died in China dr. leo
he was the director of Chinese hospital at the epicenter the corona virus
outbreak and was one of the neurosurgeons as well so these b-cells
and how they become plasma cells and how they secrete immunoglobulins or
antibodies it’s all very specific and distinct including how viruses infect
the human cells this is something that would like to go into a little more
detail there’s been a lot of questions about immunity and what happens after
someone recovers and we’ve seen some examples in the United States of people
who have recovered specifically the gentleman in Washington but there’s been
some questions some rumors and some claims that people can get the virus
twice and that for instance people can have a lot worse reaction the second
time around and that there may not be immunity I haven’t seen any reports of
that and so it’s very difficult to come up with an answer to that question I
think it might be a little early in the course to see if that is in fact
happening and one thing I will make a point of however is that oftentimes when
someone gets a viral infection their ability to withstand secondary bacterial
infections is reduced and so it’s not uncommon to have secondary bacterial
infections when someone has a severe viral infection and so I want to end
this update with an excellent article that was published on the 12th of
February 20 20 on the practical recommendations for critical care and
anesthesia teams caring for novel coronavirus
patients and I will put a link in the description below this article that is
written in Canada talks about their experience with the SARS virus back in
2002 and it talks about very practical things to do for instance in the
intensive care you know what kind of personal
protective equipment to be wearing how the flow of air in these rooms whether
or not they’re negative or positive pressure rooms are very important for
instance if you are doing generally speaking an operation that’s in an
operating room in that room is run under positive pressure ventilation something
that of course you would never want to have happen if you’re doing an operation
on somebody with this kind of virus and so they talked about switching those
kind of patients into negative pressure rooms to do the operations so that you
don’t infect other people in the hospital and so I think it’s an
excellent read for physicians health care providers who are going to be
taking care of these coronavirus or kovat 19 patients it also talks about
when to use and 95 masks versus these powered air purifying respirators
otherwise known as poppers and who should be wearing them and talking about
for instance hot zones warm zones and cold zones hot zones being in the
patient’s rooms specifically where there’s negative pressure ventilation
warm zones when you’re outside the patient’s room but still in the
intensive care unit and then finally cold zones when you’re outside of the
intensive care unit so I think this is really important information and again
we will put a link to it in the description below thanks for joining us

100 thoughts on “Coronavirus Epidemic Update 21: Antibodies, Case Fatality, Clinical Recommendations, 2nd Infections?”

  1. Please subscribe to receive notifications about new videos and visit us at
    Where we have short videos on over 60 medical topics (asthma, insomnia, hypertension, etc.)
    Quick links to our other videos on Coronavirus (COVID-19):

    – Coronavirus Epidemic Update 20: Misinformation Spread, Infection Severity, Cruise Ship, Origins:
    – Coronavirus Epidemic Update 19: Treatment and Medication Clinical Trials:
    – Coronavirus Epidemic Update 18: Cellphone Tracking, Increase in Hospitalizations, More Sleep Tips:
    – Coronavirus Epidemic Update 17: Spike in Confirmed Cases, Fighting Infections with Sleep (COVID-19):
    – Coronavirus Epidemic Update 16: Strengthening Your Immune Response to Viral Infections (COVID-19):
    – Coronavirus Epidemic Update 15: Underreporting, Prevention, 24 Day Incubation? (COVID19):
    – Coronavirus Epidemic Update 14: Hospital spread of infection, WHO allowed in China, N-95 masks:
    – Coronavirus Epidemic Update 13: Li Wenliang, nCoV vs Influenza, Dip in Daily Cases, Spread to Canada:
    – Coronavirus Epidemic Update 12: Unsupported Theories, Pneumonia, ACE2 & nCoV:
    – Coronavirus Epidemic Update 11: Antiviral Drugs, Treatment Trials for nCoV (Remdesivir, Chloroquine):
    – Coronavirus Epidemic Update 10: New Studies, Transmission, Spread from Wuhan, Prevention (2019-nCoV):
    – Coronavirus Epidemic Update 9: Fecal-Oral Transmission, Recovery vs Death Rate:
    – Coronavirus Outbreak Update 8: Travel Ban, Spread Outside of China, Quarantine, & MRSA:
    – Coronavirus Epidemic Update 7: Global Health Emergency Declared, Viral Shedding:
    – Coronavirus Outbreak Update 6: Asymptomatic Transmission & Incubation Period:
    – Coronavirus Update 5: Mortality Rate vs SARS / Influenza:
    – How Coronavirus Kills: Acute Respiratory Distress Syndrome (ARDS) & Treatment:
    – Coronavirus Update 3: Spread, Quarantine, Projections, & Vaccine:
    – Coronavirus Symptoms, Diagnosis, Treatment:
    – Coronavirus Outbreak – Transmission & Updates:

  2. The 2 or 3 percent is irrelevant if hospitals are going to be overwhelmed by the 15% of infected that will need hospitalization. As soon as there aren't enough beds, oxygen equipment to pump the lungs & enough doctors & nurses around to take care of the patients, that 2% fatality rate will shoot to something closer to 10%.

  3. Went back to your first Covid 19 video yesterday and watched all of them because I had only watched four. Wonderful videos that are easily understood. I understand more about the process of viruses work. Thanks for the great information.

    I was not as good at hand washing as I thought, I do turnoff water with the back of my hands however…I now sing Happy Birthday twice. LOL

  4. 19)
    Section NavigationDisposition of Hospitalized Patients with COVID-19
    alert icon
    On February 11, 2020 the World Health Organization announced an official name for the disease that is causing the current outbreak of coronavirus disease, COVID-19. CDC will be updating our website and other CDC materials to reflect the updated name.

    Summary Page
    Who this is for: Healthcare providers and public health officials managing patients with coronavirus disease (COVID-19).

    What this is for: To help prevent the spread of COVID-19 in healthcare facilities.

    How to use: Reference to guide healthcare staff and public health officials regarding discontinuing transmission-based precautions and discharging hospitalized patients with COVID-19.
    Summary of Recent Changes
    Revisions were made on February 11, 2020, to use of laboratory testing results:

    Negative rRT-PCR results from 2 sets of nasopharyngeal and throat swabs collected at least 24 hours apart from a patient with COVID-19 are needed before discontinuing Transmission-Based Precautions is considered. A total of four negative specimens are needed to meet this requirement.
    Limited information is available to characterize the spectrum of clinical illness, transmission efficiency, and the duration of viral shedding for patients with COVID-19. Interim guidance for discontinuation of Transmission-Based Precautions and disposition of hospitalized patients has been developed based on available information about COVID-19 and what is known about similar diseases caused by related coronaviruses (MERS-CoV and SARS-CoV). This guidance is subject to change as additional information becomes available.

    For non-hospitalized patients, see (Interim Guidance for Discontinuation of In-Home Isolation for Patients with COVID-19).

    For Hospitalized Patients with COVID-19 Under Transmission-Based Precautions:
    Currently, hospitalized patients with COVID-19 should be cared for in an Airborne Infection Isolation Room (AIIR) using Standard, Contact, and Airborne Precautions with eye protection.
    If an AIIR is not immediately available, consideration should be given to transferring the patient to a facility that has an available AIIR. If transfer is impractical or not medically appropriate, the patient should be cared for in a single-person room and the door should be kept closed. The room should ideally not have exhaust that is recirculated within the building without high-efficiency particulate air (HEPA) filtration. Healthcare personnel should still use gloves, a gown, respiratory and eye protection and follow all other recommended infection prevention and control practices when caring for these patients.
    If there are not enough AIIRs to care for patients with COVID-19, existing AIIRs should be prioritized for the care of patients who are symptomatic with severe illness (e.g., those requiring ventilator support).
    The decision to discontinue Transmission-Based Precautions for hospitalized patients with COVID-19 should be made on a case-by-case basis in consultation with clinicians, infection prevention and control specialists, and public health officials. This decision should consider disease severity, illness signs and symptoms, and results of laboratory testing for COVID-19 in respiratory specimens. Guidance for discontinuation of in-home isolation precautions is the same as that to discontinue Transmission-Based Precautions for hospitalized patients with COVID-19. Considerations to discontinue Transmission-Based Precautions include all of the following:
    Resolution of fever, without use of antipyretic medication
    Improvement in illness signs and symptoms
    Negative results of an FDA Emergency Use Authorized molecular assay for COVID-19 from at least two sets of paired nasopharyngeal and throat swabs specimens collected ≥24 hours apart* (total of four negative specimens—two nasopharyngeal and two throat). See Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Patients Under Investigation (PUIs) for 2019 Novel Coronavirus (2019-nCoV) for specimen collection guidance.
    *Initial guidance is based upon limited information and is subject to change as more information becomes available. In persons with a persistent productive cough, SARS-CoV-2-RNA might be detected for longer periods in sputum specimens than in upper respiratory tract (nasopharyngeal swab and throat swab) specimens.
    Disposition of Hospitalized Patients with COVID-19:
    Patients can be discharged from the healthcare facility whenever clinically indicated.
    Isolation should be maintained at home if the patient returns home before the decision is made to discontinue Transmission-Based Precautions. The decision to send the patient home should be made in consultation with the patient’s clinical care team and local or state public health departments and should include considerations of the home’s suitability for and patient’s ability to adhere to home isolation recommendations, and potential risk of secondary transmission to household members with


  5. One reason to pay attention in school is to build foundational understanding so that one can consume and appreciate this information.

  6. First coronavirus patient had NO connection to Wuhan seafood market – so did the disease start elsewhere? this came out on my twitter

  7. Yes the info you give is sober and informative. Although by 1:19 u make it sound like the diminishing cases are real numbers. Yes u said they were still underreported. In my view we haven't seen the peak yet, by large factor. It is unsettling and being too alarmist is not good either, but many innocent lives can be saved by fair warning signs. I'm freaking out about the real situation as it is, but the silence about the real implications makes me worry even more. Hope u understand. Great videos btw. I watch almost every one, learning a lot.

  8. binary outcome recovered compared to deaths 4-5 days previous (est. point of outcome) giving me 11% in available data. Is this a better approx.?

  9. This is the best source for updates on the Corona Virus. Glad I found it!
    The MSM does not discuss the virus at great length. If even at all.

  10. Doctor, as a Primary Care Team RN here in South Korea…I've made it practice that start of new days which happens on days you post, we three sit and listen to you. Your service is doing more than you realize. We thank you.

  11. I was amazed to hear you reveal the reasons for the positive/negative pressure rooms. That's important at home too. At home use temperature differences, fans, ect…. cover up all Air Condition Vents, in the used room. You may use simple Masking Tape. Remember to tape over the door cracks, and any holes in the room. ie… Electric Outlets. Thank you Doctor.

  12. Thanks Doc. Your rational and pragmatic approach to facts are much appreciated and more importantly educational. Thank you for not jumping on the "believe all things Chinese being reported" bandwagon. There are many so called "experts" walking back their words supporting the fact that we truly do not know the truth of this outbreak. The prudent among us are reading between the lines and peacing together the potential reality of this based on leaked information, pictures, videos which tells more of the story than a talking head. You are framing the situation nicely at this point.

  13. I would love to know your response on the family of 5 of which 4 died. It seems to imply that there exist conditions in which pretty much a hundred percent of a group die (5th is critical). What made them vulnerable?

  14. You amaze me Dr Seheult, such dedication producing daily covid-19 vids for all of us, knowledge is not only power but peace of mind knowing the truth, thank you !

    Come on people, show the good Dr and his Med Cram team your appreciation + SUBSCRIBE SUBSCRIBE SUBSCRIBE !

  15. There are more and more cases outside China because countries are not doing enough to stem the spread of the virus!! Plain insanity and irresponsibility!!!

  16. I appreciate that your thumbnail image has been changed to a more serious look during this crisis. Looking forward to someday being able to watch your videos about other medical issues I am interested in.

  17. I would suggest ensuring that a patient’s vitamin D levels are at least adequate (perhaps greater than 30 ng/ml) for supporting the innate immune system – macrophages and natural killer cells – which have vitamin D cellular receptors, and function much more effectively with D circulating.

    SARS coronavirus was found to attack lymphocytes, as well as bone marrow, where these types of cells are often manufactured.

    I propose that a strong innate immune defense, involving cells equipped with ample vitamin D compounds, may more effectively hold coronavirus at bay until the adaptive immune system (B and T cells, antibodies, etc) can specialize.

    Additionally, vitamin A has been shown to down-regulate an overactive immune response. In considering this phenomenon, I also propose that Vitamin A may allow for a less overzealous immune response in the lungs, resulting in a reduced amount of scarring. So perhaps eat your orange vegetables as well.

    Adequate levels of vitamins D and A may well eventually be determined as indicators for who more effectively deals with the novel coronavirus.

  18. I was thinking back to your other video where you say sleep can help fight off viruses. And if you think about how China overworks there own people, I really do think these people need just some time off and rest and take whatever they been giving to the “recovered.”

  19. So how long to those little memory cells last for fighting disease and do they replicate and know the same things after replicating

  20. Foreign Policy magazine says numbers are dropping in China outside Hubei Province because only people with a travel history from Hubei are being tested. So the lower numbers probably only mean fewer people are traveling from Hubei, which would be expected.

  21. You talked about immunity against viruses, and the formation of antibodies. How is HIV different from respitory viruses (like Rhinoviruses and COVID-19)? Why can't antibodies never eradicate HIV?

  22. So there are lies, damn lies and then statistic, oh yea then news paper sensationalism. As you have pointed out in many of your videos the importance of "N" in sampling. As the "N" of COVID-19 is a tiny fraction of the standard flu seconded by the shorter time frame (of COVID-19) and likely the "adverse selection" when it come to the fatality statistics out China (i.e. the infection of hospital workers who infected the critically ill patients) as covered in one of your videos. Keep up the good work!

  23. Why does it say 29 US confirmed cases at the beginning of the video but I look at the live and it still says 15? @MedCram

  24. thank you again for the latest information that is allowed, to be available! Like you I feel that the death rate should be about 30% using the formulae comparing the different viruses sine 1901 era. Another thing you rightly mentioned is the death rate of flu cases in USA is 0.1%but here is the crunch. The world death rate for flu was about 600000 people in USA there were 60000 deaths, that is 10% of all cases, but USA is only 5% of the worlds population…. so when it escapes in USA, watch out.

  25. QUESTION: Do viruses thrive better in an alkaline or acidic human enviroment? Is there a way to adjust the body's PH to thwart the virus and/or help build up our immune systems?

  26. 62 people can't handle logical scientifically based reasoning… Hopefully the lesson incubates in their brains. The rest of us thank you for your ongoing work and commitment 🤘

  27. I still have some friends joke about the Corona virus situation because of my constant awareness of current events.

    I wonder what it’s going to take for the majority of Americans to take this seriously.. 😓

  28. Thanks for making informative videos on a subject that is important to understand without hysteria. Your videos seem to stick to the facts and make a complicated subject much more clear. Thank you so much.

  29. Could anyone tell me what would happen if the coronavirus was mixed with another virus such as the common flue or could an other virus fight it off so could anyone with any knowledge answer these questions thanks

  30. Very good content. No rumors, no misinformation, no fear-mongering, no biases, no anti-China/Chinese gibberish. Just well-researched educational information about COVID-19, this new strain of Coronavirus. Brings awareness, what to expect, and what measures to take to prepare yourself just in case. This is what we need. Unlike many other Youtubers who get a lot more views by spreading a bunch of fear-mongering non-sense.

  31. Can you look into the Diamond Princess cruise ship and see what happened there? There's a Japanese Infectious Disease professor who claims that quarantine measures were not in place at the ship. And that's why the quarantine failed.

  32. Just got 5 infected sent to Sacred Heart to our city in Spokane, WA. Hard to find information as to where they came from.

  33. The number of coronavirus cases is under reported. Most people who have influenza do not go to a physician, so the number of influenza cases is even more under reported.

  34. Chloroquine effective…but how about Quinine also antimalarial; it is put in tonic water. Maybe pharmacokinetics of quinine may be more advantageous…let us know.

  35. When you figure the reported deaths at 2000 are way way underreported then you can bet your butt it is worse than sars by a huge factor. China has 10% of the world's population under quarantine, that should tell people something.

  36. If there is an uncontrolled outbreak, this virus will be more deadlier than SARS. It was shown in Wuhan hospitals, where death toll was about 20 times higher then elsewhere.

  37. How can someone activate Antigen process inside themselves, if the virus hides or not triggering the antibodies. Can someone eat something to start process or how to increase antigen circulation?

  38. I’m in Daegu Korea 31 new cases in one day 30 in Daegu. Things are shutting down here . Mayor said don’t venture out wear masks even inside. Schools closed.

  39. I don't understand why there are no other channels putting out this kind of useful, objective, insightful information about this virus… I literally haven't found one that has proven to be consistently credible.

  40. I'm sorry, I'm not getting the big fuss over this virus right now. Here in the USA the ordinary flu has killed 15,000 people so far and when the flu season ends they're expecting 20,000 deaths or more. It's on its second wave here. No one is talking about it on the news because this is considered normal. You want to see what a real pandemic can do watch a documentary on The Spanish Flu of 1918. That one was so bad that it killed millions around the world. People were told to drag their dead out on their front porch for pickup. None of the normal call the funeral home to pick up your loved one, and forget the prepaid grave plots. The death rate was so high that mass graves had to be dug. Crudely made pine boxes were the norm and those were piled up on the street with the dead in them because the grave diggers were so overwhelmed. It makes this virus look like the common cold.

  41. this morning on the way into work getting past the usual crowed of smokers/ vaper's, it came to my mind is it possible for the virus to cling to the vaping mist that's breathed out and spread via this (similar to how it was expressed as aerosol process, nano size particle clinging to dust in the air)

  42. Worldwide, are the patients that have experienced the various versions of the 2020 version of the flu more or less susceptible to the corona youknowwhat ?

  43. Please read.
    I live in the United States Texas
    They are not doing enough
    If you want to be tested you cannot get tested at a doctor's office you need to go to the CDC and only after you have tested negative for the flu.
    Why aren't they testing people?
    I was talking to a person that was in close contact with somebody that has the virus,
    He says he is not sick.
    And there is no where to get tested
    He has returned back to work
    We need a simple place to get tested,

  44. They are going around and boarding civilians up in their apts No way to get food or medical supplies
    They are being sealed inside their own coffin

  45. Why is the name in Spanish? "corona" is a Spanish word, it should be crownvirus, was it discovered or developed by a Spanish scientist?

  46. Thank you for the link to that most recent paper from Canada. It answers some questions I have about treating patients with suspected COVID-19 in less-than-ideal environments.

  47. 12% fatality? So what is that about one billion people will die? Most of our crematoriums will be running 24/7 in America soon? & still the American People have no problem with this system?

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